Smartphone based health accessory for colorimetric detection of biomarkers in sweat and saliva

A Diffusion-Based pH Regulator in Laminar Flows with Smartphone-Based Colorimetric Analysis

A strategy for an on-chip pH regulator is demonstrated computationally and experimentally, based on the diffusion characteristics of aqueous ionic solutions. Micro-flows with specific pH values are formed based on the diffusion behaviors of hydrogen and hydroxide ions in laminar flows. The final achieved pH value and its gradient in the channel can be regulated by the amount of ions transported between laminar flows, and the experimental results can be further generalized based on the normalized Nernst-Planck equation. A smartphone was applied as an image capture and analysis instrument to quantify pH values of liquids in a colorimetric detection process, with monotonic response range of ~1⁻13.

A Novel Microfluidic Point-of-Care Biosensor System on Printed Circuit Board for Cytokine Detection

Point of Care (PoC) diagnostics have been the subject of considerable research over the last few decades driven by the pressure to detect diseases quickly and effectively and reduce healthcare costs. Herein, we demonstrate a novel, fully integrated, microfluidic amperometric enzyme-linked immunosorbent assay (ELISA) prototype using a commercial interferon gamma release assay (IGRA) as a model antibody binding system. Microfluidic assay chemistry was engineered to take place on Au-plated electrodes within an assay cell on a printed circuit board (PCB)-based biosensor system. The assay cell is linked to an electrochemical reporter cell comprising microfluidic architecture, Au working and counter electrodes and a Ag/AgCl reference electrode, all manufactured exclusively via standard commercial PCB fabrication processes. Assay chemistry has been optimised for microfluidic diffusion kinetics to function under continual flow. We characterised the electrode integrity of the developed platforms with reference to biological sampling and buffer composition and subsequently we demonstrated concentration-dependent measurements of H₂O₂ depletion as resolved by existing FDA-validated ELISA kits. Finally, we validated the assay technology in both buffer and serum and demonstrate limits of detection comparable to high-end commercial systems with the addition of full microfluidic assay architecture capable of returning diagnostic analyses in approximately eight minutes.

A Portable Smartphone-Based Sensing System Using a 3D-Printed Chip for On-Site Biochemical Assays

Recently, smartphone-based chromogenic sensing with paper-based microfluidic technology has played an increasingly important role in biochemical assays. However, generally there were three defects: (i) the paper-based chips still required complicated fabrication, and the hydrophobic boundaries on the chips were not clear enough; (ii) the chromogenic signals could not be steadily captured; (iii) the smartphone apps were restricted to the detection of specific target analytes and could not be extended for different assays unless reprogrammed. To solve these problems, in this study, a portable smartphone-based sensing system with a 3D-printed chip was developed. A 3D-printed imaging platform was designed to significantly reduce sensing errors generated during signal capture, and a brand-new strategy for signal processing in downloadable apps was established. As a proof-of-concept, the system was applied for detection of organophosphorus pesticides and multi-assay of fruit juice, showing excellent sensing performance. For different target analytes, the most efficient color channel could be selected for signal analysis, and the calibration equation could be directly set in user interface rather than programming environment, thus the developed system could be flexibly extended for other biochemical assays. Consequently, this study provides a novel methodology for smartphone-based biochemical sensing.

Stress Biomarkers in Biological Fluids and Their Point-of-Use Detection

Hormones produced by glands in the endocrine system and neurotransmitters produced by the nervous system control many bodily functions. The concentrations of these molecules in the body are an indication of its state, hence the use of the term biomarker. Excess concentrations of biomarkers, such as cortisol, serotonin, epinephrine, and dopamine, are released by the body in response to a variety of conditions, for example, emotional state (euphoria, stress) and disease. The development of simple, low-cost modalities for point-of-use (PoU) measurements of biomarkers levels in various bodily fluids (blood, urine, sweat, saliva) as opposed to conventional hospital or lab settings is receiving increasing attention. This paper starts with a review of the basic properties of 12 primary stress-induced biomarkers: origin in the body (i.e., if they are produced as hormones, neurotransmitters, or both), chemical composition, molecular weight (small/medium size molecules and polymers, ranging from ∼100 Da to ∼100 kDa), and hydro- or lipophilic nature. Next is presented a detailed review of the published literature regarding the concentration of these biomarkers found in several bodily fluids that can serve as the medium for determination of the condition of the subject: blood, urine, saliva, sweat, and, to a lesser degree, interstitial tissue fluid. The concentration of various biomarkers in most fluids covers a range of 5-6 orders of magnitude, from hundreds of nanograms per milliliter (∼1 μM) down to a few picograms per milliliter (sub-1 pM). Mechanisms and materials for point-of-use biomarker sensors are summarized, and key properties are reviewed. Next, selected methods for detecting these biomarkers are reviewed, including antibody- and aptamer-based colorimetric assays and electrochemical and optical detection. Illustrative examples from the literature are discussed for each key sensor approach. Finally, the review outlines key challenges of the field and provides a look ahead to future prospects.

