While Lydia is the person I know best at the Agency right now, it’s really obvious that we’ve got an amazing mix of skills and knowledge floating around among the team.
I was thinking about the recent business down in Buenos Aires, particularly the little girl with the broken wrists, and had an idea: chemosensitive cast wraps which change color when bone healing is complete.
Now, on our planet, in humans, there are localized chemical changes in the area of a bone break. In the short term, there is an increase in the density of cytokines – those are sort of chemical 911 sent out by the body to increase blood flow and speed delivery of nutrients and other chemicals to the area. To use an analogy, this is like knowing there is an emergency in that building over there because you see, first, lots of emergency vehicles, and later, busy people wearing uniforms.
More with the metaphor. Later, during most of bone healing, there are a smaller population of people with uniforms. They’re not even, reliably, the same uniforms all the time. The metaphorical ambulances have long, long since left. However, due to the steady influx of construction materials, and construction waste, the dumpster near the building stays pretty reliably full. Not always full of the same stuff, but fairly steady output. You can judge a lot about how things are going by the frequency and size of the dump trucks.
Now, in the non-metaphorical world, the chemistry of the skin over the break, at least on limbs, is subtly but detectably different than the skin over an intact area of bone.
Imagine a cast wrap which, when that chemical difference disappears, changes color, thus indicating it is safe to remove the cast.
It is unlikely this technology would fly in the U.S. – pediatric orthopaedic lawsuits would likely see to that. However, in much of the second and third world, imaging technology, even xray, is thin on the ground, and expensive. I believe it would be quite possible to sell UNICEF and the International Cross and Crescent on a material outlay for cast wraps which would directly decrease imaging costs and indirectly decrease the likelihood of lifelong crippling injuries due to poorly healed bones.
Any of you with special senses: would you willing to work with me assessing a population of patients with healed and not quite healed broken bones to a) narrow down one consistent chemical marker present in healing bone that resolves upon bone healing, and b) to help me create a chemical using only St. James materials that changes color in the presence of trace amounts of that chemical that I can use the treat the cast wraps?
Give me that chemical, and the rest is up to persuasion, stubbornness, and engineering.
Maria,
I would be pleased to meet you and work on this idea. You can contact me through Spec Ops. I think it is about time we sought to turn our skills and abilities to making life better at home.
Thank you, and I shall. I’ll be out of town for a few days, but will pick up on this as soon as I’m back and settled.
As for helping on the homefront, it seems like there should be opportunities, and ways to do it that don’t open up the Big Box of Secrets to the world. (:
Do you want to develop this yourself, or would Logrusing a prototype from a world with humans of more or less identical physiology work for you? Any thoughts on testing? Finance? Manufacturing? Distribution? Do you want to do this in your own name or through a proxy? Do you require a color change and only that or would odor change work as well? What if the cast gets wet?
1. Does it need to be locally developed? To answer this, I will need to pick the brains of my more experienced colleagues. Does anyone know of any history of importing items or technologies and having subtle things go wrong due to the “more or less” part of “more or less identical”? (I’m still learning all the powers, and I don’t know how good the Logrus, for example, is at getting *precisely* what you want. Or, if different Logruses are more or less so.)
1a. My thought is that, with a minimal subject pool and the right Power wielders on hand, analysis and differentiation of a unique chemical marker should be fairly straightforward. But what do I know? Power wielders, what’s your sense of this?
2. Oh, testing of the product will be mandatory, to ensure safety. And, to get it adopted by reputable world health agencies, whoever is putting it forward will need to be able to provide development protocols and data. (Which can be manufactured or creatively written. But the safety issue is still there.)
3. Finance and manufacturing. If creating the chemical proves straightforward, my thought is to release it to the academic, scientific, government, and business communities and let one or more of *them* take up the burden of financing and manufacturing this. I could even write a plausible business plan mockup to go with the information to make the economic sense of it stand out.
4. I think it should be relatively simple to hide the trail on this. This isn’t about being famous, it’s about helping people.
5. Visual change would be best, I think. It’s the sensory system most humans are most strongly attuned to.
6. Cast gets wet and other application issues will definitely need worked out. However, I’m hoping I can get one or more groups to have an intellectual, financial, or enlightened self-interest in this, and get *them* to do the labor.
