Wearable and flexible electronics for continuous molecular monitoring

A Wearable Paper-Based Sweat Sensor for Human Perspiration Monitoring

The fabrication and performance of a wearable paper-based chemiresistor for monitoring perspiration dynamics (sweat rate and sweat loss) are detailed. A novel approach is introduced to measure the amount of aqueous solution in the order of microliters delivered to the sensor by monitoring a linear change in resistance along a conducting paper. The wearable sensor is based on a single-walled carbon nanotubes and surfactant (sodium dodecylbenzenesulfonate) nanocomposite integrated within cellulose fibers of a conventional filter paper. The analytical performance and the sensing mechanism are presented. Monitoring sweat loss in the human body while exercising is demonstrated using the integration of a wireless reader and a user-friendly interface. By addressing the barriers of cost, simplicity, and the truly in situ demanding measurements, this unique wearable sensor is expected to serve in the future in many different applications involving the on-body detection of biofluids, such as a monitoring tool of dehydration levels for athletes as well as a tool for enhancing the sport performance by providing an accurate recovery of the hydration status in daily exercises.

Nanowire Electronics: From Nanoscale to Macroscale

Semiconductor nanowires have attracted extensive interest as one of the best-defined classes of nanoscale building blocks for the bottom-up assembly of functional electronic and optoelectronic devices over the past two decades. The article provides a comprehensive review of the continuing efforts in exploring semiconductor nanowires for the assembly of functional nanoscale electronics and macroelectronics. Specifically, we start with a brief overview of the synthetic control of various semiconductor nanowires and nanowire heterostructures with precisely controlled physical dimension, chemical composition, heterostructure interface, and electronic properties to define the material foundation for nanowire electronics. We then summarize a series of assembly strategies developed for creating well-ordered nanowire arrays with controlled spatial position, orientation, and density, which are essential for constructing increasingly complex electronic devices and circuits from synthetic semiconductor nanowires. Next, we review the fundamental electronic properties and various single nanowire transistor concepts. Combining the designable electronic properties and controllable assembly approaches, we then discuss a series of nanoscale devices and integrated circuits assembled from nanowire building blocks, as well as a unique design of solution-processable nanowire thin-film transistors for high-performance large-area flexible electronics. Last, we conclude with a brief perspective on the standing challenges and future opportunities.

Direct in situ labeling of target drugs with a fluorophore probe to improve MALDI-MS detection sensitivity in micro-liter plasma

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for symptomatic relief from fever, inflammation, and chronic pain associated with a variety of human disorders. Long-term usage of these drugs can result in severe syndromes; hence, their dose should be controlled carefully and their side effects such as Stevens–Johnson syndrome, toxic epidermal necrolysis, phototoxicity, acute interstitial nephritis, gastrointestinal bleeding, cardiovascular diseases, and liver injury should be considered. Furthermore, the widely used combination of NSAIDs as over-the-counter (OTC) drugs with other drugs leads to adverse drug–drug interactions. Therefore, development of a throughput method to rapidly screen 20 NSAIDs in biological samples is necessary to safeguard human health. In this work, we selected a suitable fluorophore probe coupled with in situ micro-labeling (<2 min) on stainless plate for the fast detection of NSAIDs in plasma samples at the micro-liter level (5 μL) without complicated sample preparation and separation. Every step undertaken in the protocol was also at the micro-liter level; thus, a small amount of blood collected from the human finger will suffice to determine the drug concentration in blood using the proposed method. Furthermore, the proposed method we developed was also matched the modern trends of green analytical chemistry towards miniaturization of analytical methodologies.

Sensor-Instrumented Scaffold Integrated with Microporous Spongelike Ultrabuoy for Long-Term 3D Mapping of Cellular Behaviors and Functions

Real-time monitoring of cellular behaviors and functions with sensor-instrumented scaffolds can provide a profound impact on fundamental studies of the underlying biophysics and disease modeling. Although quantitative measurement of predictive data for in vivo tests and physiologically relevant information in these contexts is important, the long-term reliable monitoring of cellular functions in three-dimensional (3D) environments is limited by the required set under wet cell culture conditions that are unfavorable to electronic instrument settings. Here, we introduce an ultrabuoyant 3D instrumented scaffold that can remain afloat on the surface of culture medium and thereby provides favorable environments for the entire electronic components in the air while the cells reside and grow underneath. This setting enables high-fidelity recording of electrical cell-substrate impedance and electrophysiological signals for a long period of time (weeks). Comprehensive in vitro studies reveal the utility of this platform as an effective tool for drug screening and tissue development.

