Injection Device Research Articles

Prevalence and influence factors of occupational exposure to blood and body fluids in registered Chinese nurses: a national cross-sectional study

BackgroundOccupational exposure to blood and body fluids poses a threat to medical providers and to nurses especially. This harm is not only physical, but psychology as well and can ultimately impact patient safety. This study aims to understand the prevalence of occupational exposure to blood and body fluids among Chinese registered nurses and explores the factors that influence this exposure.MethodsA cross-sectional online survey was conducted for 31 province-level divisions in China, using a self-created questionnaire entitled Status Survey on Occupational Exposure in Nurses. Descriptive statistics were used to describe both the demographic characteristics of the respondents and the characteristics of occupational exposure. Categorical variables were presented as frequencies and percentage, and the relationship between possible influential factors and the occurrence of occupational exposure was determined using binary logistic regression.ResultsOut of a total of 20,791 nurses analyzed, over half (52.1%) of them had experienced occupational exposure to blood or body fluids, but over 1/3 (34.6%) of them did not ever report their exposures to a supervisor/official. The top three causes of under-reporting were: the source patient failed to test positive for infectious pathogens (43.6%), perception of a burdensome reporting process (24.6%), and indifferent attitude towards being infected (16.9%). Nurses who worked over 8 hours per day had higher risks of exposure (OR 1.199, 95% CI 1.130 to 1.272, P < 0.001, respectively). The occupational exposure risk from providing 1–2 types of PPE is 1.947 times that of providing 9–10 types of PPE (OR 1.947, 95% CI 1.740 to 2.178, P < 0.001). Likewise, the occupational exposure risk of providing 1–2 types of safety-engineered injection devices is 1.275 times of that of providing 5–6 types (OR 1.275, 95% CI 1.179 to 1.379, P < 0.001).ConclusionsOccupational exposure to blood and body fluids in registered nurses is common, but the rate of under-reporting such exposure is high. Implementing engineered “sharp” injury prevention devices, following exposure prevention procedures, giving sufficient education and training to healthcare personnel on exposure prevention and control, and developing exposure reporting policies are all steps that can both reduce exposure and increase its reporting.

EPINEPHRINE NASAL SPRAY (ARS-1) AND INTRAMUSCULAR INJECTION: PHARMACOKINETIC/PHARMACODYNAMIC DIFFERENCES AND DIFFERENTIAL AFFINITIES FOR ADRENERGIC RECEPTORS

<h3>Introduction</h3> Although considered clinically indistinguishable, pharmacokinetics (PK) and pharmacodynamics (PD) between epinephrine intramuscular (IM) injection devices and manual IM injection are different. Differences in PD profiles of epinephrine products affecting blood pressure (BP) were investigated. <h3>Methods</h3> This integrated analysis was based on 4 randomized, cross-over, phase 1 studies (175 participants) comparing epinephrine manual IM 0.3 mg injection, epinephrine 0.3 mg injection devices, and epinephrine 1 mg nasal spray (ARS-1) once and twice dosing. IRB approval was obtained by all clinical sites. <h3>Results</h3> Highest mean C_max values (pg/mL) were observed following epinephrine auto-injector (503), with ARS-1 (258) comparable to manual IM (254), with the trend similar with twice-dosing. Mean systolic BP (SBP) E_max change from baseline (mm Hg) and heart rate (HR) E_max change from baseline (bpm) were comparable between ARS-1 (16.9 and 13.6, respectively) and epinephrine auto-injector (18.1 and 14.4, respectively) compared to IM (10.9 and 12.8, respectively), despite expecting that HR would correlate with epinephrine concentration due to lower affinity of β-adrenergic receptors. This trend was observed with twice dosing where mean C_max with ARS-1 and epinephrine auto-injector were 486 pg/mL versus 654 pg/mL, respectively, and mean SBP E_max (mm Hg) and HR Emax (bpm), respectively, were 25.9 and 22.6 with ARS-1 and 26.7 and 22.7 with epinephrine auto-injector. <h3>Conclusion</h3> ARS-1 increased BP more efficiently than epinephrine auto-injector or manual IM injection despite differences in C_max and t_max. This is likely due to bypassing β2 receptor-mediated vasodilatation in the skeletal muscle and stimulating β1 receptors to increase HR.

