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Adjuvanted vaccines are administered through intramuscular injection. To perform appropriate injection using an appropriate needle in different age groups or different daily living activities, we investigated the depth from the skin surface to muscle fascia and bone in the deltoid muscle area in 156 elderly aged ≥ 50 years by ultrasonic echography. Subjects consisted of 50 healthy elderly aged 50–64 years, 50 subjects aged 65–74 years, and 56 subjects aged ≥ 75 years (20 outpatients, 18 who needed nursing care, and 18 bedridden in a nursing home). The mean depth ± 1.0 SD from the skin surface to muscle fascia was 7.52 ± 2.13 mm for subjects aged ≥ 75 years, being shorter than 9.16 ± 3.02 mm in those aged 50–64years (p < 0.01). The depth from the skin surface to bone was 22.54 ± 3.85 mm for subjects aged ≥ 75 years and 25.41 ± 4.24 mm for those aged 65–74 years, significantly shorter than those aged 50–64 years (p < 0.01), depending on the reduced muscle volume. The subcutaneous volume length was greater in females (8.29 ± 2.63 mm) than in males (5.62 ± 2.80 mm) aged 50–64 years (p < 0.01). A similar result was obtained in those aged 65–74 years, but there was no difference in the muscle volume length. Our study found that a five-eighths of an inch (16 mm) needle was an appropriate length for average-sized elderly aged ≥ 50 years, but it should be longer for those with large body sizes.

Nowadays, thanks to the electrospinning process, polymeric fibers in nanoscale diameters (10–500 nm) are easily producible. During the last decade, the electrospinning technique has been greatly investigated and developed. One of the most important fields of study on the electrospinning process is the influence of effective parameters on electrospun nanofibers and nanoweb properties. In this study, using polyamide-6 (PA-6)/formic acid polymer solution, three important parameters of the electrospinning process, including polymer solution concentration, needle-tip-to-collector distance, and needle length, were precisely studied. The solution concentration is a very important parameter that affects the nanowebs’ homogeneity and nanofibers’ diameter evenness. Scanning electron microscopy (SEM) analysis of the electrospun nanowebs showed that among five polymer solution concentrations (5, 10, 15, 20, and 25 wt%), 25 wt% was more suitable and provided the homogeneity and reproducibility of PA-6 nanowebs. It has been found that the needle-tip-to-collector distance had a considerable influence on the nanofibers’ diameter and the nanoweb collection zone. Morphological investigation and statistical studies showed that the nanofibers’ diameter increased with the reduction of the needle-tip-to-collector distance. Moreover, the average diameter of the nanoweb collection zone decreased by the reduction of this distance. The effect of needle length on the nanofibers’ morphology and nanowebs’ collection zone was investigated. Statistical analysis of the obtained results revealed that the increase of needle length significantly increased the average nanofibers’ diameter. Inversely, the diameter of the nanoweb collection zone reduced when needle length increased. All previously mentioned studies helped to define the optimal electrospinning condition to produce the bead-free, non-branched, and homogeneous PA-6 electrospun nanofibers and nanowebs.

The aim of the study was to determine the adaptive characteristics of pine needles associated with age and different growing conditions. The length of the needles decreases and its variability reduces with increasing dryness and poverty of the soil. In oppressed trees, the coefficient of variability of the length of the needles on the tree is 8%. The coefficient of variation in the length of needles approaching 20% will indicate the best conditions for the growth of a particular tree. Trends of the dependence of width and thickness of needles on growing conditions were not identified. The area of needles in pine forests with optimal water regime of soils (blueberry, cowberry type) varies in the range of 112–124 mm2. In extreme growing conditions pine needles area is reduced by 27–33% and equals 76–86 mm2. These ranges of values of the areas of needles are typical for plantings of the third and fourth classes of age. Changing the width and thickness of the needles is aimed at compensating for changes in the length of the needles in the direction of maintaining the optimal area for these conditions needles. In extreme conditions, the area of the assimilating tissue increases, and the area of the conducting tissue (stele) decreases. Correlation dependences of the area of the stele of needles with the cross-sectional area, with the area of conducting beams, with the number of resin canals and with the cover fabric are revealed.

