Electrochemical Paper-Based Microfluidics: Harnessing Capillary Flow for Advanced Diagnostics

Electrochemical paper-based microfluidics has attracted much attention due to the promise of transforming point-of-care diagnostics by facilitating quantitative analysis with low-cost and portable analyzers. Such devices harness capillary flow to transport samples and reagents, enabling bioassays to be executed passively. Despite exciting demonstrations of capillary-driven electrochemical tests, conventional methods for fabricating electrodes on paper impede capillary flow, limit fluidic pathways, and constrain accessible device architectures. This account reviews recent developments in paper-based electroanalytical devices and offers perspective by revisiting key milestones in lateral flow tests and paper-based microfluidics engineering. The study highlights the benefits associated with electrochemical sensing and discusses how the detection modality can be leveraged to unlock novel functionalities. Particular focus is given to electrofluidic platforms that embed electrodes into paper for enhanced biosensing applications. Together, these innovations pave the way for diagnostic technologies that offer portability, quantitative analysis, and seamless integration with digital healthcare, all without compromising the simplicity of commercially available rapid diagnostic tests.

Label-Free Detection of African Swine Fever and Classical Swine Fever in the Point-of-Care Setting Using Photonic Integrated Circuits Integrated in a Microfluidic Device

Swine viral diseases have the capacity to cause significant losses and affect the sector's sustainability, a situation further exacerbated by the lack of antiviral drugs and the limited availability of effective vaccines. In this context, a novel point-of-care (POC) diagnostic device incorporating photonic integrated circuits (PICs), microfluidics and information, and communication technology into a single platform was developed for the field diagnosis of African swine fever (ASF) and classical swine fever (CSF). The device targets viral particles and has been validated using oral fluid and serum samples. Sensitivity, specificity, accuracy, precision, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated to assess the performance of the device, and PCR was the reference method employed. Its sensitivities were 80.97% and 79%, specificities were 88.46% and 79.07%, and DOR values were 32.25 and 14.21 for ASF and CSF, respectively. The proposed POC device and PIC sensors can be employed for the pen-side detection of ASF and CSF, thus introducing novel technological advancements in the field of animal diagnostics. The need for proper validation studies of POC devices is highlighted to optimize animal biosecurity.

Two-mode sensing strategies based on tunable cobalt metal organic framework active sites to detect Hg2

Heavy metal pollution poses a major threat to human health, and developing a user-deliverable heavy metal detection strategy remains a major challenge. In this work, two-mode Hg2+ sensing platforms based on the tunable cobalt metal-organic framework (Co-MOF) active site strategy are constructed, including a colorimetric, and an electrochemical assay using a personal glucose meter (PGM) as the terminal device. Specifically, thymine (T), a single, adaptable nucleotide, is chosen to replace typical T-rich DNA aptamers. The catalytic sites of Co-MOF are tuned competitively by the specific binding of T-Hg2+-T, and different signal output platforms are developed based on the different enzyme-like activities of Co-MOF. DFT calculations are utilized to analyze the interaction mechanism between T and Co-MOF with defect structure. Notably, the two-mode sensing platforms exhibit outstanding detection performance, with LOD values as low as 0.5 nM (colorimetric) and 3.69 nM (PGM), respectively, superior to recently reported nanozyme-based Hg2+ sensors. In real samples of tap water and lake water, this approach demonstrates an effective recovery rate and outstanding selectivity. Surprisingly, the method is potentially versatile and, by exchanging out T-Hg2+-T, can also detect Ag+. This simple, portable, and user-friendly Hg2+ detection approach shows plenty of promise for application in the future.

Self-calibrating dual-sensing electrochemical sensors for accurate detection of carbon dioxide in blood

A paper-based electrochemical dual-function biosensor capable of determining pH and TCO2 was synthesized for the first time using an iridium oxide pH electrode and an all-solid-state ion electrode (ASIE). In the study, to obtain highly reliable results, the biosensor was equipped with a real-time pH correction function before TCO2 measurements. Compared to traditional liquid-filling carbon dioxide detection sensors, the utilization of ferrocene endows our novel sensor with abundant positive sites, and thus greatly improves its performance. Conversely, the introduction of MXene with conductivity close to that of metals reduces electrode resistance, which is beneficial for accelerating the electrochemical reaction of the sensor and reducing LOD. After optimization, the detection range of TCO2 is 0.095 nM-0.66 M, with a detection limit of as low as 0.023 nM. In addition, the sensor was used in real serum sample-spiked recovery experiments and comparison experiments with existing clinical blood gas analyzers, which confirmed the effectiveness of its clinical application. This study provides a method for the rational design of paper-based electrochemical biosensors and a new approach for the clinical detection of blood carbon dioxide.

Liquid foams as sensors for the detection of biomarkers

Bioassays are widely used in healthcare to detect and quantify biomarkers, such as molecules or enzymes, which are crucial in monitoring diseases and health conditions. In developed countries, healthcare professionals use specialized reagents and equipment's to perform these bioassays. However, in less-industrialized countries, the creation of low cost, fast, and technically simple bioassays is required. Herein, we propose a simple approach for detecting biochemical markers using host-guest complexes containing a surfactant. When the biochemical marker is present, the host-guest complex is disrupted, releasing the surfactant and producing foam. The read-out mechanism relies on the change of foam volume as function of biomarker concentration. This change is quantifiable by the naked eye and can be measured with a simple ruler. We claim that the use of foams as sensing tool is an attractive, inexpensive, fast, and easy to handle on-site detection method.

