An Update and Review of Measles for Emergency Physicians.

BACKGROUND: It is vital for frontline emergency physicians to immediately recognize the signs and symptoms of measles to initiate appropriate therapy and prevent spread to the health care team and other patients. OBJECTIVE: This review serves as a clinically practical updated reference for when the differential diagnosis includes measles. DISCUSSION: Measles is a highly contagious illness that classically presents with a rash, fever, cough, coryza, and conjunctivitis. Cases in the United States since 2000 have been attributed mainly to travelers who are infected abroad and then spread the illness to small, susceptible populations within the United States. Complications from measles are relatively common and can be associated with significant morbidity and mortality. Clinical suspicion should be confirmed with laboratory testing, which is most commonly a serum immunoglobulin M. The management of measles is mainly supportive. Patients that require more aggressive management include those who are pregnant, immunocompromised, or unvaccinated. Treatment may consist of the measles vaccine, intravenous immunoglobulin, vitamin A, and even ribavirin. Additionally, special precautions are required by hospital workers to help prevent the spread of the virus, which include N-95 masks and patient isolation in an airborne infection isolation room. CONCLUSION: Emergency physicians must be readily able to identify, contain patients with suspected measles, and determine who will need further medical management for this potentially life-threatening illness. As this public health crisis evolves, novel ways of screening for and reporting cases of measles is needed.

Distributed electrochemical sensors: recent advances and barriers to market adoption.

Despite predictions of their widespread application in healthcare and environmental monitoring, electrochemical sensors are yet to be distributed at scale, instead remaining largely confined to R&D labs. This contrasts sharply with the situation for physical sensors, which are now ubiquitous and seamlessly embedded in the mature ecosystem provided by electronics and connectivity protocols. Although chemical sensors could be integrated into the same ecosystem, there are fundamental issues with these sensors in the three key areas of analytical performance, usability, and affordability. Nevertheless, advances are being made in each of these fields, leading to hope that the deployment of automated and user-friendly low-cost electrochemical sensors is on the horizon. Here, we present a brief survey of key challenges and advances in the development of distributed electrochemical sensors for liquid samples, geared towards applications in healthcare and wellbeing, environmental monitoring, and homeland security. As will be seen, in many cases the analytical performance of the sensor is acceptable; it is usability that is the major barrier to commercial viability at this moment. Were this to be overcome, the issue of affordability could be addressed. Graphical Abstract ᅟ.

Recognition and Sensing of Creatinine.

Current methods for creatinine quantification suffer from significant drawbacks when aiming to combine accuracy, simplicity, and affordability. Here, an unprecedented synthetic receptor, an aryl-substituted calix[4]pyrrole with a monophosphonate bridge, is reported that displays remarkable affinity for creatinine and the creatininium cation. The receptor works by including the guest in its deep and polar aromatic cavity and establishing directional interactions in three dimensions. When incorporated into a suitable polymeric membrane, this molecule acts as an ionophore. A highly sensitive and selective potentiometric sensor suitable for the determination of creatinine levels in biological fluids, such as urine or plasma, in an accurate, fast, simple, and cost-effective way has thus been developed.

Electrochemical Pixels: Semi-open electrochemical cells with a vertically stacked design.

A novel electrochemical cell design in a vertically stacked configuration is presented. Through a layered structure using a top macroporous working electrode, a polyelectrolyte, and a bottom metallic conductor a standalone electrochemical cell with an internal reference electrode is built. This sensor allows monitoring an electrochemical property of an external solution with only one electrode in direct contact with the sample. Using paper-based platinum electrode for the porous top electrode and Nafion as polyelectrolyte material, the self-powered detection of hydrogen peroxide is performed. The system can be operated in multiple modes. In a capacitive way, the open circuit potential is measured. Alternatively, in a self-powered current mode, the system emulates a fuel cell. Additionally, a potential-current switched mode is also demonstrated. Because of this unique design and operational features this sensor is considered as an electrochemical pixel. To further demonstrate the advantages of this device, the detection of glucose is performed by building an array of sensors using a single back (reference) electrode and multiple working electrodes. These results lay the groundwork for the development of a new generation of simple and low cost biochemical sensors and electrochemical sensing arrays.

A potentiometric tattoo sensor for monitoring ammonium in sweat.

