Abstract: Processing an evacuated blood sample collection tube or other vessel by plasma enhanced chemical vapor deposition to apply a tie coating or layer (289), a barrier coating or layer (288), and optionally one or more additional coatings or layers. The tie coating or layer of SiOxCy is applied under partial vacuum and, while maintaining the partial vacuum unbroken in the lumen, the barrier coating or layer is applied. Then optionally, while maintaining the partial vacuum unbroken in the lumen, a pH protective coating or layer of SiOxCy can be applied. As a result of this processing, a coated vessel is produced having a lower gas permeation rate constant into the lumen than a corresponding vessel made by the same process except breaking the partial vacuum in the lumen between applying the tie coating or layer and applying the barrier coating or layer. Retention features are also described for keeping the vessels stoppered during exposure to reduced ambient pressure.

Abstract: The present invention relates to a drug-eluting medical device, in particular a balloon for angioplasty catheters with drug elution to prevent the restenosis of the vessel subjected to angioplasty. More particularly, the present invention relates to a catheter balloon completely or partially coated with paclitaxel in hydrated crystalline form or in hydrated solvated crystalline form, having an immediate release and bioavailability of a therapeutically effective amount of paclitaxel at the site of intervention. The balloon can be made of a polyether-polyamide block copolymer, or a polyester amide, or polyamide-12.

Abstract: A system and methods for producing a structure including a plurality of fibers is provided. The system includes a polymer collector having a predefined pattern, wherein the collector is charged at a first polarity, and a spinneret configured to dispense a polymer, wherein the spinneret is charged at a second polarity substantially opposite the first polarity such that polymer dispensed from the spinneret forms a plurality of fibers on the predefined pattern of the fiber collector.

Abstract: The present invention provides a method for preparing an injectable thermosensitive hydrogel for preventing adhesion including mixing methyl cellulose, polyethylene glycol, oxidized cellulose nanofibers and carboxymethyl cellulose. The injectable thermosensitive hydrogel for preventing adhesion is a sol at a low temperature and induces rapid gelation upon in vivo implantation due to thermosensitivity. In addition, the hydrogel can be rapidly changed into physical hydrogel without separate additives or chemical reaction during in vivo condition. In addition, the injectable thermosensitive hydrogel for preventing adhesion exhibits excellent biodegradability and biocompatibility, has no cytotoxicity, inhibits in vitro migration of rat bone marrow mesenchymal stem cells (rBMSCs), and exhibits anti-adhesion efficacy in a rat model of sidewall defect-cecum abrasion in vivo, thus being useful as an effective anti-adhesive agent.

Abstract: A method and system of and for aspirators and/or medical suction methods and systems. Surgical suction methods and systems including a clamp for restricting or occluding any flexible medical suction tubing being used.

Abstract: A surgical suction device is disclosed that includes a suction tube having a first longitudinal axis, a proximal opening, and a distal opening; a guide tube that is substantially coextensive with and parallel to the suction tube, and has a second longitudinal axis, a proximal opening, and a distal opening; a stylet having a proximal end and a distal end; and a junction point having a proximal opening and a distal opening; wherein the stylet is disposed along the second longitudinal axis and encircled by the guide tube, and urging the stylet through the guide tube along the second longitudinal axis through the junction conduit translates the distal end of the stylet to the distal opening of the junction point. The guide tube may effectively cut the length of the handle member in half.

Abstract: A system for synchronizing one or more breast-pumping sessions of an individual (such as a mother) and milk consumption by a second individual (such as a baby or infant) is described. In particular, based on measurements of a volume of the collected milk as a function of time and received information specifying milk consumption by the second individual as a function of time, a control circuit may determine a need for milk. Then, the control circuit may provide feedback based on the determined need for milk that synchronizes the one or more breast-pumping sessions and the milk consumption. For example, the feedback may alert the individual to initiate a breast-pumping session and/or may provide a signal to a breast pump that initiates a breast-pumping session.

Abstract: The present invention relates to a transcatheter method for providing fluid communication between two anatomical compartments. The present invention also relates to a transcatheter system comprising an intracorporeal connector for fluid communication between two anatomical compartments through at least one anatomical wall, wherein said connector is adapted to receive a flow regulating device, a connector, a flow regulating device and an insertion device.

