Non-invasive wearable electrochemical sensors: a review

A highly flexible Ni-Co MOF nanosheet coated Au/PDMS film based wearable electrochemical sensor for continuous human sweat glucose monitoring

The development of flexible substrate materials and nanomaterials with high electrochemical performance is of great significance for constructing efficient wearable electrochemical sensors for real-time health monitoring. Herein, a wearable electrochemical sweat sensor based on a Ni-Co MOF nanosheet coated Au/polydimethylsiloxane (PDMS) film was prepared for continuous monitoring of the glucose level in sweat with high sensitivity. First, a stretchable Au/PDMS film based three-electrode system was prepared by chemical deposition of a gold layer on the hydrophilic treated PDMS. Then, Ni-Co MOF nanosheets with high electrocatalytic activity were synthesized by a facile solvothermal method and modified on the Au/PDMS electrode. The electrocatalytic activity of the Ni-Co MOF nanosheets synthesized under different Ni : Co ratios was investigated. The Ni-Co MOF/Au/PDMS (NCAP) film electrode showed excellent electrochemical performance for glucose detection with a wide linear range of 20 μM to 790 μM and a high sensitivity of 205.1 μA mM^-1 cm^-2. In addition, the flexible sensor shows high stability and a good electrochemical response to glucose when stretched and bent to different levels. Moreover, it maintained long-term stability and high selectivity for glucose monitoring. Lastly, a sweat-absorbent cloth was used to cover the working area of the sensor and was fixed with a needle and thread to form a wearable sweat glucose sensor. The sensor can be attached to the skin for stable, accurate and continuous monitoring of glucose levels in human sweat for one day. This work validates the potential of our high-performance wearable sensor for out-of-clinic health monitoring.

Wearable microfluidic-based e-skin sweat sensors

Electronic skins (e-skins) are soft (deformable and stretchable) state-of-the-art wearable devices that emulate the attributes of human skin and act as a Human-Machine Interface (HMI). Recent advances in e-skin for real-time detection of medical signals such as pulse, temperature, electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG), electrocardiogram (ECG), and other bioelectric signals laid down an intelligent foundation for early prediction and diagnosis of diseases with a motive of reducing the risk of the ailment reaching to the end stage. In particular, sweat testing has been employed in diverse applications ranging from medical diagnosis of diabetes, cystic fibrosis, tuberculosis, blood pressure, and autonomic neuropathy to evaluating fluid and electrolyte balance in athletes. Typically, sweat testing techniques are done by trained experts and require off-body measurements, which prevent individuals from de-coding health issues quickly and independently. With the onset of soft electronics, wearable sweat sensors overcome this disadvantage via in situ sweat measurements with real-time feedback, timely diagnosis, creating the potential for preventive care and treatment. Over the past few decades, wearable microfluidic-based e-skin sweat sensors have paved a new way, promising sensing interfaces that are highly compatible with arranging medical and electronic applications. The present review highlights the recent research carried out in the microfluidic-based wearable sweat sensors with a critical focus on real-time sensing of lactate, chloride, and glucose concentration; sweat rate, simultaneously with pH, and total sweat loss for preventive care, timely diagnosis, and point-of-care health and fitness monitoring.

Inkjet Printing: A Viable Technology for Biosensor Fabrication

Printing technology promises a viable solution for the low-cost, rapid, flexible, and mass fabrication of biosensors. Among the vast number of printing techniques, screen printing and inkjet printing have been widely adopted for the fabrication of biosensors. Screen printing provides ease of operation and rapid processing; however, it is bound by the effects of viscous inks, high material waste, and the requirement for masks, to name a few. Inkjet printing, on the other hand, is well suited for mass fabrication that takes advantage of computer-aided design software for pattern modifications. Furthermore, being drop-on-demand, it prevents precious material waste and offers high-resolution patterning. To exploit the features of inkjet printing technology, scientists have been keen to use it for the development of biosensors since 1988. A vast number of fully and partially inkjet-printed biosensors have been developed ever since. This study presents a short introduction on the printing technology used for biosensor fabrication in general, and a brief review of the recent reports related to virus, enzymatic, and non-enzymatic biosensor fabrication, via inkjet printing technology in particular.

The Need to Pair Molecular Monitoring Devices with Molecular Imaging to Personalize Health

By enabling the non-invasive monitoring and quantification of biomolecular processes, molecular imaging has dramatically improved our understanding of disease. In recent years, non-invasive access to the molecular drivers of health versus disease has emboldened the goal of precision health, which draws on concepts borrowed from process monitoring in engineering, wherein hundreds of sensors can be employed to develop a model which can be used to preventatively detect and diagnose problems. In translating this monitoring regime from inanimate machines to human beings, precision health posits that continual and on-the-spot monitoring are the next frontiers in molecular medicine. Early biomarker detection and clinical intervention improves individual outcomes and reduces the societal cost of treating chronic and late-stage diseases. However, in current clinical settings, methods of disease diagnoses and monitoring are typically intermittent, based on imprecise risk factors, or self-administered, making optimization of individual patient outcomes an ongoing challenge. Low-cost molecular monitoring devices capable of on-the-spot biomarker analysis at high frequencies, and even continuously, could alter this paradigm of therapy and disease prevention. When these devices are coupled with molecular imaging, they could work together to enable a complete picture of pathogenesis. To meet this need, an active area of research is the development of sensors capable of point-of-care diagnostic monitoring with an emphasis on clinical utility. However, a myriad of challenges must be met, foremost, an integration of the highly specialized molecular tools developed to understand and monitor the molecular causes of disease with clinically accessible techniques. Functioning on the principle of probe-analyte interactions yielding a transducible signal, probes enabling sensing and imaging significantly overlap in design considerations and targeting moieties, however differing in signal interpretation and readout. Integrating molecular sensors with molecular imaging can provide improved data on the personal biomarkers governing disease progression, furthering our understanding of pathogenesis, and providing a positive feedback loop toward identifying additional biomarkers and therapeutics. Coupling molecular imaging with molecular monitoring devices into the clinical paradigm is a key step toward achieving precision health.