The development and analytical characterization of a novel ion-selective potentiometric cell in a temporary-transfer tattoo platform for monitoring ammonium levels in sweat is presented. The fabrication of this skin-worn sensor, which is based on a screen-printed design, incorporates all-solid-state potentiometric sensor technology for both the working and reference electrodes, in connection to ammonium-selective polymeric membrane based on the nonactin ionophore. The resulting tattooed potentiometric sensor exhibits a working range between 10(-4) M to 0.1 M, well within the physiological levels of ammonium in sweat. Testing under stringent mechanical stress expected on the epidermis shows that the analytical performance is not affected by factors such as stretching or bending. Since the levels of ammonium are related to the breakdown of proteins, the new wearable potentiometric tattoo sensor offers considerable promise for monitoring sport performance or detecting metabolic disorders in healthcare. Such combination of the epidermal integration, screen-printed technology and potentiometric sensing represents an attractive path towards non-invasive monitoring of a variety of electrolytes in human perspiration.

Potentiometric sensors using cotton yarns, carbon nanotubes and polymeric membranes.

A simple and generalized approach to build electrochemical sensors for wearable devices is presented. Commercial cotton yarns are first turned into electrical conductors through a simple dyeing process using a carbon nanotube ink. These conductive yarns are then partially coated with a suitable polymeric membrane to build ion-selective electrodes. Potentiometric measurements using these yarn-potentiometric sensors are demonstrated. Examples of yarns that can sense pH, K(+) and NH4(+) are presented. In all cases, these sensing yarns show limits of detection and linear ranges that are similar to those obtained with lab-made solid-state ion-selective electrodes. Through the immobilization of these sensors in a band-aid, it is shown that this approach could be easily implemented in a wearable device. Factors affecting the performance of the sensors and future potential applications are discussed.

A novel miniaturized radiofrequency potentiometer tag using ion-selective electrodes for wireless ion sensing.

Instrumental approaches to remotely and wirelessly monitoring chemical species are increasingly needed. Together with the electronic developments, efforts to optimize and validate the performance of these new devices are required. In this work, the analytical performance of a recently developed potentiometer-radiofrequency tag connected to ion-selective electrodes is evaluated. This credit card sized and extremely low power consumption device yield results that are comparable to those obtained with more sophisticated, lab-based tools. Advantages such as portability and autonomy, together with unique features, such as the ability to be read through the walls in a closed vessel are demonstrated. Future perspectives opened by this new generation of devices, such as their use in wearable devices and in decentralized settings are discussed.

Paper-based ion-selective potentiometric sensors.

A new approach to develop ultra low-cost, robust, rugged, and disposable potentiometric sensors is presented. A suspension of carbon nanotubes in a water-surfactant mixture (carbon nanotubes ink) is applied on conventional filter papers to turn them into conductive papers, which are then used as a substrate to build ion-selective electrodes. The electrodes are made by drop casting a membrane on a small circular area of the conductive paper. In this way, the carbon nanotubes act as both electric conductors and ion-to-electron transducers of the potentiometric signal. Electrodes for sensing K(+), NH(4)(+), and pH were built and tested using this approach, and the results were compared with classical solid-state ion selective electrodes using carbon nanotubes as transducers and glassy carbon as a substrate. In all cases, the analytical performance (sensitivity, linear ranges, limits of detection, selectivity, etc.) of these disposable paper electrodes was similar to that obtained for the more conventional type of ion-selective-electrodes. This opens new avenues for very low-cost platforms for generation of chemical information.

Potentiometric detection of creatinine in the presence of nicotine: Molecular recognition, sensing and quantification through multivariate regression.

Systematic errors in the calix [4] pyrrole-based potentiometric detection of creatinine have been observed in heavy smokers. This work further characterizes the interactions between the nicotinium cation and the cavitand as well as the resulting interference produced during the potentiometric detection. It is found that the nicotinium cation binds the electronic rich aromatic cavity defined by the pyrrole rings of the receptor's cone conformation with an estimated binding constant higher than 10-4 M-1 in methylene chloride. On the other hand, the creatininium cation is preferentially included in the hydrophobic aromatic cavity of the ionophore by establishing hydrogen bond interactions with the pyrrole NHs groups. Potentiometric calibrations confirmed the detection of the nicotinium cation at neutral and acidic pH, respectively. Due to the lower pka of creatinine, a methodology to quantify creatinine in presence of nicotine by using an array of three sensors at two pH values is proposed. A partial least squares regression was performed and reported recoveries of 103% with a standard deviation of 20%. The improved determination of creatinine was therefore discussed. This approach represents a step forward in the development of effective approaches to improve the measurement of creatinine in decentralized settings.

