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Rajiv Dhand,1 Joachim Eicher,2 Michaela Hänsel,3 Ingeborg Jost,4 Martin Meisenheimer,2 Herbert Wachtel2 1Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA; 2Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein 55216, Germany; 3Boehringer Ingelheim International GmbH, Ingelheim am Rhein 55216, Germany; 4Boehringer Ingelheim Pharma, Biberach an der Riss 88397, Germany Purpose: The Respimat is a handheld, propellant-free, soft-mist inhaler. Observations by patients and physicians prompted development of an improved second-generation Respimat inhaler. Human-factor studies assessing the usability of the new inhaler and in vitro assessment of aerosol performance are important to demonstrate functionality of the updated inhaler.Methods: Studies were performed to assess any possible impact of the reusable Respimat inhaler design on aerosol performance (delivered dose [DD] and fine-particle dose [FPD]) and iteratively assess and improve usability of the new design. The tiotropium–olodaterol inhalation solution for Respimat was used as a model. The DD and FPD of the reusable Respimat inhaler (across multiple cartridges) and the disposable Respimat inhaler were determined by laser diffraction and with an alternative Andersen cascade impactor. Usability was measured across three studies involving health care professionals and patients with diagnoses of COPD, asthma, or combined disease (with and without experience with the Respimat inhaler). These studies measured performance of handling tasks and collected subjective feedback directly related to the inhaler’s new or altered features, which fed into optimization of the inhaler.Results: DDs of tiotropium and olodaterol were stable up to 15 cartridges and consistently within the upper and lower limits of the disposable Respimat inhaler. The FPD was also found to be batch-consistent over the cartridges and comparable with the reference. The usability of the reusable Respimat inhaler compared with the disposable inhaler was improved in terms of assembly and daily use. Cartridge exchange was rated as intuitive and easy to very easy.Conclusion: The new reusable Respimat is a medical inhaler developed with enhanced features that meets health care professionals’ and patients’ needs. Drug delivery across multiple cartridges is not affected by the design. Compared with the original disposable inhaler, the usability of the reusable inhaler has been improved, and cartridge exchange was rated as easy to perform. The reusable Respimat provides greater convenience for patients vs the disposable inhaler, with reduced environmental impact. Keywords: inhalers, soft mist, SMI, handling, environment

Anna-Maria Ciciliani,1,2 Peter Langguth,1 Herbert Wachtel2 1Institute of Pharmacy and Biochemistry, Faculty 09 (Chemistry, Pharmaceutics and Geosciences), Johannes Gutenberg University, Mainz, 2Analytical Development Department, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany Background: Combining in vitro mouth–throat deposition measurements, cascade impactor data and computational fluid dynamics (CFD) simulations, four different inhalers were compared which are indicated for chronic obstructive pulmonary disease (COPD) treatment.Methods: The Respimat inhaler, the Breezhaler, the Genuair, and the Ellipta were coupled to the idealized Alberta throat model. The modeled dose to the lung (mDTL) was collected downstream of the Alberta throat model using either a filter or a next generation impactor (NGI). Idealized breathing patterns from COPD patient groups – moderate and very severe COPD – were applied. Theoretical lung deposition patterns were assessed by an individual path model.Results and conclusion: For the Respimat the mDTL was found to be 59% (SD 5%) for the moderate COPD breathing pattern and 67% (SD 5%) for very severe COPD breathing pattern. The percentages refer to nominal dose (ND) in vitro. This is in the range of 44%–63% in vivo in COPD patients who display large individual variability. Breezhaler showed a mDTL of 43% (SD 2%) for moderate disease simulation and 51% (SD 2%) for very severe simulation. The corresponding results for Genuair are mDTL of 32% (SD 2%) for moderate and 42% (SD 1%) for very severe disease. Ellipta vilanterol particles showed a mDTL of 49% (SD 3%) for moderate and 55% (SD 2%) for very severe disease simulation, and Ellipta fluticasone particles showed a mDTL of 33% (SD 3%) and 41% (SD 2%), respectively for the two breathing patterns. Based on the throat output and average flows of the different inhalers, CFD simulations were performed. Laminar and turbulent steady flow calculations indicated that deposition occurs mainly in the small airways. In summary, Respimat showed the lowest amount of particles depositing in the mouth–throat model and the highest amount reaching all regions of the simulation lung model. Keywords: throat model, NGI, inhalation, lung deposition, CFD, Respimat

A new degree program is proposed that provides students with broad interests a flexible way to combine their studies in engineering with studies in a wide variety of other subjects. The newly designed program in Electronics and Computing at the University of Colorado has a common core with the current Electrical and Computer Engineering programs, but the total number of required hours in the new major has been reduced to 40 hours. This makes it possible for the student to take a minor or a broad distribution of courses in other subjects. The new degree program is structured in much the same way as a liberal arts program.

