An Affordable and Sustainable Thrifty-Like Meal Plan, FoodRx, That Meets the Recommended Dietary Allowances

There is considerable controversy as to whether a healthy diet is affordable given recent inflation. In order to determine whether a healthy, climate-friendly sustainable diet can be obtained within the allotments of the Supplemental Nutrition Assistance Program (SNAP), we created and purchased 26 weeks of meal plans designed to meet the EAT-Lancet sustainability guidelines and > 90% of the RDAs for 23 macro/micronutrients for households with at least 2 adults and 1-3 children. We compared the food quantities and cost of a healthy sustainable diet purchased in Los Angeles, 2023, to the Thrifty Food Plan, 2021. We compared the volume of food and cost of basic groceries to those recommended in the Thrifty Food Plan, 2021. The costs of the sustainable diet fell within the 2023 SNAP allotments as long as the average calories required per person did not exceed 2000. The volume of fruits, vegetables, legumes, nuts, and seeds were considerably higher for the sustainable diet compared to the Thrifty Food Plan. Given that calorie needs are the determinants of food quantity and costs, the USDA may consider offering supplemental coverage for individuals with higher calorie needs to make healthy eating affordable.

Assessing the contribution of semiconductors to the sustainable development goals (SDGs) from 2017 to 2022

Semiconductor development is a major driving force for global economic growth. However, synchronizing it with the Sustainable Development Goals (SDGs) set by the United Nations remains a critical challenge. To gain insight into this, we analyzed SDG-related publications on semiconductors from 2017 to 2022 using the SciVal database. The study found 77,706 documents related to SDGs in the field of semiconductor research, with an overall increase in the number of publications each year. The main focus of these publications was SDG 7 (Affordable and Clean Energy), accounting for 68.9 % of the total publication count. Additionally, the results indicate that semiconductors have multifaceted potential in advancing a range of SDGs. From fostering innovations in healthcare (SDG 3), ensuring clean water access (SDG 6), catalyzing transformative industrial growth (SDG 9), to contributing to climate mitigation strategies (SDG 13), semiconductors emerge as versatile drivers of sustainable development. The respective publication percentages for these goals were 7.3 %, 5.9 %, 9.7 %, and 4.4 %, underscoring their capacity to make substantial contributions across various facets of sustainability. It's worth noting that only 2.9 % of these publications stem from academia-industry collaborations. This indicates a pressing need to facilitate collaboration between academia and industry, as such partnerships have the potential to amplify the impact of semiconductor innovations on the SDGs. The novelty of this study lies in its specific exploration through a comprehensive analysis spanning five years, revealing the alignment between semiconductor advancements and the latest SDGs. It uncovers the significance of collaborative ecosystems involving research institutions, businesses, and governments. Through these results, our study addresses a gap in the existing literature and advances semiconductor contributions to the SDGs.

Planet-based diets: improving environmental sustainability of healthy diets

The focus of nutritionists is on improvement of the health impact of current diets. Therefore, it is important to ask the question whether healthy diets are more sustainable. This review provides an overview on the research on synergies between health and sustainability. Synergies are found from shifts from animal-based to plant-based diets, from ultra-processed foods to fresh and whole foods and from reduction of food waste. The importance of looking at sustainability of the present diets has led to steps made in Europe to incorporate sustainability into food-based dietary guidelines. Examples from UK, Nordics, Belgium and the Netherlands are given. World Wildlife Fund has summarised the insides in a future-proof diet: the planet-based diet within planetary boundaries.

Percutaneous pelvic fixation model: an affordable and realistic simulator for pelvic trauma training

PURPOSE

To describe the construction and use of a percutaneous pelvic fixation model, evaluate its translational validity among fellowship-trained orthopedic trauma surgeons, and investigate the importance of specific criteria for effective competency-based assessment of pelvic fixation techniques.

METHODS

Five orthopedic trauma surgeons were asked to place percutaneous wires on a pelvic fixation model, including anterior column (antegrade/retrograde), posterior column (antegrade/retrograde), supra-acetabular, transsacral, and iliosacral. Evaluation criteria included successful wire placement, redirections, cortical breaches, procedure duration, radiation exposure, and quality of fluoroscopic views. Following completion, participants were provided a survey to rate the model.

