Device and method for measuring fluid properties - Patents.com

Abstract

Disclosed herein is a device for measuring one or more properties or changes in properties of a fluid sample at one or more time points. The device can include a chamber defining an interior volume of the device suitable for receiving and holding a fluid sample, and a plurality of layers, the plurality including at least a bottom layer below the chamber and at least a substrate layer above the chamber, the substrate layer connected to at least one suspended beam at both ends of the beam length, the suspended beam positioned above the chamber, the suspended beam having a surface capable of physical contact with the fluid sample, and the suspended beam configured to vibrate upon application of an actuation signal to at least one conductive path extending across the suspended beam. Related methods and uses are also disclosed.

Description

[Technical field]

[0001] This application claims the benefit of U.S. Provisional Application No. 62 / 800,704, filed February 4, 2019, which is incorporated herein by reference.

[0002] The present invention relates to devices, methods and systems for measuring fluid properties such as the viscosity of a fluid sample, the viscosity of a bulk phase of a fluid sample, the viscosity of a continuous phase of a fluid sample, the viscoelasticity of a fluid sample, the density of a fluid sample, the plasma viscosity of a blood sample, the whole blood viscosity of a blood sample, the viscoelasticity of a blood sample, the density of a blood sample, the hematocrit of a blood sample, the platelet count of a blood sample, the blood clotting time of a blood sample, the blood clot firmness of a blood sample, the platelet contractile activity of a blood sample, the fibrinolytic activity of a blood sample, the concentration of a blood clotting factor of a blood sample, the activity of a blood clotting factor of a blood sample, the concentration of a blood component of a blood sample, the activity of a blood component of a blood sample, the type of anticoagulant in a blood sample, and the concentration of an anticoagulant in a blood sample. [Background technology]

[0003] Viscometers typically derive the viscosity and / or viscoelasticity of a fluid by measuring the force required to achieve a specified shear rate (e.g., Wells-Brookfield cone-plate type viscometer) [1]. Traditional laboratory viscometers are often not conducive to portable and online measurements of viscosity and viscoelasticity due to the viscometer's cost, space requirements, and other prerequisites, e.g., vibration-free mounting. Also, sample handling in such devices often involves manual handling, which is time-consuming and prone to error.

[0004] Vibration damping-based sensors are small in size and can be used to measure fluid properties in small sample volumes. Vibration damping-based sensors induce an acoustic vibration field in the medium that, when exposed to a fluid, results in viscosity- or viscoelastic-modified damping or flow, which can be measured electronically, optically, etc. If the vibration of the sensor corresponds to a resonant vibration of the sensor, the vibration damping can be measured using, among other variables, the quality factor of the resonance, the resonant frequency, and / or the amplitude of the resonant motion. Examples of such sensors include micro-acoustic sensors such as quartz thickness shear mode resonators (TSM) [2] and surface acoustic wave (SAW) devices, which have been successfully used as alternatives to conventional viscometers [3]. These devices generally measure viscosity at relatively high frequencies and small vibration amplitudes, which can lead to significant drawbacks. The penetration depth ( TIFF0007630174000001.tif8149 where η is the fluid viscosity, ρ is the fluid density, and f is the frequency) is small due to the high vibration frequency f of the sensor, so only a thin film of liquid close to the device is probed. Therefore, for non-Newtonian fluids, including but not limited to those containing separate components / additives, the results may exhibit significant deviations from those measured with a conventional viscometer.

[0005] Whole blood viscosity (WBV), a global measure of the inherent resistance of bulk blood to flow through blood vessels, is determined by the interplay between blood cell rheology, plasma viscosity (PV), and hematocrit and may be considered a marker of circulatory function. Its main determinants are the volume fraction of red blood cells (hematocrit or Hct), plasma viscosity (determined mainly by plasma fibrinogen, other biologically reactive globulins, and lipoproteins), red blood cell deformation (under high flow / shear conditions), and red blood cell aggregation leading to coagulation / clotting (under low flow / shear conditions) [4, 5]. It has been shown that increased levels of blood viscosity within the general population may promote cardiovascular events through potential rheological effects on atherogenesis, thrombus formation, or ischemia distal to atherothrombotic stenosis or occlusion [4, 6]. Epidemiological studies have associated high blood viscosity with traditional risk factors such as male gender, cigarette smoking, blood pressure, and plasma lipids / lipoproteins [5, 7]. In a study of a random population of 1592 men and women followed for an average of 5 years, after adjusting for age and sex, the mean blood viscosity was higher in patients who had experienced ischemic heart attacks and strokes than in those who had not [8]. After correction of diastolic blood pressure, LDL cholesterol, and smoking, the association between blood viscosity (and blood viscosity corrected for hematocrit) was significant only for stroke (p<0.05). A prospective study of 331 hypertensive middle-aged men (followed for an average of 4.8 years) found that patients with diastolic blood viscosity in the upper tertile were at increased risk of cardiovascular events [9]. There is also a strong correlation between the incidence of type 2 diabetes with WBV and both the prediction of plasma hyperviscosity syndrome and the prognosis of sickle cell disease with plasma viscosity. Summary of the Invention [Problem to be solved by the invention]

[0006] Blood is a non-Newtonian fluid; that is, the viscosity of blood depends on the speed at which the blood flows through the vessels (more specifically, the shear rate of the blood). At high blood velocities, the disk-shaped red blood cells are oriented in the direction of flow and the viscosity is low. At very low shear rates, red blood cell aggregation can occur, so the viscosity increases to very high values. Also, blood must withstand a minimum shear stress (yield stress, τ y ) has been suggested and demonstrated to be necessary. To measure the viscosity of a blood sample, modern viscometers generally measure the rate of fluid flow at a specified force, or conversely, the amount of force required to achieve a prescribed rate of flow. Which method is used for plasma viscosity measurement is not important due to its Newtonian fluid nature. Ideally, the rate of flow (proportional to the shear rate) would be precisely controlled and specified when measuring whole blood viscosity, to aid in standardization of the measurement. However, current blood viscometers are bulky and require large volumes of sample, unable to enable whole blood and plasma viscosity measurements on the same sample.

[0007] The ability to rapidly measure the physical properties of blood can allow these properties to be monitored as a function of time, including real-time monitoring of blood clotting. Currently available hemodynamic tests for diagnosing and monitoring disease include blood clotting tests such as prothrombin time (PT) or international normalized ratio (INR), partial thromboplastin time (PTT), activated clotting time (ACT), and thromboelastogram (TEG). The laboratory gold standard for the measurement of all the coagulation tests mentioned above is the direct-mechanical, viscoelastic method, which monitors the change in the physical properties of a blood sample as it clots. However, these tests, when performed in the laboratory, can require large blood samples (3-5 ml), the addition of anticoagulants (e.g., sodium citrate) to preserve the sample, and laborious testing processes using vibration-sensitive instruments, and often require long turnaround times to generate test results.

[0008] Currently available point-of-care (POC) systems for coagulation diagnostic testing used in hospitals, clinics, and homes (e.g., Roche's CoaguChek®) generally follow fingerstick capillary whole blood sampling and strip-based testing methods, as commonly used in blood glucose meters. These devices are portable and easy to use, but in contrast to the gold-standard direct-mechanical laboratory methods, they typically use indirect methods (e.g., electrical, optical) that measure secondary effects due to blood clotting and are prone to error due to confounding factors, including, but not limited to, changes in hematocrit and fibrinogen concentration in blood samples. Real-time POC measurements of complex fluid physical properties (here, blood viscosity, viscoelasticity, and density) may help provide real-time feedback on the effectiveness and response time of treatment / therapy, enabling optimal hemostatic management. Also, monitoring of viscosity or viscoelasticity as a function of time may be used when performing multiple coagulation tests on the same blood sample (e.g., PT / INR, PTT, ACT, and TEG). Such devices can be effectively used to measure blood and plasma viscosity and perform standardized coagulation measurements (including but not limited to PT / INR, PTT, ACT, and TEG), thereby providing a complete picture of blood coagulation status before, during, and after therapy.

[0009] Thus, there is currently a need for rapid, real-time measurement of the rheological properties (viscosity, viscoelasticity, density, and coagulation) of whole blood and plasma in low sample volumes (e.g., <10 μl, including but not limited to fingerstick blood sampling), in vitro or in vivo. Such instruments, together with biosensors, such as glucose measurements in diabetic patients, may serve as valuable tools for rapid diagnosis and monitoring of disease and blood function. [Means for solving the problem]

[0010] In some embodiments, the present invention provides an acoustic vibration sensor that can generate relatively large vibration amplitudes and penetration depths of the acoustic field in a fluid, which can lead to higher sensitivity and a larger breadth of measurements of fluid properties. In some embodiments, the vibrating element is designed such that at least two acoustic fields corresponding to two different penetration depths can be induced in the fluid medium, such that different physical properties of the fluid can be measured using the two acoustic fields. For example, by using two penetration depths, one larger than the size of the distinct components / additives in the fluid and one smaller than the size of the distinct components / additives, the viscosity of the continuous phase and the bulk phase (reflecting the contribution from the distinct components / additives) can be accurately determined in the same sample without the need to separate the distinct components / additives from the fluid. Also, by changing the vibration mode of the sensor in the device according to some embodiments, the density of the fluid can be accurately measured, which can then be used to quantify the concentration of any distinct components / additives. The sensor will prove useful in a wide variety of fluid property measurement applications, for example, in measuring properties of foods, beverages, paints, inks, oils and petroleum products, and biological fluids in vivo and in vitro.

[0011] In some embodiments, methods and devices according to the present invention provide advantages with respect to measuring whole blood viscosity, which is highly dependent on the viscosity of the continuous phase, i.e., plasma, and the concentration of separate components such as red blood cells.

[0012] Some embodiments of the present invention provide sensors that allow for simultaneous and rapid measurement of whole blood and plasma viscosity for the same blood sample, and / or that can be configured to measure the density of blood, which can be used to determine hematocrit, since density is linearly related to hematocrit by the simple relationship ρ=1.026+0.067Hct gm / cc

[10] . Because whole blood viscosity is highly dependent on plasma viscosity and hematocrit, it may be advisable to standardize blood viscosity to a fixed hematocrit (typically, 0.45 is used) in order to compare / group blood viscosities of different solids. In most studies, whole blood viscosity is standardized (or corrected) to 45% of the standard hematocrit by the formula of Matrai et al.

[11] , TIFF0007630174000002.tif15139In formula, η WBV-0.45 is the corrected whole blood viscosity, and η WBV-Hct is the whole blood viscosity at hematocrit Hct, and η Plasma is the plasma viscosity. Therefore, to estimate standardized blood viscosity using this technique, the hematocrit, whole blood viscosity, and plasma viscosity of the sample must be accurately measured. Currently, the measurement of whole blood and plasma viscosity generally involves time-consuming sample processing, i.e., centrifugation of red blood cells to separate plasma and measure hematocrit, and measurement of viscosity using bulky instruments by trained professionals. Also, the amount of blood available from the patient may be small (e.g., capillary blood by fingerstick method), and must be analyzed quickly, preferably without the addition of anticoagulants. Current existing methods for clinical diagnosis and in vitro studies of blood in the laboratory generally involve the addition of anticoagulants such as sodium citrate and EDTA, thus deviating from the true physiological state of blood

[12] . In some embodiments, the present invention provides the advantage of performing all three measurements, i.e., whole blood viscosity, plasma viscosity, and hematocrit measurements, on the same blood sample without the need for sample pretreatment, and thus serving as a rapid POC diagnostic tool.

[0013] Thus, in one embodiment, the invention provides a device for measuring one or more properties or changes in properties of a fluid sample at one or more time points, the device comprising a chamber defining an internal volume of the device suitable for receiving and holding a fluid sample, and a plurality of layers, the plurality including at least a bottom layer below the chamber and at least a substrate layer above the chamber, the substrate layer being tethered to at least one suspended beam at both ends of the length of the beam, the suspended beam being positioned above the chamber, the suspended beam having a surface capable of physical contact with the fluid sample, and the suspended beam being configured to vibrate upon application of an actuation signal to at least one conductive path extending across the suspended beam.

[0014] In another embodiment, the present invention provides a method of measuring one or more properties or changes in properties of a fluid sample using a device according to the present invention, the method comprising: placing the fluid sample in a chamber of the device; vibrating at least one of at least one suspended beams of the device, the vibration inducing a current or voltage in at least one conductive path of the device; measuring the current or voltage at one or more times; and calculating one or more properties or changes in properties of the fluid sample using one or more of the current or voltage measurements.

[0015] In another embodiment, the present invention provides a method of determining one or more properties or changes in properties of a fluid sample, the method comprising: disposing the fluid sample in a chamber, wherein a chamber surface comprises a physical element capable of vibrating while in contact with the fluid; vibrating the physical element at one or more vibrational frequencies; measuring one or more characteristics of the vibration of the physical element at the one or more vibrational frequencies; and using one or more of the measured vibration characteristics to determine one or more properties or changes in properties of the fluid sample.

[0016] In another embodiment, the present invention provides a method for identifying the type of one or more analytes present in a fluid sample and determining the concentration of the one or more analytes, the method comprising: disposing the fluid sample in a chamber, wherein the chamber surface comprises a vibration device capable of determining one or more properties or changes in properties of the fluid using one or more of the measured vibrational properties; initiating a reaction in the fluid sample; determining one or more properties or changes in properties of one or more fluid components during the reaction using one or more of the measured fluid properties; identifying the type of one or more analytes using one or more of the measured properties of the one or more of the fluid components; and determining the concentration of the one or more analytes using one or more of the measured fluid properties.

[0017] In another embodiment, the present invention provides use of a device according to the present invention for determining at least one of the viscosity of a fluid sample, the viscosity of a bulk phase of a fluid sample, the viscosity of a continuous phase of a fluid sample, the viscoelasticity of a fluid sample, the density of a fluid sample, the plasma viscosity of a blood sample, the whole blood viscosity of a blood sample, the viscoelasticity of a blood sample, the density of a blood sample, the hematocrit of a blood sample, the platelet count of a blood sample, the blood clotting time of a blood sample, the blood clot firmness of a blood sample, the platelet contractile activity of a blood sample, the fibrinolytic activity of a blood sample, the concentration of a blood clotting factor of a blood sample, the activity of a blood clotting factor of a blood sample, the concentration of a blood component of a blood sample, the activity of a blood component of a blood sample, the type of anticoagulant in the blood sample, and the concentration of an anticoagulant in the blood sample.

[0018] Additional objects and advantages of the invention will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by the practice of the invention. The objects and advantages of the invention will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims.

[0019] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed.

[0020] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several embodiments of the invention and serve to explain, and generally to explain the principles of the invention. [Brief description of the drawings]

[0021] The foregoing aspects and advantages of the present invention will become apparent from the following detailed description, taken in conjunction with the accompanying drawings.