(It is an interesting post and Stephanie can’t resist.
Tim, maybe Maria would get a note from Greg on this? And an offer of funding?
There is the arcane way to do this and there is the mundane way to do it. There is actually a lot of good supporting research real world.
I suggest looking at Serum CTX or BAP as your biomarker to start if you’d like a line of research that has some verisimilitude:
http://www.ncbi.nlm.nih.gov/pubmed/10652955
Serum CTX: a new marker of bone resorption that shows treatment effect more often than other markers because of low coefficient of variability and large changes with bisphosphonate therapy.
http://www.pagepress.org/journals/index.php/or/article/view/or.2009.e21/1481
Comparison in bone turnover markers during early healing
of femoral neck fracture and trochanteric fracture in elderly patients
Serum CrossLaps is the assay used to evaluate the markers:
http://www.lancet.co.za/index.php/pathology-centre/pathology-newsletters/chemical-pathology/serum-beta-crosslaps-beta-ctx/
http://www.sejinbio.co.kr/Insert/Serum%20CrossLaps%20ELISA%200805A.pdf
Sampling the antibodies will present a challenge in terms of the cast being used to collect and process bodily fluids. This will be the toughest point I think, and may need to revert to magic.
It may boil down to something like a standard allergy skin test, with the cast deliberately sampling at intervals through some kind of temporary abrasion. It is unclear whether the patient’s own tendency to scratch beneath the cast might provide a sufficient mechanism. There are still some serious mechanical issues about collecting and processing that sample though.
The present assay uses wet chemistry and assay strips. It may be that the inner lining of the cast could have that material present, or have it embedded. You might stand a chance if parts of the cast were a type of slow soluble plastic with the necessary reagents embedded. As the liquid oozed slowly through the micropores of the soluble plastic it would deposit on the inner lining of the cast, preparing it much as a technician would in a lab. Then if you could collect even a microscopic sample of blood serum through abrasion you might have all the players on the field.
You’d be working at much tinier quantities than a standard lab blood sample would offer for an assay. Microscopic quantities…
WHich is good because the problem currently with the organic LEDs below is they can’t find anything small enough to hook up to them. You might run the system (create the color changes) using the energy present from galvanic skin response at a stretch. At worst case, you might need to power your casts with a tiny watch battery. (Not elegant or enviro-friendly but hey, better than a honking great x ray machine)
For the other part of your problem there are a lot of ways to get things to change colors, but there is a fellow in Korea looking at organic LEDs at the moment. The idea is for use making higher res computer/tv screens but the relevant issue is that it changes color and can be made to work with changes of electrical current or by photon excitation. It comes as a sort of thin composited film.
http://pubs.acs.org/doi/abs/10.1021/ja404256s?journalCode=jacsat
Realizing Molecular Pixel System for Full-Color Fluorescence Reproduction: RGB-Emitting Molecular Mixture Free from Energy Transfer Crosstalk
http://www.clinchem.org/content/48/12/2263.long
Different Kinetics of Bone Markers in Normal and Delayed Fracture Healing of Long Bones
http://www.bjj.boneandjoint.org.uk/content/92-B/3/329.abstract
Bone-turnover markers in fracture healing
There is tech that will read CTX levels currently but its bulky. If you could find a compact way to read CTX (or whatever biomarker you end up settling on) you could use the film as the “output device”. Many lab tests measure presence of a substance due to light absorption so this might not be such a hard thing to arrange.
As for your data on bone healing rates and amount of marker present, this paper’s a good place to start but there is a lot of existing data in oral surgery journals and in the cancer research field. You may not need to establish a lot of raw data there from scratch, more just confirmation tests of whatever apparatus you devise.
(Tim, Ani had a lot of micro miniaturization and robotics data, some of that could be sent to Maria in case it came in useful.)
Alternately, you could use magic and tie the spell decay rate to the film’s color change. You’d get a color changing cast cover and could market it as proprietary process. It would be enough to look like it was conventional tech somehow but its functioning heart would simply baffle anyone reverse engineering it. A healing mage and mech tech type could whip that up I’d imagine in short order.
You might check Imperial medical supplies…its possible that someone was ahead of you there and its just a matter of packaging it for on world use.
