Wearable Sweat Sensors: Background and Current Trends

Evaluation of sweat-based biomarkers using wearable biosensors for monitoring stress and fatigue: a systematic review

Objectives. This systematic review aims to report the evaluation of wearable biosensors for the real-time measurement of stress and fatigue using sweat biomarkers. Methods. A thorough search of the literature was carried out in databases such as PubMed, Web of Science and IEEE. A three-step approach for selecting research articles was developed and implemented. Results. Based on a systematic search, a total of 17 articles were included in this review. Lactate, cortisol, glucose and electrolytes were identified as sweat biomarkers. Sweat-based biomarkers are frequently monitored in real time using potentiometric and amperometric biosensors. Wearable biosensors such as an epidermal patch or a sweatband have been widely validated in scientific literature. Conclusions. Sweat is an important biofluid for monitoring general health, including stress and fatigue. It is becoming increasingly common to use biosensors that can measure a wide range of sweat biomarkers to detect fatigue during high-intensity work. Even though wearable biosensors have been validated for monitoring various sweat biomarkers, such biomarkers can only be used to assess stress and fatigue indirectly. In general, this study may serve as a driving force for academics and practitioners to broaden the use of wearable biosensors for the real-time assessment of stress and fatigue.

Simultaneous detection of tyrosine and uric acid in sweat using CoWO4@CNT with a hydrogel modified electrochemical biosensor

The levels of uric acid (UA) and tyrosine (Tyr) in sweat reflect a person's overall health. However, simultaneously identifying several components in sweat remains challenging. Here, we achieve simultaneous detection of UA and Tyr by synthesizing CoWO4@CNT in a single step using a hydrothermal method. CoWO4's high catalytic efficacy and large CNT reaction area allow the detection of 1-1000 μM UA (LOD = 0.14 μM) and 5-1000 μM Tyr (LOD = 4.2 μM). To increase sweat collection, we developed a polydopamine-polyacrylamide (PDA-PAM) hydrogel with a sweat absorption rate of up to 226%. Finally, by monitoring sweat at various times of day, our sensors can discriminate between UA and Tyr in real sweat, and the results are consistent with the individuals' activity levels. Overall, the effective electrocatalytically active materials and PDA-PAM hydrogel improve the detection of UA and Tyr. The remarkable performance of CoWO4@CNT in real samples shows that it has the potential to improve health detection and real-time sweat analysis.

Advances in pH Sensing: From Traditional Approaches to Next-Generation Sensors in Biological Contexts

pH has been considered one of the paramount factors in bodily functions because most cellular tasks exclusively rely on precise pH values. In this context, the current techniques for pH sensing provide us with the futuristic insight to further design therapeutic and diagnostic tools. Thus, pH-sensing (electrochemically and optically) is rapidly evolving toward exciting new applications and expanding researchers' interests in many chemical contexts, especially in biomedical applications. The adaptation of cutting-edge technology is subsequently producing the modest form of these biosensors as wearable devices, which are providing us the opportunity to target the real-time collection of vital parameters, including pH for improved healthcare systems. The motif of this review is to provide insight into trending tech-based systems employed in real-time or in-vivo pH-responsive monitoring. Herein, we briefly go through the pH regulation in the human body to help the beginners and scientific community with quick background knowledge, recent advances in the field, and pH detection in real-time biological applications. In the end, we summarize our review by providing an outlook; challenges that need to be addressed, and prospective integration of various pH in vivo platforms with modern electronics that can open new avenues of cutting-edge techniques for disease diagnostics and prevention.

A Fully Elastic Wearable Electrochemical Sweat Detection System of Tree-Bionic Microfluidic Structure for Real-Time Monitoring

Fresh sweat contains a diverse range of physiological indicators that can effectively reflect changes in the body. However, existing wearable sweat detection systems face challenges in efficiently collecting and detecting fresh sweat in real-time. Additionally, they often lack the necessary deformation capabilities, resulting in discomfort for the wearer. Here, a fully elastic wearable electrochemical sweat detection system is developed that integrates a sweat-collecting microfluidic chip, a multi-parameter electrochemical sensor, a micro-heater, and a sweat detection elastic circuit board system. The unique tree-bionic structure of the microfluidic chip significantly enhances the efficiency of fresh sweat collection and discharge, enabling real-time detection by the electrochemical sensors. The sweat multi-parameter electrochemical sensor offers high-precision and high-sensitivity measurements of sodium ions, potassium ions, lactate, and glucose. The electronic system is built on an elastic circuit board that matches perfectly to wrinkled skin, ensuring improved wearing comfort and enabling multi-channel data sampling, processing, and wireless transmission. This state-of-the-art system represents a significant advancement in the field of elastic wearable sweat detection and holds promising potential for extending its capabilities to the detection of other sweat markers or various wearable applications.

Low-dimensional nanostructures for monolithic 3D-integrated flexible and stretchable electronics

Flexible/stretchable electronics, which are characterized by their ultrathin design, lightweight structure, and excellent mechanical robustness and conformability, have garnered significant attention due to their unprecedented potential in healthcare, advanced robotics, and human-machine interface technologies. An increasing number of low-dimensional nanostructures with exceptional mechanical, electronic, and/or optical properties are being developed for flexible/stretchable electronics to fulfill the functional and application requirements of information sensing, processing, and interactive loops. Compared to the traditional single-layer format, which has a restricted design space, a monolithic three-dimensional (M3D) integrated device architecture offers greater flexibility and stretchability for electronic devices, achieving a high-level of integration to accommodate the state-of-the-art design targets, such as skin-comfort, miniaturization, and multi-functionality. Low-dimensional nanostructures possess small size, unique characteristics, flexible/elastic adaptability, and effective vertical stacking capability, boosting the advancement of M3D-integrated flexible/stretchable systems. In this review, we provide a summary of the typical low-dimensional nanostructures found in semiconductor, interconnect, and substrate materials, and discuss the design rules of flexible/stretchable devices for intelligent sensing and data processing. Furthermore, artificial sensory systems in 3D integration have been reviewed, highlighting the advancements in flexible/stretchable electronics that are deployed with high-density, energy-efficiency, and multi-functionalities. Finally, we discuss the technical challenges and advanced methodologies involved in the design and optimization of low-dimensional nanostructures, to achieve monolithic 3D-integrated flexible/stretchable multi-sensory systems.

