Cross-Cultural Validation of the TeamSTEPPS Teamwork Perceptions Questionnaire-Spanish in Colombia.

BACKGROUND: Teamwork influences health care quality and patient safety. Yet, validated instruments for assessing teamwork in Colombia are lacking. PURPOSE: The purpose of this study was to validate the Spanish version of the TeamSTEPPS-Teamwork Perceptions Questionnaire (T-TPQ-S) for the Colombian health care context. METHODS: The T-TPQ-S underwent translation, cultural adaptation, and comprehensive psychometric testing, including reliability and confirmatory factor analyses and item difficulty and discrimination analyses. RESULTS: The T-TPQ-S demonstrated high internal consistency and excellent fit to the theoretical model. Item discrimination was within expected ranges, with response thresholds displaying an ascending order. The tool better differentiated subjects with low and high teamwork perceptions. CONCLUSIONS: The T-TPQ-S is an effective, reliable, and valid instrument for assessing teamwork perception among Colombian health care workers.

Functional composites by programming entropy-driven nanosheet growth.

Nanomaterials must be systematically designed to be technologically viable1-5. Driven by optimizing intermolecular interactions, current designs are too rigid to plug in new chemical functionalities and cannot mitigate condition differences during integration6,7. Despite extensive optimization of building blocks and treatments, accessing nanostructures with the required feature sizes and chemistries is difficult. Programming their growth across the nano-to-macro hierarchy also remains challenging, if not impossible8-13. To address these limitations, we should shift to entropy-driven assemblies to gain design flexibility, as seen in high-entropy alloys, and program nanomaterial growth to kinetically match target feature sizes to the mobility of the system during processing14-17. Here, following a micro-then-nano growth sequence in ternary composite blends composed of block-copolymer-based supramolecules, small molecules and nanoparticles, we successfully fabricate high-performance barrier materials composed of more than 200 stacked nanosheets (125 nm sheet thickness) with a defect density less than 0.056 µm-2 and about 98% efficiency in controlling the defect type. Contrary to common perception, polymer-chain entanglements are advantageous to realize long-range order, accelerate the fabrication process (<30 min) and satisfy specific requirements to advance multilayered film technology3,4,18. This study showcases the feasibility, necessity and unlimited opportunities to transform laboratory nanoscience into nanotechnology through systems engineering of self-assembly.

Home-Made, Self-Powered, Skin-Attachable Sensing Platform for Diverse Vital Sign Monitoring.

Wearable electronic sensors that can perform real-time, continuous, and high-fidelity monitoring of diverse biophysical signals from the human body are burgeoning and exhibit great potential to transform traditional clinical healthcare. However, such emerging devices often suffer from strict requirements of special precursor materials and sophisticated fabrication procedures. Here, we present a new paradigm of a self-powered, skin-attachable, and multifunctional sensing platform that can be fully created just at home with daily necessities. Its operating mechanism is based on mechanical/thermal regulation of the potential difference output of a primary electrochemical cell. This proposed sensing platform is totally self-powered and can be conformally attached to the skin for continuous monitoring of both mechanical and thermal stimulations. A wide spectrum of vital physiological signs of the human body, including body temperature, heart/pulse rate, respiratory rate, coughing, and body motions, can be continuously monitored and analyzed with this home-made sensing platform. This study demonstrates that the lab-conducted professional and expensive scientific research can also be accomplished at home, opening up new opportunities for home-centered healthcare in low-resource environments. Moreover, this work can serve as a handy and cost-efficient prototype for classroom education and clinical training purposes.

Caterpillar traps: A highly flexible, distributed system of toroidal cable traps.

PURPOSE: Coil arrays are connected to the main MRI system with long, shielded coaxial cables. RF coupling of these cables to the main transmit coil can cause high shield currents, which pose risks of heating and RF burns. High-blocking resonant RF traps are placed at distinct positions along cables to mitigate these currents. Traditional traps are designed to be stiff to avoid changes in their resonant frequency, hindering the overall system flexibility. Instead of using a few high-blocking traps, we propose the use of caterpillar traps-a distributed system of small, elastic traps that cover the full length of cables. METHODS: We leverage an array of resonant toroids as traps, forming a caterpillar-like structure whereby bending only impacts individual traps minimally. Benchtop measurements are used to determine the blocking of caterpillar traps and show their robustness to bending. We also compare an anterior array system cable covered with caterpillar traps to a commercial cable with B1 + and heating measurements. RESULTS: Benchtop experiments with caterpillar traps demonstrate high robustness to bending. B1 + mapping experiments of an anterior array cable show improved blocking and flexibility compared to a commercial cable. CONCLUSION: Caterpillar traps provide sufficient attenuation to shield currents while allowing cable flexibility. Our distributed design can provide high blocking efficiency at different positions and orientations, even in cases where commercial cable traps cannot.

