Non-invasive wearable electrochemical sensors: a review

Skin-Attachable, Stretchable Electrochemical Sweat Sensor for Glucose and pH Detection

As part of increased efforts to develop wearable healthcare devices for monitoring and managing physiological and metabolic information, stretchable electrochemical sweat sensors have been investigated. In this study, we report on the fabrication of a stretchable and skin-attachable electrochemical sensor for detecting glucose and pH in sweat. A patterned stretchable electrode was fabricated via layer-by-layer deposition of carbon nanotubes (CNTs) on top of patterned Au nanosheets (AuNS) prepared by filtration onto stretchable substrate. For the detection of glucose and pH, CoWO₄/CNT and polyaniline/CNT nanocomposites were coated onto the CNT-AuNS electrodes, respectively. A reference electrode was prepared via chlorination of silver nanowires. Encapsulation of the stretchable sensor with sticky silbione led to a skin-attachable sweat sensor. Our sensor showed high performance with sensitivities of 10.89 μA mM^-1 cm^-2 and 71.44 mV pH^-1 for glucose and pH, respectively, with mechanical stability up to 30% stretching and air stability for 10 days. The sensor also showed good adhesion even to wet skin, allowing the detection of glucose and pH in sweat from running while being attached onto the skin. This work suggests the application of our stretchable and skin-attachable electrochemical sensor to health management as a high-performance healthcare wearable device.

Mobile Exergaming in Adolescents' Everyday Life-Contextual Design of Where, When, with Whom, and How: The SmartLife Case

Exergames, more specifically console-based exergames, are generally enjoyed by adolescents and known to increase physical activity. Nevertheless, they have a reduced usage over time and demonstrate little effectiveness over the long term. In order to increase playing time, mobile exergames may increase potential playing time, but need to be engaging and integrated in everyday life. The goal of the present study was to examine the context of gameplay for mobile exergaming in adolescents’ everyday life to inform game design and the integration of gameplay into everyday life. Eight focus groups were conducted with 49 Flemish adolescents (11 to 17 years of age). The focus groups were audiotaped, transcribed, and analyzed by means of thematic analysis via Nvivo 11 software (QSR International Pty Ltd., Victoria, Australia). The adolescents indicated leisure time and travel time to and from school as suitable timeframes for playing a mobile exergame. Outdoor gameplay should be restricted to the personal living environment of adolescents. Besides outdoor locations, the game should also be adaptable to at-home activities. Activities could vary from running outside to fitness exercises inside. Furthermore, the social context of the game was important, e.g., playing in teams or meeting at (virtual) meeting points. Physical activity tracking via smart clothing was identified as a motivator for gameplay. By means of this study, game developers may be better equipped to develop mobile exergames that embed gameplay in adolescents’ everyday life.

An In-Vitro Optical Sensor Designed to Estimate Glycated Hemoglobin Levels

The purpose of this research was to design an optical sensor for evaluating glycated hemoglobin (HbA1c) percentages in hemoglobin. The A1c sensors available in the market use invasive methods, while our device offers the possibility of non-invasive monitoring of HbA1c levels in diabetic patients. A prototype is assembled using two light emitting diodes with peak emission wavelengths of 535 nm and 593 nm, a photodiode, and a microcontroller. The proposed sensor measures the transmitted intensity in the form of an output voltage. We devise an approach to estimate the percentage of HbA1c in hemoglobin for a given solution. This estimation is based on the relative change in absorbance due to change in path length and molar absorption coefficients of hemoglobin and HbA1c, at the two wavelengths. We calculate the molar absorption coefficient of HbA1c at 535 nm and 593 nm wavelengths using the sensor, which is performed by a multiple variable regression analysis algorithm fed through the microcontroller. Specifically, the sensor output voltage with respect to the sample concentration is fitted to an exponentially decaying equation model. We used a commercial chemical assay called Control FD Glycohemoglobin A1c with known percentage HbA1c levels to verify our device measurements.

Wearable Wireless Tyrosinase Bandage and Microneedle Sensors: Toward Melanoma Screening

Wearable bendable bandage-based sensor and a minimally invasive microneedle biosensor are described toward rapid screening of skin melanoma. These wearable electrochemical sensors are capable of detecting the presence of the tyrosinase (TYR) enzyme cancer biomarker in the presence of its catechol substrate, immobilized on the transducer surface. In the presence of the surface TYR biomarker, the immobilized catechol is rapidly converted to benzoquinone that is detected amperometrically, with a current signal proportional to the TYR level. The flexible epidermal bandage sensor relies on printing stress-enduring inks which display good resiliency against mechanical deformations, whereas the hollow microneedle device is filled with catechol-coated carbon paste for assessing tissue TYR levels. The bandage sensor can thus be used directly on the skin whereas microneedle device can reach melanoma tissues under the skin. Both wearable sensors are interfaced to an ultralight flexible electronic board, which transmits data wirelessly to a mobile device. The analytical performance of the resulting bandage and microneedle sensing systems are evaluated using TYR-containing agarose phantom gel and porcine skin. The new integrated conformal portable sensing platforms hold considerable promise for decentralized melanoma screening, and can be extended to the screening of other key biomarkers in skin moles.

