Cilia metasurfaces for electronically programmable microfluidic manipulation.

Cilial pumping is a powerful strategy used by biological organisms to control and manipulate fluids at the microscale. However, despite numerous recent advances in optically, magnetically and electrically driven actuation, development of an engineered cilial platform with the potential for applications has remained difficult to realize1-6. Here we report on active metasurfaces of electronically actuated artificial cilia that can create arbitrary flow patterns in liquids near a surface. We first create voltage-actuated cilia that generate non-reciprocal motions to drive surface flows at tens of microns per second at actuation voltages of 1 volt. We then show that a cilia unit cell can locally create a range of elemental flow geometries. By combining these unit cells, we create an active cilia metasurface that can generate and switch between any desired surface flow pattern. Finally, we integrate the cilia with a light-powered complementary metal-oxide-semiconductor (CMOS) clock circuit to demonstrate wireless operation. As a proof of concept, we use this circuit to output voltage pulses with various phase delays to demonstrate improved pumping efficiency using metachronal waves. These powerful results, demonstrated experimentally and confirmed using theoretical computations, illustrate a pathway towards fine-scale microfluidic manipulation, with applications from microfluidic pumping to microrobotic locomotion.

Electronically integrated, mass-manufactured, microscopic robots.

Fifty years of Moore's law scaling in microelectronics have brought remarkable opportunities for the rapidly evolving field of microscopic robotics1-5. Electronic, magnetic and optical systems now offer an unprecedented combination of complexity, small size and low cost6,7, and could be readily appropriated for robots that are smaller than the resolution limit of human vision (less than a hundred micrometres)8-11. However, a major roadblock exists: there is no micrometre-scale actuator system that seamlessly integrates with semiconductor processing and responds to standard electronic control signals. Here we overcome this barrier by developing a new class of voltage-controllable electrochemical actuators that operate at low voltages (200 microvolts), low power (10 nanowatts) and are completely compatible with silicon processing. To demonstrate their potential, we develop lithographic fabrication-and-release protocols to prototype sub-hundred-micrometre walking robots. Every step in this process is performed in parallel, allowing us to produce over one million robots per four-inch wafer. These results are an important advance towards mass-manufactured, silicon-based, functional robots that are too small to be resolved by the naked eye.

Gas-phase microactuation using kinetically controlled surface states of ultrathin catalytic sheets.

Biological systems convert chemical energy into mechanical work by using protein catalysts that assume kinetically controlled conformational states. Synthetic chemomechanical systems using chemical catalysis have been reported, but they are slow, require high temperatures to operate, or indirectly perform work by harnessing reaction products in liquids (e.g., heat or protons). Here, we introduce a bioinspired chemical strategy for gas-phase chemomechanical transduction that sequences the elementary steps of catalytic reactions on ultrathin (<10 nm) platinum sheets to generate surface stresses that directly drive microactuation (bending radii of 700 nm) at ambient conditions (T = 20 °C; Ptotal = 1 atm). When fueled by hydrogen gas and either oxygen or ozone gas, we show how kinetically controlled surface states of the catalyst can be exploited to achieve fast actuation (600 ms/cycle) at 20 °C. We also show that the approach can integrate photochemically controlled reactions and can be used to drive the reconfiguration of microhinges and complex origami- and kirigami-based microstructures.

Electronically configurable microscopic metasheet robots.

Shape morphing is vital to locomotion in microscopic organisms but has been challenging to achieve in sub-millimetre robots. By overcoming obstacles associated with miniaturization, we demonstrate microscopic electronically configurable morphing metasheet robots. These metabots expand locally using a kirigami structure spanning five decades in length, from 10 nm electrochemically actuated hinges to 100 µm splaying panels making up the ~1 mm robot. The panels are organized into unit cells that can expand and contract by 40% within 100 ms. These units are tiled to create metasheets with over 200 hinges and independent electronically actuating regions that enable the robot to switch between multiple target geometries with distinct curvature distributions. By electronically actuating independent regions with prescribed phase delays, we generate locomotory gaits. These results advance a metamaterial paradigm for microscopic, continuum, compliant, programmable robots and pave the way to a broad spectrum of applications, including reconfigurable micromachines, tunable optical metasurfaces and miniaturized biomedical devices.

