SignificanceInsertable optical continuous glucose monitors (CGMs) with wearable readers are a strong option for monitoring individuals with diabetes. However, a fully insertable CGM requires a small form factor while still delivering sufficient signal to be read through tissue by an external device. Previous work has suggested that a multimodal repeating unit (barcode) approach may meet these requirements, but the biosensor geometry must be optimized to meet performance criteria.AimThis work details in silico trials conducted to evaluate the geometry of a fully insertable multimodal optical biosensor with respect to both optical output and species diffusion in vivo.ApproachMonte Carlo modeling is used to evaluate the luminescent output of three presupposed biosensor designs based on size constraints for an injectable and logical placement of the bar code compartments. Specifically, the sensitivity of the luminescent output to displacement of the biosensor in the X and Y directions, overall size of the selected design, and size of an individual repeating unit are analyzed. Further, an experimentally validated multiphysics model is used to evaluate the diffusion and reaction of glucose and oxygen within the biosensor to estimate the occurrence of chemical crosstalk between the assay components.ResultsA stacked cylinder multimodal biosensor 4.4 mm in length with repeating units 0.36 mm in length was found to yield a greater luminescent output than the current “barcode” biosensor design. In addition, it was found that a biosensor with enzymatic elements does not significantly deplete glucose locally and thus does not impact the diffusion profile of glucose in adjacent compartments containing nonenzymatic assays.ConclusionsComputational modeling was used to design the geometry of a multimodal, insertable, and optical CGM to ensure that the optical output and chemical diffusion profile are sufficient for this device to function in vivo.
Significance: Continuous glucose monitors (CGMs) are increasingly utilized as a way to provide healthcare to the over 10% of Americans that have diabetes. Fully insertable and optically transduced biosensors are poised to further improve CGMs by extending the device lifetime and reducing cost. However, optical modeling of light propagation in tissue is necessary to ascertain device performance.
Aim: Monte Carlo modeling of photon transport through tissue was used to assess the luminescent output of a fully insertable glucose biosensor that uses a multimodal Förster resonance energy transfer competitive binding assay and a phosphorescence lifetime decay enzymatic assay.
Approach: A Monte Carlo simulation framework of biosensor luminescence and tissue autofluorescence was built using MCmatlab. Simulations were first validated against previous research and then applied to predict the response of a biosensor in development.
Results: Our results suggest that a diode within the safety standards for light illumination on the skin, with far-red excitation, allows the luminescent biosensor to yield emission strong enough to be detectable by a common photodiode.
Conclusions: The computational model showed that the expected fluorescent power output of a near-infrared light actuated barcode was five orders of magnitude greater than a visible spectrum excited counterpart biosensor.
Significance: Obesity is a worldwide epidemic contributing directly to several cardiovascular risk factors including hypertension and type 2 diabetes. Wearable devices are becoming better at quantifying biomarkers relevant for the management of health and fitness. Unfortunately, both anecdotal evidence and recent studies indicate that some wearables have higher levels of error when utilized by populations with darker skin tones and high body mass index (BMI). There is an urgent need for a better evaluation of the limits of wearable health technologies when used by obese individuals.
Aims: (1) To review the current know-how on changes due to obesity in the skin epidermis, dermis, and subcutis that could affect the skin optical properties; (2) for the green wavelength range, to evaluate the difference in absorption and scattering coefficients from the abdominal skin between individuals with and without elevated BMI. The changes include alterations in layer thickness and cell size, as well as significant differences in chromophores and scatterer content, e.g., water, hemoglobin, collagen, and lipids.
Approach: We have summarized literature pertaining to changes in skin and its components in obesity and report the results of our search using articles published between years 1971 and 2020. A linear model was used to demonstrate the absorption and reduced scattering coefficient of the abdominal skin of individuals with and without elevated BMI in the green wavelength range (530 to 550 nm) that is typically found in most wearables.
Results: The general trends indicate a decrease in absorption for both dermis and subcutis and an increase in reduced scattering for both epidermis and dermis. At 544-nm wavelength, a typical wavelength used for photoplethysmography (PPG), the absorption coefficient’s relative percentage difference between high and low BMI skin, was 49% in the subcutis, 19% in the dermis, and negligible in the epidermis, whereas the reduced scattering coefficient relative difference was 21%, 29%, and 165% respectively.