Microfluidic-Based Non-Invasive Wearable Biosensors for Real-Time Monitoring of Sweat Biomarkers

Wearable biosensors are attracting great interest thanks to their high potential for providing clinical-diagnostic information in real time, exploiting non-invasive sampling of biofluids. In this context, sweat has been demonstrated to contain physiologically relevant biomarkers, even if it has not been exhaustively exploited till now. This biofluid has started to gain attention thanks to the applications offered by wearable biosensors, as it is easily collectable and can be used for continuous monitoring of some parameters. Several studies have reported electrochemical and optical biosensing strategies integrated with flexible, biocompatible, and innovative materials as platforms for biospecific recognition reactions. Furthermore, sampling systems as well as the transport of fluids by microfluidics have been implemented into portable and compact biosensors to improve the wearability of the overall analytical device. In this review, we report and discuss recent pioneering works about the development of sweat sensing technologies, focusing on opportunities and open issues that can be decisive for their applications in routine-personalized healthcare practices.

Advances in Non-Electrochemical Sensing of Human Sweat Biomarkers: From Sweat Sampling to Signal Reading

Sweat, commonly referred to as the ultrafiltrate of blood plasma, is an essential physiological fluid in the human body. It contains a wide range of metabolites, electrolytes, and other biologically significant markers that are closely linked to human health. Compared to other bodily fluids, such as blood, sweat offers distinct advantages in terms of ease of collection and non-invasive detection. In recent years, considerable attention has been focused on wearable sweat sensors due to their potential for continuous monitoring of biomarkers. Electrochemical methods have been extensively used for in situ sweat biomarker analysis, as thoroughly reviewed by various researchers. This comprehensive review aims to provide an overview of recent advances in non-electrochemical methods for analyzing sweat, including colorimetric methods, fluorescence techniques, surface-enhanced Raman spectroscopy, and more. The review covers multiple aspects of non-electrochemical sweat analysis, encompassing sweat sampling methodologies, detection techniques, signal processing, and diverse applications. Furthermore, it highlights the current bottlenecks and challenges faced by non-electrochemical sensors, such as limitations and interference issues. Finally, the review concludes by offering insights into the prospects for non-electrochemical sensing technologies. By providing a valuable reference and inspiring researchers engaged in the field of sweat sensor development, this paper aspires to foster the creation of innovative and practical advancements in this domain.

Fluid-based wearable sensors: a turning point in personalized healthcare

Nowadays, it has become very popular to develop wearable devices that can monitor biomarkers to analyze the health status of the human body more comprehensively and accurately. Wearable sensors, specially designed for home care services, show great promise with their ease of use, especially during pandemic periods. Scientists have conducted many innovative studies on new wearable sensors that can noninvasively and simultaneously monitor biochemical indicators in body fluids for disease prediction, diagnosis, and management. Using noninvasive electrochemical sensors, biomarkers can be detected in tears, saliva, perspiration, and skin interstitial fluid (ISF). In this review, biofluids used for noninvasive wearable sensor detection under four main headings, saliva, sweat, tears, and ISF-based wearable sensors, were examined in detail. This report analyzes nearly 50 recent articles from 2017 to 2023. Based on current research, this review also discusses the evolution of wearable sensors, potential implementation challenges, and future prospects.

Biomolecular sensors for advanced physiological monitoring

Body-based biomolecular sensing systems, including wearable, implantable and consumable sensors allow comprehensive health-related monitoring. Glucose sensors have long dominated wearable bioanalysis applications owing to their robust continuous detection of glucose, which has not yet been achieved for other biomarkers. However, access to diverse biological fluids and the development of reagentless sensing approaches may enable the design of body-based sensing systems for various analytes. Importantly, enhancing the selectivity and sensitivity of biomolecular sensors is essential for biomarker detection in complex physiological conditions. In this Review, we discuss approaches for the signal amplification of biomolecular sensors, including techniques to overcome Debye and mass transport limitations, and selectivity improvement, such as the integration of artificial affinity recognition elements. We highlight reagentless sensing approaches that can enable sequential real-time measurements, for example, the implementation of thin-film transistors in wearable devices. In addition to sensor construction, careful consideration of physical, psychological and security concerns related to body-based sensor integration is required to ensure that the transition from the laboratory to the human body is as seamless as possible.

The Evolving Role of Proteins in Wearable Sweat Biosensors

Sweat is an increasingly popular biological medium for fitness monitoring and clinical diagnostics. It contains an abundance of biological information and is available continuously and noninvasively. Sweat-sensing devices often employ proteins in various capacities to create skin-friendly matrices that accurately extract valuable and time-sensitive information from sweat. Proteins were first used in sensors as biorecognition elements in the form of enzymes and antibodies, which are now being tuned to operate at ranges relevant for sweat. In addition, a range of structural proteins, sometimes assembled in conjunction with polymers, can provide flexible and compatible matrices for skin sensors. Other proteins also naturally possess a range of functionalities─as adhesives, charge conductors, fluorescence emitters, and power generators─that can make them useful components in wearable devices. Here, we examine the four main components of wearable sweat sensors─the biorecognition element, the transducer, the scaffold, and the adhesive─and the roles that proteins have played so far, or promise to play in the future, in each component. On a case-by-case basis, we analyze the performance characteristics of existing protein-based devices, their applicable ranges of detection, their transduction mechanism and their mechanical properties. Thereby, we review and compare proteins that can readily be used in sweat sensors and others that will require further efforts to overcome design, stability or scalability challenges. Incorporating proteins in one or multiple components of sweat sensors could lead to the development and deployment of tunable, greener, and safer biosourced devices.

Virtual monitoring in CF - the importance of continuous monitoring in a multi-organ chronic condition

Cystic Fibrosis (CF) is a chronic life-limiting condition that affects multiple organs within the body. Patients must adhere to strict medication regimens, physiotherapy, diet, and attend regular clinic appointments to manage their condition effectively. This necessary but burdensome requirement has prompted investigations into how different digital health technologies can enhance current care by providing the opportunity to virtually monitor patients. This review explores how virtual monitoring has been harnessed for assessment or performance of physiotherapy/exercise, diet/nutrition, symptom monitoring, medication adherence, and wellbeing/mental-health in people with CF. This review will also briefly discuss the potential future of CF virtual monitoring and some common barriers to its current adoption and implementation within CF. Due to the multifaceted nature of CF, it is anticipated that this review will be relevant to not only the CF community, but also those investigating and developing digital health solutions for the management of other chronic diseases.