EPINEPHRINE VIA NEEDLE-FREE DEVICE WOULD BE ADMINISTERED FASTER AFTER SYMPTOMS: RESULTS OF A PATIENT/CAREGIVER SURVEY

<h3>Introduction</h3> Intramuscular epinephrine is first-line treatment for severe allergic reactions. However, patients/caregivers often hesitate before using an epinephrine injectable device, endangering themselves or their child because progression of an allergic reaction can be quick and unpredictable. The time people wait before device use, what triggers use, and reasons for hesitation are not understood. Insight was sought regarding time to device use after symptom development and triggers for use. <h3>Methods</h3> A 20-minute double-blind survey of patients/caregivers who used an epinephrine injectable device within the preceding 12 months was conducted (exempt from IRB approval). Respondents were asked questions about their/their child's allergy, symptoms that triggered device use, and reasons for hesitation. <h3>Results</h3> A total of 200 individuals responded (caregivers and patients, n=100 each). Average time between symptom development and device use was 8.8 minutes, and the needle in the injectable device was the main reason for delay. When respondents were presented with a needle-free delivery device concept for administering epinephrine, estimated time to use was reduced to 4.9 minutes. A needle-free device was perceived as easier/less complicated and less painful to use; the lack of a needle would eliminate harm errors (e.g., striking bone or accidental intravenous injection). Respondents noted that they would be more likely to use a needle-free device at the onset of symptoms. <h3>Conclusion</h3> A needle-free option for administering epinephrine would be used more quickly after symptoms developed and would be easier to use versus an injectable device. This underscores the need to develop epinephrine modalities utilizing a non-needle-based delivery system.

TIME BEFORE USE OF EPINEPHRINE INJECTABLE DEVICES AND TRIGGERS DRIVING USE: A PATIENT/CAREGIVER SURVEY

<h3>Introduction</h3> Intramuscular epinephrine is first-line treatment for severe allergic reactions. Despite the association between early treatment and decreased hospitalization/fatality, epinephrine injectable devices are often under-used because of patient lack of readiness, hesitancy to use, and lack of understanding regarding allergic reaction progression. Insight was gathered on time to device use after symptoms develop and the triggers that drive use. <h3>Methods</h3> A 20-minute double-blind survey of patients/caregivers who used an epinephrine injectable device within the past 12 months was conducted (exempt from IRB approval). Respondents were asked a series of questions about their/their child's allergy, current treatment, the last allergic reaction, and the number of minutes they waited before using the device, and the triggers that drove use. <h3>Results</h3> A total of 200 individuals responded (caregivers and patients, n=100 each). Average time between development of symptoms and device use was 8.8 minutes. Caregiver use occurred faster than patient use (8.3 vs 9.3 minutes, respectively), and patients treated by an allergist had the longest delay (9.5 minutes) versus pediatricians and primary care (8.4 and 8.2 minutes, respectively). Symptoms that precipitated device use included wheezing, cough, and chest tightness (80%); facial, tongue, and throat swelling (73%); and hives, reddening of skin (65%). The needle in the epinephrine injectable device was the main reason for delay in use. <h3>Conclusion</h3> There are significant delays in use of an epinephrine injectable device. This hesitation is predominantly caused by a fear of needles. This underscores the need to develop non-needle-based epinephrine modalities to treat severe allergic reactions.

Owner preference for insulin delivery device and glycaemic control in diabetic dogs.

To assess treatment satisfaction and owner preference for two delivery devices (VetPen, MSD Animal Health, and U40 insulin syringes) and the effect on glycaemic control in diabetic dogs treated with porcine insulin zinc suspension. Randomised prospective cross-over study with two arms, each of 8 weeks. Twenty client-owned diabetic dogs on insulin treatment by U40 syringe were enrolled. Dogs were randomly assigned to receive insulin by syringe or pen injector for 2 months, followed by 2 months of the other injection method. Treatment satisfaction and owners' insulin delivery device preference were assessed using a questionnaire. Glycaemic control was assessed using a clinical score, serum fructosamine and glycated haemoglobin (HbA1c%) at the time of the enrolment (T0) and the end of each arm of treatment (T2 and T4). Treatment satisfaction differed for the two types of the delivery device when the order that each device was used was taken into consideration. Owners who used the syringe first did not have a significant preference for an injection device. In contrast, owners who used the pen injector first expressed a significant preference for VetPen compared to syringes. No significant differences in the number of dogs of Groups 1 and 2 with good and poor glycaemic control at T2 and T4 were detected. Overall treatment satisfaction and preference for the two delivery methods were similar. However, VetPen was preferred by owners who were randomised to use this device first. Glycaemic control did not appear to be affected by the insulin delivery device used.

