Refillable Devices Research Articles

Trends in long term vaping among adults in England, 2013-23: population based study

ObjectiveTo examine trends in long term (>6 months) vaping among adults in England.DesignPopulation based study.SettingEngland.Participants179 725 adults (≥18 years) surveyed between October 2013 and October 2023.Main outcome measuresTime trends in...

Selecting an e-cigarette for use in smoking cessation interventions and healthcare services: findings from patient and public consultation for the COSTED trial

ObjectivesThe Cessation of Smoking Trial in the Emergency Department (COSTED) trial aims to ascertain whether brief advice, the provision of an e-cigarette starter kit and referral to stop smoking services...

How has Expenditure on Nicotine Products Changed in a Fast-Evolving Marketplace? A Representative Population Survey in England, 2018-2022.

In the last 5 years, there has been a dramatic shift in the types of nicotine products being purchased. This study aimed to estimate how much users spend on types of cigarettes and alternative nicotine products (e-cigarettes, nicotine replacement therapy (NRT), heated tobacco, and nicotine pouches) and describe changes between 2018 and 2022. Monthly representative cross-sectional survey in England. 10 323 adults who smoked cigarettes or used alternative nicotine reported their average weekly expenditure on these products, adjusted for inflation. Smokers spent £20.49 [95% CI = 20.09-20.91] on cigarettes each week (£27.66 [26.84-28.50] and £15.96 [15.49-16.28] among those who mainly smoked manufactured and hand-rolled cigarettes, respectively), e-cigarette users spent £6.30 [5.99-6.55] (£8.41 [7.17-9.78], £6.42 [5.58-7.39], and £5.93 [5.64-6.30] among those who mainly used disposable, pod, and refillable devices, respectively), NRT users £6.11 [5.53-6.69], and heated tobacco users £13.87 [9.58-20.09]. Expenditure on cigarettes grew by 10% from September 2018 to July 2020, then fell by 10% from July 2020 to June 2022. These changes coincided with a 13% reduction in cigarette consumption and a 14% increase in the proportion mainly smoking hand-rolled cigarettes. Expenditure on e-cigarettes was stable between 2018 and late 2020, then rose by 31% up to mid-2022. Expenditure on NRT increased slowly in 2018-2020 (+4%) and more quickly thereafter (+20%). Inflation-adjusted expenditure on cigarettes has fallen since 2020, such that the average smoker in England currently spends the same on cigarettes each week as in 2018. This has been achieved by smoking fewer cigarettes and switching to cheaper hand-rolled cigarettes. Expenditure on alternative nicotine has increased above inflation; users spent around a third more on these products in 2022 than between 2018-2020. People in England continue to spend substantially more on smoking cigarettes than using alternative nicotine products. The average smoker in England spends around £13 a week (~£670 a year) more than people using only e-cigarettes or NRT. The average expenditure on manufactured cigarettes is double that of hand-rolled cigarettes.

Association between electronic nicotine delivery systems (ENDS) device and E-liquid alterations and flavor use with clinical and EVALI-like symptoms

Studies reporting clinical symptoms related to electronic nicotine delivery systems (ENDS) usage, especially types of devices and e-liquids, are sparse. The sample included 1,432 current ENDS users, ages 18–64, from a nationwide online survey conducted in 2016. ENDS use included device types, nicotine content, flavors, and e-liquid used. Outcomes included any e-cigarette, or vaping, product use-associated lung injury (EVALI)-like symptoms (e.g., cough, shortness of breath, nausea) as well as any clinical symptoms. Of the sample, 50% were female, 23% non-Hispanic (NH) White, 23% NH Black, 54% Hispanic, 18% aged 18–24, 17% LGBTQ, 41% with <$50 K income, 55% 1 + any symptoms, and 33% 1 + any EVALI-like symptoms. Cough and nausea were most prevalent among EVALI-like symptoms (27% and 7.3%, respectively). The proportion having any EVALI-like symptoms was higher in the following groups: younger, Hispanic, current smokers, and current other product users. With multiple adjustments, participants who used refillable devices, varied nicotine content, used flavored products, or made their own e-liquids were more likely to have clinical symptoms than their counterparts. For example, the odds (95% CI) of having 1 + EVALI-like symptoms in participants who used refillable devices with e-liquid pour or e-liquid cartridge replacement were 1.70 (1.13, 2.56) and 1.95 (1.27, 2.99), respectively, compared to the non-refillable group. Use of products (devices and e-liquids) that can be altered and flavored products are associated with higher odds of having clinical symptoms, including EVALI-like symptoms.

