Stakeholder Perspectives on the Current and Future of Additive Manufacturing in Healthcare

Additive manufacturing (AM) technologies have disrupted many supply chains by making new designs and functionalities possible. The opportunity to realize complex customized structures has led to significant interest within healthcare; however, full utilization critically requires the alignment of the whole supply chain. To offer insights into this process, a survey was conducted to understand the views of different medical AM stakeholders. The results highlighted an agreement between academics, designers, manufacturers, and medical experts, that personalization and design control are the main benefits of AM. Interestingly, surface finish was consistently identified as an obstacle. Nevertheless, there was a degree of acceptance that post-processing was necessary to achieve appropriate quality control. Recommendations were made for extending the use of in situ process monitoring systems to support improved reproducibility. Variations in the future vision of AM were highlighted between stakeholder groups and areas of interest for development noted for each stakeholder. Collectively, this survey indicates that medical stakeholders agree on the capabilities of AM but have different priorities for its implementation and progression. This highlights a degree of disconnection among the supply chain at a ground level; thus, collaboration on AM specific standards and enhancement of communication between stakeholders from project inception is recommended.

A universal scaling law of mammalian touch

For most mammals, touch is the first sense to develop. They must feel vibrations on the surface of their skin to enable them to respond to various stimuli in their environment, a process called vibrotaction. But how do mammals perceive these vibrations? Through mathematical modeling of the skin and touch receptors, we show that vibrotaction is dominated by "surface" Rayleigh waves traveling cooperatively through all layers of the skin and bone. Applying our model to experimental data, we identify a universal scaling law for the depth of touch receptors across multiple species, indicating an evolutionarily conserved constant in the sensation of vibrations.

Contact mechanics of the human finger pad under compressive loads

The coefficient of friction of most solid objects is independent of the applied normal force because of surface roughness. This behaviour is observed for a finger pad except at long contact times (greater than 10 s) against smooth impermeable surfaces such as glass when the coefficient increases with decreasing normal force by about a factor of five for the load range investigated here. This is clearly an advantage for some precision manipulation and grip tasks. Such normal force dependence is characteristic of smooth curved elastic bodies. It has been argued that the occlusion of moisture in the form of sweat plasticises the surface topographical features and their increased compliance allows flattening under an applied normal force, so that the surfaces of the fingerprint ridges are effectively smooth. While the normal force dependence of the friction is consistent with the theory of elastic frictional contacts, the gross deformation behaviour is not and, for commonly reported values of the Young's modulus of stratum corneum, the deformation of the ridges should be negligible compared with the gross deformation of the finger pad even when fully occluded. This paper describes the development of a contact mechanics model that resolves these inconsistencies and is validated against experimental data.

Application of colloid probe atomic force microscopy to the adhesion of thin films of viscous and viscoelastic silicone fluids

The adhesive characteristics of thin films (0.2-2 μm) of linear poly(dimethylsiloxane) (PDMS) liquids with a wide range of molecular weights have been measured using an atomic force microscope with a colloid probe (diameters 5 and 12 μm) for different separation velocities. The data were consistent with a residual film in the contact region having a thickness of ∼6 nm following an extended dwell time before separation of the probe. It was possible to estimate the maximum adhesive force as a function of the capillary number, Ca, by applying existing theoretical models based on capillary interactions and viscous flow except at large values of Ca in the case of viscoelastic fluids, for which it was necessary to develop a nonlinear viscoelastic model. The compliance of the atomic force microscope colloid beam was an important factor in governing the retraction velocity of the probe and therefore the value of the adhesive force, but the inertia of the beam and viscoelastic stress overshoot effects were not significant in the range of separation velocities investigated.

Psyttalia ponerophaga (Hymenoptera: Braconidae) as a potential biological control agent of olive fruit fly Bactrocera oleae (Diptera: Tephritidae) in California