Enzyme-Based Glucose Sensor: From Invasive to Wearable Device

Blood glucose concentration is a key indicator of patients' health, particularly for symptoms associated with diabetes mellitus. Because of the large number of diabetic patients, many approaches for glucose measurement have been studied to enable continuous and accurate glucose level monitoring. Among them, electrochemical analysis is prominent because it is simple and quantitative. This technology has been incorporated into commercialized and research-level devices from simple test strips to wearable devices and implantable systems. Although directly monitoring blood glucose assures accurate information, the invasive needle-pinching step to collect blood often results in patients (particularly young patients) being reluctant to adopt the process. An implantable glucose sensor may avoid the burden of repeated blood collections, but it is quite invasive and requires periodic replacement of the sensor owing to biofouling and its short lifetime. Therefore, noninvasive methods to estimate blood glucose levels from tears, saliva, interstitial fluid (ISF), and sweat are currently being studied. This review discusses the evolution of enzyme-based electrochemical glucose sensors, including materials, device structures, fabrication processes, and system engineering. Furthermore, invasive and noninvasive blood glucose monitoring methods using various biofluids or blood are described, highlighting the recent progress in the development of enzyme-based glucose sensors and their integrated systems.

Sensors Based on Bio and Biomimetic Receptors in Medical Diagnostic, Environment, and Food Analysis

Analytical chemistry is now developing mainly in two areas: automation and the creation of complexes that allow, on the one hand, for simultaneously analyzing a large number of samples without the participation of an operator, and on the other, the development of portable miniature devices for personalized medicine and the monitoring of a human habitat. The sensor devices, the great majority of which are biosensors and chemical sensors, perform the role of the latter. That last line is considered in the proposed review. Attention is paid to transducers, receptors, techniques of immobilization of the receptor layer on the transducer surface, processes of signal generation and detection, and methods for increasing sensitivity and accuracy. The features of sensors based on synthetic receptors and additional components (aptamers, molecular imprinted polymers, biomimetics) are discussed. Examples of bio- and chemical sensors' application are given. Miniaturization paths, new power supply means, and wearable and printed sensors are described. Progress in this area opens a revolutionary era in the development of methods of on-site and in-situ monitoring, that is, paving the way from the "test-tube to the smartphone".

Flexible Electrochemical Transducer Platform for Neurotransmitters

We have designed a flexible electrochemical transducer film based on PEDOT-titania-poly(dimethylsiloxane) (PTS) for the simultaneous detection of neurotransmitters. PTS films were characterized using various techniques such as transmission electron microscopy, scanning electron microscopy, atomic force microscopy, four probe electrical conductivity, ac-impedance, and thermomechanical stability. The electrocatalytic behavior of the flexible PTS film toward the oxidation of neurotransmitters was investigated using cyclic voltammetry and differential pulse voltammetry. The fabricated transducer measured a limit of detection of 100 nm ± 5 with a response time of 15 s and a sensitivity of 63 μA mM^-1 cm^-2. The fabricated transducer film demonstrated for the simultaneous determination of epinephrine, dopamine, ascorbic acid, and uric acid with no interference between the analyte molecules. Further, transducer performance is validated by performing with real samples. The results suggested that the fabricated flexible PTS transducer with superior electrocatalytic activity, stability, and low response time can be explored for the sensing of neurotransmitters and hence can be exploited at in vitro and in vivo conditions for the early detection of the various diseases.

Understanding environmental contributions to autism: Causal concepts and the state of science

The complexity of neurodevelopment, the rapidity of early neurogenesis, and over 100 years of research identifying environmental influences on neurodevelopment serve as backdrop to understanding factors that influence risk and severity of autism spectrum disorder (ASD). This Keynote Lecture, delivered at the May 2016 annual meeting of the International Society for Autism Research, describes concepts of causation, outlines the trajectory of research on nongenetic factors beginning in the 1960s, and briefly reviews the current state of this science. Causal concepts are introduced, including root causes; pitfalls in interpreting time trends as clues to etiologic factors; susceptible time windows for exposure; and implications of a multi-factorial model of ASD. An historical background presents early research into the origins of ASD. The epidemiologic literature from the last fifteen years is briefly but critically reviewed for potential roles of, for example, air pollution, pesticides, plastics, prenatal vitamins, lifestyle and family factors, and maternal obstetric and metabolic conditions during her pregnancy. Three examples from the case-control CHildhood Autism Risks from Genes and the Environment Study are probed to illustrate methodological approaches to central challenges in observational studies: capturing environmental exposure; causal inference when a randomized controlled clinical trial is either unethical or infeasible; and the integration of genetic, epigenetic, and environmental influences on development. We conclude with reflections on future directions, including exposomics, new technologies, the microbiome, gene-by-environment interaction in the era of -omics, and epigenetics as the interface of those two. As the environment is malleable, this research advances the goal of a productive and fulfilling life for all children, teen-agers and adults. Autism Res 2018, 11: 554-586. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

This Keynote Lecture, delivered at the 2016 meeting of the International Society for Autism Research, discusses evidence from human epidemiologic studies of prenatal factors contributing to autism, such as pesticides, maternal nutrition and her health. There is no single cause for autism. Examples highlight the features of a high-quality epidemiology study, and what comprises a compelling case for causation. Emergent research directions hold promise for identifying potential interventions to reduce disabilities, enhance giftedness, and improve lives of those with ASD.

Rapid and selective sampling of IgG from skin in less than 1 min using a high surface area wearable immunoassay patch

Microprojection array (MPA) patches are an attractive approach to selectively capture circulating proteins from the skin with minimal invasiveness for diagnostics at the point-of-care or in the home. A key challenge to develop this technology is to extract sufficient quantities of specific proteins from within the skin to enable high diagnostic sensitivity within a convenient amount of time. To achieve this, we investigated the effect of MPA geometry (i.e. projection density, length and array size) on protein capture. We hypothesised that the penetrated surface area of MPAs is a major determinant of protein capture however it was not known if simultaneously increasing projection density, length and array size is possible without adversely affecting penetration and/or tolerability. We show that increasing the projection density (5000-30,000 proj. cm^-2) and array size (4-36 mm²) significantly increases biomarker capture whilst maintaining of a similar level tolerability, which supports previous literature for projection length (40-190 μm). Ultimately, we designed a high surface area MPA (30,000 proj. cm^-2, 36 mm², 140 μm) with a 4.5-fold increase in penetrated surface area compared to our standard MPA design (20,408 proj. cm^-2, 16 mm², 100 μm). The high surface area MPA captured antigen-specific IgG from mice in 30 s with 100% diagnostic sensitivity compared with 10-30 min for previous MPA immunoassay patches, which is over an order of magnitude reduction in wear time. This demonstrates for the first time that MPAs may be used for ultra-rapid (<1 min) protein capture from skin in a time competitive with standard clinical procedures like the needle and lancet, which has broad implications for minimally invasive and point-of-care diagnostics.

