Hybrid Electronic System Research Articles

Surveillance of Antimicrobial Use in Long-Term Care Facilities: An Antimicrobial Mapping Survey

ObjectivesTo explore antimicrobial management processes in Australian residential aged care facilities (RACFs), including antimicrobial prescribing, supply, administration, and documentation to inform surveillance activities. DesignVoluntary, online cross-sectional survey. Setting and ParticipantsThe survey was disseminated to all South Australian RACFs (n = 237) seeking participation from an infection prevention and control lead (preferred respondent), a nurse or senior RACF staff member, or an aged care pharmacist. MethodsThe survey was open during May-June 2023. Questions aimed to understand clinical and medication management systems, sources of antimicrobial prescription and supply, management by external health care providers and documentation of antimicrobial administration. A process map of antimicrobial management in RACFs was developed. ResultsOf the 54 RACFs included in the analysis (29.5% response rate), most used an electronic clinical documentation system (74.1%) or a hybrid electronic paper-based system (22.2%). Medication charts were either electronic (81.0%), hybrid (5.6%), or paper-based (13.0%). Antimicrobials were prescribed by the resident's usual general practitioner, but also by locums, hospital or specialist physicians, nurse practitioners, virtual care physicians, and dentists. Oral, topical, and inhaled antimicrobial formulations were usually supplied by community pharmacies, and intravenous formulations were predominately supplied by hospitals for administration by outreach nurses. Almost all RACFs (96.2%) had imprest stock of antimicrobials that included both oral and intravenous formulations. Antimicrobials were predominately administered by an enrolled nurse or a registered nurse. Conclusions and ImplicationsAntimicrobial management in RACFs is complex, particularly during care transitions. Multiple prescribers and sources of antimicrobials, use of different systems for clinical documentation, particularly by external health care providers, and clinical governance relating to imprest supplies were identified as key areas where medication management could be improved. Addressing these gaps will facilitate comprehensive, real-time antimicrobial surveillance in Australian RACFs.

The Time Response Analysis of a Hybrid Electronic Switch and Residual Current Devices System

The Time Response Analysis of a Hybrid Electronic Switch and Residual Current Devices System

Graded Mxene-Doped Liquid Metal as Adhesion Interface Aiming for Conductivity Enhancement of Hybrid Rigid-Soft Interconnection.

Hybrid rigid-soft electronic system combines the biocompatibility of stretchable electronics and the computing capacity of silicon-based chips, which has a chance to realize a comprehensive stretchable electronic system with perception, control, and algorithm in near future. However, a reliable rigid-soft interconnection interface is urgently required to ensure both the conductivity and stretchability under a large strain. To settle this demand, this paper proposes a graded Mxene-doped liquid metal (LM) method to achieve a stable solid-liquid composite interconnect (SLCI) between the rigid chip and stretchable interconnect lines. To overcome the surface tension of LM, a high-conductive Mxene is doped for the balance between adhesion and liquidity of LM. And the high-concentration doping could prevent the contact failure with chip pins, while the low-concentration doping tends to maintain the stretchability. Based on this dosage-graded interface structure, the solid light-emitting diode (LED) and other devices integrated into the stretchable hybrid electronic system could achieve an excellent conductivity insensitive to the exerted tensile strain. In addition, the hybrid electronic system is demonstrated for skin-mounted and tire-mounted temperature-test applications under the tensile strain up to 100%. This Mxene-doped LM method aims to obtain a robust interface between rigid components and flexible interconnects by attenuating the inherent Young's modulus mismatch between rigid and flexible systems and makes it a promising candidate for effective interconnection between solid electronics and soft electronics.

Flexible Hybrid Integration Enabled xsOn-Skin Electronics for Wireless Monitoring of Electrophysiology and Motion.

On-skin electronics are promising in human motion and vital sign monitoring, disease diagnosis and treatment. On-skin systems are soft and stretchable, and can maintain electrical performances during bending, stretching or twisting, etc. However, current integrated circuit based fabrication processes are not compatible with stretchable substrate, and recently proposed flexible hybrid integration methods typically involve complicated fabrication processes or structural design, and do not support high integration density. Herein, we report a series of flexible hybrid integration strategies which endow the on-skin electronics with advantages of high integration density of electric components, facile fabrications, high stretchability and reliability. Proposed strategies include: 1. High I/O density with highly stretchable and conductive composite materials as interconnects; 2. Multi-layer structures enabled by stretchable and conductive via-holes; 3. High reliability approach for chip attachment onto stretchable substrate; 4. Design and fabrication of strain separation structure. Based on these methods, an on-skin flexible hybrid electronic system (FHES) is fabricated to collect electrocardiogram (ECG) and acceleration data, wirelessly transmit and display the data in real time on a mobile phone application through Bluetooth communication. We also verify the accuracy and stability of the FHES through the measurements of ECG and acceleration data from human skin under various conditions. The flexible hybrid integration schemes proposed can be adopted for the development of a variety of on-skin systems for biomedical applications.

