Piezoelectric materials turn mechanical stress into electrical energy, and vice versa. In 1997, researchers developed piezoelectric materials that were 10 times better at coupling electrical and mechanical responses than prior state-of-the-art materials. But even scientists did not understand why the newer materials were so responsive.
Now, scientists at the Department of Energy’s Oak Ridge National Laboratory and their research partners have used neutron scattering to discover the key to piezoelectric excellence in the newer materials, which are called relaxor-based ferroelectrics. (A ferroelectric material has electrical polarization that is reversed by application of an electric field.) Their findings may provide knowledge needed to accelerate the design of functional materials for diverse applications.
Relaxor-based oxide ferroelectrics have revolutionized piezoelectric devices. In medical ultrasound, for example, the mechanical pressure of sound waves generates images of a person’s interior. Compared with the performance of traditional materials, the stronger response of relaxor-based ferroelectrics yields a more detailed electrical signal that produces better images. Instead of having somewhat blurry guidance from 2D images to diagnose a cause of pain, assess prenatal condition, guide a biopsy or assess damage after a heart attack, doctors now rely on finely detailed 3D imagery. These modern materials also made it possible to focus ultrasound waves for non-invasive medical treatments of conditions such as tumours or gallstones. This technology passes individual beams harmlessly through tissue; the beams converge on a target where their effects are concentrated, like light passing through a magnifying glass to ignite paper.
‘We figured out at an atomic level why certain materials are so great at mechanically responding to an electric field by changing shape or size,’ said lead author Michael Manley of ORNL. ‘The finding provides a basis for high-performance actuators and sensors.’ Compared to traditional polycrystalline materials, the newer piezoelectric crystals generate a greater mechanical force in response to an applied electric field.

Oak Ridge National Laboratory http://tinyurl.com/j57s466

Scientists at the University of Exeter have developed a pioneering new technique that could revolutionise the surgical treatment of epilepsy.
The team of scientists, led by Dr Marc Goodfellow and Professor John Terry, have developed the ground-breaking new method that can identify the specific regions of the brain that trigger seizures in people with epilepsy.

The new technique is designed to help surgeons and neurologists measure the relative contribution to the occurrence of seizures made by different brain regions, and so determine which regions to remove to have most benefit to the individual.

At present, people with epilepsy are treated initially through medication, which aims to dramatically reduce or remove the threat of seizures. However anti-epilepsy drugs prove ineffective in around one-third of people. In these cases, patients can elect to undergo surgery to remove small parts of the brain – which does not impact healthy brain function – but which can help reduce the chance of experiencing seizures.
Surgeons record electrical activity from the surface of the brain and study the electrical rhythms to attempt to identify the brain regions where seizures begin. However, current approaches are only partially effective with around 50% of people with epilepsy seeing significant long-term improvements following surgery.
The new method devised by the scientists, which used state-of-the-art mathematical modelling procedures, can more accurately distinguish the brain regions that are the source of seizure activity from those that become involved as a result of a seizure starting.

Professor Terry, Director of the EPSRC Centre for Predictive Modelling in Healthcare and an expert in Biological Modelling from Exeter’s Mathematics department said: ‘This research has the potential to dramatically improve surgical success rates for those patients who need it, and so also dramatically improve their quality of life.

‘The potential is truly outstanding. It gives surgeons valuable information on how different brain regions contribute to seizures, enabling them to predict the outcome of different surgical strategies and so better plan surgery.
‘Imagine someone was in a theatre and sending text messages to random audience members, making their phones ring. Current techniques are in essence akin to removing those people who receive the messages – they are contributing to the disruption and so removing them could make a difference. But clearly it would be better to identify and remove the individual sending out the messages – the original source. That is what our methods achieve – identifying the original source.’

