Smartphone-based point-of-care testing of salivary α-amylase for personal psychological measurement

Fabrication of a salivary amylase electrochemical sensor based on surface confined MWCNTs/β-cyclodextrin/starch architect for dental caries in clinical samples

Salivary α-amylase (α-ALS) has drawn attention as a possible bioindicator for dental caries. Herein, combining the synergistic properties of multi-walled carbon nanotubes (MWCNTs), β-cyclodextrin (β-CD) and starch, an electrochemical sensor is constructed employing ferrocene (FCN) as an electrochemical indicator to oversee the progression of the enzymatic catalysis of α-ALS. The method involves a two-step chemical reaction sequence on a screen-printed carbon electrode (SPCE). X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, Field emission scanning electron microscope (FE-SEM), and Dynamic light scattering (DLS) were used to characterize the synthesized material, while Static water Contact angle measurements, cyclic voltammetry (CV), and electrochemical impedance spectroscopy (EIS) were performed to monitor each step of sensor fabrication. The electrochemical sensor permitted to detect α-ALS within the linear range of 0.5-280 U mL-1, revealing detection (LOD), and quantification (LOQ) values of 0.041 U mL-1, and 0.159 U mL-1, respectively. Remarkably, the sensor demonstrated exceptional specificity and selectivity, effectively discriminating against other interfering substances in saliva. Validation of the method involved analyzing α-ALS levels in artificial saliva with an accuracy range of 97 % to 103 %, as well as in real clinical saliva samples across various age groups.

Development of enzyme-inorganic hybrid nanoflower-modified electrodes and a smartphone-controlled electrochemical analyzer for point-of-care testing of salivary amylase in saliva

Quantitation of salivary alpha-amylase (sAA) plays a significant role in not only theoretical studies but also clinical practice. This study reports a quantitative point-of-care testing (POCT) system for sAA quantitation anywhere, anytime and by anyone, which consists of customized electrodes and a smartphone-controlled electrochemical analyzer. Organic-inorganic hybrid nanoflowers (NFs) encapsulating α-glucosidase (AG) and glucose dehydrogenase (GDH) have been synthesized and modified onto screen-printed electrodes (SPCEs) to fabricate the customized electrodes. The SPCEs integrated with the smartphone-controlled electrochemical analyzer exhibit good analytical performance for sAA with a low detection limit of 5.02 U mL-1 and a wide dynamic range of 100-2000 U mL-1 using chronoamperometry. The reported POCT system has been successfully demonstrated for quantitation of sAA in clinical saliva samples, and the quantitation results correlated well with those of the Bernfeld method which is extensively used in clinics. More importantly, this study reveals the great potential of sAA as an early warning indicator of abnormal glucose metabolism in obese individuals. Considering the non-invasive saliva sampling process as well as the easy-to-use and cost-effectiveness features of this quantitative POCT system, quantitation of salivary sAA at home by laypersons might become an appealing choice for obese individuals to monitor their glucose metabolism status anytime.

Cu/Au nanoclusters with peroxidase-like activity for chemiluminescence detection of α-amylase

Herein, a novel chemiluminescence method was developed for efficient and sensitive detection of α-amylase activity. α-Amylase is closely related to our life, and α-amylase concentration is a marker for the diagnosis of acute pancreatitis. In this paper, Cu/Au nanoclusters with peroxidase-like activity were prepared using starch as a stabilizer. Cu/Au nanoclusters can catalyze H₂O₂ to generate reactive oxygen species and increase the CL signal. The addition of α-amylase makes the starch decompose and causes the nanoclusters to aggregate. The aggregation of the nanoclusters caused them to increase in size and decrease in the peroxidase-like activity, resulting in a decrease in the CL signal. α-Amylase was detected by the CL method of signal changes caused by dispersion-aggregation in the range of 0.05-8 U mL^-1 with a low detection limit of 0.006 U mL^-1. The chemiluminescence scheme based on the luminol-H₂O₂-Cu/Au NC system is of great significance for the sensitive and selective determination of α-amylase in real samples, and the detection time is short. This work provides new ideas for the detection of α-amylase based on the chemiluminescence method and the signal lasts for a long time, which can realize timely detection.

