3D Printing and Bio-Based Materials in Global Health

3D Printing and Bio-Based Materials in Global Health
اسم المؤلف
Sujata K. Bhatia , Krish W. Ramadurai
4 ديسمبر 2020
(لا توجد تقييمات)

3D Printing and Bio-Based Materials in Global Health
Sujata K. Bhatia , Krish W. Ramadurai
An Interventional Approach to the Global Burden of Surgical Disease in Low-and Middle-Income Countries
1 The Current Global Surgical Care Paradigm: An Introduction 1
1.1 The Global Burden of Surgical Disease: An Unubiquitous
Global Health Threat . 4
1.2 Defining Essential Surgical Conditions in LMICs 5
1.3 Surgically Avertable Deaths: A Silent Anomaly . 10
1.4 Surgical Interventions in Global Health: Social
and Economic Implications . 12
1.5 Catastrophic Healthcare Expenditures . 15
1.6 Disparities in Provisional Access to Surgical Supplies
in LMICs 17
References 19
2 3-Dimensional Printing and Rapid Device Prototyping . 21
2.1 The Dawn of Disruptive Innovation and Frugal Engineering . 21
2.2 3-Dimensional Printing: An Introduction to Rapid Device
Prototyping and Extant Fabrication Processes . 24
2.3 Fused Deposition Modeling and the RepRap Rapid
Prototyping Device . 32
References 37
3 3-Dimensional Device Fabrication: A Bio-Based Materials
Approach 39
3.1 Bio-Based Thermoplastic Polymers in 3-Dimensional Printing 40
3.2 Polylactic-Acid: Bio-Based Thermoplastic Polymer Properties
and Medical Device Applications 45
3.3 Chemical and Mechanical Profile Modification of Bio-Based
Materials: Natural Biocomposite Enhancement 50
3.4 Polylactic Acid Versus Acrylonitrile Butadiene Styrene
Thermoplastics 54
References 59
vii4 3-Dimensional Printing of Medical Devices and Supplies 63
4.1 Fabrication of High-Utility Surgical Toolkits . 63
4.2 3-Dimensional Printing in the Surgical Field: Applications
and Considerations . 74
4.3 3D Printed Instrument and Medical Supply Price
Competencies . 86
References 92
5 3-Dimensional Printing: Interventional Capacities in the Global
Health Arena . 95
5.1 Barriers to Entry and Adoption of Medical Device Innovations in
LMICs 96
5.2 3D Printing: A Paradigm Shift in the Global Medical Device
and Humanitarian Supply Chain . 101
5.3 The Future of 3-Dimensional Printing: Bio-Based Materials,
Medical Device Fabrication, and Open-Source Information
Dissemination . 105
5.4 Concluding Remarks . 112
References 114
viii ContentsList of Figures
Fig. 1.1 World Bank country income group classifications
(Country Income Groups, 2011) . 2
Fig. 1.2 Global volumes of surgical interventions per 100,000
individuals amongst HICs and LMICs (Weiser et al., 2008) 3
Fig. 1.3 Allocation of basic and advanced surgical care for various
surgical conditions based upon healthcare facility access
(adapted from Higashi et al., 2015) . 7
Fig. 1.4 Global surgical need estimates by country based upon
World Health Organization Global Health Estimate disease
subcategory (Rose et al., 2015) 8
Fig. 1.5 Surgical procedure type and need based upon
epidemiological region (Rose et al., 2015) . 9
Fig. 1.6 Distribution of surgical burden by LMIC super regions
including percentage of avertable and non-avertable conditions
(adapted from Higashi et al., 2015) . 11
Fig. 1.7 Depiction of the proportion of the global population
without access to surgery based upon geographic locality.
