Igniting children's enthusiasm for microbes with an origami paper microscope

The COVID-19 pandemic has underscored the urgent need for microbiology literacy in society. Microbiology knowledge, and its dissemination, can help inform and increase the objectivity of important decisions, such as treatment or vaccination. A microbiology learning experience titled "What you can't see can hurt you" was delivered as part of a larger outreach event where children were exposed to various aspects of medicine and health care fields. The activity involved an introduction to and a discussion of bacteria of clinical importance and the use of a smartphone-attachable paper-based foldable microscope. To explore the impact of this activity on participants' interest in science and microbiology, a pre- and post-activity survey of five questions on an emoji-based Likert scale was completed by the participants. A statistically significant increase in their interest in microbes and where to find them, as well as in microscopy, was observed after the event. Making microbes visible to children and allowing them to capture images of microbes exposes them directly and personally to microscopy and microbiology. An affordable low-cost paper-based microscope can become an alternative approach to teaching and learning to deliver clinical microbiology information to a wide audience range.

Microcosmos explorers: foldscope workshop for science outreach in Mexican schools

Foldscopes are ultra-low-cost paper microscopes invented by Manu Prakash and Jim Cybulski at Stanford University. They are about as light as a pencil and waterproof, all whilst offering similar optic quality to traditional microscopes. Foldscopes do not require electricity or glass slides to be used, which increases the possibilities of their use in education and outreach activities with children or people with disabilities. In 2019, thanks to a material grant of 100 foldscopes from One World Science and additional purchased foldscopes, I designed and implemented a science workshop called Exploradores del Microcosmos, or Explorers of Microcosmos in English. The aim of the workshop was to help make microscopy more accessible, in particular at underfunded schools, and stimulate active learning about ecosystems and evolution in the participants. Within this article, I describe the workshop and relay my personal insights and reflections on its execution across multiple schools and groups in Mexico.

The menace of saffron adulteration: Low-cost rapid identification of fake look-alike saffron using Foldscope and machine learning technology

Saffron authenticity is important for the saffron industry, consumers, food industry, and regulatory agencies. Herein we describe a combo of two novel methods to distinguish genuine saffron from fake in a user-friendly manner and without sophisticated instruments. A smartphone coupled with Foldscope was used to visualize characteristic features and distinguish "genuine" saffron from "fake." Furthermore, destaining and staining agents were used to study the staining patterns. Toluidine blue staining pattern was distinct and easier to use as it stained the papillae and the margins deep purple, while its stain is lighter yellowish green toward the central axis. Further to automate the process, we tested and compared different machine learning-based classification approaches for performing the automated saffron classification into genuine or fake. We demonstrated that the deep learning-based models are efficient in learning the morphological features and classifying samples as either fake or genuine, making it much easier for end-users. This approach performed much better than conventional machine learning approaches (random forest and SVM), and the model achieved an accuracy of 99.5% and a precision of 99.3% on the test dataset. The process has increased the robustness and reliability of authenticating saffron samples. This is the first study that describes a customer-centric frugal science-based approach to creating an automated app to detect adulteration. Furthermore, a survey was conducted to assess saffron adulteration and quality. It revealed that only 40% of samples belonged to ISO Category I, while the average adulteration percentage in the remaining samples was 36.25%. After discarding the adulterants from crude samples, their quality parameters improved significantly, elevating these from ISO category III to Category II. Conversely, it also means that Categories II and III saffron are more prone to and favored for adulteration by fraudsters.

Evaluation of Efficacy of Foldscope - A Paper Microscope to be Used as a Chairside Diagnostic Tool in Oral Dysplastic Lesions: A Comparative Study

Introduction:

Precancerous lesion of the oral mucosa consists of a group of diseases which sometimes resemble each other leaving the clinician in a diagnostic dilemma. Etiology of these diseases varies geographically with most frequently being tobacco use, alcohol drinking, chewing of betel quid containing areca nut, and solar rays. The long-standing practice of these lifestyle habits causes an alteration in the mucosal barrier level leading to malignant transformation. Earlier, the diagnosis of malignant transformation was confirmed using biopsy, but the advent of exfoliative cytology showed that histological features of a cell undergoing transformation are distinctive during early stages. Early diagnosis can be lifesaving, along with chairside adjunct tools that can facilitate the clinician for better diagnosis and use it as an explanatory tool for patients.

Aim:

The aim of this study was to test the efficacy of foldscope as a chairside diagnostic tool to detect dysplastic changes in potentially malignant lesions affecting the oral cavity.

Materials and Methods:

This was a cross-sectional comparative study of a total of 54 individuals clinically diagnosed with oral premalignant lesions. Exfoliative cytological smears were taken and observed under light microscope and foldscope. After Papanicolaou stain, it was subjected to cytomorphometric analysis.

