Fast Track Liver Resection: The Effect of a Comprehensive Care Package and Analgesia with Single Dose Intrathecal Morphine with Gabapentin or Continuous Epidural Analgesia

Directory of Open Access Journals (Sweden)

Jonathan B. Koea

2009-01-01

Full Text Available Background. A comprehensive care package for patients undergoing hepatectomy was developed with the aim of minimal physiological disturbance in the peri-operative period. Peri-operative analgesia with few gastrointestinal effects and reduced requirement for intravenous (IV fluid therapy was central to this plan. Methods. Data on 100 consecutive patients managed with continuous epidural infusion (n = 50; bupivicaine 0.125% and fentanyl 2 g/mL at 0.1 mL/kg/hr or intrathecal morphine (n = 50; 300 g in combination with oral gabapentin 1200 mg preoperatively and 400 mg bd postoperatively was compared. Results. The epidural and intrathecal morphine groups were equivalent in terms of patient demographics, procedures and complications. Patients receiving intrathecal morphine received less intra-operative IV fluids (median 1500 mL versus 2200 mL, =.06, less postoperative IV fluids (median 1200 mL versus 4300 mL, =.03 than patients receiving epidural infusion. Patients managed with intrathecal morphine established a normal dietary intake sooner (16 hours versus 20 hours, =.05 and had shorter hospital stays than those managed with epidural infusions (4.7 ± 0.9 days versus 6.8 ± 1.2 days, =.02. Conclusions. Single dose intrathecal morphine is a safe and effective means of providing peri-operative analgesia. Patients managed with intrathecal morphine have reduced peri-operative physiological disturbance and return home within a few days of hepatic resection.

The development of a digital signal processing and plotting package to support testing of hazardous and radioactive material packages

International Nuclear Information System (INIS)

Ludwigsen, J.S.; Uncapher, W.L.; Arviso, M.; Lattier, C.N.; Hankinson, M.; Cannone, D.J.

1995-01-01

Federal regulations allow package designers to use analysis, testing, or a combination of analysis and testing to support certification of packages used to transport hazardous or radioactive materials. In recent years, many certified packages were subjected to a combination of analysis and testing. A major part of evaluating structural or thermal package response is the collection, reduction and presentation of instrumentation measurement data. Sandia National Laboratories, under the sponsorship of the US Department of Energy, has developed a comprehensive analysis and plotting package (known as KAPP) that performs digital signal processing of both transient structural and thermal data integrated with a comprehensive plotting package designed to support radioactive material package testing

Comprehensive tobacco marketing restrictions: promotion, packaging, price and place.

Science.gov (United States)

Henriksen, Lisa

2012-03-01

Evidence of the causal role of marketing in the tobacco epidemic and the advent of the WHO Framework Convention on Tobacco Control have inspired more than half the countries in the world to ban some forms of tobacco marketing. This paper briefly describes the ways in which cigarette marketing is restricted and the tobacco industry's efforts to subvert restrictions. It reviews what is known about the impact of marketing regulations on smoking by adults and adolescents. It also addresses what little is known about the impact of marketing bans in relation to concurrent population-level interventions, such as price controls, anti-tobacco media campaigns and smoke-free laws. Point of sale is the least regulated channel and research is needed to address the immediate and long-term consequences of policies to ban retail advertising and pack displays. Comprehensive marketing restrictions require a global ban on all forms of promotion, elimination of packaging and price as marketing tools, and limitations on the quantity, type and location of tobacco retailers.

Comprehensive tobacco marketing restrictions: promotion, packaging, price and place

Science.gov (United States)

Henriksen, Lisa

2014-01-01

Evidence of the causal role of marketing in the tobacco epidemic and the advent of the WHO Framework Convention on Tobacco Control have inspired more than half the countries in the world to ban some forms of tobacco marketing. This paper briefly describes the ways in which cigarette marketing is restricted and the tobacco industry's efforts to subvert restrictions. It reviews what is known about the impact of marketing regulations on smoking by adults and adolescents. It also addresses what little is known about the impact of marketing bans in relation to concurrent population-level interventions, such as price controls, anti-tobacco media campaigns and smoke-free laws. Point of sale is the least regulated channel and research is needed to address the immediate and long-term consequences of policies to ban retail advertising and pack displays. Comprehensive marketing restrictions require a global ban on all forms of promotion, elimination of packaging and price as marketing tools, and limitations on the quantity, type and location of tobacco retailers. PMID:22345238

Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review.

Science.gov (United States)

de Bruin, Simone R; Versnel, Nathalie; Lemmens, Lidwien C; Molema, Claudia C M; Schellevis, François G; Nijpels, Giel; Baan, Caroline A

2012-10-01

To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers. Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden. Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with multiple chronic conditions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Economic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, Bangladesh.

Science.gov (United States)

LeFevre, Amnesty E; Shillcutt, Samuel D; Waters, Hugh R; Haider, Sabbir; El Arifeen, Shams; Mannan, Ishtiaq; Seraji, Habibur R; Shah, Rasheduzzaman; Darmstadt, Gary L; Wall, Steve N; Williams, Emma K; Black, Robert E; Santosham, Mathuram; Baqui, Abdullah H

2013-10-01

To evaluate and compare the cost-effectiveness of two strategies for neonatal care in Sylhet division, Bangladesh. In a cluster-randomized controlled trial, two strategies for neonatal care--known as home care and community care--were compared with existing services. For each study arm, economic costs were estimated from a societal perspective, inclusive of programme costs, provider costs and household out-of-pocket payments on care-seeking. Neonatal mortality in each study arm was determined through household surveys. The incremental cost-effectiveness of each strategy--compared with that of the pre-existing levels of maternal and neonatal care--was then estimated. The levels of uncertainty in our estimates were quantified through probabilistic sensitivity analysis. The incremental programme costs of implementing the home-care package were 2939 (95% confidence interval, CI: 1833-7616) United States dollars (US$) per neonatal death averted and US$ 103.49 (95% CI: 64.72-265.93) per disability-adjusted life year (DALY) averted. The corresponding total societal costs were US$ 2971 (95% CI: 1844-7628) and US$ 104.62 (95% CI: 65.15-266.60), respectively. The home-care package was cost-effective--with 95% certainty--if healthy life years were valued above US$ 214 per DALY averted. In contrast, implementation of the community-care strategy led to no reduction in neonatal mortality and did not appear to be cost-effective. The home-care package represents a highly cost-effective intervention strategy that should be considered for replication and scale-up in Bangladesh and similar settings elsewhere.

Materials for advanced packaging

CERN Document Server

Wong, CP

2017-01-01

This second edition continues to be the most comprehensive review on the developments in advanced electronic packaging technologies, with a focus on materials and processing. Recognized experts in the field contribute to 22 updated and new chapters that provide comprehensive coverage on various 3D package architectures, novel bonding and joining techniques, wire bonding, wafer thinning techniques, organic substrates, and novel approaches to make electrical interconnects between integrated circuit and substrates. Various chapters also address advances in several key packaging materials, including: Lead-free solders Flip chip underfills Epoxy molding compounds Conductive adhesives Die attach adhesives/films Thermal interface materials (TIMS) Materials for fabricating embedded passives including capacitors, inductors, and resistors Materials and processing aspects on wafer-level chip scale package (CSP) and MicroElectroMechanical system (MEMS) Contributors also review new and emerging technologies such as Light ...

Study protocol: evaluation of specialized outpatient palliative care (SOPC) in the German state of Hesse (ELSAH study) - work package II: palliative care for pediatric patients.

Science.gov (United States)

Ulrich, Lisa-R; Gruber, Dania; Hach, Michaela; Boesner, Stefan; Haasenritter, Joerg; Kuss, Katrin; Seipp, Hannah; Gerlach, Ferdinand M; Erler, Antje

2018-01-05

In 2007, the European Association of Palliative Care (EAPC) provided a comprehensive set of recommendations and standards for the provision of adequate pediatric palliative care. A number of studies have shown deficits in pediatric palliative care compared to EAPC standards. In Germany, pediatric palliative care patients can be referred to specialized outpatient palliative care (SOPC) services, which are known to enhance quality of life, e.g. by avoiding hospitalization. However, current regulations for the provision of SOPC in Germany do not account for the different circumstances and needs of children and their families compared to adult palliative care patients. The "Evaluation of specialized outpatient palliative care (SOPC) in the German state of Hesse (ELSAH)" study aims to perform a needs assessment for pediatric patients (children, adolescents and young adults) receiving SOPC. This paper presents the study protocol for this assessment (work package II). The study uses a sequential mixed-methods study design with a focus on qualitative research. Data collection from professional and family caregivers and, as far as possible, pediatric patients, will involve both a written questionnaire based on European recommendations for pediatric palliative care, and semi-structured interviews. Additionally, professional caregivers will take part in focus group discussions and participatory observations. Interviews and focus groups will be tape- or video-recorded, transcribed verbatim and analyzed in accordance with the principles of grounded theory (interviews) and content analysis (focus groups). A structured field note template will be used to record notes taken during the participatory observations. Statistical Package for Social Sciences (SPSS, version 22 or higher) will be used for descriptive statistical analyses. The qualitative data analyses will be software-assisted by MAXQDA (version 12 or higher). This study will provide important information on what matters

Comprehensiveness of care from the patient perspective: comparison of primary healthcare evaluation instruments.

Science.gov (United States)

Haggerty, Jeannie L; Beaulieu, Marie-Dominique; Pineault, Raynald; Burge, Frederick; Lévesque, Jean-Frédéric; Santor, Darcy A; Bouharaoui, Fatima; Beaulieu, Christine

2011-12-01

Comprehensiveness relates both to scope of services offered and to a whole-person clinical approach. Comprehensive services are defined as "the provision, either directly or indirectly, of a full range of services to meet most patients' healthcare needs"; whole-person care is "the extent to which a provider elicits and considers the physical, emotional and social aspects of a patient's health and considers the community context in their care." Among instruments that evaluate primary healthcare, two had subscales that mapped to comprehensive services and to the community component of whole-person care: the Primary Care Assessment Tool - Short Form (PCAT-S) and the Components of Primary Care Index (CPCI, a limited measure of whole-person care). To examine how well comprehensiveness is captured in validated instruments that evaluate primary healthcare from the patient's perspective. 645 adults with at least one healthcare contact in the previous 12 months responded to six instruments that evaluate primary healthcare. Scores were normalized for descriptive comparison. Exploratory and confirmatory (structural equation modelling) factor analysis examined fit to operational definition, and item response theory analysis examined item performance on common constructs. Over one-quarter of respondents had missing responses on services offered or doctor's knowledge of the community. The subscales did not load on a single factor; comprehensive services and community orientation were examined separately. The community orientation subscales did not perform satisfactorily. The three comprehensive services subscales fit very modestly onto two factors: (1) most healthcare needs (from one provider) (CPCI Comprehensive Care, PCAT-S First-Contact Utilization) and (2) range of services (PCAT-S Comprehensive Services Available). Individual item performance revealed several problems. Measurement of comprehensiveness is problematic, making this attribute a priority for measure development

Patients Comprehension of Pharmaceutical Package Inserts ...

African Journals Online (AJOL)

Tropical Journal of Pharmaceutical Research December 2015; 14 (12): ... Available online at http://www.tjpr.org ... patients/consumers about PPI. ... the perception of outpatients of Karachi about ... Do you store the medication at the temperature specified in the package insert ... drugs available in local market of Pakistan was.

Comprehensive Health Care Economics Curriculum and Training in Radiology Residency.

Science.gov (United States)

Keiper, Mark; Donovan, Timothy; DeVries, Matthew

2018-06-01

To investigate the ability to successfully develop and institute a comprehensive health care economics skills curriculum in radiology residency training utilizing didactic lectures, case scenario exercises, and residency miniretreats. A comprehensive health care economics skills curriculum was developed to significantly expand upon the basic ACGME radiology residency milestone System-Based Practice, SBP2: Health Care Economics requirements and include additional education in business and contract negotiation, radiology sales and marketing, and governmental and private payers' influence in the practice of radiology. A health care economics curriculum for radiology residents incorporating three phases of education was developed and implemented. Phase 1 of the curriculum constituted basic education through didactic lectures covering System-Based Practice, SBP2: Health Care Economics requirements. Phase 2 constituted further, more advanced didactic lectures on radiology sales and marketing techniques as well as government and private insurers' role in the business of radiology. Phase 3 applied knowledge attained from the initial two phases to real-life case scenario exercises and radiology department business miniretreats with the remainder of the radiology department. A health care economics skills curriculum in radiology residency is attainable and essential in the education of future radiology residents in the ever-changing climate of health care economics. Institution of more comprehensive programs will likely maximize the long-term success of radiology as a specialty by identifying and educating future leaders in the field of radiology. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning.

Science.gov (United States)

Grundy, A C; Walker, L; Meade, O; Fraser, C; Cree, L; Bee, P; Lovell, K; Callaghan, P

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning. Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning. There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co-facilitators. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A co-produced and co-delivered training package on service user- and carer-involved care planning was acceptable to mental health professionals. Aspects of the training that were particularly valued were the co-production model, small group discussion and the opportunity for reflective practice. The organizational context of care planning may need more consideration in future training models. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses using co-production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging. On the basis of the results reported here, we encourage mental health nurses to use co-production approaches more often. Further research will show how clinically effective this training is in improving outcomes for service users and carers. Background There is limited evidence for the acceptability of training for mental health professionals on service user- and carer-involved care planning. Aim To investigate the acceptability of a co-delivered, two-day training intervention on service user- and carer-involved care planning. Methods Community mental health professionals were invited to complete the Training Acceptability Rating Scale post-training. Responses to the quantitative items were summarized using descriptive statistics (Miles, ), and qualitative responses were coded using content analysis (Weber, ). Results Of 350 trainees, 310 completed the

Waste package performance assessment

International Nuclear Information System (INIS)

Lester, D.H.

1981-01-01

This paper describes work undertaken to assess the life-expectancy and post-failure nuclide release behavior of high-level and waste packages in a geologic repository. The work involved integrating models of individual phenomena (such as heat transfer, corrosion, package deformation, and nuclide transport) and using existing data to make estimates of post-emplacement behavior of waste packages. A package performance assessment code was developed to predict time to package failure in a flooded repository and subsequent transport of nuclides out of the leaking package. The model has been used to evaluate preliminary package designs. The results indicate, that within the limitation of model assumptions and data base, packages lasting a few hundreds of years could be developed. Very long lived packages may be possible but more comprehensive data are needed to confirm this

Comprehensive care improves physical recovery of hip-fractured elderly Taiwanese patients with poor nutritional status.

Science.gov (United States)

Liu, Hsin-Yun; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Yang, Ching-Tzu; Chou, Shih-Wei; Chen, Ching-Yen; Shyu, Yea-Ing L

2014-06-01

The effects of nutritional management among other intervention components have not been examined for hip-fractured elderly persons with poor nutritional status. Accordingly, this study explored the intervention effects of an in-home program using a comprehensive care model that included a nutrition-management component on recovery of hip-fractured older persons with poor nutritional status at hospital discharge. A secondary analysis of data from a randomized controlled trial with 24-month follow-up. A 3000-bed medical center in northern Taiwan. Subjects were included only if they had "poor nutritional status" at hospital discharge, including those at risk for malnutrition or malnourished. The subsample included 80 subjects with poor nutritional status in the comprehensive care group, 87 in the interdisciplinary care group, and 85 in the usual care group. The 3 care models were usual care, interdisciplinary care, and comprehensive care. Usual care provided no in-home care, interdisciplinary care provided 4 months of in-home rehabilitation, and comprehensive care included management of depressive symptoms, falls, and nutrition as well as 1 year of in-home rehabilitation. Data were collected on nutritional status and physical functions, including range of motion, muscle power, proprioception, balance and functional independence, and analyzed using a generalized estimating equation approach. We also compared patients' baseline characteristics: demographic characteristics, type of surgery, comorbidities, length of hospital stay, cognitive function, and depression. Patients with poor nutritional status who received comprehensive care were 1.67 times (95% confidence interval 1.06-2.61) more likely to recover their nutritional status than those who received interdisciplinary and usual care. Furthermore, the comprehensive care model improved the functional independence and balance of patients who recovered their nutritional status over the first year following discharge

Comprehensive maternity support and shared care in Switzerland: Comparison of levels of satisfaction.

Science.gov (United States)

Floris, Lucia; Irion, Olivier; Bonnet, Jocelyne; Politis Mercier, Maria-Pia; de Labrusse, Claire

2018-04-01

According to the woman-centred care model, continuous care by a midwife has a positive impact on satisfaction. Comprehensive support is a model of team midwifery care implemented in the large Geneva University Hospitals in Switzerland, which has organised shared care according to the biomedical model of practice. This model of care insures a follow up by a specific group of midwives, during perinatal period. The goal of this study was to evaluate the satisfaction and outcomes of the obstetric and neonatal care of women who received comprehensive support during pregnancy, childbirth and the postpartum period, and compare them to women who received shared care. This was a prospective comparative study between two models of care in low risk pregnant women. The satisfaction and outcomes of care were evaluated using the French version of the Women's Experiences Maternity Care Scale, two months after giving birth. In total, 186 women in the comprehensive support group and 164 in the control group returned the questionnaire. After adjustment, the responses of those in the comprehensive support programme were strongly associated with optimal satisfaction, and they had a significantly lower epidural rate. No differences were observed between the two groups in the mode of delivery. The satisfaction relative to this support programme was associated with a birth plan for intrapartum and postnatal care. Team midwifery had a positive impact on satisfaction, with no adverse effects on the obstetric and neonatal outcomes, when compared to shared care. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Integrated Comprehensive Care - A Case Study in Nursing Leadership and System Transformation.

Science.gov (United States)

Wheatley, Laura; Doyle, Winnie; Evans, Cheryl; Gosse, Carolyn; Smith, Kevin

2017-01-01

Calls for transformational change of our healthcare system are increasingly clear, persuasive and insistent. They resonate at all levels, with those who fund, deliver, provide and receive care, and they are rooted in a deep understanding that the system, as currently rigidly structured, most often lacks the necessary flexibility to comprehensively meet the needs of patients across the continuum of care. The St. Joseph's Health System (SJHS) Integrated Comprehensive Care (ICC) Program, which bundles care and funding across the hospital to home continuum, has reduced fragmentation of care, and it has delivered improved outcomes for patients, providers and the system. This case study explores the essential contribution of nursing leadership to this successful transformation of healthcare service delivery.

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial.

Science.gov (United States)

Prestmo, Anders; Hagen, Gunhild; Sletvold, Olav; Helbostad, Jorunn L; Thingstad, Pernille; Taraldsen, Kristin; Lydersen, Stian; Halsteinli, Vidar; Saltnes, Turi; Lamb, Sarah E; Johnsen, Lars G; Saltvedt, Ingvild

2015-04-25

Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18-1·30, p=0·010). Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated

Identification of physicians providing comprehensive primary care in Ontario: a retrospective analysis using linked administrative data.

