[00:00.000 --> 00:08.680]  Okay, thank you everybody for being here.
[00:08.680 --> 00:12.520]  I know it's the end of the day, it's been a long day.
[00:12.520 --> 00:13.520]  So thank you.
[00:13.520 --> 00:18.360]  I'd like to talk about the Polyvent Free Libre Open Source ventilator.
[00:18.360 --> 00:22.080]  This is hardware in a little different sense than is used in this room.
[00:22.080 --> 00:26.120]  Normally when you say hardware at this conference, you mean chips and VLSI stuff, but this is
[00:26.120 --> 00:29.440]  an electromechanical hardware device.
[00:29.440 --> 00:32.680]  This talk is co-authored with Dr. Victor Sutrin.
[00:32.680 --> 00:34.360]  Victor, can you raise your hand?
[00:34.360 --> 00:40.560]  And Antal Zeiderwick is our chief mechanical engineer for the chassis part.
[00:40.560 --> 00:44.360]  If you meet us after the talk, we'll be happy to answer questions for you.
[00:44.360 --> 00:48.760]  And we are trying to recruit software engineers and electrical and mechanical engineers to
[00:48.760 --> 00:52.520]  work on the project as well.
[00:52.520 --> 00:54.560]  So I am Robert Reed.
[00:54.560 --> 00:59.200]  I'm the founder of Public Invention, which is a US 501C3 public charity.
[00:59.200 --> 01:02.280]  Our motto is to invent in the public for the public.
[01:02.280 --> 01:06.520]  I think this conference will appreciate that we're trying to take the principles of open
[01:06.520 --> 01:12.080]  source software development and apply it not only to chip design, but to actual hardware
[01:12.080 --> 01:14.920]  inventions.
[01:14.920 --> 01:21.720]  So I'd like to create a setting in the spring of 2020 in the United States.
[01:21.720 --> 01:27.520]  So many people had died of COVID-19 so quickly in New York that they had to use refrigerated
[01:27.520 --> 01:32.440]  trucks as temporary morts for that purpose.
[01:32.440 --> 01:38.280]  At that time, there was a genuine belief that the Western world might need a million mechanical
[01:38.280 --> 01:41.100]  ventilators to try to keep people alive.
[01:41.100 --> 01:46.560]  That turned out not to be true, but it wasn't erroneous at the time based on what we knew
[01:46.560 --> 01:49.760]  from the disease progression in northern Italy.
[01:49.760 --> 01:55.920]  What we didn't know at the time was that social distancing and lockdowns would work,
[01:55.920 --> 02:01.680]  and also doctors decided they didn't need to ventilate paper people as early with COVID
[02:01.680 --> 02:03.920]  as they had previously thought.
[02:03.920 --> 02:09.880]  Nonetheless, a very large number of humanitarian engineering teams all over the world attempted
[02:09.880 --> 02:13.760]  to make emergency ventilators to solve this problem.
[02:13.760 --> 02:21.800]  It was kind of a global effort, and Victor and a young man who was 16 at the time started
[02:21.800 --> 02:26.480]  working on their own ventilator in the same effort.
[02:26.480 --> 02:31.600]  Now they started with a bellows-based design, we're going to talk about that.
[02:31.600 --> 02:38.160]  The thing they designed, the polyvent, was specifically designed to talk about fragile
[02:38.160 --> 02:39.240]  supply chains.
[02:39.240 --> 02:44.040]  So it was designed to be constructable within a low and middle income country, and that's
[02:44.040 --> 02:47.520]  one reason they went with bellows in the initial design.
[02:47.520 --> 02:53.760]  Originally, they weren't necessarily embracing open-source licensing because they didn't know
[02:53.760 --> 02:58.640]  that much about it, and everyone sort of believed, well, we're going to need large firms to
[02:58.640 --> 03:03.000]  make a lot of money, and if you have an open-source license on it, they won't want to use your
[03:03.000 --> 03:04.000]  product.
[03:04.000 --> 03:08.560]  Now, how do we know that 100 humanitarian engineering teams started?