MicroSweat: A Wearable Microfluidic Patch for Noninvasive and Reliable Sweat Collection Enables Human Stress Monitoring

Stress affects cognition, behavior, and physiology, leading to lasting physical and mental illness. The ability to detect and measure stress, however, is poor. Increased circulating cortisol during stress is mirrored by cortisol release from sweat glands, providing an opportunity to use it as an external biomarker for monitoring internal emotional state. Despite the attempts at using wearable sensors for monitoring sweat cortisol, there is a lack of reliable wearable sweat collection devices that preserve the concentration and integrity of sweat biomolecules corresponding to stress levels. Here, a flexible, self-powered, evaporation-free, bubble-free, surfactant-free, and scalable capillary microfluidic device, MicroSweat, is fabricated to reliably collect human sweat from different body locations. Cortisol levels are detected corresponding to severe stress ranging from 25 to 125 ng mL^-1 averaged across multiple body regions and 100-1000 ng mL^-1 from the axilla. A positive nonlinear correlation exists between cortisol concentration and stress levels quantified using the perceived stress scale (PSS). Moreover, owing to the sweat variation in response to environmental effects and physiological differences, the longitudinal and personalized profile of sweat cortisol is acquired, for the first time, for various body locations. The obtained sweat cortisol data is crucial for analyzing human stress in personalized and clinical healthcare sectors.

Epidermal Wearable Biosensors for Monitoring Biomarkers of Chronic Disease in Sweat

Biological information detection technology is mainly used for the detection of physiological and biochemical parameters closely related to human tissues and organ lesions, such as biomarkers. This technology has important value in the clinical diagnosis and treatment of chronic diseases in their early stages. Wearable biosensors can be integrated with the Internet of Things and Big Data to realize the detection, transmission, storage, and comprehensive analysis of human physiological and biochemical information. This technology has extremely wide applications and considerable market prospects in frontier fields including personal health monitoring, chronic disease diagnosis and management, and home medical care. In this review, we systematically summarized the sweat biomarkers, introduced the sweat extraction and collection methods, and discussed the application and development of epidermal wearable biosensors for monitoring biomarkers in sweat in preclinical research in recent years. In addition, the current challenges and development prospects in this field were discussed.

Dual-gate thin film transistor lactate sensors operating in the subthreshold regime

Organic thin-film transistors (TFTs) with an electrochemically functionalized sensing gate are promising platforms for wearable health-monitoring technologies because they are light, flexible, and cheap. Achieving both high sensitivity and low power is highly demanding for portable or wearable devices. In this work, we present flexible printed dual-gate (DG) organic TFTs operating in the subthreshold regime with ultralow power and high sensitivity. The subthreshold operation of the gate-modulated TFT-based sensors not only increases the sensitivity but also reduces the power consumption. The DG configuration has deeper depletion and stronger accumulation, thereby further making the subthreshold slope sharper. We integrate an enzymatic lactate-sensing extended-gate electrode into the printed DG TFT and achieve exceptionally high sensitivity (0.77) and ultralow static power consumption (10 nW). Our sensors are successfully demonstrated in physiological lactate monitoring with human saliva. The accuracy of the DG TFT sensing system is as good as that of a high-cost conventional assay. The developed platform can be readily extended to various materials and technologies for high performance wearable sensing applications.

Recent Progress in Development of Carbon-Nanotube-Based Photo-Thermoelectric Sensors and Their Applications in Ubiquitous Non-Destructive Inspections

The photo-thermoelectric (PTE) effect in electronic materials effectively combines photo-absorption-induced local heating and associated thermoelectric conversion for uncooled and broadband photo-detection. In particular, this work comprehensively summarizes the operating mechanism of carbon nanotube (CNT)-film-based PTE sensors and ubiquitous non-destructive inspections realized by exploiting the material properties of CNT films. Formation of heterogeneous material junctions across the CNT-film-based PTE sensors, namely photo-detection interfaces, triggers the Seebeck effect with photo-absorption-induced local heating. Typical photo-detection interfaces include a channel-electrode boundary and a junction between P-type CNTs and N-type CNTs (PN junctions). While the original CNT film channel exhibits positive Seebeck coefficient values, the material selections of the counterpart freely govern the intensity and polarity of the PTE response signals. Based on these operating mechanisms, CNT film PTE sensors demonstrate a variety of physical and chemical non-destructive inspections. The device aggregates broad multi-spectral optical information regarding the targets and reconstructs their inner composite or layered structures. Arbitrary deformations of the device are attributed to the macroscopic flexibility of the CNT films to further monitor targets from omni-directional viewing angles without blind spots. Detection of blackbody radiation from targets using the device also visualizes their behaviors and associated changes.

Emerging biotransduction strategies on soft interfaces for biosensing

As a lab-on-soft biochip providing accurate and timely biomarker information, wearable biosensors can satisfy the increasing demand for intelligent e-health services, active disease diagnosis/therapy, and huge bioinformation data. As biomolecules generally could not directly produce detectable signals, biotransducers that specifically convert biomolecules to electrical or optical signals are involved, which determines the pivotal sensing performance including 3S (sensitivity, selectivity, and stability), reversibility, etc. The soft interface poses new requirements for biotransducers, especially equipment-free, facile operation, mechanical tolerance, and high sensing performance. In this review, we discussed the emerging electrochemical and optical biotransduction strategies on wearables from the aspects of the transduction mechanism, amplification strategies, biomaterial selection, and device fabrication procedures. Challenges and perspectives regarding future biotransducers for monitoring trace amounts of biomolecules with high fidelity, sensitivity, and multifunctionality are also discussed. It is expected that through fusion with functional electronics, wearable biosensors can provide possibilities to further decentralize the healthcare system and even build biomolecule-based intelligent cyber-physical systems and new modalities of cyborgs.

