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Simmons B, Sicuri E, Carter J, Hailu A, Kiemde F, Mens P, Mumbengegwi D, Nour B, Paulussen R, Schallig H, Tinto H, van Dijk N, Conteh L. Defining a malaria diagnostic pathway from innovation to adoption: Stakeholder perspectives on data and evidence gaps. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002957. [PMID: 38753739 PMCID: PMC11098419 DOI: 10.1371/journal.pgph.0002957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/14/2024] [Indexed: 05/18/2024]
Abstract
Malaria, a major global health concern, requires effective diagnostic tools for patient care, disease control, and elimination. The pathway from concept to the adoption of diagnostic products is complex, involving multiple steps and stakeholders. To map this process, our study introduces a malaria-specific diagnostic pathway, synthesising existing frameworks with expert insights. Comprising six major stages and 31 related activities, the pathway retains the core stages from existing frameworks and integrates essential malaria diagnostic activities, such as WHO prequalification processes, global stakeholder involvement, and broader health systems considerations. To understand the scope and availability of evidence guiding the activities along this pathway, we conducted an online survey with 113 participants from various stages of the malaria diagnostic pathway. The survey assessed perceptions on four critical attributes of evidence: clear requirements, alignment with user needs, accuracy and reliability, and public and free availability. It also explored the types of evidence used and the challenges and potential solutions related to evidence generation and use. Respondents reported using a broad range of formal and informal data sources. Findings indicated differing levels of agreement on the attributes across pathway stages, with notable challenges in the Approvals and Manufacturing stage and consistent concerns regarding the public availability of data/evidence. The study offers valuable insights for optimising evidence generation and utilisation across the malaria diagnostic pathway. It highlights the need for enhanced stakeholder collaboration, improved data availability, and increased funding to support effective evidence generation, sharing, and use. We propose actionable solutions, including the use of public data repositories, progressive data sharing policies, open-access publishing, capacity-building initiatives, stakeholder engagement forums, and innovative funding solutions. The developed framework and study insights have broader applications, offering a model adaptable for other diseases, particularly for neglected tropical diseases, which face similar diagnostic challenges.
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Affiliation(s)
- Bryony Simmons
- LSE Health, London School of Economics and Political Science, London, United Kingdom
| | - Elisa Sicuri
- LSE Health, London School of Economics and Political Science, London, United Kingdom
- ISGlobal, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
| | - Jane Carter
- Amref Health Africa Headquarters, Nairobi, Kenya
| | - Asrat Hailu
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Francois Kiemde
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Petra Mens
- Amsterdam Institute for Immunology and Infectious Diseases, Infectious Diseases Programme, Amsterdam, The Netherlands
- Amsterdam University Medical Centre, Laboratory for Experimental Parasitology, Department of Medical Microbiology and Infection Prevention, Amsterdam, The Netherlands
| | - Davis Mumbengegwi
- Centre for Research Services, University of Namibia, Windhoek, Namibia
| | - Bakri Nour
- Blue Nile National Institute for Communicable Diseases, University of Gezira, Wad Medani, Sudan
| | | | - Henk Schallig
- Amsterdam Institute for Immunology and Infectious Diseases, Infectious Diseases Programme, Amsterdam, The Netherlands
- Amsterdam University Medical Centre, Laboratory for Experimental Parasitology, Department of Medical Microbiology and Infection Prevention, Amsterdam, The Netherlands
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Norbert van Dijk
- Amsterdam Institute for Immunology and Infectious Diseases, Infectious Diseases Programme, Amsterdam, The Netherlands
- Amsterdam University Medical Centre, Laboratory for Experimental Parasitology, Department of Medical Microbiology and Infection Prevention, Amsterdam, The Netherlands
| | - Lesong Conteh
- LSE Health, London School of Economics and Political Science, London, United Kingdom
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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2
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Street A. Make me a test and I will save the world: towards an anthropology of the possible in global health. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2023. [DOI: 10.1111/1467-9655.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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3
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Liang C, Wagstaff J, Aharony N, Schmit V, Manheim D. Managing the Transition to Widespread Metagenomic Monitoring: Policy Considerations for Future Biosurveillance. Health Secur 2023; 21:34-45. [PMID: 36629860 PMCID: PMC9940815 DOI: 10.1089/hs.2022.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The technological possibilities and future public health importance of metagenomic sequencing have received extensive attention, but there has been little discussion about the policy and regulatory issues that need to be addressed if metagenomic sequencing is adopted as a key technology for biosurveillance. In this article, we introduce metagenomic monitoring as a possible path to eventually replacing current infectious disease monitoring models. Many key enablers are technological, whereas others are not. We therefore highlight key policy challenges and implementation questions that need to be addressed for "widespread metagenomic monitoring" to be possible. Policymakers must address pitfalls like fragmentation of the technological base, private capture of benefits, privacy concerns, the usefulness of the system during nonpandemic times, and how the future systems will enable better response. If these challenges are addressed, the technological and public health promise of metagenomic sequencing can be realized.
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Affiliation(s)
- Chelsea Liang
- Chelsea Liang is an Independent Researcher, University of New South Wales, School of Biotechnology and Biomolecular Sciences, Sydney, Australia
| | - James Wagstaff
- James Wagstaff, PhD, is a Research Fellow, Future of Humanity Institute, University of Oxford, Oxford, UK
| | - Noga Aharony
- Noga Aharony, MS, is a PhD Student, Department of Systems Biology, Columbia University, New York, NY
| | - Virginia Schmit
- Virginia Schmit, PhD, is Director of Research, 1DatSooner, DE, and a Policy Specialist, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - David Manheim
- David Manheim, PhD, is Head of Policy and Research, ALTER, Rehovot, Israel; Lead Researcher, 1DaySooner, Claymont, DE,Visiting Researcher, Humanities and Arts Department, Technion – Israel Institute of Technology, Haifa, Israel.,Address correspondence to: David B. Manheim, 8734 First Avenue, Silver Spring, MD 20910
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4
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Optical and Electrochemical Techniques for Point-of-Care Water Quality Monitoring: A review. RESULTS IN CHEMISTRY 2022. [DOI: 10.1016/j.rechem.2022.100710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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5
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Luka G, Samiei E, Tasnim N, Dalili A, Najjaran H, Hoorfar M. Comprehensive review of conventional and state-of-the-art detection methods of Cryptosporidium. JOURNAL OF HAZARDOUS MATERIALS 2022; 421:126714. [PMID: 34325293 DOI: 10.1016/j.jhazmat.2021.126714] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/06/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
Cryptosporidium is a critical waterborne protozoan pathogen found in water resources that have been a major cause of death and serious illnesses worldwide, costing millions of dollars annually for its detection and treatment. Over the past several decades, substantial efforts have been made towards developing techniques for the detection of Cryptosporidium. Early diagnostic techniques were established based on the existing tools in laboratories, such as microscopes. Advancements in fluorescence microscopy, immunological, and molecular techniques have led to the development of several kits for the detection of Cryptosporidium spp. However, these methods have several limitations, such as long processing times, large sample volumes, the requirement for bulky and expensive laboratory tools, and the high cost of reagents. There is an urgent need to improve these existing techniques and develop low-cost, portable and rapid detection tools for applications in the water quality industry. In this review, we compare recent advances in nanotechnology, biosensing and microfluidics that have facilitated the development of sophisticated tools for the detection of Cryptosporidium spp.Finally, we highlight the advantages and disadvantages, of these state-of-the-art detection methods compared to current analytical methodologies and discuss the need for future developments to improve such methods for detecting Cryptosporidium in the water supply chain to enable real-time and on-site monitoring in water resources and remote areas.