Development of Solid-State Storage for Cell-Free Expression Systems

The fragility of biological systems during storage, transport, and utilization necessitates reliable cold-chain infrastructure and limits the potential of biotechnological applications. In order to unlock the broad applications of existing and emerging biological technologies, we report the development of a novel solid-state storage platform for complex biologics. The resulting solid-state biologics (SSB) platform meets four key requirements: facile rehydration of solid materials, activation of biochemical activity, ability to support complex downstream applications and functionalities, and compatibility for deployment in a variety of reaction formats and environments. As a model system of biochemical complexity, we utilized crudeEscherichia colicell extracts that retain active cellular metabolism and support robust levels of in vitro transcription and translation. We demonstrate broad versatility and utility of SSB through proof-of-concepts for on-demand in vitro biomanufacturing of proteins at a milliliter scale, the activation of downstream CRISPR activity, as well as deployment on paper-based devices. SSBs unlock a breadth of applications in biomanufacturing, discovery, diagnostics, and education in resource-limited environments on Earth and in space.

Pinaceae Pine Resins (Black Pine, Shore Pine, Rosin, and Baltic Amber) as Natural Dielectrics for Low Operating Voltage, Hysteresis-Free, Organic Field Effect Transistors

Four pinaceae pine resins analyzed in this study: black pine, shore pine, Baltic amber, and rosin demonstrate excellent dielectric properties, outstanding film forming, and ease of processability from ethyl alcohol solutions. Their trap-free nature allows fabrication of virtually hysteresis-free organic field effect transistors operating in a low voltage window with excellent stability under bias stress. Such green constituents represent an excellent choice of materials for applications targeting biocompatibility and biodegradability of electronics and sensors, within the overall effort of sustainable electronics development and environmental friendliness.

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.

Paper-based sensors for bacteria detection

The detection of pathogenic bacteria is essential to prevent and treat infections and to provide food security. Current gold-standard detection techniques, such as culture-based assays and polymerase chain reaction, are time-consuming and require centralized laboratories. Therefore, efforts have focused on developing point-of-care devices that are fast, cheap, portable and do not require specialized training. Paper-based analytical devices meet these criteria and are particularly suitable to deployment in low-resource settings. In this Review, we highlight paper-based analytical devices with substantial point-of-care applicability for bacteria detection and discuss challenges and opportunities for future development.

Translating diagnostics and drug delivery technologies to low-resource settings

Diagnostics and drug delivery technologies engineered for low-resource settings aim to meet their technical design specifications using strategies that are compatible with limited equipment, infrastructure, and operator training. Despite many preclinical successes, very few of these devices have been translated to the clinic. Here, we identify factors that contribute to the clinical success of diagnostics and drug delivery systems for low-resource settings, including the need to engage key stakeholders at an early stage, and provide recommendations for the clinical translation of future medical technologies.

Advanced density-based methods for the characterization of materials, binding events, and kinetics

Investigations of the densities of chemicals and materials bring valuable insights into the fundamental understanding of matter and processes. Recently, advanced density-based methods have been developed with wide measurement ranges (i.e. 0-23 g cm^-3), high resolutions (i.e. 10^-6 g cm^-3), compatibility with different types of samples and the requirement of extremely low volumes of sample (as low as a single cell). Certain methods, such as magnetic levitation, are inexpensive, portable and user-friendly. Advanced density-based methods are, therefore, beneficially used to obtain absolute density values, composition of mixtures, characteristics of binding events, and kinetics of chemical and biological processes. Herein, the principles and applications of magnetic levitation, acoustic levitation, electrodynamic balance, aqueous multiphase systems, and suspended microchannel resonators for materials science are discussed.

Rapid and inexpensive process to fabricate paper based microfluidic devices using a cut and heat plastic lamination process

Microfluidic paper-based analytical devices (microPADs) are emerging as simple-to-use, low-cost point-of-care testing platforms. Such devices are mostly fabricated at present by creating hydrophobic barriers using wax or photoresist patterning on porous paper sheets. Even though devices fabricated using these methods are used and tested with a wide variety of analytes, still they pose many serious practical limitations for low-cost automated mass fabrication for their widespread applicability. We present an affordable and simple two-step process - cut and heat (CH-microPADs) - for the selective fabrication of hydrophilic channels and reservoirs on a wide variety of porous media such as tissue/printing/filter paper and cloth types, such as cotton and polyester, by a lamination process. The technique presents many advantages as compared to existing commonly used methods. The devices possess excellent mechanical strength against bending, folding and twisting, making them virtually unbreakable. They are structurally flexible and show good chemical resistance to various solvents, acids and bases, presenting widespread applicability in areas such as clinical diagnostics, biological sensing applications, food processing, and the chemical industry. Fabricated paper media 96 well-plate CH-microPAD configurations were tested for cell culture applications using mice embryonic fibroblasts and detection of proteins and enzymes using ELISA. With a simple two-step process and minimal human intervention, the technique presents a promising step towards mass fabrication of inexpensive disposable diagnostic devices for both resource-limited and developed regions.