Colorimetric-Luminance Readout for Quantitative Analysis of Fluorescence Signals with a Smartphone CMOS Sensor

Smartphones have shown promise as an enabling technology for portable and distributed point-of-care diagnostic tests. The CMOS camera sensor can be used for detecting optical signals, including fluorescence for applications such as isothermal nucleic acid amplification tests. However, such analysis is typically limited mostly to end point detection of single targets. Here we present a smartphone-based image analysis pipeline that utilizes the CIE xyY (chromaticity-luminance) color space to measure the luminance (in lieu of RGB intensities) of fluorescent signals arising from nucleic acid amplification targets, with a discrimination sensitivity (ratio between the positive to negative signals), which is an order of magnitude more than traditional RGB intensity based analysis. Furthermore, the chromaticity part of the analysis enables reliable multiplexed detection of different targets labeled with spectrally separated fluorophores. We apply this chromaticity-luminance formulation to simultaneously detect Zika and chikungunya viral RNA via end point RT-LAMP (Reverse transcription Loop-Mediated isothermal amplification). We also show real time LAMP detection of Neisseria gonorrhoeae samples down to a copy number of 3.5 copies per 10 μL of reaction volume in our smartphone-operated portable LAMP box. Our chromaticity-luminance analysis is readily adaptable to other types of multiplexed fluorescence measurements using a smartphone camera.

Smartphone supported backlight illumination and image acquisition for microfluidic-based point-of-care testing

A smartphone-based image analysis system is advantageous for point-of-care testing applications. However, the processes of observation and image recording rely heavily on an external attachment that includes additional light sources. Moreover, microfluidic point-of-care devices are highly miniaturized, and can be clearly observed only under magnification. To address these issues, the present work proposes a novel imaging box for converting the built-in light source of a smartphone into uniform backlight illumination to avoid interference arising from reflections. A multi-piece orthoscopic lens is embedded in the imaging box to enable the imaging of micro-sized samples. As such, the colorimetric signal of a microchannel with a width as small as 25 µm can be faithfully recorded. Protein concentration quantification based on the bicinchoninic acid assay method was demonstrated with the proposed smartphone/imaging box system from an analysis of colorimetric signals. In addition, a microfluidic chip for conducting ABO blood typing was fabricated, and the microscopic imaging of induced blood coagulation can be clearly observed in a 3 µL sample using the proposed system. These results highlight the potential for adopting smartphone-based analysis systems in point-of-care testing applications.

Color Space Transformation-Based Smartphone Algorithm for Colorimetric Urinalysis

Urine strips are widely applied for rapid analysis of various indexes of urine for clinical examinations. The tests mainly rely on the application of a urine analyzer, which suffers several drawbacks and cannot meet the requirements of point-of-care testing (POCT). The integration of a smartphone with a biosensor has recently attracted great attention. We herein propose a human vision-based smartphone algorithm for colorimetric analysis of various urine indexes. A CIEDE2000 formula in CIELab color space is applied for the evaluation of color difference, which may greatly improve the analytical performances of urine strips. The proposed algorithm also possesses merits such as good accuracy, quantitative analysis, and limited calculation task, which is suitable for the application with smartphone platform. Experimental results demonstrate that the proposed method shows excellent reliability compared with the urine analyzer and some other algorithms. In addition, human real samples are successfully analyzed with excellent accuracy. Therefore, this work provides a convenient colorimetric tool for POCT urine analysis.

Consumer-friendly food allergen detection: moving towards smartphone-based immunoassays

In this critical review, we provide a comprehensive overview of immunochemical food allergen assays and detectors in the context of their user-friendliness, through their connection to smartphones. Smartphone-based analysis is centered around citizen science, putting analysis into the hands of the consumer. Food allergies represent a significant worldwide health concern and consumers should be able to analyze their foods, whenever and wherever they are, for allergen presence. Owing to the need for a scientific background, traditional laboratory-based detection methods are generally unsuitable for the consumer. Therefore, it is important to develop simple, safe, and rapid assays that can be linked with smartphones as detectors to improve user accessibility. Smartphones make excellent detection systems because of their cameras, embedded flash functions, portability, connectivity, and affordability. Therefore, this review has summarized traditional laboratory-based methods for food allergen detection such as enzyme-linked-immunosorbent assay, flow cytometry, and surface plasmon resonance, and the potential to modernize these methods by interfacing them with a smartphone readout system, based on the aforementioned smartphone characteristics. This is the first review focusing on smartphone-based food-allergen detection methods designed with the intention of being consumer-friendly. Graphical abstract A smartphone-based food allergen detection system in three easy steps (1) sample preparation, (2) allergen detection on a smartphone using antibodies, which then transmits the data wirelessly, (3) analytical results sent straight to smartphone.

A fluorometric skin-interfaced microfluidic device and smartphone imaging module for in situ quantitative analysis of sweat chemistry

The rich composition of solutes and metabolites in sweat and its relative ease of collection upon excretion from skin pores make this class of biofluid an attractive candidate for point of care analysis. Wearable technologies that combine electrochemical sensors with conventional or emerging semiconductor device technologies offer valuable capabilities in sweat sensing, but they are limited to assays that support amperometric, potentiometric, and colorimetric analyses. Here, we present a complementary approach that exploits fluorometric sensing modalities integrated into a soft, skin-interfaced microfluidic system which, when paired with a simple smartphone-based imaging module, allows for in situ measurement of important biomarkers in sweat. A network array of microchannels and a collection of microreservoirs pre-filled with fluorescent probes that selectively react with target analytes in sweat (e.g. probes), enable quantitative, rapid analysis. Field studies on human subjects demonstrate the ability to measure the concentrations of chloride, sodium and zinc in sweat, with accuracy that matches that of conventional laboratory techniques. The results highlight the versatility of advanced fluorescent-based imaging modalities in body-worn sweat microfluidics platforms, and they suggest some practical potential for these ideas.

