Fabio Balli 1 Richard Ibbotson 2 Vaibhav Chhabra 3 Juan-Pablo Pimentel 4 Victor Suturin 5 Luis Falcon 6 Janis Timm-Bottos 7 Emmanuel Kellner 8-1 Jaykumar Menon 9 Nathaniel Bechard 5 Mathilde Matringe 10 Clément le Couedic 11
1 Breathing Games, Switzerland 2 Imperial College Advanced Hackspace, UK 3 Maker Asylum, India�4 Universidad de La Sabana, Colombia 5 Public Invention, USA 6 GNU Health, Spain 7 Art Hives, Canada�8 LogAir, Switzerland 9 Open Source Pharma Foundation, India 10 EchOpen, France�11 Association Aura, France
Download, cite, edit: https://doi.org/10.5281/zenodo.5515632
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Libre and open-source respiratory health commons
15 projects communities can adapt, repair, reproduce�for low cost medical care (libre and open-source tech)
Global Alliance against chronic Respiratory Diseases (WHO GARD)
General meeting 2020-2021
A core goal of public policy should be to facilitate �the development of institutions that bring out the best in humans.
Elinor Ostrom. 2009
Harnessing open-source methodology will ensure that �funding used to develop scientific equipment is spent only once.�Scaled replication saves 90–99% on conventional costs.
Joshua Pearce. 2014
An example: open-sourcing MRI scanners in Germany could spare�up to 3.3 billion dollars within 20 years. This does not fundamentally change the medical system, or business, but promotes real innovation.
Lukas Winter et al. 2019
Today, 6 humans in 10 have no access to medical care or do not adhere to it.
Health as a business (IP) |
limited number of employees |
black box design |
excluding propriety |
centralized validation |
centralized mass production |
price barrier excludes users |
competition, dependency |
Health as commons (open-source) |
open network of interdisciplinary contributors |
iterative co-creation and documentation |
shared rights to use, repair, study, reproduce, adapt |
shared responsibility |
distributed crowd/peer production |
fair price or gratis, costs cut by 10-100 with mutualization |
solidarity, capacity building |
disease management
Please refer to the websites regarding the projects aims, and seek professional advice before using or reproducing them.
Source: isinnova.it
Isinnova Charlotte – valve for mask | |
Challenge | Providing a rapid solution to the shortage of C-PAP masks in hospitals, which ensures the right amount of air/oxygen is provided to users with a sealed system. |
Current version | 3D-printable valve to connect a commercial snorkeling mask to oxygen supply, a PEEP valve, and optionally a reservoir (adding a 3D-printed fork element). |
Readiness | Ready to manufacture, not a medical device |
Licences | open-source (not described) - mask is closed source |
Reprod. cost | filament + time (~ 10 pieces daily per printer) |
Next steps | –�� |
Inspiring story | The start-up created a prototype, tested it and printed a hundred pieces in three days. 1200 manufacturers contacted them to support with the manufacturing. |
Websites | |
Source: makerasylum.com
M19 O2 – Oxygen concentrator | |
Challenge | Activating local communities to make an oxygen concentrator in India; building capacity to manufacture and maintain it locally and in a decentralised manner. |
Current version | Delta version with indigenously sourced parts, 15 liters per minute, 96% oxygen concentration, OSHWA certification, 150 organisations contributing |
Readiness | Final stages of functional testing, ready to manufacture |
Licences | CERN OHL S 2 (hardware), MIT (software), CC BY 4 (doc) |
Reprod. cost | 1000 € material + 8 hours |
Next steps | Capacity building for repair and reuse, research paper on scaling decentralised manufacturing (Cambridge), final certification on functional testing via NABL |
Inspiring story | 1 million face shields in 49 days, 42 cities → M19 O2 The M19 collective has a centralised open source design philosophy with decentralised manufacturing. |
Websites | |
Source: openventbristol.co.uk
OpenVent – Ventilation machine | |
Challenge | Answering the shortage of ventilation machines thanks to a design that can be rapidly manufactured in various countries and at low-cost. |
