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Home , Urine test strip

Supplementary Information for Design of Appropriate-technology-assisted Tester Enabling Remote and Long-term Monitoring of Health Conditions

Hyun-Kyung Lee1* and Jeong-Hyeon Bae2

1Division of Culture & Design Management, Underwood International College, Yonsei University 2School of Urban and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST)

*Correspondence: Hyun-Kyung Lee Associate Professor Culture & Design Management, Techno Art Division The Humanities, Arts, and Social Sciences Underwood International College Yonsei University Email: [email protected]

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Table S1. Ten most common compounds that can be analyzed from urine samples. Reference color scales and abnormal ranges are provided by the manufacturers to determine urine tests, which are dependent on the reagent test strips. Suspected diseases can be estimated by comparing the urine test results with the reference. Parameter Abnormal Range Suspected Disease

Blood 0–5 Ery/µl >10 Ery/µl Inflammation or tumors in the kidneys

Gallstone disease, acute , chronic <0.2 mg/dl >1 mg/dl disease

Liver disorder, hemolytic , <1 mg/dl >2 mg/dl pulmonary jaundice

Ketones <5 mg/dl- >10 mg/dl Severe

Protein <2 mg/dl >6 mg/dl infection, diabetes, Wilson’s disease

Nitrite 0 >0.05 mg/dl Cystitis, urethritis

Diabetes, pancreas disease, , <30 mg/dl >40 mg/dl brain tumor

Diabetes, gout, hunger, dehydration, urinary pH Value 4.8–7.4 <4 or >9 tract infections

Specific Gravity 1.016–1.022 <1 or >1.040 Cystitis, urethritis

Kidney and urinary tract abnormalities, Leukocytes <10 Leu/µl >30 Leu/µl tumors

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Table S2. Comparison of our urine test device and a commercially available urine tester with high accuracy and reliability. Our urine tester Sample 1 Sample 2 Sample 3 Sample 4 (RBC/μL) +++ neg. ++ ++ Bilirubin neg. neg. + neg. Urobilinogen (mg/dl) norm. norm. 8.0 norm. (mg/dl) neg. neg. neg. neg. (mg/dl) neg. neg. 100.0 neg. neg. neg. pos. neg. Glucose (mg/dl) neg. neg. neg. neg. pH 5.0 6.0 6.5 5.0 SG 1.030 1.030 1.030 1.030 Leukocytes (WBC/μL) neg. 25.0 500.0 75.0 Commercially available urine tester Sample 1 Sample 2 Sample 3 Sample 4 Blood (RBC/μL) +++ neg. ++ ++ Bilirubin neg. neg. + neg. Urobilinogen (mg/dl) norm. norm. 8.0 norm. Ketones (mg/dl) neg. neg. neg. neg. Protein (mg/dl) neg. 30.0 300.0 30.0 Nitrite neg. neg. pos. neg. Glucose (mg/dl) neg. neg. neg. neg. pH 5.0 6.0 6.5 5.0 SG 1.030 1.030 1.030 1.030 Leukocytes (WBC//μL) neg. 75.0 500.0 neg. Note that the values highlighted in grey show a relatively significant difference compared with the control data.

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Table S3. Cost table of our urine tester (USD). Components Model Price Remark WS2812 NeoPixel Ring– RGB LED ring 12×5050 RGBW, NEX, $2.00 Worldsemi, Guangdong, China WS2818 9 mm LED Pixel RGB LED Light, Worldsemi, Guangdong, $0.01 China Raspberry Pi Foundation, Raspberry Pi Zero W $8.00 Cambridge, UK Raspberry Pi Zero 5 MP Raspberry Pi Foundation, $5.00 Camera Cambridge, UK microSDXC, SanDisk, 64 GB micro SD card $1.50 CA, US Push switch - $0.01 DC power supply (5 V, 1.5 A) - $0.30 3D-printed opaque plastic box - $2.00 optional Low-cost paper box - $0.01 Note that the price is based on bulk purchase of more than 10 or 100 (approximately) and ‘-’ indicates a commercially available mass-produced unit.

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Table S4. Comparison of our urine test device and other commercially available urine testers at the price range of < 1,000 (USD). Accurex Urit Product Our urine GIMA urine BC 401 MD-8000 31 urine /Specification tester analyzer analyzer Company - Contec Medical Dream GIMA Accurex Sale price < $20 $129 $354 $370 $835 Mobile Display 2.4” LCD LCD 2.4” LCD - LCD device1 Weight 300 g2 180 g - 180 g 180 g Device size 150´125 ´40 126´73.5 ´30 35´66´22 88.5´56.5´9.4 120´83´31 (L´W´H) No. of compounds 10 11 10 11 14 to test Time to analyze 1 – 2 5 0.1 1 1 (min) Analysis method CCD Photometer Photometer Photometer Photometer

Test throughput 15 – 30 12 500 60 60 (per hour) 3.7 V, 1900 Power 5 V, 1.5 A DC 5V, 1A DC 4.5 V DC 9 V, 1.5 A mAh3 Memory size > 1000 500 99 500 1000 (test result) Target sample Urine Urine Urine Urine Urine External interface Micro USB Micro USB USB USB USB Option Bluetooth Bluetooth Bluetooth Bluetooth Bluetooth 1A mobile device can be connected via Bluetooth to use its display as shown in Figure S7 or a 2.4” TFT LCD. 2The weight and size of our urine tester can be further reduced and optimized for commercialization. 3A battery is used.

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Negative Trace Small Moderate Large

Fig. S1. Reference color scales of a urine test strip provided by a manufacturer; quantitative test results are classified into six separate categories in a qualitative format according to the color scales in this work: “negative,” “trace,” “small,” “moderate,” “large,” and “erroneous”.

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Fig. S2. (a) An image of the urine test strip in response to a urine sample. (b) The RGB values obtained from (a) are compared with the reference color scales to quantify the concentrations of the 10 compounds in the urine sample as numbered. The y-axis indicates RGB scales ranging from 0 to 255, and linear regression results are also shown.

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Fig. S3. Online survey form offered to users directly before or after their urine test. This step collects users’ qualitative health conditions, which aids analysis of their urine test results.

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(a) (b)

Fig. S4. (a) Urine tester and urine test strips, as a set, distributed to participants. (b) The urine tester installed in a participant’s restroom.

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Fig. S5. Accurate, reliable, and commercially available urine tester (CYBOW R-50S, DFI, Gyeongsangnam- do, Republic of Korea) used for validating the results of our appropriate-technology-assisted urine tester. The sale price is approximately 700 UDS at 2019.

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Fig. S6. Images of another appropriate-technology-assisted all-in-one urine tester in which the 3D-printed plastic box was replaced with low-cost paper boxes to reduce production costs.

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Fig. S7. User health information data from the urine test device can be transmitted to a smartphone.

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