Design Optimization of Printed Multi-Layered Electroactive Actuators Used for Steerable Guidewire in Micro-Invasive Surgery.

To treat cardiovascular diseases (i.e., a major cause of mortality after cancers), endovascular-technique-based guidewire has been employed for intra-arterial navigation. To date, most commercially available guidewires (e.g., Terumo, Abbott, Cordis, etc.) are non-steerable, which is poorly suited to the human arterial system with numerous bifurcations and angulations. To reach a target artery, surgeons frequently opt for several tools (guidewires with different size integrated into angulated catheters) that might provoke arterial complications such as perforation or dissection. Steerable guidewires would, therefore, be of high interest to reduce surgical morbidity and mortality for patients as well as to simplify procedure for surgeons, thereby saving time and health costs. Regarding these reasons, our research involves the development of a smart steerable guidewire using electroactive polymer (EAP) capable of bending when subjected to an input voltage. The actuation performance of the developed device is assessed through the curvature behavior (i.e., the displacement and the angle of the bending) of a cantilever beam structure, consisting of single- or multi-stack EAP printed on a substrate. Compared to the single-stack architecture, the multi-stack gives rise to a significant increase in curvature, even when subjected to a moderate control voltage. As suggested by the design framework, the intrinsic physical properties (dielectric, electrical, and mechanical) of the EAP layer, together with the nature and thickness of all materials (EAP and substrate), do have strong effect on the bending response of the device. The analyses propose a comprehensive guideline to optimize the actuator performance based on an adequate selection of the relevant materials and geometric parameters. An analytical model together with a finite element model (FEM) are investigated to validate the experimental tests. Finally, the design guideline leads to an innovative structure (composed of a 10-stack active layer screen-printed on a thin substrate) capable of generating a large range of bending angle (up to 190°) under an acceptable input level of 550 V, which perfectly matches the standard of medical tools used for cardiovascular surgery.

Environmental impact of small-bowel capsule endoscopy.

INTRODUCTION: The environmental impact of endoscopy, including small-bowel capsule endoscopy (SBCE), has gained attention due to its contribution to the global carbon footprint. This study aimed to evaluate the greenhouse gas (GHG) emissions (kgCO2e) of SBCE, including devices life cycle and capsule journey. METHODS: SBCE devices (3 brands) were evaluated using life cycle assessment methodology (ISO 14040), including patient travelling, bowel preparation, capsule examination and video recording. A survey was conducted on 120 patients undergoing a SBCE to gather data on their transportation, activities during the procedure, and awareness of pollution generated and on 87 physicians reading capsules. RESULTS: For the 3 different capsules, the weight was 4 g (3.9-5.2% of total), while 43 to 119 g were attributed for packaging (9-97%) including 5 g of deactivation magnets (4-6%) and 11 to 50 g for instruction forms (40%). A full SBCE generated between 19 and 20 kgCO2e, including 0.04 kgCO2e (0.2%) for the capsule itself and 18 kgCO2e related to patient travelling (94.7%). Capsule retrieval would add 0.98 kgCO2e using dedicated devices. Capsule deconstruction revealed components (e.g. Neodymium) that are prohibited from environmental disposal. 76% of patients were not aware of the illegal nature of flushing capsules, and 63% would be willing to retrieve it. Data storage and physician impact were negligible. CONCLUSION: The GHG emission of SBCE is mainly determined by patient travelling. The capsule device itself has a comparably low carbon footprint. Considering capsule components disposal is illegal, retrieval of the capsule seems crucial but increasing device-related emissions.

Design Optimization of Piezocomposites Using a Homogenization Model: From Analytical Model to Experimentation.