Tuning Electrical Conductance of MoS2 Monolayers through Substitutional Doping.

Tuning electrical conductivity of semiconducting materials through substitutional doping is crucial for fabricating functional devices. This, however, has not been fully realized in two-dimensional (2D) materials due to the difficulty of homogeneously controlling the dopant concentrations and the lack of systematic study of the net impact of substitutional dopants separate from that of the unintentional doping from the device fabrication processes. Here, we grow wafer-scale, continuous MoS2 monolayers with tunable concentrations of Nb and Re and fabricate devices using a polymer-free approach to study the direct electrical impact of substitutional dopants in MoS2 monolayers. In particular, the electrical conductivity of Nb doped MoS2 in the absence of electrostatic gating is reproducibly tuned over 7 orders of magnitude by controlling the Nb concentration. Our study further indicates that the dopant carriers do not fully ionize in the 2D limit, unlike in their three-dimensional analogues, which is explained by weaker charge screening and impurity band conduction. Moreover, we show that the dopants are stable, which enables the doped films to be processed as independent building blocks that can be used as electrodes for functional circuitry.

Bidirectional Self-Folding with Atomic Layer Deposition Nanofilms for Microscale Origami.

Origami design principles are scale invariant and enable direct miniaturization of origami structures provided the sheets used for folding have equal thickness to length ratios. Recently, seminal steps have been taken to fabricate microscale origami using unidirectionally actuated sheets with nanoscale thickness. Here, we extend the full power of origami-inspired fabrication to nanoscale sheets by engineering bidirectional folding with 4 nm thick atomic layer deposition (ALD) SiNx-SiO2 bilayer films. Strain differentials within these bilayers result in bending, producing microscopic radii of curvature. We lithographically pattern these bilayers and localize the bending using rigid panels to fabricate a variety of complex micro-origami devices. Upon release, these devices self-fold according to prescribed patterns. Our approach combines planar semiconductor microfabrication methods with computerized origami design, making it easy to fabricate and deploy such microstructures en masse. These devices represent an important step forward in the fabrication and assembly of deployable micromechanical systems that can interact with and manipulate micro- and nanoscale environments.

Ambulatory Monitoring of Heart Sounds via an Implanted Device Is Superior to Auscultation for Prediction of Heart Failure Events.

BACKGROUND: We compared the relationship between the third heart sound (S3) measured by an implantable cardiac device (devS3) and auscultation (ausS3) and evaluated their prognostic powers for predicting heart failure events (HFEs). METHODS AND RESULTS: In the MultiSENSE study, devS3 was measured daily with continuous values, whereas ausS3 was assessed at study visits with discrete grades. They were compared among patients with and without HFEs at baseline and against each other directly. Cox proportional hazard models were developed between follow-up visits and over the whole study. Simulations were performed on devS3 to match the limitations of auscultation. We studied 900 patients, of whom 106 patients experienced 192 HFEs. Two S3 sensing modalities correlated with each other, but at baseline, only devS3 differentiated patients with or without HFEs (P < 0.0001). The prognostic power of devS3 was superior to that of ausS3 both between follow-up visits (HR = 5.7, P < 0.0001, and 1.7, P = 0.047, respectively) and over the whole study (HR = 2.9, P < 0.0001, and 1.4, P = 0.216, respectively). Simulation results suggested this superiority may be attributed to continuous monitoring and to subaudible measuring capability. CONCLUSIONS: S3 measured by implantable cardiac devices has stronger prognostic power to predict episodes of future HFEs than that of auscultation.

Probing the binding modes and dynamics of histidine on fumed silica surfaces by solid-state NMR.