Development of a 3D Printed Refillable Drug Delivery Device for Sustained Release to the Retina

Retinal degenerative diseases (RDD) such as age-related macular degeneration (AMD) and retinitis pigmentosa (RP) cause progressive loss of vision, affecting millions of people worldwide. Drug delivery system (DDS) such as vitreous injection and intraocular implant has been widely investigated to treat RDD. However, they are invasive and can risk infection of the eye. Thus, we have been working on the development of transscleral DDS, which are less invasive and can achieve more localized release of drug than the conventional methods [1]. We have previously reported capsule-type and sheet-type DDS devices that can be implanted on the transscleral (periocular) region of the eye [2] [3]. However, such devices need to be replaced once drug run out. Herein, we report a 3D printed refillable DDS device for long term delivery of drugs to the retina.The refillable device consisted of 3 sections: -polyvinyl alcohol gel chamber with openings to regulate drug release, the drug chamber as a reservoir for a test drug, and polydimethylsiloxane (PDMS) chamber with port holes to allow reinjection of the drug (Fig. 1a). The device was designed in SolidWorks 2018 (Dassault Systèmes, France) and 3D printed (Qidi Shadow 5.5S, QidiTech) using polyethylene glycol diacrylate (PEGDA) mixed with 1% photoinitiator (Irgacure819, w/w), and 1% photosensitizer (2-isopropylthioxanthone, w/w). PDMS and PVA hydrogel were manually introduced into the drug injection chamber and the drug release chamber, respectively. PDMS was cured by thermal curing and PVA was gelled by freeze-thawing. After introducing a model drug, Albumin-fluorescein isothiocyanate conjugate (FITC-Albumin), into the device, it was immersed in 5 mL of Dulbecco’s phosphate buffered saline(DPBS) and incubated at 37℃ inside a humidified incubator. The fluorescence intensities of DPBS solutions were measured by spectrofluorimetry to quantify diffusion of drugs from the capsule into the DPBS solution. The DPBS solutions were replaced at each measurement. In addition, drug reinjection and quantification of the released drug were performed. Quantification of the released drug was done by above-mentioned process.The refillable capsule-type DDS device was fabricated with a curved geometry such that it can fit the outer circumference of the eyeball (Fig. 1b). Specifically, the dimensions of the device were 20 mm inside diameter, 22 mm curvature diameter, 2 mm thickness and 4.4 mm width. By 3D printing, it was possible to fabricate a complex 3D shape that is not possible using conventional mold technique. Because the drug is impermeable to PEGDA, unidirectional release of the drug from the release ports was possible (Fig. 1c). The unidirectional release is important because it can reduce drug elimination by conjunctival clearance and increase efficiency of drug delivery. In vitro release tests of the device were performed with varying concentrations of PVA gel. The result showed that as the PVA concentration was increased, the drug release rate decreased. At 5 wt% PVA concentration, an extreme initial burst and complete release of FITC-Albumin in 7 days was observed whereas at 10 wt% PVA concentration, over 90% drug release in 30 days and complete release in 50 days were observed, and at 20 wt% PVA concentration, drug release over 100 days was observed. Similar drug release trends were observed when the drug was repeatedly injected into the same devices for 3 times. Also, no leakage of the drug from the PDMS port was confirmed during repeated injection.These in vitro experiment results show the potential of the device for future transscleral implants. As the next step, we are planning to implant the downsized device on rabbit’s eye and investigate biocompatibility and efficacy for treatment of RDD.

Abstract 16156: Association of Electronic Nicotine Delivery Systems (ENDS) Usage and EVALI-like Symptoms

Introduction: Comprehensive studies regarding clinical symptoms related to electronic nicotine delivery systems (ENDS) usage are sparse. Methods: The sample included 1,432 current ENDS users, ages 18-64, drawn from a national online survey conducted in 2016. A quota sampling method was used for key demographic characteristics such as age, gender, and race/ethnicity. ENDS use included types of devices, flavors, and knowledge of e-liquid used. Outcomes included any E-cigarette or Vaping use-Associated Lung Injury (EVALI)-like symptoms (e.g., cough, shortness of breath, nausea) and any clinical symptoms (see Table footnotes). Results: Of the sample, 50% were female, 23% non-Hispanic (NH) White, 23% NH Black, 54% Hispanic, 18% aged 18-24, 17% LGBTQ, 41% with &lt;$50K income, 55% 1+ any symptoms, and 33% 1+ any EVALI-like symptoms. Cough and nausea were most prevalent among EVALI-like symptoms (27% and 7.3%, respectively). The proportion of having any EVALI-like symptoms was higher in the following groups: younger, Hispanic, current smokers, and current other product users. With multiple adjustments (see Table footnotes), those who used refillable devices, varied nicotine content, flavored products or made their own e-liquids were more likely to have clinical symptoms than their counterparts. For example, the odds (95% CI) of having 1+ EVALI-like symptoms in those who used refillable devices with e-liquid pour or with e-liquid cartridge replacement were 1.70 (1.13, 2.56) and 1.95 (1.27, 2.99), respectively, compared to the non-refillable group (see Table). It should be noted that those who used non-refillable devices were also more likely not to know the nicotine content in their e-liquid. However, their use pattern seemed stable: They tended to use only one brand, one type of device, and non-flavored e-liquid (results not tabulated). Conclusions: ENDS use was significantly associated with the odds of having clinical symptoms, including EVALI-like symptoms.