In the process of activating non-conductive smart-structures using piezoelectric patches, one possible method is to add a conductive layer to ensure electrical contact of both electrodes of the ceramic. Therefore, depending on the stiffness and the thickness of this layer, changes in the overall piezoelectric properties lead to a loss in the electromechanical coupling that can be implemented. The purpose of this work is to study the impact of this added electrode layer depending on its thickness. A model of the effect of this layer on the piezoelectrical coefficients has been derived from the previous approach of Hashimoto and Yamagushi and successfully compared to experimental data. This global model computes the variation of all the piezoelectric coefficients, and more precisely of k31 or d31 for various brass electrode volumes relative to the ceramic volume. A decrease in the lateral electromechanical coupling factor k31 was observed and quantified. NAVY II PZT piezoelectric transducers were characterized using IEEE standard methods, with brass electrode thicknesses ranging from 50 to 400 microns. The model fits very well as shown by the results, leading to good expectations for the use of this design approach for actuators or sensors embedded in smart-structures.

Printed Eddy Current Testing Sensors: Toward Structural Health Monitoring Applications.

Reliable measurements in structural health monitoring mean for the instrumentation to be set in perfect reproducible conditions. The solution described in this study consists of printing the sensors directly on the parts to be controlled. This method solves the reproducibility issue, limits human error, and can be used in confined or hazardous environments. This work was limited to eddy current testing, but the settings and conclusions are transposable to any non-destructive testing methods (ultrasounds, etc.). The first salve of tests was run to establish the best dielectric and conductive ink combination. The Dupont ink combination gave the best performances. Then, the dispenser- and the screen-printing methods were carried out to print flat spiral coils on flexible substrates. The resulting sensors were compared to flex-printed circuit boards (PCB-flex) using copper for the electrical circuit. The conductive ink methods were revealed to be just as efficient. The last stage of this work consisted of printing sensors on solid parts. For this, 20-turn spiral coils were printed on 3 mm thick stainless-steel plates. The permanent sensors showed good sensibility in the same range as the portative ones, demonstrating the method's feasibility.

Haptic Feedback Device Using 3D-Printed Flexible, Multilayered Piezoelectric Coating for In-Car Touchscreen Interface.

This study focuses on the development of a piezoelectric device capable of generating feedback vibrations to the user who manipulates it. The objective here is to explore the possibility of developing a haptic system that can replace physical buttons on the tactile screen of in-car systems. The interaction between the user and the developed device allows completing the feedback loop, where the user's action generates an input signal that is translated and outputted by the device, and then detected and interpreted by the user's haptic sensors and brain. An FEM (finite element model) via ANSYS multiphysics software was implemented to optimize the haptic performance of the wafer structure consisting of a BaTiO3 multilayered piezocomposite coated on a PET transparent flexible substrate. Several parameters relating to the geometric and mechanical properties of the wafer, together with those of the electrodes, are demonstrated to have significant impact on the actuation ability of the haptic device. To achieve the desired vibration effect on the human skin, the haptic system must be able to drive displacement beyond the detection threshold (~2 µm) at a frequency range of 100-700 Hz. The most optimized actuation ability is obtained when the ratio of the dimension (radius and thickness) between the piezoelectric coating and the substrate layer is equal to ~0.6. Regarding the simulation results, it is revealed that the presence of the conductive electrodes provokes a decrease in the displacement by approximately 25-30%, as the wafer structure becomes stiffer. To ensure the minimum displacement generated by the haptic device above 2 µm, the piezoelectric coating is screen-printed by two stacked layers, electrically connected in parallel. This architecture is expected to boost the displacement amplitude under the same electric field (denoted E) subjected to the single-layered coating. Accordingly, multilayered design seems to be a good alternative to enhance the haptic performance while keeping moderate values of E so as to prevent any undesired electrical breakdown of the coating. Practical characterizations confirmed that E=20 V/µm is sufficient to generate feedback vibrations (under a maximum input load of 5 N) perceived by the fingertip. This result confirms the reliability of the proposed haptic device, despite discrepancies between the predicted theory and the real measurements. Lastly, a demonstrator comprising piezoelectric buttons together with electronic command and conditioning circuits are successfully developed, offering an efficient way to create multiple sensations for the user. On the basis of empirical data acquired from several trials conducted on 20 subjects, statistical analyses together with relevant numerical indicators were implemented to better assess the performance of the developed haptic device.

