The key role of 3D printing and the new medical sterilizable threads in the development of the translaryngeal Tracheostomy Needle Introducer.

BACKGROUND: Percutaneous tracheostomy is frequently performed in intensive care units in patients who require prolonged mechanical ventilation. The first crucial step for the physician in these procedures is the precise needle insertion into the trachea. The primary aim of this technical note was to test the new filament and share our experiences in the implementation of the new device. The secondary aim was to show how a physician with basic training in computer-aided design and three-dimensional (3D) printing could independently create useful devices for clinical practice. METHODS: To simplify this referred clinical procedure and increase its safety, 3D printing and a new medical filament were used to develop a new translaryngeal Tracheostomy Needle Introducer (tTNI) for use in conjunction with the Fantoni's method of percutaneous tracheostomy. The tTNI is composed of three parts: a support to fit on the rigid endotracheal tube of the Fantoni kit, an external particular shaped arm, and an introducer for the needle. The latest version of the device used a new filament based on a polyester matrix certified for skin contact that was sterilizable in a standard autoclave. Post-printing, minor technical interventions were required to correct small material deformities. CONCLUSIONS: Our experiences with the thread and the technical features of the material were reported herein in conjunction with some suggestions on how to solve the most frequently encountered problems. The 3D printing technique allows physicians to directly manage the prototyping process of new medical devices, making this process completely independent. The speed of the prototyping process and the testing of each piece allow faster creation of a prototype than with traditional industrial methods. Finally, the new biomedical filaments offer endless possibilities of creation and modelling.

Covid-19 Response From Global Makers: The Careables Cases of Global Design and Local Production.

Makerspaces-informal shared spaces that offer access to technologies, resources and a community of peer learners for making-across the globe initiated a rapid response to the lack of medical hardware supplies during the global pandemic outbreak in early 2020 caused by the Corona virus (COVID-19). As our health systems faced unexperienced pressure, being close to collapsing in some countries, and global supply chains failing to react immediately, makers started to prototype, locally produce and globally share designs of Open Source healthcare products, such as face shields and other medical supplies. Local collaboration with hospitals and healthcare professionals were established. These bottom-up initiatives from maker networks across the globe are showing us how responsible innovation is happening outside the constraints of profit-driven large industries. In this qualitative study we present five cases from a global network of makers that contributed to the production of personal protective equipment (PPE) and healthcare-related products. We draw our cases from the experiences made in Careables, a mixed community of people and organizations committed to the co-design and making of open, personalized healthcare for everyone. With the presented cases we reflect on the potential implications for post-pandemic local production of healthcare products and analyze them from a social innovation perspective. These global experiences are valuable indications of transformative innovations that can reduce dependencies from international supply chains and mainstream mass production.

Lead contamination in tissues of large avian scavengers in south-central Europe.

Lead poisoning from spent ammunition is known to affect many avian species. Birds of prey ingest lead when feeding on game shot with lead gunshot or bullets. Raptors with scavenging habits are particularly vulnerable to ingesting lead in areas with intensive hunting and are good indicators of the risk of poisoning from lead ammunition. To assess how much facultative and obligate avian scavengers suffer lead contamination in south-central Europe, between 2005 and 2019 we collected and analysed 595 tissue samples from 252 carcasses of 4 species (golden eagle, bearded vulture, griffon vulture, cinereous vulture). Lead concentrations in organs showed a similar pattern across species with long and small bones revealing the highest median values (5.56 and 6.8 mg/kg w.w., respectively), the brain the lowest (0.12), and the liver and kidney the intermediate (0.47 and 0.284). Overall, 111 individuals (44.0%) had lead concentrations above background thresholds in at least one tissue (i.e. >2 mg/kg w.w. in soft tissues, >8.33 in bone) and 66 (26.2%) had values indicating clinical poisoning (>6 mg/kg w.w. in liver, >4 in kidney, >16.6 in bone). Tissue lead concentrations and incidence of clinical and sub-clinical poisoning were higher in golden eagles and griffon vultures than in bearded and cinereous vultures, likely due to different feeding habits. In all species we found a rapid increase in lead values with age, but differences between age classes were significant only in the golden eagle. Birds with lead fragments in their digestive tract, as detected by X-rays, had higher median lead concentrations, suggesting that hunting ammunition is the main source of lead poisoning. Our results imply that lead impacts the demography of these long-lived species with delayed sexual maturity and low reproduction rate. A rapid transition towards lead-free bullets and gunshot is therefore required across Europe.

