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      A mountable toilet system for personalized health monitoring via the analysis of excreta

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          Abstract

          Technologies for the longitudinal monitoring of a person’s health are poorly integrated with clinical workflows, and have rarely produced actionable biometric data for healthcare providers. Here, we describe easily deployable hardware and software for the long-term analysis of a user’s excreta through data collection and models of human health. The ‘smart’ toilet, which is self-contained and operates autonomously by leveraging pressure and motion sensors, analyses the user’s urine using a standard-of-care colorimetric assay that traces red–green–blue values from images of urinalysis strips, calculates the flow rate and volume of urine using computer vision as a uroflowmeter, and classifies stool according to the Bristol stool form scale using deep learning, with performance that is comparable to the performance of trained medical personnel. Each user of the toilet is identified through their fingerprint and the distinctive features of their anoderm, and the data are securely stored and analysed in an encrypted cloud server. The toilet may find uses in the screening, diagnosis and longitudinal monitoring of specific patient populations.

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          Most cited references37

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          Fecal microbiome and volatile organic compound metabolome in obese humans with nonalcoholic fatty liver disease.

          The histopathology of nonalcoholic fatty liver disease (NAFLD) is similar to that of alcoholic liver disease. Colonic bacteria are a source of many metabolic products, including ethanol and other volatile organic compounds (VOC) that may have toxic effects on the human host after intestinal absorption and delivery to the liver via the portal vein. Recent data suggest that the composition of the gut microbiota in obese human beings is different from that of healthy-weight individuals. The aim of this study was to compare the colonic microbiome and VOC metabolome of obese NAFLD patients (n = 30) with healthy controls (n = 30). Multitag pyrosequencing was used to characterize the fecal microbiota. Fecal VOC profiles were measured by gas chromatography-mass spectrometry. There were statistically significant differences in liver biochemistry and metabolic parameters in NAFLD. Deep sequencing of the fecal microbiome revealed over-representation of Lactobacillus species and selected members of phylum Firmicutes (Lachnospiraceae; genera, Dorea, Robinsoniella, and Roseburia) in NAFLD patients, which was statistically significant. One member of phylum Firmicutes was under-represented significantly in the fecal microbiome of NAFLD patients (Ruminococcaceae; genus, Oscillibacter). Fecal VOC profiles of the 2 patient groups were different, with a significant increase in fecal ester compounds observed in NAFLD patients. A significant increase in fecal ester VOC is associated with compositional shifts in the microbiome of obese NAFLD patients. These novel bacterial metabolomic and metagenomic factors are implicated in the etiology and complications of obesity. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
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            Obesity and the human microbiome.

            Ruth E Ley (2010)
            Obesity was once rare, but the last few decades have seen a rapid expansion of the proportion of obese individuals worldwide. Recent work has shown obesity to be associated with a shift in the representation of the dominant phyla of bacteria in the gut, both in humans and animal models. This review summarizes the latest research into the association between microbial ecology and host adiposity, and the mechanisms by which microbes in the gut may mediate host metabolism in the context of obesity. Studies of the effect of excess body fat on the abundances of different bacteria taxa in the gut generally show alterations in the gastrointestinal microbiota, and changes during weight loss. The gastrointestinal microbiota have been shown to impact insulin resistance, inflammation, and adiposity via interactions with epithelial and endocrine cells. Large-scale alterations of the gut microbiota and its microbiome (gene content) are associated with obesity and are responsive to weight loss. Gut microbes can impact host metabolism via signaling pathways in the gut, with effects on inflammation, insulin resistance, and deposition of energy in fat stores. Restoration of the gut microbiota to a healthy state may ameliorate the conditions associated with obesity and help maintain a healthy weight.
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              Is Open Access

              Battery-free, skin-interfaced microfluidic/electronic systems for simultaneous electrochemical, colorimetric, and volumetric analysis of sweat

              Battery-free, wireless microfluidic/electronic system for multiparameter sweat analysis.
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                Author and article information

                Journal
                101696896
                45929
                Nat Biomed Eng
                Nat Biomed Eng
                Nature biomedical engineering
                2157-846X
                1 July 2020
                06 April 2020
                June 2020
                23 July 2020
                : 4
                : 6
                : 624-635
                Affiliations
                [1 ]Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
                [2 ]Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA.
                [3 ]Department of Surgery, Seoul Song Do Hospital, Seoul, Republic of Korea.
                [4 ]Cancer Immunology Laboratory, Seoul, Seoul Song Do Hospital, Republic of Korea.
                [5 ]Salesforce Research, Palo Alto, CA, USA.
                [6 ]Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
                [7 ]Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
                [8 ]Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA.
                [9 ]Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
                [10 ]Department of Electrical Engineering, Stanford University, Stanford, CA, USA.
                [11 ]Department of Bioengineering, Stanford University, Stanford, CA, USA.
                [12 ]Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
                [13 ]Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea.
                [14 ]College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
                [15 ]Precision Health and Integrated Diagnostic Center (PHIND), Stanford University School of Medicine, Palo Alto, CA, USA.
                [16 ]Canary Center at Stanford for Cancer Early Detection, Stanford University School of Medicine, Palo Alto, CA, USA.
                [17 ]These authors contributed equally: Seung-min Park, Daeyoun D. Won, Brian J. Lee.
                Author notes

                Author contributions

                S.S.G. conceived the original idea of the toilet system. S.-m.P. and S.S.G. strategically prioritized various clinical applications. S.-m.P., D.D.W., B.J.L., D.E. and S.S.G. contributed to overall study design, product prototyping and data analysis. A.E. and A.X.L. contributed to the development of machine learning algorithm used in the toilet. B.J.L, J.K., T.J.G., S.B. and F.B.A. contributed to uroflowmetry module design and its execution. D.D.W., A.A., J.H.K, S.S., E.H.C, H.P., Y.C., W.J.K. and J.K.L. contributed to stool analysis. D.E., J.H.Y. and A.M.B contributed to urinalysis study design and module implementation. C.Y. and S.X.W. contributed to electronic circuit design, system automation, and overall modular development and integration of the system. S.-m.P., D.D.W., B.J.L., R.S. and S.S.G. analysed all of the data and wrote the paper.

                Correspondence and requests for materials should be addressed to S.S.G. sgambhir@ 123456stanford.edu
                Author information
                http://orcid.org/0000-0002-2123-6245
                http://orcid.org/0000-0001-8424-291X
                http://orcid.org/0000-0002-2711-7554
                Article
                PMC7377213 PMC7377213 7377213 nihpa1592912
                10.1038/s41551-020-0534-9
                7377213
                32251391
                0188d888-4e80-45da-a356-29dc9d1fcd41

                Reprints and permissions information is available at www.nature.com/reprints.

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