PEDOT: Dye-Based, Flexible Organic Electrochemical Transistor for Highly Sensitive pH Monitoring

Organic electrochemical transistors (OECTs) are bioelectronic devices able to bridge electronic and biological domains with especially high amplification and configurational versatility and thus stand out as promising platforms for healthcare applications and portable sensing technologies. Here, we have optimized the synthesis of two pH-sensitive composites of PEDOT (poly(3,4-ethylenedioxythiophene)) doped with pH dyes (BTB and MO, i.e., Bromothymol Blue and Methyl Orange, respectively), showing their ability to successfully convert the pH into an electrical signal. The PEDOT:BTB composite, which exhibited the best performance, was used as the gate electrode to develop an OECT sensor for pH monitoring that can reliably operate in a two-fold transduction mode with super-Nernstian sensitivity. When the OECT transconductance is employed as analytical signal, a sensitivity of 93 ± 8 mV pH unit^-1 is achieved by successive sampling in aqueous electrolytes. When the detection is carried out by dynamically changing the pH of the same medium, the offset gate voltage of the OECT shifts by (1.1 ± 0.3) × 10² mV pH unit^-1. As a further step, the optimized configuration was realized on a PET substrate, and the performance of the resulting flexible OECT was assessed in artificial sweat within a medically relevant pH range.

Chromogenic Photonic Crystal Sensors Enabled by Multistimuli-Responsive Shape Memory Polymers

Here novel chromogenic photonic crystal sensors based on smart shape memory polymers (SMPs) comprising polyester/polyether-based urethane acrylates blended with tripropylene glycol diacrylate are reported, which exhibit nontraditional all-room-temperature shape memory (SM) effects. Stepwise recovery of the collapsed macropores with 350 nm diameter created by a "cold" programming process leads to easily perceived color changes that can be correlated with the concentrations of swelling analytes in complex, multicomponent nonswelling mixtures. High sensitivity (as low as 10 ppm) and unprecedented measurement range (from 10 ppm to 30 vol%) for analyzing ethanol in octane and gasoline have been demonstrated by leveraging colorimetric sensing in both liquid and gas phases. Proof-of-concept tests for specifically detecting ethanol in consumer medical and healthcare products have also been demonstrated. These sensors are inexpensive, reusable, durable, and readily deployable with mobile platforms for quantitative analysis. Additionally, theoretical modeling of solvent diffusion in macroporous SMPs provides fundamental insights into the mechanisms of nanoscopic SM recovery, which is a topic that has received little examination. These novel sensors are of great technological importance in a wide spectrum of applications ranging from environmental monitoring and workplace hazard identification to threat detection and process/product control in chemical, petroleum, and pharmaceutical industries.

Mobile diagnostics: next-generation technologies forin vitrodiagnostics

The emergence of a wide range of applications of smartphones along with advances in ‘liquid biopsy’ has significantly propelled medical research particularly in the field ofin vitrodiagnostics (IVD).

Recent progress and developments of iridium-based compounds as probes for environmental analytes

Metal complexes based on iridium metal centers have attracted attention as probes due to their tunable biological and chemical characteristics.

A soft, wearable microfluidic device for the capture, storage, and colorimetric sensing of sweat

Capabilities in health monitoring enabled by capture and quantitative chemical analysis of sweat could complement, or potentially obviate the need for, approaches based on sporadic assessment of blood samples. Established sweat monitoring technologies use simple fabric swatches and are limited to basic analysis in controlled laboratory or hospital settings. We present a collection of materials and device designs for soft, flexible, and stretchable microfluidic systems, including embodiments that integrate wireless communication electronics, which can intimately and robustly bond to the surface of the skin without chemical and mechanical irritation. This integration defines access points for a small set of sweat glands such that perspiration spontaneously initiates routing of sweat through a microfluidic network and set of reservoirs. Embedded chemical analyses respond in colorimetric fashion to markers such as chloride and hydronium ions, glucose, and lactate. Wireless interfaces to digital image capture hardware serve as a means for quantitation. Human studies demonstrated the functionality of this microfluidic device during fitness cycling in a controlled environment and during long-distance bicycle racing in arid, outdoor conditions. The results include quantitative values for sweat rate, total sweat loss, pH, and concentration of chloride and lactate.

Epidermal Microfluidic Electrochemical Detection System: Enhanced Sweat Sampling and Metabolite Detection

Despite tremendous recent efforts, noninvasive sweat monitoring is still far from delivering its early analytical promise. Here, we describe a flexible epidermal microfluidic detection platform fabricated through hybridization of lithographic and screen-printed technologies, for efficient and fast sweat sampling and continuous, real-time electrochemical monitoring of glucose and lactate levels. This soft, skin-mounted device judiciously merges lab-on-a-chip and electrochemical detection technologies, integrated with a miniaturized flexible electronic board for real-time wireless data transmission to a mobile device. Modeling of the device design and sweat flow conditions allowed optimization of the sampling process and the microchannel layout for achieving attractive fluid dynamics and rapid filling of the detection reservoir (within 8 min from starting exercise). The wearable microdevice thus enabled efficient natural sweat pumping to the electrochemical detection chamber containing the enzyme-modified electrode transducers. The fabricated device can be easily mounted on the epidermis without hindrance to the wearer and displays resiliency against continuous mechanical deformation expected from such epidermal wear. Amperometric biosensing of lactate and glucose from the rapidly generated sweat, using the corresponding immobilized oxidase enzymes, was wirelessly monitored during cycling activity of different healthy subjects. This ability to monitor sweat glucose levels introduces new possibilities for effective diabetes management, while similar lactate monitoring paves the way for new wearable fitness applications. The new epidermal microfluidic electrochemical detection strategy represents an attractive alternative to recently reported colorimetric sweat-monitoring methods, and hence holds considerable promise for practical fitness or health monitoring applications.

