Redox-active ions unlock substitutional doping in halide perovskites

Electrical doping of metal halide perovskites (MPHs) is a key step towards the use of this efficient and cost-effective semiconductor class in modern electronics. In this work, we demonstrate n-type doping of methylammonium lead iodide (CH₃NH₃PbI₃) by the post-fabrication introduction of Sm²⁺. The ionic radius of the latter is similar to that of Pb²⁺ and can replace it without altering the perovskite crystal lattice. It is demonstrated that once incorporated, Sm²⁺ can act as a dopant by undergoing oxidation to Sm³⁺. This results in the release of a negative charge that n-dopes the material, resulting in an increase of conductivity of almost 3 orders of magnitude. Unlike substitution doping with heterovalent ions, furtive dopants do not require counterions to maintain charge neutrality with respect to the ions they replace and are thus more likely to be incorporated into the crystalline structure. The incorporation of the dopant throughout the material is evidenced by XPS and ToF-SIMS, while the XRD pattern shows no phase separation at low and medium doping concentrations. A shift of the Fermi level towards a conduction energy of 0.52 eV confirms the doping to be n-type with a charge carrier density, calculated using the Mott-Schottky method, estimated to be nearly 10¹⁷ cm^-3 for the most conductive samples. Variable-temperature conductivity experiments show that the dopant is only partially ionized at room temperature due to dopant freeze-out.

Probing proton diffusion as a guide to environmental stability in powder-engineered FAPbI3 and CsFAPbI3 perovskites

Formamidinium lead iodide-based solar cells show promising device reliability. The grain imperfection can be further suppressed by developing powder methodology. The water uptake capability is critical for the stability of α-formamidinium lead triiodide (FAPbI₃) thin films, and elucidating the migration of hydrogen species is challenging using routine techniques such as imaging or mass spectroscopy. Here, we decipher the proton diffusion to quantify indirect monitoring of H migration by following the N-D vibration using transmission infrared spectroscopy. The technique allows a direct assessment of the perovskite degradation associated with moisture. The inclusion of Cs in FAPbI₃, reveals significant differences in proton diffusion rates, attesting to its impact. CsFAPbI₃'s ability to block the active layer access by water molecules is five times higher than α-FAPbI_3, which is significantly higher than methylammonium lead triiodide (MAPbI₃). Our protocol directly probes the local environment of the material to identify its intrinsic degradation mechanisms and stability, a key requirement for optoelectronic applications.

Narcissistic self-sorting of n-acene nano-ribbons yielding energy-transfer and electroluminescence at p-n junctions

The 2,3-didecyloxy derivative of an n-type anthracene (n-BG) and a p-type tetracene (p-R) have been synthesized and their self-assembly into nano-ribbons studied. Hyperspectral fluorescence imaging revealed their narcissistic self-sorting, leading to separated nanoribbons emitting with very different colors (blue or green for n-BG, depending on the growth solvent, and red for p-R). It is unique that the usual origins of self-sorting, such as specific H-bonding, different growth kinetics, or incompatible steric hindrance can be ruled out. Hence, the narcissistic behaviour is herein proposed to originate from a so-far unconsidered cause: the discrepancy between the quadrupolar character of n-BG and dipolar character of p-R. At the p-n junctions of these nanoribbons, inter-ribbon FRET and electro-luminescence switch-on were observed by fluorescence/luminescence microscopy.

Oncology clinical trial disruption during the COVID-19 pandemic: a COVID-19 and cancer outcomes study

Background

COVID-19 disproportionately impacted patients with cancer as a result of direct infection, and delays in diagnosis and therapy. Oncological clinical trials are resource-intensive endeavors that could be particularly susceptible to disruption by the pandemic, but few studies have evaluated the impact of the pandemic on clinical trial conduct.

