Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings

2016 ◽  
Vol 54 (1) ◽  
Author(s):  
Nathalie Acestor ◽  
Jane Goett ◽  
Arthur Lee ◽  
Tara M. Herrick ◽  
Susheela M. Engelbrecht ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Clinical Performance ◽  
Point Of Care ◽  
Low Cost ◽  
Care Providers ◽  
Low Resource Settings ◽  
Low Resource ◽  
High Resource ◽  
Rapid Assays ◽  
Urine Biomarkers

AbstractIn recent years, an increasing amount of literature is emerging on candidate urine and blood-based biomarkers associated with incidence and severity of preeclampsia (PE) in pregnant women. While enthusiasm on the usefulness of several of these markers in predicting PE is evolving, essentially all work so far has focused on the needs of high-resource settings and high-income countries, resulting primarily in multi-parameter laboratory assays based on proteomic and metabolomics analysis techniques. These highly complex methods, however, require laboratory capabilities that are rarely available or affordable in low-resource settings (LRS). The importance of quantifying maternal and perinatal risks and identifying which pregnancies can be safely prolonged is also much greater in LRS, where intensive care facilities that can rapidly respond to PE-related health threats for women and infants are limited. For these reasons, simple, low cost, sensitive, and specific point-of-care (POC) tests are needed that can be performed by antenatal health care providers in LRS and that can facilitate decisions about detection and management of PE. Our study aims to provide a comprehensive systematic review of current and emerging blood and urine biomarkers for PE, not only on the basis of their clinical performance, but also of their suitability to be used in LRS-compatible test formats, such as lateral flow and other variants of POC rapid assays.

scholarly journals Depth of Necrosis Using Different Ablation Techniques in Healthy Cervical Tissue

2017 ◽  
Vol 3 (2_suppl) ◽  
pp. 4s-5s
Author(s):  
Miriam Cremer ◽  
Karla Alfaro ◽  
Mauricio Maza ◽  
Philip E. Castle ◽  
Albert Zevallos ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Conflicts Of Interest ◽  
Low Cost ◽  
A Priori ◽  
Intraepithelial Neoplasia ◽  
Cost Effective ◽  
Care Providers ◽  
Cervical Tissue ◽  
Low Resource Settings ◽  
Low Resource

Abstract 22 Background: Screening followed by treatment has been a key contributor to the reduction of cervical cancer in industrialized countries and is critical to reduce its burden in low-resource countries. Screening technologies that are appropriate for low-resource settings have advanced considerably; however, treatment technologies have lagged. Treatment methods that are used in developing countries must be low cost, effective, and adaptable for areas with limited infrastructure and health care providers. This study was performed to determine the depth of necrosis in cervical tissue achieved with three treatment devices: conventional cryotherapy with CO2, the CryoPen (CryoPen, Corpus Christi, TX) adapted for low-resource settings, and the thermocoagulator. Methods: One hundred twenty-five women who were scheduled for hysterectomy for indications other than cervical pathology were randomly assigned to one of five treatment arms: single-freeze arms and double-freeze arms for both conventional cryotherapy and the adapted CryoPen, and a single application of thermoablation at 100° C for 40 seconds. Treatment was administered 12 to 24 hours before hysterectomy. Depth of necrosis in cervical specimens was measured by pathologists who were blinded to the treatment modality. Results: A total of 119 women have been enrolled to date, and 114 specimens have been reviewed. Mean depth of necrosis is 5.1 mm (0.9 to 8.5 mm) for single-freeze cryotherapy, 5.6 mm (3.8 to 10.5 mm) for double-freeze cryotherapy, 4.9 mm (3.5 to 8.5 mm) for single-freeze adapted CryoPen; 4.5 mm (3.0 to 7.3 mm) for double-freeze adapted CryoPen, and 3.7 mm (1.9 to 5.5 mm) for the thermoablation ( Table 1 ). Conclusion: The depths of necrosis achieved with the three different ablation modalities are competitive and surpass the targeted depth of 3.5 mm established a priori. Results thus far have demonstrated that devices that are optimized for use in low-resource settings can be as effective as conventional cryotherapy in treating cervical intraepithelial neoplasia. [Table: see text] AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Miriam Cremer Honoraria: Merck Speakers' Bureau: Merck Travel, Accommodations, Expenses: Merck Other Relationship: Basic Health International Karla Alfaro No relationship to disclose Mauricio Maza No relationship to disclose Philip E. Castle No relationship to disclose Albert Zevallos No relationship to disclose Ana Cecilia Diaz de Uriarte No relationship to disclose Manuel Alvarez No relationship to disclose Manuel Salinas No relationship to disclose Ana Sofia Ore No relationship to disclose Luis Taxa No relationship to disclose Juan Felix Expert Testimony: Johnson & Johnson, Philip Morris

