Smartphone electrocardiogram monitoring: current perspectives Andrew L Walker,1 Joseph B Muhlestein2 1University of Utah School of Medicine, Department of Internal Medicine, Salt Lake City, UT, USA; 2Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA Abstract: Three-fourths of Americans now own smartphones. Mobile health applications are becoming increasingly common for the management of various chronic diseases, and have the potential to improve health outcomes. One of these is the sector of smartphone electrocardiogram (ECG) technology. Previously, obtaining an ECG has involved a bulky machine requiring medical training to operate. Most of the smartphone ECG technologies involve a single-lead ECG obtained on a small device that communicates with a smartphone. Many companies offer smartphone ECG technology. The most prevalent and studied of these is the Kardia Mobile device by AliveCor®, which has a Food and Drug Administration-approved algorithm for detecting atrial fibrillation (AF). Here, we specifically review smartphone ECG technology including model specifications, cost, and ongoing clinical trials. We also review clinical uses of the technology including screening and monitoring of AF, QT monitoring during initiation of rhythm control medications, and the ability to accurately detect ST-elevation myocardial infarction. Keywords: smartphone, ECG, AliveCor, Kardia Mobile, Cardiac Designs, ECG Check, D-Heart, QardiaCore, EPI Mini, iHealth Rhythm, atrial fibrillation
Acute myocardial infarction (AMI) is one of the leading causes of death among the cardiovascular diseases. Of several biomarkers used for detection, increased levels of cardiac troponins have proved to be significant in diagnosing AMI. This has motivated researchers in the field to develop point-of-care biosensors for rapid detection of an episode of AMI. Over the years, various detection techniques have emerged for the estimation of cardiac troponins. This review focuses on summarizing various biosensing methods, including optical, electrochemical, and acoustic techniques, for the detection of cardiac troponins. Keywords: cardiac troponin, acute myocardial infarction, optical, electrochemical, SPR, SERS
Introduction: Mimicking physiological functions of nitric oxide (NO) has applications in regenerative medicine. However, few NO delivery systems have progressed to clinical trials owing to limitations in delivery. Materials and methods: A novel NO delivery system was explored by integrating S -nitro- N -acetylpenicillamine-functionalized long-chain aliphatic hydrocarbons (LCAHs) into a polyurethane-based polymer. Results and discussion: Contact angle analysis determined the novel delivery system to be significantly more hydrophobic than control. Chemilluminscence showed a four-phase NO release profile of the delivery system with more stable and prolong NO release than control. Conclusion: LCAHs can optimize the duration and rate of NO delivery and present a viable option for use in surgical implants and biomedical applications. Keywords: nitric oxide, biofunctionalization, materials, aliphatic hydrocarbons
Microfluidics technology: future prospects for molecular diagnostics Roger C Lo Department of Chemical Engineering, California State University, Long Beach, CA, USA Abstract: Molecular diagnostic tests have been widely used to detect and quantify biomarkers, such as nucleic acids and proteins, associated with specific health conditions or diseases to obtain the critical information for the health care providers and patients to make correct medical decisions. However, existing diagnostic instruments usually require costly reagents, long analysis time, established lab infrastructure, and trained professionals to operate, which limits their availability for large-scale screening applications in developed countries and primary care in developing countries. There is a strong demand for robust, cost-effective, and simple-to-operate instruments for molecular diagnostics. The features of microfluidics, such as short analysis time, reduction in fabrication costs, and low sample/reagent consumption, make it a natural fit for the development of new diagnostic instruments. Herein, selected work is highlighted to provide a snapshot of microfluidic devices developed for molecular diagnostics in the past 5 years, specifically focusing on their applications for the detection of agents clinically relevant to cancers, cardiac conditions, and infectious diseases, and an outlook on how microfluidics technology can be further advanced for applications in this area. Keywords: microfluidics, micro total analysis systems (µTAS), lab-on-a-chip, molecular diagnostics, point-of-care testing
