Recent Progress in Wearable Biosensors: From Healthcare Monitoring to Sports Analytics

Approaches of wearable and implantable biosensor towards of developing in precision medicine

In the relentless pursuit of precision medicine, the intersection of cutting-edge technology and healthcare has given rise to a transformative era. At the forefront of this revolution stands the burgeoning field of wearable and implantable biosensors, promising a paradigm shift in how we monitor, analyze, and tailor medical interventions. As these miniature marvels seamlessly integrate with the human body, they weave a tapestry of real-time health data, offering unprecedented insights into individual physiological landscapes. This log embarks on a journey into the realm of wearable and implantable biosensors, where the convergence of biology and technology heralds a new dawn in personalized healthcare. Here, we explore the intricate web of innovations, challenges, and the immense potential these bioelectronics sentinels hold in sculpting the future of precision medicine.

Conductive Polymer-Based Hydrogels for Wearable Electrochemical Biosensors

Hydrogels are gaining popularity for use in wearable electronics owing to their inherent biomimetic characteristics, flexible physicochemical properties, and excellent biocompatibility. Among various hydrogels, conductive polymer-based hydrogels (CP HGs) have emerged as excellent candidates for future wearable sensor designs. These hydrogels can attain desired properties through various tuning strategies extending from molecular design to microstructural configuration. However, significant challenges remain, such as the limited strain-sensing range, significant hysteresis of sensing signals, dehydration-induced functional failure, and surface/interfacial malfunction during manufacturing/processing. This review summarizes the recent developments in polymer-hydrogel-based wearable electrochemical biosensors over the past five years. Initially serving as carriers for biomolecules, polymer-hydrogel-based sensors have advanced to encompass a wider range of applications, including the development of non-enzymatic sensors facilitated by the integration of nanomaterials such as metals, metal oxides, and carbon-based materials. Beyond the numerous existing reports that primarily focus on biomolecule detection, we extend the scope to include the fabrication of nanocomposite conductive polymer hydrogels and explore their varied conductivity mechanisms in electrochemical sensing applications. This comprehensive evaluation is instrumental in determining the readiness of these polymer hydrogels for point-of-care translation and state-of-the-art applications in wearable electrochemical sensing technology.

Harnessing the role of microneedles as sensors: current status and future perspectives

In recent years, microneedles (MNs) have been transformed to serve a wide range of applications in the biomedical field. Their role as sensors in wearable devices has provided an alternative to blood-based monitoring of health and diagnostic methods. Hence, they have become a topic of research interest for several scientists working in the biomedical field. These MNs as sensors offer the continuous monitoring of biomarkers like glucose, nucleic acids, proteins, polysaccharides and electrolyte ions, which can therefore screen for and diagnose disease conditions in humans. The present review focuses on types of MN sensors and their applications. Various clinical trials and bottlenecks of MN R&D are also discussed.

Human Activity Recording Based on Skin-Strain-Actuated Microfluidic Pumping in Asymmetrically Designed Micro-Channels

The capability to record data in passive, image-based wearable sensors can simplify data readouts and eliminate the requirement for the integration of electronic components on the skin. Here, we developed a skin-strain-actuated microfluidic pump (SAMP) that utilizes asymmetric aspect ratio channels for the recording of human activity in the fluidic domain. An analytical model describing the SAMP's operation mechanism as a wearable microfluidic device was established. Fabrication of the SAMP was achieved using soft lithography from polydimethylsiloxane (PDMS). Benchtop experimental results and theoretical predictions were shown to be in good agreement. The SAMP was mounted on human skin and experiments conducted on volunteer subjects demonstrated the SAMP's capability to record human activity for hundreds of cycles in the fluidic domain through the observation of a stable liquid meniscus. Proof-of-concept experiments further revealed that the SAMP could quantify a single wrist activity repetition or distinguish between three different shoulder activities.

Innovative Material-Based Wearable Non-Invasive Electrochemical Sweat Sensors towards Biomedical Applications

Sweat is an accessible biofluid that provides useful physiological information about the body's biomolecular state and systemic health. Wearable sensors possess various advantageous features, such as lightweight design, wireless connectivity, and compatibility with human skin, that make them suitable for continuous monitoring. Wearable electrochemical sweat sensors can diagnose diseases and monitor health conditions by detecting biomedical signal changes in sweat. This paper discusses the state-of-the-art research in the field of wearable sweat sensors and the materials used in their construction. It covers biomarkers present in sweat, sensing modalities, techniques for sweat collection, and ways to power these sensors. Innovative materials are categorized into three subcategories: sweat collection, sweat detection, and self-powering. These include substrates for sensor fabrication, analyte detection electrodes, absorbent patches, microfluidic devices, and self-powered devices. This paper concludes by forecasting future research trends and prospects in material-based wearable non-invasive sweat sensors.

Wearable Biosensor Technology in Education: A Systematic Review

Wearable Biosensor Technology (WBT) has emerged as a transformative tool in the educational system over the past decade. This systematic review encompasses a comprehensive analysis of WBT utilization in educational settings over a 10-year span (2012-2022), highlighting the evolution of this field to address challenges in education by integrating technology to solve specific educational challenges, such as enhancing student engagement, monitoring stress and cognitive load, improving learning experiences, and providing real-time feedback for both students and educators. By exploring these aspects, this review sheds light on the potential implications of WBT on the future of learning. A rigorous and systematic search of major academic databases, including Google Scholar and Scopus, was conducted in accordance with the PRISMA guidelines. Relevant studies were selected based on predefined inclusion and exclusion criteria. The articles selected were assessed for methodological quality and bias using established tools. The process of data extraction and synthesis followed a structured framework. Key findings include the shift from theoretical exploration to practical implementation, with EEG being the predominant measurement, aiming to explore mental states, physiological constructs, and teaching effectiveness. Wearable biosensors are significantly impacting the educational field, serving as an important resource for educators and a tool for students. Their application has the potential to transform and optimize academic practices through sensors that capture biometric data, enabling the implementation of metrics and models to understand the development and performance of students and professors in an academic environment, as well as to gain insights into the learning process.

