Adult congenital heart disease training in Europe: current status, disparities and potential solutions.

OBJECTIVES: This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe. METHODS: A questionnaire was sent to ACHD cardiologists from 34 European countries. RESULTS: Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors 'on the job'. The median number of ACHD centres per country was 4 (range 0-28), median number of ACHD surgical centres was 3 (0-26) and the median number of ACHD training centres was 2 (range 0-28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p<0.001). CONCLUSION: Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to 'train people on the job'. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care.

An ultra-sensitive NH3 gas sensor enabled by an ion-in-conjugated polycroconaine/Ti3C2Tx core-shell composite.

MXenes are emerging sensing materials due to their metallic conductivity and rich surface chemistry for analytes; they, however, suffer from poor stability. Incorporation with functional polymers can largely prevent the performance decay and enhance the sensing performance. Herein, we demonstrate a core-shell composite, Ti3C2Tx@croconaine (poly(1,5-diaminonaphthalene-croconaine), PDAC) prepared by a facile in situ polymerization reaction, suitable for NH3 detection. Compared to pristine Ti3C2Tx, the sensor made of a Ti3C2Tx-polycroconaine composite exhibits a significantly enhanced sensitivity of 2.8% ppm-1 and an estimated achievable limit of detection of 50 ppb. The improved sensing performance could be attributed to the presence of PDAC facilitating the adsorption of NH3 and changing the tunneling conductivity between Ti3C2Tx domains. Density functional theory (DFT) calculations reveal that the adsorption energy of NH3 on PDAC is the highest among the tested gases, which supports the selectivity of the sensor to this analyte. Benefiting from the protection conferred by the PDAC shell, the composite has a reliable operation period of at least 40 days. In addition, we demonstrated a flexible paper-based sensor of the Ti3C2Tx@PDAC composite, without attenuated performance upon mechanical deformation. This work proposed a novel mechanism and a feasible methodology to synthesize MXene-polymer composites with improved sensitivity and stability for chemical sensing.

Biopolymer Blends of Poly(lactic acid) and Poly(hydroxybutyrate) and Their Functionalization with Glycerol Triacetate and Chitin Nanocrystals for Food Packaging Applications.

Polylactic acid (PLA) is a biopolymer that has potential for use in food packaging applications; however, its low crystallinity and poor gas barrier properties limit its use. This study aimed to increase the understanding of the structure property relation of biopolymer blends and their nanocomposites. The crystallinity of the final materials and their effect on barrier properties was studied. Two strategies were performed: first, different concentrations of poly(hydroxybutyrate) (PHB; 10, 25, and 50 wt %) were compounded with PLA to facilitate the PHB spherulite development, and then, for further increase of the overall crystallinity, glycerol triacetate (GTA) functionalized chitin nanocrystals (ChNCs) were added. The PLA:PHB blend with 25 wt % PHB showed the formation of many very small PHB spherulites with the highest PHB crystallinity among the examined compositions and was selected as the matrix for the ChNC nanocomposites. Then, ChNCs with different concentrations (0.5, 1, and 2 wt %) were added to the 75:25 PLA:PHB blend using the liquid-assisted extrusion process in the presence of GTA. The addition of the ChNCs resulted in an improvement in the crystallization rate and degree of PHB crystallinity as well as mechanical properties. The nanocomposite with the highest crystallinity resulted in greatly decreased oxygen (O) and carbon dioxide (CO2) permeability and increased the overall mechanical properties compared to the blend with GTA. This study shows that the addition ChNCs in PLA:PHB can be a possible way to reach suitable gas barrier properties for food packaging films.

Ultrafast photoresponse of vertically oriented TMD films probed in a vertical electrode configuration on Si chips.

Integrated photodetectors based on transition metal dichalcogenides (TMDs) face the challenge of growing their high-quality crystals directly on chips or transferring them to the desired locations of components by applying multi-step processes. Herein, we show that vertically oriented polycrystalline thin films of MoS2 and WS2 grown by sulfurization of Mo and W sputtered on highly doped Si are robust solutions to achieve on-chip photodetectors with a sensitivity of up to 1 mA W-1 and an ultrafast response time in the sub-µs regime by simply probing the device in a vertical arrangement, i.e., parallel to the basal planes of TMDs. These results are two orders of magnitude better than those measured earlier in lateral probing setups having both electrodes on top of vertically aligned polycrystalline TMD films. Accordingly, our study suggests that easy-to-grow vertically oriented polycrystalline thin film structures may be viable components in fast photodetectors as well as in imaging, sensing and telecommunication devices.