The separation of antibodies from complex mixtures can be achieved using chromatographic or non-chromatographic techniques. The purification of antibodies using chromatography involves the separation of antibodies or antibody-derived molecules present in complex mixtures by passing them through a solid phase (eg, silica resin or beads, monolithic columns, or cellulose membranes) and allowing the antibodies to bind or pass through depending on whether "bind-and-elute" or "flow-through" chromatographic methods are employed. Chromatographic methodologies can incorporate different separation techniques, such as affinity-tag binding, ion-exchange, size-exclusion chromatography, or immunoaffinity chromatography. However, in a concerted effort to become less reliant on chromatography-based separations owing to the high cost of large-scale production, non-chromatographic-based techniques such as precipitation, flocculation, crystallization, filtration, and aqueous two-phase partitioning are now becoming more popular. This review details current chromatographic and non-chromatographic methodologies used for the purification of antibodies and expands on technological advancements and practical uses that have recently been reported. Keywords: antibody, chromatography-based purification, technology advancements, non-chromatographic purification, advances in purification technology, separation techniques Corrigendum for this paper has been published
Nanomaterial-based biosensors have become one of the major topics in the field of diagnostics. With the growing demand on devices with improved sensitivity and selectivity, rapid response time, and low cost, four categories of nanomaterials have become popular in biosensor research: gold nanoparticles, graphene, carbon nanotubes, and photonic crystals. The ongoing research has brought new designs of biosensors based on nanomaterials, which have greatly improved the potential of field-deployable microfabricated devices. This review describes the recent technologies employing the aforementioned nanomaterials for electrochemical detection of biomolecules, including glucose, DNA, protein, toxins, and so on. We envisage that miniaturized lab-on-a-chip devices employing these nanomaterials will soon be an essential part of our daily life. Keywords: biosensor, nanomaterial, gold nanoparticle, graphene, carbon nanotube, photonic crystal
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Availability of fast, noninvasive/minimally invasive, and accurate diagnostic tests can maximize the benefit of patient care. The application of Raman spectroscopy (RS) in biological and biomedical applications has surged recently as a result of technological advancements in instrumentation and spectral data handling techniques. With maturation, the potential of RS in clinical diagnosis of various diseases, in particular, early cancer, has been widely explored and reported. This paper provides an introduction to the Raman theory and technology behind RS for nonspecialists interested in its clinical uses. Latest achievements in oncological, cardiovascular, and neurological applications of RS along with its clinical implementations are discussed. Keywords: Biomedical optics, clinical diagnosis, early detection, cancer, cardiology, neurology
Electronic prescriptions: opportunities and challenges for the patient and pharmacist Ashley E Lanham,1 Gary L Cochran,2 Donald G Klepser,2 1National Association of Chain Drug Stores (NACDS) Foundation, Arlington, VA, USA; 2Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA Abstract: Electronic-prescribing (e-prescribing) is one part of the larger move to increased utilization of health information technologies (HITs). Along with other HITs such as electronic health records and health information exchanges, e-prescribing is seen as a tool for improving patient-centered care. The potential benefits of e-prescribing are meant to extend to prescribers, payers, pharmacies, and patients. In general, the benefits of e-prescribing fall into the following categories: patient safety, improved prescribing, efficiency/workflow, and cost savings. Most literature to date has focused on the benefits to prescribers. This review summarizes the existing literature around the impact of e-prescribing on pharmacists and patients. While there are studies supporting many of the proposed benefits to pharmacies, such as increased legibility of prescriptions and improved workflow, there have also been studies that demonstrate unintended challenges brought about by e-prescribing. Likewise, studies examining the patient's experience with e-prescribing make it clear that patients do not always see all of the benefits of e-prescribing, which happen away from their view. There are opportunities for additional research and development of new technologies to improve the e-prescribing experience for both pharmacists and patients. Keywords: e-prescribing, community pharmacy, medication error, workflow
In their everyday situations, individuals with autism spectrum disorder (ASD) encounter problems perceiving and understanding the facial expressions of others. If people with ASD have difficulties interpreting facial emotions, it is not surprising that they would struggle in their daily social interactions. An important question is whether facial emotion skills can be learned through systematic instruction and training. The accessibility, portability, and engagement of mobile devices (ie, smartphones, tablets) afford exciting new opportunities for creating innovative apps in emotional face training. In this article, we review the current crop of facial emotion apps for autism. We evaluate the apps according to the following criteria: face-processing skills, social attributes, and usability. We discuss the key ingredients of face- processing apps that will help a person on the autism spectrum make the transition from the small screen of the mobile device to the big world of real life.