Multivariate estimation of the limit of detection by orthogonal partial least squares in temperature-modulated MOX sensors

Metal oxide semiconductor (MOX) sensors are usually temperature-modulated and calibrated with multivariate models such as partial least squares (PLS) to increase the inherent low selectivity of this technology. The multivariate sensor response patterns exhibit heteroscedastic and correlated noise, which suggests that maximum likelihood methods should outperform PLS. One contribution of this paper is the comparison between PLS and maximum likelihood principal components regression (MLPCR) in MOX sensors. PLS is often criticized by the lack of interpretability when the model complexity increases beyond the chemical rank of the problem. This happens in MOX sensors due to cross-sensitivities to interferences, such as temperature or humidity and non-linearity. Additionally, the estimation of fundamental figures of merit, such as the limit of detection (LOD), is still not standardized in multivariate models. Orthogonalization methods, such as orthogonal projection to latent structures (O-PLS), have been successfully applied in other fields to reduce the complexity of PLS models. In this work, we propose a LOD estimation method based on applying the well-accepted univariate LOD formulas to the scores of the first component of an orthogonal PLS model. The resulting LOD is compared to the multivariate LOD range derived from error-propagation. The methodology is applied to data extracted from temperature-modulated MOX sensors (FIS SB-500-12 and Figaro TGS 3870-A04), aiming at the detection of low concentrations of carbon monoxide in the presence of uncontrolled humidity (chemical noise). We found that PLS models were simpler and more accurate than MLPCR models. Average LOD values of 0.79 ppm (FIS) and 1.06 ppm (Figaro) were found using the approach described in this paper. These values were contained within the LOD ranges obtained with the error-propagation approach. The mean LOD increased to 1.13 ppm (FIS) and 1.59 ppm (Figaro) when considering validation samples collected two weeks after calibration, which represents a 43% and 46% degradation, respectively. The orthogonal score-plot was a very convenient tool to visualize MOX sensor data and to validate the LOD estimates.

Re-usable electrochemical glucose sensors integrated into a smartphone platform

This article demonstrates a new smartphone-based reusable glucose meter. The glucose meter includes a custom-built smartphone case that houses a permanent bare sensor strip, a stylus that is loaded with enzyme-carbon composite pellets, and sensor instrumentation circuits. A custom-designed Android-based software application was developed to enable easy and clear display of measured glucose concentration. A typical test involves the user loading the software, using the stylus to dispense an enzymatic pellet on top of the bare sensor strip affixed to the case, and then introducing the sample. The electronic module then acquires and wirelessly transmits the data to the application software to be displayed on the screen. The deployed pellet is then discarded to regain the fresh bare sensor surface. Such a unique working principle allows the system to overcome challenges faced by previously reported reusable sensors, such as enzyme degradation, leaching, and hysteresis effects. Studies reveal that the enzyme loaded in the pellets are stable for up to 8 months at ambient conditions, and generate reproducible sensor signals. The work illustrates the significance of the pellet-based sensing system towards realizing a reusable, point-of-care sensor that snugly fits around a smartphone and which does not face issues usually common to reusable sensors. The versatility of this system allows it to be easily modified to detect other analytes for application in a wide range of healthcare, environmental and defense domains.

An Optical Biosensing Strategy Based on Selective Light Absorption and Wavelength Filtering from Chromogenic Reaction

To overcome the time and space constraints in disease diagnosis via the biosensing approach, we developed a new signal-transducing strategy that can be applied to colorimetric optical biosensors. Our study is focused on implementation of a signal transduction technology that can directly translate the color intensity signals—that require complicated optical equipment for the analysis—into signals that can be easily counted with the naked eye. Based on the selective light absorption and wavelength-filtering principles, our new optical signaling transducer was built from a common computer monitor and a smartphone. In this signal transducer, the liquid crystal display (LCD) panel of the computer monitor served as a light source and a signal guide generator. In addition, the smartphone was used as an optical receiver and signal display. As a biorecognition layer, a transparent and soft material-based biosensing channel was employed generating blue output via a target-specific bienzymatic chromogenic reaction. Using graphics editor software, we displayed the optical signal guide patterns containing multiple polygons (a triangle, circle, pentagon, heptagon, and 3/4 circle, each associated with a specified color ratio) on the LCD monitor panel. During observation of signal guide patterns displayed on the LCD monitor panel using a smartphone camera via the target analyte-loaded biosensing channel as a color-filtering layer, the number of observed polygons changed according to the concentration of the target analyte via the spectral correlation between absorbance changes in a solution of the biosensing channel and color emission properties of each type of polygon. By simple counting of the changes in the number of polygons registered by the smartphone camera, we could efficiently measure the concentration of a target analyte in a sample without complicated and expensive optical instruments. In a demonstration test on glucose as a model analyte, we could easily measure the concentration of glucose in the range from 0 to 10 mM.