Silica nanoparticles can be designed to exhibit a diverse range of morphologies (e.g. non-porous, mesoporous), physical properties (e.g. hydrophobic, hydrophilic) and a wide range of chemical and biomolecular surface functionalizations. In the present work, the adsorption complex of histidine (His) and fumed silica nanoparticles (FSN) is probed using thermal analysis (TGA/DTG) and a battery of solid-state (SS) NMR methods supported by DFT chemical shift calculations. Multinuclear (1H/13C/15N) one- and two-dimensional magic angle spinning (MAS) SSNMR experiments were applied to determine site-specific interactions between His and FSN surfaces as a function of adsorption solution concentration, pH and hydration state. By directly comparing SSNMR observables (linewidth, chemical shift and relaxation parameters) for His-FSN adsorption complexes to various crystalline, amorphous and aqueous His forms, the His structural and dynamic environment on FSN surfaces could be determined at an atomic level. The observed 13C and 15N MAS NMR chemical shifts, linewidths and relaxation parameters show that the His surface layer on FSN has a significant dependence on pH and hydration state. His is highly dynamic on FSN surfaces under acidic conditions (pH 4) as evidenced by sharp resonances with near isotropic chemical shifts regardless of hydration level indicating a non-specific binding arrangement while, a considerably more rigid His environment with defined protonation states is observed at near neutral pH with subtle variations between hydrated and anhydrous complexes. At near neutral pH, less charge repulsion occurs on the FSN surface and His is more tightly bound as evidenced by considerable line broadening likely due to chemical shift heterogeneity and a distribution in hydrogen-bonding strengths on the FSN surface. Multiple His sites exchange with a tightly bound water layer in hydrated samples while, direct interaction with the FSN surface and significant chemical shift perturbations for imidazole ring nitrogen sites and some carbon resonances are observed after drying. The SSNMR data was used to propose an interfacial molecular binding model between His and FSN surfaces under varying conditions setting the stage for future multinuclear, multidimensional SSNMR studies of His-containing peptides on silica nanoparticles and other nanomaterials of interest.

Nano-folded Gold Catalysts for Electroreduction of Carbon Dioxide.

The local structure and geometry of catalytic interfaces can influence the selectivity of chemical reactions. Selectivity is often critical for the practical realization of reactions such as the electroreduction of carbon dioxide (CO2). Previously developed strategies to manipulate the structure and geometry of catalysts for electroreduction of CO2 involve complex processes or fail to efficiently alter the selectivity. Here, using a prestrained polymer, we uniaxially and biaxially compress a 60 nm gold film to form a nano-folded electrocatalyst for CO2 reduction. We observe two kinds of folds and can tune the ratio of loose to tight folds by varying the extent of prestrain in the polymer. We characterize the nano-folded catalysts using X-ray diffraction, scanning, and transmission electron microscopy. We observe grain reorientation and coarsening in the nano-folded gold catalysts. We measure an enhancement of Faradaic efficiency for carbon monoxide formation with the biaxially compressed nano-folded catalyst by a factor of about nine as compared to the flat catalyst (up to 87.4%). We rationalize this observation by noting that an increase of the local pH in the tight folds of the catalyst outweighs the effects of alterations in grain characteristics. Together, our studies demonstrate that nano-folded geometries can significantly alter grain characteristics, mass transport, and catalytic performance.

Strain Mapping of Two-Dimensional Heterostructures with Subpicometer Precision.

Next-generation, atomically thin devices require in-plane, one-dimensional heterojunctions to electrically connect different two-dimensional (2D) materials. However, the lattice mismatch between most 2D materials leads to unavoidable strain, dislocations, or ripples, which can strongly affect their mechanical, optical, and electronic properties. We have developed an approach to map 2D heterojunction lattice and strain profiles with subpicometer precision and the ability to identify dislocations and out-of-plane ripples. We collected diffraction patterns from a focused electron beam for each real-space scan position with a high-speed, high dynamic range, momentum-resolved detector-the electron microscope pixel array detector (EMPAD). The resulting four-dimensional (4D) phase space data sets contain the full spatially resolved lattice information on the sample. By using this technique on tungsten disulfide (WS2) and tungsten diselenide (WSe2) lateral heterostructures, we have mapped lattice distortions with 0.3 pm precision across multimicron fields of view and simultaneously observed the dislocations and ripples responsible for strain relaxation in 2D laterally epitaxial structures.

