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The communication outposts of the emerging Internet of Things are embodied by ordinary items, which desirably include all-printed flexible sensors, actuators, displays and akin organic electronic interface devices in combination with silicon-based digital signal processing and communication technologies. However, hybrid integration of smart electronic labels is partly hampered due to a lack of technology that (de)multiplex signals between silicon chips and printed electronic devices. Here, we report all-printed 4-to-7 decoders and seven-bit shift registers, including over 100 organic electrochemical transistors each, thus minimizing the number of terminals required to drive monolithically integrated all-printed electrochromic displays. These relatively advanced circuits are enabled by a reduction of the transistor footprint, an effort which includes several further developments of materials and screen printing processes. Our findings demonstrate that digital circuits based on organic electrochemical transistors (OECTs) provide a unique bridge between all-printed organic electronics (OEs) and low-cost silicon chip technology for Internet of Things applications. Though designing digital circuits using organic electrochemical transistors (OECTs) is promising due to their high performance, inherent large footprint limits adoption. Here, the authors report staggered top-gate OECTs for all-printed integrated circuits with fast switching and small footprint.

The potential of the screen printing method for large-scale production of organic electrochemical transistors (OECTs), combining high production yield with low cost, is here demonstrated. Fully screen-printed OECTs of 1 mm 2 area, based on poly(3,4-ethylenedioxythiophene) doped with poly(styrensulfonate) (PEDOT:PSS), have been manufactured on flexible polyethylene terephthalate (PET) substrates. The goal of this project effort has been to explore and develop the printing processing to enable high yield and stable transistor parameters, targeting miniaturized digital OECT circuits for large-scale integration (LSI). Of the 760 OECTs manufactured in one batch on a PET sheet, only two devices were found malfunctioning, thus achieving an overall manufacturing yield of 99.7%. A drain current ON/OFF ratio at least equal to 400 was applied as the strict exclusion principle for the yield, motivated by proper operation in LSI circuits. This consistent performance of low-footprint OECTs allows for the integration of PEDOT:PSS-based OECTs into complex logic circuits operating at high stability and accuracy.

Stretchable circuits based on liquid metals are promising for wearables but the lack of scalable processes for sintering of printed liquid metal dispersions constitutes a challenge for large-area and high-volume manufacturing. In this work, materials and methods for fully screen printed stretchable liquid metal multilayer circuits have been developed. The ink is based on liquid metal droplets dispersed in the green solvent propylene glycol using the harmless dispersion agent polyvinylpyrrolidone. The development of a scalable water-spray sintering method in combination with ink optimization yielded highly conductive prints of ≈7.3 × 10 5  S/m. Interestingly, the printed conductors experienced a resistance increase of less than 10% during 50% strain cycling, which is far below the expected 125% increase due to the geometry factor. The process allows for printing of high-performance multilayer circuits, which is demonstrated by the development of printed stretchable near-field communication tags.

This paper presents the first successful implementation of fully printed electronics for flexible and wearable smart multi-pad stimulation electrodes intended for use in medical, sports and lifestyle applications. The smart multi-pad electrodes with the electronic circuits based on organic electrochemical transistor (OECT)-based electronic circuits comprising the 3–8 decoder for active pad selection and high current throughput transistors for switching were produced by multi-layer screen printing. Devices with different architectures of switching transistors were tested in relevant conditions for electrical stimulation applications. An automated testbed with a configurable stimulation source and an adjustable human model equivalent circuit was developed for this purpose. Three of the proposed architectures successfully routed electrical currents of up to 15 mA at an output voltage of 30 V, while one was reliably performing even at 40 V. The presented results demonstrate feasibility of the concept in a range of conditions relevant to several applications of electrical stimulation.