Multiple Instance Dictionary Learning for Beat-to-Beat Heart Rate Monitoring From Ballistocardiograms

A multiple instance dictionary learning approach, dictionary learning using functions of multiple instances (DL-FUMI), is used to perform beat-to-beat heart rate estimation and to characterize heartbeat signatures from ballistocardiogram (BCG) signals collected with a hydraulic bed sensor. DL-FUMI estimates a "heartbeat concept" that represents an individual's personal ballistocardiogram heartbeat pattern. DL-FUMI formulates heartbeat detection and heartbeat characterization as a multiple instance learning problem to address the uncertainty inherent in aligning BCG signals with ground truth during training. Experimental results show that the estimated heartbeat concept obtained by DL-FUMI is an effective heartbeat prototype and achieves superior performance over comparison algorithms.

Super-Absorbent Polymer Valves and Colorimetric Chemistries for Time-Sequenced Discrete Sampling and Chloride Analysis of Sweat via Skin-Mounted Soft Microfluidics

This paper introduces super absorbent polymer valves and colorimetric sensing reagents as enabling components of soft, skin-mounted microfluidic devices designed to capture, store, and chemically analyze sweat released from eccrine glands. The valving technology enables robust means for guiding the flow of sweat from an inlet location into a collection of isolated reservoirs, in a well-defined sequence. Analysis in these reservoirs involves a color responsive indicator of chloride concentration with a formulation tailored to offer stable operation with sensitivity optimized for the relevant physiological range. Evaluations on human subjects with comparisons against ex situ analysis illustrate the practical utility of these advances.

Highly Sensitive and Wearable In2O3 Nanoribbon Transistor Biosensors with Integrated On-Chip Gate for Glucose Monitoring in Body Fluids

Nanoribbon- and nanowire-based field-effect transistor (FET) biosensors have stimulated a lot of interest. However, most FET biosensors were achieved by using bulky Ag/AgCl electrodes or metal wire gates, which have prevented the biosensors from becoming truly wearable. Here, we demonstrate highly sensitive and conformal In₂O₃ nanoribbon FET biosensors with a fully integrated on-chip gold side gate, which have been laminated onto various surfaces, such as artificial arms and watches, and have enabled glucose detection in various body fluids, such as sweat and saliva. The shadow-mask-fabricated devices show good electrical performance with gate voltage applied using a gold side gate electrode and through an aqueous electrolyte. The resulting transistors show mobilities of ∼22 cm² V^-1 s^-1 in 0.1× phosphate-buffered saline, a high on-off ratio (10⁵), and good mechanical robustness. With the electrodes functionalized with glucose oxidase, chitosan, and single-walled carbon nanotubes, the glucose sensors show a very wide detection range spanning at least 5 orders of magnitude and a detection limit down to 10 nM. Therefore, our high-performance In₂O₃ nanoribbon sensing platform has great potential to work as indispensable components for wearable healthcare electronics.

A Real-Time Wireless Sweat Rate Measurement System for Physical Activity Monitoring

There has been significant research on the physiology of sweat in the past decade, with one of the main interests being the development of a real-time hydration monitor that utilizes sweat. The contents of sweat have been known for decades; sweat provides significant information on the physiological condition of the human body. However, it is important to know the sweat rate as well, as sweat rate alters the concentration of the sweat constituents, and ultimately affects the accuracy of hydration detection. Towards this goal, a calorimetric based flow-rate detection system was built and tested to determine sweat rate in real time. The proposed sweat rate monitoring system has been validated through both controlled lab experiments (syringe pump) and human trials. An Internet of Things (IoT) platform was embedded, with the sensor using a Simblee board and Raspberry Pi. The overall prototype is capable of sending sweat rate information in real time to either a smartphone or directly to the cloud. Based on a proven theoretical concept, our overall system implementation features a pioneer device that can truly measure the rate of sweat in real time, which was tested and validated on human subjects. Our realization of the real-time sweat rate watch is capable of detecting sweat rates as low as 0.15 µL/min/cm², with an average error in accuracy of 18% compared to manual sweat rate readings.

Skin-interfaced systems for sweat collection and analytics

Recent interdisciplinary advances in materials, mechanics, and microsystem designs for biocompatible electronics, soft microfluidics, and electrochemical biosensors establish the foundations for emerging classes of thin, skin-interfaced platforms capable of capturing, storing, and performing quantitative, spatiotemporal measurements of sweat chemistry, instantaneous local sweat rate, and total sweat loss. This review summarizes scientific and technical progress in this area and highlights the implications in real time and ambulatory modes of deployment during physical activities across a broad range of contexts in clinical health, physiology research, fitness/wellness, and athletic performance.

Sensitive and Flexible Polymeric Strain Sensor for Accurate Human Motion Monitoring

Flexible electronic devices offer the capability to integrate and adapt with human body. These devices are mountable on surfaces with various shapes, which allow us to attach them to clothes or directly onto the body. This paper suggests a facile fabrication strategy via electrospinning to develop a stretchable, and sensitive poly (vinylidene fluoride) nanofibrous strain sensor for human motion monitoring. A complete characterization on the single PVDF nano fiber has been performed. The charge generated by PVDF electrospun strain sensor changes was employed as a parameter to control the finger motion of the robotic arm. As a proof of concept, we developed a smart glove with five sensors integrated into it to detect the fingers motion and transfer it to a robotic hand. Our results shows that the proposed strain sensors are able to detect tiny motion of fingers and successfully run the robotic hand.