Sorry I geeked on this a bit. It just got me thinking.
Cheers and good luck,
Stephanie
PS> You may want a multi-state indicator. Rather than just binary healed/not healed, keep on/remove; you may want an indicator for the commencement of graduated weight bearing activity in order to increase the formation of callous and the progression towards lamellar bone. One of the public health challenges of non-supervised convalescence would be the lack of advice at the appropriate point to perform the exercises necessary to accelerate healing and address functional issues. Having an indicator of when to assume activity would be good. And if you use the organic LEDs the cast itself might offer pictogram displays suggesting activities for the patient to perform.
It would be bonus if you could incorporate a lightweight ultrasound emitter and a control circuit. But the power and control functions for that would get clumsy/bulky/heavy I’d think…you’d really want to go arcane for that…in which case you go straight to healing spells and cheat. It probably isn’t a good trade for the acceleration factor in healing for this purpose. Simple and durable would be best under the conditions you plan to use it.
Just saw a news story on a temp tattoo being used to tell runners when they are about to hit the ‘wall’ (based on chemicals in their sweat) so even in non medical real life their thinking about similar ideas.
I’ve seen that too.
And sweat would be easier for her to work with but I thought of serum first because I happened to have seen that in my wanderings a while back. And again sports medicine leads the way with the affect of exercise on bone density studies. Space exploration looks at this issue too. Good point.
Sweat contains many of the things blood and urine do.
http://lsda.jsc.nasa.gov/scripts/experiment/exper.aspx?exp_index=1581
Monitoring of Bone Loss Bio-Markers in Human Sweat: A Non-Invasive, Time Efficient Means of Monitoring Bone Resorption Markers under Micro and Partial Gravity Loading Conditions (NNX08AQ37G)
You’ll like that one I think for your purposes.
http://www.google.com/patents/US5661039
Perspiration assay for bone resorption
Is a patent for a test for it, but it uses wet chemistry and column fractioning as part of the process…which is really cumbersome and definitely confined to a lab environment.
The serum assay process was a bit less far fetched in terms of re working it in a non lab environment even if the sample collection method was a problem.
They use sweat tests for drug testing these days, quite a difference from my day:
http://www.alcopro.com/library/Sweat%20Patch%20Training%20Manual%20Attachments%20Rev%20March%202003.pdf
So a cool collection mechanism exists that might be altered to suit, but still the patch media is removed and sent to a lab for testing.
But it does suggest a few more biomarkers to follow up on and some mechanisms for collection.
In any case, I think Maria could make a decent argument for an invention based on some of this…and unlike the real world, in game we really can use the black box in the flow chart “and then a miracle (magic) occurs”. 🙂
An afterthought…
The cast would be a great slow delivery system for a bunch of chemicals that might aid bone growth, healing and overall health. It has a lot of internal surface area so it could function much like a nicotine or birth control patch.
If you are planning this for use in the developing world, nutrition is probably poor as well. SO you could slowly deliver nutrients, vitamins and calcium, and various other aids to increase recovery success.
That would be very low tech I think and well within current tech to achieve.
Just a thought.
UPDATE: I was on Amazon buying a dvd and for giggles typed in vitamin patch for search. As it turns out these things have been out and available for over a year.
Vitagasm (Because why do fiction when reality is so funny!) http://www.youtube.com/watch?v=4kknC5CNFhs
B-12 http://www.amazon.com/Vita-Sciences-Vitamin-B-12-Patch/dp/B0016MLRUS
D http://www.amazon.com/Vitamin-D3-Topical-Patch-Supply/dp/B0083XMUUE/ref=sr_1_2?s=hpc&ie=UTF8&qid=1376344896&sr=1-2&keywords=vitamin+patch
Calcium http://www.amazon.com/Vitamin-Calcium-Topical-Patch-Strengthening/dp/B0083XUFHY/ref=sr_1_12?s=hpc&ie=UTF8&qid=1376344896&sr=1-12&keywords=vitamin+patch
These are only 24 hour wear kinds of things, but again with the soluble plastic idea you could conceivably “leak” the nutrients into the skin from the cast over a much longer time frame.
Pretty funny I had no idea these things were already around.