RESULTS

There were no differences between approaches on successful screw placement, wire redirections, or fluoroscopic quality. Antegrade approaches to the anterior and posterior columns took longer (p = 0.008) and used more radiation (p = 0.02). There was also a trend toward more cortical breaches with the antegrade anterior column approach (p = 0.07). Median ratings among surgeons were 4 out of 5 for their overall impression and its accuracy in tactile response, positioning constraints, and fluoroscopic projections. Learning parameters considered most important to the progression of trainees (most to least important) were successful screw placement, corridor breaches, wire redirections, quality of fluoroscopic views, radiation exposure, and procedure duration.

CONCLUSION

In being affordable, accessible, and realistic, this percutaneous pelvic fixation model represents an opportunity to advance orthopedic surgery education globally. Future research is needed to validate the findings of this pilot study and to expand upon how trainees should be evaluated within simulations and the operating room to optimize skill progression.

Bringing MRI to low- and middle-income countries: Directions, challenges and potential solutions

The global disparity of magnetic resonance imaging (MRI) is a major challenge, with many low- and middle-income countries (LMICs) experiencing limited access to MRI. The reasons for limited access are technological, economic and social. With the advancement of MRI technology, we explore why these challenges still prevail, highlighting the importance of MRI as the epidemiology of disease changes in LMICs. In this paper, we establish a framework to develop MRI with these challenges in mind and discuss the different aspects of MRI development, including maximising image quality using cost-effective components, integrating local technology and infrastructure and implementing sustainable practices. We also highlight the current solutions-including teleradiology, artificial intelligence and doctor and patient education strategies-and how these might be further improved to achieve greater access to MRI.

An affordable approach to classifying type 2 diabetes based on fasting plasma glucose, TyG index and BMI: a retrospective cohort study of NHANES Data from 1988 to 2014

BACKGROUND

The β-cell function and insulin resistance required by existing methods of classifying type 2 diabetes are not routinely adopted in most medical institutions of developing countries and regions. This study aims to propose a novel, affordable classification approach and evaluate its predictive ability for several health and mortality outcomes, including cardiovascular health (CVH), retinopathy, chronic kidney disease (CKD), nonalcoholic fatty liver disease (NAFLD), advanced liver fibrosis, and mortality caused by all-cause, cardiovascular disease (CVD), cancer.

METHODS

Based on 4060 participants with diabetes (aged ≥ 30 at the time of diagnosis) selected from the National Health and Nutrition Examination Survey III & 1999-2014, we proposed a novel, but simple classification approach based on the threshold of fasting plasma glucose (FPG), triglyceride-glucose (TyG) index and body mass index (BMI). We used logistic regression model to assess its predictability for diabetes complications, and Cox regression model to estimate the mortality risks.

RESULTS

By utilizing this approach, we characterized the subjects into four subgroups: subgroup A (obesity-related), which accounts for 37% of the total, subgroup B (age-related), 38%, subgroup C (insulin resistance), 20%, and subgroup D (severe insulin deficiency), 5%. Subjects in subgroup D had a higher risk of retinopathy, in subgroup B had a lower risk of poor cardiovascular health, nonalcoholic fatty liver disease, and advanced liver fibrosis, in subgroup C had a higher risk of all-cause mortality.

CONCLUSIONS

This study proposes an affordable and practical method for classifying patients with type 2 diabetes into different subgroups, with a view to yield a high predictability of patient outcomes and to assist clinicians in providing better treatment.