Wearable Chemosensors: A Review of Recent Progress

In recent years, there has been growing demand for wearable chemosensors for their important potential applications in mobile and electronic healthcare, patient self-assessment, human motion monitoring, and so on. Innovations in wearable chemosensors are revolutionizing the modern lifestyle, especially the involvement of both doctors and patients in the modern healthcare system. The facile interaction of wearable chemosensors with the human body makes them favorable and convenient tools for the detection and long-term monitoring of the chemical, biological, and physical status of the human body at a low cost with high performance. In this Minireview, we give a brief overview of the recent advances and developments in the field of wearable chemosensors, summarize the basic types of wearable chemosensors, and discuss their main functions and fabrication methods. At the end of this paper, the future development direction of wearable chemosensors is prospected. With continued interest and attention to this field, new exciting progress is expected in the development of innovative wearable chemosensors.

Enzymatic Fuel Cells: Towards Self-Powered Implantable and Wearable Diagnostics

With the rapid progress in nanotechnology and microengineering, point-of-care and personalised healthcare, based on wearable and implantable diagnostics, is becoming a reality. Enzymatic fuel cells (EFCs) hold great potential as a sustainable means to power such devices by using physiological fluids as the fuel. This review summarises the fundamental operation of EFCs and discusses the most recent advances for their use as implantable and wearable self-powered sensors.

Energy Harvesting from the Animal/Human Body for Self-Powered Electronics

Living subjects (i.e., humans and animals) have abundant sources of energy in chemical, thermal, and mechanical forms. The use of these energies presents a viable way to overcome the battery capacity limitation that constrains the long-term operation of wearable/implantable devices. The intersection of novel materials and fabrication techniques offers boundless possibilities for the benefit of human health and well-being via various types of energy harvesters. This review summarizes the existing approaches that have been demonstrated to harvest energy from the bodies of living subjects for self-powered electronics. We present material choices, device layouts, and operation principles of these energy harvesters with a focus on in vivo applications. We discuss a broad range of energy harvesters placed in or on various body parts of human and animal models. We conclude with an outlook of future research in which the integration of various energy harvesters with advanced electronics can provide a new platform for the development of novel technologies for disease diagnostics, treatment, and prevention.

Wearable sensors: modalities, challenges, and prospects

Wearable sensors have recently seen a large increase in both research and commercialization. However, success in wearable sensors has been a mix of both progress and setbacks. Most of commercial progress has been in smart adaptation of existing mechanical, electrical and optical methods of measuring the body. This adaptation has involved innovations in how to miniaturize sensing technologies, how to make them conformal and flexible, and in the development of companion software that increases the value of the measured data. However, chemical sensing modalities have experienced greater challenges in commercial adoption, especially for non-invasive chemical sensors. There have also been significant challenges in making significant fundamental improvements to existing mechanical, electrical, and optical sensing modalities, especially in improving their specificity of detection. Many of these challenges can be understood by appreciating the body's surface (skin) as more of an information barrier than as an information source. With a deeper understanding of the fundamental challenges faced for wearable sensors and of the state-of-the-art for wearable sensor technology, the roadmap becomes clearer for creating the next generation of innovations and breakthroughs.

Nanomaterial-Enabled Wearable Sensors for Healthcare

Highly sensitive wearable sensors that can be conformably attached to human skin or integrated with textiles to monitor the physiological parameters of human body or the surrounding environment have garnered tremendous interest. Owing to the large surface area and outstanding material properties, nanomaterials are promising building blocks for wearable sensors. Recent advances in the nanomaterial-enabled wearable sensors including temperature, electrophysiological, strain, tactile, electrochemical, and environmental sensors are presented in this review. Integration of multiple sensors for multimodal sensing and integration with other components into wearable systems are summarized. Representative applications of nanomaterial-enabled wearable sensors for healthcare, including continuous health monitoring, daily and sports activity tracking, and multifunctional electronic skin are highlighted. Finally, challenges, opportunities, and future perspectives in the field of nanomaterial-enabled wearable sensors are discussed.

Seizure Forecasting from Idea to Reality. Outcomes of the My Seizure Gauge Epilepsy Innovation Institute Workshop

The Epilepsy Innovation Institute (Ei²) is a new research program of the Epilepsy Foundation designed to be an innovation incubator for epilepsy. Ei² research areas are selected based on community surveys that ask people impacted by epilepsy what they would like researchers to focus on. In their 2016 survey, unpredictability was selected as a top issue regardless of seizure frequency or severity. In response to this need, Ei² launched the My Seizure Gauge challenge, with the end goal of creating a personalized seizure advisory system device. Prior to moving forward, Ei² convened a diverse group of stakeholders from people impacted by epilepsy and clinicians, to device developers and data scientists, to basic science researchers and regulators, for a state of the science assessment on seizure forecasting. From the discussions, it was clear that we are at an exciting crossroads. With the advances in bioengineering, we can utilize digital markers, wearables, and biosensors as parameters for a seizure-forecasting algorithm. There are also over a thousand individuals who have been implanted with ambulatory intracranial EEG recording devices. Pairing up peripheral measurements to brain states could identify new relationships and insights. Another key component is the heterogeneity of the relationships indicating that pooling findings across groups is suboptimal, and that data collection will need to be done on longer time scales to allow for individualization of potential seizure-forecasting algorithms.

Air bio-battery with a gas/liquid porous diaphragm cell for medical and health care devices

Powering future generations of medical and health care devices mandates the transcutaneous transfer of energy or harvesting energy from the human body fluid. Glucose-driven bio fuel cells (bio-batteries) demonstrate promise as they produce electrical energy from glucose, which is a substrate presents in physiological fluids. Enzymatic biofuel cells can convert chemical energy into electrical energy using enzymes as catalysts. In this study, an air bio-battery was developed for healthcare and medical applications, consisting of a glucose-driven enzymatic biofuel cell using a direct gas-permeable membrane or a gas/liquid porous diaphragm. The power generation characteristics included a maximum current density of 285μA/cm² and maximum power density of 70.7μW/cm² in the presence of 5mmol/L of glucose in solution. In addition, high-performance, long-term-stabilized power generation was achieved using the gas/liquid porous diaphragm for the reactions between oxygen and enzyme. This system can be powered using 5mmol/L of glucose, the value of which is similar to that of the blood sugar range in humans.