Emerging Role of Liquid Metals in Sensing

Low melting point metals and alloys are the group of materials that combine metallic and liquid properties, simultaneously. The fascinating characteristics of liquid metals (LMs) including softness and high electrical and thermal conductivity, as well as their unique interfacial chemistry, have started to dominate various research disciplines. Utilization of LMs as responsive interfaces, enabling sensing in a flexible and versatile manner, is one of the most promising traits demonstrated for LMs. In the context of LMs-enabled sensors, gallium (Ga) and its alloys have emerged as multipurpose functional materials with many compelling physical and chemical properties. Responsiveness to different stimuli and easy-to-functionalize interfaces of Ga-based LMs make them ideal candidates for a variety of sensing applications. However, despite the vast capabilities of Ga-based LMs in sensing, applications of these materials for developing different sensors have not been fully explored. In the present review, we provide a comprehensive overview regarding the applications of Ga-based LMs in a wide range of sensing approaches that cover different physical and chemical sensors. The unique features of Ga-based LMs, which make them promising materials for sensing, are discussed in subsections followed by relevant case studies. Finally, challenges as well as the prospected future and developing motifs are highlighted for each type of LM-based sensors.

Skin Patchable Sensor Surveillance for Continuous Glucose Monitoring

Diabetes mellitus is a physiological and metabolic disorder affecting millions of people worldwide, associated with global morbidity, mortality, and financial expenses. Long-term complications can be avoided by frequent, continuous self-monitoring of blood glucose. Therefore, this review summarizes the current state-of-art glycemic control regimes involving measurement approaches and basic concepts. Following an introduction to the significance of continuous glucose sensing, we have tracked the evolution of glucose monitoring devices from minimally invasive to non-invasive methods to present an overview of the spectrum of continuous glucose monitoring (CGM) technologies. The conveniences, accuracy, and cost-effectiveness of the real-time CGM systems (rt-CGMs) are the factors considered for discussion. Transdermal biosensing and drug delivery routes have recently emerged as an innovative approach to substitute hypodermal needles. This work reviews skin-patchable glucose monitoring sensors for the first time, providing specifics of all the major findings in the past 6 years. Skin patch sensors and their progressive form, i.e., microneedle (MN) array sensory and delivery systems, are elaborated, covering self-powered, enzymatic, and non-enzymatic devices. The critical aspects reviewed are material design and assembly techniques focusing on flexibility, sensitivity, selectivity, biocompatibility, and user-end comfort. The review highlights the advantages of patchable MNs' multi-sensor technology designed to maintain precise blood glucose levels and administer diabetes drugs or insulin through a "sense and act" feedback loop. Subsequently, the limitations and potential challenges encountered from the MN array as rt-CGMs are listed. Furthermore, the current statuses of working prototype glucose-responsive "closed-loop" insulin delivery systems are discussed. Finally, the expected future developments and outlooks in clinical applications are discussed.

Differential Amperometric Microneedle Biosensor for Wearable Levodopa Monitoring of Parkinson's Disease

Levodopa (L-Dopa) is considered to be one of the most effective therapies available for Parkinson's disease (PD) treatment. The therapeutic window of L-Dopa is narrow due to its short half-life, and long-time L-Dopa treatment will cause some side effects such as dyskinesias, psychosis, and orthostatic hypotension. Therefore, it is of great significance to monitor the dynamic concentration of L-Dopa for PD patients with wearable biosensors to reduce the risk of complications. However, the high concentration of interferents in the body brings great challenges to the in vivo monitoring of L-Dopa. To address this issue, we proposed a minimal-invasive L-Dopa biosensor based on a flexible differential microneedle array (FDMA). One working electrode responded to L-Dopa and interfering substances, while the other working electrode only responded to electroactive interferences. The differential current response of these two electrodes was related to the concentration of L-Dopa by eliminating the common mode interference. The differential structure provided the sensor with excellent anti-interference performance and improved the sensor's accuracy. This novel flexible microneedle sensor exhibited favorable analytical performance of a wide linear dynamic range (0-20 μM), high sensitivity (12.618 nA μM^-1 cm^-2) as well as long-term stability (two weeks). Ultimately, the L-Dopa sensor displayed a fast response to in vivo L-Dopa dynamically with considerable anti-interference ability. All these attractive performances indicated the feasibility of this FDMA for minimal invasive and continuous monitoring of L-Dopa dynamic concentration for Parkinson's disease.

Smart Chemical Engineering-Based Lightweight and Miniaturized Attachable Systems for Advanced Drug Delivery and Diagnostics

Smart attachable systems have attracted much attention owing to their capabilities in terms of body performance evaluation, disease diagnostics, and drug delivery. Recent advances in chemical and engineering techniques provide many opportunities to improve device fabrication and applications owing to the advantages of being lightweight and easy to control as well as their battery absence and functional diversity. This review highlights the latest developments in the field of chemical engineering-based lightweight and miniaturized attachable systems, which are mainly inspired by the natural world. Their applications for real-time monitoring, point-of-care sampling, biomarker detection, and controlled release are discussed thoroughly with respect to specific products/prototypes. The perspectives of the field, including persistence guarantee, burden reduction, and personality improvement, are also discussed. It is believed that chemical engineering-based lightweight and miniaturized attachable systems have good potential in both clinical and industrial fields, indicating a large potential to improve human lives in the near future.

Graphene-enabled wearable sensors for healthcare monitoring

Wearable sensors in healthcare monitoring have recently found widespread applications in biomedical fields for their non- or minimal-invasive, user-friendly and easy-accessible features. Sensing materials is one of the major challenges to achieve these superiorities of wearable sensors for healthcare monitoring, while graphene-based materials with many favorable properties have shown great efficiency in sensing various biochemical and biophysical signals. In this paper, we review state-of-the-art advances in the development and modification of graphene-based materials (i.e., graphene, graphene oxide and reduced graphene oxide) for fabricating advanced wearable sensors with 1D (fibers), 2D (films) and 3D (foams/aerogels/hydrogels) macroscopic structures. We summarize the structural design guidelines, sensing mechanisms, applications and evolution of the graphene-based materials as wearable sensors for healthcare monitoring of biophysical signals (e.g., mechanical, thermal and electrophysiological signals) and biochemical signals from various body fluids and exhaled gases. Finally, existing challenges and future prospects are presented in this area.

