Center for Global Health Engineering

Location of Research: Human Physiology Lab, Western New England University

Centrifuges are used in a variety of clinical laboratory processes, including the separation of red blood cells (RBCs) from plasma for measurement of patient hematocrit. Measurements of hematocrit are critical for the diagnosis and monitoring of a wide range of clinical conditions such as chronic anemia and acute blood loss. These conditions are of particular importance from a global health perspective; however, modern centrifuge systems require significant electrical and laboratory resources, and they typically cost on the order of hundreds of dollars. Additionally, centrifuges presently used in developing world clinical settings are not portable, which further limits their utility for anemia diagnosis. As a result, routine clinical laboratory tests, like hematocrit, could find broader implementation in low-resource environments through the development of inexpensive, small-scale, portable tools. In this work, we are developing a portable centrifuge that is suitable for low-resource settings. Major design constraints included total cost under $50, minimal training requirements, robust operation, and maintaining compatibility with current clinical laboratory methods.

Status: beta prototype

Location of Research: Pubic Safety Complex, Western New England University

While attending the Consortium of Universities for Global Health 2016 conference, it was made clear that University Global Health Teams in the field are exposed to multitudes of hazards that range from natural disaster, political instability, illness, injury, violence and general regional instability. Further, it was made clear in a panel session on responding to Global Health Teams in crisis, that few, or none, of the universities represented on the panel and in the audience are implementing well understood and developed standards for organizational crisis response protocols. This was in April 2016, and at that time I began talks with Michael Rust of the Department of Biomedical Engineering to develop a set of model protocols that adapt the National Response Framework to the specifics of the University of the Global Health teams. We discussed this frequently during the spring 2016 semester, and have a plan moving forward starting in the fall 2017 semester to fully exploit this gap in the knowledge. 

Status: Preliminary plan being developed

Location of Research: Hospital Suite, Western New England University

Nerve block is a common procedure in which anesthesia is administered to or around a nerve as a means to interrupt signal transduction. The procedure has applications in pain management and surgery (e.g., amputations), and is typically performed with ultrasound imaging to help locate the correct anatomy. An implication of the use of ultrasound-assisted nerve block is the need for an effective method to properly train medical professionals in the technique without putting patients at risk. This can be addressed with a training phantom that has been designed to mimic human tissue and thus allow medical staff to practice the procedure without requiring a patient to be present. Such phantoms are commercially available for nerve block procedures, but their cost structure prohibits their use in low-resource healthcare settings. To address this problem, a nerve block training phantom is being developed specifically for use in a low-resource environment.

Status: beta prototype

Location of Research: Human Physiology Lab, Western New England University

Sub-maximal step-tests (of the YMCA type) are commonly used to assess the effect of public health interventions in developing nations on an individual’s capacity to perform some task. A recent example is the related project that assessed the efficacy of treating hookworm (the public health intervention) on the capacity to perform subsistence farm labor in DR Congo (the task). Step-tests are used for this purpose because each is simple to perform and requires only limited time and basic equipment, which allows for large groups of people to be tested quickly, even in rural areas. The challenge is that step-tests (maximal or sub-maximal) resemble exercise more than they resemble work or labor. Work, such as farm labor, requires even distribution of effort across the upper and lower body at a low intensity for long durations. Conversely, step-tests are high intensity, short duration, and concentration all of the effort is in the legs. Therefore, it is not clear if step-tests are valid tools for assessing the capacity to perform work or labor. This project is exploring this threshold between exercise and labor in order to determine whether or not step-tests are valid for this purpose. During the project we will capture participants VO2max using a treadmill and maximal step test. We will then capture trending VO2 data for sub-maximal step-tests, as well as for some task that resembles work or labor, such as a rowing machine. We are also exploring developing a new sub-maximal step-test that is normalized by BMI.

