Low-cost Modalities Research Articles

(Keynote) Blood, Sweat and Tears... – Sensing of Human Performance Biomarkers in Bodily Fluids Using Point-of-Use Devices

Hormones produced by glands in the endocrine system and neurotransmitters produced by the nervous system control many bodily functions. The concentrations of these molecules in the body are an indication of its state, hence the use of the term biomarker. Excess concentrations of biomarkers, such as cortisol, serotonin, epinephrine, dopamine, are released by the body in response to a variety of conditions - emotional state (euphoria, stress), disease, etc. The development of simple, low-cost modalities for point-of-use (PoU) measurements of biomarkers levels in various bodily fluids (blood, urine, sweat, saliva) as opposed to conventional hospital or lab settings is receiving increasing attention. The presentation starts with a review of the basic properties of primary stress-related biomarkers: origin in the body (i.e. if they are produced as hormones, neurotransmitters or both), chemical composition, molecular weight (small/medium size molecules and polymers, ranging from ~100Da to ~100kDa), hydro- or lipo-philic nature. Next, a review of the published literature is presented regarding the concentration of these biomarkers found in several bodily fluids that can serve as the medium for determination of the condition of the subject: blood, urine, saliva, sweat and, to a lesser degree, interstitial tissue fluid. The concentration of various biomarkers in most fluids covers a range of 5-6 orders of magnitude, from 100s of ng/mL (~1µM) down to a few pg/mL (sub 1pM). Mechanisms and materials for point-of-use biomarker sensors are summarized and key properties are reviewed. Illustrative examples from the literature are discussed for several sensor device categories, including lateral flow (immuno)assay devices and microfluidic devices. Selected methods for detecting these biomarkers are reviewed, including antibody- and aptamer-based colorimetric assays, electrochemical and optical detection. Finally, the presentation outlines key challenges of the field and provides a look ahead to future prospects.A. J. Steckl and P. Ray, “A Review of Stress Biomarkers Concentrations in Bodily Fluids and Their Point-of-Use Detection”, ACS Sensors, 3 (10), 2025-2044, Sept 2018 (10.1021/acssensors.8b00726)V. Venkatraman and A. J. Steckl, “Quantitative Detection in Lateral Flow Immunoassay Using Integrated Organic Optoelectronics”, IEEE Sensors, 17 (24), 8343, Dec 2017 (10.1109/JSEN.2017.2764178 ).P. Ray and A. J. Steckl, “Label-Free Optical Detection of Multiple Stress Biomarkers in Sweat, Plasma, Urine and Saliva”, ACS Sensors 4, 2019. (10.1021/acssensors.9b00301)S. Dalirirad and A. J. Steckl, “Aptamer-Based Lateral Flow Assay for Point of Care Cortisol Detection in Sweat”, Sensors & Actuators 283, 79-86, Jan 2019 (https://doi.org/10.1016/j.snb.2018.11.161). Figure 1

(Invited) Blood, Sweat and Tears... – Sensing of Human Performance Biomarkers in Bodily Fluids Using Point-of-Use Devices