[03:08.560 --> 03:11.480]  Because public invention evaluated all of them.
[03:11.480 --> 03:16.720]  So we made a spreadsheet which evaluated all of the open-source ventilators along a wide
[03:16.720 --> 03:21.680]  variety of dimensions here.
[03:21.680 --> 03:27.240]  Now at the time, and still today, what we're trying to do is to create open-source medical
[03:27.240 --> 03:28.720]  devices.
[03:28.720 --> 03:34.440]  That is harder than making open-source hardware, which is harder than making open-source software,
[03:34.440 --> 03:39.560]  which is harder than copywriting text, both from a legal point of view and from an intellectual
[03:39.560 --> 03:40.560]  point of view.
[03:40.560 --> 03:45.280]  The cost of development for medical things goes up because you're attempting to produce
[03:45.280 --> 03:47.120]  regulated devices.
[03:47.120 --> 03:54.080]  Now originally, the Polyvent team was attempting to do that, but at that time in the United
[03:54.080 --> 03:57.320]  States, there was an emergency youth authorization.
[03:57.320 --> 04:03.040]  So there was a belief that we might not need to do all the things that the FDA would normally
[04:03.040 --> 04:07.080]  require.
[04:07.080 --> 04:12.880]  So while this was going on, public invention published the Open Medical Technology Manifesto,
[04:12.880 --> 04:18.560]  which is that open, shareable, repairable medical technology will make us all healthier.
[04:18.560 --> 04:25.200]  The Polyvent ventilator is aligned with that, and I invite you all to find this and sign
[04:25.200 --> 04:28.320]  it if you agree with it.
[04:28.320 --> 04:36.320]  So the Polyvent team began working on a ventilator, and they had some success in Lens, and they
[04:36.320 --> 04:41.200]  designed a very extensible system that we're going to talk about.
[04:41.200 --> 04:47.240]  But the global pandemic urgency was dissipating by about six months from that spring.
[04:47.240 --> 04:53.360]  So by October of that first year, people were no longer excited about the idea.
[04:53.360 --> 04:57.600]  So the thing that I'm most proud of perhaps of this team is that they just kept going
[04:57.600 --> 05:01.680]  and continued to develop the ventilator.
[05:01.680 --> 05:07.160]  So at that time, they joined public invention basically in exchange for making it fully
[05:07.160 --> 05:12.800]  open source, public invention began to start paying for parts and manual labor to support
[05:12.800 --> 05:15.400]  the development of the ventilator.
[05:15.400 --> 05:21.080]  It's also the case that I'm mostly a software guy, another non-profit helpful engineering
[05:21.080 --> 05:25.440]  had the VentOS software, which we're going to talk about, and the existing team didn't
[05:25.440 --> 05:26.640]  have any software.
[05:26.640 --> 05:29.160]  So it was a nice alliance.
[05:29.160 --> 05:30.640]  This is their original system.
[05:30.640 --> 05:32.680]  This is a fully functional ventilator.
[05:32.680 --> 05:36.240]  It uses dual bellows here.
[05:36.240 --> 05:38.240]  Bellows can be manufactured with 3D printers.
[05:38.240 --> 05:42.360]  So they can presumably be made in any country was the idea.
[05:42.360 --> 05:44.040]  However, there were some problems.
[05:44.040 --> 05:49.120]  The bearings to drive the bellows up and down tended to wear out.
[05:49.120 --> 05:52.120]  And there were some other improvements possible.
[05:52.120 --> 05:54.440]  We started to make those improvements.
[05:54.440 --> 06:00.080]  The big switch we made was to switch to a proportional valve based system that used pressurized air
[06:00.080 --> 06:03.280]  and pressurized oxygen.
[06:03.280 --> 06:08.000]  This was inspired by Smith College in the United States, which is probably the premier
[06:08.000 --> 06:10.600]  of women's college in the United States.
[06:10.600 --> 06:13.840]  They had made an award-winning ventilator called the Smith Vent.
[06:13.840 --> 06:14.840]  They stopped.
[06:14.840 --> 06:22.040]  I don't know why, but we continued and have used the same basic technology.
