Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study.

BACKGROUND: Worldwide, sepsis is the leading cause of death in hospitals. If mortality rates in patients with sepsis can be predicted early, medical resources can be allocated efficiently. We constructed machine learning (ML) models to predict the mortality of patients with sepsis in a hospital emergency department. METHODS: This study prospectively collected nationwide data from an ongoing multicenter cohort of patients with sepsis identified in the emergency department. Patients were enrolled from 19 hospitals between September 2019 and December 2020. For acquired data from 3,657 survivors and 1,455 deaths, six ML models (logistic regression, support vector machine, random forest, extreme gradient boosting [XGBoost], light gradient boosting machine, and categorical boosting [CatBoost]) were constructed using fivefold cross-validation to predict mortality. Through these models, 44 clinical variables measured on the day of admission were compared with six sequential organ failure assessment (SOFA) components (PaO2/FIO2 [PF], platelets (PLT), bilirubin, cardiovascular, Glasgow Coma Scale score, and creatinine). The confidence interval (CI) was obtained by performing 10,000 repeated measurements via random sampling of the test dataset. All results were explained and interpreted using Shapley's additive explanations (SHAP). RESULTS: Of the 5,112 participants, CatBoost exhibited the highest area under the curve (AUC) of 0.800 (95% CI, 0.756-0.840) using clinical variables. Using the SOFA components for the same patient, XGBoost exhibited the highest AUC of 0.678 (95% CI, 0.626-0.730). As interpreted by SHAP, albumin, lactate, blood urea nitrogen, and international normalization ratio were determined to significantly affect the results. Additionally, PF and PLTs in the SOFA component significantly influenced the prediction results. CONCLUSION: Newly established ML-based models achieved good prediction of mortality in patients with sepsis. Using several clinical variables acquired at the baseline can provide more accurate results for early predictions than using SOFA components. Additionally, the impact of each variable was identified.

Real-Time Human Activity Recognition with IMU and Encoder Sensors in Wearable Exoskeleton Robot via Deep Learning Networks.

Wearable exoskeleton robots have become a promising technology for supporting human motions in multiple tasks. Activity recognition in real-time provides useful information to enhance the robot's control assistance for daily tasks. This work implements a real-time activity recognition system based on the activity signals of an inertial measurement unit (IMU) and a pair of rotary encoders integrated into the exoskeleton robot. Five deep learning models have been trained and evaluated for activity recognition. As a result, a subset of optimized deep learning models was transferred to an edge device for real-time evaluation in a continuous action environment using eight common human tasks: stand, bend, crouch, walk, sit-down, sit-up, and ascend and descend stairs. These eight robot wearer's activities are recognized with an average accuracy of 97.35% in real-time tests, with an inference time under 10 ms and an overall latency of 0.506 s per recognition using the selected edge device.

Ligamentous structures in human glans penis.

The corpus spongiosum reportedly occupies a larger proportion of the human glans penis than does the penile body, embedding the end of the corpus cavernosus (CC). However, anatomic descriptions about the fibrous structures of glans penis in the literature cause confusion during dissection and reconstructive surgery. Forty-five penises of formalin-embalmed cadavers were dissected sagittally along the course of the distal urethra and observed macroscopically. Dense connective tissues adjacent to the fossa navicularis and spongiosum parts of the glans were cropped, and underwent Masson's trichrome and Verhoeff-Van-Gieson staining. Most (55.5%) of the specimens had distinct fibrous bands toward the distal tips of the glans penis, which elongated from the tunica albuginea of the CC. They comprised longitudinal collagen bundles continuous to the outer longitudinal layer of the tunica albuginea covering the CC and were intermingled with sparse elastic fibres. This architecture either did not reach the distal end of the glans penis (35.5% of cases), or was obscure or dispersed in all directions (9.0% of cases). The structural dimorphism and the variations in the ratio of dense connective tissue components of the fibrous skeleton are considered to contribute to the varying degrees of flexibility, distensibility and rigidity of the human glans penis.