Species interactions and climate change: How the disruption of species co-occurrence will impact on an avian forest guild.

Interspecific interactions are crucial in determining species occurrence and community assembly. Understanding these interactions is thus essential for correctly predicting species' responses to climate change. We focussed on an avian forest guild of four hole-nesting species with differing sensitivities to climate that show a range of well-understood reciprocal interactions, including facilitation, competition and predation. We modelled the potential distributions of black woodpecker and boreal, tawny and Ural owl, and tested whether the spatial patterns of the more widespread species (excluding Ural owl) were shaped by interspecific interactions. We then modelled the potential future distributions of all four species, evaluating how the predicted changes will alter the overlap between the species' ranges, and hence the spatial outcomes of interactions. Forest cover/type and climate were important determinants of habitat suitability for all species. Field data analysed with N-mixture models revealed effects of interspecific interactions on current species abundance, especially in boreal owl (positive effects of black woodpecker, negative effects of tawny owl). Climate change will impact the assemblage both at species and guild levels, as the potential area of range overlap, relevant for species interactions, will change in both proportion and extent in the future. Boreal owl, the most climate-sensitive species in the guild, will retreat, and the range overlap with its main predator, tawny owl, will increase in the remaining suitable area: climate change will thus impact on boreal owl both directly and indirectly. Climate change will cause the geographical alteration or disruption of species interaction networks, with different consequences for the species belonging to the guild and a likely spatial increase of competition and/or intraguild predation. Our work shows significant interactions and important potential changes in the overlap of areas suitable for the interacting species, which reinforce the importance of including relevant biotic interactions in predictive climate change models for increasing forecast accuracy.

Translaryngeal Tracheostomy Needle Introducer: a simple device to improve safety and reduce complications during Fantoni's translaryngeal tracheostomy procedure: trial on human cadavers.

BACKGROUND: Percutaneous dilatational tracheostomy (PDT) is the most frequently performed procedure in patients requiring prolonged mechanical ventilation. A crucial step in such procedures is needle insertion into the trachea. To simplify this procedure and increase its safety, we developed a new device, the translaryngeal Tracheostomy Needle Introducer (tTNI), for use with Fantoni's method. This cadaver study was designed to assess the performance of the tTNI on human anatomy. METHODS: We tested the tTNI in a cadaver laboratory; the operators included two experts trained in PDT and three without specific training in the procedure. We performed 58 needle insertion attempts on 13 cadavers. We compared the tTNI technique with the standard needle insertion approach using external landmarks. We recorded the number of attempts needed to optimise needle insertion, time required in seconds, final position of the needle and complications related to needle insertion. RESULTS: tTNI use resulted in fewer puncture attempts (1.91 ± 1.34 vs. 1.19 ± 0.5, p < 0.001), less time (36.8 ± 51.6 s vs. 13.14 ± 15.57 s, p < 0,001) and increased precision on the first puncture (18.87 ± 25.38° vs. 7.5 ± 12.95°, p < 0,005). We did not observe any complication with tTNI use, whereas complications found using the standard method were in line with the literature. CONCLUSIONS: The tTNI is a device that simplifies needle insertion by enhancing the accuracy of insertion with fewer attempts and higher precision, even when used by less experienced operators. Clinical testing is required to evaluate the device performance in patients.