Tim Inglis from the University of Western Australia in Australia will develop a screening test that can be used in remote and low-resource settings to detect antibiotic resistance and ensure the right antibiotics can be prescribed. The emergence of antimicrobial resistance is a huge threat to global public health, and therefore needs to be accurately and rapidly detected, characterized and monitored. They will further develop their method based on flow cytometry that uses fluorescent dyes to rapidly detect changes in bacterial cells upon first exposure to an antibiotic. Different combinations of antibiotics, bacteria and colored dyes will be evaluated, and the test will be analyzed for sensitivity and specificity.

Peter Lillehoj of Michigan State University in the U.S. will develop a low-cost skin patch that can rapidly and safely detect malaria. Current diagnostics for malaria generally require the extraction of blood, which is painful and prohibited in certain cultures. The patch will consist of an array of microneedles that painlessly collects interstitial fluid from just beneath the skin surface that is known to contain proteins from the malaria parasite in infected individuals. This sample will then be transferred to a lateral flow test strip that carries a malaria protein-specific antibody. In the presence of malaria, the test strip would indicate a positive diagnosis by displaying colored lines. They will optimize the performance of the patch by testing different arrangements of microneedles and different methods of fabrication, and develop a prototype for preliminary evaluation on synthetic and animal skin samples spiked with malaria.

Oscar Noya at the Instituto de Medicina Tropical in Venezuela will develop a simple, low-cost test based on the detection of parasite antigens that can be used to diagnose malaria in low-resource settings. They have developed a multi-antigen blot assay that can diagnose 26 diseases at the same time using saliva or small volumes of blood at low cost without the need for specialized equipment. They will use bioinformatics tools to select synthetic peptides from the malaria-causing parasite Plasmodium falciparum, and from other common pathogens such as HIV and dengue virus. The synthesized peptides will be spotted on cellulose paper and tested for their ability to detect the corresponding disease from sera and saliva samples taken from at-risk populations.

William Hanage from the Harvard T. H. Chan School of Public Health in the U.S. will develop an approach to better monitor the evolution and spread of microbial resistance to antibiotics, which is a major public health concern. Current approaches are generally slow, not widely available, and limited to analysis of a single pathogen, while often multiple pathogens coexist in each sample. They will trial a method they have developed to identify DNA sequences (motifs) linked with resistance to pneumococcus and gonococcus from existing genomic data. A reference database will be built that stores the identified resistance motifs and Bayesian model of resistance prediction in a cloud. This database can be updated over time. They will also adapt a mobile phone-sized portable DNA sequencer – the Oxford Nanopore minION instrument – for detecting these resistance motifs from human tissue samples such as urine that contain mixtures of DNA, and evaluate its capacity for detecting resistant organisms.

Laura Musselwhite of the Hospital de Câncer de Barretos in Brazil will develop a low-cost test for cervical cancer that women can easily perform at home even in low-resource settings. The test is based on a nitrocellulose strip coated in antibodies to detect the cancer-causing E6 protein produced by the human papillomavirus, which causes cervical cancer. They will enroll 50 women attending their clinic including cervical cancer patients to provide samples for adapting the assay for optimal detection in urine and simplifying it for use in non-clinical settings.

Steve Lindsay of the University of Durham in the United Kingdom will develop a non-invasive test to block the reemergence of malaria in disease-free regions by training dogs to identify specific odors that are released from people carrying the malaria parasite. It is known that people infected with the malaria-causing parasite Plasmodium falciparum produce thioethers in their breath, possibly to attract mosquitoes so that the parasite can spread more quickly to other people, thereby promoting malaria transmission. Dogs have a highly advanced sense of smell and are used at airports to detect drugs, explosives and fruit. They have also shown potential for helping to detect diseases including cancer. The investigators will take breath and skin samples from 30 asymptomatic but parasite-positive individuals both before and after treatment, and 30 negative individuals. Professional trainers will be used to help evaluate the ability of a dog to detect the difference between the positive and negative samples by training them over a two-month period.

Ian Cockburn from the Australian National University in Australia will test two approaches to improve vaccines by increasing competition for the vaccine antigen by immune cells and prolonging the survival of those immune cells. Antibody-producing B cells develop in so-called germinal centers within lymph nodes in response to infections or vaccinations. However, many diseases including malaria lack effective vaccines. They will combine a major vaccine candidate for malaria, Plasmodium falciparum circumsporozoite protein (CSP), with both a monoclonal anti-CSP antibody (so-called passive vaccination), and an immune cell-stimulating molecule hIL-21, both individually and in combination. These will be tested in mice for promoting antibody production and a protective immune response by measuring malaria parasite levels in the liver.

Wilson Cusack from Trade Co. in the U.S. will develop an SMS-based platform to provide information on market prices and facilitate trade for small-scale farmers in developing countries. The platform will maintain user anonymity, and also handle payments thereby promoting the use of mobile money. It will also enable the arrangement of transportation of goods, and provide a database for monitoring agricultural production and markets. He will further develop the platform for pilot-testing by 100 farmers in Ghana.

