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  1. Article ; Online: Development and Regulation of Connected Combined Products: Reflections From the Medtech & Pharma Platform Association.

    Kühler, Thomas C / Schoenmakers, Marc / Shergold, Oliver / Affolter, Stephan / Bolislis, Winona Rei / Foster, Ruth / Gardner, Paul / Hruschka, Svenja / Jomini, Thierry / Kaveripakam, Sathish / Mayerhofer, Karl / Scherini, Tomaso / Swierczynska, Marta / Vandal, Gretchen / Fürst-Ladani, Shayesteh

    Clinical therapeutics

    2022  Volume 44, Issue 5, Page(s) 768–782

    Abstract: Purpose: Patients taking a medicinal product in a homecare setting typically use a medical device to facilitate the injection process. Reductions in wireless connectivity costs, combined with the rapid adoption of smartphones with connectivity to cloud- ... ...

    Abstract Purpose: Patients taking a medicinal product in a homecare setting typically use a medical device to facilitate the injection process. Reductions in wireless connectivity costs, combined with the rapid adoption of smartphones with connectivity to cloud-based services, are enabling these drug delivery devices to now be connected to a digital ecosystem as connected combined products (CCPs). The purposes of this article are to identify the challenges in developing and releasing these products when they straddle different regulatory frameworks and standards and to highlight gaps in the European Union regulations.
    Methods: Industry subject matter experts from pharmaceutical, medical device, and consultancy companies, who are members of the Medtech & Pharma Platform Association, formed 4 working groups to address current best practice for developing and releasing CCPs and the different relevant regulatory frameworks. The 4 areas studied were clinical and regulatory, usability and human factors engineering, development and life cycle management, and cybersecurity.
    Findings: Development teams require new skills to create innovative products that have a good safety profile and are simple to use, such as design thinking to understand user needs and systems engineering to manage complexity and ensure interoperability. Risk management process should integrate cybersecurity, data privacy, and data integrity, whereas design control processes should enable asynchronous development cycles for hardware and software components. Regulatory frameworks exist for individual components within the CCP. However, for a complex product, regulatory guidance is needed when combining components with different risk and safety profiles and to ensure that the responsibilities and liabilities of companies contributing components are clear. The efficient management of software changes and product updates, as well as dealing with end-of-life hardware and backward compatibility to older software versions, needs agile approaches when it comes to regulatory updates.
    Implications: The regulatory uncertainties and development processes outlined in this article need to be addressed. We call for joint discussions among the various stakeholders in the fields of medicinal products, medical devices, and in vitro diagnostics, as well as standalone software, data protection, and cybersecurity experts, together with regulators and lawmakers in the European Union to meet in focused discussion groups with the aim of devising pragmatic solutions and regulations for the benefit of the sector and hence the patients it serves.
    MeSH term(s) Ecosystem ; Humans ; Pharmaceutical Preparations
    Chemical Substances Pharmaceutical Preparations
    Language English
    Publishing date 2022-04-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603113-4
    ISSN 1879-114X ; 0149-2918
    ISSN (online) 1879-114X
    ISSN 0149-2918
    DOI 10.1016/j.clinthera.2022.03.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Insulin depot formation in subcutaneoue tissue.

    Jockel, James P Leuenberger / Roebrock, Philipp / Shergold, Oliver A

    Journal of diabetes science and technology

    2013  Volume 7, Issue 1, Page(s) 227–237

    Abstract: Background: The size and geometry of an insulin depot that is formed during subcutaneous administration by an insulin pump is evaluated. A novel method is used to visualize accurately the depot formation for small volumes of insulin (of the order of 10- ... ...

    Abstract Background: The size and geometry of an insulin depot that is formed during subcutaneous administration by an insulin pump is evaluated. A novel method is used to visualize accurately the depot formation for small volumes of insulin (of the order of 10-100 µl) at a given point in time. Conventional visualization methods such as magnetic resonance imaging are unable to provide such accurate measurements because of their coarse imaging resolution and long measurement time.
    Methods: The described method consists of subcutaneously infusing dyed insulin into porcine tissue and subsequently shock freezing it with liquid nitrogen. The frozen sample is then sliced into thin layers using a cryomicrotome. A digital image of each layer is taken and then processed with proprietary software, which identifies the dyed areas on each layer and reconstructs a three-dimensional model of the insulin depot with a planar resolution of 30 × 30 µm(2) and a depth resolution of 100 µm. Since this process is not viable for living organisms, porcine tissue was used immediately following slaughter of the animal.
    Results: To date, it is most often assumed that the insulin depot takes the shape of a sphere around the tip of the cannula (e.g., 50 µl insulin equates to a spherical radius of 2.3 mm). However, in practice, such a depot form is never observed. Instead, the insulin depot initially spreads laterally (i.e., parallel) to the skin surface and in the collagen matrix that binds the adipose cells together. The depot outreach increases with larger infused volumes, e.g., maximum outreach measured at 5.0/5.7/7.1 mm (quartiles, n = 17) for 50 µl of infused insulin. Beyond a given infused volume (approximately 100 µl), the insulin also starts to spread perpendicular to the skin surface.
    Conclusions: It is concluded that formation of the insulin depot depends on the opening of channels at the boundaries between adipose cells. Hence the insulin follows a path of least resistance and depot formation is determined by the local structure of the subcutaneous tissue.
    MeSH term(s) Animals ; Insulin/analogs & derivatives ; Insulin Infusion Systems ; Subcutaneous Fat/chemistry ; Subcutaneous Fat/metabolism ; Swine
    Chemical Substances Insulin ; insulin, depot-
    Language English
    Publishing date 2013-01-01
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1932-2968
    ISSN (online) 1932-2968
    DOI 10.1177/193229681300700128
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Experimental investigation into the deep penetration of soft solids by sharp and blunt punches, with application to the piercing of skin.