Science.gov (United States)

Schultz, Susan E; Glazier, Richard H

2017-12-19

Given the changing landscape of primary care, there may be fewer primary care physicians available to provide a broad range of services to patients of all age groups and health conditions. We sought to identify physicians with comprehensive primary care practices in Ontario using administrative data, investigating how many and what proportion of primary care physicians provided comprehensive primary care and how this changed over time. We identified the pool of active primary care physicians in linked population-based databases for Ontario from 1992/93 to 2014/15. After excluding those who saw patients fewer than 44 days per year, we identified physicians as providing comprehensive care if more than half of their services were for core primary care and if these services fell into at least 7 of 22 activity areas. Physicians with 50% or less of their services for core primary care but with more than 50% in a single location or type of service were identified as being in focused practice. In 2014/15, there were 12 891 physicians in the primary care pool: 1254 (9.7%) worked fewer than 44 days per year, 1619 (12.6%) were in focused practice, and 1009 (7.8%) could not be classified. The proportion in comprehensive practice ranged from 67.5% to 74.9% between 1992/93 and 2014/15, with a peak in 2002/03 and relative stability from 2009/10 to 2014/15. Over this period, there was an increase of 8.8% in population per comprehensive primary care physician. We found that just over two-thirds of primary care physicians provided comprehensive care in 2014/15, which indicates that traditional estimates of the primary care physician workforce may be too high. Although implementation will vary by setting and available data, this approach is likely applicable elsewhere. Copyright 2017, Joule Inc. or its licensors.

A comprehensive palliative care center implementation in S.B. Ulus State Hospital

Directory of Open Access Journals (Sweden)

Ayla Kabalak

2012-06-01

Every people wants to best care and to die painless in their end-stage of life. This is a human right. Therefore, end-of-life care is considered an indicator of health quality all over the world. The ultimate goal of palliative care is to relieve the suffering of patients and their families by the comprehensive assessment and treatment of physical, psychosocial, and spiritual symptoms experienced by patients. After the patient\\s death, palliative care focuses primarily on bereavement of the family. T.C. Ministry of Health to find a solution of this important issue as a first step, the preparations for the establishment of palliative care centers and units, training of health personnel started. S.B. Ulus State Hospital as a team we have set out to open a comprehensive palliative care center. Our goal is to contribute on take place of palliative care organization in health system and to the spread across the country. [J Contemp Med 2012; 2(2.000: 122-126

Effect of Comprehensive Geriatric Training for The Long-term Care Insurance user.

OpenAIRE

磯崎, 弘司; 石井, 佐和子; 高橋, 美千子

2007-01-01

Comprehensive geriatric training (CGT) is training devised for the elderly persons which uses exercise therapy together with instrumental training. The comprehensive geriatric training was provided to a Long-term Care Insurance user group in order to evaluate the effect of the training. The subjects of the training include 12 Long-term Care Insurance users (mean 80.9 age, SD 7.6 years). Physical strength examinations were made before and after the training and their results were used to evalu...

Care package for anxiety disorders: no-show and dropout of standardised, time restricted treatment

DEFF Research Database (Denmark)

Tranberg, Hanne; Mortensen, Erik Lykke; Lau, Marianne Engelbrecht

Background: Psychotherapy has shown to be efficacious but therapy effectiveness in mental health services is compromised by patients who fail to show up for assessment, treatment start and stay in treatment. Predictors for patient non-attendance (no-show and dropout) have been identified as patient...... or therapist characteristics. Organisational variables are sparsely studied although waiting time may affect no-show and dropout. In order to reduce waiting time the Mental Health Services in Denmark have introduced care packages in the treatment of non-psychotic disorders. Care packages are courses...... and if demographic and clinical variables were predictors for no-show and dropout. Methods: The study was a quasi-experimental pre-post study in a naturalistic setting in the Mental Health Services, Capital Region of Denmark. Two samples of patients, aged above 18 years and referred for treatment for anxiety...

Guidelines for the Development of Comprehensive Care Centers for Congenital Adrenal Hyperplasia: Guidance from the CARES Foundation Initiative

Directory of Open Access Journals (Sweden)

Rink RichardC

2010-11-01

Full Text Available Patients with rare and complex diseases such as congenital adrenal hyperplasia (CAH often receive fragmented and inadequate care unless efforts are coordinated among providers. Translating the concepts of the medical home and comprehensive health care for individuals with CAH offers many benefits for the affected individuals and their families. This manuscript represents the recommendations of a 1.5 day meeting held in September 2009 to discuss the ideal goals for comprehensive care centers for newborns, infants, children, adolescents, and adults with CAH. Participants included pediatric endocrinologists, internal medicine and reproductive endocrinologists, pediatric urologists, pediatric surgeons, psychologists, and pediatric endocrine nurse educators. One unique aspect of this meeting was the active participation of individuals personally affected by CAH as patients or parents of patients. Representatives of Health Research and Services Administration (HRSA, New York-Mid-Atlantic Consortium for Genetics and Newborn Screening Services (NYMAC, and National Newborn Screening and Genetics Resource Center (NNSGRC also participated. Thus, this document should serve as a "roadmap" for the development phases of comprehensive care centers (CCC for individuals and families affected by CAH.

Comprehensive care of elderly patients with hip fracture: the orthogeriatric model

OpenAIRE

Carlo Frondini; Maria L. Lunardelli

2013-01-01

Introduction: Hip fractures in the elderly are a major source of morbidity and mortality. Interdisciplinary hospital care models proposed for the treatment of these patients include consultant teams, integrated orthopedic-geriatric care, and comprehensive geriatric-led care settings. A prospective interventional cohort study was conducted in 4 public hospitals in the Emilia-Romagna Region of Italy to compare the outcomes of these different care models. This report presents the preliminary res...

Designing for action: adapting and implementing a community-based newborn care package to affect national change in Uganda.

Science.gov (United States)

Waiswa, Peter; Namazzi, Gertrude; Kerber, Kate; Peterson, Stefan

2015-01-01

There is a lack of literature on how to adapt new evidence-based interventions for maternal and newborn care into local health systems and policy for rapid scale-up, particularly for community-based interventions in low-income settings. The Uganda Newborn Study (UNEST) was a cluster randomised control trial to test a community-based care package which was rapidly taken up at national level. Understanding this process may help inform other studies looking to design and evaluate with scale-up in mind. This study aimed to describe the process of using evidence to design a community-based maternal and newborn care package in rural eastern Uganda, and to determine the dissemination and advocacy approaches used to facilitate rapid policy change and national uptake. We reviewed UNEST project literature including meeting reports and minutes, supervision reports, and annual and midterm reports. National stakeholders, project and district staff were interviewed regarding their role in the study and perceptions of what contributed to uptake of the package under evaluation. Data related to UNEST formative research, study design, implementation and policy influence were extracted and analysed. An advisory committee of key players in development of maternal and newborn policies and programmes in Uganda was constituted from many agencies and disciplines. Baseline qualitative and quantitative data collection was done at district, community and facility level to examine applicability of aspects of a proposed newborn care package to the local setting. Data were summarised and presented to stakeholders to adapt the intervention that was ultimately tested. Quarterly monitoring of key activities and events around the interventions were used to further inform implementation. The UNEST training package, home visit schedule and behaviour change counselling materials were incorporated into the national Village Health Team and Integrated Community Case Management packages while the study

Comprehensive primary health care under neo-liberalism in Australia.

Science.gov (United States)

Baum, Fran; Freeman, Toby; Sanders, David; Labonté, Ronald; Lawless, Angela; Javanparast, Sara

2016-11-01

This paper applies a critical analysis of the impact of neo-liberal driven management reform to examine changes in Australian primary health care (PHC) services over five years. The implementation of comprehensive approaches to primary health care (PHC) in seven services: five state-managed and two non-government organisations (NGOs) was tracked from 2009 to 2014. Two questions are addressed: 1) How did the ability of Australian PHC services to implement comprehensive PHC change over the period 2009-2014? 2) To what extent is the ability of the PHC services to implement comprehensive PHC shaped by neo-liberal health sector reform processes? The study reports on detailed tracking and observations of the changes and in-depth interviews with 63 health service managers and practitioners, and regional and central health executives. The documented changes were: in the state-managed services (although not the NGOs) less comprehensive service coverage and more focus on clinical services and integration with hospitals and much less development activity including community development, advocacy, intersectoral collaboration and attention to the social determinants. These changes were found to be associated with practices typical of neo-liberal health sector reform: considerable uncertainty, more directive managerial control, budget reductions and competitive tendering and an emphasis on outputs rather than health outcomes. We conclude that a focus on clinical service provision, while highly compatible with neo-liberal reforms, will not on its own produce the shifts in population disease patterns that would be required to reduce demand for health services and promote health. Comprehensive PHC is much better suited to that task. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

A comparison of medication administration errors from original medication packaging and multi-compartment compliance aids in care homes: A prospective observational study.

Science.gov (United States)

Gilmartin-Thomas, Julia Fiona-Maree; Smith, Felicity; Wolfe, Rory; Jani, Yogini

2017-07-01

No published study has been specifically designed to compare medication administration errors between original medication packaging and multi-compartment compliance aids in care homes, using direct observation. Compare the effect of original medication packaging and multi-compartment compliance aids on medication administration accuracy. Prospective observational. Ten Greater London care homes. Nurses and carers administering medications. Between October 2014 and June 2015, a pharmacist researcher directly observed solid, orally administered medications in tablet or capsule form at ten purposively sampled care homes (five only used original medication packaging and five used both multi-compartment compliance aids and original medication packaging). The medication administration error rate was calculated as the number of observed doses administered (or omitted) in error according to medication administration records, compared to the opportunities for error (total number of observed doses plus omitted doses). Over 108.4h, 41 different staff (35 nurses, 6 carers) were observed to administer medications to 823 residents during 90 medication administration rounds. A total of 2452 medication doses were observed (1385 from original medication packaging, 1067 from multi-compartment compliance aids). One hundred and seventy eight medication administration errors were identified from 2493 opportunities for error (7.1% overall medication administration error rate). A greater medication administration error rate was seen for original medication packaging than multi-compartment compliance aids (9.3% and 3.1% respectively, risk ratio (RR)=3.9, 95% confidence interval (CI) 2.4 to 6.1, ppackaging (from original medication packaging-only care homes) and multi-compartment compliance aids (RR=2.3, 95%CI 1.1 to 4.9, p=0.03), and between original medication packaging and multi-compartment compliance aids within care homes that used a combination of both medication administration

Types, production and assessment of biobased food packaging materials

Science.gov (United States)

Food packaging performs an essential function, but packaging materials can have a negative impact on the environment. This book describes the latest advances in bio-based food packaging materials. Book provides a comprehensive review on bio-based, biodegradable and recycled materials and discusses t...

proportion: A comprehensive R package for inference on single Binomial proportion and Bayesian computations

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M. Subbiah

2017-01-01

Full Text Available Extensive statistical practice has shown the importance and relevance of the inferential problem of estimating probability parameters in a binomial experiment; especially on the issues of competing intervals from frequentist, Bayesian, and Bootstrap approaches. The package written in the free R environment and presented in this paper tries to take care of the issues just highlighted, by pooling a number of widely available and well-performing methods and apporting on them essential variations. A wide range of functions helps users with differing skills to estimate, evaluate, summarize, numerically and graphically, various measures adopting either the frequentist or the Bayesian paradigm.

Delivering quality of care while managing the interests of all stakeholders.

Science.gov (United States)

Stopper, Andrea; Raddatz, Agnieszka; Grassmann, Aileen; Stuard, Stefano; Menzer, Marcus; Possnien, Gernot; Scatizzi, Laura; Marcelli, Daniele

2011-01-01

National healthcare systems worldwide face growing challenges to reconcile interests of patients for high-quality medical care and of payers for sustainable and affordable funding. Advances in the provision of renal replacement therapy can only be made by developing and implementing appropriate sophisticated and state-of-the-art business models that include reimbursement schemes for comprehensive care packages. Such business models must succeed in integrating and reconciling the interests of all stakeholders. NephroCare as dialysis provider has adopted and tailored recognized management techniques, i.e. Balanced Scorecard and Kaizen, to achieve these goals. Success of the complete business model package is tangible - strategies initiated to improve treatment quality even at the cost of providers have been translated into win-win scenarios for the complete stakeholder community. Room for improvement exists: the possibility to extend the portfolio of service offerings within the comprehensive care frame, as well as the challenge for achieving a balance between the stability of targets while keeping these up to date concerning new insights. Copyright © 2011 S. Karger AG, Basel.

Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand?

Science.gov (United States)

Engel, Kirsten G; Heisler, Michele; Smith, Dylan M; Robinson, Claire H; Forman, Jane H; Ubel, Peter A

2009-04-01

To be able to adhere to discharge instructions after a visit to the emergency department (ED), patients should understand both the care that they received and their discharge instructions. The objective of this study is to assess, at discharge, patients' comprehension of their ED care and instructions and their awareness of deficiencies in their comprehension. We conducted structured interviews of 140 adult English-speaking patients or their primary caregivers after ED discharge in 2 health systems. Participants rated their subjective understanding of 4 domains: (1) diagnosis and cause; (2) ED care; (3) post-ED care, and (4) return instructions. We assessed patient comprehension as the degree of agreement (concordance) between patients' recall of each of these domains and information obtained from chart review. Two authors scored each case independently and discussed discrepancies before providing a final concordance rating (no concordance, minimal concordance, partial concordance, near concordance, complete concordance). Seventy-eight percent of patients demonstrated deficient comprehension (less than complete concordance) in at least 1 domain; 51% of patients, in 2 or more domains. Greater than a third of these deficiencies (34%) involved patients' understanding of post-ED care, whereas only 15% were for diagnosis and cause. The majority of patients with comprehension deficits failed to perceive them. Patients perceived difficulty with comprehension only 20% of the time when they demonstrated deficient comprehension. Many patients do not understand their ED care or their discharge instructions. Moreover, most patients appear to be unaware of their lack of understanding and report inappropriate confidence in their comprehension and recall.

Exposure management systems in emergencies as comprehensive medical care

International Nuclear Information System (INIS)

Shinohara, Teruhiko

2000-01-01

The emergency management of nuclear hazards relies on a comprehensive medical care system that includes accident prevention administration, environmental monitoring, a health physics organization, and a medical institution. In this paper, the care organization involved in the criticality accident at Tokai-mura is described, and the problems that need to be examined are pointed out. In that incident, even the expert was initially utterly confused and was unable to take appropriate measures. The author concluded that the members of the care organization were all untrained for dealing with nuclear hazards and radiation accidents. The education and training of personnel at the job site are important, and they are even more so for the leaders. Revisions of the regional disaster prevention plans and care manual are needed. (K.H.)

actuar: An R Package for Actuarial Science

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Christophe Dutang

2008-02-01

Full Text Available actuar is a package providing additional Actuarial Science functionality to the R statistical system. The project was launched in 2005 and the package is available on the Comprehensive R Archive Network since February 2006. The current version of the package contains functions for use in the fields of loss distributions modeling, risk theory (including ruin theory, simulation of compound hierarchical models and credibility theory. This paper presents in detail but with few technical terms the most recent version of the package.

The art of packaging: An investigation into the role of color in packaging, marketing, and branding

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Behzad Mohebbi

2014-12-01

Full Text Available The purpose of this study is to contribute to the existing research in the field of packaging and marketing and shed more light on the psychology of colors and their effect on packaging and marketing. Nowadays, packaging is proved to be one of the significant factors in the success of promoting product sale. However, there is a perceived gap with respect to the different aspects of packaging, in particular the graphics, design, and color of packaging. The current study provides a comprehensive overview of packaging. It elaborates on different aspects of packaging and summarizes the findings of the most recent research conducted to date probing into packaging from different perspectives. It also discusses the role of color, i.e., the psychology of colors, and graphics in packaging and product sale. It is argued that graphics and color play key roles in promoting product sale and designers and marketers should attach a great deal of importance to color in packaging. The implications for producers, marketers, practitioners, and researchers are discussed in detail and suggestions for future research are provided.

Predictors of Coordinated and Comprehensive Care Within a Medical Home for Children With Special Healthcare (CHSCN Needs

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Ashley Walker

2018-06-01

Full Text Available The purpose of this study was to examine predictors of coordinated and comprehensive care within a medical home among children with special health care needs (CSHCN. The latest version of the National Survey of Children with Special Health Care Needs (NS-CSHCN employed a national random-digit-dial sample whereby US households were screened, resulting in 40,242 eligible respondents. Logistic regression analyses were performed modeling the probability of coordinated, comprehensive care in a medical home based on shared decision-making and other factors. A total of 29,845 cases were selected for inclusion in the model. Of these, 17,390 cases (58.3% met the criteria for coordinated, comprehensive care in a medical home. Access to a community-based service systems had the greatest positive impact on coordinated, comprehensive care in a medical home. Adequate insurance coverage and being White/Caucasian were also positively associated with the dependent variable. Shared decision-making was reported by 72% of respondents and had a negative, but relatively negligible impact on coordinated, comprehensive care in a medical home. Increasing age, non-traditional family structures, urban residence, and public insurance were more influential, and negatively impacted the dependent variable. Providers and their respective organizations should seek to expand and improve health and support services at the community level.

actuar: An R Package for Actuarial Science

OpenAIRE

Dutang, Christophe; Goulet, Vincent; Pigeon, Mathieu

2008-01-01

actuar is a package providing additional Actuarial Science functionality to the R statistical system. The project was launched in 2005 and the package is available on the Comprehensive R Archive Network since February 2006. The current version of the package contains functions for use in the fields of loss distributions modeling, risk theory (including ruin theory), simulation of compound hierarchical models and credibility theory. This paper presents in detail but with few technical terms t...

Comprehensive numerical modelling of tokamaks

International Nuclear Information System (INIS)

Cohen, R.H.; Cohen, B.I.; Dubois, P.F.

1991-01-01

We outline a plan for the development of a comprehensive numerical model of tokamaks. The model would consist of a suite of independent, communicating packages describing the various aspects of tokamak performance (core and edge transport coefficients and profiles, heating, fueling, magnetic configuration, etc.) as well as extensive diagnostics. These codes, which may run on different computers, would be flexibly linked by a user-friendly shell which would allow run-time specification of packages and generation of pre- and post-processing functions, including workstation-based visualization of output. One package in particular, the calculation of core transport coefficients via gyrokinetic particle simulation, will become practical on the scale required for comprehensive modelling only with the advent of teraFLOP computers. Incremental effort at LLNL would be focused on gyrokinetic simulation and development of the shell

Medical knowledge packages and their integration into health-care information systems and the World Wide Web.

