Re-Distributed Manufacture (RDM) is defined as: "Technology, systems and strategies that change the economics and organisation of manufacturing, particularly with regard to location and scale" . In healthcare, RDM involves bringing production closer to the point of clinical need or use, enhancing the capability to deliver personalised medicine. The EPSRC funded Re-Distributed Manufacturing in Healthcare Network (RiHN- www.RiHN.org.uk) was launched in Feb 2015 and delivered by a consortium of six universities (UWE, Loughborough, Nottingham, Cambridge, Newcastle & Brunel), representing disciplines from both the social sciences and engineering and led an agenda to advance the impact of UK medical manufacturing. One area of significant research interest identified by RiHN has been the potential value of implementing RDM approaches in deployed medical care. Whilst RDM includes the notion of a shift from centralised towards decentralised production, extant research continues to assume a degree of stable environmental conditions and fixed static location (e.g. hospitals/clinics/home). However, RDM can deliver life-saving benefits in mobile medical scenarios, where there is urgent and unforeseen demand in changing and remote locations, such as in response to natural disasters and emergencies (e.g. the Ebola crisis, Cyclone Idai and recent terrorist attacks), and the rapid treatment of injured military personnel in the field. This often requires a reverse supply chain perspective, starting with the requirement based on patient need. There are a variety of medical conditions that could benefit from rapid response treatments closer to the site of a medical emergency or in field hospitals; these include (but not limited to) blast injuries to skin and tissue, haemorrhagic shock and fractures. The project will be led by a multi-disciplinary team bringing together subject matter experts that rarely meet, such as experts in trauma care, emergency medicine, innovation management and manufacturing, and will achieve the following outputs: - A review of current research capability and knowledge- sharing of current breakthroughs - Enhancing understanding of the use of RDM in deployed medical care - Identification of and development of promising RDM technologies that support treatment pathways in deployed operations - Capture of military and civilian emergency medical requirements and applications for RDM - Systematic identification and comparison of needs, applications, technologies and resources The overall outcome for the research will be the creation of 'communities of practice', producing real world demonstrators covering both the business and technical aspects of implementing RDM in deployed medical care, bringing the potential to advance the UK's capability in RDM, delivering impact to clinicians, practitioners and patients. The research will help shape how the UK Ministry of Defence, prime contractors in the defence sector, emergency and urgent care services and UK Research Council proceed with future R&D investment and resourcing. The outputs of the project will also be disseminated through a website, presentations at relevant national and international conferences, and research centres and a Special Issue journal (Health Services Management Research) and presenting the findings of the project at a showcase event. A final report will be produced, sent electronically to all interested parties, and made available digitally and via social media.

Most prosthetics used to replace joint function in the body have a very low chance of infection (<2%). When prosthetics must be inserted following trauma or where individualised implants must be made for patients, the chances of infection are significantly increased and can be as high as 50%. Treatment requires removal of the prosthetic and the implantation of another material that releases high-levels of antibiotics to the site of infection and causes a major risk to the health of the patients. The excessive use of antibiotics is one of the factors that has provoked a rise in the frequency of bacteria that are resistant to antibiotics. Consequently, there is a significant need to develop processes and designs for implants that have enhanced resistance to bacterial contamination. In this project, we will use a combination of 3D printing and silver coating to refine current methods of processing and produce surfaces that are resistant to bacterial infection. We will work with clinicians and industrial partners to develop technologies that can be used with lots of different kinds prosthetics, however, our first target is to reduce infections following the implantation of a metallic plate in the skull. Many different clinical conditions require that a surgeon makes a hole in the skull of a patient to allow for treatment. This allows the surgeon to relieve pressure, caused by swelling following head injury, or to work on the underlying brain tissue. Although most orthopaedic implants come in a range of sizes that can be made to fit patients, metallic implants that are used in the skull (and the defect), do not fit without further structural refinement. At the moment, these implants are made in hospitals by bending a titanium (or other metal sheet) over a 3D printed model of the defect and then polishing and dipping the surface in acid before sterilisation at more than 100oC. Although this kills the majority of contaminating bacteria, the incidence of infection following the implantation of these plates is much higher than with other metallic implants made outside the clinic (12-50% compared with 2%). If an infection occurs, the plate must be removed from the patient's skull, the site cleaned, and then another plate can be fixed in place. This process is dangerous for the patients since it increases risk due to anaesthesia, further infection and requires that the individual spends a period of time without a plate in place, meaning that the brain remains relatively unprotected. We aim to use technology that has been developed in a previous EPSRC project (NIDMET) to reduce the incidence of infection following the fitting of a cranial plate. We will refine an existing additive layer manufacturing process so that we are able to produce something quickly, accurately, to a high quality and surface modified with silver such that it is resistant to microbial contamination and therefore unlikely to cause infection. If we are able to reduce the incidence of infection even down to that associated with orthopaedic implants, we will improve the life of a considerable number of patients reducing costs, in terms of days of hospitalisation and cost of treatment. We will use additive layer manufacturing methodologies to address another major problem that is associated with cranial plates: artefacts that are created by the plate material in a type of MRI scanner that mean that the implant or implant site cannot be evaluated using this important imaging method. We will address incompatibility of the material with gradient field MR imaging using a process that is called topological optimisation. This is an operation that is undertaken by a computer to modify the structure of something so that it is possible to minimise the amount of material that is required for a particular structure. Minimising material, particularly around the edge of the implant, will reduce the imaging problems associated with cranial implants.