Attributes, Methods, and Frameworks Used to Evaluate Wearables and Their Companion mHealth Apps: Scoping Review

BACKGROUND

Wearable devices, mobile technologies, and their combination have been accepted into clinical use to better assess the physical fitness and quality of life of patients and as preventive measures. Usability is pivotal for overcoming constraints and gaining users' acceptance of technology such as wearables and their companion mobile health (mHealth) apps. However, owing to limitations in design and evaluation, interactive wearables and mHealth apps have often been restricted from their full potential.

OBJECTIVE

This study aims to identify studies that have incorporated wearable devices and determine their frequency of use in conjunction with mHealth apps or their combination. Specifically, this study aims to understand the attributes and evaluation techniques used to evaluate usability in the health care domain for these technologies and their combinations.

METHODS

We conducted an extensive search across 4 electronic databases, spanning the last 30 years up to December 2021. Studies including the keywords "wearable devices," "mobile apps," "mHealth apps," "physiological data," "usability," "user experience," and "user evaluation" were considered for inclusion. A team of 5 reviewers screened the collected publications and charted the features based on the research questions. Subsequently, we categorized these characteristics following existing usability and wearable taxonomies. We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist.

RESULTS

A total of 382 reports were identified from the search strategy, and 68 articles were included. Most of the studies (57/68, 84%) involved the simultaneous use of wearables and connected mobile apps. Wrist-worn commercial consumer devices such as wristbands were the most prevalent, accounting for 66% (45/68) of the wearables identified in our review. Approximately half of the data from the medical domain (32/68, 47%) focused on studies involving participants with chronic illnesses or disorders. Overall, 29 usability attributes were identified, and 5 attributes were frequently used for evaluation: satisfaction (34/68, 50%), ease of use (27/68, 40%), user experience (16/68, 24%), perceived usefulness (18/68, 26%), and effectiveness (15/68, 22%). Only 10% (7/68) of the studies used a user- or human-centered design paradigm for usability evaluation.

CONCLUSIONS

Our scoping review identified the types and categories of wearable devices and mHealth apps, their frequency of use in studies, and their implementation in the medical context. In addition, we examined the usability evaluation of these technologies: methods, attributes, and frameworks. Within the array of available wearables and mHealth apps, health care providers encounter the challenge of selecting devices and companion apps that are effective, user-friendly, and compatible with user interactions. The current gap in usability and user experience in health care research limits our understanding of the strengths and limitations of wearable technologies and their companion apps. Additional research is necessary to overcome these limitations.

Effect of Protection Polymer Coatings on the Performance of an Amperometric Galactose Biosensor in Human Plasma

Galactose monitoring in individuals allows the prevention of harsh health conditions related to hereditary metabolic diseases like galactosemia. Current methods of galactose detection need development to obtain cheaper, more reliable, and more specific sensors. Enzyme-containing amperometric sensors based on galactose oxidase activity are a promising approach, which can be enhanced by means of their inclusion in a redox polymer coating. This strategy simultaneously allows the immobilization of the biocatalyst to the electroactive surface and hosts the electron shuttling units. An additional deposition of capping polymers prevents external interferences like ascorbic or uric acid as well as biofouling when measuring in physiological fuels. This work studies the protection effect of poly(2-methacryloyloxyethyl phosphorylcholine-co-glycidyl methacrylate (MPC) and polyvinylimidazole-polysulfostyrene (P(VI-SS)) when incorporated in the biosensor design for the detection of galactose in human plasma.

Microneedle Sensors for Point-of-Care Diagnostics

Point-of-care (POC) has the capacity to support low-cost, accurate and real-time actionable diagnostic data. Microneedle sensors have received considerable attention as an emerging technique to evolve blood-based diagnostics owing to their direct and painless access to a rich source of biomarkers from interstitial fluid. This review systematically summarizes the recent innovations in microneedle sensors with a particular focus on their utility in POC diagnostics and personalized medicine. The integration of various sensing techniques, mostly electrochemical and optical sensing, has been established in diverse architectures of "lab-on-a-microneedle" platforms. Microneedle sensors with tailored geometries, mechanical flexibility, and biocompatibility are constructed with a variety of materials and fabrication methods. Microneedles categorized into four types: metals, inorganics, polymers, and hydrogels, have been elaborated with state-of-the-art bioengineering strategies for minimally invasive, continuous, and multiplexed sensing. Microneedle sensors have been employed to detect a wide range of biomarkers from electrolytes, metabolites, polysaccharides, nucleic acids, proteins to drugs. Insightful perspectives are outlined from biofluid, microneedles, biosensors, POC devices, and theragnostic instruments, which depict a bright future of the upcoming personalized and intelligent health management.