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Adlassnig, Klaus-Peter; Rappelsberger, Andrea

2008-01-01

Software-based medical knowledge packages (MKPs) are packages of highly structured medical knowledge that can be integrated into various health-care information systems or the World Wide Web. They have been established to provide different forms of clinical decision support such as textual interpretation of combinations of laboratory rest results, generating diagnostic hypotheses as well as confirmed and excluded diagnoses to support differential diagnosis in internal medicine, or for early identification and automatic monitoring of hospital-acquired infections. Technically, an MKP may consist of a number of inter-connected Arden Medical Logic Modules. Several MKPs have been integrated thus far into hospital, laboratory, and departmental information systems. This has resulted in useful and widely accepted software-based clinical decision support for the benefit of the patient, the physician, and the organization funding the health care system.

Comprehensive care and pregnancy: The unmet care needs of pregnant women with a history of rape

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Munro, Michelle L.; Rietz, Melissa Foster

2013-01-01

This paper proposes a framework for assessing the unmet needs of rape survivors during pregnancy based on the Sexual Assault Nurse Examiner (SANE) practice level theory and an empirical exploration of rape survivors’ health status in pregnancy via a secondary analysis. Our findings indicate that there may be unmet needs in pregnancy related to all five post-assault comprehensive care components: (1) physical care, (2) pregnancy prevention, (3) sexually transmitted infection screening, (4) psychological care, and (5) legal care. Rape history and its current impact on the survivor predicted somatic disorders, substance use, unwanted pregnancy, infections, posttraumatic stress disorder, and recent abuse. PMID:23215990

Fitting Community Based Newborn Care Package into the health systems of Nepal.

Science.gov (United States)

Pradhan, Y V; Upreti, S R; Kc, N P; Thapa, K; Shrestha, P R; Shedain, P R; Dhakwa, J R; Aryal, D R; Aryal, S; Paudel, D C; Paudel, D; Khanal, S; Bhandari, A; Kc, A

2011-10-01

Community-based strategies for delivering effective newborn interventions are an essential step to avert newborn death, in settings where the health facilities are unable to effectively deliver the interventions and reach their population. Effective implementation of community-based interventions as a large scale program and within the existing health system depends on the appropriate design and planning, monitoring and support systems. This article provides an overview of implementation design of Community-Based Newborn Care Package (CB-NCP) program, its setup within the health system, and early results of the implementation from one of the pilot districts. The evaluation of CB-NCP in one of the pilot districts shows significant improvement in antenatal, intrapartum and post natal care. The implementation design of the CB-NCP has six different health system management functions: i) district planning and orientation, ii) training/human resource development, iii) monitoring and evaluation, iv) logistics and supply chain management, v) communication strategy, and vi) pay for performance. The CB-NCP program embraced the existing system of monitoring with some additional components for the pilot phase to test implementation feasibility, and aligns with existing safe motherhood and child health programs. Though CB-NCP interventions are proven independently in different local and global contexts, they are piloted in 10 districts as a "package" within the national health system settings of Nepal.

78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

Science.gov (United States)

2013-02-06

... develop and test innovative health care payment and service delivery models that show promise of reducing... test innovative payment and service delivery models that reduce spending under Medicare, Medicaid or...] Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement AGENCY: Centers for...

Algorithm for comprehensive care for patients with non melanoma skin cancer

International Nuclear Information System (INIS)

Victoria Bárzaga, Hector Oscar

2011-01-01

Sequence of actions, roles of doctors and paramedical staff, preventive and therapeutic methods, diagnostic and clinical monitoring mode: an algorithm for the comprehensive care of patients with non-melanoma skin cancer including presents. Consensus on the theoretical and practical basis of the algorithm was established by the Delphi expert method variant and health personnel involved were trained in its implementation. Algorithm for making national and international specialized literature on the subject was reviewed; a critical analysis of the methods specified in Cuba for the prevention, diagnosis and treatment of disease was made, and weaknesses were determined in the process of medical care for these patients in the Clinical Surgical Teaching Military Hospital D r. Octavio de la Concepción and Pedraja a nd health areas. The results obtained with the implementation of the algorithm demonstrated its effectiveness in comprehensive care for patients with non-melanoma skin cancer, because the prevention, early diagnosis, appropriate physical examination, the correct treatment ensured notification, monitoring periodic clinical and referral of complicated patients, the occurrence of rare complications. (author)

MAKE-UP KIT PACKAGE DESIGN FOR ACTIVE WOMAN

OpenAIRE

Risdiyono, Risdiyono

2016-01-01

Packaging has a very big role in the success of product. Not only as product’s protector or as container, packaging plays critical and essential function of building brand and adding emotional value. Packaging can also represent a significant portion of a product’s selling price. Packaging cost for luxury goods such as perfume and cosmetics is accounted approximately for 30% and even maybe as high as 40% of a product’s selling price. This paper discusses a comprehensive overview of making a m...

Nirex - The complete package

International Nuclear Information System (INIS)

Carr, N.A.; Rarok, M.

2002-01-01

Through continuous interaction with its customers, Nirex had identified the need for a comprehensive range of waste containers, reflecting the variety of wastes and operational undertakings. The current range consists of five standard containers. Standardisation is introduced across all waste packages to enable the safe and efficient operation of future waste management facilities. The practical lessons learned during the development of standard containers are in turn reflected in the container design work that Nirex has undertaken. They are also fed into the advice given to customers during evaluation of waste packaging proposals. (author)

Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study

OpenAIRE

Kada, Akiko; Nishimura, Kunihiro; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Suzuki, Akifumi; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru

2017-01-01

Background Although the Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances. Methods Of the selected 1369 certified training institutions in Japan, 749 completed an acute stroke care capabilities survey. Hospital performance was determined using a 25-item score, evaluating...

A comprehensive model for intimate partner violence in South African primary care: action research

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Joyner Kate

2012-11-01

Full Text Available Abstract Background Despite extensive evidence on the magnitude of intimate partner violence (IPV as a public health problem worldwide, insubstantial progress has been made in the development and implementation of sufficiently comprehensive health services. This study aimed to implement, evaluate and adapt a published protocol for the screening and management of IPV and to recommend a model of care that could be taken to scale in our underdeveloped South African primary health care system. Methods Professional action research utilised a co-operative inquiry group that consisted of four nurses, one doctor and a qualitative researcher. The inquiry group implemented the protocol in two urban and three rural primary care facilities. Over a period of 14 months the group reflected on their experience, modified the protocol and developed recommendations on a practical but comprehensive model of care. Results The original protocol had to be adapted in terms of its expectations of the primary care providers, overly forensic orientation, lack of depth in terms of mental health, validity of the danger assessment and safety planning process, and need for ongoing empowerment and support. A three-tier model resulted: case finding and clinical care provision by primary care providers; psychological, social and legal assistance by ‘IPV champions’ followed by a group empowerment process; and then ongoing community-based support groups. Conclusion The inquiry process led to a model of comprehensive and intersectoral care that is integrated at the facility level and which is now being piloted in the Western Cape, South Africa.

Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect

Science.gov (United States)

2011-01-01

Background Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia”) in term babies for use in the Lives Saved Tool (LiST). Methods We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. Results We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental), and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental). Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%), basic emergency obstetric care (40%), and skilled birth care (25%). For TBA training we identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational). There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. Conclusion Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for evidence interpretation

Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect

Directory of Open Access Journals (Sweden)

Moran Neil F

2011-04-01

Full Text Available Abstract Background Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia” in term babies for use in the Lives Saved Tool (LiST. Methods We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth. We also reviewed Traditional Birth Attendant (TBA training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. Results We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental, and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental. Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%, basic emergency obstetric care (40%, and skilled birth care (25%. For TBA training we identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational. There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. Conclusion Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for

[Semantic Network Analysis of Online News and Social Media Text Related to Comprehensive Nursing Care Service].

Science.gov (United States)

Kim, Minji; Choi, Mona; Youm, Yoosik

2017-12-01

As comprehensive nursing care service has gradually expanded, it has become necessary to explore the various opinions about it. The purpose of this study is to explore the large amount of text data regarding comprehensive nursing care service extracted from online news and social media by applying a semantic network analysis. The web pages of the Korean Nurses Association (KNA) News, major daily newspapers, and Twitter were crawled by searching the keyword 'comprehensive nursing care service' using Python. A morphological analysis was performed using KoNLPy. Nodes on a 'comprehensive nursing care service' cluster were selected, and frequency, edge weight, and degree centrality were calculated and visualized with Gephi for the semantic network. A total of 536 news pages and 464 tweets were analyzed. In the KNA News and major daily newspapers, 'nursing workforce' and 'nursing service' were highly rated in frequency, edge weight, and degree centrality. On Twitter, the most frequent nodes were 'National Health Insurance Service' and 'comprehensive nursing care service hospital.' The nodes with the highest edge weight were 'national health insurance,' 'wards without caregiver presence,' and 'caregiving costs.' 'National Health Insurance Service' was highest in degree centrality. This study provides an example of how to use atypical big data for a nursing issue through semantic network analysis to explore diverse perspectives surrounding the nursing community through various media sources. Applying semantic network analysis to online big data to gather information regarding various nursing issues would help to explore opinions for formulating and implementing nursing policies. © 2017 Korean Society of Nursing Science

A cost-utility analysis of a comprehensive orthogeriatric care for hip fracture patients, compared with standard of care treatment.

Science.gov (United States)

Ginsberg, Gary; Adunsky, Abraham; Rasooly, Iris

2013-01-01

The economic burden associated with hip fractures calls for the investigation of innovative new cost-utility forms of organisation and integration of services for these patients. To carry out a cost-utility analysis integrating epidemiological and economic aspects for hip fracture patients treated within a comprehensive orthogeriatric model (COGM) of care, as compared with standard of care model (SOCM). A demonstration study conducted in a major tertiary medical centre, operating both a COGM ward and standard orthopaedic and rehabilitation wards. Data was collected on the clinical outcomes and health care costs of the two different treatment modalities, in order to calculate the absolute cost and disability-adjusted life years (DALY) ratio. The COGM model used 23% fewer resources per patient ($14,919 vs. $19,363) than the SOCM model and to avert 0.226 additional DALY per patient, mainly as a result of lower 1-year mortality rates among COGM patients (14.8% vs. 17.3%). A comprehensive ortho-geriatric care modality is more cost-effective, providing additional quality-adjusted life years (QALY) while using fewer resources compared with standard of care approach. The results should assist health policy-makers in optimising healthcare use and healthcare planning.

The Need for a Comprehensive Care and Education Service for Pre-School Children.

Science.gov (United States)

Blackstone, Tessa

An argument is presented for a comprehensive and universal system of care and education for preschool children outside the family. Current institutional arrangements in the United Kingdom for government provision of education and care for young children are discussed and proposals are made for alternative ways of providing this service. It is…

To what extent can behaviour change techniques be identified within an adaptable implementation package for primary care? A prospective directed content analysis.

Science.gov (United States)

Glidewell, Liz; Willis, Thomas A; Petty, Duncan; Lawton, Rebecca; McEachan, Rosemary R C; Ingleson, Emma; Heudtlass, Peter; Davies, Andrew; Jamieson, Tony; Hunter, Cheryl; Hartley, Suzanne; Gray-Burrows, Kara; Clamp, Susan; Carder, Paul; Alderson, Sarah; Farrin, Amanda J; Foy, Robbie

2018-02-17

Interpreting evaluations of complex interventions can be difficult without sufficient description of key intervention content. We aimed to develop an implementation package for primary care which could be delivered using typically available resources and could be adapted to target determinants of behaviour for each of four quality indicators: diabetes control, blood pressure control, anticoagulation for atrial fibrillation and risky prescribing. We describe the development and prospective verification of behaviour change techniques (BCTs) embedded within the adaptable implementation packages. We used an over-lapping multi-staged process. We identified evidence-based, candidate delivery mechanisms-mainly audit and feedback, educational outreach and computerised prompts and reminders. We drew upon interviews with primary care professionals using the Theoretical Domains Framework to explore likely determinants of adherence to quality indicators. We linked determinants to candidate BCTs. With input from stakeholder panels, we prioritised likely determinants and intervention content prior to piloting the implementation packages. Our content analysis assessed the extent to which embedded BCTs could be identified within the packages and compared them across the delivery mechanisms and four quality indicators. Each implementation package included at least 27 out of 30 potentially applicable BCTs representing 15 of 16 BCT categories. Whilst 23 BCTs were shared across all four implementation packages (e.g. BCTs relating to feedback and comparing behaviour), some BCTs were unique to certain delivery mechanisms (e.g. 'graded tasks' and 'problem solving' for educational outreach). BCTs addressing the determinants 'environmental context' and 'social and professional roles' (e.g. 'restructuring the social and 'physical environment' and 'adding objects to the environment') were indicator specific. We found it challenging to operationalise BCTs targeting 'environmental context

The role of nurses in comprehensive care management of pregnant women with drug addiction.

Science.gov (United States)

McKeever, Amy E; Spaeth-Brayton, Sylvia; Sheerin, Sarah

2014-01-01

Drug addiction during pregnancy is a complex health and social issue that requires an interdisciplinary health care team providing nonjudgmental, comprehensive care. Critical challenges include onset of and attendance at prenatal care, potential obstetric complications, transition to extrauterine life and potential neonatal abstinence syndrome for the neonate, newborn feeding issues, postpartum depression and risk of relapse for women. © 2014 AWHONN.

Exploring the usefulness of comprehensive care plans for children with medical complexity (CMC: a qualitative study

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Adams Sherri

2013-01-01

Full Text Available Abstract Background The Medical Home model recommends that Children with Special Health Care Needs (CSHCN receive a medical care plan, outlining the child’s major medical issues and care needs to assist with care coordination. While care plans are a primary component of effective care coordination, the creation and maintenance of care plans is time, labor, and cost intensive, and the desired content of the care plan has not been studied. The purpose of this qualitative study was to understand the usefulness and desired content of comprehensive care plans by exploring the perceptions of parents and health care providers (HCPs of children with medical complexity (CMC. Methods This qualitative study utilized in-depth semi-structured interviews and focus groups. HCPs (n = 15 and parents (n = 15 of CMC who had all used a comprehensive care plan were recruited from a tertiary pediatric academic health sciences center. Themes were identified through grounded theory analysis of interview and focus group data. Results A multi-dimensional model of perceived care plan usefulness emerged. The model highlights three integral aspects of the care plan: care plan characteristics, activating factors and perceived outcomes of using a care plan. Care plans were perceived as a useful tool that centralized and focused the care of the child. Care plans were reported to flatten the hierarchical relationship between HCPs and parents, resulting in enhanced reciprocal information exchange and strengthened relationships. Participants expressed that a standardized template that is family-centered and includes content relevant to both the medical and social needs of the child is beneficial when integrated into overall care planning and delivery for CMC. Conclusions Care plans are perceived to be a useful tool to both health care providers and parents of CMC. These findings inform the utility and development of a comprehensive care plan template as well as a model of how

Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program

Science.gov (United States)

Howell, Doris M.; Abernathy, Tom; Cockerill, Rhonda; Brazil, Kevin; Wagner, Frank; Librach, Larry

2011-01-01

Purpose: Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Methods: Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. Results: Subjects with gastrointestinal symptoms (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; phome care expenditures. Conclusions: Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Relevance: Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources. PMID:22294993

Mind the (knowledge) gap: the effect of a communication instrument on emergency department patients' comprehension of and satisfaction with care.

Science.gov (United States)

Simmons, Stefanie; Sharp, Brian; Fowler, Jennifer; Fowkes, Hope; Paz-Arabo, Patricia; Dilt-Skaggs, Mary Kate; Singal, Bonita; Carter, Thomas

2015-02-01

We developed a communication instrument to be used in the Emergency Department (ED) and hypothesized that use of this guide would increase patient comprehension of and satisfaction with care. This multi-site trial enrolled 643 patients in treatment and control groups. Comprehension of care was assessed by chart review and satisfaction measured via validated survey. Use of the instrument was not associated with improvements in patient knowledge about their care, with a mean of 4.6 (95% CI: 4.8-5.8) comprehension defects in the control group and 4.4 (95% CI: 3.9-4.9) in the treatment group. There was no significant effect on patient satisfaction 76.4% versus 76.9%, p=0.34. Elderly patients in both groups were found to have 1.1 (ppatients. Patients frequently misunderstand medical care in the ED. Comprehension decreases with increasing age. An isolated communication instrument does not improve satisfaction with or understanding of the care received. Providing a structured place for providers and patients to record details of care does not seem to improve satisfaction with or comprehension of care. Interventions that focus on communication skills and face time with patients may prove more effective. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Seeking maternal care at times of conflict: the case of Lebanon.

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Kabakian-Khasholian, Tamar; Shayboub, Rawan; El-Kak, Faysal

2013-01-01

Providing quality maternity care within the emergency care packages for internally displaced populations in war-affected areas is somewhat challenging, although very essential. In this retrospective study, we describe the experiences and health care seeking behaviors of 1,015 pregnant and postpartum women during the 2006 war in Lebanon. Women reported interruptions in regular maternity care and experienced more complications during this period. Availability of health services and experiences of complications were the most important determinants of health care seeking behaviors. Maternal health services should be a part of any comprehensive emergency responsiveness plan, catering to women's needs in war-affected areas.

Cost Benefit of Comprehensive Primary and Preventive School-Based Health Care.

Science.gov (United States)

Padula, William V; Connor, Katherine A; Mueller, Josiah M; Hong, Jonathan C; Velazquez, Gabriela Calderon; Johnson, Sara B

2018-01-01

The Rales Health Center is a comprehensive school-based health center at an urban elementary/middle school. Rales Health Center provides a full range of pediatric services using an enriched staffing model consisting of pediatrician, nurse practitioner, registered nurses, and medical office assistant. This staffing model provides greater care but costs more than traditional school-based health centers staffed by part-time nurses. The objective was to analyze the cost benefit of Rales Health Center enhanced staffing model compared with a traditional school-based health center (standard care), focusing on asthma care, which is among the most prevalent chronic conditions of childhood. In 2016, cost-benefit analysis using a decision tree determined the net social benefit of Rales Health Center compared with standard care from the U.S. societal perspective based on the 2015-2016 academic year. It was assumed that Rales Health Center could handle greater patient throughput related to asthma, decreased prescription costs, reduced parental resources in terms of missed work time, and improved student attendance. Univariate and multivariate probabilistic sensitivity analyses were conducted. The expected cost to operate Rales Health Center was $409,120, compared with standard care cost of $172,643. Total monetized incremental benefits of Rales Health Center were estimated to be $993,414. The expected net social benefit for Rales Health Center was $756,937, which demonstrated substantial societal benefit at a return of $4.20 for every dollar invested. This net social benefit estimate was robust to sensitivity analyses. Despite the greater cost associated with the Rales Health Center's enhanced staffing model, the results of this analysis highlight the cost benefit of providing comprehensive, high-quality pediatric care in schools, particularly schools with a large proportion of underserved students. Copyright © 2018 American Journal of Preventive Medicine. Published by

Creating a roadmap for delivering gender-sensitive comprehensive care for women Veterans: results of a national expert panel.