Current version | Respirator combining an approved bag valve mask and a motorized arm, with adjustable PEEP valve, standard air outlet and setting interface. Requires a power outlet. |
Readiness | TRL 3 |
Licence | MIT (hardware) |
Reprod. cost | 380 € material |
Next steps | 3d-printed flow sensors prototyping, laboratory testing (MHRA), application for medical device clearance (FDA, EUA, ISO-13485), life testing. |
Inspiring story | ?�� |
Websites | |
Polyvent – Ventilator co-design platform | |
Challenge | Lowering entry hurdles to locally develop and produce intense care unit ventilators. Bridging geographical clusters around one adaptable design for accessibility. |
Current version | Fourth prototype in development. Includes several interchangeable modules: gas drive, control, gas routing, gas supply, and more. |
Readiness | 6/10 |
Licence | CERN OHL S |
Reprod. cost | 1500 € material + 50 hours + 300 € post |
Next steps | Finish the latest version and replicate 6 times to disseminate in the global clusters centering around universities. |
Inspiring story | We have been operating as volunteers since the very beginning of the pandemic, and are still growing!� |
Websites | |
Source: jogl.io
Source: openpcr.org
OpenPCR – Genetic material development | |
Challenge | Improving access to genetic research with a low-cost, do-it yourself polymerase chain reaction thermocycler, especially for low-resource regions, students, hobbyists |
Current version | Thermocycler with 16 sample well block to control PCR for DNA sequencing and barcoding. Heated lid, 2 °C �per second ramp time. Software for Mac and Windows. |
Readiness | Ready for production |
Licences | GPL 3 (hardware, software and doc) |
Reprod. cost | 510 € kit + 5 hours |
Next steps | Designs are accessible but the kit sold by the organization was replaced by a ten times more expensive model |
Inspiring story | Two graduate students tested 60 samples of seafood�in New York sushi restaurants and grocery stores and found out that most of them were mislabeled. |
Websites | |
OSPF OpenVax – Repurposing vaccines | |
Challenge | Rapidly and equitably fighting epidemics by repurposing existing widely-available off-patent low-cost vaccines with strong safety records to achieve medicine for all. |
Current version | Computational discovery and late stage clinical trials. Creating an ecosystem of crowdsourced and computer- driven drug discovery, generics manufacturing. |
Readiness | Collab. on phase 3 Covid-19 vaccine trials in Brazil |
Licences | Public domain, dev. open source licenses for pharma |
Reprod. cost | 1% usual costs |
Next steps | Develop field, create open model of R&D, create new generation of innate-immunity vaccines, curb epidemics earlier and more equitably with off the shelf vaccines |
Inspiring story | Completing, with Gov of India, a multicentric phase 2b clinical trial for an off-patent TB adjunct therapy, for less than 1% the usual cost, and a decade faster than usual. |
Website | |
Source: ospfound.org
ANTICOV & DNDi – Repurposing treatments | |
Challenge | Identifying treatments for mild and moderate cases of covid-19. Ensuring populations affected who live in impoverished regions can access low-cost treatments. |
Current version | Clinical research ongoing in 13 African countries. �Open access protocols, operating procedures, and results. Public tracking of participation available day + 1. |
Readiness | Recruitment open (target 3000 participants aimed) |
Licences | IP agreements for shared use rights |
Reprod. cost | Affordable (max 1$ per treatment) |
Next steps | Release of data safety analysis, launch of additional research arms, identification of new drug candidates for treatment, acceleration of regulatory approvals |
Inspiring story | Thanks to compulsory licensing, DNDi was able to make one of their treatments accessible at 300 €, when the pharma manufacturer initially set the price at 50,000 €. |
Websites | DNDi: www.dndi.org�ANTICOV Consortium: www.anticov.org |
Source: anticov.org
disease prevention
Please refer to the websites regarding the projects aims, and seek professional advice before using or reproducing them.
