Continuous positive airway pressure (CPAP) is a method of respiratory support used around the world to treat children with lower respiratory tract infections (LRTI) (WHO, 2016, Oxygen Therapy for Children, World Health Organization, Geneva, Switzerland, Report). Bubble continuous positive airway pressure (bCPAP) is an effective form of CPAP that is currently used in both high- and low-resource countries. Low-cost, modified bCPAP devices have been designed as an ideal form of CPAP in low-resource areas (Bjorklund, A. R., Mpora, B. O., Steiner, M. E., Fischer, G., Davey, C. S., and Slusher, T. M., 2018, “Use of a Modified Bubble Continuous Positive Airway Pressure (bCPAP) Device for Children in Respiratory Distress in Low- and Middle-Income Countries: A Safety Study,” Paediatr. Int. Child Health, 39(3), pp. 1–8). However, patients in low-resource settings undergoing bCPAP treatment are often given pure oxygen, which has been linked to retinopathy of prematurity, cardiovascular complications, and patient mortality (Rodgers, J. L., Iyer, D., Rodgers, L. E., Vanthenapalli, S., and Panguluri, S. K., 2019, “Impact of Hyperoxia on Cardiac Pathophysiology,” J. Cell. Physiol., 234(8), pp. 1–9; Ramgopal, S., Dezfulian, C., Hickey, R. W., Au, A. K., Venkataraman, S., Clark, R. S. B., and Horvat, C. M., 2019, “Association of Severe Hyperoxemia Events and Mortality Among Patients Admitted to a Pediatric Intensive Care Unit,” JAMA Network Open, 2(8), p. e199812). This problem is typically avoided by using commercial oxygen blenders, which can titrate down the concentration of oxygen delivered to the minimum needed; however, these blenders can cost nearly 1000 USD and are almost always unavailable in low-resource settings. The lack of available low-cost oxygen blenders compatible with modified bCPAP circuits creates a barrier for low-resource hospitals to be able to provide blended oxygen to patients. There is a need for a low-cost oxygen blender for use in low-resource settings. We propose a passive oxygen blender that operates via entrainment of atmospheric air. The device can easily be assembled in low-resource areas using a 22 gauge hypodermic needle, two 3 cc syringes, tape or super glue, and the materials required for bCPAP—for approximately 1.40 USD per device. The blender has not been clinically tested yet, but can achieve oxygen concentrations as low as 60% with bCPAP levels of 5 cm H2O (490 Pa) when used in a standard bCPAP circuit without a patient.

Bubble CPAP is used in low-resource settings to support children with pneumonia. Low-cost modifications of bubble CPAP using 100% oxygen introduces the risk of hyperoxia. Our team developed a low-cost, readily constructible oxygen blender to lower the oxygen concentration. The next step in development was to test its construction among new users and ascertain three outcomes: construction time, outflow oxygen concentration, and an assessment of the user experience. Workshops were conducted in two countries. Instructions were delivered using a live demonstration, a video, and written instructions in the respective native language. Twelve volunteers participated. Average construction times were 24 minutes for the first attempt and 15 minutes for the second. The oxygen concentrations were 53–63% and 41–51% for the 5 and 10 mm entrainment ports, respectively. This novel, low-cost oxygen blender for bubble CPAP can be constructed among new users with reliable performance across devices.

The COVID-19 pandemic has fundamentally altered the pedagogical approach to education at every level of training, including at the undergraduate level and graduate or professional level. These unprecedented times have tested academic resilience, agility, creativity, and adaptability in all aspects, including inventive alternative teaching methods. With an increasing reliance on virtual instruction, self-directed learning, and hybrid models of instruction, certain approaches of hands-on training, practice-based learning, and evaluation have had to evolve. The University of Minnesota’s Master of Medical Device Innovation students are typically immersed in clinical environments through physician shadowing in the operating room, evaluating unmet needs and untapped areas of potential innovation. Engineers who can immerse themselves in surgical education, shadowing, and frontline medical experience can better appreciate, recognize, and enhance current medical technologies and processes. With the OR case restrictions in the era of COVID-19, these learners were faced with limited clinical exposure and thus limited familiarity with the dynamics and processes of clinical practice. As such not only education, but the functioning of the entire industry is stunted. From an instructive perspective, this creates a challenge for students attempting to generate relevant and feasible practicum ideas, accurate prototypes, and offers fewer opportunities to develop these ideas alongside the experts and medical professionals - the target audience. Simulation education provides a means for students to engage with clinical practice in a meaningful way that bridges the gap between clinical exposure and virtual learning. A hands-on approach in which students were able to practice fundamental surgical skills of suturing, knot-tying, and the basics of laparoscopy. Learners were offered three didactic workshop sessions that introduced these skills and then were given opportunities to perform with supervision from expert educators. Low-cost, low-fidelity models of pertinent anatomy and physiology provided students an immersive experience that allowed them to develop a deeper understanding of interventional skills. Three two hour-long sessions of guided skills practice on low-cost simulators were attended by the 2022 Masters of Medical Device Innovation cohort and subjective measures of their understanding of the fundamental concepts were evaluated. High-level findings of these workshops suggest that simulation education is an effective tool in advancing the baseline understanding of surgical principles as opposed to virtual instruction and may offer some further benefit, not possible even through clinical shadowing itself.