Skin-interfaced systems for sweat collection and analytics

Paper-Cut Flexible Multifunctional Electronics Using MoS2 Nanosheet

Art and science represent human creativity and rational thinking, respectively. When the two seemingly opposite fields are intertwined, there is always a life-changing spark. In particular, the integration of ancient traditional Chinese art into the latest electronic devices is always been an unexcavated topic. Fabricating two-dimensional material with a tensile strain less than 3% with an ultimate global stretch has been an important problem that plagues the current flexible electronics field. The current research is limited to material in small scale, and it is always necessary to develop and extend large-sized flexible electronic systems. Here, inspired by the traditional Chinese paper-cut structure, we present a highly deformable multifunctional electronic system based on the MoS2 nanosheet. In this work, we first demonstrate how the traditional paper-cut structure can open the view of flexible electronics. In order to obtain a large area of MoS2 with excellent performance, we use a metal-assisted exfoliation method to transfer MoS2, followed by fabricating a field effect transistor to characterize its excellent electrical properties. Two photodetectors and a temperature sensor are produced with good performance. The mechanical simulation proves that the structure has more advantages in stretchability than other typical paper-cut structures. From the experimental and mechanical point of view, it is proved that the device can work stably under high deformation. We finally show that the device has broad application prospects in highly deformed organs, tissues, and joints. These findings set a good example of traditional Chinese culture to guide innovation in the field of electronic devices.

Skin-Inspired Surface-Microstructured Tough Hydrogel Electrolytes for Stretchable Supercapacitors

Double-network tough hydrogels have raised increasing interest in stretchable electronic applications as well as electronic skin (e-skin) owing to their excellent mechanical properties and functionalities. While hydrogels have been extensively explored as solid-state electrolytes, stretchable energy storage devices based on tough hydrogel electrolytes are still limited despite their high stretchability and strength. A key challenge remains in the robust electrode/electrolyte interface under large mechanical strains. Inspired by the skin structure that involves the microstructured interface for the tight connection between the dermis and epidermis, we demonstrated that a surface-microstructured tough hydrogel electrolyte composed of agar/polyacrylamide/LiCl (AG/PAAm/LiCl) could be exploited to allow stretchable supercapacitors with enhanced mechanical and electrochemical performance. The prestretched tough hydrogel electrolyte was treated to generate surface microstructures with a roughness of tens of micrometers simply via mechanical rubbing followed by the attachment of activated carbon electrodes on both sides to realize the fabrication of the stretchable supercapacitor. Through investigating the properties of the tough hydrogel electrolyte and the electrochemical performance of the as-fabricated supercapacitors under varied strains, the surface-microstructured hydrogel electrolyte was shown to enable robust adhesion to electrodes, improving electrochemical behavior and capacitance, as well as having better performance retention under repeated stretching cycles, which surpassed the pristine hydrogel with smooth surfaces. Our approach could provide an alternative and general strategy to improve the interfacial properties between the electrode and the hydrogel electrolyte, driving new directions for functional stretchable devices based on tough hydrogels.

Wearable Sensors for Biochemical Sweat Analysis

Sweat is a largely unexplored biofluid that contains many important biomarkers ranging from electrolytes and metabolites to proteins, cytokines, antigens, and exogenous drugs. The eccrine and apocrine glands produce and excrete sweat through microscale pores on the epidermal surface, offering a noninvasive means for capturing and probing biomarkers that reflect hydration state, fatigue, nutrition, and physiological changes. Recent advances in skin-interfaced wearable sensors capable of real-time in situ sweat collection and analytics provide capabilities for continuous biochemical monitoring in an ambulatory mode of operation. This review presents a broad overview of sweat-based biochemical sensor technologies with an emphasis on enabling materials, designs, and target analytes of interest. The article concludes with a summary of challenges and opportunities for researchers and clinicians in this swiftly growing field.