Continuously Quantifying Oral Chemicals Based on Flexible Hybrid Electronics for Clinical Diagnosis and Pathogenetic Study.

Simultaneous monitoring of diverse salivary parameters can reveal underlying mechanisms of intraoral biological processes and offer profound insights into the evolution of oral diseases. However, conventional analytical devices with bulky volumes, rigid formats, and discrete sensing mechanisms deviate from the requirements of continuous biophysiological quantification, resulting in huge difficulty in precise clinical diagnosis and pathogenetic study. Here, we present a flexible hybrid electronic system integrated with functional nanomaterials to continuously sense Ca2+, pH, and temperature for wireless real-time oral health monitoring. The miniaturized system with an island-bridge structure that is designed specifically to fit the teeth is only 0.4 g in weight and 31.5 × 8.5 × 1.35 mm3 in dimension, allowing effective integration with customized dental braces and comfort attachment on teeth. Characterization results indicate high sensitivities of 30.3 and 60.6 mV/decade for Ca2+ and pH with low potential drifts. The system has been applied in clinical studies to conduct Ca2+ and pH mappings on carious teeth, biophysiological monitoring for up to 12 h, and outcome evaluation of dental restoration, providing quantitative data to assist in the diagnosis and understanding of oral diseases. Notably, caries risk assessment of 10 human subjects using the flexible system validates the important role of saliva buffering capacity in caries pathogenesis. The proposed flexible system may offer an open platform to carry diverse components to support both clinical diagnosis and treatment as well as fundamental research for oral diseases and induced systemic diseases.

Machine-learned, waterproof MXene fiber-based glove platform for underwater interactivities

Waterproofness is of value and critical for electronic systems, especially involving underwater interactivities. Yet, the most reported works are related to waterproof flexible sensors. System-level waterproof platforms integrating with sensing, processing and wirelessly transmitting to provide consumer-grade performance have been seldom reported. Herein, we construct a machine-learning-assisted waterproof hybrid electronic system via the whole encapsulation technique integrating fiber sensors and processing center based on flexible printed circuit board (FPCB) so as to achieve fully underwater interactivities. The fiber sensors can be seamlessly integrated with the FPCB through knitting techniques, which exhibit excellent robustness, washability, and waterproofness, with resistance varying within in ± 0.6% in tape water, sweat, and saline solution for up to 15 days. The hybrid platform is demonstrated for an underwater piano playing “Happy birthday to you” and the remote control of a robotic hand in water using the multilayer perceptron that achieves a 98.1% classification accuracy for 20 kinds of hand gestures. Our work may promote advances in waterproof system-level electronics from device design, system integration to algorithm optimization.

Spectrum and Outcome of Emergency General Surgery Laparotomies at a Tertiary Center in South Africa

BackgroundNontraumatic surgical emergencies constitute a significant portion of total surgical workload and are associated with a significant mortality rate. The spectrum and outcome of surgical emergencies in a low-middle-income country may differ from that in high-income countries. This study aims to describe the spectrum and outcome of emergency laparotomy for nontrauma surgical emergencies at a single-tertiary center in South Africa. MethodsA retrospective interrogation of a hybrid electronic record system of consecutive patients undergoing emergency laparotomy for nontraumatic surgical emergencies presenting to Greys Hospital from December 2012 to December 2018. ResultsOne thousand four hundred sixty four patients were included with a median age of 34 y (IQR 23-52) and male predominance (861; 59%). The mortality rate was 12.5% (183). The most common comorbidity was human immunodeficiency virus (353; 24.1%) which did not influence mortality. At least one comorbidity increased the odds of mortality by 4 times (95% CI 2.7-6.2). Mortality was associated with longer waiting times to operation (12.8 versus 8.4 h; P < 0.001) and longer operating times (105 min versus 80 min respectively; P < 0.001). Temporary abdominal closure was used in 245 (16.7%) patients. Planned repeat laparotomy was performed in 193 (13.2%) patients. Acute appendicitis (594, 40.6%) was the most common pathology of which 61.4% had the American Association for the Surgery of Trauma grade of 4 or more (high grade). This was followed by perforated peptic ulcer disease (10.5%). The adverse event rate was 51.5% (754). Postoperative pulmonary complications and acute kidney injury were the most common. The strongest predictors of mortality were abdominal compartment syndrome (OR 26.5, 95% CI 9.36-94.13) and postoperative hemodynamic instability 17.43 (OR 17.4, 95% CI 11.80-25.98). ConclusionsOur spectrum of disease differs to that found in high-income countries. The morbidity and mortality rates are significant, and attention must be focused on attempts to reduce this. Various comorbidities and adverse events are associated with increased mortality.