[0022] [Figure 1(a)] 1 illustrates a schematic depiction of one embodiment of a substrate layer including a physical element (i.e., a suspended beam) suitable for measuring the absolute value and / or change in viscosity, viscoelasticity, and / or density of a fluid sample independently and / or before, during, and after a reaction. [Figure 1(b)] 1 shows an exploded view of a substrate layer illustrating the component layers that contribute to the substrate layer. [Figure 2(a)] 1 shows a schematic diagram of a sensor device embodiment in the form of a disposable test strip for use in determining the viscosity, viscoelasticity, and / or density of a fluid sample, particularly a bodily fluid such as blood. [Figure 2(b)] 1 shows an exploded view of a test strip, showing the components therein. [Figure 2(c)] 1 shows a photograph of an assembled disposable test strip without a blood sample being introduced to the strip. [Figure 2(d)] 1 shows a photograph of an assembled disposable test strip with a blood sample introduced to the strip. [Figure 3(a)] 1 shows a Finite Element Analysis (FEA) simulation of one embodiment of a physical element (as seen in FIG. 1 ) depicting the fundamental resonance of in-plane vibration along the width (x-axis) direction. [Figure 3(b)]A finite element analysis (FEA) simulation of one embodiment of a physical element (as seen in FIG. 1) is shown depicting the fundamental resonance of out-of-plane vibration along the thickness (z-axis) direction. [Figure 4(a)] An example of a single amplitude frequency scan (3500-7000 Hz) of a physical element subjected to in-plane vibration with air present in the chamber to measure a resonant frequency of 4907 Hz is shown. [Figure 4(b)] An example of a single amplitude frequency scan (750-3250 Hz) of the same physical element subjected to out-of-plane vibration with air present in the chamber to measure a resonant frequency of 1374 Hz is shown. [Figure 5(a)] 1 illustrates an example of a set of normalized amplitude-frequency scans of physical elements in multiple strips. [Figure 5(b)] Statistical binning of the square root of each of these resonant frequencies is shown. [Figure 6] 1 shows an example of an amplitude frequency scan of the in-plane vibration of a physical element in air and in contact with a 40.38% v / v ethylene glycol (EG) solution. [Figure 7(a)] 1 shows an example of a graph illustrating the relationship between fluid properties and response of a physical element subjected to in-plane resonant vibration, i.e., amplitude, of an ethylene glycol solution in deionized water. [Figure 7(b)] 1 shows an example of a graph illustrating the in-plane resonant vibration of an ethylene glycol solution in deionized water, i.e., the relationship between fluid properties and the response of a physical element subjected to frequency. [Figure 7(c)] 1 shows an example of a graph illustrating the relationship between fluid properties and response of a physical element subjected to in-plane resonant vibration of an ethylene glycol solution in deionized water, i.e., a quality factor. [Figure 8] An example of the correlation between INR results from Roche's CoaguChek® XS system and a disposable test strip under the present invention (Abram's CoagCare) is shown. [Figure 9]An example of damping upon out-of-plane vibration of a physical element within a disposable test strip is shown, where the sensor signal exhibits a steady and predictable decrease upon exposure to a blood sample with an increase in hematocrit from 0 to 80%. [Figure 10] 1 shows an example of an uncalibrated aPTT blood clotting time measured using physical elements within a disposable test strip. [Figure 11] 1 shows an example of an uncalibrated low-range ACT blood clotting time measured using a physical element within a disposable test strip. [Figure 12] 1 shows an example of an uncalibrated high-range ACT blood clotting time measured using a physical element within a disposable test strip. [Figure 13(a)] 1 shows an example of an amplitude frequency scan of a vibrating physical element in a disposable test strip with a blood sample in a chamber undergoing clotting. [Figure 13(b)] 1 shows an example of a phase frequency scan of a vibrating physical element in a disposable test strip with a blood sample in a chamber undergoing clotting. [Figure 14(a)] 1 shows an exemplary illustration of extracted hemostatic parameters related to the blood coagulation cascade. [Figure 14(b)] 1 shows one example of a corresponding viscoelastic vibration damping fit to vibration amplitude data from a physical element within a disposable test strip having a blood sample in a chamber undergoing clotting. [Figure 15] An exemplary illustration of hemostatic parameters extracted from fits used to generate cleaved fibrinogen or fibrin and thrombin concentration profiles as a function of time during the blood clotting cascade as measured using physical elements within a disposable test strip is shown. [Figure 16(a)]FIG. 1 shows an exemplary illustration of the variation in thrombin generation and activated clotting time (ACT) in the presence of a heparin anticoagulant (thrombin inhibitor) as measured using physical elements within a disposable test strip. Shown are uncalibrated thrombin concentration or generation profiles measured in blood samples with increasing heparin concentration from 0 to 3 IU / ml. [Figure 16(b)] 1 shows an exemplary illustration of the variation in thrombin generation and activated clotting time (ACT) in the presence of a heparin anticoagulant (thrombin inhibitor) as measured using physical elements within a disposable test strip. Correlation plots of corresponding ACT times in samples as measured using a disposable test strip (CoagCare ACT) and the TEG-5000 RapidTEG assay are shown. [Figure 17(a)] 1 shows an exemplary illustration of hemostatic parameters extracted from fits that are being used to monitor a characteristic property of a blood clot during the blood clotting cascade, clot firmness G, as measured using physical elements within a disposable test strip; FIG. 2 shows typical vibrational characteristics of an in-plane vibration mode of a suspended beam measured as a function of time used to monitor clot firmness G; [Figure 17(b)] 1 shows an exemplary illustration of hemostatic parameters extracted from a fit that is being used to monitor a blood clot specific property, clot firmness G, during the blood clotting cascade, as measured using physical elements within a disposable test strip. A dose response of clot firmness G showing an increasing trend upon exposure to blood samples with increasing concentrations of cleavable fibrinogen is shown. [Figure 18(a)] 1 shows an exemplary illustration of hemostatic parameters extracted from a fit used to monitor the activity of a blood component, platelets, during the blood clotting cascade as measured using physical elements within a disposable test strip. 2 shows typical vibration characteristics of an in-plane vibration mode of a suspended beam measured as a function of time used to monitor platelet contraction. [Figure 18(b)]1 shows an exemplary illustration of hemostatic parameters extracted from a fit that is being used to monitor the activity of a blood component, platelets, in the blood coagulation cascade as measured using physical elements within a disposable test strip. 2 shows a dose response for platelet contraction rate that shows a decreasing trend when exposed to blood samples with increasing concentrations of eptifibatide GPIIb / IIIa platelet inhibitor. [Figure 19(a)] 1 shows an exemplary illustration of hemostatic parameters extracted from fits used to monitor a blood clot specific property, the fibrinolysis rate, Lys-Rate, during the blood clotting cascade, as measured using physical elements within a disposable test strip. 2 shows typical vibration characteristics of an in-plane vibration mode of a suspended beam measured as a function of time used to monitor the fibrinolysis rate, Lys-Rate. [Figure 19(b)] 1 shows an exemplary illustration of hemostatic parameters extracted from a fit that is being used to monitor a blood clot specific property, the fibrinolysis rate, Lys-Rate, during the blood clotting cascade, as measured using physical elements within a disposable test strip. 2 shows a dose response of the fibrinolysis rate, Lys-Rate, which shows an increasing trend upon exposure to blood samples with increasing concentrations of tissue plasminogen activator (tPA). [Figure 20(a)] FIG. 1 shows an exemplary illustration of TEG-like viscoelastic parameters extracted using hemostasis parameters from a fit being used to determine the concentration of a Factor IIa (dabigatran or Pradaxa®) inhibitor-based anticoagulant as measured using physical elements within a disposable test strip. Shown is a dose response of clot formation time (R) upon exposure to blood samples with increasing concentrations of dabigatran. [Figure 20(b)]1 shows an exemplary illustration of TEG-like viscoelastic parameters extracted using hemostatic parameters from a fit that are being used to determine the concentration of a Factor IIa (dabigatran or Pradaxa®) inhibitor-based anticoagulant, as measured using physical elements within a disposable test strip. Further shown is a correlation plot between these R-times, measured using a disposable test strip (CoagCare), and ACT-times, measured using a TEG-5000 RapidTEG assay. [Figure 21(a)] FIG. 1 shows an exemplary illustration of TEG-like viscoelastic parameters extracted using hemostasis parameters from a fit being used to determine the concentration of a Factor Xa (rivaroxaban or Xarelto®) inhibitor-based anticoagulant as measured using physical elements within a disposable test strip. Shown is a dose response of clot formation time (R) upon exposure to blood samples with increasing concentrations of rivaroxaban. [Figure 21(b)] 1 shows an exemplary illustration of TEG-like viscoelastic parameters extracted using hemostatic parameters from a fit that are being used to determine the concentration of a Factor Xa (rivaroxaban or Xarelto®) inhibitor-based anticoagulant, as measured using physical elements within a disposable test strip. Further shown is a correlation plot between these R-times, measured using a disposable test strip (CoagCare), and ACT-times, measured using a TEG-5000 RapidTEG assay. [Figure 22(a)] The blood coagulation cascade process is depicted, specifically showing the inhibition of thrombin activity or the cleavage / conversion of fibrinogen to fibrin by dabigatran, and the inhibition of thrombin generation via factor Xa by rivaroxaban, and their respective effects on clot formation time (R). [Figure 22(b)]1 shows the effect of rivaroxaban on maximum thrombin generation (ThrombinPeak) and clot firmness G with increasing rivaroxaban in the tested blood samples, as measured using a physical element within the disposable test strip. [Figure 22(c)] 1 shows the effect of dabigatran on maximum thrombin generation (ThrombinPeak) and clot firmness G with increasing dabigatran in the tested blood samples, as measured using a physical element within a disposable test strip. [Figure 22(d)] The differential response of rivaroxaban and dabigatran is shown using a metric expressed as the ratio of normalized ThrombinPeak to clot firmness G (referred to as [Fibrinogen]2 in this figure) plotted for samples tested with increasing concentrations of dabigatran and rivaroxaban (referred to as novel oral anticoagulants or NOACs in this figure). DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0023] definition To facilitate understanding of the present invention, certain terms are defined below. Terms not defined herein have the meaning commonly understood by those skilled in the art in the area relevant to the present invention. Terms such as "a", "an", and "the" are not intended to refer to a singular entity only, but include a general class of which a particular example may be used for illustration. While the terminology herein is used to describe certain embodiments of the present invention, their use does not define the scope of the present invention, except as outlined in the claims.

[0024] The prothrombin time (PT) or international normalized ratio (INR) test is an important indicator of the activity of extrinsic pathway coagulation factors, which is the clotting time when tissue thromboplastin (tissue factor) and / or calcium ions are added to a plasma or whole blood sample to induce clot formation. Warfarin is prescribed to inhibit multiple factors involved in the coagulation cascade, and its effectiveness is measured by the PT or INR test.

[0025] The partial thromboplastin time (PTT) test is an indicator of the intrinsic pathway clotting factors and measures the time it takes for whole blood to clot. The PTT is often used as a starting point when investigating the cause of a bleeding or thrombotic episode. The PTT test is used to determine the effectiveness of heparin therapy administered to patients with disruptions to the intrinsic pathway (typically during invasive procedures).

[0026] The activated clotting time (ACT) test is used to monitor the effects of high-dose heparin before, during, and shortly after surgery that requires the administration of strong anticoagulants, such as cardiac bypass surgery, cardiac angioplasty, and dialysis. The test is performed in situations where the partial thromboplastin time (PTT) test is not clinically useful or takes too long.

[0027] Thromboelastography or thromboelastogram (TEG) is a method to test the efficiency of blood clotting. It is important in surgery, anesthesiology, and trauma-related care, among others. A small blood sample (typically 0.36 ml) is placed in a cuvette (cup), which is gently rotated over 4°45´ (cycle time 6 / min) to mimic slow venous flow and activate clotting in the presence of activators (e.g. thromboplastin, kaolin). When the sensor shaft is inserted into the sample, a clot forms between the cup and the sensor. The speed and strength of clot formation are measured in various ways and depend on the activity of the plasma coagulation system, platelet function, fibrinolysis, and other factors that may be affected by disease, environment, and drugs.

[0028] Quality factor (Q-factor) is a measure of the "quality" of a resonant vibration system, and is a measure of the sharpness of the vibration resonance, or frequency selectivity of a resonant vibration system, measured over a range of frequencies in the vicinity of the resonant vibration frequency. Q-factor can be measured by monitoring the amplitude of the vibration as a function of frequency in the vicinity of the resonant frequency. Q-factor can be defined in several ways, with a common definition being the ratio of the resonant frequency to the width of the peak. The width of the resonant peak can be determined, for example, as the distance between two frequencies above and below the resonant frequency at which the amplitude of the vibration drops to half the magnitude of the amplitude at the resonant frequency, commonly known as the full width at half maximum (FWHM). When a resonant vibration system exhibits a resonant frequency and an anti-resonant frequency (as identified by the amplitude vs. frequency relationship), another way to measure the Q-factor is by computing the ratio of the resonant frequency to the difference between the anti-resonant frequency and the resonant frequency.

[0029] Shear penetration depth (δ s )teeth, TIFF0007630174000003.tif8130, where f is the vibration frequency, η is the viscosity of the fluid sample, and ρ is the density of the fluid sample.

[0030] Determination of fluid properties, including but not limited to viscosity, viscoelasticity, and density, may be accomplished by determining the vibrational characteristics of a physical element. The vibration may correspond to one of the natural or fundamental frequencies of the resonance or vibration of the physical element. The principle of resonance may be further defined in terms of the function of a tuning fork. When a tuning fork is excited by striking it against a surface or object, its beam or prongs resonate at a particular frequency, known as the fundamental frequency. The fundamental frequency of the prongs depends on the physical properties of the prongs, such as their length and cross-sectional area, as well as the material from which the fork is made. More broadly, the fundamental frequency of resonance or vibration of any physical element depends on their geometric shape and material properties.

[0031] Electromagnetism has been used as part of a variety of applications, for example to induce and monitor the motion of a rotor as part of a motor assembly. A possible electromagnetic mechanism of actuation involves applying an electric current in the presence of a magnetic field, resulting in motion in a current-carrying substrate as a result of the Lorentz force experienced by the conductor. The Lorentz force F L are the electric field E, and F L E is defined as the force experienced by a charge q moving with velocity v in the presence of a magnetic field B given by E = q [E + (v × B)]. Alternatively, motion within a moving body having a conductive path through it can be detected by electromagnetic induction. Electromagnetic induction is the production of a current or voltage at both ends of a moving conductor in the presence of a magnetic field. Thus, the principles of electromagnetism can be used to accurately both induce and monitor motion. Alternatively, motion can be induced and monitored using actuation methods such as piezoelectric, capacitive, electromagnetic, and thermal methods. Motion can also be monitored optically.

[0032] In some embodiments of the invention, a device is provided in which vibration of a physical element (formed on or as part of a substrate layer) is configured to monitor a physical property of a fluid, the physical element comprising a suspended beam, the suspended beam attached to the substrate layer at both ends of the length or width of the beam and capable of vibration. The physical element comprises at least one conductive path extending therethrough, the suspended beam may have a planar, flat shape. An example of a planar, flat shape may be a rectangular shape with a length and width in the range of 0.1-20 mm and a thickness less than one fifth of the length or width, the flatness of the element being defined by a surface roughness less than one fifth of the length or width. In alternative embodiments, the physical element may be a non-rectangular shape. When an actuation signal via an electric current passes through the physical element in the presence of a magnetic field with magnetic flux lines intersecting the physical element, vibration is induced in the physical element. In a constant magnetic field, vibration is induced in the physical element when an electric field via a time-varying electric current is applied / injected into at least one conductive path through the physical element. Alternatively, vibrations can be induced in the physical element using the application of a constant electric field through the physical element in the presence of a time-varying magnetic field. Also, the relative directions of the electric and magnetic fields can target specific types of vibrations and control the vibration characteristics (such as amplitude, frequency, etc.) of the physical element. The vibrations are monitored by measuring a detection signal, i.e., a voltage or current induced by electromagnetic induction, in at least one conductive path through the physical element within a range of frequencies near the vibration frequency. In some embodiments of the invention, the actuation signal and the detection signal are applied and measured over the same or independent conductive paths through the physical element. Alternatively, other methods can be used to monitor the vibrations, including, but not limited to, optical, piezoelectric, thermal, etc.

[0033] The vibration induced in the physical element may be either a resonant or non-resonant frequency of the physical element. In some embodiments of the invention, if the frequency of the time-varying actuation signal corresponds to one or more of the natural or fundamental frequencies of the resonance of the physical element, a corresponding vibration mode is induced in the physical element. In other embodiments of the invention, the frequency of the time-varying actuation signal corresponds to one or more harmonics of one or more of the natural or fundamental resonance frequencies. The resonant vibration characteristics may vary depending on the physical dimensional structure and material of the physical element, i.e., the suspended beam, which is attached to the substrate layer at both ends of the length of the beam, and may target specific frequencies of vibration.

[0034] For example, the suspended beam may be a flat rectangle. Considering the length l and width w of the rectangular beam, two specific frequencies of resonance of the physical element can be designed along the length and width directions, respectively, and the magnitude of the resonance frequency can be controlled by the corresponding lengths l and w. In some embodiments of the present invention, the resonance frequency of vibration may correspond to the in-plane and out-of-plane modes of vibration of the physical element. In some embodiments of the present invention, the resonance characteristics of the vibration induced in the physical element may be computerized by monitoring the detection signal induced at a range of frequencies near the resonant vibration frequency. The measurable or quantifiable vibration characteristics of the physical element include, but are not limited to, vibration amplitude, phase, frequency, and quality factor. In some embodiments of the present invention, the actuation signal may correspond to a first resonant vibration, which couples to a second resonant or non-resonant vibration, resulting in both vibration modes induced in the physical element. In this case, the detection signal may be measured near either or both of the induced vibration frequencies.

[0035] In another embodiment of the invention, vibration of the physical element may be induced by coupling, interfacing, or contacting the substrate on which the physical element is located with a vibration-inducing actuator that uses one or a combination of excitation fields selected from (i) a piezoelectric-based mechanical field, (ii) a capacitive field, (iii) an electromagnetic field, and (iv) a thermal excitation field. In some embodiments of the invention, the physical element comprises at least one conductive path extending therethrough, and the at least one conductive path may include an element having a limited electrical conductivity, such as a thermal resistor, a piezoresistor, or the like. For example, a piezoelectric quartz (PZT) vibrator may be physically affixed to the substrate layer, and the PZT vibrator may be driven to induce vibration of the physical element at a particular vibration frequency. When the PZT vibrator is driven at a frequency corresponding to one of the natural or fundamental frequencies (or harmonics thereof) of the resonance of the physical element, the corresponding vibration mode is excited. The geometry and material properties of the physical element, which may include a planar, flat suspended beam, may be configured such that the natural or fundamental frequency of resonance of the physical element is at a particular value or within a given range of frequencies, such as 1 Hz to 1 MHz. The PZT, when actuated at said frequencies, induces a resonant vibration of the physical element.

[0036] Another embodiment involves applying a capacitive field between the physical element and one or more isolated stationary electrodes (located a finite distance from the substrate layer tethered to the physical element) to induce vibration. The capacitive field can be established by applying a time-varying voltage signal between a conductive path extending through the physical element and one or more stationary electrodes. Applying a time-varying voltage at the natural or fundamental frequency of the physical element (or harmonics thereof) can induce a resonant vibration of the physical element.

[0037] In yet another embodiment, a thermal resistor is provided as part of a conductive path extending through the physical element. Vibration of the physical element at a resonant or non-resonant frequency can be induced by heating the resistor as a current passes through the conductive path extending through the physical element. Steady or transient vibrations can be induced in the physical element by applying a time-varying current signal.

[0038] In another embodiment of the invention, the vibrations induced in the physical element are detected by one or a combination of detection fields resulting from the vibrations and selected from: (i) piezoelectric-based electric fields, (ii) capacitive fields, (iii) electromagnetic fields, (iv) thermal fields, and (v) optical field detection. For example, if a piezoelectric crystal (PZT) vibrator affixed to a substrate is used to induce vibrations in the physical element, the vibration characteristics can be monitored by measuring the electrical input characteristics of the PZT in a frequency range near the vibration frequency excited in the physical element.

[0039] Alternatively, one or more piezoresistors can be provided as part of a conductive path extending through the physical element, which exhibit a change in resistance due to vibration of the physical element. The vibration can be monitored by incorporating the piezoresistors as part of a Wheatstone bridge circuit and measuring the bridge voltage over a range of frequencies near the vibration frequency excited in the physical element.

[0040] In yet another alternative, one or more thermal resistors are provided as part of the conductive path extending through the physical element, capable of measuring the change in temperature due to vibration of the physical element. The thermal resistors may be made of a pyroelectric material capable of inducing a voltage with a change in temperature. The vibration of the physical element may be monitored by measuring the change in voltage across the resistor within a frequency range near the vibration frequency excited in the physical element.

[0041] In yet another alternative, an optical sensor module is used to induce an optical signal on the physical element and a photodetector is used to monitor the reflected or transmitted optical signal. Vibration of the physical element can be monitored by measuring the output signal of the photodetector in the vicinity of the vibrational frequency excited in the physical element. Alternatively, the photodetector module can be incorporated on the physical element as part of a conductive path extending through the physical element. When an optical signal is induced on the photodetector, vibration of the physical element can be monitored by measuring the change in the output of the photodetector in a frequency range in the vicinity of the vibrational frequency excited in the physical element.

[0042] In some embodiments of the invention, one or more physical elements (i.e., suspended beams) are located above a chamber, the chamber defining an interior volume suitable for receiving and holding a fluid sample, and the one or more suspended beams are configured to vibrate upon application of an actuation signal.