Source: wikimedia.org
Geneva Hand Hygiene Model – Hand rub | |
Challenge | One in ten patients gets infected when receiving care. Minimize the time required by caregivers to wash their hands. Nosocomial disease kill 20-50000 people daily. |
Current version | WHO hand rub kills 99.9% of bacteria in a few seconds. Composition: ethanol or isopropyl alcohol, hydrogen peroxide, glycerol, sterile distilled or boiled cold water. |
Readiness | Validated recipe ready for local production |
Licences | Patent-free |
Reprod. cost | ~ 3.50 € / liter (vs 21-68 € for commercial product) |
Next steps | Foster the adoption of efficient hand washing in medical settings and in the broader population. Strengthen infection prevention and control |
Inspiring story | In Kenya, Dr Pittet discovers that hand rub costs three times the European price. He releases patent-free the recipe created with W. Griffiths so that all can afford it. |
Websites | |
Source: github.com
Pulmonary Toolkit – 3D lung modeling | |
Challenge | Providing a functional and robust software to visualize and analyze (segmentation, detection, etc.) 3D medical lung images for academic research. |
Current version | Toolkit with: GUI visualization and analysis (CT & MRI), library of algorithms, framework to run and develop algorithms, API to use external code. Requires MatLab. |
Readiness | Alpha version |
Licences | GPL 3 and others |
Reprod. cost | 0 € + time |
Next steps | Developing functionalities such as freehand editing, zooming, export of non-mesh data.� |
Inspiring story | ?�� |
Websites | |
Source: bemask.org
BEclear – Transparent mask | |
Challenge | Building a clear mask that eases emotional relatedness and lip-reading while providing sound filtering. Initially thought for deaf people and for educational settings. |
Current version | Iterative design and testing, 1500 produced. Combination of conventional medical mask with vacuum-formed plastic adapter. Aim at KF94 standard. |
Readiness | TRL 3 |
Licences | CERN OHL P (hardware) |
Reprod. cost | 7 € material or 17 € product + post |
Next steps | Lab (filtration, pressure, blood resistance, flame spread, sound) and user testing, design-for-manufacture. Application submitted to Canadian research fund. |
Inspiring story | Initiated by volunteers from Enable Buffalo, the project mobilized a dozen researchers within 10 days to sketch a plan towards the production of 100K units/months. |
Websites | |
Source: logair.io
LogAir – Air quality mapping | |
Challenge | Helping everyone map air quality using cheap portable devices. Generating data to avoid polluted streets, and motivating policy changes. |
Current version | Arduino-compatible hardware measuring particulate matter and position data, one point per second. �App and backend to collect and display data. |
Readiness | Reproducible and functional |
Licences | CERN OHL 1.2 (hardware), Apache 2 (software) |
Reprod. cost | 50 € material + 1 hour |
Next steps | Grow the community�Improve and characterize the hardware�Industrialization |
Inspiring story | From Switzerland to China, LogAir helps citizens take on environmental health by themselves, and build a case for healthier cities and communities in six countries. |
Websites | |
Your morning commute route is too polluted today. Check alternative paths!
Going for your 7AM run? Check the healthiest routes and parks nearby.
This is not a good spot in town for your asthma. Check some alternatives here!
Source: gnuhealth.org
GNU Health – Digital health ecosystem | |
Challenge | Providing medical and patient communities with �a libre, freely adaptable and modular software suite for the management of medical services and records. |
Current version | Hospital / Laboratory Info Management System (3.8), Health Info System, Personal Health Record (1.0).�ICD [9,10,11], ICF, HL7 FHIR, JSON-RPC, XML, GPG. |
Readiness | Adopted by 100s organizations, millions of end-users. |
Licences | GPL 3 (software), CC BY-SA 4 (doc) |
Reprod. cost | 0 € + time varies depending on complexity |
Next steps | Capacity building for repair and reuse, research paper on scaling decentralised manufacturing (Cambridge), final certification on functional testing via NABL |
Inspiring story | Individuals with respiratory conditions track their vitals, activity, nutrition and emotional status, and share them in real-time with med pro (Argentina covid observatory). |
Websites | |
health�promotion
Please refer to the websites regarding the projects aims, and seek professional advice before using or reproducing them.