A Universal Strategy for Stretchable Polymer Nonvolatile Memory via Tailoring Nanostructured Surfaces

Building stretchable memory is an effective strategy for developing next-generation memory technologies toward stretchable and wearable electronics. Here we demonstrate a universal strategy for the fabrication of high performance stretchable polymer memory via tailoring surface morphology, in which common conjugated polymers and sharp reduced graphene oxide (r-rGO) films are used as active memristive layers and conductive electrodes, respectively. The fabricated devices feature write-once-read-many-times (WORM) memory, with a low switching voltage of 1.1 V, high ON/OFF current ratio of 10⁴, and an ideal long retention time over 12000 s. Sharp surface-induced resistive switching behavior has been proposed to explore the electrical transition. Moreover, the polymer memory show reliable electrical bistable properties with a stretchability up to 30%, demonstrating their great potential candidates as high performance stretchable memory in soft electronics.

Integrating Artificial and Human Intelligence: A Partnership for Responsible Innovation in Biomedical Engineering and Medicine

Historically, the term "artificial intelligence" dates to 1956 when it was first used in a conference at Dartmouth College in the US. Since then, the development of artificial intelligence has in part been shaped by the field of neuroscience. By understanding the human brain, scientists have attempted to build new intelligent machines capable of performing complex tasks akin to humans. Indeed, future research into artificial intelligence will continue to benefit from the study of the human brain. While the development of artificial intelligence algorithms has been fast paced, the actual use of most artificial intelligence (AI) algorithms in biomedical engineering and clinical practice is still markedly below its conceivably broader potentials. This is partly because for any algorithm to be incorporated into existing workflows it has to stand the test of scientific validation, clinical and personal utility, application context, and is equitable as well. In this context, there is much to be gained by combining AI and human intelligence (HI). Harnessing Big Data, computing power and storage capacities, and addressing societal issues emergent from algorithm applications, demand deploying HI in tandem with AI. Very few countries, even economically developed states, lack adequate and critical governance frames to best understand and steer the AI innovation trajectories in health care. Drug discovery and translational pharmaceutical research stand to gain from AI technology provided they are also informed by HI. In this expert review, we analyze the ways in which AI applications are likely to traverse the continuum of life from birth to death, and encompassing not only humans but also all animal, plant, and other living organisms that are increasingly touched by AI. Examples of AI applications include digital health, diagnosis of diseases in newborns, remote monitoring of health by smart devices, real-time Big Data analytics for prompt diagnosis of heart attacks, and facial analysis software with consequences on civil liberties. While we underscore the need for integration of AI and HI, we note that AI technology does not have to replace medical specialists or scientists and rather, is in need of such expert HI. Altogether, AI and HI offer synergy for responsible innovation and veritable prospects for improving health care from prevention to diagnosis to therapeutics while unintended consequences of automation emergent from AI and algorithms should be borne in mind on scientific cultures, work force, and society at large.

Eyeglasses-based tear biosensing system: Non-invasive detection of alcohol, vitamins and glucose

We report on a wearable tear bioelectronic platform, integrating a microfluidic electrochemical detector into an eyeglasses nose-bridge pad, for non-invasive monitoring of key tear biomarkers. The alcohol-oxidase (AOx) biosensing fluidic system allowed real-time tear collection and direct alcohol measurements in stimulated tears, leading to the first wearable platform for tear alcohol monitoring. Placed outside the eye region this fully wearable tear-sensing platform addresses drawbacks of sensor systems involving direct contact with the eye as the contact lenses platform. Integrating the wireless electronic circuitry into the eyeglasses frame thus yielded a fully portable, convenient-to-use fashionable sensing device. The tear alcohol sensing concept was demonstrated for monitoring of alcohol intake in human subjects over multiple drinking courses, displaying good correlation to parallel BAC measurements. We also demonstrate for the first time the ability to monitor tear glucose outside the eye and the utility of wearable devices for monitoring vitamin nutrients in connection to enzymatic flow detector and rapid voltammetric scanning, respectively. These developments pave the way to build an effective eyeglasses system capable of chemical tear analysis.