    Shergold, Oliver A / Fleck, Norman A

    Journal of biomechanical engineering

    2005  Volume 127, Issue 5, Page(s) 838–848

    Abstract: An experimental study has been conducted on the penetration of silicone rubbers and human skin in vivo by sharp-tipped and flat-bottomed cylindrical punches. A penetrometer was developed to measure the penetration of human skin in vivo, while a ... ...

    Abstract An experimental study has been conducted on the penetration of silicone rubbers and human skin in vivo by sharp-tipped and flat-bottomed cylindrical punches. A penetrometer was developed to measure the penetration of human skin in vivo, while a conventional screw-driven testing machine was used to penetrate the silicone rubbers. The experiments reveal that the penetration mechanism of a soft solid depends upon the punch tip geometry: a sharp tipped punch penetrates by the formation and wedging open of a mode I planar crack, while a flat-bottomed punch penetrates by the growth of a mode II ring crack. The planar crack advances with the punch, and friction along the flanks of the punch leads to a rising load versus displacement response. In contrast, the flat-bottomed punch penetrates by jerky crack advance and the load on the punch is unsteady. The average penetration pressure on the shank cross section of a flat-bottomed punch exceeds that for a sharp-tipped punch of the same diameter In addition, the penetration pressure decreases as the diameter of the sharp-tipped punch increases. These findings are in broad agreement with the predictions of Shergold and Fleck [Proc. R. Soc. London, Ser. A (in press)] who proposed models for the penetration of a soft solid by a sharp-tipped and flat-bottomed punch.
    MeSH term(s) Compressive Strength ; Computer Simulation ; Elasticity ; Hardness ; Hardness Tests ; Humans ; Models, Biological ; Physical Stimulation/methods ; Skin/injuries ; Skin/physiopathology ; Stress, Mechanical ; Wounds, Nonpenetrating/physiopathology ; Wounds, Stab/physiopathology
    Language English
    Publishing date 2005-10-12
    Publishing country United States
    Document type Clinical Trial ; Comparative Study ; Journal Article
    ZDB-ID 243094-0
    ISSN 1528-8951 ; 0148-0731
    ISSN (online) 1528-8951
    ISSN 0148-0731
    DOI 10.1115/1.1992528
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: The penetration of a soft solid by a liquid jet, with application to the administration of a needle-free injection.

    Shergold, Oliver A / Fleck, Norman A / King, Toby S

    Journal of biomechanics

    2006  Volume 39, Issue 14, Page(s) 2593–2602

    Abstract: Liquid jet injections have been performed on human skin in vivo and silicone rubber using Intraject needle-free injectors. The discharge characteristics of the liquid jet were measured using a custom-built test instrument. The experiments reveal that a ... ...

    Abstract Liquid jet injections have been performed on human skin in vivo and silicone rubber using Intraject needle-free injectors. The discharge characteristics of the liquid jet were measured using a custom-built test instrument. The experiments reveal that a high-speed liquid jet penetrates a soft solid by the formation and opening of a planar crack. The fluid stagnation pressure required for skin penetration decreases with increasing diameter of the liquid jet. These findings are consistent with the slow-speed penetration of a soft solid by a sharp-tipped punch. It is demonstrated that the Shergold-Fleck sharp-tipped punch penetration model [Shergold, O.A., Fleck, N.A., 2004. Mechanisms of deep penetration of soft solids. Proc. Roy. Soc. Lond. A 460, 3037-3058.] gives adequate predictions for the pressure required to penetrate a soft solid by a high-speed liquid jet.
    MeSH term(s) Biomechanical Phenomena ; Drug Delivery Systems/instrumentation ; Drug Delivery Systems/methods ; Humans ; Injections, Jet/instrumentation ; Injections, Jet/methods ; Models, Theoretical ; Pressure ; Punctures ; Shear Strength ; Silicone Elastomers/chemistry ; Skin/physiopathology ; Wounds, Penetrating/physiopathology
    Chemical Substances Silicone Elastomers
    Language English
    Publishing date 2006
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 218076-5
    ISSN 1873-2380 ; 0021-9290
    ISSN (online) 1873-2380
    ISSN 0021-9290
    DOI 10.1016/j.jbiomech.2005.08.028
    Database MEDical Literature Analysis and Retrieval System OnLINE

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