4 Some Distinctions Among Major Biomedical Bibliographic Sources… MEDLINEBest coverage of dental literature among major biomedical bibliographic databasesPertinent subheadings to identify references to Instrumentation (IS) and Methods (MT)EMBASEGenerally considered to provide better coverage of selected subject specialty areas, including:Biomedical engineering & instrumentation, medical devicesOphthalmologyPlastic surgeryPharmaceutics (PR) singled out as a LINK term, as are routes of drug administration – Important in isolating references to new drug delivery systems that include a device componentQuicker to adopt new vocabulary for use in controlled indexing, e.g., drug eluting stent added as controlled (thesaurus) term in June 2003When primary source cites device brand name(s) and/or specific manufacturers, EMBASE includes names in online records (provides access to product-oriented literature, even when names have been omitted in the author’s original title and abstract)
5 Some Distinctions Among Major Biomedical Bibliographic Sources… BIOSIS PreviewsBroader subject coverage: all life sciences, including biophysics & bioengineeringPertinent Major Concept indexing: “Biomedical Engineering”; “Equipment, Apparatus, Devices and Instrumentation”Emphasis on research, rather than routine clinical practice or established procedures, making it a good source for searching medical technologies under development & preclinical literatureProvides access to additional resources not found in other “Big 4” filesBooks, theses, reports, U.S. patents, proceedings of scientific symposia, conference papers & poster presentations at scientific meetingsSciSearchMulti-disciplinary in scope, with coverage of 5,200 journals, provides access to a cross-section of literature that includes not only biomedical journals, but also engineering, mathematics, biophysics, and pharmaceutical technology resourcesCover-to-cover indexing not found elsewhereExtremely timely; very short lag timeNatural language indexing reflects terminology changes, new concept vocabularyCited reference search capabilities
6 Complementary Resources International Pharmaceutical AbstractsCan contribute unique references to specialty journals in the pharmaceutics & pharmaceutical technology subject areas – helpful when focusing on new drug delivery technologies that involve a device componentCA SearchAnother source for pharmaceutics-oriented literature. Also indexes conference proceedings & provides a selective gateway to the patent literatureJICSTCoverage of literature published in Japan, encompassing all fields of science, technology, and medicine. Indexing of 6,000 journals + conference papers, technical reportsPASCALOften yields additional references to scientific & technical literature, including conference papers
7 Engineering Literature Indexes In the engineering literature, topical emphasis shifts to durability testing, mathematical analysis, materials science (preparation, characterization, manufacturing)Database coverage of technical conference proceedings is a bonusEI CompendexTake advantage of hierarchical Classification Code indexing: Bioengineering codes under CC=46CC= (BIOENGINEERING)CC= (BIOMEDICAL ENGINEERING)CC= (BIOLOGICAL MATERIALS)CC= (BIOMECHANICS)CC= (HUMAN ENGINEERING)CC= (HUMAN REHABILITATION ENGINEERING)CC= (MEDICINE)CC= (HEALTH CARE)CC= (BIOTECHNOLOGY)CC= (GENETIC ENGINEERING)CC= (BIOLOGY)CC= (IMMUNOLOGY)CC= (MEDICAL ENGINEERING & EQUIPMENT)CC= (BIOMEDICAL EQUIPMENT, GENERAL)CC= (HOSPITALS, EQUIPMENT & SUPPLIES)CC= (DENTAL EQUIPMENT & SUPPLIES)CC= (PROSTHETICS)CC= (BIOMATERIALS)
8 Engineering Literature Indexes INSPECDevice related class codes under: CC=A87, CC=B75, e.g.:CC=A8770 Biomedical engineeringCC=A8770E Patient diagnostic methods & instrumentationCC=A8770F ElectrodiagnosticsCC=A8770J Prosthetics & other practical applicationsCC=A8780 Biophysical instrumentation & techniquesCC=A8780B BiosensorsCC=B7500 Medical physics & biomedical engineeringCC=B7510 Biomedical measurement & imagingCC=B7510B Radiation & radioactivity applications in biomedicineCC=B7510D Bioelectric signalsCC=B7520C Radiation therapyCC=B7520E Prosthetics & orthoticsCC=B7530 Health PhysicsCC=B7530B Radiation protection & dosimetryCC=B7540 Hospital Engineeringplus…CC=C1290L Systems theory applications in biology & medicineCC=C Biological & medical control systemsCC=C3385C Prosthetic & orthotic control systemsCC=C Medical administrationCC=C Biology and medical computingCC=D Health care applications
9 Engineering Literature Indexes MEDITEC: Biomedical EngineeringBMED on DataStar, present, updated weeklyCompiled by FIZ Technik, the MEDITEC database contains citations, with abstracts, to the international literature on biomedical engineering. Information is compiled from journals, conference papers, books, technical reports, and dissertations. The primary language of the database is German, but many search terms and abstracts are also in English.Topics covered include:Biomedical measurements (recording, plotting, processing, and evaluation of physiological parameters)Medical imaging (e.g., computed tomography, magnetic resonance imaging)Data processing in medicineBiomaterials and materials for medical instrumentationMedical instruments for diagnostic and therapeutic applicationsProstheses and rehabilitation engineeringClinical laboratory technologyOptometry and ophthalmological instrumentsDental technologyClinical engineering, hospital management