[06:22.040 --> 06:27.360]  Now we already had a spirometer, the VentMon, which was made by public invention.
[06:27.360 --> 06:39.120]  We used that as part of our system, and eventually we started to redesign for education.
[06:39.120 --> 06:45.200]  We started with the proportional valve on the left, which is a Birket proportional valve.
[06:45.200 --> 06:49.480]  It was really kind of an engineering mistake because it was larger than what we needed
[06:49.480 --> 06:52.840]  and the airflow was not as precise as what we needed.
[06:52.840 --> 06:57.520]  The valve on the right is difficult to source, it's made in the United States by IQ valve.
[06:57.520 --> 07:02.520]  It's a very precisely controlled proportional valve.
[07:02.520 --> 07:05.560]  Like all projects, we learned as we went along.
[07:05.560 --> 07:11.080]  This was what we called the Polyvent One, even though it's after the Velo's module.
[07:11.080 --> 07:13.360]  This was, again, fully functional.
[07:13.360 --> 07:20.040]  We performed some tests with professors of education in biomedical engineering.
[07:20.040 --> 07:28.960]  This system worked, but we decided to redesign it for education.
[07:28.960 --> 07:33.720]  So while this was going on, the COVID pandemic continues.
[07:33.720 --> 07:38.800]  In India, around this time, there was a terrible, terrible spike of death.
[07:38.800 --> 07:42.000]  Now this was not due to a lack of ventilators.
[07:42.000 --> 07:46.080]  People say it was due to a lack of oxygen.
[07:46.080 --> 07:49.640]  We have also, public invention have also worked on an oxygen concentrate.
[07:49.640 --> 07:56.080]  The reason I bring it up is that what we're attempting to do and what many of you are
[07:56.080 --> 07:59.320]  attempting to do in the software that you produce is to make the world better for a
[07:59.320 --> 08:00.840]  lot of people.
[08:00.840 --> 08:07.520]  Making open source medical devices is a new way, a new avenue for open source philosophy
[08:07.520 --> 08:10.960]  to make the world better for a very large number of people.
[08:10.960 --> 08:15.240]  It's quite a technical challenge, but that's why we're doing it.
[08:15.240 --> 08:21.000]  So based on educator feedback, we made a lighter single deck design.
[08:21.000 --> 08:22.640]  We made a transparent case.
[08:22.640 --> 08:28.080]  We made the inside spacious and modular so that students could look at it and you could
[08:28.080 --> 08:29.680]  also repair it more easily.
[08:29.680 --> 08:32.320]  You didn't have to take the whole thing apart.
[08:32.320 --> 08:37.880]  That is very different than the way professionally designed medical equipment is made.
[08:37.880 --> 08:39.800]  It's not made to be easy to repair.
[08:39.800 --> 08:41.920]  It's not made to be easy to understand.
[08:41.920 --> 08:53.360]  So it's quite a departure from what you would see in a normal for profit sort of made device.
[08:53.360 --> 09:00.360]  We also, Nathaniel did a really good job designing a modular card based electronic control system.
[09:00.360 --> 09:05.840]  And this actually paid off when a second public invention team created a card that we were
[09:05.840 --> 09:10.640]  able to put into the device to control a general purpose alarm device, which we're working
[09:10.640 --> 09:11.640]  on.
[09:11.640 --> 09:18.080]  So that team did that with no interaction with Victor's team just based on the documentation
[09:18.080 --> 09:19.720]  that we have.
[09:19.720 --> 09:26.360]  So this is the timeline and we've been getting better and better as we go along like most
[09:26.360 --> 09:27.520]  projects.
[09:27.520 --> 09:32.160]  In October, we did a classroom evaluation with 12 biomedical engineering students at
[09:32.160 --> 09:36.320]  Rice University in Houston, Texas in the United States.
[09:36.320 --> 09:38.760]  This is the device as it stands today.
[09:38.760 --> 09:40.240]  This is the Polyvent 2.
[09:40.240 --> 09:43.680]  That's what the students looked used.