Bioplastics and Carbon-Based Sustainable Materials, Components, and Devices: Toward Green Electronics.

The continuously growing number of short-life electronics equipment inherently results in a massive amount of problematic waste, which poses risks of environmental pollution, endangers human health, and causes socioeconomic problems. Hence, to mitigate these negative impacts, it is our common interest to substitute conventional materials (polymers and metals) used in electronics devices with their environmentally benign renewable counterparts, wherever possible, while considering the aspects of functionality, manufacturability, and cost. To support such an effort, in this study, we explore the use of biodegradable bioplastics, such as polylactic acid (PLA), its blends with polyhydroxybutyrate (PHB) and composites with pyrolyzed lignin (PL), and multiwalled carbon nanotubes (MWCNTs), in conjunction with processes typical in the fabrication of electronics components, including plasma treatment, dip coating, inkjet and screen printing, as well as hot mixing, extrusion, and molding. We show that after a short argon plasma treatment of the surface of hot-blown PLA-PHB blend films, percolating networks of single-walled carbon nanotubes (SWCNTs) having sheet resistance well below 1 kΩ/□ can be deposited by dip coating to make electrode plates of capacitive touch sensors. We also demonstrate that the bioplastic films, as flexible dielectric substrates, are suitable for depositing conductive micropatterns of SWCNTs and Ag (1 kΩ/□ and 1 Ω/□, respectively) by means of inkjet and screen printing, with potential in printed circuit board applications. In addition, we exemplify compounded and molded composites of PLA with PL and MWCNTs as excellent candidates for electromagnetic interference shielding materials in the K-band radio frequencies (18.0-26.5 GHz) with shielding effectiveness of up to 40 and 46 dB, respectively.

Inkjet-Deposited Single-Wall Carbon Nanotube Micropatterns on Stretchable PDMS-Ag Substrate-Electrode Structures for Piezoresistive Strain Sensing.

Printed piezoresistive strain sensors based on stretchable roll-to-roll screen-printed silver electrodes on polydimethylsiloxane substrates and inkjet-deposited single-wall carbon nanotube micropatterns are demonstrated in this work. With the optimization of surface wetting and inkjet printing parameters, well-defined microscopic line patterns of the nanotubes with a sheet resistance of <100 Ω/□ could be deposited between stretchable Ag electrodes on the plasma-treated substrate. The developed stretchable devices are highly sensitive to tensile strain with a gauge factor of up to 400 and a pressure sensitivity of ∼0.09 Pa-1, respond to bending down to a radius of 1.5 mm, and are suitable for mounting on the skin to monitor and resolve various movements of the human body such as cardiac cycle, breathing, and finger flexing. This study indicates that inkjet deposition of nanomaterials can complement well other printing technologies to produce flexible and stretchable devices in a versatile manner.

Composites of ion-in-conjugation polysquaraine and SWCNTs for the detection of H2S and NH3 at ppb concentrations.

Several different methods are established for the analysis of gases, including optical spectroscopy, photoacoustic spectroscopy as well as colorimetric and resistive sensing, the measurements systems are either too complex or have limited sensitivity. In particular, when the goal is to apply a large number of sensors in networks, it is highly desirable to have devices that are simple, have low cost and energy consumption, yet sensitive and selective to monitor analytes even in traces. Herein, we propose a new type of resistive sensor device based on a composite of single-wall carbon nanotubes and an ion-in-conjugation polymer, poly(1,5-diaminonaphthalene-squaraine), capable of detecting H2S and NH3 in air even at room temperature with a theoretical concentration limit of ∼1 ppb and ∼7 ppb, respectively. Density functional theory calculations revealed that H atoms of the analytes and O atoms of the polymer chain interact and form hydrogen bonds, and the electron withdrawal from the gas molecules by the polymer chain results in the change of its electrical conductivity. To demonstrate the feasibility of the new nanocomposites in sensing, we show the devices for monitoring food safety with good sensor stability of operation for at least 3 months of period of time.

Composites of ion-in-conjugation polysquaraine and SWCNTs for the detection of H2S and NH3at ppb concentrations.