Smartphone-Based Point-of-Care Urinalysis Under Variable Illumination

Urine tests are performed by using an off-the-shelf reference sheet to compare the color of test strips. However, the tabular representation is difficult to use and more prone to visual errors, especially when the reference color-swatches to be compared are spatially apart. Thus, making it is difficult to distinguish between the subtle differences of shades on the reagent pads. This manuscript represents a new arrangement of reference arrays for urine test strips (urinalysis). Reference color swatches are grouped in a doughnut chart, surrounding each reagent pad on the strip. The urine test can be evaluated using naked eye by referring to the strip with no additional sheet necessary. Along with this new strip, an algorithm for smartphone based application is also proposed as an alternative to deliver diagnostic results. The proposed colorimetric detection method evaluates the captured image of the strip, under various color spaces and evaluates ten different tests for urine. Thus, the proposed system can deliver results on the spot using both naked eye and smartphone. The proposed scheme delivered accurate results under various environmental illumination conditions without any calibration requirements, exhibiting performances suitable for real-life applications and an ease for a common user.

Cutting Edge Methods for Non-Invasive Disease Diagnosis Using E-Tongue and E-Nose Devices

Biomimetic cross-reactive sensor arrays (B-CRSAs) have been used to detect and diagnose a wide variety of diseases including metabolic disorders, mental health diseases, and cancer by analyzing both vapor and liquid patient samples. Technological advancements over the past decade have made these systems selective, sensitive, and affordable. To date, devices for non-invasive and accurate disease diagnosis have seen rapid improvement, suggesting a feasible alternative to current standards for medical diagnostics. This review provides an overview of the most recent B-CRSAs for diagnostics (also referred to electronic noses and tongues in the literature) and an outlook for future technological development.

Smartphone-Based Dual-Modality Imaging System for Quantitative Detection of Color or Fluorescent Lateral Flow Immunochromatographic Strips

Nowadays, lateral flow immunochromatographic assays are increasingly popular as a diagnostic tool for point-of-care (POC) test based on their simplicity, specificity, and sensitivity. Hence, quantitative detection and pluralistic popular application are urgently needed in medical examination. In this study, a smartphone-based dual-modality imaging system was developed for quantitative detection of color or fluorescent lateral flow test strips, which can be operated anywhere at any time. In this system, the white and ultra-violet (UV) light of optical device was designed, which was tunable with different strips, and the Sobel operator algorithm was used in the software, which could enhance the identification ability to recognize the test area from the background boundary information. Moreover, this technology based on extraction of the components from RGB format (red, green, and blue) of color strips or only red format of the fluorescent strips can obviously improve the high-signal intensity and sensitivity. Fifty samples were used to evaluate the accuracy of this system, and the ideal detection limit was calculated separately from detection of human chorionic gonadotropin (HCG) and carcinoembryonic antigen (CEA). The results indicated that smartphone-controlled dual-modality imaging system could provide various POC diagnoses, which becomes a potential technology for developing the next-generation of portable system in the near future.

Enhancing the Usability of an Optical Reader System to Support Point-of-Care Rapid Diagnostic Testing: An Iterative Design Approach

BACKGROUND

In today's health care environment, increasing costs and inadequate medical resources have created a worldwide need for more affordable diagnostic tools that are also portable, fast, and easy to use. To address this issue, numerous research and commercial efforts have focused on developing rapid diagnostic technologies; however, the efficacy of existing systems has been hindered by usability problems or high production costs, making them infeasible for deployment in at-home, point-of-care (POC), or resource-limited settings.

OBJECTIVE

The aim of this study was to create a low-cost optical reader system that integrates with any smart device and accepts any type of rapid diagnostic test strip to provide fast and accurate data collection, sample analysis, and diagnostic result reporting.

METHODS

An iterative design methodology was employed by a multidisciplinary research team to engineer three versions of a portable diagnostic testing device that were evaluated for usability and overall user receptivity.

RESULTS

Repeated design critiques and usability studies identified a number of system requirements and considerations (eg, software compatibility, biomatter contamination, and physical footprint) that we worked to incrementally incorporate into successive system variants. Our final design phase culminated in the development of Tidbit, a reader that is compatible with any Wi-Fi-enabled device and test strip format. The Tidbit includes various features that support intuitive operation, including a straightforward test strip insertion point, external indicator lights, concealed electronic components, and an asymmetric shape, which inherently signals correct device orientation. Usability testing of the Tidbit indicates high usability for potential user communities.

CONCLUSIONS

This study presents the design process, specification, and user reception of the Tidbit, an inexpensive, easy-to-use, portable optical reader for fast, accurate quantification of rapid diagnostic test results. Usability testing suggests that the reader is usable among and can benefit a wide group of potential users, including in POC contexts. Generally, the methodology of this study demonstrates the importance of testing these types of systems with potential users and exemplifies how iterative design processes can be employed by multidisciplinary research teams to produce compelling technological solutions.

The Evaluation of a Low-Cost Colorimeter for Glucose Detection in Salivary Samples

Given the limited access to healthcare resources, low-income settings require the development of affordable technology. Here we present the design and evaluation of a low-cost colorimeter applied to the non-invasive monitoring of Diabetes Mellitus through the detection of glucose in salival fluid. Samples were processed by the glucose oxidase-peroxidase enzymatic system and analyzed with the development equipment. A light emission diode of 532.5 nm was used as an excitation source and a RGB module was used as a receptor. A calibration curve to quantify the concentration of salivary glucose (0 to 18 mg/dL) was carried out by relating the RGB components registered with glucose concentrations, achieving a limit of detection of 0.17 mg/dL with a CV of 5% (n = 3). Salivary samples of diabetic and healthy volunteers were processed with the equipment showing an average concentration of 1.5519 ± 0.4511 mg/dL for the first and 4.0479 ± 1.6103 mg/dL for the last, allowing a discrimination between both groups. Results were validated against a UV-Vis-NIR spectrophotometer with a correspondence of R² of 0.98194 between both instruments. Results suggest the potential application of the developed device to the sensitive detection of relevant analytes with a low-cost, user-friendly, low-power and portable instrumentation.

