Pressure-Regulated Ventilator Splitting for Disaster Relief: Design, Testing, and Clinical Experience.

The coronavirus disease 2019 (COVID-19) pandemic has revealed that even the best-resourced hospitals may lack sufficient ventilators to support patients under surge conditions. During a pandemic or mass trauma, an affordable, low-maintenance, off-the-shelf device that would allow health care teams to rapidly expand their ventilator capacity could prove lifesaving, but only if it can be safely integrated into a complex and rapidly changing clinical environment. Here, we define an approach to safe ventilator sharing that prioritizes predictable and independent care of patients sharing a ventilator. Subsequently, we detail the design and testing of a ventilator-splitting circuit that follows this approach and describe our clinical experience with this circuit during the COVID-19 pandemic. This circuit was able to provide individualized and titratable ventilatory support with individualized positive end-expiratory pressure (PEEP) to 2 critically ill patients at the same time, while insulating each patient from changes in the other's condition. We share insights from our experience using this technology in the intensive care unit and outline recommendations for future clinical applications.

Extracorporeal Hypothermic Perfusion Device for Intestinal Graft Preservation to Decrease Ischemic Injury During Transportation.

INTRODUCTION: The small intestine is one of the most ischemia-sensitive organs used in transplantation. To better preserve the intestinal graft viability and decrease ischemia-reperfusion injury, a device for extracorporeal perfusion was developed. We present the results for the first series of perfused human intestine with an intestinal perfusion unit (IPU). METHODS: Five human intestines were procured for the protocol. (1) An experimental segment was perfused by the IPU delivering cold preservation solution to the vascular and luminal side continually at 4 ºC for 8 h. (2) Control (jejunum and ileum) segments were preserved in static cold preservation. Tissue samples were obtained for histopathologic grading according to the Park/Chiu scoring system (0 = normal, 8 = transmural infarction). RESULTS: Jejunal experimental segments scored 2.2 with the Park/Chiu system compared to the control segments, which averaged 3.2. Overall scoring for ileum experimental and control segments was equal with 1.6. CONCLUSION: This data presents proof of concept that extracorporeal intestinal perfusion is feasible. The evidence shows that the IPU can preserve the viability of human intestine, and histopathologic evaluation of perfused intestine is favorable. Our early results can eventually lead to expanding the possibilities of intestinal preservation.

Investigation of a passive capstan based grasp enhancement feature in a voluntary-closing prosthetic terminal device.

Body-powered prosthetic terminal devices fall into two main categories: voluntary-closing devices, which require the user to exert a force to maintain a grasp, and voluntary opening devices, which generally utilize springs to close and maintain a force. As a result, voluntary-closing devices often have a locking feature that allows the user to relax and transport objects while maintaining a firm grip. In this paper, we examine a new type of capstan-based passive brake mechanism in a voluntary-closing prosthetic terminal device. Three different mechanisms were compared on the benchtop and with human subjects: the passive capstan grasp enhancement, a "pull-to-lock, pull-to-release" mechanism, and a manual cable locking mechanism. Standard tests of prosthetic device dexterity, including the Box and Blocks test and Southampton Hand Assessment Protocol, were performed with an instrumented prosthesis socket simulator with each device. While results are similar across the three mechanisms, the passive capstan mechanism does not require a physical user input to engage or disengage the lock, adding a benefit over the existing mechanisms.

Strengthening of 3D printed fused deposition manufactured parts using the fill compositing technique.

In this paper, we present a technique for increasing the strength of thermoplastic fused deposition manufactured printed parts while retaining the benefits of the process such as ease, speed of implementation, and complex part geometries. By carefully placing voids in the printed parts and filling them with high-strength resins, we can improve the overall part strength and stiffness by up to 45% and 25%, respectively. We discuss the process parameters necessary to use this strengthening technique and the theoretically possible strength improvements to bending beam members. We then show three-point bend testing data comparing solid printed ABS samples with those strengthened through the fill compositing process, as well as examples of 3D printed parts used in real-world applications.