Patients and methods

This prospective, multicenter study assesses the impact of the pandemic on therapeutic clinical trials at two large academic centers in the Northeastern United States between December 2019 and June 2021. The primary objective was to assess the enrollment on, accrual to, and activation of oncology therapeutic clinical trials during the pandemic using an institution-wide cohort of (i) new patient accruals to oncological trials, (ii) a manually curated cohort of patients with cancer, and (ii) a dataset of new trial activations.

Results

The institution-wide cohort included 4756 new patients enrolled to clinical trials from December 2019 to June 2021. A major decrease in the numbers of new patient accruals (−46%) was seen early in the pandemic, followed by a progressive recovery and return to higher-than-normal levels (+2.6%). A similar pattern (from −23.6% to +30.4%) was observed among 467 newly activated trials from June 2019 to June 2021. A more pronounced decline in new accruals was seen among academically sponsored trials (versus industry sponsored trials) (P < 0.05). In the manually curated cohort, which included 2361 patients with cancer, non-white patients tended to be more likely taken off trial in the early pandemic period (adjusted odds ratio: 2.60; 95% confidence interval 1.00-6.63), and substantial pandemic-related deviations were recorded.

Conclusions

Substantial disruptions in clinical trial activities were observed early during the pandemic, with a gradual recovery during ensuing time periods, both from an enrollment and an activation standpoint. The observed decline was more prominent among academically sponsored trials, and racial disparities were seen among people taken off trial.

Supramolecular gating of TADF process in self-assembled nano-spheres for high-resolution OLED applications

Acridine-based donor-acceptor chromophores exhibiting E-type delayed fluorescence were substituted with bis-biuret H-bonding motifs to induce the formation of hollow spheres which can be deposited from solution to form the active component of OLED devices. In solution, the contribution of the delayed component is sensitive to disruption of the aggregates.

On the robustness of model-based algorithms for photoacoustic tomography: Comparison between time and frequency domains

For photoacoustic image reconstruction, certain parameters such as sensor positions and speed of sound have a major impact on the reconstruction process and must be carefully determined before data acquisition. Uncertainties in these parameters can lead to errors produced by a modeling mismatch, hindering the reconstruction process and severely affecting the resulting image quality. Therefore, in this work, we study how modeling errors arising from uncertainty in sensor locations affect the images obtained by matrix model-based reconstruction algorithms based on time domain and frequency domain models of the photoacoustic problem. The effects on the reconstruction performance with respect to the uncertainty in the knowledge of the sensors location are compared and analyzed both in a qualitative and quantitative fashion for both time and frequency models. Ultimately, our study shows that the frequency domain approach is more sensitive to this kind of modeling errors. These conclusions are supported by numerical experiments and a theoretical sensitivity analysis of the mathematical operator for the direct problem.

Comment on "Eppur si Muove: Proton Diffusion in Halide Perovskite Single Crystals": Eppur Non si Muove: A Critical Evaluation of Proton Diffusion in Halide Perovskite Single Crystals

A recent report by Cahen and co-workers is examined that finds the diffusion constant for proton migration in methylammonium lead triiodide single crystals to be 2 × 10⁵ -fold greater than that previously reported by Sadhu et al. By comparing the conversion of single crystals versus microcrystalline samples, it is concluded that proton diffusion in macroscopic single crystals is accelerated by the presence of defects acting as high-diffusivity paths.

Comprehensive theoretical and experimental study of near infrared absorbing copolymers based on dithienosilole

A new conjugated copolymer with alternating dithienosilole and thienoisoindigo units displays improved near-infrared absorption compared to previously reported dithienosilole-based copolymers.

Role of Oxide/Metal Bilayer Electrodes in Solution Processed Organic Field Effect Transistors

High performance, air stable and solution-processed small molecule 2,7-dioctyl[1]benzothieno[3,2-b]benzothiophene (C₈-BTBT) based organic field-effect transistors (OFETs) with various electrode configurations were studied in detail. The contact resistance of OFET devices with Ag, Au, WO₃/Ag, MoO₃/Ag, WO₃/Au, and MoO₃/Au were compared. Reduced contact resistance and consequently improved performance were observed in OFET devices with oxide interlayers compared to the devices with bare metal electrodes. The best oxide/metal combination was determined. The possible mechanisms for enhanced electrical properties were explained by favorable morphological and electronic structure of organic/metal oxide/metal interfaces.

