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revolution3d · 2 years
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Best 3D Rendering Services Provider in Los Angeles California | 3D Revolution
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3D Revolution has evolved into one of the largest 3D Rendering Studios in Los Angeles and is intent on dominating the 3D Architectural Visualisation space with our beautiful photorealistic 3D Rendering and our Realistic 3D and VR/AR Interactive Tours for Properties Developers, Architects, Builders and Homeowners. Get World Class 3D Rendering Services in Los Angeles, California . Our 3D Rendering Specialists help builders, designers and property developers throughout Los Angeles California. To Know More Info, Please Visit:- https://www.3drevolutionusa.com/
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panoramcgi · 6 months
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Your Vision, Realized: Trusted Partner for Businesses & Developers on 3D Renderings in California
California, a land of innovation and boundless creativity, is a hub for businesses and developers pushing the boundaries of design and construction. Here at [Your Company Name], we understand the importance of translating your vision into a tangible reality. That's why we offer exceptional 3D rendering services in California, empowering you to showcase your projects with stunning visuals and unparalleled clarity.
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Beyond Visualization: Unveiling the Power of 3D Renderings
3D renderings are no longer a futuristic concept, but a crucial tool for businesses and developers in California. These high-fidelity visuals go beyond mere aesthetics, offering a multitude of benefits throughout the project lifecycle.
Optimizing Design and Communication
Early Exploration of Design Ideas: 3D renderings allow you to experiment with various design options before breaking ground. Furniture layouts, color schemes, and architectural elements can be readily explored and compared within the virtual environment. This fosters informed decision-making at an early stage, saving valuable time and resources down the line.
Enhanced Communication and Collaboration: 3D renderings bridge the gap between your vision and the understanding of stakeholders, clients, and investors. High-quality visuals provide a clear picture of the final space, eliminating ambiguity and ensuring everyone is on the same page from the outset.
Marketing and Fundraising Advantages in California
Securing Funding and Investors in California's Competitive Market: 3D renderings are a powerful marketing tool for attracting investors and securing funding, particularly in California's competitive market. These visuals showcase the envisioned project in a compelling and impactful manner, fostering excitement and confidence in the project's potential.
Accelerated Pre-Leasing or Sales for Commercial and Residential Projects: For real estate developments in California, 3D renderings allow you to market properties before construction is complete. Potential tenants or buyers can virtually experience the finished space, leading to faster pre-leasing or sales cycles.
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California-Specific Expertise: Partnering for Success
As a California-based 3D rendering company, we understand the unique needs and regulations of the state's diverse construction landscape. Our team of experienced professionals possesses a deep knowledge of local building codes and design trends. This ensures your 3D renderings not only showcase your vision but also adhere to relevant California building standards.
Beyond the Basics: Our Commitment to Exceptional 3D Renderings in California
We go beyond offering basic 3D renderings. We are committed to providing a comprehensive service that caters to your specific project needs. Here's what sets us apart:
Unmatched Quality: We utilize cutting-edge 3D rendering software and highly skilled artists to create photorealistic visuals that capture every detail of your project.
Collaborative Approach: We believe in close collaboration with our clients. We work closely with you throughout the process, ensuring the final renderings exceed your expectations.
Flexibility and Scalability: Our services are flexible and scalable to accommodate projects of all sizes and budgets. We offer a range of packages to suit your specific needs.
Investing in Success: The Value of 3D Renderings in California
By partnering with a trusted provider of 3D renderings in California, you gain a valuable tool to optimize your project's success. 3D renderings not only enhance communication and design decision-making but also provide a powerful marketing advantage in California's competitive real estate and business environment.
Partnering for a Brighter Future
At Panoram CGI , we are passionate about helping businesses and developers in California bring their visions to life. Contact us today to discuss your project and discover how our exceptional 3D rendering services can empower you to achieve success. Together, we can turn your vision into a reality, one stunning 3D rendering at a time.
Blog source: https://panoramcgi.weebly.com/blog/your-vision-realized-trusted-partner-for-businesses-developers-on-3d-renderings-in-california
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Days Go By Set Design: The Journey So Far
Hey guys, Bez (the writer) here. Over the past couple of weeks, designer Liv and I have been working on our concept for the set of Days Go By. This will be the second iteration of our set concept since the first draft; since the demands of the production have changed with the script over the years, many things about the basic stage layout have had to change too. Today, I'm going to give you all a look at the evolution of the set design so far.
Model 1.0
Back in the days of 'Workin' Boys', we weren't even sure that the show would ever actually be put on a real-life stage, but we still wanted to design our set so that we could visualise the scenes as we wrote them. Our initial concept for the set needed to accommodate a variety of interior and exterior locations, so we went with relatively simple design that consisted of a city skyline backdrop, a staircase and an elevated platform with an upstage centre entrance as well as one at the top of the stairs and underneath.
The original design was sketched out and constructed into a physical diorama by artist Ofir:
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As we developed the characters and story more, we began to develop further ideas for the set and how we could make it unique and visually compelling.
Model 1.1
Once we established that the musical would deal with themes of gentrification and corporate culture, we decided to incorporate an office building structure and apartment complex structure as part of the fixed set. Depending on the location, the action of a given scene would be localised near either the residential or commercial building, to set up this dichotomy of home versus workplace, family versus career etc. I dipped my toes into 3D graphic design to create this mockup of the new design:
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We kept the stairs + platform at the back with the intention of using it as both a fire escape, a staircase and landing inside a house and a distant bridge in the city. The backdrop would have similarly been some sort of silhouetted city skyline to add to this urban setting.
After rebranding and doing a major overhaul of the story and characters, the set inevitably needed an upgrade. At this point in the process of writing the libretto + album, we felt ready to start drawing up concept art for the new set.
Model 2.0
Now we knew that our show would take place in the 80s and would be satirising aspects of American culture, I dove into researching 80s interior, graphic and textile design trends and their histories so we could design a most radical set for our musical. As we aren't sure of our venue at this stage, we also took into account the most likely measurements of an average theatre so that we could design a 3D scale model that would allow us to experiment with set pieces, lighting, projections and more.
As the latest iteration of the show contains a lot more symbolism and metaphor, we wanted to go with a somewhat abstract but recognisable design to allow for a variety of locations and moods. To indicate the general setting of California, we researched some artistic renderings of California city skylines reminiscent of the time period that we could draw upon in our final designs. On the upstage wall, there is a staircase with a door at the top that functions as an entrance/exit, with the other two entrances being via the wings. As most of our set pieces will be trucked or carried in, we calculated how much space we would be likely to have backstage to store set pieces and designed said pieces according to these measurements to ensure they would fit in the wings. This also allowed us to see how large certain set pieces would be in relation to a performer, so we could scale certain parts up or down as needed to achieve the intended effect.
For the time being, we have used placeholder blocks and images to give a general idea of what we intend for the set to look like when it is constructed. Here is a sneak peek at the latest stage design concept as well as a few different locations + potential lighting states for each, programmed by Liv using the open source tool Blender:
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And that's where we are today! Inevitably, the design will get some tweaking once it gets to the final planning stages, but we thought you'd appreciate this sneak peek at the progress of the musical's design aspects at this stage in the development. Thanks again for all your support, Bez
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spacerenderings · 3 years
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Santa Barbara Interior Design | spacerenderings.com | 3238551965
Building and Construction 3D Rendering Services for Engineers, Architects & Contractors: https://spacerenderings.com/
Find Us On Google Maps: https://g.page/space-renderings
Building and Construction 3D Rendering Services are used for Commercial buildings, Residential buildings, Engineering Projects. The industry is growing at a rapid pace worldwide. The reason is that every business industry relies more on visualizing their idea or concept before they put it into practice. We Are Providing You With Building & Construction 3d Rendering Services By Our Expert Santa Barbara Architects 3d Rendering Service Providers. If you're looking for a design team for Santa Barbara interior design, with our experience, we can guarantee success! Give us a call today.
Space Renderings Address: 133 E De La Guerra St, Santa Barbara, California, 93101 Phone: (323) 855-1965
Our Blog: https://spacerenderings.tumblr.com
Next Video: https://is.gd/u6RHTT
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letsjonebenblog · 4 years
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Perspective view of Multiple Family Building Rendering Oakland California. Aspirational quality CGI exterior rendering to your property. 3D Rendering Services for Architectural and Real Estate Development. JMSD Consultant Rendering Studio collaborate with Real Estate & Architectural professionals in Los Angeles, San Diego, San Jose, San Francisco and Other city of California and all the US surroundings. We specialize in Real Estate and Architectural 3D Rendering Services for Residential Homes or Commercial projects. Contact us! get in touch email us at [email protected].