Powering smart contact lenses for continuous health monitoring: Recent advancements and future challenges

As the tear is noninvasively and continuously available, it has been turned into a convenient biological interface as a wearable medical device for out-of-hospital and self-monitoring applications. Recent progress in integrated circuits (ICs) and biosensors coupled with wireless data communication techniques have led to the implementation of smart contact lenses that can continuously sample tear fluid, analyze physiological conditions, and wirelessly transmit data to an electronic device such as smartphone, which can send data to relevant healthcare units. Continuous analyte monitoring is one of the significant characteristics of wearable biosensors. However, despite several advantages over other on-skin wearable medical devices, batteries cannot be incorporated on smart contact lenses for continuous electrical power supply due to the limited area. Herein, we review the progress of power delivery techniques of smart contact lenses for the first time. Different approaches, including wireless power transmission (WPT), biofuel cells, supercapacitors, flexible batteries, wired connections, and hybrid methods, are thoroughly discussed to understand the principles of self-sustainable contact lens biosensors comprehensively. Additionally, recent progress in contact lens biosensors is reviewed in detail, thereby providing the prospects for further developments of smart contact lenses as a common biosensing platform for various disease monitoring and diagnostic applications.

Smartphone-Operated Wireless Chemical Sensors: A Review

Wireless chemical sensors have been developed as a result of advances in chemical sensing and wireless communication technology. Because of their mobility and widespread availability, smartphones have been extensively combined with sensors such as hand-held detectors, sensor chips, and test strips for biochemical detection. Smartphones are frequently used as controllers, analyzers, and displayers for quick, authentic, and point-of-care monitoring, which may considerably streamline the design and lower the cost of sensing systems. This study looks at the most recent wireless and smartphone-supported chemical sensors. The review is divided into four different topics that emphasize the basic types of wireless smartphone-operated chemical sensors. According to a study of 114 original research publications published during recent years, market opportunities for wireless and smartphone-supported chemical sensor systems include environmental monitoring, healthcare and medicine, food quality, sport, and fitness. The issues and illustrations for each of the primary chemical sensors relevant to many application areas are covered. In terms of performance, the advancement of technologies related to chemical sensors will result in smaller and more lightweight, cost-effective, versatile, and durable devices. Given the limitations, we suggest that wireless and smartphone-supported chemical sensor systems play a significant role in the sensor Internet of Things.

Multifunctional hybrid skin patch for wearable smart healthcare applications

Recent advances in wearable patches have included various sensors to monitor either physiological signs, such as the heart rate and respiration rate, or metabolites. Nevertheless, most of these have focused only on a single physiological measurement at a time, which significantly inhibits the calibration of various biological signals and diagnostic facilities. In this study, a novel multifunctional hybrid skin patch was developed for the electrochemical analysis of sweat glucose levels and simultaneous monitoring of electrocardiograms (ECGs). Furthermore, pH and temperature sensors were co-integrated onto the same patch for the calibration of the glucose biosensor to prevent inevitable inhibition and weakening of enzyme activity due to changes in the sweat pH and temperature levels. The fabricated electrochemical glucose biosensor exhibited excellent linearity (R² = 0.9986) and sensitivity (29.10 μA mM^-1 cm^-2), covering the normal range of human sweat. The potentiometric pH sensor displayed a good response with an excellent sensitivity of -77.81 mV/pH and high linearity (R² = 0.991), indicating that it can distinguish variations in the typical pH range for human sweat. Furthermore, the P, QRS complex, and T peaks in the measured ECG waveforms could be clearly distinguished, indicating the reliability of the fabricated flexible dry electrodes for continuous monitoring. The fabricated skin patch overcomes the inconvenience of the mandatory attachment of multiple patches on the human body by fully integrating all the electrochemical and electrophysiological sensors on a single patch, thus facilitating advanced glycemic control and continuous ECG monitoring for smart management of chronic diseases and healthcare applications.

A Distance-Based Microfluidic Paper-Based Biosensor for Glucose Measurements in Tear Range

The prevalence of diabetes has increased over the past years. Therefore, developing minimally invasive, user-friendly, and cost-effective glucose biosensors is necessary especially in low-income and developing countries. Cellulose paper-based analytical devices have attracted the attention of many researchers due to affordability, not requiring trained personnel, and complex equipment. This paper describes a microfluidic paper-based analytical device (μPAD) for detecting glucose concentration in tear range with the naked eye. The paper-based biosensor fabricated by laser CO2; and glucose oxidase/horseradish peroxidase (GOx/HRP) enzyme solution coupled with tetramethylbenzidine (TMB) were utilized as reagents. A sample volume of 10 μl was needed for the biosensor operation and the results were observable within 5 min. The color intensity-based and distance-based results were analyzed by ImageJ and Tracker to evaluate the device performance. Distance-based results showed a linear behavior in 0.1-1.2 mM with an R² = 0.9962 and limit of detection (LOD) of 0.1 mM. The results could be perceived by the naked eye without needing additional equipment or trained personnel in a relatively short time (3-5 min).

Nanomaterials for IoT Sensing Platforms and Point-of-Care Applications in South Korea

Herein, state-of-the-art research advances in South Korea regarding the development of chemical sensing materials and fully integrated Internet of Things (IoT) sensing platforms were comprehensively reviewed for verifying the applicability of such sensing systems in point-of-care testing (POCT). Various organic/inorganic nanomaterials were synthesized and characterized to understand their fundamental chemical sensing mechanisms upon exposure to target analytes. Moreover, the applicability of nanomaterials integrated with IoT-based signal transducers for the real-time and on-site analysis of chemical species was verified. In this review, we focused on the development of noble nanostructures and signal transduction techniques for use in IoT sensing platforms, and based on their applications, such systems were classified into gas sensors, ion sensors, and biosensors. A future perspective for the development of chemical sensors was discussed for application to next-generation POCT systems that facilitate rapid and multiplexed screening of various analytes.