Portable Imaging backup plan…
Until you get this sorted I thought I’d mention this. Its for vet use but no doubt it would work. It provides digital imaging, is portable, lightweight and made for field conditions. You don’t need a lab for processing and the power requirements aren’t huge, it would definitely run off the same portable generators or solar set ups generally in place in field hospitals and UN camps.
There are no doubt human equivalents and the military I’m sure has bought similar items (http://www.minxray.com/medical.html), no doubt at a higher cost because its for humans. For those in the know, buying vet grade supplies is not exactly a new idea for cost savings (particularly for antibiotics) and is generally considered far better than the no treatment option. The standards are generally the same for imaging as humans will be handling the equipment and the lawsuits if you damage a thoroughbred are not really something a company wants to deal with.
Most medical personnel used to practicing in modern western hospitals may not be aware of the alternative options.
http://www.soundeklin.com/products/digital-x-ray/equine/mark-1109
MARK 1109
VETERINARY DIGITAL X RAY EQUIPMENT
eFilm software for viewing images from all DICOM modalities including DR, CR, digital ultrasound, MRI, CT and nuclear scintigraphy
AccuStitch™ DICOM image stitching software for assembly of single image from multiple DR DICOM images of large body parts (e.g., equine necks)
High strength molded polyethylene external case
Water and dust resistant construction
All external connections on the same side of the case
Built-in carrying handles
The whole system together weighs 53 lbs and is 18 x 20 x 16.
Its definitely small enough to include in an equipment load out for an excursion.
Another choice:
http://www.vetxray.com/dyncat.cfm?catid=2410
Even smaller and costs about $8300.
It sounded like you had a specific, real time, requirement in the present. This would probably see you through until you come up with something spiffy.
Ok last post, I think I’ve nearly got it out of my system because I’ve been trying to puzzle out the identification of an endpoint for healing (or at least, de-casting). The other measures indicate bone growth/remodeling, but that is more or less continuously taking place all our lives even without an injury present.
For fracture union, they’ve had good luck with ALP as the marker. The other markers may be useful to track too or not, it may be that you will want a sort of “cocktail” of markers to track for various points in the process, or to identify issues which may indicate delayed healing or a failure to heal properly.
It is found in sweat like its other cousins.
http://www.isca.in/IJBS/Archive/v2i2/8.ISCA-IRJBS-2012-217.pdf
Evaluation of Serum Alkaline Phosphatase as a Biomarker of Healing
Process Progression of Simple Diaphyseal Fractures
in Adult Patients
It gives some good tracking of the biomarker concentration with radiological verification of fracture healing progress. This is a full article freely available so it may be more convenient. Interestingly, the article suggests this may be MORE accurate than radiological verification which may have as low as a 50% accuracy rate in assessing tibial fractures. (which is a bit surprising really)
*grin* I love collaboration. (And so does Maria.) OOC, I’m starting a new job this week, so if I’m a little quiet, we’ll blame it on Maria’s spotty email access while she’s out of town. (:
No problem, I think its left to you at this point. This just gets you past the literature review more or less and eliminates the information that’s already out there and accessible even to a layman.
A point about something earlier, there are waterproof casts now. Generally they aren’t used because most insurance companies won’t pay for the upgrade. Also, my understanding is that they generally aren’t applied until after the first two weeks (inflammatory stage of healing) when you come back and swap plaster for the plastic version.
Also, in low hygiene areas or jungle areas, you may need to treat a surface infection inside the cast due to insect/animal infestation, mold, invasive plant life (don’t ask how I know about that one), self injury or some other issue.
Having been casted twice in my life my suggestion is that you use a waterproof polymer splint that is removable rather than an actual cast. If you have a problem and need to uncast because of swelling or some other problem you might be too remote or the visiting medical team may not be due in yet, so you might need to do it yourself if a problem crops up. It may be less secure but the problem of self removal with non optimal tools is an issue in our culture, it would just get worse in more primitive conditions.
Even here (rural Maine) doctors give serious consideration to patient self help because it can be such a long way to treatment centers and in bad weather transport may be impossible or very delayed. So we think about medical care differently. This is true in many rural areas here in the US.
Within the US, your device has application for charity care. Most Americans aren’t aware of the depth of the issue in some regions. You could look at:
Remote Area Medical
http://www.ramusa.org/projects/ruralamerica.htm
They are known for working in the poorest areas of the Appalachians.