Science.gov (United States)

deKleijn, Miriam; Lagro-Janssen, Antoine L M; Canelo, Ismelda; Yano, Elizabeth M

2015-04-01

Women Veterans are a significant minority of users of the VA healthcare system, limiting provider and staff experience meeting their needs in environments historically designed for men. The VA is nonetheless committed to ensuring that women Veterans have access to comprehensive care in environments sensitive to their needs. We sought to determine what aspects of care need to be tailored to the needs of women Veterans in order for the VA to deliver gender-sensitive comprehensive care. Modified Delphi expert panel process. Eleven clinicians and social scientists with expertise in women's health, primary care, and mental health. Importance of tailoring over 100 discrete aspects of care derived from the Institute of Medicine's definition of comprehensive care and literature-based domains of sex-sensitive care on a 5-point scale. Panelists rated over half of the aspects of care as very-to-extremely important (median score 4+) to tailor to the needs of women Veterans. The panel arrived at 14 priority recommendations that broadly encompassed the importance of (1) the design/delivery of services sensitive to trauma histories, (2) adapting to women's preferences and information needs, and (3) sex awareness and cultural transformation in every facet of VA operations. We used expert panel methods to arrive at consensus on top priority recommendations for improving delivery of sex-sensitive comprehensive care in VA settings. Accomplishment of their breadth will require national, regional, and local strategic action and multilevel stakeholder engagement, and will support VA's national efforts at improving customer service for all Veterans.

Plain packaging of cigarettes: do we have sufficient evidence?

Directory of Open Access Journals (Sweden)

Smith CN

2015-04-01

Full Text Available Collin N Smith,1 John D Kraemer,2 Andrea C Johnson,1 Darren Mays1 1Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA; 2Department of Health Systems Administration, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA Abstract: Tobacco industry marketing is a primary factor influencing cigarette smoking behavior and the cigarette pack has become an important marketing vehicle for tobacco companies. Standardized “plain” cigarette packaging is advocated as a public health policy to prevent and reduce morbidity and mortality caused by smoking by reducing youth smoking initiation and promoting cessation among smokers. Plain packaging was implemented in Australia in December 2012, and several other countries are considering doing so, but each faces foreseeable legal resistance from opponents to such measures. Tobacco companies have challenged these public health policies, citing international trade agreements and intellectual property laws. Decision-making in these court cases will hinge in part on whether the evidence indicates the public health benefits of plain packaging outweigh any potential harm to tobacco manufacturers’ interests. We reviewed the available evidence in support of plain packaging, finding evidence from observational, experimental, and population-based studies. Results indicate that plain packaging can reduce positive perceptions of smoking and dissuade tobacco use. Governments deciding to implement plain cigarette packaging measures can rely on this evidence to help make a strong case that plain packaging plays an important role in the context of comprehensive smoking prevention efforts. Keywords: cigarette smoking, tobacco, plain packaging, regulation, policy

mediation: R package for causal mediation analysis

OpenAIRE

Tingley, Dustin; Yamamoto, Teppei; Hirose, Kentaro; Keele, Luke; Imai, Kosuke

2012-01-01

In this paper, we describe the R package mediation for conducting causal mediation analysis in applied empirical research. In many scientific disciplines, the goal of researchers is not only estimating causal effects of a treatment but also understanding the process in which the treatment causally affects the outcome. Causal mediation analysis is frequently used to assess potential causal mechanisms. The mediation package implements a comprehensive suite of statistical tools for conducting su...

DHLW Glass Waste Package Criticality Analysis (SCPB:N/A)

International Nuclear Information System (INIS)

Davis, J.W.

1996-01-01

This analysis is prepared by the Mined Geologic Disposal System (MGDS) Waste Package Development Department (WPDD) to determine the viability of the Defense High-Level Waste (DHLW) Glass waste package concept with respect to criticality regulatory requirements in compliance with the goals of the Waste Package Implementation Plan (Ref. 5.1) for conceptual design. These design calculations are performed in sufficient detail to provide a comprehensive comparison base with other design alternatives. The objective of this evaluation is to show to what extent the concept meets the regulatory requirements or indicate additional measures that are required for the intact waste package

3D microelectronic packaging from fundamentals to applications

CERN Document Server

Goyal, Deepak

2017-01-01

This volume provides a comprehensive reference for graduate students and professionals in both academia and industry on the fundamentals, processing details, and applications of 3D microelectronic packaging, an industry trend for future microelectronic packages. Chapters written by experts cover the most recent research results and industry progress in the following areas: TSV, die processing, micro bumps, direct bonding, thermal compression bonding, advanced materials, heat dissipation, thermal management, thermal mechanical modeling, quality, reliability, fault isolation, and failure analysis of 3D microelectronic packages. Numerous images, tables, and didactic schematics are included throughout. This essential volume equips readers with an in-depth understanding of all aspects of 3D packaging, including packaging architecture, processing, thermal mechanical and moisture related reliability concerns, common failures, developing areas, and future challenges, providing insights into key areas for future resea...

System-in-package RF design and applications

CERN Document Server

Gaynor, Michael P

2006-01-01

In the past few years, System in Package (SiP) design has fueled a revolution in the use of modules in wireless devices due its effectiveness in meeting the increasingly demanding requirements for reliability, shielding, performance, size, and cost. Here's the first comprehensive resource on SiP design techniques that offers designers state-of-the-art packaging know-how. Moreover, the book provides numerous examples that illustrate real-world capabilities, constraints, trade-offs, and options at every step.

A System for Planning and Achieving Comprehensive Health Care in Residential Institutions for the Mentally Retarded.

Science.gov (United States)

Decker, Harold A.

Based on a view of health care intertwining medicine intimately with other components of institutional care, the monograph presents a system of concepts and operating techniques for providing comprehensive health care to institutionalized retardates. Background of the system is explained in terms of its research basis (two studies by the author of…

Comprehensive and subacute care interventions improve health-related quality of life for older patients after surgery for hip fracture: a randomised controlled trial.

Science.gov (United States)

Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Chou, Shih-Wei; Chen, Ching-Yen; Yang, Ching-Tzu

2013-08-01

Elderly patients with hip fracture have been found to benefit from subacute care interventions that usually comprise usual care with added geriatric intervention, early rehabilitation, and supported discharge. However, no studies were found on the effects of combining subacute care and health-maintenance interventions on health outcomes for elders with hip fracture. To compare the effects of an interdisciplinary comprehensive care programme with those of subacute care and usual care programmes on health-related quality of life (HRQoL) for elderly patients with hip fracture. Randomised controlled trial. A 3000-bed medical centre in northern Taiwan. Patients with hip fracture (N=299) were randomised into three groups: subacute care (n=101), comprehensive care (n=99), and usual care (n=99). Subacute care included geriatric consultation, continuous rehabilitation, and discharge planning. Comprehensive care consisted of subacute care plus health-maintenance interventions to manage depressive symptoms, manage malnutrition, and prevent falls. Usual care included only 1-2 in-hospital rehabilitation sessions, discharge planning without environmental assessment, no geriatric consultation, and no in-home rehabilitation. HRQoL was measured using the Medical Outcomes Study Short-Form 36 Taiwan version at 1, 3, 6, and 12 months after discharge. Participants in the comprehensive care group improved more in physical function, role physical, general health and mental health than those in the usual care group. The subacute care group had greater improvement in physical function, role physical, vitality, and social function than the usual care group. The intervention effects for both comprehensive and subacute care increased over time, specifically from 6 months after hip fracture onward, and reached a maximum at 12 months following discharge. Both comprehensive care and subacute care programmes may improve health outcomes of elders with hip fracture. Our results may provide a

Classification of a palliative care population in a comprehensive cancer centre

DEFF Research Database (Denmark)

Benthien, K.S; Nordly, M.; Videbæk, K.

2016-01-01

PURPOSE: The purposes of the present study were to classify the palliative care population (PCP) in a comprehensive cancer centre by using information on antineoplastic treatment options and to analyse associations between socio-demographic factors, cancer diagnoses, treatment characteristics...... and receiving specialist palliative care (SPC). METHODS: This is a cross-sectional screening study of patients with cancer in the Department of Oncology, Rigshospitalet, Copenhagen University Hospital for 6 months. Patients were assessed to be included in the DOMUS study: a randomised controlled trial...... of accelerated transition to SPC at home (NCT01885637). The PCP was classified as patients with incurable cancer and limited or no antineoplastic treatment options. Patients with performance status 2-4 were further classified as the essential palliative care population (EPCP). RESULTS: During the study period...

Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

Science.gov (United States)

2015-11-24

This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

Test facilities for radioactive material transport packages (AEA Technology, Winfrith, UK)

International Nuclear Information System (INIS)

Burgess, M.H.

1991-01-01

Transport packages for radioactive materials are tested to demonstrate compliance with national and international regulations. The involvement of AEA Technology is traced from the establishment of the early IAEA Regulations. Transport package design, testing, assessment and approval requires a wide variety of skills and facilities. The comprehensive capability of AEA Technology in these areas is described with references to practical experience in the form of a short bibliography. The facilities described include drop-test cranes and targets (up to 700te); air guns for impacts up to sonic velocities; pool fires, furnaces and rigs for thermal tests including heat dissipation on prototype flasks; shielding facilities and instruments; criticality simulations and leak test instruments. These are illustrated with photographs demonstrating the comprehensive nature of package testing services supplied to customers. (author)

Comprehensive Care Plan Development Using Resident Assessment Instrument Framework: Past, Present, and Future Practices

Directory of Open Access Journals (Sweden)

Mary Ellen Dellefield

2015-10-01

Full Text Available Development of the comprehensive care plan (CCP is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework—the Resident Assessment Instrument (RAI. Consistent compliance with this requirement has been difficult to achieve. To improve the quality of CCP development within this framework, an increased understanding of complex factors contributing to inconsistent compliance is required. In this commentary, we examine the history of the comprehensive care plan; its development within the RAI framework; linkages between the RAI and registered nurse staffing; empirical evidence of the CCP’s efficacy; and the limitations of extant standards of practices in CCP development. Because of the registered nurse’s educational preparation, professional practice standards, and licensure obligations, the essential contributions of professional nurses in CCP development are emphasized. Recommendations for evidence-based micro and macro level practice changes with the potential to improve the quality of CCP development and regulatory compliance are presented. Suggestions for future research are given.

An R package for analyzing and modeling ranking data.

Science.gov (United States)

Lee, Paul H; Yu, Philip L H

2013-05-14

In medical informatics, psychology, market research and many other fields, researchers often need to analyze and model ranking data. However, there is no statistical software that provides tools for the comprehensive analysis of ranking data. Here, we present pmr, an R package for analyzing and modeling ranking data with a bundle of tools. The pmr package enables descriptive statistics (mean rank, pairwise frequencies, and marginal matrix), Analytic Hierarchy Process models (with Saaty's and Koczkodaj's inconsistencies), probability models (Luce model, distance-based model, and rank-ordered logit model), and the visualization of ranking data with multidimensional preference analysis. Examples of the use of package pmr are given using a real ranking dataset from medical informatics, in which 566 Hong Kong physicians ranked the top five incentives (1: competitive pressures; 2: increased savings; 3: government regulation; 4: improved efficiency; 5: improved quality care; 6: patient demand; 7: financial incentives) to the computerization of clinical practice. The mean rank showed that item 4 is the most preferred item and item 3 is the least preferred item, and significance difference was found between physicians' preferences with respect to their monthly income. A multidimensional preference analysis identified two dimensions that explain 42% of the total variance. The first can be interpreted as the overall preference of the seven items (labeled as "internal/external"), and the second dimension can be interpreted as their overall variance of (labeled as "push/pull factors"). Various statistical models were fitted, and the best were found to be weighted distance-based models with Spearman's footrule distance. In this paper, we presented the R package pmr, the first package for analyzing and modeling ranking data. The package provides insight to users through descriptive statistics of ranking data. Users can also visualize ranking data by applying a thought

Radioactive material package testing capabilities at Sandia National Laboratories

International Nuclear Information System (INIS)

Uncapher, W.L.; Hohnstreiter, G.F.

1995-01-01

Evaluation and certification of radioactive and hazardous material transport packages can be accomplished by subjecting these packages to normal transport and hypothetical accident test conditions. The regulations allow package designers to certify packages using analysis, testing, or a combination of analysis and testing. Testing can be used to substantiate assumptions used in analytical models and to demonstrate package structural and thermal response. Regulatory test conditions include impact, puncture, crush, penetration, water spray, immersion, and thermal environments. Testing facilities are used to simulate the required test conditions and provide measurement response data. Over the past four decades, comprehensive testing facilities have been developed at Sandia National Laboratories to perform a broad range of verification and certification tests on hazardous and radioactive material packages or component sections. Sandia's facilities provide an experience base that has been established during the development and certification of many package designs. These unique facilities, along with innovative instrumentation data collection capabilities and techniques, simulate a broad range of testing environments. In certain package designs, package testing can be an economical alternative to complex analysis to resolve regulatory questions or concerns

Cystinosis in adult and adolescent patients: Recommendations for the comprehensive care of cystinosis

Directory of Open Access Journals (Sweden)

Gema Ariceta

2015-05-01

Conclusions: Guidelines for the comprehensive care of cystinosis provide a support tool for health professionals who look after these patients. They are based on the following main pillars: (a a multidisciplinary approach; (b appropriate disease monitoring and control of white blood cell (WBC cystine levels; (c the importance of adherence to cysteamine treatment; and (d the promotion of patient self-care by means of disease education programmes. All these recommendations will lead us, in a second phase, to create a coordinated model of transition from paediatric to adult care services which will cover the specific needs of cystinosis.

Comprehensive Oral Health Care to Reduce the Incidence of Severe Early Childhood Caries (s-ECC) in Urban China.

Science.gov (United States)

Si, Yan; Guo, Yan; Yuan, Chao; Xu, Tao; Zheng, Shu Guo

2016-03-01

To explore the effectiveness of comprehensive oral health care to reduce the caries incidence for children with severe early childhood caries (s-ECC) in an urban area in China. A total of 357 children aged 3 to 4 years old and diagnosed with s-ECC were recruited in this randomised controlled, single-blinded clinical trial for 1 year. Children of two different kindergarten classes were enrolled in this study and randomly divided into a test group (205 children) and a control group (152 children). The test group received comprehensive oral health care, which included: oral health examination, oral health education, topical fluoride application and dental treatment, and the children in the control group only received the oral health examination. The evaluation of the oral health questionnaire for parents was also performed. An evaluation was carried out at the time of recruitment and 1 year later to explore the effectiveness of the comprehensive oral health care model. The differences in decayed teeth (dt), decayed tooth surfaces (ds), filled teeth (ft), filled tooth surfaces (fs) and the ratio of ft /(dt + ft) between the two groups were statistically significant (P comprehensive oral health care program reduces and prevents caries amongst children with s-ECC.

[The importance of longitudinality, comprehensiveness, coordination and continuity of nursing home care].

Science.gov (United States)

Corrales-Nevado, Dolores; Palomo-Cobos, Luis

2014-01-01

Home care is essential for dependent persons, in order to support the high levels of morbidity, for the elderly as well as their caregivers, as it enables patients to remain in their familiar environment as long as possible, fulfilling the wish expressed by most of the population. Home care is the activity that best represents the essential attributes (longitudinality, comprehensiveness, continuity, coordination) of the primary, and that suffers most when these attributes are not included in the activities undertaken by primary care teams, or due to cuts in health-care. Home care requires highly skilled, versatile and committed nursing staff, with whom the population identifies as a source of care, and where they are assessed for their relevance and effectiveness. Nurses with wide clinical care skills, with a balanced content of treatment and prevention, and the freedom to develop their work, are needed in order to continuously monitor the health problems of their acute and chronic patients, in the family and community. Copyright © 2013 Elsevier España, S.L. All rights reserved.

A comprehensive approach to quality management of intensive care services.

Science.gov (United States)

Hariharan, Seetharaman; Dey, Prasanta Kumar

2010-01-01

The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance. The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated. Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state-of-the-art equipment, well maintained facilities, IT-based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis. The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit. The paper focuses on a uniform model that can be applied to most intensive care units.

Incorporating person centred care principles into an ongoing comprehensive cancer management program: An experiential account

Directory of Open Access Journals (Sweden)

Vallath Nandini

2011-01-01

Full Text Available Recent research indicates a definite positive impact on treatment outcomes when an integrative approach that focuses on symptom control and quality of life is provided along with the standard therapeutic regimens. However implementation or practice of this approach is not seen widely due to the culture of medical training and practice. This article presents the initial development of a program for incorporating integrative care principles into an ongoing comprehensive cancer care program at a tertiary centre. The key purpose of the program being to develop, facilitate, and establish comprehensive and holistic processes including palliative care principles, that would positively enhance the quantity and quality of life of the person with disease, as well as create an environment that reflects and sustains this approach. The vision, objectives, goals, strategies, activities and results within the 7 months of implementation are documented. The new learnings gained during the process have also been noted in the hope that the model described may be used to conceptualize similar care giving facilities in other centres.

Test facilities for radioactive material transport packages (AEA Technology plc, Winfrith,UK)

International Nuclear Information System (INIS)

Gillard, J.E.

2001-01-01

Transport containers for radioactive materials are tested to demonstrate compliance with national and international standards. Transport package design, testing, assessment and approval requires a wide range of skills and facilities. The comprehensive capability of AEA Technology in these areas is described. The facilities described include drop-test cranes and targets (up to 700 tonne); pool fires, furnaces and rigs for thermal tests, including heat dissipation on prototype flasks; shielding facilities; criticality simulations and leak test techniques. These are illustrated with photographs demonstrating the comprehensive nature of package testing services supplied to customers. (author)

Test facilities for radioactive material transport packages (AEA Technology plc, Winfrith,UK)

Energy Technology Data Exchange (ETDEWEB)

Gillard, J.E

2001-07-01

Transport containers for radioactive materials are tested to demonstrate compliance with national and international standards. Transport package design, testing, assessment and approval requires a wide range of skills and facilities. The comprehensive capability of AEA Technology in these areas is described. The facilities described include drop-test cranes and targets (up to 700 tonne); pool fires, furnaces and rigs for thermal tests, including heat dissipation on prototype flasks; shielding facilities; criticality simulations and leak test techniques. These are illustrated with photographs demonstrating the comprehensive nature of package testing services supplied to customers. (author)

A comprehensive picture of palliative care at home from the people involved.

