Infraorbital nerve block for pain management in pediatric cleft lip surgery in resource-limited areas of Indonesia: A case series.

INTRODUCTION AND IMPORTANCE: Cleft lip and palate (CLP) are congenital anomalies of the craniofacial region, commonly found in low- and middle-income countries, including Indonesia. Surgical correction of clefts typically begins at around three months of age to support infant growth. An infraorbital nerve block is an option for regional anesthesia in CLP surgery. This case series aims to determine the effectiveness of infraorbital nerve block in pain management for pediatric CLP surgery. CASE PRESENTATION: This case series includes five patients who fulfilled the Millard criteria for CLP surgery. All patients received general anesthesia followed by an infraorbital nerve block with 0.2 % ropivacaine in the infraorbital foramen area using the intraoral approach. Data were collected preoperatively, intraoperatively, and postoperatively. DISCUSSION: The combination of general anesthesia and infraorbital nerve block resulted in stable hemodynamics, low delirium scores, low pain intensity, and adequate oral intake postoperatively. CONCLUSION: Infraorbital nerve block with ropivacaine provides intraoperative hemodynamic stability, decreased delirium, and effective postoperative pain management in pediatric patients undergoing CLP surgery.

Label-Free Neuropeptide Detection beyond the Debye Length Limit.

Biosensors with high selectivity, high sensitivity, and real-time detection capabilities are of significant interest for diagnostic applications as well as human health and performance monitoring. Graphene field-effect transistor (GFET) based biosensors are suitable for integration into wearable sensor technology and can potentially demonstrate the sensitivity and selectivity necessary for real-time detection and monitoring of biomarkers. Previously reported DC-mode GFET biosensors showed a high sensitivity for sensing biomarkers in solutions with a low salt concentration. However, due to Debye length screening, the sensitivity of the DC-mode GFET biosensors decreases significantly during operation in a physiological fluid such as sweat or interstitial fluid. To overcome the Debye screening length limitation, we report here alternating current (AC) mode heterodyne-based GFET biosensors for sensing neuropeptide-Y (NPY), a key stress biomarker, in artificial sweat at physiologically relevant ionic concentrations. Our AC-mode GFET biosensors show a record ultralow detection limit of 2 × 10-18 M with an extensive dynamic range of 10 orders of magnitude in sensor response to target NPY concentration. The sensors were characterized for various carrier frequencies (ranging from 30 kHz to 2 MHz) of the applied AC voltages and various salt concentrations (10, 50, and 100 mM). Contrary to DC-mode sensing, the AC-mode sensor response increases with an increase in salt concentration in the electrolyte. The sensor response can be further enhanced by tuning the carrier frequency of the applied AC voltage. The optimum response frequency of our sensor is approximately 400-600 kHz for salt concentrations of 50 and 100 mM, respectively. The salt-concentration- and frequency-dependent sensor response can be explained by an electrolyte-gated capacitance model.

Biomarkers and Detection Platforms for Human Health and Performance Monitoring: A Review.

Human health and performance monitoring (HHPM) is imperative to provide information necessary for protecting, sustaining, evaluating, and improving personnel in various occupational sectors, such as industry, academy, sports, recreation, and military. While various commercially wearable sensors are on the market with their capability of "quantitative assessments" on human health, physical, and psychological states, their sensing is mostly based on physical traits, and thus lacks precision in HHPM. Minimally or noninvasive biomarkers detectable from the human body, such as body fluid (e.g., sweat, tear, urine, and interstitial fluid), exhaled breath, and skin surface, can provide abundant additional information to the HHPM. Detecting these biomarkers with novel or existing sensor technologies is emerging as critical human monitoring research. This review provides a broad perspective on the state of the art biosensor technologies for HHPM, including the list of biomarkers and their physiochemical/physical characteristics, fundamental sensing principles, and high-performance sensing transducers. Further, this paper expands to the additional scope on the key technical challenges in applying the current HHPM system to the real field.

Usability of Telemedicine in Physical Therapy Rehabilitation: Systematic review.