Doping engineering of conductive polymer hydrogels and their application in advanced sensor technologies

Conductive polymer hydrogels are emerging as an advanced electronic platform for sensors by synergizing the advantageous features of soft materials and organic conductors. Doping provides a simple yet effective methodology for the synthesis and modulation of conductive polymer hydrogels. By utilizing different dopants and levels of doping, conductive polymer hydrogels show a highly flexible tunability for controllable electronic properties, microstructures, and structure-derived mechanical properties. By rationally tailoring these properties, conductive polymer hydrogels are engineered to allow sensitive responses to external stimuli and exhibit the potential for application in various sensor technologies. The doping methods for the controllable structures and tunable properties of conductive polymer hydrogels are beneficial to improving a variety of sensing performances including sensitivity, stability, selectivity, and new functions. With this perspective, we review recent progress in the synthesis and performance of conductive polymer hydrogels with an emphasis on the utilization of doping principles. Several prototype sensor designs based on conductive polymer hydrogels are presented. Furthermore, the main challenges and future research are also discussed.

Recent Advances on Electrochemical Biosensing Strategies toward Universal Point-of-Care Systems

A number of very recently developed electrochemical biosensing strategies are promoting electrochemical biosensing systems into practical point-of-care applications. The focus of research endeavors has transferred from detection of a specific analyte to the development of general biosensing strategies that can be applied for a single category of analytes, such as nucleic acids, proteins, and cells. In this Minireview, recent cutting-edge research on electrochemical biosensing strategies are described. These developments resolved critical challenges regarding the application of electrochemical biosensors to practical point-of-care systems, such as rapid readout, simple biosensor fabrication method, ultra-high detection sensitivity, direct analysis in a complex biological matrix, and multiplexed target analysis. This Minireview provides general guidelines both for scientists in the biosensing research community and for the biosensor industry on development of point-of-care system, benefiting global healthcare.

Superhydrophobic Electrically Conductive Paper for Ultrasensitive Strain Sensor with Excellent Anticorrosion and Self-Cleaning Property

Recently, a paper-based (PB) strain sensor has turned out to be an ideal substitute for the polymer-based one because of the merits of renewability, biodegradability, and low cost. However, the hygroexpansion and degradation of the paper after absorbing water are the great challenges for the practical applications of the PB strain sensor. Herein, the superhydrophobic electrically conductive paper was fabricated by simply dip-coating the printing paper into the carbon black (CB)/carbon nanotube (CNT)/methyl cellulose suspension and hydrophobic fumed silica (Hf-SiO₂) suspension successively to settle the problem. Because of the existence of ultrasensitive microcrack structures in the electrically conductive CB/CNT layer, the sensor was capable of detecting an ultralow strain as low as 0.1%. During the tension strain range of 0-0.7%, the sensor exhibited a gauge factor of 7.5, almost 3 times higher than that of the conventional metallic-based sensors. In addition, the sensor displayed frequency-independent and excellent durability and reproductivity over 1000 tension cycles. Meanwhile, the superhydrophobic Hf-SiO₂ layer with a micro-nano structure and low surface energy endowed the sensor with outstanding waterproof and self-cleaning properties, as well as great sustainability toward cyclic strain and harsh corrosive environment. Finally, the PB strain sensor could effectively monitor human bodily motions such as finger/elbow joint/throat movement and pulse in real time, especially for the wet or rainy conditions. All these pave way for the fabrication of a high-performance PB strain sensor.

Quality Mapping of Offset Lithographic Printed Antenna Substrates and Electrodes by Millimeter-Wave Imaging

