3D Printing High-Quality Low-Cost Free Medical Hardware

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3D Printing High-Quality Low-Cost Free Medical Hardware
Making medical devices accessible and hackable for all
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Despite the dramatic falls in costs of production, medical devices have remained prohibitively expensive for all but the richest countries and physicians. Using 3D printing, rapid prototyping and Free hardware licenses, we have been developing and releasing off-patent medical devices that perform as well as the gold standard for a fraction of the cost. In this lecture, we discuss the history and scope of the problem, our progress to date and how attendees can participate and make their own medical devices.
Telecommunication Computer hardware Chaos (cosmogony) Bit Cartesian coordinate system
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Curve Fisher information Quicksort Disk read-and-write head Mereology Frequency response
Domain name Pulse (signal processing) Beat (acoustics) Software Computer hardware Projective plane Freeware Mereology Equivalence relation
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Pairwise comparison Goodness of fit Context awareness Electric generator Process (computing) Thermodynamisches System 1 (number) Right angle Disk read-and-write head Mereology Usability Physical system
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Degree (graph theory) Freeware
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hello hello and welcome to the next talk in this beautiful beautiful tent it's about 3d printing so we finally get to know a really really practical application of 3d printing which is just a medical devices so please welcome our next speaker
hello thank you very much for coming tonight I know it's a bit late thank you for being here my name is Terra Klugh Bonnie I am Palestinian who lives in Canada I work as a physician as a doctor both in Palestine the Gaza Strip and in Canada I want to start my talk for you today by
talking about some medical devices and what it is that brought me into them I start that by telling you a story and
actually to really explain this idea to you I have to tell you two stories but I'll start with this one first and it's a true story about the humble
stethoscope now you've probably seen a
stethoscope if you ever been to a doctor you've definitely had one put on you one moment while we see what happened here let's try that again this of course is
the stethoscope that most people are familiar with there's some variation of it now this particular stethoscope is apparently some very big technology while it really must be because the costs for it are quite exorbitant it
costs for that particular stethoscope about 200 u.s. which seems kind of
ridiculous when you think about it because this particular stethoscope contains absolutely no new technology I mean no new technology this here is the
patent that covers all of the workings
of the modern stethoscope you'll notice from the date that it's dated 1963 for the patent issuance 1964 the patent filing even in the United States that patent has expired it's long expired there was some additional work done on
stethoscopes after this mainly by one
small group of people they sort of modified a little bit how to listen this particular patent covers the modern
Littman cardiology 3 the main stethoscope I brought them all with me that's this head here which you'll see in a moment and then after that there was just a little bit of work making it so that you could listen one side or the other and finally when those patents were
about to run out this particular stuff scope here which
is the most expensive one you can get you see it right there and you see it
right here the most expensive stuff scope money can buy why there's no good
reason for it there's no good reason for it and that's what brings me really to my second story I told you that I had to
my second story is a little bit more personal a little bit more intimate and it's also a true story this one is about death it's the kind of death that that
you would sort of expect it's not about a story that's really about the different sorts of things that I've seen
in my for example I was at this particular
massacre in Egypt where I would do what people in the 1800's did put my ear to the chests of patients there is no new
technology there's no old technology that would change the fact that when you do not expect hundreds of people to be massacred you will not be carrying a stethoscope with you but that's deaf in
the field and that death in the field is for really for our purposes not relevant
what I want to talk to you about is death in a hospital because that is one
place where technology matters that is one place where it matters what we do and how we do it and so when I was in
the war in Gaza Strip in 2012 I witnessed all kinds of things and I had
to hold my head to the chests of
patients because there were no good stethoscopes and that was a tragedy that
was a travesty that was unacceptable and
that was something that I couldn't have and it's not just me it's a lot of people but when you have this particular problem you ask yourself well what can I do the problem is so much bigger than I am the problem is so much greater than I am what can I do and that's when one day I
was playing with my nephew and I saw that my nephew had this stethoscope
which cost a dollar I picked it up I listened to it I put it on his chest and guess what it didn't suck it wasn't terrible somebody with probably more talent than they should have had developing this particular toy banged it
together in what had to have been a week or two or a month put it together so
that it could be manufactured for pennies and I thought to myself well why