Nanobiosensors: Concepts and Emerging Clinical Applications

Biosensors have been one of the most fascinating topics for scientists for a long time. This is because biological moieties are multifaceted and are unswervingly related to the presence of a healthy atmosphere. The biosensor approach has also endured profound changes in recent years. Biosensors have been emphasized for various applications, including food quality estimation, surveillance systems, and health and metabolic abnormality diagnostics. The advances in nanotechnology have led to a considerable potential to enhance biosensors' sensitivity, robustness, and anti-interference capabilities. Several new nanomaterials (such as nanoparticles, nanotubes, nanorods, and nanowires) have been fabricated due to the evolution of nanotechnology, and their unique features are gradually being identified, allowing for much faster detection and reproducibility. Biosensor performance has also been enhanced substantially as a result of their use. Because of their capacity to detect a wide range of compounds at deficient concentrations, nanobiosensors have sparked much interest. This article discusses biosensors based on various nanomaterials, their evolution, accompanying features, and their applications in multiple fields.

Simultaneous detection of urea and lactate in sweat based on a wearable sweat biosensor

Urea and lactate are biomarkers in sweat that is closely associated with human health. This study introduces portable, rapid, sensitive, stable, and high-throughput wearable sweat biosensors utilizing Au-Ag nanoshuttles (Au-Ag NSs) for the simultaneous detection of sweat urea and lactate. The Au-Ag NSs arrays within the biosensor's microfluidic cavity provide a substantial surface-enhanced Raman scattering (SERS) enhancement effect. The limit of detection (LOD) for urea and lactate are 2.35 × 10-6 and 8.66 × 10-7 mol/L, respectively. This wearable sweat biosensor demonstrates high resistance to compression bending, repeatability, and stability and can be securely attached to various body parts. Real-time sweat analysis of volunteers wearing the biosensors during exercise demonstrated the method's practicality. This wearable sweat biosensor holds significant potential for monitoring sweat dynamics and serves as a valuable tool for assessing bioinformation in sweat.

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.

Recent advances in nanobiosensors for sustainable healthcare applications: A systematic literature review

The need for novel healthcare treatments and drugs has increased due to the expanding human population, detection of newer diseases, and looming pandemics. The development of nanotechnology offers a platform for cutting-edge in vivo non-invasive monitoring and point-of-care-testing (POCT) for rehabilitative disease detection and management. The advancement and uses of nanobiosensors are currently becoming more common in a variety of scientific fields, such as environmental monitoring, food safety, biomedical, clinical, and sustainable healthcare sciences, since the advent of nanotechnology. The identification and detection of biological patterns connected to any type of disease (communicable or not) have been made possible in recent years by several sensing techniques utilizing nanotechnology concerning biosensors and nanobiosensors. In this work, 2218 articles are drawn and screened from six digital databases out of which 17 were shortlisted for this review by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) technique. As a result, this study uses a systematic methodology to review some recently developed extremely sensitive nanobiosensors, along with their biomedical, point-of-care diagnostics (POCD), or healthcare applications and their capabilities, particularly for the prediction of some fatal diseases based on a few of the most recent publications. The potential of nanobiosensors for medicinal, therapeutic, or other sustainable healthcare applications, notably for ailments diagnostics, is also recognized as a way forward in the manifestation of future trends.

Diagnostic Accuracy of Single-Lead Electrocardiograms Using the Kardia Mobile App and the Apple Watch 4: Validation Study

BACKGROUND

To date, the 12-lead electrocardiogram (ECG) is the gold standard for cardiological diagnosis in clinical settings. With the advancements in technology, a growing number of smartphone apps and gadgets for recording, visualizing, and evaluating physical performance as well as health data is available. Although this new smart technology is innovative and time- and cost-efficient, less is known about its diagnostic accuracy and reliability.

OBJECTIVE

This study aimed to examine the agreement between the mobile single-lead ECG measurements of the Kardia Mobile App and the Apple Watch 4 compared to the 12-lead gold standard ECG in healthy adults under laboratory conditions. Furthermore, it assessed whether the measurement error of the devices increases with an increasing heart rate.

METHODS

This study was designed as a prospective quasi-experimental 1-sample measurement, in which no randomization of the sampling was carried out. In total, ECGs at rest from 81 participants (average age 24.89, SD 8.58 years; n=58, 72% male) were recorded and statistically analyzed. Bland-Altman plots were created to graphically illustrate measurement differences. To analyze the agreement between the single-lead ECGs and the 12-lead ECG, Pearson correlation coefficient (r) and Lin concordance correlation coefficient (CCCLin) were calculated.

RESULTS

The results showed a higher agreement for the Apple Watch (mean deviation QT: 6.85%; QT interval corrected for heart rate using Fridericia formula [QTcF]: 7.43%) than Kardia Mobile (mean deviation QT: 9.53%; QTcF: 9.78%) even if both tend to underestimate QT and QTcF intervals. For Kardia Mobile, the QT and QTcF intervals correlated significantly with the gold standard (rQT=0.857 and rQTcF=0.727; P<.001). CCCLin corresponded to an almost complete heuristic agreement for the QT interval (0.835), whereas the QTcF interval was in the range of strong agreement (0.682). Further, for the Apple Watch, Pearson correlations were highly significant and in the range of a large effect (rQT=0.793 and rQTcF=0.649; P<.001). CCCLin corresponded to a strong heuristic agreement for both the QT (0.779) and QTcF (0.615) intervals. A small negative correlation between the measurement error and increasing heart rate could be found of each the devices and the reference.

CONCLUSIONS

Smart technology seems to be a promising and reliable approach for nonclinical health monitoring. Further research is needed to broaden the evidence regarding its validity and usability in different target groups.