Improved Device Performance of Solution-Processed Single-Wall Carbon Nanotube Transistors by a Patterning Technique Using a Selective Surface Treatment.

During the fabrication processes for single-wall carbon nanotube thin-film transistors (SWCNT-TFTs), the impurities of organic residues such as photoresist and developer can be induced, which affects the charge transport. As a result, solution-processed SWCNT-TFTs exhibit poor and non-uniform device performance regardless of the intrinsic electrical characteristics. Here, we demonstrate a patterning technique using a selective surface treatment with solution-processed hydrophobic fluorocarbon copolymer in SWCNT-TFTs. By using the difference of wettability in a selective area, a channel region in SWCNT-TFTs can be patterned without the conventional photolithography and etching process. Furthermore, the optimized surface treatment results in denser random networks of SWCNTs in the channel patterned by such technique, compared to the dropcasted SWCNT. The statistical results of the key device metrics such as mobility and threshold voltage extracted from 30 SWCNT-TFTs conclusively prove the improved device performance of SWCNT-TFTs fabricated by such pattering technique. We believe that this work can provide a promising route to stimulate the process innovation of fabrication for high performance solution-processed electronics based on SWCNT random networks.

Low-Voltage Operating Single-Wall Carbon Nanotube Thin-Film Transistors Using High Work Function Contacts on Flexible Substrates.

There have been constant attempts as regards high-performance thin-film transistors (TFTs) by improving the charge injection between the source/drain electrode (S/D) and the channel. In this paper, we investigate the effect of the electric contact on the device performance of single-wall carbon nanotube (SWCNT) TFTs employing the suitable work function material. In order to realize the electric contacts for the dominant hole injection between the S/D and the SWCNT active channel, a high work function material of molybdenum trioxide (MoOx) fabricated by an optimized process are utilized. The contact resistance is extracted by plotting the width-normalized resistance of SWCNTTFT with Pd and MoOx contacts as a function of channel length. We also demonstrate low-voltage operating SWCNT TFTs on flexible polyimide substrates with the reduced electric contacts. Without a buffer film which has been widely used to improve the device performance of TFT on a flexible substrate, high-performance low-voltage operating SWCNT-TFTs were achieved.

The Effect of Crystalline Aluminum Oxide on Device Performance of Solution-Processed Indium-Gallium-Zinc-Oxide Thin-Film Transistors Operating at Low Voltage.

High dielectric constant (high-k) materials have been extensively investigated for low-voltage operating electronics. In recent years, solution-processed high-k dielectrics have been of technological interests in low fabrication cost, large area process and good film quality, compared to the vacuum-process technology. In this paper, we demonstrate solution-processed aluminum oxide (Al2O3) dielectrics for high performance solution-processed indium-gallium-zinc-oxide (IGZO) thin-film transistors (TFTs) operating at low voltage. The material and electrical properties of Al2O3 dielectrics fabricated at different post-annealing temperatures were analyzed by atomic force microscopy, scanning electron microscopy, X-ray diffraction and capacitance-voltage measurements. We also investigate the effect of crystalline Al2O3 dielectrics on the device performance of solution-processed IGZO TFTs. It is concluded that improved interfacial characteristics of crystalline Al2O3 dielectrics enhance the device performance of solution-processed IGZO TFTs operating at 3 V.

Functionalized Carbon Nanotube Sensors for the Detection of Sub-ppm Nitric Oxide Gas.

In this paper, we demonstrate the highly sensitive carbon nanotube (CNT) sensors for the detection of sub-ppm nitric oxide (NO) gas operating at room temperature. Such achievement can be realized by functionalizing CNT thin films with amine-based polymers through a solution-process technology at low temperature. In addition to high sensitivity, functionalized CNT sensors exhibit high selectivity towards NO gas, which is an effective and practical factor for health-care monitoring nano-electronics. We also investigated the effect of a post-cleaning treatment on the sensing performance of functionalized CNT thin films for sub-ppm NO gas sensors. We believe that this work can open-up new routes to realize high performance human-interactive electronics for respiratory diseases detection in exhaled air.

