Cloud-Integrated Smart Nanomembrane Wearables for Remote Wireless Continuous Health Monitoring of Postpartum Women.

Noncommunicable diseases (NCD), such as obesity, diabetes, and cardiovascular disease, are defining healthcare challenges of the 21st century. Medical infrastructure, which for decades sought to reduce the incidence and severity of communicable diseases, has proven insufficient in meeting the intensive, long-term monitoring needs of many NCD disease patient groups. In addition, existing portable devices with rigid electronics are still limited in clinical use due to unreliable data, limited functionality, and lack of continuous measurement ability. Here, a wearable system for at-home cardiovascular monitoring of postpartum women-a group with urgently unmet NCD needs in the United States-using a cloud-integrated soft sternal device with conformal nanomembrane sensors is introduced. A supporting mobile application provides device data to a custom cloud architecture for real-time waveform analytics, including medical device-grade blood pressure prediction via deep learning, and shares the results with both patient and clinician to complete a robust and highly scalable remote monitoring ecosystem. Validated in a month-long clinical study with 20 postpartum Black women, the system demonstrates its ability to remotely monitor existing disease progression, stratify patient risk, and augment clinical decision-making by informing interventions for groups whose healthcare needs otherwise remain unmet in standard clinical practice.

Continuous real-time assessment of acute cognitive stress from cardiac mechanical signals captured by a skin-like patch.

The inability to objectively quantify cognitive stress in real-time with wearable devices is a crucial unsolved problem with serious negative consequences for dementia and mental disability patients and those seeking to improve their quality of life. Here, we introduce a skin-like, wireless sternal patch that captures changes in cardiac mechanics due to stress manifesting in the seismocardiogram (SCG) signals. Judicious optimization of the device's micro-structured interconnections and elastomer integration yields a device that sufficiently matches the skin's mechanics, robustly yet gently adheres to the skin without aggressive tapes, and captures planar and longitudinal SCG waves well. The device transmits SCG beats in real-time to a user's device, where derived features relate to the heartbeat's mechanical morphology. The signals are assessed by a series of features in a support vector machine regressor. Controlled studies, compared to gold standard cortisol and following the validated imaging test, show an R-squared correlation of 0.79 between the stress prediction and cortisol change, significantly improving over prior works. Likewise, the system demonstrates excellent robustness to external temperature and physical recovery status while showing excellent accuracy and wearability in full-day use.

At-home wireless sleep monitoring patches for the clinical assessment of sleep quality and sleep apnea.

Although many people suffer from sleep disorders, most are undiagnosed, leading to impairments in health. The existing polysomnography method is not easily accessible; it's costly, burdensome to patients, and requires specialized facilities and personnel. Here, we report an at-home portable system that includes wireless sleep sensors and wearable electronics with embedded machine learning. We also show its application for assessing sleep quality and detecting sleep apnea with multiple patients. Unlike the conventional system using numerous bulky sensors, the soft, all-integrated wearable platform offers natural sleep wherever the user prefers. In a clinical study, the face-mounted patches that detect brain, eye, and muscle signals show comparable performance with polysomnography. When comparing healthy controls to sleep apnea patients, the wearable system can detect obstructive sleep apnea with an accuracy of 88.5%. Furthermore, deep learning offers automated sleep scoring, demonstrating portability, and point-of-care usability. At-home wearable electronics could ensure a promising future supporting portable sleep monitoring and home healthcare.

Ultrathin Crystalline Silicon Nano and Micro Membranes with High Areal Density for Low-Cost Flexible Electronics.

Ultrathin crystalline silicon is widely used as an active material for high-performance, flexible, and stretchable electronics, from simple passive and active components to complex integrated circuits, due to its excellent electrical and mechanical properties. However, in contrast to conventional silicon wafer-based devices, ultrathin crystalline silicon-based electronics require an expensive and rather complicated fabrication process. Although silicon-on-insulator (SOI) wafers are commonly used to obtain a single layer of crystalline silicon, they are costly and difficult to process. Therefore, as an alternative to SOI wafers-based thin layers, here, a simple transfer method is proposed for printing ultrathin multiple crystalline silicon sheets with thicknesses between 300 nm to 13 µm and high areal density (>90%) from a single mother wafer. Theoretically, the silicon nano/micro membrane can be generated until the mother wafer is completely consumed. In addition, the electronic applications of silicon membranes are successfully demonstrated through the fabrication of a flexible solar cell and flexible NMOS transistor arrays.

Advances in Soft and Dry Electrodes for Wearable Health Monitoring Devices.