The transition to a sustainable society is driving the development of green electronic solutions designed to have a minimal environmental impact. One promising route to achieve this goal is to construct electronics from biobased materials like cellulose, which is carbon neutral, non‐toxic, and recyclable. This is especially true for internet‐of‐things devices, which are rapidly growing in number and are becoming embedded in every aspect of our lives. Here, paper‐based sensor circuits are demonstrated, which use triboelectric pressure sensors to help elderly people communicate with the digital world using an interface in the form of an electronic “book”, which is more intuitive to them. The sensors are manufactured by screen printing onto flexible paper substrates, using in‐house developed cellulose‐based inks with non‐hazardous solvents. The triboelectric sensor signal, generated by the contact between a finger and chemically modified cellulose, can reach several volts, which can be registered by a portable microcontroller card and transmitted by Bluetooth to any device with an internet connection. Apart from the microcontroller (which can be easily removed), the whole system can be recycled at the end of life. A triboelectric touch interface, manufactured using printed electronics on flexible paper substrates, using cellulose‐based functional inks is demonstrated. These metal‐free green electronics circuits are implemented in an “electronic book” demonstrator, equipped with wireless communication that can control remote devices, as a step toward sustainable and recyclable internet‐of‐things devices.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Background Accurate diagnosis and staging are essential for optimal treatment planning of prostate cancer. By combining functional and anatomical imaging, PSMA-PET/mpMRI offers a potential to improve lesion detection and enhance staging accuracy. This study aimed to evaluate the diagnostic performance of lesion detection and local staging of prostate cancer using combined PSMA-PET/mpMRI compared to standalone mpMRI or PSMA-PET. Results Fifty-five patients with intermediate- to high-risk prostate cancer scheduled for robot-assisted laparoscopic radical prostatectomy were included. All patients underwent [ 68 Ga]PSMA-PET/mpMRI prior to surgery. Whole-mount histopathology and surgical report served as reference standard. Two radiologists independently evaluated mpMRI, while two nuclear medicine physicians assessed PSMA-PET. For the PSMA-PET/mpMRI analysis, a consensus evaluation was performed by a new set of readers in two teams, each comprising one radiologist and one nuclear medicine physician. Lesion localization was reported based on the PI-RADS v2.1 sector map and compared to histopathology. Among 130 histopathologically confirmed lesions, mean detection rates were 38% (49.5/130) for PSMA-PET/mpMRI, 32% (41/130) for mpMRI and 32% (41/130) for PSMA-PET. For clinically significant prostate cancer (csPC) (≥0.5 ml, ≥ISUP 2; 42 lesions), mean detection rates were 85% (35.5/42) for PSMA-PET/mpMRI, 75% (31.5/42) for mpMRI and 70% (29.5/42) for PSMA-PET. The mean false discovery rates were 8% (PSMA-PET/mpMRI), 15% (mpMRI) and 12% (PSMA-PET). The likelihood of extraprostatic extension (EPE) and seminal vesicle invasion (SVI) were scored using a 5-point Likert scale, where scores of 1–3 were classified as negative and scores of 4–5 were considered positive. Sensitivity for EPE was 32% for PSMA-PET/mpMRI, 37% for mpMRI and 7% for PSMA-PET, with a specificity of 100%, 96% and 98%, respectively. For SVI, sensitivity was 50% for PSMA-PET/mpMRI and 38% for mpMRI and PSMA-PET, with a specificity of 100%, 95% and 97% respectively. Conclusions PSMA-PET/mpMRI provided higher and a more consistent performance in localized prostate cancer detection and staging without increasing false-positive findings.

ObjectiveThe prescription-based Rx-risk index has previously been developed to measure multimorbidity. We aimed to adapt and evaluate the validity of the Rx-risk index in prediction of mortality among persons with type 2 diabetes.DesignRegistry-based study.SettingAdults with type 2 diabetes in Norway identified within the ‘Outcomes and Multimorbidity In Type 2 diabetes’ cohort, with linkage to prescriptions from the Norwegian Prescription Database and mortality from the Population Registry.ParticipantsWe defined a calibration sample of 42 290 adults diagnosed with type 2 diabetes 1950–2013, and a temporal validation sample of 7085 adults diagnosed 2014–2016 to evaluate the index validity over timePrimary outcome measureAll-cause mortalityMethodsFor the calibration sample, dispensed drug prescriptions in 2013 were used to define 44 morbidity categories. Weights were estimated using regression coefficients from a Cox regression model with 5 year mortality as the outcome and all morbidity categories, age and sex included as covariates. The Rx-risk index was computed as a weighted sum of morbidities. The validity of the index was evaluated using C-statistic and calibration plots.ResultsIn the calibration sample, mean (SD) age at start of follow-up and duration of diabetes was 63.8 (12.4) and 10.1 (7.0) years, respectively. The overall C-statistic was 0.82 and varied from 0.74 to 0.85 when stratifying on age groups, sex, level of education and country of origin. In the validation sample, mean (SD) age and duration of diabetes was 59.7 (13.0) and 2.0 (0.8) years, respectively. Despite younger age, shorter duration of diabetes and later time period, the C-index was high both in the total sample (0.84) and separately for men (0.83) and women (0.84).ConclusionsThe Rx-risk index showed good discrimination and calibration in predicting mortality and thus presents a valid tool to assess multimorbidity among persons with type 2 diabetes.