BACKGROUND: The term 'Telemedicine' was coined in the 1970s to imply 'healing at a distance. Physical therapy rehabilitation (PTR) focuses on the re-institution of function in bodily strength and movement. Covid-19 has created a challenge in one-on-one PTR sessions due to social distancing, which requires the minimization of all non-essential physical contact. Most outpatient services in PTR have had to be staggered and minimized to increase adherence to social distancing requirements and flatten the pandemic's curve. Telemedicine is applicable in PTR in several ways, including guided therapy sessions, and remote monitoring of patient progress through videoconferencing. Telemedicine allows patients to access PTR from the comfort of their homes, which minimizes travel costs and general strain on the body. Although it has been encumbered by various challenges, telemedicine could revolutionize the delivery of PTR while also increasing access to essential healthcare services. OBJECTIVE: Purpose: Covering the main aspects of telemedicine usability in physical therapy rehabilitation, that encourage using of the telemedicine in physical therapy in the world regions not covered by, especially the Middle East. METHODS: Method: A systematic search in libgen.is, jmir.org, wiley.com, sagepub.com, and scholar.google.com. was performed using the search terms: Telemedicine; asynchronous telemedicine; synchronous telemedicine; Covid-19; rehabilitation medicine; physical therapy rehabilitation; videoconferencing; Medicaid programs; telehealth; and HIPAA. Papers published up to Oct. 22nd, 2020, in English, were included. RESULTS: Telemedicine is cost-effective for physical therapy Rehabilitation particularly in pandemic like COVID19, also it's time and human resources saving especially with hands-off skills rehabilitation. CONCLUSIONS: Telemedicine is a revolutionary aspect of medicine that has seen an unexpected uptake following the Covid-19 pandemic. While people formerly preferred live sessions for PTR, the convenience of telemedicine is increasingly emerging. The various advantages, including reduced cost implications, reduced waiting time, and reduction of non-essential travel to obtain therapy have increased the preference for telemedicine. [9] The WHO recognizes the importance of Telemedicine, and conducted a regional and global survey to analyze its viability. At the onset of global lockdown due to Covid-19, the APTA expressed the need for physiotherapists to utilize telemedicine as an alternative for efficient PTR delivery within the bounds of social recommendations for curve-flattening. Telemedicine in PTR has various advantages including cost reduction, the convenience of access, reduction of long waiting lists among others for the patient. [10] PTR can also be availed to areas that are too remote to have a full-fledged PTR center. Through the utilization of nurse aides and other social support systems, therapists can effectively conduct therapy sessions through videoconferencing. Laws governing the adoption and use of telemedicine for PTR include the HIPAA and other DPL, which regulate the extent to which therapists can collect, use, and store data collected during online therapy sessions. Therapists need to obtain verifiable consent from the patient before commencement.

Efficient Closed-loop Maximization of Carbon Nanotube Growth Rate using Bayesian Optimization.

A major technological challenge in materials research is the large and complex parameter space, which hinders experimental throughput and ultimately slows down development and implementation. In single-walled carbon nanotube (CNT) synthesis, for instance, the poor yield obtained from conventional catalysts is a result of limited understanding of input-to-output correlations. Autonomous closed-loop experimentation combined with advances in machine learning (ML) is uniquely suited for high-throughput research. Among the ML algorithms available, Bayesian optimization (BO) is especially apt for exploration and optimization within such high-dimensional and complex parameter space. BO is an adaptive sequential design algorithm for finding the global optimum of a black-box objective function with the fewest possible measurements. Here, we demonstrate a promising application of BO in CNT synthesis as an efficient and robust algorithm which can (1) improve the growth rate of CNT in the BO-planner experiments over the seed experiments up to a factor 8; (2) rapidly improve its predictive power (or learning); (3) Consistently achieve good performance regardless of the number or origin of seed experiments; (4) exploit a high-dimensional, complex parameter space, and (5) achieve the former 4 tasks in just over 100 hundred experiments (~8 experimental hours) - a factor of 5× faster than our previously reported results.

Strain engineering and epitaxial stabilization of halide perovskites.

Strain engineering is a powerful tool with which to enhance semiconductor device performance1,2. Halide perovskites have shown great promise in device applications owing to their remarkable electronic and optoelectronic properties3-5. Although applying strain to halide perovskites has been frequently attempted, including using hydrostatic pressurization6-8, electrostriction9, annealing10-12, van der Waals force13, thermal expansion mismatch14, and heat-induced substrate phase transition15, the controllable and device-compatible strain engineering of halide perovskites by chemical epitaxy remains a challenge, owing to the absence of suitable lattice-mismatched epitaxial substrates. Here we report the strained epitaxial growth of halide perovskite single-crystal thin films on lattice-mismatched halide perovskite substrates. We investigated strain engineering of α-formamidinium lead iodide (α-FAPbI3) using both experimental techniques and theoretical calculations. By tailoring the substrate composition-and therefore its lattice parameter-a compressive strain as high as 2.4 per cent is applied to the epitaxial α-FAPbI3 thin film. We demonstrate that this strain effectively changes the crystal structure, reduces the bandgap and increases the hole mobility of α-FAPbI3. Strained epitaxy is also shown to have a substantial stabilization effect on the α-FAPbI3 phase owing to the synergistic effects of epitaxial stabilization and strain neutralization. As an example, strain engineering is applied to enhance the performance of an α-FAPbI3-based photodetector.