10 Answering medical device inquiries requires access to… Biomedical bibliographic databasesEngineering literatureRegulatory resourcesA highly focused collection of full-text industry newslettersSubject specialty company & product directoriesMarket research sources (reports, statistics)Intellectual property databases
11 Regulatory Information Sources DIOGENES FDA Regulatory Updates – File 158, DIOG (FOI Services)Premarket Application (PMA) approvals & 510K notifications ( )Access to DIOGENES on Dialog facilitates downloading of retrospective data for post-processing and analysis, e.g., easy export of XML data in EXCEL spreadsheet format via DialogLink 5Product recalls ( )More retrospective coverage than offered on FDA Web site ( )FDA.GOV search capabilities for product recalls are extremely limited. The current search interface identifies only the co-occurrence of terms within entire issues of the FDA Enforcement Report, making it difficult to isolate pertinent data from individual recalls & resulting in many “false drops”Enhanced accessibility to recall data through DIOGENES on DialogEasy to single out Class I, II, or III recalls for given companies in specified time periodsDialog users of DIOGENES can also produce RANKed analyses of enforcement actions for comparisons/trend monitoringMedical Device Reports (MDRs = adverse experience/incident reports), 1985 –DIALOG RANK capabilities enable statistical analysis of MDRs, e.g., examination of a specified company’s product line by ranked incidence of adverse experience reports; review the “track record” of an entire device category & compare incidence of AEs associated with given companies
12 Regulatory Information Sources Health Devices Alerts – File 198 (ECRI), updated weeklyDatabase compiles reports of problems with specified devices, plus references to published evaluations and technology assessmentsMDRs ( )Action Items – Most are related to recalls that ECRI has investigated or verified (1982 -)Provide details not readily accessible elsewhere online, such as specific follow-up recommendations issued by manufacturers to avoid or remedy further problems with named devicesECRI also often identifies errors or omissions in original FDA notices (e.g., incorrect serial #s of affected models)Abstracts of articles from the published literature,Brand & mfg name access to pertinent bibliography in primary medical literature, augmenting accessibility to same articles cited in EMBASE & MEDLINEECRI abstracts of source documents typically provide more detailed data than that included in the original author abstract reproduced in other bibliographic databases
13 Regulatory Information Sources Regulatory Affairs JournalPHRJ on DataStar, January 2003 – presentForthcoming on DialogWorldwide regulatory intelligence, news, and informed commentaryProduced by T&F Informa UK Ltd (formerly PJB Publications), these full-text journals report on pertinent legislation, approval application requirements & guidelines, pharmacovigilance initiatives, and harmonisation, trade, and environmental issues with potential impact on drug regulation & marketing worldwideRAJ Pharma, updated monthly, covers both human & veterinary drug regulatory developmentsRAJ Devices, updated bimonthly, focuses on medical device & in vitro diagnostics
14 Extracts from RAJ Devices TOC – March/April 2005 issue
15 Examples of searchable data elements in the Regulatory Affairs Journal online Country or region namese.g., “UK” or “European Union”Article typee.g., “Worldwide update” “Reference-Guidelines” “Reference-Standards” “Organisational Charts”Product sectorsSubject categoriesArticle title & full text, including…Cited referencesUseful when searching for discussion related to specific regulations, directives, or guidelines issued by government authoritiesKeywords - Controlled descriptors identifying specific topics discussed in articlesExamples: “Environment” or “Counterfeit Medicines”
18 Regulatory Affairs Journal enhanced with Images on DataStarWeb platform Example from RAJ - Devices
19 Regulatory Information Sources EURALex(formerly ERA News, EPLC Update) , , updated monthlyComplete text in PHIND (File , PHIN/PHIC)Reports on European legal and regulatory affairs likely to affect the human and animal drug and device markets, including changes in the structure and organization of national healthcare systems, individual governments’ policies regarding pricing and reimbursement, control of clinical trials, intellectual property protection, advertising, competition and company law, etc.Includes expert commentary & analysis of implicationsEach issue typical covers..New directives, regulations, and guidelinesCourt cases & rulingsDevelopments at national, as well as European, levelMeetings
20 Regulatory Information Resources CELEX - European Union Law (CLXE)1951 – present, updated weeklyCELEX provides the full text and/or references for all European Community legislation and is the only interactive online database covering all EC law.Coverage includes treaties and other agreements, preparatory legislative documents, parliamentary questions, and individual nation’s implementation measures.CELEX can help answer such questions as:Has the EC passed legislation on a particular topic?Has this been amended?Has the European Court of Justice ruled on it?Has there been a question in the European Parliament on it?
