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Syncope is a common cause of emergency department visits and hospitalizations. Echocardiogram is frequently used as a diagnostic tool in the evaluation of syncope, performed in 39% to 91% of patients. The diagnostic yield of echocardiogram for detecting clinically important abnormalities in patients with a normal history, physical examination, and electrocardiogram (ECG), however, is extremely low. In contrast, echocardiograms performed on patients with syncope with a positive cardiac history, abnormal examination, and/or ECG identify an abnormality in up to 29% of cases, though these abnormalities are not always defi nitively the cause of symptoms. Recently updated clinical guidelines for syncope management from the American College of Cardiology now recommend echocardiogram only if initial history or examination suggests a cardiac etiology, or ECG is abnormal. Universal echocardiography in patients with syncope exposes a signifi cant number of patients to unnecessary testing and cost and does not represent evidence-based or high-value patient care.

A sensing platform for the in situ, real-time analysis of phosphate in natural waters has been realised using a combination of microfluidics, colorimetric reagent chemistries, low-cost LED-based optical detection and wireless communications. Prior to field deployment, the platform was tested over a period of 55 days in the laboratory during which a total of 2682 autonomous measurements were performed (854 each of sample, high standard and baseline, and 40 × 3 spiked solution measurements). The platform was subsequently field-deployed in a freshwater stream at Lough Rea, Co., Galway, Ireland, to track changes in phosphate over a five day period. During this deployment, 165 autonomous measurements (55 each of sample, high standard, and baseline) were performed and transmitted via general packet radio service (GPRS) to a web interface for remote access. Increases in phosphate levels at the sampling location coincident with rainfall events (min 1.45 µM to max 10.24 µM) were detected during the deployment. The response was found to be linear up to 50 µM PO43−, with a lower limit of detection (LOD) of 0.09 µM. Laboratory and field data suggest that despite the complexity of reagent-based analysers, they are reasonably reliable in remote operation, and offer the best opportunity to provide enhanced in situ chemical sensing capabilities. Modifications that could further improve the reliability and scalability of these platforms while simultaneously reducing the unit cost are discussed.

The fabrication of highly reliable and rugged fluidic chips designed for use in autonomous analyses for nutrient monitoring is described. The chips are based on a two-layer configuration with the fluidic channels produced in one layer using precision micromilling. The second capping layer contains through holes for sample/standard and reagent addition and waste removal post-analysis. Two optically clear polymethyl methacrylate (PMMA) windows are integrated into the opaque PMMA chip, orthogonal to a 22.5 mm-long section of the channel downstream from a serpentine reagent and sample/standard mixing region. An LED source is coupled into the channel through one of the windows, and the light intensity is monitored with a photodiode located at the distal end of the channel outside the second optically clear window. Efficient coupling of the source through the channel to the detector is achieved using custom-designed alignment units produced using 3D printing. In contrast to fluidic chips produced using solvent adhesion, the thermal-/pressure-bonded simplified method presented removes the need for surface treatment. Optimization of the thermal/pressure conditions leads to very strong adhesion between the PMMA layers, requiring forces in the region of 2000 N to separate them, which is necessary for the use in long-term deployments. Profilometry imaging shows minimal evidence of channel distortion after bonding. Finally, we show the potential of these techniques for environmental applications. The fluidic chips were integrated into prototype nutrient analyzers that display no evidence of leakage in extensive lab tests involving 2500 phosphate measurements using the yellow (vanadomolybdophosphoric acid) method. Similarly, excellent analytical performance (LOD is 0.09 μM) is reported for a 28-day field trial comprising 188 in situ autonomous phosphate measurements (564 measurements) in total including calibration.

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