Development and Optimization of 3D-Printed Flexible Electronic Coatings: A New Generation of Smart Heating Fabrics for Automobile Applications.

Textile-based Joule heaters in combination with multifunctional materials, fabrication tactics, and optimized designs have changed the paradigm of futuristic intelligent clothing systems, particularly in the automobile field. In the design of heating systems integrated into a car seat, conductive coatings via 3D printing are expected to have further benefits over conventional rigid electrical elements such as a tailored shape and increased comfort, feasibility, stretchability, and compactness. In this regard, we report on a novel heating technique for car seat fabrics based on the use of smart conductive coatings. For easier processes and integration, an extrusion 3D printer is employed to achieve multilayered thin films coated on the surface of the fabric substrate. The developed heater device consists of two principal copper electrodes (so-called power buses) and three identical heating resistors made of carbon composites. Connections between the copper power bus and the carbon resistors are made by means of sub-divide the electrodes, which is critical for electrical-thermal coupling. Finite element models (FEM) are developed to predict the heating behavior of the tested substrates under different designs. It is pointed out that the most optimized design solves important drawbacks of the initial design in terms of temperature regularity and overheating. Full characterizations of the electrical and thermal properties, together with morphological analyses via SEM images, are conducted on different coated samples, making it possible to identify the relevant physical parameters of the materials as well as confirm the printing quality. It is discovered through a combination of FEM and experimental evaluations that the printed coating patterns have a crucial impact on the energy conversion and heating performance. Our first prototype, thanks to many design optimizations, entirely meets the specifications required by the automobile industry. Accordingly, multifunctional materials together with printing technology could offer an efficient heating method for the smart textile industry with significantly improved comfort for both the designer and user.

Design Rules of Bidirectional Smart Sensor Coating for Condition Monitoring of Bearings.

This paper reports a novel monitoring technique of bearings' bidirectional load (axial and radial) based on a smart sensor coating, which is screen printed onto the surface of a cross-shaped steel substrate. To ensure the accuracy and stability of measurement as well as the durability of the printed coating, the developed prototype is built according to design rules commonly used in electronic circuits. The finite element model (FEM) is used to predict the mechanical property of the tested substrate under either unidirectional or bidirectional loads. Regarding the output voltage of the piezoelectric sensor, experimental results are revealed to be well-corelated to the numerical simulation. It is pointed out that the output signal generated from the sensor (electrode) could be particularly affected due to the capacitive parasite coming from the conductive tracks (CTs). Such a phenomenon might be reduced by printing them on the dielectric layer rather than on the piezocomposite layer. The study also investigates a highly anisotropic shape of electrodes (rectangular instead of circle), indicating that the orientation of such electrodes (axial or radial) does affect the output measurement. To sum up, the high performance of a sensor network coating depends not only on the ultimate characteristics of its own materials, but also on its structural design. Such an issue has been rarely reported on in the literature, but is nonetheless crucial to achieving reliable condition monitoring of bearings, especially for multidirectional loads-a key signature of early failure detection.

Carbon footprint of atrial fibrillation catheter ablation.