Biosensors for saliva biomarkers

The analysis of salivary biomarkers has gained interest and is advantageous for simple, safe, and non-invasive testing in diagnosis as well as treatment. This chapter explores the importance of saliva biomarkers and summarizes recent advances in biosensor fabrication. The identification of diagnostic, prognostic and therapeutic markers in this matrix enables more rapid and frequent testing when combined with the use of biosensor technology. Challenges and future goals are highlighted and examined.

Moving toward smart biomedical sensing

The development of novel biomedical sensors as highly promising devices/tools in early diagnosis and therapy monitoring of many diseases and disorders has recently witnessed unprecedented growth; more and faster than ever. Nonetheless, on the eve of Industry 5.0 and by learning from defects of current sensors in smart diagnostics of pandemics, there is still a long way to go to achieve the ideal biomedical sensors capable of meeting the growing needs and expectations for smart biomedical/diagnostic sensing through eHealth systems. Herein, an overview is provided to highlight the importance and necessity of an inevitable transition in the era of digital health/Healthcare 4.0 towards smart biomedical/diagnostic sensing and how to approach it via new digital technologies including Internet of Things (IoT), artificial intelligence, IoT gateways (smartphones, readers), etc. This review will bring together the different types of smartphone/reader-based biomedical sensors, which have been employing for a wide variety of optical/electrical/electrochemical biosensing applications and paving the way for future eHealth diagnostic devices by moving towards smart biomedical sensing. Here, alongside highlighting the characteristics/criteria that should be met by the developed sensors towards smart biomedical sensing, the challenging issues ahead are delineated along with a comprehensive outlook on this extremely necessary field.

Micro and nanofluidics for high throughput drug screening

In this book chapter, we elaborate on the state-of-the-art technology developments in high throughput screening, microfluidics and nanofluidics. This book chapter further elaborated on the application of microfluidics and nanofluidics for high throughput drug screening with respect to communicable diseases and non-communicable diseases such as cancer. As a future perspective, there is tremendous potential for microfluidics and nanofluidics to be applied in high throughput drug screening which could be applied for various biotechnology applications such as in cancer precision medicine, point-of-care diagnostics and imaging. With the integration of Fourth industrial revolution (4IR) technologies with micro and nanofluidics technologies, it envisioned that such integration along with digital health would enable next generation technology development in medical field.

Smartphone-Based Electrochemical System for Biosensors and Biodetection

With the advantages of high popularity, convenient operation, open-source operation systems, high resolution imaging, and excellent computing capabilities, smartphones have been widely used as the core of detection system for calculation, control, and real-time display. Hence, smartphones play an important role in electrochemical detection and optical detection. Smartphone-based electrochemical systems were combined with screen-printed electrode and interdigital electrodes for in situ detection. The electrodes were modified with biomaterials, chemical materials, and nanomaterials for biosensors and biodetection, such as 3-amino phenylboronic acid nanocomposites, graphene, gold nanoparticles, zinc oxide nanoparticles, carbon nanotubes, proteins, peptides, and antibodies. With the modified electrodes, the smartphone-based impedance system was used to detect acetone, bovine serum albumin, human serum albumin, and trinitrotoluene, while smartphone-based amperometric system was employed to monitor glucose, ascorbic acid, dopamine, uric acid, and levodopa. The smartphone-based electrochemical system for biosensors and biodetection has provided miniaturized and portable alternative for diagnosis, which is promising to find application in point-of-care testing (POCT).