A Thermally Powered ISFET Array for On-Body pH Measurement

Recent advances in electronics and electrochemical sensors have led to an emerging class of next generation wearables, detecting analytes in biofluids such as perspiration. Most of these devices utilize ion-selective electrodes (ISEs) as a detection method; however, ion-sensitive field-effect transistors (ISFETs) offer a solution with improved integration and a low power consumption. This work presents a wearable, thermoelectrically powered system composed of an application-specific integrated circuit (ASIC), two commercial power management integrated circuits and a network of commercial thermoelectric generators (TEGs). The ASIC is fabricated in 0.35 m CMOS and contains an ISFET array designed to read pH as a current, a processing module which averages the signal to reduce noise and encodes it into a frequency, and a transmitter. The output frequency has a measured sensitivity of 6 to 8 kHz/pH for a pH range of 7-5. It is shown that the sensing array and processing module has a power consumption 6 W and, therefore, can be entirely powered by body heat using a TEG. Array averaging is shown to reduce noise at these low power levels to 104 V (input referred integrated noise), reducing the minimum detectable limit of the ASIC to 0.008 pH units. The work forms the foundation and proves the feasibility of battery-less, on-body electrochemical for perspiration analysis in sports science and healthcare applications.

Surface coatings of silver nanowires lead to effective, high conductivity, high-strain, ultrathin sensors

Integrated sensors for bodily measurements require a sensing material that is highly conductive, flexible, thin and sensitive. It is important that these materials are non-invasive in application but robust in nature to allow for effective, continuous measurement. Herein, we report a comparative study of two simple, scalable methods to produce silver nanowire (AgNW) polyurethane (PU) composite materials: layer-by-layer (LBL) and mixed filtration. Both types of composites formed were ultrathin (∼50 μm) and highly conductive (10⁴ S m^-1), with the LBL method ultimately found to be superior due to its low percolation threshold. Electrical resistance of the LBL composites was found to vary with strain, making these materials suitable for strain sensing. LBL composites displayed a working strain up to ∼250% and a high gauge factor (G), with values of G ∼70 reported. The sensors reported here were ∼10⁹-times more conductive and ∼10⁴-times thinner than their carbon-based composite sensor counterparts with similar gauge factor. This made the strain sensors presented here among one of the most flexible, highly sensitive, thinnest, conductive materials in literature. We demonstrated that with these properties, the LBL composites formed were ideal for bodily motion detection.

Organic Electronics for Point-of-Care Metabolite Monitoring

In this review we focus on demonstrating how organic electronic materials can solve key problems in biosensing thanks to their unique material properties and implementation in innovative device configurations. We highlight specific examples where these materials solve multiple issues related to complex sensing environments, and we benchmark these examples by comparing them to state-of-the-art commercially available sensing using alternative technologies. We have categorized our examples by sample type, focusing on sensing from body fluids in vitro and on wearable sensors, which have attracted significant interest owing to their integration with everyday life activities. We finish by describing a future trend for in vivo, implantable sensors, which aims to build on current progress from sensing in biological fluids ex vivo.

Prolonged and localized sweat stimulation by iontophoretic delivery of the slowly-metabolized cholinergic agent carbachol

BACKGROUND

Continuous non-invasive sampling and sensing of multiple classes of analytes could revolutionize medical diagnostics and wearable technologies, but also remains highly elusive because of the many confounding factors for candidate biofluids such as interstitial fluid, tears, saliva, and sweat. Eccrine sweat biosensing has seen a recent surge in demonstrations of wearable sampling and sensing devices. However, for subjects at rest, access to eccrine sweat is highly limited and unpredictable compared to saliva and tears.

OBJECTIVE

Reported here is a prolonged and localized sweat stimulation by iontophoretic delivery of the slowly-metabolized nicotinic cholinergic agonist carbachol.

METHODS

Presented here are detailed measurements of natural baseline sweat rates across multiple days, confirming a clear need for localized sweat stimulation. Iontophoresis was performed with either carbachol or pilocarpine in order to stimulate sweat in subjects at rest. Furthermore, improved methods of quantifying sweat generation rates (nL/min/gland) are demonstrated.

RESULTS

In-vivo testing reveals that carbachol stimulation can surpass a major goal of 24-h sweat access, in some cases providing more than an order of magnitude longer duration than stimulation with commonly-used pilocarpine. Also demonstrated is reduction of the traditional iontophoretic dosage for sweat stimulation (<5.25-42mC/cm²). This increases the viability of repeated dosing as demonstrated herein, and for carbachol is as much as 100-1000X less than used for other applications.

CONCLUSION

This work is not only significant for wearable sweat biosensing technology, but could also have broader impact for those studying topical skin products, antiperspirants, textiles and medical adhesives, nerve disorders, the effects of perspiration on skin-health, skin related diseases such as idiopathic pure sudomotor failure and hyperhidrosis, and other skin- and perspiration-related applications.