Abstract: Blood pumps discussed herein may be suitable for use as a ventricular assist device (VAD) or the like. The blood pumps cause minimal blood damage, are energy efficient, and can be powered by implanted batteries for extended periods of time. Further, these pumps are also beneficial because they may improve the quality of life of a patient with a VAD by reducing restrictions on the patient's lifestyle. The blood pumps can provide radial and axial stability to a rotating impeller that is driven by a separate rotor. Both radial and axial stability can be provided, at least in part, by one or more permanent magnetic couplings between the rotor and the impeller and/or one or more permanent magnetic bearings between the pump housing and the impeller.

Abstract: A catheter system for a catheter pump is disclosed. The system can include an elongate catheter body having a distal portion including an expandable cannula having an inlet and an outlet. The expandable cannula can have a delivery profile and an operational profile larger than the delivery profile. An impeller assembly can include an impeller shaft and an impeller body. A sheath can have a cannula retention zone disposed over the expandable cannula and a separation zone. The cannula retention zone can have a first configuration adapted to retain the expandable cannula in the delivery profile. The system can be adapted to separate the separation zone into a first portion and a second portion disposed across a gap. The gap can enable the elongate catheter body to pass between the first and second portion so that the sheath can be removed from the elongate catheter body.

Abstract: A method of detecting a disruption in a diurnal rhythm of a patient having an implantable blood pump comprising calculating a moving average convergence divergence (MACD) based on power consumed by the implantable blood pump to maintain a constant rotational speed of an impeller of the implantable blood pump and generating an alert when the calculated MACD does not cross a MACD zero line for a predetermined MACD zero line crossing time threshold.

Abstract: A device to convert redundant uterus to ventricular assist device and total artificial heart by capturing and extracting muscular power of uterus being mechanical energy and transfer the energy to pump blood in the circulatory system with the transfer being one of indirect transfer through transfer fluid and where required directly to blood with the uterus based compression chambers directly pumping blood in the aortic circulation at least. A system of connecting joints and pipes organized around a mode change over valve set controlled by micro controller enabling the device to operate in different modes and an external pipe connector connected to external pump which greatly extends the utility of the invention enabling patient to treat problems from lung, kidney, liver, gastro intestinal system and manage sepsis. The purpose of the invention is give additional life span or time to a patient especially with heart failure.

Abstract: To provide a concentration calculating module configured to measure the concentrations of two constituents simultaneously with higher accuracy. The concentration measuring module includes a light source configured to emit light into a housing; a first light receiving unit configured to have sensitivity to a wavelength of output light of the light source and receive light radiated from inside the housing; and a second light receiving unit configured to have sensitivity to a longer wavelength than the first light receiving unit and receive light radiated from inside the housing.

Abstract: The present invention generally relates to a process suitable for extracorporeal lung support. The process relies on exposing blood, separated by a semipermeable membrane from the dialysis liquid. The dialysis liquid of the present invention comprises a buffering agent and has a high buffering capacity for H* ions. Carbon dioxide, bicarbonate and hydrogen cations can be efficiently transported across a semipermeable membrane to the dialysis liquid. The present invention also allows for the regeneration and recycling of the dialysis liquid, and thus for its recycling and repeated use. The versatility of the dialysis liquid allows to adjust the pH of the dialysis liquid, add fluids to the dialysis liquid and/or to the blood in the extracorporeal circuit and to remove substances from the blood in the extracorporeal circuit, depending on the conditions and needs.

Abstract: A peritoneal dialysis device includes: a dialysate catheter that is connected at a first end to a dialysate container connector and at a second to a four-way joint; an injection catheter that is connected at a first end to an injection catheter connector and at a second end to the four-way joint; a waste fluid catheter that is connected at a first end to a waste fluid container connector and at a second end to the four-way joint; and a syringe catheter that is connected at a first end to a syringe and at a second end to the four-way joint.

Abstract: A medical injection and suction device includes: a housing that encloses a driving motor; a syringe mount disposed on a wall of an upper side of the housing; a plurality of valves disposed on the wall of the upper side of the housing and on a side of the syringe mount; a slider that moves toward or away from the housing and is disposed on a lateral side of the housing; a driving rod connected to the slider; and at least one slide rod. The driving rod extends through a wall of the lateral side of the housing. An end of the driving rod is connected to the driving motor. The driving motor drives the driving rod to move the slider. An end of the at least one slide rod is connected to the wall of the lateral side of the housing. The slider is disposed in a slidable manner on the slide rod.