Electronic cigarette use among Italian smokers: patterns, settings, and adverse events.

Information is scanty on the patterns and settings of electronic cigarette use and on its possible adverse events. To fill the knowledge gap on these issues, we conducted a survey among ever-smokers attending smoking cessation services (SCS) in Italy. In 2016-2018, we enrolled 395 ever-smokers aged ⩾18 years who were current or former electronic cigarette users in 12 SCS from northern, central, and southern Italy. In all, 12.4% of ever smokers were regular, 9.4% occasional, and 78.2% past users of electronic cigarettes. Of all users, 93.8% consumed electronic cigarettes with nicotine, 95.9% used refillable devices, and 76.6% purchased electronic cigarette devices or liquids in vape shops. The mean duration of use was 3.7 months and the mean number of puffs per day was 86. Among users, 71.5% used electronic cigarettes in at least 1 smoke-free indoor environment, 53.7% in workplaces, 49.5% in restaurants and bars, 33.5% in train/metro stations or airports, and 18.4% in public transports. The use of electronic cigarettes in smoke-free environments significantly decreased with age and increased with duration of use and nicotine dependence. In our sample, 47.1% reported at least 1 adverse event attributable to electronic cigarette use: 19.5% dry cough, 12.0% dry mouth, 7.6% throat or mouth irritation, and 6.8% sore throat. In Italy, most conventional cigarette smokers use electronic cigarettes where smoking conventional cigarettes is prohibited. About half of users reported 1 or more symptoms attributable to electronic cigarettes, despite the relatively short duration of use.

&lt;p&gt;The Evolving Treatment of Diabetic Retinopathy&lt;/p&gt;

PurposeTo review the current therapeutic options for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) and examine the evidence for integration of laser and pharmacotherapy.MethodsA review of the PubMed database was performed using the search terms diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor (VEGF), vitrectomy, pars plana vitreous surgery, antiangiogenic therapy. With additional cross-referencing, this yielded 835 publications of which 301 were selected based on content and relevance.ResultsMany recent studies have evaluated the pharmacological, laser and surgical therapeutic strategies for the treatment and prevention of DR and DME. Several newer diagnostic systems such as optical coherence tomography (OCT), microperimetry, and multifocal electroretinography (mfERG) are also assisting in further refinements in the staging and classification of DR and DME. Pharmacological therapies for both DR and DME include both systemic and ocular agents. Systemic agents that promote intensive glycemic control, control of dyslipidemia and antagonists of the renin-angiotensin system demonstrate beneficial effects for both DR and DME. Ocular therapies include anti-VEGF agents, corticosteroids and nonsteroidal anti-inflammatory drugs. Laser therapy, both as panretinal and focal or grid applications continue to be employed in management of DR and DME. Refinements in laser devices have yielded more tissue-sparing (subthreshold) modes in which many of the benefits of conventional continuous wave (CW) lasers can be obtained without the adverse side effects. Recent attempts to lessen the burden of anti-VEGF injections by integrating laser therapy have met with mixed results. Increasingly, vitreoretinal surgical techniques are employed for less advanced stages of DR and DME. The development and use of smaller gauge instrumentation and advanced anesthesia agents have been associated with a trend toward earlier surgical intervention for diabetic retinopathy. Several novel drug delivery strategies are currently being examined with the goal of decreasing the therapeutic burden of monthly intravitreal injections. These fall into one of the five categories: non-biodegradable polymeric drug delivery systems, biodegradable polymeric drug delivery systems, nanoparticle-based drug delivery systems, ocular injection devices and with sustained release refillable devices. At present, there remains no one single strategy for the management of the particular stages of DR and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials.ConclusionPharmacotherapy, both ocular and systemic, will be the primary mode of intervention in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a first-line option when cost and treatment burden are more constrained. Results with subthreshold laser appear promising but will require more rigorous study to establish its role as adjunctive therapy. Evidence to support an optimal integration of the various treatment options is lacking. Central to the widespread adoption of any therapeutic regimen for DR and DME is substantiation of safety, efficacy, and cost-effectiveness by a body of sound clinical trials.