To estimate thresholds for Body Mass Index (BMI) and arm circumference above which a longer needle is needed to ensure intramuscular (IM) delivery of a vaccine in the deltoid muscle at the site recommended by New Zealand (NZ) immunization guidelines. A combined analysis of two studies, including 442 adults, with measurements of arm circumference, BMI and skin to deltoid muscle distance (SDMD) at the NZ immunization guideline-recommended IM injection site. Receiver Operator Characteristic curves identified arm circumference and BMI cut-points that gave 100% sensitivity for SDMD thresholds. These thresholds were: SDMD of 20 mm, accounting for a minimal penetration of 5 mm into muscle with the standard needle; and 25 mm, which is the length of a standard needle for IM injection, representing the depth this can reach. Cut-point values for arm circumference, at which a longer needle would be required, were higher for males than females: 35 cm versus 30 cm for the 20 mm cut-point, and 40 cm versus 36.7 cm for the 25 mm cut-point respectively. The BMI cut-points were also higher for male than females: 24.6 kg/m2 versus 23.7 kg/m2 for the 20 mm cut-point, and 38.2 kg/m2 vs 31.6 kg/m2 for the 25 mm cut-point respectively. Arm circumference and BMI cut-points provide practical measures from which to choose a needle length that increases the chance of successful IM vaccination. Based on our data, an arm circumference of 35 cm for men and 30 cm for women should prompt selection of a longer needle to ensure intramuscular injection at the deltoid site. Thresholds for the different skin to deltoid sites proposed internationally should be determined to enable successful IM vaccination in clinical practice beyond NZ.

Background Tension pneumothorax (TP) is a life-threatening condition. The immediate recommended management is needle decompression (ND), followed by the insertion of an intercostal chest drain. The European Trauma Course (ETC) and the Advanced Trauma Life Support (ATLS) guidelines differ on needle size and decompression site, creating clinical uncertainty. This meta-analysis aims to explore the optimal approach for emergency needle decompression in TP. Methods This meta-analysis followed the PRISMA 2020 guidelines. It included English-language RCTs, cohort, case–control, cross-sectional studies, and case series with more than six patients. Studies on adults undergoing needle decompression therapy for TP or with chest wall thickness measurements were included. Ovid MEDLINE, Embase, and Web of Science databases were searched until May 31, 2024. Data were extracted, assessed for quality using OCEBM and GRADE, and analyzed using SPSS and OpenMeta with random-effects models. Primary outcome: needle decompression failure rate. Secondary outcomes: patient demographics, cannula size, and chest wall thickness comparisons. Results This review analyzed 51 studies on needle decompression for TP, with a weighted mean patient age of 36.67 years. Radiological data from 24 studies (n = 8046) indicated a 32.84% failure rate for needle penetration into the pleural cavity (I 2 : 99.72%). Increased needle length reduced failure rates by 7.76% per cm. No significant differences in chest wall thickness between genders were observed (T-test, p = 0.77), but thickness at the 5th anterior axillary line (5AAL) and 5th midaxillary line (5MAL) was less than at the 2nd midclavicular line (2MCL). Injury rates were higher at 5AAL than 5MAL, with strong positive correlations between needle length and injury at these sites (0.88, 0.91). Conclusion Based on our meta-analysis, a 7 cm needle may be appropriate for decompression of right-sided tension pneumothorax at either the 5th intercostal space along the midaxillary line or the 2nd intercostal space along the midclavicular line. For left-sided cases, given the potential risk of cardiac injury, the 2nd midclavicular line is a safer option. However, these recommendations should be interpreted with caution due to considerable heterogeneity among the included studies, potential risk of bias, and variability in measurement techniques. Clinical decisions should always be individualized, taking into account patient-specific factors.

The mRNA COVID vaccines are only licensed for intramuscular injection but it is unclear whether successful intramuscular administration is required for immunogenicity. In this observational study, eligible adults receiving their first ComirnatyTM/BNT162b2 dose had their skin to deltoid muscle distance (SDMD) measured by ultrasound. The relationship between SDMD and height, weight, body mass index, and arm circumference was assessed. Three needle length groups were identified: ‘clearly sufficient’ (needle exceeding SDMD by >5 mm), ‘probably sufficient’ (needle exceeding SDMD by ≤ 5 mm), and ‘insufficient’ (needle length ≤ SDMD). Baseline and follow-up finger prick blood samples were collected and the primary outcome variable was mean spike antibody levels in the three needle length groups. Participants (n = 402) had a mean age of 34.7 years, BMI 29.1 kg/m2, arm circumference 37.5 cm, and SDMD 13.3 mm. The SDMD was >25 mm in 23/402 (5.7%) and >20 mm in 61/402 (15.2%) participants. Both arm circumference (≥40 cm) and BMI (≥33 kg/m2) were able to identify those with a SDMD of >25 mm, the length of a standard injection needle, with a sensitivity of 100% and specificities of 71.2 and 79.9%, respectively. Of 249/402 (62%) participants with paired blood samples, there was no significant difference in spike antibody titres between needle length groups. The mean (SD) spike BAU/mL was 464.5 (677.1) in 'clearly sufficient needle length' (n = 217) compared with 506.4 (265.1) in 'probably sufficient' (n = 21, p = 0.09), and 489.4 (452.3) in 'insufficient needle length' (n = 11, p = 0.65). A 25 mm needle length is likely to be inadequate to ensure vaccine deposition within the deltoid muscle in a small proportion of adults. Vaccine-induced spike antibody titres were comparable in those vaccinated with a needle of sufficient versus insufficient length suggesting deltoid muscle deposition may not be required for an adequate antibody response to mRNA vaccines.