Offset lithographic printed flexible antenna substrate boards and electrodes have attracted much attention recently due to the boost of flexible electronics. Unmanned quality inspection of these printed substrate boards and electrodes demands high-speed, large-scale and nondestructive methods, which is highly desired for manufacturing industries. The work here demonstrates two kinds of millimeter (mm)-wave imaging technologies for the quality (surface uniformity and functionality parameters) inspection of printed silver substrates and electrodes on paper and thin polyethylene film, respectively. One technology is a mm-wave line scanner system and the other is a terahertz-time domain spectroscopy-based charge-coupled device (CCD) imaging system. The former shows the ability of detecting transmitted mm-wave amplitude signals only; its detection is fast in a second time scale and the system shows great potential for the inspection of large-area printed surface uniformity. The latter technology achieves high spatial resolution images of up to hundreds of micrometers at the cost of increased inspection time, in a time scale of tens of seconds. With the exception of absorption rate information, the latter technology offers additional phase information, which can be used to work out 2D permittivity distribution. Moreover, its uniformity is vital for the antenna performance. Additionally, the results demonstrate that compression rolling treatment significantly improves the uniformity of printed silver surfaces and enhances the substrate’s permittivity values.

Graphene-based fully integrated portable nanosensing system for on-line detection of cytokine biomarkers in saliva

Saliva has been reported to contain various cytokine biomarkers which are associated with some severe diseases such as cancers. Non-invasive saliva diagnosis using wearable or portable devices may pave a new avenue for monitoring conditions of the high risk population. Here, a graphene-based fully integrated portable nanosensing system, the entire size of which is smaller than a smart-phone and can be handheld, is presented for on-line detection of cytokine biomarkers in saliva. This miniaturized system employs an aptameric graphene-based field effect transistor (GFET) using a buried-gate geometry with HfO₂ as the dielectric layer and on-line signal processing circuits to realize the transduction and processing of signals which reflect cytokine concentrations. The signal can be wirelessly transmitted to a smart-phone or cloud sever through the Wi-Fi connection for visualizing the trend of the cytokine concentration change. Interleukin-6 (IL-6) is used as a representative to examine the sensing capability of the system. Experimental results demonstrate that the nanosensing system responds to the change of IL-6 concentration within 400s in saliva with a detection limit down to 12 pM. Therefore, this portable system offers the practicality to be potentially used for non-invasive saliva diagnosis of diseases at early stage.

Ultrasensitive and Highly Compressible Piezoresistive Sensor Based on Polyurethane Sponge Coated with a Cracked Cellulose Nanofibril/Silver Nanowire Layer

With the rapid development of flexible wearable electronics, a piezoresistive sensor with low detection limit and wide strain sensing range turns out to be a great challenge for its application in this field. Here, a cracked cellulose nanofibril/silver nanowire (CA) layer-coated polyurethane (PU) sponge was acquired through a simple dip-coating process followed by precompression treatment. The electrical conductivity and mechanical property of the conductive CA@PU sponge could be effectively tuned through changing the dip-coating number. As a piezoresistive sensor, the sponge exhibited the capability of detecting both small and large motions over a wide compression strain range of 0-80%. Based on the "crack effect", the sensor possessed a detection limit as low as 0.2% and the gauge factor [GF, GF = (Δ R/ R₀)/ε, where Δ R, R₀, and ε represent the instantaneous resistance change, original resistance, and strain applied, respectively] was as high as 26.07 in the strain range of 0-0.6%. Moreover, the "contact effect" enabled the sensor to be applicable for larger strain, and the GF decreased first and then became stable with increasing compression strain. In addition, frequency- and strain-dependent sensing performances were observed, demonstrating that the sensor can respond reliably to different applied frequencies and strains. Furthermore, the sensor displayed exceptional stability, repeatability, and durability over 500 cycles. Finally, the sensor could be applicable for the detection of various human bodily motions, such as phonation, stamping, knee bending, and wrist bending. Most importantly, the sponge also exhibited great potential for the fabrication of artificial electronic skin. Herein, the conductive CA@PU sponge will undoubtedly promote the development of high-performance flexible wearable electronics.