can't I make this this is my stethoscope my personal stuff scope you even see my name engraved on it this is a lot stethoscope I will ever buy because when I started looking at this stethoscope I realized that hey
doesn't have to be this way this is when I learned to make a light blink and that opened the whole world to me and I realized looking at this Arduino and that blinking light that there was no good reason why we couldn't do this why that community of hackers who spent hundreds of hours doing beautiful things can't spend those hundreds of hours doing beautiful things in the medical field it was that flashing light that's
what got me and here came my 3d printer right after that and I thought why not
there was a problem though that problem was that I don't know I really don't I know medicine but I don't know anything else so I got onto the RepRap IRC channel and I started asking does anybody know what we're doing does anybody know how I can progress and there was one person actually who answered that call probably here
actually I can't quite see the audience but I thought you he's here yeah there we go the hand waving Clemente was truly an inspirational part of this story an understated one and when he looked at this problem he understood the potential and he said we need some friends and so
the merry gang of sort of bandits as it were started coming together this is Jennifer glove also here saw her earlier and off we went off we went and we had
to ask ourselves what should we do what should we make we made a list of these priority projects these things that if I could bring them into Gaza if I could bring them into the third world in which I work and live if I could have some of that with me then I felt like I could change the lives of my patients I could change the lives of the people around me they deserve good health and I wanted them to have it this is Jen's first iteration of
the stethoscope head and with this first iteration what we had was the beginning of a project what we had was a model that we could then see how it would work
by the way it was terrible and within a few days we had another version slightly less terrible and then one day I took this very model here actually and I put it to I think my own chest I forget
whose heart I listen to and I thought we got it this particular had costs 30 cents to produce I don't know what that is in Euros like two to Euro cents or something like that
it is the hard work of quite a few people dedicated people it costs less than 10000 euros to develop and we put it out obviously for free obviously
I wanted the people I worked with to be
able to take it and to print it and to make it and to improve it because I knew that all I wanted to do is just sort of bring the idea and then have other people take it and and do better because as I'm constantly reminded I don't know when it comes to this stuff so what the smarter people figure it out here's some other shots of this and so
what we had with us was a stethoscope exactly like my nephew's a piece of plastic made by some merry folk who wanted to try to do something and then
the next question became how can we prove that this is usable because here's a problem that happens in the third
world when you get out into the third world and you give something to the people who are there very often it's crappy it's being used on people to test things it's substandard it's not acceptable in
the first world and so I thought I work
in a first world institutional Center I'm an academic physician I am called associate professor as it were what is it that we can do here to test it this is how you test a
stethoscope we made a very similar protocol I didn't put in the photo because I didn't ask Clemente for permission of it however it's what we call the hello I didn't put it in the presentation called the Hello Kitty protocol because the only balloons we found when we were doing this project were Hello Kitty balloons and it turns out that if you
take a balloon and you fill it with water exactly like this very sophisticated protocol put a speaker to one side and a microphone to another side you can test it you can figure out
how good your stethoscope is and so
instead of trying to run the physics we printed stethoscopes and we printed some
with larger channels and some with smaller channels and some with larger infill and some narrower infill and some with higher sort of intake and wider and narrower and then we picked the best we compared them all to the Littman cardiology 3v
gold standard these toughest cope I want on my patients here's our final product this
is an audio frequency response curve everywhere the blue is higher than the pink that is the free open hardware stuff escopeta Lippman cardiology 3 and performance
we did it we got it that head is as good or better you see
the large peak in the early sort of part
of the frequency response curve that gives gives doctors when they're listening the feeling of superior sound quality to the live in cardiology 3 I've put this stuff escopeta necks of many of my physician colleagues and they've been using it for the past approximately six months so have I so have i I've been
using it in Gaza and I've been using it in Canada this stethoscope is as good as
any stethoscope out there in the world and we have the data to prove it and so