scholarly journals A fully battery-powered inexpensive spectrophotometric system for high-sensitivity point-of-care analysis on a microfluidic chip

The Analyst ◽  
2016 ◽  
Vol 141 (12) ◽  
pp. 3898-3903 ◽  
Author(s):  
Maowei Dou ◽  
Juan Lopez ◽  
Misael Rios ◽  
Oscar Garcia ◽  
Chuan Xiao ◽  
...  
Keyword(s):  
Microfluidic Chip ◽  
Point Of Care ◽  
Low Cost ◽  
High Sensitivity ◽  
Power Supplies ◽  
Low Resource Settings ◽  
Low Resource ◽  
External Power

A low-cost b̲a̲ttery-powered s̲pectrophotometric s̲ystem (BASS) was developed for high-sensitivity point-of-care analysis in low-resource settings on a microfluidic chip without relying on external power supplies.

scholarly journals Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings

2020 ◽  
Vol 30 (1) ◽  
Author(s):  
GM Monsur Habib ◽  
Roberto Rabinovich ◽  
Kalyani Divgi ◽  
Salahuddin Ahmed ◽  
Samir Kumar Saha ◽  
...  
Keyword(s):  
Pulmonary Rehabilitation ◽  
Low Cost ◽  
Mode Of Delivery ◽  
Well Being ◽  
Chronic Obstructive ◽  
Low Resource Settings ◽  
Chronic Respiratory Diseases ◽  
Low Resource ◽  
Breathing Exercises ◽  
High Resource

AbstractPulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high-resource settings. In low- and middle-income countries, PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; pre-publication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED, and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality of life (HRQoL), breathlessness, included components, and mode of delivery. We used Cochrane risk of bias (RoB) to assess study quality and synthesised data narratively. From 8912 hits, we included 13 studies: 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, and breathing exercises. Low cost services, adapted to the setting, used limited equipment and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low-resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.

scholarly journals A low-cost fluorescence reader for in vitro transcription and nucleic acid detection with Cas13a

2019 ◽  
Author(s):  
Florian Katzmeier ◽  
Lukas Aufinger ◽  
Aurore Dupin ◽  
Jorge Quinteiro ◽  
Matthias Lenz ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Limit Of Detection ◽  
Point Of Care ◽  
Low Cost ◽  
Nucleic Acid Detection ◽  
Fluorescence Detector ◽  
Flat Detector ◽  
Low Resource Settings ◽  
Low Resource

AbstractPoint-of-care testing (POCT) in low-resource settings requires tools that can operate independent of typical laboratory infrastructure. Due to its favorable signal-to-background ratio, a wide variety of biomedical tests utilize fluorescence as a readout. However, fluorescence techniques often require expensive or complex instrumentation and can be difficult to adapt for POCT. To address this issue, we developed a pocket-sized fluorescence detector costing less than $15 that is easy to manufacture and can operate in low-resource settings. It is built from standard electronic components, including an LED and a light dependent resistor, filter foils and 3D printed parts, and reliably detected less than 10 nM fluorescein concentrations (with a lower limit of detection of ≈6.8 nM), which is sufficient to follow typical biochemical reactions used in POCT applications. All assays are conducted on filter paper, which allows for a flat detector architecture to improve signal collection. We validate the device by quantifying in vitro RNA transcription and also demonstrate sequence-specific detection of target RNAs in the nanomolar range using a Cas13a-based fluorescence assay. Cas13a is a RNA-guided, RNA-targeting CRISPR effector with promiscuous RNase activity upon recognition of its RNA target. Cas13a sensing is highly specific and adaptable and in combination with our detector represents a promising approach for nucleic acid POCT. Furthermore, our open-source device architecture could be a valuable educational tool that integrates hardware, software and biochemistry concepts.