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Affiliation(s)
- George Luka
- School of Engineering, University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada.
| | - Ehsan Samiei
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada.
| | - Nishat Tasnim
- School of Engineering, University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada.
| | - Arash Dalili
- School of Engineering, University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada.
| | - Homayoun Najjaran
- School of Engineering, University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada.
| | - Mina Hoorfar
- School of Engineering, University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada.
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6
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Castle LM, Schuh DA, Reynolds EE, Furst AL. Electrochemical Sensors to Detect Bacterial Foodborne Pathogens. ACS Sens 2021; 6:1717-1730. [PMID: 33955227 DOI: 10.1021/acssensors.1c00481] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bacterial foodborne pathogens cause millions of illnesses each year and disproportionately impact those in developing countries. To combat these diseases and their spread, effective monitoring of foodborne pathogens is needed. Technologies to detect these microbes must be deployable at the point-of-contamination, often in nonideal environments. Electrochemical sensors are uniquely suited for field-deployable monitoring, as they are quantitative, rapid, and do not require expensive instrumentation. When combined with the inherent recognition capabilities of biomolecules, electrochemistry is unmatched for quantitative biological measurements with minimal equipment requirements. This Review is centered on recent advances in electrochemical sensors for the detection of bacterial foodborne pathogens with a specific emphasis on field-deployable platforms, as this is a key requirement of any technology that could effectively halt the spread of foodborne diseases. Innovative electrochemical sensing strategies are highlighted that demonstrate the ability of these technologies to achieve high sensitivity and large detection ranges with rapid readout. Sensing strategies are categorized on the basis of whether they incorporate biological pretreatments or biorecognition elements, and their key advantages and disadvantages are summarized. As this class of sensors continues to mature, methods to incorporate device specificity and to detect targets from complex solutions will enable the translation of these platforms from laboratory prototypes to real-world implementation.
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Affiliation(s)
- Lauren M. Castle
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Daena A. Schuh
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Erin E. Reynolds
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Ariel L. Furst
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
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7
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Kumar S, Gallagher R, Bishop J, Kline E, Buser J, Lafleur L, Shah K, Lutz B, Yager P. Long-term dry storage of enzyme-based reagents for isothermal nucleic acid amplification in a porous matrix for use in point-of-care diagnostic devices. Analyst 2021; 145:6875-6886. [PMID: 32820749 DOI: 10.1039/d0an01098g] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Nucleic acid amplification test (NAAT)-based point-of-care (POC) devices are rapidly growing for use in low-resource settings. However, key challenges are the ability to store the enzyme-based reagents in dry form in the device and the long-term stability of those reagents at elevated temperatures, especially where ambient temperatures could be as high as 45 °C. Here, we describe a set of excipients including a combination of trehalose, polyethylene glycol and dextran, and a method for using them that allows long-term dry storage of enzyme-based reagents for an isothermal strand displacement amplification (iSDA) reaction in a porous matrix. Various porous materials, including nitrocellulose, cellulose, and glass fiber, were tested. Co-dried reagents for iSDA always included those that amplified the ldh1 gene in Staphylococcus aureus (a polymerase and a nicking enzyme, 4 primers, dNTPs and a buffer). Reagents also either included a capture probe and a streptavidin-Au label required for lateral flow (LF) detection after amplification, or a fluorescent probe used for real-time detection. The reagents showed the best stability in a glass fiber matrix when stored in the presence of 10% trehalose and 2.5% dextran. The reagents were stable for over a year at ∼22 °C as determined by lateral flow detection and gel electrophoresis. The reagents also exhibited excellent stability after 360 h at 45 °C; the assay still detected as few as 10 copies of ldh1 gene target by lateral flow detection, and 50 copies with real-time fluorescence detection. These results demonstrate the potential for incorporation of amplification reagents in dry form in point-of-care devices for use in a wide range of settings.
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Affiliation(s)
- Sujatha Kumar
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Seattle, Washington, USA.
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8
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Salamanca-Buentello F, Daar AS. Nanotechnology, equity and global health. NATURE NANOTECHNOLOGY 2021; 16:358-361. [PMID: 33782590 DOI: 10.1038/s41565-021-00899-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.
| | - Abdallah S Daar
- Department of Surgery, Temerty Faculty of Medicine, Toronto, Ontario (Emeritus), Canada
- Department of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto (Emeritus), Toronto, Canada
- Stellenbosch Institute for Advanced Study, Stellenbosch, Western Cape, South Africa
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9
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Murray LP, Mace CR. Usability as a guiding principle for the design of paper-based, point-of-care devices - A review. Anal Chim Acta 2020; 1140:236-249. [PMID: 33218486 DOI: 10.1016/j.aca.2020.09.063] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022]
Abstract
Due to their portability, versatility for supporting multiple assay formats, and potential for resulting in low-cost assays, paper-based analytical devices (PADs) are an increasingly popular format as a platform for the development of point-of-care tests. However, very few PADs have been translated successfully to their intended environments outside of academic settings. Often overlooked as a factor that inhibits translation, usability is a vital characteristic of any successful point-of-care test. Recent advancements in PAD design have demonstrated improved usability by simplifying various aspects of user operation, including sample collection, sample processing, device operation, detection, and readout/interpretation. Field testing at various stages of device design can offer critical feedback about device usability, especially when it involves the proposed end-user or other stakeholders. By highlighting advances in usability, we aim to encourage thoughtful and rigorous design at the academic prototyping stage to address one outstanding hurdle that limits the number of PADs that make it from the benchtop to the point-of-care.
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Affiliation(s)
- Lara P Murray
- Department of Chemistry, Tufts University, Medford, MA, 02155, USA
| | - Charles R Mace
- Department of Chemistry, Tufts University, Medford, MA, 02155, USA.