AIMS: Climate change represents the biggest global health threat of the 21st century. Health care system is itself a large contributor to greenhouse gas (GHG) emissions. In cardiology, atrial fibrillation (AF) catheter ablation is an increasing activity using numerous non-reusable materials that could contribute to GHG emission. Determining a detailed carbon footprint analysis of an AF catheter ablation procedure allows the identification of the main polluting sources that give opportunities for reduction of environmental impact. To assess the carbon footprint of AF catheter ablation procedure. To determine priority actions to decrease pollution. METHODS AND RESULTS: An eco-audit method used to predict the GHG emission of an AF catheter ablation procedure was investigated. Two workstations were considered including surgery and anaesthesia. In the operating room, every waste produced by single-use medical devices, pharmaceutical drugs, and energy consumption during intervention were evaluated. All analyses were limited to the operating room. Thirty procedures were analysed over a period of 8 weeks: 18 pulmonary veins isolation RF ablations, 7 complex RF procedures including PVI, roof and mitral isthmus lines, ethanol infusion of the Marshall vein and cavo tricuspid isthmus line, and 5 pulmonary vein isolation with cryoballoon. The mean emission during AF catheter ablation procedures was 76.9 kg of carbon dioxide equivalent (CO2-e). The operating field accounted for 75.4% of the carbon footprint, while only 24.6% for the anaesthesia workstation. On one hand, material production and manufacturing were the most polluting phases of product life cycle which, respectively, represented 71.3% (54.8 kg of CO2-e) and 17.0% (13.1 kg of CO2-e) of total pollution. On the other hand, transport contributed in 10.6% (8.1 kg of CO2-e), while product use resulted in 1.1% (0.9 kg of CO2-e) of GHG production. Electrophysiology catheters were demonstrated to be the main contributors of environmental impact with 29.9 kg of CO2-e (i.e. 38.8%). Three dimensional mapping system and electrocardiogram patches were accounting for 6.8 kg of CO2-e (i.e. 8.8% of total). CONCLUSION: AF catheter ablation involves a mean of 76.9 kg of CO2-e. With an estimated 600 000 annual worldwide procedures, the environmental impact of AF catheter ablation activity is estimated equal to 125 tons of CO2 emission each day. It represents an equivalent of 700 000 km of car ride every day. Electrophysiology catheters and patches are the main contributors of the carbon footprint. The focus must be on reducing, reusing, and recycling these items to limit the impact of AF ablation on the environment. A road map of steps to implement in different time frames is proposed.

Molten-State Dielectrophoretic Alignment of EVA/BaTiO3 Thermoplastic Composites: Enhancement of Piezo-Smart Sensor for Medical Application.

Dielectrophoresis has recently been used for developing high performance elastomer-based structured piezoelectric composites. However, no study has yet focused on the development of aligned thermoplastic-based piezocomposites. In this work, highly anisotropic thermoplastic composites, with high piezoelectric sensitivity, are created. Molten-state dielectrophoresis is introduced as an effective manufacturing pathway for the obtaining of an aligned filler structure within a thermoplastic matrix. For this study, Poly(Ethylene-co Vinyl Acetate) (EVA), revealed as a biocompatible polymeric matrix, was combined with barium titanate (BaTiO3) filler, well-known as a lead-free piezoelectric material. The phase inversion method was used to obtain an optimal dispersion of the BaTiO3 within the EVA thermoplastic matrix. The effect of the processing parameters, such as the poling electric field and the filler content, were analyzed via dielectric spectroscopy, piezoelectric characterization, and scanning electron microscopy (SEM). The thermal behavior of the matrix was investigated by thermogravimetric analysis (TGA) and differential scanning calorimetry analysis (DSC). Thermoplastic-based structured composites have numerous appealing advantages, such as recyclability, enhanced piezoelectric activity, encapsulation properties, low manufacturing time, and being light weight, which make the developed composites of great novelty, paving the way for new applications in the medical field, such as integrated sensors adaptable to 3D printing technology.

Extrusion-Based 3D Printing of Stretchable Electronic Coating for Condition Monitoring of Suction Cups.

Suction cups (SCs) are used extensively by the industrial sector, particularly for a wide variety of automated material-handling applications. To enhance productivity and reduce maintenance costs, an online supervision system is essential to check the status of SCs. This paper thus proposes an innovative method for condition monitoring of SCs coated with printed electronics whose electrical resistance is supposed to be correlated with the mechanical strain. A simulation model is first examined to observe the deformation of SCs under vacuum compression, which is needed for the development of sensor coating thanks to the 3D printing process. The proposed design involves three circle-shaped sensors, two for the top and bottom bellows (whose mechanical strains are revealed to be the most significant), and one for the lip (small strain, but important stress that might provoke wear and tear in the long term). For the sake of simplicity, practical measurement is performed on 2D samples coated with two different conductive inks subjected to unidirectional tensile loading. Graphical representations together with analytical models of both linear and nonlinear piezoresistive responses allows for the characterization of the inks' behavior under several conditions of displacement and speed inputs. After a comparison of the two inks, the most appropriate is selected as a consequence of its excellent adhesion and stretchability, which are essential criteria to meet the target field. Room temperature extrusion-based 3D printing is then investigated using a motorized 3D Hyrel printer with a syringe-extrusion modular system. Design optimization is finally carried out to enhance the surface detection of sensitive elements while minimizing the effect of electrodes. Although several issues still need to be further considered to match specifications imposed by our industrial partner, the achievement of this work is meaningful and could pave the way for a new generation of SCs integrated with smart sensing devices. The 3D printing of conductive ink directly on the cup's curving surface is a true challenge, which has been demonstrated, for the first time, to be technically feasible throughout the additive manufacturing (AM) process.