Background: Embryo selection procedure is one of the critical success factors in in vitro fertilization treatment. Various embryo selection technologies have emerged within the past decade. These technologies are either used in combination with morphology or introduced to replace the conventional morphological evaluation. This review aims at investigating the effect of these novel embryo selection technologies on in vitro fertilization success rates. Methods: A systematic review of the literature was performed among full-text English articles in the PubMed database. Study selection was based on the predefined inclusion and exclusion criteria. Clinical effectiveness of the selected studies was measured in terms of implantation, pregnancy, live birth, and multiple pregnancy rates. Results: Five studies were identified that fitted the inclusion criteria. In these studies, researchers used aneuploidy screening, metabolomic profiling, and time-lapse imaging analysis as the new technologies. Among these studies, the one that conducted a randomized controlled trial of a commercial time-lapse imaging system demonstrated significant improvement in implantation rate. Conclusion: Studies using emerging technologies for embryo assessment provide promising results in retrospective analysis. On the other hand, randomized controlled trial studies that test the efficacy of novel embryo selection techniques in clinical practice failed to demonstrate a consistent improvement in the resulting success rates. This review provides a snapshot of the most recent literature on embryo assessment and embryo selection studies. Our findings show that there is a lack of comparative measurements and analyses that are able to assess benefits of the novel technologies in the field of embryo selection.
Lower cost alternatives are needed for the traditional in-person behavioral weight loss programs to overcome challenges of lowering the worldwide prevalence of overweight and obesity. Smartphones have become ubiquitous and provide a unique platform to aid in the delivery of a behavioral weight loss program. The technological capabilities of a smartphone may address certain limitations of a traditional weight loss program, while also reducing the cost and burden on participants, interventionists, and health care providers. Awareness of the advantages smartphones offer for weight loss has led to the rapid development and proliferation of weight loss applications (apps). The built-in features and the mechanisms by which they work vary across apps. Although there are an extraordinary number of a weight loss apps available, most lack the same magnitude of evidence-based behavior change strategies typically used in traditional programs. As features develop and new capabilities are identified, we propose a conceptual model as a framework to guide the inclusion of features that can facilitate behavior change and lead to reductions in weight. Whereas the conventional wisdom about behavior change asserts that more is better (with respect to the number of behavior change techniques involved), this model suggests that less may be more because extra techniques may add burden and adversely impact engagement. Current evidence is promising and continues to emerge on the potential of smartphone use within weight loss programs; yet research is unable to keep up with the rapidly improving smartphone technology. Future studies are needed to refine the conceptual model’s utility in the use of technology for weight loss, determine the effectiveness of intervention components utilizing smartphone technology, and identify novel and faster ways to evaluate the ever-changing technology.
Bioprinting technology has emerged as a powerful tool for building tissue and organ structures for drug discovery and regenerative medicine applications. In general, bioprinting uses a computer-controlled three-dimensional (3D) printing device to accurately deposit cells and biomaterials into precise geometries with the goal of creating anatomically correct biological structures. While traditional 3D printing uses metals, plastics, and polymers as printing materials or "ink", bioprinting deals with living cells and biological matrix. Hence, there are significant challenges to make a transition from traditional 3D printing to bioprinting, and ultimately achieve functional outcomes in bioprinted tissues. Therefore, it is critical that there is new technology development and in-depth basic research in bioprinted tissues, such as developing novel biomaterials specifically for use in bioprinting and biofabrication techniques, understanding the cell–matrix remodeling for the desired mechanical properties, and functional outcomes, establishing proper vascular perfusion, etc. Currently, there is active research going on bioprinting technology and its potential as a future source for tissue implants. This review paper overviews the current state of the art in bioprinting technology and focuses on the outcomes of the bioprinted tissues and their potential applications in drug discovery and regenerative medicine. Current challenges and limitations are highlighted, and future directions for next-generation bioprinting technology are also presented. Keywords: 3D bioprinting, vascularization, tissue regeneration, 3D tissue model, biofabrication, regenerative medicine
Hazardous drinking and alcohol use disorder (AUD) are substantial contributors to USA and global morbidity and mortality. Patient self-management and continuing care are needed to combat these public health threats. However, services are rarely provided to patients outside of clinic settings or following brief intervention. Smartphone applications ("apps") may help narrow the divide between traditional health care and patient needs. The purpose of this review is to identify and summarize smartphone apps to reduce alcohol consumption or treat AUD that have been evaluated for feasibility, acceptability, and/or efficacy. We searched two research databases for peer-reviewed journal articles published in English that evaluated smartphone apps to decrease alcohol consumption or treat AUD. We identified six apps. Two of these apps (A-CHESS and LBMI-A) promoted self-reported reductions in alcohol use, two (Promillekoll and PartyPlanner) failed to promote self-reported reductions in alcohol use, and two (HealthCall-S and Chimpshop) require further evaluation and testing before any conclusions regarding efficacy can be made. In summary, few evaluations of smartphone apps to reduce alcohol consumption or treat AUD have been reported in the scientific literature. Although advances in smartphone technology hold promise for disseminating interventions among hazardous drinkers and individuals with AUD, more systematic evaluations are necessary to ensure that smartphone apps are clinically useful.