Modulating the mixed potential for developing biosensors: Direct potentiometric determination of glucose in whole, undiluted blood.

The growing demand for tools to generate chemical information in decentralized settings is creating a vast range of opportunities for potentiometric sensors, since their combination of robustness, simplicity of operation and cost can hardly be rivalled by any other technique. In previous works, we have shown that the mixed potential of a Pt electrode can be controlled with analytical purposes using a coating of Nafion, thus providing a way to develop a potentiometric biosensor for glucose. Unfortunately, the linear range of this device did not match the relevant clinical range for glucose in blood. This work presents a novel strategy to control the mixed potential that allows the development of a potentiometric biosensor for the direct detection of glucose in whole, undiluted blood without any sample pretreatment. By changing the ionomer, the analytical response can be tuned, shifting the linear range while keeping the sensitivity. Aquivion, a polyelectrolyte from the same family as Nafion, is used to stabilize the mixed potential of a platinized paper-based electrode, to entrap the enzyme and to reduce the interference from negatively charged species. Factors affecting the generation of the signal and the principle of detection are discussed. Optimization of the biosensor composition was achieved with particular focus on the characterization of the linear range and sensitivity. The accurate measurement of blood sugar levels in a single drop of whole blood with excellent recovery is presented.

Controlling the mixed potential of polyelectrolyte-coated platinum electrodes for the potentiometric detection of hydrogen peroxide.

The use of a Pt electrode coated with a layer of Nafion has been described in previous works as an attractive way to perform the potentiometric detection of hydrogen peroxide. Despite of the attractive features of this approach, the nature of the non-Nernstian response of this system was not properly addressed. In this work, using a mixed potential model, the open circuit potential of the Pt electrode is shown to be under kinetic control of the oxygen reduction reaction (ORR). It is proposed that hydrogen peroxide acts as an oxygenated species that blocks free sites on the Pt surface, interfering with the ORR. Therefore, the effect of the polyelectrolyte coating can be understood in terms of the modulation of the factors that affects the kinetics of the ORR, such as an increase of the H+ concentration, minimization of the effect of the spectator species, etc. Because of the complexity and the lack of models that accurately describe systems with practical applications, this work is not intended to provide a mechanistic but rather a phenomenological view on problem. A general framework to understand the factors that affect the potentiometric response is provided. Experimental evidence showing that the use of polyelectrolyte coatings are a powerful way to control the mixed potential open new ways for the development of robust and simple potentiometric sensors.

A Wearable Paper-Based Sweat Sensor for Human Perspiration Monitoring.

The fabrication and performance of a wearable paper-based chemiresistor for monitoring perspiration dynamics (sweat rate and sweat loss) are detailed. A novel approach is introduced to measure the amount of aqueous solution in the order of microliters delivered to the sensor by monitoring a linear change in resistance along a conducting paper. The wearable sensor is based on a single-walled carbon nanotubes and surfactant (sodium dodecylbenzenesulfonate) nanocomposite integrated within cellulose fibers of a conventional filter paper. The analytical performance and the sensing mechanism are presented. Monitoring sweat loss in the human body while exercising is demonstrated using the integration of a wireless reader and a user-friendly interface. By addressing the barriers of cost, simplicity, and the truly in situ demanding measurements, this unique wearable sensor is expected to serve in the future in many different applications involving the on-body detection of biofluids, such as a monitoring tool of dehydration levels for athletes as well as a tool for enhancing the sport performance by providing an accurate recovery of the hydration status in daily exercises.

Ionophore-Based Optical Sensor for Urine Creatinine Determination.

