37 research outputs found
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Application of phononic crystals as liquid sensors for the development of novel point of care technologies
Currently, a rapid development of point of care technologies can be observed, mainly due to the alternative they offer to traditional complex laboratory equipment, not only saving costs, but also improving patients convenience, delivering quick and reliable measurement results, increasing the confidence in clinical decisions and most importantly, improving patient care. Phononic crystals were recently introduced, and their unique capabilities to control the transmission of waves has paved the way for the development of many applications, including the development of acoustic sensors. Phononic crystal sensors offer a fundamentally different measurement principle to the development of point of care technologies by enabling the measurement of the acoustic properties of small liquid samples. So far, various phononic crystal sensors have been proposed to be used as liquid sensors. However, they are still in very early stages of development and suffer several drawbacks like high analyte consumption, complex manufacturing procedures, highly dependent on ambient variables and no portability, making it impossible to implement them in point of care devices. The main objective of this study is to evaluate the potential implementation of multi-layered phononic crystals as liquid sensors for biomedical applications, especially for developing point of care technologies. Theoretical and experimental studies were performed in order to evaluate the behaviour of the designed structures. For computing the frequency response of phononic crystals, the transmission line model and the finite element method were used. Different liquid analytes were utilised during the experimental realisations to corroborate the results obtained during the theoretical studies. Variations in the acoustic properties of small liquid samples, resulted in measurable changes in the transmission coefficient of the phononic crystal, specifically shifting the frequency of relevant transmission peaks located inside bandgaps, which provide boundary conditions for eliminating noise and enhancing their quality factor. The introduction of multiple defect modes showed to be a feasible alternative to generate differential measurements in phononic crystals and compensate the effect of temperature. Furthermore, the use of biorecognition agents was also utilised and discussed to enhance the detection capabilities of this new sensors
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Cavity Resonance Sensor with Disposable Analyte Container for Point of Care Testing
The use of phononic crystals and resonant structures as sensing platforms paves the way to the development of new biomedical technologies. An acoustic sensor with a resonant cavity and a disposable element was investigated in this paper. The sensor consists of seven layers with high acoustic impedance mismatch. The disposable element used was a glass spectrophotometry cuvette and, during the experimentation, it was filled with different liquid analytes showing characteristic transmission features that could be used as measures to differentiate and identify them. Experimental transmission curves were obtained using an electronic characterization system that uses a double sideband modulation technique to acquire valuable information about the structure being analyzed. Simulations using the 1-D transmission line method were performed to support the experimental realizations. The frequency of maximum transmission has been found to be strongly dependent on the speed of sound of the analyte under test
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Fully-disposable multilayered phononic crystal liquid sensor with symmetry reduction and a resonant cavity
Phononic crystals are artificial structures with unique capabilities to control the transmission of acoustic waves. These novel periodic composite structures bring new possibilities for developing a fundamentally new sensor principle that combines features of both ultrasonic and resonant sensors. This paper reports the design, fabrication and evaluation of a phononic crystal sensor for biomedical applications, especially for its implementation in point of care testing technologies. The key feature of the sensor system is a fully-disposable multi-layered phononic crystal liquid sensor element with symmetry reduction and a resonant cavity. The phononic crystal structure consists of eleven layers with high acoustic impedance mismatch. A defect mode was utilized in order to generate a well-defined transmission peak inside the bandgap that can be used as a measure. The design of the structures has been optimized with simulations using a transmission line model. Experimental realizations were performed to evaluate the frequency response of the designed sensor using different liquid analytes. The frequency of the characteristic transmission peaks showed to be dependent on the properties of the analytes used in the experiments. Multi-layered phononic crystal sensors can be used in applications, like point of care testing, where the on-line measurement of small liquid samples is required
Use of Transient Time Response as a Measure to Characterize Phononic Crystal Sensors
Phononic crystals are periodic composite structures with specific resonant features that are gaining popularity in the field as liquid sensors. The introduction of a structural defect in an otherwise periodic regular arrangement can generate a resonant mode, also called defect mode, inside the characteristic band gaps of phononic crystals. The morphology, as well as the frequency in which these defect modes appear, can give useful information on the composition and properties of an analyte. Currently, only gain and frequency measurements are performed using phononic crystal sensors. Other measurements like the transient response have been implemented in resonant sensors such as quartz microbalances showing great results and proving to be a great complimentary measure to the gain and frequency measurements. In the present paper, a study of the feasibility of using the transient response as a measure to acquire additional information about the analyte is presented. Theoretical studies using the transmission line model were realized to show the impact of variations in the concentration of an analyte, in this case, lithium carbonate solutions, in the transient time of the system. Experimental realizations were also performed showing that the proposed measurement scheme presents significant changes in the resulting data, indicating the potential use of this measure in phononic crystal sensors. This proposed measure could be implemented as a stand-alone measure or as a compliment to current sensing modalities
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Acoustic spectrometer: Resonant sensing platform for measuring volumetric properties of liquid samples
A sensing platform for measuring volumetric properties of liquid samples using phononic crystals is presented in this paper. The proposed sensor concept is based on the transmission of elastic and acoustic waves through solids and liquids respectively to gather relevant information about the properties of the liquid under test. A major difference between this concept and the majority of current resonant sensors, like the well-known quartz crystal microbalance, is that the acoustic spectrometer proposed measures bulk properties and not interfacial properties of the liquid. The sensing platform uses a disposable analyte container to facilitate the measurement of hazardous substances and enable its use in biomedical applications. An electronic characterization system based on the acquisition of three mixed signals was developed to obtain the frequency response of the designed sensor. Finally, experimental and theoretical realizations were performed, using different analytes and showing characteristic transmission features that can be used as measures to determine the physical value speed of sound
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Use of Transient Time Response as a Measure to Characterize Phononic Crystal Sensors
Phononic crystals are periodic composite structures with specific resonant features that are gaining strength in the field as liquid sensors. The introduction of a structural defect in an otherwise periodic regular arrangement can generate a resonant mode, also called defect mode, inside the characteristic band gaps of phononic crystals. The morphology, as well as the frequency in which these defect modes appear, can give useful information on the composition and properties of an analyte. Currently, only gain, and frequency measurements are performed using phononic crystal sensors. Other measurements like the transient response have been implemented in resonant sensors such as quartz microbalances showing great results and proving to be a great complimentary measure to the gain and frequency measurements. In the present paper, a study of the feasibility of using the transient response as a measure to acquire additional information about the analyte is presented. Theoretical studies using the transmission line model were realized to show the impact of variations in the concentration of an analyte, in this case, lithium carbonate solutions, in the transient time of the system. Experimental realizations were also performed showing that the proposed measurement scheme presents significant changes in the resulting data, indicating the potential use of this measure in phononic crystal sensors. This proposed measure could be implemented as a stand-alone measure or as a compliment to current sensing modalities
Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.
BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112
Global economic burden of unmet surgical need for appendicitis
Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US 73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was 75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially
Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy
Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe
Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2
The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality