A Review of the Application of Additive Manufacturing in Prosthetic and Orthotic Clinics from a Biomechanical Perspective

Prostheses and orthoses are common assistive devices to meet the biomechanical needs of people with physical disabilities.The traditional fabrication approach for prostheses or orthoses is a materialwasting,time-consuming,and labor-intensive process.Additive manufacturing(AM)technology has advantages that can solve these problems.Many trials have been conducted in fabricating prostheses and orthoses.However,there is still a gap between the hype and the expected realities of AM in prosthetic and orthotic clinics.One of the key challenges is the lack of a systematic framework of integrated technologies with the AM procedure;another challenge is the need to design a prosthetic or orthotic product that can meet the requirements of both comfort and function.This study reviews the current state of application of AM technologies in prosthesis and orthosis fabrication,and discusses optimal design using computational methods and biomechanical evaluations of product performance.A systematic framework of the AM procedure is proposed,which covers the scanning of affected body parts through to the final designed adaptable product.A cycle of optimal design and biomechanical evaluation of products using finite-element analysis is included in the framework.A mature framework of the AM procedure and sufficient evidence that the resulting products show satisfactory biomechanical performance will promote the application of AM in prosthetic and orthotic clinics.

Using UNAIDS’s organizing framework to assess Nigeria’s national HIV monitoring and evaluation system

The Nigeria National Response Management Information System (NNRIMS), developed in 2004 as a framework for monitoring and evaluating the country’s response to HIV, does not function at an optimum level due to several challenges, including a confusing proliferation of vertical reporting systems, competition among sectors, and the nascent nature of the monitoring and evaluation (M&E) sub-systems within many institutions. An assessment of the existing M&E system was conducted to verify whether the system has the capacities to provide essential data for monitoring the epidemic and identifying critical programming gaps. Nigeria’s National Agency for the Control of AIDS (NACA) used an organizing framework for a national HIV M&E system developed by UNAIDS, to assess the strengths and weaknesses of the NNRIMS to generate data for evidence-based decisionmaking. The participatory approach used during an assessment workshop ensured that the process was country-led and -owned to build consensus and local capacity, and that it encouraged adoption of a single national-level multisectoral HIV M&E system. The assessment found an operable M&E system at the national level but a much weaker system at the state and local levels and across seven other sectors. There are multiple data collection and reporting tools at the facility level that lead to vertical reporting systems, which increases the burden of reporting at lower levels, especially by service providers. Human resources are being developed, but problems remain with the quantity and quality of staff. Data use, though evident at the national level, is still very weak among five of the seven sectors assessed. The assessment results have been used to develop a national costed M&E workplan to which all stakeholders contributed in a coordinated response to strengthen the system.