Electrophysiology signals are crucial health status indicators as they are related to all human activities. Current demands for mobile healthcare have driven considerable interest in developing skin-mounted electrodes for health monitoring. Silver-Silver chloride-based (Ag-/AgCl) wet electrodes, commonly used in conventional clinical practice, provide excellent signal quality, but cannot monitor long-term signals due to gel evaporation and skin irritation. Therefore, the focus has shifted to developing dry electrodes that can operate without gels and extra adhesives. Compared to conventional wet electrodes, dry ones offer various advantages in terms of ease of use, long-term stability, and biocompatibility. This review outlines a systematic summary of the latest research on high-performance soft and dry electrodes. In addition, we summarize recent developments in soft materials, biocompatible materials, manufacturing methods, strategies to promote physical adhesion, methods for higher breathability, and their applications in wearable biomedical devices. Finally, we discuss the developmental challenges and advantages of various dry electrodes, while suggesting research directions for future studies.

Soft Wireless Bioelectronics Designed for Real-Time, Continuous Health Monitoring of Farmworkers.

Hotter summers caused by global warming and increased workload and duration are endangering the health of farmworkers, a high-risk population for heat-related illness (HRI), and deaths. Although prior studies using wearable sensors show the feasibility of employing field-collected data for HRI monitoring, existing devices still have limitations, such as data loss from motion artifacts, device discomfort from rigid electronics, difficulties with administering ingestible sensors, and low temporal resolution. Here, this paper introduces a wireless, wearable bioelectronic system with functionalities for continuous monitoring of skin temperature, electrocardiograms (ECG), heart rates (HR), and activities, configured in a single integrated package. Advanced nanomanufacturing based on laser machining allows rapid device fabrication and direct incorporation of sensors with a highly breathable substrate, allowing for managing excessive sweating and multimodal stresses. To validate the device's performance in agricultural settings, the device is applied to multiple farmworkers at various operations, including fernery, nursery, and crop. The accurate data recording, including high-fidelity ECG (signal-to-noise ratio: >20 dB), accurate HR (r = 0.89, r2 = 0.65 in linear correlation), and reliable temperature/activity, confirms the device's capability for multiparameter health monitoring of farmworkers.

Advances in Microsensors and Wearable Bioelectronics for Digital Stethoscopes in Health Monitoring and Disease Diagnosis.

Acoustic stethoscopes have demonstrated beneficial factors aiding diagnosis from the doctors with accurate body sounds. Still, the conventional acoustic stethoscopes require a substantial amount of clinical experience and hearing skills for the physicians to accurately diagnose symptoms from abnormal sounds. Especially for cardiopulmonary systems, it is crucial to collect sounds with precision since they contain valuable information in specific frequency ranges for various sounds. This review paper summarizes recent advances and technical developments in microsensors, circuits, chips, and integrated electronics for fabricating different digital stethoscopes that offer portable detection of body sounds. They solve the limitations of conventional stethoscopes, aiming for wireless auscultation in digitized medicine. Overall, this comprehensive review will help researchers design and develop new wearable electronics and digital stethoscopes for advancing human healthcare, continuous monitoring, and better diagnosis.

Recent Advances in Printing Technologies of Nanomaterials for Implantable Wireless Systems in Health Monitoring and Diagnosis.

The development of wireless implantable sensors and integrated systems, enabled by advances in flexible and stretchable electronics technologies, is emerging to advance human health monitoring, diagnosis, and treatment. Progress in material and fabrication strategies allows for implantable electronics for unobtrusive monitoring via seamlessly interfacing with tissues and wirelessly communicating. Combining new nanomaterials and customizable printing processes offers unique possibilities for high-performance implantable electronics. Here, this report summarizes the recent progress and advances in nanomaterials and printing technologies to develop wireless implantable sensors and electronics. Advances in materials and printing processes are reviewed with a focus on challenges in implantable applications. Demonstrations of wireless implantable electronics and advantages based on these technologies are discussed. Lastly, existing challenges and future directions of nanomaterials and printing are described.

Printed, Soft, Nanostructured Strain Sensors for Monitoring of Structural Health and Human Physiology.

Soft strain sensors that are mechanically flexible or stretchable are of significant interest in the fields of structural health monitoring, human physiology, and human-machine interfaces. However, existing deformable strain sensors still suffer from complex fabrication processes, poor reusability, limited adhesion strength, or structural rigidity. In this work, we introduce a versatile, high-throughput fabrication method of nanostructured, soft material-enabled, miniaturized strain sensors for both structural health monitoring and human physiology detection. Aerosol jet printing of polyimide and silver nanowires enables multifunctional strain sensors with tunable resistance and gauge factor. Experimental study of soft material compositions and multilayered structures of the strain sensor demonstrates the capabilities of strong adhesion and conformal lamination on different surfaces without the use of conventional fixtures and/or tapes. A two-axis, printed strain gauge enables the detection of force-induced strain changes on a curved stem valve for structural health management while offering reusability over 10 times without losing the sensing performance. Direct comparison with a commercial film sensor captures the advantages of the printed soft sensor in enhanced gauge factor and sensitivity. Another type of a stretchable strain sensor in skin-wearable applications demonstrates a highly sensitive monitoring of a subject's motion, pulse, and breathing, validated by comparing it with a clinical-grade system. Overall, the presented comprehensive study of materials, mechanics, printing-based fabrication, and interfacial adhesion shows a great potential of the printed soft strain sensor for applications in continuous structural health monitoring, human health detection, machine-interfacing systems, and environmental condition monitoring.