[09:43.680 --> 09:50.000]  As you can see, it actually uses an acrylic case so you can see all of the components.
[09:50.000 --> 09:54.760]  And I don't have a good layout diagram, but it's laid out in a way where it's physically
[09:54.760 --> 09:59.040]  modular as well as being electronically modular.
[09:59.040 --> 10:03.240]  The software is too, of course, because we learned a lot from the open source software
[10:03.240 --> 10:05.320]  community on how to do this.
[10:05.320 --> 10:11.920]  So it's now our intention with the Polyvent to continue to eventually make a design basis
[10:11.920 --> 10:15.240]  that can be used for a medical ventilator.
[10:15.240 --> 10:22.840]  But we believe that by sort of infiltrating the research and education community, we have
[10:22.840 --> 10:25.320]  a better shot of eventually accomplishing that.
[10:25.320 --> 10:31.680]  So the Polyvent platform right now is for medical and veterinary doctors, but really
[10:31.680 --> 10:36.560]  it's for biomedical engineering students, even you can teach business school classes
[10:36.560 --> 10:38.200]  on it.
[10:38.200 --> 10:42.200]  You can certainly do mechanical electrical engineering software engineering.
[10:42.200 --> 10:50.200]  And we consider ourselves firmly part of the emerging discipline of humanitarian engineering.
[10:50.200 --> 10:55.880]  So what we did to make the classroom instructor, I am not a teacher.
[10:55.880 --> 11:01.440]  I'm mostly a computer programmer, is we made fake broken parts and we asked the students
[11:01.440 --> 11:06.200]  to turn their backs and we would install a fake broken part and then they would attempt
[11:06.200 --> 11:07.360]  to find it.
[11:07.360 --> 11:11.800]  Now this class they were taking is in fact a troubleshooting class.
[11:11.800 --> 11:19.000]  So it worked rather well and of the 12 students who were there, they really strongly believe
[11:19.000 --> 11:21.720]  that this would be useful in other universities.
[11:21.720 --> 11:28.960]  So it's our hope to sort of sell this at cost, even though it's completely open source.
[11:28.960 --> 11:32.800]  We could make it if they wanted to, all the physical designs, all the software designs
[11:32.800 --> 11:39.480]  are completely open, but making things like this in hardware requires, as one of the gentlemen
[11:39.480 --> 11:42.360]  in the previous talk, a certain amount of tooling and so forth.
[11:42.360 --> 11:47.720]  So people like a graduate school may find it easier to pay us $5,000 for one of these,
[11:47.720 --> 11:54.080]  which is sort of the hardware costs are about $2,000 and it takes some labor to put it together.
[11:54.080 --> 11:57.920]  It's kind of the cost for us to make it rather than build one themselves.
[11:57.920 --> 12:03.840]  But they could, they can build it and modify it themselves based on licenses that I'm
[12:03.840 --> 12:06.520]  sure you're all familiar with.
[12:06.520 --> 12:11.840]  So this is kind of a schematic of the design that you saw there physically and the thing
[12:11.840 --> 12:16.800]  that's most important is Nathaniel did a really good job designing an electronic extensible
[12:16.800 --> 12:18.000]  card system.
[12:18.000 --> 12:23.320]  And this is based on an IEEE standard I'm not familiar with, but basically you plug
[12:23.320 --> 12:27.880]  slots into it and it exposes pins of the ESP32.
[12:27.880 --> 12:34.200]  So if you have a device that you would like to add to the ventilator, like a humidifier,
[12:34.200 --> 12:41.920]  a nebulizer, a heater, an additional set of instrumentation, you can just design a card
[12:41.920 --> 12:43.640]  and stick it in there.
[12:43.640 --> 12:48.120]  And that's what the general purpose alarm device team of public convention did.
[12:48.120 --> 12:53.120]  This is a physical photograph of how those things slide in there.
[12:53.120 --> 12:59.480]  This card right here is a card with a bunch of power transistors which control the solenoid
[12:59.480 --> 13:02.640]  valves which are in the system.
[13:02.640 --> 13:05.680]  Because obviously it takes 24 volts to do that.