Associations between vaping and relapse to smoking: preliminary findings from a longitudinal survey in the UK

BackgroundMost smokers attempting to quit relapse. There is little evidence whether the use of e-cigarettes (‘vaping’) increases or decreases relapse. This study aimed to assess 1) whether vaping predicted relapse among ex-smokers, and 2) among ex-smokers who vaped, whether vaping characteristics predicted relapse.MethodsLongitudinal web-based survey of smokers, recent ex-smokers and vapers in the UK, baseline in May/June 2016 (n = 3334), follow-up in September 2017 (n = 1720). Those abstinent from smoking ≥ 2 months at baseline and followed up were included. Aim 1: Relapse during follow-up was regressed onto baseline vaping status, age, gender, income, nicotine replacement therapy use and time quit smoking (n = 374). Aim 2: Relapse was regressed onto baseline vaping frequency, device type, nicotine strength and time quit smoking (n = 159).ResultsOverall, 39.6% relapsed. Compared with never use (35.9%), past/ever (45.9%; adjOR = 1.13; 95% CI, 0.61–2.07) and daily vaping (34.5%; adjOR = 0.61; 95% CI, 0.61–1.89) had similar odds of relapse, for non-daily vaping evidence of increased relapse was inconclusive (65.0%; adjOR = 2.45; 95% CI, 0.85–7.08). Among vapers, non-daily vaping was associated with higher relapse than daily vaping (adjOR = 3.88; 95% CI, 1.10–13.62). Compared with modular devices (18.9% relapse), tank models (45.6%; adjOR = 3.63; 95% CI, 1.33–9.95) were associated with increased relapse; evidence was unclear for disposable/cartridge refillable devices (41.9%; adjOR = 2.83; 95% CI, 0.90–8.95). Nicotine strength had no clear association with relapse.ConclusionRelapse to smoking is likely to be more common among ex-smokers vaping infrequently or using less advanced devices. Research into the effects of vaping on relapse needs to consider vaping characteristics.

A drug refillable device for transscleral sustained drug delivery to the retina

Continuous drug administration with better adherence to treatment and less invasive procedures is important in treating retinal diseases such as age-related macular disease. In this study, we report a drug-refillable device consisting of a silicone reservoir and an injectable gelatin/chitosan gel (iGel). The silicone reservoir was fabricated with polydimethylsiloxane (PDMS) using a computer-aided design and manufacturing to have micropores at a releasing side for uniaxial release to the sclera. A stainless steel wire and sheet were combined in the side and bottom of the reservoir to ensure flexibility and to fit on the curvature of the eyeball and prevent irritation to the sclera through the bottom of the reservoir. The drug was injected and formulated in the reservoir by in situ crosslinking of gelatin/chitosan gel with the crosslinker; 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride. The in vitro release study using fluorescein molecules showed that the release rate from encapsulated iGel in the reservoir was slower than that from the original iGel. After reinjecting the iGel into the reservoir, the same release profile as the first injection was observed. The reservoir containing iGel was placed on the sclera of a rabbit and the distribution of 150 kDa fluorescein isothiocyanate-dextran (FD150) in the retina and choroid/retinal pigment epithelium (choroid/RPE) was studied. The cryosections showed that FD150 was observed in the choroid/RPE. Homogenates of the retina and choroid/RPE showed fluorescence during 12 weeks implantation, indicating the drug could be delivered to the retina by using the device. The drug filling was successful into the reservoir implanted on the sclera through the conjunctiva by using a needle. In conclusion, the refillable drug delivery device is a promising tool to administer drugs long-term by reinjection with less invasiveness to intraocular tissues.

Knocking tobacco out

Knocking tobacco out

Electronic cigarette use among US adults in the Population Assessment of Tobacco and Health (PATH) Study, 2013–2014

BackgroundElectronic cigarette (e-cigarette) use in the USA is increasing. As such, it is critical to understand who uses e-cigarettes, how e-cigarettes are used and what types of products are prevalent....

Boom In E-Cigarettes Sparks Debate

Inside a basement shop in Washington, D.C., on a bustling street filled with restaurants and nightclubs, a hazy cloud with the sweet scent of cotton candy and vanilla custard lingers in the air. Two men are sitting at a tasting bar smoking the latest flavors of “e-juice,” while the shop manager “vapes” on his electronic cigarette, or “box mod” device, behind the counter. The back wall is lined with hundreds of 10–15-mL eyedropper bottles, each with a colorful, eye-catching label announcing an enticing flavor. Melon head, razzletaz, serious kiwi, Swedish fish, gummy bear, taste the rainbow—the list goes on. The vials contain e-juice, a liquid concoction of varying amounts of nicotine, propylene glycol, glycerin, and food-grade flavorings. The juice is heated inside battery-operated, refillable devices that come in myriad sizes, colors, shapes, and styles. Nicotine in the e-juice, as well as any flavors, is aerosolized and inhaled by the user. ...