Skin-conformal, soft material-enabled bioelectronic system with minimized motion artifacts for reliable health and performance monitoring of athletes.

Recent advances in biosensors, bioelectronics, and system integration allow the development of wristband-type devices for health and performance monitoring of athletes. Although these devices provide adequate sensing outputs, they suffer from signal loss due to improper contact of a rigid sensor with the skin. In addition, when a rubber band tightly secures the sensor to the skin, the gap between sensor and skin causes inevitable motion artifacts, resulting in corrupted data. Consequently, the rigidity and bulky form factor of the existing devices are not suitable for a practical use since athletes typically go through strenuous activities during training and matches. Here, we introduce a soft, wearable flexible hybrid electronics (WFHE) with integrated flexible sensors and circuits in an ultrathin, low-modulus elastomer. The thin-film bioelectronic system avoids the use of bulky, rigid sensors, while providing negligible mechanical and thermal burdens to the wearer. Enabling conformal contact between sensor and skin minimizes undesired motion artifacts. A set of computational and experimental studies of soft materials, flexible mechanics, and system packaging provides key fundamental design factors for a comfortable, reliable, waterproof bioelectronic system. Skin conformal WFHE with sparse signal reconstruction enables reliable, continuous monitoring of photoplethysmogram, heart rate, and activities of athletes. Development of a quantitative analysis between impact force and impact velocity extracted from motion acceleration provides an objective assessment of an athletic punching force. Collectively, this study shows the first demonstration of a wireless, soft, thin-film electronics for a real-time, reliable assessment of athletic health and performance.

A Simulation Study of a Radiofrequency Localization System for Tracking Patient Motion in Radiotherapy.

One of the most widely used tools in cancer treatment is external beam radiotherapy. However, the major risk involved in radiotherapy is excess radiation dose to healthy tissue, exacerbated by patient motion. Here, we present a simulation study of a potential radiofrequency (RF) localization system designed to track intrafraction motion (target motion during the radiation treatment). This system includes skin-wearable RF beacons and an external tracking system. We develop an analytical model for direction of arrival measurement with radio frequencies (GHz range) for use in a localization estimate. We use a Monte Carlo simulation to investigate the relationship between a localization estimate and angular resolution of sensors (signal receivers) in a simulated room. The results indicate that the external sensor needs an angular resolution of about 0.03 degrees to achieve millimeter-level localization accuracy in a treatment room. This fundamental study of a novel RF localization system offers the groundwork to design a radiotherapy-compatible patient positioning system for active motion compensation.

Immunosensor towards low-cost, rapid diagnosis of tuberculosis.

A rapid, accurate tuberculosis diagnostic tool that is compatible with the needs of tuberculosis-endemic settings is a long-sought goal. An immunofluorescence microtip sensor is described that detects Mycobacterium tuberculosis complex cells in sputum in 25 minutes. Concentration mechanisms based on flow circulation and electric field are combined at different scales to concentrate target bacteria in 1 mL samples onto the surfaces of microscale tips. Specificity is conferred by genus-specific antibodies on the microtip surface. Immunofluorescence is then used to detect the captured cells on the microtip. The detection limit in sputum is 200 CFU mL(-1) with a success rate of 96%, which is comparable to PCR.

Nanostructured biosensing platform-shadow edge lithography for high-throughput nanofabrication.

One of the critical challenges in nanostructured biosensors is to manufacture an addressable array of nanopatterns at low cost. The addressable array (1) provides multiplexing for biomolecule detection and (2) enables direct detection of biomolecules without labeling and amplification. To fabricate such an array of nanostructures, current nanolithography methods are limited by the lack of either high throughput or high resolution. This paper presents a high-resolution and high-throughput nanolithography method using the compensated shadow effect in high-vacuum evaporation. The approach enables the fabrication of uniform nanogaps down to 20 nm in width across a 100 mm silicon wafer. The nanogap pattern is used as a template for the routine fabrication of zero-, one-, and two-dimensional nanostructures with a high yield. The method can facilitate the fabrication of nanostructured biosensors on a wafer scale at a low manufacturing cost.