Objective: This article aims to address knowledge gaps and misconceptions among healthcare professionals regarding needle selection (specifically the length and gauge/size chosen) for intramuscular (IM) and subcutaneous (SC) injections. It investigates the impact of needle selection on injection efficacy and adverse effects, considering factors, such as, needle length, size, patient characteristics, and medication requirements. It also aims to evaluate current injection guidelines against research findings from the past two decades, identifying areas requiring revision or updating. Methods: The discussion paper employs a literature review, including an analysis of past research that employs imaging techniques, such as, CT and ultrasound to examine tissue depth in both IM and SC injection practices; the author's extensive experience across various clinical settings, including immunisation, primary care, and acute care settings. The author's roles as academic staff and a clinical facilitator allow for the identification of gaps between theoretical knowledge and practical implementation in injection practices. These insights contribute to a comprehensive understanding of the challenges faced by healthcare professionals. Results: The study reveals significant discrepancies in needle selection practices, with traditional methods often diverging from evidence-based recommendations. Challenges noted include reliance on needle hub colour coding for IM and SC injections and insufficient understanding regarding the rationale behind these injection methods. Another additional barrier is interpreting needle packaging information to identify the actual needle length for injection. Staff training and education is essential to improving accuracy and safety in injection practices. Further, patient characteristics, such as, weight, BMI, gender, and injection sites were found to impact needle selection, highlighting the need for tailored approaches. The article suggests that inconsistent and outdated guidelines from various agencies in injection practices and techniques often lack robust scientific rationale. Implications for research, policy, and practice: The findings and recommendations have significant implications for healthcare policies and guidelines. They highlight the need to incorporate research findings to update current guidelines, ensuring safe and effective injection practices across all clinical settings. An algorithmic flow chart could be developed to reflect the above concerns. What is already known about the topic? - Nursing textbooks often differ in IM and SC procedures, with some based on non-evidence- based recommendations. - Unsafe injections have severe consequences, including increased morbidity and mortality, along with substantial medical costs. - Complications like muscle fibrosis, abscesses, gangrene, and nerve injury May arise. Inappropriate injections can result in subtherapeutic absorption and reduced medication efficacy. What this paper adds: - This article highlights the overreliance on traditional practices in injection procedures and advocates for nurses to embrace evidence-based approaches in their injection techniques. - It also emphasises the importance of proper needle selection, including the correct identification of length and gauge/size (rather than relying solely on the needle colour hub for IM/SC injections), to ensure medication efficacy and patient safety. - This shift towards best practice is anticipated to enhance nursing proficiency in intramuscular and subcutaneous injections, ultimately leading to improved patient outcomes.

Introduction: White pine blister rust (WPBR) disease, caused by an invasive fungal pathogen (Cronartium ribicola J.C. Fisch), has long been the primary biotic threat to eastern white pine in Canada. A hybridization program initiated in Ontario, Canada in the 1950s aimed to transfer blister rust resistance from Himalayan blue pine to eastern white pine, resulting in WPBR-resistant interspecific hybrids. Metabolic adjustments related to disease resistance may cause trade-offs with tolerance to abiotic stress (e.g., frost, heat, drought). To evaluate the adaptive potential of WPBR-resistant hybrids, it is crucial to understand how morphological and physiological traits change during multi-generation backcrossing, as these shifts may influence both growth performance and resilience to climate change.Methods: We assessed changes in photosynthetic-related traits, as well as needle morphology and resistance to xylem cavitation of eastern white pine and Himalayan blue pine, and their hybrids with varying levels of white pine parentage ranging from 50 to 87.5%.Results and discussion: Needle length and specific leaf area (SLA) decreased linearly by increasing eastern white pine parentage; inversely, needle density increased by increasing eastern white pine parentage. Variations in needle morphology were not translated into variations in light-saturated photosynthesis (Amax), mesophyll conductance (gm), maximum rate of carboxylation (Vcmax), and maximum rate of electron transport (Jmax). Photosynthetic nitrogen use efficiency (PNUE) decreased, while water use efficiency (WUEi) increased with increasing eastern white pine parentage. Increasing needle density and declining PNUE reflect greater investment in structural tissue, which is commonly associated with frost and drought tolerance. Also, Himalayan blue pine and hybrids were more resistant to xylem cavitation than eastern white pine. Hybrid pines recovered most of their eastern white pine morpho-physiological characteristics after two rounds of backcrossing. Consequently, WPBR-resistant interspecific hybrids should have integrated stress tolerance traits of eastern white pine enabling them to adapt to abiotic and biotic stresses in Canadian boreal forests.