Anatomy of the lateral femoral cutaneous nerve relevant to clinical findings in meralgia paresthetica.

INTRODUCTION: Compression of the lateral femoral cutaneous nerve (LFCN), known as meralgia paresthetica (MP), is common. We investigated the topographic anatomy of the LFCN focusing on the inguinal ligament and adjacent structures. METHODS: Distances from various bony and soft-tissue landmarks to the LFCN were investigated in 33 formalin-embalmed cadavers. RESULTS: The mean distance from the anterior superior iliac spine (ASIS) to the LFCN was 8.8 mm. In approximately 90% of cases, the LFCN lay <2 cm from the medial tip of the ASIS, whereas, in 76% of cases, it was <1 cm away. The mean angle between the inguinal ligament and LFCN was 83.3°. CONCLUSIONS: We determined the variability of the location of the LFCN at the boundary between the pelvic and femoral portions. The reported results will be helpful for diagnosis and treatment of MP. Muscle Nerve 55: 646-650, 2017.

Highly uniform and stable n-type carbon nanotube transistors by using positively charged silicon nitride thin films.

Air-stable n-doping of carbon nanotubes is presented by utilizing SiN(x) thin films deposited by plasma-enhanced chemical vapor deposition. The fixed positive charges in SiN(x), arising from (+)Si ≡ N3 dangling bonds induce strong field-effect doping of underlying nanotubes. Specifically, an electron doping density of ∼ 10(20) cm(-3) is estimated from capacitance voltage measurements of the fixed charge within the SiN(x). This high doping concentration results in thinning of the Schottky barrier widths at the nanotube/metal contacts, thus allowing for efficient injection of electrons by tunnelling. As a proof-of-concept, n-type thin-film transistors using random networks of semiconductor-enriched nanotubes are presented with an electron mobility of ∼ 10 cm(2)/V s, which is comparable to the hole mobility of as-made p-type devices. The devices are highly stable without any noticeable change in the electrical properties upon exposure to ambient air for 30 days. Furthermore, the devices exhibit high uniformity over large areas, which is an important requirement for use in practical applications. The work presents a robust approach for physicochemical doping of carbon nanotubes by relying on field-effect rather than a charge transfer mechanism.

Design of surfactant-substrate interactions for roll-to-roll assembly of carbon nanotubes for thin-film transistors.

Controlled assembly of single-walled carbon nanotube (SWCNT) networks with high density and deposition rate is critical for many practical applications, including large-area electronics. In this regard, surfactant chemistry plays a critical role as it facilitates the substrate-nanotube interactions. Despite its importance, detailed understanding of the subject up until now has been lacking, especially toward tuning the controllability of SWCNT assembly for thin-film transistors. Here, we explore SWCNT assembly with steroid- and alkyl-based surfactants. While steroid-based surfactants yield highly dense nanotube thin films, alkyl surfactants are found to prohibit nanotube assembly. The latter is attributed to the formation of packed alkyl layers of residual surfactants on the substrate surface, which subsequently repel surfactant encapsulated SWCNTs. In addition, temperature is found to enhance the nanotube deposition rate and density. Using this knowledge, we demonstrate highly dense and rapid assembly with an effective SWCNT surface coverage of ~99% as characterized by capacitance-voltage measurements. The scalability of the process is demonstrated through a roll-to-roll assembly of SWCNTs on plastic substrates for large-area thin-film transistors. The work presents an important process scheme for nanomanufacturing of SWCNT-based electronics.

Biowaste-Derived Triboelectric Nanogenerators for Emerging Bioelectronics.