For the funding, distribution and tedious logistics you have a lot of choices. There are a bunch of NGOs (Non Government Organizations) that would take this on. You could apply through the Gates Foundation, they do a lot of work in sustainable medical change in third world countries. TED is another choice. In game, I left behind a foundation that did charity work on St James. If you talked to Jenny in character (the trump artist) she could put you in touch with Greg, who dealt with all of Gudrun’s (and Ani’s) charitable outreach both on world and off world. He helped with her solar water well project and for her solar light/fetal heart monitor suitcase. (Lack of light is a major contributor to loss of life in low medical service areas. A simple thing that can save a newborn’s life. This in game was modeled on a real world project started by others that you can actually contribute to for anyone feeling charitably inclined. We Care Solar wecaresolar.org
http://www.cnn.com/2013/02/28/health/cnnheroes-stachel-solar-power)
https://www.doctorswithoutborders.org/donate/?
Good luck.
A Caution about persistent or obvious signs of medical care under some political conditions…
I realized I left out a crucial consideration, perhaps this is already known to you, but if not it bears stating.
In some places it may be more than a patient, and their family’s, lives are worth to be seen as having received medical treatment from a foreign source, NGO, or even from a local AID agency. Its particularly a bad idea to be obviously American if providing services in many places.
http://www.europarl.europa.eu/sides/getDoc.do?type=MOTION&reference=B7-2013-0076&language=MT
European Parliament resolution on the recent attacks on medical aid workers in Pakistan
http://www.swissinfo.ch/eng/politics/Rise_in_attacks_is_double_blow_in_crisis_zones.html?cid=32626412
There have been instances over the last 50 years at least of patients and their families facing retaliation and being executed by local factions, warlords, militias, etc. for receiving medical treatment. This is a concern for local aid providers and even for the US military in offering humanitarian services to local populations.
(The US military does frequently offer charity care to local populations adjacent to where they are stationed and medics with patrolling units are usually as helpful as possible to local citizens where time and resources allow. This sometimes backfires in generating a conflict with local attitudes. Recently this has included decisions to withhold certain kinds of care for fear it will prove to be a burden to the patient or get them labeled as a collaborator.
Interestingly, this problem does not appear to apply to the use of Viagra as medium of bribe/currency/gift to local leaders and influential men. Accepting this as a “gift” is winked at.
Unfortunately, much as the US does provide humanitarian assistance, often our foreign policy has made the work of aid workers more dangerous as it is often tied to foreign policy initiatives. Strangely, people seem to resent the ‘gift’ that comes with strings attached. Also, the recent hunt for Bin Laden used a vaccination program as a ruse for information gathering…this was not very wise and has come at a great cost to those attempting to provide assistance legitimately. Aid workers are often accused of being foreign operatives, and this paranoia has not been entirely without foundation over the years.)
Practicing medicine in those conditions may take a different emphasis, focusing on what treatments can be given “in stealth” and avoiding treatments likely to leave visible signs. Doctors have gone to considerable trouble to camouflage a professional treatment intervention with the outward signs of inexpert local care. Immunizations that don’t leave obvious scars/marks are preferred (smallpox vaccinations leave a characteristic mark, although that vaccine is under review currently for other reasons as well).
Practitioners may also need to plan around practice protocols that would be in place otherwise, specifically follow up care. You never know when an aid organization is going to be forced to withdraw from a region due to violence, revocation of government permission to operate, or the insistence of their home governments/organizations. Anything that has to be looked at more than once should always include patient instructions for what to do if medical help is no longer present.
Medical materials and food aid used or left for use in place also need to be considered in terms of their value to local militias, governments/militaries, or thieves. Diversion is common. Outright theft is the norm. It is not at all unknown for a militia to wait until aid workers have visited and then hit a village for any supplies/materials left behind in some areas. It is also not unknown for patients to sell medication given them, or have it taken from them by senior family members for sale in order to buy food, protection, or other necessary items. Some organizations factor this in as a predicted loss factor. In other cases AID organizations withdraw when the predation becomes so intense that its clear that they are unable to be effective. Its no use getting outraged about it, its just a fact of life in that environment and whatever you are devising should be considered accordingly. A few water well projects have found frustration when a militia has moved in after a successful completion of the project, evicted the inhabitants, and simply taken over the newly attractive piece of real estate. Sometimes the presence of UN peacekeepers help, but they aren’t always authorized. It can be heartbreaking for AID personnel to find that the help they have given has resulted in a worse situation for the people they had hoped to assist.