Several different methods are established for the analysis of gases, including optical spectroscopy, photoacoustic spectroscopy as well as colorimetric and resistive sensing, the measurements systems are either too complex or have limited sensitivity. In particular, when the goal is to apply a large number of sensors in networks, it is highly desirable to have devices that are simple, have low cost and energy consumption, yet sensitive and selective to monitor analytes even in traces. Herein, we propose a new type of resistive sensor device based on a composite of single-wall carbon nanotubes and an ion-in-conjugation polymer, poly(1,5-diaminonaphthalene-squaraine), capable of detecting H2S and NH3in air even at room temperature with a theoretical concentration limit of ~1 ppb and ~7 ppb, respectively. Density functional theory calculations revealed that H atoms of the analytes and O atoms of the polymer chain interact and form hydrogen bonds, and the electron withdrawal from the gas molecules by the polymer chain results in the change of its electrical conductivity. To demonstrate the feasibility of the new nanocomposites in sensing, we show the devices for monitoring food safety with good sensor stability of operation for at least 3 months of period of time.

Flexible planar supercapacitors by straightforward filtration and laser processing steps.

There is ever increasing demand for flexible energy storage devices due to the development of wearable electronics and other small electronic devices. The electrode flexibility is best provided by a special set of nanomaterials, but the required methodology typically consists of multiple steps and are designed just for the specific materials. Here, a facile and scalable method of making flexible and mechanically robust planar supercapacitors with interdigital electrode structure made of commercial carbon nanomaterials and silver nanowires is presented. The capacitor structure is achieved with vacuum filtration through a micropatterned contact mask and finished with simple laser processing steps. A maximum specific capacitance of 4 F cm-3 was measured with cyclic voltammetry at scan rate of 5 mV s-1. The reliability and charge transfer properties of devices were further investigated with galvanostatic charge-discharge measurements and electrochemical impedance spectroscopy, respectively. Furthermore, mechanical bending tests confirmed the devices have excellent mechanical integrity, and the deformations have no adverse effects on the electrochemical charge-discharge behavior and stability.

Ultra-low permittivity porous silica-cellulose nanocomposite substrates for 6G telecommunication.

The continuously increasing demand for faster data traffic of our telecommunication devices requires new and better materials and devices that operate at higher frequencies than today. In this work, a porous composite of silica nanoshells and cellulose nanofibers is demonstrated as a suitable candidate of dielectric substrates to be used in future 6G frequency bands. The hollow nanospheres of amorphous SiO2 with outstanding electromagnetic properties were obtained by a template-assisted Stöber process, in which a thin shell of silica is grown on polystyrene nanospheres first, and then the polymer core is burned off in a subsequent step. To be able to produce substrates with sufficient mechanical integrity, the nanoshells of SiO2 were reinforced with cellulose nanofibers resulting in a porous composite of very low mass density (0.19 ± 0.02 g cm-3), which is easy to press and mold to form films or slabs. The low relative dielectric permittivity (ε r = 1.19 ± 0.01 at 300 GHz and ε r = 1.17 ± 0.01 at 2.0 THz) and corresponding loss tangent (tan δ= 0.011 ± 0.001 at 300 GHz and tan δ = 0.011 ± 0.001 at 2.0 THz) of the composite films are exploited in substrates for radio frequency filter structures designed for 300 GHz operation.

Grid-type transparent conductive thin films of carbon nanotubes as capacitive touch sensors.

Transparent conductive films are used in a wide variety of devices. While solar cell top electrodes as well as tablet and mobile phone screens require high optical transparency and low sheet resistance (>80% and <10 Ω/□) to maximize power efficiency; other, less demanding applications, such as those in capacitive touch panels and antistatic coatings, in which only small currents are involved, can be managed with coatings of moderate conductivity. In this paper, we show that area-selective argon plasma treated polyethylene terephthalate surfaces are suitable for localized deposition of carbon nanotubes from their aqueous dispersions by a simple dip coating and subsequent drying processes. The as-deposited carbon nanotubes form entangled networks in microscopic patterns over the plasma-treated surface areas with sheet resistance of <1 kΩ/□ and optical transparency of ~75%. Based on this process, we demonstrate grid-type transparent conductive thin films of carbon nanotubes as capacitive touch sensors. Since each process step is robust, easy to up and downscale, and may be implemented even in roll-to-roll and sheet-to-sheet fabrication, the demonstrated technology is promising to produce grid-type structures even at an industrial scale in the future.