Practical and Efficient: A Pocket-Sized Device Enabling Detection of Formaldehyde Adulteration in Vegetables

Formaldehyde, as a carcinogenic substance, is often intentionally used to adulterate vegetables to increase their shelf life, and the adhesive tape used to attach labels can also leave formaldehyde on the surface of vegetables. However, as the "gold" standard, gas chromatography (GC) and high-performance liquid chromatography (HPLC) are expensive for individual tests and confined to the laboratory owing to their size and a suitable detector (low-cost, portable, fast detection speed) to check formaldehyde contamination in vegetables not being available. Here, we tested formaldehyde contamination in vegetables using a low-cost and hand-held detector combined with a screen-printed electrode (SPE) amperometric sensor and an open-sourced potentiostat. The analyzer can detect a concentration of 100 μmol/L formaldehyde and achieve a good linear range between 100 and 1000 μmol/L. Furthermore, the detector successfully identified formaldehyde contamination in 53 samples of six different kinds of vegetables even after residual formaldehyde on the surface was evaporated. Most importantly, under the practicability-oriented idea, a cost-effective strategy was implemented for this detector design rather than using other pricey methods (e.g., photolithography, electron-beam evaporation, chemical deposition), which enormously reduces the cost (under ∼USD 0.5 per test) and meets all of the requirements of ASSURED device. We believe this cheap, portable detector could help law-enforcing authorities, healthcare workers, and customers to screen formaldehyde contamination easily. Also, the cost-saving strategy is appropriate for low-income areas, where there is a lack of laboratories, funds, and trained experts.

Recent advances in flexible and wearable chemo- and bio-sensors based on two-dimensional transition metal carbides and nitrides (MXenes)

Due to their excellent hydrophilicity, outstanding conductivity, unique structures, and physicochemical properties, MXenes have become a potential candidate material for flexible and wearable chemo- and bio-sensors.

Digital Technologies for Emotion-Regulation Assessment and Intervention: A Conceptual Review

The ability to regulate emotions in response to stress is central to healthy development. While early research in emotion regulation predominantly employed static, self-report measurement, the past decade has seen a shift in focus toward understanding the dynamic nature of regulation processes. This is reflected in recent refinements in the definition of emotion regulation, which emphasize the importance of the ability to flexibly adapt regulation efforts across contexts. The latest proliferation of digital technologies employed in mental health research offers the opportunity to capture the state- and context-sensitive nature of emotion regulation. In this conceptual review, we examine the use of digital technologies (ecological momentary assessment; wearable and smartphone technology, physical activity, acoustic data, visual data, and geo-location; smart home technology; virtual reality; social media) in the assessment of emotion regulation and describe their application to interventions. We also discuss challenges and ethical considerations, and outline areas for future research.

Printed microfluidic sweat sensing platform for cortisol and glucose detection

Wearable sweat biosensors offer compelling opportunities for improved personal health monitoring and non-invasive measurements of key biomarkers. Inexpensive device fabrication methods are necessary for scalable manufacturing of portable, disposable, and flexible sweat sensors. Furthermore, real-time sweat assessment must be analyzed to validate measurement reliability at various sweating rates. Here, we demonstrate a "smart bandage" microfluidic platform for cortisol detection and continuous glucose monitoring integrated with a synthetic skin. The low-cost, laser-cut microfluidic device is composed of an adhesive-based microchannel and solution-processed electrochemical sensors fabricated from inkjet-printed graphene and silver solutions. An antibody-derived cortisol sensor achieved a limit of detection of 10 pM and included a low-voltage electrowetting valve, validating the microfluidic sensor design under typical physiological conditions. To understand effects of perspiration rate on sensor performance, a synthetic skin was developed using soft lithography to mimic human sweat pores and sweating rates. The enzymatic glucose sensor exhibited a range of 0.2 to 1.0 mM, a limit of detection of 10 μM, and reproducible response curves at flow rates of 2.0 μL min^-1 and higher when integrated with the synthetic skin, validating its relevance for human health monitoring. These results demonstrate the potential of using printed microfluidic sweat sensors as a low-cost, real-time, multi-diagnostic device for human health monitoring.

Sensing Glucose Concentration Using Symmetric Metasurfaces under Oblique Incident Terahertz Waves

In this article, a planar metamaterial sensor designed at terahertz (THz) frequencies is utilized to sense glucose concentration levels that cover hypoglycemia, normal, and hyperglycemia conditions that vary from 54 to 342 mg/dL. The sensor was developed using a symmetric complementary split rectangular resonator at an oblique incidence angle. The resonance frequency shift was used as a measure of the changes in the glucose level of the samples. The increase in the glucose concentration level exhibited clear and noticeable redshifts in the resonance frequency. For instance, a 67.5 GHz redshift has been observed for a concentration level of 54 mg/dL and increased up to 122 GHz for the 342 mg/dL concentration level. Moreover, a high sensitivity level of 75,700 nm/RIU was observed for this design. In the future, the proposed THz sensors may have potential applications in diagnosing hypocalcemia and hyperglycemia cases.

Exploring the factors influencing adoption of health-care wearables among generation Z consumers in India

Purpose

The purpose of this study is to identify the major factors influencing the adoption of health-care wearables in generation Z (Gen Z) customers in India. A conceptual framework using push pull and mooring (PPM) adoption theory was developed.

Design/methodology/approach

Data was collected from 208 Gen Z customers based on 5 constructs related to the adoption of health-care wearables. Confirmatory factor analysis and structural equation modelling was used to analyse the responses. The mediation paths were analysed using bootstrapping method and examination of the standardized direct and indirect effects in the model.

Findings

The study results indicated that the antecedent factors consisted of push (real-time health information availability), pull (normative environment) and mooring (decision self-efficacy) factors. The mooring factor (MOOR) was related to the push factor but not the pull factor. The MOOR, in turn, was related to the switching intention of Gen Z customers for health wearables adoption.

Research limitations/implications

The research study extended the literature related to the PPM theory in the context of the adoption of health wearables among Gen Z customers in India.