Fully Stretchable Capillary Microfluidics-Integrated Nanoporous Gold Electrochemical Sensor for Wearable Continuous Glucose Monitoring

Biosensor systems for wearable continuous monitoring are desired to be developed into conformal patch platforms. However, developing such patches is very challenging owing to the difficulty of imparting materials and components with both high stretchability and high performance. Herein, we report a fully stretchable microfluidics-integrated glucose sensor patch comprised of an omnidirectionally stretchable nanoporous gold (NPG) electrochemical biosensor and a stretchable passive microfluidic device. A highly electrocatalytic NPG electrode was formed on a stress-absorbing 3D micropatterned polydimethylsiloxane (PDMS) substrate to confer mechanical stretchability, high sensitivity, and durability in non-enzymatic glucose detection. A thin, stretchable, and tough microfluidic device was made by embedding stretchable cotton fabric as a capillary into a thin polyurethane nanofiber-reinforced PDMS channel, enabling collection and passive, accurate delivery of sweat from skin to the electrode surface, with excellent replacement capability. The integrated glucose sensor patch demonstrated excellent ability to continuously and accurately monitor the sweat glucose level.

Passive sweat collection and colorimetric analysis of biomarkers relevant to kidney disorders using a soft microfluidic system

The rich range of biomarkers in sweat and the ability to collect sweat in a non-invasive manner create interest in the use of this biofluid for assessments of health and physiological status, with potential applications that range from sports and fitness to clinical medicine. This paper introduces two important advances in recently reported classes of soft, skin-interfaced microfluidic systems for sweat capture and analysis: (1) a simple, broadly applicable means for collection of sweat that bypasses requirements for physical/mental exertion or pharmacological stimulation and (2) a set of enzymatic chemistries and colorimetric readout approaches for determining the concentrations of creatinine and urea in sweat, throughout ranges that are physiologically relevant. The results allow for routine, non-pharmacological capture of sweat for patient populations, such as infants and the elderly, that cannot be expected to sweat through exercise, and they create potential opportunities in the use of sweat for kidney disease screening/monitoring. Studies on human subjects demonstrate these essential capabilities, with quantitative comparisons to standard methods. The results expand the range of options available in microfluidic sampling and sensing of sweat for disease diagnostics and health monitoring.

Softening gold for elastronics

Gold, one of the noble metals, has played a significant role in human society throughout history. Gold's excellent electrical, optical and chemical properties make the element indispensable in maintaining a prosperous modern electronics industry. In the emerging field of stretchable electronics (elastronics), the main challenge is how to utilize these excellent material properties under various mechanical deformations. This review covers the recent progress in developing "softening" gold chemistry for various applications in elastronics. We systematically present material synthesis and design principles, applications, and challenges and opportunities ahead.

Skin-Mountable Biosensors and Therapeutics: A Review

Miniaturization of electronic components and advances in flexible and stretchable materials have stimulated the development of wearable health care systems that can reflect and monitor personal health status by health care professionals. New skin-mountable devices that offer seamless contact onto the human skin, even under large deformations by natural motions of the wearer, provide a route for both high-fidelity monitoring and patient-controlled therapy. This article provides an overview of several important aspects of skin-mountable devices and their applications in many medical settings and clinical practices. We comprehensively describe various transdermal sensors and therapeutic systems that are capable of detecting physical, electrophysiological, and electrochemical responses and/or providing electrical and thermal therapies and drug delivery services, and we discuss the current challenges, opportunities, and future perspectives in the field. Finally, we present ways to protect the embedded electronic components of skin-mountable devices from the environment by use of mechanically soft packaging materials.