Microfluidic Wearable Devices for Sports Applications

This study aimed to systematically review the application and research progress of flexible microfluidic wearable devices in the field of sports. The research team thoroughly investigated the use of life signal-monitoring technology for flexible wearable devices in the domain of sports. In addition, the classification of applications, the current status, and the developmental trends of similar products and equipment were evaluated. Scholars expect the provision of valuable references and guidance for related research and the development of the sports industry. The use of microfluidic detection for collecting biomarkers can mitigate the impact of sweat on movements that are common in sports and can also address the issue of discomfort after prolonged use. Flexible wearable gadgets are normally utilized to monitor athletic performance, rehabilitation, and training. Nevertheless, the research and development of such devices is limited, mostly catering to professional athletes. Devices for those who are inexperienced in sports and disabled populations are lacking. Conclusions: Upgrading microfluidic chip technology can lead to accurate and safe sports monitoring. Moreover, the development of multi-functional and multi-site devices can provide technical support to athletes during their training and competitions while also fostering technological innovation in the field of sports science.

Electrochemical Wearable Biosensors and Bioelectronic Devices Based on Hydrogels: Mechanical Properties and Electrochemical Behavior

Hydrogel-based wearable electrochemical biosensors (HWEBs) are emerging biomedical devices that have recently received immense interest. The exceptional properties of HWEBs include excellent biocompatibility with hydrophilic nature, high porosity, tailorable permeability, the capability of reliable and accurate detection of disease biomarkers, suitable device-human interface, facile adjustability, and stimuli responsive to the nanofiller materials. Although the biomimetic three-dimensional hydrogels can immobilize bioreceptors, such as enzymes and aptamers, without any loss in their activities. However, most HWEBs suffer from low mechanical strength and electrical conductivity. Many studies have been performed on emerging electroactive nanofillers, including biomacromolecules, carbon-based materials, and inorganic and organic nanomaterials, to tackle these issues. Non-conductive hydrogels and even conductive hydrogels may be modified by nanofillers, as well as redox species. All these modifications have led to the design and development of efficient nanocomposites as electrochemical biosensors. In this review, both conductive-based and non-conductive-based hydrogels derived from natural and synthetic polymers are systematically reviewed. The main synthesis methods and characterization techniques are addressed. The mechanical properties and electrochemical behavior of HWEBs are discussed in detail. Finally, the prospects and potential applications of HWEBs in biosensing, healthcare monitoring, and clinical diagnostics are highlighted.

Nanostructured wearable electrochemical and biosensor towards healthcare management: a review

In recent years, there has been a rapid increase in demand for wearable sensors, particularly these tracking the surroundings, fitness, and health of people. Thus, selective detection in human body fluid is a demand for a smart lifestyle by quick monitoring of electrolytes, drugs, toxins, metabolites and biomolecules, proteins, and the immune system. In this review, these parameters along with the main features of the latest and mostly cited research work on nanostructured wearable electrochemical and biosensors are surveyed. This study aims to help researchers and engineers choose the most suitable selective and sensitive sensor. Wearable sensors have broad and effective sensing platforms, such as contact lenses, Google Glass, skin-patch, mouth gourds, smartwatches, underwear, wristbands, and others. For increasing sensor reliability, additional advancements in electrochemical and biosensor precision, stability in uncontrolled environments, and reproducible sample conveyance are necessary. In addition, the optimistic future of wearable electrochemical sensors in fields, such as remote and customized healthcare and well-being is discussed. Overall, wearable electrochemical and biosensing technologies hold great promise for improving personal healthcare and monitoring performance with the potential to have a significant impact on daily lives. These technologies enable real-time body sensing and the communication of comprehensive physiological information.

The Use of Wearable Inertial Sensors and Workplace-Based Exercises to Reduce Lateral Epicondylitis in the Workstation of a Textile Logistics Center

People whose jobs involve repetitive motions of the wrist and forearm can suffer from lateral epicondylitis, which is a significant burden on both the individual and the employer due to treatment costs, reduced productivity, and work absenteeism. This paper describes an ergonomic intervention to reduce lateral epicondylitis in the workstation of a textile logistics center. The intervention includes workplace-based exercise programs, evaluation of risk factors, and movement correction. An injury- and subject-specific score was calculated from the motion captured with wearable inertial sensors at the workplace to evaluate the risk factors of 93 workers. Then, a new working movement was adapted to the workplace, which limited the observed risk factors and took into account the subject-specific physical abilities. The movement was taught to the workers during personalized sessions. The risk factors of 27 workers were evaluated again after the intervention to validate the effectiveness of the movement correction. In addition, active warm-up and stretching programs were introduced as part of the workday to promote muscle endurance and improve resistance to repetitive stress. The present strategy offered good results at low cost, without any physical modification of the workplace and without any detriment to productivity.

Advances in Integration, Wearable Applications, and Artificial Intelligence of Biomedical Microfluidics Systems

Microfluidics attracts much attention due to its multiple advantages such as high throughput, rapid analysis, low sample volume, and high sensitivity. Microfluidics has profoundly influenced many fields including chemistry, biology, medicine, information technology, and other disciplines. However, some stumbling stones (miniaturization, integration, and intelligence) strain the development of industrialization and commercialization of microchips. The miniaturization of microfluidics means fewer samples and reagents, shorter times to results, and less footprint space consumption, enabling a high throughput and parallelism of sample analysis. Additionally, micro-size channels tend to produce laminar flow, which probably permits some creative applications that are not accessible to traditional fluid-processing platforms. The reasonable integration of biomedical/physical biosensors, semiconductor microelectronics, communications, and other cutting-edge technologies should greatly expand the applications of current microfluidic devices and help develop the next generation of lab-on-a-chip (LOC). At the same time, the evolution of artificial intelligence also gives another strong impetus to the rapid development of microfluidics. Biomedical applications based on microfluidics normally bring a large amount of complex data, so it is a big challenge for researchers and technicians to analyze those huge and complicated data accurately and quickly. To address this problem, machine learning is viewed as an indispensable and powerful tool in processing the data collected from micro-devices. In this review, we mainly focus on discussing the integration, miniaturization, portability, and intelligence of microfluidics technology.