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architectnews · 3 years
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Midtown Viaduct Manhattan, New York City
Midtown Viaduct Manhattan Design, New York Moynihan Train Hall, NYC Architecture Images
Midtown Viaduct Manhattan, NY
May 5, 2021
Midtown Viaduct Design for Manhattan
Architecture: DXA Studio
Location: New York, USA
DXA Studio To Exhibit The Midtown Viaduct During Venice Architecture Biennale 2021
Conceptual Design for Urban Pedestrian Pathway Would Link Moynihan Train Hall with the Hudson Yards in Manhattan
The Midtown Viaduct, New York, NY
New York, May 4, 2021 – DXA studio, a New York-based architecture and design firm known for a diverse range of projects primarily in Manhattan and Brooklyn, today announced it will exhibit its conceptual design for The Midtown Viaduct during the Venice Architecture Biennale 2021 from May 22nd to November 21st.
The Midtown Viaduct is an urban pathway that would span Ninth Avenue and connect the new Moynihan Train Hall at West 31st Street to the High Line and Hudson Yards at 30th Street in Manhattan. The proposal was awarded Grand Prize at the 2019 Design Challenge organized by Metals in Construction magazine.
“It is an honor to be invited to display our concept for the Midtown Viaduct during the Venice Architecture Biennale, which is one of the premier international showcases for architectural design in the world,” said Jordan Rogove, Co-Founder and Partner of DXA studio.
The Midtown Viaduct will be shown at Palazzo Bembo in Venice as part of the exhibition Time Space Existence, organized by the European Cultural Centre, which features “completed and ongoing projects, innovative proposals, researches and utopian dreams of architectural expressions.”
Drawing inspiration from the architectural icons it connects, DXA’s award-winning design references the historic interlaced steel plate work of the High Line and the intricate steel structure of the original inner concourse of the 1910 Penn Station. The structural steel fabrication also harkens back to the 19th century with the structural framing concept of the Statue of Liberty. Today the curved structural framing can be executed with a combination of innovative techniques, such as water jet cut steel and pre-fabrication assembly, to create a beautifully bending pedestrian path over the heavily trafficked avenue.
“The Midtown Viaduct goes beyond much needed connections to transform a disused area of the city into an activated, dynamic and social pedestrian amenity that would service millions of people every year,” said Wayne Norbeck, Co-Founder and Partner of DXA studio.
The proposed structure consists of transverse ribs shaped according to the cross-section of the pedestrian pathway and spaced approximately every 10 feet at the longer linear paths. The resulting formation makes an interlaced and dynamic public space for this rapidly emerging area of the city.
All original 3D modeling and graphics for the exhibit were done in-house by DXA studio. ATOMIC was responsible for the 3D printing, assembling, and painting of the model. DXA and ATOMIC collaborated on the joining method. Based on DXA’s direction, ATOMIC also devised a system for suspending the model from the ceiling with cables, as well as the design and testing of the lighting system.
About DXA studio
DXA studio is an award-winning design practice that provides a rare balance of expertly crafted design with technical proficiency. Believing in the power of architecture to positively influence the lives of all that engage it, DXA focuses on authenticity, sustainability, and innovation in all their projects.
Established in 2011, DXA’s expertise spans the full spectrum of design services and project categories including multi-family and single family residential, commercial, institutional and hotel design. In-depth research and analysis happen prior to design, identifying opportunities to push boundaries and integrate technological advances in building materials, construction, and sustainable strategies. By capitalizing on these discoveries, the site, program and unique opportunities of each project, DXA produces creative solutions and distinctive design work that consistently outperforms expectations. For more information, visit www.dxastudio.com.
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Location: Queens, New York City, USA
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seokingstar · 5 years
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Affordable 3D rendering
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Welcome To Pixelprovisuals.com
PixelPro Visuals - Photorealistic 3D Rendering Service in California!
 Affordable 3D rendering        
Photorealistic render orange county
We are a group of creative individuals passionate to create visually stunning 3D models of Architectural Properties. We offer affordable 3D rendering to Southern California and beyond.
We are a team of creative individuals specialized in creating stunning 2D and 3D digital images for residential and commercial properties. California 3D render Our experienced designers can create life like, photo-realistic interior or exterior renders for architectural assets.
 So whether you are an interior designer trying to show your creative vision to your client or an Architect or builder working on a development project, we will create 3D model for your home improvement projects, new construction, landscape design that you can easily show to your client, explain to your contractors or just keep it to yourself for reference.
For a designer or developer one of the important thing is to communicate your vision to your client through visually appealing and technically accurate way, our experienced and professional designers will create high quality 3D image for projects whether that is
completed, under development or proposed for future build
 Architectural 3D model California
Who is 3D Rendering for?
Architects, Builder, Interior designers, Real Estate development specialists, anyone who is looking to construct, renovate or upgrade any real estate properties will find 3D rendering helpful. An accurate and realistic 3D photo is the easiest way to communicate the vision of developer to the client.
 How we start our work?
In order to start any project we just need some basic information about the project, like scope of the project, some kind of design files, hand sketches, photographs of the existing structure or CAD files etc.  We may also request to send us sample image of material or texture that customer wants to see in the render image.
 How does the communication work?
Email is the easiest and fastest way to communicate with us. Drop us an email and we will get back to you ASAP. You cal also contact us to the phone number specified. We exchange all documents thru email and for larger documents we use Google Drive or Dropbox to share updates..
 How the work is done?
We work remotely from multiple location and we distribute projects between our developers based on project priority and availability. As a customer you will always have a dedicated person communicating with you and  giving you daily status updates.                                                                
 How to make payment?
We will share secure payment link to you which can be paid by any credit or debit card. In some cases as we start building the model we request 40% advance payment to keep our developers inspired, and after the completion we request for the remaining payment.                          
 How is the Quality control?
Once we start a project, after completion of each phase we make sure to get it reviewed by the client. That helps timely delivery of great quality product. Additionally we offer multiple revisions through out the life cycle of the project.
   Address: California,USA
 Visit For more information: https://www.pixelprovisuals.com
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studiokarras-blog · 5 years
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California Interior Designers and Architectures
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Interior Designers make your home beautiful that gives your surroundings a touch of aesthetics. Besides giving an aesthetic look to our room California interior designers studio Karras also gives you a peaceful life. A room that is created with good interior design is all you need for a satisfying home environment. We provide complete interior design solutions for all kinds of interior spaces with our highly skilled Interior Designers team.
Studio Karras is an established California interior designer specialized in providing exceptional and stunning interior designing services that include material selection, 3D rendering, creative space planning, detailed drawings, and project supervision for both commercial and residential projects in California. Our team is well experienced with various international styles. We also aim to build lasting relations with our clients through strong communications and great work.
For more details contact us at 3109232046 or mail us at [email protected]. Web Address: https://www.studiokarras.com/editorial/
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revolution3d · 4 years
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3D Apartments Commercial Rendering Services in Los Angeles. Looking to showcase your new commercial or industrial space user our 3D Photo Realistic images and 3D Videos to help sell your vision.
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raogbl · 6 years
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The Stack Rock Group is focused on delivering wonderful projects to the world and in their every project they are using SketchUp that makes their work easier.
Trevor Ball is a designer and partner at Stack Rock Group, around 10 years earlier he was given free reign to choose a 3D modeler for making architecture designs and he chose SketchUp. After that in these 10 years he has become the lead 3D designer, Trevor and his team use SketchUp for all of their visualization projects. He has given an interview to Caroline Early where he has shared a lot about his company and his work, this article is just a little description of that conversation.
A little about Stock Rock Group: It is an eccentric and creative Landscape Architecture firm based in Boise, Idaho and they are creative idealists who can see every kind of possibilities. They usually set foundation of project with skillful and right questions that help their clients to clarify their personal and business goals, needs, wants and desires etc. Usually the group guides general contractors, construction managers, homeowners, landscape and building contractors, building architects, real estate developers, corporations, institutions, municipalities, wineries and vineyards through their individual attention and detail excursion for every project. Their collaborative, thoughtful process helps clients to grow their businesses, project sustainability and grows many more positive impacts on their environment.
Stock Rock Group is also called a “SketchUp Firm” as all the landscape architects knows that it is very necessary to express their designs to clients in a decent and culinary way for which they use SketchUp in all their 3D projects for strong visualization. Modeling in 3D also helps their clients to understand fully about the site which gives them the feeling about the final project and also allow the architects to make any further change in the project. SketchUp helps them to import the linework of every concept and model them quickly that helps them to meet the deadlines and client meetings.
Reason to become total SketchUp techie: Trevor calls himself ‘total SketchUp nerd’ as he has been working with it since ten years, everyday and he loves SketchUp’s native commands as it gives him the ability to customize toolbars, help to find numerous groundbreaking extensions. According to him, SketchUp has any kind of extension for users for any field and the SketchUp Community forums have some of SketchUp Sages that will answer any asked questions by the users in a record time plus there is also other helpful users and SketchUp team members.
The team at Stock Rock Group: Though Trevor and his helpers is a part of a small team which is an 11 members team currently at Stack Rock Group and based in Boise, Idaho but has a growing office in Salt Lake City where they design projects all over the country like from California to Florida and everything in between. All the members know that they have the chance to make this firm exactly the place they want it to be, for which they are very serious and focused on their works. Moreover that, they don’t believe in finding the area f improvement rather they like to improve in every bit of their work. This little team is so dedicated and talented that it can handle a lot of projects around Boise like from small backyard planting, parks to medical and college campus, luxury residential properties, corporate campuses etc. and many more.