Performance of the quadripolar CRT-D system: Five-year results from the Quadripolar Pacing Post-Approval Study.

BACKGROUND: Cardiac resynchronization therapy (CRT) is associated with challenges such as elevated capture thresholds, diaphragmatic stimulation, and lead instability. OBJECTIVE: This study aimed to assess the long-term safety and efficacy of the quadripolar CRT-defibrillator (CRT-D) device system with the Quartet 1458Q left ventricular (LV) lead in a CRT-indicated population observed for 5 years and to evaluate all-cause mortality and impact of baseline characteristics on survival through 5 years. METHODS: Patients indicated for a CRT-D system were observed every 6 months after implantation for 5 years, and device performance and adverse events were assessed at each visit. The 3 primary end points were freedom from quadripolar CRT-D system-related complications through 5 years, freedom from Quartet 1458Q LV lead-related complications through 5 years, and mean programmed pacing capture threshold at 5 years. RESULTS: The study enrolled 1970 participants at 71 sites. The quadripolar CRT-D system was successfully implanted in 97.2% of participants. Freedom from quadripolar CRT-D device system-related complications through 5 years was 89.7%. Freedom from Quartet 1458Q LV lead-related complications through 5 years was 95.7%; 3.49% of participants had LV lead-related complications, and an overall LV lead complication rate was 0.0122 event per patient-year. The mean LV pacing capture threshold was 1.52 ± 1.01 V at 5 years. The 5-year survival rate was 67.4%. CONCLUSION: The quadripolar CRT-D system with the Quartet 1458Q LV lead exhibited low rates of complications and stable electrical performance through 5 years of follow-up and suggested a higher 5-year survival rate compared with traditional CRT systems.

Technical-tactical behavior analysis of general duty police officers during non-compliant suspect apprehensions: A novel approach to establish minimum force requirements.

BACKGROUND: While effective apprehensions of non-compliant suspects are central to public safety, the minimal force needed to transition a suspect from standing to the ground, vital for apprehension success, has not been established. OBJECTIVE: To examine the technical-tactical behaviors of general duty police officers during simulated apprehensions and quantify the minimum force required to destabilize non-compliant suspects. METHODS: Task simulations conducted with 91 officers were analyzed to identify common grappling movements, strikes, control tactics, and changes in body posture. A separate assessment of 55 male officers aimed to determine the minimum force required for destabilization in five body regions (wrist, forearm, shoulder, mid-chest, and mid-back). Data are presented as mean±standard deviation. RESULTS: On average, apprehensions took 7.3±3.2 seconds. While all officers used grappling movements (100%) and the majority employed control tactics (75%), strikes were seldom used (4%). Apprehensions typically began with a two-handed pull (97%; Contact Phase), 55% then attempted an arm bar takedown, followed by a two-handed cross-body pull (68%; Transition/Control Phase), and a two-handed push to the ground (19%; Ground Phase). All officers began in the upright posture, with most shifting to squat (75%), kneel (58%), or bent (45%) postures to complete the apprehension. The minimum force required to disrupt balance differed across body regions (wrist: 54±12 kg; forearm: 49±12 kg; shoulder: 42±10 kg; mid-chest: 44±11 kg; mid-back: 30±7 kg, all P < 0.05), except between the shoulder and chest (P = 0.19). CONCLUSION: These findings provide insights that can enhance the design and accuracy of future apprehension evaluations and inform the optimization of law enforcement physical employment standards.

Postoperative performance of the Quartet® left ventricular heart lead.