Results:

Cytological changes in potentially malignant lesions detected using foldscope were appreciable and found to be a mirror image of the routine light microscope.

Conclusion:

Morphological parameters assessed by foldscope proved to be employed in routine practice as well as in the mass screening of oral lesions.

Foldscope: A smartphone based diagnostic tool for fungal keratitis

Purpose:

Smartphone-based microscopy tool like foldscope (FS) may serve the purpose of a low-cost diagnostic alternative to the compound light microscope especially in areas with limited resources. The purpose of this study was to detect fungal pathogens causing keratitis on direct smear by smartphone-mounted FS and to evaluate the efficacy of FS against routine compound light microscope (CLM).

Methods:

The prospective study was conducted at a tertiary eye care center from September 2019 to March 2020. The study included 60 smear examinations (Gram stain [GM] n = 30, Lactophenol Cotton Blue [LCB] n = 30) to detect fungal pathogens from corneal scraping material of clinically suspected fungal keratitis (FK) cases. The diagnostic utility of FS was compared with CLM for both GM and LCB wet mount. Data collected were used to quantify the agreement using Cohen’s kappa between CLM and FS imaging.

Results:

Forty-six samples out of 60 were positive for fungi using CLM. GM stain and LCB showed 22/30 (73.33%) and 24/30 (80%) positive results with CLM, respectively. Moderate agreement (0.49) was observed between CLM and FS with the smartphone method. LCB mount showed high specificity of 1.00 over 0.87 of GM stain for FS with the smartphone.

Conclusion:

Direct smear can be an early and sensitive measure to diagnose FK other than clinical suspicion. The smartphone-mounted FS has limited sensitivity as an alternative to CLM, but excellent specificity in the present study for FK. The FS as a smartphone-based diagnostic tool is simple, portable, and inexpensive in resource-constrained rural or remote clinical and public health settings in the absence of CLM and other higher diagnostic modalities.

Role of early foldscopy (microscopy) of endotracheal tube aspirates in deciding restricted empirical therapy in ventilated patients

PURPOSE

Prevention of healthcare-associated infections (HAI) like ventilator associated pneumonia (VAP) is particularly challenging especially in resource limited settings. Complex microbial interactions between patients and health care workers (HCWs) further complicate the situation, requiring a holistic approach for successful management. To bridge the gap between laboratory and intensive care unit (ICU) this study was conducted to find the role of hand-held microscope 'Foldscope' in restricting empirical therapy in intubated patients.

METHODS

A total of 75 endotracheal aspirates (ETA) were collected from intubated patients in the ICU with (group 1) and without (group 2) VAP. For group 2, those with less than 48 ​h ventilation and with endotracheal tube (ETT) in situ were considered. Presence of biomass was detected through foldscope and ETA samples were processed for quantitative gram staining (QGS), semi-quantitative and quantitative culture. Phenotypic and genotypic characterization of Acinetobacter baumannii, the commonest isolate, was done and findings were statistically analysed.

RESULTS

Biomass was present as seen through a foldscope in 45 cases (90%) in group 1 and 17 cases (68%) in group 2. In both the groups, A. baumannii was the most common isolate. Biomass production, significant QGS and culture was significantly more in group 1 (p ​< ​0.05). However, carbapenem resistant A. baumannii (CRAB) was comparably present in both the groups thus showing limited role of empirical carbapenem therapy.

CONCLUSIONS

Early assessment of biomass in mechanically ventilated patients could provide guidance for empirical antibiotic therapy. Foldscope proved to be an excellent tool for restricting empirical therapy and driving antimicrobial stewardship in low resource settings.

Validation of salivary ferning based estrus identification method in a large population of water buffaloes (Bubalus bubalis) using Foldscope

Missing an estrus event is an economic problem in buffaloes because of lack of a simple and accurate estrus identification method. Saliva, a non-invasive fluid available every time, showed typical fern-like crystallization patterns at early estrus in buffaloes. However, to implement this salivary ferning based estrus identification method in the field conditions, the present study, for the first time, validated this method in four buffalo population samples (PS) representing four different field scenarios, an organized herd (PS1, 10 buffaloes monitored daily for a year (149 estrus events)), artificial insemination (AI) centers (PS2, 114 buffaloes brought for AI), induced estrus condition (PS3, 44 buffaloes) and farmers' doorsteps (PS4, 275 random buffaloes with unknown reproductive history and no estrous signs). Totally, 582 saliva samples were collected from 443 buffaloes. Salivary smears were observed under a simple microscope and/or a less expensive (< 1USD) paper microscope, Foldscope. On the basis of salivary fern-like patterns, the proportions of estrus identification were significantly different among PS. Specifically, the proportions in the PS1 (0.74, P < 0.0001) and PS4 (0.08, P < 0.05) were significantly higher than their population proportion estimates, 0.5 and zero, respectively. Therefore, this estrus identification method is much useful in the PS1 and PS4, the practical field scenarios requiring an accurate estrus prediction method, compared to the PS2 and PS3. Especially, this method is 91 % confirmatory to detect early estrus in PS4. Therefore, salivary ferning is a useful technique to identify early estrus in buffaloes in the field conditions at farmers' doorsteps.

