Separate two-way repeated measures ANOVAs were performed to analyze function and strength data. There was a significant hand by time interaction for function, but not for strength. Conclusion and relevance to the study of disability and rehabilitation: The increase in manual gross dexterity suggests that the Cyborg Beast 2 3 D-printed prosthesis can be used as a transitional device to improve function in children with traumatic or congenital upper-limb differences. Implications for Rehabilitation Children's prosthetic needs are complex due to their small size, rapid growth, and psychosocial development. Advancements in computer-aided design and additive manufacturing offer the possibility of designing and printing transitional prostheses at a very low cost, but there is limited knowledge on the function of this type of devices. The use of 3D printed transitional prostheses may improve manual gross dexterity in children after several weeks of using it.

Objective: The objective of the current investigation was twofold: i) described a remote fitting procedure for upper limb 3D printed prostheses and ii) assess patient satisfaction and comfort with 3D printed prostheses fitted remotely.Design: A qualitative study using content and score analysis to describe patient satisfaction after 4 weeks of using an upper limb 3D printed prosthesis fitted remotely. The novel remote fitting procedure is described in detail.Subjects: Six children (three girls and three boys, 6 to 16 years of age) and 2 adults (males of 25 and 59 years of age) with congenital (n=7) and acquired (n=1) upper limb loss participated in this study. Results:The research participants reported a score of 3.92 ± 0.50 (closer to the statement "quite satisfied") for the device satisfaction section of the QUEST questionnaire (Table 2). This acceptable level of satisfaction of our research participant reported in the QUEST was confirmed by the agreement scores of the OPUS items related to prosthetic fitting (My prosthesis fits well = 4.13 ± 0.50) and comfort (My prosthesis is comfortable throughout the day = 3.57 ± 0.98).Furthermore, the comfort level rating in the general prosthetic survey resulted in a score of 3.75 ± 0.70 (closer to the statement "the prosthetic device feels comfortable") confirming the results of the QUEST and OPUS. Conclusions:The ability to fit an upper-limb prosthesis remotely, represents a promising methodology to fit upper-limb 3D printed prostheses for patients from developing countries or rural areas. The increasing availability of smartphones and other digital devices makes it possible to obtain photographs from patients located in rural areas that have little or no access to trained technicians. These photographs along with the cost-effective desktop 3D printers allows for the 3 extraction of the anthropometric measurements required for the development of a 3D printed upper limb prosthesis remotely.

BackgroundTraditional prosthetic fabrication relies heavily on plaster casting and 3D models for the accurate production of prosthetics to allow patients to begin rehabilitation and participate in daily activities. Recent technological advancements allow for the use of 2D photographs to fabricate individualized prosthetics based on patient anthropometrics. Additive manufacturing (i.e. 3D printing) enhances the capability of prosthesis manufacturing by significantly increasing production speed and decreasing production cost. Existing literature has extensively described the validity of using computer-aided design and 3D printing for fabrication of upper limb prostheses. The present investigation provides a detailed description of the development of a patient specific body-powered 3D printed partial finger prosthesis and compares its qualitative and functional characteristics to a commercially available finger prosthesis.Case presentationA 72-year old white male with a partial finger amputation at the proximal interphalangeal joint of the left hand performed a simple gross motor task with two partial finger prostheses and completed two self-reported surveys (QUEST & OPUS). Remote fitting of the 3D printed partial finger began after receipt of 2D photographs of the patient’s affected and non-affected limbs. Prosthetic fitting when using 3D printable materials permitted the use of thermoforming around the patient’s residual limb, allowing for a comfortable but tight-fitting socket. Results of the investigation show improved performance in the Box and Block Test when using both prostheses (22 blocks per minute) as compared to when not using a prosthesis (18 blocks per minute). Both body-powered prostheses demonstrated slightly lower task-efficiency when compared to the non-affected limb (30 blocks per minute) for the gross motor task. Results of the QUEST and OPUS describe specific aspects of both prostheses that are highly relevant to quality of life and functional performance when using partial finger prostheses.ConclusionThe use of 3D printing exhibits great potential for the fabrication of functional partial finger prostheses that improve function in amputees. In addition, 3D printing provides an alternative means for patients located in underdeveloped or low-income areas to procure a functional finger prosthesis.

Objectives: Though ablation is a relatively safe procedure for atrial fibrillation (AF) treatment, a rare but potentially fatal complication in the form of cardiac perforation could occur. The aim of this study was to examine the underlying predictors associated with cardiac perforation. Methods: The 2013-2018 Centers for Medicare & Medicaid Services (CMS) Medicare Standard Analytic Files (SAF) data was used for this study. Patients aged $65 years who underwent ablation procedure with a primary diagnosis of AF were identified, with first such occurrence classified as index procedure. The main outcome of interest was the occurrence of cardiac perforation within 30 days of the index ablation. Baseline demographic, comorbid, and procedure-related characteristics were examined. Univariate logistic regression followed by generalized estimating equation (GEE) with logit link and binomial distribution were used to assess the underlying predictors of cardiac perforation. Sensitivity analysis was performed by controlling for hospital ablation volume. Results: The final sample included 102,389 patients. The average age was 71 years, 43.8% were female, and 94.2% were white. Cardiac perforation occurred in 0.61% (n=623) of patients within 30 days of the index ablation procedure. From univariate logistic regression, female gender, prior history of cardiac surgery, non-use of intracardiac echocardiography (ICE), hypothyroidism, obesity, and fluid and electrolyte disorders were identified as significant predictors. When examining these factors together in a GEE model, prior cardiac surgery (odds ratio [OR] 0.15; 95% confidence interval [CI] 0.08-0.26), obesity (OR 1.35; 95% CI 1.10-1.65), non-use of ICE (OR 5.06; 95% CI 4.16-6.15), and female gender (OR 1.34; 95% CI 1.15-1.57) emerged as significant predictors of cardiac perforation. Results: were consistent when controlling for hospital ablation volume. Conclusions: One of the strongest predictors of cardiac perforation during ablation for AF was a modifiable factor, i.e., the non-use of ICE.

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