[13:05.680 --> 13:09.760]  So now I'd like to talk about software.
[13:09.760 --> 13:13.200]  The software system is called Vint OS.
[13:13.200 --> 13:16.840]  I didn't name it, really it's not an operating system.
[13:16.840 --> 13:19.160]  But we kind of think of it that way.
[13:19.160 --> 13:24.600]  It runs on an ESP32 and it was created by a different non-profit, which I'm a board
[13:24.600 --> 13:30.320]  member, helpful at engineering, and some other people worked on it, in particular Ben Coons.
[13:30.320 --> 13:35.640]  Now interestingly, this was forked to make an oxygen concentrator, which we have since
[13:35.640 --> 13:37.920]  quit working on, called the AUX.
[13:37.920 --> 13:46.560]  But that was forked to be used by me for NASA, the U.S. National Aeronautics and Space Administration,
[13:46.560 --> 13:50.200]  to make a control system for a high-tech ceramic oxygen generator.
[13:50.200 --> 13:56.440]  So a lot of times, as I'm sure you guys understand, open source code lives even if its initial
[13:56.440 --> 13:58.400]  purpose is not met.
[13:58.400 --> 14:02.800]  If you write good code that's documented with a good license, you can use it for some
[14:02.800 --> 14:05.600]  other purpose and we're trying to do that.
[14:05.600 --> 14:10.240]  In fact, Ben made a number of improvements that really need to come back into Vint OS
[14:10.240 --> 14:15.160]  and I kind of need a volunteer to help me do that because there's always more software
[14:15.160 --> 14:16.800]  work to be done.
[14:16.800 --> 14:21.200]  So the Vint OS architecture, and this is where we're really talking about an embedded system
[14:21.200 --> 14:27.400]  that you guys will understand, is a simple Arduino platform compiled with PlatformIO.
[14:27.400 --> 14:31.480]  Configuration modes in PlatformIO set pre-processed with compile time switches, which give us
[14:31.480 --> 14:37.160]  a wide variety of hardware architectures we can compile into, although the PolyVent is
[14:37.160 --> 14:43.760]  effectively the only machine on which it really runs today, but we could support other architectures.
[14:43.760 --> 14:48.200]  It almost doesn't run on an Arduino Uno because it's too big, but technically it will run
[14:48.200 --> 14:49.880]  on an Uno.
[14:49.880 --> 14:51.760]  We use an ESP32.
[14:51.760 --> 14:54.320]  We have a pretty good hardware abstraction layer.
[14:54.320 --> 14:59.240]  The basic architecture is what's called a superloop or simple loop architecture and
[14:59.240 --> 15:08.600]  we believe that's appropriate for a life-critical medical device like the one that we're designing.
[15:08.600 --> 15:16.840]  So Vint OS claims to be a operating system that is universal.
[15:16.840 --> 15:21.600]  It's a universal platform for mechanical human ventilation.
[15:21.600 --> 15:23.880]  How is that possible?
[15:23.880 --> 15:28.840]  Well it's possible because all ventilators do almost exactly the same thing.
[15:28.840 --> 15:31.320]  They're relatively straightforward.
[15:31.320 --> 15:33.800]  They're simple devices.
[15:33.800 --> 15:37.960]  Simple doesn't mean easy because if you do something wrong the patient dies, but they
[15:37.960 --> 15:40.880]  are still relatively simple devices.
[15:40.880 --> 15:42.760]  Thank you.
[15:42.760 --> 15:48.600]  In particular, doctors normally want to vary the breasts per minute.
[15:48.600 --> 15:51.720]  As you become sicker you require more breasts per minute.
[15:51.720 --> 15:53.520]  You hope that doesn't happen.
[15:53.520 --> 16:00.880]  The inhalation time and the exhalation time ratio is varied for the comfort of the patient.
[16:00.880 --> 16:05.840]  If you are approaching death they may have to make that what would be very uncomfortable
[16:05.840 --> 16:10.960]  for a healthy person to try to keep you alive.