Flexible Electronics toward Wearable Sensing

Wearable sensors play a crucial role in realizing personalized medicine, as they can continuously collect data from the human body to capture meaningful health status changes in time for preventive intervention. However, motion artifacts and mechanical mismatches between conventional rigid electronic materials and soft skin often lead to substantial sensor errors during epidermal measurement. Because of its unique properties such as high flexibility and conformability, flexible electronics enables a natural interaction between electronics and the human body. In this Account, we summarize our recent studies on the design of flexible electronic devices and systems for physical and chemical monitoring. Material innovation, sensor design, device fabrication, system integration, and human studies employed toward continuous and noninvasive wearable sensing are discussed. A flexible electronic device typically contains several key components, including the substrate, the active layer, and the interface layer. The inorganic-nanomaterials-based active layer (prepared by a physical transfer or solution process) is shown to have good physicochemical properties, electron/hole mobility, and mechanical strength. Flexible electronics based on the printed and transferred active materials has shown great promise for physical sensing. For example, integrating a nanowire transistor array for the active matrix and a conductive pressure-sensitive rubber enables tactile pressure mapping; tactile-pressure-sensitive e-skin and organic light-emitting diodes can be integrated for instantaneous pressure visualization. Such printed sensors have been applied as wearable patches to monitor skin temperature, electrocardiograms, and human activities. In addition, liquid metals could serve as an attractive candidate for flexible electronics because of their excellent conductivity, flexibility, and stretchability. Liquid-metal-enabled electronics (based on liquid-liquid heterojunctions and embedded microchannels) have been utilized to monitor a wide range of physiological parameters (e.g., pulse and temperature). Despite the rapid growth in wearable sensing technologies, there is an urgent need for the development of flexible devices that can capture molecular data from the human body to retrieve more insightful health information. We have developed a wearable and flexible sweat-sensing platform toward real-time multiplexed perspiration analysis. An integrated iontophoresis module on a wearable sweat sensor could enable autonomous and programmed sweat extraction. A microfluidics-based sensing system was demonstrated for sweat sampling, sensing, and sweat rate analysis. Roll-to-roll gravure printing allows for mass production of high-performance flexible chemical sensors at low cost. These wearable and flexible sweat sensors have shown great promise in dehydration monitoring, cystic fibrosis diagnosis, drug monitoring, and noninvasive glucose monitoring. Future work in this field should focus on designing robust wearable sensing systems to accurately collect data from the human body and on large-scale human studies to determine how the measured physical and chemical information relates to the individual's specific health conditions. Further research in these directions, along with the large sets of data collected via these wearable and flexible sensing technologies, will have a significant impact on future personalized healthcare.

Enokitake Mushroom-like Standing Gold Nanowires toward Wearable Noninvasive Bimodal Glucose and Strain Sensing

We have recently demonstrated that Enokitake mushroom-like gold with nanoparticles as the "head" and nanowires as the "tail" could grow directly on elastomeric substrates, which are extremely stretchable electrodes that can be used as wearable sensors for detecting strain and pressure. In this work, we show that such electrodes can also be used as intrinsically stretchable glucose biosensors. By modifying the vertical gold nanowire electrodes with glucose oxidase and Prussian blue nanoparticles, a limit of detection of 10 μM, sensitivity of 23.72 μA·mM^-1·cm^-2, and high selectivity can be achieved. The as-obtained glucose biosensors were able to maintain a high sensing performance under various mechanical deformations. Even for 30% strain, a sensitivity of 4.55 μA·mM^-1·cm^-2 toward glucose detection in the artificial sweat was possible. Furthermore, it was found that strains could be simultaneously detected with a gauge factor of 2.30 (strain 0-10%) and 22.64 (strain 10-20%), demonstrating the potential of such bimodal sensors to allow simultaneous monitoring of physical and biological signals.

In Vivo Sampling: A Promising Technique for Detecting and Profiling Endogenous Substances in Living Systems

Endogenous substances, naturally occurring in living organisms, are critical components with physiological and biological functions. Discovery and quantitative measurement of endogenous substances in living biotas are important for food analysis, crop cultivation, and quality assessment. Low or non-invasive in vivo sampling techniques offer the advantages of minimal perturbation to the investigated system and potentially obtain more accurate feedback compared to in vitro sampling. In this perspective, we summarize the up-to-date progress in the development of microdialysis and solid-phase microextraction as valuable tools for in vivo sampling of endogenous substances in food and agriculture chemistry. We discuss their feasibility for on-site and real-time in vivo monitoring and highlight the prospects in searching for highly specific coatings, miniaturized sampling devices, and instruments that well meet the trend for high-efficient and high-throughput analyses.