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10
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Point-Of-Care or Point-Of-Need Diagnostic Tests: Time to Change Outbreak Investigation and Pathogen Detection. Trop Med Infect Dis 2020; 5:tropicalmed5040151. [PMID: 32992688 PMCID: PMC7709694 DOI: 10.3390/tropicalmed5040151] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022] Open
Abstract
In the recent years, the progress of international trade and travel has led to an increased risk of emerging infections. Around 75 percent of the pathogens causing these infections are of animal origin. Point-of-care tests (POCT) and point-of-need tests (PONT) have been established in order to directly provide accurate and rapid diagnostics at field level, the patient bed-side or at the site of outbreaks. These assays can help physicians and decision makers to take the right action without delay. Typically, POCT and PONT rely on genomic identification of pathogens or track their immunological fingerprint. Recently, protocols for metagenomic diagnostics in the field have been developed. In this review, we give an overview of the latest developments in portable diagnostic methods. In addition, four mobile platforms for the implementation of these techniques at point-of-care and point-of-need are described. These approaches can provide reliable diagnostics and surveillance, especially in low resource settings as well as at the level of one health.
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11
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Xu L, Wang A, Li X, Oh KW. Passive micropumping in microfluidics for point-of-care testing. BIOMICROFLUIDICS 2020; 14:031503. [PMID: 32509049 PMCID: PMC7263483 DOI: 10.1063/5.0002169] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/14/2020] [Indexed: 05/11/2023]
Abstract
Suitable micropumping methods for flow control represent a major technical hurdle in the development of microfluidic systems for point-of-care testing (POCT). Passive micropumping for point-of-care microfluidic systems provides a promising solution to such challenges, in particular, passive micropumping based on capillary force and air transfer based on the air solubility and air permeability of specific materials. There have been numerous developments and applications of micropumping techniques that are relevant to the use in POCT. Compared with active pumping methods such as syringe pumps or pressure pumps, where the flow rate can be well-tuned independent of the design of the microfluidic devices or the property of the liquids, most passive micropumping methods still suffer flow-control problems. For example, the flow rate may be set once the device has been made, and the properties of liquids may affect the flow rate. However, the advantages of passive micropumping, which include simplicity, ease of use, and low cost, make it the best choice for POCT. Here, we present a systematic review of different types of passive micropumping that are suitable for POCT, alongside existing applications based on passive micropumping. Future trends in passive micropumping are also discussed.
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Affiliation(s)
- Linfeng Xu
- Department of Bioengineering and Therapeutic
Sciences, Schools of Medicine and Pharmacy, University of California San
Francisco, 1700 4th Street, Byers Hall 304, San Francisco, California
94158, USA
| | - Anyang Wang
- SMALL (Sensors and MicroActuators Learning Lab),
Department of Electrical Engineering, University at Buffalo, The State University of New
York, Buffalo, New York 14260, USA
| | - Xiangpeng Li
- Department of Bioengineering and Therapeutic
Sciences, Schools of Medicine and Pharmacy, University of California San
Francisco, 1700 4th Street, Byers Hall 304, San Francisco, California
94158, USA
| | - Kwang W. Oh
- SMALL (Sensors and MicroActuators Learning Lab),
Department of Electrical Engineering, University at Buffalo, The State University of New
York, Buffalo, New York 14260, USA
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12
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Arumugam S, Colburn DAM, Sia SK. Biosensors for Personal Mobile Health: A System Architecture Perspective. ADVANCED MATERIALS TECHNOLOGIES 2020; 5:1900720. [PMID: 33043127 PMCID: PMC7546526 DOI: 10.1002/admt.201900720] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Indexed: 05/29/2023]
Abstract
Advances in mobile biosensors, integrating developments in materials science and instrumentation, are fueling an expansion in health data being collected and analyzed in decentralized settings. For example, semiconductor-based sensors are enabling measurement of vital signs, and microfluidic-based sensors are enabling measurement of biochemical markers. As biosensors for mobile health are becoming increasingly paired with smart devices, it will become critical for researchers to design biosensors - with appropriate functionalities and specifications - to work seamlessly with accompanying connected hardware and software. This article describes recent research in biosensors, as well as current mobile health devices in use, as classified into four distinct system architectures that take into account the biosensing and data processing functions required in personal mobile health devices. We also discuss the path forward for integrating biosensors into smartphone-based mobile health devices.
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Affiliation(s)
- Siddarth Arumugam
- Department of Biomedical Engineering, Columbia University, 10027 New York, United States
| | - David A M Colburn
- Department of Biomedical Engineering, Columbia University, 10027 New York, United States
| | - Samuel K Sia
- Department of Biomedical Engineering, Columbia University, 10027 New York, United States
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13
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Krampa FD, Aniweh Y, Kanyong P, Awandare GA. Recent Advances in the Development of Biosensors for Malaria Diagnosis. SENSORS (BASEL, SWITZERLAND) 2020; 20:E799. [PMID: 32024098 PMCID: PMC7038750 DOI: 10.3390/s20030799] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 02/07/2023]
Abstract
The impact of malaria on global health has continually prompted the need to develop more effective diagnostic strategies that could overcome deficiencies in accurate and early detection. In this review, we examine the various biosensor-based methods for malaria diagnostic biomarkers, namely; Plasmodium falciparum histidine-rich protein 2 (PfHRP-2), parasite lactate dehydrogenase (pLDH), aldolase, glutamate dehydrogenase (GDH), and the biocrystal hemozoin. The models that demonstrate a potential for field application have been discussed, looking at the fabrication and analytical performance characteristics, including (but not exclusively limited to): response time, sensitivity, detection limit, linear range, and storage stability, which are first summarized in a tabular form and then described in detail. The conclusion summarizes the state-of-the-art technologies applied in the field, the current challenges and the emerging prospects for malaria biosensors.
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Affiliation(s)
- Francis D. Krampa
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, P.O. Box LG 25, Legon, Accra, Ghana; (Y.A.); (P.K.); (G.A.A.)
- Department of Biochemistry, Cell & Molecular Biology, University of Ghana, P.O. Box LG 54, Legon, Accra, Ghana
| | - Yaw Aniweh
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, P.O. Box LG 25, Legon, Accra, Ghana; (Y.A.); (P.K.); (G.A.A.)
| | - Prosper Kanyong
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, P.O. Box LG 25, Legon, Accra, Ghana; (Y.A.); (P.K.); (G.A.A.)
- Department of Chemistry, University of Oxford, South Parks Road, Oxford OX1 3QZ, UK
| | - Gordon A. Awandare
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, P.O. Box LG 25, Legon, Accra, Ghana; (Y.A.); (P.K.); (G.A.A.)