INTRODUCTION: The Quartet(®) left ventricular (LV) lead is the first with 4 pacing electrodes (tip and 3 rings) that enables pacing from 10 different pacing vectors. Postoperative performance of this lead was evaluated in a prospective, nonrandomized, multicenter IDE study. METHODS: Patients with standard indications for CRT-D were enrolled. Electrical performance and presence of phrenic nerve stimulation (PNS) were assessed during pacing from each of 10 vectors at predischarge (within 7 days), 1 month, and 3 months postimplant. RESULTS: The Quartet LV lead was implanted successfully in 170 patients (95.5% implant success rate, 68 ± 11 years, 68.5% male, LVEF: 25 ± 7%, NYHA class III: 98.3% and class IV: 1.7%). Mean follow-up was 4.7 ± 1.9 months. Capture threshold and impedance for each of the 10 LV lead pacing vectors remained stable during follow-up. LV lead dislodgement occurred in 6 (3.5%) patients and PNS was observed in 23 (13.5%) patients. PNS was resolved noninvasively in all 23 (100%) patients, either by reprogramming to pace from the additional LV lead pacing vectors alone (13 pts, 56.5%), reprogramming to pace from the additional LV lead pacing vectors and reprogramming pacing output (4 pts, 17.4%), or by reprogramming pacing output alone (6 pts, 26.1%). CONCLUSIONS: The Quartet LV lead electrical performance was stable and was associated with a high implant success and low dislodgement rate during 3-month follow-up. In all patients with PNS, the 10 pacing vectors combined with reduced output programming enabled the elimination of PNS noninvasively.

Cardiac resynchronization therapy: double cannulation approach to coronary venous lead placement via a prominent thebesian valve.

We report identification of a prominent Thebesian valve by cardiovascular computed tomography (CT) angiography impeding cannulation of the coronary sinus, with subsequent successful coronary venous lead placement with cannulation of the coronary sinus ostium via a transvenous femoral vein approach and subsequent cannulation of the ostium with the coronary venous lead with a left subclavian approach. A 57-year-old man with nonischemic dilated cardiomyopathy, New York Heart Association Class III heart failure, left bundle branch block, and an ejection fraction of 15%, underwent an attempted cardiac resynchronization therapy implantable cardiac defibrillator (ICD). As the coronary sinus ostium could not be cannulated, a dual chamber ICD was placed. The patient subsequently underwent cardiovascular CT angiography, which identified a prominent Thebesian valve at the coronary sinus ostium as the anatomic obstacle to cannulation. Reattempted transvenous cardiac resynchronization therapy was accomplished successfully with a double cannulation approach: cannulation of the coronary sinus ostium with a catheter via a transvenous femoral vein approach and subsequent cannulation with the coronary venous lead via a left subclavian approach. When a prominent Thebesian valve is identified as an obstacle to transvenous left ventricular lead placement, cannulation of the coronary sinus by an alternate venous approach may allow for a coronary venous route rather than necessitate an epicardial approach.

Noise, artifact, and oversensing related inappropriate ICD shock evaluation: ALTITUDE noise study.

BACKGROUND: Approximately 12-21% of implantable cardioverter defibrillator (ICD) patients receive inappropriate shocks. We sought to determine the incidence and causes of noise/artifact and oversensing (NAO) resulting in ICD shocks. METHODS: A random sample of 2,000 patients who received ICD and cardiac resynchronization therapy defibrillator shocks and were followed by a remote monitoring system was included. Seven electrophysiologists analyzed stored electrograms from the 5,279 shock episodes. Episodes were adjudicated as appropriate or inappropriate shocks. RESULTS: Of the 5,248 shock episodes with complete adjudication, 1,570 (30%) were judged to be inappropriate shocks. Of these 1,570, 134 (8.5%) were a result of NAO. The 134 NAO episodes were determined to be due to external noise in 76 (57%), lead connector-related in 37 (28%), muscle noise in 11 (8%), oversensing of atrium in seven (5%), T-wave oversensing in two (2%), and other noise in one (1%). The ICD shock itself resulted in a marked decrease in the level of noise in 60 of 134 (45%) NAO episodes, and the magnitude of this effect varied with the type of NAO (58% for external noise, 35% for muscle, 27% for lead/connector, and 0% for oversensing; P = 0.03). There was no significant difference in NAO likelihood based on type of lead (integrated bipolar 89/1,802 vs dedicated bipolar 9/140, P = 0.67). CONCLUSIONS: External noise and lead/connector noise were the primary causes, while T-wave oversensing was the least common cause of NAO resulting in ICD shock. Noise/artifact decreased immediately after a shock in nearly half of episodes. The specific ICD lead type did not impact the likelihood of NAO.