scholarly journals Resistance Training as a Countermeasure for Key Non-Communicable Diseases in Low-Resource Settings: A Review

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Brandon Stuwart Shaw ◽  
Ina Shaw
Keyword(s):  
Resistance Training ◽  
Low Cost ◽  
Active Role ◽  
Communicable Diseases ◽  
Cochrane Library ◽  
Health Improvement ◽  
Non Communicable Diseases ◽  
Low Resource Settings ◽  
Low Resource ◽  
High Resource

Background: Non-communicable diseases (NCDs) are responsible for 60% of global deaths. Of these NCD-attributable deaths, about 80% are in low- to middle-income countries (LMICs). The role of exercise in major NCDs is evident; however, popular and cost-effective aerobic modes of exercise, such as walking, consistently do not meet minimum intensity guidelines for health improvement. Interestingly, low-cost resistance training (using callisthenics, Pilates, elastic tubing, etc.) has proven equally effective to conventional resistance training using weight machines in improving several health parameters related to NCDs, although their effectiveness in LMICs is not as well documented as in high-income countries (HICs). Objectives: This review aimed to examine low-cost approaches of resistance training to health promotion, NCD risk reduction, and NCD rehabilitation/management to mitigate the epidemic of NCDs in lower-resource settings. Methods: An electronic search was performed on the following databases from inception until December 2019: PubMed/Medline, Sport Discuss, Embase, Science Direct, Current Contents, CISTI Source, Google Scholar, Cochrane Library, Cochrane Database of Systematic Reviews, CINAHL EBM Reviews, and international e-catalogues. Results: Data on resistance training provision cost in low-resource settings indicates that it is not reasonable to use this mode of training in low-resource settings in the same way as it is used in high-resource ones. This review summarized some strategies which can be employed to ensure the delivery of all core resistance training components in low-resource settings. The data suggests that resistance training be adapted for delivery in non-clinical settings in LMICs. Conclusions: Program design variables of resistance training are similar in low- and well-resourced settings. However, only individuals with low-risk will be able to perform exercise without adverse consequences in home-based settings. Health care practitioners in LMICs should take an active role in promoting resistance training when promoting health, reducing NCD risk, and NCD rehabilitation.

scholarly journals Point-of-care device to diagnose and monitor neonatal jaundice in low-resource settings

2017 ◽  
Vol 114 (51) ◽  
pp. E10965-E10971 ◽  
Author(s):  
Pelham A. Keahey ◽  
Mathieu L. Simeral ◽  
Kristofer J. Schroder ◽  
Meaghan M. Bond ◽  
Prince J. Mtenthaonnga ◽  
...  
Keyword(s):  
Total Bilirubin ◽  
Point Of Care ◽  
Low Cost ◽  
Neurological Impairment ◽  
Reference Laboratory ◽  
Reference Standard ◽  
Low Resource Settings ◽  
Low Resource ◽  
Increased Risk ◽  
Pilot Clinical Study

Newborns are at increased risk of jaundice, a condition in which excess bilirubin accumulates in blood. Left untreated, jaundice can lead to neurological impairment and death. Jaundice resulting from unconjugated hyperbilirubinemia is easily treated with exposure to blue light, and phototherapy systems have been developed for low-resource settings; however, there are no appropriate solutions to diagnose and monitor jaundice in these settings. To address this need we present BiliSpec, a low-cost reader and disposable lateral flow card designed to measure the concentration of total bilirubin from several drops of blood at the point of care. We evaluated the performance of BiliSpec, using blood from normal volunteers spiked with varying amounts of bilirubin; results measured using BiliSpec correlated well with a reference laboratory bilirubinometer (r = 0.996). We then performed a pilot clinical study using BiliSpec to measure total bilirubin in neonates at risk for jaundice at Queen Elizabeth Central Hospital in Blantyre, Malawi. Concentrations measured using BiliSpec correlated well with those measured using a laboratory reference standard in 94 patient samples ranging from 1.1 mg/dL to 23.0 mg/dL in concentration (r = 0.973). The mean difference between bilirubin levels measured with BiliSpec and the reference standard was 0.3 mg/dL (95% CI: −1.7–2.2 mg/dL).