Wearable biosensors for healthcare monitoring

Wearable biosensors are garnering substantial interest due to their potential to provide continuous, real-time physiological information via dynamic, noninvasive measurements of biochemical markers in biofluids, such as sweat, tears, saliva and interstitial fluid. Recent developments have focused on electrochemical and optical biosensors, together with advances in the noninvasive monitoring of biomarkers including metabolites, bacteria and hormones. A combination of multiplexed biosensing, microfluidic sampling and transport systems have been integrated, miniaturized and combined with flexible materials for improved wearability and ease of operation. Although wearable biosensors hold promise, a better understanding of the correlations between analyte concentrations in the blood and noninvasive biofluids is needed to improve reliability. An expanded set of on-body bioaffinity assays and more sensing strategies are needed to make more biomarkers accessible to monitoring. Large-cohort validation studies of wearable biosensor performance will be needed to underpin clinical acceptance. Accurate and reliable real-time sensing of physiological information using wearable biosensor technologies would have a broad impact on our daily lives.

Achievements and Challenges for Real-Time Sensing of Analytes in Sweat within Wearable Platforms

Physiological sensors in a wearable form have rapidly emerged on the market due to technological breakthroughs and have become nearly ubiquitous with the Apple Watch, FitBit, and other wearable devices. While these wearables mostly monitor simple biometric signatures, new devices that can report on the human readiness level through sensing molecular biomarkers are critical to optimizing the human factor in both commercial sectors and the Department of Defense. The military is particularly interested in real-time, wearable, minimally invasive monitoring of fatigue and human performance to improve the readiness and performance of the war fighter. However, very few devices have ventured into the realm of reporting directly on biomarkers of interest. Primarily this is because of the difficulties of sampling biological fluids in real-time and providing accurate readouts using highly selective and sensitive sensors. When additional restrictions to only use sweat, an excretory fluid, are enforced to minimize invasiveness, the demands on sensors becomes even greater due to the dilution of the biomarkers of interest, as well as variability in salinity, pH, and other physicochemical variables which directly impact the read-out of real-time biosensors. This Account will provide a synopsis not only on exemplary demonstrations and technological achievements toward implementation of real-time, wearable sweat sensors but also on defining problems that still remain toward implementation in wearable devices that can detect molecular biomarkers for real world applications. First, the authors describe the composition of minimally invasive biofluids and then identify what biomarkers are of interest as biophysical indicators. This Account then reviews demonstrated techniques for extracting biofluids from the site of generation and transport to the sensor developed by the authors. Included in this discussion is a detailed description on biosensing recognition elements and transducers developed by the authors to enable generation of selective electrochemical sensing platforms. The authors also discuss ongoing efforts to identify biorecognition elements and the chemistries necessary to enable high affinity, selective biorecognition elements. Finally, this Account presents the requirements for wearable, real-time sensors to be (1) highly stable, (2) portable, (3) reagentless, (4) continuous, and (5) responsive in real-time, before delving into specific methodologies to sense classes of biomarkers that have been explored by academia, government laboratories, and industry. Each platform has its areas of greatest utility, but also come with corresponding weaknesses: (1) ion selective electrodes are robust and have been demonstrated in wearables but are limited to detection of ions, (2) enzymatic sensors enable indirect detection of metabolites and have been demonstrated in wearables, but the compounds that can be detected are limited to a subset of small molecules and the sensors are sensitive to flow, (3) impedance-based sensors can detect a wide range of compounds but require further research and development for deployment in wearables. In conclusion, while substantial progress has been made toward wearable molecular biosensors, substantial barriers remain and need to be solved to enable deployment of minimally invasive, wearable biomarker monitoring devices that can accurately report on psychophysiological status.

Bio-Integrated Wearable Systems: A Comprehensive Review

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

Design and Fabrication of Heterogeneous, Deformable Substrates for the Mechanically Guided 3D Assembly