Abstract: A dialysis machine (e.g., a peritoneal dialysis machine) may include a housing. The machine may further include a leak detector disposed in the housing, the leak detector being an electrical circuit. In response to fluid contacting the leak detector, a leak in the dialysis machine is detectable. The machine is configured to send a signal based on a short of the electrical circuit from fluid contact with the leak detector to indicate a leak condition.

Abstract: An exposure cell and method for treatment of carbon monoxide poisoning in the blood of a living body by removal of a portion of blood from the body, placing the portion in the exposure cell, exposing the portion in the cell to light of wave length and intensity that causes dissociation of carbon monoxide from hemoglobin, and returning the portion to the body. The exposure cell has an exposure zone outside of the body, that holds the portion, and a window that allows light from outside the zone to enter the zone to disassociate carbon monoxide from the portion. Oxygen is injected into the zone and carbon monoxide is removed from the zone.

Abstract: A dialysis system comprising: a sorbent cartridge including a zirconium phosphate layer followed by at least one of a urease layer, a zirconium oxide layer, or a carbon layer; a pump in fluid communication sorbent cartridge; and a control unit in operable communication with the pump, wherein the control unit is programmed to cause the pump to pump a dialysis fluid to flow (i) in a first direction through the sorbent cartridge, wherein the zirconium phosphate layer is contacted by the dialysis fluid before the at least one of the urease layer, zirconium oxide layer or carbon layer and (ii) in a second direction through the sorbent cartridge wherein the at least one of the urease layer, zirconium oxide layer or carbon layer is contacted by the dialysis fluid before the zirconium phosphate layer.

Abstract: A fluid delivery system (1) includes a reservoir (7) for storing a fluid, a pumping chamber (8) and an actuator (20). The pumping chamber (8) has a volume, an inlet valve (48) providing selective fluid communication between the pumping chamber volume and the reservoir, an outlet valve (49), and a membrane (47) the displacement of which changes the pumping chamber volume. The actuator (20) moves a drive member (21) in reciprocating motion. The actuator (20) is disposed in a housing (9) having an aperture (36) from which the drive member projects. The reservoir (7) and the pumping chamber (8) are arranged in a cartridge (3) removably attachable to the housing. When the cartridge (3) is attached to the housing (9) the drive member (20) is operatively coupled to the pumping chamber membrane (47). The fluid delivery system may be applied to an infusion system for the infusion of a liquid therapeutic product, such as insulin.

Abstract: Provided is a flexible and conformal wearable, self-contained medical device. The medical device comprises an integral housing formed by a flexible upper portion and a flexible lower portion joined along their perimeters. The medical device is also provided in a plurality of shapes and configurations for increasing the flexibility and conformability of the housing. The components contained within the housing, such as a drug reservoir, printed circuit board, and power supply are preferably constructed from flexible materials and are formed, connected and positioned according to the configuration of the housing in a manner for enhancing flexibility of the housing. A thermal bubble micropump is provided for controlling flow of a drug from the flexible reservoir, that utilizes a thermal resistor provided locally to a thermal expansion fluid that causes a surrounding membrane to expand and displace a volume of drug to be provided to the user.

Abstract: A patch pump including a medicament reservoir having an inner surface defining an elongate piston engagement pathway, an electric motor having a rotary drive output element, a piston replaceably axially fixed to the electric motor. The piston having an outer surface arranged for sealing engagement with the inner surface of the medicament reservoir, the piston also including a rotary to longitudinal drive converter receiving a rotary drive input from the rotary drive output element of the electric motor and providing a longitudinal drive to the reservoir, thereby driving the medicament reservoir in longitudinal motion relative to the piston in which the elongate piston engagement pathway defined by the inner surface of the medicament reservoir is displaced axially and in sealing engagement with the outer surface of said piston.

Abstract: A delivery device for delivering a medication to a patient includes a catheter with a catheter insertion mechanism, a housing, and a base with a surface for supporting a pump mechanism. A noise dampening member in or on the device inhibits noise and vibrations from the pump mechanism from transferring through the base and housing. The noise dampening member can be an elastomer that is coated on or adhered to the base. The noise dampening member can be molded in or on the base in a suitable location to dampen noise produced by the mechanical component. The noise dampening member can be between the base and the mechanical component or spaced from the mechanical component. The noise dampening member can be molded in a recessed area formed in the base and can have a top face that is recessed, aligned with or project from the top face of the base.