3D printed bionic self-powered sensing device based on fern-shaped nitrogen doped BiVO4 photoanode with enriched oxygen vacancies

A portable three-dimensional (3D) printed bionic sensing device with enhanced photoelectric response was fabricated for sensitive detection of Bisphenol A (BPA). The proposed sensor is operated upon by using a highly reactive dual-electrode system to generate electrical output and provide the sensing signal under photoirradiation, without an external power source. The fern-shaped nitrogen doped BiVO4 photoanode with enriched oxygen vacancies (Ov) bismuth vanadate (N/Ov/BiVO4) photoanode was first synthesized and applied to construct a bionic sensing device. Density functional theoretical (DFT) calculation shows that the synergistic of nitrogen doping and Ov on the surface of photoanode leads to the emergence of impurity levels in BiVO4’s electronic structure, promoting the effective separation of photogenerated electron-hole pairs. Impressively, the unique fern-shaped bionic structure enhances the mass transfer efficiency of the sensing system and provides abundant binding sites of aptamer, realizing signal amplification. Moreover, a portable sensing device for automatic sample injection and detection is developed by integrating the detection system into a micromodel based on micro-nano 3D printing technology. Benefit from this ingenious design, the proposed bionic aptasensor displayed excellent electricity output and achieved high sensitivity and selectivity of BPA detection with a low limit of detection (0.025 nM) and broad linear range from 0.1 nM to 100 μM, paving a new way for the development of portable and on-site sensing devices.

Effects of Reactive Species Produced by Electrolysis of Water Mist and Air through Non-Thermal Plasma on the Performance and Exhaust Gas of Gasoline Engines.

Countries are paying increasing attention to environmental issues and are moving towards the goal of energy saving and carbon reduction. This research presents a method to analyse the effects of the use of non-thermal plasma (NTP) and water injection (WI) devices on the efficiency of internal combustion engines. The devices were installed on the intake manifold to investigate the effects of additional substances produced by electrolysis on the engine performance and exhaust emissions. According to the results, the addition of the NTP and WI devices affected the power efficiency and the rate of change of the brake-specific fuel consumption (BSFC) of the internal combustion engines. In addition, the change rate of hydrocarbons (HC), carbon monoxide (CO), and nitrogen oxides (NOx) in the exhaust gases was affected. In conclusion, the study found that the additional substances generated by the NTP-electrolysed water mist or air influenced the fuel combustion efficiency and exhaust emissions.

Development of an optically gated Fe/n-GaAs spin-polarized transistor

Efficient modulation of electrically injected spin signals that is suitable for modern-day transistor functionality is yet to be established. In this work, we demonstrate in detail the fabrication of a $\mathrm{Fe}/n\text{-GaAs}$ spin injection device and the experimental setup for an optical gating of the nonlocal spin transport signal. In situ scanning electron microscopy interface imaging reveals more uniform current distribution at the $\mathrm{Fe}/n\text{-GaAs}$ injector interface at bias voltages higher than the Schottky barrier height. Three- and four-terminal Hanle measurements confirm successful spin injection into $n$-GaAs, with strong interfacial spin dephasing at high magnetic fields. A time-resolved pump-probe Kerr rotation setup was used to illuminate circularly polarized light in the region of the pure spin current in $\mathrm{Fe}/n\text{-GaAs}$ lateral spin injection devices, where ($0.4\ifmmode\pm\else\textpm\fi{}0.3)%$ modulation of the nonlocal signal depending on the light helicity was observed at 30 K.