Cucurbituril and Azide Cofunctionalized Graphene Oxide for Ultrasensitive Electro-Click Biosensing

To achieve high selectivity and sensitivity simultaneously in an electrochemical biosensing platform, cucurbituril and azide cofunctionalized graphene oxide, a new functional nanomaterial that acts as a go-between to connect the recognition element with amplified signal architecture, is developed in this work. The cucurbituril and azide cofunctionalized graphene oxide features a high specific surface area with abundant levels of the two types of functional groups. Specifically, it emerges as a powerful tool to link recognition elements with simplicity, high yield, rapidity, and highly selective reactivity through azide-alkynyl click chemistry. Moreover, it possesses many host molecules to interact with guest molecules (also signal molecules)-grafted branched ethylene imine polymer, through which the detection sensitivity can be greatly improved. Together with electro-click technology, a highly controllable, selective, and sensitive biosensing platform can be easily created. For VEGF₁₆₅ protein detection, the electro-click assay has high selectivity and sensitivity; a dynamic detection range from 10 fg mL^-1 to 1 ng mL^-1 with a detection limit of 8 fg mL^-1 was achieved. The electro-click biosensing strategy based on cucurbituril and azide cofunctionalized graphene oxide would have great promise for other target analytes with a broad range of applications.

Wearable Ring-Based Sensing Platform for Detecting Chemical Threats

This work describes a wireless wearable ring-based multiplexed chemical sensor platform for rapid electrochemical monitoring of explosive and nerve-agent threats in vapor and liquid phases. The ring-based sensor system consists of two parts: a set of printed electrochemical sensors and a miniaturized electronic interface, based on a battery-powered stamp-size potentiostat, for signal processing and wireless transmission of data. A wide range of electrochemical capabilities have thus been fully integrated into a 3D printed compact ring structure, toward performing fast square-wave voltammetry and chronoamperometric analyses, along with interchangeable screen-printed sensing electrodes for the rapid detection of different chemical threats. High analytical performance is demonstrated despite the remarkable miniaturization and integration of the ring system. The attractive capabilities of the wearable sensor ring system have been demonstrated for sensitive and rapid voltammetric and amperometric monitoring of nitroaromatic and peroxide explosives, respectively, along with amperometric biosensing of organophosphate (OP) nerve agents. Such ability of the miniaturized wearable sensor ring platform to simultaneously detect multiple chemical threats in both liquid and vapor phases and alert the wearer of such hazards offers considerable promise for meeting the demands of diverse defense and security scenarios.

General Metal-Ion Mediated Method for Functionalization of Graphene Fiber

Graphene fibers (GFs) are attractive materials for wearable electronics because of their lightness, superior flexibility, and electrical conductivity. However, the hydrophobic nature and highly stacked structure endow GFs similar characteristics in nature to solid carbon fibers. Therefore, the interior functionalization of GFs so as to achieve synergistic interaction between graphene nanosheets and active materials thus enhance the performance of hybrid fibers remains a challenge. Herein, a general metal-ion mediated strategy is developed to functionalize GFs and nanoparticles of Cu, Fe₂O₃, NiO, and CoO are successfully incorporated into GFs, respectively. As proof-of-concept applications, the obtained functionalized GFs are used as electrodes for electrochemical sensors and supercapacitors. The performances of thus-devised fiber sensor and supercapacitor are greatly improved.

Portable biosensor for monitoring cortisol in low-volume perspired human sweat

A non-faradaic label-free cortisol biosensor was demonstrated using MoS₂ nanosheets integrated into a nanoporous flexible electrode system. Low volume (1–5 μL) sensing was achieved through use of a novel sensor stack design comprised of vertically aligned metal electrodes confining semi-conductive MoS₂ nanosheets. The MoS₂ nanosheets were surface functionalized with cortisol antibodies towards developing an affinity biosensor specific to the physiological relevant range of cortisol (8.16 to 141.7 ng/mL) in perspired human sweat. Sensing was achieved by measuring impedance changes associated with cortisol binding along the MoS₂ nanosheet interface using electrochemical impedance spectroscopy. The sensor demonstrated a dynamic range from 1–500 ng/mL with a limit of detection of 1 ng/mL. A specificity study was conducted using a metabolite expressed in human sweat, Ethyl Glucuronide. Continuous dosing studies were performed during which the sensor was able to discriminate between four cortisol concentration ranges (0.5, 5, 50, 500 ng/mL) for a 3+ hour duration. Translatability of the sensor was shown with a portable form factor device, demonstrating a comparable dynamic range and limit of detection for the sensor. The device demonstrated a R² correlation value of 0.998 when comparing measurements to the reported impedance values of the benchtop instrumentation.

Activity Recognition Using Complex Network Analysis

In this paper, we perform complex network analysis on a connectivity dataset retrieved from a monitoring system in order to classify simple daily activities. The monitoring system is composed of a set of wearable sensing modules positioned on the subject's body and the connectivity data consists of the correlation between each pair of modules. A number of network measures are then computed followed by the application of statistical significance and feature selection methods. These methods were implemented for the purpose of reducing the total number of modules in the monitoring system required to provide accurate activity classification. The obtained results show that an overall accuracy of 84.6% for activity classification is achieved, using a random forest classifier, and when considering a monitoring system composed of only two modules positioned at the neck and thigh of the subject's body.

Carbon Nanotube-Based Ion Selective Sensors for Wearable Applications

Wearable electronics offer new opportunities in a wide range of applications, especially sweat analysis using skin sensors. A fundamental challenge in these applications is the formation of sensitive and stable electrodes. In this article we report the development of a wearable sensor based on carbon nanotube (CNT) electrode arrays for sweat sensing. Solid-state ion selective electrodes (ISEs), sensitive to Na⁺ ions, were prepared by drop coating plasticized poly(vinyl chloride) (PVC) doped with ionophore and ion exchanger on CNT electrodes. The ion selective membrane (ISM) filled the intertubular spaces of the highly porous CNT film and formed an attachment that was stronger than that achieved with flat Au, Pt, or carbon electrodes. Concentration of the ISM solution used influenced the attachment to the CNT film, the ISM surface morphology, and the overall performance of the sensor. Sensitivity of 56 ± 3 mV/decade to Na⁺ ions was achieved. Optimized solid-state reference electrodes (REs), suitable for wearable applications, were prepared by coating CNT electrodes with colloidal dispersion of Ag/AgCl, agarose hydrogel with 0.5 M NaCl, and a passivation layer of PVC doped with NaCl. The CNT-based REs had low sensitivity (-1.7 ± 1.2 mV/decade) toward the NaCl solution and high repeatability and were superior to bare Ag/AgCl, metals, carbon, and CNT films, reported previously as REs. CNT-based ISEs were calibrated against CNT-based REs, and the short-term stability of the system was tested. We demonstrate that CNT-based devices implemented on a flexible support are a very attractive platform for future wearable technology devices.

