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Programmable multistep syntheses can be useful tools in molecule discovery and process optimization, and have recently been bolstered by advances in computational chemistry and machine learning applications to molecule design. Current approaches rely on advanced liquid handling and reactor design that can reliably create fractions and aliquots of reagents and products. Here we report on the use of non-aqueous synthesis programming of pharmaceutically relevant molecules using reconfigurable paper comprising an Ampli chemical plug and play construction set. Liquid fractions and reactions are replaced with paperfluidic membranes on blocks that can be snapped together and disconnected for real time design of experiments. Reagents are embedded into the paper membranes of each block, and reactions are synthesized by snapping together blocks and allowing solution to run through them in a sequence. We explored the use of Ampli to synthesize two pharmaceutically relevant species, gold nanoparticles and the antibiotic metronidazole. Reaction products were characterized by different spectroscopic techniques (Raman spectroscopy, optical absorption spectroscopy, dynamic light scattering). The resulting products were extracted to form functional nanoparticles used in diagnostic immunoassays, and our paper synthesized metronizadole was functional in an anti-bacterial disk diffusion assay. We investigated how to map off-the-shelf reactions onto individual Ampli blocks and how to successfully generate and extract these products. This paper based pharmaceutical synthesis was faster, significantly more affordable, and lighter than traditional methods with important implications for local and distributed manufacturing.

COVID-19 first appeared in December of 2019 in Wuhan, China. Since then it has become a global pandemic. A robust and scalable diagnostics strategy is crucial for containing and monitoring the pandemic. RT-PCR is a known, reliable method for COVID-19 diagnostics which can differentiate between SARS-CoV-2 and other viruses. However, PCR is location dependent, time consuming and relatively expensive. Thus, there is a need for a more flexible method which may be produced in an off-the-shelf format and distributed more widely. Paper-based immunoassays can fulfill this function. Here we present the first steps towards a paper-based test which can differentiate between different between the Spike protein of various coronaviruses, SARS-CoV-1, SARS-CoV-2 and CoV-HKU1 with negligible cross reactivity for HCoV-OC43 and HCoV-229E in a single assay which takes less than 30 minutes. Furthermore, our test can distinguish between fractions of the same Spike protein. This is done by an altered assay design with four test line locations where each antigen builds a unique, identifiable binding pattern. The effect of several factors, such as running media, immunoprobe concentration and antigen interference is considered. We find that running media has a significant effect on the final binding pattern where human saliva provides results while human serum leads to the lowest signal quality.

The COVID-19 pandemic has led to an unprecedented global health challenge, creating sudden, massive demands for diagnostic testing, treatment, therapies, and vaccines. In particular, the development of diagnostic assays for SARS-CoV-2 has been pursued as they are needed for quarantine, disease surveillance, and patient treatment. One of the major lessons the pandemic highlighted was the need for fast, cheap, scalable and reliable diagnostic methods, such as paper-based assays. Furthermore, it has previously been suggested that paper-based tests may be more suitable for settings with lower resource availability and may help alleviate some supply chain challenges which arose during the COVID-19 pandemic. Therefore, we explore how such devices may fit in a comprehensive diagnostic strategy and how some of the challenges to the technology, e.g. low sensitivity, may be addressed. We discuss the properties of the SARS-CoV-2 virus itself, the COVID-19 disease pathway, and the immune response. We then describe the different diagnostic strategies that have been pursued, focusing on molecular strategies for viral genetic material, antigen tests, and serological assays, and innovations for improving the diagnostic sensitivity and capabilities. Finally, we discuss pressing issues for the future, and what needs to be addressed for the ongoing pandemic and future outbreaks.

There has been an increasing and urgent demand to develop nucleic acid bioassays which not only offer high analytical performance but which are also amenable with point-of-care testing. Hydrogels present a versatile class of materials with biocompatible antifouling properties and the ability to be engineered for a range of advanced sensing applications. Fibrous substrates like nitrocellulose offer low-cost and durable platforms to run complex bioassays while enabling portability and ease of handling. We demonstrate herein the ability to synergistically combine these two materials into a portable biosensing platform by leveraging projection lithography. We demonstrate the direct polymerization of hydrogel sensing motifs within a range of fibrous substrates with precise control over their shape, size, location, and functionality. Spatial encoding of the hydrogel motifs enables the multiplex detection of multiple biomarkers on the same test. As a proof-of-concept, we apply the platform to the detection of microRNA, an emerging class of circulating biomarkers with promising potential for early diagnosis and monitoring of cancer. The assay offers a large dynamic range (over three orders of magnitude), high sensitivity (limit of detection of 2.5 amol), as well as versatility and ease of handling. Finally, the bioassay is validated using real biological samples, namely, total RNA extracted from the sera of late-stage breast cancer patients, demonstrating its utility and compatibility with clinical biosensing applications.