21 Answering medical device inquiries requires access to… Biomedical bibliographic databasesEngineering literatureRegulatory resourcesA highly focused collection of full-text industry newslettersSubject specialty company & product directoriesMarket research sources (reports, statistics)Intellectual property databases
22 Among full-text subject specialty sources in PHIND… Pharmaceutical & Healthcare Industry News Database (File , PHIN/PHIC) includes:Clinica – World Medical Device & Diagnostics NewsLegendary for its scope and timeliness, Clinica reports on a broad spectrum of scientific, political, regulatory, and financial news of vital interest to device industry personnel. Coverage includes informed commentary, critical evaluation of current events, and trend analysis.InstrumentaCurrent awareness source focusing on the analytical instrument and laboratory equipment industriesTargetFocuses on worldwide drug delivery technology & business developments, including products/platforms incorporating medical devicesEach of these titles is offered for TOC Alerts (automated current awareness & document delivery service -- see additional information in handout)
23 ALERT Capabilities on Dialog Customized current awareness service for ongoing monitoring of new developmentsUser specifies keywords, other factors to be searched in each update to a databaseNew material matching user-defined parameters forwarded daily, weekly, biweekly, or monthlyOption for Multi-file Alert with duplicate detectionTOC (Table of Contents) Interactive AlertsFull table-of-contents scans delivered to -boxUser checks off titles for which full text neededFull documents delivered within minutes by returnCopyright compliance incorporated into service
24 Dialog Interactive TOC Alerts Current Dialog users can set up TOC Alerts by logging on to DialogWeb ( with their standard user # and passwordGo to the opening screen in Command Mode.Note: You need not be familiar with Dialog commands to set up an Interactive AlertClick on Alerts in the Quick Functions box.
25 From the subsequent “Alerts” screen, click on Add Subscriptions
26 Use the pull-down Publications menu to select a newsletter title After selecting a newsletter title, type in an address for the recipient (you, your client)Tip: Prior to initiating the service, you may wish to arrange for creation of a special mailbox within your organization’s system, from which daily alerts will be disseminated internally to a designated distribution list. Each individual recipient will be able to order full-text documents directly, and Dialog will automatically aggregate multiple copy orders to calculate ERA discounts, when applicable.
27 Users simply check off items in their replies to order full-text articles (delivered within 2 hrs) at standard database output rates.Note that this is a non-invasive “push” (current awareness) service. No response is necessary, if no items in a Table of Contents are of interest. Built-in “grace period”: each Interactive Alert ends with a “reply by” date (usually two weeks hence) for automated document delivery.