Knowledge and self-reported practice of insulin injection device disposal and associated factors among diabetes patients in Addis Ababa, Ethiopia: A cross-sectional study

Background: Diabetes mellitus is a serious long-term condition with a major impact on the lives and well-being, of societies worldwide. Poor disposal practices of devices potentially result in personal injury and injuries to people in the household and the general community. This study aimed to assess the knowledge and self-reported practice of insulin injection device disposal and associated factors among diabetes patients in TASH, Addis Ababa, Ethiopia. Method: A cross-sectional study was conducted among 182 adults with diabetes. The study participants were selected through systematic random sampling. Data were collected from March/17/2020 - May/18/2020. Patients were interviewed using a structured questionnaire. Data were entered into Epi-data version 4. 6 and exported to SPSS version 25.0 for analysis. Bivariable and multivariable logistic regression with crude and adjusted odds ratios along with the 95% confidence interval was computed and interpreted accordingly. Good practice and adequate knowledge were defined based on median calculation; a result above the median value of good practice and adequate knowledge with a p - value &lt; 0.05 was considered to declare a result as statistically significant. Results: About 54% of the participants had inadequate knowledge about safe insulin injection waste disposal. More than two-thirds (73%) of respondents had poor practice and 92.3% of respondents did not know how to dispose of lancets after use. Conclusion: This study revealed that the knowledge and practice of diabetic patients were inadequate and poor towards safe insulin injection waste disposal in the study area. Educating patients and awareness creation training on proper insulin injection device disposal should be considerable.

Comprehensive Review on Fault Ride-Through Requirements of Renewable Hybrid Microgrids

The world is interested in applying grid codes to increase the reliability of power systems through a micro-grid (MG). In a common practice, the MG comprises a wind farm, and/or photovoltaic (PV) arrays that are integrated with diesel generators and energy storage devices. Fault ride-through (FRT) capability is an important requirement of grid codes. FRT means that the MG is still connected to the grid during numerous disturbances such as faults. This is required to ensure that there is no loss of power generated due to grid faults. Reactive currents must be injected into the grid to increase the power system stability and restore voltage. To enhance FRT for doubly fed induction generator (DFIG) based WT installation, internal control modifications of rotor-side converters and grid-side converters are applied. The solutions that depend on these modifications are traditional and advanced control techniques. Advanced control techniques are needed due to the non-linear nature and less robustness of traditional ones. External hardware devices are also added to improve the FRT of DFIG which are classified into protection devices, reactive power injection devices, and energy storage devices. A comprehensive review of FRT enhancements of DFIG-based WTs, PV systems, and MGs using hardware and software methods is presented in this effort. A classification of FRT of PV systems is characterized plus various inverter control techniques are indicated. Several FRT methods for hybrid PV-WT are presented, with full comparisons. The overall operation and the schematic diagrams of the DFIG-WT with FRT methods are discussed and highlighted. Many Robust control methods for controlling grid connected AC, DC and hybrid AC/DC MGs in power systems are addressed. A total of 210 reported articles were review, including the most up-to-date papers published in the literature. This review may be used as the basis to improve system reliability for those interested in FRT methods. Various traditional and advanced control techniques to improve the FRT abilities are summarized and discussed, including protection devices, reactive power injection devices, and energy storage. In addition, the classifications of FRT hardware methods for DFIG are presented, including grid code requirements.

The Internet of Bodies: The Human Body as an Efficient and Secure Wireless Channel

The Internet of Bodies (IoB) is a network of smart objects placed in, on, and around the human body, allowing for intra- and inter-body communications. This position article aims to provide a glimpse into the opportunities created by implantable, injectable, ingestible, and wearable IoB devices. The article starts with a thorough discussion of application-specific design goals, technical challenges, and enabling communication standards. We discuss why the highly radiative nature of radio frequency (RF) systems results in inefficient communication due to over-ex-tended coverage, causing interference and becoming susceptible to eavesdropping. Alternatively, body channel communication (BCC) uses the human body as a transmission medium by coupling harmless electrical signals, yielding secure and efficient communication thanks to better channel conditions and lower signal leakage than over-the-air RF systems. Numerical results show that various BCC topologies can respectively reach 8–12 Mb/s and 1.5-3 Mb/s max-sum and max-min rates with 1 MHz bandwidth and -30 dBm transmission power, which is three orders of magnitude lower than safety limits. Moreover, the BCC is capable of accommodating tens of IoB nodes up to 1 Mb/s rates, which is sufficient for most IoB applications. Furthermore, as the cyber and biological worlds meet, security risks and privacy concerns take center stage, leading to a discussion of multi-faceted legal, societal, ethical, and political issues related to technology governance.