Some projects handled by the team: One of their main commercial projects was the HP campus located in Boise which is the first Sustainable SITES Initiative certified corporate campus in the world. SITES is the United States’ Green Building Council sustainable rating system for landscapes. This campus is above 200 acres where are 46 acres of moistened turf grass; 36 acres of active farmland etc. This project is like an investment in the local ecosystem services and as a sustainable model for site users and the community that become a huge success.
They are continuously focused on taking care their current clients and working on new projects; also unfinished with VR and alternatives rotes for rendering.
SketchUp or Google SketchUp is mainly a3D modeling computer program that is used for a broad range of drawing applications used by architects, interior designer, landscape architects, civil and mechanical engineers, film and video game designers also.
SketchUp can be getting as a freeware version named SketchUp Make and a paid version with many more extra benefits called SketchUp Pro. SketchUp is software from Trimble Company and there is an online library of free model congregations and 3D Warehouse to which users can add other models; besides that, the program has drawing layout functionality with variable ‘styles’, supports third-party ‘plug-in’ programs hosted on the Extension Warehouse to supply other abilities and enables placement of its models in Google Earth. As SketchUp users are most of architects, designers, builders, makers and engineers etc. who works hard to give a nice shape to our physical world, they need great tools to do the work. SketchUp is in mission to bring their best to produce some great tools for drawing as drawing is the key thing of the SketchUp users. They draw to search ideas, to identify the things and to show other people their work that they do with love and love to build; SketchUp understands it truly and trying to improve their software day by day.
Source: blog.sketchup.com/article/stack-rock-group-team-landscape-designers
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stephenmccull · 4 years
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Inside the Race to Build a Better $500 Emergency Ventilator
As the coronavirus crisis lit up this spring, headlines about how the U.S. could innovate its way out of a pending ventilator shortage landed almost as hard and fast as the pandemic itself.
The New Yorker featured “The MacGyvers Taking on the Ventilator Shortage,” an effort initiated not by a doctor or engineer but a blockchain activist. The University of Minnesota created a cheap ventilator called the Coventor; MIT had the MIT Emergency Ventilator; Rice University, the ApolloBVM. NASA created the VITAL, and a fitness monitor company got in the game with Fitbit Flow. The price tags varied from $150 for the Coventor to $10,000 for the Fitbit Flow — all significantly less than premium commercially available hospital ventilators, which can run $50,000 apiece.
Around the same time, C. Nataraj, a Villanova College of Engineering professor, was hearing from front-line doctors at Philadelphia hospitals fearful of running out of ventilators for COVID-19 patients. Compelled to help, Nataraj put together a volunteer SWAT team of engineering and medical talent to invent the ideal emergency ventilator. The goal: build something that could operate with at least 80% of the function of a typical hospital ventilator, but at 20% or less of the cost.
For decades, Nataraj has worked on medical projects — like finding a better way to diagnose a potentially deadly brain injury in premature infants — primarily with doctors at Children’s Hospital of Philadelphia and the Geisinger Health system in rural Pennsylvania, so key clinical players came together swiftly. By March 23, he had approached engineering faculty about collaborating on a monthslong effort to build the NovaVent, a basic, low-cost ventilator with parts that cost about $500. The schematics would be open-sourced, so others could use them free of charge to mass-manufacture the device.
The New Yorker wasn’t alone in referencing the ’80s TV series “MacGyver,” whose protagonist was a Swiss Army knife-carrying secret agent who got the job done with wits and whatever was at hand. The suggestion was that these ventilators were simple enough to throw together with parts from a medical supply closet or your neighborhood hardware store. “Everybody can make it,” one headline read, enticingly. These miracle machines, the thinking went, could be helpful in U.S. hospitals facing critical shortages, perhaps in cities surging with sick patients.
To understand the potential utility and true costs of these emergency ventilators, KHN followed Villanova’s team for three months as it developed, tested and prepared to submit the NovaVent for Food and Drug Administration approval.
The team tapped a maker of car parts, along with roboticists. It gathered input from anesthesiologists as well as electrical, mechanical, fluid systems and computer engineers. It tapped nurses to help ensure that users would immediately know how to operate the ventilator. Local manufacturers 3D-printed pieces of the machine.
Nataraj and his team realized that some of the other ultra-bare-bones machines wouldn’t meet the standards of the modern U.S. health care system. But they also believed there was a lot of room for Villanova’s team to innovate between those and the high-end, expensive devices from corporations like Philips or Medtronic.
One thing is clear: The $500 ventilator is something of a unicorn.
While the parts for the NovaVent cost about that much, the brainpower and people hours added uncounted value. In the early phases, the core group — all volunteers — worked 20 to 25 hours a week, Nataraj said, mainly via Zoom calls from home on top of their day jobs.
Teams of two or three were allowed into the lab to work — virtually the only people on campus. The effort, after all, was in line with the university’s Augustinian mission, which values the pursuit of knowledge, stewardship and community over the individual.
By the time they realized what they could achieve with the $500 model, the first wave of crisis had passed. Yet in those weeks, an alarm resounded across the land about the dismal state of America’s public health system.
So the NovaVent mission pivoted: build better low-cost vents for hospitals in poor and rural U.S. communities that have few, if any, ventilators.
One immediate legacy of the innovation happening at Villanova and elsewhere is the public-spirited nature of the effort, said Dr. Julian Goldman, an anesthesiologist at Massachusetts General Hospital who helps set standards for medical devices: “People from different walks of life in terms of their skills — engineers, clinicians, pure scientists — all thinking and working to try to figure out how to move very quickly to solve a national emergency with many dimensions: How do we make the patient safer? How do we make the caregiver safer? How do we deal with supply chain limitations?”
From other ventures, new designs have already been used as a jumping-off point to build emergency ventilators overseas. They’ve also bolstered New York City’s stockpile and could add to state and national reserves as well.
The early, urgent concerns about a looming ventilator shortage were well founded: On March 13, the U.S. had about 200,000 ventilators, according to the Society of Critical Care Medicine. But because of the surge of COVID patients, it was predicted the country could soon need as many as 960,000.
In early April, New York Gov. Andrew Cuomo said the state would run out of ventilators in six days, leaving doctors with the sort of grim calculation they’d heard about from hard-hit northern Italy: “If a person comes in and needs a ventilator and you don’t have a ventilator, the person dies.”
In Philadelphia, 12 miles east of Villanova, hospital administrators braced for shortages and reported short supplies of the drugs required to sedate patients on ventilators.
President Donald Trump invoked the Defense Production Act to get major manufacturers to make ventilators, though GM was already working on it. When GM signed a $500 million contract to deliver 30,000 ventilators to the U.S. government by August, the NovaVent team wondered whether its own efforts would be futile.
“We said, ‘Well, GM is making it. Why are we making it?’” Nataraj said. “But there was a lot of uncertainty with the epidemiological models. We didn’t know how bad it was going to get. Or [the curve] could completely collapse and there’d be no need at all.”
And for a few weeks, it did seem the worst was over. The rate of new cases began to slow in the nation’s early epicenters. Hot spots flared in nearly every pocket of the country, but those too were mostly contained.
People spilled back into normal life, gathering in backyards, beaches and bars. In June, news coverage moved on to the calls for racial justice and mass protests after the videotaped killing of George Floyd in the custody of Minneapolis police.
In the background, the highly contagious coronavirus tore across the South, through Florida, Georgia, Texas and Arizona, and surged in California. Some states reported ICU beds were quickly at or above capacity. This mercurial virus had proved uncontrollable, and the prospect of ventilator shortages had bubbled up once again.
***
Past pandemics have been mothers of innovation. Progress in mechanical ventilation began in earnest after a 1952 polio outbreak in Copenhagen, Denmark. According to the American Journal of Respiratory and Critical Care Medicine, 50 patients a day arrived at the Blegdams Infectious Disease Hospital. Many had paralyzed respiratory muscles; nearly 90% died.
An anesthesiologist at the hospital realized patients were dying from respiratory failure rather than renal failure, as was previously believed, and recommended forcing oxygen into the lungs of patients. This worked — mortality dropped to 40%. But one big problem remained: Patients had to be “hand-bagged,” with more than 1,500 medical students squeezing resuscitator bags for 165,000 total hours.
“They’d recruit nurses and medical students to stand there and squeeze a bag,” says Dr. S. Mark Poler, a Geisinger Health system anesthesiologist on the NovaVent team. “Sometimes they were just so exhausted that they would fall asleep and stop ventilating. It was obviously a catastrophe, so that was the motivation for creating mechanical ventilators.”
The first ones were simple machines, much like the basic emergency-use ventilators created during the COVID crisis. But those came with hazards such as damaging the lungs by forcing in too much air. More sophisticated machines would deliver better control. These engineering marvels — the monitors, the different modes of ventilation, the slick touch-screen controls designed to minimize the risk of injury or error — improved patient treatment but also drove costs sky-high.