Non-invasive in-vivo glucose-based stress monitoring in plants

Plant stress responses involve a suite of genetically encoded mechanisms triggered by real-time interactions with their surrounding environment. Although sophisticated regulatory networks maintain proper homeostasis to prevent damage, the tolerance thresholds to these stresses vary significantly among organisms. Current plant phenotyping techniques and observables must be better suited to characterize the real-time metabolic response to stresses. This impedes practical agronomic intervention to avoid irreversible damage and limits our ability to breed improved plant organisms. Here, we introduce a sensitive, wearable electrochemical glucose-selective sensing platform that addresses these problems. Glucose is a primary plant metabolite, a source of energy produced during photosynthesis, and a critical molecular modulator of various cellular processes ranging from germination to senescence. The wearable-like technology integrates a reverse iontophoresis glucose extraction capability with an enzymatic glucose biosensor that offers a sensitivity of 22.7 nA/(μM·cm²), a limit of detection (LOD) of 9.4 μM, and a limit of quantification (LOQ) of 28.5 μM. The system's performance was validated by subjecting three different plant models (sweet pepper, gerbera, and romaine lettuce) to low-light and low-high temperature stresses and demonstrating critical differential physiological responses associated with their glucose metabolism. This technology enables non-invasive, non-destructive, real-time, in-situ, and in-vivo identification of early stress response in plants and provides a unique tool for timely agronomic management of crops and improving breeding strategies based on the dynamics of genome-metabolome-phenome relationships.

Bioluminescent-Triple-Enzyme-Based Biosensor with Lactate Dehydrogenase for Non-Invasive Training Load Monitoring

Saliva is one of the most significant biological liquids for the development of a simple, rapid, and non-invasive biosensor for training load diagnostics. There is an opinion that enzymatic bioassays are more relevant in terms of biology. The present paper is aimed at investigating the effects of saliva samples, upon altering the lactate content, on the activity of a multi-enzyme, namely lactate dehydrogenase + NAD(P)H:FMN-oxidoreductase + luciferase (LDH + Red + Luc). Optimal enzymes and their substrate composition of the proposed multi-enzyme system were chosen. During the tests of the lactate dependence, the enzymatic bioassay showed good linearity to lactate in the range from 0.05 mM to 0.25 mM. The activity of the LDH + Red + Luc enzyme system was tested in the presence of 20 saliva samples taken from students whose lactate levels were compared by the Barker and Summerson colorimetric method. The results showed a good correlation. The proposed LDH + Red + Luc enzyme system could be a useful, competitive, and non-invasive tool for correct and rapid monitoring of lactate in saliva. This enzyme-based bioassay is easy to use, rapid, and has the potential to deliver point-of-care diagnostics in a cost-effective manner.

High-Figure-of-Merit Biosensing and Enhanced Excitonic Absorption in an MoS2-Integrated Dielectric Metasurface

Among the transitional metal dichalcogenides (TMDCs), molybdenum disulfide (MoS₂) is considered an outstanding candidate for biosensing applications due to its high absorptivity and amenability to ionic current measurements. Dielectric metasurfaces have also emerged as a powerful platform for novel optical biosensing due to their low optical losses and strong near-field enhancements. Once functionalized with TMDCs, dielectric metasurfaces can also provide strong photon-exciton interactions. Here, we theoretically integrated a single layer of MoS₂ into a CMOS-compatible asymmetric dielectric metasurface composed of TiO₂ meta-atoms with a broken in-plane inversion symmetry on an SiO₂ substrate. We numerically show that the designed MoS₂-integrated metasurface can function as a high-figure-of-merit (FoM=137.5 RIU-1) van der Waals-based biosensor due to the support of quasi-bound states in the continuum. Moreover, owing to the critical coupling of the magnetic dipole resonances of the metasurface and the A exciton of the single layer of MoS₂, one can achieve a 55% enhanced excitonic absorption by this two-port system. Therefore, the proposed design can function as an effective biosensor and is also practical for enhanced excitonic absorption and emission applications.

Novel Wearable Optical Sensors for Vital Health Monitoring Systems-A Review

Wearable sensors are pioneering devices to monitor health issues that allow the constant monitoring of physical and biological parameters. The immunity towards electromagnetic interference, miniaturization, detection of nano-volumes, integration with fiber, high sensitivity, low cost, usable in harsh environments and corrosion-resistant have made optical wearable sensor an emerging sensing technology in the recent year. This review presents the progress made in the development of novel wearable optical sensors for vital health monitoring systems. The details of different substrates, sensing platforms, and biofluids used for the detection of target molecules are discussed in detail. Wearable technologies could increase the quality of health monitoring systems at a nominal cost and enable continuous and early disease diagnosis. Various optical sensing principles, including surface-enhanced Raman scattering, colorimetric, fluorescence, plasmonic, photoplethysmography, and interferometric-based sensors, are discussed in detail for health monitoring applications. The performance of optical wearable sensors utilizing two-dimensional materials is also discussed. Future challenges associated with the development of optical wearable sensors for point-of-care applications and clinical diagnosis have been thoroughly discussed.