Practical implications

The study outcome would enable managers working in health wearable organizations to understand consumer behaviour towards health wearables.

Social implications

The use of health wearables among Gen Z individuals would lead to future generations adopting a healthy lifestyle resulting in an effective workforce and better economy.

Originality/value

This was one of the few studies which have explored the PPM theory to explore the factors for the adoption of health wearables among Gen Z customers in India.

Noninvasive Estimation of Glycated Hemoglobin In-Vivo Based on Photon Diffusion Theory and Genetic Symbolic Regression Models

The diagnosis and management of diabetes require frequent monitoring of blood sugar levels. Prolonged exposure of most of the monosaccharides in the bloodstream results in the glycation of hemoglobin. This glycated hemoglobin (HbA1c) based test plays an important role to avoid diabetic complications. However, noninvasive estimation of HbA1c is a very new, promising, and challenging topic in modern bioengineering scopes. The purpose of this study is to develop and verify mathematical models in order to quantify the glycated hemoglobin in-vivo percentage non-invasively. This research utilized photon diffusion theory to develop the finger models and genetic symbolic regression methods to solve the models to estimate the level of glycated hemoglobin in the blood. The validation of these models with human participants indicated a high degree of correlation (0.887 and 0.907 Pearsons r value), and high precision (2.56% and 2.96% coefficient of variation (%CV)) for transmission and reflection type noninvasive digital volume pulse-based signals. This research will be a breakthrough for the application of noninvasive HbA1c estimation.

Applications of Advanced Materials for Non-Enzymatic Glucose Monitoring: From Invasive to the Wearable Device

Diabetes mellitus (DM) is a global health problem leading to many complications and disabilities in life adjusting activities and even dead. Monitoring glucose levels is a key factor in diagnosis and management of DM. Conventional glucose sensors consisted of immobilized enzymes, are so susceptible to environmental conditions. In this way, nonenzymatic biosensors have attracted extensive attentions in many clinical diagnostics applications. To date, the finger pricking test is a common enzyme-based glucometer that is an invasive and inconvenient and may lead to infections in the injection sites. So, working on the possibility of cutaneous or subcutaneous insertion of devices as a noninvasive or minimally-invasive systems for continuous glucose controlling approaches through human biofluids (blood, perspiration, tears, saliva, etc.) have stimulated growing interest. This review summarizes recent nonenzymatic and noninvasive biofluids glucose monitoring systems which are highly resilience and stretchable to continuously adapt to body movements during common physical activity. Sensors are based on their constituent materials including carbon-based, metal nanoparticles, polymer, and hydrogel systems are classified for electrochemical, and optical glucose detection. Finally, we address the drawbacks and challenges of enzyme-free sensors which are aroused sustaining research passion to be used in point-of-care medical diagnostics applications.

Progress of Wearable and Flexible Electrochemical Biosensors With the Aid of Conductive Nanomaterials

Conductive nanomaterials have recently gained a lot of interest due to their excellent physical, chemical, and electrical properties, as well as their numerous nanoscale morphologies, which enable them to be fabricated into a wide range of modern chemical and biological sensors. This study focuses mainly on current applications based on conductive nanostructured materials. They are the key elements in preparing wearable electrochemical Biosensors, including electrochemical immunosensors and DNA biosensors. Conductive nanomaterials such as carbon (Carbon Nanotubes, Graphene), metals and conductive polymers, which provide a large effective surface area, fast electron transfer rate and high electrical conductivity, are summarized in detail. Conductive polymer nanocomposites in combination with carbon and metal nanoparticles have also been addressed to increase sensor performance. In conclusion, a section on current challenges and opportunities in this growing field is forecasted at the end.

The Application of Wearable Glucose Sensors in Point-of-Care Testing

Diabetes and its complications have become a worldwide concern that influences human health negatively and even leads to death. The real-time and convenient glucose detection in biofluids is urgently needed. Traditional glucose testing is detecting glucose in blood and is invasive, which cannot be continuous and results in discomfort for the users. Consequently, wearable glucose sensors toward continuous point-of-care glucose testing in biofluids have attracted great attention, and the trend of glucose testing is from invasive to non-invasive. In this review, the wearable point-of-care glucose sensors for the detection of different biofluids including blood, sweat, saliva, tears, and interstitial fluid are discussed, and the future trend of development is prospected.

JTrack: A Digital Biomarker Platform for Remote Monitoring of Daily-Life Behaviour in Health and Disease

Health-related data being collected by smartphones offer a promising complementary approach to in-clinic assessments. Despite recent contributions, the trade-off between privacy, optimization, stability and research-grade data quality is not well met by existing platforms. Here we introduce the JTrack platform as a secure, reliable and extendable open-source solution for remote monitoring in daily-life and digital-phenotyping. JTrack is an open-source (released under open-source Apache 2.0 licenses) platform for remote assessment of digital biomarkers (DB) in neurological, psychiatric and other indications. JTrack is developed and maintained to comply with security, privacy and the General Data Protection Regulation (GDPR) requirements. A wide range of anonymized measurements from motion-sensors, social and physical activities and geolocation information can be collected in either active or passive modes by using JTrack Android-based smartphone application. JTrack also provides an online study management dashboard to monitor data collection across studies. To facilitate scaling, reproducibility, data management and sharing we integrated DataLad as a data management infrastructure. Smartphone-based Digital Biomarker data may provide valuable insight into daily-life behaviour in health and disease. As illustrated using sample data, JTrack provides as an easy and reliable open-source solution for collection of such information.