A Surface Plasmon Resonance Plastic Optical Fiber Biosensor for the Detection of Pancreatic Amylase in Surgically-Placed Drain Effluent

Postoperative pancreatic fistula (POPF), the major driver of morbidity and mortality following pancreatectomy, is caused by an abnormal communication between the pancreatic ductal epithelium and another epithelial surface containing pancreas-derived, enzyme-rich fluid. There is a strong correlation between the amylase content in surgically-placed drains early in the postoperative course and the development of POPF. A simple and cheap method to determine the amylase content from the drain effluent has been eagerly advocated. Here, we developed an amylase optical biosensor, based on a surface plasmon resonance (SPR) plastic optical fiber (POF), metallized with a 60 nm layer of gold and interrogated with white light. The sensor was made specific by coupling it with an anti-amylase antibody. Each surface derivatization step was optimized and studied by XPS, contact angle, and fluorescence. The POF-biosensor was tested for its response to amylase in diluted drain effluents. The volume of sample required was 50 µL and the measurement time was 8 min. The POF-biosensor showed selectivity for amylase, a calibration curve log-linear in the range of 0.8-25.8 U/L and a limit of detection (LOD) of ~0.5 U/L. In preliminary tests, the POF-biosensor allowed for the measurement of the amylase content of diluted surgically-placed drain effluents with an accuracy of >92% with respect to the gold standard. The POF-biosensor allows for reliable measurement and could be implemented to allow for a rapid bedside assessment of amylase value in drains following pancreatectomy.

Recent Advances in Nanomaterial-Enabled Wearable Sensors: Material Synthesis, Sensor Design, and Personal Health Monitoring

Wearable sensors have gained much attention due to their potential in personal health monitoring in a timely, cost-effective, easy-operating, and noninvasive way. In recent studies, nanomaterials have been employed in wearable sensors to improve the sensing performance in view of their excellent properties. Here, focus is mainly on the nanomaterial-enabled wearable sensors and their latest advances in personal health monitoring. Different kinds of nanomaterials used in wearable sensors, such as metal nanoparticles, carbon nanomaterials, metallic nanomaterials, hybrid nanocomposites, and bio-nanomaterials, are reviewed. Then, the progress of nanomaterial-based wearable sensors in personal health monitoring, including the detection of ions and molecules in body fluids and exhaled breath, physiological signals, and emotion parameters, is discussed. Furthermore, the future challenges and opportunities of nanomaterial-enabled wearable sensors are discussed.

Current methods for stress marker detection in saliva

•

Introduction of relevant biomarkers in stress conditions.

•

Reference ranges of biomarkers in normal conditions.

•

Saliva as easy-accessible specimen.

•

Review of analytical methods for biomarker determination in saliva.

•

Possibilities for design of point-of-care devices.

Stress and stress-related diseases are leading to drastic consequences in private and professional life. Therefore, the need for stress prevention strategies is of personal and economic interest. Especially during the recent period related to covid-19 outbreak and lock-down, an ongoing discussion of increasing stress etiology is reported. Biomarker analysis may help to assist diagnosis and classification of stress-related diseases and therefore support therapeutical decisions. Due to its non-invasive sampling, the analysis of saliva has become highly attractive compared to the detection methods in other specimen. This review article summarizes the status of research, innovative approaches, and trends. Scientific literature published since 2011 was excerpted with concentration on the detection of up to seven promising marker substances. Most often reported cortisol represents the currently best evaluated stress marker, while norepinephrine (noradrenaline) or its metabolite 3-methoxy-4-hydroxyphenylglycol is also a quite commonly considered stress marker. Other complementary stress marker candidates are testosterone, dehydroepiandrosterone (DHEA) and its sulfonated analogue DHEA-S, alpha-amylase, secretory immunoglobulin A, and chromogranin A. Several working groups are researching in the field of stress marker detection to develop reliable, fast, and affordable methods. Analytical methods reported mainly focused on immunological and electrochemical as well as chromatographic methods hyphenated to mass spectrometric detection to yield the required detection limits.

Quantitative hematocrit measurement of whole blood in a point-of-care lateral flow device using a smartphone flow tracking app

We present a rapid and quantitative point-of-care (PoC) system based on a smartphone application that is capable of accurately tracking the flow of red blood cells (RBCs) through a no-reaction lateral flow assay (nrLFA) device. Utilizing only the camera feed from the smartphone and built-in image processing, the nrLFA is identified and RBC fluid flow distances and rates are recorded in parallel with the test without the need of any custom hardware or enclosure. We demonstrated the application by first measuring and then calculating hematocrit (Hct) values of whole blood samples with nominal content of 28%, 35%, 40%, and 45% Hct on the nrLFA platform. The PoC system was able to accurately measure (to within 1% Hct of nominal values) whole blood Hct in ~10-20 s after sample dispensing.

Biosensors for Personal Mobile Health: A System Architecture Perspective

Advances in mobile biosensors, integrating developments in materials science and instrumentation, are fueling an expansion in health data being collected and analyzed in decentralized settings. For example, semiconductor-based sensors are enabling measurement of vital signs, and microfluidic-based sensors are enabling measurement of biochemical markers. As biosensors for mobile health are becoming increasingly paired with smart devices, it will become critical for researchers to design biosensors - with appropriate functionalities and specifications - to work seamlessly with accompanying connected hardware and software. This article describes recent research in biosensors, as well as current mobile health devices in use, as classified into four distinct system architectures that take into account the biosensing and data processing functions required in personal mobile health devices. We also discuss the path forward for integrating biosensors into smartphone-based mobile health devices.

Portable, low cost smartphone-based potentiostat system for the salivary α-amylase detection in stress paradigm

The aim of this study was to explore a novel, low-cost smartphone-based biosensor system and establish an efficient analysis method for the detection of potential stress biomarker, salivary α-amylase(sAA). This system consists of Smartphone with sAA-detection, Screen-printed electrodes(SPEs) and potentiostat module. The presented technique that using a small perturbation to obtain a linearized response could affect the composition of the sample as to cyclic voltammetry which repeatedly reduces and oxidizes the sample. For application, 6 healthy graduate students took a 5 minutes Trier Social Stress Test(TSST). Results show that this method could detect sAA activities conveniently and accurately. Calibration curve of sAA whose quantitative range is from 50 and 1200 U mL-1 with a limit of detection(LOD) of 1.6 U mL-1, is Y=-52.324X+295.63, R^2=0.9933. After psychological stress, sAA secretion was significant verified. It is concluded that this smartphone-based sAA detection system is reliable for determination of Salivary α-amylase and useful in the assessment of Psychological stress.

Patterned plasmonic gradient for high-precision biosensing using a smartphone reader

Smartphone-compatible biosensors are believed to be one of the key techniques for improving the quality of diagnosis in remote areas. However, to date, few smartphone-compatible biosensors can reach the specifications of their conventional counterparts due to the limitations of consumer-grade detectors carried by phones. To circumvent this issue, we reported a metasurface-inspired bio-sensor, patterned plasmonic gradient (PPG), which transduces local index information into 2D patterns. By harnessing the powerful imaging and computational capability of modern smartphones, the PPG is sensitive enough to detect tiny refractive index changes induced by a submonolayer of molecules with high precision (Δn < 0.001) in a large dynamic range. It allows us to monitor the conjugation process between biotin and a trace amount of streptavidin (15 nM, 20 μL) in real-time. With high sensitivity and accuracy, the PPG provides a high performance bio-sensing solution for the places where professional equipment is inaccessible.