Binocular Viewing Facilitates Size Constancy for Grasping and Manual Estimation.

A prerequisite for efficient prehension is the ability to estimate an object's distance and size. While most studies demonstrate that binocular viewing is associated with a more efficient grasp programming and execution compared to monocular viewing, the factors contributing to this advantage are not fully understood. Here, we examined how binocular vision facilitates grasp scaling using two tasks: prehension and manual size estimation. Participants (n = 30) were asked to either reach and grasp an object or to provide an estimate of an object's size using their thumb and index finger. The objects were cylinders with a diameter of 0.5, 1.0, or 1.5 cm placed at three distances along the midline (40, 42, or 44 cm). Results from a linear regression analysis relating grip aperture to object size revealed that grip scaling during monocular viewing was reduced similarly for both grasping and estimation tasks. Additional analysis revealed that participants adopted a larger safety margin for grasping during monocular compared to binocular viewing, suggesting that monocular depth cues do not provide sufficient information about an object's properties, which consequently leads to a less efficient grasp execution.

Automatic parameter selection for electron ptychography via Bayesian optimization.

Electron ptychography provides new opportunities to resolve atomic structures with deep sub-angstrom spatial resolution and to study electron-beam sensitive materials with high dose efficiency. In practice, obtaining accurate ptychography images requires simultaneously optimizing multiple parameters that are often selected based on trial-and-error, resulting in low-throughput experiments and preventing wider adoption. Here, we develop an automatic parameter selection framework to circumvent this problem using Bayesian optimization with Gaussian processes. With minimal prior knowledge, the workflow efficiently produces ptychographic reconstructions that are superior to those processed by experienced experts. The method also facilitates better experimental designs by exploring optimized experimental parameters from simulated data.

Ventricular tachycardia in the era of ventricular assist devices.

Sustained ventricular tachycardia (VT) in patients with advanced cardiomyopathy is a potentially life-threatening arrhythmia. Newer treatment strategies have evolved that combine the use of catheter ablation to target the substrate for VT and ventricular assist devices (VADs) to hemodynamically support the failing ventricle. This editorial is targeted to the practicing clinician caring for these difficult patients. The current article reviews the use of percutaneous VADs to support catheter ablation of VT, the use of durable VADs to support the failing heart in patients with recurrent VT, ventricular arrhythmias in patients with durable VADs, and the use of catheter ablation to treat VT in patients with durable VADs.

Impact of relaxation training on patient-perceived measures of anxiety, pain, and outcomes after interventional electrophysiology procedures.

BACKGROUND: Electrophysiology procedures vary in invasiveness, duration, and anesthesia utilized. While complications are low and efficacy high, cases are elective and patient experiences related to anxiety, pain, and perceived outcomes are not well studied. We sought to determine if a 30-minute audio compact disc (CD) that teaches relaxation techniques and wellness perception prior to an elective procedure impacts validated measures of anxiety, pain, and procedural outcomes. METHODS: Sixty-one patients were randomly assigned to a control group (CG) (N(CG) = 31) or interventional group (IG) (N(IG) = 30). Both groups answered a baseline Hospital Anxiety and Depression Scale (HADS-A) survey consisting only of anxiety assessment questions. The IG listened to the CD the night prior to their procedure. Heart rate and blood pressure were monitored on admission and prior to the procedure. Postprocedure, both groups completed two HADS-A surveys as well as two Patient Experience Surveys (PES). There was no statistical difference in the demographics and the rate of procedural complications between the groups. The statistical significance of our data was determined using a Student's t-test and χ(2) test. RESULTS: At baseline, both groups had equal amounts of anxiety prior to their procedures (P = 0.2). The patients in the IG had lower systolic blood pressures during admission and prior the administration of analgesics in comparison to the CG. Postprocedure, results from administering the HADS-A demonstrated that the IG had 33% lower anxiety (P = 0.02) than CG patients. CONCLUSION: The implementation of basic relaxation teaching techniques prior to planned electrophysiology procedures lowers systolic blood pressure and postprocedural anxiety.