The Spigelian hernia or Spiegel's hernia is rarely found, with less than 900 cases reported in medical literature. It was first described by J T Klinkosch in 1764 and was named by Adriaan van den Spieghel. The etiology of the hernia may be related to predisposing factors such as weakness of the abdominal wall by the insertion of vascular structures next to the semilunar or arcuate line of Douglas. However, some factors such as obesity, chronic bronchopneumopathies, and pregnancy may be associated with the etiology. Anatomically, most of these hernias occur between the lateral border of the rectus abdominis muscle and the lateral semilunar or Spigelian line that marks the transition of the transversus abdominis muscle to the aponeurosis. Spiegel's hernia can cause serious cases of organ incarceration because its diagnosis is often made at a late stage. Laparoscopic surgery is now an established method for itstreatment. We describe a surgical treatment unprecedented in the literature of Spiegel's hernia with a new procedure: the da Vinci Robotic System. This article also provides in detail the technical advantages and reliability of the robotics-assisted surgical approach on the patient. Robotics-assisted surgical repair for Spiegel's hernia has never been carried out or published previously. The authors show two cases of correction of Spiegel's hernia through surgical robotics, with the use of a mesh-type and double-sided peritoneum suture and the hernia ring suture. Advantages of the robotic approach in relation to laparoscopic technique are highlighted. A systematic review of relevant literature and the history of Spiegel's hernia are reported. The pain score was lower than that reported in pure laparoscopic surgery reports. This may be related to the increased stability of the trocar approach in robotics. It was technically easier to visualize the anterior wall and to suture this site through robotic surgery when compared to the laparoscopic approach. The robotic surgery has proven to be a procedure with significant advantages in terms of intraoperative techniques and postoperative clinical care. However, new cases should be evaluated with a larger follow-up for new conclusions. Keywords: hernia, robotic, reliability, outcome
Editorial for Advanced Health Care Technologies Utkan Demirci, ShuQi Wang, Fatih Inci Bio-Acoustic-MEMS in Medicine (BAMM) Laboratory, Stanford University School of Medicine, Radiology Department, Canary Center at Stanford for Cancer Early Detection, Palo Alto, CA, USAWithout doubt, science and technologies have tremendously changed the world, so have the health care technologies. In recent human history, we have witnessed that the state-of-the-art health care technologies such as medical imaging, molecular diagnostics, tissue engineering and regenerative medicine, single cell analysis, high throughput DNA sequencing, and rapid screening tests have restructured the medical practice of disease prevention, diagnosis, and treatment. Emerging technologies including bio/nanotechnologies, microfluidics, and single-cell imaging/analysis have created a niche to impact human health care systems, ranging from identifying etiologies, creating new therapeutics, and improving clinical outcomes in both developed and developing countries. We believe that advanced health care technologies hold the promise to prevent, treat, and cure devastating diseases including infectious diseases such as acquired immunodeficiency syndrome (AIDS), tuberculosis, and cancer, thus taking steps towards creating a disease-free world, eliminating poverty and enhancing life quality in the future.