Triboelectric nanogenerators (TENGs) combine contact electrification and electrostatic induction effects to convert waste mechanical energy into electrical energy. As conventional devices contribute to electronic waste, TENGs based on ecofriendly and biocompatible materials have been developed for various energy applications. Owing to the abundance, accessibility, low cost, and biodegradability of biowaste (BW), recycling these materials has gained considerable attention as a green approach for fabricating TENGs. This review provides a detailed overview of BW materials, processing techniques for BW-based TENGs (BW-TENGs), and potential applications of BW-TENGs in emerging bioelectronics. In particular, recent progress in material design, fabrication methods, and biomechanical and environmental energy-harvesting performance is discussed. This review is aimed at promoting the continued development of BW-TENGs and their adoption for sustainable energy-harvesting applications in the field of bioelectronics.

Bioinspired nanoplatforms for human-machine interfaces: Recent progress in materials and device applications.

The panoramic characteristics of human-machine interfaces (HMIs) have prompted the needs to update the biotechnology community with the recent trends, developments, and future research direction toward next-generation bioelectronics. Bioinspired materials are promising for integrating various bioelectronic devices to realize HMIs. With the advancement of scientific biotechnology, state-of-the-art bioelectronic applications have been extensively investigated to improve the quality of life by developing and integrating bioinspired nanoplatforms in HMIs. This review highlights recent trends and developments in the field of biotechnology based on bioinspired nanoplatforms by demonstrating recently explored materials and cutting-edge device applications. Section 1 introduces the recent trends and developments of bioinspired nanomaterials for HMIs. Section 2 reviews various flexible, wearable, biocompatible, and biodegradable nanoplatforms for bioinspired applications. Section 3 furnishes recently explored substrates as carriers for advanced nanomaterials in developing HMIs. Section 4 addresses recently invented biomimetic neuroelectronic, nanointerfaces, biointerfaces, and nano/microfluidic wearable bioelectronic devices for various HMI applications, such as healthcare, biopotential monitoring, and body fluid monitoring. Section 5 outlines designing and engineering of bioinspired sensors for HMIs. Finally, the challenges and opportunities for next-generation bioinspired nanoplatforms in extending the potential on HMIs are discussed for a near-future scenario. We believe this review can stimulate the integration of bioinspired nanoplatforms into the HMIs in addition to wearable electronic skin and health-monitoring devices while addressing prevailing and future healthcare and material-related problems in biotechnologies.

Recent advances in biosensors based on metal-oxide semiconductors system-integrated into bioelectronics.

Metal-oxide semiconductors (MOSs) have emerged as pivotal components in technology related to biosensors and bioelectronics. Detecting biomarkers in sweat provides a glimpse into an individual's metabolism without the need for sample preparation or collection steps. The distinctive attributes of this biosensing technology position it as an appealing option for biomedical applications beyond the scope of diagnosis and healthcare monitoring. This review encapsulates ongoing developments of cutting-edge biosensors based on MOSs. Recent advances in MOS-based biosensors for human sweat analyses are reviewed. Also discussed is the progress in sweat-based biosensing technologies to detect and monitor diseases. Next, system integration of biosensors is demonstrated ultimately to ensure the accurate and reliable detection and analysis of target biomarkers beyond individual devices. Finally, the challenges and opportunities related to advanced biosensors and bioelectronics for biomedical applications are discussed.

Realization of Extremely High-Gain and Low-Power in nMOS Inverter Based on Monolayer WS2 Transistor Operating in Subthreshold Regime.

In this work, we report an n-type metal-oxide-semiconductor (nMOS) inverter using chemical vapor deposition (CVD)-grown monolayer WS2 field-effect transistors (FETs). Our large-area CVD-grown monolayer WS2 FETs exhibit outstanding electrical properties including a high on/off ratio, small subthreshold swing, and excellent drain-induced barrier lowering. These are achieved by n-type doping using AlOx/Al2O3 and a double-gate structure employing high-k dielectric HfO2. Due to the superior subthreshold characteristics, monolayer WS2 FETs show high transconductance and high output resistance in the subthreshold regime, resulting in significantly higher intrinsic gain compared to conventional Si MOSFETs. Therefore, we successfully realize subthreshold operating monolayer WS2 nMOS inverters with extremely high gains of 564 and 2056 at supply voltage (VDD) of 1 and 2 V, respectively, and low power consumption of ∼2.3 pW·µm-1 at VDD = 1 V. In addition, the monolayer WS2 nMOS inverter is further expanded to the demonstration of logic circuits such as AND, OR, NAND, NOR logic gates, and SRAM. These findings suggest the potential of monolayer WS2 for high-gain and low-power logic circuits and validate the practical application in large areas.