Investigation of Blood Coagulation Using Impedance Spectroscopy: Toward Innovative Biomarkers to Assess Fibrinogenesis and Clot Retraction.

This study focused on a coagulation assessment based on the novel technique of blood-impedance-magnitude measurement. With the impedance characterization of recalcified human blood, it was possible to identify two significative biomarkers (i.e., measurable indicators) related to fibrin formation (1st marker) and clot retraction (2nd marker). The confocal microscopy of clotting blood provided a complete visual analysis of all the events occurring during coagulation, validating the significance of the impedance biomarkers. By analyzing the impedance phase angle (Φ) of blood during coagulation, as well as those of the clot and serum expelled after retraction, it was possible to further clarify the origin of the 2nd marker. Finally, an impedance-magnitude analysis and a rotational thromboelastometry test (ROTEM®) were simultaneously performed on blood sampled from the same donor; the results pointed out that the 1st marker was related to clotting time. The developed technique gives rise to a comprehensive and evolutive insight into coagulation, making it possible to progressively follow the whole process in real time. Moreover, this approach allows coagulation to be tested on any materials' surface, laying the ground for new studies related to contact coagulation, meaning, thrombosis occurring on artificial implants. In a near future, impedance spectroscopy could be employed in the material characterization of cardiovascular prostheses whose properties could be monitored in situ and/or online using effective biomarkers.

Optimization Strategies Used for Boosting Piezoelectric Response of Biosensor Based on Flexible Micro-ZnO Composites.

Piezoelectric ZnO-based composites have been explored as a flexible and compact sensor for the implantable biomedical systems used in cardio surgery. In this work, a progressive development route was investigated to enhance the performance of piezoelectric composites incorporated with different shape, concentration and connectivity of ZnO fillers. ZnO microrods (MRs) have been successfully synthesized homogeneously in aqueous solution using a novel process-based on chemical bath deposition (CBD) method. The morphological analysis along with Raman scattering and cathodoluminescence spectroscopy of ZnO MRs confirm their high crystalline quality, their orientation along the polar c-axis and the presence of hydrogen-related defects acting as shallow donors in their center. The experimental characterizations highlight that ZnO MR-based composites, with a higher aspect ratio (AR), lead to a significant improvement in the mechanical, dielectric and piezoelectric properties as opposed to the ZnO microparticles (MP) counterparts. The dielectrophoretic (DEP) process is then subjected to both ZnO MP- and MR-based composites, whose performance is expected to be improved as compared to the randomly dispersed composites, thanks to the creation of chain-like structures along the electric field direction. Furthermore, a numerical simulation using COMSOL software is developed to evaluate the influence of the material structuration as well as the filler's shape on the electric field distribution within different phases (filler, matrix and interface) of the composites. Finally, the aligned MR piezoelectric composites are revealed to be high potential in the development of innovative compact and biocompatible force-sensing devices. Such a technological breakthrough allows the achievement of a real-time precise characterization of mitral valve (MV) coaptation to assist surgeons during MV repair surgery.

Dielectrophoresis Structurization of PZT/PDMS Micro-Composite for Elastronic Function: Towards Dielectric and Piezoelectric Enhancement.