The olive fruit fly, Bactrocera oleae (Rossi), is a newly invasive, significant threat to California's olive industry. As part of a classical biological control programme, Psyttalia ponerophaga (Silvestri) was imported to California from Pakistan and evaluated in quarantine. Biological parameters that would improve rearing and field-release protocols and permit comparisons to other olive fruit fly biological control agents were measured. Potential barriers to the successful establishment of P. ponerophaga, including the geographic origins of parasitoid and pest populations and constraints imposed by fruit size, were also evaluated as part of this investigation. Under insectary conditions, all larval stages except neonates were acceptable hosts. Provided a choice of host ages, the parasitoids' host-searching and oviposition preferences were a positive function of host age, with most offspring reared from hosts attacked as third instars. Immature developmental time was a negative function of tested temperatures, ranging from 25.5 to 12.4 days at 22 and 30 degrees C, respectively. Evaluation of adult longevity, at constant temperatures ranging from 15 to 34 degrees C, showed that P. ponerophaga had a broad tolerance of temperature, living from 3 to 34 days at 34 and 15 degrees C, respectively. Lifetime fecundity was 18.7 +/- 2.8 adult offspring per female, with most eggs deposited within 12 days after adult eclosion. Olive size affected parasitoid performance, with lower parasitism levels on hosts feeding in larger olives. The implications of these findings are discussed with respect to field manipulation and selection of parasitoid species for olive fruit fly biological control in California and worldwide.

Effect of PANTA on growth of Mycobacterium kansasii in BACTEC 12B medium

Mycobacterium kansasii isolates from two patients showed relatively slow growth in BACTEC 12B medium (12B) (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md.) compared with the more rapid growth of these isolates on solid media. This finding prompted an evaluation of the effect of PANTA (Becton Dickinson) on the growth rate of these isolates. Suspensions of one isolate from each of these two patients (A and B), six additional isolates from six other patients (C through H), and one M. kansasii American Type Culture Collection isolate were inoculated into 12B with PANTA, 12B with reconstituting fluid only, and Middlebrook 7H11 agar plates (Remel, Lenexa, Kans.). For the isolates from patients A and B, the average times to detection for 12B with PANTA, 12B with reconstituting fluid, and Middlebrook 7H11 agar were 12.3, 7.4, and 9.0 days, respectively. For the remaining six patient isolates and the American Type Culture Collection strain, the average times to detection for these media were 9.2, 8.1, and 9.6 days. Susceptibility tests performed with the isolates from patients A and B with the individual component antibiotics of PANTA and testing of four of the other isolates with nalidixic acid alone suggested that nalidixic acid exerts some degree of inhibition on the growth of M. kansasii. The eight patient isolates were also inoculated onto Lowenstein Jensen medium (Remel) and onto a variety of selective mycobacterial media containing nalidixic acid and other antimicrobial agents. All isolates showed some degree of inhibition on at least one of these selective media.

Dietary fish oil augments nitric oxide production or release in patients with type 2 (non-insulin-dependent) diabetes mellitus

Decreased release of nitric oxide from damaged endothelium is responsible for the impaired endothelium-dependent vasodilator responses found in animal models of vascular disease. Dietary supplementation with fish oils has been shown to augment endothelium-dependent relaxations, principally by improving the release of nitric oxide from injured endothelium. Using forearm venous occlusion plethysmography we studied vascular responses to 60, 120, 180 and 240 nmol/min of acetylcholine (an endothelium-dependent vasodilator) and 3, 6 and 9 nmol/min of glyceryl trinitrate (an endothelium-independent vasodilator) infused into the brachial artery in 23 patients with Type 2 (non-insulin-dependent) diabetes mellitus. NG monomethyl-L-arginine was employed to inhibit stimulated and basal release of nitric oxide from the endothelium. On completion of the baseline studies patients randomly received either fish oil or matching olive oil capsules in a double-blind crossover fashion for 6 weeks followed by a 6-week washout period and a final 6-week treatment phase. Studies, identical to the initial baseline studies, were performed at the end of the active treatment periods at 6 and 18 weeks. Fish oil supplementation significantly improved forearm blood flow responses to each dose of acetylcholine when compared to the vasodilator responses recorded at baseline and after olive oil administration (p < 0.01). Neither fish oil nor olive oil supplementation produced any significant changes in forearm blood flow to the incremental infusions of glyceryl trinitrate when compared with responses recorded during the baseline studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Impaired endothelium-dependent and independent vasodilation in patients with type 2 (non-insulin-dependent) diabetes mellitus