Geographic information system and foldscope technology in detecting intestinal parasitic infections among school children of South India

BACKGROUND

Effective and efficient use of technological advances will ease public health interventions and also help in reaching a larger population. Geographic Information System (GIS) and Foldscope are two such technologies, which have promising utilities in public health. Identifying intestinal parasitic infections early through feasible technologies will help in their effective management. With this objective, this study was conducted to assess the prevalence of intestinal parasitic infections among school children in southern districts of Karnataka, India.

METHODS

This cross-sectional study was conducted among randomly selected 10 urban, 10 rural, and 5 tribal schools of southern districts of Karnataka. A total of 1052 children studying in these schools were selected. Stool samples were collected and examined under Foldscope for parasitic infestation. The schools where children with worm infestations present were plotted in the GIS map.

FINDINGS

Among 1052 children included in this study, 139 (13.2%) were found to have an intestinal parasitic infestation. Among these children, 24.6% were in the age group of 5-9 years, 12.2% were males, and 14.4% were females. Urban students had higher odds (2.765) of parasitic infections compared to rural students. Mean age, height, and weight were significantly lesser among subjects with a worm infestation.

INTERPRETATION

Utility of Foldscope and GIS was found to be feasible and effective in the detection and mapping of parasitic infestations. The prevalence of parasitic infestation was found to be high among urban school children. Age, weight, height, and urban residence were found to be the major predictors of outcome.

Understanding the Role of the Clitellum in the Regeneration Events of the Earthworm Eudrilus eugeniae

Regeneration is a complex mechanism to restore lost or damaged body parts. In earthworms, regeneration capability varies among different species, and it is important to explore the mechanism behind the regeneration process. Interestingly, regeneration in earthworms is either dependent or independent of clitellum segments. In the present study, juvenile earthworms (Eudrilus eugeniae) were amputated at 3 different sites, namely the head, clitellum, and tail segments (at segments 10, 15, and 30, respectively), and their regeneration ability was documented using a foldscope. The amputated segments having the intact clitellum were able to heal the wounds and form the regenerative blastema. The smaller portions of the amputated segments (segments 1-10 and 1-15) without intact clitellum were unable to heal the wound, and death occurs within 12-24 h. The larger portions of the amputated segments (segments 15 and 30 to anus) without intact clitellum were able to heal the wound but lacked the regeneration capability. In control worms, alkaline phosphatase (ALP) signals were observed at the anterior tip, clitellum, and gut epithelium tissues, whereas, upon amputation, the enriched signals from the clitellum diminished, but profound signals were observed at the amputation site and regenerative blastema. Interestingly, on days 3 and 4, blastemal tips lacked ALP signals due to initiation of the differentiation process in the regeneration blastema. In summary, using a foldscope microscope, the role of the clitellum in the regeneration mechanism was indicated by ALP activity.

Foldscope as a primary diagnostic tool for oral and urinary tract infections and its effectiveness in oral health education

Due to its speed, accuracy and cost-effectiveness, microscopy has become an integral part of clinical examination for disease diagnosis. However, modern microscopes are very costly and require skilled personnel for their operation and maintenance, and specimen processing and analysis is labour-intensive. Further, lack of such expensive diagnostic tools in remote areas is a serious concern. Affordable point-of-care diagnostic tools are the most useful for timely disease diagnosis and management. The Foldscope is an affordable origami-based microscopy device composed of a series of paper clippings, which, upon assembly, can hold a specimen slide for observation, and this specimen can be viewed via a mobile phone camera attached to it. The present study evaluated the use of the Foldscope in the clinical diagnosis of oral and urinary tract infections and evaluated its efficacy as a motivational tool for improving oral health among school children in India. We qualitatively compared the Foldscope to a clinical microscope by examining five different types of clinical samples. Of the different types of clinical samples, the Foldscope was effective in detecting infection in dental plaque samples and urine samples. Thus, we further analysed 31 dental plaque samples of patients aged 3-13 years and 25 urine samples of patients aged 11-62 years. We also evaluated the use of the Foldscope as an educational tool for motivating oral hygiene among 80 school children aged 12 years and found that students in the Foldscope intervention group had better measures of oral hygiene than did students in the nonintervention group. In summary, our study indicated that the Foldscope is useful in detecting urinary tract infections and kidney stones in urine samples and is a useful motivational tool for oral health education among school-aged children. Furthermore, it may also be useful in oral health monitoring in resource poor settings. LAY DESCRIPTION: Poor and remote population often suffers due to lack of capacity to buy products or avail services which are expensive. In such a society people are not able to afford even the basic detection of diseases. Foldscope may come to rescue here! Foldscope is a paper-based, use-and-throw, affordable microscope. This study explores the use of Foldscope in clinics and diseases diagnosis using patient samples. Preliminary detection of disease associated symptoms in dental and urinary infections and digital record keeping via storage in mobile phone memory and hospital OPD records for monitoring patient's health are some of the advantages of Foldscope for clinical use in resource poor settings. It identifies that Foldscope not only can be used by students or teachers for educational purposes but it can also pave a path for promotion of dental hygiene among young children. The study also suggests that further improvement in design or resolution of Foldscope will broaden the scope of its application, in future.