A Noninvasive Sweat Glucose Biosensor Based on Glucose Oxidase/Multiwalled Carbon Nanotubes/Ferrocene-Polyaniline Film/Cu Electrodes

Diabetes remains a great threat to human beings' health and its world prevalence is projected to reach 9.9% by 2045. At present, the detection methods used are often invasive, cumbersome and time-consuming, thus increasing the burden on patients. In this paper, we propose a novel noninvasive and low-cost biosensor capable of detecting glucose in human sweat using enzyme-based electrodes for point-of-care uses. Specifically, an electrochemical method is applied for detection and the electrodes are covered with multilayered films including ferrocene-polyaniline (F-P), multi-walled carbon nanotubes (MWCNTs) and glucose oxidase (GOx) on Cu substrates (GOx/MWCNTs/F-P/Cu). The coated layers enhance the immobilization of GOx, increase the conductivity of the anode and improve the electrochemical properties of the electrode. Compared with the Cu electrode and the F-P/Cu electrode, a maximum peak current is obtained when the MWCNTs/F-P/Cu electrode is applied. We also study its current response by cyclic voltammetry (CV) at different concentrations (0-2.0 mM) of glucose solution. The best current response is obtained at 0.25 V using chronoamperometry. The effective working lifetime of an electrode is up to 8 days. Finally, to demonstrate the capability of the electrode, a portable, miniaturized and integrated detection device based on the GOx/MWCNTs/F-P/Cu electrode is developed. The results exhibit a short response time of 5 s and a correlation coefficient R² of 0.9847 between the response current of sweat with blood glucose concentration. The LOD is of 0.081 mM and the reproducibility achieved in terms of RSD is 3.55%. The sweat glucose sensor is noninvasive and point-of-care, which shows great development potential in the health examination and monitoring field.

A Soft Wearable Microfluidic Patch with Finger-Actuated Pumps and Valves for On-Demand, Longitudinal, and Multianalyte Sweat Sensing

Easy sample collection, physiological relevance, and ability to noninvasively and longitudinally monitor the human body are some of the key attributes of wearable sweat sensors. Examples typically include reversible sensors or an array of single-use sensors embedded in specialized microfluidics for temporal analysis of sweat. However, evolving this field to a level that truly represents "lab-on-skin" technology will require the incorporation of advanced functionalities that give the user the freedom to (1) choose the precise time for performing sample analysis and (2) select sensors from an array embedded within the device for performing condition-specific sample analysis. Here, we introduce new concepts in wearable microfluidic platforms that offer such capabilities. The described technology involves a series of finger-actuated pumps, valves, and sensors incorporated within soft, wearable microfluidics. The incoming sweat collects in the inlet chamber and can be analyzed by the user at the time of their choosing. On-demand sweat analyte assessment is achieved by pulling a thin tab to activate a pump which opens a valve and allows the pooled sweat to enter a chamber embedded with sensors for the desired analytes. The article describes a thorough characterization of the platform that demonstrates the robustness of the pumping, valving, and sensing aspects of the device under conditions mimicking real-life scenarios. A two-day-long human pilot study validates the system and illustrates the device's ability to offer on-demand, longitudinal, and multianalyte sensing. Our work represents the first example of a wearable system with such on-demand sensing capabilities and opens exciting avenues in sweat sensing for acquiring new insights into human physiology.

Graphene and Its Derivatives: Synthesis and Application in the Electrochemical Detection of Analytes in Sweat

Wearable sensors and invasive devices have been studied extensively in recent years as the demand for real-time human healthcare applications and seamless human-machine interaction has risen exponentially. An explosion in sensor research throughout the globe has been ignited by the unique features such as thermal, electrical, and mechanical properties of graphene. This includes wearable sensors and implants, which can detect a wide range of data, including body temperature, pulse oxygenation, blood pressure, glucose, and the other analytes present in sweat. Graphene-based sensors for real-time human health monitoring are also being developed. This review is a comprehensive discussion about the properties of graphene, routes to its synthesis, derivatives of graphene, etc. Moreover, the basic features of a biosensor along with the chemistry of sweat are also discussed in detail. The review mainly focusses on the graphene and its derivative-based wearable sensors for the detection of analytes in sweat. Graphene-based sensors for health monitoring will be examined and explained in this study as an overview of the most current innovations in sensor designs, sensing processes, technological advancements, sensor system components, and potential hurdles. The future holds great opportunities for the development of efficient and advanced graphene-based sensors for the detection of analytes in sweat.

Stretchable broadband photo-sensor sheets for nonsampling, source-free, and label-free chemical monitoring by simple deformable wrapping

Chemical monitoring communicates diverse environmental information from industrial and biological processes. However, promising and sustainable systems and associated inspection devices that dynamically enable on-site quality monitoring of target chemicals confined inside transformable and opaque channels are yet to be investigated. This paper designs stretchable photo-sensor patch sheets for nonsampling, source-free, and label-free on-site dynamic chemical monitoring of liquids flowing inside soft tubes via simple deformable surface wrapping. The device integrates carbon nanotube-based broadband photo-absorbent thin films with multilayer-laminated stretchable electrodes and substrates. The patterned rigid-soft structure of the proposed device provides durability and optical stability against mechanical deformations with a stretchability range of 70 to 280%, enabling shape-conformable attachments to transformable objects. The effective use of omnidirectional and transparent blackbody radiation from free-form targets themselves allows compact measurement configuration and enhances the functionality and simplicity of this scheme, while the presenting technology monitors concentrations of arbitrary water-soluble chemicals.