Lightweight custom composite prosthetic components using an additive manufacturing-based molding technique.

Additive manufacturing techniques are becoming more prominent and cost-effective as 3D printing becomes higher quality and more inexpensive. The idea of 3D printed prosthetics components promises affordable, customizable devices, but these systems currently have major shortcomings in durability and function. In this paper, we propose a fabrication method for custom composite prostheses utilizing additive manufacturing, allowing for customizability, as well the durability of professional prosthetics. The manufacturing process is completed using 3D printed molds in a multi-stage molding system, which creates a custom finger or palm with a lightweight epoxy foam core, a durable composite outer shell, and soft urethane gripping surfaces. The composite material was compared to 3D printed and aluminum materials using a three-point bending test to compare stiffness, as well as gravimetric measurements to compare weight. The composite finger demonstrates the largest stiffness with the lowest weight compared to other tested fingers, as well as having customizability and lower cost, proving to potentially be a substantial benefit to the development of upper-limb prostheses.

Grasp and force based taxonomy of split-hook prosthetic terminal devices.

In this paper, we analyze the use of the body-powered split-hook prosthetic terminal device, which is the most commonly used upper-limb prosthesis. We developed two taxonomies of split-hook use, one on grasp shape and one on force exertion, illustrating the functional capabilities and use cases of the device. Video captured from an amputee using a body-powered split-hook during a number of common activities was used to lend weight to the completeness of the classifications. These taxonomies serve to establish a common language and means of comparing the types of grasps achievable by simple terminal devices to those of advanced myoelectric terminal devices or even human hands. The first taxonomy categorizes the grasp type based on the contacts with the environment while the second is categorized by the method and limitation of force exertion. We discuss the difference between grasps capable of holding objects compared to those that are capable of acquiring objects and the importance of non-prehensile uses of the split-hook. The classification schemes lay the groundwork for further detailed study of split-hook use, and the discussion of the use cases described may help guide terminal device developers to create improved prostheses.

Novel differential mechanism enabling two DOF from a single actuator: application to a prosthetic hand.

There will always be a drive to reduce the complexity, weight, and cost of mobile platforms while increasing their inherent capabilities. This paper presents a novel method of increasing the range of achievable grasp configurations of a mechatronic hand controlled by a single actuator. By utilizing the entire actuator space, the hand is able to perform four grasp types (lateral, precision, precision/power, and power) with a single input resulting in a potentially lighter and simpler hand design. We demonstrate this strategy in a prototype hand that is evaluated to determine the benefit of this method over the addition of a second actuator. Results show a decrease in weight but a 0.8 sec transition time between grasp types with the proposed method. The prototype hand can be controlled by a single EMG signal that can command a change in grasp type or an opening/closing of the hand. We discuss the potential of this mechanism to improve prosthetic hand design as compared to current myoelectric systems.

Mechanical design and performance specifications of anthropomorphic prosthetic hands: a review.

In this article, we set forth a detailed analysis of the mechanical characteristics of anthropomorphic prosthetic hands. We report on an empirical study concerning the performance of several commercially available myoelectric prosthetic hands, including the Vincent, iLimb, iLimb Pulse, Bebionic, Bebionic v2, and Michelangelo hands. We investigated the finger design and kinematics, mechanical joint coupling, and actuation methods of these commercial prosthetic hands. The empirical findings are supplemented with a compilation of published data on both commercial and prototype research prosthetic hands. We discuss numerous mechanical design parameters by referencing examples in the literature. Crucial design trade-offs are highlighted, including number of actuators and hand complexity, hand weight, and grasp force. Finally, we offer a set of rules of thumb regarding the mechanical design of anthropomorphic prosthetic hands.

Performance characteristics of anthropomorphic prosthetic hands.

In this paper we set forth a review of performance characteristics for both common commercial prosthetics as well as anthropomorphic research devices. Based on these specifications as well as surveyed results from prosthetic users, ranges of hand attributes are evaluated and discussed. End user information is used to describe the performance requirements for prosthetic hands for clinical use.