Sharing protocols with the end-users may allow their flexible implementation to produce nanotechnology solutions for global health challenges that better cater for local needs.

Problem Health professions education does not routinely incorporate training in innovation or creative problem solving. Although some models of innovation education within graduate medical education exist, they often require participants' full-time commitment and removal from clinical training or rely upon participants' existing expertise. There is a need for curricula that teach innovation skills that will enable trainees to identify and solve unmet clinical challenges in everyday practice. To address this gap in surgical graduate education, the authors developed the Surgical Program in Innovation (SPIN). Approach SPIN, a 6-month workshop-based curriculum, was established in 2016 in the Beth Israel Deaconess Medical Center Department of Surgery to teach surgical trainees the basics of the innovation process, focusing on surgeon-driven problem identification, product design, prototype fabrication, and initial steps in the commercialization process. Participating surgical residents and graduate students attend monthly workshops taught by medical, engineering, and medical technology (MedTech) industry faculty. Participants collaborate in teams to develop a novel device, fabricate a protype, and pitch their product to a panel of judges. Outcomes From academic years 2015-2016 to 2017-2018, 49 trainees, including 41 surgical residents, participated in SPIN. Across this period, 13 teams identified an unmet need, ideated a solution, and designed and pitched a novel device. Ten teams fabricated prototypes. The 22 SPIN participants who responded to both pre- and postcourse surveys reported significant increases in confidence in generating problem statements, computer-aided design, fabrication of a prototype, and initial commercialization steps (product pitching and business planning). Next steps Incorporating innovation education and design thinking into clinical training will prove essential in preparing future physicians to be lifelong problem finders and solvers. The authors plan to expand SPIN to additional clinical specialties, as well as to assess its impact in fostering future innovation and collaboration among program participants.

We exploit the cross-reactivity of dengue (DENV) and Zika (ZIKV) virus polyclonal antibodies for nonstructural protein 1 (NS1) to construct a selective sensor that can detect yellow fever virus (YFV) NS1 in a manner similar to chemical olfaction. DENV and ZIKV antibodies were screened for their ability to bind to DENV, ZIKV, and YFV NS1 by enzyme linked immunosorbent assay (ELISA) and in pairs in paper immunoassays. A strategic arrangement of antibodies immobilized on paper and conjugated to different colored gold NPs was used to distinguish the three biomarkers. Machine learning of test area RGB values showed that with two spots, readout accuracies of 100% and 87% were obtained for both pure NS1 and DENV/YFV mixtures, respectively. Additional image preprocessing allowed differentiation between all four DENV serotypes with 92% accuracy. The technique was extended to hack a commercial DENV test to detect YFV and ZIKV by augmentation with DENV and ZIKV polyclonal antibodies.

We exploit the cross-reactivity of dengue (DENV) and zika (ZIKV) virus polyclonal antibodies for nonstructural protein 1 (NS1) to construct a selective sensor that can detect yellow fever virus (YFV) NS1 in a manner similar to chemical olfaction. DENV and ZIKV antibodies were screened for their ability to bind to DENV, ZIKV, and YFV NS1 by ELISA and in pairs in paper immunoassays. A strategic arrangement of antibodies immobilized on paper and conjugated to different colored gold NPs was used to distinguish the three biomarkers. Machine learning of test area RGB values showed that with two spots, readout accuracies of 100% and 87% were obtained for both pure NS1 and DENV/YFV mixtures, respectively. Additional image pre-processing allowed differentiation between all 4 DENV serotypes with 92% accuracy. The technique was extended to hack a commercial DENV test to detect YFV and ZIKV by augmentation with DENV and ZIKV polyclonal antibodies.TOC GRAPHIC