Highly Stretchable Wearable Electrochemical Sensor Based on Ni-Co MOF Nanosheet-Decorated Ag/rGO/PU Fiber for Continuous Sweat Glucose Detection

A noninvasive fiber material-based wearable electrochemical sensor to continuously monitor the glucose level in sweat is highly desirable for smart fabrics for personal diabetes management. To achieve it, the key challenge is to construct fibers with high stretchability and excellent electrochemical performance. Herein, a highly stretchable Ni-Co metal-organic framework/Ag/reduced graphene oxide/polyurethane (Ni-Co MOF/Ag/rGO/PU) fiber-based wearable electrochemical sensor is fabricated for monitoring the glucose level in sweat continuously with high sensitivity and accuracy. The rGO/PU fiber was simply produced by an improved wet spinning technology, and the Ni-Co MOF nanosheet was coated on its surface to prepare the Ni-Co MOF/Ag/rGO/PU (NCGP) fiber electrode. The Ni-Co MOF has a large specific surface area and high catalytic activity, which enables the fiber sensors with good electrochemical performance with a high sensitivity of 425.9 μA·mM^-1·cm^-2 and a wide linear range of 10 μM-0.66 mM. More importantly, the NCGP fiber electrode also shows extremely high stretching and bending stability under mechanical deformation. Also, the NCGP fiber electrode has high selectivity and long-time storage stability. Moreover, the NCGP fiber-based three-electrode system was sewn with an absorbent fabric and fixed on a stretchable polydimethylsiloxane film substrate to form a nonenzymatic sweat glucose wearable sensor, which realized real-time monitoring of glucose in human sweat with high accuracy. This indicates that our designed NCGP fiber can be used as a wearable electrochemical sensor for the bio-diagnostics of body sweat.

Electrochemical detection of dopamine with negligible interference from ascorbic and uric acid by means of reduced graphene oxide and metals-NPs based electrodes

Dopamine is an important neurotransmitter involved in many human biological processes as well as in different neurodegenerative diseases. Monitoring the concentration of dopamine in biological fluids, i.e., blood and urine is an effective way of accelerating the early diagnosis of these types of diseases. Electrochemical sensors are an ideal choice for real-time screening of dopamine as they can achieve fast, portable inexpensive and accurate measurements. In this work, we present electrochemical dopamine sensors based on reduced graphene oxide coupled with Au or Pt nanoparticles. Sensors were developed by co-electrodeposition onto a flexible substrate, and a systematic investigation concerning the electrodeposition parameters (concentration of precursors, deposition time and potential) was carried out to maximize the sensitivity of the dopamine detection. Square wave voltammetry was used as an electrochemical technique that ensured a high sensitive detection in the nM range. The sensors were challenged against synthetic urine in order to simulate a real sample detection scenario where dopamine concentrations are usually lower than 600 nM. Our sensors show a negligible interference from uric and ascorbic acids which did not affect sensor performance. A wide linear range (0.1-20 μm for gold nanoparticles, 0.1-10 μm for platinum nanoparticles) with high sensitivity (6.02 and 7.19 μA μM^-1 cm^-2 for gold and platinum, respectively) and a low limit of detection (75 and 62 nM for Au and Pt, respectively) were achieved. Real urine samples were also assayed, where the concentrations of dopamine detected aligned very closely to measurements undertaken using conventional laboratory techniques. Sensor fabrication employed a cost-effective production process with the possibility of also being integrated into flexible substrates, thus allowing for the possible development of wearable sensing devices.

Ten Years Progress of Electrical Detection of Heavy Metal Ions (HMIs) Using Various Field-Effect Transistor (FET) Nanosensors: A Review

Heavy metal pollution remains a major concern for the public today, in line with the growing population and global industrialization. Heavy metal ion (HMI) is a threat to human and environmental safety, even at low concentrations, thus rapid and continuous HMI monitoring is essential. Among the sensors available for HMI detection, the field-effect transistor (FET) sensor demonstrates promising potential for fast and real-time detection. The aim of this review is to provide a condensed overview of the contribution of certain semiconductor substrates in the development of chemical and biosensor FETs for HMI detection in the past decade. A brief introduction of the FET sensor along with its construction and configuration is presented in the first part of this review. Subsequently, the FET sensor deployment issue and FET intrinsic limitation screening effect are also discussed, and the solutions to overcome these shortcomings are summarized. Later, we summarize the strategies for HMIs' electrical detection, mechanisms, and sensing performance on nanomaterial semiconductor FET transducers, including silicon, carbon nanotubes, graphene, AlGaN/GaN, transition metal dichalcogenides (TMD), black phosphorus, organic and inorganic semiconductor. Finally, concerns and suggestions regarding detection in the real samples using FET sensors are highlighted in the conclusion.

Development and Initial Validation of an Acute Readiness Monitoring Scale in Military Personnel

Personnel in many professions must remain "ready" to perform diverse activities. Managing individual and collective capability is a common concern for leadership and decision makers. Typical existing approaches for monitoring readiness involve keeping detailed records of training, health and equipment maintenance, or - less commonly - data from wearable devices that can be difficult to interpret as well as raising privacy concerns. A widely applicable, simple psychometric measure of perceived readiness would be invaluable in generating rapid evaluations of current capability directly from personnel. To develop this measure, we conducted exploratory factor analysis and confirmatory factor analysis with a sample of 770 Australian military personnel. The 32-item Acute Readiness Monitoring Scale (ARMS) demonstrated good model fit, and comprised nine factors: overall readiness; physical readiness; physical fatigue; cognitive readiness; cognitive fatigue; threat-challenge (i.e., emotional/coping) readiness; skills-and-training readiness; group-team readiness, and equipment readiness. Readiness factors were negatively correlated with recent stress, current negative affect and distress, and positively correlated with resilience, wellbeing, current positive affect and a supervisor's rating of solider readiness. The development of the ARMS facilitates a range of new research opportunities: enabling quick, simple and easily interpreted assessment of individual and group readiness.

Superior Non-Invasive Glucose Sensor Using Bimetallic CuNi Nanospecies Coated Mesoporous Carbon

The assessment of blood glucose levels is necessary for the diagnosis and management of diabetes. The accurate quantification of serum or plasma glucose relies on enzymatic and nonenzymatic methods utilizing electrochemical biosensors. Current research efforts are focused on enhancing the non-invasive detection of glucose in sweat with accuracy, high sensitivity, and stability. In this work, nanostructured mesoporous carbon coupled with glucose oxidase (GO_x) increased the direct electron transfer to the electrode surface. A mixed alloy of CuNi nanoparticle-coated mesoporous carbon (CuNi-MC) was synthesized using a hydrothermal process followed by annealing at 700 °C under the flow of argon gas. The prepared catalyst's crystal structure and morphology were explored using X-ray diffraction and high-resolution transmission electron microscopy. The electrocatalytic activity of the as-prepared catalyst was investigated using cyclic voltammetry (CV) and amperometry. The findings show an excellent response time of 4 s and linear range detection from 0.005 to 0.45 mM with a high electrode sensitivity of 11.7 ± 0.061 mA mM cm^-2 in a selective medium.