Piezoelectric materials have been used for decades in the field of sensors as transducers and energy harvesters. Among these, piezoelectric composites are emerging being extremely advantageous in terms of production, costs, and versatility. However, the piezoelectric performances of a composite with randomly dispersed filler are not comparable with bulk ferroelectric ceramics and electroactive polymers. In order to achieve highly performing and low-cost materials, this work aims to develop flexible composites made of Lead zirconate titanate (PZT) filler in Polydimethylsiloxane (PDMS) matrix, with a specific internal structure called quasi-1-3 connectivity. Such a structure, comprising particles arranged in columns along a preferred direction, is performed through dielectrophoresis by applying an alternating electric field on the composite before and during the polymerization. The developed flexible material could be introduced into complex structures in various application fields, as sensors for structural monitoring.

Eco-audit of conventional heart surgery procedures.

OBJECTIVES: Healthcare systems have a significant environmental impact and, thus, indirectly affect public health. In order to improve current practices, a better understanding of the actual environmental impact generated by surgical procedures is necessary. METHODS: An eco-audit methodology was carried out to assess the greenhouse gas emissions arising from conventional isolated cardiac surgery procedures. This inquiry took into account 3 workstations (the surgical, the anaesthesia and the cardiopulmonary bypass workstations). All wastes were analysed including the disposable medical products, pharmaceuticals and energy consumption during such surgeries. RESULTS: Twenty-eight cardiac surgeries were analysed out of a 4-week study period. The mean emissions during a single cardiac surgery was 124.3 kg of carbon dioxide equivalent (CO2-e). Eighty-nine per cent of the total emissions was related to the use of disposable medical products. The environmental impact of pharmaceuticals used at anaesthesia workstations was 12.4 kg of CO2-e (10% of total greenhouse gas emission), with 11.1 kg of CO2-e resulting from the use of halogenated gas. Direct electrical consumption resulted in 4.0 kg of CO2-e per surgery (3% of all emission), including lighting and air conditioning. CONCLUSIONS: Conventional isolated cardiac procedures yield the global warming equivalent of a 1080 km plane ride for a single passenger. The environmental impact of such life-saving interventions, therefore, must be put in perspective alongside pollution induced by 'non-indispensable' human activities. However, numerous initiatives at the local and individual level as well as at a larger systemic and countrywide scale appear to provide accessible pathways to meaningfully reduce greenhouse gas emissions during cardiac surgery.

Influence of Matrix and Surfactant on Piezoelectric and Dielectric Properties of Screen-Printed BaTiO3/PVDF Composites.

The aim of this paper was to provide insight into the impact of matrix and surfactants on the rheology, morphology, and dielectric and piezoelectric properties of screen-printed BaTiO3/PVDF composites. Two matrices were compared (PVDF-HFP and PVDF-TrFE), and lead-free BaTiO3 microparticles were added in volume fractions of 30% and 60%. Here, we demonstrated that the presence of surfactants, helping to prevent phase separation, was crucial for achieving a decent screen-printing process. Fourier-transform infrared (FTIR) spectroscopy together with scanning electron microscopy (SEM) showed that the two "fluoro-benzoic acid" surfactants established stable bonds with BaTiO3 and improved the dispersion homogeneity, while the "fluoro-silane" proved to be ineffective due to it evaporating during the functionalization process. PVDF-TrFE composites featured a more homogeneous composite layer, with fewer flaws and lower roughness, as compared with PVDF-HFP composites, and their inks were characterized by a higher viscosity. The samples were polarized in either AC or DC mode, at two different temperatures (25 °C and 80 °C). The 30% BaTiO3 PVDF-TrFE composites with two fluorinated surfactants featured a higher value of permittivity. The choice of the surfactant did not affect the permittivity of the PVDF-HFP composites. Concerning the d33 piezoelectric coefficient, experimental results pointed out that PVDF-TrFE matrices made it possible to obtain higher values, and that the best results were achieved in the absence of surfactants (or by employing the fluoro-silane). For instance, in the composites with 60% BaTiO3 and polarized at 80 °C, a d33 of 7-8 pC/N was measured, which is higher than the values reported in the literature.