Nucleic acid amplification tests (NAATs), which amplify and detect pathogen nucleic acids, are vital methods to diagnose diseases, particularly in cases where patients exhibit low levels of infection. For many blood-borne pathogens such as HIV or Plasmodium, it is necessary to first extract pathogen RNA or DNA from patient blood prior to analysis with NAATs. Traditional nucleic acid extraction methods are expensive, resource-intensive and are often difficult to deploy to resource-limited areas where many blood-borne infections are widespread. Here, we describe a portable, paper-and-plastic device for instrument-free nucleic acid extraction from whole blood, which we call SNAPflex, that builds upon our previous work extracting RNA in a 2D platform from nasopharyngeal swabs. We demonstrated improved extraction of HIV RNA from simulated patient samples compared to traditional extraction methods and long-term stability of extracted RNA without the need for cold storage. We further demonstrated successful extraction and recovery of Plasmodium falciparum DNA from simulated patient samples with superior recovery compared to existing extraction methods. The SNAPflex device extracts and purifies DNA and RNA from whole blood which can be amplified with traditional NAATs, and was designed to easily manufacture and integrate into existing health systems.

Global attempts to renew scientific education aim to stop the decline of young people's interest in science and technology, and to promote the development of citizens' scientific literacy for sustainable development. Among other changes, these aims require the adaptation of K12 Biological Science Teacher’s training to meet the new objectives.Scientific literacy involves knowing science and how knowledge is developed and validated, recognizing the interactions between science, technology and society, that is, the nature of science (NoS; a set of meta-scientific contents that encompass historical, epistemological and sociological aspects of science with great value for scientific education). It also involves grasping of cognitive skills underlying critical thinking (CT; a set of cognitive abilities, including self-regulation and metacognitive processes) and creative problem solving. Therefore, scientific literacy contributes to making informed decisions, facilitating the participation of citizens in situations and dilemmas of scientific tenor.In addition, CT is closely related to the performance of educators in their professional work. Particularly, in the teaching of science, CT skills favour and enhance the learning of concepts and theories linked not only to science but also to the NoS.Considering the current conditions of middle-higher K12 Biological Science Teachers’ formation and classrooms´ limitations in our country and the region, we propose a pilot project aiming to promote the transformation of initial teachers´ training, seeking to improve the development of CT skills and to deepen NoS comprehension. It will involve the immersion of K12 Biological Science Teacher students in Biological Science Living Physical and "mirror" Virtual Reality Laboratories. These laboratories will be equipped with "do it yourself" (DIY), "do it with others" (DIWO) and "bring your own device" (BYOD) technologies for the implementation of research-type activities framed in the philosophy of the "fabrication laboratories". The virtual platform will also comprise a library with didactic resources under permissive licenses to ensure a broader impact.Within these environments, K12 Biological Science Teacher students will engage in the creation of didactic units involving problem solving and knowledge building in parallel to deeper understanding of scientific processes. We also hope to promote the creativity and innovation of the participants, and the appropriation of DIY/DIWO/BYOD and virtual reality technologies as educational resources in the classroom and everyday life.Thanks to the virtual environment, this approach would also allow to reach both National and International K12 Biological Science Teacher students and graduate Biological Science Teachers. Considering the universal access to the Internet and free access to educational platforms in several countries, we also hope to impact on the non-formal and informal Biological Science education and contribute to achieving quality education for all (Objective # 4 of the Agenda for Sustainable Development 2030, UNESCO) beyond geographical and cultural barriers.This pilot project will be implemented by an interinstitutional, multidisciplinary and international team. It will capitalize on confluent groups´ previous experience and complementary strengths in Science didactics (particularly biology), engineering, arts, virtual reality, fabrication, as well as open hardware and open software culture.The experimental approach corresponds to a quasi-experimental pre-test/post-test design with control groups, and formative and summative evaluation.As a result of the implementation of this educational innovation we expect to contribute to the improvement of Biological Science Teachers students´ CT skills and promote their active involvement in practical activities that should enhance their professional activity.