The endothelium plays a pivotal role in modulating the reactivity of vascular smooth muscle through the formation of several vasoactive substances. We examined the effects of endothelium-dependent and independent vasodilators on forearm blood flow in 29 patients with Type 2 (non-insulin-dependent) diabetes mellitus and in 21 control subjects, using venous occlusion plethysmography. Via a brachial artery cannula, increasing amounts of acetylcholine and glyceryl trinitrate were infused in doses of 60, 120, 180 and 240 mmol per min and 3, 6 and 9 nmol per min respectively. NG monomethyl-L-arginine, a stereospecific inhibitor of endothelium derived relaxing factor, was infused to inhibit basal and stimulated release of this dilator substance. Reactive hyperaemic forearm blood flow did not differ between groups. Forearm blood flow responses to each dose of acetylcholine were significantly greater in control than diabetic subjects (p less than 0.01 for all doses). NG monomethyl-L-arginine attenuated forearm blood flow from maximal stimulated values when responses were compared with the natural decline to acetylcholine in forearm flow in both control and diabetic subjects (p less than 0.05 for both groups), but had no effect on basal blood flow responses. Forearm blood flow responses to each dose of glyceryl trinitrate were significantly greater in control than diabetic subjects (p less than 0.05 for all). These data provide evidence for endothelial and smooth muscle dysfunction in diabetes which may have important therapeutic implications.

Modified toluidine blue O stain for Pneumocystis carinii: further evaluation of some technical factors

A modified toluidine blue O (TBO) stain for Pneumocystis carinii cysts was evaluated with regard to the influence of (i) the age and extent of use of the sulfation reagent, (ii) the source of TBO, (iii) the TBO content of the staining solution, and (iv) the amount of TBO present in the alcohol wash solutions. All TBOs evaluated, except for a new TBO obtained from Roboz Surgical Instrument Co., Inc., Washington, D.C., produced satisfactory results. Each lot of TBO should be quality controlled before use to ensure that the P. carinii cysts stain lavender against a blue background. We have ourselves decided to use only certified TBO with a high dye content. As extensively used sulfation reagent provided less satisfactory results than did either freshly prepared or 1-week-old unused sulfation reagent, we have decided to prepare fresh sulfation reagent at least weekly and to discard used sulfation reagent after 10 slides have been processed.

Relationships between selenium and other parameters in drinking water and blood of subjects from high and low cardiovascular disease rate areas of Georgia

Plasma, erythrocyte and home tap water samples were taken from life-long residents of two counties (Evans-rural and Chatham-urban) in the high cardiovascular disease (CVD) belt of southeastern Georgia and from Habersham County, a rural county of North Georgia which is outside of the CVD belt. One-half of the subjects from each cohort had a serious CVD problem and the remaining half were healthy controls. Water samples were analyzed for hardness, total dissolved solids, pH and selenium (Se) content. Blood samples were analyzed for Se (by neutron activation analysis) and glutathione peroxidase (GSHPx). Se levels in all water samples were less than 0.01 ppb. Water hardness and total dissolved solids levels were higher in the CVD belt counties. There were no significant differences (P greater than 0.05), but water hardness and total dissolved solid levels were inversely correlated (p greater than 0.01) with the activity of erythrocyte GSHPx, a selenium containing enzyme which detoxifies oxidized fats.

Pantothenic acid requirements of channel catfish fingerlings

In 8- and 12-week feeding trials, channel catfish fingerlings were fed purified diets containing four levels (0, 10, 30 and 60 mg/kg) and six levels (0, 5, 10, 20, 40 and 80 mg/kg) of supplemental calcium pantothenate, respectively. The dietary pantothenate level required for maximal growth, feed conversion and prevention of gross deficiency signs was approximately 10 mg/kg of diet. Fish fed the unsupplemented diet showed severe anorexia, loss of weight, clubbed gills, anemia, high mortality rates and eroded skins, lower jaws, fins and barbels. Fused gill filaments were not obtained as reported in pantothenate deficient salmonids.

Pyridoxine requirements of channel catfish

In 20 and 12 week feeding trials, channel catfish fingerlings were fed purified diets containing five levels (0, 5, 10, 20, and 30 mg/kg) and six levels (0, 1, 2, 5, 10, and 20 mg/kg) of supplemental pyridoxine hydrochloride. Fish fed unsupplemented diets (pyridoxine content of 1.2 mg/kg) were characterized by anoxeria, nervous disorders, tetany, greenish-blue body coloration, and eventual mortality. Anemia, which has been reported in pyridoxine deficient salmonids, was not observed in pyridoxine deficient catfish. However, a microcytic, normochromic anemia was observed in groups fed high dietary levels of pyridoxine (20 mg/kg or greater). The dietary pyridoxine level required for maximal growth was approximately 3 mg/kg of diet. All other deficiency signs were prevented by 2.2 mg/kg of diet.