[16:10.960 --> 16:15.240]  Pressure control ventilation keeps constant pressure through the inhalation.
[16:15.240 --> 16:21.280]  You want that pressure to be low because high pressure can cause damage to your lungs.
[16:21.280 --> 16:26.160]  But as you approach death that pressure may have to go up to try to keep you alive.
[16:26.160 --> 16:32.280]  Doctors, I'm not a medical doctor, Victor is a physiologist, not a medical doctor.
[16:32.280 --> 16:34.240]  Clinicians know how to balance these things.
[16:34.240 --> 16:38.680]  It's our desire to give them the power to do that.
[16:38.680 --> 16:45.280]  Basically you just blow air into the patient's lungs and then you stop and the lungs deflate
[16:45.280 --> 16:46.280]  on their own.
[16:46.280 --> 16:49.320]  That's the way positive pressure ventilation works.
[16:49.320 --> 16:59.600]  It's simple but you have to control all these things.
[16:59.600 --> 17:03.800]  This is sort of a diagram of a universal ventilator.
[17:03.800 --> 17:06.920]  All ventilators are sort of the same in this sense.
[17:06.920 --> 17:12.760]  There's an air drive which produces air in one way or another and that's the most mechanical
[17:12.760 --> 17:14.280]  system that's part of it.
[17:14.280 --> 17:19.400]  There's a sense module and ours is completely separated in the sense that we use the Ventmon
[17:19.400 --> 17:24.120]  which is a separate device that we would like to productize.
[17:24.120 --> 17:29.840]  We gave a bunch away because we had a grant to give them away but it's basically a spirometer.
[17:29.840 --> 17:33.840]  It measures everything about human breath and if you connect it to the ventilator it
[17:33.840 --> 17:36.920]  allows you to see what the ventilator is doing.
[17:36.920 --> 17:41.280]  A controller is what this room would think of as the embedded system.
[17:41.280 --> 17:43.680]  That's where VentOS runs.
[17:43.680 --> 17:51.640]  Our interface is we use a Internet of Things based public data cloud and we're still working
[17:51.640 --> 17:58.440]  on aspects of the clinical interface.
[17:58.440 --> 18:03.200]  If we think about philosophy, the Unix way, and of course I didn't write this, this is
[18:03.200 --> 18:08.520]  on Wikipedia you can find us, is to write programs that do one thing and do it well,
[18:08.520 --> 18:13.240]  write programs to work together, and write programs to handle text streams because they're
[18:13.240 --> 18:14.600]  a universal interface.
[18:14.600 --> 18:16.080]  This is from the 70s.
[18:16.080 --> 18:23.040]  This is very old philosophy which has served the world in good stead because Linux and
[18:23.040 --> 18:26.360]  open source software is eating the world.
[18:26.360 --> 18:31.200]  How do you apply the same things to the kinds of electromechanical devices that we're building?
[18:31.200 --> 18:32.480]  There aren't even chips.
[18:32.480 --> 18:34.320]  They're moving air around.
[18:34.320 --> 18:37.440]  Well, you attempt to do the same thing.
[18:37.440 --> 18:40.600]  You build machines that do one thing and do it well.
[18:40.600 --> 18:43.960]  That is not the way Johnson and Johnson would build a ventilator.
[18:43.960 --> 18:49.440]  They would put everything in the same case but we're not Johnson to Johnson, right?
[18:49.440 --> 18:50.920]  We can do something different.
[18:50.920 --> 18:57.680]  We make a physically separated device where physical components handle one component at
[18:57.680 --> 19:01.440]  a time and then they're integrated in a soft way.
[19:01.440 --> 19:08.360]  By using digital control, we make them all roboticizable or controllable by a controller
[19:08.360 --> 19:12.280]  so that we can use them and they can be reused in that way.
[19:12.280 --> 19:16.080]  In my experience, instead of handling text streams, the modern way to do this is you
[19:16.080 --> 19:21.600]  handle JSON objects that are communicated either via SPI or I squared C and that's kind
[19:21.600 --> 19:27.720]  of a universal control language that's easy for both programmers and the hardware devices
[19:27.720 --> 19:31.080]  to understand.