Activity modification in heat: critical assessment of guidelines across athletic, occupational, and military settings in the USA

Exertional heat illness (EHI) risk is a serious concern among athletes, laborers, and warfighters. US Governing organizations have established various activity modification guidelines (AMGs) and other risk mitigation plans to help ensure the health and safety of their workers. The extent of metabolic heat production and heat gain that ensue from their work are the core reasons for EHI in the aforementioned population. Therefore, the major focus of AMGs in all settings is to modulate the work intensity and duration with additional modification in adjustable extrinsic risk factors (e.g., clothing, equipment) and intrinsic risk factors (e.g., heat acclimatization, fitness, hydration status). Future studies should continue to integrate more physiological (e.g., valid body fluid balance, internal body temperature) and biometeorological factors (e.g., cumulative heat stress) to the existing heat risk assessment models to reduce the assumptions and limitations in them. Future interagency collaboration to advance heat mitigation plans among physically active population is desired to maximize the existing resources and data to facilitate advancement in AMGs for environmental heat.

Soft, Skin-Integrated Multifunctional Microfluidic Systems for Accurate Colorimetric Analysis of Sweat Biomarkers and Temperature

Real-time measurements of the total loss of sweat, the rate of sweating, the temperature of sweat, and the concentrations of electrolytes and metabolites in sweat can provide important insights into human physiology. Conventional methods use manual collection processes (e.g., absorbent pads) to determine sweat loss and lab-based instrumentation to analyze its chemical composition. Although such schemes can yield accurate data, they cannot be used outside of laboratories or clinics. Recently reported wearable electrochemical devices for sweat sensing bypass these limitations, but they typically involve on-board electronics, electrodes, and/or batteries for measurement, signal processing, and wireless transmission, without direct means for measuring sweat loss or capturing and storing small volumes of sweat. Alternative approaches exploit soft, skin-integrated microfluidic systems for collection and colorimetric chemical techniques for analysis. Here, we present the most advanced platforms of this type, in which optimized chemistries, microfluidic designs, and device layouts enable accurate assessments not only of total loss of sweat and sweat rate but also of quantitatively accurate values of the pH and temperature of sweat, and of the concentrations of chloride, glucose, and lactate across physiologically relevant ranges. Color calibration markings integrated into a graphics overlayer allow precise readout by digital image analysis, applicable in various lighting conditions. Field studies conducted on healthy volunteers demonstrate the full capabilities in measuring sweat loss/rate and analyzing multiple sweat biomarkers and temperature, with performance that quantitatively matches that of conventional lab-based measurement systems.

Bio-Integrated Wearable Systems: A Comprehensive Review

Bio-integrated wearable systems can measure a broad range of biophysical, biochemical, and environmental signals to provide critical insights into overall health status and to quantify human performance. Recent advances in material science, chemical analysis techniques, device designs, and assembly methods form the foundations for a uniquely differentiated type of wearable technology, characterized by noninvasive, intimate integration with the soft, curved, time-dynamic surfaces of the body. This review summarizes the latest advances in this emerging field of "bio-integrated" technologies in a comprehensive manner that connects fundamental developments in chemistry, material science, and engineering with sensing technologies that have the potential for widespread deployment and societal benefit in human health care. An introduction to the chemistries and materials for the active components of these systems contextualizes essential design considerations for sensors and associated platforms that appear in following sections. The subsequent content highlights the most advanced biosensors, classified according to their ability to capture biophysical, biochemical, and environmental information. Additional sections feature schemes for electrically powering these sensors and strategies for achieving fully integrated, wireless systems. The review concludes with an overview of key remaining challenges and a summary of opportunities where advances in materials chemistry will be critically important for continued progress.