University of Exeterwww.exeter.ac.uk/news/featurednews/title_527678_en.html

Siemens Healthineers recently announced the company is expanding its informatics capabilities for point-of-care testing with the acquisition of Conworx Technology GmbH, the Berlin-based developer of point-of-care device interfaces and data management solutions. The addition of the Conworx suite – including UniPOC and POCcelerator – complements the Siemens Healthineers award-winning RAPIDComm Data Management System and will elevate the informatics offerings for the point-of-care market by delivering open connectivity for more than 100 different instruments from all major manufacturers.
This acquisition is another proof point of the Siemens Healthineers strategic direction to enable healthcare providers around the world to meet their current and evolving challenges and to excel in their respective environments. Through products and solutions designed to increase efficiency and to reduce costs, Siemens Healthineers is setting new trends in healthcare together with its customers – working under the motto ‘Engineering Success. Pioneering Healthcare. Together.’
As the trend of consolidation and industrialization in healthcare continues and regulatory requirements for point-of-care testing intensify, the need for sophisticated informatics to communicate instrument and patient data at the point of care becomes increasingly important. Siemens Healthineers and Conworx will deliver open connectivity offerings that will enable seamless data integration from any manufacturer’s point-of-care analyser – managed by a single informatics solution to streamline operations and access to data, and improve risk management.
‘As hospitals consolidate and acquire physician offices, there is a huge need by emerging healthcare networks for seamless integration of hundreds of decentralized devices that are spread across dozens of sites.’ said Peter Koerte, President, Point of Care Diagnostics, Siemens Healthineers. ‘It is clear to us that to satisfy our customers’ needs, we must deliver solutions that ensure superb connectivity, no matter which analyser is being connected. We are determined to continue Conworx’s practice of working closely with every vendor to ensure that all connected analysers are working to the best of their ability.’
Now a wholly-owned subsidiary of Siemens Healthcare GmbH, Conworx’s team of 75 employees will merge with the Siemens Healthineers team to become Siemens Healthineers Point of Care Informatics. This new team of interface development, application development and data management specialists will be led by Roman Rosenkranz, the current CEO of Conworx Technology GmbH.
‘By joining with Siemens Healthineers, we will get access to a global organization to even better support our joint customer base’ said Roman Rosenkranz, CEO of Conworx Technology GmbH. ‘Together we will be able to develop leading informatics products that help our customers to manage their growing point-of-care networks now and in the future.’
Conworx Technology GmbH was established in 1999. The deal was closed by Siemens Healthcare GmbH in late October 2016.

www.conworx.com/en/ www.siemens.com/healthineers

A novel heart valve replacement method has been revealed that offers hope for the thousands of patients with rheumatic heart disease who need the procedure each year.

‘Over the past decade heart valve surgery has been revolutionised by transcatheter aortic valve implantation (TAVI),’ said lead author Dr Jacques Scherman, a cardiac surgeon in the Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, South Africa. ‘Heart valves are replaced or repaired via a catheter, obviating the need for open heart surgery or a heart-lung machine.’

He continued: ‘TAVI is only indicated in patients with calcific degenerative aortic valve disease, which is the most prevalent aortic valve pathology in developed countries. In developing countries, rheumatic heart disease still accounts for the majority of patients in need of a heart valve intervention.’
Rheumatic heart disease is caused by rheumatic fever, which results from a streptococcal infection. Patients develop fibrosis of the heart valves, leading to valvular heart disease, heart failure and death. In Africa alone there are around 15 million patients living with rheumatic heart disease of whom 100 000 per year might need a heart valve intervention at some stage of their life. The vast majority of these patients have no access to cardiac surgery or sophisticated cardiac imaging.

Dr Scherman said: ‘Inspired by the success of TAVI for calcific aortic valve disease, we developed a simplified TAVI device for transcatheter aortic valve replacement in patients with rheumatic heart disease.’
Currently available balloon expandable TAVI devices require the use of sophisticated cardiovascular imaging to correctly position the new valve. They also use a temporary pacemaker which allows the heart to beat so quickly that it stops blood circulating to the rest of the body (called rapid ventricular pacing).

Dr Scherman said: ‘Rapid ventricular pacing can only be tolerated for a short period and therefore limits the time available to do the implantation.’
The team in South Africa developed a novel TAVI device which is ‘non-occlusive’, meaning that there is no need to stop blood circulating to the body with rapid ventricular pacing. The device is also ‘self-locating’ and does not require sophisticated cardiac imaging for positioning.