Purpose: The purpose of this prospective clinical trial was to evaluate over a 5-year period the treatment outcomes for immediately loaded full-arch fixed prostheses supported by two axially inclined and two tilted implants used to rehabilitate edentulous arches. This report presents preliminary 1-year results. Materials and Methods: Thirty-seven patients were recruited for treatment with either mandibular or maxillary full-arch fixed prostheses supported by four implants. Within 24 hours, the implants were immediately loaded with screw-retained full-arch acrylic resin provisional restorations. Definitive reconstructions were delivered 6 months later. Complete full-arch prostheses were supported by metal frameworks combined with high-density acrylic resin. Follow-up visits were scheduled for 6 and 12 months after initial prosthetic loading and then annually for up to 5 years. Digital radiographs were obtained immediately, 6 months after surgery, and at each annual follow-up visit. Marginal peri-implant bone levels were assessed using digital image analysis. Results: The 1-year implant survival rates were 96.0% for axially positioned implants and 94.6% for tilted implants. The survival rates were 96.6% for maxillary implants and 98.7% for mandibular implants. The prosthetic survival rate was 100%. No significant differences were found in the results for tilted versus axially positioned implants. One year after loading, the mean marginal bone loss was 0.82 ± 0.31 mm around the axially oriented implants and 0.76 ± 0.49 mm around the tilted implants (P .05). Conclusions: Preliminary data from this clinical trial show high implant survival rates for immediately loaded full-arch prostheses supported by four implants. Immediate loading of tilted implants may be considered a viable treatment option for the rehabilitation of edentulous patients. Int J Oral Maxillofac Implants 2010;25:1011-1018. [ABSTRACT FROM AUTHOR]

Recent advances in periodontal plastic surgery have encouraged reassessment of the envelope technique and its modified version, the tunnel technique, for root coverage. This article describes alterations in the technique-sensitive tunnel approach, which include an undermining split flap preparation of the buccal tissues with newly developed instruments to minimize trauma and ensure a better blood supply for the connective tissue graft. The use of a microsurgical concept, including microsurgical blades and suture material, improves wound healing and establishes a better esthetic result. Because these modifications simplify the tunnel approach, the spectrum of indications for the tunnel technique may be expanded and a broader application achieved. [ABSTRACT FROM AUTHOR]

Using a solid-state diffusion technique, conducting perylene radical ion salt films have been prepared with alkali ions (Na+ and K+) and antimony hexachloride (SbCl6-) as counter ions. The successful preparation of separate radical anion salt films and cation salt films, respectively, is proved by in situ absorption spectroscopy, conductivity measurements, and electron spin resonance. In contrast to comparatively weakly doped inorganic semiconductors, the ion salts have a high concentration of charge carriers of roughly one charge per molecular unit entailing correlation of the carriers. The sandwich structures consisting of both the cation salt layer and the anion salt layer, form an electrical junction comparable to the PIN-junctions (p-doped, intrinsic, n-doped) known from inorganic diodes. The rectifying ratio amounts up to 105:1 at ±0.5 V and the breakdown voltage in the reverse sense is -20 V at 300 K. © 1995 American Institute of Physics. [ABSTRACT FROM AUTHOR]

We present correlated temperature dependent reflection and conductivity measurements on crystals and films of the undeuterated (h8) and the partly deuterated (d6) (2,5-dimethyl- dicyanoquinonediimine)2Cu radical anion salt. Using thin optical fibers, it was possible to study individual needle like crystals of a diameter of only a few μm. The temperature dependence of the reflectivity of single (d6) needles in the visible and the near-infrared region shows a ‘‘dip’’, which coincides with the phase transition in the conductivity. To interpret our data, we extended the commonly used models for the conductivity from Drude and Epstein, so that we are able to deal with reflection and conductivity in terms of one consistent model. For the (d6) films, a metal–insulator phase transition has been proved by reflection and conductivity. With the assumption of a broad distribution of different phase transition temperatures for the crystallites of the films, the observed spectra of films can also be treated with the model used for the crystals. © 1995 American Institute of Physics. [ABSTRACT FROM AUTHOR]