Development of schemes to form complex three-dimensional (3D) mesostructures in functional materials is a topic of broad interest, thanks to the ubiquitous applications across a diversity of technologies. Recently established schemes in the mechanically guided 3D assembly allow deterministic transformation of two-dimensional structures into sophisticated 3D architectures by controlled compressive buckling resulted from strain release of prestretched elastomer substrates. Existing studies mostly exploited supporting substrates made of homogeneous elastomeric material with uniform thickness, which produces relatively uniform strain field to drive the 3D assembly, thus posing limitations to the geometric diversity of resultant 3D mesostructures. To offer nonuniform strains with desired spatial distributions in the 3D assembly, this paper introduces a versatile set of concepts in the design of engineered substrates with heterogeneous integration of materials of different moduli. Such heterogeneous, deformable substrates can achieve large strain gradients and efficient strain isolation/magnification, which are difficult to realize using the previously reported strategies. Theoretical and experimental studies on the underlying mechanics offer a viable route to the design of heterogeneous, deformable substrates to yield favorable strain fields. A broad collection of 3D mesostructures and associated heterogeneous substrates is fabricated and demonstrated, including examples that resemble windmills, scorpions, and manta rays and those that have application potentials in tunable inductors and vibrational microsystems.

Wearable Fluid Capture Devices for Electrochemical Sensing of Sweat

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

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

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

Advanced electronic skin devices for healthcare applications

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

Epidermis-Inspired Ultrathin 3D Cellular Sensor Array for Self-Powered Biomedical Monitoring

Sensing devices with wearability would open the door to many advanced applications including soft robotics, artificial intelligence, and healthcare monitoring. Here, inspired by the configuration of the human epidermis, we present a flexible three-dimensional (3D) cellular sensor array (CSA) via a one-step thermally induced phase separation method. The CSA was framed by the 3D cellular electret with caged piezoelectric nanoparticles, which was ultrathin (80 μm), lightweight, and highly robust. For biomedical sensing, the 3D-CSA holds a decent pressure sensitivity up to 0.19 V kPa^-1 with a response time of less than 16 ms. Owing to its rigid structural symmetry, the 3D-CSA could be identically operated from its both sides. It was demonstrated to successfully measure the human heartbeat, detect the eyeball motion for sleeping monitoring, and tactile imaging. Mimicking the functionalities of the human skin with a self-powered operation feature, the 3D-CSA was expected to represent a substantial advancement in wearable electronics for healthcare.

Measurement of cytokine biomarkers using an aptamer-based affinity graphene nanosensor on a flexible substrate toward wearable applications

We present an approach for the label-free detection of cytokine biomarkers using an aptamer-functionalized, graphene-based field effect transistor (GFET) nanosensor on a flexible, SiO2-coated substrate of the polymer polyethylene naphthalate (PEN). The nanosensor conforms to the underlying nonplanar surface and performs GFET-based rapid transduction of the aptamer-biomarker binding, thereby potentially allowing the detection of cytokine biomarkers that are sampled reliably from human bodily fluids (e.g., sweat) in wearable sensing applications. In characterizing the suitability of the nanosensor for wearable applications, we investigate the effects of substrate bending on the equilibrium dissociation constant between the aptamer and the biomarker as well as the graphene transconductance. The utility of the nanosensor is demonstrated by the detection of tumor necrosis factor-α (TNF-α), an inflammatory cytokine biomarker. Experimental results show that the flexible nanosensor can specifically respond to changes in the TNF-α concentration within 5 minutes with a limit of detection as low as 26 pM in a repeatable manner.