Being able to hide a cast if a warlord and his gang roll into your village may be an important feature in your design. If you end up using magic, I’d suggest putting in an illusion spell that makes the viewer with negative intentions think its just a cobbled together dirty splint. If you use tech/conventional medical designs, giving the patient a chance to ditch that cast in an emergency is important. Their limb may heal crooked, but they and their family may be more likely to come out of it alive.
From the ‘Trouble in Paradise’ department…
Normal values for serum (blood) concentrations of ALP: The normal value is 20 to 140 IU/L in adults as the specs for that assay. The spike value at healing trended at 500-680u/L in the paper above.
There isn’t good validating research to establish the correlation between levels of bone ALP present in sweat and serum. This could be a serious difficulty in making sweat sampling relevant to your project. Definitely an area of more work needed.
Potential Confounds:
ALP can be strongly influenced by a wide range of pharmaceuticals including: anti-inflammatory, narcotic pain meds, sedatives, antibiotics and common birth control pills.
Adults have much lower ALP values than children…as children are still growing. Good data for kids could be hard to come by and a “growth spurt” sends ALP values all over the charts, making the notion of a normal value for ALP (or most of these markers) for kids and adolescents a real issue and a potential ‘false positive’ for healing.
Some results using other markers discussed:
Sex- and Age-Specific Reference Curves for Serum Markers of Bone Turnover in Healthy Children from 2 Months to 18 Years
http://jcem.endojournals.org/content/92/2/443.full
They had problems even after screening for healthy kids in terms of getting anything approaching a normative curve and had to use some serious statistical gymnastics.
Another peds study which is cool because it looked at vegetarian kids (where the concern for decreased levels of nutrients derived from animal proteins may in some way mimic kids with dietary deficiencies in developing nations…save for the fact that the overall caloric content and dietary variety of the studied kids is far greater):
Serum concentration of biochemical bone markers in vegetarian children
http://www.advms.pl/?q=system/files/49_52Ambroszkiewicz.pdf
Size, complexity and location of fracture.
Complicating medical conditions such as: malnutrition, infections, abnormal liver function and digestive disorders.
Sweat gland function.
Contamination of sample from skin collection.
In your intended population you may have your work cut out for you and you’d need to rule out a bunch of medical conditions before you could be sure you were getting a clear read on bone junction. The research above was done with otherwise healthy subjects. Your population is probably not going to be in that category.
But research isn’t supposed to be easy, or everyone would do it. Its a worthwhile effort to work through the challenges and obstacles.
Alkaline Phosphatase Assay Kit (Look its Yellow!)
http://www.abcam.com/Alkaline-Phosphatase-Assay-Kit-Colorimetric-ab83369.html
The kit uses p-nitrophenyl phosphate (pNPP) as a phosphatase substrate which turns yellow (?max= 405 nm) when dephosphorylated by ALP.
Ok, here’s a piece of your puzzle. This stuff turns color (Yellow!) when in contact with ALP. Lots of tablet strips for a modest price…you may be able to repurpose this. It should be noted that sample prep is expected using this indicator, that will need to be gotten round. You still have the mechanical sampling issue though and making the scale relevant to sweat versus serum…and the issue of making it work for kids. And avoiding contamination.
(they also include a cool bit of reading that would give you a sense of what a third world peds sample might look like: Lahiry G et al. Assessment of impact on health of children working in the garbage dumping site in Dhaka, Bangladesh. J Trop Pediatr 57:472-5 (2011). http://www.ncbi.nlm.nih.gov/pubmed/21266452?dopt=Abstract This is for liver enzymes.)