[19:31.080 --> 19:33.280]  How realistic is this?
[19:33.280 --> 19:38.880]  That's debatable because we're nowhere close to having an FDA-based ventilator at the moment.
[19:38.880 --> 19:42.360]  However, we have done a lot with very little money.
[19:42.360 --> 19:49.040]  We built the Ventmon which is kind of our most realized device because it's much easier
[19:49.040 --> 19:50.920]  than a ventilator, right?
[19:50.920 --> 19:56.160]  VentOS is an existing operating system, Polyvent is a ventilator.
[19:56.160 --> 20:01.240]  I'm very proud that we've defined two data standards based on JSON, the public invention
[20:01.240 --> 20:05.600]  respiratory data standard and the public invention respiratory control standard.
[20:05.600 --> 20:10.520]  Now, as you guys, I'm going to come back to this but as you guys know, progress is often
[20:10.520 --> 20:12.640]  made through defining standards.
[20:12.640 --> 20:17.240]  It's often not very glamorous to do so but the work of defining the standards is really
[20:17.240 --> 20:22.360]  what allows other people to take your work and utilize it in a standard way.
[20:22.360 --> 20:25.840]  In this case, we've done work that has not been recognized.
[20:25.840 --> 20:30.120]  No one else is using these standards yet but I hope that will change.
[20:30.120 --> 20:32.440]  We tried to build an oxygen concentrator.
[20:32.440 --> 20:34.840]  We sort of stopped working on that.
[20:34.840 --> 20:41.560]  We also have vent display which gives a complete dynamic display of breath plots and the things
[20:41.560 --> 20:44.520]  that clinicians need to do.
[20:44.520 --> 20:50.400]  So if we map that to our diagram here, what we find is that the device that we're calling
[20:50.400 --> 20:54.160]  the ventilator really could be thought of as an air drive.
[20:54.160 --> 20:56.400]  It's the part that makes the air.
[20:56.400 --> 21:01.200]  We have a separate device, the Ventmon, which can be used as a sense module and we have
[21:01.200 --> 21:08.600]  a separate set of programs which happens to be an IoT defined public lake and some JavaScript
[21:08.600 --> 21:17.840]  that runs in a browser to do the clinical GUI aspects of the system.
[21:17.840 --> 21:24.120]  We're also designing a general purpose alarm device as I'm sure you understand in any
[21:24.120 --> 21:31.180]  intensive care unit, thank you, situation you have to produce alarms when the patient
[21:31.180 --> 21:32.180]  needs care.
[21:32.180 --> 21:37.680]  Now, that can occur because your machine has broken or the battery has failed or you've
[21:37.680 --> 21:43.800]  run out of power or someone has tripped over a hose but then that happens a lot but it
[21:43.800 --> 21:49.640]  also can occur simply because the patient's condition is deteriorating.
[21:49.640 --> 21:54.880]  In any case, you have to be able to produce a device which can generically alert people
[21:54.880 --> 21:57.560]  to the fact that something has to be done.
[21:57.560 --> 22:03.160]  While following the UNIX way adopted the hardware, our idea is to make a separately packageable
[22:03.160 --> 22:09.120]  device that could be used for a cap door or a burglar alarm or all kinds of other devices
[22:09.120 --> 22:14.120]  in hopes that we can build a community of practice using that which will strengthen
[22:14.120 --> 22:35.480]  the use for medical alerts.
[22:35.480 --> 22:38.200]  This is the software that I was talking about.
[22:38.200 --> 22:40.920]  This runs in a browser.
[22:40.920 --> 22:43.320]  This is what is produced by the Ventmon.
[22:43.320 --> 22:47.400]  I probably should be showing a video but this is actually dynamic as the machine breeze
[22:47.400 --> 22:53.520]  or the patient breeze, you're seeing the pressure flow and various events like the measurement
[22:53.520 --> 22:58.480]  of the humidity and temperature, the end of the breath, the beginning of the breath.