Hormones produced by glands in the endocrine system and neurotransmitters produced by the nervous system control many bodily functions. The concentrations of these molecules in the body are an indication of its state, hence the use of the term biomarker. Excess concentrations of biomarkers, such as cortisol, serotonin, epinephrine, dopamine, are released by the body in response to a variety of conditions - emotional state (euphoria, stress), disease, etc. The development of simple, low-cost modalities for point-of-use (PoU) measurements of biomarkers levels in various bodily fluids (blood, urine, sweat, saliva) as opposed to conventional hospital or lab settings is receiving increasing attention. The presentation starts with a review of the basic properties of primary stress-related biomarkers: origin in the body (i.e. if they are produced as hormones, neurotransmitters or both), chemical composition, molecular weight (small/medium size molecules and polymers, ranging from ~100Da to ~100kDa), hydro- or lipo-philic nature. Next, a review of the published literature is presented regarding the concentration of these biomarkers found in several bodily fluids that can serve as the medium for determination of the condition of the subject: blood, urine, saliva, sweat and, to a lesser degree, interstitial tissue fluid. The concentration of various biomarkers in most fluids covers a range of 5-6 orders of magnitude, from 100s of ng/mL (~1µM) down to a few pg/mL (sub 1pM). Mechanisms and materials for point-of-use biomarker sensors are summarized and key properties are reviewed. Illustrative examples from the literature are discussed for several sensor device categories, including lateral flow (immuno)assay devices and microfluidic devices. Selected methods for detecting these biomarkers are reviewed, including antibody- and aptamer-based colorimetric assays, electrochemical and optical detection. Finally, the presentation outlines key challenges of the field and provides a look ahead to future prospects.A.J. Steckl and P. Ray, “A Review of Stress Biomarkers Concentrations in Bodily Fluids and Their Point-of-Use Detection”, ACS Sensors, 3 (10), 2025-2044, Sept 2018 (10.1021/acssensors.8b00726).V. Venkatraman and A.J. Steckl, “Quantitative Detection in Lateral Flow Immunoassay using Integrated Organic Optoelectronics”, IEEE Sensors, 17 (24), 8343, Dec 2017 (10.1109/JSEN.2017.2764178 ).P. Ray and A.J. Steckl, “Label-Free Optical Detection of Multiple Stress Biomarkers in Sweat, Plasma, Urine and Saliva”, ACS Sensors 4, 2019. (10.1021/acssensors.9b00301)S. Dalirirad and A.J. Steckl, “Aptamer-Based Lateral Flow Assay for Point of Care Cortisol Detection in Sweat”, Sensors & Actuators 283, 79-86, Jan 2019 (https://doi.org/10.1016/j.snb.2018.11.161). Figure 1

Development of an audio and computer cognitive behavioral therapy for depression in older adults

Background: The purpose of this paper is to discuss the development of two novel technology-based interventions for depression in older adults while comparing older adults’ preferences for audio-based and computer-based cognitive behavioral therapy for depressive symptoms. The audio program consisted of eight compact discs and a workbook while the computer program consisted of 11 modules of similar duration provided on a tablet PC. Both interventions consisted of the following topics: 1) introduction, 2) identifying and changing unhelpful thoughts, 3) addressing feelings, 4) relaxation, 5) engaging in pleasant events, 6) assertiveness, and 7) problem-solving. Methods: Fifty-one older adults were recruited from medical settings and rural communities and randomly assigned to an immediate treatment group (computer or audio) with minimal contact or a four-week minimal contact delayed treatment control condition. Results: Participants rated computer-based and audio-based cognitive behavioral therapy fairly equally, with 75% of those who received audio treatment and 85% of those who received computer-based treatment indicating benefits to their mood.Discussion: Computer-based or audio-based cognitive behavioral treatments may be valuable, low-cost modalities to deliver psychotherapy to older adults with depressive symptoms within a health care setting. Both modalities seem to be accepted by older adults.

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

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

Audio and Computer Cognitive Behavioral Therapy for Depressive Symptoms in Older Adults: A Pilot Randomized Controlled Trial

The purpose of this study was to develop and explore the feasibility of audio-based (ACBT) and computer-based (CCBT) cognitive behavioral therapies for older adults with depressive symptoms. The audio program consisted of 8 compact discs and a workbook while the computer program consisted of 11 modules of similar duration provided on a tablet PC. Both interventions consisted of the following topics: identifying and changing unhelpful thoughts, addressing feelings, relaxation, engaging in pleasant events, assertiveness, and problem-solving. Fifty-one older adults were recruited from medical settings and rural communities. Participants were randomly assigned to immediate treatment (ACBT or CCBT) or delayed treatment control condition. Analyses were conducted to examine change on interviewer-based and self-reported depression. A significant interaction effect between time and condition was found on the interviewer-based depression scale. This suggests that both types of treatments decreased depressive symptoms over time when compared to a delayed treatment control. Computer-based and audio-based cognitive behavioral treatments may be valuable low-cost modalities to deliver psychotherapy to older adults with depressive symptoms.