scholarly journals A framework for designing medical devices resilient to low-resource settings

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Davide Piaggio ◽  
Rossana Castaldo ◽  
Marco Cinelli ◽  
Sara Cinelli ◽  
Alessia Maccaro ◽  
...  
Keyword(s):  
Delphi Study ◽  
Middle Income ◽  
Low Resource Settings ◽  
Health Technologies ◽  
Low Resource ◽  
Middle Income Countries ◽  
High Resource ◽  
International Experts ◽  
Global Population ◽  
Different Parts

Abstract Background To date (April 2021), medical device (MD) design approaches have failed to consider the contexts where MDs can be operationalised. Although most of the global population lives and is treated in Low- and Middle-Income Countries (LMCIs), over 80% of the MD market share is in high-resource settings, which set de facto standards that cannot be taken for granted in lower resource settings. Using a MD designed for high-resource settings in LMICs may hinder its safe and efficient operationalisation. In the literature, many criteria for frameworks to support resilient MD design were presented. However, since the available criteria (as of 2021) are far from being consensual and comprehensive, the aim of this study is to raise awareness about such challenges and to scope experts’ consensus regarding the essentiality of MD design criteria. Results This paper presents a novel application of Delphi study and Multiple Criteria Decision Analysis (MCDA) to develop a framework comprising 26 essential criteria, which were evaluated and chosen by international experts coming from different parts of the world. This framework was validated by analysing some MDs presented in the WHO Compendium of innovative health technologies for low-resource settings. Conclusions This novel holistic framework takes into account some domains that are usually underestimated by MDs designers. For this reason, it can be used by experts designing MDs resilient to low-resource settings and it can also assist policymakers and non-governmental organisations in shaping the future of global healthcare.

scholarly journals Applying heat and humidity using stove boiled water for decontamination of N95 respirators in low resource settings

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0255338
Author(s):  
Siddharth Doshi ◽  
Samhita P. Banavar ◽  
Eliott Flaum ◽  
Surendra Kulkarni ◽  
Ulhas Vaidya ◽  
...  
Keyword(s):  
Large Scale ◽  
Low Cost ◽  
Low Resource Settings ◽  
Low Resource ◽  
Surgical Masks ◽  
Temperature And Humidity ◽  
Similar Temperature ◽  
N95 Respirators ◽  
Electricity Access ◽  
Uv C

Global shortages of N95 respirators have led to an urgent need of N95 decontamination and reuse methods that are scientifically validated and available world-wide. Although several large scale decontamination methods have been proposed (hydrogen peroxide vapor, UV-C); many of them are not applicable in remote and low-resource settings. Heat with humidity has been demonstrated as a promising decontamination approach, but care must be taken when implementing this method at a grassroots level. Here we present a simple, scalable method to provide controlled humidity and temperature for individual N95 respirators which is easily applicable in low-resource settings. N95 respirators were subjected to moist heat (>50% relative humidity, 65–80°C temperature) for over 30 minutes by placing them in a sealed container immersed in water that had been brought to a rolling boil and removed from heat, and then allowing the containers to sit for over 45 minutes. Filtration efficiency of 0.3–4.99 μm incense particles remained above 97% after 5 treatment cycles across all particle size sub-ranges. This method was then repeated at a higher ambient temperature and humidity in Mumbai, using standard utensils commonly found in South Asia. Similar temperature and humidity profiles were achieved with no degradation in filtration efficiencies after 6 cycles. Higher temperatures (>70°C) and longer treatment times (>40 minutes) were obtained by insulating the outer vessel. We also showed that the same method can be applied for the decontamination of surgical masks. This simple yet reliable method can be performed even without electricity access using any heat source to boil water, from open-flame stoves to solar heating, and provides a low-cost route for N95 decontamination globally applicable in resource-constrained settings.

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