The proof of concept study presented today tested the device in a sheep model. The investigators found that the device was easy to use and positioned the valve correctly, and the procedure could be performed without rapid ventricular pacing.

Dr Scherman said: ‘We showed that this new non-occlusive, self-locating TAVI delivery system made it easy to perform transcatheter aortic valve replacement. Using tactile feedback the device is stabilised in the correct position within the aortic root during the implantation. It also has a temporary backflow valve to prevent blood leaking backwards into the ventricle during the implantation of the new valve. All these factors together allowed for a slow, controlled implantation compared to the currently available balloon expandable devices.’

He added: ‘This simplified approach to transcatheter aortic valve replacement could be done in hospitals without cardiac surgery at a fraction of the cost of conventional TAVI. It has the potential to save the lives of the large numbers of rheumatic heart disease patients in need of valve replacement.’

European Society of Cardiology www.escardio.org/The-ESC/Press-Office/Press-releases/novel-heart-valve-replacement-offers-hope-for-thousands-with-rheumatic-heart-disease

Home-based telemental health for depression is well received by patients and delivers as good a quality of life as in-person visits, according to the results of a clinical trial in 241 depressed elderly veterans reported by investigators at the Medical University of South Carolina and the Ralph H. Johnson VA Medical Center.

Depression affects 10 percent of Americans and is a leading cause of disability and mortality. And yet, only an estimated 56 percent of patients with depression seek treatment. Barriers to treatment include mobility issues, transportation costs, missed days of work, geographic isolation and fear of the associated stigma. By overcoming some of those barriers, proponents of telemental health say it could improve access to care for these patients.

Leonard E. Egede, M.D., director of the MUSC Center for Health Disparities Research and a Veterans Affairs physician, led a team of MUSC and VA Medical Center investigators, along with Christopher Frueh, Ph.D., director of clinical research at The Menninger Clinic and adjunct professor from Baylor College of Medicine.

‘This is the largest randomized clinical trial to date examining whether differences exist in patient perceptions, satisfaction, therapeutic alliance and quality of life between telemental health and same-room care,’ Egede said.

Male and female veterans aged 58 years and older who met the criteria for major depressive disorder, including Vietnam-era veterans, were eligible for enrollment in the trial. All participants received eight weeks of behavioural activation therapy and were randomly assigned to telemental health or in-person counselling. Behavioural activation reflects the notion that the patient’s activity plays a role in how the person feels and the goal of therapy is to reduce behaviours that promote depression.

Telemental health treatment sessions were delivered via in-home videoconferencing using a standard telephone line and did not require an internet connection. The 36-item Short Form Survey was used to assess quality of life and the Charleston Psychiatric Outpatient Satisfaction Scale was used to assess patient satisfaction. Scores on these scales did not differ significantly at 12-month follow-ups between veterans who received depression care via telemental heath and those who received in-person care.

Egede and colleagues had previously reported primary outcome and cost analysis results from this same trial of 241 depressed elderly veterans. In a 2015 Lancet Psychiatry article, Egede showed that telemental health was not inferior to same-room delivery in patients with a major depressive disorder for eliciting a treatment response. A treatment response was defined as a 50 percent decrease in depression symptoms at a 12-month follow-up appointment versus baseline and the absence of a diagnosis of major depressive disorder at a 12-month follow-up.

In an article published, Egede showed that the overall inpatient costs as well as outpatient and pharmacy costs for treating depression increase over time in elderly veterans, regardless of whether the treatment is delivered in person or via telemental health. This increase in cost is likely a result of the rising number of visits.

In conjunction with these earlier findings that primary outcomes and costs for telemental health are similar to those for in-person depression care, the report suggests that telemental health is a viable alternative to in-person visits because it delivers a similar quality of life and patient satisfaction.

EurekAlert www.eurekalert.org/pub_releases/2016-11/muos-ssh112316.php