- Department of Biochemistry, Cell & Molecular Biology, University of Ghana, P.O. Box LG 54, Legon, Accra, Ghana
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14
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Bono MS, Beasley S, Hanhauser E, Hart AJ, Karnik R, Vaishnav C. Fieldwork-based determination of design priorities for point-of-use drinking water quality sensors for use in resource-limited environments. PLoS One 2020; 15:e0228140. [PMID: 31978158 PMCID: PMC6980542 DOI: 10.1371/journal.pone.0228140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/08/2020] [Indexed: 01/16/2023] Open
Abstract
Improved capabilities in microfluidics, electrochemistry, and portable assays have resulted in the development of a wide range of point-of-use sensors intended for environmental, medical, and agricultural applications in resource-limited environments of developing countries. However, these devices are frequently developed without direct interaction with their often-remote intended user base, creating the potential for a disconnect between users' actual needs and those perceived by sensor developers. As different analytical techniques have inherent strengths and limitations, effective measurement solution development requires determination of desired sensor attributes early in the development process. In this work, we present our findings on design priorities for point-of-use microbial water sensors based on fieldwork in rural India, as well as a guide to fieldwork methodologies for determining desired sensor attributes. We utilized group design workshops for initial identification of design priorities, and then conducted choice-based conjoint analysis interviews for quantification of user preferences among these priorities. We found the highest user preference for integrated reporting of contaminant concentration and recommended actions, as well as significant preferences for mostly reusable sensor architectures, same-day results, and combined ingredients. These findings serve as a framework for future microbial sensor development and a guide for fieldwork-based understanding of user needs.
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Affiliation(s)
- Michael S. Bono
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Sydney Beasley
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Technology and Policy Program, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Emily Hanhauser
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - A. John Hart
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Rohit Karnik
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Chintan Vaishnav
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, United States of America
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15
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Wang Z, Ai X, Zhang Z, Wang Y, Wu X, Haindl R, Yeow EKL, Drexler W, Gao M, Xing B. NIR nanoprobe-facilitated cross-referencing manifestation of local disease biology for dynamic therapeutic response assessment. Chem Sci 2019; 11:803-811. [PMID: 34123056 PMCID: PMC8146619 DOI: 10.1039/c9sc04909f] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pharmacological interventions for effective treatment require opportune, dynamic and accurate manifestation of pathological status. Traditional clinical techniques relying on biopsy-based histological examinations and blood tests are dramatically restricted due to their invasiveness, unsatisfactory precision, non-real-time reporting and risk of complications. Although current strategies through molecular imaging enable non-invasive and spatiotemporal mapping of pathological changes in intact organisms, environment-activatable, sensitive and quantitative sensing platforms, especially for dynamic feedback of the therapeutic response, are still urgently desired in practice. Herein, we innovatively integrate deep-tissue penetrable multispectral optoacoustic tomography (MSOT) and near-infrared (NIR) optical imaging based technology by tailoring a free radical-responsive chromophore with photon-upconverting nanocrystals. During the therapeutic process, the specific reactions between the drug-stimulated reactive oxygen species (ROS) and radical-sensitive probes result in an absorption shift, which can be captured by MSOT. Meanwhile, the radical-triggered reaction also induces multispectral upconversion luminescence (UCL) responses that exhibit the opposite trend in comparison to MSOT. Such reversed-ratiometric dual-modal imaging outcomes provide an ideal cross-referencing system that guarantees the maximum sensing specificity and sensitivity, thus enabling precise disease biology evaluation and treatment assessments in vivo.
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Affiliation(s)
- Zhimin Wang
- Division of Chemistry and Biological Chemistry, School of Physical & Mathematical Sciences, Nanyang Technological University Singapore 637371 Singapore
| | - Xiangzhao Ai
- Division of Chemistry and Biological Chemistry, School of Physical & Mathematical Sciences, Nanyang Technological University Singapore 637371 Singapore
| | - Zhijun Zhang
- Division of Chemistry and Biological Chemistry, School of Physical & Mathematical Sciences, Nanyang Technological University Singapore 637371 Singapore
| | - Yong Wang
- Center for Molecular Imaging and Nuclear Medicine, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University Suzhou 215123 China
| | - Xiangyang Wu
- Division of Chemistry and Biological Chemistry, School of Physical & Mathematical Sciences, Nanyang Technological University Singapore 637371 Singapore
| | - Richard Haindl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna 1090 Vienna Austria
| | - Edwin K L Yeow
- Division of Chemistry and Biological Chemistry, School of Physical & Mathematical Sciences, Nanyang Technological University Singapore 637371 Singapore
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna 1090 Vienna Austria
| | - Mingyuan Gao
- Center for Molecular Imaging and Nuclear Medicine, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University Suzhou 215123 China
| | - Bengang Xing
- Division of Chemistry and Biological Chemistry, School of Physical & Mathematical Sciences, Nanyang Technological University Singapore 637371 Singapore
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16
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Affiliation(s)
- Zohaib Khurshid
- Department of Prosthodontics and Implantology, School of Dentistry, King Faisal University, Al-Hofuf, Saudi Arabia
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17
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Shandilya R, Bhargava A, Bunkar N, Tiwari R, Goryacheva IY, Mishra PK. Nanobiosensors: Point-of-care approaches for cancer diagnostics. Biosens Bioelectron 2019; 130:147-165. [PMID: 30735948 DOI: 10.1016/j.bios.2019.01.034] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 01/12/2019] [Indexed: 12/24/2022]
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18
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Chikowe I, Bliese SL, Lucas S, Lieberman M. Amoxicillin Quality and Selling Practices in Urban Pharmacies and Drug Stores of Blantyre, Malawi. Am J Trop Med Hyg 2018; 99:233-238. [PMID: 29692302 PMCID: PMC6085786 DOI: 10.4269/ajtmh.18-0003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/13/2018] [Indexed: 11/07/2022] Open
Abstract
This study evaluated a newly developed paper analytical device (PAD) for screening amoxicillin samples in Blantyre urban townships. Covert shoppers attempted to buy amoxicillin from a geographically stratified selection of private pharmacies (N = 22 out of 26) and drug stores (N = 23 out of 103) in the township area. According to the PAD results, all 42 samples obtained by the shoppers contained amoxicillin and none contained suspicious filler materials. Next, the products were assayed using high-performance liquid chromatography. Consistent with the PAD results, all samples contained the correct amount of amoxicillin with no unexpected ingredients. However, one sample was purchased as amoxicillin and contained that ingredient, but was packaged in capsules that are normally used to package ampicillin. Almost every sample failed a simple packaging analysis. Nine in 10 samples were missing their original packaging and/or inserts (52.4% repackaged capsules and 35.7% repackaged blister packs). Only 33.3% of the packages had expiry dates, 16.7% had batch numbers, and 47.6% had the manufacturer's name. Dispensing practices were likewise unsatisfactory. Ninety-five percentage of the sellers sold the amoxicillin without a prescription, even though this medicine is regulated as prescription-only in Malawi. Although the chemical analysis showed that amoxicillin quality was good, our market survey revealed poor adherence to prescription-only medicine dispensing of antibiotics, which threatens antimicrobial stewardship efforts. Furthermore, the wide prevalence of repackaging deprives medicines of important information needed during patient's use, regulatory investigations, and pharmacovigilance reporting.