Point-of-Care and Label-Free Detection of Porcine Reproductive and Respiratory Syndrome and Swine Influenza Viruses Using a Microfluidic Device with Photonic Integrated Circuits

Swine viral diseases challenge the sector’s sustainability by affecting productivity and the health and welfare of the animals. The lack of antiviral drugs and/or effective vaccines renders early and reliable diagnosis the basis of viral disease management, underlining the importance of point-of-care (POC) diagnostics. A novel POC diagnostic device utilizing photonic integrated circuits (PICs), microfluidics, and information and communication technologies for the detection of porcine reproductive and respiratory syndrome virus (PRRSV) and swine influenza A (SIV) was validated using spiked and clinical oral fluid samples. Metrics including sensitivity, specificity, accuracy, precision, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated to assess the performance of the device. For PRRSV, the device achieved a sensitivity of 83.5%, specificity of 77.8%, and DOR values of 17.66, whereas the values for SIV were 81.8%, 82.2%, and 20.81, respectively. The POC device and PICs can be used for the detection of PRRSV and SIV in the field, paving the way for the introduction of novel technologies in the field of animal POC diagnostics to further optimize livestock biosecurity.

Field validation of the performance of paper-based tests for the detection of the Zika and chikungunya viruses in serum samples

In low-resource settings, resilience to infectious disease outbreaks can be hindered by limited access to diagnostic tests. Here we report the results of double-blinded studies of the performance of paper-based diagnostic tests for the Zika and chikungunya viruses in a field setting in Latin America. The tests involved a cell-free expression system relying on isothermal amplification and toehold-switch reactions, a purpose-built portable reader and onboard software for computer vision-enabled image analysis. In patients suspected of infection, the accuracies and sensitivities of the tests for the Zika and chikungunya viruses were, respectively, 98.5% (95% confidence interval, 96.2–99.6%, 268 serum samples) and 98.5% (95% confidence interval, 91.7–100%, 65 serum samples) and approximately 2 aM and 5 fM (both concentrations are within clinically relevant ranges). The analytical specificities and sensitivities of the tests for cultured samples of the viruses were equivalent to those of the real-time quantitative PCR. Cell-free synthetic biology tools and companion hardware can provide de-centralized, high-capacity and low-cost diagnostics for use in low-resource settings.

Portable and sensitive detection of non-glucose target by enzyme-encapsulated metal-organic-framework using personal glucose meter

Personal glucose meter (PGM) is one of the most commercially available POC (point-of-care) devices for monitoring the level of glucose reliably, yet its non-glucose quantification ability is limited since such strategy needs ingenious interface design and tedious enzyme conjugation. Herein, we constructed a portable and sensitive platform that can detect non-glucose target by combining enzyme-encapsulated zeolitic imidazole framework-90 (ZIF-90) with personal glucose meter. ZIF-90 is an ideal carrier and susceptor due to the extraordinary capability of packaging enzyme and stimuli-responsiveness. We selected adenosine-5'-triphosphate (ATP) as the target model of non-glucose analytes. Upon ATP-induced decomposition of MOF, the released enzyme (glucose oxidase or invertase) catalyzed substrate and gave rise to the change of the glucose concentration for PGM assay. This method determined ATP with a remarkably sensitivity of 233 nM and effective recovery in real serum samples. Our strategy provides a facile and practical approach for measuring the non-glucose target using PGM, and could potentially be applied in bimolecular detection in point-of-care diagnosis.

A Review of Isothermal Amplification Methods and Food-Origin Inhibitors against Detecting Food-Borne Pathogens

The isothermal amplification method, a molecular-based diagnostic technology, such as loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA), is widely used as an alternative to the time-consuming and labor-intensive culture-based detection method. However, food matrices or other compounds can inhibit molecular-based diagnostic technologies, causing reduced detection efficiencies, and false-negative results. These inhibitors originating from food are polysaccharides and polyphenolic compounds in berries, seafood, and vegetables. Additionally, magnesium ions needed for amplification reactions can also inhibit molecular-based diagnostics. The successful removal of inhibitors originating from food and molecular amplification reaction is therefore proposed to enhance the efficiency of molecular-based diagnostics and allow accurate detection of food-borne pathogens. Among molecular-based diagnostics, PCR inhibitors have been reported. Nevertheless, reports on the mechanism and removal of isothermal amplification method inhibitors are insufficient. Therefore, this review describes inhibitors originating from food and some compounds inhibiting the detection of food-borne pathogens during isothermal amplification.

Challenges and recent trends with the development of hydrogel fiber for biomedical applications

Hydrogel is the most emblematic soft material which possesses significantly tunable and programmable characteristics. Polymer hydrogels possess significant advantages including, biocompatible, simple, reliable and low cost. Therefore, research on the development of hydrogel for biomedical applications has been grown intensely. However, hydrogel development is challenging and required significant effort before the application at an industrial scale. Therefore, the current work focused on evaluating recent trends and issues with hydrogel development for biomedical applications. In addition, the hydrogel's development methodology, physicochemical properties, and biomedical applications are evaluated and benchmarked against the reported literature. Later, biomedical applications of the nano-cellulose-based hydrogel are considered and critically discussed. Based on a detailed review, it has been found that the surface energy, intermolecular interactions, and interactions of hydrogel adhesion forces are major challenges that contribute to the development of hydrogel. In addition, compared to other hydrogels, nanocellulose hydrogels demonstrated higher potential for drug delivery, 3D cell culture, diagnostics, tissue engineering, tissue therapies and gene therapies. Overall, nanocellulose hydrogel has the potential for commercialization for different biomedical applications.