Stimulated Parotid Saliva Is a Better Method for Depression Prediction

Background: Saliva cortisol is considered to be a biomarker of depression prediction. However, saliva collection methods can affect the saliva cortisol level. Objective: This study aims to determine the ideal saliva collection method and explore the application value of saliva cortisol in depression prediction. Methods: 30 depressed patients and 30 healthy controls were instructed to collect saliva samples in the morning with six collection methods. Simultaneous venous blood was collected. Enzyme-linked immunosorbent assay was used to determine the cortisol level. The 24-observerrated Hamilton depression rating scale (HAMD-24) was used to assess the severity of depression. Results: The significant differences in saliva cortisol levels depend on the saliva collection methods. The level of unstimulated whole saliva cortisol was most correlated with blood (r = 0.91). The stimulated parotid saliva cortisol can better predict depression. The area under the curve was 0.89. In addition, the saliva cortisol level of the depression patients was significantly higher than the healthy controls. The correlation between the cortisol level and the HAMD-24 score was highly significant. The higher the saliva cortisol level, the higher the HAMD-24 score. Conclusions: All the above findings point to an exciting opportunity for non-invasive monitoring of cortisol through saliva.

Smart Consumer Wearables as Digital Diagnostic Tools: A Review

The increasing usage of smart wearable devices has made an impact not only on the lifestyle of the users, but also on biological research and personalized healthcare services. These devices, which carry different types of sensors, have emerged as personalized digital diagnostic tools. Data from such devices have enabled the prediction and detection of various physiological as well as psychological conditions and diseases. In this review, we have focused on the diagnostic applications of wrist-worn wearables to detect multiple diseases such as cardiovascular diseases, neurological disorders, fatty liver diseases, and metabolic disorders, including diabetes, sleep quality, and psychological illnesses. The fruitful usage of wearables requires fast and insightful data analysis, which is feasible through machine learning. In this review, we have also discussed various machine-learning applications and outcomes for wearable data analyses. Finally, we have discussed the current challenges with wearable usage and data, and the future perspectives of wearable devices as diagnostic tools for research and personalized healthcare domains.

Laser-Induced Graphene-Based Wearable Epidermal Ion-Selective Sensors for Noninvasive Multiplexed Sweat Analysis

Wearable sweat sensors are a rapidly rising research area owing to their convenience for personal healthcare and disease diagnosis in a real-time and noninvasive manner. However, the fast and scalable fabrication of flexible electrodes remains a major challenge. Here, we develop a wearable epidermal sensor for multiplexed sweat analysis based on the laser-induced graphene (LIG) technique. This simple and mask-free technique allows the direct manufacturing of graphene electrode patterns on commercial polyimide foils. The resulting LIG devices can simultaneously monitor the pH, Na⁺, and K⁺ levels in sweat with the sensitivities of 51.5 mV/decade (pH), 45.4 mV/decade (Na⁺), and 43.3 mV/decade (K⁺), respectively. Good reproducibility, stability, and selectivity are also observed. On-body testing of the LIG-based sensor integrated with a flexible printed circuit board during stationary cycling demonstrates its capability for real-time sweat analysis. The concentrations of ions can be remotely and wirelessly transmitted to a custom-developed smartphone application during the period in which the sensor user performs physical activities. Owing to the unique advantages of LIG technique, including facile fabrication, mass production, and versatile, more physiological signals (glucose, uric acid, tyrosine, etc.) could be easily expanded into the LIG-based wearable sensors to reflect the health status or clinical needs of individuals.

Skin Pigmentation Influence on Pulse Oximetry Accuracy: A Systematic Review and Bibliometric Analysis

Nowadays, pulse oximetry has become the standard in primary and intensive care units, especially as a triage tool during the current COVID-19 pandemic. Hence, a deeper understanding of the measurement errors that can affect precise readings is a key element in clinical decision-making. Several factors may influence the accuracy of pulse oximetry, such as skin color, body temperature, altitude, or patient movement. The skin pigmentation effect on pulse oximetry accuracy has long been studied reporting some contradictory conclusions. Recent studies have shown a positive bias in oxygen saturation measurements in patients with darkly pigmented skin, particularly under low saturation conditions. This review aims to study the literature that assesses the influence of skin pigmentation on the accuracy of these devices. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to conduct a systematic review retrospectively since February 2022 using WOS, PubMed, and Scopus databases. We found 99 unique references, of which only 41 satisfied the established inclusion criteria. A bibliometric and scientometrics approach was performed to examine the outcomes of an exhaustive survey of the thematic content and trending topics.

Wearable microfluidic-based e-skin sweat sensors

Electronic skins (e-skins) are soft (deformable and stretchable) state-of-the-art wearable devices that emulate the attributes of human skin and act as a Human-Machine Interface (HMI). Recent advances in e-skin for real-time detection of medical signals such as pulse, temperature, electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG), electrocardiogram (ECG), and other bioelectric signals laid down an intelligent foundation for early prediction and diagnosis of diseases with a motive of reducing the risk of the ailment reaching to the end stage. In particular, sweat testing has been employed in diverse applications ranging from medical diagnosis of diabetes, cystic fibrosis, tuberculosis, blood pressure, and autonomic neuropathy to evaluating fluid and electrolyte balance in athletes. Typically, sweat testing techniques are done by trained experts and require off-body measurements, which prevent individuals from de-coding health issues quickly and independently. With the onset of soft electronics, wearable sweat sensors overcome this disadvantage via in situ sweat measurements with real-time feedback, timely diagnosis, creating the potential for preventive care and treatment. Over the past few decades, wearable microfluidic-based e-skin sweat sensors have paved a new way, promising sensing interfaces that are highly compatible with arranging medical and electronic applications. The present review highlights the recent research carried out in the microfluidic-based wearable sweat sensors with a critical focus on real-time sensing of lactate, chloride, and glucose concentration; sweat rate, simultaneously with pH, and total sweat loss for preventive care, timely diagnosis, and point-of-care health and fitness monitoring.

