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Kumar, Ashok Ashwin

This paper describes an inexpensive, handheld device that couples the most common forms of electrochemical analysis directly to “the cloud” using any mobile phone, for use in resource-limited settings. The device is designed to operate with a wide range of electrode formats, performs on-board mixing of samples by vibration, and transmits data over voice using audio—an approach that guarantees broad compatibility with any available mobile phone (from low-end phones to smartphones) or cellular network (second, third, and fourth generation). The electrochemical methods that we demonstrate enable quantitative, broadly applicable, and inexpensive sensing with flexibility based on a wide variety of important electroanalytical techniques (chronoamperometry, cyclic voltammetry, differential pulse voltammetry, square wave voltammetry, and potentiometry), each with different uses. Four applications demonstrate the analytical performance of the device: these involve the detection of (i) glucose in the blood for personal health, (ii) trace heavy metals (lead, cadmium, and zinc) in water for in-field environmental monitoring, (iii) sodium in urine for clinical analysis, and (iv) a malarial antigen (Plasmodium falciparum histidine-rich protein 2) for clinical research. The combination of these electrochemical capabilities in an affordable, handheld format that is compatible with any mobile phone or network worldwide guarantees that sophisticated diagnostic testing can be performed by users with a broad spectrum of needs, resources, and levels of technical expertise.

This Communication demonstrates the generation of over 300 phase-separated systems—ranging from two to six phases—from mixtures of aqueous solutions of polymers and surfactants. These aqueous multiphase systems (MuPSs) form self-assembling, thermodynamically stable step-gradients in density using a common solvent, water. The steps in density between phases of a MuPS can be very small (Δρ ≈ 0.001 g/cm3), do not change over time, and can be tuned by the addition of co-solutes. We use two sets of similar objects, glass beads and pellets of different formulations of Nylon, to demonstrate the ability of MuPSs to separate mixtures of objects by differences in density. The stable interfaces between phases facilitate the convenient collection of species after separation. These results suggest that the stable, sharp step-gradients in density provided by MuPSs can enable new classes of fractionations and separations based on density.

This paper demonstrates the use of aqueous multiphase systems (MuPSs) as media for rate-zonal centrifugation to separate nanoparticles of different shapes and sizes. The properties of MuPSs do not change with time or during centrifugation; this stability facilitates sample collection after separation. A three-phase system demonstrates the separation of the reaction products (nanorods, nanospheres, and large particles) of a synthesis of gold nanorods, and enriches the nanorods from 48 to 99% in less than ten minutes using a benchtop centrifuge.

Although simple and low-cost interventions for sickle cell disease (SCD) exist in many developing countries, child mortality associated with SCD remains high, in part, because of the lack of access to diagnostic tests for SCD. A density-based test using aqueous multiphase systems (SCD-AMPS) is a candidate for a low-cost, point-of-care diagnostic for SCD. In this paper, the field evaluation of SCD-AMPS in a large (n = 505) case-control study in Zambia is described. Of the two variations of the SCD-AMPS used, the best system (SCD-AMPS-2) demonstrated a sensitivity of 86% (82–90%) and a specificity of 60% (53–67%). Subsequent analysis identified potential sources of false positives that include clotting, variation between batches of SCD-AMPS, and shipping conditions. Importantly, SCD-AMPS-2 was 84% (62–94%) sensitive in detecting SCD in children between 6 months and 1 year old. In addition to an evaluation of performance, an assessment of end-user operability was done with health workers in rural clinics in Zambia. These health workers rated the SCD-AMPS tests to be as simple to use as lateral flow tests for malaria and HIV.

Magnetische Levitation (MagLev) ist eine einfache Trennmethode für Kristallpolymorphe mit Dichteunterschieden (Δρ) von nur 0.001 g cm−3. Für vier organische Verbindungen wurden dichtebasierte Trennungen verschiedener kristalliner Formen gezeigt: 5-Methyl-2-[(2-nitrophenyl)amino]-3-thiophencarbonitril, Sulfathiazol, Carbamazepin und trans-Zimtsäure.

Cells often exist in heterogeneous mixtures. Density provides a property to separate several types of cells from the mixed sample in which they originate. Density-based separation methods provide a standard method to quickly separate or enrich specific populations of cells, such as lymphocytes from whole blood. This dissertation explores the use of aqueous multiphase systems (AMPS) as self-forming step-gradients in density for the separation of cells. AMPS were first discovered over a hundred years ago as aqueous two-phase systems. Density as a tool to separate cells is at least as old. Despite this long history, the work in this thesis is the first work to use AMPS to perform density-based separations on cells. This combination provides a powerful technique to separate cells and enable new testing at the point-of-care. Chapter 1 provides a short overview of aqueous multiphase systems and density-based separations of cells. Chapter 2 describes the process of taking technology, including AMPS, from a demonstration in a laboratory to a large scale evaluation in a field setting. In Chapter 3 and Appendix I, AMPS provide a means to enrich reticulocytes from whole blood as a means to grow malaria parasites. Chapter 4 and Appendix II describe the development and proof-of-prinicple of a density-based diagnostic test for sickle cell disease (SCD) using AMPS. Chapter 5 and Appendix III detail the results of a large scale field evaluation of a rapid test for SCD using AMPS in Zambia. Demonstrations of AMPS for density- and size-based separations are provided in Appendices IV and V. Appendix VI demonstrates the general usefulness of density to separate crystal polymorphs with another density-based separation method: magnetic levitation in a paramagnetic fluid. Beyond density, novel combinations of technology, such as electrochemistry and telecommunications provide opportunities for enabling global health (Appendix VII).