Urban Nature Experiences Reduce Stress in the Context of Daily Life Based on Salivary Biomarkers

Stress reduction through contact with nature is well established, but far less is known about the contribution of contact parameters - duration, frequency, and nature quality. This study describes the relationship between duration of a nature experience (NE), and changes in two physiological biomarkers of stress - salivary cortisol and alpha-amylase. It is the first study to employ long-term, repeated-measure assessment and the first evaluation wherein study participants are free to choose the time of day, duration, and the place of a NE in response to personal preference and changing daily schedules. During an 8-week study period, 36 urban dwellers were asked to have a NE, defined as spending time in an outdoor place that brings a sense of contact with nature, at least three times a week for a duration of 10 min or more. Their goal was compliance within the context of unpredictable opportunity for taking a nature pill. Participants provided saliva samples before and after a NE at four points over the study period. Before-NE samples established the diurnal trajectory of each stress indicator and these were in line with published outcomes of more closely controlled experiments. For salivary cortisol, an NE produced a 21.3%/hour drop beyond that of the hormone's 11.7% diurnal drop. The efficiency of a nature pill per time expended was greatest between 20 and 30 min, after which benefits continued to accrue, but at a reduced rate. For salivary alpha-amylase, there was a 28.1%/h drop after adjusting for its diurnal rise of 3.5%/h, but only for participants that were least active sitting or sitting with some walking. Activity type did not influence cortisol response. The methods for this adaptive management study of nature-based restoration break new ground in addressing some complexities of measuring an effective nature dose in the context of normal daily life, while bypassing the limitations of a clinical pharmacology dose-response study. The results provide a validated starting point for healthcare practitioners prescribing a nature pill to those in their care. This line of inquiry is timely in light of expanding urbanization and rising healthcare costs.

Hand-held Colorimetry Sensor Platform for Determining Salivary α-Amylase Activity and Its Applications for Stress Assessment

This study develops a hand-held stress assessment meter with a chemically colorimetric strip for determining salivary α-amylase activity, using a 3,5 dinitrosalicylic acid (DNS) assay to quantify the reducing sugar released from soluble starch via α-amylase hydrolysis. The colorimetric reaction is produced by heating the strip with a mini polyester heater plate at boiling temperature to form a brick red colored product, which measured at 525 nm wavelength. This investigation describes in detail the design, construction, and performance evaluation of a hand-held α-amylase activity colorimeter with a light emitted diode (LED) and photo-detector with built-in filters. The dimensions and mass of the proposed prototype are only 120 × 60 × 60 mm³ and 200 g, respectively. This prototype has an excellent correlation coefficient (>0.995), comparable with a commercial ultraviolet–visible spectroscope, and has a measurable α-amylase activity range of 0.1–1.0 U mL⁻¹. The hand-held device can measure the salivary α-amylase activity with only 5 μL of saliva within 12 min of testing. This sensor platform effectively demonstrates that the level of salivary α-amylase activity increases more significantly than serum cortisol, the other physiological stressor biomarker, under physiologically stressful exercise conditions. Thus, this work demonstrates that the hand-held α-amylase activity meter is an easy to use and cost-effective stress assessment tool for psychoneuroendocrinology research.

Pushing the limits of electrochemistry toward challenging applications in clinical diagnosis, prognosis, and therapeutic action

Constant progress in the identification of biomarkers at different molecular levels in samples of different natures, and the need to conduct routine analyses, even in limited-resource settings involving simple and short protocols, are examples of the growing current clinical demands not satisfied by conventional available techniques. In this context, the unique features offered by electrochemical biosensors, including affordability, real-time and reagentless monitoring, simple handling and portability, and versatility, make them especially interesting for adaptation to the increasingly challenging requirements of current clinical and point-of-care (POC) diagnostics. This has allowed the continuous development of strategies with improved performance in the clinical field that were unthinkable just a few years ago. After a brief introduction to the types and characteristics of clinically relevant biomarkers/samples, requirements for their analysis, and currently available methodologies, this review article provides a critical discussion of the most important developments and relevant applications involving electrochemical biosensors reported in the last five years in response to the demands of current diagnostic, prognostic, and therapeutic actions related to high prevalence and high mortality diseases and disorders. Special attention is paid to the rational design of surface chemistry and the use/modification of state-of-the-art nanomaterials to construct electrochemical bioscaffolds with antifouling properties that can be applied to the single or multiplex determination of biomarkers of accepted or emerging clinical relevance in particularly complex clinical samples, such as undiluted liquid biopsies, whole cells, and paraffin-embedded tissues, which have scarcely been explored using conventional techniques or electrochemical biosensing. Key points guiding future development, challenges to be addressed to further push the limits of electrochemical biosensors towards new challenging applications, and their introduction to the market are also discussed.