Wearable Electronic Tongue for Non-Invasive Assessment of Human Sweat

Sweat is a promising biofluid in allowing for non-invasive sampling. Here, we investigate the use of a voltammetric electronic tongue, combining different metal electrodes, for the purpose of non-invasive sample assessment, specifically focusing on sweat. A wearable electronic tongue is presented by incorporating metal electrodes on a flexible circuit board and used to non-invasively monitor sweat on the body. The data obtained from the measurements were treated by multivariate data processing. Using principal component analysis to analyze the data collected by the wearable electronic tongue enabled differentiation of sweat samples of different chemical composition, and when combined with ¹H-NMR sample differentiation could be attributed to changing analyte concentrations.

Progress of shrink polymer micro- and nanomanufacturing

Traditional lithography plays a significant role in the fabrication of micro- and nanostructures. Nevertheless, the fabrication process still suffers from the limitations of manufacturing devices with a high aspect ratio or three-dimensional structure. Recent findings have revealed that shrink polymers attain a certain potential in micro- and nanostructure manufacturing. This technique, denoted as heat-induced shrink lithography, exhibits inherent merits, including an improved fabrication resolution by shrinking, controllable shrinkage behavior, and surface wrinkles, and an efficient fabrication process. These merits unfold new avenues, compensating for the shortcomings of traditional technologies. Manufacturing using shrink polymers is investigated in regard to its mechanism and applications. This review classifies typical applications of shrink polymers in micro- and nanostructures into the size-contraction feature and surface wrinkles. Additionally, corresponding shrinkage mechanisms and models for shrinkage, and wrinkle parameter control are examined. Regarding the size-contraction feature, this paper summarizes the progress on high-aspect-ratio devices, microchannels, self-folding structures, optical antenna arrays, and nanowires. Regarding surface wrinkles, this paper evaluates the development of wearable sensors, electrochemical sensors, energy-conversion technology, cell-alignment structures, and antibacterial surfaces. Finally, the limitations and prospects of shrink lithography are analyzed.

Recent Progress in Intelligent Wearable Sensors for Health Monitoring and Wound Healing Based on Biofluids

The intelligent wearable sensors promote the transformation of the health care from a traditional hospital-centered model to a personal portable device-centered model. There is an urgent need of real-time, multi-functional, and personalized monitoring of various biochemical target substances and signals based on the intelligent wearable sensors for health monitoring, especially wound healing. Under this background, this review article first reviews the outstanding progress in the development of intelligent, wearable sensors designed for continuous, real-time analysis, and monitoring of sweat, blood, interstitial fluid, tears, wound fluid, etc. Second, this paper reports the advanced status of intelligent wound monitoring sensors designed for wound diagnosis and treatment. The paper highlights some smart sensors to monitor target analytes in various wounds. Finally, this paper makes conservative recommendations regarding future development of intelligent wearable sensors.

Technological advances in electrochemical biosensors for the detection of disease biomarkers

With an increasing focus on health in contemporary society, interest in the diagnosis, treatment, and prevention of diseases has grown rapidly. Accordingly, the demand for biosensors for the early diagnosis of disease is increasing. However, the measurement range of existing electrochemical sensors is relatively high, which is not suitable for early disease diagnosis, requiring the detection of small amounts of biocomponents. Various attempts have been made to overcome this and amplify the signal, including binding with various labeling molecules, such as DNA, enzymes, nanoparticles, and carbon materials. Efforts are also being made to increase the sensitivity of electrochemical sensors, and the combination of nanomaterials, materials, and biotechnology offers the potential to increase sensitivity in a variety of ways. Recent studies suggest that electrochemical sensors can be a powerful tool in providing comprehensive insights into the targeting and detection of disease-associated biomarkers. Significant advances in nanomaterial and biomolecule approaches for improved sensitivity have resulted in the development of electrochemical biosensors capable of detecting multiple biomarkers in real time in clinically relevant samples. In this review, we have discussed the recent studies on electrochemical sensors for detection of diseases such as diabetes, degenerative diseases, and cancer. Further, we have highlighted new technologies to improve sensitivity using various materials, including DNA, enzymes, nanoparticles, and carbon materials.

Design and Implementation of a Wearable Accelerometer-Based Motion/Tilt Sensing Internet of Things Module and Its Application to Bed Fall Prevention

Accelerometer-based motion sensing has been extensively applied to fall detection. However, such applications can only detect fall accidents; therefore, a system that can prevent fall accidents is desirable. Bed falls account for more than half of patient falls and are preceded by a clear warning indicator: the patient attempting to get out of bed. This study designed and implemented an Internet of Things module, namely, Bluetooth low-energy-enabled Accelerometer-based Sensing In a Chip-packaging (BASIC) module, with a tilt-sensing algorithm based on the patented low-complexity COordinate Rotation DIgital Computer (CORDIC)-based algorithm for tilt angle conversions. It is applied for detecting the postural changes (from lying down to sitting up) and to protect individuals at a high risk of bed falls by prompting caregivers to take preventive actions and assist individuals trying to get up. This module demonstrates how motion and tilt sensing can be applied to bed fall prevention. The module can be further miniaturized or integrated into a wearable device and commercialized in smart health-care applications for bed fall prevention in hospitals and homes.