Synopsis of the September 2022 Issue of the IEEE Letters on Electromagnetic Compatibility Practice and Applications

In this letter, experimental characterization and behavioral modeling of an off-the-shelf damped sinusoidal wave generator operating at different frequencies are addressed. Two modeling strategies are developed which lead to an active and a passive circuit representation of the generator, whose involved parameters are optimized by making use of time-domain measurement results obtained with the generator connected to different load impedances. It is shown that either the active or the passive model can assure accurate prediction of the generated waveforms, depending on the specific frequency. The proposed models can be effortlessly implemented in common circuit simulators, and used for systematic design of injection devices for transient conducted susceptibility testing as well as for simulation of the corresponding test setups. As an illustrative example, the proposed models are exploited to predict the actual waveform induced at the input pins of the device under test in a simplified pulse current injection test setup.

Impact of Routines and Rituals on Burden of Treatment, Patient Training, Cognitive Load, and Anxiety in Self-Injected Biologic Therapy

BackgroundSelf-injection of biologics is a mainstay of chronic disease treatment, yet the process of self-injection often causes persistent apprehension and anxiety, distinct from needle phobia. While literature alludes to the role that routines and rituals play in self-injection, there is no comprehensive study on the routines and rituals self-injectors employ, nor of the process by which they are discovered and ingrained.MethodsWe conducted a mixed-method, observational pilot ethnography study of 27 patients with plaque psoriasis, psoriatic arthritis, or ankylosing spondylitis with and without prior biologic self-injection experience. Patients submitted self-made videos, photos, and projective exercises of an actual biologic self-injection and completed validated instruments to assess burden of treatment. Videos and photos containing routine and ritual elements were thematically categorized based on functional and emotional benefit, and analyzed for differences based on current biologic, dosing frequency, time on current biologic, and burden of treatment measures.ResultsDuring patients’ initial at-home injections, training gaps became apparent, leading to a process of experimentation aimed at reducing pain/anxiety, increasing confidence, and building a consistent injection process. Routines were present in 27/27 (100%) patients and anchored the time, place, and process for injection, and incorporated approved use steps for the injection device. Ritual elements served as emotional coping strategies for patients and were present in 21/27 (77.8%) of patients.ConclusionOur findings suggest that providing patients device training using adult learning principles, teaching routines and rituals concurrently, and providing at-home opportunities for practice with a device trainer may be useful strategies to reduce anxiety, avoid unnecessary experimentation, and improve adherence to injection therapy. While further studies are needed to generalize our findings, we posit that routine and ritual elements can be incorporated into existing patient-clinician interactions or novel digital interventions through mobile medical applications, smart training devices, and connected injection ecosystems.

Patient Preferences for Attributes of Biologic Treatments in Moderate to Severe Asthma: A Discrete Choice Experiment Study.

PurposeMultiple biologics are available for moderate to severe asthma. Given the important relationship between patient engagement in healthcare decision-making and health outcomes, patient preference is an increasingly important consideration. This study elicited patients’ preferences for attributes of biologic therapies for moderate to severe asthma.Patient and MethodsA discrete choice experiment (DCE) questionnaire was designed to collect data from an existing survey panel of adults with moderate to severe asthma in the United States. Patients were asked to select their preferred hypothetical treatment from profiles with varying attributes related to efficacy, safety, and administration convenience. Conditional logit regression models were used to quantify patient preferences.ResultsOf 301 eligible patients who completed the survey, the mean age was 46.7±15.1 years and 71.8% were female. Patients had asthma for 22.5±16.3 years on average, and most (97.3%) had experienced ≥1 asthma attack in the past 12 months. Among treatment attributes examined, patients most valued the absence of a black box warning for the risk of a life-threatening allergic reaction, effectiveness of reducing severe asthma exacerbations, and improvement in lung function (all p < 0.001). Home administration setting for subcutaneous injections (vs doctor’s office/clinic) (p = 0.009) and ability of a biologic to treat additional chronic condition(s) (p < 0.05) were also considered important. Dosing frequency and type of injection device were not significant factors.ConclusionPatients with moderate to severe asthma valued efficacy and safety over convenience attributes when selecting biologic treatments. Awareness of these preferences can facilitate patient-physician shared decision-making when managing moderate to severe asthma in clinical practice.