Reagent Filming for Universal Point-of-Care Diagnostics

Simplifying assays while maintaining the robustness of reagents is a challenge in diagnostics. This problem is exacerbated when translating quality diagnostic assays to developing countries that lack resources and infrastructure such as trained health workers, high-end equipment, and cold-chain systems. To solve this problem, in this study, a simple solution that films assay reagents to simplify the operation of diagnostic assays and preserve the stability of diagnostic reagents without using cold chains is presented. A polyvinyl-alcohol-based water-soluble film is used to encapsulate premeasured and premixed reagents. The reagent film, produced through a simple and scalable cast-drying process, provides a glassy inner matrix with abundant hydroxyl groups that can stabilize various reagents (ranging from chemicals to biological materials) by restricting molecular mobility and generating hydrogen bonds. The reagent film is applied to an enzymatic glucose assay, a high-sensitivity immunoassay for cardiac troponin, and a molecular assay for viral RNA detection, to test its practicability and universal applicability. The film-based assays result in excellent analytical/diagnostic performance and stable long-term reagent storage at elevated temperatures (at 25 or 37 °C, for six months), demonstrating clinical readiness. This technology advances the development and distribution of affordable high-quality diagnostics to resource-limited regions.

On-Chip Optical Anodic Stripping with Closed Bipolar Cells and Cathodic Electrochemiluminescence Reporting

The aim of this work was to develop a simple, accessible, and point-of-use sensor to measure heavy metal ions in water in low-resource areas that cannot accommodate expensive or technical solutions. This report describes a new bipolar electrochemical sensor platform that reimagines conventional anodic stripping voltammetry in a wireless bipolar format with an optical electrochemiluminescent readout that can be quantified with any simple optical sensor like that found on most modern cell phone cameras. We call this technique as optical anodic stripping. Using a new nonlithographic fabrication process, devices could be produced rapidly and simply at <$1/sensor. The sensing scheme was developed, characterized, and optimized using electrochemical and optical methods. Quantitation of Pb²⁺ in both lab and natural water samples was rapid (2-3 min), accurate, precise, and highly linear in the 25-1000 ppb range and was shown to be sufficiently selective in the presence of other common heavy metal ions such as Cu²⁺, Cd²⁺, and Zn²⁺.

Nanodiagnostics to Face SARS-CoV-2 and Future Pandemics: From an Idea to the Market and Beyond

The COVID-19 pandemic made clear how our society requires quickly available tools to address emerging healthcare issues. Diagnostic assays and devices are used every day to screen for COVID-19 positive patients, with the aim to decide the appropriate treatment and containment measures. In this context, we would have expected to see the use of the most recent diagnostic technologies worldwide, including the advanced ones such as nano-biosensors capable to provide faster, more sensitive, cheaper, and high-throughput results than the standard polymerase chain reaction and lateral flow assays. Here we discuss why that has not been the case and why all the exciting diagnostic strategies published on a daily basis in peer-reviewed journals are not yet successful in reaching the market and being implemented in the clinical practice.

Paper-Based Optode Devices (PODs) for Selective Quantification of Potassium in Biological Fluids

This paper describes the design, fabrication, and feasibility of paper-based optode devices (PODs) for sensing potassium selectively in biological fluids. PODs operate in exhaustive mode and integrate with a handheld, smartphone-connected optical reader. This integrated measuring system provides significant advantages over traditional optode membranes and other paper-based designs, by obtaining a linear optical response to potassium concentration via a simple, stackable design and by harnessing a smartphone to provide an easy-to-use interface, thus enabling remote monitoring of diseases.

Microcapillary-based multicolor assay for quantitative and sensitive point-of-care testing of proteins

A microcapillary-based multicolor assay was developed for proteins quantification in serum sample with the assistance of manual centrifugal platform. The proposed assay only required the operation of "one suction and one extrusion" to realize the target detection. Myoglobin (Myo), a biomarker in the early stage of acute myocardial infarction (AMI), was chosen as the model target. The microcapillary was first modified with polydopamine (PDA), then Myo aptamer was immobilized on the PDA modified microcapillary and hybridized with glucose oxidase (Gox) functionalized DNA probe (DNA-Gox). The step "one suction" referred to the inhalation of the sample into the functionalized microcapillary. Then the target Myo in the sample could bind to the Myo aptamer on the microcapillary so that DNA-Gox complexes were released from the microcapillary into solution. Through the step "one extrusion", the DNA-Gox complexes in the solution could catalyze glucose to generate hydrogen peroxide, and then the etching of gold nanorods (AuNRs) was initiated, causing a color change from brown to yellow. According to the color change based on the etching of AuNRs, as low as 0.1 nM Myo was detected with naked eyes. Combined with the manual centrifugal platform, even the Myo in the serum samples could be detected without power supply. It was expected to build a universal and adaptable sensing platform for different targets more quickly and efficiently.

Functional paper-based materials for diagnostics

Functional papers are the subject of extensive research efforts and have already become an irreplaceable part of our modern society. Among other issues, they enable fast and inexpensive detection of a plethora of analytes and simplify laboratory work, for example in medical tests. This article focuses on the molecular and structural fundamentals of paper and the possibilities of functionalization, commercially available assays and their production, as well as on current and future challenges in research in this field.