Francisco Diéguez from Disal in Chile will determine whether samples collected from portable toilets found across Pacific coastal regions in South America can be used to monitor pathogenic diseases and antibiotic resistance and help combat these major public health concerns. The portable toilets are tagged with electronic chips that are used to monitor their location and state. They will develop a method for weekly collection and storage of fecal and urine samples from toilets in and around Lima, Peru. Existing methods including immune assays will be used to identify the bacterial species and the presence of antibiotic resistance in the samples, and these will be geographically mapped across communities and correlated with local medical reports.

Tyler Radford from Humanitarian OpenStreetMap Team in the U.S. will partner with the local tech community in Uganda to develop web- and phone-based applications that enable individuals to locate their nearest financial services such as an ATM or mobile money provider, and help financial service providers identify the best locations to expand access across developing countries. They will build a phone-based application for consumers that includes a simple search function as well as the ability to upload relevant information about the financial service, such as opening hours, to increase the value of the application. They will also develop a discovery application incorporating data from the existing OpenStreetMap, which includes locations of existing financial services, schools etc., and can identify underserved areas that would benefit from new services. The applications will be pilot-tested in Uganda, and success measured by the number of users and subsequently by the degree of expansion of financial services.

Robert Schlaberg from the University of Utah in the U.S. will develop an approach that can detect all viruses, bacteria, fungi and parasites in post-mortem samples in order to identify the cause of death and inform disease-control efforts. Determining whether a specific pathogen caused the death of an individual is difficult with current methods partly because of the wide variety of pathogens and the potential for contamination of the tissues. They have developed an analysis tool – Taxonomer – that can identify individual pathogens from sequencing RNA in tissues. They will optimize these methods for post-mortem tissues, which contain fragmented RNA, and test them on known positive post-mortem tissues and fluids. They will also develop an approach that can use post-mortem samples to differentiate between death caused by infectious agents versus non-infectious causes by analyzing samples for specific immune responses that are linked to a range of infections.

Ry Young III from Texas A&M AgriLife Research in the U.S. will engineer particles that resemble bacteria-infecting viruses (phage), but are functionally defective, for developing treatments that can more safely modify bacteria in the infant gut and thereby protect against disease and malnutrition. So-called lytic phage physically destroy the bacteria they infect and are considered to be potentially highly valuable for treating many childhood infectious diseases that are prevalent in developing countries and cause substantial morbidity and mortality. However, phage can randomly change their behavior by mutating their genome, and can transfer genes between different species, raising safety concerns. They will modify the defective prophage PBSX from the harmless bacterium Bacillus subtilis to produce phage-like particles - phagocins - that cannot replicate and that kill bacterial cells without lysing them. They will evaluate the ability of the phagocins to infect and kill a variety of bacteria, and optimize methods for their low-cost production.

Stephen Rogerson from the University of Melbourne in Australia will develop a low-cost diagnostic using an electrical immunosensor platform that can detect very low levels of the malaria parasite in blood and saliva samples to aid malaria-elimination efforts. The platform detects changes in electrical impedance caused by the binding of two molecules, and they postulate that it can improve the limit of detection of current related diagnostic tests by up to 1000 fold. They will develop planar dielectric immunosensors for the malaria-causing Plasmodium parasite by coating the sensors with molecules that bind two specific parasite proteins. The sensitivity and specificity of the sensors will be evaluated using infected blood and saliva samples.

Paul Bollyky from Stanford Medical School in the U.S. will study whether filamentous phage – viruses that infect bacteria – direct structural changes in the lining of the intestines and thereby promote the growth of healthy bacteria to protect against disease. Phage are considered to be a potentially rich therapeutic resource for infectious diarrhea and environmental enteropathy, which are prevalent in developing countries, but much remains to be learned about them. They have shown that a phage of the genus inovirus directed the formation of bacterial biofilms, which have specific crystal-like properties. They will use their newly developed software package along with polarization microscopy to image intestinal bacterial populations and analyze the structure of biofilms in human specimens and mouse models, and study the effect of phage, bacterial infection, and diet. They will also measure inovirus from around 2000 stool samples from children in Bangladesh to determine whether the levels decrease in line with the severity of diarrhea, suggesting that this phage might be protective. The effect of these isolated phage on intestinal structure will also be analyzed in mouse models.

Harvey Rubin from the University of Pennsylvania in the U.S. will develop a new quantitative imaging technology that uses acoustics to measure the total body levels of the tuberculosis-causing bacterium, Mycobacterium tuberculosis. Current imaging methods are generally expensive or unable to measure in all parts of the body. This technology involves shining near-infrared light, which is safe and can penetrate deep into the body, to thermally expand a molecule activated in the presence of M. tuberculosis. This thermal expansion results in the emission of a specific sound that can be detected using standard ultrasound equipment. They have selected a reducing enzyme from the bacterium for activating the molecule, and will build around 100 different combinations of the enzyme substrate, linker and light-absorbing molecule. These will be tested in the laboratory using various models and a high-resolution real time 3D photoacoustic scanner to identify the optimal conjugate.