Integration of solar energy into low-cost housing for sustainable development: case study in developing countries

The United Nations Development Program reported that two-thirds of the world's population will be living in cities by 2050, which would account for more than 60% of the world's energy consumption. Developing countries experience substantial urbanization and informal settlements compared with other parts of the world. This indicates a paradigm shift in the global energy landscape, which heralds an increase in greenhouse gas emissions. According to Indonesia's National Energy General Plan (PR 22), solar panels are expected to cover at least 25% of rooftops. In Uganda, the Sustainable Energy for All (SE4All) program aims to ensure high penetration of solar energy in the country. This study aims to integrate clean energy into low-cost housing development for sustainable cities in Uganda and Indonesia. We propose an optimal energy system and examine the most significant design parameters that exhibit a desirable performance ratio and energy yield. This project was undertaken in two stages: energy yield estimation and detailed energy system design using two different software programs. Stage 1 aimed to estimate the energy yield based on the available roof area considering existing homes in Uganda and Indonesia. A photovoltaic (PV) array was designed with suitable inverters, tilt angles, and orientations. Stage 2 was intended to determine the optimal tilt angles. Five different PV systems were developed and tested using the optimal tilt angle determined earlier. Finally, an optimizer was integrated into the PV system to investigate potential improvements in the energy yield. The inclusion of an optimizer significantly increased the energy yield from 0.5% to 5.3%. For Uganda, the levelized cost of electricity (LCOE) with and without an optimizer ranged from $0.25/kWh to $0.36/kWh, whereas for Indonesia, the LCOE ranged from $0.25/kWh to $0.3/kWh. The amounts of carbon dioxide reduction were 173.894 t and 122.742 t in Indonesia and Uganda, respectively. The techno-economic outcome of this study serves as a reference model for other developing countries planning similar initiatives that can be replicated with local contextualization and assistive schemes.

Low-cost alternatives for the management of acute ischemic stroke in low and middle-income countries

Acute ischemic stroke (AIS) patients arriving within a suitable time frame are treated with recanalization therapy i.e. intravenous thrombolysis (IVT) with alteplase and/or mechanical thrombectomy (MT). IVT with alteplase is indicated in AIS patients presenting within 4.5 hours of onset regardless of vascular territory involved. MT is indicated in AIS patients presenting within 24 hours of onset with large vessel occlusion in the anterior circulation. However, MT is ludicrously expensive and requires exorbitant setup, devices, and expertise which is not currently feasible in LMICs. Therefore, in LMICs the only feasible recanalization option left for AIS patients is IVT. The cost of IVT varies across the LMICs, however, most of them cost around 2000-5000 USD. Apart from IVT, patients with AIS often have other significant medical costs including those for neuroimaging, intensive care, and prolonged rehabilitative treatment. In LMICs, these costs can only be afforded by a handful of patients. The majority of the LMICs have health insurance in their infancy and family members of AIS patients opt-out IVT due to the economic burden. In general, the current treatment guidelines for AIS are not very useful in LMICs because of cost-related issues among several other factors. In this editorial, we discuss evidence for alternative treatment strategies that can help tackle the rising epidemic of AIS in poor countries by improvising on existing clinical guidelines and seeking alternative treatment regimens.

Financing primary healthcare for rural areas

Context:

Primary healthcare in India is provided by both public and private providers. However, access to good quality primary healthcare is lacking in underserved populations such as communities in rural and remote areas and families in low income quartiles. While there are government programs on comprehensive primary healthcare, stagnant investments restrict their reach and quality. At the same time, there are several for-profit and not-for-profit primary healthcare providers that fill the gap, but are limited in scale and geographical reach. They also often find it challenging to provide affordable comprehensive primary healthcare.

Aims:

The Consultation on Financing Primary Healthcare was organized to draw lessons for financial sustenance of comprehensive and equitable primary healthcare initiatives. Eighteen academicians and practitioners, representing different institutions from across India, presented and engaged in discussions around the theme of financing primary healthcare.

Methods and Material:

The Consultation proceedings were recorded, transcribed, analyzed, and synthesized to bring out the key insights.

Results:

The Consultation drew insights from the experiences and evidence shared by the participants on the ways to finance primary healthcare services sustainably, especially for underserved populations. The financing models discussed include public-private partnership, user fees, community financing, subscription and cross-subsidy. Cost-reduction strategies such as task-shifting and use of appropriate technology were also identified as key to improving efficiency in service delivery.