[0043] In some embodiments of the invention, the interior volume of the chamber is configured to receive and hold a fluid sample in a predetermined position before a fluid property measurement is performed. The chamber is formed by multiple layers such that there is at least one layer above the chamber (substrate layer) and at least one layer below the chamber (bottom layer), whereby one or more physical elements (tethered to the substrate layer) have a surface that can physically contact the fluid sample. The use of at least one substrate layer above the chamber (tethered to one or more physical elements) and at least one bottom layer below the chamber allows for advantages including, but not limited to, using the minimum number of layers required to define the chamber (thus reducing costs) while ensuring contact between one or more surfaces of the physical element sensor and the fluid in the chamber. The substrate layer may be generally parallel to the layer below the chamber, except for out-of-plane vibrations of one or more physical elements tethered to the substrate layer during which the physical elements deform from a parallel configuration. In another embodiment of the invention, the top surface of the chamber consists of at least a portion of the substrate layer to which one or more physical elements are tethered. When introduced into the chamber, the fluid sample contacts one or more physical elements and affects vibration of the physical elements, occupying at least a volume near the region below the one or more physical elements and above the bottom of the chamber. Furthermore, to define one or more fluid access paths to one or more of the physical elements, the fluid sample may also occupy additional volumes within the chamber below regions of the substrate layer leading toward and / or away from the one or more physical elements. In yet another embodiment of the invention, the flow of fluid into the chamber is directed along the length of the suspended beam (i.e., the physical element), occupying a volume at least near the region below the beam and above the bottom of the chamber.In yet another embodiment of the invention, depending on the surface wetting properties (e.g., contact angle) under the suspended beam and the bottom surface of the chamber, once introduced, the fluid can occupy a volume along the length of the beam at least near a region under the beam and above the bottom of the chamber, which region is either within or greater than the width of the suspended beam based on fluid wetting interactions. For example, the region, if greater than or equal to the width of the suspended beam, may be within 1.1, 1.2, 1.3, 1.4, 1.5, 2, 3, 4, 5, 6, 7, 8, 9, or 10 times the width of the beam. In another example, the region, if within the width of the suspended beam, may be within 0.01, 0.05, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, or 1 times the width of the beam. These embodiments enable advantages including, but not limited to, reducing the fluid volume required to be examined, with the fluid occupying a volume at least near the region below the physical element (i.e., the suspended beam) and above the bottom of the chamber, improving the sensitivity of the device to measuring physical properties of the fluid by maximizing the surface area of ​​the device (i.e., the suspended beam) that is exposed to the fluid, and avoiding unintended interactions between the fluid and other regions of the chamber.

[0044] When a fluid sample is present in the chamber, the face of the physical element is in contact with the fluid sample in the chamber below it, so that the effect on the vibration of the physical element (e.g., damping) can be used to determine one or more physical properties of the fluid, such as viscosity, viscoelasticity, and density. In some embodiments of the present invention, the vibration induced in the physical element can be at a non-resonant frequency. Measurable or quantifiable vibration characteristics of the physical element include, but are not limited to, vibration amplitude, phase, frequency, and quality factor. In all resonant devices, the quality factor is influenced by the surroundings, and the quality factor of a resonant system varies depending on the viscosity, viscoelasticity, and density of the medium in contact. The amplitude of the vibrating element is proportional to the viscosity of the fluid, and when in contact with a low viscosity fluid, the element vibrates at a much higher amplitude over a narrow frequency range, close to the natural or fundamental frequency, compared to when in contact with a high viscosity fluid. Introduction of a fluid sample in the vicinity of the physical element damps the vibration characteristics of the physical element, changing the amplitude, phase, frequency, and / or quality factor, indicative of the viscosity, viscoelasticity, and density of the fluid. In some embodiments of the invention, the conductive pathway through the physical element comprises one or more heating elements, including, but not limited to, one or more resistive track heaters, for controlling the temperature of the fluid medium in the chamber, and / or one or more sensing elements for monitoring the temperature of the fluid medium in the chamber. In some embodiments of the invention, one or more conductive pathways comprising one or more heating elements and / or one or more sensing elements may be disposed on a layer below the chamber to respectively control and monitor the temperature of the fluid medium in the chamber.

[0045] In some embodiments of the invention, when the physical element is in contact with a biological fluid that may undergo a reaction leading to clotting, the vibration element is further damped by the increase in viscosity or viscoelasticity of the fluid sample as it clots. This damping effect can be measured periodically (i.e., at two or more time points) to determine the clotting of the bodily fluid as a function of time. In some embodiments of the invention, the biological fluid includes whole blood or plasma. In some embodiments, blood clotting is initiated by physical contact with a negatively charged substrate or by the addition of a compound that induces blood clotting, such as thromboplastin, and the time to formation of a blood clot can be accurately determined as part of a blood test, such as prothrombin time (PT), partial thromboplastin time (PTT), activated clotting time (ACT), etc. In some embodiments, the vibration damping of the physical element can be used to monitor the viscoelasticity of the blood periodically (i.e., at two or more time points), and the corresponding viscoelastic parameters can be accurately determined as part of a blood test, such as a thromboelastogram (TEG). In other embodiments, the measured blood viscoelastic parameters can be used to detect the presence of one or more anticoagulants in blood, to distinguish between two or more anticoagulants in blood, and / or to determine the concentration of one or more anticoagulants in blood. In other embodiments, the measured blood viscoelastic parameters can be used to detect the presence of, measure the concentration of, and / or measure the activity of blood clotting factors (e.g., fibrinogen, thrombin) and / or blood components (e.g., red blood cells, platelets). In other embodiments, the measured blood viscoelastic parameters can be used to determine blood clot-specific properties (e.g., clot firmness, fibrinolysis).

[0046] As previously discussed, the fluid properties can be determined from the vibrational properties of the physical element. Alternatively, the entire structure consisting of the physical element and the chamber formed by the substrate and bottom layer can be vibrated at a corresponding resonant or non-resonant frequency to determine the fluid properties, such as the fluid density. Once introduced into the chamber, the additional mass of the fluid dampens the vibration of the entire structure, which then exhibits a reduction in measurable vibration properties, such as vibration amplitude, frequency, and Q factor.

[0047] In-plane vibration One method of measuring the viscosity and viscoelasticity of a fluid involves confining the fluid between a fixed parallel plate or planar structure and a movable parallel plate or planar structure and monitoring the drag experienced by the movable planar structure as it moves at a constant velocity within its own plane relative to the fixed planar structure. The fluid experiences a true shear stress which results in a shear strain in the fluid, and the viscosity and viscoelasticity of the fluid are computed to be determined by the ratio of the applied stress to the strain experienced by the fluid.

[0048] Miniaturized microacoustic sensors such as quartz thickness shear mode resonators (TSM) and surface acoustic wave (SAW) devices have been successfully used as alternatives to conventional viscometers, but these devices measure viscosity at relatively high frequencies and small vibration amplitudes. The penetration depth of the shear waves excited by these sensors is Because the TIFF0007630174000004.tif8135 is small (due to the high frequency), only a thin film of liquid close to the device is probed. In addition, due to the small penetration depth, these sensors are unable to detect particles (size > δ) in complex or non-Newtonian fluids. s ) and can only measure the viscosity of the continuous phase of the fluid. Finally, the smaller the vibration amplitude of these sensors, the lower the measurement sensitivity.

[0049] In the device and method according to the invention, the physical element may be configured such that the suspended beam has at least one natural or fundamental frequency of vibration corresponding to the in-plane vibration. When a fluid sample is introduced and confined in a chamber located below the physical element in contact with the fluid, the vibration induced in the physical element applies a true shear stress to the fluid. By measuring the vibration properties of the physical element, which can be further translated into the shear rate and shear stress experienced by the fluid, the viscosity and viscoelasticity of the fluid can be determined. In some embodiments of the invention, the in-plane vibration of the physical element can be tuned to be sensitive to fluid density, and thus the fluid density can be determined from the damping of the vibration properties. The present device and methodology provide high accuracy measurements of absolute and instantaneous values ​​of viscosity, viscoelasticity, and / or density of the fluid in a fluid sample.

[0050] In one embodiment of the invention, based on the geometric design, structure, and material properties of the physical element, the vibration frequency can be relatively low, such as in the range of tens of kilohertz or less (e.g., 30, 25, 20, 15, 10, 5, 4, 3, 2, or 1 kHz or less), resulting in a relatively large shear penetration depth into the fluid of interest. Also, higher vibration amplitudes can be achieved, resulting in a higher sensitivity to fluid viscosity. In another embodiment of the invention, the physical element can have at least two in-plane vibration modes, one with a low frequency (see above) and one with a high frequency (e.g., above 30 kHz), with associated large and small shear penetration depths, respectively. For fluids with separate components / additives, including non-Newtonian fluids, vibrations corresponding to a shear penetration depth smaller than the size of the separate components / additives can be used to determine the fluid viscosity corresponding to the continuous phase, and shear penetration depths larger than the size of the separate components / additives can be used to determine the bulk viscosity of the fluid. In some embodiments of the invention, the size of the separate components / additives may be a number ranging from 0.5 to 500 μm. "Size" may refer to the hydrodynamic diameter or maximum physical dimension measured along standard Cartesian coordinates. These two in-plane vibrational modes may be induced simultaneously or sequentially in the physical element, thereby allowing for the measurement of the viscosity of the continuous and bulk phases of complex or non-Newtonian fluids. In some embodiments of the invention, the amplitude of the vibration induced in the physical element is controlled by increasing the amplitude of actuation and, as a result, the shear rate applied to the fluid. TIFF0007630174000005.tif7130 can be controlled. In some embodiments of the invention where electromagnetic actuation is used, the amplitude of vibration can be changed by changing the magnitude of the current through the conductive path and / or the applied magnetic field. Thus, fluid viscosity at different shear rates can be determined for complex or non-Newtonian fluids.

[0051] In some embodiments, the device may be configured such that vibration of the physical element induces a first acoustic field in the fluid sample having a first shear penetration depth less than a threshold value, the threshold value being in the range of 0.5 microns to 500 microns, and vibration at a second vibration frequency induces a second acoustic field in the fluid sample having a second shear penetration depth greater than the threshold value. In some embodiments, the first and second shear penetration depths differ by at least a minimal amount, which may be a value of 0.5, 1, 2, 3, 4, 5, 10, 15, 20, 25, or 30 microns or more, or a value in the range of 0.5 to 1, 1 to 2, 2 to 3, 3 to 4, 4 to 5, 5 to 10, 10 to 15, 15 to 20, 20 to 25, or 25 to 30 microns.

[0052] In some embodiments of the present invention, when a biological fluid such as blood is introduced into the chamber, the two in-plane vibration modes may have a penetration depth greater than or less than the average size of red blood cells, which form a separate component in the sample. In some embodiments of the present invention, the two in-plane vibration modes may have a penetration depth greater than or less than 5 μm, which corresponds to a lower limit of the size of red blood cells. In some embodiments of the present invention, the two in-plane vibration modes may have a penetration depth greater than or less than 10 μm, which corresponds to an upper limit of the size of red blood cells. As discussed above, the two in-plane vibration modes can be used to simultaneously or sequentially measure the viscosity of the plasma (continuous phase) and whole blood (bulk phase) of a blood sample. In some embodiments of the present invention, when a biological fluid such as blood is introduced into the chamber, the two in-plane vibration modes may have a penetration depth greater than or less than the average size of platelets, which form a separate component in the sample. In some embodiments of the present invention, the two in-plane vibration modes may have a penetration depth greater than or less than 2 μm, which corresponds to a lower limit of the size of platelets. In some embodiments of the invention, the two in-plane vibrational modes may have a penetration depth greater than or less than 0.5 μm, which corresponds to the size of some macromolecules or macromolecular assemblies, the size being defined by the hydrodynamic diameter of the molecule.

[0053] The chamber of the device according to the invention defines an internal volume suitable for receiving and holding a fluid sample and consists of a substrate layer located above the chamber, tethered to at least one physical element in contact with the fluid, the substrate layer being arranged in a manner that allows the motion or vibration of the suspended beam. The motion or vibration can occur in an unhindered manner, i.e., occupying any of the ranges of space traversed during vibration, and does not result in collision or contact with other solid materials of the physical element. For clarity, "unhindered" does not mean "absolutely no resistance", the fluid, if present, provides some resistance or damping to the vibration, the beam structure can provide a restoring force when the suspended beam is displaced from its rest position, and the presence of resistance by the fluid, restoring force by the beam structure, etc. are fully consistent with "unhindered" motion or vibration as used herein. The chamber is defined by a substrate layer and a bottom layer located above and below the chamber, respectively, such that the physical element (tethered to the substrate layer) has a surface that can physically contact the fluid sample in the chamber, and the substrate layer can be formed, patterned, or otherwise assembled or constructed to include one or more physical elements. In some embodiments of the invention, the substrate layer is affixed to the bottom layer by an intermediate layer in all areas except the area where the physical element is located above the chamber, thereby effectively restricting the movement of the substrate only to the physical element. In some embodiments of the invention, the chamber can include multiple physical elements within the same substrate or multiple substrates as part of multiple layers in the device.

[0054] In another embodiment of the invention, a shear wave field is induced in a fluid held within a chamber when vibrations are induced in a physical element (i.e., a suspended beam). The device can be configured such that the distance (D) between the bottom layer and the physical element tethered to the substrate layer is configured to have a standing shear-wave field induced in the fluid medium between the bottom layer and the suspended beam during vibration. To induce a consistent and reliable standing shear-wave field, the distance D is set to the shear penetration depth of the vibration. For example, if the fluid medium is water having a density of 1 gm / cc and a viscosity of 1 cP, and a vibration frequency of 1 kHz, the distance D may be δ s = 17.84 μm or less. The shear wavelength (λ) of the field induced in the fluid medium in the chamber below the physical element s the lower the ratio of the distance D to the fluid medium, the more consistent and uniform the acoustic field provided in the fluid medium; TIFF0007630174000007.tif7131, where δ s is the shear penetration depth TIFF0007630174000008.tif7131, δ l is the loss tangent angle of the fluid medium.

[0055] The distance D may be adjustable or permanently fixed depending on the nature of the surrounding medium. In some embodiments of the present invention, the distance D may be adjusted by an intermediate layer between the substrate layer and the bottom layer comprising the physical element. The intermediate layer may be made of a flexible material such as foam, polymeric substrate, etc., such that the thickness of the intermediate layer may be changed by applying compression to the device in the thickness direction. The compression pressure may be applied offline before the measurement depending on the fluid sample, or in real time, with the fluid to be tested introduced into the chamber, while simultaneously monitoring the fluid-induced stationary shear wave field. In some embodiments of the present invention, the distance D may be adjusted by using an automated assembly to physically move the bottom layer closer to the physical element or further away from the physical element, or vice versa, and then filling the area around the physical element between the substrate layer and the bottom layer comprising the physical element to form the chamber. The filling material may be one that can flow and change state from a fluid to a solid, including, but not limited to, epoxies, etc. In some embodiments of the present invention, an acoustic field imposed on a fluid confined between a physical element and a chamber wall can be used to determine not only the viscosity of the fluid, but also its viscoelastic properties, and the presence of a fixed chamber wall close to the vibrating physical element provides an additional advantage for monitoring with high precision the change in the physical properties of the fluid as a function of time during gel formation.

[0056] In some embodiments of the invention, when a biological fluid such as blood is introduced into the chamber and undergoes a clotting reaction, the blood clot formed between the physical element and the chamber wall can be used to compute the viscoelastic properties of the blood clot. In some embodiments of the invention, the viscoelastic properties of blood undergoing clotting can be monitored as a function of time and the corresponding viscoelastic parameters can be accurately determined as part of a blood test such as a thromboelastogram (TEG). In other embodiments, the measured blood viscoelastic parameters can be used to detect the presence of one or more anticoagulants in the blood, to distinguish between two or more anticoagulants in the blood, and / or to determine the concentration of one or more anticoagulants in the blood. In other embodiments, the measured blood viscoelastic parameters can be used to detect the presence of, measure the concentration of, and / or measure the activity of blood clotting factors (e.g., fibrinogen, thrombin) and / or blood components (e.g., red blood cells, platelets). In other embodiments, the measured blood viscoelastic parameters can be used to determine blood clot-specific properties (e.g., clot firmness, fibrinolysis).

[0057] Out-of-plane vibration In another embodiment of the invention, the suspended beam (i.e., the physical element) may have at least one natural or fundamental frequency of vibration that corresponds to an out-of-plane vibration. When a fluid sample is introduced and confined in the chamber, and the physical element is positioned above the chamber and in contact with the fluid, the vibrational characteristics of the suspended beam are damped. The density of the fluid may be determined by monitoring the vibrational characteristics, including, but not limited to, vibration amplitude, phase, frequency, and quality factor. Upon addition of the fluid sample to the chamber, the vibrational characteristics may be measured as a change in the respective properties. In addition, the out-of-plane vibration of the physical element may be tuned to be sensitive to the fluid density, and thus the fluid density may be determined from the damping of the vibrational characteristics. In some embodiments of the invention, the measured fluid density may be used to identify the concentration of at least one distinct component / additive in the fluid. The distinct component / additive may be, for example, a macromolecule, a macromolecular complex (e.g., a cytoskeletal filament), a red blood cell, a platelet, a particle, or a solid phase object. In some embodiments of the invention, the vibration of the physical element may be configured to independently measure the densities of the continuous and bulk phases of the fluid using the same or different resonant vibration modes of the physical element.

[0058] In another embodiment of the invention, the physical element can allow for the measurement of the continuous phase viscosity, bulk viscosity, and density of the fluid. In some embodiments of the invention, a standardized measurement of the bulk viscosity of the fluid can be determined as a function of one or more of the continuous phase, bulk phase viscosity, fluid density, and the concentration of separate components / additives (if present). Furthermore, the static or dynamic viscoelastic properties of the fluid as a function of time can be determined from the measured (or standardized measured) viscosity of the fluid at different applied shear rates using various theoretical or empirical models. For example, τ can be determined by statistical methods such as regression analysis. y To determine the values ​​of and k, the bulk viscosities measured at different shear rates were TIFF0007630174000009.tif7131, where τy is the yield stress of the fluid, TIFF0007630174000010.tif7129 ​​is the shear rate applied to the fluid and k is a constant.

[0059] In another embodiment of the invention, when the fluid to be tested is blood introduced into the chamber, a physical element is used to measure the plasma viscosity (η plasma , continuous phase), whole blood viscosity (η WBV The total blood viscosity (the total volume of the blood, the bulk phase), and blood density can be measured. The measured blood density can be used to identify the concentration of red blood cells or hematocrit (Hct) in the sample. Because whole blood viscosity is highly dependent on plasma viscosity and hematocrit, blood viscosity needs to be standardized or corrected to a fixed hematocrit (typically, 0.45 is used) in order to identify the normality or abnormality of blood viscosity in different individuals. The equation for standardized or corrected whole blood viscosity at a fixed hematocrit of 0.45 is given by: TIFF0007630174000011.tif14129In formula, η WBV-0.45 is the normalized or corrected whole blood viscosity at a hematocrit of 0.45, and η WBV-Hct is the whole blood viscosity at hematocrit Hct, and η plasma is the plasma viscosity.