Application of Rubrene Air-Gap Transistors as Sensitive MEMS Physical Sensors

Micro-electromechanical systems (MEMS) made of organic materials have attracted efforts for the development a new generation of physical, chemical, and biological sensors, for which the electromechanical sensitivity is the current major concern. Here, we present an organic MEMS made of a rubrene single-crystal air-gap transistor. Applying mechanical pressure on the semiconductor results in high variations in drain current: an unparalleled gauge factor above 4000 has been measured experimentally. Such a high sensitivity is induced by the modulation of charge injection at the interface between the gold electrode and the rubrene semiconductor as an unusual transducing effect. Applying these devices to the detection of acoustic pressure shows that force down to 230 nN can be measured with a resolution of 40 nN. This study demonstrates that MEMS based on rubrene air-gap transistors constitute a step forward in the development of high-performance flexible sensors.

A Multifunctional Interlayer for Solution Processed High Performance Indium Oxide Transistors

Multiple functionality of tungsten polyoxometalate (POM) has been achieved applying it as interfacial layer for solution processed high performance In₂O₃ thin film transistors, which results in overall improvement of device performance. This approach not only reduces off-current of the device by more than two orders of magnitude, but also leads to a threshold voltage reduction, as well as significantly enhances the mobility through facilitated charge injection from the electrode to the active layer. Such a mechanism has been elucidated through morphological and spectroscopic studies.

Standardisierter Computer-basiert-organisierter Report des EEG (SCORE) – Eine strukturierende Form der EEG-Befundung

Eine 2013 von der „International Federation of Clinical Neurophysiology“ gegründete Taskforce hat eine international konsensfähige EEG-Terminologie entwickelt. Im Folgenden soll das Resultat – die 2. Version des Standardized Computer-based Organized Reporting of EEG (SCORE) - vorgestellt werden. Die Terminologie wurde im Rahmen eines Softwarepaketes (SCORE-EEG) in der klinischen Praxis an über 12.000 EEGs getestet. Die Auswahl der Begriffe ist kontextabhängig: die initiale Auswahl bestimmt, welche weiteren Auswahlmöglichkeiten zur Verfügung stehen. Im Verlauf wird automatisch ein Befund erstellt und dessen Einzelmerkmale in eine Datenbank eingespeist. SCORE verfügt über Module spezifisch für die Befundung epileptischer Anfälle, sowie charakteristischer neonataler und intensivmedizinische EEG-Merkmale. SCORE ist nicht nur ein nützliches Werkzeug im ambulanten, klinischen und wissenschaftlichen Setting, es erleichtert auch Qualitätssicherung, Datenaustausch und die EEG-Aus und Weiterbildung.

Kinetic Isotope Effects Provide Experimental Evidence for Proton Tunneling in Methylammonium Lead Triiodide Perovskites

The occurrence of proton tunneling in MAPbI₃ hybrid organic inorganic perovskites is demonstrated through the effect of isotopic labeling of the methylammonium (MA) component on the dielectric permittivity response. Deuteration of the ammonium group results in the acceleration of proton migration (inverse primary isotope effect), whereas deuteration of the methyl group induces a normal secondary isotope effect. The activation energies for proton migration are calculated to be 50 and 27 meV for the tetragonal and orthorhombic phases, respectively, which decrease upon deuteration of the ammonium group. The low activation barrier and the deviation from unity of the ratio of the pre-exponential factors (A_H/A_D = 0.3-0.4) are consistent with a tunneling mechanism for proton migration. Deuteration of the PEDOT:PSS hole transport layer results in a behavior that is intermediate between that of the deuterated and undeuterated perovskite, due to extrinsic ion migration between the two materials.