Vacuum formed coils for MRI.

PURPOSE: To describe a digital fabrication method used for custom MRI receive coils with vacuum forming and electroless copper plating. METHODS: Our process produces intricate copper traces on curved surfaces. A three-dimensional scan of a desired anatomy is obtained and used to design coil elements. The layout is predistorted with a self built simulation of the vacuum forming process and the geometric overlaps are tested with electromagnetic simulation software. The desired coil geometry is patterned onto a polycarbonate sheet by sandblasting through a tape mask. The sandblasted areas are then catalyzed with a palladium-tin solution and vacuum formed. The catalyzed, three-dimensional part is placed into a custom built plating tank and copper plated. Electronic components are attached to the copper traces to form resonant receive coils. The methods described here are demonstrated and tested with an 8 channel visual cortex coil array. RESULTS: The prototype coils exhibit quality factor ratios higher than three, indicating body noise dominance. The coil array shows high signal-to-noise ratio (SNR) near the periphery of a head shaped phantom. In vivo images with up to 0 . 37 × 0 . 37 × 0 . 67 mm 3 $$ 0.37\times 0.37\times 0.67\;{\mathrm{mm}}^3 $$ spatial resolution were acquired on a human volunteer. CONCLUSION: This work presents the first example of vacuum formed coils with direct electroless copper plating. Our fabrication method results in coil arrays that are in close proximity to the body. This methods described here may enable the rapid development of a set of coils of different sizes for applications including longitudinal fMRI studies and MR-guided therapies.

Tuning Strain Sensor Performance via Programmed Thin-Film Crack Evolution.

Stretchable strain sensors with well-controlled sensitivity and stretchability are crucial for applications ranging from large deformation monitoring to subtle vibration detection. Here, based on single-metal material on the elastomer and one-pot evaporation fabrication method, we realize controlled strain sensor performance via a novel programable cracking technology. Specifically, through elastomeric substrate surface chemistry modification, the microcrack generation and morphology evolution of the strain sensing layer is controlled. This process allows for fine tunability of the cracked film morphology, resulting in strain sensing devices with a sensitivity gauge factor of over 10 000 and stretchability up to 100%. Devices with a frequency response up to 5.2 Hz and stability higher than 1000 cycles are reported. The reported strain sensors, tracking both subtle and drastic mechanical deformations, are demonstrated in healthcare devices, human-machine interaction, and smart-home applications.

Quantitative anatomy mimicking slice phantoms.

PURPOSE: To present a reproducible methodology for building an anatomy mimicking phantom with targeted T1 and T2 contrast for use in quantitative magnetic resonance imaging. METHODS: We propose a reproducible method for creating high-resolution, quantitative slice phantoms. The phantoms are created using gels with different concentrations of NiCl2 and MnCl2 to achieve targeted T1 and T2 values. We describe a calibration method for accurately targeting anatomically realistic relaxation pairs. In addition, we developed a method of fabricating slice phantoms by extruding 3D printed walls on acrylic sheets. These procedures are combined to create a physical analog of the Brainweb digital phantom. RESULTS: With our method, we are able to target specific T1 /T2 values with less than 10% error. Additionally, our slice phantoms look realistic since their geometries are derived from anatomical data. CONCLUSION: Standardized and accurate tools for validating new techniques across sequences, platforms, and different imaging sites are important. Anatomy mimicking, multi-contrast phantoms designed with our procedures could be used for evaluating, testing, and verifying model-based methods.

A Single-Mode, Self-Adapting, and Self-Powered Mechanoreceptor Based on a Potentiometric-Triboelectric Hybridized Sensing Mechanism for Resolving Complex Stimuli.