[22:58.480 --> 23:03.200]  What you have on the right here is what a doctor in an ICU would typically compute about
[23:03.200 --> 23:05.360]  the breath traces.
[23:05.360 --> 23:10.400]  This is not super sophisticated but the thing that I really like about it is it runs in
[23:10.400 --> 23:16.920]  a browser so it's distributed generally and then secondly the software functionality
[23:16.920 --> 23:20.960]  of doing all those computations completely separated from the ventilator.
[23:20.960 --> 23:25.280]  In most devices this is built into the panel of the ventilator and cannot be reused in
[23:25.280 --> 23:36.480]  any other way.
[23:36.480 --> 23:41.520]  Lots of the things we've been talking about, VentOS can claim to be a universal system
[23:41.520 --> 23:48.840]  because it implements a hardware abstraction layer that lets you interface to turbines,
[23:48.840 --> 23:58.480]  fans, in our case proportional valves, bellows, other ways of producing gas.
[23:58.480 --> 24:03.440]  Following the open source methodology, it's not so much a machine as an ecosystem.
[24:03.440 --> 24:09.240]  We're trying to build a respiration ecosystem.
[24:09.240 --> 24:15.320]  As we've said, we've already seen that one piece of functionality has been added as a
[24:15.320 --> 24:22.040]  PCB that's put into the control module and that is an SPI interface to the general purpose
[24:22.040 --> 24:29.240]  alarm device which I mentioned previously.
[24:29.240 --> 24:33.960]  You might say, well why on earth would we ever have a respiration ecosystem?
[24:33.960 --> 24:39.120]  Well, there's a good reason from kind of a patient point of view which is all of these
[24:39.120 --> 24:47.040]  devices which accomplish various medical purposes, a ventilator, an O2 concentrator, a by level
[24:47.040 --> 24:53.200]  positive pressure air wave machine, a CPAP machine, a PAPR, a bag valve mass monitor,
[24:53.200 --> 24:59.160]  all of those essentially need standards of respiration data exchange which we have developed
[24:59.160 --> 25:04.360]  but nobody else has used and many of them need the same sense module that we've been
[25:04.360 --> 25:06.480]  talking about in the Vintmont.
[25:06.480 --> 25:13.240]  In that sense, if you think of the way open source software has made components that work
[25:13.240 --> 25:19.680]  together really effectively, what we're trying to do is to create hardware and software components
[25:19.680 --> 25:27.160]  integrated which work together as effectively in the realm of human respiration.
[25:27.160 --> 25:32.440]  In a sense, we're trying to democratize the field of medical respiration and education
[25:32.440 --> 25:34.720]  around it.
[25:34.720 --> 25:37.040]  Open source software has already shown us the way.
[25:37.040 --> 25:40.320]  We're just taking things that were developed by open source software and attempting to
[25:40.320 --> 25:42.480]  apply them to hardware.
[25:42.480 --> 25:48.080]  In particular, as I'm sure you guys know, the development of standards like HTTP, HTML,
[25:48.080 --> 25:55.200]  JSON, etc. are absolutely critical to the progress and interaction of multiple components
[25:55.200 --> 26:00.320]  in the embedded architecture world but open source software more generally.
[26:00.320 --> 26:08.920]  We're trying to accomplish the same thing by producing respiration standards.
[26:08.920 --> 26:11.320]  These of course exist in GitHub repos.
[26:11.320 --> 26:12.960]  Thank you very much.
[26:12.960 --> 26:18.120]  In short, we built the most open, extensible ecosystem for a classroom.
[26:18.120 --> 26:21.160]  It's the most open, best documented system.
[26:21.160 --> 26:24.560]  I can claim that because I evaluated all of the other ones.
[26:24.560 --> 26:29.440]  There are other open source ventilators but you cannot find their designs online.
[26:29.440 --> 26:30.800]  They're not really open.
[26:30.800 --> 26:34.400]  They're just thinking about being open.
[26:34.400 --> 26:35.760]  That concludes my talk.
[26:35.760 --> 26:36.760]  Thank you very much.
[26:36.760 --> 26:54.960]  Thank you very much.