In Operando Observation of Neuropeptide Capture and Release on Graphene Field-Effect Transistor Biosensors with Picomolar Sensitivity.

Transmission electron microscopy (TEM) is being pushed to new capabilities which enable studies on systems that were previously out of reach. Among recent innovations, TEM through liquid cells (LC-TEM) enables in operando observation of biological phenomena. This work applies LC-TEM to the study of biological components as they interact on an abiotic surface. Specifically, analytes or target molecules like neuropeptide Y (NPY) are observed in operando on functional graphene field-effect transistor (GFET) biosensors. Biological recognition elements (BREs) identified using biopanning with affinity to NPY are used to functionalize graphene to obtain selectivity. On working devices capable of achieving picomolar responsivity to neuropeptide Y, LC-TEM reveals translational motion, stochastic positional fluctuations due to constrained Brownian motion, and rotational dynamics of captured analyte. Coupling these observations with the electrical responses of the GFET biosensors in response to analyte capture and/or release will potentially enable new insights leading to more advanced and capable biosensor designs.

Carbon Nanotubes and Related Nanomaterials: Critical Advances and Challenges for Synthesis toward Mainstream Commercial Applications.

Advances in the synthesis and scalable manufacturing of single-walled carbon nanotubes (SWCNTs) remain critical to realizing many important commercial applications. Here we review recent breakthroughs in the synthesis of SWCNTs and highlight key ongoing research areas and challenges. A few key applications that capitalize on the properties of SWCNTs are also reviewed with respect to the recent synthesis breakthroughs and ways in which synthesis science can enable advances in these applications. While the primary focus of this review is on the science framework of SWCNT growth, we draw connections to mechanisms underlying the synthesis of other 1D and 2D materials such as boron nitride nanotubes and graphene.

Insight on Structure of Water and Ice Next to Graphene Using Surface-Sensitive Spectroscopy.

The water/graphene interface has received considerable attention in the past decade due to its relevance in various potential applications including energy storage, sensing, desalination, and catalysis. Most of our knowledge about the interfacial water structure next to graphene stems from simulations, which use experimentally measured water contact angles (WCAs) on graphene (or graphite) to estimate the water-graphene interaction strength. However, the existence of a wide spectrum of reported WCAs on supported graphene and graphitic surfaces makes it difficult to interpret the water-graphene interactions. Here, we have used surface-sensitive infrared-visible sum frequency generation (SFG) spectroscopy to probe the interfacial water structure next to graphene supported on a sapphire substrate. In addition, the ice nucleation properties of graphene have been explored by performing in situ freezing experiments as graphitic surfaces are considered good ice nucleators. For graphene supported on sapphire, we observed a strong SFG peak associated with highly coordinated, ordered water next to graphene. Similar ordering was not detected next to bare sapphire, implying that the observed ordering of water molecules in the former case is a consequence of the presence of graphene. Our analysis indicates that graphene behaves like a hydrophobic (or negatively charged) surface, leading to enhanced ordering of water molecules. Although liquid water orders next to graphene, the ice formed is proton disordered. This research sheds light on water-graphene interactions relevant in optimizing the performance of graphene in various applications.

Understanding properties of engineered catalyst supports using contact angle measurements and X-ray reflectivity.

There is significant interest in broadening the type of catalyst substrates that support the growth of high-quality carbon nanotube (CNT) carpets. In this study, ion beam bombardment has been utilized to modify catalyst substrates for CNT carpet growth. Using a combination of contact angle measurements (CAMs) and X-ray reflectivity (XRR) for the first time, new correlations between the physicochemical properties of pristine and engineered catalyst substrates and CNT growth behavior have been established. The engineered surfaces obtained after exposure to different degrees of ion beam damage have distinct physicochemical properties (porosity, layer thickness, and acid-base properties). The CAM data were analyzed using the van Oss-Chaudhury-Good model, enabling the determination of the acid-base properties of the substrate surfaces. For the XRR data, a Fourier analysis of the interference patterns enabled extraction of layer thickness, while the atomic density and interfacial roughness were extracted by analyzing the amplitude of the interference oscillations. The dramatic transformation of the substrate from "inactive" to "active" is attributed to a combined effect of substrate porosity or damage depth and Lewis basicity. The results reveal that the efficiency of catalyst substrates can be further improved by increasing the substrate basicity, if the minimum surface porosity is established. This study advances the use of a non-thermochemical approach for catalyst substrate engineering, as well as demonstrates the combined utility of CAM and XRR as a powerful, nondestructive, and reliable tool for rational catalyst design.

