
Glia – High-quality low-cost open source medical hardware - robtherobber
https://glia.org/
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seren
They are certainly working designs and products, but I am not sure there are
actually medical devices[0].

The research (self) validation [1] talk about similar performances than an
existing product.

However, it does not talk about bio compatibility of the material used,
potential contamination during manufacturing process, what kind of
disinfectants can be used on the product, what is the operating range in terms
of pressure, temperature, humidity, etc

A proper medical device manufacturer is also supposed to have a complaint
handling unit, to raise and analyze every adverse effect on the field, and
report to regulatory bodies the worst hazardous case in a limited time frame,
be able to do recall and so on.

So I believe that this coming from the Gaza strip is a real boon because you
don't have any other choice, but it does not mean that you could translate
that model everywhere in the world.

Edit :

it seems this is registered as a Class 1 medical device in Canada, so it is
possible that all my previous point have been addressed (still I am not quite
sure how you can validate only a design without the manufacturing/shipping
part) I am working on a Class 3 device so it is possible I am more paranoid
that I should be...

>> In Canada, it is produced by Glia as a Class I device. Glia holds a Medical
Device Establishment License from Health Canada.

I am not sure how you could pass an audit if your documentation contains
"Lorem Ipsum" [2]

[0] The homepage mentions medical Hardware, but this page
[https://docs.glia.org/](https://docs.glia.org/) still talks about medical
device

[1] [https://glia.org/stethoscope/](https://glia.org/stethoscope/)

[2]
[https://docs.glia.org/docs/stethoscope/manufacturing/](https://docs.glia.org/docs/stethoscope/manufacturing/)

~~~
danvoell
Does US class 1 require - "complaint handling unit, to raise and analyze every
adverse effect on the field, and report to regulatory bodies the worst
hazardous case in a limited time frame, be able to do recall and so on." \-
Don't know so I'm asking. I would assume any product with class 2 has these
requirements. My assumption under class 1 is that you need to be able to
determine you built the product to a predefined set of specifications.

~~~
seren
The device is registered in Canada and I found that information [0] :

>For all devices except Class I, implement an ISO 13485:2016 under the Medical
Device Single Audit Program (MDSAP) compliant quality management system, which
includes the specific requirements of the CMDR. ISO 13485 certification, used
to demonstrate compliance with European regulations, does not meet Canadian
requirements. Updates to the existing procedures, or new procedures, must be
implemented.

So it seems you don't need to implement post market surveillance for a class 1
device or having a complaint handling unit.

[0] [https://www.emergobyul.com/resources/canada-process-
chart](https://www.emergobyul.com/resources/canada-process-chart)

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monkmartinez
This is certainly cool and I love my Craftbot 3d printer. However, one has to
mention the problems with using 3d printed devices like this. This is not to
tear apart the project, but I would hope valid criticism. Medical gear like
this is commodity stuff that is actually very inexpensive. I do think 3D
printing will democratize the really expensive medical equipment, but we are
not there yet.

#1 cleanability - It is very hard to properly clean a 3d printed item and each
print may be a little different than the others.

#2 Cost - For the same cost, I can buy a stethoscope on Aliexpress that is
made from aluminum and pvc. For about $5 I can purchase an actual Littmann
replica made from the same durable parts as the previously mentioned steth
from Aliexpress. The same goes for all of the designed products they have.

#3 Durability - PETG and ABS are relatively durable, but they do not compare
to aluminum in terms of strength. In emergent situations, I would not trust
plastic for my gear. In the clinical setting, I can see the use case, but
still like the term "buy once, cry once" when it comes to tools that will see
lots of use.

~~~
galazzah
I actually attended a talk by Dr. Loubani this past weekend at MIT and one
thing he emphasized was that everything they do has to be reliably replicated
in Gaza. So yeah, one could conceivably purchase the Littmann replica from
AliExpress but getting it into Gaza? Another story...

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danvoell
Good Luck team Glia! Keep fighting the good fight. Most people look at
insurance, hospitals, pharmaceuticals as too profit hungry. Medical devices
are equally to blame. All the big OEMs have doctors (sales person) selling to
doctors in the surgery room so that their products, which haven't been
materially updated in 60 years can be sold at a 1000% margin. Its another
industry where the price should, in theory, be getting lower, but here we are.
Good Luck Guys!

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lb0
Seeing projects that are neither fun- nor money-driven (though both are valid
motivations and doesn't exclude this) but some guys really trying to improve a
tiny bit on this world makes me sentimental lately.

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jglauche
I was involved in the early stages of the project, more specificity I designed
the 3d printed stethoscope prototype:

[https://journals.plos.org/plosone/article?id=10.1371/journal...](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193087)

Happy to answer questions

~~~
etcher
What 3D printer and software did you use?

~~~
jglauche
I got a prototype of the Lulzbot mini, which I used to print it (and I still
have that printer!).

I designed it in a ruby thing that translates things into openscad
(crystalscad was the name, but I deprecated it for multiple reasons. There's
jenncad in my github repository as its successor, but I didn't have the chance
to get it anywhere to stable)

Other software I used were printrun and slic3r.

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majewsky
For everyone interested in this topic, another non-profit in the same area is
Cadus, a Berlin-based makerspace producing innovative low-cost medical
infrastructure for crisis response.

[https://www.cadus.org/en/](https://www.cadus.org/en/)

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amelius
I'm wondering: if we can get a can of Coca Cola to just about any part of the
world, then why can't we (with the proper logistics) get basic medical
equipment there? And wouldn't this equipment be cheaper and/or of higher
quality than 3d printed?