At this time, there are no interactive mobile apps designed to increase informed decisions about colorectal cancer screening among women. Colorectal cancer is the third leading cause of cancer death among women. The study's purpose was to explore the usability, acceptability, and satisfaction with a mobile app designed to increase colorectal cancer screening informed decisions among 50- to 64-year-old women. Using previous research, an interactive mobile app to increase informed decisions about colorectal cancer screening was developed and pilot tested among African American and Caucasian women (N = 41). In total, 80.6% of women strongly agree/agreed that the mobile app made them think about colorectal cancer screening, 83.8% strongly agree/agreed that the mobile app provided enough information to make a decision about colorectal cancer screening, and 86.1% strongly agree/agreed that the mobile app could help them talk to their provider about colorectal cancer screening. Participants (63.2%) identified family/spouse as who they would talk to about their colorectal cancer screening decision. Participants found the mobile app easy to use and useful in making colorectal cancer screening decisions. Social support is important when making decisions about colorectal cancer screening. Healthcare professionals need new strategies, such as mobile apps, that engage patients, have the potential to increase patient-provider communication, and increase colorectal cancer screening adherence.

The design and fabrication of reconfigurable, modular paperfluidics driven by a prefabricated reusable block library, asynchronous modular paperfluidic linear instrument-free (Ampli) block, are reported. The blocks are inspired by the plug-and-play modularity of electronic breadboards that lower prototyping barriers in circuit design. The resulting biochemical breadboard is a paperfluidic construction set that can be functionalized with chemical, biological, and electrical elements. Ampli blocks can form standard paperfluidic devices without any external instrumentation. Furthermore, their modular nature enhances fluidics in ways that fixed devices cannot. The blocks' ability to start, stop, modify, and reverse reaction flows, reagents, and rates in real time is demonstrated. These enhancements allow users to increase colorimetric signals, fine tune reaction times, and counter check multiplexed diagnostics for false positives or negatives. The modular construction demonstrates that field-ready, distributed fabrication of paper analytical systems can be standardized without requiring the “black box” of craft and technique inherent in paper-based systems. Ampli assembly and point-of-care redesign extends the usability of paper analytical systems and invites user-driven prototyping beyond the lab setting demonstrating “Design for Hack” in diagnostics.

Polymerization-based amplification (PBA) uses a visible-light photopolymerization reaction for rapid, low-cost signal amplification and colorimetric detection in disease diagnostics. PBA is particularly useful for point-of-care testing (POCT) in the developing world where laboratory infrastructure and access to advanced technologies may be limited. To date, PBA has required expensive (∼5K USD), desktop-based light sources to drive these photopolymerization reactions, which has limited its use in limited-resource areas and for POCT applications. Here, we present a portable, lightweight, and low-cost device that can generate light of the intensity and wavelengths required to perform the PBA reactions rapidly (

Patient: Female, 57 Final Diagnosis: Baclofen toxicity Symptoms: Encephalopathy • hypotonia Medication: Baclofen Clinical Procedure: Hemodialysis Specialty: Critical Care Objective: Unusual or unexpected effect of treatment Background: Baclofen is a centrally acting gamma-aminobutyric acid agonist used for the symptomatic relief of skeletal muscle spasm and spasticity in traumatic spinal cord lesions, multiple sclerosis, cerebral palsy, and stroke. It is also used in the treatment of chronic hiccups and cocaine abuse. Baclofen-induced central nervous system depression is rare at the usual therapeutic doses. However, patients with impaired renal function are at a higher risk of developing baclofen toxicity, even at a lower dose. Case Report: A 57-year-old woman with end-stage renal disease on hemodialysis was admitted to our emergency department with progressive confusion and a generalized decrease in muscular tone. There was no obvious metabolic or infectious etiology that could have explained her condition. A comprehensive laboratory and imaging workup was negative. A review of her medication showed that she had recently been prescribed baclofen for muscular spasm. She was diagnosed with baclofen toxicity and was treated with emergent hemodialysis, which improved her mental status and her decreased muscle tone. Repeated sessions of hemodialysis administered on her second and third days of admission ultimately produced sustained clinical improvement and a complete return to her baseline mental status. She was subsequently discharged home with instructions to stay off baclofen. Conclusions: Baclofen toxicity is an under-diagnosed condition, especially in patients with renal dysfunction. Physicians should consider baclofen toxicity in patients with suboptimal kidney function on baclofen who present with altered mental status. Emergent hemodialysis and intensive care unit monitoring is recommended.