Behavioral Modeling of an Off-the-Shelf Damped Sinusoidal Transient Generator

In this letter, experimental characterization and behavioral modeling of an off-the-shelf damped sinusoidal wave generator operating at different frequencies are addressed. Two modeling strategies are developed which lead to an active and a passive circuit representation of the generator, whose involved parameters are optimized by making use of time-domain measurement results obtained with the generator connected to different load impedances. It is shown that either the active or the passive model can assure accurate prediction of the generated waveforms, depending on the specific frequency. The proposed models can be effortlessly implemented in common circuit simulators, and used for systematic design of injection devices for transient conducted susceptibility testing as well as for simulation of the corresponding test setups. As an illustrative example, the proposed models are exploited to predict the actual waveform induced at the input pins of the device under test in a simplified pulse current injection test setup.

Case study of user experience-driven design in a new local anaesthetic dentistry jet injection device

ABSTRACT This case study explored how human-centred design methodologies can improve clinician experience and reduce patient treatment anxiety in the application of a new dental local anaesthetic jet-injection system. An initial embodiment of the prototype injector, dubbed the ‘Kiwi’ injector, was developed to better understand the user experience during dental-injection procedures. Further design development was undertaken in two distinct phases. Stage one entailed the initial non-functional Kiwi injector model being used as a design probe to explore clinician views on its aesthetics and ergonomics. The second stage explored the clinician and patient experiences of the functional Kiwi Injector while administering a local anaesthetic to the patient. Stage one findings highlighted clinician satisfaction with the aesthetics of the non-functional prototype device but expressed the desire to make the device smaller. Stage two clinical study results highlighted an issue with the functional jet injector configuration, where the participating dental clinicians speculated that a greater bend in the wand and change of trigger position would significantly improve the Kiwi injector ergonomic performance. This research has demonstrated the benefits of applying a structured and staged human-centred user experience design process to inform the design of a new dental anaesthetic delivery device.

A direct shear apparatus for intact rock under dynamic moisture content

Under field conditions, the moisture content of rock changes with the weather during prolonged creep. In order to investigate the effect of moisture content change on long-term shear strength and deformation behavior, a shear apparatus for intact rock was developed. Since three prefabricated holes are drilled in the upper part of the rock sample, the water injection device and the gas injection device can be used to inject water and gas into the rock sample alternately during the test to adjust the moisture content without removing the normal load and shear load. By using silicone gasket and seals in the shear box, fluid injection at a pressure of 5 MPa was achieved without leakage. Shear creep tests of argillaceous shale were conducted under both constant and dynamic moisture conditions, and the results were described by the Nishihara model. The experimental results revealed that there are significant differences in the long-term shear strength and deformation of argillaceous shale under different moisture content conditions. The proposed rock shear apparatus can advance the quantitative study of the shear creep properties of rock samples during moisture content changes and has certain practical application value for the prediction of engineering rock mass stability during rainfall.

Injectable mesoporous bioactive nanoparticles regenerate bone tissue under osteoporosis conditions