[0060] In another embodiment of the invention, a chamber can be incorporated into a disposable test strip with a substrate layer that includes physical elements. The chamber is assembled to suspend one or more physical elements in the substrate layer above the chamber, with a surface that can physically contact the fluid sample in the chamber below, while another part of the substrate layer is affixed to a bottom layer below the chamber as part of multiple layers stacked to form the test strip. Furthermore, the chamber may be composed of multiple layers that are patterned / formed to position its walls closely together to form a capillary. The materials selected to create the surfaces of the chamber can be selected to provide low surface tension and / or contact angle (e.g., 45 degrees or less) that allows the chamber to fill by capillary action. These materials are selected because they enhance liquid filling without interfering with the reaction. Examples of such materials will be widely known to those skilled in the art. In some embodiments of the invention, the substrate layer and bottom layer of the chamber can comprise multiple components, including, but not limited to, conductive paths for performing electrochemical analysis and / or detecting the presence of analytes in the fluid in the chamber and / or the fluid itself. In some embodiments of the present invention, the conductive pathway can be used to perform electrochemical detection of sugar levels in a blood sample introduced into the chamber.

[13] In some embodiments of the present invention, the substrate layer and the bottom layer may further comprise a conductive pathway including one or more heating elements, such as a resistive track heater, and / or one or more temperature sensors, respectively, for controlling and monitoring the temperature of the chamber.

[0061] In some embodiments, the fluid sample can be introduced into the chamber where the fluid sample begins to undergo a chemical reaction immediately after its addition. For example, the chamber can contain an agent that reacts with the sample as soon as the sample is present, an agent can be added to the sample as soon as the sample is present, or one or more of the chamber's surfaces can promote or catalyze a reaction in the fluid sample. When a fluid is introduced and confined in the chamber enclosed inside the test strip, the vibration characteristics of the physical elements (including but not limited to amplitude, phase, frequency, Q factor, etc.) generally stabilize temporarily before further changes occur due to chemical reactions, allowing for rapid determination of the physical properties of the fluid. The fast response time of the sensor can also allow for accurate identification of the time when the fluid sample was introduced into the chamber.

[0062] The substrate layer comprising the physical elements can be made of any suitable inert material, and can be selected from polymers such as polyester (PET), plastics, and the like, among others. The substrate layer can be fabricated using mass production methods, including, but not limited to, roll-to-roll continuous flow manufacturing. The physical elements can be formed or patterned by etching, laser processing, or mechanical punching (e.g., using a die) of the substrate layer. The conductive paths through the physical elements can be created by patterned conductive paths on the substrate layer forming a circuit, such as in the case of a printed circuit board. The conductive circuits can be of any suitable conductive material, and can be selected from, but not limited to, conductive polymers or inks, gold, platinum, copper, or silver. The conductive paths can be patterned by several methods, such as laser ablation, or by screen printing or inkjet printing. Furthermore, the conductive paths can be insulated from the fluid by deposition of an insulating layer on the conductive paths, or the conductive layer can be embedded within the substrate layer comprising the physical elements.

[0063] In some embodiments of the invention, the conductive path may be exposed to a fluid to allow electrochemical analysis and / or detection of the presence of an analyte in the fluid in the chamber and / or the fluid itself. In some embodiments of the invention, the conductive path may be used to perform electrochemical detection of sugar levels in a blood sample introduced into the chamber. The conductive path may serve to form a closed electrical path through the physical element. In some embodiments of the invention, the substrate comprising the physical element may be made of a substantially or entirely metallic material that also serves the purpose of the additional function of the conductive path through the physical element.

[0064] In other embodiments, the physical element is substantially non-metallic. For example, the metal content of the physical element may be less than 50%, 40%, 30%, 20%, 10%, 5%, or 1% by weight or volume. The configuration of the device in which the physical element is substantially non-metallic can provide beneficial properties. For example, the substrate can be made of polyester, and the conductive path can be formed by printing a conductive ink onto the polyester substrate. The use of a substantially non-metallic physical element allows for independent control of the geometry of the polyester substrate and the conductive path, resulting in finer control over the vibrational characteristics of the physical element than if the element were substantially metallic. Furthermore, flexible polyester is compatible with high volume roll-to-roll continuous flow manufacturing processes, which may be beneficial for cost-effective manufacturing of substrate layers, for example, as part of a disposable test strip.

[0065] In some embodiments of the present invention, the substrate layer on which the physical elements are disposed can be patterned by laser cutting a sheet of polyester, on which conductive paths are printed in a specific pattern to provide electrical conductivity through the physical elements. Conductive inks, including but not limited to silver inks and palladium inks, can be used to print the conductive paths on the substrate layer.

[0066] In certain embodiments, a series of edge connectors can be provided on the disposable strip to allow direct contact or connection between the test meter and the physical element. A further purpose of the conductive circuit would be to activate the device in a state ready to receive a fluid sample by bridging the contacts provided by the edge connectors. Alternatively, the physical element can be excited and / or monitored by non-contact means such as acoustic wave amplitude reflection, light beam, or radio frequency. The individual layers of the test strip can be fabricated and aligned such that no further trimming or adjustment to their size and / or circumferential surface is required after assembly of the test strip. Alternatively, multiple test strips can be produced simultaneously by fabricating and aligning the individual layers of the test strip and trimming to the desired size and shape of the individual disposable test strip after assembly.

[0067] In another embodiment of the invention, the fluid to be tested is a biological fluid, in particular blood. The chamber may comprise one or more reagents, including at least one blood clotting agent in an amount suitable for inducing clotting of the blood sample in the chamber. In some embodiments of the invention, the reagent is present in the chamber in a dry form. The reagent may be added to the chamber before or after the assembly of the strip is complete. Furthermore, the reagent may be provided on the chamber-facing surface of the physical element of the substrate layer located above the chamber. In some embodiments of the invention, the reagent is added to the chamber before or after the introduction of blood. In some embodiments of the invention, the reagent consists of one or a combination of anticoagulants (such as heparin, warfarin, etc.), molecules with variable viscosity (such as dextran), and clotting factor molecules capable of inducing clotting. In general, coagulation factor molecules include naturally occurring or synthetic compounds that either promote or inhibit blood clotting, including, but not limited to, Factors I, II, III, IV, V, VI, VII, VIII, IX, X, XI, XII, XIII, von Willebrand Factor, prekallikrein, high molecular weight kininogen, fibronectin, antithrombin III, heparin cofactor II, protein C, protein S, protein Z, protein Z-related protease inhibitor, plasminogen, alpha 2-antiplasmin, tissue plasminogen activator (tPA), urokinase, plasminogen activator inhibitor-1 (PAI1), plasminogen activator inhibitor-2 (PAI2), and cancer procoagulant. In general, "viscosity-changing molecules" include compounds that, when introduced into blood present in the chamber, change the viscosity of the blood by at least 0.001 cP. In other embodiments, the above-mentioned reagents may be present in the fluid when introduced into the chamber, and do not necessarily have to be present in the device as such. For example, the reagents may be present in a blood sample as a result of administration to an individual who provided the blood. In another embodiment, the device comprises a plurality of chambers in which one or more of the reagents are provided in one or more chambers, and houses at least one substrate with one or more physical elements suspended above the chambers and having a surface capable of physical contact with the fluid in the chamber.Furthermore, the same blood sample can be directed and divided into multiple microfluidic pathways leading to different chambers within the device, and thus blood clotting can be induced and monitored in separate regions of the device within the same blood sample.

[0068] In some embodiments of the present invention, when a biological fluid such as blood is introduced into the chamber, the two in-plane vibration modes of the physical element may have a penetration depth greater than or less than the average size of red blood cells, which form a separate component in the sample. In some embodiments of the present invention, the two in-plane vibration modes may have a penetration depth greater than or less than 5 μm, which corresponds to approximately the lower limit of the size of red blood cells. The two in-plane vibration modes can be used to simultaneously or sequentially measure the viscosity of the plasma (continuous phase) and the whole blood (bulk phase) of a blood sample. In some embodiments of the present invention, when a biological fluid such as blood is introduced into the chamber, the two in-plane vibration modes may have a penetration depth greater than or less than the average size of platelets, which form a separate component in the sample. In some embodiments of the present invention, the two in-plane vibration modes may have a penetration depth greater than or less than 2 μm, which corresponds to the lower limit of the size of platelets. In some embodiments of the present invention, the two in-plane vibration modes may have a penetration depth greater than or less than 0.5 μm, which corresponds to approximately the size of some macromolecules and / or macromolecular complexes. As discussed above, the two penetration depths may differ by at least a minimum amount, or by an amount within a given range.

[0069] In another embodiment of the invention, when the fluid to be tested is blood introduced into the chamber, the physical element is the plasma viscosity (η plasma , continuous phase), whole blood viscosity (η WBVThe whole blood viscosity is highly dependent on the plasma viscosity and hematocrit, so blood viscosity needs to be standardized or corrected to a fixed hematocrit (typically 0.45 is used) to identify normality or abnormality of blood viscosity in different individuals.

[0070] In some embodiments of the invention, the biological fluid consists of blood or plasma, and clotting can be initiated by physical contact with a negatively charged substrate or exposure to a compound that induces blood clotting, including, but not limited to, thromboplastin and kaolin. Thus, a compound that induces blood clotting, such as thromboplastin, can be present in the device according to the invention and used in the method according to the invention, including before the addition of blood or plasma. Alternatively, a compound that induces blood clotting, such as thromboplastin, can be added to the blood or plasma before or after insertion into the chamber. The plasma, whole blood viscosity, viscoelasticity, and / or density of the sample can be monitored before, during, and / or after the clotting reaction. Additionally, the time to formation of a blood clot can be determined as part of a blood test, including, but not limited to, prothrombin time (PT), partial thromboplastin time (PTT), activated clotting time (ACT), and the like. In some embodiments of the invention, when a biological fluid, such as blood, is introduced into the chamber and undergoes a clotting reaction, the blood clot formed between the physical element and the chamber wall can be used to measure the viscoelastic properties of the blood clot. In some embodiments of the invention, the viscoelastic properties of blood undergoing clotting can be monitored as a function of time and blood tests such as thromboelastogram (TEG) can be performed. In some embodiments of the invention, the hematocrit computed in the blood sample by the measured blood density can be used to calibrate the above-mentioned blood clotting tests (PT, PTT, ACT, TEG, etc.) performed.

[0071] In some embodiments of the invention, when a biological fluid such as blood is introduced into the chamber and undergoes a clotting reaction, the damping of vibrational properties in one or more physical elements in the substrate layer can be used to determine the real-time viscoelastic properties of the blood as it clots. Measurable or quantifiable vibrational properties of the physical elements include, but are not limited to, vibrational amplitude, phase, frequency, and quality factor. In some embodiments of the invention, the vibration of one or more physical elements can be either in-plane or out-of-plane. In some embodiments of the invention, where the vibration corresponds to a natural or fundamental resonant frequency (or a harmonic thereof) of the physical element, the vibrational properties are determined by actuating and detecting vibration of the physical element at a range of frequencies near the resonant frequency. These vibrational properties, such as amplitude and phase, can be measured as a function of frequency near the resonant frequency (e.g., amplitude vs. frequency, and phase vs. frequency scans), which can be monitored and recorded periodically (i.e., at two or more points in time) to determine different aspects of the blood clotting cascade. Using frequency scans of these vibrational properties monitored periodically over time, tests such as thromboelastograms (TEGs) can be performed and viscoelastic curves and parameters of the characteristic wine glass shape can be extracted. TEG-like viscoelastic parameters include, but are not limited to, clot formation time (R), activated clotting time (ACT), maximum thrombin generation (ThrombinPeak), clot firmness (G), platelet contraction rate (Plt-Cont), and fibrinolysis rate (Lys-Rate). In some embodiments of the present invention, considering that smaller clots form faster, TEG-like curves and parameters can be extracted in less than 10 minutes due to the device's high sensitivity of physical elements and the low blood sample volume required to test. This provides a significant advantage over commercially available TEG systems (e.g., Haemonetics' TEG-5000, 6s, and Instrumentation Laboratory's ROTEM), which take up to 30-60 minutes to generate the entire TEG curve and parameters.In some embodiments of the invention, the vibration of the physical element can be at high frequency (e.g., on the order of tens, hundreds, or thousands of kHz), so that the coagulation test measurements performed using the disposable test strip are insensitive to ambient vibration (e.g., frequencies <100 Hz). This provides a significant advantage over commercially available systems that are vibration sensitive and stationary. A mathematical model of viscoelastic vibration damping of the physical element, incorporating different kinetic processes in the blood coagulation cascade, is used to fit data from frequency scans of the vibration characteristics as a function of time, and thus provides the threshold thrombin generation time (R), the rate of catalysis by prothrombinase or factor Xa (k2), the rate of catalysis by thrombin or factor IIa (k1), the concentration of cleavable fibrinogen or factor I (C). fibrinogen These measured hemostatic parameters can be used to extract viscoelastic parameters, such as TEG, allowing the monitoring of the concentration and activity of different coagulation factors (e.g., fibrinogen, thrombin), properties specific to blood clots (e.g., clot firmness G, fibrinolysis rate Lys-Rate), as well as the activity / effect of different blood components involved in coagulation (e.g., platelet contraction rate Plt-Cont, effect of red blood cells or hematocrit), as a function of time during the blood coagulation cascade.

[0072] In some embodiments of the present invention, monitoring the concentration of cleaved fibrinogen as a function of time during the blood coagulation cascade and plotting it by mirroring it around the time axis (e.g., x-axis is time and y-axis is fibrinogen concentration) can allow the generation of a wine-glass shaped viscoelastic curve that is typically output in a TEG test. Alternatively, one of the vibration characteristics (e.g., amplitude) at one or more vibration frequencies can be plotted as a function of time and mirrored around the time axis to generate a typical TEG-like viscoelastic curve. In another embodiment of the invention, monitoring the concentration of thrombin as a function of time during the blood coagulation cascade allows for the measurement of threshold thrombin generation time (e.g., clot formation time R), time to maximum thrombin generation (e.g., ACT), maximum thrombin concentration (e.g., ThrombinPeak), and area under the thrombin generation curve at different time durations (e.g., endogenous thrombin potential (ETP)), which in turn can be used to perform tests such as thrombin generation assay (TGA). In yet another embodiment of the invention, thrombin concentration can be extracted by monitoring the rate of increase in cleaved fibrinogen concentration. In yet another embodiment of the invention, thrombin concentration and / or threshold thrombin generation time or clot formation time R can be monitored to detect the presence and quantify the effect of one or more anticoagulants in the blood, including but not limited to heparin and factor Xa inhibitors (e.g., rivaroxaban, apixaban).

[0073] In some embodiments of the invention, a blood clot specific property such as clot firmness G can be monitored as a function of time during the blood clotting cascade and plotted by mirroring it around the time axis (e.g., x-axis is time and y-axis is clot firmness G), allowing the generation of a wine-glass shaped viscoelastic curve that is typically output in TEG tests. In another embodiment of the invention, clot firmness G can be monitored to measure the concentration and quantify the effect of one or more coagulation factors, including but not limited to cleavable fibrinogen or factors I and XIIIa. In yet another embodiment of the invention, clot firmness G can be expressed as a function of the concentration of cleaved fibrinogen (e.g., G is expressed as (C fibrinogen ) 2In yet another embodiment of the invention, the clot firmness G, the concentration of cleaved fibrinogen, and / or the threshold thrombin generation time or clot formation time R can be monitored to detect the presence of and quantify the effect of one or more anticoagulants in the blood, including but not limited to factor IIa inhibitors (e.g., dabigatran). In yet another embodiment of the invention, monitoring the activity / effect of different blood components involved in clotting (e.g., platelets, red blood cells, or hematocrit) as a function of time during the blood clotting cascade can allow for the measurement of the concentrations of these blood components (e.g., platelets) and their corresponding quantification of the effect of the blood clotting process, such as platelet contraction, and the effect of red blood cells on clot firmness. In yet another embodiment of the present invention, the platelet contraction rate Plt-Cont is monitored to detect the presence and quantify the effect of one or more platelet agonists, including but not limited to adenosine diphosphate (ADP), arachidonic acid (AA), collagen, and thrombin receptor activator peptide 6 (TRAP-6), and / or platelet inhibitors, including but not limited to glycoprotein (GP) IIb / IIIa inhibitors (e.g., abciximab, eptifibatide), aspirin (registered trademark), and clopidogrel, in the blood, and thus can be used to perform tests such as platelet function assays (PFA) (e.g., Roche's Multiplate Analyzer).

[0074] In some embodiments of the present invention, monitoring a blood clot specific characteristic, such as the fibrinolysis rate Lys-Rate, as a function of time during the blood clotting cascade can allow for quantification of blood clotting processes, such as intrinsic and extrinsic fibrinolysis. In another embodiment of the present invention, the fibrinolysis rate Lys-Rate can be monitored to detect the presence and quantify the effect of one or more additives in the blood, including, but not limited to, tissue plasminogen activator (tPA) and tranexamic acid (TXA), which affect one or more blood clotting processes (e.g., extrinsic fibrinolysis).

[0075] In some embodiments of the invention, the concentration and / or effect of two or more coagulation factors can be monitored to distinguish between the presence of two or more anticoagulants, for example, between factor Xa (e.g., rivaroxaban, apixaban) inhibitor-based anticoagulants and factor IIa (e.g., dabigatran) inhibitor-based anticoagulants. In another embodiment of the invention, the concentration of thrombin and cleaved / or uncleaved fibrinogen (or their effect on one or more vibration characteristics) can be monitored to distinguish between the presence of factor Xa and factor IIa inhibitor-based anticoagulants in blood. This is because factor Xa inhibitors tend to reduce thrombin concentrations but have limited or no effect on cleaved or uncleaved fibrinogen concentrations, while factor IIa inhibitors tend to reduce cleaved fibrinogen concentrations (or increase uncleaved fibrinogen concentrations) and thus allow a differentiation response that allows for the distinction between anticoagulants. In another embodiment of the invention, this differentiation response allowing for the discrimination between anticoagulants may be a metric defined by the ratio of thrombin to the concentration of cleaved or uncleaved fibrinogen. In yet another embodiment of the invention, this differentiation response allowing for the discrimination between anticoagulants may be a metric defined by the ratio of one or a combination of the vibrational properties of the suspended beam sensitive to the thrombin concentration to one or a combination of the vibrational properties sensitive to the concentration of cleaved or uncleaved fibrinogen. In yet another embodiment of the invention, after successful identification of a particular anticoagulant in blood, the effect of the anticoagulant on the clot formation time R may be used to determine the concentration of the anticoagulant using a predetermined calibration or anticoagulant dose-response curve for the clot formation time R.