Wearable Bioelectronics: Enzyme-Based Body-Worn Electronic Devices

In this Account, we detail recent progress in wearable bioelectronic devices and discuss the future challenges and prospects of on-body noninvasive bioelectronic systems. Bioelectronics is a fast-growing interdisciplinary research field that involves interfacing biomaterials with electronics, covering an array of biodevices, encompassing biofuel cells, biosensors, ingestibles, and implantables. In particular, enzyme-based bioelectronics, built on diverse biocatalytic reactions, offers distinct advantages and represents a centerpiece of wearable biodevices. Such wearable bioelectronic devices predominately rely on oxidoreductase enzymes and have already demonstrated considerable promise for on-body applications ranging from highly selective noninvasive biomarker monitoring to epidermal energy harvesting. These systems can thus greatly increase the analytical capability of wearable devices from the ubiquitous monitoring of mobility and vital signs, toward the noninvasive analysis of important chemical biomarkers. Wearable enzyme electrodes offer exciting opportunities to a variety of areas, spanning from healthcare, sport, to the environment or defense. These include real-time noninvasive detection of biomarkers in biofluids (such as sweat, saliva, interstitial fluid and tears), and the monitoring of environmental pollutants and security threats in the immediate surrounding of the wearer. Furthermore, the interface of enzymes with conducting flexible electrode materials can be exploited for developing biofuel cells, which rely on the bioelectrocatalytic oxidation of biological fuels, such as lactate or glucose, for energy harvesting applications. Crucial for such successful application of enzymatic bioelectronics is deep knowledge of enzyme electron-transfer kinetics, enzyme stability, and enzyme immobilization strategies. Such understanding is critical for establishing efficient electrical contacting between the redox enzymes and the conducting electrode supports, which is of fundamental interest for the development of robust and efficient bioelectronic platforms. Furthermore, stretchable and flexible bioelectronic platforms, with mechanical properties similar to those of biological tissues, are essential for handling the rigors of on-body operation. As such, special attention must be given to changes in the behavior of enzymes due to the uncontrolled conditions of on-body operation (including diverse outdoor activities and different biofluids), for maintaining the attractive performance that these bioelectronics devices display in controlled laboratory settings. Therefore, a focus of this Account is on interfacing biocatalytic layers onto wearable electronic devices for creating efficient and stable on-body electrochemical biosensors and biofuel cells. With proper attention to key challenges and by leveraging the advantages of biocatalysis, electrochemistry, and flexible electronics, wearable bioelectronic devices could have a tremendous impact on diverse biomedical, fitness, and defense fields.

Organic Transistor-Based Chemical Sensors for Wearable Bioelectronics

Bioelectronics for healthcare that monitor the health information on users in real time have stepped into the limelight as crucial electronic devices for the future due to the increased demand for "point-of-care" testing, which is defined as medical diagnostic testing at the time and place of patient care. In contrast to traditional diagnostic testing, which is generally conducted at medical institutions with diagnostic instruments and requires a long time for specimen analysis, point-of-care testing can be accomplished personally at the bedside, and health information on users can be monitored in real time. Advances in materials science and device technology have enabled next-generation electronics, including flexible, stretchable, and biocompatible electronic devices, bringing the commercialization of personalized healthcare devices increasingly within reach, e.g., wearable bioelectronics attached to the body that monitor the health information on users in real time. Additionally, the monitoring of harmful factors in the environment surrounding the user, such as air pollutants, chemicals, and ultraviolet light, is also important for health maintenance because such factors can have short- and long-term detrimental effects on the human body. The precise detection of chemical species from both the human body and the surrounding environment is crucial for personal health care because of the abundant information that such factors can provide when determining a person's health condition. In this respect, sensor applications based on an organic-transistor platform have various advantages, including signal amplification, molecular design capability, low cost, and mechanical robustness (e.g., flexibility and stretchability). This Account covers recent progress in organic transistor-based chemical sensors that detect various chemical species in the human body or the surrounding environment, which will be the core elements of wearable electronic devices. There has been considerable effort to develop high-performance chemical sensors based on organic-transistor platforms through material design and device engineering. Various experimental approaches have been adopted to develop chemical sensors with high sensitivity, selectivity, and stability, including the synthesis of new materials, structural engineering, surface functionalization, and device engineering. In this Account, we first provide a brief introduction to the operating principles of transistor-based chemical sensors. Then we summarize the progress in the fabrication of transistor-based chemical sensors that detect chemical species from the human body (e.g., molecules in sweat, saliva, urine, tears, etc.). We then highlight examples of chemical sensors for detecting harmful chemicals in the environment surrounding the user (e.g., nitrogen oxides, sulfur dioxide, volatile organic compounds, liquid-phase organic solvents, and heavy metal ions). Finally, we conclude this Account with a perspective on the wearable bioelectronics, especially focusing on organic electronic materials and devices.

The Digital Outcome Measure

Improving clinical outcomes remains the gold standard in advancing healthcare. Focusing on outcomes holds the potential to unite all clinical stakeholders including payers, industry, providers, and patients. Yet, the dominant ways in which outcomes are captured, provider-collected or patient-reported, have significant limitations. The emerging field of biosensors and wearables, which aims to capture many types of health data, holds promise to specifically capture outcomes while complementing existing outcome collection methods. A digital outcome measure, unlike a traditional provider-collected or patient-reported outcome measure, depends less on active patient or provider participation. Thus, digital outcome measures may be more amenable to standardization as well as greater collection consistency, frequency, and accuracy.