Science.gov (United States)

Appelin, Gunilla; Brobäck, Gunilla; Berterö, Carina

2005-12-01

The purpose of this study was to identify the comprehensive picture of palliative care in the home, as experienced by the people involved. The study is a secondary analysis of three phenomenological studies including six cancer patients, six next of kin and six district nurses. Data were collected in qualitative interviews using an interview guide. The interviews were tape-recorded and transcribed verbatim. In this secondary analysis, data were analysed by hermeneutic analysis guided by Gadamer. The guiding questions during the reading were: Is there an advantage receiving palliative care at home? Is there a disadvantage receiving palliative care at home? The findings indicate that the advantages of palliative care at home is; striving for normal life, including the care in the home composed of physical care and emotional/mental care. Striving for normal life also includes emotional feelings, safety and resources and policies which regulates this activity. Disadvantages of palliative care at home are commitment, composed of adaptation and extra work, and demands, composed of frustration and uncertainty. If the people involved are to be able to manage the situation and optimize living while dying, there must be support and resources facilitating the situation.

Comprehensive cardiac rehabilitation

DEFF Research Database (Denmark)

Kruse, Marie; Hochstrasser, Stefan; Zwisler, Ann-Dorthe O

2006-01-01

OBJECTIVES: The costs of comprehensive cardiac rehabilitation are established and compared to the corresponding costs of usual care. The effect on health-related quality of life is analyzed. METHODS: An unprecedented and very detailed cost assessment was carried out, as no guidelines existed...... and may be as high as euro 1.877. CONCLUSIONS: Comprehensive cardiac rehabilitation is more costly than usual care, and the higher costs are not outweighed by a quality of life gain. Comprehensive cardiac rehabilitation is, therefore, not cost-effective....

Essential to increase the use of generics in Europe to maintain comprehensive health care?

Directory of Open Access Journals (Sweden)

Brian Godman

2012-12-01

Full Text Available INTRODUCTION: Reforms have been introduced across Europe to increase prescribing efficiency with existing drugs. These include measures to lower prices of generics as well as increase their prescribing versus originators and patented products in a class or related class. This is essential to maintain comprehensive health care in Europe given continued pressures. The alternative is insufficient funds for new innovative drugs and increasing drug volumes with ageing populations. OBJECTIVE: To review the influence of measures and initiatives to increase the prescribing and dispensing of generics at low prices on ambulatory care prescribing efficiency. In view of this, provide guidance as authorities strive to introduce further reforms to meet their goals. METHODOLOGY: A narrative review of published papers combined with case histories. RESULTS: The different supply- and demand-side measures have reduced generic prices to as low as 2% to 3% of pre-patent loss prices in some cases as well as appreciably enhanced their utilisation. As a result, prescribing efficiency has increased without compromising care. In some cases, the reforms have led to expenditure actually falling despite appreciably increased volumes. CONCLUSIONS: Increasing use of generics at low prices will help maintain the European ideals of comprehensive and equitable health care. However, countries will continually need to learn from each other.

Nurturing care: promoting early childhood development.

Science.gov (United States)

Britto, Pia R; Lye, Stephen J; Proulx, Kerrie; Yousafzai, Aisha K; Matthews, Stephen G; Vaivada, Tyler; Perez-Escamilla, Rafael; Rao, Nirmala; Ip, Patrick; Fernald, Lia C H; MacMillan, Harriet; Hanson, Mark; Wachs, Theodore D; Yao, Haogen; Yoshikawa, Hirokazu; Cerezo, Adrian; Leckman, James F; Bhutta, Zulfiqar A

2017-01-07

The UN Sustainable Development Goals provide a historic opportunity to implement interventions, at scale, to promote early childhood development. Although the evidence base for the importance of early childhood development has grown, the research is distributed across sectors, populations, and settings, with diversity noted in both scope and focus. We provide a comprehensive updated analysis of early childhood development interventions across the five sectors of health, nutrition, education, child protection, and social protection. Our review concludes that to make interventions successful, smart, and sustainable, they need to be implemented as multi-sectoral intervention packages anchored in nurturing care. The recommendations emphasise that intervention packages should be applied at developmentally appropriate times during the life course, target multiple risks, and build on existing delivery platforms for feasibility of scale-up. While interventions will continue to improve with the growth of developmental science, the evidence now strongly suggests that parents, caregivers, and families need to be supported in providing nurturing care and protection in order for young children to achieve their developmental potential. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comprehensiveness and programmatic vulnerability to stds/hiv/aids in primary care

Directory of Open Access Journals (Sweden)

Luciane Ferreira do Val

2014-08-01

Full Text Available This study aimed to identify programmatic vulnerability to STDs/HIV/AIDS in primary health centers (PHCs. This is a descrip - tive and quantitative study carried out in the city of São Paulo. An online survey was applied (FormSUS platform, involving administrators from 442 PHCs in the city, with responses received from 328 of them (74.2%, of which 53.6% were nurses. At - tention was raised in relation to program - matic vulnerability in the PHCs regarding certain items of infrastructure, prevention, treatment, prenatal care and integration among services on STDs/HIV/AIDS care. It was concluded that in order to reach comprehensiveness of actions for HIV/ AIDS in primary health care, it is necessary to consider programmatic vulnerability, in addition to more investment and reor - ganization of services in a dialogue with the stakeholders (users, multidisciplinary teams, and managers, among others.

Emerging Chitosan-Based Films for Food Packaging Applications.

Science.gov (United States)

Wang, Hongxia; Qian, Jun; Ding, Fuyuan

2018-01-17

Recent years have witnessed great developments in biobased polymer packaging films for the serious environmental problems caused by the petroleum-based nonbiodegradable packaging materials. Chitosan is one of the most abundant biopolymers after cellulose. Chitosan-based materials have been widely applied in various fields for their biological and physical properties of biocompatibility, biodegradability, antimicrobial ability, and easy film forming ability. Different chitosan-based films have been fabricated and applied in the field of food packaging. Most of the review papers related to chitosan-based films are focusing on antibacterial food packaging films. Along with the advances in the nanotechnology and polymer science, numerous strategies, for instance direct casting, coating, dipping, layer-by-layer assembly, and extrusion, have been employed to prepare chitosan-based films with multiple functionalities. The emerging food packaging applications of chitosan-based films as antibacterial films, barrier films, and sensing films have achieved great developments. This article comprehensively reviews recent advances in the preparation and application of engineered chitosan-based films in food packaging fields.

The comprehensive care project: measuring physician performance in ambulatory practice.

Science.gov (United States)

Holmboe, Eric S; Weng, Weifeng; Arnold, Gerald K; Kaplan, Sherrie H; Normand, Sharon-Lise; Greenfield, Sheldon; Hood, Sarah; Lipner, Rebecca S

2010-12-01

To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice. Ambulatory-based general internists in 13 states participated in the assessment. We assessed physician-level performance, adjusted for patient factors, on 46 individual measures, an overall composite measure, and composite measures for chronic, acute, and preventive care. Between- versus within-physician variation was quantified by intraclass correlation coefficients (ICC). External validity was assessed by correlating performance on a certification exam. Medical records for 236 physicians were audited for seven chronic and four acute care conditions, and six age- and gender-appropriate preventive services. Performance on the individual and composite measures varied substantially within (range 5-86 percent compliance on 46 measures) and between physicians (ICC range 0.12-0.88). Reliabilities for the composite measures were robust: 0.88 for chronic care and 0.87 for preventive services. Higher certification exam scores were associated with better performance on the overall (r = 0.19; pmeasures and by sampling feasible numbers of patients for each condition. © Health Research and Educational Trust.

[A Comprehensive Care System for Children with Anorexia Nervosa in Pediatric Practice].

Science.gov (United States)

Watanabe, Hisako

2015-01-01

Against the backdrop of rapid industrialization and westernization after the World War II, there has been an ever increasing number of children with anorexia nervosa (AN) in pediatric practice, making it one of the most common diseases in children. With a severe lack of AN specialists in Japan, pediatricians need to face the daunting task of treating AN on their own. Malnutrition overlooked during periods of growth and development yields a risk of death, growth disturbance and an intractable conditions with secondary disorders of brain atrophy, osteoporosis, infertility, maltreatment and childrearing failures, mental disorders and others, which can last for life. Prevention is the best and a must for AN, and an early detection and treatment need to be in place to mitigate its progress and aggravation. It is crucial that an effective care is provided in early, treatable stage to assist the patient back to a healthy developmental trajectory. In 1993, the Department of Pediatrics, School of Medicine, Keio University (hereafter PKU) appointed a child psychiatrist as its fulltime staff and has included inpatient treatment of AN as a compulsory item of its postgraduate training program. Over the past twenty years, PKU has developed a comprehensive treatment system of AN (Scientific Report of Ministry of Welfare and Labor 2006). In the primary care of AN, a screening tool using simple physical measurement of weight on growth chart combined with pulse proves effective. When a weight on growth chart reveals an unhealthy weight loss and is combined with bradycardia, it detects AN at sensitivity of 83% and specificity of 93%. In the secondary care of AN, 40 pediatric institutions affiliated with PKU implemented early treatment of AN with the support of the Mental Health Division of PKU. In the tertiary care for severely emaciated AN patients, an around-the-clock intensive treatment program, called Anorexia Nervosa Intensive Care Unit (ANICU) was instituted. The gist of ANICU

Home care packages: insights into the experiences of older people leading up to the introduction of consumer directed care in Australia.

Science.gov (United States)

Day, Jenny; Taylor, Ann Clare Thorington; Summons, Peter; Van Der Riet, Pamela; Hunter, Sharyn; Maguire, Jane; Dilworth, Sophie; Bellchambers, Helen; Jeong, Sarah; Haydon, Gunilla; Harris, Margaret; Higgins, Isabel

2017-04-01

This paper reports phase one, conducted from March to June 2015, of a two-phase, qualitative descriptive study designed to explore the perceptions and experiences of older people before and after the introduction of consumer directed care (CDC) to home care packages (HCP) in Australia. Eligible consumers with a local HCP provider were mailed information about the study. Data collection occurred before the introduction of CDC and included face-to-face, in-depth interviews, summaries of interviews, field notes and reflective journaling. Semi-structured questions and 'emotional touchpoints' relating to home care were used to guide the interview conversation. Line-by-line data analysis, where significant statements were highlighted and clustered to reveal emergent themes, was used. Five older people, aged 81 to 91 years, participated in the study. The four emergent themes were: seeking quality and reciprocity in carer relationships; patchworking services; the waiting game; and technology with utility. Continuity of carers was central to the development of a trusting relationship and perceptions of care quality among older consumers. Care coordinators and workers should play a key role in ensuring older people receive timely information about CDC and their rights and responsibilities. Participants' use of contemporary technologies suggests opportunities to improve engagement of HCP clients in CDC.

Technology acceptance for an Intelligent Comprehensive Interactive Care (ICIC system for care of the elderly: a survey-questionnaire study.

Directory of Open Access Journals (Sweden)

Alice M K Wong

Full Text Available The key components of caring for the elderly are diet, living, transportation, education, and safety issues, and telemedical systems can offer great assistance. Through the integration of personal to community information technology platforms, we have developed a new Intelligent Comprehensive Interactive Care (ICIC system to provide comprehensive services for elderly care. The ICIC system consists of six items, including medical care (physiological measuring system, Medication Reminder, and Dr. Ubiquitous, diet, living, transportation, education (Intelligent Watch, entertainment (Sharetouch, and safety (Fall Detection. In this study, we specifically evaluated the users' intention of using the Medication Reminder, Dr. Ubiquitous, Sharetouch, and Intelligent Watch using a modified technological acceptance model (TAM. A total of 121 elderly subjects (48 males and 73 females were recruited. The modified TAM questionnaires were collected after they had used these products. For most of the ICIC units, the elderly subjects revealed great willingness and/or satisfaction in using this system. The elderly users of the Intelligent Watch showed the greatest willingness and satisfaction, while the elderly users of Dr. Ubiquitous revealed fair willingness in the dimension of perceived ease of use. The old-old age group revealed greater satisfaction in the dimension of result demonstrability for the users of the Medication Reminder as compared to the young-old and oldest-old age groups. The women revealed greater satisfaction in the dimension of perceived ease of use for the users of Dr. Ubiquitous as compared to the men. There were no statistically significant differences in terms of gender, age, and education level in the other dimensions. The modified TAM showed its effectiveness in evaluating the acceptance and characteristics of technologic products for the elderly user. The ICIC system offers a user-friendly solution in telemedical care and improves the

Technology acceptance for an Intelligent Comprehensive Interactive Care (ICIC) system for care of the elderly: a survey-questionnaire study.

Science.gov (United States)

Wong, Alice M K; Chang, Wei-Han; Ke, Pei-Chih; Huang, Chun-Kai; Tsai, Tsai-Hsuan; Chang, Hsien-Tsung; Shieh, Wann-Yun; Chan, Hsiao-Lung; Chen, Chih-Kuang; Pei, Yu-Cheng

2012-01-01

The key components of caring for the elderly are diet, living, transportation, education, and safety issues, and telemedical systems can offer great assistance. Through the integration of personal to community information technology platforms, we have developed a new Intelligent Comprehensive Interactive Care (ICIC) system to provide comprehensive services for elderly care. The ICIC system consists of six items, including medical care (physiological measuring system, Medication Reminder, and Dr. Ubiquitous), diet, living, transportation, education (Intelligent Watch), entertainment (Sharetouch), and safety (Fall Detection). In this study, we specifically evaluated the users' intention of using the Medication Reminder, Dr. Ubiquitous, Sharetouch, and Intelligent Watch using a modified technological acceptance model (TAM). A total of 121 elderly subjects (48 males and 73 females) were recruited. The modified TAM questionnaires were collected after they had used these products. For most of the ICIC units, the elderly subjects revealed great willingness and/or satisfaction in using this system. The elderly users of the Intelligent Watch showed the greatest willingness and satisfaction, while the elderly users of Dr. Ubiquitous revealed fair willingness in the dimension of perceived ease of use. The old-old age group revealed greater satisfaction in the dimension of result demonstrability for the users of the Medication Reminder as compared to the young-old and oldest-old age groups. The women revealed greater satisfaction in the dimension of perceived ease of use for the users of Dr. Ubiquitous as compared to the men. There were no statistically significant differences in terms of gender, age, and education level in the other dimensions. The modified TAM showed its effectiveness in evaluating the acceptance and characteristics of technologic products for the elderly user. The ICIC system offers a user-friendly solution in telemedical care and improves the quality of

Fielding of the on-axis diagnostic package at Z

International Nuclear Information System (INIS)

Hurst, M.J.; Nash, T.J.; Derzon, M.; Kellogg, J.W.; Torres, J.; McGurn, J.; Seaman, J.; Jobe, D.; Lazier, S.E.

1998-06-01

The authors have developed a comprehensive diagnostic package for observing z-pinch radiation along the pinch axis on the Z accelerator. The instrumentation, which was fielded on the axial package, are x-ray diagnostics requiring direct lines of sight to the target. The diagnostics require vacuum access to the center of the accelerator. The environment is a hostile one, where one must deal with an intense, energetic photon flux (>100 keV), EMP, debris (e.g. bullets or shrapnel), and mechanical shock in order for the diagnostics to survive. In addition, practical constraints require the package be refurbished and utilized on a once a day shot schedule. In spite of this harsh environment, the authors have successfully fielded the diagnostic package with a high survivability of the data and the instruments. In this paper, they describe the environment and issues related to the re-entrant diagnostic package's implementation and maintenance

IDES: Interactive Data Entry System: a generalized data acquisition software package

International Nuclear Information System (INIS)

Gasser, S.B.

1980-04-01

The Interactive Data Entry System (IDES) is a software package which greatly assists in designing and storing forms to be used for the directed acquisition of data. Objective of this package is to provide a viable man/machine interface to any comprehensive data base. This report provides a technical description of the software and can be used as a user's manual

Potential benefits of a CAD package for designing multivariable control systems

International Nuclear Information System (INIS)

Mensah, S.

1983-01-01

An open-ended CAD package, MVPACK, has been developed and implemented on a PDP-11/45 minicomputer at the Chalk River Nuclear Laboratories. The package is fully interactive, and includes a comprehensive state-of-the-art methematical library to support development of complex multi-variable control algorithms. Coded in RATFOR, MVPACK operates with a flexible data structure which makes efficient use of minicomputer resources and provides a standard framework for program generation. The existence of a help mechanism enhances the simplicity of package utilization. The capability of the package as a tool for designing control systems is illustrated with the design of a regulating system for an evaporator

The drift-flux correlation package MDS

International Nuclear Information System (INIS)

Hoeld, A.

2001-01-01

Based on the SONNENBURG drift-flux correlation, developed at GRS/Garching (Germany), a comprehensive drift-flux correlation package (MDS) has been established. Its aim is to support thermal-hydraulic mixture-fluid models, models being used for the simulation of the steady state and transient behaviour of characteristic thermal-hydraulic parameters of single- or two-phase fluids flowing along coolant channels of different types (being, e.g., parts of NPP-s, steam generators etc.). The characteristic properties of this package with respect to the behaviour at co- and counter-current flow, its inverse solutions needed for steady state simulations, its behaviour when approaching the lower or upper boundary of a two-phase region, its verification and behaviour with respect to other correlations will be discussed. An adequate driver code, MDSDRI, has been established too, allowing to test the package very thoroughly out of the complex thermal-hydraulic codes. (author)

The drift-flux correlation package MDS

Energy Technology Data Exchange (ETDEWEB)

Hoeld, A. [Bernaysstr. 16A, Munich, F.R. (Germany)

2001-07-01

Based on the SONNENBURG drift-flux correlation, developed at GRS/Garching (Germany), a comprehensive drift-flux correlation package (MDS) has been established. Its aim is to support thermal-hydraulic mixture-fluid models, models being used for the simulation of the steady state and transient behaviour of characteristic thermal-hydraulic parameters of single- or two-phase fluids flowing along coolant channels of different types (being, e.g., parts of NPP-s, steam generators etc.). The characteristic properties of this package with respect to the behaviour at co- and counter-current flow, its inverse solutions needed for steady state simulations, its behaviour when approaching the lower or upper boundary of a two-phase region, its verification and behaviour with respect to other correlations will be discussed. An adequate driver code, MDSDRI, has been established too, allowing to test the package very thoroughly out of the complex thermal-hydraulic codes. (author)

A home-based comprehensive care model in patients with Multiple Sclerosis: A study pre-protocol [version 1; referees: 2 approved

Directory of Open Access Journals (Sweden)

Lufei Young

2015-09-01

Full Text Available Background Disability is prevalent in individuals with multiple sclerosis (MS, leading to difficulty in care access, significant caregiver burden, immense challenges in self-care and great societal burden.  Without highly coordinated, competent and accessible care, individuals living with progressive MS experience psychological distress, poor quality of life, suffer from life-threatening complications, and have frequent but avoidable healthcare utilizations. Unfortunately, current healthcare delivery models present severe limitations in providing easily accessible, patient-centered, coordinated comprehensive care to those with progressive MS. We propose a home-based comprehensive care model (MAHA to address the unmet needs, challenges, and avoidable complications in individuals with progressive MS with disabling disease. Objective The article aims to describe the study design and methods used to implement and evaluate the proposed intervention.   Method The study will use a randomized controlled design to evaluate the feasibility of providing a 24-month, home-based, patient-centered comprehensive care program to improve quality of life, reduce complications and healthcare utilizations overtime (quarterly for 24 months. A transdisciplinary team led by a MS-Comprehensivist will carry out this project. Fifty MS patients will be randomly assigned to the intervention and usual care program using block randomization procedures. We hypothesize that patients in the intervention group will have fewer complications, higher quality of life, greater satisfaction with care, and reduced healthcare utilization. The proposed project is also expected to be financially sustainable in fee-for-service models but best suited for and gain financial success in valued-based care systems.   Discussion This is the first study to examine the feasibility and effectiveness of a home-based comprehensive care management program in MS patients living with progressive

ShapeSelectForest: a new r package for modeling landsat time series

Science.gov (United States)

Mary Meyer; Xiyue Liao; Gretchen Moisen; Elizabeth Freeman

2015-01-01

We present a new R package called ShapeSelectForest recently posted to the Comprehensive R Archival Network. The package was developed to fit nonparametric shape-restricted regression splines to time series of Landsat imagery for the purpose of modeling, mapping, and monitoring annual forest disturbance dynamics over nearly three decades. For each pixel and spectral...