Frequency-Selective Photobleaching as a Route to Chromatic Control in Supramolecular OLED Devices

We report a series of molecules that spontaneously self-organize into small electroluminescent domains of sub-micrometer dimensions when dissolved in tetrahydrofuran. The self-assembled spherical aggregates have an average diameter of 300 nm and exhibit efficient energy transfer from the blue to the green or red component. The aggregates can be chromatically addressed or patterned by selective bleaching of the energy-acceptor component using a laser source. This allows the fabrication of electroluminescence devices by directly photopatterning the active layer without the need of additional steps. Submicron features (700 nm) can be achieved using a collimated light source.

Crucial Role of the Electron Transport Layer and UV Light on the Open-Circuit Voltage Loss in Inverted Organic Solar Cells

Understanding the degradation mechanisms in organic photovoltaics is crucial in order to develop stable organic semiconductors and robust device architectures. The rapid loss of efficiency, referred to as burn-in, is a major issue to be addressed. This study reports on the influence of the electron transport layer (ETLs) and UV light on the drop of open-circuit voltage (V_oc) for P3HT:PC₆₀BM-based devices. The results show that V_oc loss is induced by the UV and, more importantly, that the ETL can amplify it, with TiO_x yielding a stronger drop than ZnO. Using impedance spectroscopy (IS) and X-ray photoelectron spectroscopy (XPS), different degradation mechanisms were identified according to whether the ETL is TiO_x or ZnO. For TiO_x-based devices, the formation of an interface dipole was identified, resulting in a loss of the flat-band potential (V_fb) and, thus, of the V_oc. For ZnO-based devices, chemical modifications of the metal oxide and active layer at the interface were detected, resulting in a doping of the active layer which impacts the V_oc. This study highlights the role of the architecture and, more specifically, of the ETL in the severity of burn-in and degradation pathways.

Psychiatric and behavioral side effects of anti-epileptic drugs in adolescents and children with epilepsy

PURPOSE

The objective of the study was to compare the psychiatric and behavioral side effect (PBSE) profiles of both older and newer antiepileptic drugs (AEDs) in children and adolescent patients with epilepsy.

METHOD

We used logistic regression analysis to test the correlation between 83 non-AED/patient related potential predictor variables and the rate of PBSE. We then compared for each AED the rate of PBSEs and the rate of PBSEs that led to intolerability (IPBSE) while controlling for non-AED predictors of PBSEs.

RESULTS

922 patients (≤18 years old) were included in our study. PBSEs and IPBSEs occurred in 13.8% and 11.2% of patients, respectively. Overall, a history of psychiatric condition, absence seizures, intractable epilepsy, and frontal lobe epilepsy were significantly associated with increased PBSE rates. Levetiracetam (LEV) had the greatest PBSE rate (16.2%). This was significantly higher compared to other AEDs. LEV was also significantly associated with a high rate of IPBSEs (13.4%) and dose-decrease rates due to IPBSE (6.7%). Zonisamide (ZNS) was associated with significantly higher cessation rate due to IPBSE (9.1%) compared to other AEDs.

CONCLUSION

Patients with a history of psychiatric condition, absence seizures, intractable epilepsy, or frontal lobe epilepsy are more likely to develop PBSE. PBSEs appear to occur more frequently in adolescent and children patients taking LEV compared to other AEDs. LEV-attributed PBSEs are more likely to be associated with intolerability and subsequent decrease in dose. The rate of ZNS-attributed IPBSEs is more likely to be associated with complete cessation of AED.

Piezoelectric polymer gated OFET: Cutting-edge electro-mechanical transducer for organic MEMS-based sensors

The growth of micro electro-mechanical system (MEMS) based sensors on the electronic market is forecast to be invigorated soon by the development of a new branch of MEMS-based sensors made of organic materials. Organic MEMS have the potential to revolutionize sensor products due to their light weight, low-cost and mechanical flexibility. However, their sensitivity and stability in comparison to inorganic MEMS-based sensors have been the major concerns. In the present work, an organic MEMS sensor with a cutting-edge electro-mechanical transducer based on an active organic field effect transistor (OFET) has been demonstrated. Using poly(vinylidenefluoride/trifluoroethylene) (P(VDF-TrFE)) piezoelectric polymer as active gate dielectric in the transistor mounted on a polymeric micro-cantilever, unique electro-mechanical properties were observed. Such an advanced scheme enables highly efficient integrated electro-mechanical transduction for physical and chemical sensing applications. Record relative sensitivity over 600 in the low strain regime (<0.3%) was demonstrated, which represents a key-step for the development of highly sensitive all organic MEMS-based sensors.