Abstract: An apparatus and method for the aseptic delivery of a biologic medication in a wearable form factor. The apparatus and method allow for standard off-the-shelf drug cartridges to be utilized without compromising the sterility of the biologic. Further, by utilizing a two part assembly, manufacturing costs are minimized.

Abstract: Ambulatory infusion pumps, cannula insertion mechanisms, and medicament sealing assemblies, including cannula seal assemblies, plus related components, as well as component combinations and related methods.

Abstract: Provided is a liquid medicine injection device having a needle holder slid immediately by using the elasticity of a spring such that a needle installed at the needle holder may be instantly inserted into a patient.

Abstract: In an acute care setting, rapid onset of the therapeutic effects of medication is highly desirable. The invention provides in-line filters suitable for rapid delivery of a positively charged protein therapeutic via intravenous administration.

Abstract: A medical tube set is provided, including a length of tubing having a first end, and an opposite second end, the first end connected to a spike. An outlet valve is connected to the second end and forms a connector configured for affixing the second end to a medication delivery device, the connector having a connector body having an inlet end and an opposite delivery end. A tip cover is slidably engaged on the delivery end and is movable between an extended position in which the cover obscures the delivery end, and a retracted position in which the delivery end is exposed for delivery of fluid from the tubing in a medical apparatus.

Abstract: A device and method for measuring an IV pump infusion system flow comprises a fluid source configured to store medicinal fluid and a weight sensing mechanism comprising a weight sensor and microprocessor. The weight sensing mechanism is configured to detect the weight of the fluid source as the medicinal fluid leaves the fluid source. The device in the infusion system administers medicinal fluid using a set flow rate for the IV pump input into the control unit prior to infusion, measures the change in mass of the fluid source containing medicinal fluid as fluid exits the source, calculates the flow rate based on the change in mass over time, compares the calculations with a set flow rate, and adjusts the IV pump and flow rate based on the compared deviations, for improved delivery accuracy. This configuration may also prevent patient harm and medicine waste.

Abstract: Infusion systems, infusion devices, and related operating methods are provided. An exemplary method of operating an infusion device capable of delivering fluid to a user involves determining a current value for a physiological condition of the user influenced by the fluid violates a first threshold value, determining a predicted value for the physiological condition of the user violates a second threshold value, and automatically altering operation of the infusion device to modify delivery of the fluid to the user after determining the predicted value violates the second threshold value when the current value violates the first threshold value.

Abstract: An injection device has a housing, in which a syringe can be held, which has an injection needle, a holding chamber, a plunger tip, and a syringe plunger; and a control assembly for the controlled actuation of the syringe during an application process, which includes at least an insertion stroke, an injection stroke, and a return stroke. The control assembly has an actuation element for receiving a manual driving force, a syringe holder, which can be slid in relation to the housing and to which the holding chamber can be fastened, a plunger holder, which can be slid in relation to the housing and to which the syringe plunger can be fastened, and a transmission device, which has a gearing for coupling the plunger holder to the actuation element, by means of which gearing the plunger holder can be driven in accordance with a motion of the actuation element relative to the housing.

Abstract: The present invention relates to an automatic multifunctional liquid injector having a separation type operation device and enabling: an operation unit to be combined thereto in a replaceable manner such that an operation can be performed by selectively mounting a hydro-lifting operation unit and a filler operation unit according to a procedure; and set values to be input, in accordance with each operation, into a control means of a syringe driving unit such that the optimum set value is selected through a user's selection, thereby enabling an effective procedure.

Abstract: A medical delivery device (1; 10) comprises a rod element (3; 30), a dosage member (6; 60) and a lock mechanism. The rod element (3; 30) has a stem (31; 310) with a longitudinal axis (38; 380), a distal end and a proximal end. The dosage member (6; 60) comprises a delivery orifice (62; 620) and a chamber body (61; 610) with a distal end, a proximal end and a hollow interior. The stem (31; 310) of the rod element (3; 30) extends into the interior of the chamber body (61; 610) of the dosage member (6; 60) and the delivery orifice (62; 620) is arranged adjacent to the proximal end of the stem (31; 310) of the rod element (3; 30).