28 Other full-text newsletters of potential interest to device searchers… ESPICOM Pharmaceutical & Medical Device News (File 441, MDNE) includes:Cardiovascular Device BusinessDrug Delivery InsightMedical Imaging BusinessFDA News (File 182) includes:Devices & Diagnostics Letter (weekly)FDANews Device Daily BulletinThe GMP Letter (monthly)Gale Group Newsletter Database (File 636) includes:Biomedical MaterialsBiotech Equipment UpdateHospital Materials ManagementMedical Textiles
29 Answering medical device inquiries requires access to… Biomedical bibliographic databasesEngineering literatureRegulatory resourcesA highly focused collection of full-text industry newslettersSubject specialty company & product directoriesMarket research sources (reports, statistics)Intellectual property databases
30 Subject Specialty Company Directories Health Devices Sourcebook (File 188), updated annuallyProvides current address and marketing information for more than 6,000 North American (U.S. & Canadian) manufacturers, distributors, and service companies associated with any of more than 4,500 classes of products. Listings include sources for diagnostic and therapeutic devices and materials, including laboratory equipment and reagents, systems and instruments used to monitor and test equipment, and selected hospital furniture or supplies.Manufacturer records typically includename, address, telephone number, fax #, website URL, addressyear startedparent company (when applicable)# employees, # sales peopletotal annual salesfiscal year (month-month range used)names & titles of executive staffplus product categories or classes produced and their brand namesAlso identify whether publicly or privately owned, minority-owned, woman-owned, eligible for GSA and/VA contractsService company entries show category of service (e.g., maintenance, repairs, leases), geographical areas covered, and contact information.
31 Subject Specialty Company Directories ESPICOM Pharmaceutical & Medical Company Profiles (File 510, MDCO)Detailed reports on more than 200 ethical pharmaceutical, generics, and medical device companies worldwideNew profiles published annually, updated monthly as new information becomes available
32 Example of Major Section Headings in ESPICOM’s 2004 profile for Abbott ? RANK S1 SE;CONT;ALLDIALOG RANK ResultsRANK: S1/ Field: SE= File(s): 510(Rank fields found in 108 records--8 unique terms) Page 1 of 1RANK No. Items TermPRODUCT PORTFOLIOAGREEMENTSRESEARCH AND DEVELOPMENTRECENT HISTORY/CORPORATE STRATEGYSTRUCTURE AND ACTIVITIESFINANCIAL INDICATORSGEOGRAPHICAL BREAKDOWNPROFILE OVERVIEW---end of results---
33 Example of Major Section Headings in ESPICOM’s 2005 profile for Zimmer RANK: S4/ Field: SE= File(s): 510(Rank fields found in 61 records -- 8 unique terms) Page 1 of 1RANK No. Items TermPRODUCTSCORPORATE HISTORYFINANCIAL REVIEWRESEARCH AND DEVELOPMENTCORPORATE STRUCTUREINTERNATIONAL ACTIVITIESOVERVIEWSTRATEGIC FOCUS---end of results---Financial Review includes separate records tabulating revenue by geographic segment, by operating division, and by product category, as well as overall “financial indicators” data
34 Extract from a sample record… DIALOG(R)File 510:ESPICOM Pharm & Med Co. Profile(c) 2005 ESPICOM Bus. Int. All rts. reserv.Main Title: Zimmer 2005 Medical Device CompanyPub. Date: FEBRUARY 2005Source: Medical Device Companies AnalysisFISCAL 2004 (Part 4)Sales of orthopaedic surgical products rose by 9% in 2004 based oncombined results for Zimmer and Centerpulse in 2003.Table 3, Revenue by Product Category, (US$ million)*% Change2003/2004Reconstructive , ,TraumaSpineOrthopaedic Surgical ProductsTotal Revenue , ,
35 Answering medical device inquiries requires access to… Biomedical bibliographic databasesEngineering literatureRegulatory resourcesA highly focused collection of full-text industry newslettersSubject specialty company & product directoriesMarket research sources (reports, statistics)Intellectual property databases
36 Subject Specialty Product Directories Drug Pipeline databasesDO cover products under development in formulations that use drug delivery technologies combining devices + drugs or biologicsExamples:Drug-eluting stentsSurgical implantsMetered-dose inhalers