Wearable biosensors for healthcare monitoring

Wearable biosensors are garnering substantial interest due to their potential to provide continuous, real-time physiological information via dynamic, noninvasive measurements of biochemical markers in biofluids, such as sweat, tears, saliva and interstitial fluid. Recent developments have focused on electrochemical and optical biosensors, together with advances in the noninvasive monitoring of biomarkers including metabolites, bacteria and hormones. A combination of multiplexed biosensing, microfluidic sampling and transport systems have been integrated, miniaturized and combined with flexible materials for improved wearability and ease of operation. Although wearable biosensors hold promise, a better understanding of the correlations between analyte concentrations in the blood and noninvasive biofluids is needed to improve reliability. An expanded set of on-body bioaffinity assays and more sensing strategies are needed to make more biomarkers accessible to monitoring. Large-cohort validation studies of wearable biosensor performance will be needed to underpin clinical acceptance. Accurate and reliable real-time sensing of physiological information using wearable biosensor technologies would have a broad impact on our daily lives.

Emerging paper microfluidic devices

Paper has unique advantages over other materials, including low cost, flexibility, porosity, and self-driven liquid pumping, thus making it widely used in various fields in biology, chemistry, physics and materials science.

From Point-of-Care Testing to eHealth Diagnostic Devices (eDiagnostics)

Point-of-care devices were originally designed to allow medical testing at or near the point of care by health-care professionals. Some point-of-care devices allow medical self-testing at home but cannot fully cover the growing diagnostic needs of eHealth systems that are under development in many countries. A number of easy-to-use, network-connected diagnostic devices for self-testing are needed to allow remote monitoring of patients' health. This Outlook highlights the essential characteristics of diagnostic devices for eHealth settings and indicates point-of-care technologies that may lead to the development of new devices. It also describes the most representative examples of simple-to-use, point-of-care devices that have been used for analysis of untreated biological samples.

Concentration cell-based potentiometric analysis for point-of-care testing with minimum background

One of the most critical problems of point-of-care testing is how to reduce the interference of background, especially under resource-limited conditions when sample pretreatment is not available. In this work we report a potentiometric method for point-of-care testing with minimum background. The method is based on the principles of a concentration cell which is a type of galvanic cells. It is an electrochemical cell having two carbon electrodes. The potential of each electrode is determined by ratio of a redox couple (i.e. Fe(CN)₆^4-/3-) on the electrode surface. On one electrode, the adsorbed enzyme catalyzes the oxidation of analyte by Fe(CN)₆^3- which produces Fe(CN)₆^4-. The shift of the potential was because of the analyte as well as the background. In the other channel, no enzyme was present so that the shift of the potential, if any, is owing to the background. By measuring the potential difference between the two electrodes (i.e. voltage of the concentration cell), analyte can be quantitatively determined with most of the background eliminated. As the proof-of-concept analyte, blood glucose is quantitatively detected using a voltammeter with acceptable selectivity and accuracy. Noble metal electrodes that are indispensable for conventional electrochemical sensing are not required. All these features simplify the fabrication procedure and reduce the cost for the detection. Therefore, we believe it is promising for electrochemical point-of-care testing.