Background Intramuscular (IM) injection of epinephrine (adrenaline) at the mid-anterolateral (AL) thigh is the international standard therapy for acute anaphylaxis. Concerns exist regarding implications of epinephrine auto-injector needles not penetrating the muscle in patients with greater skin-to-muscle-distances (STMD). Methods This open-label, randomized, crossover study investigated pharmacokinetics and pharmacodynamics following injection of epinephrine in healthy volunteers. Individuals were stratified by maximally compressed STMD (low, < 15 mm; moderate, 15–20 mm; high, > 20 mm). Participants received epinephrine injections via EpiPen ® Auto-Injector (EpiPen; 0.3 mg/0.3 mL) or IM syringe (0.3 mg/0.3 mL) at mid-AL thigh or received saline by IM syringe in a randomized order. Eligible participants received a fourth treatment (EpiPen [0.3 mg/0.3 mL] at distal-AL thigh). Model-independent pharmacokinetic parameters and pharmacodynamics were assessed. Results There were numerical trends toward higher peak epinephrine concentrations (0.52 vs 0.35 ng/mL; geometric mean ratio, 1.40; 90% CI 117.6–164.6%) and more rapid exposure (time to peak concentration, 20 vs 50 min) for EpiPen vs IM syringe at mid-AL thigh across STMD groups. Absorption was faster over the first 30 min for EpiPen vs IM syringe (partial area under curve [AUC] over first 30 min: geometric mean ratio, 2.13; 90% CI 159.0–285.0%). Overall exposure based on AUC to the last measurable concentration was similar for EpiPen vs IM syringe (geometric mean ratio, 1.13; 90% CI 98.8–129.8%). Epinephrine pharmacokinetics after EpiPen injection were similar across STMD groups. Treatments were well tolerated. Conclusions Epinephrine delivery via EpiPen resulted in greater early systemic exposure to epinephrine vs IM syringe as assessed by epinephrine plasma levels. Delivery via EpiPen was consistent across participants with a wide range of STMD, even when the needle may not have penetrated the muscle. Trial registrations This trial was registered with the German Clinical Trials Register (DRKS-ID: DRKS00011263; secondary ID, EudraCT 2016-000104-29) on 23 March 2017.

In this study, FSW experiments were conducted on a 4 mm-thick A380 aluminium alloy plate and 6061 aluminium alloy using four different needle lengths (2.5 mm, 2.8 mm, 3.0 mm, and 3.5 mm) of H13 steel. The experiments were conducted at the same welding parameters (1000 rpm and 120 mm/min) to explore the effects of different stirring needle lengths on the microstructures and properties of the FSW joints. The experimental results show that FSW joints with varying lengths of needles have a significant effect on the microstructures and properties of welded joints, and the tensile strength increases and then decreases with increases in the needle length. A 2.8 mm needle length can achieve the maximum tensile strength of 203 MPa, about 85.3% of the base material. Too long or too short a needle leads to a decrease in joint performance. Furthermore, different needle lengths have a significant influence on the flowability of the weld core zone, and a suitable needle length will lead to better flowability in the weld core zone. With increases in the needle length, the heat production also increases, and the area of the RS-HAZ will increase with the heat production. When the joints achieve appropriate heat production, the weld core zone will experience grain refinement. At the same time, the grain will grow in the RS-HAZ; the hardness cloud diagram shows that, in the RS-HAZ, the material properties are weaker, and the tensile specimens are mainly fractured in the RS-HAZ. Finally, the tensile specimens exhibit mixed fracture.