"Teaching Case": ComprehensiveCare and the Failed Implementation of an Electronic Health Records System

Science.gov (United States)

Gomillion, David L.

2017-01-01

Administrator Jennifer Stanton attempts to adopt an Electronic Health Records system at ComprehensiveCare, a multispecialty healthcare practice. Consultants from the vendor provide guidance to the organization, but do not provide that guidance in a way that the non-technical administrator understands. The project experiences escalation of…

ggseqlogo: a versatile R package for drawing sequence logos.

Science.gov (United States)

Wagih, Omar

2017-11-15

Sequence logos have become a crucial visualization method for studying underlying sequence patterns in the genome. Despite this, there remains a scarcity of software packages that provide the versatility often required for such visualizations. ggseqlogo is an R package built on the ggplot2 package that aims to address this issue. ggseqlogo offers native illustration of publication-ready DNA, RNA and protein sequence logos in a highly customizable fashion with features including multi-logo plots, qualitative and quantitative colour schemes, annotation of logos and integration with other plots. The package is intuitive to use and seamlessly integrates into R analysis pipelines. ggseqlogo is released under the GNU licence and is freely available via CRAN-The Comprehensive R Archive Network https://cran.r-project.org/web/packages/ggseqlogo. A detailed tutorial can be found at https://omarwagih.github.io/ggseqlogo. wagih@ebi.ac.uk. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Materials of Criticality Safety Concern in Waste Packages

International Nuclear Information System (INIS)

Larson, S.L.; Day, B.A.

2006-01-01

10 CFR 71.55 requires in part that the fissile material package remain subcritical when considering 'the most reactive credible configuration consistent with the chemical and physical form of the material'. As waste drums and packages may contain unlimited types of materials, determination of the appropriately bounding moderator and reflector materials to ensure compliance with 71.55 requires a comprehensive analysis. Such an analysis was performed to determine the materials or elements that produce the most reactive configuration with regards to both moderation and reflection of a Pu-239 system. The study was originally performed for the TRUPACT-II shipping package and thus the historical fissile mass limit for the package, 325 g Pu-239, was used [1]. Reactivity calculations were performed with the SCALE package to numerically assess the moderation or reflection merits of the materials [2]. Additional details and results are given in SAIC-1322-001 [3]. The development of payload controls utilizing process knowledge to determine the classification of special moderator and/or reflector materials and the associated fissile mass limit is also addressed. (authors)

Newborn care in Indonesia, Lao People's Democratic Republic and the Philippines: a comprehensive needs assessment.

Science.gov (United States)

Duysburgh, Els; Kerstens, Birgit; Diaz, Melissa; Fardhdiani, Vini; Reyes, Katherine Ann V; Phommachanh, Khamphong; Temmerman, Marleen; Rodriques, Basil; Zaka, Nabila

2014-02-15

Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, Lao People's Democratic Republic (PDR) and the Philippines. We assessed newborn health policies, services and care in the three countries through document review, interviews and health facility visits. Findings were triangulated to describe newborns' health status, the health policy and the health system context for newborn care and the equity situation regarding newborn survival. (1) In the three countries, decline of neonatal mortality is lagging behind compared to that of under-five mortality. (2) Comprehensive newborn policies in line with international standards exist, although implementation remains poor. An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities. Management capacity and skills at decentralised level were often found to be limited. (3) Quality of newborn care provided at primary healthcare and referral level is generally substandard. Limited knowledge and skills among providers of newborn care are contributing to poor quality of care. (4) Socio-economic and geographic inequities in newborn care are considerable. Similar important challenges for newborn care have been identified in Indonesia, Lao PDR and the Philippines. There is an urgent need to address weak leadership and governance regarding newborn care, quality

How Peru introduced a plan for comprehensive HIV prevention and care for transwomen.

Science.gov (United States)

Salazar, Ximena; Núnez-Curto, Arón; Villayzán, Jana; Castillo, Regina; Benites, Carlos; Caballero, Patricia; Cáceres, Carlos F

2016-01-01

As a group, transwomen in Peru have the highest prevalence of HIV (>20%) in the country, but they have little access to HIV prevention, testing and care services. Until recently, Peru's national HIV programme did not recognize transwomen and had remained essentially static for decades. This changed in December 2014, when the Ministry of Health expressed its commitment to improve programming for transwomen and to involve transwomen organizations by prioritizing the development of a "Targeted Strategy Plan of STIs/HIV/AIDS Prevention and Comprehensive Care for Transwomen." A policy dialogue between key stakeholders - Peru's Ministry of Health, academic scientists, civil society, transgender leaders and international agencies - created the conditions for a change in Peru's national HIV policy for transwomen. Supported by the effective engagement of all sectors, the Ministry of Health launched a plan to provide comprehensive HIV prevention and care for transwomen. The five-year plan includes new national guidelines for HIV prevention, care and support, and country-level investments in infrastructure and equipment. In addition to new biomedical strategies, the plan also incorporates several strategies to address structural factors that contribute to the vulnerability of transwomen. We identified three key factors that created the right conditions for this change in Peru's HIV policy. These factors include (1) the availability of solid evidence, based on scientific research; (2) ongoing efforts within the transwomen community to become better advocates of their own rights; and (3) a dialogue involving honest discussions between stakeholders about possibilities of changing the nation's HIV policy. The creation of Peru's national plan for HIV prevention and care for transwomen shows that long-term processes, focused on human rights for transwomen in Peru, can lead to organizational and public-policy change.

Antimicrobial food packaging: potential and pitfalls

Science.gov (United States)

Malhotra, Bhanu; Keshwani, Anu; Kharkwal, Harsha

2015-01-01

Nowadays food preservation, quality maintenance, and safety are major growing concerns of the food industry. It is evident that over time consumers’ demand for natural and safe food products with stringent regulations to prevent food-borne infectious diseases. Antimicrobial packaging which is thought to be a subset of active packaging and controlled release packaging is one such promising technology which effectively impregnates the antimicrobial into the food packaging film material and subsequently delivers it over the stipulated period of time to kill the pathogenic microorganisms affecting food products thereby increasing the shelf life to severe folds. This paper presents a picture of the recent research on antimicrobial agents that are aimed at enhancing and improving food quality and safety by reduction of pathogen growth and extension of shelf life, in a form of a comprehensive review. Examination of the available antimicrobial packaging technologies is also presented along with their significant impact on food safety. This article entails various antimicrobial agents for commercial applications, as well as the difference between the use of antimicrobials under laboratory scale and real time applications. Development of resistance amongst microorganisms is considered as a future implication of antimicrobials with an aim to come up with actual efficacies in extension of shelf life as well as reduction in bacterial growth through the upcoming and promising use of antimicrobials in food packaging for the forthcoming research down the line. PMID:26136740

Making the CARE Comprehensive Geriatric Assessment as the Core of a Total Mobile Long Term Care Support System in China.

Science.gov (United States)

Cui, Yanyan; Gong, Dongwei; Yang, Bo; Chen, Hua; Tu, Ming-Hsiang; Zhang, Chaonan; Li, Huan; Liang, Naiwen; Jiang, Liping; Chang, Polun

2018-01-01

Comprehensive Geriatric Assessments (CGAs) have been recommended to be used for better monitoring the health status of elder residents and providing quality care. This study reported how our nurses perceived the usability of CGA component of a mobile integrated-care long term care support system developed in China. We used the Continuity Assessment Record and Evaluation (CARE), developed in the US, as the core CGA component of our Android-based support system, in which apps were designed for all key stakeholders for delivering quality long term care. A convenience sample of 18 subjects from local long term care facilities in Shanghai, China were invited to assess the CGA assessment component in terms of Technology Acceptance Model for Mobile based on real field trial assessment. All (100%) were satisfied with the mobile CGA component. 88.9% perceived the system was easy to learn and use. 99.4% showed their willingness to use for their work. We concluded it is technically feasible to implement a CGA-based mobile integrated care support system in China.

mediation: R Package for Causal Mediation Analysis

Directory of Open Access Journals (Sweden)

Dustin Tingley

2014-09-01

Full Text Available In this paper, we describe the R package mediation for conducting causal mediation analysis in applied empirical research. In many scientific disciplines, the goal of researchers is not only estimating causal effects of a treatment but also understanding the process in which the treatment causally affects the outcome. Causal mediation analysis is frequently used to assess potential causal mechanisms. The mediation package implements a comprehensive suite of statistical tools for conducting such an analysis. The package is organized into two distinct approaches. Using the model-based approach, researchers can estimate causal mediation effects and conduct sensitivity analysis under the standard research design. Furthermore, the design-based approach provides several analysis tools that are applicable under different experimental designs. This approach requires weaker assumptions than the model-based approach. We also implement a statistical method for dealing with multiple (causally dependent mediators, which are often encountered in practice. Finally, the package also offers a methodology for assessing causal mediation in the presence of treatment noncompliance, a common problem in randomized trials.

Module 13: Bulk Packaging Shipments by Highway

International Nuclear Information System (INIS)

Przybylski, J.L.

1994-07-01

The Hazardous Materials Modular Training Program provides participating United States Department of Energy (DOE) sites with a basic, yet comprehensive, hazardous materials transportation training program for use onsite. This program may be used to assist individual program entities to satisfy the general awareness, safety training, and function specific training requirements addressed in Code of Federal Regulation (CFR), Title 49, Part 172, Subpart H -- ''Training.'' Module 13 -- Bulk Packaging Shipments by Highway is a supplement to the Basic Hazardous Materials Workshop. Module 13 -- Bulk Packaging Shipments by Highway focuses on bulk shipments of hazardous materials by highway mode, which have additional or unique requirements beyond those addressed in the ten module core program. Attendance in this course of instruction should be limited to those individuals with work experience in transporting hazardous materials utilizing bulk packagings and who have completed the Basic Hazardous Materials Workshop or an equivalent. Participants will become familiar with the rules and regulations governing the transportation by highway of hazardous materials in bulk packagings and will demonstrate the application of these requirements through work projects and examination

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative.

Science.gov (United States)

Dale, Stacy B; Ghosh, Arkadipta; Peikes, Deborah N; Day, Timothy J; Yoon, Frank B; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Conway, Patrick H; Rajkumar, Rahul; Press, Matthew J; Sessums, Laura; Brown, Randall

2016-06-16

The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-$11; 95% confidence interval [CI], -$23 to $1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account ($7; 95% CI, -$5 to $19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (Pinitiative practices relative to comparison practices (P=0.006 and Pinitiative have reported progress in transforming the delivery of primary care. However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after

A model to estimate the cost of the National Essential Public Health Services Package in Beijing, China.

Science.gov (United States)

Yin, Delu; Wong, Sabrina T; Chen, Wei; Xin, Qianqian; Wang, Lihong; Cui, Mingming; Yin, Tao; Li, Ruili; Zheng, Xiaoguo; Yang, Huiming; Yu, Juanjuan; Chen, Bowen; Yang, Weizhong

2015-06-06

In order to address several health challenges, the Chinese government issued the National Essential Public Health Services Package (NEPHSP) in 2009. In China's large cities, the lack of funding for community health centers and consequent lack of comprehensive services and high quality care has become a major challenge. However, no study has been carried out to estimate the cost of delivering the services in the package. This project was to develop a cost estimation approach appropriate to the context and use it to calculate the cost of the NEPHSP in Beijing in 2011. By adjusting models of cost analysis of primary health care and workload indicators of staffing need developed by the World Health Organization, a model was developed to estimate the cost of the services in the package through an intensive interactive process. A total of 17 community health centers from eight administrative districts in Beijing were selected. Their service volume and expenditure data in 2010 were used to evaluate the costs of providing the NEPHSP in Beijing based on the applied model. The total workload of all types of primary health care in 17 sample centers was equivalent to the workload requirement for 14,056,402 standard clinic visits. The total expenditure of the 17 sample centers was 26,329,357.62 USD in 2010. The cost of the workload requirement of one standard clinic visit was 1.87 USD. The workload of the NEPHSP was equivalent to 5,514,777 standard clinic visits (39.23 % of the total workload). The model suggests that the cost of the package in Beijing was 7.95 USD per capita in 2010. The cost of the NEPHSP in urban areas was lower than suburban areas: 7.31 and 8.65 USD respectively. The average investment of 3.97 USD per capita in NEPHSP was lower than the amount needed to meet its running costs. NEPHSP in Beijing is therefore underfunded. Additional investment is needed, and a dynamic cost estimate mechanism should be introduced to ensure services remain adequately funded.

A Randomized Controlled Trial of a Nurse-Led Supportive Care Package (SurvivorCare) for Survivors of Colorectal Cancer.

Science.gov (United States)

Jefford, Michael; Gough, Karla; Drosdowsky, Allison; Russell, Lahiru; Aranda, Sanchia; Butow, Phyllis; Phipps-Nelson, Jo; Young, Jane; Krishnasamy, Mei; Ugalde, Anna; King, Dorothy; Strickland, Andrew; Franco, Michael; Blum, Robert; Johnson, Catherine; Ganju, Vinod; Shapiro, Jeremy; Chong, Geoffrey; Charlton, Julie; Haydon, Andrew; Schofield, Penelope

2016-08-01

colorectal cancer report distressing effects after completing treatment. Strategies to identify and respond to survivors' issues are needed. In a randomized controlled trial, the addition of a nurse-led supportive care package (SurvivorCare) to usual post-treatment care did not impact survivors' distress, quality of life, or unmet needs. However, patients receiving the SurvivorCare intervention were more satisfied with survivorship care. Factors for consideration in the design of subsequent studies are discussed. ©AlphaMed Press.

A comprehensive approach to addiction medicine as an appropriate response to the HIV epidemic among drug users.

Science.gov (United States)

Gerra, Gilberto

2013-12-01

The services for drug-dependence treatment and care, particularly in low-income countries, should not be fragmented and uncoordinated. A basic package of interventions should be provided in the same place and managed by the same team, with a one-stop shop approach. The services for substance use disorders should be appealing, accessible, voluntary-based, and science-based. They should also, like efforts to fight other diseases, be included in the community and the public health systems; that is, those who are affected by drug use and those who serve them should not face discrimination. The first-line assistance and the second-line essential elements of the comprehensive package will be described. The work of the United Nations Office on Drugs and Crime (UNODC) and World Health Organization (WHO) to promote science-based and voluntary-based ethical treatment in Asia will be illustrated.

Promoting Listening Reading Comprehension for Nonverbal English Language Learners Who Have a Severe Intellectual Delay

Science.gov (United States)

Kemper, Talya

2012-01-01

This study used an alternating treatment design to examine the use of a listening reading comprehension intervention package. This package was implemented in English as well as bilingually (on alternating days). This package was applied to four participants who were English Language Learners, were diagnosed with a severe intellectual delay, and…

What Are the Perceptions, Experiences, and Behaviors of Health Care Providers After Implementation of a Comprehensive Smoke-Free Hospital Policy?

Science.gov (United States)

Luck, Kerrie E; Doucet, Shelley

2018-01-01

The aim of this study was to explore the perceptions, experiences, and behaviors of health care providers (HCPs) after the implementation of a comprehensive smoke-free policy. This qualitative descriptive study, using semi-structured interviews, was conducted with 28 HCPs working in a Canadian hospital. Four overarching themes emerged from the analysis including (a) greater support for tobacco reduction, (b) enhanced patient care and interactions, (c) improved staff morale, and (d) some barriers still exist. The main findings suggest a comprehensive smoke-free hospital environment can strengthen the tobacco-free workplace culture within a hospital setting among HCPs where support for tobacco reduction is amplified, patient care and interactions regarding tobacco dependence are improved, and staff morale is enhanced. While there are still some challenging barriers as well as opportunities for improvements, the implementation of a comprehensive smoke-free policy heightened the call-to-action among HCPs to take a more active role in tobacco reduction.

gkmSVM: an R package for gapped-kmer SVM.

Science.gov (United States)

Ghandi, Mahmoud; Mohammad-Noori, Morteza; Ghareghani, Narges; Lee, Dongwon; Garraway, Levi; Beer, Michael A

2016-07-15

We present a new R package for training gapped-kmer SVM classifiers for DNA and protein sequences. We describe an improved algorithm for kernel matrix calculation that speeds run time by about 2 to 5-fold over our original gkmSVM algorithm. This package supports several sequence kernels, including: gkmSVM, kmer-SVM, mismatch kernel and wildcard kernel. gkmSVM package is freely available through the Comprehensive R Archive Network (CRAN), for Linux, Mac OS and Windows platforms. The C ++ implementation is available at www.beerlab.org/gkmsvm mghandi@gmail.com or mbeer@jhu.edu Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Plain packaging of cigarettes: do we have sufficient evidence?