that ends the tale of the stethoscope we have several other projects that are on the go we have a pulse oximeter that is also going quite well and is ready basically for calibration in this special way you have to take human beings and desaturate them we have an electrocardiogram that is not quite as advanced and after we're done those we plan on doing dialysis those of you in biomedical engineering those of you in medicine understand that about those three devices those are three of the most ubiquitous life-saving devices in any medical center those are three of the most expensive and those are three of the easiest to beat I can't I haven't yet looked closely at the patents for hemodialysis I can't imagine there's a patent there that's that's still valid and so what we want to do is we want to take these devices one by one and do for them what initially started to be done for software when the free software movement began replacing expensive closed proprietary solutions that was the dream of people who were making proprietary software maybe 25 years ago now of course re free software 25 years ago now of course free software beats and exceeds proprietary software in a lot of ways if we do this if we create this culture if we go to places like Gaza like parts of southern Africa such as Botswana Rwanda etc and create this culture than in another 25 years you'll see that there is a equivalent of Apache in the free hardware domain of Medicine that there is an equivalent of Mozilla and the free hardware domain of medicine and that's not something that we want to own that something that we want to contribute to because at the end of the day that's what open hardware is about and that's what the open ethos is about so really all of this is a pitch because
what I want is I want you the people in this room have got to be some of the smartest in the world you know the technology and more importantly because I've met some brilliant engineers you understand the politics what I want is
not the best devices what I want is the best devices that are also free and with
your help we can make that happen now what I'd like to do is to make this a conversation to start picking at your brains and have you pick at mine the the glia team we call it glia it's on github it's glia X and I'll post that as well if you look at the schedule that's on there the glia team is all here I'll answer any questions that I can I want you to ask and I want to figure out what you think we should be doing better and what you think we can do moving forward
so we have a good 15 20 minutes and that would more than easily put us way ahead of schedule thank you very much and do you think we can take questions now Marcel
hello okay now it works thank you for a beautiful talk now there are two mics as you know there's one to the right and one to the left so please just line up
if you have any questions we will start on the left now yes nor the mic is on so
first of all please introduce yourself as well yes I would very much like to invest myself my name is Lam like L am like the Turkish word for poi all like local area network or like all left activist Myron or whatever so look you know talking about free medical devices so you did just show two things to the
audience one of them is one man is pretty tiny as you are up there because you're like alone there you are one person talking to a lack a big audience many people listening to you just introducing your ideas to the brain neurons and kind of like saving it and maybe spreading in the round you do this all by yourself because you are tiny
at the same time you are great because you are spreading an idea and this idea is just awesome and everybody in this room just got this because you really did your thing you did awesome you found something that is great that is great for Humanity that's great for all of us straight for me for my grandmother for your granddaughter it's gonna be great for everybody because this is free it's free like water is free you need water to live you do need water to live and do you need those things to be healthy would you please mind just asking questions thank you yes like what can I do to support you thank you very much LEM I appreciate the
comment and appreciate the question the main things there are a few things here to support and it depends on your competency so for example if I mean it's just like any open source or free project Libre project if your abilities in hardware we need that grab the source play this is a small team of people who are trying to do a lot we need help if you have competence in management if you have competence in design anything that you have competence in great right now the points of of extreme dearth that we need are people who understand the science and know how to run randomized control trials and and non-inferiority trials and also the other thing is people who know the engineering and are willing to participate and collaborate with Clemente and Jen and others Thank You am could we please get the mic on
stage left yeah like my comment and that is like I actually also built a stethoscope myself and I guess all the people like many people who can build a status cup because just building one is
really easy I figured that also out I guess what we then as non-medical people would need is actually kind of your help in how to figure out if they actually broke because I have no idea if the stethoscope eyeball was any good I could hear my heart beating but like how like I would be very interested in to actually learn like what all the little beats mean but yeah kind of you know