37 Pharmaprojects (File 128,928,PHAR) Only pipeline file to enhance the EPhMRA therapeutic classification scheme with an entire category designed to improve indexing of formulationsOnly file to have hierarchical indexing for routes of administration, as well“Novelty” rating will help identify products involving new formulationsSample application…Drug-eluting stents are indexed with the TC code F9A (Formulation, Implant)This code can also be used to locate products in other therapeutic areas under investigation for delivery via implantation
38 E5 1349 NR=1 (ALL PRECLINICAL) E6 1657 NR=2 (ESTABLISHED STRATEGY) ? S TC=F9AS TC=F9A? E NR=Ref Items Index-termE NA=99MTC-ECDE NA=99MTC-5T4 MABE *NR=E NR=0 (NOT AVAILABLE)E NR=1 (ALL PRECLINICAL)E NR=2 (ESTABLISHED STRATEGY)E NR=3 (NEW FORMULATION)E NR=4 (LOW NOVELTY)E NR=5 (2ND, 3RD OR 4TH COMPOUND)E NR=6 (LEADING COMPOUND)? S E7S NR='3' (NEW FORMULATION)? S S1 AND S2S S1 AND S2F9A represents FORMULATION, IMPLANTEXPAND for Novelty Rating options ? S S3 AND TC=KS S3 AND TC=KFocusing on anticancer products (K category)
39 IMS R&D Focus (File 445, 955, IPUR) Indexing of drug-eluting stents“Stent” may appear in the product Name ( /NA) or in the pharmacological action ( /AC) fieldHowever, for stents still in early stage of development, keyword could appear in record text (/TX)Recommendation: search “stent” without qualification to a specific fieldDrug Name: drug delivery system, vascular stent sirolimus; sirolimus vascular stentDRUG INFORMATION:Pharmacological Action: antiproliferative agent; stentTherapeutic Class Code: C1D (Coronary Therapy); V7A (All Other Non-Therapeutic Products)Clinical Indications: restenosis
40 IMS R&D Focus Broader approaches to searching drug delivery As was illustrated in the previous record extracts, “Drug Delivery System” may be identified in the product Name field ( /NA)The phrase may also appear in the Substance Origin fieldRecommendation: search the phrase without qualification to a specific fieldAdditional records can be located by searching…“Delivery System” in the Indications field“Drug Design Technology” in the /IN fieldThe keyword “Technology” in Status ( /ST) indexing
41 IMS R&D Focus Broader approaches to searching drug delivery ? DSSet Items DescriptionS DRUG()DELIVERY()SYSTEM/PROFILES (DELIVERY()SYSTEM OR DRUG()DESIGN()TECHNOLOGY)/INS TECHNOLOGY/STS S2 OR S3Locates additional records not identified with previous strategy./AVAIL limits results to products available for licensing.? S S4 NOT S1S S4 NOT S1? S S5/AVAILS S5/AVAILBecause many of these records lack specific Therapeutic (TC) or Indications indexing, search keywords for potential applications as “free text” (without field qualification).? S S6 AND VACCINE?S S6 AND VACCINE?See sample record in handout
42 Extract from sample record DIALOG(R)File 445:IMS R&D Focus(c) 2004 IMS Health & Affiliates. All rts. reserv.Drug Name: Powder Mediated Epidermal DeliveryBrand Name: PMEDR&D Focus - September 27, 2004 ( )COMPANY INFORMATION:Originator: PowderMed; (UK); NA; NA; NALicensing Countries: WorldwideLicensing Contact: Brenda Reynolds, Chief Operating Officer,PowderMed Ltd, 4 Robert Robinson Avenue, TheOxford Science Park, Oxford, OX4 4GA, UK; Tel:; Fax ;DRUG INFORMATION:Pharmacological Action: biotechnologyTherapeutic Class Code: V7A (All Other Non-Therapeutic Products)Clinical Indications: delivery systemDrug Status: New DrugMolecular Code:Extract from sample record
43 IMS R&D Focus – sample record continued… LATEST INFORMATION:27 September 2004: At the European Partnering & Investment Conference, 16 September 2004, London, UK, R&D focus discussed PowderMed's proprietary Powder Mediated Epidermal Delivery (PMED) technology with Clive Dix, CEO of PowderMed, and Brenda Reynolds, COO. The PMED technology has utility in the development of therapeutic DNA vaccines, and PowderMed is seeking partners interested in collaborations using the PMED technology. The technology uses the PowderJect device to propel DNA precipitated onto microscopic gold particles into the epidermis. Microscopic gold particles, 1-3 mcM in diameter, have an appropriate density and size for direct DNA delivery into immunological active antigen presenting cells (APC). Once inside the APC, the DNA elutes off the gold and produces the encoded protein; the presentation of this protein by the APC to the lymphocytes results in the generation of T-cell-mediated immune responses. The technology can be used to develop vaccines that generate T-cell mediated responses to a broad range of viral and cancer antigens….