Conversion to an electronic missing medication request system at an academic medical center

Missing medications can negatively contribute to the financial and operational workflows of pharmacy departments and add medication safety challenges. The missing medication request (MMR) system at the study institution converted to entirely electronic in June 2018 from a hybrid electronic system. This study evaluated 4-week periods pre- and post-conversion. The objective of this study was to evaluate the impact of conversion to an electronic MMR system on the quantity of requests received at an academic medical center. The average daily number of MMR's decreased from the pre-conversion group to the post-conversion group (1.77 (±0.16) vs 1.48 (±0.17), p < 0.001). During post-conversion, the median triage time was 8 min [3 min-19 min], pharmacists triaged 62.4% of requests, and 29.6% of requests were declined. Conversion to an electronic MMR system represents one solution to decreasing missing medications. Future studies are needed to evaluate the financial, operational, and medication safety impact of conversion.

ACF bonding technology for paper- and PET-based disposable flexible hybrid electronics

In light of the necessity to introduce reliable interconnection technologies for the development of disposable diagnostic kits, fine-pitch flip-chip integration of bare silicon dies on the paper and polyethylene terephthalate (PET)-based substrates have gained increasing importance. As the key-enabler of a hybrid electronic system, the interconnection technology should provide reliable electrical and mechanical properties. Paper and PET are temperature- and pressure-sensitive, and are not compatible with the conventional flip-chip bonding technologies, i.e., soldering and thermo-compression bonding. In this study, the feasibility of implementing Anisotropic Conductive Films (ACF) in hybrid integration was assessed, in which bare silicon dies with the thicknesses of 30 µm and 730 µm were bonded to screen-printed paper and PET substrates. As an alternative to direct bare die bonding, the integration of PET- and paper-based interposers to printed substrates was also addressed here. Correspondingly, the long-term reliability of the ACF-bonded samples was assessed via dynamic bend cycling tests. It was shown that ACF provides robust and reliable interconnects on both substrates with a failure cycle of more than 45,000 cycles.

All-printed nanomembrane wireless bioelectronics using a biocompatible solderable graphene for multimodal human-machine interfaces

Recent advances in nanomaterials and nano-microfabrication have enabled the development of flexible wearable electronics. However, existing manufacturing methods still rely on a multi-step, error-prone complex process that requires a costly cleanroom facility. Here, we report a new class of additive nanomanufacturing of functional materials that enables a wireless, multilayered, seamlessly interconnected, and flexible hybrid electronic system. All-printed electronics, incorporating machine learning, offers multi-class and versatile human-machine interfaces. One of the key technological advancements is the use of a functionalized conductive graphene with enhanced biocompatibility, anti-oxidation, and solderability, which allows a wireless flexible circuit. The high-aspect ratio graphene offers gel-free, high-fidelity recording of muscle activities. The performance of the printed electronics is demonstrated by using real-time control of external systems via electromyograms. Anatomical study with deep learning-embedded electrophysiology mapping allows for an optimal selection of three channels to capture all finger motions with an accuracy of about 99% for seven classes.

A hybrid electronic nose system for discrimination of pathogenic bacterial volatile compounds.

A hybrid electronic nose comprising an array of three organic-inorganic nanocomposite gas sensors [zinc tetra tert-butyl phthalocyanine (ZnTTBPc), zinc tetra-phenyl porphyrin (ZnTPP), and cobalt tetraphenyl-porphyrin (CoTPP)] coupled with three commercial metal-oxide semiconductor gas sensors (TGS 2444, TGS 2603 and TGS 2620) was developed to discriminate bacterial volatile compounds. Each type of gas sensor had its own strengths and weaknesses in terms of its capability to detect complex odors from the five different bacterial species tested. Bacterial samples were controlled at a fixed initial bacterial concentration by measuring the optical density at 600 nm of the culture suspensions. A comparative evaluation of the volatile compound fingerprints from five bacterial species grown in Luria-Bertani medium was conducted to identify the optimal incubation time for detection of volatile biomarkers to discriminate among bacteria. The results suggest that the hybrid electronic nose was indeed able to discriminate among the bacterial species and culture media, with a variance based on contributions of 92.4% from PC1 and 7.2% from PC2, at an incubation time of 6 hours. Furthermore, the results of hierarchical cluster analysis showed that bacterial odor data formed two major bacterial groups, with the maximum cluster distance close to 25. Intra-group similarity was demonstrated as the two bacterial species (E. cloacae and P. aeruginosa) from among the Gram-negative bacteria had a greater similarity with a cluster distance close to 4. Finally, the minimum distance between E. cloacae and S. Typhi was approximately 1, at an equal distance from E. coli and S. aureus.