2D, 3D and 4D printing are fertile areas for design and material experimentation, and thus the architectural detail in the future. Here Skylar Tibbits, along with his collaborators - Lina Kara'in (MIT Self-Assembly Lab) , Jose Gomez-Marquez, Anna Young and Joaquin Navarro (Little Devices Lab, MIT), Lee Gehrke, Helena de Puig and Justina Tam (Gehrke Lab, MIT), and Joseph Schaeffer and Carlos Olguin (Autodesk Inc) - describe the development of DNAdisPLAY: a project that created a physical prototype and design workflow for 2D bioprinting, resulting in the development of software, hardware and printed DNA patterns on paper.

Historically, many industries such as manufacturing have undergone a trend away from centralized, large-scale production toward a more distributed form. Currently, this same trend is witnessed in biological manufacturing and bioprocessing, with the rise of biological foundries where one can synthesize, grow, isolate, and purify a broad range of biologics. The adoption of distributed practices for biological processing has significant implications for healthcare, diagnostics, and therapies. This essay discusses the many diverse factors that have facilitated this growth, ranging from the establishment of available biological components, or "parts," low-cost programmable hardware, and others. Currently existing examples of distributed biological foundries are also identified, separating the discussion into those that are accessible only by elite users and the more recent emerging foundries that are more accessible to the general population. Taking lessons from other fields, it is argued that this trend toward distributed biological manufacturing is inevitable, so adapting to this trend is important for the progress of creating new therapeutics, sensors, diagnostics, and reagents for biomedical applications.

The recent Zika virus (ZIKV) outbreak demonstrates that cost-effective clinical diagnostics are urgently needed to detect and distinguish viral infections to improve patient care. Unlike dengue virus (DENV), ZIKV infections during pregnancy correlate with severe birth defects, including microcephaly and neurological disorders. Because ZIKV and DENV are related flaviviruses, their homologous proteins and nucleic acids can cause cross-reactions and false-positive results in molecular, antigenic, and serologic diagnostics. We report the characterization of monoclonal antibody pairs that have been translated into rapid immunochromatography tests to specifically detect the viral nonstructural 1 (NS1) protein antigen and distinguish the four DENV serotypes (DENV1-4) and ZIKV without cross-reaction. To complement visual test analysis and remove user subjectivity in reading test results, we used image processing and data analysis for data capture and test result quantification. Using a 30-μl serum sample, the sensitivity and specificity values of the DENV1-4 tests and the pan-DENV test, which detects all four dengue serotypes, ranged from 0.76 to 1.00. Sensitivity/specificity for the ZIKV rapid test was 0.81/0.86, respectively, using a 150-μl serum input. Serum ZIKV NS1 protein concentrations were about 10-fold lower than corresponding DENV NS1 concentrations in infected patients; moreover, ZIKV NS1 protein was not detected in polymerase chain reaction-positive patient urine samples. Our rapid immunochromatography approach and reagents have immediate application in differential clinical diagnosis of acute ZIKV and DENV cases, and the platform can be applied toward developing rapid antigen diagnostics for emerging viruses.

Point-of-care (POC) diagnostics such as lateral flow and dipstick immunoassays use gold nanoparticle (NP)-antibody conjugates for visual readout. We investigated the effects of NP conjugation, surface chemistries, and antibody immobilization methods on dipstick performance. We compared orientational, covalent conjugation, electrostatic adsorption, and a commercial conjugation kit for dipstick assays to detect dengue virus NS1 protein. Assay performance depended significantly on their conjugate properties. We also tested arrangements of multiple test lines within strips. Results show that orientational, covalent conjugation with PEG shield could improve NS1 detection. These approaches can be used to optimize immunochromatographic detection for a range of biomarkers.

Making in health as the intentional activity when individuals shape, form, assemble and transform objects with their own hands-on skills and nearby resources. It represents the integration of a skillset, a toolset and a mindset. Nursing has a rich tradition of making -- one that has produced numerous devices and tools that created a direct path to improved patient outcomes. For this report, we looked back at more than 100 years of nursing history to uncover this rich tradition of creating and spreading tangible, nurse-made devices and discover how nurse making has evolved over time -- including its links to nursing research and clinical innovation. We examine the transformation of making in nurse practice from it's heyday in the early part of the 20th century, a resurgence in the midcentury, and its transition to a state of stealth making. Nurses formed a network of innovators in history and in the present that are changing the way care is delivered, redefining the role of prototyping, and highlighting the importance of creativity over evidence as the source of innovation in practice.