Electrochemical micropipette-tip for low-cost environmental applications: Determination of anionic surfactants through their interaction with methylene blue

Miniaturization is one of the main requirements in the design of portable devices that allow in-field analysis. This is especially interesting in environmental monitoring, where the time of the sample-to-result process could be decreased considerably by approaching the analytical platforms to the sampling point. We employed traditional mass-produced and low-cost elements (micropipette tips and pins) in an out-of-box application to generate an innovative and cost-effective platform for analytical purposes. We have designed simple and easy-to-use electrochemical cells inside polypropylene micropipette tips with three stainless-steel pins acting as the working, reference and counter electrodes of a potentiostatic system. The pin acting as working electrode was previously coated with carbon ink, meanwhile the rest were used unmodified. In this way, electrochemical in-the-tip measurements were done directly using low volumes (μL) of sample. The devices showed good reproducibility, with a relative standard deviation of 7% (n = 5) for five different tip-based complete electrochemical cells. As a proof-of-concept, its utility has been probed by the determination of an anionic surfactant (sodium dodecyl sulphate, SDS) in water through its interaction with methylene blue (MB). Two different alternatives were presented based on the: 1) increase in the current intensity of the cathodic peak of MB due to the presence of SDS; 2) electrochemical determination of the MB remaining in the aqueous phase after extraction of the pair SDS-MB to an organic medium.

Charging Organic Liquids by Static Charge

Aqueous liquids can be charged effectively by a number of methods for many important applications. Organic liquids, however, cannot be charged effectively by existing methods due to their low conductivities, especially the insulating nonpolar organic liquids; hence, there has not been any significant application developed based on charged organic liquids. This study describes an effective fundamental strategy for charging organic liquids, including nonpolar organic liquids: static charge is simply mixed into the liquid. Analyses suggested that the charged species are molecular ions that reside in the bulk of the liquid after charging. This method is simple and general, and the amount and polarity of charge can be flexibly tunable. The effectiveness of this method gives rise to opportunities for the development of novel applications. Charged organic droplets are manipulated for the first time by an electric field for controlling organic reactions. Particles with charge embedded in their bulk matrices are fabricated for the first time (i.e., via polymerizing the liquid monomers mixed with static charge). The charge in this novel class of bulk-charged particles is stable and permanent, especially when compared to the typical surface-charged particles. Simultaneous bulk-charged and bulk-magnetic particles are fabricated for the first time via simply mixing both the static charge and magnetic nanoparticles into the liquid monomers. These highly versatile particles are responsive to both electric and magnetic fields for practical applications.

Usability as a guiding principle for the design of paper-based, point-of-care devices - A review

Due to their portability, versatility for supporting multiple assay formats, and potential for resulting in low-cost assays, paper-based analytical devices (PADs) are an increasingly popular format as a platform for the development of point-of-care tests. However, very few PADs have been translated successfully to their intended environments outside of academic settings. Often overlooked as a factor that inhibits translation, usability is a vital characteristic of any successful point-of-care test. Recent advancements in PAD design have demonstrated improved usability by simplifying various aspects of user operation, including sample collection, sample processing, device operation, detection, and readout/interpretation. Field testing at various stages of device design can offer critical feedback about device usability, especially when it involves the proposed end-user or other stakeholders. By highlighting advances in usability, we aim to encourage thoughtful and rigorous design at the academic prototyping stage to address one outstanding hurdle that limits the number of PADs that make it from the benchtop to the point-of-care.

Towards smart personalized perspiration analysis: An IoT-integrated cellulose-based microfluidic wearable patch for smartphone fluorimetric multi-sensing of sweat biomarkers

Practical obstacles, such as intricate designs and expensive equipment/materials, in the fabrication of wearable sweat sensors, have limited their feasibility as a personalized healthcare device. Herein, we have fabricated a cellulose-based wearable patch, which further paired with a smartphone-based fluorescence imaging module and a self-developed smartphone app for non-invasive and in situ multi-sensing of sweat biomarkers including glucose, lactate, pH, chloride, and volume. The developed Smart Wearable Sweat Patch (SWSP) sensor comprises highly fluorescent sensing probes embedded in paper substrates, and microfluidic channels consisted of cotton threads to harvest sweat from the skin surface and to transport it to the paper-based sensing probes. The imaging module was fabricated by a 3D printer, equipped with UV-LED lamps and an optical filter to provide the in situ capability of capturing digital images of the sensors via a smartphone. A smartphone app was also designed to quantify the concentration of the biomarkers via a detection algorithm. Additionally, we have recommended an Internet of Things (IoT)-based model for our developed SWSP sensor to promote its potential application for the future. The field studies on human subjects were also conducted to investigate the feasibility of our developed SWSP sensor for the analysis of sweat biomarkers. Our findings convincingly demonstrated the applicability of our developed SWSP sensor as a smart, user-friendly, ultra-low-cost (~0.03 $ per sweat patch), portable, selective, rapid, and non-invasive healthcare monitoring device for immense applications in health personalization, sports performance monitoring, and medical diagnostics.

Magnetic Levitation in Chemistry, Materials Science, and Biochemistry

All matter has density. The recorded uses of density to characterize matter date back to as early as ca. 250 BC, when Archimedes was believed to have solved "The Puzzle of The King's Crown" using density.^[1] Today, measurements of density are used to separate and characterize a range of materials (including cells and organisms), and their chemical and/or physical changes in time and space. This Review describes a density-based technique-magnetic levitation (which we call "MagLev" for simplicity)-developed and used to solve problems in the fields of chemistry, materials science, and biochemistry. MagLev has two principal characteristics-simplicity, and applicability to a wide range of materials-that make it useful for a number of applications (for example, characterization of materials, quality control of manufactured plastic parts, self-assembly of objects in 3D, separation of different types of biological cells, and bioanalyses). Its simplicity and breadth of applications also enable its use in low-resource settings (for example-in economically developing regions-in evaluating water/food quality, and in diagnosing disease).