Low-Cost Wearable Fluidic Sweat Collection Patch for Continuous Analyte Monitoring and Offline Analysis

Sweat sensors allow for new unobtrusive ways to continuously monitor an athlete's performance and health status. Significant advances have been made in the optimization of sensitivity, selectivity, and durability of electrochemical sweat sensors. However, comparing the in situ performance of these sensors in detail remains challenging because standardized sweat measurement methods to validate sweat sensors in a physiological setting do not yet exist. Current collection methods, such as the absorbent patch technique, are prone to contamination and are labor-intensive, which limits the number of samples that can be collected over time for offline reference measurements. We present an easy-to-fabricate sweat collection system that allows for continuous electrochemical monitoring, as well as chronological sampling of sweat for offline analysis. The patch consists of an analysis chamber hosting a conductivity sensor and a sequence of 5 to 10 reservoirs that contain level indicators that monitor the filling speed. After testing the performance of the patch in the laboratory, elaborate physiological validation experiments (3 patch locations, 6 participants) were executed. The continuous sweat conductivity measurements were compared with laboratory [Na⁺] and [Cl^-] measurements of the samples, and a strong linear relationship (R² = 0.97) was found. Furthermore, sweat rate derived from ventilated capsule measurement at the three locations was compared with patch filling speed and continuous conductivity readings. As expected from the literature, sweat conductivity was linearly related to sweat rate as well. In short, a successfully validated sweat collection patch is presented that enables sensor developers to systematically validate novel sweat sensors in a physiological setting.

Screen-Printed Carbon Black/Recycled Sericin@Fabrics for Wearable Sensors to Monitor Sweat Loss

Wearable sensors to monitor human sweat loss are important for real-time health monitoring, requiring electrically conductive, mechanically flexible fabrics as working electrodes. Here, a textile-based sweat monitor was fabricated by screen printing of carbon black and recycled sericin on cotton fabrics. The obtained fabric with excellent flexibility, good hydrophilicity (86°), and proper resistivity (61.7 Ω/cm²) can be used as a working electrode for a wearable sweat monitor. A wearable sweat monitor is highly sensitive (42.7% in acidic sweat), flexible, and can be washed (99.1% retention after 30 washes). This work offers a promising approach for the fabrication of wearable sensors and promotes the widespread applications of personalized health-monitoring devices.

Recent advances in flexible and wearable sensors for monitoring chemical molecules

In recent years, real-time health management has received increasing attention, benefiting from the rapid development of flexible and wearable devices. Conventionally, flexible and wearable devices are used for collecting health data such as electrophysiological signals, blood pressure, heart rate, etc. The monitoring of chemical factors has shown growing significance, providing the basis for the screening, diagnosis, and treatment of many diseases. Nowadays, in order to understand the health status of the human body more comprehensively and accurately, researchers in the community have started putting effort into developing wearable devices for monitoring chemical factors. Progressively, more flexible chemical sensors with wearable real-time health-monitoring functionality have been developed thanks to advances relating to wireless communications and flexible electronics. In this review, we describe the variety of chemical molecules and information that can currently be monitored, including pH levels, glucose, lactate, uric acid, ion levels, cytokines, nutrients, and other biomarkers. This review analyzes the pros and cons of the most advanced wearable chemical sensors in terms of wearability. At the end of this review, we discuss the current challenges and development trends relating to flexible and wearable chemical sensors from the aspects of materials, electrode designs, and soft-hard interface connections.

Wearable Sweat Loss Measuring Devices: From the Role of Sweat Loss to Advanced Mechanisms and Designs

Wearable sweat sensors have received significant research interest and have become popular as sweat contains considerable health information about physiological and psychological states. However, measured biomarker concentrations vary with sweat rates, which has a significant effect on the accuracy and reliability of sweat biosensors. Wearable sweat loss measuring devices (SLMDs) have recently been proposed to overcome the limitations of biomarker tracking and reduce inter- and intraindividual variability. In addition, they offer substantial potential for monitoring human body homeostasis, because sweat loss plays an indispensable role in thermoregulation and skin hydration. Previous studies have not carried out a comprehensive and systematic review of the principles, importance, and development of wearable SLMDs. This paper reviews wearable SLMDs with a new health perspective from the role of sweat loss to advanced mechanisms and designs. Two types of sweat and their measurement significance for practical applications are highlighted. Then, a comprehensive review of advances in different wearable SLMDs based on hygrometers, absorbent materials, and microfluidics is presented by describing their respective device architectures, present situations, and future directions. Finally, concluding remarks on opportunities for future application fields and challenges for future sweat sensing are presented.

Can Wearable Sweat Lactate Sensors Contribute to Sports Physiology?

The rise of wearable sensors to measure lactate content in human sweat during sports activities has attracted the attention of physiologists given the potential of these “analytical tools” to provide real-time information. Beyond the assessment of the sensing technology per se, which, in fact, has not rigorously been validated yet in controlled conditions, there are many open questions about the true usefulness of such wearable sensors in real scenarios. On the one hand, the evidence for the origin of sweat lactate (e.g., via the sweat gland, derivation from blood, or other alternative mechanisms), its high concentration (1–25 mM or even higher) compared to levels in the blood, and the possible correlation between different biofluids (particularly blood) is rather contradictory and generates vivid debate in the field. On the other hand, it is important to point out that accurate detection of sweat lactate is highly dependent on the procedure used to collect and/or reach the fluid, and this can likely explain the large discrepancies reported in the literature. In brief, this paper provides our vision of the current state of the field and a thoughtful evaluation of the possible reasons for present controversies, together with an analysis of the impact of wearable sweat lactate sensors in the physiological context. Finally, although there is not yet overwhelming scientific evidence to provide an unequivocal answer to whether wearable sweat lactate sensors can contribute to sports physiology, we still understand the importance to bring this challenging question up-front to create awareness and guidance in the development, validation, and implementation of wearable sensors.

Temporal profiling of cytokines in passively expressed sweat for detection of infection using wearable device

This work presents the viability of passive eccrine sweat as a functional biofluid toward tracking the human body's inflammatory response. Cytokines are biomarkers that orchestrate the manifestation and progression of an infection/inflammatory event. Hence, noninvasive, real-time monitoring of cytokines can be pivotal in assessing the progression of infection/inflammatory event, which may be feasible through monitoring of host immune markers in eccrine sweat. This work is the first experimental proof demonstrating the ability to detect inflammation/infection such as fever, FLU directly from passively expressed sweat in human subjects using a wearable "SWEATSENSER" device. The developed SWEATSENSER device demonstrates stable, real-time monitoring of inflammatory cytokines in passive sweat. An accuracy of >90% and specificity >95% was achieved using SWEATSENSER for a panel of cytokines (interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α) over an analytical range of 0.2-200 pg mL-1. The SWEATSENSER demonstrated a correlation of Pearson's r > 0.98 for the study biomarkers in a cohort of 26 subjects when correlated with standard reference method. Comparable IL-8 levels (2-15 pg mL-1) between systemic circulation (serum) and eccrine sweat through clinical studies in a cohort of 15 subjects, and the ability to distinguish healthy and sick (infection) cohort using inflammatory cytokines in sweat provides pioneering evidence of the SWEATSENSER technology for noninvasive tracking of host immune response biomarkers. Such a wearable device can offer significant strides in improving prognosis and provide personalized therapeutic treatment for several inflammatory/infectious diseases.