Recent Progress in Optical Biosensors Based on Smartphone Platforms

With a rapid improvement of smartphone hardware and software, especially complementary metal oxide semiconductor (CMOS) cameras, many optical biosensors based on smartphone platforms have been presented, which have pushed the development of the point-of-care testing (POCT). Imaging-based and spectrometry-based detection techniques have been widely explored via different approaches. Combined with the smartphone, imaging-based and spectrometry-based methods are currently used to investigate a wide range of molecular properties in chemical and biological science for biosensing and diagnostics. Imaging techniques based on smartphone-based microscopes are utilized to capture microscale analysts, while spectrometry-based techniques are used to probe reactions or changes of molecules. Here, we critically review the most recent progress in imaging-based and spectrometry-based smartphone-integrated platforms that have been developed for chemical experiments and biological diagnosis. We focus on the analytical performance and the complexity for implementation of the platforms.

Flexible and disposable paper- and plastic-based gel micropads for nematode handling, imaging, and chemical testing

Today, the area of point-of-care diagnostics is synonymous with paper microfluidics where cheap, disposable, and on-the-spot detection toolkits are being developed for a variety of chemical tests. In this work, we present a novel application of microfluidic paper-based analytical devices (μPADs) to study the behavior of a small model nematode, Caenorhabditis elegans. We describe schemes of μPAD fabrication on paper and plastic substrates where membranes are created in agarose and Pluronic gel. Methods are demonstrated for loading, visualizing, and transferring single and multiple nematodes. Using an anthelmintic drug, levamisole, we show that chemical testing on C. elegans is easily performed because of the open device structure. A custom program is written to automatically recognize individual worms on the μPADs and extract locomotion parameters in real-time. The combination of μPADs and the nematode tracking program provides a relatively low-cost, simple-to-fabricate imaging and screening assay (compared to standard agarose plates or polymeric microfluidic devices) for non-microfluidic, nematode laboratories.

Towards an ultra-rapid smartphone- connected test for infectious diseases

The development is reported of an ultra-rapid, point-of-care diagnostic device which harnesses surface acoustic wave (SAW) biochips, to detect HIV in a finger prick of blood within 10 seconds (sample-in-result-out). The disposable quartz biochip, based on microelectronic components found in every consumer smartphone, is extremely fast because no complex labelling, amplification or wash steps are needed. A pocket-sized control box reads out the SAW signal and displays results electronically. High analytical sensitivity and specificity are found with model and real patient blood samples. The findings presented here open up the potential of consumer electronics to cut lengthy test waiting times, giving patients on the spot access to potentially life-saving treatment and supporting more timely public health interventions to prevent disease transmission.

Towards Addressing the Body Electrolyte Environment via Sweat Analysis:Pilocarpine Iontophoresis Supports Assessment of Plasma Potassium Concentration

Electrolyte concentration in sweat depends on environmental context and physical condition but also on the pathophysiological status. Sweat analyzers may be therefore the future way for biological survey although how sweat electrolyte composition can reflect plasma composition remains unclear. We recruited 10 healthy subjects and 6 patients to have a broad range of plasma electrolyte concentrations (chloride, potassium and sodium) and pH. These variables were compared to those found in sweat produced following cycling exercise or pilocarpine iontophoresis, a condition compatible with operating a wearable device. We found no correlation between plasma and sweat parameters when exercise-induced sweat was analyzed, and we could identify a correlation only between plasma and sweat potassium concentration (R = 0.78, p < 0.01) when sweat was induced using pilocarpine iontophoresis. We tested measurement repeatability in sweat at 24hr-interval for 3 days in 4 subjects and found a great intra-individual variability regarding all parameters in exercise-induced sweat whereas similar electrolyte levels were measured in pilocarpine-induced sweat. Thus, electrolyte concentration in sweat sampled following physical activity does not reflect concentration in plasma while pilocarpine iontophoresis appears to be promising to reproducibly address sweat electrolytes, and to make an indirect evaluation of plasma potassium concentration in chronic kidney disease and arrhythmia.

Paper-based assays for urine analysis

A transformation of the healthcare industry is necessary and imminent: hospital-centered, reactive care will soon give way to proactive, person-centered care which focuses on individuals' well-being. However, this transition will only be made possible through scientific innovation. Next-generation technologies will be the key to developing affordable and accessible care, while also lowering the costs of healthcare. A promising solution to this challenge is low-cost continuous health monitoring; this approach allows for effective screening, analysis, and diagnosis and facilitates proactive medical intervention. Urine has great promise for being a key resource for health monitoring; unlike blood, it can be collected effortlessly on a daily basis without pain or the need for special equipment. Unfortunately, the commercial rapid urine analysis tests that exist today can only go so far-this is where the promise of microfluidic devices lies. Microfluidic devices have a proven record of being effective analytical devices, capable of controlling the flow of fluid samples, containing reaction and detection zones, and displaying results, all within a compact footprint. Moving past traditional glass- and polymer-based microfluidics, paper-based microfluidic devices possess the same diagnostic ability, with the added benefits of facile manufacturing, low-cost implementation, and disposability. Hence, we review the recent progress in the application of paper-based microfluidics to urine analysis as a solution to providing continuous health monitoring for proactive care. First, we present important considerations for point-of-care diagnostic devices. We then discuss what urine is and how paper functions as the substrate for urine analysis. Next, we cover the current commercial rapid tests that exist and thereby demonstrate where paper-based microfluidic urine analysis devices may fit into the commercial market in the future. Afterward, we discuss various fabrication techniques that have been recently developed for paper-based microfluidic devices. Transitioning from fabrication to implementation, we present some of the clinically implemented urine assays and their importance in healthcare and clinical diagnosis, with a focus on paper-based microfluidic assays. We then conclude by providing an overview of select biomarker research tailored towards urine diagnostics. This review will demonstrate the applicability of paper-based assays for urine analysis and where they may fit into the commercial healthcare market.