Human skin is equipped with slow adapting (SA) and fast adapting (FA) capabilities simultaneously. To mimic such functionalities, elaborately designed devices have been explored by integrating multiple sensing elements or adopting multimode sensing principles. However, the complicated fabrication, signal mismatch of different modules, complex operation, and high power-consumption hinder their widespread applications. Here, a new type of single-mode and self-powered mechanoreceptor that can mimic both SA and FA via seamless fusion of complementary while compatible potentiometric and triboelectric sensing principles is reported. The resultant potentiometric-triboelectric hybridized mechanoreceptor exhibits distinctive features that are hard to achieve via currently existing methods, including single-mode output (only voltage signal), greatly simplified operation (single-measurement setup), ultralow power-consumption (<1 nW), self-adaptive response behavior, and good capability for resolving complex stimuli. Diverse mechanical characteristics, including magnitude, duration, frequency, applying and releasing speed, can be well interpreted with this single-mode and self-powered mechanoreceptor. Its promising application for monitoring object manipulations with a soft robotic gripper is explored. Furthermore, the versatility of the mechanoreceptor for resolving complex stimuli in diverse daily scenarios is demonstrated. This work presents a new design that will significantly simplify the fabrication/operation and meanwhile boost the functionality/energy-efficiency of future electronic devices and smart systems.

Printed, flexible, compact UHF-RFID sensor tags enabled by hybrid electronics.

Sensor data can be wirelessly transmitted from simple, battery-less tags using Radio Frequency Identification (RFID). RFID sensor tags consist of an antenna, a radio frequency integrated circuit chip (RFIC), and at least one sensor. An ideal tag can communicate over a long distance and be seamlessly integrated onto everyday objects. However, miniaturized antenna designs often have lower performance. Here we demonstrate compact, flexible sensor tags with read range comparable to that of conventional rigid tags. We compare fabrication techniques for flexible antennas and demonstrate that screen and stencil printing are both suitable for fabricating antennas; these different techniques are most useful at different points in the design cycle. We characterize two versions of flexible, screen printed folded dipoles and a meandered monopole operating in the 915 MHz band. Finally, we use these antennas to create passive sensor tags and demonstrate over the air communication of sensor data. These tags could be used to form a network of printed, flexible, passive, interactive sensor tags.

Wireless User-Generic Ear EEG.

In the past few years it has been demonstrated that electroencephalography (EEG) can be recorded from inside the ear (in-ear EEG). To open the door to low-profile earpieces as wearable brain-computer interfaces (BCIs), this work presents a practical in-ear EEG device based on multiple dry electrodes, a user-generic design, and a lightweight wireless interface for streaming data and device programming. The earpiece is designed for improved ear canal contact across a wide population of users and is fabricated in a low-cost and scalable manufacturing process based on standard techniques such as vacuum forming, plasma-treatment, and spray coating. A 2.5 × 2.5 cm2 wireless recording module is designed to record and stream data wirelessly to a host computer. Performance was evaluated on three human subjects over three months and compared with clinical-grade wet scalp EEG recordings. Recordings of spontaneous and evoked physiological signals, eye-blinks, alpha rhythm, and the auditory steady-state response (ASSR), are presented. This is the first wireless in-ear EEG to our knowledge to incorporate a dry multielectrode, user-generic design. The user-generic ear EEG recorded a mean alpha modulation of 2.17, outperforming the state-of-the-art in dry electrode in-ear EEG systems.

A potentiometric mechanotransduction mechanism for novel electronic skins.

Human skin perceives external mechanical stimuli by sensing the variation in the membrane potential of skin sensory cells. Many scientists have attempted to recreate skin functions and develop electronic skins (e-skins) based on active and passive sensing mechanisms. Inspired by the skin sensory behavior, we investigated materials and electronic devices that allow us to encode mechanical stimuli into potential differences measured between two electrodes, resulting in a potentiometric mechanotransduction mechanism. We present here a potentiometric mechanotransducer that is fabricated through an all-solution processing approach. This mechanotransducer shows ultralow-power consumption, highly tunable sensing behavior, and capability to detect both static and low-frequency dynamic mechanical stimuli. Furthermore, we developed two novel classes of sensing devices, including strain-insensitive sensors and single-electrode-mode e-skins, which are challenging to achieve using the existing methods. This mechanotransduction mechanism has broad impact on robotics, prosthetics, and health care by providing a much improved human-machine interface.

Highly Flexible Transparent Micromesh Electrodes via Blade-Coated Polymer Networks for Organic Light-Emitting Diodes.