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Affiliation(s)
- Ibrahim Chikowe
- Biomedical Sciences and Pharmacy Departments, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sarah L. Bliese
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana
| | - Samuel Lucas
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana
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19
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Hui CY, Liu M, Li Y, Brennan JD. A Paper Sensor Printed with Multifunctional Bio/Nano Materials. Angew Chem Int Ed Engl 2018. [DOI: 10.1002/ange.201712903] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Christy Y. Hui
- Biointerfaces Institute; McMaster University; 1280 Main Street West Hamilton Ontario L8S 4O3 Canada
| | - Meng Liu
- Biointerfaces Institute; McMaster University; 1280 Main Street West Hamilton Ontario L8S 4O3 Canada
- Department of Biochemistry and Biomedical Sciences; McMaster University; 1280 Main Street West Hamilton Ontario L8S 4K1 Canada
- School of Environmental Science and Technology; Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education); Dalian University of Technology; Dalian 116024 China
| | - Yingfu Li
- Biointerfaces Institute; McMaster University; 1280 Main Street West Hamilton Ontario L8S 4O3 Canada
- Department of Biochemistry and Biomedical Sciences; McMaster University; 1280 Main Street West Hamilton Ontario L8S 4K1 Canada
| | - John D. Brennan
- Biointerfaces Institute; McMaster University; 1280 Main Street West Hamilton Ontario L8S 4O3 Canada
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20
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Hui CY, Liu M, Li Y, Brennan JD. A Paper Sensor Printed with Multifunctional Bio/Nano Materials. Angew Chem Int Ed Engl 2018; 57:4549-4553. [PMID: 29504183 DOI: 10.1002/anie.201712903] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/12/2018] [Indexed: 01/08/2023]
Abstract
We report a paper-based aptasensor platform that uses two reaction zones and a connecting bridge along with printed multifunctional bio/nano materials to achieve molecular recognition and signal amplification. Upon addition of analyte to the first zone, a fluorescently labelled DNA or RNA aptamer is desorbed from printed graphene oxide, rapidly producing an initial fluorescence signal. The released aptamer then flows to the second zone where it reacts with printed reagents to initiate rolling circle amplification, generating DNA amplicons containing a peroxidase-mimicking DNAzyme, which produces a colorimetric readout that can be read in an equipment-free manner or with a smartphone. The sensor was demonstrated using an RNA aptamer for adenosine triphosphate (a bacterial marker) and a DNA aptamer for glutamate dehydrogenase (Clostridium difficile marker) with excellent sensitivity and specificity. These targets could be detected in spiked serum or feacal samples, demonstrating the potential for testing clinical samples.
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Affiliation(s)
- Christy Y Hui
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4O3, Canada
| | - Meng Liu
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4O3, Canada.,Department of Biochemistry and Biomedical Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.,School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Yingfu Li
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4O3, Canada.,Department of Biochemistry and Biomedical Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - John D Brennan
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4O3, Canada
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21
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Zhan L, Guo SZ, Song F, Gong Y, Xu F, Boulware DR, McAlpine MC, Chan WCW, Bischof JC. The Role of Nanoparticle Design in Determining Analytical Performance of Lateral Flow Immunoassays. NANO LETTERS 2017; 17:7207-7212. [PMID: 29120648 PMCID: PMC5747258 DOI: 10.1021/acs.nanolett.7b02302] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Rapid, simple, and cost-effective diagnostics are needed to improve healthcare at the point of care (POC). However, the most widely used POC diagnostic, the lateral flow immunoassay (LFA), is ∼1000-times less sensitive and has a smaller analytical range than laboratory tests, requiring a confirmatory test to establish truly negative results. Here, a rational and systematic strategy is used to design the LFA contrast label (i.e., gold nanoparticles) to improve the analytical sensitivity, analytical detection range, and antigen quantification of LFAs. Specifically, we discovered that the size (30, 60, or 100 nm) of the gold nanoparticles is a main contributor to the LFA analytical performance through both the degree of receptor interaction and the ultimate visual or thermal contrast signals. Using the optimal LFA design, we demonstrated the ability to improve the analytical sensitivity by 256-fold and expand the analytical detection range from 3 log10 to 6 log10 for diagnosing patients with inflammatory conditions by measuring C-reactive protein. This work demonstrates that, with appropriate design of the contrast label, a simple and commonly used diagnostic technology can compete with more expensive state-of-the-art laboratory tests.
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Affiliation(s)
- Li Zhan
- Department of Mechanical Engineering, University of Minnesota, 111 Church
Street SE, Minneapolis, Minnesota 55455, United States
| | - Shuang-zhuang Guo
- Department of Mechanical Engineering, University of Minnesota, 111 Church
Street SE, Minneapolis, Minnesota 55455, United States
| | - Fayi Song
- Institution of Biomaterials and Biomedical Engineering & Terrence
Donnelly Center for Cellular and Biomolecular Research, University of Toronto, 160 College
Street, Toronto, Ontario 3E1, Canada
| | - Yan Gong
- The Key Key Laboratory of Biomedical Information Engineering of Ministry of
Education, School of Life Science and Technology, Bioinspired Engineering and Biomechanics
Center (BEBC), Xi’an Jiaotong University, Xi’an 710049, China
| | - Feng Xu
- The Key Key Laboratory of Biomedical Information Engineering of Ministry of
Education, School of Life Science and Technology, Bioinspired Engineering and Biomechanics
Center (BEBC), Xi’an Jiaotong University, Xi’an 710049, China
| | - David R. Boulware
- Department of Medicine, Microbiology Research Facility (MRF), University of
Minnesota, 689 SE 23rd Avenue, Minneapolis, Minnesota, 55455, United States
| | - Michael C. McAlpine
- Department of Mechanical Engineering, University of Minnesota, 111 Church
Street SE, Minneapolis, Minnesota 55455, United States
| | - Warren C. W. Chan
- Institution of Biomaterials and Biomedical Engineering & Terrence
Donnelly Center for Cellular and Biomolecular Research, University of Toronto, 160 College
Street, Toronto, Ontario 3E1, Canada
| | - John C. Bischof
- Department of Mechanical Engineering, University of Minnesota, 111 Church
Street SE, Minneapolis, Minnesota 55455, United States
- Department of Biomedical Engineering, University of Minnesota, 312 Church
Street SE, Minneapolis, Minnesota 55455, United States
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22
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Byrnes SA, Weigl BH. Selecting analytical biomarkers for diagnostic applications: a first principles approach. Expert Rev Mol Diagn 2017; 18:19-26. [PMID: 29200322 DOI: 10.1080/14737159.2018.1412258] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Biomarkers are objective indications of a medical state that can be measured accurately and reproducibly. Traditional biomarkers enable diagnosis of disease through detection of disease-specific molecules, disease-mediated molecular changes, or distinct physiological or anatomical signatures. Areas covered: This work provides a framework for selecting biomarkers that are most likely to provide useful information about a patient's disease state. Though the authors emphasize markers related to disease, this work is also applicable to biomarkers for monitoring physiological changes such as ovulation or pregnancy. Additionally, the scope was restricted to biomarkers that are amenable to analytical detection across a range of health care levels, including low resource settings. The authors describe trade-offs between biomarkers' sensitivity/specificity for a disease-causing agent, the complexity of detection, and how this knowledge can be applied to the development of diagnostic tests. This report also details additional assessment criteria for successful tests. Expert commentary: Biomarker selection should primarily be driven by an attempt to answer an explicit clinical question (preferably causative relationship of the biomarker to disease-state), and only then by test development expediency (ease of detection). This framework is useful for stakeholders from test developers to clinicians to identify the trade-offs for diagnostic biomarkers for any use case.