Wearable Fluid Capture Devices for Electrochemical Sensing of Sweat

Wearable sensing technologies are vital for realizing personalized health monitoring. Noninvasive human sweat sampling is essential for monitoring an individual's physical state using rich physiological data. However, existing wearable sensing technologies lack the controlled capture of body sweat and in performing on-device measurement without inflammatory contact. Herein, we report the development of a wearable sweat-capture device using patterned graphene arrays with controlled superwettability and electrical conductivity for simultaneously capturing and electrochemically measuring sweat droplets. The sweat droplets exhibited strong attachment on the superhydrophilic graphene patterns, even during moderate exercising. The captured sweat droplets present strong electrochemical signals using graphene films as the working electrode and metal pins as the counter electrode arrays assembled on 3D printed holders, at the detection limit of 6 μM for H₂O₂ sensing. This research enables full-body spatiotemporal mapping of sweat, which is beneficial for a broad range of personalized monitoring applications, such as drug abuse detection, athletics performance optimization, and physiological wellness tracking.

Fluid-permeable enzymatic lactate sensors for micro-volume specimen

Sensing of lactate in perspiration provides a way to monitor health and control exercise. The volume of perspiration is miniscule, and the efficient collection of perspiration is desired for its effective sensing. We developed mesh-type enzymatic electrodes fabricated on textile meshes and integrated the meshes into an enzymatic biofuel cell. We tested them as self-powered lactate sensors for a small volume of lactate solution. A fluid-permeable enzymatic anode was fabricated based on an insulating textile mesh that was coated with carbon nanotubes (CNTs) and lactate oxidase. The anode was further coated with polyurethane to increase the linear range by limiting the diffusion of lactate while maintaining the advantages of the original textile mesh, such as flexibility, stretchability, and permeability. Permeability of the mesh-type lactate-oxidizing anode allowed a vertically stacked structure of the anode and a previously developed air-breathing cathode. This resulted in a small overall device size (1 cm2). The mesh-type sensor was tested using a small flow rate of lactate solution, and a moderate linearity of amperometric response for a wide concentration range (5 to ≥20 mM) was confirmed. The fluid-permeable anode and enzymatic biofuel cell show the potential of the sensor for continuous monitoring of lactate in perspiration on skin.

Waterproof, electronics-enabled, epidermal microfluidic devices for sweat collection, biomarker analysis, and thermography in aquatic settings

Noninvasive, in situ biochemical monitoring of physiological status, via the use of sweat, could enable new forms of health care diagnostics and personalized hydration strategies. Recent advances in sweat collection and sensing technologies offer powerful capabilities, but they are not effective for use in extreme situations such as aquatic or arid environments, because of unique challenges in eliminating interference/contamination from surrounding water, maintaining robust adhesion in the presence of viscous drag forces and/or vigorous motion, and preventing evaporation of collected sweat. This paper introduces materials and designs for waterproof, epidermal, microfluidic and electronic systems that adhere to the skin to enable capture, storage, and analysis of sweat, even while fully underwater. Field trials demonstrate the ability of these devices to collect quantitative in situ measurements of local sweat chloride concentration, local sweat loss (and sweat rate), and skin temperature during vigorous physical activity in controlled, indoor conditions and in open-ocean swimming.

Stretchable, transparent and imperceptible supercapacitors based on Au@MnO2 nanomesh electrodes

A wearable supercapacitor achieved high transparency of 82.1% and an excellent areal capacitance of 0.53 mF cm⁻², together with high stretchability (160% strain).

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

Wearable sweat sensors rely either on electronics for electrochemical detection or on colorimetry for visual readout. Non-ideal form factors represent disadvantages of the former, while semiquantitative operation and narrow scope of measurable biomarkers characterize the latter. Here, we introduce a battery-free, wireless electronic sensing platform inspired by biofuel cells that integrates chronometric microfluidic platforms with embedded colorimetric assays. The resulting sensors combine advantages of electronic and microfluidic functionality in a platform that is significantly lighter, cheaper, and smaller than alternatives. A demonstration device simultaneously monitors sweat rate/loss, pH, lactate, glucose, and chloride. Systematic studies of the electronics, microfluidics, and integration schemes establish the key design considerations and performance attributes. Two-day human trials that compare concentrations of glucose and lactate in sweat and blood suggest a potential basis for noninvasive, semi-quantitative tracking of physiological status.