Stretchable Sensors with Tunability and Single Stimuli-Responsiveness through Resistivity Switching Under Compressive Stress.

The fascinating human somatosensory system with its complex structure is composed of numerous sensory receptors possessing distinct responsiveness to stimuli. It is a continuous source of inspiration for tactile sensors that mimic its functions. However, to achieve single stimulus-responsiveness with mechanical decoupling is particularly challenging in the light of structural design and has not been fully addressed to date. Here we propose a novel structural design inspired by combining the characteristics of electronic skin (e-skin) and electronic textile (e-textile) into a hybrid interface to achieve a stretchable single stimuli-responsive tactile sensor. The stencil printable biocarbon composite/silver-plated nylon hybrid interface possesses an extraordinary resistance switching (ΔR/R0 up to ∼104) under compressive stress which is controllable by the composite film-thickness. It achieves a very high normal pressure sensitivity (up to 60.8 kPa-1) in a wide dynamic range (up to ∼50 kPa) in the piezoresistive operation mode and can effectively decouple stresses induced by stretching or bending. In addition, the device is capable of high accuracy strain sensing in its capacitive operation mode through dimensional change dominant response. Because of these intriguing features, it has potential for the next-generation Internet of Things devices and user-interactive systems capable of providing visual feedback and more advanced robotics or even prosthetics.

Lightweight Hierarchical Carbon Nanocomposites with Highly Efficient and Tunable Electromagnetic Interference Shielding Properties.

High-performance electromagnetic interference shielding is becoming vital for the next generation of telecommunication and sensor devices among which portable and wearable applications require highly flexible and lightweight materials having efficient absorption-dominant shielding. Herein, we report on lightweight carbon foam-carbon nanotube/carbon nanofiber nanocomposites that are synthesized in a two-step robust process including a simple carbonization of open-pore structure melamine foams and subsequent growth of carbon nanotubes/nanofibers by chemical vapor deposition. The microstructure of the nanocomposites resembles a 3-dimensional hierarchical network of carbonaceous skeleton surrounded with a tangled web of bamboo-shaped carbon nanotubes and layered graphitic carbon nanofibers. The microstructure of the porous composite enables absorption-dominant (absorbance ∼0.9) electromagnetic interference shielding with an effectiveness of ∼20-30 dB and with an equivalent mass density normalized shielding effectiveness of ∼800-1700 dB cm3 g-1 at the K-band frequency (18-26.5 GHz). Moreover, the hydrophobic nature of the materials grants water-repellency and stability in humid conditions important for reliable operation in outdoor use, whereas the mechanical flexibility and durability with excellent piezoresistive behavior enable strain-responsive tuning of electrical conductivity and electromagnetic interference shielding, adding on further functionalities. The demonstrated nanocomposites are versatile and will contribute to the development of reliable devices not only in telecommunication but also in wearable electronics, aerospace engineering, and robotics among others.

Transient Tachypnea of the Newborn Is Associated With an Increased Risk of Hospitalization Due to Respiratory Syncytial Virus Bronchiolitis.

BACKGROUND: Transient tachypnea of the newborn (TTN) is a self-limiting respiratory disorder, resulting from a failure to clear the lungs of perinatal fluid. As similar pathophysiologic features are present in children with respiratory syncytial virus (RSV) bronchiolitis, we hypothesized that these two conditions may be connected. METHODS: This was a population-based cohort study that included all children born in term (≥37 weeks of gestation) without congenital malformations in Finland between 1996 and 2015. Children diagnosed with TTN (International Statistical Classification of Diseases and Related Health Problems, 10th Revision [ICD-10] code P22.1) after birth and children hospitalized because of RSV bronchiolitis (ICD-10 code J21.0) during first year of life were identified from the Medical Birth Register and National Hospital Discharge Register, respectively, and the data were linked. Logistic regression was used to analyze the association between these two conditions. RESULTS: Of the 1,042,045 children included in the study cohort, 16,327 (1.57%) were diagnosed with TTN at birth and 12,345 (1.18%) were hospitalized because of RSV bronchiolitis during the first year of life. The rate of RSV hospitalization was higher in children with a history of TTN compared with children without TTN diagnosis [260/16,327 (1.59%) vs. 12,085/1,025,718 (1.18%), respectively; P value <0.0001]. After adjusting for gestational age at birth, mode of delivery, gender, birth weight, multiple births, older siblings and maternal smoking, TTN was associated with increased risk for RSV hospitalization (odds ratio: 1.31, 95% confidence interval: 1.16-1.48). CONCLUSIONS: TTN diagnosis after birth was associated with increased risk for RSV hospitalization during the first year of life.