Status: early stages

Location of Research: College of Pharmacy, Western New England University & HEAL Africa Hospital, North Kivu, DR Congo

It is estimated that 30 to 50 percent of medications on the world market are low quality or counterfeit (LQ/C), with the dominate proportion being located in low income countries (LIC). LIC do not generally have robust, regular oversight of the nation’s drug stock, for lack of resources, and so the population is exposed to LQ/C. This situation has the potential to harm individual and public health through increased morbidity and reduced trust in healthcare systems. This project to develop a transferable and economically sustainable testing protocol began during a related project (efficacy of hookworm treatment) at which time the Congolese physician suggested that the locally sourced Albendazole could not be trusted. We determined that there was no reasonably accessible method to test for quality, and so sought to develop a method and device that allowed the testing of medications for quality at, or near, the point-of-care. The objective was for this method and device to be as low cost and accessible as practicable, while still maintaining reliable results. For this, we introduced sample preparation procedures that do not require cutting edge laboratory equipment. A side effect was the introduction of some randomness in quality of prepared samples.  To compensate, we incorporated a multicriteria sorting algorithm in the method that has returned highly reliable results (low false positives and low false negatives). This method has been validated and published, and a related LED-based spectrophotometry is currently being developed. 

Status: Dissertation research published, continuing to advance method and device

Location of Research: Kindu General Hospital, Maniema Province, DR Congo, & Biologic Lab at Western New England University

While in Kindu for a related project, we noticed that the local radiologist did not have access to a stable supply of ultrasound gel. We sought an alternative, and found a paper that describe a corn-starch slurry alternative. Corn starch was not available, but cassava root flour was widely available. We experimented with various recipes, and found that an 8 parts flour, to 32 parts water, to 1 part salt mixture offered reasonable usability and visibility for the radiologist. The low cost structure of slurry enables the radiologist to produce it daily in-house at a cost of less than $0.1 per pint; a reducing from $10 to purchase one pint on the local market. This project has continued to evaluate the quality of ultrasound images obtained with cassava flour slurry (CFS) compared with conventional gel in order to determine objectively whether CFS could be a true low-cost alternative through a blinded non-inferiority trial using an obstetrical ultrasound unit in an academic medical center. Conclusions were that CFS produces comparable image quality to commercial ultrasound gel.The dissemination of these results and the simple CFS recipe could significantly increase access to ultrasound for screening, monitoring and diagnostic purposes in resource-limited settings.

Status: Project on-hold, with two papers published, and wide spread dissemination of research and method.

Project Location: Democratic Republic of the Congo: South Kivu and Maniema Provinces

This project was funded by the Gates Foundation Explorations program, Round 11. It sought to test the efficacy of mass distribution campaigns using Albendazole to treat hookworm. We partnered with doctors from HEAL Africa Hospital, Goma, DR Congo, to identify a location and study population. The study took place on Idjwi Island in Lake Kivu (North/South Kivu Province, DR Congo), and the City of Kindu, Maniema Province DR Congo, and in each location we leveraged existing cohorts of women who work with the community health program and community healthcare workers through the Safe Motherhood Program. In total we interacted with 400 women. Each was tested for hookworm and a measure of fitness we termed “work capacity” that was intended as a proxy variable for capacity to perform farm labor.  We returned after 7 months to test the durability of the initial Albendazole treatment by testing each women for work capacity. The study was double-blinded, with the analysis using a paired-test, with results demonstrating that there was a statistically significant benefit in work capacity. This project as spurred two follow up project. The first was a method and device to infer quality of medications at or near the point of care. The second is a validation of the step test as being representative of an individual’s capacity to perform agricultural or other similar labor.

Status: Project Complete. Two follow up projects continuing

Christian Salmon is an Associate Professor of Industrial Engineering at Western New England University. He holds a Bachelor’s of Science in Civil Engineering, and a Master and Doctorate of Science in Engineering Management from George Washington University, with a concentration in Risk and Emergency Management. For the past eight years Christian has concentrated his research efforts and field projects in the area of Global Health. For this, he has partnered with healthcare professionals whom adopt a global perspective to lowering the barriers that prevent access to healthcare at the frontiers of global health through enablement of local healthcare providers with access to information, technologies, and locally sourced supplies.