A Soft Polydimethylsiloxane Liquid Metal Interdigitated Capacitor Sensor and Its Integration in a Flexible Hybrid System for On-Body Respiratory Sensing.

We report on the dual mechanical and proximity sensing effect of soft-matter interdigitated (IDE) capacitor sensors, together with its modelling using finite element (FE) simulation to elucidate the sensing mechanism. The IDE capacitor is based on liquid-phase GaInSn alloy (Galinstan) embedded in a polydimethylsiloxane (PDMS) microfludics channel. The use of liquid-metal as a material for soft sensors allows theoretically infinite deformation without breaking electrical connections. The capacitance sensing is a result of E-field line disturbances from electrode deformation (mechanical effect), as well as floating electrodes in the form of human skin (proximity effect). Using the proximity effect, we show that spatial detection as large as 28 cm can be achieved. As a demonstration of a hybrid electronic system, we show that by integrating the IDE capacitors with a capacitance sensing chip, respiration rate due to a human’s chest motion can be captured, showing potential in its implementation for wearable health-monitoring.

Wireless, intraoral hybrid electronics for real-time quantification of sodium intake toward hypertension management

Recent wearable devices offer portable monitoring of biopotentials, heart rate, or physical activity, allowing for active management of human health and wellness. Such systems can be inserted in the oral cavity for measuring food intake in regard to controlling eating behavior, directly related to diseases such as hypertension, diabetes, and obesity. However, existing devices using plastic circuit boards and rigid sensors are not ideal for oral insertion. A user-comfortable system for the oral cavity requires an ultrathin, low-profile, and soft electronic platform along with miniaturized sensors. Here, we introduce a stretchable hybrid electronic system that has an exceptionally small form factor, enabling a long-range wireless monitoring of sodium intake. Computational study of flexible mechanics and soft materials provides fundamental aspects of key design factors for a tissue-friendly configuration, incorporating a stretchable circuit and sensor. Analytical calculation and experimental study enables reliable wireless circuitry that accommodates dynamic mechanical stress. Systematic in vitro modeling characterizes the functionality of a sodium sensor in the electronics. In vivo demonstration with human subjects captures the device feasibility for real-time quantification of sodium intake, which can be used to manage hypertension.

19‐3: Invited Paper: Key Enabling Technology for Stretchable LED Display and Electronic System

Key enabling technology for stretchable hybrid electronic is presented, which includes rigid/soft strain‐engineered stretchable PCB platform, inkjet‐printed programmable routing interconnects with printed cross‐over, stable direct chip bonding, and modulus‐gradient conductive core‐shell structured via. Pre‐stretching combined with an inkjet‐printing process enabled us to fabricate stretchable highly‐stable silver interconnects, which are used stretchable LED displays, chip‐based adder/multiplier, analog watch, and sensor/display integrated systems. All stretchable hybrid electronic system showed highly stable operation even under 15~20% tensile strain (maximum strain that typical patch‐type devices undergo).

Global differences in electronic portfolio utilization - a review of the literature and research implications.

Global differences in electronic portfolio utilization - a review of the literature and research implications.

Cognitive workload changes for nurses transitioning from a legacy system with paper documentation to a commercial electronic health record