Essential role of laboratory physicians in transformation of laboratory practice and management to a value-based patient-centric model

The laboratory is a vital part of the continuum of patient care. In fact, there are few programs in the healthcare system that do not rely on ready access and availability of complex diagnostic laboratory services. The existing transactional model of laboratory "medical practice" will not be able to meet the needs of the healthcare system as it rapidly shifts toward value-based care and precision medicine, which demands that practice be based on total system indicators, clinical effectiveness, and patient outcomes. Laboratory "value" will no longer be focused primarily on internal testing quality and efficiencies but rather on the relative cost of diagnostic testing compared to direct improvement in clinical and system outcomes. The medical laboratory as a "business" focused on operational efficiency and cost-controls must transform to become an essential clinical service that is a tightly integrated equal partner in direct patient care. We would argue that this paradigm shift would not be necessary if laboratory services had remained a "patient-centric" medical practice throughout the last few decades. This review is focused on the essential role of laboratory physicians in transforming laboratory practice and management to a value-based patient-centric model. Value-based practice is necessary not only to meet the challenges of the new precision medicine world order but also to bring about sustainable healthcare service delivery.

Fieldwork-based determination of design priorities for point-of-use drinking water quality sensors for use in resource-limited environments

Improved capabilities in microfluidics, electrochemistry, and portable assays have resulted in the development of a wide range of point-of-use sensors intended for environmental, medical, and agricultural applications in resource-limited environments of developing countries. However, these devices are frequently developed without direct interaction with their often-remote intended user base, creating the potential for a disconnect between users' actual needs and those perceived by sensor developers. As different analytical techniques have inherent strengths and limitations, effective measurement solution development requires determination of desired sensor attributes early in the development process. In this work, we present our findings on design priorities for point-of-use microbial water sensors based on fieldwork in rural India, as well as a guide to fieldwork methodologies for determining desired sensor attributes. We utilized group design workshops for initial identification of design priorities, and then conducted choice-based conjoint analysis interviews for quantification of user preferences among these priorities. We found the highest user preference for integrated reporting of contaminant concentration and recommended actions, as well as significant preferences for mostly reusable sensor architectures, same-day results, and combined ingredients. These findings serve as a framework for future microbial sensor development and a guide for fieldwork-based understanding of user needs.

FRET-Created Traffic Light Immunoassay Based on Polymer Dots for PSA Detection

There have been enormous efforts for developing the next generations of fluorometric lateral flow immunochromatographic strip (ICTS) owing to the great advances in fluorescent materials in these years. Here we developed one type of fluorometric ICTS based on ultrabright semiconducting polymer dots (Pdots) in which the traffic light-like signals were created by energy transfer depending on the target concentration. This platform was successfully applied for qualitatively rapid screening and quantitatively precise analysis of prostate-specific antigen (PSA) in 10 min from merely one drop of the whole blood sample. This FRET-created traffic light ICTS possesses excellent specificity and an outstanding detection sensitivity of 0.32 ng/mL for PSA. Moreover, we conducted proof-of-concept experiments to demonstrate its potential for multiplexed detection of cancer biomarkers at the same time in an individual test strip by taking advantage of the traffic light signals. To the best of our knowledge, it is the first model of a traffic light-like immunoassay test strip based on Pdots with multiplexing ability. These results would pave an avenue for designing the next generation of point-of-care diagnostics.

Wireless colorimetric readout to enable resource-limited point-of-care

A scalable, generic wireless colour detector for point-of-care diagnostics in resource-limited settings is presented. The challenges faced in these settings have limited the effectiveness of point-of-care diagnostics. By combining the growing fields of paper-based diagnostics and printed electronics with Southern African clinic perspectives, a mass-producible, low-cost, paper-based solution for result readout and communication was developed. Printed radio frequency identification devices with sensing capabilities were manufactured, targeting colour detection from lateral flow test strip devices and other typical paper-based rapid test formats. The results were compared to those obtained from a commercial lateral flow test strip reader and image analysis using ImageJ, and demonstrate suitability for delivering automated readout and communication of results. The wireless colour detector is compatible with different test strip form factors, providing a modular solution and reducing the need for training. The solution is low cost and maintenance free, and thus fitting for resource-limited settings. A scalable version of the solution has been developed, making use of standard manufacturing processes for printing and packaging industries, initially using sheet-to-sheet formats, but with the goal of being scalable to roll-to-roll processes. This would enable the possibility of local manufacture, and mass distribution of the devices to those resource-limited areas where they are most needed, and where they will have the greatest impact on point-of-care testing.