State of Sweat: Emerging Wearable Systems for Real-Time, Noninvasive Sweat Sensing and Analytics

Skin-interfaced wearable systems with integrated colorimetric assays, microfluidic channels, and electrochemical sensors offer powerful capabilities for noninvasive, real-time sweat analysis. This Perspective details recent progress in the development and translation of novel wearable sensors for personalized assessment of sweat dynamics and biomarkers, with precise sampling and real-time analysis. Sensor accuracy, system ruggedness, and large-scale deployment in remote environments represent key opportunity areas, enabling broad deployment in the context of field studies, clinical trials, and recent commercialization. On-body measurements in these contexts show good agreement compared to conventional laboratory-based sweat analysis approaches. These device demonstrations highlight the utility of biochemical sensing platforms for personalized assessment of performance, wellness, and health across a broad range of applications.

Touch-Based Fingertip Blood-Free Reliable Glucose Monitoring: Personalized Data Processing for Predicting Blood Glucose Concentrations

Diabetes prevalence has been rising exponentially, increasing the need for reliable noninvasive approaches for glucose monitoring. Different biofluids have been explored recently for replacing current blood finger-stick glucose strips with noninvasive painless sensing devices. While sweat has received considerable attention, there are mixed reports on correlating the sweat results with blood glucose levels. Here, we demonstrate a new rapid and reliable approach that combines a simple touch-based fingertip sweat electrochemical sensor with a new algorithm that addresses for personal variations toward the accurate estimate of blood glucose concentrations. The new painless and simple glucose self-testing protocol leverages the fast sweat rate on the fingertip for rapid assays of natural perspiration, without any sweat stimulation, along with the personalized sweat-response-to-blood concentration translation. A reliable estimate of the blood glucose sensing concentrations can thus be realized through a simple one-time personal precalibration. Such system training leads to a substantially improved accuracy with a Pearson correlation coefficient higher than 0.95, along with an overall mean absolute relative difference of 7.79%, with 100% paired points residing in the A + B region of the Clarke error grid. The speed and simplicity of the touch-based blood-free fingertip sweat assay, and the elimination of periodic blood calibrations, should lead to frequent self-testing of glucose and enhanced patient compliance toward the improved management of diabetes.

Recent progress, challenges, and opportunities for wearable biochemical sensors for sweat analysis

Sweat is a promising, yet relatively unexplored biofluid containing biochemical information that offers broad insights into the underlying dynamic metabolic activity of the human body. The rich composition of electrolytes, metabolites, hormones, proteins, nucleic acids, micronutrients, and exogenous agents found in sweat dynamically vary in response to the state of health, stress, and diet. Emerging classes of skin-interfaced wearable sensors offer powerful capabilities for the real-time, continuous analysis of sweat produced by the eccrine glands in a manner suitable for use in athletics, consumer wellness, military, and healthcare industries. This perspective examines the rapid and continuous progress of wearable sweat sensors through the most advanced embodiments that address the fundamental challenges currently restricting widespread deployment. It concludes with a discussion of efforts to expand the overall utility of wearable sweat sensors and opportunities for commercialization, in which advances in biochemical sensor technologies will be critically important.

A Field Evaluation of Construction Workers' Activity, Hydration Status, and Heat Strain in the Extreme Summer Heat of Saudi Arabia

OBJECTIVES

Assess the impact of summer heat exposure (June-September) on residential construction workers in Al-Ahsa, Saudi Arabia by evaluating (i) heart rate (HR) responses, hydration status, and physical workload among workers in indoor and outdoor construction settings, (ii) factors related to physiological responses to work in hot conditions, and (iii) how well wet-bulb globe temperature-based occupational exposure limits (WBGTOELs) predict measures of heat strain.

METHODS

Twenty-three construction workers (plasterers, tilers, and laborers) contributed 260 person-days of monitoring. Workload energy expenditure, HR, fluid intake, and pre- and postshift urine specific gravity (USG) were measured. Indoor and outdoor heat exposures (WBGT) were measured continuously and a WBGTOEL was calculated. The effects of heat exposure and workload on heart rate reserve (HRR), a measure of cardiovascular strain, were examined with linear mixed models. A metric called 'heat stress exceedance' (HSE) was constructed to summarize whether the environmental heat exposure (WBGT) exceeded the heat stress exposure limit (WBGTOEL). The sensitivity and specificity of the HSE as a predictor of cardiovascular strain (HRR ≥30%) were determined.

RESULTS

The WBGTOEL was exceeded frequently, on 63 person-days indoors (44%) and 91(78%) outdoors. High-risk HRR occurred on 26 and 36 person-days indoors and outdoors, respectively. The HSE metric showed higher sensitivity for HRR ≥30% outdoors (89%) than indoors (58%) and greater specificity indoors (59%) than outdoors (27%). Workload intensity was generally moderate, with light intensity work more common outdoors. The ability to self-pace work was associated with a lower frequency of HRR ≥30%. USG concentrations indicated that workers began and ended their shifts dehydrated (USG ≥1.020).

CONCLUSIONS

Construction work where WBGTOEL is commonly exceeded poses health risks. The ability of workers to self-pace may help reduce risks.

Wearable strain sensor for real-time sweat volume monitoring

Reliably monitoring sweat volume has attracted much attention due to its important role in the assessment of physiological health conditions and the prevention of dehydration. Here, we present the first example of wearable strain sensor for real-time sweat volume monitoring. Such sweat volume monitoring sensor is simply fabricated via embedding strain sensing fabric in super-absorbent hydrogels, the hydrogels can wick sweat up off the skin surface to swell and then trigger the strain sensing fabrics response. This sensor can realize real-time detection of sweat volume (0.15-700 μL), shows excellent repeatability and stability against movement or light interference, reliability in the non-pathological range (pH: 4-9 and salinity: 0-100 mM NaCl) in addition. Such sensor combing swellable hydrogels with strain sensing fabrics provides a novel measurement method of wearable devices for sweat volume monitoring.