This proposal is concerned with the research and development of new manufacturing and assembly methods that add electronics functionality to textiles. Textiles are ubiquitous and are used, for example, in clothing, home furnishings as well as medical, automotive and aerospace applications. Textiles are one of the most common materials with which humans come into contact, but, at present, their functionality is limited to their appearance and physical properties. There is considerable and growing interest in SMart and Interactive Textiles (SMIT) that add electronic functionality to textiles. SMIT offer a far greater range of functionality that can include sensing, data processing and interaction with the user and, as a result, can be applied in a vast range of applications potentially wherever textiles are present. The overall objective of the research is to develop new manufacturing assembly methods that enable the reliable packaging of advanced electronic components (e.g. microcontrollers) in ultra-thin die form within a textile yarn. The programme of research will investigate approaches for mounting the ultra-thin die onto thin flexible polymer films strips that contain patterned conductive interconnects and bond pads. Individual die will be located on the strip and conductive tracks on the plastic substrate will them together forming a long, very thin, flexible circuit or filament. The filaments will then be surrounded by classical textile fibres (e.g. polyester, cotton, wool, silk) and connected to conductive wires to form an electronic yarn (EY) that will, essentially, appear to be a standard textile yarn but which has embedded within it, circuitry and components. The ultimate goal is to incorporate these EYs into the textile in such a way as to protect the electronic components and interconnects from the rigours of use whilst maintaining the feel, drape and breathability of the textile. A key aspect of the technology is the use of ultra-thin die which are highly flexible and, together with a rectangular footprint, will minimise the profile of the die within the filament. This will then serve to reduce the impact on the yarn making the electronics virtually invisible and minimising yarn diameter.

The development of implantable prosthetics has revolutionised medicine. Where joint injury or destruction would once have once significantly reduced quality of life, to the detriment of a patient's fitness and health, we can now almost fully restore function. The manufacturing methods used for the production of prosthetics are quite crude and often require the casting of metal into a mould before finishing by hand. As a consequence they are usually made to only a few different sizes and the resulting structures must be made to fit by the surgeon. This is acceptable for the majority of patients who require joint replacement, but there are some medical conditions that require very irregularly shaped (customised) structures to enable an adequate repair. For example, bone cancers often require extensive cutting away of the bone and this can leave a very large and irregular defect. Similarly the bone structure of the face and skull is very specific to an individual and when bone must be removed, again due to cancer or following physical damage. To restore physical appearance, it would be best if a clinician were able to generate a plate that could allow them to replace like for like. In this project, we will refine an Additive Layer Manufacturing (ALM) technology called selective laser meeting (SLM) to allow us to produce implants that are individual to a patient. These technologies use lasers to fuse powder and create a three dimensional object in a layer by layer fashion. By taking three dimensional images (MRI and CT) from a patient, operators can design structures that will be able to directly replace tissue with the optimum shaped implant. In this project, we will work with doctors from the Royal Orthopaedic Hospital, Queen Elizabeth Hospital and the Royal Centre for Defence Medicine to develop a process that we hope will eventually allow these clinicians to produce implants in their own hospitals or even on the front-line of a conflict and enable better treatment for their patients. As well as allowing the production of complex-shaped parts, ALM has another significant advantage over casting in that it allows the production of very complex porous structures within a material. This means that we can modify the physical properties of the material by incorporating holes or structured porosity into the structure. These holes can be sealed from the surface of the prosthesis, or can be linked to the surface using a network of even narrower holes. We would like to explore the use of this added manufacturing capability to make prosthetics with a very closely defined internal structure that is completely interconnected. A second, cement like, material can then be injected into the pore structure and will harden in place. This second phase can be used to modify mechanical properties or could be used as a carrier for drugs that may stop infection or help the tissue to heal. It is hoped that this modification could help us eliminate implant-based infections, which is the leading cause of failure following prosthetic implantation.