what I'm getting at like we also need kind of like how to's how to actually build the stuff and then how to test them and stuff like that so what is the product of glia as an academic it's a basically an academic project right now within my academic work what's the goal of glia there's two products one of them is the product how to make it the Bill of Materials the stl files the BR DS the schematics the all that stuff the second one is how to test it because if you're making something yourself how do you know what it tastes like you can bake the cake but how do you know it's the cake that I want and in that sense in this particular case you probably will not buy this particular here the stethoscope so I was talking about here's and you're welcome to come here and play with them if you want you can steal them I don't really care but basically with these stethoscopes we've run the test there's the frequency response curve that data is available grab the data and play with it if you can exceed it using the test setup which we'll affectionately call Hello Kitty from now on then then you've beaten our product in which case send a pull request I gladly take it well of course once we verify it so that's that's the way to do it I don't expect you to be a doctor in fact it it was one of the things that drove people crazy when they were working with me because they would send me products I take them into work I would use them I'd say no it's wrong how do you know I don't know it's wrong until finally we started to develop some more systematic ways of figuring it out the first thing we do in any project is set the specifications and any good engineer will tell you that if you don't have specifications you're gonna run around in circles so it's a it's an excellent question the specifications and and the testing material is up there within the github every every project has a testing folder in it that says how we tested and how you would test to know that you've reached equivalency thank you and you didn't introduce yourself Maya thank you now stage right please very cool there
are a couple of things that I thought I've got Barbara Mittleman a couple of things I thought about when you were talking one is that it's relatively easy at some level to engineer things that are relatively low-tech so is that the scope the information transfer is essentially from the chest to your ear doesn't require the same kind information transfer that you have in for example a dialysis machine particularly if you're going to be doing recording and need to be interoperable with the rest of the medical record and all of that sort of thing so that's one piece of interest that I have in how you're thinking about sort of making this an end-to-end solution in a much more complex medical setting the second thing which you also spoke to at least peripherally is about the documentation of how well engineered these are what the performance characteristics are and how they compare to what else is out there and that's really about getting real getting publications in the peer-reviewed literature which is not really going to be terribly receptive to this because the reviewers aren't going to know how to review this in the places that you're going to need to put it so I'm wondering how do you think you're going to get the culture change that goes along with it and then the third piece of it is about the kinds of low-tech engineering that you can do with 3d printing for example for prosthetics particularly for kids because kids grow for assistive devices for things where you really have a static piece of equipment but that you may need to trade it out frequently and so that this is something you also can take into the third world pretty easily if you can do it so a bunch of different questions a bunch of different axes in the sense of where you can go with it but it's very interesting work so these are these are definitely things that I've been thinking about a lot that we've been
thinking about a lot that I'd really love for you to think with us about first I think your first question was just in terms of the complexity of devices we have picked the devices that
are the most expensive that is that there's lots of parts to them that people think should be expensive but are actually the easiest to do so for example I've taken I've looked into the insides of lots of these dialysis machines that are broken and so on it's just a peristaltic pump right that's it that's it a peristaltic pump in an Arduino will probably do it people have done it for 500 sorry can you do a vent can you in can you engineer a ventilator like this so ventilator is very complex for a few other reasons so we're we're going to go with things a diocese first ventilators probably in the second tier and then things like MRIs DTR in the third tier but for this tier I mean all we need to do is to get a pump to push things from one place to another according to Health Canada and I'm pretty sure FDA would be the same the device we make will not be a class 4 that is the most difficult class because it doesn't itself contact blood instead what it does is you can actually make it one of the big problems in lots of these third-world countries is that they kind of have to take what they can in terms of the disposables and the disposables are what's really expensive so if you could make a dialysis machine that could take any disposable because why would we care we're happy to make it interoperable why do we care then they can take any disposables and the disposables are actually where the danger lives for the patient so the disposables are the things you have to get right and the things we don't have to get right not now later later I have some ideas about about that as well now in terms of the peer-reviewed publications yes we have to peer review yes we have to publish that's how we're gonna prove it otherwise it's just a chart and on github repository how will we do that well we're gonna publish we're well I mean I don't imagine plus one is gonna say no if the data solid I don't care aware I care that it's accurate and that it's respectable and so long as it's those two things then we can present it to people the fact is that stethoscopes that are sold now don't have to be peer-reviewed and don't have to be validated as a class 1 medical device which means that all you need to prove is that rodents aren't taking craps all over your product to send it off and that's it that's it you have to be able to recall it so that if the rodents do you can say oh I'm sorry rodents and such and then bring it back that's a class 1 medical device they need no evidence at all we're already beating almost every stethoscope on the market right now and the peer review I think is gonna be a cakewalk frankly I think it's gonna be easy we've got solid data we're using tested techniques we took them out of peer reviewed publications we're using methods that the people use this is not gonna be hard Thanks Stage Left