Electroluminescence from Spontaneously Generated Single-Vesicle Aggregates Using Solution-Processed Small Organic Molecules

Self-assembled aggregates offer great potential for tuning the morphology of organic semiconductors, thereby controlling their size and shape. This is particularly interesting for applications in electroluminescent (EL) devices, but there has been, to date, no reports of a functional EL device in which the size and color of the emissive domains could be controlled using self-assembly. We now report a series of molecules that spontaneously self-organize into small EL domains of sub-micrometer dimensions. By tailoring the emissive chromophores in solution, spherical aggregates that have an average size of 300 nm in diameter and emit any one color, including CIE D65 white, are spontaneously formed in solution. We show that the individual aggregates can be used in EL devices built either using small patterned electrodes or using a sandwich architecture to produce devices emitting in the blue, green, red, and white. Furthermore, sequential deposition of the three primary colors yields an RGB device in which single aggregates of each color are present in close proximity.

Lanthanum Hexaboride As Novel Interlayer for Improving the Thermal Stability of P3HT:PCBM Organic Solar Cells

For efficient organic photovoltaic (OPV) solar cells, a low work function electrode is necessary to enhance the built-in voltage of the active layer, thereby improving the overall efficiency. Calcium is often used for this purpose in the laboratory; however, its development on a larger scale is impaired by its high reactivity with oxygen and water and the resulting low stability of solar cells under operation. The influence of a novel interlayer, lanthanum hexaboride (LaB6), on the electronic properties of OPV is studied in this work. Similarly to calcium, when LaB6 is used as an interlayer, it enhances the built-in voltage in the device, leading to a higher fill factor (FF) and optimal open circuit voltage (V(oc)). As a result, optimized LaB6-based devices present significantly improved power conversion efficiencies. More importantly, while calcium/aluminum (Ca/Al) and aluminum (Al) cathodes lose their capacity to enhance the internal electrical field during thermal aging, the LaB6/aluminum (LaB6/Al) electrode remains stable. This remarkable effect results in a highly stable V(oc) and flat-band potential during aging.

Solution-Processed Small-Molecule Bulk Heterojunctions: Leakage Currents and the Dewetting Issue for Inverted Solar Cells

In organic photovoltaic (PV) devices based on solution-processed small molecules, we report here that the physicochemical properties of the substrate are critical for achieving high-performances organic solar cells. Three different substrates were tested: ITO coated with

PEDOT

PSS, ZnO sol-gel, and ZnO nanoparticles. PV performances are found to be low when the ZnO nanoparticles layer is used. This performance loss is attributed to the formation of many dewetting points in the active layer, because of a relatively high roughness of the ZnO nanoparticles layer, compared to the other layers. We successfully circumvented this phenomenon by adding a small quantity of polystyrene (PS) in the active layer. The introduction of PS improves the quality of film forming and reduces the dark currents of solar cells. Using this method, high-efficiency devices were achieved, even in the case of substrates with higher roughness.

New synthetic routes towards soluble and dissymmetric triphenodioxazine dyes designed for dye-sensitized solar cells

New π-conjugated structures are constantly the subject of research in dyes and pigments industry and electronic organic field. In this context, the triphenodioxazine (TPDO) core has often been used as efficient photostable pigments and once integrated in air stable n-type organic field-effect transistor (OFET). However, little attention has been paid to the TPDO core as soluble materials for optoelectronic devices, possibly due to the harsh synthetic conditions and the insolubility of many compounds. To benefit from the photostability of TPDO in dye-sensitized solar cells (DSCs), an original synthetic pathway has been established to provide soluble and dissymmetric molecules applied to a suitable design for the sensitizers of DSC. The study has been pursued by the theoretical modeling of opto-electronic properties, the optical and electronic characterizations of dyes and elaboration of efficient devices. The discovery of new synthetic pathways opens the way to innovative designs of TPDO for materials used in organic electronics.