Size-Dependent H2 Sensing Over Supported Pt Nanoparticles.

Catalyst size affects the overall kinetics and mechanism of almost all heterogeneous chemical reactions. Since the functional sensing materials in resistive chemical sensors are practically the very same nanomaterials as the catalysts in heterogeneous chemistry, a plausible question arises: Is there any effect of the catalyst size on the sensor properties? Our study attempts to give an insight into the problem by analyzing the response and sensitivity of resistive H2 sensors based on WO3 nanowire supported Pt nanoparticles having size of 1.5±0.4 nm, 6.2±0.8 nm, 3.7±0.5 nm and 8.3±1.3 nm. The results show that Pt nanoparticles of larger size are more active in H2 sensing than their smaller counterparts and indicate that the detection mechanism is more complex than just considering the number of surface atoms of the catalyst.

Heterozygous junctophilin-2 (JPH2) p.(Thr161Lys) is a monogenic cause for HCM with heart failure.

During the last two decades, mutations in sarcomere genes have found to comprise the most common cause for hypertrophic cardiomyopathy (HCM), but still significant number of patients with dominant HCM in the family are left without molecular genetic diagnosis. Next generation sequencing (NGS) does not only enable evaluation of established HCM genes but also candidate genes for cardiomyopathy are frequently tested which may lead to a situation where conclusive interpretation of the variant requires extensive family studies. We aimed to characterize the phenotype related to a variant in the junctophilin-2 (JPH2) gene, which is less known non-sarcomeric candidate gene. In addition, we did extensive review of the literature and databases about JPH2 variation in association with cardiac disease. We characterize nine Finnish index patients with HCM and heterozygous for JPH2 c.482C>A, p.(Thr161Lys) variant were included and segregation studies were performed. We identified 20 individuals affected with HCM with or without systolic heart failure and conduction abnormalities in the nine Finnish families with JPH2 p.(Thr161Lys) variant. We found 26 heterozygotes with the variant and penetrance was 71% by age 60 and 100% by age 80. Co-segregation of the variant with HCM phenotype was observed in six families. Main clinical features were left ventricular hypertrophy, arrhythmia vulnerability and conduction abnormalities including third degree AV-block. In some patients end-stage severe left ventricular heart failure with normal or mildly enlarged diastolic dimensions was detected. In conclusion, we propose that the heterozygous JPH2 p.(Thr161Lys) variant is a new Finnish mutation causing atypical HCM.

Unmodified and multi-walled carbon nanotube modified tetrahedral amorphous carbon (ta-C) films as in vivo sensor materials for sensitive and selective detection of dopamine.

Unmodified and multi-walled carbon nanotube (MWCNT) modified tetrahedral amorphous carbon (ta-C) films of 15 and 50 nm were investigated as potential in vivo sensor materials for the detection of dopamine (DA) in the presence of the main interferents, ascorbic acid (AA) and uric acid (UA). The MWCNTs were grown directly on ta-C by chemical vapor deposition (designated as ta-C+CNT) and were characterized with X-ray photoelectron spectroscopy, Raman spectroscopy, scanning and transmission electron microscopy. Electroanalytical sensitivity and selectivity were determined with cyclic voltammetry. Biocompatibility of the materials was assessed with cell cultures of mouse neural stem cells (mNSCs). The detection limits of DA for both ta-C and ta-C+CNT electrodes ranged from 40 to 85 nM, which are well within the required range for in vivo detection. The detection limits were lower for both ta-C and ta-C+CNT electrodes with 50 nm of ta-C compared to 15 nm. The ta-C electrodes showed a large dynamic linear range of 0.01-100 µM but could not resolve between the oxidation peaks of DA, AA and UA. Modification with MWCNTs, however, resulted in excellent selectivity and all three analytes could be detected simultaneously at physiologically relevant concentrations using cyclic voltammetry. Based on cell culture of mNSCs, both ta-C and ta-C+CNT exhibited good biocompatibility, demonstrating their potential as in vivo sensor materials for the detection of DA.