Ophthalmic sensing technologies for ocular disease diagnostics

Point-of-care diagnosis and personalized treatments are critical in ocular physiology and disease. Continuous sampling of tear fluid for ocular diagnosis is a need for further exploration. Several techniques have been developed for possible ophthalmological applications, from traditional spectroscopies to wearable sensors. Contact lenses are commonly used devices for vision correction, as well as for other therapeutic and cosmetic purposes. They are increasingly being developed into ocular sensors, being used to sense and monitor biochemical analytes in tear fluid, ocular surface temperature, intraocular pressure, and pH value. These sensors have had success in detecting ocular conditions, optimizing pharmaceutical treatments, and tracking treatment efficacy in point-of-care settings. However, there is a paucity of new and effective instrumentation reported in ophthalmology. Hence, this review will summarize the applied ophthalmic technologies for ocular diagnostics and tear monitoring, including both conventional and biosensing technologies. Besides applications of smart readout devices for continuous monitoring, targeted biomarkers are also discussed for the convenience of diagnosis of various ocular diseases. A further discussion is also provided for future aspects and market requirements related to the commercialization of novel types of contact lens sensors.

Malignancies and Biosensors: A Focus on Oral Cancer Detection through Salivary Biomarkers

Oral cancer is among the deadliest types of malignancy due to the late stage at which it is usually diagnosed, leaving the patient with an average five-year survival rate of less than 50%. The booming field of biosensing and point of care diagnostics can, in this regard, play a major role in the early detection of oral cancer. Saliva is gaining interest as an alternative biofluid for non-invasive diagnostics, and many salivary biomarkers of oral cancer have been proposed. While these findings are promising for the application of salivaomics tools in routine practice, studies on larger cohorts are still needed for clinical validation. This review aims to summarize the most recent development in the field of biosensing related to the detection of salivary biomarkers commonly associated with oral cancer. An introduction to oral cancer diagnosis, prognosis and treatment is given to define the clinical problem clearly, then saliva as an alternative biofluid is presented, along with its advantages, disadvantages, and collection procedures. Finally, a brief paragraph on the most promising salivary biomarkers introduces the sensing technologies commonly exploited to detect oral cancer markers in saliva. Hence this review provides a comprehensive overview of both the clinical and technological advantages and challenges associated with oral cancer detection through salivary biomarkers.

Wearable Assistive Robotics: A Perspective on Current Challenges and Future Trends

Wearable assistive robotics is an emerging technology with the potential to assist humans with sensorimotor impairments to perform daily activities. This assistance enables individuals to be physically and socially active, perform activities independently, and recover quality of life. These benefits to society have motivated the study of several robotic approaches, developing systems ranging from rigid to soft robots with single and multimodal sensing, heuristics and machine learning methods, and from manual to autonomous control for assistance of the upper and lower limbs. This type of wearable robotic technology, being in direct contact and interaction with the body, needs to comply with a variety of requirements to make the system and assistance efficient, safe and usable on a daily basis by the individual. This paper presents a brief review of the progress achieved in recent years, the current challenges and trends for the design and deployment of wearable assistive robotics including the clinical and user need, material and sensing technology, machine learning methods for perception and control, adaptability and acceptability, datasets and standards, and translation from lab to the real world.

Biosymbiotic, personalized, and digitally manufactured wireless devices for indefinite collection of high-fidelity biosignals

Digital medicine, the ability to stream continuous information from the body to gain insight into health status, manage disease, and predict onset health problems, is only gradually developing. Key technological hurdles that slow the proliferation of this approach are means by which clinical grade biosignals are continuously obtained without frequent user interaction. To overcome these hurdles, solutions in power supply and interface strategies that maintain high-fidelity readouts chronically are critical. This work introduces a previously unexplored class of devices that overcomes the limitations using digital manufacturing to tailor geometry, mechanics, electromagnetics, electronics, and fluidics to create unique personalized devices optimized to the wearer. These elastomeric, three-dimensional printed, and laser-structured constructs, called biosymbiotic devices, enable adhesive-free interfaces and the inclusion of high-performance, far-field energy harvesting to facilitate continuous wireless and battery-free operation of multimodal and multidevice, high-fidelity biosensing in an at-home setting without user interaction.

Electrospun Nylon Fibers with Integrated Polypyrrole Molecularly Imprinted Polymers for the Detection of Glucose

Electrospun nylon 6,6 fibers incorporating polypyrrole (PPy) molecular-imprinted polymers (MIPs) were produced for the selective detection of d-glucose using a thermal detection methodology. PPy MIPs were produced using a facile bulk synthesis approach and electrospun into intricate fibrous scaffolds giving a highly mass-producible sensing interface. The maximum incorporation of MIPs and greatest sensing performance was found to be 12.1 wt % in conjunction with the heat-transfer method (HTM), a low-cost and simple thermal detection method that measures changes in the thermal resistance at the solid-liquid interface. It is demonstrated that a 12.1% incorporation of MIPs into electrospun fibers produces the widest working linear range with a limit of detection of 0.10 ± 0.01 mM. There were no observed changes in the measured thermal resistance response to incubation with a series of structurally similar compounds, providing evidence toward the selectivity of the platform. Additionally, the sensing platform exhibited a linear working response to glucose samples in artificial sweat solutions in the biologically relevant range. This is the first report of the incorporation of MIPs into nylon 6,6 fibers for the detection of glucose and points toward the possibility of developing mass-producible electrospun fibers embedded with low-cost recognition elements of improved thermal and chemical stability for the application of wearable sensor technology.

Cactus-Spine-Inspired Sweat-Collecting Patch for Fast and Continuous Monitoring of Sweat

A sweat sensor is expected to be the most appropriate wearable device for noninvasive healthcare monitoring. However, the practical use of sweat sensors is impeded by irregular and low sweat secretion rates. Here, a sweat-collecting patch that can collect sweat efficiently for fast and continuous healthcare monitoring is demonstrated. The patch uses cactus-spine-inspired wedge-shaped wettability-patterned channels on a hierarchical microstructured/nanostructured surface. The channel shape, in combination with the superhydrophobic/superhydrophilic surface materials, induces a unidirectional Laplace pressure that transports the sweat to the sensing area spontaneously even when the patch is aligned vertically. The patch demonstrates superior sweat-collecting efficiency and reduces the time required to fill the sensing area by transporting sweat almost without leaving it inside the channel. Therefore, a sensor based on the patch responds quickly to biochemicals in sweat, and the patch enables the continuous monitoring of changes in sweat biochemicals according to their changes in the wearer's blood.