A suspending-droplet mode paper-based microfluidic platform for low-cost, rapid, and convenient detection of lead(II) ions in liquid solution

A paper-based microfluidic device based on unconventional principle was developed and used to detect lead ions through a two-step process including heated incubation and subsequent mixing. The device was made by generating a superhydrophobic pattern, which defines channel and reservoir barriers, on a water-impermeable paper substrate, followed by loading and drying the reagents in the defined reservoirs. Different from the conventional paper-based devices that are made of water-permeable paper, the as-prepared device holds water drops in discrete reservoirs, and the water drops will not move unless the device is titled along the direction of the predefined channels. In this way, the liquid samples applied onto the device are handled as individual drops and could be stored, transported, and mixed on demand. Different from the conventional paper-based devices that use capillary force to drive liquid, our new device uses wetting and gravity as driving force. We name this operation principle suspending-droplet mode paper-based device (SD-μPAD). The use of a Teflon contact-printing stamp makes the production of such devices rapid, cost efficient, and mass productive. Utilizing a G-quadruplex-based luminescence switch-on assay, we demonstrated rapid, convenient, highly sensitive, and low cost detection of lead(II) ions in water samples, using a custom made battery-powered portable device, and a smart phone as the detector.

A Smartphone-Based Automatic Measurement Method for Colorimetric pH Detection Using a Color Adaptation Algorithm

This paper proposes a smartphone-based colorimetric pH detection method using a color adaptation algorithm for point-of-care applications. Although a smartphone camera can be utilized to measure the color information of colorimetric sensors, ambient light changes and unknown built-in automatic image correction operations make it difficult to obtain stable color information. This paper utilizes a 3D printed mini light box and performs a calibration procedure with a paper-printed comparison chart and a reference image which overcomes the drawbacks of smartphone cameras and the difficulty in preparing for the calibration procedure. The color adaptation is performed in the CIE 1976 u'v' color space by using the reference paper in order to stabilize the color variations. Non-rigid u'v' curve interpolation is used to produce the high-resolution pH estimate. The final pH value is estimated by using the best-matching method to handle the nonlinear curve properties of multiple color patches. The experimental results obtained using a pH indicator paper show that the proposed algorithm provides reasonably good estimation of pH detection. With paper-printed accurate color comparison charts and smart color adaptation techniques, superior estimation is achieved in the smartphone-based colorimetric pH detection system for point-of-care application.

Smartphone coupled handheld array reader for real-time toxic gas detection

Smartphones and related accessories are rapidly expanding their applications in various fields. Herein we developed a smartphone coupled handheld array reader with the integration of complementary metal oxide (CMOS) image sensor for detecting various toxic gases by colorimetric monitoring approach. In this study, toxic gases such as hydrogen fluoride (HF), chlorine (Cl₂), ammonia (NH₃), and formaldehyde (CH₂O) were detected using titanium nanoparticles (TiO₂ NPs) blended poly (vinyl alcohol) (PVA) hydrogel test strips, which were patterned with chemically responsive dyes. The dye colors changed based on acid-base reactions, and the colorimetric reader monitored the array strips and mapped them in the form of chrominance data. The observed signals transferred to a smartphone that displays the detected toxic gases and their exposure levels with the aid of the smartphone app "Toxic Gas Detection". The colorimetric array reader was precisely constructed with an auto-calibration system to minimize potential errors. Various concentration of toxic gases (0.5-10 ppm) were analyzed and achieved the detection limit of 1 ppm for each gas. Also, various analytical performance including sensitivity, stability, selectivity, and reproducibility analysis proved the reliability and accuracy of the detection system. Additionally, the smartphone app can be installed on any type of tablet, laptop, or other portable device. This study proved that smartphone coupled colorimetric array reader is a suitable system for detecting various toxic gases, chemicals and biochemical analysis with real-time monitoring approach.

Turning the Page: Advancing Paper-Based Microfluidics for Broad Diagnostic Application

Infectious diseases are a major global health issue. Diagnosis is a critical first step in effectively managing their spread. Paper-based microfluidic diagnostics first emerged in 2007 as a low-cost alternative to conventional laboratory testing, with the goal of improving accessibility to medical diagnostics in developing countries. In this review, we examine the advances in paper-based microfluidic diagnostics for medical diagnosis in the context of global health from 2007 to 2016. The theory of fluid transport in paper is first presented. The next section examines the strategies that have been employed to control fluid and analyte transport in paper-based assays. Tasks such as mixing, timing, and sequential fluid delivery have been achieved in paper and have enabled analytical capabilities comparable to those of conventional laboratory methods. The following section examines paper-based sample processing and analysis. The most impactful advancement here has been the translation of nucleic acid analysis to a paper-based format. Smartphone-based analysis is another exciting development with potential for wide dissemination. The last core section of the review highlights emerging health applications, such as male fertility testing and wearable diagnostics. We conclude the review with the future outlook, remaining challenges, and emerging opportunities.