The emergency ventilators of 2020 focused on models that, typically, used an Ambu bag and some sort of mechanical “arm” to squeeze it. Most people are familiar with Ambu bags from scenes in TV programs like “ER” where paramedics compress the manual resuscitator bags to help patients breathe as they’re rushed inside from an ambulance. The bags are already widely available in hospitals, cost $30 to $40 and are FDA-approved.
But making machines that are that simple could render them effectively useless (or, worse, dangerous). Medical experts watching university and hospital teams coalesce across the country this spring to develop low-cost emergency ventilators took notice — and worried.
***
Goldman, the Massachusetts General anesthesiologist, was among the medical experts nervous about all the slapped-together ventilators.
“We had the maker community being stood up very quickly, but they don’t know what they don’t know,” said Goldman, chair of the COVID-19 working group for the Association for the Advancement of Medical Instrumentation, the primary source of standards for the medical device industry. “There were videos of harebrained ideas for building ventilators online by people who don’t know any better, and we were very concerned about that.”
The general public doesn’t really understand the nuances required to build a safe medical device, Goldman said.
“They look at something and think, well, this can’t be that hard to build. It just blows air,” he said. “‘I’ll take a vacuum cleaner and turn it on reverse. … It’s a ventilator!’”
AAMI wanted to encourage innovation, but also safety. So Goldman assembled a meeting of 38 engineers, regulators and clinicians to quickly write boiled-down guidelines for emergency-use ventilators.
The simplest ventilators were based on the idea of a piston in a car engine, Poler said: Put a piston on a crankshaft, hook it up to a motor and use a paddle or “arm” to compress the Ambu bag.
“It’s better than no ventilator at all, but it goes at one speed. It doesn’t really have any controls,” Poler said — not ideal when patients need to be monitored for changes in how their lungs are responding, or not, to treatment.
Villanova’s team of engineers, doctors and nurses realized that the simplest ventilators, the ones that AAMI was concerned about, seemed to ignore some basic, practical considerations: What sort of hospitals would these be used in, and under what conditions? What sorts of patients would be put on these ventilators? For how long? Would they be used as backups for higher-end ventilators? What about error alarms?
All good questions, Poler said, but the answer to all of them essentially is “we hope to never use these.”
Their best use? “A surge situation where you simply don’t have enough of the sophisticated ventilators.”
***
Rather than go totally bare-bones, the Villanova team designed the devices as though they would one day be deployed in modern health care.
Flow sensors, which monitor patient ventilation, cost several hundred dollars, so the team designed its own in the lab and 3D-printed it at a cost of 50 cents, Nataraj said, enabled by strides in 3D-printing technology that have vastly cut the price of so many devices. Southco, a Pennsylvania-based global manufacturer that makes parts like the latch on your car’s glove box, was tapped to use its 3D printers to make airflow tubes and couplings for the ventilator.
Garrett Clayton, director of Villanova’s Center for Nonlinear Dynamics and Control, was the day-to-day keeper of the prototype. He was particularly excited about the addition of a handle, which made it easier for him, and eventually others, to lug the 20-pound device from the lab to home and back.
Clayton’s computerized control system measures the flow rate of air going into the patient and converts it into volume, much as commercial ventilators do. That controls how hard and fast the Ambu bag is squeezed; it’s made of a hobby-grade Arduino microcontroller board. A direct-current motor attached to a linear actuator with a fist-shaped piece of PVC on the end pushes the bag in and out. The operator of the ventilator can control the respiratory rate (the number of breaths per minute), as well as the ratio between inspiration and expiration and the volume of air going in.
While traditional ventilators have many control methods, Clayton’s team focused on just one: how much volume is forced into the airway. “We have a set point so we don’t damage the lung,” he said.
Polly Tremoulet, a research psychologist and human factors consultant for ECRI and Children’s Hospital of Philadelphia, was pulled in to focus on error messages and make sure the ventilators’ buttons and displays “spoke the user’s language,” whether that user was an anesthesiologist in New Jersey or a nurse in India pulled into an ICU COVID ward.
Graduate student Emily Hylton and other nursing students were brought in to provide feedback about using the NovaVent and ask questions such as: Would all the controls and monitors look familiar to nurses at the bedside?
The very prospect of these low-cost devices is relatively new, Nataraj said, because of the price of microcontrollers with any real capacity: “Twenty years ago, they cost, oh gosh, $20,000 — and now they’re $20.”
By May 30, the first NovaVent prototype was complete. It was successfully tested on an artificial lung at Children’s Hospital of Philadelphia on June 12. Villanova has applied for a patent for the NovaVent, to help ensure it won’t be commercialized by others.
“If you make it free without having a patent, other people can take it and charge for it,” Clayton said. “A patent protects the open-source nature of it.”
Once a provisional patent is received, the team will submit the ventilator for Emergency Use Authorization from the FDA — hewing to the guidelines set up by AAMI.
***
Within weeks of kicking off the NovaVent project, the curve in the East Coast had indeed flattened, and states had enough standard ventilators to treat every patient. The life-threatening ventilator shortage had not materialized. Some of the emergency-use ventilators based on designs by other teams, like the one at MIT, did go into production — but even those didn’t end up in hospitals, and instead went into city stockpiles meant to reduce potential future reliance on the federal government. So the Villanova team seized on a new, global mission.
“We thought if it wasn’t useful in the U.S. market,” Nataraj said, “we know the developing world, especially sub-Saharan Africa, Latin America and Central America, they don’t have the same kind of facilities that we do here.”
Where the ventilators might end up remains to be seen. Early on, Pennsylvania showed interest in helping Villanova find manufacturing partners. The team has spoken with engineers in India, Cambodia and Sudan (which reportedly has only 80 ventilators in the entire country) who are interested in possibly finding a way to manufacture the NovaVent.
Six thousand emergency ventilators based on the design by the University of Minnesota have been manufactured in the U.S., according to Dr. Stephen Richardson, a cardiac anesthesiologist who worked on that project. Three thousand were made by North Dakota aviation and agricultural manufacturer Appareo for state emergency stockpiles in North Dakota and South Dakota. UnitedHealth Group provided $3 million in funding to manufacture another 3,000 units made by Boston Scientific, which were donated to countries like Peru and Honduras through U.S. organizations; others were sent to the U.S. government.
Like the Villanova team, Richardson said he thinks the most promising potential for these ventilators is in developing countries.
“When we were arranging to get these donated to Honduras, we were speaking with a physician who was telling me that [at] his hospital right now, the med students are just hand-ventilating patients. For everything, and for COVID specifically,” Richardson said. “Right now, in Pakistan or in any low-resource country, a family member is hand-ventilating a toddler. Before COVID and after COVID, this is a problem.”
For Poler, the project was a reminder that the country needs to tend to its stockpiles. “People were thinking about [ventilator reserves] in the ’90s, and then they basically quit thinking about it,” he said. “COVID is a shocking reminder that we shouldn’t have stopped thinking about it.”
Goldman said the national efforts may not result in a flood of cheap ventilators in U.S. hospitals. International use could also be tricky. In countries with few resources, even very low-cost ventilators may not be feasible because of lack of electricity or compressed oxygen, though there is “potentially a sweet spot of need and capability where these things could be deployed.”
On the upside, he said, the pandemic kicked off a nearly unprecedented global engineering effort to share information and solve the problem.
“If there’s going to be a magic bullet to come out of this, it’s going to be the capability of our communities and our infrastructure,” he said. “People stood up, put in the appropriate processes and spirit, worked hard, made it happen. We’ve added resilience to the health care sector. That’s the outcome here.”
As for the NovaVent, team members were relieved they didn’t have to rush it into manufacturing as COVID-19 was ripping through the Northeast this spring, thanks to aggressive efforts to flatten the curve. “We ended up without a ventilator shortage, which is excellent,” Clayton said. “But with the increase in cases now, it’s very possible some of them may get used.”
To build on the project, Villanova is raising money for a laboratory for affordable medical technologies called NovaMed. The lab formalizes the process of making inexpensive medical equipment that follows the 80-20 function-to-cost rule. The university says the lab is “motivated by the belief that income should not determine who has access to lifesaving care.”
The effort to prevent a ventilator shortage, Nataraj said, made him think more critically about the American health care system overall.
“How come we haven’t built the technology, the economic and social systems that are able to handle a situation like this — especially when something like this was predicted?” he said. “It’s absolute nonsense. Why should a single person die because we weren’t prepared?”
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
USE OUR CONTENT
This story can be republished for free (details).
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gordonwilliamsweb · 4 years
Text
Inside the Race to Build a Better $500 Emergency Ventilator
As the coronavirus crisis lit up this spring, headlines about how the U.S. could innovate its way out of a pending ventilator shortage landed almost as hard and fast as the pandemic itself.
The New Yorker featured “The MacGyvers Taking on the Ventilator Shortage,” an effort initiated not by a doctor or engineer but a blockchain activist. The University of Minnesota created a cheap ventilator called the Coventor; MIT had the MIT Emergency Ventilator; Rice University, the ApolloBVM. NASA created the VITAL, and a fitness monitor company got in the game with Fitbit Flow. The price tags varied from $150 for the Coventor to $10,000 for the Fitbit Flow — all significantly less than premium commercially available hospital ventilators, which can run $50,000 apiece.