Creatinine is a metabolite present in urine, and its concentration is used to diagnose and monitor kidney performance. For that reason, the development of new sensors to analyze this metabolite and obtain accurate results in a short period of time is necessary. An optical disposable sensor for monitoring creatinine levels in urine is described. The system, based on a new aryl-substituted calix[4]pyrrole synthetic receptor, has an unusual coextraction scheme. Due to the low p Ka values of creatininium (p Ka 4.8), a careful selection of a lipophilic pH indicator that works in acid medium is required. The sensor components were optimized, and the new sensor displays a good response time to creatinine (approximately 3 min) over a wide dynamic range (from 1 × 10-5 to 1 × 10-2 M). Moreover, the optical selectivity coefficients obtained for creatinine over common cations present in urine meet the requirements for real sample measurements. With a good sensor-to-sensor reproducibility (RSD, 5.1-6.9% in the middle of the range), this method provides a simple, quick, cost-effective, and selective alternative to the conventional methodology based on Jaffé's reaction.

Atmospheric pressure chemical ionization source. 1. Ionization of compounds in the gas phase.

A novel chemical ionization source for organic mass spectrometry is introduced. This new source uses a glow discharge in the flowing afterglow mode for the generation of excited species and ions. The direct-current gas discharge is operated in helium at atmospheric pressure; typical operating voltages and currents are around 500 V and 25 mA, respectively. The species generated by this atmospheric pressure glow discharge are mixed with ambient air to generate reagent ions (mostly ionized water clusters and NO+), which are then used for the ionization of gaseous organic compounds. A wide variety of substances, both polar and nonpolar, can be ionized. The resulting mass spectra generally show the parent molecular ion (M+ or MH+) with little or no fragmentation. Proton transfer from ionized water clusters has been identified as the main ionization pathway. However, the presence of radical molecular ions (M+) for some compounds indicates that other ionization mechanisms are also involved. The analytical capabilities of this source were evaluated with a time-of-flight mass spectrometer, and preliminary characterization shows very good stability, linearity, and sensitivity. Limits of detection in the single to tens of femtomole range are reported for selected compounds.

Atmospheric pressure chemical ionization source. 2. Desorption-ionization for the direct analysis of solid compounds.

The flowing afterglow-atmospheric pressure glow discharge (APGD) ionization source described in part 1 of this study (in this issue) is applied to the direct analysis of condensed-phase samples. When either liquids or solids are exposed to the ionizing beam of the APGD, strong signals for the molecular ions of substances present on their surfaces can be detected without compromising the integrity of the solid sample structure or sample substrate. As was observed for gas-phase compounds in part 1 of this study, both polar and nonpolar substances can be ionized and detected by mass spectrometry. The parent molecular ion (or its protonated counterpart) is usually the main spectral feature, with little or no fragmentation in evidence. Preliminary quantitative results show that this approach offers very good sensitivity (detection limits in the picogram regime are reported for several test compounds in part 1 of this study) and linear response to the analyte concentration. Examples of the application of this strategy to the analysis of real-world samples, such as the direct analysis of pharmaceutical compounds or foods is provided. The ability of this source to perform spatially resolved analysis is also demonstrated. Preliminary studies of the mechanisms of the reactions involved are described.

A disposable, simple, fast and low-cost paper-based biosensor and its application to the determination of glucose in commercial orange juices.

A new biosensor for monitoring glucose levels in beverages is presented. The measurements are performed using potentiometric detection. Working electrodes are made using platinised paper as support and a biocompatible polymeric membrane made of a mixture of polyvinyl alcohol and chitosan containing glucose oxidase as the recognition layer. The system is based on the detection of the hydrogen peroxide generated by an enzymatic reaction performed in a highly sensitive, selective and simple way. The biosensors display suitable analytical performance (sensitivity -119.6 ±â€¯6.4 mV/dec in the 0.03-1.0 mM range with a limit of detection of 0.02 mM). Determination of glucose in commercial orange juices is presented. These results were validated against conventional standard methods, showing good accuracy and fast analytical response. The methodology presented herein does not require complex samples treatment, offering an alternative to conventional methods, particularly for determinations performed with minimal expertise and without a laboratory infrastructure.

Identification of a unique insertion in plant organellar DNA polymerases responsible for 5'-dRP lyase and strand-displacement activities: Implications for Base Excision Repair.