Continuous Glucose Monitoring in Healthy Adults—Possible Applications in Health Care, Wellness, and Sports

Introduction: Continuous glucose monitoring (CGM) systems were primarily developed for patients with diabetes mellitus. However, these systems are increasingly being used by individuals who do not have diabetes mellitus. This mini review describes possible applications of CGM systems in healthy adults in health care, wellness, and sports. Results: CGM systems can be used for early detection of abnormal glucose regulation. Learning from CGM data how the intake of foods with different glycemic loads and physical activity affect glucose responses can be helpful in improving nutritional and/or physical activity behavior. Furthermore, states of stress that affect glucose dynamics could be made visible. Physical performance and/or regeneration can be improved as CGM systems can provide information on glucose values and dynamics that may help optimize nutritional strategies pre-, during, and post-exercise. Conclusions: CGM has a high potential for health benefits and self-optimization. More scientific studies are needed to improve the interpretation of CGM data. The interaction with other wearables and combined data collection and analysis in one single device would contribute to developing more precise recommendations for users.

Advanced sensor technologies and the future of work

Exposure science is fundamental to the field of occupational safety and health. The measurement of worker exposures to hazardous agents informs effective workplace risk mitigation strategies. The modern era of occupational exposure measurement began with the invention of the personal sampling device, which is still widely used today in the practice of occupational hygiene. Newer direct-reading sensor devices are incorporating recent advances in transducers, nanomaterials, electronics miniaturization, portability, batteries with high-power density, wireless communication, energy-efficient microprocessing, and display technology to usher in a new era in exposure science. Commercial applications of new sensor technologies have led to a variety of health and lifestyle management devices for everyday life. These applications are also being investigated as tools to measure occupational and environmental exposures. As the next-generation placeable, wearable, and implantable sensor technologies move from the research laboratory to the workplace, their role in the future of work will be of increasing importance to employers, workers, and occupational safety and health researchers and practitioners. This commentary discusses some of the benefits and challenges of placeable, wearable, and implantable sensor technologies in the future of work.

Applicability of Physiological Monitoring Systems within Occupational Groups: A Systematic Review

The emergence of physiological monitoring technologies has produced exceptional opportunities for real-time collection and analysis of workers' physiological information. To benefit from these safety and health prognostic opportunities, research efforts have explored the applicability of these devices to control workers' wellbeing levels during occupational activities. A systematic review is proposed to summarise up-to-date progress in applying physiological monitoring systems for occupational groups. Adhering with the PRISMA Statement, five databases were searched from 2014 to 2021, and 12 keywords were combined, concluding with the selection of 38 articles. Sources of risk of bias were assessed regarding randomisation procedures, selective outcome reporting and generalisability of results. Assessment procedures involving non-invasive methods applied with health and safety-related goals were filtered. Working-age participants from homogeneous occupational groups were selected, with these groups primarily including firefighters and construction workers. Research objectives were mainly directed to assess heat stress and physiological workload demands. Heart rate related variables, thermal responses and motion tracking through accelerometry were the most common approaches. Overall, wearable sensors proved to be valid tools for assessing physiological status in working environments. Future research should focus on conducting sensor fusion assessments, engaging wearables in real-time evaluation methods and giving continuous feedback to workers and practitioners.

Oxygen Saturation Behavior by Pulse Oximetry in Female Athletes: Breaking Myths

The myths surrounding women’s participation in sport have been reflected in respiratory physiology. This study aims to demonstrate that continuous monitoring of blood oxygen saturation during a maximal exercise test in female athletes is highly correlated with the determination of the second ventilatory threshold (VT2) or anaerobic threshold (AnT). The measurements were performed using a pulse oximeter during a maximum effort test on a treadmill on a population of 27 healthy female athletes. A common behavior of the oxygen saturation evolution during the incremental exercise test characterized by a decrease in saturation before the aerobic threshold (AeT) followed by a second significant drop was observed. Decreases in peripheral oxygen saturation during physical exertion have been related to the athlete’s physical fitness condition. However, this drop should not be a limiting factor in women’s physical performance. We found statistically significant correlations between the maximum oxygen uptake and the appearance of the ventilatory thresholds (VT1 and VT2), the desaturation time, the total test time, and between the desaturation time and the VT2. We observed a relationship between the desaturation time and the VT2 appearance. Indeed, a linear regression model between the desaturation time and the VT2 appearance can predict 80% of the values in our sample. Besides, we suggest that pulse oximetry is a simple, fairly accurate, and non-invasive technique for studying the physical condition of athletes who perform physical exertion.

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.