The how to:
http://www.abcam.com/ps/products/83/ab83369/documents/ab83369%20Alkaline%20Phosphatase%20Assay%20Kit%20Colorimetric%20Protocol%20v2%20%28website%29.pdf
Earlier I talked about using light sensing materials in the cast to mimic lab equipment. If you read through the protocol, there are still wet sample prep issues to work through and temperature control concerns with their process; however they are using a microplate reader as their test instrument. Wiki gives a good explanation of how these work: http://en.wikipedia.org/wiki/Plate_reader. This equipment is not huge, is common to a LOT of medical lab tests, and runs about the same cost as a small field xray machine. You could operate it under field conditions, but the limiting factor would be a clean area to do the work and the presence of adequate sample refrigeration. The latter may not be as huge an issue as it seems considering field hospitals often have to provide cold storage for vaccines prior to use, a lot of good technology exists for field refrigeration under extremely specific tolerances for temperature storage, its standard kit.
Essentially, the process measures the wavelength of light generated by the sample: 405nm.
This is where the guy from Korea and his mollecular organic led technology comes in. If instead of the microplate reader, another device could be used as to interpret optical data and produce an output, you might be able to dispense with that part of the process.
There is another process that relies on less wet sample prep:
http://www.abnova.com/protocol_pdf/KA1642.pdf
But still uses the reader. It does let you work with the samples at room temperature, which is bonus. The cell method uses PBS and lysed wash (it breaks down the cell membrane, essentially its a type of detergent).
If you look at your in game goals in several steps, you could conceivably achieve a great deal of good in increments.
First, you could work on getting more compact diagnostic equipment into the field, both xray and lab equipment. Initial assessment of fractures and other conditions will benefit from this as its preferred to see that an initial fracture reduction (straightening of the broken bone) has a achieved a good alignment. You’ll also probably always need it for peds follow ups given their growth spurt issues.
Second, you could work on getting the present ALP test to rely less on laboratory processing. Getting this closer to what we are used to seeing as a glucose test strip kind of thing seems more in line with what your original post was suggesting and would get you closer to the cast idea. It would also make ALP testing a lot more portable and less equipment dependent, which would help in bone healing assessments but also assessments of liver function and a bunch of other conditions. This would be a good thing in itself.
Next you could work on getting the mechanism to read the results tied to the cast/splint. Whether you use a medium change (like glucose strips or litmus types of change on sensitive media), or connect it to a smarter output medium (like the organic LEDs) would depend on what step 2 taught you.
The protocol does offer an option for cell sample processing. It is unclear to me whether that might be an option instead of serum or sweat.
One thing that the lab process provides is the comparison to a standard sample. This is an important check against background contamination in your process. I’m not sure how you’d mimic that using the cast as test medium.
(Tracy, while this is far from a fully fledged idea at this point, and clinical test data is lacking for use…which isn’t strictly necessary to a patent; you should consider a patent application for your idea. If you file electronically as a small entity the fee is about $100. It would protect the concept at least. I think you’d find it a bit maddening to suddenly find a bit of game fiction turned into a viable product for a company.
Given, it might be you’d be paid to suppress development eventually. Imaging centers are a huge profit center for the medical community and this would cut into a fraction of that…which many people won’t like.
http://www.uspto.gov/patents/resources/types/utility.jsp
If Apple can claim patent protection for a rounded rectangle, I think you have an argument for this. http://www.theregister.co.uk/2013/08/10/usitc_issues_mixed_ruling_in_apple_samsung_case/
There are options for a provisional patent as well that you could look into.)
Burn dressings that change color to signal infection
http://www.bbc.co.uk/news/health-21900955
You may find the nanocapsules idea useful. They seem to function much as I’d suggested with impregnated soluble plastic.
Biomarkers and Suicide…
You may want to read this with a critical eye, there’s a lot of research coming out of the psychiatric community and some of it has methodological problems and very small sample sizes, yet claim big conclusions.
Suicide is always a big concern and is a difficult topic. It has become more so with the astronomical rates of suicide and suicide attempts among the armed forces over the last decade, which has become an epidemic.
http://www.nature.com/mp/journal/vaop/ncurrent/abs/mp201395a.html
Discovery and validation of blood biomarkers for suicidality
You may find some fictional analogue of this research has applications in terms of mission stress for your organization.
In real world terms, my money would be on making a working version of a cast wrap beating a reliable blood test for suicidality by about 30 years. The psych research is a LOT younger and a LOT more concerning in terms of validity and application.