[0076] To provide an automated means for determining the viscosity, viscoelasticity, and / or density of a fluid sample, monitoring or reading the device according to the present invention may be provided by the use of a machine, such as a metering device, that can interact with the sensor device of the present invention in a manner that allows the meter to determine the result of the sample test. In some embodiments of the present invention, the metering device comprises one or more of a processor, a bus, an input interface such as a keypad or data port, an input interface such as a resistive or capacitive touch screen display, an output interface such as a display screen, an output interface such as a data port, a wired and / or wireless connection for the input and / or output interface, a power source such as a battery or a power cord or a power receptacle, a strip connector interface for providing electrical conductivity, and the like. In some embodiments of the present invention, when the sensor device is connected or engaged with the meter, the meter provides an automated means for determining the physical properties of the fluid, including, but not limited to, viscosity, viscoelasticity, and / or density. For example, when the meter is connected to the sensor device, the meter can releasably / temporarily engage with a test strip, and typically has the ability to output the test result by a visual display or readout. Additionally, when the meter processes the data received from the sensor device, the meter can process this information and apply correction factors that can account for any batch-to-batch variations associated with the manufacturing of disposable test strips.

[0077] In some embodiments of the invention, the instrument may include electronic components as part of a processor unit configured to induce and detect vibrations of a physical element. When the instrument is connected to a sensor device, electrical conductivity is established between the processor unit and a conductive path through one or more physical elements in the sensor device. In some embodiments of the invention, vibrations at a particular frequency are induced in the physical element by the processor unit applying a time-varying actuation signal, such as a voltage / current, corresponding to a vibration frequency through one or more conductive paths in the physical element. Similarly, a time-varying detection signal, such as a voltage / current, is measured by the processor unit through one or more conductive paths in the physical element in the vicinity of the vibration frequency. In some embodiments of the invention, where the vibration corresponds to a natural resonant frequency or a fundamental resonant frequency (or a harmonic thereof) of the physical element, the resonant characteristics are determined by actuating and detecting vibrations of the physical element in a range of frequencies in the vicinity of the resonant frequency, for example, within 1.5, 2, 3, 4, or 5 times the resonant frequency. The measured resonant characteristics may include, but are not limited to, resonant amplitude, phase, resonant frequency, Q factor, etc. In some embodiments of the invention, when vibrations of the physical element are induced and / or detected using electromagnetism, the actuation signal provided by the processor unit corresponds to a current injected / applied in the range of 100 nA to 10 A, e.g., 100 μA to 1 A, through a conductive path in the physical element in the presence of a magnetic field in the range of 0.001 T to 10 T, e.g., 0.01 T to 2 T. Similarly, in some embodiments, the detection signal measured by the processor unit corresponds to a voltage in the range of 0.01 μV to 10 V, e.g., 1 μV to 1 V, in the presence of a magnetic field in the range of 0.001 T to 10 T or 0.01 T to 2 T. In some embodiments, the amplitude of the vibrations induced in the physical element is in the range of 1 nanometer to 100 microns, e.g., 10 nanometers to 10 microns. The instrument comprises one or more enclosures for housing one or more permanent or variable magnet assemblies (such as electromagnets) in the vicinity of a connector that provides electrical conductivity to one or more physical elements in the sensor device.In some embodiments of the invention, the meter comprises an upper half and a lower half that form part of a clamshell-based assembly that allows for the enclosure of items into either the lower or upper half, including, but not limited to, a touch screen display, connectors to sensor devices, magnet assembly, processor unit, battery, data port, and power cord receptacle for input and output interfaces. The upper and lower halves may include one or more alignment features that allow for precise assembly and fastening or fastening of the two halves using means such as a snap-fit ​​assembly, a screw-based compression assembly, or the like.

[0078] In some embodiments of the invention, the meter may include facilities for sampling environmental conditions such as temperature, humidity, altitude, air pressure, etc., and applying correction factors to the measurement response. In another embodiment of the invention, the meter provides an actuation signal for vibration of a physical element within a range of frequencies in the vicinity of the resonant frequency of the physical element, measures the detection signal from the vibration, and records a scan of the vibration characteristic as a function of frequency. This frequency scan of the vibration characteristic may be used as a metric to identify any batch-to-batch variations associated with the manufacture of disposable test strips. In yet another embodiment of the invention, the frequency scan of the vibration characteristic may also be used to detect and monitor the resonant frequency of the physical element as a function of time, which may be sensitive to environmental conditions such as temperature, humidity, etc., and may be used to measure these environmental conditions using predefined calibration curves established to allow for them. Additionally, the meter may have a memory facility, which may allow for storing and recalling previous readings, for example, to provide a comparison of measurements across two or more dates or times. This feature may be particularly useful in the case of periodic testing to monitor different aspects of the blood clotting cascade (e.g., anticoagulant levels such as warfarin, heparin, etc.). In some embodiments of the invention, to calibrate the machine or individual sensor devices, the meter may perform an initial self-test on a disposable strip prior to blood introduction. When blood is introduced to the strip, changes in the fluid properties of the area around the vibrating physical element result in changes in the vibrational characteristics of the structure, including the electronics, which initiates the analysis of the blood sample. Over a known period of time, the analysis is completed and changes in the viscosity, viscoelasticity, and density of the blood sample before, during, and after the clotting reaction are measured. After a suitable reaction time has elapsed, an algorithm may be used to convert the measured vibrational characteristics of the physical element into a usable test result.

[0079] FIG. 1(a) shows an embodiment of a substrate layer of a sensor device of the present invention, which consists of a physical element, the vibration of which is suitable for measuring a property of a fluid, including, but not limited to, viscosity, viscoelasticity, and / or density. The fluid may be a biological fluid, and the property may be measured before, during, and after a chemical reaction. As shown in FIG. 1(a), a substrate layer assembly 100 is provided for integration into a disposable test strip embodiment of a sensor device of the present invention. According to this embodiment, the substrate layer comprises a "physical element" (e.g., as a result of being machined to form the physical element), which includes a suspended beam 101 attached to the body of the substrate layer 102 at both ends of the length of the beam 101. The body of the substrate layer 102 is maintained to be stationary, such that the physical element is configured to perform an unhindered movement or vibration when actuated. Also, the body of the substrate layer 102 may be relatively larger than the suspended beam 101. The two conductors 103 and 104 are formed and patterned on the substrate layer such that there are two independent and isolated conductive paths through the physical element. In an alternative embodiment, a single conductor is formed and patterned on the substrate layer. A magnetic field 105 is applied in a direction perpendicular to the plane of the substrate layer. In the presence of a constant magnetic field 105, a time-varying current applied through one or both conductors 103 and 104 causes the physical element to vibrate in-plane, the vibrations may be at the fundamental or harmonic resonant frequencies of the physical element. Alternatively, a magnetic field 105 applied in the same plane as that of the physical element causes the physical element to vibrate out-of-plane, again, the vibrations may be at the fundamental or harmonic resonant frequencies of the physical element. In the presence of the magnetic field 105, the vibrations of the conductors 103 and 104 electromagnetically induce a "detection voltage" that may be used to ascertain the characteristics of the physical vibration movement within the structure. Time-varying current and sense voltage can be applied and measured through either one of the conductors 103 and 104, respectively, thus isolating the actuation and sense signals reducing crosstalk or interference.In an alternative embodiment, a single conductor can be formed and patterned on the substrate layer, such that both the time-varying current and the detection voltage can be applied and measured through the same conductor. The shape and geometry of the suspended beam 101, as well as the exact location of attachment of the beam 101 to the body of the substrate layer 102, can be selected to obtain optimal sensitivity for the measurement of fluid properties, ascertained by methods such as finite element analysis, empirical analysis, theoretical analysis, trial and error, etc. In addition, the geometry can be matched to relatively low or high vibration frequencies, resulting in relatively large or small shear penetration depths into the fluid being examined. The amplitude of the vibration induced in the physical element may also be controlled by the current applied through either or both of the conductors 103 and 104, and the shear rate applied to the fluid may then be controlled by the current. TIFF0007630174000013.tif6128 can be controlled.

[0080] FIG. 1(b) shows an exploded schematic of a substrate layer assembly for integration into a disposable test strip. Substrate layer 110 is patterned to form a rectangular suspended beam (i.e., physical element) that is attached to the body of the substrate layer at both ends of the beam's length. The structure of the physical element may be formed by any suitable method, such as conventional methods of laser cutting, CNC milling, chemical etching, stamping, or mechanical punching (e.g., using a die) of the substrate layer. Separate, isolated, patterned conductive tracks 111 and 112 are disposed on substrate layer 110. These conductive tracks may be disposed by any suitable method, such as conventional methods of screen printing, inkjet printing, or laser ablation, and may be made of any suitable conductive and chemically inert material. A patterned insulating dielectric layer 113 is disposed over conductive tracks 111 and 112 such that the conductive tracks are completely insulated everywhere, except over areas 114 and 115 dedicated to providing electrical connection to the physical element.

[0081] Further embodiments are shown in Figure 2. Figure 2(a) shows a further embodiment of a sensor device in the form of a disposable test strip 200. Figure 2(b) shows an exploded schematic view of the disposable test strip 200 of Figure 2(a). Figures 2(c) and 2(d) show photographs of a disposable test strip assembled without and with a blood sample introduced to the strip, respectively.

[0082] The disposable test strip 200 consists of a base substrate 201 on which is disposed a hydrophilic wicking layer 202, which may optionally include a reagent that facilitates a chemical reaction. The base substrate 201 provides rigidity and improves the overall hardness of the disposable test strip. A chamber forming layer 203 is disposed on the hydrophilic wicking layer 202. This chamber forming layer may be formed, for example, using a patterned precast film, or by laser cutting or mechanically punching (e.g., using a die) a film, or by screen printing or inkjet printing a suitable non-reactive polymeric material. This chamber forming layer is patterned to have cutouts 204 for forming chamber walls in the vicinity of a physical element that can be suspended for unhindered movement or vibration over the chamber, and has a face of the physical element that can be in physical contact with the fluid sample in the chamber. In an alternative embodiment, the reagent that facilitates a chemical reaction in the fluid may be present as a sublayer. In yet another alternative embodiment, the reagent may be provided on any interior surface of the chamber. The assembled "bottom stack" of layers consists of a base substrate 201, a hydrophilic layer 202, and a chamber-forming layer 203. To form the assembly, one or both sides of these component layers may incorporate an adhesive (e.g., a pressure-sensitive adhesive) to facilitate adhesion between each of the layers. A reagent layer for facilitating reactions within the chambers may alternatively be loaded onto the exposed surface of the hydrophilic wicking layer 202 after the "bottom stack" of layers has been assembled.

[0083] A physical element sensor device assembly 205 as detailed in the embodiment depicted in FIG. 1(a) and FIG. 1(b) may be laminated on top of a "bottom stack" including a base substrate 201, a hydrophilic layer 202, and a chamber forming layer 203, such that a physical element (or rectangular suspended beam) is suspended over a "chamber" defined by the sidewalls of a cutout 204 in the chamber forming layer 203. To facilitate adhesion between the two layers to form the disposable test strip 200, an adhesive (e.g., a pressure sensitive adhesive) may be incorporated on the corresponding sides of the physical element sensor device assembly 205 and / or the chamber forming layer 203 that face each other. The physical element sensor device assembly 205 is patterned to have three circular openings 206, as seen in FIG. 2(a). These circular openings may be formed by any suitable method, such as conventional methods of laser cutting, CNC milling, chemical etching, stamping, or mechanical punching (e.g., using a die) of the physical element sensor device assembly 205. As seen in FIG. 2(b), these three circular openings are also patterned in the “bottom stack” of layers in the same exact locations as the three circular openings 206 on the physical element sensor device assembly 205. The circular openings may be formed in the individual layers of the “bottom stack” or may be patterned after assembly of these layers to form the “bottom stack” assembly using any suitable method, such as conventional methods of laser cutting, CNC milling, chemical etching, stamping, or mechanical punching (e.g., using a die). The three circular alignment openings on the physical element sensor device assembly 205 and the “bottom stack” layers serve as alignment features to facilitate alignment between the two assemblies to ensure precise positioning of the suspended beam on the chamber. The physical element sensor device assembly 205 is further patterned to have two rectangular openings 207 and 208, which serve, respectively, as ports for introducing fluid into the strip and as vents for allowing air to escape from the chamber as it fills the fluid sample.The locations of these rectangular openings may be selected to be above the chamber and within the footprint of the cutout 204 in the chamber forming layer 203 to provide access for fluid to enter the chamber and for air to escape the chamber. Additionally, the opening size, shape, and geometry of these rectangular openings may be designed and selected to optimize the introduction of fluids and the venting of air into the chamber.

[0084] The distance (D) between the bottom hydrophilic layer 202 and the physical element sensor device assembly 205, as defined by the height of the chamber forming layer 203, and the geometry of the cutout 204 in the chamber forming layer can be designed and selected to optimize the volume of the chamber and optimize the introduction of fluid and venting of air into the chamber. The distance D or height of the chamber forming layer 203 can be further configured such that the vibrating physical element induces a steady shear wave field in the fluid medium within the chamber between the bottom hydrophilic layer 202 and the physical element sensor device assembly 205. Depending on the fluid properties, the distance D can be determined by the shear penetration depth to induce a consistent and reliable steady shear wave field. The shear wavelength (λ) of the field induced in the medium surrounding the physical element can be configured to be equal to or smaller than the s the lower the ratio of the distance D to the fluid medium, the more consistent and uniform the acoustic field provided in the fluid medium; TIFF0007630174000015.tif8148, where δ s is the shear penetration depth TIFF0007630174000016.tif8147, δ lis the loss tangent angle of the medium. The distance D can be configured to be adjustable or permanently fixed depending on the properties of the fluid to be tested, introduced into the chamber. The chamber forming layer 203 can be formed from a single or multiple laminated polymer substrates to adjust the distance D and incorporate pressure sensitive adhesives on both sides to facilitate lamination to the physical element sensor device assembly 205 above, and the hydrophilic layer 202 below. An acoustic field established in the fluid confined between the physical element and the chamber wall can be used to determine not only the viscosity of the fluid, but also the viscoelastic properties of the fluid. Also, the presence of a fixed chamber wall close to the vibrating physical element provides an additional advantage for monitoring the physical properties of the fluid as a function of time with high accuracy.

[0085] The structure and arrangement of the elements of the chamber forming layer 203 may comprise two or more auxiliary separate pads arranged against the body of the chamber forming layer 203 to define an opening that allows the loading of a fluid sample into a chamber defined by an internal volume provided in the sensor device. The fluid may be a biological fluid, for example blood. The arrangement of two or more auxiliary pads contributing to the chamber forming layer 203 may be arranged against the body of the chamber forming layer 203 to further provide the main opening with at least one additional channel or opening, typically provided on a different side of the chamber. These secondary openings allow for side filling of liquid or also allow air to escape from the chamber as it is loaded into the fluid sample, due to the opening being communicable with the central chamber.

[0086] Figure 2(c) depicts a photograph of the assembled disposable test strip 200 shown in Figure 2(a). Figure 2(d) shows a further embodiment depicting a photograph of an assembled disposable test strip with a blood sample introduced into the chamber through a rectangular opening 207 in the physical element sensor device assembly 205 as depicted in Figures 2(a) and 2(b), affecting vibration of the physical element (i.e., the suspended beam). In this embodiment, the top surface of the chamber is comprised of at least a portion of a substrate layer, and the suspended beam is attached to the body of the substrate layer at both ends of the length of the beam. When a blood sample is introduced into the disposable test strip through the inlet port (i.e., rectangular opening 207 in FIG. 2(a)), it flows into the chamber under the region of the substrate layer leading to the suspended beam, then the flow of blood is directed through the chamber along the length of the beam while maintaining contact with the underside of the beam, and finally flows through the chamber under the region of the substrate layer passing through the beam to the vent port (i.e., rectangular opening 208 in FIG. 2(a)), which allows air to escape from the chamber as it is loaded into the fluid sample. Given the good surface wetting properties (e.g., low contact angle) of the bottom surface of the chamber (i.e., hydrophilic wicking layer 202), the blood sample occupies an area in the chamber below the suspended beam and above the bottom of the chamber along the length of the beam, which area extends up to or beyond the width of the beam (e.g., within 1.5 times the width of the beam, as seen in FIG. 2(d)). The bottom surface of the chamber (i.e., hydrophilic wicking layer 202) is disposed with a reagent that induces blood clotting in the vicinity of the area under the suspended beam. After introducing a blood sample into the disposable test strip, the blood undergoes reagent-induced clotting, and the physical properties of the blood sample (e.g., viscosity, viscoelasticity, density) before, during, and after clotting are determined by periodically monitoring the oscillations of the suspended beam and the corresponding damping experienced by the beam.

[0087] Figure 3 shows in-plane (Figure 3(a)) and out-of-plane (Figure 3(b)) vibrations induced in a physical element sensor device assembly such as that detailed in the embodiment depicted in Figures 1(a) and 1(b) and assembled in the form of a disposable test strip such as that detailed in the embodiment depicted in Figures 2(a) and 2(b) and computed using finite element analysis (FEA) simulations. Figure 3(a) shows the fundamental resonance of the in-plane vibration in the width direction of the physical element (x-y plane or x-axis when viewed from a top view) that can be induced by fixing the direction of the magnetic field and varying the direction of the applied current or electric field applied to the physical element, or by varying the direction of the magnetic field and fixing the direction of the applied current or electric field applied to the physical element. Figure 3(b) shows the fundamental resonance of out-of-plane vibration in the thickness direction (z-axis when viewed in the yz plane or cross-sectional / side view) of a physical element that can be induced by fixing the direction of the magnetic field and varying the direction of the applied current or electric field applied to the physical element, or by varying the direction of the magnetic field and fixing the direction of the applied current or electric field applied to the physical element. In one embodiment, in-plane vibration (Figure 3(a)) and out-of-plane vibration (Figure 3(b)) can be induced in a single physical element or a combination of multiple physical elements located above a single chamber or multiple individual chambers, where a face of one or more of the physical elements can be in physical contact with the fluid in one or more of the chambers.

[0088] 4-22 are discussed in the Examples section below.

[0089] [Example] The following specific examples are to be construed as merely illustrative, and not limitative of the remainder of the disclosure in any way whatsoever. Without further elaboration, it is believed that one skilled in the art can, based on the description herein, utilize the present invention to its fullest extent.

[0090] Example 1: Determining the Fluid Properties of Ethylene Glycol-Water Solutions Using a Physical Element Sensor Device Assembled into a Disposable Test Strip material and method: Figure 2(b) shows an exploded schematic view of the disposable test strip 200 of Figure 2(a). The strip was fabricated and assembled using standard diagnostic test strip manufacturing materials made of a polyester-based substrate with an acrylic adhesive to hold the structure in place.