~~~
zubiaur
We can. An aliexpress stethoscope is 2.34 with free shipping.

~~~
jotm
Good luck buying from AliExpress in Palestine

~~~
nathancahill
You don't have to buy directly from AliExpress in Palestine. There are
thousands of people that resell AliExpress in your common street market. A
huge percentage of everything you see street vendors selling is ultimately
sourced from China for 2.34. The issue is that every middleman takes a bit of
markup until it reaches the street. So now you're paying 10, cash, and you
have it immediately.

~~~
galazzah
Not just Palestine, but Gaza. The cost of getting anything, medical equipment
especially, into Gaza is insanely high and it's usually an unreliable process.
Thats likely why theres such a huge emphasis on being able to create the
entire unit in the Gaza Strip.

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JshWright
The tourniquet is a "knock-off" of the North American Rescue CAT[1]. I'd be
pretty wary of using it in real life... The windlass ends up under a lot of
shear force, and I would be surprised if a printed thermoplastic was able to
deal with that without failing with some regularity. I've seen cheap injection
molded versions snap, and I'd expect the same here.

In reading their "field validation" blog po... err... "reports", it looks like
they failed pretty badly. Seems irresponsible to be publishing a design they
know is badly flawed.

[1] [https://www.narescue.com/combat-application-tourniquet-c-
a-t...](https://www.narescue.com/combat-application-tourniquet-c-a-t.html)

~~~
fenwick67
They fixed those flaws, the second deployment of 78 units had no failures
(content warning: this post is somewhat graphic)

[https://medium.com/@trklou/3d-printed-tourniquet-day-2-of-
ga...](https://medium.com/@trklou/3d-printed-tourniquet-day-2-of-gaza-field-
trials-ends-badly-may-14-970b3f291e7)

~~~
JshWright
I don't put a lot of stock in the second test. Assuming the same people were
involved, it's likely they were (consciously or not) being a lot more gentle
with the devices.

~~~
_tarek_
I was one of the medics there. The failures have stopped after the
modification, even with new medics. One of the major issues is that it's such
a chaotic scene that it is essentially impossible to fine-tune the stress
applied to the device, so your specific concern doesn't apply here. Our
testing on the bench also showed that the refined windlass (rod thing) did not
cause the same failure even when about 10x the force was applied.

We have received ethics approval for a proper (unblinded) head-to-head multi-
site RCT between our 3D printed version, our desktop-injected version and the
premium brand, but it will take time for that data to shake out.

tarek : )

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epmaybe
Off topic, but I knew that I recognized the guy in blue scrubs on their home
page! Tarek Loubani is a Canadian doctor, who made national news when he was
shot by an israeli sniper.

[https://en.wikipedia.org/wiki/Tarek_Loubani](https://en.wikipedia.org/wiki/Tarek_Loubani)

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pnathan
What's interesting is none of these people are in the US. I feel that the
regulatory burden, pay scales, and the political climate are shifting a lot of
the scrappy innovation to outside of the US.

ed: awesome ideas, I hope to see tons more designs delivered.

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agucova
This is awesome! I think these initiatives are urgently needed, especially in
the case of pulse oximeters and electrocardiograms.

For both, the components (of medical quality) are extremely cheap, but there
aren't any clinically validated open source devices in the market. I think
they're relative low-hanging fruits in biomedical engineering, and they have a
lot of impact potential.

I really think open source medical devices are the future, I would love to see
more biomedical engineers and doctors excited about this.

Does anyone know if there is a roadmap for their pulse oximeter/ECG? I would
love to collaborate remotely.

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anfractuosity
I'm just wondering regarding the stethoscope, I was looking at -
[https://en.wikipedia.org/wiki/Stethoscope#Acoustic](https://en.wikipedia.org/wiki/Stethoscope#Acoustic)
which mentions there are seem to be two types of acoustic pickup, bell or
diaphragm. The Glia one appears to be the bell type I think?

It says that the "bell transmits low frequency sounds, while the diaphragm
transmits higher frequency sounds". Is there an advantage of one type over the
other, or are they used in different scenarios?

~~~
jglauche
Hey, I made the prototype for it. I reverse engineered a Littmann cardiology 3
and used a similar diaphragm setup. For the early prototypes I used the one
that came with the Littmann stethoscope; later on we got the same result with
different approaches, such as cutting out one out of transparent plastic sheet
or using shrinkwrap around it.

~~~
anfractuosity
Cheers, that's very interesting!

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pkaye
I'm curious about their dialysis system. I'm presently on dialysis myself.
Some of the technology is straightforward. Its mostly making sure everything
is sterile or you get a massive infection. The simplest technology is
literally a bad of sugar solution that is fed by gravity and a second bag to
drain out the solution. No power needed except to heat the solution to body
temperature but you can manage without heating in a pinch. Again it all has to
be super sterile so lots of one time use of plastics.

~~~
_tarek_
What are you wondering about specifically?

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beyondCritics
Cool! Now it is time for you (alleged hackers) to produce cool software for
these devices, open sourve preferred. The heart is the most critical muscle of
the body. It is possible to detect a whole lot of disease using ecg data. Also
there is alleged tibetian pulse diagnosis and where are some papers about
pulse diagnosis.

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luc_
This seems really cool in theory - my main question, though, is why does a
Tourniquet need to be 3d-printed? Cant one make one from a cloth and a piece
of wood?

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funnylights
A startup that is focused on real issues besides games and social networking
(aka advertiser playgrounds) — give these guys some props. Coincidence it
didn’t come from the Bay Area?

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etcher
This is awesome. We seriously need affordable healthcare so it's great to see
people innovating in this field to bring costs down.