Control of carrier mobilities for performance enhancement of anthracene-based polymer solar cells

Charge carrier mobilities in anthracene-based polymer solar cells were controlled using organic field-effect transistors. The best solar cell device performance was achieved using classical PCBM.

Di(p-methoxyphenyl)amine end-capped tri(p-thiophenylphenyl)amine based molecular glasses as hole transporting materials for solid-state dye-sensitized solar cells

Star shaped hole conducting molecular glasses were synthetized and applied in solid state dye-sensitized solar cells.

A solvent additive to enhance the efficiency and the thermal stability of polymer:fullerene solar cells

A novel bisazide molecule to be used in polymer–fullerene bulk heterojunction (BHJ) solar cells with two distinct functionalities is reported here.

Metal Residues in Semiconducting Polymers: Impact on the Performance of Organic Electronic Devices

The effect of impurities on the optoelectronic and charge transport properties of semiconducting polymers was investigated through the performance of organic photovoltaics (OPVs) and organic field effect transistors (OFETs), respectively. A model representative semiconducting polymer, i.e., poly(3-hexylthiophene) (P3HT), was synthesized and purified using different methods such as precipitation, metals' complexation, and Soxhlet extraction. After the purification processes, each fraction was analyzed to determine its composition in metals (impurities) by various techniques. OFETs and OPVs fabricated from these purified polymer fractions were found to show different charge carrier properties and photovoltaic behaviors. The purest fraction which was obtained after Soxhlet extraction complemented by metals' complexation with the help of ethylenediamine and 15-crown-5 ether showed the best performance in both OPVs and OFETs.

Thermal stabilisation of polymer-fullerene bulk heterojunction morphology for efficient photovoltaic solar cells

A novel stable bisazide molecule that can freeze the bulk heterojunction morphology at its optimized layout by specifically bonding to fullerenes is reported. The concept is demonstrated with various polymers: fullerene derivatives systems enable highly thermally stable polymer solar cells.

Supramolecular control of electronic properties in aromatic materials

The use of supramolecular interactions for controlling the electronic and photophysical properties of organic π-conjugated materials is described. This leads to materials presenting unique properties, such as light-induced switching of polarization (photopolism), or the spontaneous formation of highly luminescent vesicles. In another approach, reversible covalent bonds are used to prepare densely packed fullerene monolayers whose conductivity could be probed using conducting AFM.

Oligocarbazole-based chromophores for efficient thin-film dye-sensitized solar cells

Carb your enthusiasm: Carbazole-based sensitizers with high extinction coefficients are synthesized for application in dye-sensitized solar cells (DSCs). The dyes perform efficiently with both iodine and cobalt electrolytes, showing power conversion efficiencies of up to 5.8% on TiO₂ films of 15 μm thickness, and retaining 90% of their efficiency in devices with thinner films.

MoO3 Thickness, Thermal Annealing and Solvent Annealing Effects on Inverted and Direct Polymer Photovoltaic Solar Cells

Several parameters of the fabrication process of inverted polymer bulk heterojunction solar cells based on titanium oxide as an electron selective layer and molybdenum oxide as a hole selective layer were tested in order to achieve efficient organic photovoltaic solar cells. Thermal annealing treatment is a common process to achieve optimum morphology, but it proved to be damageable for the performance of this kind of inverted solar cells. We demonstrate using Auger analysis combined with argon etching that diffusion of species occurs from the MoO₃/Ag top layers into the active layer upon thermal annealing. In order to achieve efficient devices, the morphology of the bulk heterojunction was then manipulated using the solvent annealing technique as an alternative to thermal annealing. The influence of the MoO₃ thickness was studied on inverted, as well as direct, structure. It appeared that only 1 nm-thick MoO₃ is enough to exhibit highly efficient devices (PCE = 3.8%) and that increasing the thickness up to 15 nm does not change the device performance.