Use of -l-ascorbic acid, ethocel coated ascorbic acid and ascorbate 2-sulfate in diets for channel catfish, Ictalurus punctatus

Purified diets with five levels (25, 50, 75, 100, and 200 mg/kg) of supplemental L-ascorbic acid (LAA), and equimolar levels of ethylcellulose coated L-ascorbic acid (EAA) and dipotassium L-ascorbate 2-sulfate dihydrate (AS) were pelleted and fed to 7.9 +/- 0.2 g channel catfish fingerlings for 20 weeks. A dietary level of 23 mg/kg of all three forms of vitamin C prevented spinal abnormalities. Approximately 50 mg/kg diet of either LAA or EAA was sufficient for maximal growth and feed efficiency. Growth response to AS was similar to a Michaelis-Menten type curve and 200 mg/kg diet of AS was necessary to achieve maximal growth. Blood and liver ascorbic acid levels were positively correlated with supplemental levels of LAA, EAA, and AS up to 200 mg/kg; however, blood and liver ascorbic acid levels of fish fed AS were considerably less than those fed LAA and EAA. Weight gains were positively correlated with blood ascorbate levels up to 7 microgram/ml. No measurable level of AS was detected in blood or liver. These results suggest that the rate of enzymatic hydrolysis of AS to LAA or rapid excretion of AS may have been the limiting factor.

Dietary niacin requirements for channel catfish

Channel catfish fingerlings were fed purified diets containing five levels (0, 25, 50, 100, and 150 mg/kg) and six levels (0, 5, 10, 25, 50, and 100 mg/kg) of supplemental niacin in 20 and 12 weeks feeding studies, respectively. The dietary niacin level required to provide maximal growth in rapidly growing channel catfish fingerlings was found to be approximately 14 mg/kg of diet. Fish fed unsupplemented diets (niacin content of 1.6 mg/kg diet) demonstrated poor growth, anemia, skin and fin lesions and hemorrhages, exophthalmia and total mortality in 20 weeks. Mortality and gross deficiency signs were prevented by 11.6 mg niacin/kg diet and anemia was prevented by 6.6 mg/kg. No histological abnormalities were observed in the heart, hepatopancreas, kidney, lateral muscle, gastrointestinal tract and gill tissues of deficient fish.

Riboflavin requirement of channel catfish fingerlings

Channel catfish fingerlings were fed purified diets containing five levels (0, 20, 40, 80, and 120 mg/kg) and six levels (0, 3, 8, 20, 40, and 80 mg/kg) of riboflavin in separate 20 and 12 week feeding studies. The dietary riboflavin level required to provide maximal growth in channel catfish fingerlings was found to be approximately 9 mg/kg of diet. All fish fed unsupplemented diets (riboflavin content less than 0.1 mg/kg diet) demonstrated a short body dwarfism which was the result of arrested longitudinal growth of the vertebrae. This abnormality did not occur in groups fed 3 mg/kg or higher levels of riboflavin. No histological abnormalities were recognized in the liver, kidney, lateral muscle, gastrointestinal tract, gills, or bones of deficient fish.

The influence of dietary fat levels and environmental temperature on digestible energy and absorbability of animal fat in catfish diets

A study was conducted on the effects of three dietary levels of animal fat (5%, 10%, and 15%) and two environmental temperatures (23 and 28 degrees) on the digestible energy (DE) and apparent absorbability (AA) of animal fat in diets of 150 g catfish. Results obtained by the use of the chromic oxide indicator technique demonstrated that at 28 degrees and substitution levels up to 10% of diet, animal fat had a DE value of 7,000 kcal/kg and an AA of 94%. At the 15% level of substitution, both DE and AA were substantially reduced. At each level of substitution, DE and AA values were considerably lower in fish reared at 23 degrees. At supplemental levels up to 10% of diet, the DE and AA values for catfish at 23 degrees were 6,130 kcal/kg and 70%, respectively. Results from this study reconfirmed previous growth data which indicated that animal fat is an excellent dietary energy source for catfish which are reared at optimum temperatures.

Thiamin requirement of channel catfish fingerlings

In separate 20 and 12 week feeding studies, channel catfish fingerlings were fed semipurified diets containing five levels (0, 2.5, 5.0, 10.0 and 15.0 mg/kg) and six levels (0, 0.5, 1.0, 2.5, 5.0 and 10.0 mg/kg) of supplemented thiamin hydrochloride respectively. The dietary thiamin level required to provide maximal growth and prevent deficiency symptoms in channel catfish fingerlings was found to be approximately 1 mg/kg of diet. Fish fed unsupplemented diets (thiamin content of less 1 mg/kg diet) demonstrated anorexia, extremely poor growth, dark coloration of the skin and increased mortality rates. Neurological symptoms were not observed. Histological examinations of the heart, hepatopancreas, kidney, lateral muscle, gastrointestinal tract and gills of deficient fish revealed no abnormalities.