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Affiliation(s)
- Samantha A Byrnes
- a Department of Bioengineering , University of Washington , Seattle , WA , USA.,b Intellectual Ventures Laboratory , Bellevue , WA , USA
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23
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An Open Software Platform for the Automated Design of Paper-Based Microfluidic Devices. Sci Rep 2017; 7:16224. [PMID: 29176646 PMCID: PMC5701164 DOI: 10.1038/s41598-017-16542-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/09/2017] [Indexed: 11/13/2022] Open
Abstract
Paper-based microfluidic devices have many applications in biomedical and environmental analysis. However, the process of prototyping device designs can be tedious, error-prone, and time-consuming. Here, we present a cross-platform, open-source software tool—AutoPAD—developed to quickly create and modify device designs and provide a free alternative to commercial design software. The capabilities that we designed to be inherent to AutoPAD (e.g., automatic zone alignment and design refactoring) highlight its potential use in nearly any paper-based microfluidic device application and for creating nearly any desired design, which we demonstrate through the recreation of numerous device designs from the literature.
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Abstract
PURPOSE OF REVIEW Recent advances in point-of-care technologies to ensure universal access to affordable quality-assured diagnostics have the potential to transform patient management, surveillance programmes, and control of infectious diseases. Decentralization of testing can put tremendous stresses on fragile health systems if the laboratory is not involved in the planning, introduction, and scale-up strategies. RECENT FINDINGS The impact of investments in novel technologies can only be realized if these tests are evaluated, adopted, and scaled up within the healthcare system with appropriate planning and understanding of the local contexts in which these technologies will be used. SUMMARY In this digital age, the laboratory needs to take on the role of the Command Centre for technology introduction and implementation. Implementation science is needed to understand the political, cultural, economic, and behavioural context for technology introduction. The new paradigm should include: building a comprehensive system of laboratories and point-of-care testing sites to provide quality-assured diagnostic services with good laboratory-clinic interface to build trust in test results and linkage to care; building and coordinating a comprehensive national surveillance and communication system for disease control and global health emergencies; conducting research to monitor the impact of new tools and interventions on improving patient care.
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25
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Anany H, Chou Y, Cucic S, Derda R, Evoy S, Griffiths M. From Bits and Pieces to Whole Phage to Nanomachines: Pathogen Detection Using Bacteriophages. Annu Rev Food Sci Technol 2017; 8:305-329. [DOI: 10.1146/annurev-food-041715-033235] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- H. Anany
- Canadian Institute for Food Safety, University of Guelph, Guelph, Ontario, Canada N1G 2W1;, ,
- Department of Microbiology, Faculty of Science, Ain Shams University, Cairo, Egypt 11566
| | - Y. Chou
- Department of Chemistry and Alberta Glycomics Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2G2
| | - S. Cucic
- Canadian Institute for Food Safety, University of Guelph, Guelph, Ontario, Canada N1G 2W1;, ,
| | - R. Derda
- Department of Chemistry and Alberta Glycomics Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2G2
| | - S. Evoy
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2G2
| | - M.W. Griffiths
- Canadian Institute for Food Safety, University of Guelph, Guelph, Ontario, Canada N1G 2W1;, ,
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26
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Abbas JJ, Smith B, Poluta M, Velazquez-Berumen A. Improving health-care delivery in low-resource settings with nanotechnology: Challenges in multiple dimensions. Nanobiomedicine (Rij) 2017; 4:1849543517701158. [PMID: 29942391 PMCID: PMC5998261 DOI: 10.1177/1849543517701158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/07/2017] [Indexed: 01/07/2023] Open
Abstract
In the two decades after 1990, the rates of child and maternal mortality dropped by over 40% and 47%, respectively. Despite these improvements, which are in part due to increased access to medical technologies, profound health disparities exist. In 2015, a child born in a developing region is nearly eight times as likely to die before the age of 5 than one born in a developed region and developing regions accounted for nearly 99% of the maternal deaths. Recent developments in nanotechnology, however, have great potential to ameliorate these and other health disparities by providing new cost-effective solutions for diagnosis or treatment of a variety of medical conditions. Affordability is only one of the several challenges that will need to be met to translate new ideas into a medical product that addresses a global health need. This article aims to describe some of the other challenges that will be faced by nanotechnologists who seek to make an impact in low-resource settings across the globe.
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Affiliation(s)
- James J Abbas
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Barbara Smith
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Mladen Poluta
- Western Cape Department of Health, Cape Town, South Africa
| | - Adriana Velazquez-Berumen
- Essential Medicines and Health Products Department, Health Systems and Innovation Cluster, World Health Organization, Geneva, Switzerland
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27
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Engel N, Wachter K, Pai M, Gallarda J, Boehme C, Celentano I, Weintraub R. Addressing the challenges of diagnostics demand and supply: insights from an online global health discussion platform. BMJ Glob Health 2016; 1:e000132. [PMID: 28588980 PMCID: PMC5321377 DOI: 10.1136/bmjgh-2016-000132] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 01/04/2023] Open
Abstract
Several barriers challenge development, adoption and scale-up of diagnostics in low and middle income countries. An innovative global health discussion platform allows capturing insights from the global health community on factors driving demand and supply for diagnostics. We conducted a qualitative content analysis of the online discussion ‘Advancing Care Delivery: Driving Demand and Supply of Diagnostics’ organised by the Global Health Delivery Project (GHD) (http://www.ghdonline.org/) at Harvard University. The discussion, driven by 12 expert panellists, explored what must be done to develop delivery systems, business models, new technologies, interoperability standards, and governance mechanisms to ensure that patients receive the right diagnostic at the right time. The GHD Online (GHDonline) platform reaches over 19 000 members from 185 countries. Participants (N=99) in the diagnostics discussion included academics, non-governmental organisations, manufacturers, policymakers, and physicians. Data was coded and overarching categories analysed using qualitative data analysis software. Participants considered technical characteristics of diagnostics as smaller barriers to effective use of diagnostics compared with operational and health system challenges, such as logistics, poor fit with user needs, cost, workforce, infrastructure, access, weak regulation and political commitment. Suggested solutions included: health system strengthening with patient-centred delivery; strengthened innovation processes; improved knowledge base; harmonised guidelines and evaluation; supply chain innovations; and mechanisms for ensuring quality and capacity. Engaging and connecting different actors involved with diagnostic development and use is paramount for improving diagnostics. While the discussion participants were not representative of all actors involved, the platform enabled a discussion between globally acknowledged experts and physicians working in different countries.