Around the same time, C. Nataraj, a Villanova College of Engineering professor, was hearing from front-line doctors at Philadelphia hospitals fearful of running out of ventilators for COVID-19 patients. Compelled to help, Nataraj put together a volunteer SWAT team of engineering and medical talent to invent the ideal emergency ventilator. The goal: build something that could operate with at least 80% of the function of a typical hospital ventilator, but at 20% or less of the cost.
For decades, Nataraj has worked on medical projects — like finding a better way to diagnose a potentially deadly brain injury in premature infants — primarily with doctors at Children’s Hospital of Philadelphia and the Geisinger Health system in rural Pennsylvania, so key clinical players came together swiftly. By March 23, he had approached engineering faculty about collaborating on a monthslong effort to build the NovaVent, a basic, low-cost ventilator with parts that cost about $500. The schematics would be open-sourced, so others could use them free of charge to mass-manufacture the device.
The New Yorker wasn’t alone in referencing the ’80s TV series “MacGyver,” whose protagonist was a Swiss Army knife-carrying secret agent who got the job done with wits and whatever was at hand. The suggestion was that these ventilators were simple enough to throw together with parts from a medical supply closet or your neighborhood hardware store. “Everybody can make it,” one headline read, enticingly. These miracle machines, the thinking went, could be helpful in U.S. hospitals facing critical shortages, perhaps in cities surging with sick patients.
To understand the potential utility and true costs of these emergency ventilators, KHN followed Villanova’s team for three months as it developed, tested and prepared to submit the NovaVent for Food and Drug Administration approval.
The team tapped a maker of car parts, along with roboticists. It gathered input from anesthesiologists as well as electrical, mechanical, fluid systems and computer engineers. It tapped nurses to help ensure that users would immediately know how to operate the ventilator. Local manufacturers 3D-printed pieces of the machine.
Nataraj and his team realized that some of the other ultra-bare-bones machines wouldn’t meet the standards of the modern U.S. health care system. But they also believed there was a lot of room for Villanova’s team to innovate between those and the high-end, expensive devices from corporations like Philips or Medtronic.
One thing is clear: The $500 ventilator is something of a unicorn.
While the parts for the NovaVent cost about that much, the brainpower and people hours added uncounted value. In the early phases, the core group — all volunteers — worked 20 to 25 hours a week, Nataraj said, mainly via Zoom calls from home on top of their day jobs.
Teams of two or three were allowed into the lab to work — virtually the only people on campus. The effort, after all, was in line with the university’s Augustinian mission, which values the pursuit of knowledge, stewardship and community over the individual.
By the time they realized what they could achieve with the $500 model, the first wave of crisis had passed. Yet in those weeks, an alarm resounded across the land about the dismal state of America’s public health system.
So the NovaVent mission pivoted: build better low-cost vents for hospitals in poor and rural U.S. communities that have few, if any, ventilators.
One immediate legacy of the innovation happening at Villanova and elsewhere is the public-spirited nature of the effort, said Dr. Julian Goldman, an anesthesiologist at Massachusetts General Hospital who helps set standards for medical devices: “People from different walks of life in terms of their skills — engineers, clinicians, pure scientists — all thinking and working to try to figure out how to move very quickly to solve a national emergency with many dimensions: How do we make the patient safer? How do we make the caregiver safer? How do we deal with supply chain limitations?”
From other ventures, new designs have already been used as a jumping-off point to build emergency ventilators overseas. They’ve also bolstered New York City’s stockpile and could add to state and national reserves as well.
The early, urgent concerns about a looming ventilator shortage were well founded: On March 13, the U.S. had about 200,000 ventilators, according to the Society of Critical Care Medicine. But because of the surge of COVID patients, it was predicted the country could soon need as many as 960,000.
In early April, New York Gov. Andrew Cuomo said the state would run out of ventilators in six days, leaving doctors with the sort of grim calculation they’d heard about from hard-hit northern Italy: “If a person comes in and needs a ventilator and you don’t have a ventilator, the person dies.”
In Philadelphia, 12 miles east of Villanova, hospital administrators braced for shortages and reported short supplies of the drugs required to sedate patients on ventilators.
President Donald Trump invoked the Defense Production Act to get major manufacturers to make ventilators, though GM was already working on it. When GM signed a $500 million contract to deliver 30,000 ventilators to the U.S. government by August, the NovaVent team wondered whether its own efforts would be futile.
“We said, ‘Well, GM is making it. Why are we making it?’” Nataraj said. “But there was a lot of uncertainty with the epidemiological models. We didn’t know how bad it was going to get. Or [the curve] could completely collapse and there’d be no need at all.”
And for a few weeks, it did seem the worst was over. The rate of new cases began to slow in the nation’s early epicenters. Hot spots flared in nearly every pocket of the country, but those too were mostly contained.
People spilled back into normal life, gathering in backyards, beaches and bars. In June, news coverage moved on to the calls for racial justice and mass protests after the videotaped killing of George Floyd in the custody of Minneapolis police.
In the background, the highly contagious coronavirus tore across the South, through Florida, Georgia, Texas and Arizona, and surged in California. Some states reported ICU beds were quickly at or above capacity. This mercurial virus had proved uncontrollable, and the prospect of ventilator shortages had bubbled up once again.
***
Past pandemics have been mothers of innovation. Progress in mechanical ventilation began in earnest after a 1952 polio outbreak in Copenhagen, Denmark. According to the American Journal of Respiratory and Critical Care Medicine, 50 patients a day arrived at the Blegdams Infectious Disease Hospital. Many had paralyzed respiratory muscles; nearly 90% died.
An anesthesiologist at the hospital realized patients were dying from respiratory failure rather than renal failure, as was previously believed, and recommended forcing oxygen into the lungs of patients. This worked — mortality dropped to 40%. But one big problem remained: Patients had to be “hand-bagged,” with more than 1,500 medical students squeezing resuscitator bags for 165,000 total hours.
“They’d recruit nurses and medical students to stand there and squeeze a bag,” says Dr. S. Mark Poler, a Geisinger Health system anesthesiologist on the NovaVent team. “Sometimes they were just so exhausted that they would fall asleep and stop ventilating. It was obviously a catastrophe, so that was the motivation for creating mechanical ventilators.”
The first ones were simple machines, much like the basic emergency-use ventilators created during the COVID crisis. But those came with hazards such as damaging the lungs by forcing in too much air. More sophisticated machines would deliver better control. These engineering marvels — the monitors, the different modes of ventilation, the slick touch-screen controls designed to minimize the risk of injury or error — improved patient treatment but also drove costs sky-high.
The emergency ventilators of 2020 focused on models that, typically, used an Ambu bag and some sort of mechanical “arm” to squeeze it. Most people are familiar with Ambu bags from scenes in TV programs like “ER” where paramedics compress the manual resuscitator bags to help patients breathe as they’re rushed inside from an ambulance. The bags are already widely available in hospitals, cost $30 to $40 and are FDA-approved.
But making machines that are that simple could render them effectively useless (or, worse, dangerous). Medical experts watching university and hospital teams coalesce across the country this spring to develop low-cost emergency ventilators took notice — and worried.
***
Goldman, the Massachusetts General anesthesiologist, was among the medical experts nervous about all the slapped-together ventilators.
“We had the maker community being stood up very quickly, but they don’t know what they don’t know,” said Goldman, chair of the COVID-19 working group for the Association for the Advancement of Medical Instrumentation, the primary source of standards for the medical device industry. “There were videos of harebrained ideas for building ventilators online by people who don’t know any better, and we were very concerned about that.”
The general public doesn’t really understand the nuances required to build a safe medical device, Goldman said.
“They look at something and think, well, this can’t be that hard to build. It just blows air,” he said. “‘I’ll take a vacuum cleaner and turn it on reverse. … It’s a ventilator!’”
AAMI wanted to encourage innovation, but also safety. So Goldman assembled a meeting of 38 engineers, regulators and clinicians to quickly write boiled-down guidelines for emergency-use ventilators.
The simplest ventilators were based on the idea of a piston in a car engine, Poler said: Put a piston on a crankshaft, hook it up to a motor and use a paddle or “arm” to compress the Ambu bag.
“It’s better than no ventilator at all, but it goes at one speed. It doesn’t really have any controls,” Poler said — not ideal when patients need to be monitored for changes in how their lungs are responding, or not, to treatment.
Villanova’s team of engineers, doctors and nurses realized that the simplest ventilators, the ones that AAMI was concerned about, seemed to ignore some basic, practical considerations: What sort of hospitals would these be used in, and under what conditions? What sorts of patients would be put on these ventilators? For how long? Would they be used as backups for higher-end ventilators? What about error alarms?
All good questions, Poler said, but the answer to all of them essentially is “we hope to never use these.”
Their best use? “A surge situation where you simply don’t have enough of the sophisticated ventilators.”
***
Rather than go totally bare-bones, the Villanova team designed the devices as though they would one day be deployed in modern health care.