Batch injection analysis towards auxiliary diagnosis of periodontal diseases based on indirect amperometric detection of salivary α-amylase on a cupric oxide electrode

This study describes, for the first time, the use of a batch injection analysis system with amperometric detection (BIA-AD) to indirectly determine salivary α-amylase (sAA) levels in saliva samples for chronic periodontitis diagnosis. A chemical/thermal treatment was explored to generate a CuO film on a Cu electrode surface. This procedure offered good stability (RSD = 0.3%), good repeatability (RSD < 1.3%) and excellent reproducibility (RSD < 1.5%). The sAA concentration levels were determined based on the detection of maltose produced by enzymatic hydrolysis of starch. The analytical performance was investigated, and a linear correlation was observed for a maltose concentration range between 0.5 and 6.0 mmol L^-1 with a correlation coefficient equal to 0.999. The analytical sensitivity and the limit of detection were 48.8 μA/(mmol L^-1) and 0.05 mmol L^-1, respectively. In addition, the proposed system provided an excellent analytical frequency (120 analysis h^-1). The clinical feasibility of the proposed method was investigated by the determination of sAA levels in four saliva samples (two from healthy control persons (C1 and C2) and two from patients with chronic periodontitis (P1 and P2)). The accuracy provided by the BIA-AD system ranged from 93 to 98%. The sAA concentration levels achieved for each sample were compared to the values found by spectrophotometry and there was no statistically significant difference between them at a confidence level of 95%. Finally, the method reported herein emerges as a simple, low cost and promising tool for assisting periodontal diseases diagnosis.

Correlations Between Objective Behavioral Features Collected From Mobile and Wearable Devices and Depressive Mood Symptoms in Patients With Affective Disorders: Systematic Review

Background

Several studies have recently reported on the correlation between objective behavioral features collected via mobile and wearable devices and depressive mood symptoms in patients with affective disorders (unipolar and bipolar disorders). However, individual studies have reported on different and sometimes contradicting results, and no quantitative systematic review of the correlation between objective behavioral features and depressive mood symptoms has been published.

Objective

The objectives of this systematic review were to (1) provide an overview of the correlations between objective behavioral features and depressive mood symptoms reported in the literature and (2) investigate the strength and statistical significance of these correlations across studies. The answers to these questions could potentially help identify which objective features have shown most promising results across studies.

Methods

We conducted a systematic review of the scientific literature, reported according to the preferred reporting items for systematic reviews and meta-analyses guidelines. IEEE Xplore, ACM Digital Library, Web of Sciences, PsychINFO, PubMed, DBLP computer science bibliography, HTA, DARE, Scopus, and Science Direct were searched and supplemented by hand examination of reference lists. The search ended on April 27, 2017, and was limited to studies published between 2007 and 2017.

Results

A total of 46 studies were eligible for the review. These studies identified and investigated 85 unique objective behavioral features, covering 17 various sensor data inputs. These features were divided into 7 categories. Several features were found to have statistically significant and consistent correlation directionality with mood assessment (eg, the amount of home stay, sleep duration, and vigorous activity), while others showed directionality discrepancies across the studies (eg, amount of text messages [short message service] sent, time spent between locations, and frequency of mobile phone screen activity).

Conclusions

Several studies showed consistent and statistically significant correlations between objective behavioral features collected via mobile and wearable devices and depressive mood symptoms. Hence, continuous and everyday monitoring of behavioral aspects in affective disorders could be a promising supplementary objective measure for estimating depressive mood symptoms. However, the evidence is limited by methodological issues in individual studies and by a lack of standardization of (1) the collected objective features, (2) the mood assessment methodology, and (3) the statistical methods applied. Therefore, consistency in data collection and analysis in future studies is needed, making replication studies as well as meta-analyses possible.

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).

Saliva Liquid Biopsy for Point-of-Care Applications

Saliva is a non-invasive biofluid, which is easy to collect, transport, and store. Because of its accessibility and connection to systemic diseases, saliva is one of the best candidates for the advancement of point-of-care medicine, where individuals are able to easily monitor their health status by using portable convenient tools such as smartphones. There are a variety of scenarios with which saliva can be used: studies have been conducted on using saliva to measure stress hormones, enzyme levels, developmental disease biomarkers, and even cancer mutations. If validated biomarkers were combined with high-quality detection tools, saliva would open up a new frontier in high-quality healthcare, allowing physicians and patients to work together for real-time health monitoring and high-impact personalized preventative medicine. One of the most exciting emerging frontiers of saliva is liquid biopsy, which is a non-invasive means to assess the presence and characteristics of cancer in a patient. This article will review current basic knowledge of biomarkers, review their relation to different diseases and conditions, and explore liquid biopsy for point-of-care applications.