Supplementation of a semipurified casein diet for catfish with free amino acids and gelatin

Semipurified diets with casein as the sole protein source were supplemented with gelatin, arginine, cystine, methionine or tryptophan, and fed to channel catfish (Ictalurus punctatus) fingerlings. Increasing the arginine level from 1.1% to 1.7% of diet by the isonitrogenous substitution of gelatin for casein resulted in a significant enhancement of growth. However, the addition of free arginine, cystine, tryptophan or methionine to casein had little effect on growth or food conversion. These data substantiate a previous report that suggested catfish were similar to carp in their inability to utilize free amino acids.

Effects of dietary lipids, dietary protein and environmental temperatures on growth, feed conversion and body composition of channel catfish

Studies were conducted to determine the effects of several lipid supplements in practical-type diets for channel catfish (Ictalurus punctatus) fingerlings reared at 23 degrees and 28 degrees. Maximum growth and feed efficiency were obtained when diets were supplemented with 9% animal tallow, 9% menhaden oil or a combination of the two (4.5% of each). A growth suppression was observed when fish were fed a diet containing a combination of 3% corn oil, 3% animal tallow and 3% menhaden oil. In studies on interactions of dietary protein and lipid at 23 degrees and 28 degrees, increasing dietary protein from 25% to 35% resulted in higher gains. At 28 degrees, increasing dietary lipid from 5% to 12% resulted in increased gains with diets containing 35% protein but not withdiets containing 25% protein. At 23 degrees, 5% lipid was sufficient in all cases. Carcass lipid levels increased with increasing temperature and were positively correlated with weight gains and negatively correlated with carcass moisture content. Improved protein conversion (protein fed: protein gained) was noted when dietary protein levels were increased from 25% to 35%; when dietary lipid levels were increased from 5% to 12%; and when environmental temperature was increased from 23 degrees to 28 degrees.

Effect of essential and nonessential fatty acids in complex mixture on fatty acid composition of liver lipids

Linoleate, linolenate, arachidonate, docosahexenoate and six other fatty acids were major components of 24 ester preparations fed as 5% of the diet for 60 days to groups of male white rats. The experiment was designed so as to provide that all major fatty acid components were independent of each other in the sense that the intake of each was poorly correlated with the intake of any of the others. Fatty acid compositions of liver lipids were determined and were related to the composition of the diet lipids. Linolenate and docosahexaenoate contents of diet and tissue revealed the same relationships reported previously from experiments in which individual pure acid esters were added to a fat-free diet. Linoleate, when fed in lipid mixtures, was more effective in raising the linoleate concentration in liver lipids than when fed alone, but this increase did not change the shape of the dose-response curve or the estimated nutritional requirement. Large amounts of fish oil in the diet tended to depress the arachidonate concentration in tissue lipids.

Dietary effects of the esters of butyric, caproic, caprylic, capric, lauric, myristic, palmitic, and stearic acids on food intake, weight gain, plasma glucose, and tissue lipid in the male white rat

Eight saturated fatty acid esters were fed to male white rats for 30 days in a 1/81 fractional factorial experiment in which diets contained 12-38% of their total energy as lipid. Marked increases in food intake, feed efficiency, and weight gain were achieved when lipid provided 36% of diet energy, and when that lipid was more than half caproate, caprate, myristate, and/or stearate. Caproate was the only saturated fatty acid to increase plasma glucose levels. The feeding of stearate or caprylate decreased plasma and liver cholesterol. Caprate increased liver fat. The short-chain fatty acids (butyrate to myristate) increased the concentration of fat in the carcass.

Studies on the vitamin C requirements of channel catfish (Ictalurus punctatus)

Three feeding studies on the vitamin C requirements of channel catfish were conducted with practical and semipurified diets. In a long-duration study in which fish achieved almost a 4,000% increase in weight, 50 mg of l-ascorbic acid/kg diet was required for maximal growth and food efficiency. A diet stability study revealed that excessive losses in activity of l-ascorbic acid occurred when practical diets were stored for 16 weeks at 20 degrees. The typical scoliosis condition associated with severe vitamin C deficiency in fish occurred in the nonsupplemented groups in the study with practical diets. Severe growth reductions were obtained from fish fed nonsupplemented semi-purified diets, yet no incidences of spinal abnormalities were noted.