Abstract: It is provided a drug delivery device (1) comprising: a housing (4), a number sleeve (7) contained within the housing (4) and being rotatable with respect thereto and an axial retention mechanism (6) which is designed to axially restrain the number sleeve (7) to the housing (4) and to allow rotation of the number sleeve (7) with respect to the housing (4), wherein the axial retention mechanism (6) comprises a retention element (11). It is further provided a method of assembly of such a drug delivery device (1).

Abstract: An injection device incorporating a dose setting mechanism is presented where the dose setting mechanism contains a dose selector having one or more dose stops corresponding to a finite set of predetermined fixed doses, where the set of finite predetermined fixed doses includes a lowest fixed dose and one or more higher fixed doses, and where at least one of the one or more higher fixed doses is equal to the lowest fixed dose plus a fractional amount of the lowest fixed dose. The dose setting mechanism can further include a floating spline that is rotationally engaged with a snap element such that the snap element can rotate relative to the floating spline during both dose setting and dose delivery.

Abstract: Methods, systems, and devices are disclosed for tracking delivery of medication. In one aspect, a medication delivery tracking device can interface with and be physically placed on a medication delivery pen device. The medication delivery tracking device can detect an occurrence of a delivery of a medication by the medication delivery pen device. In some implementations, the medication delivery tracking device can detect a dose amount of the medication delivered by the medication delivery pen device.

Abstract: A syringe including a barrel, a plunger moveably arranged within said barrel and a plunger rod for driving said plunger is provided. The syringe includes a first engagement member arranged at the plunger rod such that a longitudinal movement of the plunger rod yields a rotational movement of said first engagement member, said first engagement member including a grooved surface, and a second engagement member arranged at the barrel to engage with said grooved surface of the first engagement member such that feedback is given to a user as the plunger rod is moved relative to the barrel for driving said plunger. Wherein, for a given distance D travelled by the plunger rod relative to the barrel, a point of the grooved surface of the first engagement member moves a distance d, wherein d?D.

Abstract: A syringe assembly includes: a barrel with a puncture needle; and a cap that is mounted on the barrel and in which a tip of the puncture needle 6 is located. The cap includes: a seal cap that is made of an elastic material and that is water vapor permeable for autoclave sterilization; and a cylindrical cover member made of a thermoplastic plastic material that is harder than the seal cap. The cylindrical cover member and the seal cap are configured such that a force of engagement between the cylindrical cover member and the seal cap is increased by autoclave sterilization.

Abstract: A protective device, for covering a needle tip of a needle of a medical instrument after puncturing of a puncture object by the needle, includes an inner cylinder, an outer cylinder, and a spring. The outer cylinder receives a cam structure of the inner cylinder and has a guide passage structure that includes one or more guide passages. The outer cylinder is provided with a lateral top part and a distal-end inclined edge part as resistance force generating parts for causing the inner cylinder to generate a resistance force at a puncture position or in the vicinity of the puncture position.

Abstract: An apparatus having an outer wall that encompasses an interior chamber that holds a predetermined volume of fluid and gas where the gas rises to one end of the interior chamber and the fluid flows to the other end of the interior chamber. The apparatus also has an inlet port that allows for fluid to ingress into the interior chamber and an outlet port that allows for fluid to egress out of the interior chamber.

Abstract: A single plate capacitive bubble detection sensor. The detector may employ a single active plate. A parasitic capacitance of the active plate relative to the environment may be monitored without reference to any particular ground source. In this regard, highly sensitive measurements may be made of a tube disposed adjacent to the active plate to detect, for example, the presence of air, liquid, or a change between liquid and air in the tube.

Abstract: A handheld cryoanesthesia or analgesia device for cooling a target area on cutaneous membranes, mucous membranes, and tissue of the mucocutaneous zone having an elongated body and a thermoelectric cooling system disposed within the elongated body. The thermoelectric cooling system is configured to physically contact and thermally couple the target area of the cutaneous membranes, mucous membranes, and tissue of the mucocutaneous zone to induce cryoanesthesia or analgesia. The thermoelectric cooling system includes a thermally-conductive cold tip, a thermally-conductive cooling power concentrator thermally coupled to the cold tip, at least one Peltier unit module thermally coupled to the cooling power concentrator, a heatsink thermally coupled to at least one Peltier unit module, a power source, at least one thermal sensor, and a controller operably outputting a control signal to the Peltier unit module to maintain a predetermined temperature.