Point-of-care diagnostics to improve maternal and neonatal health in low-resource settings

Each day, approximately 830 women and 7400 newborns die from complications during pregnancy and childbirth. Improving maternal and neonatal health will require bringing rapid diagnosis and treatment to the point of care in low-resource settings. However, to date there are few diagnostic tools available that can be used at the point of care to detect the leading causes of maternal and neonatal mortality in low-resource settings. Here we review both commercially available diagnostics and technologies that are currently in development to detect the leading causes of maternal and neonatal mortality, highlighting key gaps in development where innovative design could increase access to technology and enable rapid diagnosis at the bedside.

Use of Mobile Health Technology in the Prevention and Management of Diabetes Mellitus

Cardiovascular disease is the leading cause of morbidity and mortality globally, with diabetes being an independent risk factor. Adequate diabetes management has proven to be resource-intensive, requiring frequent lab work, primary care and specialist visits, and time-consuming record-keeping by the patient and care team. New mobile health (mHealth) technologies have enhanced how diabetes is managed and care is delivered. While more recent work has investigated mHealth devices as complementary tools in behavioral interventions for diabetes prevention and management, little is still known about the effectiveness of mHealth technology as stand-alone intervention tools for reducing diabetes risk. In addition, more work is needed to identify the role of mHealth technology in treating vulnerable populations to ameliorate cardiovascular health disparities. With advances in mobile health technology development for diabetes prevention and management, these modalities will likely play an increasingly prominent role in reducing cardiometabolic risk for the US population.

Novel Opportunities for Improving the Quality of Preanalytical Phase. A Glimpse to the Future?

The preanalytical phase is crucial for assuring the quality of in vitro diagnostics. The leading aspects which contribute to enhance the vulnerability of this part of the total testing process include the lack of standardization of different practices for collecting, managing, transporting and processing biological specimens, the insufficient compliance with available guidelines and the still considerable number of preventable human errors. As in heavy industry, road traffic and aeronautics, technological advancement holds great promise for decreasing the risk of medical and diagnostic errors, thus including those occurring in the extra-analytical phases of the total testing process. The aim of this article is to discuss some potentially useful technological advances, which are not yet routine practice, but may be especially suited for improving the quality of the preanalytical phase in the future. These are mainly represented by introduction of needlewielding robotic phlebotomy devices, active blood tubes, drones for biological samples transportation, innovative approaches for detecting spurious hemolysis and preanalytical errors recording software products.

Wearable physiological systems and technologies for metabolic monitoring

Wearable sensors allow continuous monitoring of metabolites for diabetes, sports medicine, exercise science, and physiology research. These sensors can continuously detect target analytes in skin interstitial fluid (ISF), tears, saliva, and sweat. In this review, we will summarize developments on wearable devices and their potential applications in research, clinical practice, and recreational and sporting activities. Sampling skin ISF can require insertion of a needle into the skin, whereas sweat, tears, and saliva can be sampled by devices worn outside the body. The most widely sampled metabolite from a wearable device is glucose in skin ISF for monitoring diabetes patients. Continuous ISF glucose monitoring allows estimation of the glucose concentration in blood without the pain, inconvenience, and blood waste of fingerstick capillary blood glucose testing. This tool is currently used by diabetes patients to provide information for dosing insulin and determining a diet and exercise plan. Similar technologies for measuring concentrations of other analytes in skin ISF could be used to monitor athletes, emergency responders, warfighters, and others in states of extreme physiological stress. Sweat is a potentially useful substrate for sampling analytes for metabolic monitoring during exercise. Lactate, sodium, potassium, and hydrogen ions can be measured in sweat. Tools for converting the concentrations of these analytes sampled from sweat, tears, and saliva into blood concentrations are being developed. As an understanding of the relationships between the concentrations of analytes in blood and easily sampled body fluid increases, then the benefits of new wearable devices for metabolic monitoring will also increase.

A Self-Powered Wearable Noninvasive Electronic-Skin for Perspiration Analysis Based on Piezo-Biosensing Unit Matrix of Enzyme/ZnO Nanoarrays

The emerging multifunctional flexible electronic-skin for establishing body-electric interaction can enable real-time monitoring of personal health status as a new personalized medicine technique. A key difficulty in the device design is the flexible power supply. Here a self-powered wearable noninvasive electronic-skin for perspiration analysis has been realized on the basis of a piezo-biosensing unit matrix of enzyme/ZnO nanoarrays. The electronic-skin can detect lactate, glucose, uric acid, and urea in the perspiration, and no outside electrical power supply or battery is used in the biosensing process. The piezoelectric impulse of the piezo-biosensing units serves as the power supply and the data biosensor. The working mechanism can be ascribed to the piezoelectric-enzymatic-reaction coupling effect of enzyme/ZnO nanowires. The electronic-skin can real-time/continuously monitor the physiological state of a runner through analyzing the perspiration on his skin. This approach can promote the development of a new-type of body electric and self-powered biosensing electronic-skin.