Plant mitochondrial and chloroplast genomes encode essential proteins for oxidative phosphorylation and photosynthesis. For proper cellular function, plant organelles must ensure genome integrity. Although plant organelles repair damaged DNA using the multi-enzyme Base Excision Repair (BER) pathway, the details of this pathway in plant organelles are largely unknown. The initial enzymatic steps in BER produce a 5'-deoxyribose phosphate (5'-dRP) moiety that must be removed to allow DNA ligation and in plant organelles, the enzymes responsible for the removal of a 5'-dRP group are unknown. In metazoans, DNA polymerases (DNAPs) remove the 5'-dRP moiety using their intrinsic lyase and/or strand-displacement activities during short or long-patch BER sub-pathways, respectively. The plant model Arabidopsis thaliana encodes two family-A DNAPs paralogs, AtPolIA and AtPolIB, which are the sole DNAPs in plant organelles identified to date. Herein we demonstrate that both AtPolIs present 5'-dRP lyase activities. AtPolIB performs efficient strand-displacement on a BER-associated 1-nt gap DNA substrate, whereas AtPolIA exhibits only moderate strand-displacement activity. Both lyase and strand-displacement activities are dependent on an amino acid insertion that is exclusively present in plant organellar DNAPs. Within this insertion, we identified that residue AtPollB-Lys593 acts as nucleophile for lyase activity. Our results demonstrate that AtPolIs are functionally equipped to play a role in short-patch BER and suggest a major role of AtPolIB in a predicted long-patch BER sub-pathway. We propose that the acquisition of insertion 1 in the polymerization domain of AtPolIs was a key component in their evolution as BER associated and replicative DNAPs.

Paper-based enzymatic electrode with enhanced potentiometric response for monitoring glucose in biological fluids.

A novel paper-based potentiometric sensor with an enhanced response for the detection of glucose in biological fluids is presented. The electrode consists on platinum sputtered on a filter paper and a Nafion membrane to immobilize the enzyme glucose oxidase. The response obtained is proportional to the logarithm of the concentration of glucose, with a sensitivity of -119±8mV·decade-1, a linear range that spans from 10-4M to 10-2.5 M and a limit of detection of 10-4.5 M of glucose. It is shown that Nafion increases the sensitivity of the technique while minimizing interferences. Validation with human serum samples shows an excellent agreement when compared to standard methods. This approach can become an interesting alternative for the development of simple and affordable devices for point of care and home-based diagnostics.

A novel wireless paper-based potentiometric platform for monitoring glucose in blood.

A novel low-cost, compact and sensitive paper-based platform for the accurate monitoring of glucose in biological fluids is presented. Paper-based working and reference electrodes are combined to build a whole potentiometric cell, which also fits a sampling module for simple and fast determination of glucose in a single drop of blood. The working electrode is built using a platinized filter paper coated with a Nafion membrane that entraps the enzyme glucose oxidase; the reference electrode is made by casting a polyvinylbutyral-based membrane onto a conductive paper. The system works by detecting the hydrogen peroxide generated as a result of the enzymatic reaction. Selectivity is achieved due to the permselective behaviour of Nafion, while a significant enhancement of the sensitivity is reached by exploiting the Donnan-coupled formal potential. Under optimum conditions, a sensitivity of -95.9 ± 4.8 mV per decade in the 0.3-3 mM range is obtained. Validation of the measurements has been performed against standard methods in human serum and blood. Final integration with a wireless reader allows for truly in situ measurements with a less than 2 minute procedure including a two-point calibration, washing and measurement. This low-cost analytical device opens up new prospects for rapid diagnostic results in non-laboratory settings.

Characterization of a new ionophore-based ion-selective electrode for the potentiometric determination of creatinine in urine.

The optimization, analytical characterization and validation of a novel ion-selective electrode for the highly sensitive and selective determination of creatinine in urine is presented. A newly synthesized calix[4]pyrrole-based molecule is used as an ionophore for the enhanced recognition of creatininium cations. The calculation of the complex formation constants in the polymeric membrane with creatininium, potassium and sodium confirms the strong selective interactions between the ionophore and the target. The optimization of the potentiometric sensor presented here yields an outstanding analytical performance, with a linear range that spans from 1µM to 10mM and limit of detection of 10-6.2M. The calculation of the selectivity coefficients against most commonly found interferences also show significant improvements when compared to other sensors already reported. The performance of this novel sensor is tested by measuring creatinine in real urine samples (N=50) and comparing the values against the standard colorimetric approach (Jaffé's reaction). The results show that this sensor allows the fast and accurate determination of creatinine in real samples with minimal sample manipulation.