Ralph Lin and Kathryn Vasilaky of Groundtruth, LLC in the U.S. will develop a new approach to more accurately measure rainfall across farming regions in developing countries so that insurers can make more informed and rapid decisions for paying out to small-scale farmers with insurance against seasonal crop loss. This will also help farmers decide the best time to plant their crops, which is critical for maximizing yield. Satellite data are not currently accurate or stable enough to measure rainfall over small areas. They will further develop their existing low-cost field sensors to automatically upload rainfall data to a cloud server, and develop an SMS-platform that allows farmers to register their own rainfall measurements on the same server. Combining these two methods, along with satellite data, should improve the confidence of the measurements. They will recruit farmers in India to test their approach and help optimize it.

James Goulding from the University of Nottingham in the United Kingdom will address the knowledge gap in developing countries that is hampering development particularly of financial services by accessing real-time mobile phone call records and mobile financial transactions and using them to locate and model financial behavior across Tanzania. This approach could be faster, lower cost and more reliable than existing approaches that use small sample sizes or are based on crowd-sourcing. They will mathematically process call records to extract location, and produce nation-wide informational maps supplemented by data from unmanned aerial vehicles and local residents for regions lacking detailed maps. These data will then be used to generate predictive models of financial flows, mobility and communications across the country for informing financial service providers and commercial enterprises. Their approach will be evaluated by comparison with existing models.

Sai Reddy of ETH Zürich in Switzerland will study how low levels of the immune system-stimulating molecule C3d attached to a protein from a pathogen (antigen) can lead to the production of large numbers of pathogen-fighting antibodies and thereby boost the efficacy of vaccines. They hypothesize that it involves stimulating the process of somatic hypermutation in antibody-producing B cells, which results in high titers of antibodies that can bind very strongly to the target pathogen. They will generate the C3d protein fused to a number of different antigens, use them to immunize mice, and subsequently analyze somatic hypermutation using high-throughput sequencing of antibodies and bioinformatics methods.

Julia Reichelstein of EFL Global Ltd in Bermuda will promote access to financial services for poor communities by producing a psychometric test for distribution by SMS that can identify dependable new customers and evaluate the risk of lending to them. Individuals in developing countries that would benefit from credit to break out of poverty and in turn boost economic growth are often unable to access financial services largely due to their lack of credit history. They have developed a simple questionnaire that evaluates psychometric traits such as intelligence, business acumen and honesty, to measure risk and future earning potential. They will create an automated SMS version to expand distribution while decreasing costs, and engage with a lending partner for pilot testing in a developing region with a large rural population.

Rupert Scofield from FINCA International, Inc. in the U.S. will promote financial inclusion in the Democratic Republic of Congo by partnering with First Access and mobile network operators to build a credit-scoring model for individuals based on mobile phone usage and financial data. The aim is to provide financial services and develop new products for the unbanked majority.

Iris Braun of IFMR LEAD in India will expand access to microloans for the poor in Bangladesh by piloting a simple credit-scoring test for rating individuals. Poor households are often in need of small, short-term loans to buffer fluctuations in income, but formally accessing these loans is problematic as most people have no credit score, and/or are unable to complete the application process. Their approach involves assessing customers by accessing their mobile customer data, such as top-up frequency, and by psychological testing, as well as performing a social survey to analyze local financial needs. The scores can then be passed to mobile money lenders to give them more confidence to lend to poorer households.

The study aims to assess the effect of depression on pregnancy and develop biomarkers for adverse pregnancy outcomes. It plans to analyze stress outcomes on pregnancy, fetal growth and birth weight. The overall aim of the study is to determine stress biomarkers for early detection of mothers at risk of preterm birth and intrauterine growth restriction (IUGR) and to develop interventions to reduce stress and reduce adverse birth outcomes.

The Pratt Pouch, a foilized, polyethylene pouch (similar to a ketchup pouch) designed and proven to safely store NVP doses, offers an innovative way to expand NVP coverage. The Elizabeth Glaser Pediatric AIDS Foundation and its partners propose to introduce and scale up the Pratt Pouch in antenatal care, delivery, and postnatal care services in Uganda. Integrating this technology into existing services will simplify dosing and ensure all HIV-positive women have access to infant NVP. The easy-to-use pouches will empower women to immediately initiate NVP after delivery and encourage them to deliver in a health facility or bring their infants for postnatal care within 14 days.

A reliable, low-cost screening tool to identify high-risk cephalopelvic disproportion (CPD) patients is of paramount importance especially in resource-limited areas where a timely referral to a medical facility for assisted delivery or cesarean section would make the difference between saving the life of mother and child and potential loss of both patients. To address this pressing need we propose to develop and test a simple, ultra-low cost portable technology using off-the-shelf Microsoft Kinect sensor to quantify an obstructive score to identify women at high risk for CPD. The technology will create very high precision 3D patient models from which a plethora of traditional and novel anthropometric and volume measures can be extracted and used in conjunction with machine learning algorithms to establish a clinical score identifying high risk for CPD. This novel technology has the potential to establish a better risk assessment for obstruction than currently available clinical practice in low-resource setting, thus providing a low-cost avenue to save lives at birth.