Christian is a cofounder and codirector of InnovationsCZ, a 501(3)c founded to facilitate research-to-practice. He is also the founding director of the Center for Global Health Engineering at Western New England University. Recent and current projects include developing an economically sustainable method for testing quality of medications at or near the point-of-care, and developing a cassava flour-based ultrasound gel that uses locally sourced materials.

Michael J. Rust received his Ph.D. degree in Electrical Engineering from the University of Cincinnati,  in 2009. During his undergraduate training, he worked for Ethicon Endo-Surgery and AtriCure, companies that specialize in the development of novel surgical devices. While completing his doctoral dissertation, Dr. Rust served as an NSF GK-12 Graduate Fellow, which allowed him to develop hands-on engineering activities for high school students.

In 2009, he joined the faculty of Western New England University where he currently holds the position of Associate Professor of Biomedical Engineering. He teaches undergraduate courses in bioinstrumentation, physiology, lab-on-a-chip, and global health. Dr. Rust has published numerous papers in professional conferences and technical journals, and he is a co-inventor on two US patents. He is a member of the Biomedical Engineering Society (BMES), the Institute for Electrical and Electronics Engineers (IEEE), and the American Society for Engineering Education (ASEE). Dr. Rust’s work has been funded by the National Science Foundation (NSF), National Institutes of Health (NIH), American Society for Quality (ASQ), Kern Entrepreneurial Engineering Network (KEEN), and the Jenzabar Foundation.

His research interests involve the development of point-of-care medical technologies, including bioinstrumentation for use in low-resource settings. Dr. Rust’s expertise includes Guatemalan healthcare, and he has taken over 80 students to the country through course-based field experiences. He is also the cofounder and Chief Technical Officer at New England Breath Technologies, which is developing a non-invasive breathalyzer for monitoring diabetes.

A Aziz, P Dara, F Hughes, C Solorzano, MM Muller, C Salmon, M Salmon, N Benfield, Cassava flour slurry as a low-cost alternative to commercially available gel for obstetrical ultrasound: a blinded non-inferiority trial comparison of image quality, International Journal of Obstetrics and Gynecology. Published Online February 22, 2018 DOI: 10.1111/1471-0528.15123

Zewdie, A., Debebe, F., Aklilu, A., Salmon, M., Salmon, C., “A survey of emergency medicine and orthopaedic physicians’ knowledge, attitude, and practice towards the use of peripheral nerve blocks” African Journal of Emergency Medicine, 7 (2017) 79–83,

Salmon, M., Landes, M., Hunchak, C., Paluku, P., Lalisya, L., Salmon, C., Muller, M., Wachira, B., Mangan, J., Chaganlal, K., Kalanzi, J., Zazh, A., Berman, S., Sied, E., Lamprecht, H., “Getting it Right the First Time: Defining Regionally Relevant Training Curricula and Provider Core Competencies for Point-of-Care Ultrasound Education on the African Continent”. Annals of Emergency Medicine, V 69, No. 2: February 2017.

Salmon M., Salmon, C., Masoda, M., Salumu, M., Bozzi, M., Nieburg, P., Harrison, L., Humphries, D., Uvon, N., Wendel, S., Trout, C., Cappello, M., “Mass distribution of albendazole in Sub-Saharan Africa: Can this improve the lives of women small holder farmers?” The Lancet Global Health, Volume 4 Special Issue S1-S36 Consortium of Universities for Global Health 7th annual conference (2016)

Salmon M, Salmon C, Bissinger A, Muller MM, Gebreyesus A, Geremew H, et al. (2015) Alternative Ultrasound Gel for a Sustainable Ultrasound Program: Application of Human Centered Design. PLoS ONE 10(8): e0134332. doi:10.1371/journal.pone.0134332