[0091] Bottom Stack Assembly: The base substrate 201 consisted of a double-sided pressure sensitive adhesive (PSA) layer (0.0032 inch thick, AR90445, Adhesives Research, Inc.) laminated on one side onto a polyester (PET) layer (0.010 inch thick, Melinex® 339, Dupont Teijin) to provide structural support. A polyester substrate 202 (0.0045 inch thick, ARFlow90469, Adhesives Research, Inc.) with a hydrophilic wicking layer on one side was laminated onto the base substrate with the hydrophilic side facing away from the base substrate. A chamber forming layer 203 made of a double-sided PSA (0.005 inch thick, AR8939, Adhesives Research, Inc.) was patterned with cutouts 204 to form chamber walls adjacent the physical elements and laminated on one side onto the hydrophilic layer on top of the base substrate such that the hydrophilic side was exposed through the cutouts. The base substrate 201, hydrophilic layer 202, and first chamber forming layer 203 layers were also patterned with three circular openings in the same exact locations as the three circular openings 206 on the physical element sensing device assembly 205 to serve as alignment features to facilitate assembly of the substrate layers on top of the "bottom stack". Finally, the assembled "bottom stack" consisting of the base substrate 201, hydrophilic layer 202, and first chamber forming layer 203 was cut into a strip (1.6 x 3.0 cm) surrounding the chamber as shown in FIG. 2 ) footprint.

[0092] Physical Element Sensor Device Assembly: The physical element sensor device was fabricated by screen printing a silver-based conductive ink (at thicknesses ranging from 0.003 inches to 0.0030 inches) onto a polyester substrate to pattern the conductive paths 103 and 104 through the suspended beam 101 and to provide electrical pads for connection to the instrumentation, as depicted in FIG. 1(a). As shown in FIG. 1(b), an insulating dielectric layer 113 made of a polymer ink was screen printed over the conductive tracks 111 and 112 such that the conductive tracks were completely insulated everywhere except over the areas 114 and 115 dedicated to providing electrical connection to the instrumentation. The physical element consisting of the suspended beam was patterned by laser machining of the polyester substrate consisting of the conductive paths and the dielectric layer. The physical elements were fabricated in the shape of rectangular beams with lengths and widths varying from 0.5 to 20 mm.

[0093] Final disposable strip assembly: The physical element sensor device assembly 205 was suspended above the chamber such that the suspended beam was defined by the hydrophilic layer 202 and the sidewalls of the cutout 204 in the chamber forming layer 203, and was stacked on top of the "bottom stack" assembly such that the beam formed a portion of the top surface of the chamber. To facilitate alignment between the two assemblies and ensure accurate positioning of the suspended beam on the chamber, an alignment fixture was used to match three circular openings on the physical element sensor device assembly 205 and the "bottom stack" assembly. The distance (D) between the hydrophilic surface of the hydrophilic layer 202 and the physical element sensor device assembly 205, defined by the height of the chamber forming layer 203 (0.005 inches), and the geometry of the suspended beam in the polyester substrate layer were selected such that the total volume of fluid required to be tested was <10 μl.

[0094] Measurement method: The instrumentation used to perform the measurements was fabricated using standard stereolithography (SLA) processes. It was designed to include a strip receptacle with mechanical guides to ensure consistent and reliable insertion and connection of the strip to the electrical connector at the end of the receptacle. The connector provided electrical connection to a conductive path through the suspended beam to apply and detect a time-varying current / voltage at frequencies near the resonant frequencies of the beam. The strip receptacle consisted of a resistive heater, and optionally a thermistor, to control and monitor the temperature of the strip during measurements (e.g., 37C for blood testing). The design also included a magnetic enclosure to precisely position a permanent magnet (sintered magnet, N52 grade, 0.1-0.5T) relative to the strip within the receptacle to provide the in-plane and / or out-of-plane magnetic fields (with respect to the strip surface) necessary to enable detection of electromagnetic actuation and vibration in the suspended beam at frequencies near one or more resonant frequencies of the beam (e.g., in-plane and out-of-plane resonances). A function generator (Hewlett-Packard HP33120), low noise preamplifier (Stanford Research SR560), DSP lock-in amplifier (Stanford Research SR850), and data acquisition unit (National Instruments USB-6009) were used to apply current through the suspended beam and measure the "detected voltage" from the suspended beam, with all instrumentation controlled via a general purpose interface bus (GPIB) wired connection to a computer running Python code that automated the measurement process. In some tests, an off-the-shelf microcontroller-based printed circuit board (PCB) system interfaced with a custom PCB was used to minimize and further automate this measurement process.

[0095] Currents on the order of 0.1-1 A at various frequencies (detailed in the Results section below) were introduced into the physical element or suspended beam through the first conductive path in the presence of a magnetic field (0.1-0.5 T). When considering a magnetic field perpendicular to the suspended beam (along the z-axis in Fig. 3(a)), an in-plane motion corresponding to the fundamental frequency of resonance in a direction perpendicular to the long side of the rectangular beam (along the x-axis in Fig. 3(a)) was induced when a current was applied at or near that frequency. When considering a magnetic field parallel to the suspended beam and perpendicular to the long side of the beam (along the x-axis in Fig. 3(b)), an out-of-plane motion corresponding to the fundamental frequency of resonance in a direction perpendicular to the rectangular beam (along the z-axis in Fig. 3(b)) was induced when a current was applied at or near that frequency. The vibration characteristics of the suspended beam, i.e., amplitude, phase, frequency, and quality factor, were measured by monitoring the "detection voltage" induced by electromagnetic induction at various frequencies through a second conductive path extending through the suspended beam. These vibration characteristics, such as the amplitude and phase of the "detection voltage", were measured as a function of frequency (e.g., amplitude vs. frequency and phase vs. frequency scans) in the vicinity of the resonant frequency, and the response of these characteristics to physical properties was measured for various fluid types (in this example, ethylene glycol solutions).

[0096] Sensor Characterization: Prior to fluid testing, multiple disposable test strips were generated and the vibration amplitude and phase of the suspended beam in air for each of the test strips was recorded using the instrument (as described above). Examples of amplitude frequency scans in air for in-plane and out-of-plane vibrations of a physical element are shown in Figures 4(a) and 4(b), respectively. In this specific example, frequency sweeps of in-plane and out-of-plane vibrations were performed near 3500-7000 Hz and 750-3250 Hz to measure resonant frequencies of 4907 Hz and 1374 Hz, respectively. To measure the consistency between strips during the run, the amplitude frequency scans of in-plane vibrations of the beam from multiple strips were normalized to identify their respective resonant frequencies. The square root of these resonant frequencies was used as a metric for the consistency between strips to measure fluid properties that was statistically binned to identify variance between strips. An example of a set of normalized amplitude frequency scans of physical elements in multiple strips and the statistical binning of their respective square root resonant frequencies is shown in Figures 5(a) and 5(b), respectively. In this specific example, 192 disposable test strips were tested and the square root of the resonant frequency metric was found to have a mean deviation of 70.46 Hz. 1 / 2 and standard deviation 1.19Hz 1 / 2 and the coefficient of variance (CV) was 1.68%.

[0097] Fluid Inspection Procedure: Ethylene glycol solutions were prepared using deionized water with different concentrations ranging from 0 to 40.38%, as shown in Table I. The solutions were prepared with 20 ml of deionized water and corresponding volumes of ethylene glycol solution concentrations. When a fluid sample was introduced into the assembled disposable test strip through the inlet port (i.e., rectangular opening 207 in FIG. 2(a)), it was wicked into the chamber under the region of the substrate layer leading to the suspended beam, followed by fluid flow being directed through the chamber along the length of the beam while maintaining contact with the underside of the beam (at or slightly beyond the width of the beam), and finally through the chamber under the region of the substrate layer passing through the beam to the vent port (i.e., rectangular opening 208 in FIG. 2(a)), which allows air to escape from the chamber as it is loaded into the fluid sample.

[0098] Table I TIFF0007630174000017.tif39162

[0099] result: The amplitude frequency scans of the in-plane and out-of-plane vibrations of the suspended beam in the single-use disposable test strip were measured before and after the insertion of four ethylene glycol solutions (as described above), with three strips tested per solution. After the solution was inserted, the normalized fractional change in resonance amplitude, frequency, and quality factor (for in-plane and out-of-plane vibrations) was computed. As the concentration of ethylene glycol increases, the sensor is damped, thereby decreasing the amplitude and frequency. As the solution becomes denser and more viscous, this causes the physical element to vibrate more slowly and less forcefully when in contact with the fluid in both in-plane and out-of-plane modes. An example of the amplitude frequency scan of the in-plane vibration of the physical element in air and in contact with a 40.38% v / v ethylene glycol (EG) solution is shown in FIG. 6. In this specific example, both the amplitude and frequency of the in-plane resonance peak are reduced when the solution is introduced into the strip.

[0100] An example of the vibration characteristics of the in-plane modes of a physical element when exposed to ethylene glycol solutions of various concentrations is shown in Figure 7. In this specific example, the logarithms of the normalized fractional rate of change of the resonance amplitude, frequency, and quality factor trended linearly with the logarithm of the product of the density and viscosity of the ethylene glycol solution, as seen in Figures 7(a), 7(b), and 7(c), respectively. The results of this example are as predicted by the theory of vibration damping of mechanical structures, where damping is proportional to the inverse square root of the product of the density and viscosity of the fluid.

[0101] By monitoring the in-plane and out-of-plane vibrations of a physical element, the viscosity and density of any fluid can be inferred. The density of the fluid can be estimated from the out-of-plane mode properties, and the product of viscosity and density can be estimated from the in-plane modes, thus allowing independent and absolute measurements of the density and viscosity of the fluid under examination.

[0102] Example 2: Performing Prothrombin Time (PT) or International Normalized Ratio (INR) Coagulation Tests Using a Physical Element Sensor Device Assembled into a Disposable Test Strip material and method: In this example, the general methods and procedures used were similar to those outlined in "Example 1," except for the incorporation of reagents to induce blood clotting, and the acquisition and processing of blood samples, which are described in detail below.

[0103] Incorporation of Prothrombin Time Reagent: The disposable test strips used in this example incorporated a reagent consisting of rabbit brain thromboplastin (Pacific Hemostasis Prothrombin Time Reagent, Thromboplastin-DS, product number 29-227-3), calcium chloride (25 mM), and Tween (2% v / v in water). Prior to final assembly of the strips, the reagent was incorporated by dispensing the solution onto the exposed hydrophilic surface in the bottom stack, followed by air drying in a humidity-controlled dry box at standard room temperature and pressure. The ratio of reagent volume to blood tested in the chamber was maintained close to 2:1 to ensure successful initiation of the blood clotting reaction. The assembled strips incorporating the reagent were then placed and heat sealed in a metal foil pouch with a desiccant (e.g., silica gel) to ensure optimal drying of the reagent with minimal time delay in initiating the clotting reaction when contacted with the blood sample, and subsequently stored for several days before use.

[0104] Blood sample acquisition and processing: In this example, capillary whole blood samples from patients undergoing warfarin therapy and normal subjects in an anticoagulation clinic were used by fingerstick. After obtaining informed consent based on an Institutional Review Board (IRB) approved protocol, a standard lancet was used to extract blood samples by fingerstick, and a pipette or dropper was used to extract samples for insertion into disposable test strips. Following standard medical procedures in the anticoagulation clinic, a lancet was used a second time to extract blood samples for testing with Roche's commercially available CoaguChek® XS system.

[0105] result: In this example, the vibrational characteristics (e.g., amplitude) of the in-plane modes of the physical elements in a single-use disposable test strip were monitored and recorded before and after the introduction of a blood sample to measure the changes in the viscosity and viscoelasticity of the blood sample as a function of time as the blood sample undergoes clotting. Upon entering the chamber, the blood sample reacted with the dry reagents and initiated clotting through the extrinsic coagulation pathway. An algorithm was used to track the measured vibrational characteristics, viscosity, and / or viscoelasticity as a function of time to identify the time to clot formation (measured from the blood sample insertion time t=0), otherwise known as the prothrombin time (PT). PT / INR results from a commercially available Roche CoaguChek® XS system were also recorded for comparison. An example of the correlation between the INR results from Roche's CoaguChek® XS system and a disposable test strip under the present invention (Abram's CoagCare) is shown in FIG. 8. In this specific example, two rounds of testing were performed: a calibration round (19 patients, 7 normals) and a correlation round (16 patients, 7 normals). The calibration round was used to determine a calibration curve to establish the relationship between PT times measured using disposable test strips and INR results from the CoaguChek® XS system. The correlation round was used to apply this calibration curve to the measured PT times and calculate the measured INR results. In this specific example, the regression coefficient R was determined over an INR range of 0.5 to 3, with all data points falling within the U.S. Food and Drug Administration (FDA) 510(k) clearance limits imposed on commercially available PT / INR systems. 2 A good linear correlation was demonstrated with a σ of 0.8.

[0106] Example 3: Performance of Hematocrit (Hct) Measurements Using a Physical Element Sensor Device Assembled into a Disposable Test Strip material and method: In this example, the general methods and procedures used were similar to those outlined in "Example 1," except for the acquisition and processing of blood samples, which is detailed below.

[0107] Blood sample acquisition and processing: In this example, venous whole blood samples from normal subjects were used. After obtaining informed consent under an Institutional Review Board (IRB) approved protocol, phlebotomy was performed to extract blood samples by venipuncture and samples were dispensed directly into collection tubes containing ethylenediaminetetraacetic acid (EDTA) anticoagulant. EDTA-anticoagulated whole blood samples were centrifuged to extract plasma and resuspended with red blood cells to compound whole blood samples, with hematocrits ranging from 0 to 80% in 10% increments. Blood samples were dispensed onto disposable test strips using a standard microliter pipette.

[0108] result: In this example, the vibrational characteristics (e.g., amplitude) of the out-of-plane modes of a physical element within a single-use disposable test strip were monitored and recorded before and after the introduction of a blood sample to measure the density of the blood sample. Upon entering the chamber, the blood sample interacts with the physical element and dampens the vibration of the physical element, primarily due to the density of the blood sample. An example of the signal damping experienced by a physical element within a disposable test strip is shown in Figure 9, where the sensor signal undergoes a steady and predictable decrease (after a vibration damping fit, regression coefficient R) upon exposure to a blood sample with an increase in hematocrit from 0 to 80%. 2 = 0.88). Because density is linearly related to the hematocrit in a blood sample by the simple relationship ρ = 1.026 + 0.067 Hct gm / cc, the damping of the vibration signature can be used to accurately ascertain the hematocrit from the computerized blood density.

[0109] Example 4: Performance of an Activated Partial Thromboplastin Time (aPTT) Coagulation Test Using a Physical Element Sensor Device Assembled into a Disposable Test Strip material and method: In this example, the general methods and procedures used were similar to those outlined in "Example 1," except for the incorporation of reagents to induce blood clotting, and the acquisition and processing of blood samples, which are described in detail below.

[0110] Incorporation of activated partial thromboplastin time reagent: The disposable test strips used in this example incorporated reagents consisting of Actin-FS Activated Partial Thromboplastin Time Reagent (Siemens Diagnostics, Catalog No. B4218-20), calcium chloride (25 mM), and Tween (2% v / v in water). Prior to final assembly of the strips, the reagents were incorporated by dispensing the solutions onto the exposed hydrophilic surfaces in the bottom stack, followed by air drying in a humidity-controlled dry box at standard room temperature and pressure. The ratio of reagent volume to blood tested in the chamber was maintained close to 2:1 to ensure successful initiation of the blood clotting reaction. The assembled strips incorporating the reagents were then placed and heat sealed in a metal foil pouch with a desiccant (e.g., silica gel) to ensure optimal drying of the reagents while minimizing the time delay in initiating the clotting reaction when contacted with the blood sample, and subsequently stored for several days before use.

[0111] Blood sample acquisition and processing: In this example, venous whole blood and fingerstick capillary whole blood samples from normal subjects were used. After obtaining informed consent under an Institutional Review Board (IRB) approved protocol, phlebotomy was performed to extract blood samples by venipuncture and the samples were dispensed directly into blood collection tubes containing sodium citrate anticoagulant. Whole blood samples were formulated by in vitro spiking of citrated whole blood samples with unfractionated heparin (ScienCell, Cat. No. 0863) at heparin concentrations varying from 0.0 to 1.0 IU / ml in 0.2 IU / ml increments. Additionally, a standard lancet was used to extract capillary whole blood samples by fingerstick technique. A standard microliter pipette was used to dispense blood samples into disposable test strips.

[0112] result: In this example, the vibrational properties (e.g., amplitude) of the in-plane modes of a physical element within a single-use disposable test strip were monitored and recorded before and after the introduction of a blood sample to measure changes in the viscosity and viscoelasticity of the blood sample as a function of time as the blood sample undergoes clotting. Upon entering the chamber, the blood sample reacted with the dried reagents and initiated clotting through the intrinsic clotting pathway. An algorithm was used to track the measured vibrational properties, viscosity, and / or viscoelasticity as a function of time to identify the time to clot formation (measured from the blood sample insertion time t=0), otherwise known as the partial thromboplastin time (aPTT). An example of uncalibrated aPTT clotting time measured using a physical element within a disposable test strip is shown in FIG. 10, where the clotting time follows a linear dose response (regression coefficient R 2 = 0.92). In this specific example, the aPTT clotting times measured in capillary whole blood samples by fingerstick from normal subjects (not on heparin therapy) were close to the times measured in venous whole blood samples from subjects without heparin (0.0 IU / ml).

[0113] Example 5: Performance of a low range activated clotting time (ACT) coagulation test using a physical element sensor device assembled into a disposable test strip material and method: In this example, the general methods and procedures used were similar to those outlined in "Example 1," except for the incorporation of reagents to induce blood clotting, and the acquisition and processing of blood samples, which are described in detail below.

[0114] Incorporation of activated clotting time reagent: The disposable test strips used in this example incorporated a reagent consisting of kaolin, calcium chloride (25 mM), and Tween (2% v / v aqueous solution) suspended in distilled water. The reagent was incorporated by dispensing the solution onto the exposed hydrophilic surface in the bottom stack prior to final assembly of the strips, followed by air drying in a humidity-controlled dry box at standard room temperature and pressure. The ratio of reagent volume to blood tested in the chamber was kept close to 2:1 to ensure successful initiation of the blood clotting reaction and optimal sensitivity to the low range of heparin concentrations in the blood sample. The assembled strips incorporating the reagent were then placed in a metal foil pouch with a desiccant (e.g., silica gel) and heat sealed to ensure optimal drying of the reagent with minimal time delay in initiating the clotting reaction when in contact with the blood sample, and subsequently stored for several days before use.