Science.gov (United States)

Smith, Collin N; Kraemer, John D; Johnson, Andrea C; Mays, Darren

2015-01-01

Tobacco industry marketing is a primary factor influencing cigarette smoking behavior and the cigarette pack has become an important marketing vehicle for tobacco companies. Standardized “plain” cigarette packaging is advocated as a public health policy to prevent and reduce morbidity and mortality caused by smoking by reducing youth smoking initiation and promoting cessation among smokers. Plain packaging was implemented in Australia in December 2012, and several other countries are considering doing so, but each faces foreseeable legal resistance from opponents to such measures. Tobacco companies have challenged these public health policies, citing international trade agreements and intellectual property laws. Decision-making in these court cases will hinge in part on whether the evidence indicates the public health benefits of plain packaging outweigh any potential harm to tobacco manufacturers’ interests. We reviewed the available evidence in support of plain packaging, finding evidence from observational, experimental, and population-based studies. Results indicate that plain packaging can reduce positive perceptions of smoking and dissuade tobacco use. Governments deciding to implement plain cigarette packaging measures can rely on this evidence to help make a strong case that plain packaging plays an important role in the context of comprehensive smoking prevention efforts. PMID:25897269

Destructive examination of shipping package 9975-02101

Energy Technology Data Exchange (ETDEWEB)

Daugherty, W. L. [Savannah River Site (SRS), Aiken, SC (United States)

2016-05-01

Destructive and non-destructive examinations have been performed on the components of shipping package 9975-02101 as part of the comprehensive Model 9975 package surveillance program. This package is one of ten high-wattage packages that were selected for field surveillance in FY15, and was identified to contain several non-conforming conditions. Most of these conditions (mold, stains, drum corrosion, calculated fiberboard dimensions and fiberboard damage) relate to the accumulation of water in the outer and lower portions of the cane fiberboard assembly. In the short term, this causes local but reversible changes in the fiberboard properties. Long-term effects can include the permanent loss of fiberboard properties (thus far observed only in the bottom fiberboard layers) and reduced drum integrity due to corrosion. The observed conditions must be fully evaluated by KAC to ensure the safety function of the package is being maintained. Three of the other nine FY15 high-wattage packages examined in the K-Area Complex showed similar behavior. Corrosion of the overpack drum has been seen primarily in those packages with relatively severe fiberboard degradation. Visual examination of the drums in storage for external corrosion should be considered as a screening tool to identify additional packages with potential fiberboard degradation. Where overpack drum corrosion has been observed, it is typically heaviest adjacent to the stitch welds along the bottom edge. It is possible that changes to the stitch weld design would reduce the degree of corrosion in this area, but would not eliminate it. Several factors can contribute to the concentration of moisture in the fiberboard, including higher than average initial moisture content, higher internal temperature (due to internal heat load and placement with the array of packages), and the creation of additional moisture as the fiberboard begins to degrade.

Integralidade e cuidado a grávidas adolescentes na Atenção Básica Comprehensive care of pregnant adolescents in Primary Care

Directory of Open Access Journals (Sweden)

Mônica Cecília Pimentel de Melo

2011-05-01

Full Text Available O pré-natal em adolescentes tem se caracterizado por ações técnicas buscando-se na atualidade qualificar o cuidado na perspectiva da integralidade. O Programa de Agentes Comunitários de Saúde/Programa Saúde da Família (PACS/PSF constitui estratégia para avançar nas mudanças requeridas, o que motivou esta investigação científica, que teve como objetivos conhecer o processo de cuidado pré-natal a adolescentes grávidas por profissionais de saúde do PACS/PSF e analisá-lo na perspectiva da integralidade. É um estudo qualitativo, tendo a integralidade como enfoque teórico. Foi desenvolvido em unidades de PACS/PSF em um município da Bahia, sendo sujeitos do estudo profissionais que cuidam de gestantes adolescentes. O material empírico foi produzido por meio de entrevista semiestruturada e observação não participante, em consultas e visitas domiciliárias e analisado pela técnica de análise de discurso. A análise revelou que o cuidado pré-natal à adolescente se concretiza sob o modelo biomédico, e o cumprimento de rotinas e protocolos institucionais sobrepõe-se à singularidade da adolescente. Assim, distancia-se da integralidade, na medida em que as práticas são orientadas por sujeições ideológicas a um modelo que nega às adolescentes grávidas a oportunidade de serem sujeitos.Prenatal adolescent care is characterized by technical actions seeking to provide assistance from the perspective of comprehensive care. The Community Health Agent Program/Family Health Program (PACS/PSF is a strategy for implementing the changes envisaged, which motivated this scientific investigation. The scope of the research was to assess prenatal care to pregnant adolescents by health professionals of PACS/PSF and analyze it from the standpoint of comprehensive care. It is a qualitative study, with comprehensive care as its theoretical focus. It was conducted in PACS/PSF units in a city in the State of Bahia, and the subjects of study

A review of the recent advances in starch as active and nanocomposite packaging films

Directory of Open Access Journals (Sweden)

Umar Shah

2015-12-01

Full Text Available Technological advances have led to increased constraints regarding food packaging due to environmental issues, consumer health concerns, and economic restrictions associated therewith. Hence, food scientists and technologists are now more focused on developing biopolymer packages. Starch satisfies all the principle aspects, making it a promising raw material for edible coatings/films. Starch as a package material has grabbed much attention both at academic as well as industrial levels. Besides this, the role of various plasticizers, polys, sugars, and wetting agents are discussed and their importance in packaging industries. Herein, the role of starch as packaging material and nanofillers/composites is discussed in detail. The review summons a comprehensive and current overview of the widely available information and recent advances in starch film packaging.

A randomized controlled trial of comprehensive early intervention care in patients with first-episode psychosis in Japan: 1.5-year outcomes from the J-CAP study.

Science.gov (United States)

Nishida, Atsushi; Ando, Shuntaro; Yamasaki, Syudo; Koike, Shinsuke; Ichihashi, Kayo; Miyakoshi, Yuji; Maekawa, Sanae; Nakamura, Tomohisa; Natsubori, Tatsunobu; Ichikawa, Eriko; Ishigami, Hiroki; Sato, Kojiro; Matsunaga, Asami; Smith, Jo; French, Paul; Harima, Hirohiko; Kishi, Yoshiki; Fujita, Izumi; Kasai, Kiyoto; Okazaki, Yuji

2018-04-08

The first episode of psychosis represents a critical period wherein comprehensive early intervention in psychosis (EIP) may alter the course of illness. However, evidence from randomized controlled trials that have examined the impact of comprehensive EIP care on clinical and functional recovery assessed by independent blinded raters is limited. The objective of this study was to conduct a single-blinded multicenter trial comparing comprehensive EIP care and standard care in young patients with first-episode psychosis (FEP) in Japan (J-CAP Study). A total of 77 participants with FEP (aged 15-35 years) were randomized to receive standard care or specialized comprehensive EIP care and were followed up for 1.5 years (trial no.: UMIN000005092). Function (measured with the Global Assessment of Functioning) and clinical remission (defined by internationally standardized criteria proposed by the Remission in Schizophrenia Working Group) were evaluated by independent raters who were blinded to group assignment. Dropout rate and other secondary outcomes were also examined. The specialized EIP care group had a higher clinical remission rate (odds ratio, 6.3; 95% confidence interval, 1.0-37.9) and lower treatment dropout rate (odds ratio, 0.038; 95% confidence interval, 0.002-0.923) than the standard care group, even after adjusting for baseline characteristics. Functional improvement in the specialized EIP care group was slightly higher than that in the standard care group, but this difference was not statistically significant (p = 0.195). From the results, we conclude that comprehensive EIP care may provide advantages over standard care in patients with FEP. Copyright © 2018. Published by Elsevier Ltd.

Compatibility of packaging components with simulant mixed waste

International Nuclear Information System (INIS)

Nigrey, P.J.; Dickens, T.G.

1996-01-01

The purpose of hazardous and radioactive materials packaging is to enable these materials to be transported without posing a threat to the health or property of the general public. To achieve this aim, regulations in the US have been written establishing general design requirements for such packagings. While no regulations have been written specifically for mixed waste packaging, regulations for the constituents of mixed wastes, i.e., hazardous and radioactive substances, have been codified by the US Department of Transportation (US DOT, 49 CFR 173) and the US Nuclear Regulatory Commission (NRC, 10 CFR 71). Based on these national requirements, a Chemical Compatibility Testing Program was developed in the Transportation Systems Department at Sandia National Laboratories (SNL). The program provides a basis to assure any regulatory body that the issue of packaging material compatibility towards hazardous and radioactive materials has been addressed. In this paper, the authors present the results of the second phase of this testing program. The first phase screened five liner materials and six seal materials towards four simulant mixed wastes. This phase involved the comprehensive testing of five candidate liner materials to an aqueous Hanford Tank simulant mixed waste. The comprehensive testing protocol involved exposing the respective materials a matrix of four gamma radiation doses (∼ 1, 3, 6, and 40 kGy), three temperatures (18, 50, and 60 C), and four exposure times (7, 14, 28, and 180 days). Following their exposure to these combinations of conditions, the materials were evaluated by measuring five material properties. These properties were specific gravity, dimensional changes, hardness, stress cracking, and mechanical properties

WGCNA: an R package for weighted correlation network analysis.

Science.gov (United States)

Langfelder, Peter; Horvath, Steve

2008-12-29

Correlation networks are increasingly being used in bioinformatics applications. For example, weighted gene co-expression network analysis is a systems biology method for describing the correlation patterns among genes across microarray samples. Weighted correlation network analysis (WGCNA) can be used for finding clusters (modules) of highly correlated genes, for summarizing such clusters using the module eigengene or an intramodular hub gene, for relating modules to one another and to external sample traits (using eigengene network methodology), and for calculating module membership measures. Correlation networks facilitate network based gene screening methods that can be used to identify candidate biomarkers or therapeutic targets. These methods have been successfully applied in various biological contexts, e.g. cancer, mouse genetics, yeast genetics, and analysis of brain imaging data. While parts of the correlation network methodology have been described in separate publications, there is a need to provide a user-friendly, comprehensive, and consistent software implementation and an accompanying tutorial. The WGCNA R software package is a comprehensive collection of R functions for performing various aspects of weighted correlation network analysis. The package includes functions for network construction, module detection, gene selection, calculations of topological properties, data simulation, visualization, and interfacing with external software. Along with the R package we also present R software tutorials. While the methods development was motivated by gene expression data, the underlying data mining approach can be applied to a variety of different settings. The WGCNA package provides R functions for weighted correlation network analysis, e.g. co-expression network analysis of gene expression data. The R package along with its source code and additional material are freely available at http://www.genetics.ucla.edu/labs/horvath/CoexpressionNetwork/Rpackages/WGCNA.

Quality and safety aspects of reusable plastic food packaging materials : influence of reuse on intrinsic properties

NARCIS (Netherlands)

Jetten, J.; Kruijf, N. de

2002-01-01

The aim of the project was to develop a comprehensive package of quality assurance criteria for use by the industry and by regulatory authorities to ensure the quality and safety-in-use (sensory, microbiological and chemical safety) of reused plastics for food packaging. The paper describes the

[The Effectiveness of Cooling Packaging Care in Relieving Chemotherapy-Induced Skin Toxicity Reactions in Cancer Patients Receiving Chemotherapy: A Systematic Review].

Science.gov (United States)

Hsu, Ya-Hui; Hung, Hsing-Wei; Chen, Shu-Ching

2017-08-01

Anti-cancer chemotherapy may cause skin-toxicity reactions. Different types of cooling packages affect chemotherapy-induced skin toxicity reactions differently. To evaluate the effects of cooling packing care on chemotherapy-induced skin toxicity reactions in cancer patients receiving chemotherapy. A systematic review approach was used. Searches were conducted in databases including Cochrane Library, Embase, MEDLINE, PubMed and Airiti Library using the keywords "chemotherapy cutaneous toxicity", "chemotherapy skin reaction", "chemotherapy skin toxicity", "frozen glove", "frozen sock", "cooling packaging care", "ice gloves", "ice socks", "usual care", "severity", "comfort", "satisfaction", "severity", and "comfort". The search focused on articles published before December 2016. Based on the inclusion and exclusion criteria, 5 articles involving relevant randomized controlled trials were extracted for review. Elasto-Gel ice gloves or ice socks that were chilled to -25°C- -30°C and used for 15 mins during initial chemotherapy, for one hour during chemotherapy infusion, and for 15 mins after chemotherapy were shown to improve the frequency and severity of chemotherapy-induced skin toxicity reactions. Several studies were limited by small sample sizes and different types of cooling packing programs, temperature, timing, and frequency. Thus, further research is recommended to verify the effects of cooling packing care. Cancer patients who were treated with docetaxel or PLD and who used ice gloves or ice socks that were chilled to -25°C- -30°C for 15 mins during initial chemotherapy, for one hour during chemotherapy infusion, and for 15 mins after chemotherapy improved significantly in terms of the frequency and severity of their chemotherapy-induced skin toxicity reactions. Local cooling packing care is a non-pharmacotherapy approach that is low cost and free of side effects. This review is intended to provide a reference for clinical care.

Evaluating a nurse-led survivorship care package (SurvivorCare) for bowel cancer survivors: study protocol for a randomized controlled trial.

Science.gov (United States)

Jefford, Michael; Aranda, Sanchia; Gough, Karla; Lotfi-Jam, Kerryann; Butow, Phyllis; Krishnasamy, Mei; Young, Jane; Phipps-Nelson, Jo; Russell, Lahiru; King, Dorothy; Schofield, Penelope

2013-08-19

Colorectal cancer (CRC) is the most common cancer affecting both men and women in Australia. The illness and related treatments can cause distressing adverse effects, impact on emotional and psychological well-being, and adversely affect social, occupational and relationship functioning for many years after the end of treatment or, in fact, lifelong. Current models of follow-up fail to address the complex needs arising after treatment completion. Strategies to better prepare and support survivors are urgently required. We previously developed a nurse-led supportive care program (SurvivorCare) and tested it in a pilot study involving 10 CRC survivors. The intervention was found to be highly acceptable, appropriate, relevant and useful. This study is a multisite, randomised controlled trial, designed to assess the impact of the addition of the SurvivorCare intervention to usual post-treatment care, for people with potentially cured CRC. SurvivorCare comprises the provision of survivorship educational materials, a tailored survivorship care plan, an individually tailored nurse-led, face-to-face end of treatment consultation and three subsequent telephone calls. Eligible patients have completed treatment for potentially cured CRC. Other eligibility criteria include stage I to III disease, age greater than 18 years and adequate understanding of English. All consenting patients complete questionnaires at three time points over a six-month period (baseline, two and six months). Measures assess psychological distress, unmet needs and quality of life. This supportive care package has the potential to significantly reduce individual suffering, whilst reducing the burden of follow-up on acute cancer services through enhanced engagement with and utilisation of general practitioners and community based services. If the intervention is successful in achieving the expected health benefits, it could be disseminated readily. All training and supporting materials have been developed

Quality and safety aspects of reusable plastic food packaging materials : a European study to underpin future legislation

NARCIS (Netherlands)

Jetten, J.; Kruijf, N. de; Castle, L.

1999-01-01

The objective of this study was to develop a comprehensive package of quality assurance criteria for use by industry and regulatory authorities for ensuring the quality and safety-in-use (sensory, microbiological and chemical) of reused plastics for food packaging. The study included thermal

CRISTAL V2 Package: Principles and validation domain

International Nuclear Information System (INIS)

Gomit, Jean-Michel; Cochet, Bertrand; Leclaire, Nicolas; Carmouze, Coralie; Damian, Frederic; Entringer, Arnaud; Gagnier, Emmanuel

2017-04-01

The purpose of this document is to provide a comprehensive and global view of the CRISTAL V2 package. In particular, it sets out the principles of the computational approaches available to the user, through four calculation 'routes': - the 'multigroup Monte Carlo' route, - the 'multigroup deterministic' route, - the 'point-wise Monte Carlo' route, - the 'criticality standard calculation' route. (authors)

Effect of self - care education on quality of life in patients with primary hypertension: comparing lecture and educational package.

Science.gov (United States)

Aghajani, Mohamad; Mirbagher Ajorpaz, Neda; Kafaei Atrian, Mahbube; Raofi, Zahra; Abedi, Fatemeh; Naeimi Vartoni, Sajad; Soleimani, Akbar

2013-12-01

Hypertension is a dangerous risk factor for public health. It profoundly affects the patients' quality of life. However, there is lack of agreement on the best method for self-care management in patients with hypertension. This study was conducted to compare the effect of lecture and educational pamphlets on quality of life (QOL) in patients with primary hypertension. A quasi-experimental study was performed on 90 patients with chronic primary hypertension referred to two outpatient clinics in Kashan city. Patients were randomly divided into three groups including lecture group, educational package group, and control group. The participants' quality of life was measured using the SF-36 questionnaire at the beginning of the study, and two months later. Data was analyzed using ANOVA and Chi-Square tests. No significant differences were observed between the three groups for demographics characteristics and QOL before the intervention except for marital status. Mean scores of QOL dimensions of the intervention groups were increased at the end of the study, except for the dimension of bodily pain. Tukey post-Hoc test showed that except for general health, the two intervention groups were not significantly different in other dimensions, and significant differences were observed between the control group and the two intervention groups (P educational package can both improve some dimensions of the QOL in patients with hypertension. However, as pamphlets are cheap and easy to use, this method may be used as an effective method for self-care education in health care settings in Iran, where the system is faced with nursing shortage.

The basic benefit package: composition and exceptions to the rules. A case study.

Science.gov (United States)

Kroneman, Madelon; de Jong, Judith D

2015-03-01

With the introduction of the Health Insurance Act in 2006 in the Netherlands, the basic package of the former sickness funds became valid for all citizens. The basic benefit package has been subject to change, responding to increasing health care expenditures, medical innovations and the economic crisis. In this paper we address the decision criteria used to assess the package annually since 2006 and describe some developments that do not follow the criteria, leading to a yo-yo effect. We discuss the formation of the decision for in- or exclusion and why some treatments seem to follow an, at first sight, arbitrary in- and exclusion pathway. We first describe the official way of establishing the basic benefit package and than will describe why some treatments follow a deviated path. We conclude that political pressure and pressure from interest groups may lead to inclusion or postponement of exclusion. Reform of the organization of certain forms of health care (in our example mental care) may lead to seemingly inconsequent changes. The yo-yo effect of some treatments or pharmaceuticals may have negative effects on health care providers, insurers and patients. The seemingly well defined criteria available for defining the basic package appear to be broadly interpretable and other influences may determine the final decision of inclusion or exclusion. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty : A systematic literature review

NARCIS (Netherlands)

Hopman, Petra; De Bruin, Simone R.; Forjaz, Maria João; Rodriguez-blazquez, Carmen; Tonnara, Giuseppe; Lemmens, Lidwien C.; Onder, Graziano; Baan, Caroline A.; Rijken, Mieke

2016-01-01

Objective To describe comprehensive care programs targeting multimorbid and/or frail patients and to estimate their effectiveness regarding improvement of patient and caregiver related outcomes, healthcare utilization and costs. Methods Systematic search in six electronic databases for scientific

IMAP: A complete Ion Micro-Analysis Package for the nuclear microprobe

International Nuclear Information System (INIS)

Antolak, A.J.; Hildner, M.L.; Morse, D.H.; Bench, G.S.