Status of MyHealthWay and Suggestions for Widespread Implementation, Emphasizing the Utilization and Practical Use of Personal Medical Data.

OBJECTIVES: In the Fourth Industrial Revolution, there is a focus on managing diverse medical data to improve healthcare and prevent disease. The challenges include tracking detailed medical records across multiple institutions and the necessity of linking domestic public medical entities for efficient data sharing. This study explores MyHealthWay, a Korean healthcare platform designed to facilitate the integration and transfer of medical data from various sources, examining its development, importance, and legal implications. METHODS: To evaluate the management status and utilization of MyHealthWay, we analyzed data types, security, legal issues, domestic versus international issues, and infrastructure. Additionally, we discussed challenges such as resource and infrastructure constraints, regulatory hurdles, and future considerations for data management. RESULTS: The secure sharing of medical information via MyHealthWay can reduce the distance between patients and healthcare facilities, fostering personalized care and self-management of health. However, this approach faces legal challenges, particularly relating to data standardization and access to personal health information. Legal challenges in data standardization and access, particularly for secondary uses such as research, necessitate improved regulations. There is a crucial need for detailed governmental guidelines and clear data ownership standards at institutional levels. CONCLUSIONS: This report highlights the role of Korea's MyHealthWay, which was launched in 2023, in transforming healthcare through systematic data integration. Challenges include data privacy and legal complexities, and there is a need for data standardization and individual empowerment in health data management within a systematic medical big data framework.

Charge transport study of high mobility polymer thin-film transistors based on thiophene substituted diketopyrrolopyrrole copolymers.

In this paper, we report on the device physics and charge transport characteristics of high-mobility dual-gated polymer thin-film transistors with active semiconductor layers consisting of thiophene flanked DPP with thienylene-vinylene-thienylene (PDPP-TVT) alternating copolymers. Room temperature mobilities in these devices are high and can exceed 2 cm(2) V(-1) s(-1). Steady-state and non-quasi-static measurements have been performed to extract key transport parameters and velocity distributions of charge carriers in this copolymer. Charge transport in this polymer semiconductor can be explained using a Multiple-Trap-and-Release or Monroe-type model. We also compare the activation energy vs. field-effect mobility in a few important polymer semiconductors to gain a better understanding of transport of DPP systems and make appropriate comparisons.

Synthesis, characterization and organic field effect transistor performance of a diketopyrrolopyrrole-fluorenone copolymer.

A diketopyrrolopyrrole (DPP) with fluorenone (FN) based low band gap alternating copolymer (PDPPT-alt-FN) has been synthesized via Suzuki coupling. PDPPT-alt-FN exhibits a deep HOMO level with a lower band gap. Fabricated organic thin film transistors using PDPPT-alt-FN as a channel semiconductor show p-channel behaviour with the highest hole mobility of 0.083 cm(2) V(-1) s(-1) measured in air.

In-Advance Prediction of Pressure Ulcers via Deep-Learning-Based Robust Missing Value Imputation on Real-Time Intensive Care Variables.