[0115] Blood sample acquisition and processing: In this example, venous whole blood samples from normal subjects were used. After obtaining informed consent under an Institutional Review Board (IRB) approved protocol, phlebotomy was performed to extract blood samples by venipuncture and samples were dispensed directly into blood collection tubes containing sodium citrate anticoagulant. Whole blood samples were compounded by in vitro spiking of citrated whole blood samples with unfractionated heparin (ScienCell, Cat. No. 0863) at heparin concentrations varying from a low range of 0.0 to 3.0 IU / ml in 1.0 IU / ml increments. Blood samples were dispensed onto disposable test strips using a standard microliter pipette.

[0116] result: In this example, the vibrational properties (e.g., amplitude) of the in-plane modes of a physical element within a single-use disposable test strip were monitored and recorded before and after the introduction of a blood sample to measure changes in the viscosity and viscoelasticity of the blood sample as a function of time as the blood sample undergoes clotting. Upon entering the chamber, the blood sample reacted with the dried reagents and initiated clotting through the intrinsic clotting pathway. An algorithm was used to track the measured vibrational properties, viscosity, and / or viscoelasticity as a function of time to identify the time to clot formation (measured from the blood sample insertion time, t=0), otherwise known as the activated clotting time (ACT). An example of uncalibrated ACT clotting time measured using a physical element within a disposable test strip is shown in FIG. 11, where the clotting time follows a linear dose response (regression coefficient R 2 = 0.99). In this specific example, the measured ACT clotting time corresponds to a low range of ACT measurements, which corresponds to the low range of heparin therapy used during cardiac and hepatic surgery, given that the sensitivity of the system is 0.0-3.0 IU / ml.

[0117] Example 6: Performance of a high range Activated Clotting Time (ACT) coagulation test using a physical element sensor device assembled into a disposable test strip material and method: In this example, the general methods and procedures used were similar to those outlined in "Example 1," except for the incorporation of reagents to induce blood clotting, and the acquisition and processing of blood samples, which are described in detail below.

[0118] Incorporation of activated clotting time reagent: The disposable test strips used in this example incorporated a reagent consisting of kaolin, calcium chloride (25 mM), and Tween (2% v / v aqueous solution) suspended in distilled water. The reagent was incorporated by dispensing the solution onto the exposed hydrophilic surface in the bottom stack prior to final assembly of the strips, followed by air drying in a humidity-controlled dry box at standard room temperature and pressure. The ratio of reagent volume to blood tested in the chamber was kept close to 2:1 to ensure successful initiation of the blood clotting reaction and optimal sensitivity to a high range of heparin concentrations in the blood sample. The assembled strips incorporating the reagent were then placed in a metal foil pouch with a desiccant (e.g., silica gel) and heat sealed to ensure optimal drying of the reagent with minimal time delay in initiating the clotting reaction when contacted with the blood sample, and subsequently stored for several days prior to use.

[0119] Blood sample acquisition and processing: In this example, venous whole blood samples from normal subjects were used. After obtaining informed consent under an Institutional Review Board (IRB) approved protocol, phlebotomy was performed to extract blood samples by venipuncture and samples were dispensed directly into blood collection tubes containing sodium citrate anticoagulant. Whole blood samples were compounded by in vitro spiking of citrated whole blood samples with unfractionated heparin (ScienCell, Cat. No. 0863) at heparin concentrations varying from a high range of 1.0-5.0 IU / ml in 1.0 IU / ml increments. Blood samples were dispensed onto disposable test strips using a standard microliter pipette.

[0120] result: In this example, the vibrational properties (e.g., amplitude) of the in-plane modes of a physical element within a single-use disposable test strip were monitored and recorded before and after the introduction of a blood sample to measure changes in the viscosity and viscoelasticity of the blood sample as a function of time as the blood sample undergoes clotting. Upon entering the chamber, the blood sample reacted with the dried reagents and initiated clotting through the intrinsic clotting pathway. An algorithm was used to track the measured vibrational properties, viscosity, and / or viscoelasticity as a function of time to identify the time to clot formation (measured from the blood sample insertion time t=0), otherwise known as the activated clotting time (ACT). An example of uncalibrated ACT clotting time measured using a physical element within a disposable test strip is shown in FIG. 12, where the clotting time follows a linear dose response (regression coefficient R 2 = 0.95). In this specific example, the measured ACT clotting time corresponds to a high range of ACT measurements, which corresponds to the high range of heparin therapy used during cardiac and hepatic surgery, given that the sensitivity of the system is 1.0-5.0 IU / ml.

[0121] Example 7: Performance of Thromboelastogram (TEG) Coagulation Tests Using a Physical Element Sensor Device Assembled into a Disposable Test Strip material and method: In this example, the general methods and procedures used were similar to those outlined in "Example 1," except for the incorporation of reagents to induce blood clotting, and the acquisition and processing of blood samples, which are described in detail below.

[0122] Incorporation of thromboelastogram reagents: The disposable test strips used in this example incorporated a reagent consisting of rabbit brain thromboplastin (Pacific Hemostasis Prothrombin Time Reagent, Thromboplastin-DS, product number 29-227-3), calcium chloride (25 mM), and Tween (2% v / v in water). Prior to final assembly of the strips, the reagent was incorporated by dispensing the solution onto the exposed hydrophilic surface in the bottom stack, followed by air drying in a humidity-controlled dry box at standard room temperature and pressure. The ratio of reagent volume to blood tested in the chamber was maintained close to 2:1 to ensure successful initiation of the blood clotting reaction. The assembled strips incorporating the reagent were then placed and heat sealed in a metal foil pouch with a desiccant (e.g., silica gel) to ensure optimal drying of the reagent with minimal time delay in initiating the clotting reaction when contacted with the blood sample, and subsequently stored for several days before use.

[0123] Blood sample acquisition and processing: In this example, venous and fingerstick capillary whole blood samples from normal subjects were used. In addition, fingerstick capillary whole blood samples from patients undergoing warfarin therapy in an anticoagulation clinic were used. After obtaining informed consent under an Institutional Review Board (IRB) approved protocol, phlebotomy was performed to extract blood samples by venipuncture and samples were directly aliquoted into blood collection tubes containing sodium citrate anticoagulant. Citrated whole blood samples were designed to incorporate various amounts of unfractionated heparin (0-3 IU / ml), cleavable fibrinogen (42-231 mg / dL), eptifibatide (GPIIb / IIIa platelet inhibitor, 0-12 μg / mL), and tissue plasminogen activator (tPA, 0-1.8 nM) in vitro. Additionally, for some tests, after obtaining informed consent under an Institutional Review Board (IRB)-approved protocol, blood samples were extracted using a standard lancet via the finger stick technique, and a standard microliter pipette or dropper was used to retrieve the sample for insertion into the disposable test strip. Finally, for some tests, blood samples were also tested using two Haemonetics TEG-5000 instruments (two tests per instrument) to perform a side-by-side comparison with results generated using disposable test strips, and these corresponding TEG curves and parameters were recorded.

[0124] result: In this example, the vibrational characteristics (amplitude and phase) of the in-plane vibration mode of a physical element in a single-use disposable test strip were measured as a function of frequency near the resonant frequency, and these amplitude and phase frequency scans were periodically monitored to determine different aspects of the blood clotting cascade. Upon entering the chamber, the blood sample reacted with the dried reagent and initiated clotting through the extrinsic clotting pathway. Examples of amplitude and phase frequency scans of a vibrating physical element in a disposable test strip with a blood sample in the chamber undergoing clotting are shown in Figures 13(a) and 13(b), respectively, and it can be seen that the amplitude and phase magnitudes at the resonant frequency peak decrease as the blood clotting cascade progresses. Using these amplitude and phase frequency scans monitored periodically over time, a thromboelastogram (TEG) test was performed to extract the characteristic wine-glass shaped viscoelastic curve and parameters. The TEG-like viscoelastic parameters extracted were clot formation time (R), activated clotting time (ACT), maximum thrombin generation (ThrombinPeak), clot firmness (G), platelet contraction rate (Plt-Cont), and fibrinolysis rate (Lys-Rate). A mathematical model of viscoelastic oscillation damping of physical elements, incorporating different kinetic processes in the coagulation cascade, was used to fit data from amplitude- and phase-frequency scans as a function of time. The model provided threshold thrombin generation (R), rate of catalysis by prothrombinase or factor Xa (k2), rate of catalysis by thrombin or factor IIa (k1), concentration of cleavable fibrinogen or factor I (C fibrinogenThese measured hemostatic parameters allowed the extraction of different hemostatic parameters such as TEG (Tissue Strength Index [TBI]), clot firmness (G), platelet contraction rate (Plt-Cont), and fibrinolysis rate (Lys-Rate). These measured hemostatic parameters were used to extract viscoelastic parameters like TEG described above to monitor the concentration and activity of different coagulation factors (e.g., fibrinogen, thrombin), properties specific to blood clots (e.g., clot firmness G, fibrinolysis rate Lys-Rate), as well as the activity / effect of different blood components involved in coagulation (e.g., platelet contraction rate Plt-Cont) as a function of time during the blood coagulation cascade.

[0125] Examples of extracted hemostatic parameters related to the blood clotting cascade and corresponding viscoelastic vibration damping fits to vibration amplitude data from a physical element in a disposable test strip with a blood sample in a chamber undergoing clotting are shown in Figures 14(a) and 14(b), respectively. In this specific example, the vibration amplitude data and its fits plotted as a function of time and mirrored about the time axis, along with the extraction of the TEG-like viscoelastic parameters described above, as well as a typical TEG-like wine-glass shaped viscoelastic curve, were generated in less than 5-10 minutes. This fast turnaround time was made possible due to the high sensitivity of the physical element device, given that smaller blood clots form faster, and the small blood sample volume required to test.

[0126] An example showing hemostatic parameters extracted from fits used to generate cleaved fibrinogen or fibrin and thrombin concentration profiles as a function of time during the blood clotting cascade as measured using physical elements in a disposable test strip is shown in FIG. 15. An example of a typical mathematical formula used to track the concentrations of cleaved fibrinogen (or converted fibrin) and thrombin is shown on the left hand side of FIG. 15. In this specific example, blood clotting measurements using disposable strips were performed using three warfarin patient samples (with increasing PT values ​​of 17.4, 36.4, and 54.4 seconds), and various aspects of the blood clotting cascade were inhibited due to increasing levels of warfarin. As seen on the right hand side of FIG. 15, cleaved fibrinogen and thrombin concentration profiles were generated for these three samples showing a steady decrease in maximum thrombin generation with increasing warfarin activity across the samples. Note that the cleaved fibrinogen concentration profile has been mirrored around the time axis as a function of time. Additionally, other parameters such as time to maximum thrombin generation (similar to ACT) and time to maximum fibrin formation (TMA) were observed to be delayed with increasing warfarin activity across samples. Note that this cleaved fibrinogen or fibrin formation profile as a function of time mirrored around the time axis can also be used to report a typical TEG-like wine-glass shaped viscoelastic curve along with the measured TEG-like viscoelastic parameters.

[0127] One example showing the variation of thrombin generation and activated clotting time (ACT) in the presence of a heparin anticoagulant (thrombin inhibitor) as measured using physical elements within a disposable test strip is shown in FIG. 16. In this specific example, FIG. 16(a) shows the concentration or generation profile of thrombin measured in blood samples (uncalibrated, therefore arbitrary units) with increasing heparin concentration from 0 to 3 IU / ml, where it was observed that peak thrombin generation was reduced and delayed (i.e., increased ACT) due to the thrombin inhibitory effect of heparin. It is noted that the thrombin concentration profile and corresponding parameters generated in less than 5-10 minutes are similar to typical thrombin generation assay (TGA) curves, and parameters measured with commercially available systems, and thus the results can be calibrated to perform this TGA measurement. This provides a significant advantage over commercially available TGA systems that take up to 30-60 minutes to generate the entire TGA curve and parameters. Furthermore, in this specific example, FIG. 16(b) shows a linear dose response (regression coefficient R 2 FIG. 2 shows a correlation plot of increasing ACT times in samples measured using a disposable test strip (CoagCare ACT) and the TEG-5000 RapidTEG assay, demonstrating ACT-times of 100-fold higher than that of the CoagCare ACT-5000 RapidTEG assay (Figure 2).

[0128] One example showing hemostatic parameters extracted from the fits that are being used to monitor a blood clot specific property, clot firmness G, during the blood clotting cascade, as measured using physical elements within a disposable test strip, is shown in FIG. 17. In this specific example, FIG. 17(a) shows typical vibrational characteristics of an in-plane vibration mode of a suspended beam measured as a function of time, with the first observed sharp increase indicating clot firmness G, which tracks the conversion of fibrinogen to fibrin (i.e., cleavage) followed by cross-linking of fibrinogen to form a fibrin network. This clot firmness G is computed using the hemostatic parameters extracted from the fits. Further, in this specific example, FIG. 17(b) shows a dose response for clot firmness G, which shows an increasing trend (with good fit to a mathematical formulation) when exposed to a blood sample with increasing concentrations of cleavable fibrinogen.

[0129] One example showing hemostatic parameters extracted from the fits that are being used to monitor the activity of a blood component, platelets, in the blood coagulation cascade, as measured using physical elements in a disposable test strip, is shown in FIG. 18. In this specific example, FIG. 18(a) shows typical vibration characteristics of the in-plane vibration mode of a suspended beam measured as a function of time, where the sharp drop observed (following an initial increase) indicates the onset of platelet contraction after adhesion to the crosslinked fibrin network. This platelet contraction rate, Plt-Cont, is computed using the hemostatic parameters extracted from the fits. Furthermore, in this specific example, FIG. 18(b) shows a dose response for platelet contraction rate that shows a decreasing trend (with good fit to mathematical formulas) when exposed to blood samples with increasing concentrations of eptifibatide GPIIb / IIIa platelet inhibitor. It should be noted that the measured platelet contraction rate can also be used to measure the concentration of platelets and perform specific platelet function assays (PFA) in the presence of agonists (e.g., adenosine diphosphate (ADP), arachidonic acid (AA)) similar to those performed in commercially available systems (e.g., Roche's Multiplate Analyzer).

[0130] FIG. 19 shows an example of hemostatic parameters extracted from the fit that are used to monitor a blood clot specific characteristic, the fibrinolysis rate, Lys-Rate, during the blood clotting cascade, as measured using physical elements in a disposable test strip. In this specific example, FIG. 19(a) shows typical vibration characteristics of the in-plane vibration mode of a suspended beam measured as a function of time, where the initial sharp rise followed by the gradual decrease observed indicates the fibrinolysis rate, Lys-Rate, which tracks the dissolution or destruction of the cross-linked fibrin network. This fibrinolysis rate, Lys-Rate, is computed using the hemostatic parameters extracted from the fit. Furthermore, in this specific example, FIG. 19(b) shows the dose response of the fibrinolysis rate, Lys-Rate, which shows an increasing trend with a good exponential fit to a mathematical formula when exposed to a blood sample with increasing concentrations of tissue plasminogen activator (tPA), which enhances the external fibrinolysis process of the blood clotting cascade.

[0131] One example showing TEG-like viscoelastic parameters extracted using hemostatic parameters from fits being used to determine the concentration of factor IIa (dabigatran or Pradaxa®) and factor Xa (rivaroxaban or Xarelto®) inhibitor based anticoagulants as measured using physical elements within a disposable test strip is shown in Figures 20, 21, and 22. In this specific example, Figure 20(a) shows a linear trend (regression coefficient R ) that increases with increasing concentrations of dabigatran, which directly inhibits thrombin or factor IIa activity, or in other words the cleavage / conversion of fibrinogen to fibrin, when exposed to a blood sample. 2 FIG. 20(b) shows a dose response of clot formation time (R) showing a linear correlation (regression coefficient R = 0.997) between increasing R times in dabigatran blood samples as measured using a disposable test strip (CoagCare) and ACT times as measured using the TEG-5000 RapidTEG assay. 2=0.997). Further in this specific example, FIG. 21(a) shows an increasing linear trend (regression coefficient R 2 FIG. 21(b) shows a dose response of clot formation time (R) showing a linear correlation (regression coefficient R = 0.989). FIG. 21(b) further shows a correlation plot between increasing R times in rivaroxaban blood samples as measured using a disposable test strip (CoagCare) and ACT times measured using the TEG-5000 RapidTEG assay, which shows a linear correlation (regression coefficient R 2 =0.997). Further, in this example, Figure 22(a) depicts the blood coagulation cascade process, specifically the inhibition of thrombin activity or fibrinogen cleavage / conversion to fibrin by dabigatran, and the inhibition of thrombin generation by rivaroxaban via factor Xa, as detailed above, and their respective effects on clot formation time (R). Figure 22(b) shows the exponential trend (regression coefficient R 2 Figure 22(c) specifically shows the effect of rivaroxaban in reducing maximum thrombin generation (ThombinPeak) at dabigatran concentration (ThombinPeak = 0.997) but has limited or no effect on clot firmness G, which tracks cleaved fibrinogen converted to fibrin (as seen in Figure 17). This limited effect is due to the fact that, despite rivaroxaban's inhibition of factor Xa-mediated thrombin generation (as seen in Figure 22(a)), typically only a minimum threshold amount of thrombin needs to be generated before the clotting process can stepwise convert fibrinogen to fibrin. Figure 22(c) shows a quadratic trend (regression coefficient R 2Figure 22(a) specifically shows the effect of dabigatran in reducing clot firmness G (tracking cleaved fibrinogen converted to fibrin) with G = 0.98, but with limited or no effect on maximum thrombin generation (ThrombinPeak). This limited effect is due to the fact that dabigatran not only inhibits thrombin activity, but has little or no effect on processes upstream of the coagulation cascade to thrombin that affect its generation (as seen in Figure 22(a)). This differential response of factor IIa inhibitor anticoagulants and factor Xa inhibitor anticoagulants on thrombin generation and activity, or fibrinogen cleavage / conversion, was used to differentiate their presence in these blood samples. FIG. 22(d) shows normalized ThrombinPeak and clot firmness G (referred to in this figure as novel oral anticoagulants or NOACs) that showed increasing and decreasing linear trends, respectively, when plotted for the samples tested. 2 This differentiation response is exemplified using a metric expressed as a ratio between the time to clot formation, R, referred to as the ratio of the time to clot formation, R, and ...