From Point-of-Care Testing to eHealth Diagnostic Devices (eDiagnostics)

Point-of-care devices were originally designed to allow medical testing at or near the point of care by health-care professionals. Some point-of-care devices allow medical self-testing at home but cannot fully cover the growing diagnostic needs of eHealth systems that are under development in many countries. A number of easy-to-use, network-connected diagnostic devices for self-testing are needed to allow remote monitoring of patients' health. This Outlook highlights the essential characteristics of diagnostic devices for eHealth settings and indicates point-of-care technologies that may lead to the development of new devices. It also describes the most representative examples of simple-to-use, point-of-care devices that have been used for analysis of untreated biological samples.

Advanced electronic skin devices for healthcare applications

Electronic skin, a kind of flexible electronic device and system inspired by human skin, has emerged as a promising candidate for wearable personal healthcare applications. Wearable electronic devices with skin-like properties will provide platforms for continuous and real-time monitoring of human physiological signals such as tissue pressure, body motion, temperature, metabolites, electrolyte balance, and disease-related biomarkers. Transdermal drug delivery devices can also be integrated into electronic skin to enhance its non-invasive, real-time dynamic therapy functions. This review summarizes the recent progress in electronic skin devices for applications in human health monitoring and therapy systems as well as several potential mass production technologies such as inkjet printing and 3D printing. The opportunities and challenges in broadening the applications of electronic skin devices in practical healthcare are also discussed.

Kirigami-Inspired Deformable 3D Structures Conformable to Curved Biological Surface

By introducing stretchability and/or deformability to planar electronics, devices can conformably attach to 3D curved surfaces with minimal invasiveness, which is of great interest for next-generation wearables in clinical and biological applications. Here, a feasible route is demonstrated to generate deformable 3D structures as a robust platform to construct electronic systems by utilizing silver nanowires/parylene hybrid films in a way analogous to the art of kirigami. The hybrid films exhibit outstanding electrical conductivity along with decent optical transparency, flexibility, and long-term stability. These merits enable these films to work as electrodes for electrocardiogram recording with comparable accuracy to a commercial counterpart, and to fabricate a 7-GHz monopole antenna with good omni-directionality and a peak gain of 1.35 dBi. More importantly, a general scheme for constructing 3D deformable electronic systems is presented, including unique patterning procedures and rational cut designs inspired by kirigami. As an example, deformable transparent humidity sensors are fabricated to work on elbows and finger joints for sweating monitoring. The strategy demonstrated here for 3D deformable system construction is versatile and holds great promise for future advanced health monitoring at diverse and complex epidermal surfaces.

Missing RRI Interpolation Algorithm based on Locally Weighted Partial Least Squares for Precise Heart Rate Variability Analysis

The R-R interval (RRI) fluctuation in electrocardiogram (ECG) is called heart rate variability (HRV), which reflects activities of the autonomic nervous system (ANS) and has been used for various health monitoring services. Accurate R wave detection is crucial for success in HRV-based health monitoring services; however, ECG artifacts often cause missing R waves and deteriorate the accuracy of HRV analysis. The present work proposes a new missing RRI interpolation technique based on Just-In-Time (JIT) modeling. In the JIT modeling framework, a local regression model is built by weighing samples stored in the database according to the distance from a query and output is estimated only when an estimate is requested. The proposed method builds a local model and estimates missing RRI only when an RRI detection error is detected. Locally weighted partial least squares (LWPLS) is adopted for local model construction. The proposed method is referred to as LWPLS-based RRI interpolation (LWPLS-RI). The performance of the proposed LWPLS-RI was evaluated through its application to RRI data with artificial missing RRIs. We used the MIT-BIH Normal Sinus Rhythm Database for nominal RRI dataset construction. Missing RRIs were artificially introduced and they were interpolated by the proposed LWPLS-RI. In addition, MEAN that replaces the missing RRI by a mean of the past RRI data was compared as a conventional method. The result showed that the proposed LWPLS-RI improved root mean squared error (RMSE) of RRI by about 70% in comparison with MEAN. In addition, the proposed method realized precise HRV analysis. The proposed method will contribute to the realization of precise HRV-based health monitoring services.