Prevention of Diabetes: Countless Opportunities and Clear Challenges.

Prevention of diabetes poses significant challenges; especially when applied as public health intervention. While several trials, most importantly Diabetes Prevention Program, show that intensive lifestyle modification leading to weight loss is the most important intervention, many individuals and some populations may show resistance to these interventions. Roadblocks to lifestyle intervention alone or in combination include: age, some ethnic groups (e.g., south Asians), genetic make-up, and some characteristics of body phenotype. Recent data show that non-alcoholic fatty liver disease along with insulin resistance may constitute 'metabolically unhealthy phenotype'. These subgroups would need more intensive interventions to convert prediabetes to normal glucose regulation. Whether 'fatty pancreas' and sarcopenia, latter more often seen in Asian Indians and with advancing age, are other phenotypes requiring intensive and different interventions (e.g., more resistance exercise in latter) remains to be researched. Further, variations in dietary quality (Mediterranean diet enriched with extra virgin olive oil, high-protein diets) without changing much of calories, provide attractive options for intervention. Many of such innovations require more research. Translation of lessons from diabetes prevention studies to general population is daunting but possible. However, such community-based interventions need substantial human and material resources, which pose hurdles in underserved populations and developing countries. In such situations, low-cost modalities, for example, use of trained community educators and digital and social media, constitute attractive approaches.

Staging Issues in Cervical Cancer

Background: Worldwide cervical cancer is third most common cancer, but diagnostic, therapeutic problems continue in developing countries where it is most common cancer in women. Very few women report at operable stage. For those subjected to surgery, intraoperative findings, histopathology provides information for continuing or abandoning surgery, adjuvant therapy after surgery and so on. However clinical investigative staging may not be correct, leading to avoidable morbidity of surgery. Objective: Study was done to know relationship between clinical, intraoperative, postoperative staging in women who underwent surgery for cervical cancer. Material methods: Analysis duration was divided into 4 yearly 7 blocks. During study period 266 women underwent abdominal radical hysterectomy, 15 were for endometrial cancer so, 251 (94.36% radical hysterectomies for cervical cancer, 13.05% of all cervical cancers cases (stage I A, I B1, II A1) were study subjects. Results: Cervical cancer cases increased over the years and also operable cases of cervical cancer from 13.33% to 30.00%. However of 251cases taken for surgery, 28% would not have been for surgery if were known to be of stage which was found intraoperative (preoperative under staging), over staging was only in 2%. Correlating clinical, histopathological staging 36% would not have been for surgery if correct staging (after histopathology) was known pre-operatively. Clinical intraoperative staging had 72% agreement. Histopathological staging which helps in planning treatment agreed with clinical staging in 64%. Problem of under staging continued over years. Conclusion: With present day techniques available to women with low resources, there is a lot of under staging of cervical cancer cases which leads to unnecessary surgery. Low cost modalities for better evaluation of cases preoperatively and will help in reducing morbidity, save resources also.

Bone Quality-Beyond Bone Mineral Density.

Both bone mass and quality are responsible for bone strength. Whereas bone mass is measured with bone mineral density, quantification of bone quality is more complex and involves bone architecture, texture, and mechanical parameters. Over the last decade, significant progress has been made in developing technologies to measure bone quality. These include novel low-cost modalities such as trabecular bone score measured on dual-energy X-ray absorptiometry images and quantitative ultrasound as well as more advanced imaging modalities such as multidetector computed tomography, magnetic resonance imaging, and high-resolution peripheral quantitative computed tomography. We describe the reasons to measure bone quality and present the different modalities currently used to quantify it. This article also summarizes the strengths and weaknesses as well as the clinical feasibility of these technologies.