[0132] List of Features and Embodiments The following list provides additional features that may be present in the devices and / or methods according to the present invention. 1. The substrate layer may be composed of a material selected from a group of materials including polymers such as polyester (PET), plastics, printed circuit boards, and the like, and / or may be fabricated using mass manufacturing methods including roll-to-roll continuous flow manufacturing. 2. The physical elements of the substrate layer (i.e., the suspended beams) can be patterned / shaped by techniques selected from etching, laser processing, printing, and mechanical punching / cutting. 3. The conductive pathways extending across the physical elements may comprise pure metals (e.g., silver, gold, palladium, titanium, tungsten, platinum, stainless steel, etc.), metal alloys, semiconductor materials (e.g., silicon), conductive polymers, etc., and / or the electrical pathways may be incorporated on top, bottom, within, or as part of a substrate layer. 4. The conductive paths extending across the physical element may be formed by a technique selected from metal evaporation, thin metal film extrusion, printing, or laser processing. 5. When actuating vibration of a physical element and measuring a signal from the physical element, an electric field can be applied and a detection signal can be measured across an independent conductive path. 6. When actuating vibrations of a physical element and measuring a signal from the physical element, the vibrations can be induced through a time-varying electric field and a constant magnetic field, or a constant electric field and a time-varying magnetic field. The time-varying field can correspond to at least one of the fundamental or harmonic frequencies of the resonance of the physical element. 7. The detected signal resulting from vibration of the physical element may be monitored within a range of frequencies close to (e.g., within 1.5, 2, 3, 4, or 5 times) the frequency of the time-varying excitation field(s). 8. The vibration of a physical element, or of two or more independent physical elements, may be induced at two or more frequencies, and the vibration may include two in-plane vibrations, and / or in-plane and out-of-plane vibrations at different frequencies. 9. The underlayer of the device according to the invention can be positioned at a fixed or adjustable distance below the base layer and / or the base layer can be sandwiched or affixed anywhere on the underlayer, except for the physical element. 10. A method according to the invention may include inducing a standing shear wave field in a medium between the physical element and an underlying layer. 11. Devices according to the present invention may include additional layers, such as those shown in Figure 2(b). 12. One or more layers of the device according to the invention may comprise at least one channel or opening suitable for allowing entry of a fluid sample into the reaction chamber, which at least one channel or opening may optionally be of suitable dimensions to allow the fluid sample to enter said reaction chamber by capillary action and / or which at least one channel or opening may be suitable for allowing the displacement of air therethrough upon filling of the reaction chamber with the fluid sample. 13. At least one surface of a chamber of the device may have a low contact angle with fluids (eg, 45 degrees or less), which may facilitate capillary action of an aqueous fluid sample into the chamber. 14. The method involves applying different shear rates This may include computing static or dynamic viscoelastic properties of the fluid from the measured viscosity and / or density of the fluid at TIFF0007630174000018.tif7128, where theoretical or empirical models may be used in such computing. 15. A change in one vibrational characteristic or a combination of vibrational characteristics of at least one physical element can be used in a method for determining fluid properties before, during, and / or after a chemical reaction in a sample. 16. A method for analyzing a blood sample may include contacting the blood sample with at least one blood clotting agent before, during, or after introduction of the sample into a chamber, and vibrational characteristics of the at least one physical element are used to determine blood fluid properties and blood clotting reaction kinetics, such as clotting time in PT, PTT, ACT, and / or TEG clotting tests. 17. A method of analyzing a blood sample may include determining the concentration of red blood cells or hematocrit in the blood sample. This determination may be performed prior to contacting the fluid with a clotting reagent or may use data obtained prior to contacting the fluid with a clotting reagent. Blood clotting reaction kinetics and / or blood fluid properties may be calibrated or adjusted using the measured hematocrit. 18. When analyzing a blood sample containing an anticoagulant, the method may include distinguishing between one or more anticoagulants in the blood sample and determining the concentration of the one or more anticoagulants, which may be performed before or after contacting the blood sample with a clotting reagent, or may use data obtained before or after contacting the blood sample with a clotting reagent.

[0133] The following list provides additional non-limiting examples of systems and methods contemplated in accordance with the present invention. 1. A system for measuring a fluid, comprising: a resonator configured to apply a shear rate and / or a shear stress to the fluid; a sensor configured to measure vibration of the resonator during application of shear rate and / or shear stress; and a processor configured to identify parameters indicative of the viscosity, viscoelasticity, and / or density of the fluid based on damping of vibrations of the resonator induced by the fluid at a fixed applied shear rate and / or shear stress. 2. The system of embodiment 1, wherein the sensor is configured to measure at least one of: (a) a resonant frequency of the vibration; (b) a quality factor of the resonant vibration; (c) an amplitude of the resonant vibration; and (d) a phase of the resonant vibration. 3. The system of embodiment 1, wherein the sensor is configured to measure a combination of (a) the resonant frequency of the vibration, (b) the quality factor of the resonant vibration, (c) the amplitude of the resonant vibration, and (d) the phase of the resonant vibration. 4. The system of embodiment 1, wherein the resonator is a purely in-plane resonator. 5. The system of embodiment 1, wherein the resonator is a purely out-of-plane resonator. 6. a thermal sensor configured to sense a temperature of the fluid during the measurement of vibration; 2. The system of embodiment 1, further comprising a thermal actuator configured to control the temperature of the fluid during vibration measurement. 7. A method for measuring a fluid, comprising: applying a shear rate and / or a shear stress to the fluid via the resonator; Measuring vibration of the resonator during application of shear rate and / or shear stress; and identifying parameters indicative of the viscosity, viscoelasticity, and / or density of the fluid based on damping of vibrations of the resonator induced by the fluid at a fixed applied shear rate and / or shear stress. 8. the measured vibration is an in-plane vibration of the resonator at a frequency f for a fixed applied shear rate and / or shear stress such that the penetration depth of the shear waves (δ=Sqrt(η / ρπf)) is relatively small, The identified parameters are the constant-phase viscosity (η cp 8. The method of embodiment 7, wherein 9. the measured vibration is an in-plane vibration of the resonator at a frequency f for a fixed applied shear rate and / or shear stress such that the penetration depth of the shear waves (δ=Sqrt(η / ρπf)) is relatively large, The identified parameters are the bulk viscosity (η bulk 8. The method of embodiment 7, wherein 10. The identified parameters are the concentration of additive in the non-Newtonian fluid (c s 8. The method of embodiment 7, wherein 11. The method of embodiment 10, wherein the non-Newtonian fluid comprises particles or solid phase objects. 12. 8. The method of embodiment 7, further comprising identifying a standardized measurement of the bulk viscosity of the complex non-Newtonian fluid at standardized additive concentrations as a function of the fluid properties. 13. A standardized measurement of the constant phase viscosity (η cp), bulk viscosity of the fluid (η bulk ), and the concentration of the additive (c s 13. The method of claim 12, wherein the first and second vertices are identified as a function of one or more of: 14. Using different theoretical or empirical models, different applied shear rates 8. The method of embodiment 7, further comprising computing static or dynamic viscoelastic properties of the complex non-Newtonian fluid as a function of time from the viscosity and / or density of the fluid measured at TIFF0007630174000019.tif9131. 15. Viscoelastic properties are determined by the yield stress (τ y 15. The method of embodiment 14, comprising: 16. Viscoelastic properties are determined by the Casson model 15. The method of embodiment 14, as determined according to TIFF0007630174000020.tif24130. 17. Different theoretical or empirical models were used to estimate the s ) and the applied shear rate The static or dynamic viscoelastic properties of complex non-Newtonian fluids are computed from the standardized bulk viscosity of the fluid computed in TIFF0007630174000021.tif10139, thereby allowing the computation of the fluid properties and the additive concentration (c s 8. The method of embodiment 7, further comprising enabling one to identify an empirical relationship between 18. Viscoelastic properties are determined by the yield stress (τ y 18. The method of embodiment 17, comprising: 19. Viscoelastic properties are determined by the Casson model. 18. The method of embodiment 17, as determined according to TIFF0007630174000022.tif24139. List of cited references 1.R.Rosencranz,S.A.Bogen,“Clinical laboratory measurement of serum,plasma,and blood viscosity,”American Journal of Clinical Pathology,vol.125,Suppl.1,pp.S78-S86,2006。 2.E.Nwanko, C.J.Durning,“Fluid property investigation by impedance characterization of quartz crystal resonators(2 parts),”Sensors and Actuators A.Physical,vol.72,pp.99-109,1999。 3.B.Jakoby,M.Scherer,M.Buskies,H.Eisenschmid,“An automotive engine oil viscosity sensor,”IEEE Sensors Journal,vol.3,pp.562-568,2003。 4.G.D.O.Lowe,“Blood rheology in arterial disease,”Clinical Science,vol.71,pp.137-146,1986。 5.G.D.O.Lowe,“Blood rheology and vascular disease,”Haemostasis and Thrombosis(ed.by A.L.Bloom et al),3 rd ed.,pp.1169-1188.Churchill Livingstone,Edinburgh,1994。 6.L.Dintenfass,“Blood Microrheology:viscosity factors in blood flow ischaemia and thrombosis,”Butterworth,London,1971。 7.G.D.O.Lowe,W.C.S Smith,H.D.Tunstall-Pedoe,I.K.Crombie,S.E.Lennie,J.Anderson,J.C.Barbenel,“Cardiovascular risk and haemorheology:results from the Scottish Heart Health Study and the MONICA project,Glasgow,”Clinical Haemorheology,vol.8,pp.518-524,1988。 8.G.D.O.Lowe,A.J.Lee,A.Rumley,J.F.Price,F.G.R.Fowkes,“Blood viscosity and risk of cardiovascular events:the Edinburgh Artery Study,”British Journal of Haematology,vol.96,pp.168-73,1997。 9.G.Ciuffetti,G.Schillaci,R.Lombardini,M.Pirro,G.Vaudo,E.Mannarino,“Prognostic impact of low-shear whole blood viscosity in hypertensive men,”European Journal of Clinical Investigation,vol.35 no.2,pp.93-98,February 2005。 10.S.Chien,J.Dormandy,E.Ernst,A.Matrai,“Clinical Hemorheology,” Martinus Nijhoff Publishers,Dordrecht,1987。 11.A.Matrai,R.B.Whittington,E.Ernst,“A simple method of estimating whole blood viscosity at standardized hematocrit,”Clinical Haemorheology,vol.7,pp.261-265,1987。 12. WI Rosenblum, “In vitro measurements of the effects of anticoagulants on the flow properties of blood: The relationship of these effects to red cell shrinkage,” Blood, vol. 31, no. 2, pp. 234-241, 1968. 13. J. Wang, “Electrochemical Glucose Biosensors,” Chemical Reviews, vol. 108, pp. 814-825, 2008. ***

[0134] The specification is most thoroughly understood in light of the teachings of the references cited herein. The embodiments herein provide examples of embodiments of the invention and should not be construed as limiting the scope of the invention. Those skilled in the art will readily recognize that many other embodiments are encompassed by the invention. All publications and patents cited in this disclosure are incorporated by reference in their entirety. To the extent that any material incorporated by reference contradicts or is inconsistent with the present specification, the present specification takes precedence over any such material. The citation of any reference herein is not an admission that such reference is prior art to the present invention.

[0135] Unless otherwise indicated, all numerical values ​​expressing amounts of ingredients, reaction conditions, and the like used in this specification, including the claims, should be understood as approximations and may vary depending on the desired properties sought to be obtained by the present invention. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should be construed in light of the number of significant digits and ordinary rounding approaches. Recitation of a series of numbers herein with different amounts of significant digits should not be construed as implying that the numbers given with fewer significant digits have the same precision as the numbers given with more significant digits.

[0136] The use of the article "a" or "an" when used in conjunction with the term "comprising" in the claims and / or this specification can mean "one," but is also consistent with the meanings of "one or more," "at least one," and "one or more." The use of the term "or" in the claims is used to mean "and / or," unless expressly stated to refer to alternatives only or that the alternatives are mutually exclusive, but the present disclosure supports a definition that refers to alternatives only, as well as "and / or."

[0137] Unless otherwise indicated, the term "at least" preceding a series of elements should be understood to refer to all of the elements in the series. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific embodiments of the invention described herein. Such equivalents are intended to be encompassed by the following claims.

[0138] Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, the preferred methods and materials are described herein.

[0139] Publications discussed herein are provided solely for their disclosure prior to the filing date of the present application. Nothing herein should be construed as an admission that the present invention is not entitled to antedate such publications by virtue of prior invention. Further, the dates of publication provided may be different from the actual publication dates, which may need to be independently confirmed.

[0140] Other embodiments of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.

Claims

1. 1. A device for measuring one or more properties or changes in properties of a fluid sample at one or more time points, said device comprising: a chamber defining a single interior volume of the device suitable for receiving and holding the fluid sample; a plurality of layers, the plurality of layers including at least a bottom layer below the chamber and at least a substrate layer above the chamber; the substrate layer is connected to at least one suspended beam at both ends of the length of the beam; the suspended beam is positioned above the chamber, the suspended beam having a surface capable of physical contact with the fluid sample; The device, wherein the suspended beam is configured to vibrate upon application of an actuation signal to at least one conductive path extending across the suspended beam.

2. 13. The device of claim 1, further comprising at least one magnetic field source configured to provide a magnetic field having field lines intersecting the suspended beam, whereby the suspended beam oscillates when the actuation signal in the form of a current or voltage is applied and at least one of the magnetic field and actuation signal is varied in time.

3. 3. The device of claim 1, further comprising at least one magnetic field source configured to provide a magnetic field having field lines intersecting the suspended beam, whereby vibration of the suspended beam induces a current or voltage across at least one conductive path.

4. an actuator configured to vibrate the suspended beam by applying one or more excitation fields selected from: (i) a piezoelectric-based mechanical field, (ii) a capacitive field, (iii) an electromagnetic field, and (iv) a thermal excitation field; 4. The device of claim 1, wherein vibration of the suspended beam generates one or more signals selected from: (i) a piezoelectric based electrical signal, (ii) a capacitive signal, (iii) an electromagnetic signal, (iv) a thermal signal, and (v) an optical detection signal.

5. 5. A device as claimed in any one of claims 1 to 4, comprising at least two independent conductive paths extending across the suspended beam, whereby one of the conductive paths can be used to cause vibration of the suspended beam and another of the conductive paths can be used for detection of current or voltage induced by the vibration.

6. The device of any one of claims 1 to 5, wherein an upper surface of the chamber comprises at least a portion of the substrate layer.

7. 7. The device of claim 1, wherein the fluid sample, when applied to the chamber, occupies at least a volume beneath at least one of the at least one suspended beams and adjacent a region above the bottom layer.

8. A device according to any preceding claim, wherein flow of the fluid sample into the chamber is directed along the length of at least one of the at least one suspended beam.

9. The device of any one of claims 1 to 8, wherein the fluid sample influences the vibrations in at least one of the at least one suspended beams.

10. The device of any one of claims 1 to 9, wherein at least one of the substrate layer or the bottom layer comprises at least one conductive path configured to detect the presence of the fluid sample in the chamber.

11. The device, (i) at least one clotting agent in an amount effective to induce clotting of a blood sample upon placement of the blood sample in the chamber and exposure of the blood sample to the clotting agent; (ii) at least one anticoagulant; (iii) at least one coagulation factor; or (iv) at least one active agent selected from at least one agent that alters fluid viscosity in an amount sufficient to change the viscosity by at least 0.001 centipoise.

12. 13. A method of measuring one or more properties or changes in properties of a fluid sample using the device of claim 1, the method comprising: placing the fluid sample in the chamber of the device; vibrating at least one of the at least one suspended beams of the device, the vibration inducing a current or a voltage in at least one of the conductive paths of the device; measuring the current or voltage at one or more times; and calculating said one or more properties or changes in properties of said fluid sample using one or more of said current or voltage measurements.

13. The method of claim 12 , wherein at least one vibration characteristic selected from amplitude, phase, change in vibration frequency, and quality factor is measured and used to determine one or more properties of the fluid sample.

14. The vibration characteristics are (a) a time point prior to the reaction in the fluid sample; (b) a time point during the reaction in the fluid sample; and (c) at least two of the following time points in the fluid sample after the reaction; The method according to any one of claims 12 to 13, wherein the reaction changes one or more of the properties of the fluid sample being measured.

15. 15. The method of any one of claims 12 to 14, wherein the method comprises an in-plane vibration step and an out-of-plane vibration step, and at least two properties of the fluid sample are selected from continuous phase viscosity, bulk viscosity, viscoelasticity, and density.

16. 16. The method of any one of claims 12 to 15, wherein the fluid sample is a blood sample and at least one of plasma viscosity, whole blood viscosity, blood viscoelasticity, blood density, hematocrit, platelet count, blood clotting time, blood clot firmness, platelet contractile activity, fibrinolytic activity, concentration of blood clotting factors, activity of blood clotting factors, concentration of blood components, activity of blood components, type of anticoagulant present in the sample, and concentration of anticoagulant present in the sample are determined.

17. 13. A method of determining one or more properties or changes in properties of a fluid sample using the device of claim 1, the method comprising: placing the fluid sample in a chamber, the chamber surface comprising a physical element capable of vibrating while in contact with the fluid sample; vibrating the physical element at one or more vibrational frequencies; measuring one or more characteristics of the vibration of the physical element at the one or more vibrational frequencies; and determining one or more properties or changes in properties of the fluid sample using one or more of the measured vibrational characteristics.

18. 20. The method of claim 17, wherein the method includes an in-plane vibration step and an out-of-plane vibration step, and the one or more properties of the fluid sample are selected from continuous phase viscosity, bulk viscosity, viscoelasticity, and density.

19. 19. The method of any one of claims 17 to 18, wherein the fluid sample is a blood sample undergoing a clotting reaction and the one or more properties of the fluid sample are selected from plasma viscosity, whole blood viscosity, blood viscoelasticity, blood density, hematocrit, platelet count, blood clotting time, blood clot firmness, platelet contractile activity, and fibrinolytic activity.

20. 20. The method of any one of claims 17 to 19, wherein the fluid sample is a blood sample undergoing a clotting reaction and one or more properties or changes in properties of one or more fluid components selected from thrombin (Factor IIa), fibrinogen (Factor I), fibrin (Factor Ia), prothrombinase (Factor Xa), anticoagulants, platelets, red blood cells, and macromolecules or macromolecular complexes are determined.

21. 12. Use of the device according to any one of claims 1 to 11 for determining at least one of the following: viscosity of a fluid sample, viscosity of a bulk phase of a fluid sample, viscosity of a continuous phase of a fluid sample, viscoelasticity of a fluid sample, density of a fluid sample, plasma viscosity of a blood sample, whole blood viscosity of a blood sample, viscoelasticity of a blood sample, density of a blood sample, hematocrit of a blood sample, platelet count of a blood sample, blood clotting time of a blood sample, blood clot firmness of a blood sample, platelet contractile activity of a blood sample, fibrinolytic activity of a blood sample, concentration of a blood clotting factor of a blood sample, activity of a blood clotting factor of a blood sample, concentration of a blood component of a blood sample, activity of a blood component of a blood sample, type of anticoagulant in the blood sample, and concentration of an anticoagulant in the blood sample.

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