Soft, Skin-Interfaced Microfluidic Systems with Wireless, Battery-Free Electronics for Digital, Real-Time Tracking of Sweat Loss and Electrolyte Composition

Sweat excretion is a dynamic physiological process that varies with body position, activity level, environmental factors, and health status. Conventional means for measuring the properties of sweat yield accurate results but their requirements for sampling and analytics do not allow for use in the field. Emerging wearable devices offer significant advantages over existing approaches, but each has significant drawbacks associated with bulk and weight, inability to quantify volumetric sweat rate and loss, robustness, and/or inadequate accuracy in biochemical analysis. This paper presents a thin, miniaturized, skin-interfaced microfluidic technology that includes a reusable, battery-free electronics module for measuring sweat conductivity and rate in real-time using wireless power from and data communication to electronic devices with capabilities in near field communications (NFC), including most smartphones. The platform exploits ultrathin electrodes integrated within a collection of microchannels as interfaces to circuits that leverage NFC protocols. The resulting capabilities are complementary to those of previously reported colorimetric strategies. Systematic studies of these combined microfluidic/electronic systems, accurate correlations of measurements performed with them to those of laboratory standard instrumentation, and field tests on human subjects exercising and at rest establish the key operational features and their utility in sweat analytics.

A fluorometric skin-interfaced microfluidic device and smartphone imaging module for in situ quantitative analysis of sweat chemistry

The rich composition of solutes and metabolites in sweat and its relative ease of collection upon excretion from skin pores make this class of biofluid an attractive candidate for point of care analysis. Wearable technologies that combine electrochemical sensors with conventional or emerging semiconductor device technologies offer valuable capabilities in sweat sensing, but they are limited to assays that support amperometric, potentiometric, and colorimetric analyses. Here, we present a complementary approach that exploits fluorometric sensing modalities integrated into a soft, skin-interfaced microfluidic system which, when paired with a simple smartphone-based imaging module, allows for in situ measurement of important biomarkers in sweat. A network array of microchannels and a collection of microreservoirs pre-filled with fluorescent probes that selectively react with target analytes in sweat (e.g. probes), enable quantitative, rapid analysis. Field studies on human subjects demonstrate the ability to measure the concentrations of chloride, sodium and zinc in sweat, with accuracy that matches that of conventional laboratory techniques. The results highlight the versatility of advanced fluorescent-based imaging modalities in body-worn sweat microfluidics platforms, and they suggest some practical potential for these ideas.

Recent Patient Health Monitoring Platforms Incorporating Internet of Things-Enabled Smart Devices

Synergistic integration of the Internet of Things (IoT), cloud computing, and big data technologies in healthcare have led to the notion of "smart health." Smart health is an emerging concept that refers to the provision of healthcare services for prevention, diagnosis, treatment, and follow-up management at any time or any place by connecting information technologies and healthcare. As a significant breakthrough in smart healthcare development, IoT-enabled smart devices allow medical centers to carry out preventive care, diagnosis, and treatment more competently. This review focuses on recently developed patient health monitoring platforms based on IoT-enabled smart devices that can collect real-time patient data and transfer information for assessment by healthcare providers, including doctors, hospitals, and clinics, or for self-management. We aimed to summarize the available information about recently approved devices and state-of-the-art developments through a comprehensive, systematic literature review. In this review, we also discuss possible future directions for the integration of cloud computing and blockchain, which may offer unprecedented breakthroughs in on-demand medical services. The combination of IoT with real-time, remote patient monitoring empowers patients to assert more control over their care, thereby allowing them to actively monitor their particular health conditions.