please I'm Fox pH awx I'm a neuroscientist neuroscience student Anna
hacker you said you need scientifically inclined people to run experiments and so I have a three pronged question for you have you decided on standards for running these experiments for reproducibility and empiricism - do you
have a preferred data format to standardize the process and three have you already chosen or selected a forum or database for data sharing okay let me go backwards from those in terms of forum for data sharing currently we have an ad hoc forum which is basically just to get hep repository that's currently where our data lives we haven't as such sat down and truly structured the scientific approach and that has to do with a lot of parts I'll come back to sort of my main thing I don't know so we're trying very hard to get people who really are in the know you know science research is like cryptography it's a bad idea to roll your own so in this case we're trying not to roll our own we're trying to bring in other systems that other people know I have an idea what I think is a good idea but I what I've been doing is approaching people who know it takes a lot of time to do that we're not yet done that in terms of how to engage with that processor what format it's gonna be project dependent for example for the pulse oximeter you you literally I kid you not you have to sit people in a room and desaturate them give them non oxygen solution until they become like at the edge of death and then measure their blood work while you're measuring them simultaneously on another finger it's insane but that's that's the protocol so that runs very differently there's no such thing as a randomized control trial there how do you you know what what do you do there to randomize it other things yes you can randomize other things you know you kind of have to do just a standard non-inferiority like the stethoscope we thought about for example doing a randomized control trial with a stethoscope putting a sham stuff the scope on people's ears and having them compare it and then putting the Lippman cardiology 3 in there these things don't always make sense all the time the bottom line is if you're interested then please leave your contact information afterwards or contact me my my name is tarik ta rek my email address is terra cotta org so easy email me or email anybody from the team Clemente yaniv or Jen wash and they'll be able to to sort of get in touch with you put you in touch also we're on freenode and it's in the channel open med or if you hit RepRap you can you can usually find me my name my nickname is orange e on that will do you thank you thank you so much fox i appreciate ur stage right please
hello my name is Karen and when I was listening I was wondering your devices out of plastic right so I would expect that to be pretty sensitive to cold and
heat for example so I was wondering how sustainability's in the sense of how long can you use your device or your head in comparison to other ones so we there's a few parts to that one of them
is that the devices are incredibly cheap so they're they're very very cheap to manufacture so if you can get longevity that's you know a third or a half I think will be fine for the stethoscope we just don't have enough experience with it for me to tell you that oh it's it's as good as metal for as long as metal there's no doubt it won't be there's no doubt that a piece of metal will last longer than a piece of plastic however any place where we're going for example the Gaza Strip is a closed system I don't know if you're familiar with the politics there is essentially a hermetic seal around the place nothing and nothing out with you know I mean I'm oversimplifying but basically and so they're one of the important things was we didn't start until there was already a plastic processing system when you finish with the setup you know we set up a 3d printer actually which coming back to the other question is making prosthetics right now because we found out much higher priority than stethoscopes but when you set up a 3d printer then we make sure that that cheek-by-jowl we also have a setup for something else that can generate filament and that's context dependent so in a place like the Gaza Strip there's a very rich economy of people gathering plastic taking it grinding it into chips and then making filaments out of it they were already doing that before we arrived places like India there's collectives of people garbage pickers who do the same thing so you can find you know those are sold those particular plastics the Indian plastics aren't preferred they're HDPE which if your 3d printer you know you don't necessarily want to print with but there are lots of good usable plastics coming back to the initial question of longevity I don't know but I think it'll be good enough for our purposes stage left please
and hello Jana introduction so I'm known a campground as Maddock I've been working as a physician in some troubled areas of the world sometimes with not little more than my bare hands so I'm very fascinated by your idea I'm so pleased allowed two questions first is
did you think of preparing surgical devices as well and second is do you think of in future maybe foundation task force anything to bring your equipment or production equipment to such troubled areas I'd love to talk to you offline