The osteogenic capability of mesoporous bioactive nanoparticles (MBNPs) in the SiO2CaO system has been assessed in vivo using an osteoporotic rabbit model. MBNPs have been prepared using a double template method, resulting in spherical nanoparticles with a porous core-shell structure that has a high surface area and the ability to incorporate the anti-osteoporotic drug ipriflavone. In vitro expression of the pro-inflammatory genes NF-κB1, IL-6, TNF-α, P38 and NOS2 in RAW-264.7 macrophages, indicates that these nanoparticles do not show adverse inflammatory effects. An injectable system has been prepared by suspending MBNPs in a hyaluronic acid-based hydrogel, which has been injected intraosseously into cavitary bone defects in osteoporotic rabbits. The histological analyses evidenced that MBNPs promote bone regeneration with a moderate inflammatory response. The incorporation of ipriflavone into these nanoparticles resulted in a higher presence of osteoblasts and enhanced angiogenesis at the defect site, but without showing significant differences in terms of new bone formation. Statement of significanceMesoporous bioactive glass nanoparticles have emerged as one of the most interesting materials in the field of bone regeneration therapies. For the first time, injectable mesoporous bioactive nanoparticles have been tested in vivo using an osteoporotic animal model. Our findings evidence that MBG nanoparticles can be loaded with an antiosteoporotic drug, ipriflavone, and incorporated in hyaluronic acid to make up an injectable hydrogel. The incorporation of MBG nanoparticles promotes bone regeneration even under osteoporotic conditions, whereas the presence of IP enhances angiogenesis as well as the presence of osteoblast cells lining in the newly formed bone. The injectable device presented in this work opens new possibilities for the intraosseous treatment of osteoporotic bone using minimally invasive surgery.

Patient Preference for Self-Injection Devices in Rheumatoid Arthritis: A Discrete Choice Experiment in China.

ObjectiveRheumatoid arthritis (RA) is increasingly treated with biologics, which is commonly administered by injection devices. The aim of this study is to evaluate patients’ preferences for self-injection devices in RA, and to elicit their willingness to pay (WTP) for injector devices in China.MethodsRA patients were recruited from Beijing, Shanghai, Guangzhou, Chengdu, Wuhan and Xi’an in China. A discrete choice experiment (DCE) was employed to elicit patient preferences. Patients were presented with 15 choice sets that consisted of seven attributes, which were developed based on literature review and further validated by physicians. The seven attributes were as follows: operation steps, injection pain, feedback indication, needle visibility, needle protection, size and out-of-pocket costs. A mixed logit model was used to analyze the relative importance of seven attributes and to calculate the WTP for a changed attribute level.ResultsAnalyses included 114 adults with RA (mean age of 44.6 years old). When choosing the injection device, all attributes had significant influence. Among nonmonetary attributes, very slight injection pain was the most preferred for patients, followed by auto-injection method, thicker size, hidden needle, with needle protection and multiple feedback indication. Patients had a negative preference for increasing out-of-pocket costs. Patients were willing to pay CNY 45.26 for improving slight injection pain to very slight injection pain, CNY 13.26 for the auto-injection method, CNY 12.22 for the thicker size, CNY 10.06 for the hidden needle, CNY 9.82 for needle protection, and CNY 9.70 for multiple feedback indicators.ConclusionThe results suggested that injection pain was the most important attribute for RA patients. Meanwhile, all other enhanced attributes of self-injection devices also significantly influence patients’ selection on injection devices. Findings suggested that there is significant potential value in developing self-injection devices that could further help improve treatment adherence and promote patient-centered care in autoimmune diseases.

Threat Modeling and Risk Analysis for Miniaturized Wireless Biomedical Devices

The landscape of miniaturized wireless biomedical devices (MWBDs) is rapidly expanding as proactive mobile healthcare proliferates. MWBDs are diverse and include various injectable, ingestible, implantable, and wearable devices. While the growth of MWBDs increases the flexibility of medical services, the adoption of these technologies brings privacy and security risks for their users. MWBDs can operate with sensitive, private information and affect patients through the use of stimulation and drug delivery. Therefore, these devices require trust and need to be secure. Embedding protective mechanisms into MWBDs is challenging because they are restricted in size, power budget, as well as processing and storage capabilities. Nevertheless, MWBDs need to be at least minimally securable in the face of evolving threats. The main intent of this work is to make the primary stakeholders of MWBDs aware of associated risks and to help the architects and the manufacturers of MWBDs protect their emerging designs in a repeatable and structured manner. Making MWBDs securable begins with performing threat modeling. This paper introduces a domain-specific qualitative-quantitative threat model dedicated to MWBDs. The proposed model is then applied to representative case studies from each category of MWBDs.