ObjectiveHealthcare institutions worldwide are moving to electronic health records (EHRs). These transitions are particularly numerous in the US where healthcare systems are purchasing and implementing commercial EHRs to fulfill federal requirements. Despite the central role of EHRs to workflow, the cognitive impact of these transitions on the workforce has not been widely studied. This study assesses the changes in cognitive workload among pediatric nurses during data entry and retrieval tasks during transition from a hybrid electronic and paper information system to a commercial EHR. Materials and methodsBaseline demographics and computer attitude and skills scores were obtained from 74 pediatric nurses in two wards. They also completed an established and validated instrument, the NASA-TLX, that is designed to measure cognitive workload; this instrument was used to evaluate cognitive workload of data entry and retrieval. The NASA-TLX was administered at baseline (pre-implementation), 1, 5 and 10 shifts and 4 months post-implementation of the new EHR. ResultsMost nurse participants experienced significant increases of cognitive workload at 1 and 5 shifts after “go-live”. These increases abated at differing rates predicted by participants’ computer attitudes scores (p=0.01). ConclusionsThere is substantially increased cognitive workload for nurses during the early phases (1–5 shifts) of EHR transitions. Health systems should anticipate variability across workers adapting to “meaningful use” EHRs. “One-size-fits-all” training strategies may not be suitable and longer periods of technical support may be necessary for some workers.

Band-Selective NMR of a π- d Hybridized Electronic System

A ~ - d hybrid electronic system, (DMe-DCNQI) 2 Cu, where the ~ orbital of the organic molecule, DMe-DCNQI, is strongly hybridized with the d xy orbital of Cu, has been studied by 15 N and 13 C NMR at three sites. The analysis of Knight shift, K , local spin susceptibilities in the ~ and d orbitals were determined separately. The ~ and d spin susceptibilities were found to be quite different in magnitude and temperature dependence. Moreover, the Knight shift was separated into those of two constituent bands; a one-dimensional ~ band and a three-dimensional ~ - d band. The relative weight of the band susceptibilities is strongly temperature-dependent. DCNQI: d - ~ Interaction antiferromagnetic and ferromagnetic fluctuations 13 C and 15 N-NMR

Solar Cell Performance Under Different Illumination Conditions

ABSTRACTWe numerically simulate performance data of hydrogenated amorphous silicon (a-Si:H) and copper indium gallium diselenide (CIGS) based solar cells for various illumination conditions. For ease of comparison, we model typical single junctions with the very same software. The study allows us to evaluate the cell feasibility in different hybrid electronic systems like smart cards, wrist watches, transponder systems, and mobile sensors. At an illumination intensity of 1 sun, the optical bandgap of the absorber material and the series resistances determine the spectral sensitivity of the solar cell to particular illumination spectra. For intensities of 10-2 suns and so-called D65 spectrum, which represents daylight under cloudy skies, the efficiency of a-Si:H solar cells nearly equates the CIGS cell performance although the AM 1.5 efficiency of the CIGS diode exceeds the one of our a-Si:H cell by more than a factorof two. Infrared-weighted black body radiation leads to superior performance of the CIGS type, whereas for ultraviolet-weighted illumination the a-Si:H cell shows better performance. For intensities below 10-4 suns theexternal shunt resistance dominates the current-voltage characteristics of both cell types, resulting in poor performance independent of the incident spectrum. We complete our study by simulating the solar-powered charging process of a gold capacitor, which serves us as a model for the energy storage within a hybrid electronic system. The charging behavior under various realistic illumination conditions shows particular cellcharacteristics: high open circuit voltages qualify a-Si:H solar cells for electronic systems that require increased voltages and CIGS cells are suited for applications with higher current need.

Orbital- and band-dependent susceptibility in a π–d hybrid electronic system, (DMe-DCNQI) 2Cu

A π–d hybrid electronic system, (DMe-DCNQI)2Cu, where the π orbital of the organic molecule, DMe-DCNQI, is strongly hybridized with the d xy orbital of Cu, has been studied by 15 N and 13 C NMR at three sites. The analysis of Knight shift, K, and local spin susceptibilities in the π and d orbitals was carried out separately. The π and d spin susceptibilities were found to be quite different in magnitude and temperature dependence. Moreover, the Knight shift was separated into those of two constituent bands; a one-dimensional π band and a three-dimensional π–d band. The relative weight of the band susceptibilities is strongly temperature dependent.

Computer-Aided Engineering Technology for the Design of Electronic Systems

The integration of system and architecture of the design process is key to reducing design cycle time and cost in developing complex hardware and software systems. In this paper, we present an Integrated Engineering Environment. It is a design, analysis, verification, and management environment for the system and architectural levels of complex systems, a system synthesis framework. Discussion is included about Computer-Aided Engineering software simulation tools which offer the opportunity to gain confidence in the performance of sophisticated digital, analog, and hybrid electronic system designs before making a commitment to hardware. This approach should be considered in today's environment, where it is important to find innovative ways to control development and operational costs. With the concern for the loss of our defense industrial base, and when the original design team may no longer be available, using this technique makes it possible to re-engineer existing designs, converting them to current technology.