Flow sensors, which monitor patient ventilation, cost several hundred dollars, so the team designed its own in the lab and 3D-printed it at a cost of 50 cents, Nataraj said, enabled by strides in 3D-printing technology that have vastly cut the price of so many devices. Southco, a Pennsylvania-based global manufacturer that makes parts like the latch on your car’s glove box, was tapped to use its 3D printers to make airflow tubes and couplings for the ventilator.
Garrett Clayton, director of Villanova’s Center for Nonlinear Dynamics and Control, was the day-to-day keeper of the prototype. He was particularly excited about the addition of a handle, which made it easier for him, and eventually others, to lug the 20-pound device from the lab to home and back.
Clayton’s computerized control system measures the flow rate of air going into the patient and converts it into volume, much as commercial ventilators do. That controls how hard and fast the Ambu bag is squeezed; it’s made of a hobby-grade Arduino microcontroller board. A direct-current motor attached to a linear actuator with a fist-shaped piece of PVC on the end pushes the bag in and out. The operator of the ventilator can control the respiratory rate (the number of breaths per minute), as well as the ratio between inspiration and expiration and the volume of air going in.
While traditional ventilators have many control methods, Clayton’s team focused on just one: how much volume is forced into the airway. “We have a set point so we don’t damage the lung,” he said.
Polly Tremoulet, a research psychologist and human factors consultant for ECRI and Children’s Hospital of Philadelphia, was pulled in to focus on error messages and make sure the ventilators’ buttons and displays “spoke the user’s language,” whether that user was an anesthesiologist in New Jersey or a nurse in India pulled into an ICU COVID ward.
Graduate student Emily Hylton and other nursing students were brought in to provide feedback about using the NovaVent and ask questions such as: Would all the controls and monitors look familiar to nurses at the bedside?
The very prospect of these low-cost devices is relatively new, Nataraj said, because of the price of microcontrollers with any real capacity: “Twenty years ago, they cost, oh gosh, $20,000 — and now they’re $20.”
By May 30, the first NovaVent prototype was complete. It was successfully tested on an artificial lung at Children’s Hospital of Philadelphia on June 12. Villanova has applied for a patent for the NovaVent, to help ensure it won’t be commercialized by others.
“If you make it free without having a patent, other people can take it and charge for it,” Clayton said. “A patent protects the open-source nature of it.”
Once a provisional patent is received, the team will submit the ventilator for Emergency Use Authorization from the FDA — hewing to the guidelines set up by AAMI.
***
Within weeks of kicking off the NovaVent project, the curve in the East Coast had indeed flattened, and states had enough standard ventilators to treat every patient. The life-threatening ventilator shortage had not materialized. Some of the emergency-use ventilators based on designs by other teams, like the one at MIT, did go into production — but even those didn’t end up in hospitals, and instead went into city stockpiles meant to reduce potential future reliance on the federal government. So the Villanova team seized on a new, global mission.
“We thought if it wasn’t useful in the U.S. market,” Nataraj said, “we know the developing world, especially sub-Saharan Africa, Latin America and Central America, they don’t have the same kind of facilities that we do here.”
Where the ventilators might end up remains to be seen. Early on, Pennsylvania showed interest in helping Villanova find manufacturing partners. The team has spoken with engineers in India, Cambodia and Sudan (which reportedly has only 80 ventilators in the entire country) who are interested in possibly finding a way to manufacture the NovaVent.
Six thousand emergency ventilators based on the design by the University of Minnesota have been manufactured in the U.S., according to Dr. Stephen Richardson, a cardiac anesthesiologist who worked on that project. Three thousand were made by North Dakota aviation and agricultural manufacturer Appareo for state emergency stockpiles in North Dakota and South Dakota. UnitedHealth Group provided $3 million in funding to manufacture another 3,000 units made by Boston Scientific, which were donated to countries like Peru and Honduras through U.S. organizations; others were sent to the U.S. government.
Like the Villanova team, Richardson said he thinks the most promising potential for these ventilators is in developing countries.
“When we were arranging to get these donated to Honduras, we were speaking with a physician who was telling me that [at] his hospital right now, the med students are just hand-ventilating patients. For everything, and for COVID specifically,” Richardson said. “Right now, in Pakistan or in any low-resource country, a family member is hand-ventilating a toddler. Before COVID and after COVID, this is a problem.”
For Poler, the project was a reminder that the country needs to tend to its stockpiles. “People were thinking about [ventilator reserves] in the ’90s, and then they basically quit thinking about it,” he said. “COVID is a shocking reminder that we shouldn’t have stopped thinking about it.”
Goldman said the national efforts may not result in a flood of cheap ventilators in U.S. hospitals. International use could also be tricky. In countries with few resources, even very low-cost ventilators may not be feasible because of lack of electricity or compressed oxygen, though there is “potentially a sweet spot of need and capability where these things could be deployed.”
On the upside, he said, the pandemic kicked off a nearly unprecedented global engineering effort to share information and solve the problem.
“If there’s going to be a magic bullet to come out of this, it’s going to be the capability of our communities and our infrastructure,” he said. “People stood up, put in the appropriate processes and spirit, worked hard, made it happen. We’ve added resilience to the health care sector. That’s the outcome here.”
As for the NovaVent, team members were relieved they didn’t have to rush it into manufacturing as COVID-19 was ripping through the Northeast this spring, thanks to aggressive efforts to flatten the curve. “We ended up without a ventilator shortage, which is excellent,” Clayton said. “But with the increase in cases now, it’s very possible some of them may get used.”
To build on the project, Villanova is raising money for a laboratory for affordable medical technologies called NovaMed. The lab formalizes the process of making inexpensive medical equipment that follows the 80-20 function-to-cost rule. The university says the lab is “motivated by the belief that income should not determine who has access to lifesaving care.”
The effort to prevent a ventilator shortage, Nataraj said, made him think more critically about the American health care system overall.
“How come we haven’t built the technology, the economic and social systems that are able to handle a situation like this — especially when something like this was predicted?” he said. “It’s absolute nonsense. Why should a single person die because we weren’t prepared?”
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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letsjonebenblog · 2 years
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dinafbrownil · 4 years
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Inside the Race to Build a Better $500 Emergency Ventilator
As the coronavirus crisis lit up this spring, headlines about how the U.S. could innovate its way out of a pending ventilator shortage landed almost as hard and fast as the pandemic itself.
The New Yorker featured “The MacGyvers Taking on the Ventilator Shortage,” an effort initiated not by a doctor or engineer but a blockchain activist. The University of Minnesota created a cheap ventilator called the Coventor; MIT had the MIT Emergency Ventilator; Rice University, the ApolloBVM. NASA created the VITAL, and a fitness monitor company got in the game with Fitbit Flow. The price tags varied from $150 for the Coventor to $10,000 for the Fitbit Flow — all significantly less than premium commercially available hospital ventilators, which can run $50,000 apiece.
Around the same time, C. Nataraj, a Villanova College of Engineering professor, was hearing from front-line doctors at Philadelphia hospitals fearful of running out of ventilators for COVID-19 patients. Compelled to help, Nataraj put together a volunteer SWAT team of engineering and medical talent to invent the ideal emergency ventilator. The goal: build something that could operate with at least 80% of the function of a typical hospital ventilator, but at 20% or less of the cost.
For decades, Nataraj has worked on medical projects — like finding a better way to diagnose a potentially deadly brain injury in premature infants — primarily with doctors at Children’s Hospital of Philadelphia and the Geisinger Health system in rural Pennsylvania, so key clinical players came together swiftly. By March 23, he had approached engineering faculty about collaborating on a monthslong effort to build the NovaVent, a basic, low-cost ventilator with parts that cost about $500. The schematics would be open-sourced, so others could use them free of charge to mass-manufacture the device.
The New Yorker wasn’t alone in referencing the ’80s TV series “MacGyver,” whose protagonist was a Swiss Army knife-carrying secret agent who got the job done with wits and whatever was at hand. The suggestion was that these ventilators were simple enough to throw together with parts from a medical supply closet or your neighborhood hardware store. “Everybody can make it,” one headline read, enticingly. These miracle machines, the thinking went, could be helpful in U.S. hospitals facing critical shortages, perhaps in cities surging with sick patients.
To understand the potential utility and true costs of these emergency ventilators, KHN followed Villanova’s team for three months as it developed, tested and prepared to submit the NovaVent for Food and Drug Administration approval.
The team tapped a maker of car parts, along with roboticists. It gathered input from anesthesiologists as well as electrical, mechanical, fluid systems and computer engineers. It tapped nurses to help ensure that users would immediately know how to operate the ventilator. Local manufacturers 3D-printed pieces of the machine.
Nataraj and his team realized that some of the other ultra-bare-bones machines wouldn’t meet the standards of the modern U.S. health care system. But they also believed there was a lot of room for Villanova’s team to innovate between those and the high-end, expensive devices from corporations like Philips or Medtronic.
One thing is clear: The $500 ventilator is something of a unicorn.