The availability of transparent conductive thin films that exhibit mechanical flexibility and are adapted to low-cost and large-area fabrication is a major obstacle for high-performance flexible thin-film optoelectronics. Here, by combining printing, thin-film deposition, and wet-etching processes, interconnected transparent metal micromesh (TMM) electrodes are reported. Blade-coating is used to generate self-assembled polymer micromesh networks on flexible substrates. The network structures are subsequently converted into conductive metal networks. As-fabricated TMM films display a surface roughness of around 20 nm with thickness down to 50 nm. A transmittance of 86% and a conductance of 80 Ω sq-1 are achieved at the described optimal blade-coating suspension concentration. The electrodes show mechanical flexibility with no conductivity degradation with the smallest bending radius of 1 mm or at repeated bending over 3000 cycles at a bending radius of 15 mm. We successfully demonstrate organic light-emitting diodes (OLEDs) using TMM electrodes via the blade-coating technique. The printed OLEDs have a low turn-on voltage of 3.4 V and can achieve a luminance of over 4000 cd/m2 at 6.5 V. At a luminance of 100 cd/m2, the OLEDs show a current density of 7.6 mA/cm2, an external quantum efficiency (EQE) of 3.6%, and a luminous efficacy of 1.4 lm/W.

A New Frontier of Printed Electronics: Flexible Hybrid Electronics.

The performance and integration density of silicon integrated circuits (ICs) have progressed at an unprecedented pace in the past 60 years. While silicon ICs thrive at low-power high-performance computing, creating flexible and large-area electronics using silicon remains a challenge. On the other hand, flexible and printed electronics use intrinsically flexible materials and printing techniques to manufacture compliant and large-area electronics. Nonetheless, flexible electronics are not as efficient as silicon ICs for computation and signal communication. Flexible hybrid electronics (FHE) leverages the strengths of these two dissimilar technologies. It uses flexible and printed electronics where flexibility and scalability are required, i.e., for sensing and actuating, and silicon ICs for computation and communication purposes. Combining flexible electronics and silicon ICs yields a very powerful and versatile technology with a vast range of applications. Here, the fundamental building blocks of an FHE system, printed sensors and circuits, thinned silicon ICs, printed antennas, printed energy harvesting and storage modules, and printed displays, are discussed. Emerging application areas of FHE in wearable health, structural health, industrial, environmental, and agricultural sensing are reviewed. Overall, the recent progress, fabrication, application, and challenges, and an outlook, related to FHE are presented.

A flexible organic reflectance oximeter array.

Transmission-mode pulse oximetry, the optical method for determining oxygen saturation in blood, is limited to only tissues that can be transilluminated, such as the earlobes and the fingers. The existing sensor configuration provides only single-point measurements, lacking 2D oxygenation mapping capability. Here, we demonstrate a flexible and printed sensor array composed of organic light-emitting diodes and organic photodiodes, which senses reflected light from tissue to determine the oxygen saturation. We use the reflectance oximeter array beyond the conventional sensing locations. The sensor is implemented to measure oxygen saturation on the forehead with 1.1% mean error and to create 2D oxygenation maps of adult forearms under pressure-cuff-induced ischemia. In addition, we present mathematical models to determine oxygenation in the presence and absence of a pulsatile arterial blood signal. The mechanical flexibility, 2D oxygenation mapping capability, and the ability to place the sensor in various locations make the reflectance oximeter array promising for medical sensing applications such as monitoring of real-time chronic medical conditions as well as postsurgery recovery management of tissues, organs, and wounds.

Flexible Blade-Coated Multicolor Polymer Light-Emitting Diodes for Optoelectronic Sensors.

A method to print two materials of different functionality during the same printing step is presented. In printed electronics, devices are built layer by layer and conventionally only one type of material is deposited in one pass. Here, the challenges involving printing of two emissive materials to form polymer light-emitting diodes (PLEDs) that emit light of different wavelengths without any significant changes in the device characteristics are described. The surface-energy-patterning technique is utilized to print materials in regions of interest. This technique proves beneficial in reducing the amount of ink used during blade coating and improving the reproducibility of printed films. A variety of colors (green, red, and near-infrared) are demonstrated and characterized. This is the first known attempt to print multiple materials by blade coating. These devices are further used in conjunction with a commercially available photodiode to perform blood oxygenation measurements on the wrist, where common accessories are worn. Prior to actual application, the threshold conditions for each color are discussed, in order to acquire a stable and reproducible photoplethysmogram (PPG) signal. Finally, based on the conditions, PPG and oxygenation measurements are successfully performed on the wrist with green and red PLEDs.

Materials and methods for higher performance screen-printed flexible MRI receive coils.