Recent Progress in Obtaining Semiconducting Single-Walled Carbon Nanotubes for Transistor Applications.

High purity semiconducting single-walled carbon nanotubes (s-SWCNTs) with a narrow diameter distribution are required for high-performance transistors. Achieving this goal is extremely challenging because the as-grown material contains mixtures of s-SWCNTs and metallic- (m-) SWCNTs with wide diameter distributions, typically inadequate for integrated circuits. Since 2000, numerous ex situ methods have been proposed to improve the purity of the s-SWCNTs. The majority of these techniques fail to maintain the quality and integrity of the s-SWCNTs with a few notable exceptions. Here, the progress in realizing high purity s-SWCNTs in as-grown and post-processed materials is highlighted. A comparison of transistor parameters (such as on/off ratio and field-effect mobility) obtained from test structures establishes the effectiveness of various methods and suggests opportunities for future improvements.

Laser-induced nanoscale thermocapillary flow for purification of aligned arrays of single-walled carbon nanotubes.

Although aligned arrays of single-walled carbon nanotubes (SWNTs) have outstanding potential for use in broad classes of advanced semiconductor devices, the relatively large population of metallic SWNTs (m-SWNTs) that results from conventional growth techniques leads to significantly degraded performance. Recently reported methods based on thermocapillary effects that enable removal of m-SWNTs from such arrays offer exceptional levels of efficiency, but the procedures are cumbersome and require multiple processing steps. Here we present a simple, robust alternative that yields pristine arrays of purely semiconducting SWNTs (s-SWNTs) by use of irradiation with an infrared laser. Selective absorption by m-SWNTs coated with a thin organic film initiates nanoscale thermocapillary flows that lead to exposure only of the m-SWNTs. Reactive ion etching eliminates the m-SWNTs without damaging the s-SWNTs; removal of the film completes the purification. Systematic experimental studies and computational modeling of the thermal physics illuminates the essential aspects of this process. Demonstrations include use of arrays of s-SWNTs formed in this manner as semiconducting channel materials in statistically relevant numbers of transistors to achieve both high mobilities (>900 cm2 V(-1) s(-1)) and switching ratios (>10(4)). Statistical analysis indicates that the arrays contain at least 99.8% s-SWNTs and likely significantly higher.

Microwave purification of large-area horizontally aligned arrays of single-walled carbon nanotubes.

Recent progress in the field of single-walled carbon nanotubes (SWNTs) significantly enhances the potential for practical use of this remarkable class of material in advanced electronic and sensor devices. One of the most daunting challenges is in creating large-area, perfectly aligned arrays of purely semiconducting SWNTs (s-SWNTs). Here we introduce a simple, scalable, large-area scheme that achieves this goal through microwave irradiation of aligned SWNTs grown on quartz substrates. Microstrip dipole antennas of low work-function metals concentrate the microwaves and selectively couple them into only the metallic SWNTs (m-SWNTs). The result allows for complete removal of all m-SWNTs, as revealed through systematic experimental and computational studies of the process. As one demonstration of the effectiveness, implementing this method on large arrays consisting of ~20,000 SWNTs completely removes all of the m-SWNTs (~7,000) to yield a purity of s-SWNTs that corresponds, quantitatively, to at least to 99.9925% and likely significantly higher.

Using nanoscale thermocapillary flows to create arrays of purely semiconducting single-walled carbon nanotubes.

Among the remarkable variety of semiconducting nanomaterials that have been discovered over the past two decades, single-walled carbon nanotubes remain uniquely well suited for applications in high-performance electronics, sensors and other technologies. The most advanced opportunities demand the ability to form perfectly aligned, horizontal arrays of purely semiconducting, chemically pristine carbon nanotubes. Here, we present strategies that offer this capability. Nanoscale thermocapillary flows in thin-film organic coatings followed by reactive ion etching serve as highly efficient means for selectively removing metallic carbon nanotubes from electronically heterogeneous aligned arrays grown on quartz substrates. The low temperatures and unusual physics associated with this process enable robust, scalable operation, with clear potential for practical use. We carry out detailed experimental and theoretical studies to reveal all of the essential attributes of the underlying thermophysical phenomena. We demonstrate use of the purified arrays in transistors that achieve mobilities exceeding 1,000 cm(2) V(-1) s(-1) and on/off switching ratios of ∼10,000 with current outputs in the milliamp range. Simple logic gates built using such devices represent the first steps toward integration into more complex circuits.