Conclusions: These findings suggest that there could be significant errors in the output of optical devices used for monitoring health and fitness if changes due to obesity are not accounted for in their design.
Cardiovascular disease is the leading cause of death in the United States. Thus, much work is being done to develop monitoring technologies to lessen its morbidity and mortality. A common cardiovascular sensing modality is photoplethysmography (PPG), which relates local blood volume to changes in the intensity of light reaching a photodetector after traveling through tissue. Sufficient PPG signal quality from individuals with certain physiologies/anatomies can be difficult to obtain: one such example is the absorbing effect of melanin, causing poor PPG signal from individuals with a dark skin tone. Using optical phantoms, in vitro testing systems can enable device developers to quickly explore device performance under different conditions to help ensure strong performance. Here, we propose a phantom testing system for the in vitro evaluation of PPG. A pump system flows blood phantom through a 3-layer polydimethylsiloxane (PDMS) tissue phantom (mimicking epidermis, dermis, subcutis) of the volar wrist with an inset vessel representing the radial artery. The pump changes pressure to represent pressure throughout the cardiac cycle, and a PPG sensor (660nm) is placed on the tissue phantom. The effect of skin tone is analyzed by using epidermal phantoms with different optical properties representing Fitzpatrick Skin Tone I (3% volume fraction melanosome) and Fitzpatrick Skin Tone III (15% volume fraction melanosome). It was found that the PPG sensor was able to successfully and accurately register the synthetic PPG waveform, and the PPG AC/DC ratio decreased 17.7% when comparing the 3% volume fraction melanosome phantom to the 15% volume fraction melanosome phantom.
Remote and continuous blood glucose monitoring is a highly researched topic due to the prevalence of diabetes. In addition to being the 7th leading cause of death, diabetes features high comorbidity rates involving chronic diseases such as cardiovascular disease and kidney disease. This is in part due to poor monitoring of blood glucose levels, especially amongst the medically underserved who lack regular physician access. Optical signal transduction via a fully implantable biosensor is a promising way to provide necessary disease monitoring due to potential for low cost, longer lifetime and lack of transcutaneous components. Such a sensor would enable administration through a syringe and thus allow other healthcare workers to administer the biosensor- expanding access. However, light transport through turbid media such as skin features many absorptive and scattering events that lower assay efficacy. One such way to increase signal is the inclusion of multiple sensing modalities and rational design selection. Here, we present design selection for a multimodal and fully implantable glucose biosensor. First, three designs are postulated, then their fluorescence is simulated via Monte Carlo Modeling. The best performing design is then further improved upon by determining the number of needed repeating units as well as length. Overall, it was determined that a stacked cylinder design, 0.43cm in length with 0.036cm thick repeating units provides the best fluorescent signal. Future work should involve the experimental validation of this model, as well as the inclusion of the sensing modalities so that an exact response can be estimated.
Blood pressure is a primary candidate to be remotely characterized by continuous monitoring devices, as high blood pressure is frequently a symptom of chronic conditions such as diabetes, obesity, and cardiovascular disease while also leading to morbidity itself. Much work has been done to characterize an electrocardiogram (EKG)-photoplethysmogram (PPG) continuous monitor, however a dual PPG continuous monitor may yield more accurate results due to the lack of the inherent pre-ejection period. To predict the anticipated signal of a remote dual-photoplethysmogram (PPG) blood pressure monitor, we utilized parallelized multi-layer Monte Carlo modelling to estimate light transport through the index finger at the proximal phalange. Monte Carlo models of the digital artery and surrounding tissue were created that represent various skin tones as well as the presence of arterioles. Additionally, the signal contribution by arteriole and artery was also determined. By varying incident wavelength, source-detector separation, skin tone, and arterial diameter as a function of pulse propagation; the feasibility of a proximal phalange PPG can be estimated and further optimized to aid development of a dual-PPG blood pressure monitor. The modelling results indicate that at a separation of 3.0mm, 700nm wavelength provides signal resolution that is indicative of contribution from the artery and not the arterioles, which could be beneficial for estimating pulse transit time toward calculating blood pressure. Further work should be completed to optimize sourcedetector separation for arterial contribution to signal and explore various locations on the body, as much optical property variation exists within literature.
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