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.

Challenges of development and implementation of point of care pharmacogenetic testing

INTRODUCTION

Just as technology was the underlying driver of the sequencing of the human genome and subsequent generation of volumes of genome sequence data from healthy and affected individuals, animal, plant, and microbial species alike, so too will technology revolutionize diagnostic testing. One area of intense interest is the use of genetic data to inform decisions regarding drug selection and drug dosing, known as pharmacogenetic (PGx) testing, to improve likelihood of successful treatment outcomes with minimal risks.

AREAS COVERED

This commentary will provide an overview of implementation research of PGx testing, the benefits of point-of-care (POC) testing and overview of POC testing platforms, available PGx tests, and barriers and facilitators to the development and integration of POC-PGx testing into clinical settings. Sources include the published literature, and databases from the Centers for Medicaid and Medicare Services, Food and Drug Administration. Expert commentary: The utilization of POC PGx testing may enable more routine test use, but the development and implementation of such tests will face some barriers before personalized medicine is available to every patient. In particular, provider training, availability of clinical decision supports, and connectivity will be key areas to facilitate routine use.

New Functionalities for Paper-Based Sensors Lead to Simplified User Operation, Lower Limits of Detection, and New Applications

In the last decade, paper analytical devices (PADs) have evolved into sophisticated yet simple sensors with biological and environmental applications in the developed and developing world. The focus of this review is the technological improvements that have over the past five years increased the applicability of PADs to real-world problems. Specifically, this review reports on advances in sample processing, fluid flow control, signal amplification, and component integration. Throughout, we have sought to emphasize advances that retain the main virtues of PADs: low cost, portability, and simplicity.

Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health

Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for use in these settings. These challenges can be mitigated by taking advantage of affordable consumer electronics mobile devices such as webcams, mobile phones, charge-coupled device (CCD) cameras, lasers, and LEDs. Low-cost, portable multi-wavelength fluorescence plate readers have been developed for many applications including detection of microbial toxins such as C. Botulinum A neurotoxin, Shiga toxin, and S. aureus enterotoxin B (SEB), and flow cytometry has been used to detect very low cell concentrations. However, the relatively low sensitivities of these devices limit their clinical utility. We have developed several approaches to improve their sensitivity presented here for webcam based fluorescence detectors, including (1) image stacking to improve signal-to-noise ratios; (2) lasers to enable fluorescence excitation for flow cytometry; and (3) streak imaging to capture the trajectory of a single cell, enabling imaging sensors with high noise levels to detect rare cell events. These approaches can also help to overcome some of the limitations of other low-cost optical detection technologies such as CCD or phone-based detectors (like high noise levels or low sensitivities), and provide for their use in low-cost medical diagnostics in resource-poor settings.

An exothermic chip for point-of-care testing using a forehead thermometer as a readout

We report an exothermic chip for quantitative point-of-care testing using a forehead thermometer as a readout. The chip has a capillary channel that directs an aqueous sample into an exothermic reservoir. NaOH powders are preloaded in the reservoir as the exothermic reagent. At the inlet of the capillary channel, a microvalve is fabricated using an aptamer-modified hydrogel which is responsive to a specific analyte. When the aqueous sample comes in contact with the hydrogel valve, the hydrogel shrinks due to the selective analyte-hydrogel interaction. The volume reduction of the hydrogel increases the capillary flow rate, and thus increases the heat produced by NaOH dissolution. A forehead thermometer is used to measure the temperature increment which is correlated with the analyte concentration. Using this method, heavy metal ions (Hg(2+) and Pb(2+)) in different real samples are quantitatively analyzed.

Water turbidity sensing using a smartphone

Smartphone based platform turbidimeter measuring turbidity in drinking and different environmental water bodies.