Closure of large oroantral fistulas using septal cartilage.

The aim of this work is to describe a relatively new technique for closure of large oroantral fistulas. Fistulas were treated surgically using autograft septal cartilage and a buccal pyramidal flap. There were 11 patients, 8 of whom had chronic oroantral fistulas. Four cases had extensive sinusitis and were managed by endoscopic sinus surgery. Complete closure of the fistula was obtained in 10 cases (90.9%), whereas 1 case (9.1%) failed. No other complications occurred. The septal cartilage and pyramidal buccal flap technique is a viable alternative for the closure of large oroantral fistulas.

Electrostatic dimension of aligned-array carbon nanotube field-effect transistors.

Accurate electrostatics modeling of nanotubes (NTs)/nanowires (NWs) has significant implications for the ultimate scalability of aligned-array NT/NW field-effect transistors (FETs). The analysis to date has focused on limits of capacitive coupling between the 1D channel and 2D gate that is strictly relevant only in the linear response operation of NT/NW-FETs. Moreover, the techniques of electrostatic doping by independent gates that cover only part of the channel are widely used, but the nature of its electrostatic coupling has not been explored. In this paper, we use a three-dimensional, self-consistent model for NT/NW-FETs to interpret the essence of electrostatic coupling with complex configuration of electrode geometries. The interplay between 3D electric fields and its 1D termination onto the NTs/NWs suggests surprising complexity of electrostatic interaction not captured in simpler models. This coupling can change the performance metrics such as ON and OFF currents by orders of magnitude depending on (1) NT/NW density, (2) bias voltage, and (3) gate overlap length. Remarkably, this parasitic coupling persists regardless of the gate oxide thickness, changes in dielectric constant, and/or the width of the diameter distribution of NTs/NWs. The predictions of the model are systematically validated by a series of experiments.

Quantitative thermal imaging of single-walled carbon nanotube devices by scanning Joule expansion microscopy.

Electrical generation of heat in single-walled carbon nanotubes (SWNTs) and subsequent thermal transport into the surroundings can critically affect the design, operation, and reliability of electronic and optoelectronic devices based on these materials. Here we investigate such heat generation and transport characteristics in perfectly aligned, horizontal arrays of SWNTs integrated into transistor structures. We present quantitative assessments of local thermometry at individual SWNTs in these arrays, evaluated using scanning Joule expansion microscopy. Measurements at different applied voltages reveal electronic behaviors, including metallic and semiconducting responses, spatial variations in diameter or chirality, and localized defect sites. Analytical models, validated by measurements performed on different device structures at various conditions, enable accurate, quantitative extraction of temperature distributions at the level of individual SWNTs. Using current equipment, the spatial resolution and temperature precision are as good as ∼100 nm and ∼0.7 K, respectively.

Electroluminescence in aligned arrays of single-wall carbon nanotubes with asymmetric contacts.

High quantum efficiencies and low current thresholds are important properties for all classes of semiconductor light emitting devices (LEDs), including nanoscale emitters based on single wall carbon nanotubes (SWNTs). Among the various configurations that can be considered in SWNT LEDs, two terminal geometries with asymmetric metal contacts offer the simplest solution. In this paper, we study, experimentally and theoretically, the mechanisms of electroluminescence in devices that adopt this design and incorporate perfectly aligned, horizontal arrays of individual SWNTs. The results suggest that exciton mediated electron-hole recombination near the lower work-function contact is the dominant source of photon emission. High current thresholds for electroluminescence in these devices result from diffusion and quenching of excitons near the metal contact.

Epidermal electronics.

We report classes of electronic systems that achieve thicknesses, effective elastic moduli, bending stiffnesses, and areal mass densities matched to the epidermis. Unlike traditional wafer-based technologies, laminating such devices onto the skin leads to conformal contact and adequate adhesion based on van der Waals interactions alone, in a manner that is mechanically invisible to the user. We describe systems incorporating electrophysiological, temperature, and strain sensors, as well as transistors, light-emitting diodes, photodetectors, radio frequency inductors, capacitors, oscillators, and rectifying diodes. Solar cells and wireless coils provide options for power supply. We used this type of technology to measure electrical activity produced by the heart, brain, and skeletal muscles and show that the resulting data contain sufficient information for an unusual type of computer game controller.