The darker shades represent increased lack of access
to essential surgical care services (Alkire et al., 2015) 12
Fig. 1.8 Number of surgically avertable deaths in LMICs
(Mock et al., 2015) . 13
Fig. 1.9 Cost-effectiveness of surgical interventions compared
to other public health interventions (Chao et al., 2014) 14
Fig. 1.10 Cyclical nature of poverty in relation to the elective care
of an acute trauma that eventually becomes a chronic
condition if not properly treated (Dare, 2015) . 16
Fig. 1.11 Annual and cumulative Gross Domestic Product (GDP)
lost in LMICs from five categories of surgical conditions
(Meara et al., 2015) . 17
Fig. 2.1 Depiction of the 3-dimensional printing process from 3D
CAD Model to 3D object fabrication (Taneva et al., 2015) . 24
ixFig. 2.2 Representation of the coordinate geometric configuration
of information in an .STL file; the object as depicted
on the left was created in a CAD program and saved as an .STL
file. The graphical information displayed in the .STL file
is shown on the right for the same object, with the surface
of the object being represented in a coordinate triangulated
pattern (Gross et al., 2014) . 25
Fig. 2.3 Stereolithography (SLA) 3-dimensional printing process
(Gross et al., 2014) . 27
Fig. 2.4 Selective Laser Slintering (SLS) 3-dimensional printing
process (Gross et al., 2014) . 27
Fig. 2.5 Fused Deposition Modeling (FDM) 3-dimensional printing
process (Gross et al., 2014) . 28
Fig. 2.6 Digital Light Processing (DLP) 3-dimensional printing
process (Gross et al., 2014) . 29
Fig. 2.7 Inkjet 3-dimensional printing process (Gross et al., 2014) 30
Fig. 2.8 Overview schematic of the RepRap FDM 3D printer design
and self-replicated components shown in red
(Simonite, 2010) . 32
Fig. 2.9 RepRap self-replicated plastic components
(Romero et al., 2014) . 34
Fig. 2.10 Internal and axial mechanics of RepRap FDM rapid
prototyping (Jin et al., 2015) 36
Fig. 2.11 A RepRap Mendel FDM 3D Printer with threaded
aluminum rod frame assembly and modular build platform
(RepRapPro, 2017) . 36
Fig. 3.1 Potential benefits of combining 3D printing technology
with biomaterials (Adapted from Van Wijk &
Van Wijk, 2015) . 40
Fig. 3.2 Conversion of biomass into biomaterials and bio-based
plastics (Van Wijk & Van Wijk, 2015) 42
Fig. 3.3 Cellulose and starch chemical compositions (Storz & Vorlop,
2013) 44
Fig. 3.4 Bio-based materials comparison table (Adapted from
Van Wijk & Van Wijk, 2015) . 45
Fig. 3.5 PLA bone tissue engineering scaffold (Tissue Repair, 2016) 46
Fig. 3.6 Abbott ABSORB II PLA Bioresorbable Stent
(Hodsden, 2015) . 47
Fig. 3.7 The natural cycle of PLA extraction (Xiao et al., 2012) . 48
Fig. 3.8 PLA L-Lactide (left), D-Lactide (middle), and Meso-Lactide
(right) stereoisomeric confirmations
(Corneillie & Smet, 2015) 48
Fig. 3.9 Amorphous (left) and crystalline (right) polymer
structures (Ströck, 2006) . 50
x List of FiguresFig. 3.10 Types of PLA materials property modifiers (Adapted from
Hamad et al., 2015; Mathew et al., 2004; Van Wijk &
Van Wijk, 2015) . 51
Fig. 3.11 Types of fiber biocomposite materials for PLA
enhancement (adapted from Li et al., 2013; Shih &
Huang, 2011; Tokoro et al., 2007; Xiao et al., 2012) . 53
Fig. 3.12 Comparative analysis of PLA versus ABS impact,
compressive, flexural, and tensile strength
(PLA and ABS Strength Data) 55
Fig. 3.13 Summary of time-varied UFP emission rates for
16 different 3D printer and filament combinations.