Patient: Male, 47 Final Diagnosis: Bilateral psoas abscess • acute lower extremity deep vein thrombosis • bilateral pulmonary embolism Symptoms: Progressive left leg swelling • productive cough with whitish sputum • right flank pain Medication: Antibiotics and anticoagulation Clinical Procedure: CT-guided percutaneous drain placement Specialty: Internal Medicine/Critical Care Objective: Unusual presentation Background: Psoas abscesses are a known cause of back pain, but they have not been reported as a cause of acute lower extremity thromboses and bilateral pulmonary emboli. We report a patient with bilateral psoas abscesses causing extensive pulmonary emboli through compression of the iliac vein. Case Report: A 47-year-old man presented with bilateral leg swelling over 4 weeks. Physical examination revealed a thin male with bilateral leg swelling, extending to the thigh on his left side. He had hemoglobin of 10.5 g/dl, leukocytosis of 16 000/ml, and an elevated D-dimer. A computed tomography (CT) angiogram of his chest showed extensive bilateral pulmonary emboli and infarcts. He remained febrile with vague flank pain, prompting a CT of his abdomen and pelvis that showed large, multiloculated, septated, bilateral psoas abscesses with compression of the left femoral vein by the left psoas abscess and a thrombus distal to the occlusion. Two liters of pus was drained from the left psoas abscess by CT-guidance, and although the Gram staining showed Gram-positive cocci in clusters, cultures from the abscess and blood were negative. A repeat CT showed resolution of the abscesses, and the drain was removed. He was discharged to a nursing home to complete a course of intravenous antibiotics and anticoagulation. Conclusions: Although the infectious complications of psoas abscesses have been described in the literature, the mechanical complications of bilateral psoas abscesses are lacking. It is important to assess for complete resolution of psoas abscesses through follow-up imaging to prevent venous thromboembolic events.

Rapid point-of-care (POC) diagnostic devices are needed for field-forward screening of severe acute systemic febrile illnesses. Multiplexed rapid lateral flow diagnostics have the potential to distinguish among multiple pathogens, thereby facilitating diagnosis and improving patient care. Here, we present a platform for multiplexed pathogen detection using multi-colored silver nanoplates. This design requires no external excitation source and permits multiplexed analysis in a single channel, facilitating integration and manufacturing., National Institutes of Health (U.S.) (NIH NIAID (AI100190)), SUTD-MIT International Design Centre (IDC)

Histoplasma duboisii, a variant ofHistoplasma capsulatumthat causes “African histoplasmosis,” can be resistant to itraconazole, requiring intravenous amphotericin B treatment. Rarely, these patients do not respond to intravenous antifungal therapy, and in such cases, patients may progress to develop secondary hemophagocytic lymphohistiocytosis (HLH). We present a case of a 34-year-old male patient with sickle cell disease who presented with a 5-month history of an enlarging painless axillary mass, persistent low grade fevers, night sweats, weight loss, and anorexia. An excisional biopsy of the right axillary lymph node revealed yeast and granulomas consistent with histoplasma infection. He was started on oral itraconazole. After 4 weeks of therapy, laboratory evaluation revealed worsening anemia, thrombocytopenia, and transaminitis. Due to failure of oral therapy, he was admitted for intravenous amphotericin B treatment. During his hospital course anemia, thrombocytopenia, and transaminitis all worsened. A bone marrow biopsy was done that was consistent with HLH. His clinical status continued to deteriorate, developing multiorgan failure and disseminated intravascular coagulation. He unfortunately had a cardiorespiratory arrest after eight days of admission and passed away.

Innovations in international health require the use of state-of-the-art technology to enable clinical chemistry for diagnostics of bodily fluids. We propose the implementation of a portable and affordable lock-in amplifier-based instrument that employs digital technology to perform biochemical diagnostics on blood, urine, and other fluids. The digital instrument is composed of light source and optoelectronic sensor, lock-in detection electronics, microcontroller unit, and user interface components working with either power supply or batteries. The instrument performs lock-in detection provided that three conditions are met. First, the optoelectronic signal of interest needs be encoded in the envelope of an amplitude-modulated waveform. Second, the reference signal required in the demodulation channel has to be frequency and phase locked with respect to the optoelectronic carrier signal. Third, the reference signal should be conditioned appropriately. We present three approaches to condition the signal appropriately: high-pass filtering the reference signal, precise offset tuning the reference level by low-pass filtering, and by using a voltage divider network. We assess the performance of the lock-in instrument by comparing it to a benchmark device and by determining protein concentration with single-color absorption measurements. We validate the concentration values obtained with the proposed instrument using chemical concentration measurements. Finally, we demonstrate that accurate retrieval of phase information can be achieved by using the same instrument.

