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Every year, antimicrobial resistance causes the death of around 700 000 people, and this number is expected to rise to an estimated 10 million deaths annually by 2050. (1) Antimicrobial [...]

Biomedical and clinical scientists play a major role in translating observations into interventions – therapeutics, diagnostics, and medical devices including screening instruments – that improve the health of individuals and the public. This path from observation to intervention is often long and beset with obstacles, many unanticipated. We believe that sharing concrete, real-word examples of scientists in academia moving along this path will highlight some of the types of challenges one may face; here we focus on an intervention being developed by the Zaman lab at Boston University – PharmaChk, the first quantitative, field-based instrument for medicine quality screening. Specifically, this paper describes the first ten years of scientific and engineering work towards the development of this instrument. Launched from a need observed by medicine quality scientists, the development of PharmaChk has required the integration of multiple technologies enabled by knowledge and expertise across diverse fields of science and engineering, including chemistry, ultrasonics, fluid dynamics, optics, computer science, and automation. These efforts have been shaped and driven by the many challenges we have faced and the technical, commercial, and financial support that we have received from many collaborators. By sharing this example, we hope to inspire our colleagues to pursue their own paths to new healthcare solutions. [ABSTRACT FROM AUTHOR]

Poor intra-facility maternity care is a major contributor to maternal mortality in low- and middle-income countries. Close to 830 women die each day due to preventable maternal complications, partly due to the increasing number of women giving birth in health facilities that are not adequately resourced to manage growing patient populations. Barriers to adequate care during the ‘last mile’ of healthcare delivery are attributable to deficiencies at multiple levels: education, staff, medication, facilities, and delays in receiving care. Moreover, the scope and multi-scale interdependence of these factors make individual contributions of each challenging to analyze, particularly in settings where basic data registration is often lacking. To address this need, we have designed and implemented a novel systems-level and dynamic mathematical model that simulates the impact of hospital resource allocations on maternal mortality rates at Mnazi Mmoja Hospital (MMH), a referral hospital in Zanzibar, Tanzania. The purpose of this model is to provide a rigorous and flexible tool that enables hospital administrators and public health officials to quantitatively analyze the impact of resource constraints on patient outcomes within the maternity ward, and prioritize key areas for further human or capital investment. Currently, no such tool exists to assist administrators and policy makers with effective resource allocation and planning. This paper describes the structure and construct of the model, provides validation of the assumptions made with anonymized patient data and discusses the predictive capacity of our model. Application of the model to specific resource allocations, maternal treatment plans, and hospital loads at MMH indicates through quantitative results that medicine stocking schedules and staff allocations are key areas that can be addressed to reduce mortality by up to 5-fold. With data-driven evidence provided by the model, hospital staff, administration, and the local ministries of health can enact policy changes and implement targeted interventions to improve maternal health outcomes at MMH. While our model is able to determine specific gaps in resources and health care delivery specifically at MMH, the model should be viewed as an additional tool that may be used by other facilities seeking to analyze and improve maternal health outcomes in resource constrained environments. [ABSTRACT FROM AUTHOR]

Drug release testing plays a major role along all parts of the dosage form development and manufacturing process. However, official methods to perform this type of testing are often resource intensive and require highly specialized facilities. Affordable and accessible methods for studying drug release behavior are currently lacking. This work presents a small volume approach to solid dissolution and drug release testing of solid dosage forms using ultrasonic agitation. Cavitation and acoustic streaming were generated by a microprobe horn delivering a 40 kHz acoustic signal into a 50 mL test vessel. These two phenomena resulted in breakdown of and release of drug from tablet samples. Prednisone Performance Verification Tablets were used as model tablets to study the effect of system parameters on the drug release process. The effects of these parameters on the acousto-hydrodynamic environment were studied using streak photography and hydrophone measurements. Drug release behavior showed a slow/fast threshold transition separated by a highly variable regime as a function of the system parameters. Observations from drug release experiments and results from acoust-hydrodynamic characterization experiments suggested that this transition is dominated by acoustic streaming. This method represents a screening method to probe relative differences in dosage form composition and acts as a complimentary approach to official testing methods. The small volume format of this test has potential applications in the study of drug release properties from low-dose and novel solid dosage forms as well as reduced cost and increased accessibility of release testing for post-manufacturing tablet quality screening, a current need in low- and middle-income countries. [ABSTRACT FROM AUTHOR]