Smartphone-Based pH Sensor for Home Monitoring of Pulmonary Exacerbations in Cystic Fibrosis

Currently, Cystic Fibrosis (CF) patients lack the ability to track their lung health at home, relying instead on doctor checkups leading to delayed treatment and lung damage. By leveraging the ubiquity of the smartphone to lower costs and increase portability, a smartphone-based peripheral pH measurement device was designed to attach directly to the headphone port to harvest power and communicate with a smartphone application. This platform was tested using prepared pH buffers and sputum samples from CF patients. The system matches within ~0.03 pH of a benchtop pH meter while fully powering itself and communicating with a Samsung Galaxy S3 smartphone paired with either a glass or Iridium Oxide (IrOx) electrode. The IrOx electrodes were found to have 25% higher sensitivity than the glass probes at the expense of larger drift and matrix sensitivity that can be addressed with proper calibration. The smartphone-based platform has been demonstrated as a portable replacement for laboratory pH meters, and supports both highly robust glass probes and the sensitive and miniature IrOx electrodes with calibration. This tool can enable more frequent pH sputum tracking for CF patients to help detect the onset of pulmonary exacerbation to provide timely and appropriate treatment before serious damage occurs.

Plasmonics Enhanced Smartphone Fluorescence Microscopy

Smartphone fluorescence microscopy has various applications in point-of-care (POC) testing and diagnostics, ranging from e.g., quantification of immunoassays, detection of microorganisms, to sensing of viruses. An important need in smartphone-based microscopy and sensing techniques is to improve the detection sensitivity to enable quantification of extremely low concentrations of target molecules. Here, we demonstrate a general strategy to enhance the detection sensitivity of a smartphone-based fluorescence microscope by using surface-enhanced fluorescence (SEF) created by a thin metal-film. In this plasmonic design, the samples are placed on a silver-coated glass slide with a thin spacer, and excited by a laser-diode from the backside through a glass hemisphere, generating surface plasmon polaritons. We optimized this mobile SEF system by tuning the metal-film thickness, spacer distance, excitation angle and polarization, and achieved ~10-fold enhancement in fluorescence intensity compared to a bare glass substrate, which enabled us to image single fluorescent particles as small as 50 nm in diameter and single quantum-dots. Furthermore, we quantified the detection limit of this platform by using DNA origami-based brightness standards, demonstrating that ~80 fluorophores per diffraction-limited spot can be readily detected by our mobile microscope, which opens up new opportunities for POC diagnostics and sensing applications in resource-limited-settings.

Mitigating the Hook Effect in Lateral Flow Sandwich Immunoassays Using Real-Time Reaction Kinetics

The quantification of analyte concentrations using lateral flow assays is a low-cost and user-friendly alternative to traditional lab-based assays. However, sandwich-type immunoassays are often limited by the high-dose hook effect, which causes falsely low results when analytes are present at very high concentrations. In this paper, we present a reaction kinetics-based technique that solves this problem, significantly increasing the dynamic range of these devices. With the use of a traditional sandwich lateral flow immunoassay, a portable imaging device, and a mobile interface, we demonstrate the technique by quantifying C-reactive protein concentrations in human serum over a large portion of the physiological range. The technique could be applied to any hook effect-limited sandwich lateral flow assay and has a high level of accuracy even in the hook effect range.

Protein, enzyme and carbohydrate quantification using smartphone through colorimetric digitization technique

In this paper the utilization of smartphone as a detection platform for colorimetric quantification of biological macromolecules has been demonstrated. Using V-channel of HSV color space, the quantification of BSA protein, catalase enzyme and carbohydrate (using D-glucose) have been successfully investigated. A custom designed android application has been developed for estimating the total concentration of biological macromolecules. The results have been compared with that of a standard spectrophotometer which is generally used for colorimetric quantification in laboratory settings by measuring its absorbance at a specific wavelength. The results obtained with the designed sensor is found to be similar when compared with the spectrophotometer data. The designed sensor is low cost, robust and we envision that it could promote diverse fields of bio-analytical investigations. Schematic illustration of the smartphone sensing mechanism for colorimetric analysis of biomolecular samples.

Beyond Wicking: Expanding the Role of Patterned Paper as the Foundation for an Analytical Platform

While a number of assays for soluble analytes have been developed using paper-based microfluidic devices, the detection and analysis of blood cells has remained an outstanding challenge. In this Feature, we discuss how the properties of paper determine the performance of paper-based microfluidic devices and permit the design of cellular assays, which can ultimately impact disparities in healthcare that exist in limited-resource settings.

Smartphone-Based Rapid Screening of Urinary Biomarkers

An ambulatory pre-screening Point-of-Care (POC) device compatible with commercially available diapers has been developed to rapidly screen urine samples for incontinent or functionally impaired elderly. This POC device consists of a set of colorimetric reaction pads with accompanying reference colors. A smartphone with camera is a convenient tool for analysis of colorimetric assays; and a software application has been developed for smartphones to photograph the colorimetric assay and classify colorimetric reactions according to the reference colors. To facilitate detection of multiple biomarkers, e.g., 12 biomarkers with 2-7 references per biomarker, automatic localization of test/reference pads has been implemented through recognition of corner alignment marks and projective coordinate transformation for perspective removal. Each test run trains a set of classifiers from extracted reference data, which is used to classify the extracted test data. The smartphone application gives semi-quantitative results and functions independently of illumination intensity, illumination color, device type (smartphone brand/model), device settings (ISO, shutter speed, aperture) and automatic camera preprocessing. The smartphone application has been tested successfully on Samsung Galaxy S3, S6 Edge, S7 Edge, ZTE Nubia V7 mini and Iphone 6 in various illumination conditions.