44 Adis R&D Insight (File 107,907,ADRD) Adis does not provide systematic, controlled indexing for easy identification of products incorporating new drug delivery technologiesHowever, “textword” searches using terms illustrated here will help locate pertinent records. Results could be combined with Indication keywords or Therapeutic Categories? S DRUG()DELIVERY(3N)(SYSTEM OR TECHNOLOGY OR PLATFORM OR PROPRIETARY OR FORMULATION?)/TXS DRUG()DELIVERY(3N)(SYSTEM OR TECHNOLOGY OR PLATFORM OR PROPRIETARY OR FORMULATION?)/TXExtracts from sample records in handout
45 ...an injection formulation of the nonsteroidal anti-inflammatory drug meloxicam (see separate profile) using its proprietary parenteral drug delivery Biochronomer(TM) system . The formulation is in preclinical development for the treatment of inflammation following arthroscopic surgery, as......see separate profile: Teriparatide injection) for this indication. The technology: Macroflux(TM) is a transdermal drug delivery technology, which utilises a titanium microprojection array to create superficial pathways through the skin barrier enabling......is developing a proprietary formulation of anaesthetic propofol (Propofol IDD-D(TM)) using its Insoluble Drug Delivery (TM) (IDD) technology . The IDD technology is complimentary to SkyePharma's proprietary nanoparticle technology that is developed to...Extracts from sample records – Adis R&D Insight
46 Answering medical device inquiries requires access to… Biomedical bibliographic databasesEngineering literatureRegulatory resourcesA highly focused collection of full-text industry newslettersSubject specialty company & product directoriesMarket research sources (reports, statistics)Intellectual property databases
47 Resources for Market Research include… MARKETFULL collection of full-text syndicated market research reportsINVESTEXT (File 745,545, INVE) for access to complete investment analyst reportsStatistical sources such as…Incidence & Prevalence (File 465, IAPV)TableBase (File 93,BTBL)Country profile data from ESPICOM…
48 ESPICOM Country Healthcare Reports (File 511, MDST) Provides overviews ofHealthcare administration and provisionManufacturing & trade regulationsRegistration procedures (drug & device approval process)Price controlsAvenues of distributionReports include extensive statistical dataGeographic scope: 74 nations
49 ?S CN=BRAZILS CN='BRAZIL'?REPORT S1/TITLESDIALOG(R) ONLINE TABLE OF CONTENTSLIST OF REPORT TITLESITEM NUMBER, MAIN TITLE1 Brazil 2005 Generic Markets AnalysisMarch /19 records2 Brazil 2005 World Medical Market AnalysisJanuary /49 records3 BRAZIL 2005 World Pharmaceutical Market AnalysisJanuary /63 records4 Brazil 2004 World Medical Market AnalysisApril /40 recordsEnter one item number, P for next page, or EXIT to leave TITLES:?2Enter (S)ection Headings only, (C)omplete table of contents,M to return to Main Menu Listing or EXIT to leave TITLES:?CNote that Generic [Drug] Market Assessments have recently been added to this database
50 Extracts from Table of Contents MEDICAL DEVICE MARKET2 MEDICAL DEVICE MARKET--Current Size--TABLE 1, TABLE I. SUMMARY OF THEMEDICAL DEVICE MARKET IN BRAZIL IN Projections--TABLE 2, TABLEII. MARKET PROJECTIONS, (US$ MILLIONS)--TABLE 3, TABLE III.3 Outlook--TABLE 4, TABLE III. SWOT ANALYSIS OF THE BRAZILIAN MEDICALDEVICES MARKET--Market Structure (Part 1)--Medical DeviceImports--TABLE 5, TABLE IV. IMPORTS OF MEDICAL EQUIPMENT & SUPPLIES,(US$000S)4 Market Structure (Part 2)--TABLE 6, TABLE V. IMPORTS OF MEDICALEQUIPMENT & SUPPLIES, (% CHANGE OVER PREVIOUS YEAR)--MarketStructure (Part 3)--Domestic Production--ABIMO / SINAEMO--TABLE 7,DOMESTIC PRODUCERS INCMarket developments--Cuts in Import Tariffs6 KEY NATIONAL DATA PROJECTIONS--TABLE 8, TABLE VI. KEY DATAINTERNATIONAL MARKET COMPARISONS7 INTERNATIONAL MARKET COMPARISONS--INTERNATIONAL MARKET COMPARISONS(Part 1)--TABLE 9, TABLE VII. THE WORLD'S TOP 50 MEDICAL DEVICEMARKETS, (US$ MILLIONS)--TABLE 10, TABLE VIII. THE WORLD'STOP 50 MEDICAL DEVICE M