Source: breathinggames.net
Breathing Games – Fun respiratory care | |
Challenge | Tackling low adherence with ludic self- and mutual care. Fostering health and digital literacy through co-creation.�Ease breath data collection and use as visual narratives. |
Current version | Open game environment for up to four players, �Games for children with asthma in 10 languages,�gamepad with modular nose (flow in/out + resistance). |
Readiness | Games playable on Win, Mac – Gamepad reproducible |
Licences | AGPL 3 (soft.), CERN OHL S (hardware), CC BY-SA 4 (doc) |
Reprod. cost | 50 € material + 6 hours (gamepad), 0 € (games) |
Next steps | Multiplayer game: have communities build levels�Games for asthma: intl. study in various settings�Gamepad: iteratively improve enclosure and outcomes |
Inspiring story | A professor in linguistics mobilized and coordinated around 20 volunteers so that our games for asthma �can be played in a dozen languages. |
Websites | |
member of
Source: cemi.org.co
CEMI – Traditional medicine | |
Challenge | Preserving a living heritage of communal ways to take care of respiratory health. Maintaining natural, local resources such as medicinal plants. |
Current version | Guide to preserve the air quality, understand health �as a whole system, adopt healthy habits in one’s daily life, value traditional knowledge and natural remedies. |
Readiness | Ready to use |
Licences | – |
Reprod. cost | Cost to garden medicinal plants |
Next steps | Promoting intercultural initiatives to recover/strengthen traditional medicine knowledge and resources. Research-action to promote the health of communities. |
Inspiring story | A local committee of traditional medicine users worked with a local university to co-create a training program to enhance intercultural skills of medical students. |
Websites | |
xx
Art Hives – Social support network | |
Challenge | Providing people with freely accessible, inclusive spaces to build solidarity and respond creatively to community issues, and cultivate the artist in each human. |
Current version | 224 art hives for dialogue, skill-sharing and art-making between, mostly in North America and Western Europe, including online gatherings. |
Readiness | Guides to launch an Art Hive (in person or online) |
Licences | CC BY (guide) |
Reprod. cost | Material to launch an art hive |
Next steps | Developing and contributing to public practice art therapy through qualitative and quantitative research, building more accessible ways to art therapy. |
Inspiring story | A young adult with cystic fibrosis joined an Art Hive as a volunteer to socialize, contribute at his own rhythm, share music he created, and learn to play Tibetan bowl. |
Websites | |
Source: Victoria Kelly
Next steps.
Next steps
Research policies:�integrate open-source as an ethical requirement in medical research methods
Regulation and monitoring:�fund and build capacity for community-driven, open source innovation
Production and distribution: fund and build capacity for distributed manufacturing (crowd/peer production)
Source: breathinggames.net
doi.org/10.5281/zenodo.5515632
www.breathinggames.net/openvillage
Thank you.
Source: Vectors Market, flaticon
Source: …
Title – Aim | |
Challenge | Goal, audience.�� |
Current version | ...�� |
Readiness | … |
Licences | … |
Reprod. cost | x € + x hours |
Next steps | …�� |
Inspiring story | …�� |
Websites | www…�www… |
Copy this slide and add your open-source, not-for-profit initiative for respi health. Please keep the format as is.
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References
References
| 0 – Minimum | 1 | 2 | 3 | 4 – Maximum |
Health�(see Greenhalgh) | not acting, not supported (isolated) | coping with illness (disease management) | whole-system approach (prevention, promotion) | critical public health (political action) | holistic, lifelong wellbeing |
low compliance ← | | → intimate adhesion | |||
Contributors | experts alone | users consulted�in end product | users give inputs�in certain stages | users participate�on full life cycle | users adopt initiative for other aims (forking) |
top-down ← | | | | → emerging | |
Process, standards,�documents, software, ... | closed not shared | closed and shared | partly open and shared | fully open and shared | fully libre, contributing to other libre projects |
opaque ← | | | | → trustworthy | |
Licenses including for the core | patent, copyright | patent with free reuse | public domain�(ex. CC 0) | non-commercial licence�(ex. CC BY-NC) | Reciprocity�(ex. Peer Production lic.) |
excluding rights ← | | | | → building commons | |
Resource allocation�(see Benkler) | for-profit company | social enterprise, cooperative | open access commons | open access commons with value accounting | fewest projects possible,, as much as needed |
extractive ← | | | | → generative | |
Physical availability | not produced | centralized | decentralized | distributed, industries (mass production) | distributed, communities (crowd production) |
not available ← | | | | → locally reproducible | |
Impact validation�(see Guba and Lincoln) | not tested | tested with users | positivist, quantitative studies | naturalistic, mixed methods, one setting | naturalistic, mixed methods, multi settings |
not validated ← | | | | → validated | |
Annex: Project assessment