A wearable fluidic collection patch and ion chromatography method for sweat electrolyte monitoring during exercise

This paper presents a method to continuously collect and reliably measure sweat analyte concentrations during exercise. The method can be used to validate newly developed sweat sensors and to obtain insight into intraindividual variations of sweat analytes in athletes. First, a novel design of a sweat collection system is created. The sweat collection patch, that is made from hydrophilized foil and a double-sided acrylate adhesive, consists of a reservoir array that collects samples consecutively in time. During a physiological experiment, sweat can be collected from the back of a participant and the filling speed of the collector is monitored by using a camera. After the experiment, Na+, Cl- and K+ levels are measured with ion chromatography. Sweat analyte variations are measured during exercise for an hour at three different locations on the back. The Na+ and Cl- variations show a similar trend and the absolute concentrations vary with the patch location. Na+ and Cl- concentrations increase and K+ concentrations seem to decrease during this exercise. With this new sweat collection system, sweat Na+, Cl- and K+ concentrations can be collected over time during exercise at medium to high intensity, to analyse the trend in electrolyte variations per individual.

Microfluidics by Additive Manufacturing for Wearable Biosensors: A Review

Wearable devices are nowadays at the edge-front in both academic research as well as in industry, and several wearable devices have been already introduced in the market. One of the most recent advancements in wearable technologies for biosensing is in the area of the remote monitoring of human health by detection on-the-skin. However, almost all the wearable devices present in the market nowadays are still providing information not related to human ‘metabolites and/or disease’ biomarkers, excluding the well-known case of the continuous monitoring of glucose in diabetic patients. Moreover, even in this last case, the glycaemic level is acquired under-the-skin and not on-the-skin. On the other hand, it has been proven that human sweat is very rich in molecules and other biomarkers (e.g., ions), which makes sweat a quite interesting human liquid with regards to gathering medical information at the molecular level in a totally non-invasive manner. Of course, a proper collection of sweat as it is emerging on top of the skin is required to correctly convey such liquid to the molecular biosensors on board of the wearable system. Microfluidic systems have efficiently come to the aid of wearable sensors, in this case. These devices were originally built using methods such as photolithographic and chemical etching techniques with rigid materials. Nowadays, fabrication methods of microfluidic systems are moving towards three-dimensional (3D) printing methods. These methods overcome some of the limitations of the previous method, including expensiveness and non-flexibility. The 3D printing methods have a high speed and according to the application, can control the textures and mechanical properties of an object by using multiple materials in a cheaper way. Therefore, the aim of this paper is to review all the most recent advancements in the methods for 3D printing to fabricate wearable fluidics and provide a critical frame for the future developments of a wearable device for the remote monitoring of the human metabolism directly on-the-skin.

A Flexible 3D Organic Preamplifier for a Lactate Sensor

Organic transistors are promising platforms for wearable biosensors. However, the strategies to improve signal amplification have yet to be determined, particularly regarding biosensors that generate very weak signals. In this study, an organic voltage amplifier is presented for a lactate sensor on flexible plastic foil. The preamplifier is based on a 3D complementary inverter, which is achieved by vertically stacking complementary transistors with a shared gate between them. The shared gate is extended and functionalized with a lactate oxidase enzyme to detect lactate. The sensing device successfully detects the lactate concentration in the human sweat range (20-60 mm) with high sensitivity (6.82 mV mm^-1 ) due to high gain of its amplification. The 3D integration process is cost-effective as it is solution-processable and doubles the number of transistors per unit area. The device presented in this study would pave the way for the development of high-gain noninvasive sweat lactate sensors that can be wearable.

Development of a microfluidic collection system to measure electrolyte variations in sweat during exercise

A wide variety of electrochemical sweat sensors are recently being developed for real-time monitoring of biomarkers. However, from a physiological perspective, little is known about how sweat biomarkers change over time. This paper presents a method to collect and analyze sweat to identify inter and intraindividual variations of electrolytes during exercise. A new microfluidic sweat collection system is developed which consists of a patch covering the collection surface and a sequence of reservoirs. Na⁺, Cl^- and K⁺ are measured with ion chromatography afterwards. The measurements show that with the new collector, variations in these ion concentrations can be measured reliably over time.

Large-Scale Patterning of Reactive Surfaces for Wearable and Environmentally Deployable Sensors

Wearable interfaces are central to multiple healthcare and wellness strategies encompassing diet and nutrition, personalized health monitoring, and performance optimization. Specifically, the advent of flexible electronic formats coupled with microfluidic interfaces has resulted in sophisticated conformal devices for biofluid sampling and quantification. Here, a complementary approach is presented to wearable sensing by using a large-scale, conformal, distributed format that relies on the use of biomaterial-based inks to print and stabilize deterministic patterns of biochemical reporters with high resolution. Colorimetric devices can vary in size and a sensing T-shirt based on a colorimetric pattern is developed to illustrate the utility that such formats can add to the wearable interface space. Image analysis allows parameter variation to be tracked in real-time, yielding a map-like format of distributed biophysical response.

Contact lens-based lysozyme detection in tear using a mobile sensor

We report a method for sensing analytes in tear-fluid using commercial contact lenses (CLs) as sample collectors for subsequent analysis with a cost-effective and field-portable reader. In this study we quantify lysozyme, the most prevalent protein in tear fluid, non-specifically bound to CLs worn by human participants. Our mobile reader uses time-lapse imaging to capture an increasing fluorescent signal in a standard well-plate, the rate-of-change of which is used to indirectly infer lysozyme concentration through the use of a standard curve. We empirically determined the best-suited CL material for our sampling procedure and assay, and subsequently monitored the lysozyme levels of nine healthy human participants over a two-week period. Of these participants who were regular CL wearers (6 out of 9), we observed an increase in lysozyme levels from 6.89 ± 2.02 μg mL-1 to 10.72 ± 3.22 μg mL-1 (mean ± SD) when inducing an instance of digital eye-strain by asking them to play a game on their mobile-phones during the CL wear-duration. We also observed a lower mean lysozyme concentration (2.43 ± 1.66 μg mL-1) in a patient cohort with dry eye disease (DED) as compared to the average monitoring level of healthy (no DED) human participants (6.89 ± 2.02 μg mL-1). Taken together, this study demonstrates tear-fluid analysis with simple and non-invasive sampling steps along with a rapid, easy-to-use, and cost-effective measurement system, ultimately indicating physiological differences in human participants. We believe this method could be used in future tear-fluid studies, even supporting multiplexed detection of a panel of tear biomarkers toward improved diagnostics and prognostics as well as personalized mobile-health applications.