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Affiliation(s)
- Nora Engel
- Department of Health, Ethics & Society/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Keri Wachter
- Harvard Medical School, Global Health Delivery Project at Harvard University, Boston, Massachusetts, USA
| | - Madhukar Pai
- McGill Global Health Programs & McGill International TB Centre, McGill University, Montreal, Canada
| | - Jim Gallarda
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | | | | | - Rebecca Weintraub
- Harvard Medical School, Global Health Delivery Project at Harvard University, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
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Trends and Challenges in Pesticide Resistance Detection. TRENDS IN PLANT SCIENCE 2016; 21:834-853. [PMID: 27475253 DOI: 10.1016/j.tplants.2016.06.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 06/06/2023]
Abstract
Pesticide resistance is a crucial factor to be considered when developing strategies for the minimal use of pesticides while maintaining pesticide efficacy. This goal requires monitoring the emergence and development of resistance to pesticides in crop pests. To this end, various methods for resistance diagnosis have been developed for different groups of pests. This review provides an overview of biological, biochemical, and molecular methods that are currently used to detect and quantify pesticide resistance. The agronomic, technical, and economic advantages and drawbacks of each method are considered. Emerging technologies are also described, with their associated challenges and their potential for the detection of resistance mechanisms likely to be selected by current and future plant protection methods.
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29
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Dittrich S, Tadesse BT, Moussy F, Chua A, Zorzet A, Tängdén T, Dolinger DL, Page AL, Crump JA, D’Acremont V, Bassat Q, Lubell Y, Newton PN, Heinrich N, Rodwell TJ, González IJ. Target Product Profile for a Diagnostic Assay to Differentiate between Bacterial and Non-Bacterial Infections and Reduce Antimicrobial Overuse in Resource-Limited Settings: An Expert Consensus. PLoS One 2016; 11:e0161721. [PMID: 27559728 PMCID: PMC4999186 DOI: 10.1371/journal.pone.0161721] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022] Open
Abstract
Acute fever is one of the most common presenting symptoms globally. In order to reduce the empiric use of antimicrobial drugs and improve outcomes, it is essential to improve diagnostic capabilities. In the absence of microbiology facilities in low-income settings, an assay to distinguish bacterial from non-bacterial causes would be a critical first step. To ensure that patient and market needs are met, the requirements of such a test should be specified in a target product profile (TPP). To identify minimal/optimal characteristics for a bacterial vs. non-bacterial fever test, experts from academia and international organizations with expertise in infectious diseases, diagnostic test development, laboratory medicine, global health, and health economics were convened. Proposed TPPs were reviewed by this working group, and consensus characteristics were defined. The working group defined non-severely ill, non-malaria infected children as the target population for the desired assay. To provide access to the most patients, the test should be deployable to community health centers and informal health settings, and staff should require <2 days of training to perform the assay. Further, given that the aim is to reduce inappropriate antimicrobial use as well as to deliver appropriate treatment for patients with bacterial infections, the group agreed on minimal diagnostic performance requirements of >90% and >80% for sensitivity and specificity, respectively. Other key characteristics, to account for the challenging environment at which the test is targeted, included: i) time-to-result <10 min (but maximally <2 hrs); ii) storage conditions at 0–40°C, ≤90% non-condensing humidity with a minimal shelf life of 12 months; iii) operational conditions of 5–40°C, ≤90% non-condensing humidity; and iv) minimal sample collection needs (50–100μL, capillary blood). This expert approach to define assay requirements for a bacterial vs. non-bacterial assay should guide product development, and enable targeted and timely efforts by industry partners and academic institutions.
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Affiliation(s)
- Sabine Dittrich
- Foundation for Innovative New Diagnostics (FIND), 9 Chemin des Mines, 1202 Geneva, Switzerland
- * E-mail:
| | - Birkneh Tilahun Tadesse
- Foundation for Innovative New Diagnostics (FIND), 9 Chemin des Mines, 1202 Geneva, Switzerland
- Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland
- Hawassa University, College of Medicine and Health Sciences, Department of Pediatrics, Hawassa, Ethiopia
| | - Francis Moussy
- World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Arlene Chua
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Anna Zorzet
- ReAct Europe, Uppsala University, Box 256, 751 05, Uppsala, Sweden
| | - Thomas Tängdén
- ReAct Europe, Uppsala University, Box 256, 751 05, Uppsala, Sweden
| | - David L. Dolinger
- Foundation for Innovative New Diagnostics (FIND), 9 Chemin des Mines, 1202 Geneva, Switzerland
- World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Anne-Laure Page
- Epidemiology and Population Health, Epicentre, Paris, France
| | - John A. Crump
- Centre for International Health, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
- Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, United States of America
- Division of Infectious Diseases and International Health, Box 102359, Duke University Medical Center, Durham, NC, 27710, United States of America
| | - Valerie D’Acremont
- Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Bugnon 44, 1011, Lausanne, Switzerland
| | - Quique Bassat
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Yoel Lubell
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul N. Newton
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao PDR
| | - Norbert Heinrich
- Division for Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany; German Center for Infection Research, Munich partner site, Leopoldstr 5, D-80802, Munich, Germany
| | - Timothy J. Rodwell
- Foundation for Innovative New Diagnostics (FIND), 9 Chemin des Mines, 1202 Geneva, Switzerland
| | - Iveth J. González
- Foundation for Innovative New Diagnostics (FIND), 9 Chemin des Mines, 1202 Geneva, Switzerland
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30
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Ford Carleton P, Schachter S, Parrish JA, Collins JM, Crocker JB, Dixon RF, Edgman-Levitan S, Lewandrowski KB, Stahl JE, Klapperich C, Cabodi M, Gaydos CA, Rompalo AM, Manabe Y, Wang TH, Rothman R, Geddes CD, Widdice L, Jackman J, Mathura RA, Lash TB. National Institute of Biomedical Imaging and Bioengineering Point-of-Care Technology Research Network: Advancing Precision Medicine. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2016; 4:2800614. [PMID: 27730014 PMCID: PMC5052024 DOI: 10.1109/jtehm.2016.2598837] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/16/2016] [Accepted: 05/16/2016] [Indexed: 12/28/2022]
Abstract
To advance the development of point-of-care technology (POCT), the National Institute of Biomedical Imaging and Bioengineering established the POCT Research Network (POCTRN), comprised of Centers that emphasize multidisciplinary partnerships and close facilitation to move technologies from an early stage of development into clinical testing and patient use. This paper describes the POCTRN and the three currently funded Centers as examples of academic-based organizations that support collaborations across disciplines, institutions, and geographic regions to successfully drive innovative solutions from concept to patient care.