Most migratory birds return every year to the same breeding sites and some species show a similarly high fidelity to wintering grounds as well. Fidelity to stopover sites during migration has been much less studied and is usually found to be lower. Here, we investigate site fidelity and distance to previously visited sites throughout the annual cycle in the common cuckoo, a nocturnal trans‐Saharan migrant, based on satellite‐tracking data from repeated annual migrations of thirteen adult males. All birds (100%) returned to the same breeding grounds, with a median shortest distance of only 1 km from the locations in previous year. This was in strong contrast to a much lower and much less precise site fidelity at non‐breeding sites during the annual cycle: In only 18% of the possible cases in all non‐breeding regions combined, did the cuckoos return to within 50 km of a previously visited non‐breeding site, with no significant differences among the main staging regions (Europe in autumn, Sahel in autumn, wintering in Central Africa, West Africa in spring, Europe in spring). The shortest distance to a previously visited non‐breeding site differed among the staging regions with median shortest distances for the longest stopovers of 131 km [2;1223] (median [min;max]) in Europe, 207 km [1;2222] in Sahel in autumn and 110 km [0;628] in Central Africa. The distance to a previously visited staging site decreased with the time spent at the stopover in a previous year. Understanding the drivers of recurrence and site selection in migratory birds are important for guiding conservation efforts in this group but further studies are needed to establish whether the patterns observed in cuckoos are general among terrestrial migrants with continuous distribution of habitat.

ObjectiveThis 1-year study aimed to assess low-dose budesonide therapy for maintenance of clinical remission in patients with collagenous colitis.DesignA prospective, randomised, placebo-controlled study beginning with an 8-week open-label induction phase in which patients with histologically confirmed active collagenous colitis received budesonide (Budenofalk, 9 mg/day initially, tapered to 4.5 mg/day), after which 92 patients in clinical remission were randomised to budesonide (mean dose 4.5 mg/day; Budenofalk 3 mg capsules, two or one capsule on alternate days) or placebo in a 12-month double-blind phase with 6 months treatment-free follow-up. Primary endpoint was clinical remission throughout the double-blind phase.ResultsClinical remission during open-label treatment was achieved by 84.5% (93/110 patients). The median time to remission was 10.5 days (95% CI (9.0 to 14.0 days)). The maintenance of clinical remission at 1 year was achieved by 61.4% (27/44 patients) in the budesonide group versus 16.7% (8/48 patients) receiving placebo (treatment difference 44.5% in favour of budesonide; 95% CI (26.9% to 62.7%), p<0.001). Health-related quality of life was maintained during the 12-month double-blind phase in budesonide-treated patients. During treatment-free follow-up, 82.1% (23/28 patients) formerly receiving budesonide relapsed after study drug discontinuation. Low-dose budesonide over 1 year resulted in few suspected adverse drug reactions (7/44 patients), all non-serious.ConclusionsBudesonide at a mean dose of 4.5 mg/day maintained clinical remission for at least 1 year in the majority of patients with collagenous colitis and preserved health-related quality of life without safety concerns. Treatment extension with low-dose budesonide beyond 1 year may be beneficial given the high relapse rate after budesonide discontinuation.Trial registration numbershttp://www.clinicaltrials.gov (NCT01278082) and http://www.clinicaltrialsregister.eu (EudraCT: 2007-001315-31).