Engineering Steps for Mobile Point-of-Care Diagnostic Devices

Mobile phone technology is a perfect companion for point-of-care diagnostics as they come equipped with advanced processors, high resolution cameras, and network connectivity. Despite several academic pursuits, only a few mobile phone diagnostics have been tested in the field, commercialized or achieved regulatory approval. This review will address the challenges associated with developing mobile diagnostics and suggest strategies to overcome them. We aim to provide a resource for researchers to accelerate the development of new diagnostics. Our Account includes an overview of published mobile phone diagnostics and highlights lessons learned from their approach to diagnostic development. Also, we have included recommendations from regulatory and public health agencies, such as the U.S. Food and Drug Administration and World Health Organization, to further guide researchers. We believe that the development of mobile phone point-of-care diagnostics takes place in four distinct steps: (1) Needs and Value Assessment, (2) Technology Development, (3) Preclinical Verification, and (4) Clinical Validation and Field Trials. During each step, we outline developmental strategies to help researchers avoid potential challenges. (1) Researchers commonly develop devices to maximize technical parameters such as sensitivity and time which do not necessarily translate to increased clinical impact. Researchers must focus on assessing specific diagnostic needs and the value which a potential device would offer. (2) Often, researchers claim they have developed devices for feasible implementation at the point-of-care, yet they rely on laboratory resources. Researchers must develop equipment-free devices which are agnostic to any mobile phone. (3) Another challenge researchers face is decreased performance during field evaluations relative to initial laboratory verification. Researchers must ensure that they simulate the field conditions during laboratory verification to achieve successful translation. (4) Finally, proper field testing of devices must be performed in conditions which match that of the final intended use. The future of mobile phone point-of-care diagnostic devices is bright and has the potential to radically change how patients are diagnosed. Before we reach this point, researchers must take a step backward and focus on the first-principles of basic research. The widespread adoption and rapid scaling of these devices can only be achieved once the fundamentals have been considered. The insights and strategies provided here will help researchers avoid pitfalls, streamline development and make better decisions during the development of new diagnostics. Further, we believe this Account can help push the field of mobile diagnostics toward increased productivity, leading to more approved devices and ultimately helping curb the burden of disease worldwide.

Clinical Relevance of Home Monitoring of Vital Signs and Blood Glucose Levels: A Narrative Review

OBJECTIVES

We sought to assess the presence and reporting quality of peer-reviewed literature concerning the accuracy, precision, and reliability of home monitoring technologies for vital signs and glucose determinations in older adult populations.

METHODS

A narrative literature review was undertaken searching the databases Medline, Embase, and Compendex. Peer-reviewed publications with keywords related to vital signs, monitoring devices and technologies, independent living, and older adults were searched. Publications between the years 2012 and 2018 were included. Two reviewers independently conducted title and abstract screening, and four reviewers independently undertook full-text screening and data extraction with all disagreements resolved through discussion and consensus.

RESULTS

Two hundred nine articles were included. Our review showed limited assessment and low-quality reporting of evidence concerning the accuracy, precision, and reliability of home monitoring technologies. Of 209 articles describing a relevant device, only 45 percent (n = 95) provided a citation or some evidence to support their validation claim. Of forty-eight articles that described the use of a comparator device, 65 percent (n = 31) used low-quality statistical methods, 23 percent (n = 11) used moderate-quality statistical methods, and only 12 percent (n = 6) used high-quality statistical methods.

CONCLUSIONS

Our review found that current validity claims were based on low-quality assessments that do not provide the necessary confidence needed by clinicians for medical decision-making purposes. This narrative review highlights the need for standardized health technology reporting to increase health practitioner confidence in these devices, support the appropriate adoption of such devices within the healthcare system, and improve health outcomes.

Signal-Enhanced Detection of Multiplexed Cardiac Biomarkers by a Paper-Based Fluorogenic Immunodevice Integrated with Zinc Oxide Nanowires

Using a single test to comprehensively evaluate multiple cardiac biomarkers for early diagnosis and prevention of acute myocardial infarction (AMI) has faced enormous challenges. Here, we have developed paper-based fluorogenic immunodevices for multiplexed detection of three cardiac biomarkers, namely, human heart-type fatty acid binding protein (FABP), cardiac troponin I (cTnI), and myoglobin, simultaneously. The detection is based on a strategy using zinc oxide nanowires (ZnO NWs) to enhance fluorescence signals (∼5-fold compared to that on pure paper). The immunodevices showed high sensitivity and selectivity for FABP, cTnI, and myoglobin with detection limits of 1.36 ng/mL, 1.00 ng/mL, and 2.38 ng/mL, respectively. Additionally, the paper-based immunoassay was rapid (∼5 min to complete the test) and portable (using a homemade chamber with a smartphone and an ultraviolet lamp). The developed devices integrated with ZnO NWs enable quantitative, sensitive, and simultaneous detection of multiple cardiac biomarkers in point-of-care settings, which provides a useful approach for monitoring AMI diseases and may be extended to other medical diagnostics and environmental assessments.

Fabrication of laser printed microfluidic paper-based analytical devices (LP-µPADs) for point-of-care applications

Microfluidic paper-based analytical devices (µPADs) have provided a breakthrough in portable and low-cost point-of-care diagnostics. Despite their significant scope, the complexity of fabrication and reliance on expensive and sophisticated tools, have limited their outreach and possibility of commercialization. Herein, we report for the first time, a facile method to fabricate µPADs using a commonly available laser printer which drastically reduces the cost and complexity of fabrication. Toner ink is used to pattern the µPADs by printing, without modifying any factory configuration of the laser printer. Hydrophobic barriers are created by heating the patterned paper which melts the toner ink, facilitating its wicking into the cross-section of the substrate. Further, we demonstrate the utilization of the fabricated device by performing two assays. The proposed technique provides a versatile platform for rapid prototyping of µPADs with significant prospect in both developed and resource constrained region.