3D printing and continuous flow chemistry technology to advance pharmaceutical manufacturing in developing countries

The realization of a downward spiralling of diseases in developing countries requires them to become self-sufficient in pharmaceutical products. One of the ways to meet this need is by boosting the local production of active pharmaceutical ingredients and embracing enabling technologies. Both 3D printing and continuous flow chemistry are being exploited rapidly and they are opening huge avenues of possibilities in the chemical and pharmaceutical industries due to their well-documented benefits. The main barrier to entry for the continuous flow chemistry technique in low-income settings is the cost of set-up and maintenance through purchasing of spare flow reactors. This review article discusses the technical considerations for the convergence of state-of-the-art technologies, 3D printing and continuous flow chemistry for pharmaceutical manufacturing applications in developing countries. An overview of the 3D printing technique and its application in fabrication of continuous flow components and systems is provided. Finally, quality considerations for satisfying regulatory requirements for the approval of 3D printed equipment are underscored. An in-depth understanding of the interrelated aspects in the implementation of these technologies is crucial for the realization of sustainable, good quality chemical reactionware.

Hydrokinetic turbines for moderate sized rivers

If hydrokinetic turbines are to make a significant contribution to small scale off-grid power supply, they will need to be affordable, reliable and easily deployed at many sites, not just a few with exceptional combinations of depth and high flow velocity. Few if any products currently on the market meet these criteria. This paper addresses the challenge of providing small scale electrical power and pumping from rivers, in particular for villages in high rainfall tropical areas where there is no mains power, not much wind or sunny weather in the wet season, and not enough elevation for conventional micro-hydro. Hydrokinetic power is proposed, and candidate turbines are evaluated, including multiple small axial flow turbines, various forms of horizontal axis Darrieus turbines, water wheels, and belt turbines. The importance of channel blockage in enhancing turbine power output is discussed.

CAR T cell therapy: newer approaches to counter resistance and cost

The genetically engineered Chimeric Antigen Receptor bearing T-cell (CAR T cell) therapy has been emerged as the new paradigm of cancer immunotherapy. However, recent studies have reported an increase in the number of relapsed haematological malignancies. This review provides newer insights into how the efficacy of CAR T cells might be increased by the application of new genome editing technologies, monitoring the complexity of tumor types and T cells sub-types. Next, tumor mutation burden along with tumormicroenvironment and epigenetic mechanisms of CAR T cell as well as tumor cell may play a vital role to tackle the cancer resistance mechanisms. These studies highlight the need to consider traditional cancer therapy in conjunction with CAR T cell therapy for relapsed or cases unresponsive to treatment. Of note, this therapy is highly expensive and requires multi-skill for successful implementation, which results in reduction of its accessibility/affordability to the patients. Here, we also propose a model for cost minimization of CAR T cell therapy by a collaboration of academia, hospitals and industry.

Validation of a low-cost inertial motion capture system for whole-body motion analysis

While some low-cost inertial motion capture (IMC) systems are now commercially available, generally, they have not been evaluated against gold standard optical motion capture (OMC). The objective was to validate the low-cost Neuron IMC system with OMC. Whole-body kinematics were recorded on five healthy subjects during manual handling of boxes for about 32 min while wearing 17 magnetic and inertial measurement units with Optotrak clusters serving as a reference. The kinematical model was calibrated anatomically for OMC and with poses for IMC. Local coordinate systems were aligned with angular velocities to dissociate differences due to technology or kinematical model. Descriptive statistics including the root mean square error (RMSE), coefficient of multiple correlation (CMC) and limits of agreement (LoA) were applied to the joint angle curves. The average technological error yielded 5.8° and 4.9° for RMSE, 0.87 and 0.96 for CMC and 0.4 ± 8.6° and -0.3 ± 6.0° for LoA about the frontal and transverse axes respectively, whereas the longitudinal axis yielded 10.5° for RMSE, 0.78 for CMC and 3.3 ± 13.1° for LoA. Differences due to technology and to the model contributed similarly to the total difference between IMC and OMC. For many joints and axes, RMSE stayed under 5°, CMC over 0.9 and LoA under 10°, especially for the transverse axis and lower limb. The Neuron low-cost IMC system showed potential for tracking complex human movements of long duration in a normal laboratory environment with a certain error level that may be suitable for many applications involving large IMC distribution.