about this it would be really amazing to do that surgical tools are a big priority we already have a repository of surgical tools that we've been testing and right now we have a inadequate needle holder that's in progress it's actually significantly improved and in fact I am the the weakest link in that production because I'm the one who's testing it so if you'd like to test these devices and I'd be happy to set you up with a 3d printer if you don't already have it it would be great to have somebody who can actually be testing them so the surgical devices are were easy to basically I mean maybe Jen should answer this you know easy for me
to get Jen to do where basically what it
came down to was that we sent her a bunch of these devices and then she started manufacturing or rather creating them using a little bit of a derivative that created openness CAD files surgical tools I'm with you there they're essential but surgical tools while they're a class-one device we we can't we can't mess around with that so I wanted to get some experience I think of the stuff is scope like our calling card it's a way that you can in a very concrete way show to somebody what you're doing it's very simple very few moving parts almost no risk of failure so if it fails stick your ear to the patient if you really need to so that's why we started there and that's why that's the first project that we're using to talk to people you can understand it very easily or as if I were standing here with you know forceps it would be much harder to sort of explain what we're doing second question about structures for deployment d/f thoughts oh yes well I can tell you I can talk to you a little bit about the failures that that I've that we've experienced as a group you know initially we tried to create it as a bit of a non-profit and that didn't quite work because immediately when you in-state something in any kind of corporate framework people will look at it very differently so right now we're in the midst of a transition to have it be an academic project like a genuine true academic project we had initially avoided that because we wanted to open the ability to get funding in a few different ways but but having said that what what we ended up doing is I think now migrating back to the academic ideal since since really frankly the project will never make money and in my opinion never should make money it should only make devices thank you much and I think I see Jen at the microphone did you want to say something yes my name is spider bite Jennifer go home
you pronounced his watch sorry you had a question we were just talking about the manufacturer of the surgical tools yeah that's it and how they I'd sort of tasked you with them and they were
difficult to do and they are not really thrilled to do I made a talk by the way for cows cologne early this year and well you can look up one talk on on the CCC with you go Paige thank you so much Jennifer appreciate it thanks could we
get stage right now please hello my name is Marius I'm the author of software called openers Kent which I believe is the tool used to design of 3d prints and I just want to say how can I help how can I make your life easier well firstly I just want to say thank you I love open
house cat it's it's been it's been really wonderful so thank you
also I feel really honored to meet you so that's it's a privilege of mine right now I think in terms of of how to help we've definitely hidden to lots of limits in openness CAD and I would like you to maybe commune with Jennifer she's she's probably the best person to talk about some of the limits that we've hit in terms of how to go forward I mean you clearly have the software knowledge and software tools so it would be really great to talk to you afterwards and see what what you're thinking and where maybe there's room for a collaboration on that it's I would find a very hard to believe that there isn't massive room for collaboration Thanks I'm sure there
is I thank you stage left hi I'll identify as tasseled room and
okay I have some academic degrees pal high and deep and I'm a little involved in medical devices and I am kind of wondering I mean I first of all it's
great what you're trying to do you're trying to make medical devices actually really open source and free and I am wondering whether you shouldn't go ahead and actually publish everything under something like it because I mean that was something that makes medical devices expensive are artificial artificial
scarcities and gatekeepers and the both the regulatory institutions and the academic publishing industry are gatekeepers that create unnecessary scarcity so I'm wondering whether whether it would be feasible to make the jump and go completely open-source in crowd and get git repositories in the cloud even for the scientific publication part I love your idea done
there's the github repository that I
brought up I don't know if you can see it in your screen there basically its github or so ya github.com / glia X just
because we couldn't get the glia one
here the repositories stethoscope pulse ox Mehta which is kind of where we're trying to assemble back to Fox I don't know where she is right now but okay where we were sort of assembling how how
to do the overarching project the ECG repository Gosselin actually do you mind
if I tell you a little story about gods during the war last year exactly a year ago now Gaza ran out of gas like there was no gods which is deeply ironic because the word God has actually derived from the word Gaza because the
first guys ever made historically was made with with Gaza processed segments called Gaza tongue anyway that's just a
silly factoid there okay but the actual