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31
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Abstract
Cellulose has emerged as an attractive substrate for the production of economical, disposable, point-of-care (POC) analytical devices. Development of novel methods of (bio)activation is central to broadening the application space of cellulosic materials. Ironically, such efforts are stymied by the inherent biocompatibility and recalcitrance of cellulose fibers. Here, we have elaborated a versatile, chemo-enzymatic approach to activate cellulosic materials for CuAAC "click chemistry", to develop new fluorogenic esterase sensors. Gentle, aqueous modification conditions facilitate broad applicability to cellulose papers, gauzes, and hydrogels. Tethering of the released fluorophore to the cellulose surface prevents signal degradation due to diffusion and enables straightforward, sensitive visualization with a simple light source in resource-limited situations.
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Affiliation(s)
- Fatemeh Derikvand
- The Michael Smith Laboratories and Department of Chemistry, University of British Columbia , 2185 East Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - DeLu Tyler Yin
- The Michael Smith Laboratories and Department of Chemistry, University of British Columbia , 2185 East Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Ryan Barrett
- The Michael Smith Laboratories and Department of Chemistry, University of British Columbia , 2185 East Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Harry Brumer
- The Michael Smith Laboratories and Department of Chemistry, University of British Columbia , 2185 East Mall, Vancouver, British Columbia V6T 1Z4, Canada
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32
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Wang S, Lifson MA, Inci F, Liang LG, Sheng YF, Demirci U. Advances in addressing technical challenges of point-of-care diagnostics in resource-limited settings. Expert Rev Mol Diagn 2016; 16:449-59. [PMID: 26777725 DOI: 10.1586/14737159.2016.1142877] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed.
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Affiliation(s)
- ShuQi Wang
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine , Zhejiang University , Hangzhou , China.,b Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Hangzhou , China.,c Institute for Translational Medicine , Zhejiang University , Hangzhou , China.,d The Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology , Stanford School of Medicine, Stanford University , Palo Alto , CA , USA
| | - Mark A Lifson
- d The Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology , Stanford School of Medicine, Stanford University , Palo Alto , CA , USA
| | - Fatih Inci
- d The Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology , Stanford School of Medicine, Stanford University , Palo Alto , CA , USA
| | - Li-Guo Liang
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine , Zhejiang University , Hangzhou , China.,b Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Hangzhou , China.,c Institute for Translational Medicine , Zhejiang University , Hangzhou , China
| | - Ye-Feng Sheng
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine , Zhejiang University , Hangzhou , China.,b Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Hangzhou , China.,c Institute for Translational Medicine , Zhejiang University , Hangzhou , China.,d The Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology , Stanford School of Medicine, Stanford University , Palo Alto , CA , USA
| | - Utkan Demirci
- d The Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology , Stanford School of Medicine, Stanford University , Palo Alto , CA , USA
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33
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Michael IJ, Kim TH, Sunkara V, Cho YK. Challenges and Opportunities of Centrifugal Microfluidics for Extreme Point-of-Care Testing. MICROMACHINES 2016; 7:mi7020032. [PMID: 30407405 PMCID: PMC6190358 DOI: 10.3390/mi7020032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/21/2016] [Accepted: 02/14/2016] [Indexed: 12/18/2022]
Abstract
The advantages offered by centrifugal microfluidic systems have encouraged its rapid adaptation in the fields of in vitro diagnostics, clinical chemistry, immunoassays, and nucleic acid tests. Centrifugal microfluidic devices are currently used in both clinical and point-of-care settings. Recent studies have shown that this new diagnostic platform could be potentially used in extreme point-of-care settings like remote villages in the Indian subcontinent and in Africa. Several technological inventions have decentralized diagnostics in developing countries; however, very few microfluidic technologies have been successful in meeting the demand. By identifying the finest difference between the point-of-care testing and extreme point-of-care infrastructure, this review captures the evolving diagnostic needs of developing countries paired with infrastructural challenges with technological hurdles to healthcare delivery in extreme point-of-care settings. In particular, the requirements for making centrifugal diagnostic devices viable in developing countries are discussed based on a detailed analysis of the demands in different clinical settings including the distinctive needs of extreme point-of-care settings.
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Affiliation(s)
- Issac J Michael
- Department of Biomedical Engineering, School of Life Sciences, Ulsan National Institute of Science and Technology (UNIST), 100 Banyeon-ri, Eonyang-eup, Ulju-gun, Ulsan 689-798, Korea.
| | - Tae-Hyeong Kim
- Department of Biomedical Engineering, School of Life Sciences, Ulsan National Institute of Science and Technology (UNIST), 100 Banyeon-ri, Eonyang-eup, Ulju-gun, Ulsan 689-798, Korea.
| | - Vijaya Sunkara
- Department of Biomedical Engineering, School of Life Sciences, Ulsan National Institute of Science and Technology (UNIST), 100 Banyeon-ri, Eonyang-eup, Ulju-gun, Ulsan 689-798, Korea.
| | - Yoon-Kyoung Cho
- Department of Biomedical Engineering, School of Life Sciences, Ulsan National Institute of Science and Technology (UNIST), 100 Banyeon-ri, Eonyang-eup, Ulju-gun, Ulsan 689-798, Korea.
- Center for Soft and Living Matter, Institute for Basic Science (IBS), UNIST-gil 50, Ulsan 689-798, Korea.
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34
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Welburn SC, Molyneux DH, Maudlin I. Beyond Tsetse--Implications for Research and Control of Human African Trypanosomiasis Epidemics. Trends Parasitol 2016; 32:230-241. [PMID: 26826783 DOI: 10.1016/j.pt.2015.11.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/02/2015] [Accepted: 11/13/2015] [Indexed: 01/16/2023]
Abstract
Epidemics of both forms of human African trypanosomiasis (HAT) are confined to spatially stable foci in Sub-Saharan Africa while tsetse distribution is widespread. Infection rates of Trypanosoma brucei gambiense in tsetse are extremely low and cannot account for the catastrophic epidemics of Gambian HAT (gHAT) seen over the past century. Here we examine the origins of gHAT epidemics and evidence implicating human genetics in HAT epidemiology. We discuss the role of stress causing breakdown of heritable tolerance in silent disease carriers generating gHAT outbreaks and see how peculiarities in the epidemiologies of gHAT and Rhodesian HAT (rHAT) impact on strategies for disease control.
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Affiliation(s)
- Susan C Welburn
- Centre for Infectious Diseases, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK.
| | - David H Molyneux
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ian Maudlin
- Centre for Infectious Diseases, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
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