Muller, M., Salmon, M., Salmon, C., Malemo, L., Wendel, S., Ruhangaza, C., Milinganyo, D., Benfield, N., Reynolds, T., Utilization of Focused Assessment with Sonography for Trauma (FAST) in a referral hospital in an acute conflict zone. Afr J Emerg Med (2015), DOI 10.1016/j.afjem.2014.09.003

Salmon, C., Afnan, A., M. Salmon, R. Priefer, M. Rust, “Detecting substandard pharmaceuticals through spectral finger-printing”. Annals of Global Health Poster Abstracts from the 6^th Annual CUGH Conference, Mobilizing Research for Global Health, Vol. 81, Num. 1. Jan-Feb 2015

Malemo KL M. Salmon, C. Salmon, M. Mutendi, T. Reynolds, “Ultrasound guide regional anesthesia a multicenter feasibility trail for use in low resource settings.” Canjsurg.ca.Vol.57(3 suppl 1) June 2014. DOI: 10.1503/cjs.015713. (abstract)

Laura Keyser, L., McKinney, J., Salmon, C., Furaha, C., Kinsindja, R., Benfield, N., “Analysis of a pilot program to implement physical therapy for women with gynecologic fistula in the Democratic Republic of Congo”. International Journal of Gynecology Obstetrics, June 26, 2014

Salmon M., Salmon C., Benfield B. Lusi J., Masumba D., Bitwe R., Masoda M., Ruel T., Vanrooyen M. “An ACCESS Guide for ICT Training on Information and Research Tools in Low Resource Settings”. (2013), The International Journal of Technology, Knowledge and Society, Volume 9, ISSN 1832-3669.

Salmon, C., “Airport Mediated Disease”, Transportation Research Board 2016, Washington DC, January 8-12, 2016

Salmon, C., St. Jean, L., Sattari, M., “A transportable, validated and culturally sensitive metric of work capacity for use in subsistence agricultural workforce health assessment in Democratic Republic of Congo”, Annual CUGH Global Health Conference, April 9-11, 2016, San Francisco, CA. (poster session)

Margaret, M., Salmon, C., Masoda, M., Salumu, M., Bozzi, M., Nieburg, P., Harrison, L., Humphries, D., Uvon, N., Wendel, S., Trout, C., Cappello, M., “Mass distribution of albendazole in Sub-Saharan Africa: Can this improve the lives of women small holder farmers?” Annual CUGH Global Health Conference, April 9-11, 2016, San Francisco, CA.

T. Papu, M.J. Rust, and A.W. Browne, “A portable centrifuge for point-of-care measurement of hematocrit in low-resource settings,” Point of Care, vol. 13, no. 2, pp. 48-53, June 2014.

G. Spencer, N.S. Striglio, M.J. Rust, C.M. Salmon, and A.A. Afnan, “A system to identify substandard pharmaceuticals in a low-resource healthcare setting,” abstract published in Proceedings of the 2016 ASEE-NE Conference, Kingston, RI, April 28-30, 2016.

E.A. Dubuc, M.J. Rust, C. Salmon, “Nerve block training phantom for use with ultrasound systems in low-resource environments,” Proceedings of the 40th Annual Northeast Bioengineering Conference, Boston, MA, April 25-27, 2014.

Global Health Initiative in Guatemala, M.J. Rust (PI), S. Northrup (Co-PI), The Jenzabar Foundation, 2015

Portable centrifuge for use in low-resource environments, M.J. Rust (PI), A.W. Browne (Co-PI), American Society for Quality Biomedical Division, Dr. Richard J. Schlesinger Grant Program, 2012

Lab-on-a-chip design of an immunochromatographic assay for the developing world, M.J.

Rust (PI), American Society for Quality Biomedical Division, 2010

Salmon (PI), Massachusetts Technology Transfer Center, ACORN grant, 2017.