Educational Exhibit Abstract No. 292 - Interventional radiology in the developing world: challenges and opportunities

Learning Objectives Learn the financial and intellectual challenges of bringing minimally invasive procedures to the developing world. Learn where to find funding and equipment for humanitarian use. Learn how experiences from the battlefield environment can be applied to remote, underserved areas. Learn how low cost modalities can be used to perform minimally invasive procedures. Background Though the evolution of minimally invasive interventional radiology procedures has allowed these therapies to minimize or obviate the need for morbid, open surgeries, there remain significant obstacles that must be overcome to safely and practically implement these procedures in the developing world. Careful consideration to resource allocation, personnel training, and procedural selection is crucial to maintain a safe and sustainable IR practice in the underserved world. Clinical Findings/Procedure Details This exhibit will introduce strategies for implementing an IR service in developing nations. Financial requirements may be mitigated by a careful needs based analysis and reliance on cost-effective modalities. Alternative and durable training schemes involving long term partnerships with foreign institutions and medical simulation training can be used to overcome the practical and ethical limitations of traditional training methods in the underdeveloped world. IR practice in the austere environment, including in combat, as well as effective mobile health care programs can be used as a framework to establish practices in impoverished nations. Creative implementation of the most basic and relatively inexpensive radiological equipment has made interventional procedures possible in the underserved world; commonly performed procedures in developed nations can be modified as a lower-cost technique with minimal changes in efficacy or safety. Conclusion and/or Teaching Points With the assistance of international humanitarian organizations, careful planning, and innovative techniques, local providers in impoverished nations can have access to the training and equipment necessary to offer life-saving, minimally invasive procedures to underdeveloped countries and make significant medical contributions to the global community.

Classification-based event detection in ecological monitoring networks

Power-budgeting is a fundamental challenge in sensor networks today and the energy requirement of different sensing modalities is unevenly distributed. As a result, it is advisable to activate power-hungry sensors only during informative periods. Using low-power sensors, one can predict these informative periods due to strong correlations exhibited by environmental modalities. In this article, we consider an application of detecting “events” using classification based methods to increase the lifetime of the network. Specifically, we explore the problem of using low-power sensors to predict precipitation, which is one of the primary drivers of ecological activity. Such predictions can allow us to schedule the activation of expensive sensors (such as CO2) when they are most informative. In order to achieve this trade-off between power and collecting informative data, we focus our efforts on predicting/ classifying precipitation based on features extracted from inexpensive ambient temperature and barometric pressure modalities. Experimental results obtained from weather data collected over multiple years demonstrates that we can achieve accuracy towards 80% using these low-cost modalities and simple linear classifiers.

Unilateral Gynecomastia Induced by Treatment With 1 mg of Oral Finasteride

To determine which treatment modalities for condylomata acuminata are associated with the lowest direct medical costs.Cost-effectiveness analysis.Ambulatory private practice, primary or specialty care.Adults with no presenting complaints other than condylomata acuminata.Construction of a cost-effectiveness model. From a literature review, extraction of commonly accepted guidelines regarding duration and frequency as well as reports of efficacies of typical treatment regimens; from Medicare physician fee schedules, costs of physician visits and physician-administered treatments; from published data, average wholesale prices of medications.Estimated direct medical costs per complete clearance associated with different treatment options for condylomata acuminata.Mean direct medical costs per complete clearance are lowest for surgical excision ($285). Other low-cost modalities are loop electrosurgical excision procedure ($316), electrodesiccation ($347), carbon dioxide laser ($416), podofilox ($424), and pulsed-dye laser ($479). Higher-cost modalities are cryotherapy ($951), trichloroacetic acid ($986), imiquimod ($1255), podophyllum resin ($1632), and interferon alfa-2b ($6665).Surgical modalities, including excision, electrodesiccation, loop electrosurgical excision procedure, and laser, as well as podofilox are low-cost options for the treatment of condylomata acuminata.