PURPOSE: To develop methods for characterizing materials used in screen-printed MRI coils and improve signal-to-noise ratio (SNR) with new lower-loss materials. METHODS: An experimental apparatus was created to characterize dielectric properties of plastic substrates used in receive coils. Coils were fabricated by screen printing conductive ink onto several plastic substrates. Unloaded and sample loaded quality factor (QUnloaded /QLoaded ) measurements and scans on a 3T scanner were used to characterize coil performance. An experimental method was developed to describe the relationship between a coil's QUnloaded and the SNR it provides in images of a phantom. In addition, 3T scans of a phantom and the head of a volunteer were obtained with a proof-of-concept printed eight-channel array, and the results were compared with a commercial 12-channel array. RESULTS: Printed coils with optimized substrates exhibited up to 97% of the image SNR when compared with a traditional coil on a loading phantom. QUnloaded and the SNR of coils were successfully correlated. The printed array resulted in images comparable to the quality given by the commercial array. CONCLUSION: Using the proposed methods and materials, the SNR of printed coils approached that of commercial coils while using a new fabrication technique that provided more flexibility and close contact with the patient's body. Magn Reson Med 78:775-783, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

High-performance flexible energy storage and harvesting system for wearable electronics.

This paper reports on the design and operation of a flexible power source integrating a lithium ion battery and amorphous silicon solar module, optimized to supply power to a wearable health monitoring device. The battery consists of printed anode and cathode layers based on graphite and lithium cobalt oxide, respectively, on thin flexible current collectors. It displays energy density of 6.98 mWh/cm(2) and demonstrates capacity retention of 90% at 3C discharge rate and ~99% under 100 charge/discharge cycles and 600 cycles of mechanical flexing. A solar module with appropriate voltage and dimensions is used to charge the battery under both full sun and indoor illumination conditions, and the addition of the solar module is shown to extend the battery lifetime between charging cycles while powering a load. Furthermore, we show that by selecting the appropriate load duty cycle, the average load current can be matched to the solar module current and the battery can be maintained at a constant state of charge. Finally, the battery is used to power a pulse oximeter, demonstrating its effectiveness as a power source for wearable medical devices.

Screen-printed flexible MRI receive coils.

Magnetic resonance imaging is an inherently signal-to-noise-starved technique that limits the spatial resolution, diagnostic image quality and results in typically long acquisition times that are prone to motion artefacts. This limitation is exacerbated when receive coils have poor fit due to lack of flexibility or need for padding for patient comfort. Here, we report a new approach that uses printing for fabricating receive coils. Our approach enables highly flexible, extremely lightweight conforming devices. We show that these devices exhibit similar to higher signal-to-noise ratio than conventional ones, in clinical scenarios when coils could be displaced more than 18 mm away from the body. In addition, we provide detailed material properties and components performance analysis. Prototype arrays are incorporated within infant blankets for in vivo studies. This work presents the first fully functional, printed coils for 1.5- and 3-T clinical scanners.

Monitoring of Vital Signs with Flexible and Wearable Medical Devices.

Advances in wireless technologies, low-power electronics, the internet of things, and in the domain of connected health are driving innovations in wearable medical devices at a tremendous pace. Wearable sensor systems composed of flexible and stretchable materials have the potential to better interface to the human skin, whereas silicon-based electronics are extremely efficient in sensor data processing and transmission. Therefore, flexible and stretchable sensors combined with low-power silicon-based electronics are a viable and efficient approach for medical monitoring. Flexible medical devices designed for monitoring human vital signs, such as body temperature, heart rate, respiration rate, blood pressure, pulse oxygenation, and blood glucose have applications in both fitness monitoring and medical diagnostics. As a review of the latest development in flexible and wearable human vitals sensors, the essential components required for vitals sensors are outlined and discussed here, including the reported sensor systems, sensing mechanisms, sensor fabrication, power, and data processing requirements.

Screen printed passive components for flexible power electronics.

Additive and low-temperature printing processes enable the integration of diverse electronic devices, both power-supplying and power-consuming, on flexible substrates at low cost. Production of a complete electronic system from these devices, however, often requires power electronics to convert between the various operating voltages of the devices. Passive components-inductors, capacitors, and resistors-perform functions such as filtering, short-term energy storage, and voltage measurement, which are vital in power electronics and many other applications. In this paper, we present screen-printed inductors, capacitors, resistors and an RLC circuit on flexible plastic substrates, and report on the design process for minimization of inductor series resistance that enables their use in power electronics. Printed inductors and resistors are then incorporated into a step-up voltage regulator circuit. Organic light-emitting diodes and a flexible lithium ion battery are fabricated and the voltage regulator is used to power the diodes from the battery, demonstrating the potential of printed passive components to replace conventional surface-mount components in a DC-DC converter application.