The role of sampling in wearable sweat sensors

Wearable sweat sensors demonstrate outstanding performance in non-invasive, real-time monitoring of vital biomarkers in sweat, which offer an opportunity for individuals to achieve dynamic monitoring their own physiology in molecular-level. As a key step in sweat analysis that impact the accuracy of results, frequently-used sweat sampling methods are introduced in this review, and the emphasis is sweat sampling in wearable sensors including absorbent materials, superhydrophobic/superhydrophilic surface, sweat guidance and epidermal microfluidic systems. In the end, we also propose the remaining challenges in the practical, large-scale application of wearable sweat sensors and provide personal prospects on the future development.

Ultra-simple wearable local sweat volume monitoring patch based on swellable hydrogels

Quantifiably monitoring sweat rate and volume is important to assess the stress level of individuals and/or prevent dehydration, but despite intense research, a convenient, continuous, and low-cost method to monitor sweat rate and total sweat volume loss remains an un-met need. We present here an ultra-simple wearable sensor capable of measuring sweat rate and volume accurately. The device continuously monitors sweat rate by wicking the produced sweat into hydrogels that measurably swell in their physical geometry. The device has been designed as a simple to fabricate, low-cost, disposable patch. This patch exhibits stable and predictable operation over the maximum variable chemistry expected for sweat (pH 4-9 and salinity 0-100 mM NaCl). Preliminary in vivo testing of the patch has been achieved during aerobic exercise, and the sweat rates measured via the patch accurately follow actual sweat rates.

Field Research Cooperative Wearable Systems: Challenges in Requirements, Design and Validation

The widespread availability of wearable devices is evolving them into cooperative systems. Communication and distribution aspects such as the Internet of Things, Wireless Body Area Networks, and Local Wireless Networks provide the means to develop multi-device platforms. Nevertheless, the field research environment presents a specific feature set, which increases the difficulty in the adoption of this technology. In this text, we review the main aspects of Field Research Gears and Wearable Devices. This review is made aiming to understand how to create cooperative systems based on wearable devices directed to the Field Research Context. For a better understanding, we developed a case study in which we propose a cooperative system architecture and provide validation aspects. For this matter, we provide an overview of a previous device architecture and study an integration proposal.

A Capillary-Evaporation Micropump for Real-Time Sweat Rate Monitoring with an Electrochemical Sensor

Sweat collection and real time monitoring of sweat rate play essential roles in physiology monitoring and assessment of an athlete’s performance during exercise. In this paper, we report a micropump for sweat simulant collection based on the capillary–evaporation effect. An electrochemical sensor is integrated into the micropump, which monitors the flow rate in real-time by detecting the current using three electrodes. The evaporation rate from micropore array, equivalent to the sweat rate, was theoretically and numerically investigated. The designed micropump yields the maximum collection rate as high as 0.235 μL/min. In addition, the collection capability of the micropump was validated experimentally; the flow rate through the microchannel was further detected in real-time with the electrochemical sensor. The experimental maximum collection rate showed good consistency with the theoretical data. Our proposed device shows the potential for sweat collection and real-time monitoring of sweat rate, which is a promising candidate for being a wearable platform for real-time physiology and performance monitoring during exercise.

Multifunctional Directional Water Transport Fabrics with Moisture Sensing Capability

Previous fabrics with directional fluid transport capability typically have a single function to transport liquid. Multifunctional directional fluid fabrics are highly desirable for making "smart" textiles but remain a challenge to develop. In this study, we have for the first time prepared a multifunctional, directional water transport fabric. By using a two-step coating process, we applied polypyrrole (PPy), a conducting polymer, on one side of a hydrophilic fabric (cotton). We showed that the single-side PPy-coated fabrics had reasonable conductivity (surface resistance in the range of 43-54 kΩ/□) and a one-way water transport function. We further showed that by integrating metal-plated nylon wires on the two sides, the fabric can be used as a capacitive sensor to sense water content in the fabric. The conducting layer enables the sensor device to have a sufficient capacitance response. Reasonable integration of the metal electrodes allows the device to have a minimal effect on the directional water transport and breathability of the fabric. Such a novel multifunctional fabric may find applications in making "smart" clothing.

An Artificial Sweating System for Sweat Sensor Testing Applications

This research proposes a completely automated, computer-controlled fluid mixing and dispensing system, which is suitable for testing sweat sensing devices, as an alternative to requiring human trials during the development phase of a sweat sensor device. An arm mold was designed and implemented with dragon skin and pores to simulate sweating action. The relay controlled mixing tanks allow for the different concentration of fluid solutions at various rates of fluid dispensing through pores. The onboard single board computer controls a dozen electronic relays and it switches and presents an easy to use graphical user interface to allow end users to conduct the experiments with ease and not require further programming. With the recent advances in sweat sensors, this platform offers a unique way of testing sensing devices during development, allowing for researchers to focus on their design parameters one at a time before actual validation through human trials are conducted. The current device can provide sweat rates from 1 µL/min to 500 µL/min. Furthermore, concentrations of 10 mM up to 200 mM of salt concentrations were able to be repeatedly produced. In an ANOVA test with salt concentrations varying from 40–60 mM, a p-value of 0.365 shows that the concentration does not have any effect on the flow rate. Similarly, a p-value of 0.329 and 0.167 for different relative humidity and temperature shows that the system does not present a statistical difference. Lastly, when the interactions among all the factors were considered, a p-value of 0.416 clearly presents that the system performance is insensitive to different factors, thus validating the system reliability.