Toward practical application of paper-based microfluidics for medical diagnostics: state-of-the-art and challenges

Microfluidic paper-based analytical devices (μPADs) have emerged as a promising diagnostic platform a decade ago. In contrast to highly active academic developments, their entry into real-life applications is still very limited. This discrepancy is attributed to the gap between research developments and their practical utility, particularly in the aspects of operational simplicity, long-term stability of devices, and associated equipment. On the basis of these backgrounds, this review attempts to: 1) identify the reasons for success of paper-based devices already in the market, 2) describe the current status and remaining issues of μPADs in terms of operational complexity, signal interpretation approaches, and storage stability, and 3) discuss the possibility of mass production based on established manufacturing technologies. Finally, the state-of-the-art in commercialisation of μPADs is discussed, and the "upgrades" required from a laboratory-based prototype to an end user device are demonstrated on a specific example.

Technical aspects and challenges of colorimetric detection with microfluidic paper-based analytical devices (μPADs) - A review

Paper-based devices are a leading alternative among the main analytical tools for point-of-care testing, due to their portability, low-cost, and ease-of-use. Colorimetric readouts are the most common method of detection in these microfluidic devices, enabling qualitative, semi-quantitative and fully quantitative analysis of multiple analytes. There is a multitude of ways to obtain a colorimetric output in such devices, including nanoparticles, dyes, redox and pH indicators, and each has unique drawbacks and benefits. There are also multiple variables that impact the analysis of colorimetric reactions in microfluidic paper-based systems, including color homogeneity, image capture methods, and the data handling itself. Here, we present a critical review of recent developments and challenges of colorimetric detection on microfluidic paper-based analytical devices (μPADs), and present thoughts and insights towards future perspectives in the area to improve the use of colorimetric readouts in conjunction with μPADs.

A smartphone-based diagnostic platform for rapid detection of Zika, chikungunya, and dengue viruses

Current multiplexed diagnostics for Zika, dengue, and chikungunya viruses are situated outside the intersection of affordability, high performance, and suitability for use at the point-of-care in resource-limited settings. Consequently, insufficient diagnostic capabilities are a key limitation facing current Zika outbreak management strategies. Here we demonstrate highly sensitive and specific detection of Zika, chikungunya, and dengue viruses by coupling reverse-transcription loop-mediated isothermal amplification (RT-LAMP) with our recently developed quenching of unincorporated amplification signal reporters (QUASR) technique. We conduct reactions in a simple, inexpensive and portable "LAMP box" supplemented with a consumer class smartphone. The entire assembly can be powered by a 5 V USB source such as a USB power bank or solar panel. Our smartphone employs a novel algorithm utilizing chromaticity to analyze fluorescence signals, which improves the discrimination of positive/negative signals by 5-fold when compared to detection with traditional RGB intensity sensors or the naked eye. The ability to detect ZIKV directly from crude human sample matrices (blood, urine, and saliva) demonstrates our device's utility for widespread clinical deployment. Together, these advances enable our system to host the key components necessary to expand the use of nucleic acid amplification-based detection assays towards point-of-care settings where they are needed most.

Smartphone-based enzymatic biosensor for oral fluid L-lactate detection in one minute using confined multilayer paper reflectometry

The development of smartphone-based biosensors for point-of-care testing (POCT) applications allows realizing "all in one" instruments, with large potential distribution among the general population. With this respect, paper color-based detection performed by reflectance measurement is the most popular, simple, inexpensive and straightforward method. Despite the large number of scientific publications related to these biosensors, they still suffer from a poor detectability and reproducibility related to inhomogeneity of color development, which leads to low assay reproducibility. To overcome these problems, we propose a smartphone paper-based biosensor, in which all the reagents necessary to complete the analysis are co-entrapped on paper in a "wafer"-like bilayer film of polyelectrolytes (Poly (allyl amine hydrochloride/poly(sodium 4-styrene sulfonate)). Using a 3D printing low-cost technology we fabricated the smartphone-based device that consists in a cover accessory attached to the smartphone and incorporating a light diffuser over the flash to improve the image quality, a mini dark box and a disposable analytical cartridge containing all the reagents necessary for the complete analysis. The biosensor was developed exploiting coupled enzyme reactions for quantifying L-lactate in oral fluid, which is considered a biomarker of poor tissue perfusion, a key element in the management of severe sepsis, septic shock and in sports performance evaluation. The developed method is sensitive, rapid, and it allows detecting L-lactate in oral fluid in the relevant physiological range, with a limit of detection of 0.1mmolL^-1. The extreme simplicity of assay execution (no reagents need to be added) and flexibility of fabrication of the device, together with the high assay versatility (any oxidase can be coupled with HRP-based color change reaction) make our approach suitable for the realization of smartphone-based biosensors able to non-invasively detect a large variety of analytes of clinical interest.

Photonic crystals: emerging biosensors and their promise for point-of-care applications

Biosensors are extensively employed for diagnosing a broad array of diseases and disorders in clinical settings worldwide. The implementation of biosensors at the point-of-care (POC), such as at primary clinics or the bedside, faces impediments because they may require highly trained personnel, have long assay times, large sizes, and high instrumental cost. Thus, there exists a need to develop inexpensive, reliable, user-friendly, and compact biosensing systems at the POC. Biosensors incorporated with photonic crystal (PC) structures hold promise to address many of the aforementioned challenges facing the development of new POC diagnostics. Currently, PC-based biosensors have been employed for detecting a variety of biotargets, such as cells, pathogens, proteins, antibodies, and nucleic acids, with high efficiency and selectivity. In this review, we provide a broad overview of PCs by explaining their structures, fabrication techniques, and sensing principles. Furthermore, we discuss recent applications of PC-based biosensors incorporated with emerging technologies, including telemedicine, flexible and wearable sensing, smart materials and metamaterials. Finally, we discuss current challenges associated with existing biosensors, and provide an outlook for PC-based biosensors and their promise at the POC.