Treating HIV in developing countries involves highly active antiretroviral therapies that require strict adherence by the patient. Current methods of self-reporting to monitor adherence to a drug regimen are less reliable than a drug test. This work introduces proof-of-concept of a new assay involving azide-alkyne cycloaddition to detect the presence of azidothymidine (AZT), a common antiretroviral therapy used in developing countries, in patient urine. Spotting experiments were performed on a paper-based platform with simple materials that selectively detects urine samples containing AZT and these results were confirmed by NMR and UV-Vis spectroscopy. The detection of the assay to AZT was found to be around 12mM. This assay can be translated into a point-of-care set-up that can be used by clinicians to directly monitor patient adherence while increasing efficiency and reducing the costs of health care for HIV patients.

Collaborative approach for global health technology is reported. The Global Health Initiative (GHI) at the Center for Integration of Medicine and Innovative Technology, the Center for Global Health at Massachusetts General Hospital (MGH), and Innovations in International Health at Massachusetts Institute of Technology (IIH@MIT) have formed a collaboration that puts our research and development model, Global Health Technology 2.0, to work and advances a growing global health portfolio.

The design of medical technologies for developing countries is a multidisciplinary process. We describe a model process for an appropriate medical device design. D-Lab Health combines real world projects and partners with a diverse student team to provide experiential educational opportunities in a developing country health care setting; in turn, the partners benefit from student medical device designs. In order to effectively communicate practical design strategies toward an appropriate design for medical technology, a series of accelerated technology learning modules was developed using commercially available and customized medical devices. Each module included a formal framework for the students to think about the competing priorities of the user, chooser, payer, and approver of such global health technologies, christened the “global health innovation compass.” These modules provided a hands-on laboratory experience that demystified the design process. This was particularly useful for nonengineering students who were able to add value to the project through their life-sciences background. An essential component of the course was a week-long visit to our field partners in Nicaragua to enable the students to get first hand experience and to identify a health need they could address with a technology solution. Subsequently, the students utilized their hands-on training to develop medical device prototypes within an abbreviated production schedule of 3 weeks. We describe the design process for one such prototype “a low cost glucometer.”

Objective: To test whether a critical care consult team can be used to identify patients who have methicillin-resistant Staphylococcus aureus nasal colonization during a window period at which they are at highest risk for methicillin-resistant S. aureus infection and can most benefit from topical decolonization strategies. Design: Prospective cohort study. Setting: Two adult tertiary care hospitals. Patients: Patients with at least one risk factor for methicillin-resistant S. aureus nasal colonization who were seen by a critical care consult team for potential intensive care unit admission were enrolled. Interventions: Nasal cultures for methicillin-resistant S. aureus were performed on all subjects. All subjects were followed for the development of a methicillin-resistant S. aureus infection for 60 days or until hospital discharge. Demographic and outcome data were recorded on all subjects. Measurements and Main Results: Two hundred subjects were enrolled. Overall 29 of 200 (14.5%) were found to have methicillin-resistant S. aureus nasal colonization. Methicillin-resistant S. aureus infections occurred in seven of 29 (24.1%) subjects with methicillin-resistant S. aureus nasal colonization vs. one of 171 (0.6%) subjects without methicillin-resistant S. aureus nasal colonization (p < .001). Methicillin-resistant S. aureus clinical specimens were recovered in 15 of 29 (51.7%) subjects with methicillin-resistant S. aureus nasal colonization vs. two of 171 (1.2%) without methicillin-resistant S. aureus nasal colonization. Conclusions: A critical care consult team can be used to rapidly recognize patients with methicillin-resistant S. aureus nasal colonization who are at very elevated risk for methicillin-resistant S. aureus infection. The use of such a team to recognize patients who have greatest potential benefit from decolonization techniques might reduce the burden of severe methicillin-resistant S. aureus infections.