Each data point represents data from 1 min intervals,
with the combination of data points representing the entire
printing period (ranging between 2.5–4 h). Boxes show
the 25th and 75th percentile values with the 50th percentile
in between. Whiskers represent upper and lower adjacent
values, and circles represent outliers beyond those values
(Azimi et al., 2016) . 56
Fig. 3.14 VOC emission rate and the sum of the top 10 detectable
VOCs (RVOC) resulting from operation of 16 different
3D printer and filament combinations, which is divided
into a low emitters, with ERVOC < 40 lg/min,
and b high emitters, with ERVOC > 40 lg/min
(Azimi et al., 2016) . 57
Fig. 3.15 Comparison of total UFP and VOC emissions per mass
of filament (Azimi et al., 2016) 57
Fig. 4.1 Surgical instrument profile: Left side Stainless steel surgical
instruments: A Debakey tissue forceps, B scalpel handle,
C right angle clamp, D curved hemostat, E Allis tissue clamp,
F straight hemostat, G sponge clamp, H Adson’s toothed
forceps, and I smooth forceps. Right side 3D-printed
acrylonitrile butadiene styrene surgical instruments:
O Debakey tissue forceps, P Scalpel handle, Q Towel clamp,
R Right-angle clamp, S Curved hemostat, T Allis tissue clamp,
U Kelly hemostat, V Sponge clamp, W Smooth forceps,
and X Adson’s toothed forceps (Wong & Pfahnl, 2014) . 65
Fig. 4.2 3D-printed polylactic acid Army-Navy surgical retractor
(Rankin et al., 2014) 65
Fig. 4.3 3D-printed acrylonitrile butadiene styrene needle driver
(Kondor et al., 2013) 66
Fig. 4.4 3D-printed acrylonitrile butadiene styrene umbilical cord
clamp (Molitch, 2013) . 66
List of Figures xiFig. 4.5 Modified CAD model with driving dimensions
and two-piece hinge connection point
(Kondor et al., 2013) 67
Fig. 4.6 PLA axial mechanical properties (3D Matter, 2016) 68
Fig. 4.7 3D Printer infill density configurations (Budmen, 2013) . 68
Fig. 4.8 Infill patterns at varying densities. Left to right: 20, 40, 60,
and 80%. Top to bottom: Honeycomb, concentric, line,
rectilinear, hilbert curve, archimedean chords,
and octagram spiral (Hodgson, 2016) . 70
Fig. 4.9 3D CAD PLA modified scalpel handle, 3D coordinate
plane (Scalpel Truss Handle, 2016) . 71
Fig. 4.10 3D CAD PLA modified scalpel handle, angular view
(Scalpel Truss Handle, 2016) . 72
Fig. 4.11 3D CAD PLA modified Kelly hemostat, 3D coordinate
plane (Pugliese, 2016) . 72
Fig. 4.12 3D CAD PLA modified Kelly hemostat, angular view
(Pugliese, 2016) 73
Fig. 4.13 3D CAD PLA tenaculum, 3D coordinate plane
(Tenaculum 3D Model, 2012) . 73
Fig. 4.14 3D CAD PLA tenaculum, angular view
(Tenaculum 3D Model, 2012) . 74
Fig. 4.15 3D CAD PLA modified vascular clamp, 3D coordinate
plane (Vascular Clamp, 2013) . 75
Fig. 4.16 3D CAD PLA modified vascular clamp, angular view
(Vascular Clamp, 2013) 76
Fig. 4.17 3D CAD PLA modified umbilical cord clamp,
3D coordinate plane (Umbilical Cord Clamp, 2016) 77
Fig. 4.18 3D CAD PLA modified umbilical cord clamp,
angular view (Umbilical Cord Clamp, 2016) 78
Fig. 4.19 3D CAD PLA modified Army-Navy surgical retractor,
3D coordinate plane (Rankin et al., 2014) 79
Fig. 4.20 3D CAD PLA modified Adson’s toothed forceps,
3D coordinate plane (Toothed Forceps, 2016) . 80
Fig. 4.21 3D CAD PLA modified Adson’s toothed forceps,
angular view (Toothed Forceps, 2016) 81
Fig. 4.22 3D CAD PLA modified allis tissue clamp/forceps,
3D coordinate plane (Tissue Forceps, 2011) 82
Fig. 4.23 3D CAD PLA modified allis tissue clamp/forceps,