Evaluating the performance of a low-cost mobile phone attachable microscope in cervical cytology

Background

Cervical cancer remains a global health problem especially in remote areas of developing countries which have limited resources for cervical cancer screening. In this study, we evaluated the performance of a low-cost, smartphone attachable paper-based microscope when used for classifying images of cervical cytology.

Methods

Cervical cytology samples included: 10 Normal, 10 Low-grade squamous intraepithelial lesion (LSIL), 10 High-grade squamous intraepithelial lesion (HSIL), and 10 Malignant Pap Smears. The agreement between conventional microscopy vs. Foldscope imaging was calculated using a weighted kappa coefficient. A confusion matrix was created with three classes: Normal, LSIL, and HSIL/malignant, to evaluate the performance of the Foldscope by calculating the accuracy, sensitivity, and specificity.

Results

We observed a kappa statistic of 0.68 for the agreement. This translates into a substantial agreement between the cytological classifications by the Foldscope vs. conventional microscopy. The accuracy of the Foldscope was 80%, with a sensitivity and specificity of 85 and 90% for the HSIL/Mal category, 80 and 83.3%, for LSIL, and 70 and 96.7% for Normal.

Conclusions

This study highlights the usefulness of the Foldscope in cervical cytology, demonstrating it has substantial agreement with conventional microscopy. Its use could improve cytologic interpretations in underserved areas and, thus, improve the quality of cervical cancer screening. Improvements in existing limitations of the device, such as ability to focus, could potentially increase its accuracy.

Using Foldscope to Monitor Superoxide Production and Cell Death During Pathogen Infection in Arabidopsis Under Different Nitrogen Regimes

Nitrogen nutrition plays a role in plant growth development and resistance against biotic and abiotic stress. During pathogen infection various signal molecules such as reactive oxygen species, calcium, reactive nitrogen species, salicylic acid, and ethylene plays an important role. The form of nitrogen nutrition such as nitrate or ammonium plays a role in production of these molecules. Under nitrate nutrition NO is predominant. The produced NO plays a role in reacting with superoxide to generate peroxynitrite to induce cell death during hypersensitive response elicited by avirulent pathogens. Excess of ROS is also detrimental to plants and NO plays a role in regulating ROS. Hence it is important to observe superoxide production during infection. By using an avirulent Pseudomonas syringae and Arabidopsis differential N nutrition we show superoxide production in leaves using a paper microscope called Foldscope, which can be applied as a simple microscope to observe objects. The data also compared with root system infected with pathogenic Fusarium oxysporum. Taken together here we show that Foldscope is a cost-effective and powerful technique to visualize superoxide and cell death in plants during infection.

Virtual microscopy made economical and effortless using the Foldscope and a smartphone with screen mirroring

CONTEXT

Virtual Microscopy.

AIM

The aim of this study was to demonstrate, as a proof of concept, the integration of a Foldscope, along with a smartphone and screen mirroring devices, into the regular academic teaching program for use with all types of regular slides for economical virtual microscopy.

SETTING DESIGN & METHODS

For the purpose of this demonstration, a microscopic slide of a ground section of a tooth, a smartphone (iPhone6), a Foldscope and an Apple TV module were chosen to demonstrate the integration of a low-cost unbreakable microscope along with a smartphone to facilitate immediate viewing, capture, sharing and even projection of the image by screen mirroring, if required, in a classroom setting.

CONCLUSION

The Foldscope microscope (Foldscope Instruments, Palo Alto, CA, USA) invented by Manu Prakash is an extremely economical, Origami style, fold to assemble microscope available from popular online retailers at approximately Rupees 500 aimed at simplifying and enabling diagnostics and education worldwide. The Foldscope, integrated with a smartphone, allows for easy screen casting thus proving invaluable as an educational tool by creating an effortless bridge between analogue input and digital output, facilitating instant digitization of slides for viewing, display, communication and storage. This article demonstrates the use of the Foldscope for virtual microscopy in a classroom scenario, by employing the screen mirroring capabilities of a smartphone.