Engineering nanocellulose hydrogels for biomedical applications

Nanocellulose hydrogels are highly hydrated porous cellulosic soft materials with good mechanical properties. These cellulose-based gels can be produced from bacterial or plant cellulose nanofibrils, which are hydrophilic, renewable, biodegradable and biocompatible. Nanocellulose, whether fibrils (CNF), crystals (CNC) or bacterial (BNC), has a high aspect ratio and surface area, and can be chemically modified with functional groups or by grafting biomolecules. Cellulose functionalization provides enhanced physical and chemical properties and control of biological interactions, tailoring its hydrogels for specific applications. Here, we critically review nanocellulose hydrogels for biomedical applications. Nanocellulose hydrogels have been demonstrated for 3D cell culture, mimicking the extracellular matrix (ECM) properties with low cytotoxicity. For wound dressing and cartilage repair, nanocellulose gels promote cell regeneration while providing the required mechanical properties for tissue engineering scaffolds. The encapsulation of therapeutics within nanocellulose allows the targeted delivery of drugs. Currently, cellulose crosslinking to peptides and proteins enables a new generation of low cost and renewable smart materials used in diagnostics. Last, the organized mesh of fibres contained in hydrogels drives applications in separation of biomolecules and cells. Nanocellulose hydrogels have emerged as a highly engineerable platform for multiple biomedical applications, providing renewable and performant solutions to life sciences.

Development of a "Dual Gates" Locked, Target-Triggered Nanodevice for Point-of-Care Testing with a Glucometer Readout

Developing a facile and sensitive sensing platform is of importance for point-of-care testing (POCT). Herein, a sensitive and portable POCT platform based on "dual gates" aminated magnetic mesoporous silica nanocomposites (AMMS) bearing polydopamine (PDA)-aptamer (Apt) two-tier shells, as a novel nanodevice, is designed for target detection through a target-triggered glucose (GO) release from AMMS with personal glucometer (PGM) readout. In the absence of target, GO can be firmly captured in pores by the designed "dual gates", which would decrease the high background signal of this system and ensure the accuracy of the detection results. Upon the introduction of the target molecules under acidic conditions (pH 5.5), the subsequent PDA self-degradation and the specific Apt-target reaction can cause the departure of "dual gates" and the opening of pores to release the loaded GO molecules, which could be quantitatively monitored by a portable PGM. It has been demonstrated that such POCT platform shows high sensitivity and excellent selectivity for aflatoxin B1 (AFB1) detection, accompanied by the well-presented reproducibility and stability. Importantly, this sensing platform was further validated by assaying contaminated samples, where the obtained results were well matched with that by HPLC. Regarding the features of portability, high sensitivity, and high throughput detection, the developed platform might find wide applications in POCT.

Colorimetric and Fluorescent Dual-Mode Immunoassay Based on Plasmon-Enhanced Fluorescence of Polymer Dots for Detection of PSA in Whole Blood

Although enormous efforts have been devoted to the development of new types of fluorometric immunochromatographic test strip (ICTS) with improved sensitivity over the past years, it still remains a big challenge to design ICTS with colorimetric and fluorescent bimodal signal readout for rapid yet accurate detection of cancer markers in a clinic. Scientists have tried to prepare bimodal reporters by combining fluorescent dyes with metal nanomaterials, but their fluorescence was easily quenched by metal nanomaterials through surface energy transfer, making dual colorimetric and fluorometric ICTS very difficult to be achieved. As compared to conventional fluorescent probes, semiconducting polymer dots (Pdots) exhibit extraordinary fluorescence brightness and facile surface functionalization, which are very suitable to be engineered as bimodal signal reporting reagents. Here, we integrated highly fluorescent Pdots with strongly plasmonic Au nanorods to form Pdot-Au hybrid nanocomposites with dual colorimetric and fluorescent readout abilities. We further utilized these nanohybrids in ICTS for qualitatively fast screening (colorimetry) as well as quantitatively accurate determination (fluorometry) of prostate-specific antigen (PSA) within 10 min. By taking advantage of the plasmon-enhanced fluorescence of Pdots on Au nanorods, this immunoassay possesses much better detection sensitivity of 1.07 pg/mL for PSA, which is at least 2 orders of magnitude lower than that of conventional fluorometric ICTS. Moreover, the direct detection of PSA from human whole blood collected without sample pretreatment makes this Pdot-based ICTS platform promising for on-site point-of-care diagnostics.

Point-of-Need DNA Testing for Detection of Foodborne Pathogenic Bacteria

Foodborne pathogenic bacteria present a crucial food safety issue. Conventional diagnostic methods are time-consuming and can be only performed on previously produced food. The advancing field of point-of-need diagnostic devices integrating molecular methods, biosensors, microfluidics, and nanomaterials offers new avenues for swift, low-cost detection of pathogens with high sensitivity and specificity. These analyses and screening of food items can be performed during all phases of production. This review presents major developments achieved in recent years in point-of-need diagnostics in land-based sector and sheds light on current challenges in achieving wider acceptance of portable devices in the food industry. Particular emphasis is placed on methods for testing nucleic acids, protocols for portable nucleic acid extraction and amplification, as well as on the means for low-cost detection and read-out signal amplification.

Route towards sustainable smart sensors: ferroelectric polyvinylidene fluoride-based materials and their integration in flexible electronics

Printed ferroelectric devices are ideal candidates for self-powered and multifunctional sensor skins, contributing to a sustainable smart future.

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.

The Many Roads to an Ideal Paper-based Device

The recent Zika and Ebola virus outbreaks highlight the need for low-cost diagnostics that can be rapidly deployed and used outside of established clinical infrastructure. This demand for robust point-of-care (POC) diagnostics is further driven by the increasing burden of drug-resistant diseases, concern for food and water safety, and bioterrorism. As has been discussed in previous chapters, paper-based tests provide a simple and compelling solution to such needs.