While the parts for the NovaVent cost about that much, the brainpower and people hours added uncounted value. In the early phases, the core group — all volunteers — worked 20 to 25 hours a week, Nataraj said, mainly via Zoom calls from home on top of their day jobs.
Teams of two or three were allowed into the lab to work — virtually the only people on campus. The effort, after all, was in line with the university’s Augustinian mission, which values the pursuit of knowledge, stewardship and community over the individual.
By the time they realized what they could achieve with the $500 model, the first wave of crisis had passed. Yet in those weeks, an alarm resounded across the land about the dismal state of America’s public health system.
So the NovaVent mission pivoted: build better low-cost vents for hospitals in poor and rural U.S. communities that have few, if any, ventilators.
One immediate legacy of the innovation happening at Villanova and elsewhere is the public-spirited nature of the effort, said Dr. Julian Goldman, an anesthesiologist at Massachusetts General Hospital who helps set standards for medical devices: “People from different walks of life in terms of their skills — engineers, clinicians, pure scientists ��� all thinking and working to try to figure out how to move very quickly to solve a national emergency with many dimensions: How do we make the patient safer? How do we make the caregiver safer? How do we deal with supply chain limitations?”
From other ventures, new designs have already been used as a jumping-off point to build emergency ventilators overseas. They’ve also bolstered New York City’s stockpile and could add to state and national reserves as well.
The early, urgent concerns about a looming ventilator shortage were well founded: On March 13, the U.S. had about 200,000 ventilators, according to the Society of Critical Care Medicine. But because of the surge of COVID patients, it was predicted the country could soon need as many as 960,000.
In early April, New York Gov. Andrew Cuomo said the state would run out of ventilators in six days, leaving doctors with the sort of grim calculation they’d heard about from hard-hit northern Italy: “If a person comes in and needs a ventilator and you don’t have a ventilator, the person dies.”
In Philadelphia, 12 miles east of Villanova, hospital administrators braced for shortages and reported short supplies of the drugs required to sedate patients on ventilators.
President Donald Trump invoked the Defense Production Act to get major manufacturers to make ventilators, though GM was already working on it. When GM signed a $500 million contract to deliver 30,000 ventilators to the U.S. government by August, the NovaVent team wondered whether its own efforts would be futile.
“We said, ‘Well, GM is making it. Why are we making it?’” Nataraj said. “But there was a lot of uncertainty with the epidemiological models. We didn’t know how bad it was going to get. Or [the curve] could completely collapse and there’d be no need at all.”
And for a few weeks, it did seem the worst was over. The rate of new cases began to slow in the nation’s early epicenters. Hot spots flared in nearly every pocket of the country, but those too were mostly contained.
People spilled back into normal life, gathering in backyards, beaches and bars. In June, news coverage moved on to the calls for racial justice and mass protests after the videotaped killing of George Floyd in the custody of Minneapolis police.
In the background, the highly contagious coronavirus tore across the South, through Florida, Georgia, Texas and Arizona, and surged in California. Some states reported ICU beds were quickly at or above capacity. This mercurial virus had proved uncontrollable, and the prospect of ventilator shortages had bubbled up once again.
***
Past pandemics have been mothers of innovation. Progress in mechanical ventilation began in earnest after a 1952 polio outbreak in Copenhagen, Denmark. According to the American Journal of Respiratory and Critical Care Medicine, 50 patients a day arrived at the Blegdams Infectious Disease Hospital. Many had paralyzed respiratory muscles; nearly 90% died.
An anesthesiologist at the hospital realized patients were dying from respiratory failure rather than renal failure, as was previously believed, and recommended forcing oxygen into the lungs of patients. This worked — mortality dropped to 40%. But one big problem remained: Patients had to be “hand-bagged,” with more than 1,500 medical students squeezing resuscitator bags for 165,000 total hours.
“They’d recruit nurses and medical students to stand there and squeeze a bag,” says Dr. S. Mark Poler, a Geisinger Health system anesthesiologist on the NovaVent team. “Sometimes they were just so exhausted that they would fall asleep and stop ventilating. It was obviously a catastrophe, so that was the motivation for creating mechanical ventilators.”
The first ones were simple machines, much like the basic emergency-use ventilators created during the COVID crisis. But those came with hazards such as damaging the lungs by forcing in too much air. More sophisticated machines would deliver better control. These engineering marvels — the monitors, the different modes of ventilation, the slick touch-screen controls designed to minimize the risk of injury or error — improved patient treatment but also drove costs sky-high.
The emergency ventilators of 2020 focused on models that, typically, used an Ambu bag and some sort of mechanical “arm” to squeeze it. Most people are familiar with Ambu bags from scenes in TV programs like “ER” where paramedics compress the manual resuscitator bags to help patients breathe as they’re rushed inside from an ambulance. The bags are already widely available in hospitals, cost $30 to $40 and are FDA-approved.
But making machines that are that simple could render them effectively useless (or, worse, dangerous). Medical experts watching university and hospital teams coalesce across the country this spring to develop low-cost emergency ventilators took notice — and worried.
***
Goldman, the Massachusetts General anesthesiologist, was among the medical experts nervous about all the slapped-together ventilators.
“We had the maker community being stood up very quickly, but they don’t know what they don’t know,” said Goldman, chair of the COVID-19 working group for the Association for the Advancement of Medical Instrumentation, the primary source of standards for the medical device industry. “There were videos of harebrained ideas for building ventilators online by people who don’t know any better, and we were very concerned about that.”
The general public doesn’t really understand the nuances required to build a safe medical device, Goldman said.
“They look at something and think, well, this can’t be that hard to build. It just blows air,” he said. “‘I’ll take a vacuum cleaner and turn it on reverse. … It’s a ventilator!’”
AAMI wanted to encourage innovation, but also safety. So Goldman assembled a meeting of 38 engineers, regulators and clinicians to quickly write boiled-down guidelines for emergency-use ventilators.
The simplest ventilators were based on the idea of a piston in a car engine, Poler said: Put a piston on a crankshaft, hook it up to a motor and use a paddle or “arm” to compress the Ambu bag.
“It’s better than no ventilator at all, but it goes at one speed. It doesn’t really have any controls,” Poler said — not ideal when patients need to be monitored for changes in how their lungs are responding, or not, to treatment.
Villanova’s team of engineers, doctors and nurses realized that the simplest ventilators, the ones that AAMI was concerned about, seemed to ignore some basic, practical considerations: What sort of hospitals would these be used in, and under what conditions? What sorts of patients would be put on these ventilators? For how long? Would they be used as backups for higher-end ventilators? What about error alarms?
All good questions, Poler said, but the answer to all of them essentially is “we hope to never use these.”
Their best use? “A surge situation where you simply don’t have enough of the sophisticated ventilators.”
***
Rather than go totally bare-bones, the Villanova team designed the devices as though they would one day be deployed in modern health care.
Flow sensors, which monitor patient ventilation, cost several hundred dollars, so the team designed its own in the lab and 3D-printed it at a cost of 50 cents, Nataraj said, enabled by strides in 3D-printing technology that have vastly cut the price of so many devices. Southco, a Pennsylvania-based global manufacturer that makes parts like the latch on your car’s glove box, was tapped to use its 3D printers to make airflow tubes and couplings for the ventilator.
Garrett Clayton, director of Villanova’s Center for Nonlinear Dynamics and Control, was the day-to-day keeper of the prototype. He was particularly excited about the addition of a handle, which made it easier for him, and eventually others, to lug the 20-pound device from the lab to home and back.
Clayton’s computerized control system measures the flow rate of air going into the patient and converts it into volume, much as commercial ventilators do. That controls how hard and fast the Ambu bag is squeezed; it’s made of a hobby-grade Arduino microcontroller board. A direct-current motor attached to a linear actuator with a fist-shaped piece of PVC on the end pushes the bag in and out. The operator of the ventilator can control the respiratory rate (the number of breaths per minute), as well as the ratio between inspiration and expiration and the volume of air going in.
While traditional ventilators have many control methods, Clayton’s team focused on just one: how much volume is forced into the airway. “We have a set point so we don’t damage the lung,” he said.
Polly Tremoulet, a research psychologist and human factors consultant for ECRI and Children’s Hospital of Philadelphia, was pulled in to focus on error messages and make sure the ventilators’ buttons and displays “spoke the user’s language,” whether that user was an anesthesiologist in New Jersey or a nurse in India pulled into an ICU COVID ward.
Graduate student Emily Hylton and other nursing students were brought in to provide feedback about using the NovaVent and ask questions such as: Would all the controls and monitors look familiar to nurses at the bedside?
The very prospect of these low-cost devices is relatively new, Nataraj said, because of the price of microcontrollers with any real capacity: “Twenty years ago, they cost, oh gosh, $20,000 — and now they’re $20.”
By May 30, the first NovaVent prototype was complete. It was successfully tested on an artificial lung at Children’s Hospital of Philadelphia on June 12. Villanova has applied for a patent for the NovaVent, to help ensure it won’t be commercialized by others.
“If you make it free without having a patent, other people can take it and charge for it,” Clayton said. “A patent protects the open-source nature of it.”