Abstract: A solution for injecting one or more fluids into a patient is proposed. A corresponding injection system (200) comprises one or more supply stations (105a;105b) each one for supplying one of the fluids to be injected from a container (110a;110b); at least one of the supply stations (105a;105b) comprises housing means (115a, 120a;115b, 120b) defining a chamber for housing the container (110a;110b), the chamber having a connection port (132a;132b) for connecting the container (110a; 110b) to a delivery arrangement (135,145) for delivering the fluid to the patient, and a conditioning device (205a;205b) for thermally conditioning the fluid in the chamber, wherein the conditioning device (205a;205b) comprises a first conditioning element (210a;210b) arranged around the connection port (132a;132b) and a second conditioning element (215;215a;215b) extending transversally to the first conditioning element (210;210a;210b).

Abstract: A method and apparatus that enables the production of micron-scale free-standing bubbles made of liquids containing surfactants are provided. The method and apparatus of the invention overcomes the limitations of conventional bubble forming techniques by using a controlled cavitation process in a liquid media.

Abstract: A cartridge which contains medicine/substance that is consumed by heating and inhaling when connected to a smartphone charging port for heating power and application control of user access, dosing, and data collection. The duration of use is limited to smartphone charging port connectivity, eliminating risk of accidental overheating. Application control of access ensures user and dosing specifications, preventing non-authorized user/accidental excess consumption. Data collection via this method of consumption informs and guides subsequent user cartridge/dosing decisions and recommendations.

Abstract: The invention relates to a drug and device system for the directed application of a substance into a hollow space, such as a hollow organ, or into a body cavity of a patient, i.e. a mammalian patient, in particular for use in the course of a therapeutic pneumoperitoneum. In particular, herein the present invention is for use in cancer/tumor treatment, including metastatic forms thereof, and is also directed to a kit and its use in a method of treatment, comprising the said drug and device system for the said directed application.

Abstract: A dual chamber nebulizer apparatus for atomizing and administering a first and second liquid medicine includes a housing having first and second chambers for holding the first and second liquid medicines. An atomizer member is situated in the housing and configured to atomize liquid into vapor. An air flow member is coupled to the housing and in fluid communication with the atomizer, the flow member having an inlet port for receiving a compressed air flow to the atomizer member. First and second aspiration tubes are in communication with the atomizer member and extend into first and second chambers, respectively. The atomizer member includes a junction in communication with the first and second aspiration tubes, the valve selectively allowing both of the liquid medicines to be drawn through respective aspiration tubes and directed to the atomizer member when the compressed airflow is directed to the atomizer member.

Abstract: The present invention relates to an inhaler which comprises a durable unit and a replaceable (cartridge) unit, and which comprises systems, subsystems and elements to provide an “open-inhale-close” user experience. A durable unit comprises a breath-actuated trigger mechanism, and optionally electronics for providing user feedback, and telehealth can capability. A replaceable unit comprises a mouthpiece, blister strip, aerosol path dose counter and a blister piercing and aerosolization engine assembly assembly. A lockout mechanism may be provided to prevent further use of the cartridge when the dose counter reaches a preselected limit, such as zero.

Abstract: An inhaler (10) for the inhalation of inhalable substances comprise: a canister (50) having an interior reservoir (84) containing pressurised inhalable substances including fluid; a metering valve (52) including a metering chamber (82) and a valve stem (54) defining a communication path between the metering chamber and the interior reservoir, the communication path (86) including an opening (106) configured to permit flow between a transfer space inside the valve stem and the interior reservoir, the interior reservoir being arranged for orientation above the metering chamber whereby gas such as air located within the metering chamber is replaced with liquid from the interior reservoir.

Abstract: An inhaler housing (14) for an inhaler (10) for inhaling inhalable substances, the inhaler having: a body (14) and a dose counter (24) with a return spring (28), wherein a distinct guide surface (162) is provided for guiding the end of the return spring into a recess (152), the distinct guide surface being wider than an entrance mouth (160) of the recess, a dose counter chamber (22) being provided which is separated from a tubular interior space (182) of the inhaler by a barrier (180), the barrier including a stepped upper wall area (184) including at least three steps (186, 188, 190, 192) at different levels, the inhaler having a valve stem block (62) having an inner bore and a valve stem block having a seal (224) in the inner bore with a second diameter which is smaller than a first diameter of the inner bore, the inhaler having a canister (150) being adapted to move during operation between 1 and 4 mm, a drive being arranged to apply a firing force of between 15N and 60N of force to the canister at a posit