P3HT:PCBM, best seller in polymer photovoltaic research

In the fi eld of polymer-based photovoltaic cells, poly(3-hexylthiophene) (P3HT) and 1-(3-methoxycarbonyl)propyl-1-phenyl[6,6]C₆₁ (PCBM) are, to date, the most-studied active materials around the world for the bulk-heterojunction structure. Various power-conversion effi ciencies are reported up to approximately 5%. This Research News article is focused on a survey of the tremendous literature published between 2002 and 2010 that exhibits solar cells based on blends of P3HT and PCBM.

Low-temperature UV processing of nanoporous SnO₂ layers for dye-sensitized solar cells

Connection of SnO₂ particles by simple UV irradiation in air yielded cassiterite SnO₂ porous films at low temperature. XPS, FTIR, and TGA-MS data revealed that the UV treatment has actually removed most of the organics present in the precursor SnO₂ colloid and gave more hydroxylated materials than calcination at high temperature. As electrodes for dye-sensitized solar cells (DSCs), the N3-modified 1-5 μm thick SnO₂ films showed excellent photovoltaic responses with overall power conversion efficiency reaching 2.27% under AM1.5G illumination (100 mW cm⁻²). These performances outperformed those of similar layers calcined at 450 °C mostly due to higher V(oc) and FF. These findings were rationalized in terms of slower recombination rates for the UV-processed films on the basis of dark current analysis, photovoltage decay, and electrical impedance spectroscopy studies.

The Third Injection Technique Workshop in Athens (TITAN)

The first Injection Technique workshop brought together endocrinologists and injection experts from around the world in Strasbourg in 1997. From its work came groundbreaking recommendations which advanced best practices in areas such as the use of a skin fold when injecting. The second Injection Technique workshop, with an expanded format including nurses and diabetes educators, took place in Barcelona in 2000. The initial stimulus to use shorter injecting needles can be said to date from this meeting. The third Injection Technique workshop was held in Athens in September 2009 and involved 127 experts from across the globe. After a comprehensive review of all publications since 2000 as well as several unpublished studies, the attendees divided into smaller groups to debate and draft new injecting recommendations based on the new data and their collective experience. This paper summarizes all the formal presentations given at this practical consensus workshop.

New injection recommendations for patients with diabetes

AIM

Injections administered by patients are one of the mainstays of diabetes management. Proper injection technique is vital to avoiding intramuscular injections, ensuring appropriate delivery to the subcutaneous tissues and avoiding common complications such as lipohypertrophy. Yet few formal guidelines have been published summarizing all that is known about best practice. We propose new injection guidelines which are thoroughly evidence-based, written and vetted by a large group of international injection experts.

METHODS

A systematic literature study was conducted for all peer-reviewed studies and publications which bear on injections in diabetes. An international group of experts met regularly over a two-year period to review this literature and draft the recommendations. These were then presented for review and revision to 127 experts from 27 countries at the TITAN workshop in September, 2009.

RESULTS

Of 292 articles reviewed, 157 were found to meet the criteria of relevance to the recommendations. Each recommendation was graded by the weight it should have in daily practice and by its degree of support in the medical literature. The topics covered include The Role of the Professional, Psychological Challenges, Education, Site Care, Storage, Suspension and Priming, Injecting Process, Proper Use of Pens and Syringes, Insulin analogues, Human and Pre-mixed Insulins, GLP-1 analogs, Needle Length, Skin Folds, Lipohypertrophy, Rotation, Bleeding and Bruising, Pregnancy, Safety and Disposal.

CONCLUSION

These injecting recommendations provide practical guidance and fill an important gap in diabetes management. If followed, they should help ensure comfortable, effective and largely complication-free injections.