Once a provisional patent is received, the team will submit the ventilator for Emergency Use Authorization from the FDA — hewing to the guidelines set up by AAMI.
***
Within weeks of kicking off the NovaVent project, the curve in the East Coast had indeed flattened, and states had enough standard ventilators to treat every patient. The life-threatening ventilator shortage had not materialized. Some of the emergency-use ventilators based on designs by other teams, like the one at MIT, did go into production — but even those didn’t end up in hospitals, and instead went into city stockpiles meant to reduce potential future reliance on the federal government. So the Villanova team seized on a new, global mission.
“We thought if it wasn’t useful in the U.S. market,” Nataraj said, “we know the developing world, especially sub-Saharan Africa, Latin America and Central America, they don’t have the same kind of facilities that we do here.”
Where the ventilators might end up remains to be seen. Early on, Pennsylvania showed interest in helping Villanova find manufacturing partners. The team has spoken with engineers in India, Cambodia and Sudan (which reportedly has only 80 ventilators in the entire country) who are interested in possibly finding a way to manufacture the NovaVent.
Six thousand emergency ventilators based on the design by the University of Minnesota have been manufactured in the U.S., according to Dr. Stephen Richardson, a cardiac anesthesiologist who worked on that project. Three thousand were made by North Dakota aviation and agricultural manufacturer Appareo for state emergency stockpiles in North Dakota and South Dakota. UnitedHealth Group provided $3 million in funding to manufacture another 3,000 units made by Boston Scientific, which were donated to countries like Peru and Honduras through U.S. organizations; others were sent to the U.S. government.
Like the Villanova team, Richardson said he thinks the most promising potential for these ventilators is in developing countries.
“When we were arranging to get these donated to Honduras, we were speaking with a physician who was telling me that [at] his hospital right now, the med students are just hand-ventilating patients. For everything, and for COVID specifically,” Richardson said. “Right now, in Pakistan or in any low-resource country, a family member is hand-ventilating a toddler. Before COVID and after COVID, this is a problem.”
For Poler, the project was a reminder that the country needs to tend to its stockpiles. “People were thinking about [ventilator reserves] in the ’90s, and then they basically quit thinking about it,” he said. “COVID is a shocking reminder that we shouldn’t have stopped thinking about it.”
Goldman said the national efforts may not result in a flood of cheap ventilators in U.S. hospitals. International use could also be tricky. In countries with few resources, even very low-cost ventilators may not be feasible because of lack of electricity or compressed oxygen, though there is “potentially a sweet spot of need and capability where these things could be deployed.”
On the upside, he said, the pandemic kicked off a nearly unprecedented global engineering effort to share information and solve the problem.
“If there’s going to be a magic bullet to come out of this, it’s going to be the capability of our communities and our infrastructure,” he said. “People stood up, put in the appropriate processes and spirit, worked hard, made it happen. We’ve added resilience to the health care sector. That’s the outcome here.”
As for the NovaVent, team members were relieved they didn’t have to rush it into manufacturing as COVID-19 was ripping through the Northeast this spring, thanks to aggressive efforts to flatten the curve. “We ended up without a ventilator shortage, which is excellent,” Clayton said. “But with the increase in cases now, it’s very possible some of them may get used.”
To build on the project, Villanova is raising money for a laboratory for affordable medical technologies called NovaMed. The lab formalizes the process of making inexpensive medical equipment that follows the 80-20 function-to-cost rule. The university says the lab is “motivated by the belief that income should not determine who has access to lifesaving care.”
The effort to prevent a ventilator shortage, Nataraj said, made him think more critically about the American health care system overall.
“How come we haven’t built the technology, the economic and social systems that are able to handle a situation like this — especially when something like this was predicted?” he said. “It’s absolute nonsense. Why should a single person die because we weren’t prepared?”
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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from Updates By Dina https://khn.org/news/inside-the-race-to-build-a-better-500-emergency-ventilator/
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toomanysinks · 5 years
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The team behind Baidu’s first smart speaker is now using AI to make films
The HBO sci-fi blockbuster Westworld has been an inspiring look into what humanlike robots can do for us in the meatspace. While current technologies are not quite advanced enough to make Westworld a reality, startups are attempting to replicate the sort of human-robot interaction it presents in virtual space.
Rct studio, which just graduated from Y Combinator and ranked among TechCrunch’s nine favorite picks from the batch, is one of them. The “Westworld” in the TV series, a far-future theme park staffed by highly convincing androids, lets visitors live out their heroic and sadistic fantasies free of consequences.
There are a few reasons why rct studio, which is keeping mum about the meaning of its deliberately lower-cased name for later revelation, is going for the computer-generated world. Besides the technical challenge, playing a fictional universe out virtually does away the geographic constraint. The Westworld experience, in contrast, happens within a confined, meticulously built park.
“Westworld is built in a physical world. I think in this age and time, that’s not what we want to get into,” Xinjie Ma, who heads up marketing for rct, told TechCrunch. “Doing it in the physical environment is too hard, but we can build a virtual world that’s completely under control.”
Rct studio wants to build the Westworld experience in virtual worlds. / Image: rct studio
The startup appears suitable to undertake the task. The eight-people team is led by Cheng Lyu, the 29-year-old entrepreneur who goes by Jesse and helped Baidu build up its smart speaker unit from scratch after the Chinese search giant acquired his voice startup Raven in 2017. Along with several of Raven’s core members, Lyu left Baidu in 2018 to start rct.
“We appreciate a lot the support and opportunities given by Baidu and during the years we have grown up dramatically,” said Ma, who previously oversaw marketing at Raven.
Let AI write the script
Immersive films, or games, depending on how one wants to classify the emerging field, are already available with pre-written scripts for users to pick from. Rct wants to take the experience to the next level by recruiting artificial intelligence for screenwriting.
At the center of the project is the company’s proprietary engine, Morpheus. Rct feeds it mountains of data based on human-written storylines so the characters it powers know how to adapt to situations in real time. When the codes are sophisticated enough, rct hopes the engine can self-learn and formulate its own ideas.
https://techcrunch.com/wp-content/uploads/2019/04/rct_mopheus-engine_texttorender.mp4
“It takes an enormous amount of time and effort for humans to come up with a story logic. With machines, we can quickly produce an infinite number of narrative choices,” said Ma.
To venture through rct’s immersive worlds, users wear a virtual reality headset and control their simulated self via voice. The choice of audio came as a natural step given the team’s experience with natural language processing, but the startup also welcomes the chance to develop new devices for more lifelike journeys.
“It’s sort of like how the film Ready Player One built its own gadgets for the virtual world. Or Apple, which designs its own devices to carry out superior software experience,” explained Ma.
On the creative front, rct believes Morpheus could be a productivity tool for filmmakers as it can take a story arc and dissect it into a decision-making tree within seconds. The engine can also render text to 3D images, so when a filmmaker inputs the text “the man throws the cup to the desk behind the sofa,” the computer can instantly produce the corresponding animation.
Path to monetization
Investors are buying into rct’s offering. The startup is about to close its Series A funding round just months after banking seed money from Y Combinator and Chinese venture capital firm Skysaga, the startup told TechCrunch.
The company has a few imminent tasks before achieving its Westworld dream. For one, it needs a lot of technical talent to train Morpheus with screenplay data. No one on the team had experience in filmmaking, so it’s on the lookout for a creative head who appreciates AI’s application in films.
Rct studio’s software takes a story arc and dissects it into a decision-making tree within seconds. / Image: rct studio
“Not all filmmakers we approach like what we do, which is understandable because it’s a very mature industry, while others get excited about tech’s possibility,” said Ma.
The startup’s entry into the fictional world was less about a passion for films than an imperative to shake up a traditional space with AI. Smart speakers were its first foray, but making changes to tangible objects that people are already accustomed to proved challenging. There has been some interest in voice-controlled speakers, but they are far from achieving ubiquity. Then movies crossed the team’s mind.
“There are two main routes to make use of AI. One is to target a vertical sector, like cars and speakers, but these things have physical constraints. The other application, like Alpha Go, largely exists in the lab. We wanted something that’s both free of physical limitation and holds commercial potential.”
The Beijing and Los Angeles-based startup isn’t content with just making the software. Eventually, it wants to release its own films. The company has inked a long-term partnership with Future Affairs Administration, a Chinese sci-fi publisher representing about 200 writers, including the Hugo award-winning Cixin Liu. The pair is expected to start co-producing interactive films within a year.
Rct’s path is reminiscent of a giant that precedes it: Pixar Animation Studios . The Chinese company didn’t exactly look to the California-based studio for inspiration, but the analog was a useful shortcut to pitch to investors.
“A confident company doesn’t really draw parallels with others, but we do share similarities to Pixar, which also started as a tech company, publishes its own films, and has built its own engine,” said Ma. “A lot of studios are asking how much we price our engine at, but we are targeting the consumer market. Making our own films carry so many more possibilities than simply selling a piece of software.”
Our 9 favorite startups from Y Combinator W19 Demo Day 2
source https://techcrunch.com/2019/04/07/rct-studio-profile/
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seokingstar · 5 years
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