Compressed Sensing with Gaussian Sampling Kernel for Ultrasound Imaging

Recently, compressed sensing (CS) has been applied to ultrasound imaging for either data reduction or frame rate improvement. However, there are no detailed reports yet on strategies for lateral undersampling of channel data in conventional focused beamforming (CFB) and its recovery exploiting the CS approach. We propose a strategic lateral undersampling approach for channel data using the Gaussian sampling scheme and compare it with a direct extension of the often-used uniform undersampling reported for axial undersampling to the lateral direction and 2-D random sampling reported in the literature. As opposed to the reported 2-D random undersampling, we explore undersampling of channel data in the lateral direction by acquiring radiofrequency data from only a reduced number of chosen receive elements and subjecting these data to further undersampling in the axial direction. The effect of the sampling schemes on CS recovery was studied using data from simulations and experiments for various lateral and axial undersampling rates. The results suggest that CS-recovered data from the Gaussian distribution-based channel data subsampling yielded better recovery and contrast in comparison to those obtained from the often-used uniform distribution-based undersampling. Although 90% of the samples from the original data using the proposed sampling scheme were discarded, the contrast of the CS-recovered image was comparable to that of the reference image. Thus, CS with the proposed Gaussian sampling scheme for channel data subsampling not only reduces the data size significantly, but also strategically uses only a few active receive elements in the process; thus, it can provide an attractive option for the affordable point-of-care ultrasound system.

Improving quality of the informed consent process: Developing an easy-to-read, multimodal, patient-centered format in a real-world setting

OBJECTIVE

To develop a patient-centered informed consent and assessment tool written at a 6th grade-level that is multimodal, affordable, transportable, and readily modifiable for protocol updates.

METHODS

This quality improvement initiative was performed in two phases on an actively-recruiting study at a pediatric diabetes clinic. In phase I, 38 volunteers underwent the standard-paper consent process, a comprehension assessment and provided feedback. Using feedback and the structure of the Plan-Do-Study-Act cycle a multimodal consent and assessment were developed. In phase II, volunteers were randomized to the standard (n = 25) or the multimodal consent (n = 25) and all completed the same comprehension assessment via touch-screen tablet. Primary outcomes were comparison of the individual and total comprehension assessment scores.

RESULTS

Total comprehension scores were higher in the multimodal versus the standard consent group (p <  0.001) and on the elements of benefits (p <  0.001), risks (p <  0.001), volunteerism (p <  0.012), results (p <  0.001), confidentiality (p <  0.004) and privacy (p < 0.001).

CONCLUSION

A multimodal consent and assessment presented sequentially on a touch-screen tablet were patient-centered enhancements to standard consent.

PRACTICE IMPLICATIONS

Multimodal standardization of delivery with improved readability may strengthen the informed consent process.

What is cost-efficient phenotyping? Optimizing costs for different scenarios

Progress in remote sensing and robotic technologies decreases the hardware costs of phenotyping. Here, we first review cost-effective imaging devices and environmental sensors, and present a trade-off between investment and manpower costs. We then discuss the structure of costs in various real-world scenarios. Hand-held low-cost sensors are suitable for quick and infrequent plant diagnostic measurements. In experiments for genetic or agronomic analyses, (i) major costs arise from plant handling and manpower; (ii) the total costs per plant/microplot are similar in robotized platform or field experiments with drones, hand-held or robotized ground vehicles; (iii) the cost of vehicles carrying sensors represents only 5-26% of the total costs. These conclusions depend on the context, in particular for labor cost, the quantitative demand of phenotyping and the number of days available for phenotypic measurements due to climatic constraints. Data analysis represents 10-20% of total cost if pipelines have already been developed. A trade-off exists between the initial high cost of pipeline development and labor cost of manual operations. Overall, depending on the context and objsectives, "cost-effective" phenotyping may involve either low investment ("affordable phenotyping"), or initial high investments in sensors, vehicles and pipelines that result in higher quality and lower operational costs.

Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym

Background

Stroke rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches.

Methods

A typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the Robot Gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies.

Results

No significant differences were observed when comparing the results of the pre-intervention Mini-mental, Brunnstrom Test, and Geriatric Depression Scale Test, showing that both groups were functionally similar prior to the intervention. Although, both training groups were functionally equivalent, they had a significant age difference. The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups. The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group. On the Time Up and Go Test, no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups. For the 6 Minute Walk Test, both groups presented a statistically significant difference pre- and post-intervention, showing progress in their performance. The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term.

Conclusions

The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group. In the lower extremity tests, the intervention patients showed more improvement than those subjected to traditional therapy. These results support that the Robot Gym can be as effective as traditional therapy for stroke patients, presenting a more cost- and labor-efficient option for countries with scarce clinical resources and funding.

Trial registration

ISRCTN98578807.

How does venture capital operate in medical innovation?

While health policy scholars wish to encourage the creation of technologies that bring more value to healthcare, they may not fully understand the mandate of venture capitalists and how they operate. This paper aims to clarify how venture capital operates and to illustrate its influence over the kinds of technologies that make their way into healthcare systems. The paper draws on the international innovation policy scholarship and the lessons our research team learned throughout a 5-year fieldwork conducted in Quebec (Canada). Current policies support the development of technologies that capital investors identify as valuable, and which may not align with important health needs. The level of congruence between a given health technology-based venture and the mandate of venture capital is highly variable, explaining why some types of innovation may never come into existence. While venture capitalists' mandate and worldview are extraneous to healthcare, they shape health technologies in several, tangible ways. Clinical leaders and health policy scholars could play a more active role in innovation policy. Because certain types of technology are more likely than others to help tackle the intractable problems of healthcare systems, public policies should be equipped to promote those that address the needs of a growing elderly population, support patients who are afflicted by chronic diseases and reduce health disparities.

Open-source hardware for medical devices

Open-source hardware is hardware whose design is made publicly available so anyone can study, modify, distribute, make and sell the design or the hardware based on that design. Some open-source hardware projects can potentially be used as active medical devices. The open-source approach offers a unique combination of advantages, including reducing costs and faster innovation. This article compares 10 of open-source healthcare projects in terms of how easy it is to obtain the required components and build the device.

Innovating to improve primary care in less developed countries: towards a global model

One of the biggest problems in global health is the lack of well trained and supported health workers in less developed settings. In many rural areas there are no physicians, and it is important to find ways to support and empower nurses and other health workers. The Knowledge Translation Unit of the University of Cape Town Lung Institute has spent 14 years developing a series of innovative packages to support and empower nurses and other health workers. PACK (Practical Approach to Care Kit) Adult comprises policy-based and evidence-informed guidelines; onsite, team and case-based training; non-physician prescribing; and a cascade system of scaling up. A series of randomised trials has shown the effectiveness of the packages, and methods are now being developed to respond cost-effectively and sustainably to global demand for implementing PACK Adult. Global health would probably benefit from less time and money spent developing new innovations and more spent on finding ways to spread those we already have.

An Inexpensive Suturing Training Model

INTRODUCTION

Demonstrations and training on live-subjects are not always the optimal means of introducing the students to minor oral surgery. Hence, the use of teaching models permit the students to handle the surgical instruments in a limited field under a semi-realistic circumstance and also helps in developing psychomotor skills in an non stressed situation. One among the competent exercise in oral surgery is suturing. Though there exist a variety of commercially available suturing training models, cost factor restrain their acquirement in few units.

METHODS & MATERIALS

This paper describes the construction of a simple and cost-effective suturing model for preclinical training. The construction of this model requires an orange peel, putty impression material and plaster of paris. This suturing model can be created in ten minutes.

CONCLUSION

This model can be constructed by the students with minimal effort and low cost in order to practice suturing.