question there is okay I've already seen this github am gonna link it but the the question is whether you could even put the first publication of your sign of your science of your actual science on
the github first done it's all done I tell you we're not doing anything that's
not public here so the stethoscope okay okay I need to fix the testing readme MD and I just haven't gotten around to it
but here's all the data here's the the wav files that we use to make this here's the setup here's you know the the PNG files the plot data we used open source software well I mean every everything but three ml paper I'm serious about that I mean the Journal paper should also be there and there's their personal I haven't written it yet but I what I have done is where's the
readme on this thing here there we go stuff scope validation this is more or less the the paper as it'll be published I I apologize the photos there because I
moved the directories the photos don't show up any longer but you know it's it's there the once the publication is written it'll be there I'm not
interested I'm not interested in in pursuing things in the traditional manner of waiting an embargo and so on so okay so this is this was the Droid I
was looking for thank you very much problem maybe a bit of background there
is that before this I was involved in an a now defunct unfortunately Medical Journal called open medicine which really had the goal of publishing everything in the open had the first Wikipedia sort of journal articles and so on so it's the philosophy is there the philosophy is definitely there I'm I'm a free a free software free Hardware
fanatic is maybe a way to describe it or fundamentalist I don't know maybe that's the only place where I'm as a
Palestinian I'm allowed to call myself a fundamentalist state right please hi my
name is Bruno I have a question for you aren't you afraid that medical equipment companies are going to try to sue you out of market they can have everything
I've got I don't care the the real question is what are they gonna sue me for so everything that we're doing is actually covered under patent we're we're just making things that they've already patented who's before if they own a patent patent they can sue you because you are the legal advice that we got was to work out of their expired patents so we have so the reason for that is because danger lives in innovation so that's not where we're going first there's a lot of medical devices that have been out of patent for many many years the first stuff escopeta xin victorian times basically men who didn't want to put their ears to the breasts of women and and really the stethoscope was done by 1965 by 1984 everything you know about the modern stethoscope that is this one which is Littman's most lucrative one this is called I think the cardiology specialist or something anyway everything is done as of 1984 and after that all of the patents have to do with electronic stethoscopes which if you I think doc mad doc can tell you electronic stuff scopes are terrible unless you're hearing impaired they're no good so I'm not worried about being sued I mean it's part of an academic project good luck to them but I think the the other part as well is that we live in this very beautiful space the people who are taking our products can never afford there's a Lippman cardiology three costs one month salary for a doctor in most of the places where we are they have there are no Lipman Cardiology's cardiology threes in Gaza in fact in a hospital that has coverage area of almost 1 million people there's things like only one otoscope thing to look in your ear there's two or three stethoscopes and they're all cheap ones so these aren't markets where they're going to feel the hit and they're not gonna notice it you know I I'm not I'm not that worried I stay if they fascinate us well I mean you guys can carry on on gethub
Thank You Bruno stage left please hi I'm Evan I just was wondering if you could comment on sterilization with plastic versus metal
and in terms of sterilization thank you in terms of sterilization the method that we're planning on using right now is basically non heat based sterilization so chemical sterilization and gamma-rays sterilization so these are the these are very adequate very working methods that that are time-tested so no problem however I have a hunch I actually have a hunch that sterilization is not as important as we think and one of my academic goals in the next 10 to 15 years will be to prove it so that people can make sterile equipment for example dialysis catheter which is very very important and currently is made sterile
people can make those in a kitchen sink and then sterilize them post-facto using for example alcohol which is widely available or UV radiation which is widely available things like that so I have a hunch that it's gonna turn out that you don't need them a sterile as we think so long as you're willing to accept a couple of things but that's that's the goal otherwise if we need to make metal I mean you can you can just do like I think it was jury who'd been doing sort of stuff with metals where you 3d print things and then you would do lost I forget what the process is called lost casting or something I forget thank you okay do we have any more questions anyway so I can't see anybody okay then please please thank Tariq again
and I want to thank you all for being here and thank you all for listening if you'd like I'll be here we've got another 12 minutes of this session which I'd love to have just kind of as a free talk with whoever's interested so come on up and if you'd like to give me your contact information or take mine my email address is terracotta org or you can find us on github or on freenode thank you


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