This paper presents methods that use Magnetic Levitation (MagLev) to measure very small differences in density of solid diamagnetic objects suspended in a paramagnetic medium. Previous work in this field has shown that, while it is a convenient method, standard MagLev cannot resolve differences in density < 0.0001 g/mm3 for macroscopic objects (> mm) because i) objects close in density prevent each other from reaching equilibrium height due to hard contact and excluded volume and ii) using weaker magnets or reducing the magnetic susceptibility of the medium destabilizes the magnetic trap. The present work investigates ways to increase the sensitivity of MagLev without destabilization by i) rotating the standard configuration relative to the gravitational field, and therefore, exploiting the weak magnetic gradients along alternative axes of measurement, and ii) tuning the sensitivity by manipulating the geometries of the magnets. These modifications enable an improvement in the resolution up to 1300 over the standard configuration, and measurements with resolution down to 10-6 g/cm3. Three examples of characterizing the small differences density among “identical” samples of materials—Nylon spheres, PMMA spheres, and drug spheres—demonstrate the applicability of high-sensitivity, rotated Maglev to measure the density of small (0.1 – 1 mm) objects with high sensitivity, for use in materials science, separations, and quality control of manufactured products.

This paper describes the design and fabrication of a “pop-up” electrochemical paper-based analytical device (pop-up-EPAD) to measure beta-hydroxybutyrate (BHB)—a key biomarker for diabetic ketoacidosis—using a commercial glucometer. Pop-up-EPADs are inspired by pop-up greeting cards and children's books. They are made from a single sheet of paper folded into a three-dimensional (3D) device that changes shape, and fluidic and electrical connectivity, by simply folding and unfolding the structure. The reconfigurable 3D structure makes it possible to change the fluidic path and to control timing; it also provides mechanical support for the folded and unfolded structures that enables good registration and repeatability on folding. A pop-up-EPAD designed to detect BHB shows performance comparable to commercially available plastic test strips over the clinically relevant range of BHB in blood when used with a commercial glucometer that integrates the ability to measure glucose and BHB (combination BHB/glucometer). With simple modifications of the electrode and fluid path design, the pop-up-EPAD also detects BHB using a simple glucometer—a device that is much more available than combination BHB/glucometers. Strategies that use a “3D pop-up”—that is, large-scale changes a 3D structure and fluidic paths—by folding/unfolding add functionality (e.g., controlled timing, fluidic handling and path programming, control over complex sequences of steps, and alterations in electrical connectivity) to EPADs, and should enable the development of new classes of paper-based diagnostic de-vices.

Iron deficiency anemia (IDA) is a nutritional disorder that impacts over one billion people worldwide, it causes permanent cognitive impairment in children, fatigue in adults, and suboptimal outcomes in pregnancy. IDA can be diagnosed by detection of red blood cells (RBCs) that are characteristically small (microcytic) and deficient in hemoglobin (hypochromic), typically by examining the results of a complete blood count performed by a hematology analyzer. These instruments are expensive, not portable, and require trained personnel; they are therefore, unavailable in many low-resource settings. This paper describes a low-cost and rapid method to diagnose IDA using aqueous multiphase systems (AMPS)—thermodynamically stable mixtures of biocompatible polymers and salt that spontaneously form discrete layers having sharp steps in density. AMPS are preloaded into a microhematocrit tube and used with a drop of blood from a fingerstick. After only two minutes in a low-cost centrifuge, the tests (n = 152) were read by eye with a sensitivity of 84% (72-93%) and a specificity of 78% (68-86%), corresponding to an area under the curve (AUC) of 0.89. The AMPS test outperforms diagnosis by hemoglobin alone (AUC = 0.73) and is comparable to methods used in clinics like reticulocyte hemoglobin concentration (AUC = 0.91). Standard machine learning tools were used to analyze images of the resulting tests captured by a standard desktop scanner to 1) slightly improve diagnosis of IDA—sensitivity of 90% (83-96%) and a specificity of 77% (64-87%), and 2) predict several important red blood cell parameters, such as mean corpuscular hemoglobin concentration. These results suggest that the use of AMPS combined with machine learning provides an approach to developing point-of-care hematology.

This paper demonstrates the enrichment of reticulocytes by centrifuging whole blood through aqueous multiphase systems (AMPSs)—immiscible phases of solutions of polymers that form step-gradients in density. The interfaces of an AMPS concentrate cells; this concentration facilitates the extraction of blood enriched for reticulocytes. AMPS enrich reticulocytes from blood from both healthy and hemochromatosis donors. Varying the osmolality and density of the phases of AMPS provides different levels of enrichment and yield of reticulocytes. A maximum enrichment of reticulocytemia of 64 ± 3% was obtained from donors with hemochromatosis. When used on peripheral blood from normal donors, AMPS can provide a higher yield of enriched reticulocytes and a higher proportion of reticulocytes expressing CD71 than differential centrifugation followed by centrifugation over Percoll. Blood enriched for reticulocytes by AMPS could be useful for research on malaria. Several species of malaria parasites show a preference to invade young erythrocytes and reticulocytes; this preference complicates in vitro cultivation of these species in human blood. Plasmodium knowlesi malaria parasites invade normal human blood enriched for reticulocytes by AMPSs at a rate 2.2 times greater (P < 0.01) than they invade unenriched blood. Parasite invasion in normal blood enriched by AMPS was 1.8 times greater (P < 0.05) than in blood enriched to a similar reticulocytemia by differential centrifugation followed by centrifugation over Percoll. The enrichment of reticulocytes that are invaded by malaria parasites demonstrates that AMPSs can provide a label-free method to enrich cells for biological research.