 Today, we'll be presenting our pilot project. The project focuses on evaluating 3D technology for medical, humanitarian applications. Pierre is a physiotherapist. I'm a biomedical engineer. We were recruited by the MSF Foundation, located in Paris. The foundation focuses on funding and managing innovation projects like ours. We arrived in Amman in February 2017 last year. To initiate the pilot project at the MSF Amman Reconstructive Surgery Hospital. For the past 10 years, the Reconstructive Surgery Project has been providing complex surgical operations to patients affected by conflict, primarily from Syria, Iraq, and Yemen. The RSP specializes in orthopedic, craniofacial, and plastic surgery, and also provides rehab care and psychosocial support for our patients. So, what is the 3D project? The 3D project aims to evaluate the 3D technology to see if it can have any impact on the access to rehabilitation and prostate care on our field. The main thing about this project was to see if we can get this impact on specific patient population, neglected patient population. Among them, amputee population, especially upper limb amputee population. On the field, we might not have any solution for this population. So, we decided to focus first, first of all on below elbow prosthetics. So, for patients who lost their arm below their elbow. And the idea was to have a multidisciplinary action over the patient. So, we have engineers, we have rehabilitation professionals as physiotherapists, occupational therapists, and prosthetic and orthopedic clinicians. And we try to define the needs of the patient and try to see if we can find a prosthesis, realize a prosthesis that can fit this need. So, I will briefly go through the whole process of what we are doing with the patient. So, the first thing that we are doing with the patient is the assessment. We have the chance at the RSP hospital to have an occupational therapist since mid-2017, that is helping us on our project. And she's doing with our physiotherapist and the supervisor of the project now in Jordan, in Amman, all the process with the patient. So, the assessment aims to find the needs that the patient have. Like, where are the difficulties? Where are the challenges in the daily life of the patient? And try to see what kind of prosthesis and what kind of care we can provide to the patient. The second part is the first part of the designing of the prosthesis. So, we are going to scan our patients. And we have 3D surface scanner, as you can see on the left part of the slide. And we are scanning the stamp of the patient, but also the sound side if they are unilateral patients. So, it helps us to design the socket, and which is here. So, the socket which is here, which is the interface between the stamp of the patient and the prosthetic. And the socket is now fully digitalized and is completely created on the computer on this project. And the second part, which is the scanning of the harm, aims to scale the prosthetic of your patient. So, you can see this prosthetic, for example, was done for the patient on the left that was who wants to drive. He was already driving, but he has difficulties. So, we try to make a prosthesis with a space between the thumb and the finger that can hold us in to catch the steel wheel and to release it easily. So, we're currently using desktop 3D printers. So, not very expensive printers. We're printing in various materials. So, we start with the check sockets and the check hands, which are printed in a readily available PLA material. We print them in thin shells to conserve material. Once we have the final design, once the size of the hand has been validated, the fit of the socket has been validated, we go ahead and we print the final device. So, as you can see here, and this was a system that was developed by our collaborators, Limforge, at that on the hands, you can see we have a flexible TPU material. So, this allows the fingers to flex. And then for the forearm and the connectors, we use the PLA material. And for the socket, shown on the bottom here, this is a semi-flex copolyester material. So, throughout the process, we tested many different types of materials to reach these final materials. So, we've tried the prosthesis on the patient. The first are test prosthesis and test socket to check if the volume of the socket is good to the stamp of the patient and also the size of the prosthetic is according to the anatomy of the patient. Once we are happy with this, we provide them another bench of prosthetics and that will lead to the final prosthetic. But we also try to see with the patient if it suits their expectation in terms of activity. So, if we are speaking again about this patient who wants to drive here on the bottom right of the slide, I can see the patient trying to catch the steering wheel and when we were good with the prosthesis, we make him try to drive with the prosthesis and he was pretty able. So, once we're happy with the prosthesis, we check the alignment, we check the length of the prosthesis and then we finally provide them the different prosthesis. In between that, we start rehabilitation sessions. So, the goal was not only to provide prosthesis, but also to combine the patient into the whole process so they can accept the prosthesis and that we cannot still fit their needs. So, we have a rehabilitation session now for each of our patients and you can see some of this activity right now. And then the final device is here. So, we paint the final device according to the skin tone of the patient. We have here one of the device that we provide to one of our patients. It's a small device. This one is a two and a half years old patient and you can see that the stump is pretty short and we'll talk a little bit about after. The last part of the workflow with the patient and one of the most important is the follow-up. So, as we say, we are providing prosthesis, we are also providing rehabilitation and assessment but we try also to follow them up during the time. So, we are making assessments at 15 days, three months and we hope to do some at one year to check if they can still use the prosthesis and if we can modify what we are doing with them. I will share with you one of these examples. So, this little girl that you can see on this slide was using an active system. So, by active system means that the sum which is right here on the left part of the slide was activated by this harness through the other shoulder. So, she was moving the shoulder and then it was making the thumb moving and after three months of using, we figured out that she was not so much using the prosthesis for his active system. It's a little bit heavier and it's a little bit more difficult to use. And so, we suggest her to turn to a passive devices such as the one that I just showed you which is lighter, it's simple and we design a closed grip, well, a closed grip between the thumb and the finger that allows her to catch different things. So, the result is now that she's using more devices, it's lighter and it's more comfortable for her. So, sometimes the solution is the easiest one. I'll share also a second case with you. So, this little boy is a bilateral congenital amputee. He's four years old and there is most of his activity he wasn't able to do by himself. So, he learned how to draw with the prosthesis but one of the most concerning activity that his parents and he also wanted to perform was eating by himself. So, we designed a very specific tool which is short here and allowed to catch adapted ustensils for eating and is now available, is now able, sorry, to eat by himself, which is a big win because we are matching, once again, the assessment and the need of the patient. And that set new goals that you can see on the left and one of our main concern now that we are trying to deal with the rehabilitation program process with this patient is to make him change by himself the different tools. So, he can use the hand for the drawing but also by himself change it to eat something. So, along the way we faced several design challenges. With the post-processing we noticed that when we switched to the flexible hand from the initial rigid hand the paint was starting to break away. So, we developed new paint formulations as you can see on this new hand that provided a more durable coating. For the structural design, we soon realized that not all PLA material is created equal. So, we started using a stronger PLA material and also changed the design around. As you can see here, we made a thicker shell on the forearm and applied internal reinforcement structure on the interior near the connector piece. Lastly, from the patient assessments we learned how critical it was to get the aesthetics right. So, initially we were using measurements that clinicians provided of the hand and later we also used the unaffected side and mirrored that to the design we were scaling. And we were still seeing, as you can see at the bottom right that the hand just still was off a little bit. So, then we went back to the drawing board and developed a new workflow with help from a volunteer industrial designer. As you can see from the 3D scan, even with a high quality scanner you still have, if you see on the blue, you still have holes and artifacts that you need to repair. And for me, this was a very time consuming process. So, we reached out to an industrial designer who is used to sculpting, digital sculpting and he was able to clean the scans in a short amount of time to generate a usable scan that would be used to generate the final prosthetic device. And it's important to note here that now we can create an exact mirror of their unaffected side into the device. So, we'll try to go quickly on the results. So, after one year we've seen the patient, the first thing is that we could fit some of our patients. So, that was the first question, can we fit patients? So, certain prostheses were given to 11 patients and nine are still using them. We know that nine of the patients are still using them. One broke and the patient went back to his original country so we didn't get the chance to provide him a new one. And the second one we don't have news as he went back to Syria. The second thing that I want to share is that at two weeks, we had a satisfaction rate of among 90% with a validated tool. So, two weeks is a bit short so we hope to have soon the result at three months and hopefully next year at one year. The good thing is that those patients are using them and the prosthesis doesn't cost so much. As you see, the raw material is around $20 to $50 which is a fraction of the conventional cost. So, what we can conclude after this one year is is it feasible? And the answer is yes, it's feasible. We can make this kind of prosthesis with all the capabilities on site. We can manufacture that and we can tailor them to the need of the patient. So, they are cost effective. The sons also to be lightweight and they are comfortable with the socket. And now for next year, as we see that we can do it on site with a local team that is now continuing this project, we want to see the durability of our next year and also if it's possible to outsource some of the part of the process to do this prosthesis. Very quickly, we have other application that we are looking for. One is burn mask and trying to see if we can use the scanning technology to improve the comfort of the patient to make this burn mask for burn faces. And very quickly, we're also exploring surgical applications so providing 3D models that the surgeons can use to educate the patients on the procedure but also preoperatively plan their procedures. We're also working with a software company to develop an automated software for limb deformity correction. And these are some of the other applications we've explored throughout the first year. Lastly, we'd like to acknowledge everyone that's been involved in this project. There's been, Pierre mentioned the local team, the reconstructive surgery project in hospital and Amon has been incredibly supportive. We've had many individual volunteers, clinical collaborators as well as technical collaborators and we thank you all for your generous support. And MSL Foundation and everyone, thank you. Thank you.