angular view (Tissue Forceps, 2011) 82
Fig. 4.24 3D CAD PLA modified smooth tissue forceps,
3D coordinate plane (Forceps, 2012) 83
Fig. 4.25 3D CAD PLA modified smooth tissue forceps,
angular view (Forceps, 2012) . 83
xii List of FiguresFig. 4.26 3D CAD PLA modified sponge clamp, 3D coordinate
plane (Sponge Forceps, 2012) . 84
Fig. 4.27 3D CAD PLA modified sponge clamp, angular view
(Sponge Forceps, 2012) 84
Fig. 4.28 3D CAD PLA modified pennington clamp,
3D coordinate plane (Pennington Clamp 3D Model, 2012) . 85
Fig. 4.29 3D CAD PLA modified pennington clamp,
angular view (Pennington Clamp 3D Model, 2012) 85
Fig. 4.30 3D CAD PLA modified needle driver, 3D coordinate
plane (Needle Driver, 2012) 86
Fig. 4.31 3D CAD PLA modified needle driver, angular view
(Needle Driver, 2012) . 87
Fig. 4.32 3D CAD PLA modified senn retractor, 3D coordinate
plane (Senn Retractor, 2012) 88
Fig. 4.33 3D CAD PLA modified senn retractor, angular view
(Senn Retractor, 2012) . 89
Fig. 4.34 3D CAD PLA modified debakey tissue forceps,
3D coordinate plane (Tweezers V2, 2009) . 90
Fig. 4.35 3D CAD PLA modified debakey tissue forceps,
angular view (Forceps V2, 2009) 91
Fig. 5.1 Barriers to open-source appropriate technology
(Zelenika & Pearce, 2011) 97
Fig. 5.2 Solar power printer schematic design. Photovoltaic cells
are connected in parallel with a combiner box utilized
to combine and drive the DC supply towards a 30-amp
charge controller, to control the charging and discharging
of the batteries. During charging periods four 120 AH batteries
are fed DC current, while discharging continues to power
the RepRap printer and a laptop through a DC/AC inverter
(King & Babasola, 2014) 98
Fig. 5.3 Community-scale solar-powered open-source RepRap
3D printer system for off-grid communities
(King & Babasola, 2014) 99
Fig. 5.4 Current global medical device supply chain (Engel, 2014) . 102
Fig. 5.5 Global medical device supply chain schematic
with implementation of 3D printing (Engel, 2014) . 103
Fig. 5.6 District-level healthcare facilities and their role in surgical
care access and delivery (Meara et al., 2015) . 104
Fig. 5.7 Access to fundamental surgical elements increases
surgical output and delivery in LMICs (adapted from
Henry et al., 2012) . 105
Fig. 5.8 ROW 3D printed prosthetic hand (3D Printing
and Prosthetics, 2017; Refuge Open War, 2017) . 108
List of Figures xiiiFig. 5.9 3D printing and the medical device value chain
(Engel, 2014) 109
Fig. 5.10 Radiographic images can be converted to 3D print files
to create customized anatomical models; radiographic
image conversion of spinal segment into .STL format
shown (Ventola, 2014) 110
Fig. 5.11 Surgeons extract tumor utilizing 3D-printed model
(Surgeons extract tumor, 2014) 110
Fig. 5.12 The NIH 3D print exchange website (Ventola, 2014) . 111
List of Tables
Table 1.1 Three categories of essential surgical conditions, including
number of deaths and disability-adjusted life years per
condition as depicted (adapted from Debas et al., 2015) . 7
Table 2.1 Five primary types of 3-dimensional printing processes:
SLA, SLS, FDM, DLP, and Inkjet (AlAli et al., 2015) . 26
Table 3.1 PLA physical properties depend on tacticity and
stereo-isomeric confirmation (Adapted from Marshall) 49
Table 4.1 PLA and stainless steel surgical instrument per-unit
and total toolkit cost comparison 91
Table 5.1 Future biomaterials for 3D printing (adapted from
Van Wijk & Van Wijk, 2015) 106
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