Pressure ulcers (PUs) are a prevalent skin disease affecting patients with impaired mobility and in high-risk groups. These ulcers increase patients' suffering, medical expenses, and burden on medical staff. This study introduces a clinical decision support system and verifies it for predicting real-time PU occurrences within the intensive care unit (ICU) by using MIMIC-IV and in-house ICU data. We develop various machine learning (ML) and deep learning (DL) models for predicting PU occurrences in real time using the MIMIC-IV and validate using the MIMIC-IV and Kangwon National University Hospital (KNUH) dataset. To address the challenge of missing values in time series, we propose a novel recurrent neural network model, GRU-D++. This model outperformed other experimental models by achieving the area under the receiver operating characteristic curve (AUROC) of 0.945 for the on-time prediction and AUROC of 0.912 for 48h in-advance prediction. Furthermore, in the external validation with the KNUH dataset, the fine-tuned GRU-D++ model demonstrated superior performances, achieving an AUROC of 0.898 for on-time prediction and an AUROC of 0.897 for 48h in-advance prediction. The proposed GRU-D++, designed to consider temporal information and missing values, stands out for its predictive accuracy. Our findings suggest that this model can significantly alleviate the workload of medical staff and prevent the worsening of patient conditions by enabling timely interventions for PUs in the ICU.

Enhanced Triboelectric Effects of Self-Poled MoS2-Embedded PVDF Hybrid Nanocomposite Films for Bar-Printed Wearable Triboelectric Nanogenerators.

Self-poled molybdenum disulfide embedded polyvinylidene fluoride (MoS2@PVDF) hybrid nanocomposite films fabricated by a bar-printing process are demonstrated to improve the output performances of triboelectric nanogenerators (TENGs). Comparative analyses of MoS2@PVDF films with different MoS2 concentrations and the synergic effect based on postannealing at different temperatures were examined to increase the triboelectric open-circuit voltage and the short-circuit current (∼200 V and ∼11.8 µA, respectively). A further comprehensive study of the structural and electrical changes that occur on the surfaces of the proposed hybrid nanocomposite films revealed that both MoS2 incorporation into PVDF and postannealing can individually promote the formation of the ß-crystal phase and generate polarity in the PVDF. In addition, MoS2, which provides triboelectric trap states, was found to play a significant role in improving the charge capture capacity of the nanocomposite film and increasing the potential difference between two electrodes of TENGs. The produced electrical energy of the developed wearable TENGs with excellent operational stability for a long duration was utilized to power a variety of mobile smart gadgets in addition to low-power electronic devices. We believe that this study can provide a simple and effective approach to improving the energy-harvesting capabilities of wearable TENGs based on hybrid nanocomposite films.

Self-reconfigurable high-weight-per-volume-gelatin films for all-solution-processed on-skin electronics with ultra-conformal contact.

Although conventional skin-attachable electronics exhibit good functionalities, their direct attachment (without any adhesive) to human skin with sufficient conformal contact is challenging. Herein, all-solution-processed on-skin electronics based on self-reconfigurable high-weight-per- volume-gelatin (HWVG) film constructed using an effective, biocompatible water absorption-evaporation technique are demonstrated. Completely conformal contact of self-reconfigurable HWVG films is realized by rapidly inducing anisotropic swelling in the perpendicular direction and covering any curvature on the skin without spatial gap or void after shrinking. A sufficiently thin HWVG film (~2 um) exhibited higher adhesion owing to van der Waals force and the carboxylic acid and amine groups in HWVG film form cross-linkages through intermolecular bonds with human skin. Self-reconfigurable HWVG films with high biocompatibility are optimized to afford a superior efficiency of 87.83 % at a concentration of 20 % (w/v) and a storage modulus of 1822 MPa at 36.5 °C. Furthermore, functional nanoelectrodes consisting of self-reconfigurable silver nanowires/HWVG films for high-performance on-skin sensors allowing the detection of sensitive motion and electrophysiological signals, as well as an armband-type sensor system incorporated with a smartphone for health-care monitoring are demonstrated. Outstanding performances, including stability, reliability, flexibility, re-usability, biocompatibility, and permeability of on-skin electronics based on HWVG films can open-up a prospective route to realizing breathable human-machine interfaces based on biocompatible materials and processes.