Substrate Materials for Biomolecular Immobilization within Electrochemical Biosensors

Electrochemical biosensors have potential applications for agriculture, food safety, environmental monitoring, sports medicine, biomedicine, and other fields. One of the primary challenges in this field is the immobilization of biomolecular probes atop a solid substrate material with adequate stability, storage lifetime, and reproducibility. This review summarizes the current state of the art for covalent bonding of biomolecules onto solid substrate materials. Early research focused on the use of Au electrodes, with immobilization of biomolecules through ω-functionalized Au-thiol self-assembled monolayers (SAMs), but stability is usually inadequate due to the weak Au-S bond strength. Other noble substrates such as C, Pt, and Si have also been studied. While their nobility has the advantage of ensuring biocompatibility, it also has the disadvantage of making them relatively unreactive towards covalent bond formation. With the exception of Sn-doped In2O3 (indium tin oxide, ITO), most metal oxides are not electrically conductive enough for use within electrochemical biosensors. Recent research has focused on transition metal dichalcogenides (TMDs) such as MoS2 and on electrically conductive polymers such as polyaniline, polypyrrole, and polythiophene. In addition, the deposition of functionalized thin films from aryldiazonium cations has attracted significant attention as a substrate-independent method for biofunctionalization.

Biomedical Applications of Electromagnetic Detection: A Brief Review

This paper presents a review on the biomedical applications of electromagnetic detection in recent years. First of all, the thermal, non-thermal, and cumulative thermal effects of electromagnetic field on organism and their biological mechanisms are introduced. According to the electromagnetic biological theory, the main parameters affecting electromagnetic biological effects are frequency and intensity. This review subsequently makes a brief review about the related biomedical application of electromagnetic detection and biosensors using frequency as a clue, such as health monitoring, food preservation, and disease treatment. In addition, electromagnetic detection in combination with machine learning (ML) technology has been used in clinical diagnosis because of its powerful feature extraction capabilities. Therefore, the relevant research involving the application of ML technology to electromagnetic medical images are summarized. Finally, the future development to electromagnetic detection for biomedical applications are presented.

Continuous Ketone Monitoring: A New Paradigm for Physiologic Monitoring

In this issue of JDST, Alva and colleagues present for the first time, development of a continuous ketone monitor (CKM) tested both in vitro and in humans. Their sensor measured betahydroxybutyrate (BHB) in interstitial fluid (ISF). The sensor was based on wired enzyme electrochemistry technology using BHB dehydrogenase. The sensor required only a single retrospective calibration without a need for further adjustments over 14 days. The device produced a linear response over the 0-8 mM range with good accuracy. This novel CKM could provide a new dimension of useful automatically collected information for managing diabetes. Passively collected ISF ketone information would be useful for predicting and managing ketoacidosis in patients with type 1 diabetes, as well as other states of abnormal ketonemia. Although additional studies of this CKM will be required to assess performance in intended patient populations and prospective factory calibration will be required to support real time measurements, this novel monitor has the potential to greatly improve outcomes for people with diabetes. In the future, a CKM might be integrated with a continuous glucose monitor in the same sensor platform.

Accurate Monitoring of Parkinson's Disease Symptoms With a Wearable Device During COVID-19 Pandemic

BACKGROUND

Accurate assessment of symptoms in Parkinson's disease (PD) is essential for optimal treatment decisions. During the past few years, different monitoring modalities have started to be used in the everyday clinical practice, mainly for the evaluation of motor symptoms. However, monitoring technologies for PD have not yet gained wide acceptance among physicians, patients, and caregivers. The COVID-19 pandemic disrupted the patients' access to healthcare, bringing to the forefront the need for wearable sensors, which provide effective remote symptoms' evaluation and follow-up.

CASE REPORT

We report two cases with PD, whose symptoms were monitored with a new wearable CE-marked system (PDMonitor^®), enabling appropriate treatment modifications.

CONCLUSION

Objective assessment of the patient's motor symptoms in his daily home environment is essential for an accurate monitoring in PD and enhances treatment decisions.

Energy Solutions for Wearable Sensors: A Review

Wearable sensors have gained popularity over the years since they offer constant and real-time physiological information about the human body. Wearable sensors have been applied in a variety of ways in clinical settings to monitor health conditions. These technologies require energy sources to carry out their projected functionalities. In this paper, we review the main energy sources used to power wearable sensors. These energy sources include batteries, solar cells, biofuel cells, supercapacitors, thermoelectric generators, piezoelectric and triboelectric generators, and radio frequency (RF) energy harvesters. Additionally, we discuss wireless power transfer and some hybrids of the above technologies. The advantages and drawbacks of each technology are considered along with the system components and attributes that make these devices function effectively. The objective of this review is to inform researchers about the latest developments in this field and present future research opportunities.

Wearable Sensors in Sports for Persons with Disability: A Systematic Review

The interest and competitiveness in sports for persons with disabilities has increased significantly in the recent years, creating a demand for technological tools supporting practice. Wearable sensors offer non-invasive, portable and overall convenient ways to monitor sports practice. This systematic review aims at providing current evidence on the application of wearable sensors in sports for persons with disability. A search for articles published in English before May 2020 was performed on Scopus, Web-Of-Science, PubMed and EBSCO databases, searching titles, abstracts and keywords with a search string involving terms regarding wearable sensors, sports and disability. After full paper screening, 39 studies were included. Inertial and EMG sensors were the most commonly adopted wearable technologies, while wheelchair sports were the most investigated. Four main target applications of wearable sensors relevant to sports for people with disability were identified and discussed: athlete classification, injury prevention, performance characterization for training optimization and equipment customization. The collected evidence provides an overview on the application of wearable sensors in sports for persons with disability, providing useful indication for researchers, coaches and trainers. Several gaps in the different target applications are highlighted altogether with recommendation on future directions.