1993-01-01

Microprobe techniques using scanned, focused MeV ions are routinely used in Livermore for materials characterization. Comprehensive data analysis with these techniques is accomplished with the computer software package IMAP, for Ion Micro-Analysis Package. IMAP consists of a set of command language procedures for data processing and quantitative spectral analysis. Deconvolution of the data is achieved by spawning sub-processes within IMAP which execute analysis codes for each specific microprobe technique. IMAP is structured to rapidly analyze individual spectra or multi-dimensional data blocks which classify individual events by the two scanning dimensions, the energy of the detected radiation and, when necessary, one sample rotation dimension. Several examples are presented to demonstrate the utility of the package

A comprehensive waste collection cost model applied to post-consumer plastic packaging waste

NARCIS (Netherlands)

Groot, J.J.; Bing, X.; Bos-Brouwers, H.E.J.; Bloemhof, J.M.

2014-01-01

Post-consumer plastic packaging waste (PPW) can be collected for recycling via source separation or post-separation. In source separation, households separate plastics from other waste before collection, whereas in post-separation waste is separated at a treatment centre after collection. There are

The UK core performance code package

International Nuclear Information System (INIS)

Hutt, P.K.; Gaines, N.; McEllin, M.; White, R.J.; Halsall, M.J.

1991-01-01

Over the last few years work has been co-ordinated by Nuclear Electric, originally part of the Central Electricity Generating Board, with contributions from the United Kingdom Atomic Energy Authority and British Nuclear Fuels Limited, to produce a generic, easy-to-use and integrated package of core performance codes able to perform a comprehensive range of calculations for fuel cycle design, safety analysis and on-line operational support for Light Water Reactor and Advanced Gas Cooled Reactor plant. The package consists of modern rationalized generic codes for lattice physics (WIMS), whole reactor calculations (PANTHER), thermal hydraulics (VIPRE) and fuel performance (ENIGMA). These codes, written in FORTRAN77, are highly portable and new developments have followed modern quality assurance standards. These codes can all be run ''stand-alone'' but they are also being integrated within a new UNIX-based interactive system called the Reactor Physics Workbench (RPW). The RPW provides an interactive user interface and a sophisticated data management system. It offers quality assurance features to the user and has facilities for defining complex calculational sequences. The Paper reviews the current capabilities of these components, their integration within the package and outlines future developments underway. Finally, the Paper describes the development of an on-line version of this package which is now being commissioned on UK AGR stations. (author)

Economic/climate recovery scorecards. How climate friendly are the economic recovery packages?

International Nuclear Information System (INIS)

Hoehne, N.; Eisbrenner, K.; Phylipsen, D.; Burck, J.; Van der Straeten, L.

2009-04-01

As global leaders head to the G20 summit to consider solutions to the current global economic crisis, a new report prepared by Ecofys and Germanwatch for WWF and E3G reveals that many of the economic recovery packages being discussed are a missed opportunity in terms of stimulating a green recovery, and actually run the risk of locking the world into a high-carbon future. The report provides the most detailed and comprehensive analysis to date of the proposed 'stimulus' packages of five key countries - France, Germany, Italy, the UK and the US - as well as the package agreed by the European Union as a whole.

Third single energy market package of the EU Commission

International Nuclear Information System (INIS)

Heller, W.

2008-01-01

In adopting the so-called Third Single Energy Market Package on September 9, 2007, the European Commission has initiated a comprehensive reform of the single energy market. The main item of the package is the separation of generation and supply from the transmission grids and transport networks in the electricity and gas sectors (ownership unbundling), an approach favored by the Commission. On the other hand, the Commission wants to advance protection of the European market in case firms from third countries, to the extent in which they do not comply with the EU unbundling requirements, would want to assume control over an EU grid or network. The key points of the package are presented. The legal and entrepreneurial ramifications are discussed, for instance, under the aspect of protection of ownership, and concrete as well as potential concerns about ownership unbundling are voiced. (orig.)

Testing of package design AWG 668 to the 1985 IAEA Regulations (as amended 1990)

International Nuclear Information System (INIS)

1992-01-01

This report gives details of the tests for Normal Transport (Type A Tests) and Accident Conditions (Type B Tests) carried out on the AWE(A) packaging assembly AWG 668 and demonstrates the ability of the packaging to remain leak tight after the tests with no damage to the contents. Included in the report are a comprehensive quality plan and test certificates for the leak tests. (author)

"Plain packaging" regulations for tobacco products: the impact of standardizing the color and design of cigarette packs.

Science.gov (United States)

Hammond, David

2010-01-01

Tobacco packaging and labeling policies have emerged as prominent and cost-effective tobacco control measures. Although packaging policies have primarily focused on health warnings, there is growing recognition of the importance of packaging as a marketing tool for the tobacco industry. The current paper reviews evidence on the potential impact of standardizing the color and design of tobacco packages -so called "plain" packaging. The evidence indicates three primary benefits of plain packaging: increasing the effectiveness of health warnings, reducing false health beliefs about cigarettes, and reducing brand appeal especially among youth and young adults. Overall, the research to date suggests that "plain" packaging regulations would be an effective tobacco control measure, particularly in jurisdictions with comprehensive restrictions on other forms of marketing.

Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study.

Science.gov (United States)

Javanparast, Sara; Coveney, John; Saikia, Udoy

2009-02-23

Due to the multifaceted aspect of child malnutrition, a comprehensive approach, taking social factors into account, has been frequently recommended in health literature. The Alma-Ata declaration explicitly outlined comprehensive primary health care as an approach that addresses the social, economic and political causes of poor health and nutrition. Iran as a signatory country to the Alma Ata Declaration has established primary health care since 1979 with significant progress on many health indicators during the last three decades. However, the primary health care system is still challenged to reduce inequity in conditions such as child malnutrition which trace back to social factors. This study aimed to explore the perceptions of the Iranian health stakeholders with respect to the Iranian primary health care performance and actions to move towards a comprehensive approach in addressing childhood malnutrition. Health stakeholders are defined as those who affect or can be affected by health system, for example health policy-makers, health providers or health service recipients. Stakeholder analysis approach was undertaken using a qualitative research method. Different levels of stakeholders, including health policy-makers, health providers and community members were interviewed as either individuals or focus groups. Qualitative content analysis was used to interpret and compare/contrast the viewpoints of the study participants. The results demonstrated that fundamental differences exist in the perceptions of different health stakeholders in the understanding of comprehensive notion and action. Health policy-makers mainly believed in the need for a secure health management environment and the necessity for a whole of the government approach to enhance collaborative action. Community health workers, on the other hand, indicated that staff motivation, advocacy and involvement are the main challenges need to be addressed. Turning to community stakeholders, greater

The development and evaluation of a holistic needs assessment and care planning learning package targeted at cancer nurses in the UK.

Science.gov (United States)

Henry, R; Hartley, B; Simpson, M; Doyle, N

2014-01-01

A project team from the United Kingdom Oncology Nursing Society developed a blended e-learning website to facilitate nurses to further develop their confidence and competencies in a range of skills related to assessing the holistic needs of people with cancer. The project team identified three areas which were integral to an holistic needs assessment (HNA) implementation project. These were project support information, project management skills, and practical competencies delivered in a blended e-learning package containing a series of accessible video presentations, supporting documents, and practical activities. The team worked with internal and external partners to ensure that a robust and inspiring programme was created. www.hnaforcancer.com was launched in October 2012 as a blended learning programme that incorporates e-learning on core subjects. These subjects are packaged as videoed presentations with supporting learning material and can be accessed via the UKONS website. By the end of the programme participants were equipped to identify and explore the essential requirements for HNA and care planning, more able to recognise potential need, and initiate care to prevent or minimise the risk of complications. Participants had also developed confidence and competency in new skills, including basic project management.

Comprehensive care program for elderly patients over 65 years with hip fracture.

Science.gov (United States)

Fernández-Moyano, A; Fernández-Ojeda, R; Ruiz-Romero, V; García-Benítez, B; Palmero-Palmero, C; Aparicio-Santos, R

2014-01-01

To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery. Copyright © 2012 Elsevier España, S.L. All rights reserved.

A Geant4 simulation package for the SAGE spectrometer

International Nuclear Information System (INIS)

Papadakis, P; Cox, D M; Butler, P A; Herzberg, R-D; Pakarinen, J; Konki, J; Greenlees, P T; Hauschild, K; Rahkila, P; Sandzelius, M; Sorri, J

2012-01-01

A comprehensive Geant4 simulation was built for the SAGE spectrometer. The simulation package includes the silicon and germanium detectors, the mechanical structure and the electromagnetic fields present in SAGE. This simulation can be used for making predictions through simulating experiments and for comparing simulated and experimental data to better understand the underlying physics.

Financial planning on a comprehensive scale.

Science.gov (United States)

Mishra, Simita

2013-04-01

Hospitals and health systems that wish to explore the shift to comprehensive care management should: Assess the investments in infrastructure necessary to support comprehensive care management, Gauge the financial implications and set quality and financial goals, Monitor performance using metrics such as patient satisfaction, avoidable admissions, out-of-group referrals, and average length of stay.

Development of comprehensive care system for children with autism syndrome disorders in Russia: one project experience

Directory of Open Access Journals (Sweden)

Alekhina S.V.

2016-12-01

Full Text Available Attention to the issue of children with ASD in our country is growing steadily. Since the release of the new Law «About the education in Russian Federation», where for the first time this category of children was secured by state guarantees, all normative acts and basic solutions are focused on the development of comprehensive care for children with ASD and their families. Official initiatives are in many ways supported with the activity of community organizations and parental associations, representing the interests of families. Experience of many years becomes the basis for efficient solutions and social problems analysis of the identification, education and support of people with autism. Also it becomes platform for social and psychological support of their families. Currently, in the Russian Federation, domestic model for providing comprehensive medical and social, psychological and educational assistance for children with autism just begin to develop. However, the policy, conducted by the government for individuals with disabilities, including children with ASD, confirms state structures readiness to take the main measures of comprehensive rehabilitation and habilitation. The article describes the experience of creating integrated care systems for children with ASD in Russia. The example of project real¬ization involving three of the Russian Federation states, which is aimed at ensuring high quality of life of children, is shown

The Effect of Care Package on Motor Development among 12-Month-Old Infants in Saqqez-Iran: A Randomized Clinical Trial Study

Directory of Open Access Journals (Sweden)

Jamile Ahmadi

2017-08-01

Full Text Available Background The initial years of life particularly the first two years are regarded as the most important brain development period. This study attempted to determine the effect of care package on motor development in 12-month-old infants in Saqqez-Iran. Materials and Methods:This study was a clinical trial conducted in 2016 on 70 infants of 12 months of age selected randomly in intervention and control groups in Saqqez-Iran. The care package was taught to mothers of infants in intervention group by the researchers based on the book "Ages and Stages Learning Activities 0-5 years". These teachings for gross motor, included walking, pulling and pushing the toys, swinging, playing with ball, crawling, etc. and for fine motor skills included building towers, painting, filling a box with household items and emptying it, giving children books, stringing, etc. Motor skills (gross and fine were measured by Age and Stage Questionnaire (ASQ-2 screening tool before intervention, 4 and 8 weeks after the intervention. Data were analyzed using SPSS version 20.0 software. Results: In the intervention group, 56.2% and in the control group 51.4% were female, respectively. Results showed that 4 and 8 weeks after the intervention in gross movement, average scores in the intervention group were more than the control group (P = 0.02, and mean score in three times (before intervention, 4 and 8 weeks after the intervention was significant difference (P = 0.002. Also, for fine movement, results showed that in this area average scores in the intervention group were more than the control group (P=0.02; and the average score was a significant difference in that three times (P=0.01. Conclusion: Results revealed that the impact of care package in intervention group compared with control group in level of significance led to an improvement in motor skills domain (gross and fine movement in 12-month-old infants in this study.

Hemophilia and von Willebrand's disease: 1. Diagnosis, comprehensive care and assessment. Association of Hemophilia Clinic Directors of Canada.

Science.gov (United States)

1995-07-01

To present current strategies for the assessment and comprehensive care of patients with hemophilia and von Willebrand's disease. Hospital care, home care, single-provider care and multidisciplinary care. Morbidity and quality of life associated with bleeding and treatment. Relevant clinical studies and reports published from 1974 to 1994 were examined. A search was conducted of own reprint files, MEDLINE, citations in the articles reviewed and references provided by colleagues. In the MEDLINE search the following terms were used singly or in combination: "hemophilia," "von Willebrand's disease," "Factor VIII," "Factor IX," "von Willebrand factor," "diagnosis," "management," "home care," "comprehensive care," "inhibitor," "AIDS," "hepatitis," "life expectancy," "complications," "practice guidelines," "consensus statement" and "controlled trial." The in-depth review included only articles written in English from North America and Europe that were relevant to human disease and to a predetermined outline. The availability of treatment products in Canada was also considered. Minimizing morbidity and maximizing functional status and quality of life were given a high value. The optimal use of treatment procedures and home care offers patients the advantages of minimized disability, improved survival and financial benefit. It is also cost effective. Potential harm, including the risk of hepatitis B, hepatitis C and HIV infection, has now been minimized through viral inactivation of plasma-derived coagulation-factor concentrates and through the use of recombinant clotting factor concentrates and other non-plasma-derived hemostatic agents. Patients with hemophilia and severe von Willebrand's disease should be followed in comprehensive care centres that offer expertise in the diagnosis, assessment and management of bleeding and complications and that can meet the educational and counselling needs of patients, family members and health care providers. Eligible patients should

Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

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Raymond M Khan

2017-01-01

Full Text Available Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs. Earlier initiatives used the concept of ventilator care bundles (sets of interventions, with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization. The approach of the Comprehensive Unit-based Safety Program (CUSP was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs (a total of 271 beds in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.

MVPACK: a package for the computer-aided design of multivariable control systems

International Nuclear Information System (INIS)

Mensah, S.

1984-01-01

The design and analysis of high performing controllers for large complex plants require a collection of interactive, powerful computer software. MVPACK, an open-ended package for the computer aided design of control systems has been developed in the Reactor Control Branch of the Chalk River Nuclear Laboratories. The package is fully interactive, and includes a comprehensive state-of-the-art mathematical library to support development of complex multivariable control algorithms. Coded in RATFOR, MVPACK operates with a flexible data structure which makes efficient use of minicomputer resources and provides a standard framework for program generation. The existence of a help mechanism enhances the simplicity of package utilization. This report provides the technical description of the package. It reviews the specifications used in the design and implementation of the package. The database structure, the supporting libraries and the design and analysis modules of MVPACK are described. The report includes several application examples to illustrate the capability of the package. Experience with MVPACK shows that the package provides a synergistic environment for control and regulation systems design, and that it is a unique tool in training of control system engineers

Guidelines for a Comprehensive Care Program to Ostomized Patients and Families: a Nursing proposal

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Paula Alvarenga de Figueiredo

2016-01-01

Full Text Available Objectives: describe care needs and demands that mark the discursive practices of ostomized clients and family members and discuss guidelines for a comprehensive care program to ostomized clients and their families, organized by macrosociological categories. Method: Creative and Sensitive, involving 17 ostomized subjects and family members at a municipal outpatient clinic. The ethical aspects were complied with. A characterization form was used, as well as Creativity and Sensitivity Dynamics: "speaking map", "body-knowledge" and "calendar". Critical Discourse Analysis was applied. Results: the health needs and care demands of the ostomized patients and their family members, in their multiple dimensions, were constituted in the home and community, outpatient and social context, implying new orientations for nursing care. The unveiling of the data brought elements that constituted guidelines, in a macrosociological approach, to achieve the expanded integrality of nursing care. Conclusion: the ostomized clients are unique in their genre/peculiar from Latin sui generis, calling for strategies that respond to and distinguish their specificities. Elaborating a Public Health Policy that improves and reorganizes the care demands, taking into account these individual biopsychosocial and spiritual aspects, is a possible and irrevocable target in the attempt to achieve better conditions of health and wellbeing.

Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

Directory of Open Access Journals (Sweden)

Ekerstad N

2016-12-01

Full Text Available Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, 3Department of Molecular and Clinical Medicine, Institute of Medicine, 4Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation, 5Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 6Division of Economics, Department of Management and Engineering, Linköping University, Linköping, 7Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206 or control group (n=202. Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3. Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by

Examining leadership as a strategy to enhance health care service delivery in regional hospitals in South Africa.

Science.gov (United States)

Govender, Sagaren; Gerwel Proches, Cecile N; Kader, Abdulla

2018-01-01

Four public hospitals in South Africa, which render both specialized and nonspecialized services to thousands of patients, were examined to determine the impact of leadership on health care service delivery. These hospitals were inundated by various problems that were impacting negatively on health care service delivery. This research study aimed to gain a comprehensive understanding of the challenges, complexities and constraints facing public health care in KwaZulu-Natal (KZN) and to examine leadership as a strategy to enhance healthcare service delivery with a particular focus on four regional hospitals in the KZN Province. The mixed-method research approach was utilized. Purposive sampling and stratified random sampling were employed in the research setting, and in-depth, semistructured interviews and questionnaires were used to collect data. Data were analyzed using the Nvivo computer software package for in-depth interviews and the Statistical Package for the Social Sciences (SPSS) software for the quantitative analysis. The research findings showed that the current leadership framework adopted by the health care leaders in regional hospitals in KZN is weak and is contributing to poor health care service delivery. This study, therefore, aimed to address the current challenges and weaknesses that are impacting negatively on health care service delivery in regional hospitals in the KZN Province and made recommendations for improvement.

Testing of AWE (A) package design AWG 446Eu4 to IAEA (1985) Regulations Standard

International Nuclear Information System (INIS)

Cohen, L.R.

1990-10-01

This report gives details of the tests for normal transport (Type A tests) and accident conditions (Type B tests) carried out on the AWE(A) packaging assembly AWG 446Eu4 and demonstrates the ability of the packaging to remain leaktight after the tests with no damage to the contents. Included in the report are a comprehensive quality plan and test certificates for the leak tests. (author)

SUSTAINABLE PACKAGING SOLUTIONS FOR ORGANIC FRESH BERRIES

Directory of Open Access Journals (Sweden)

Elisabeta Elena TĂNASE

2017-12-01

Full Text Available Climate changes and particularly global warming are topics carefully treated by specialists already since decades. The most pregnant factor that influences climate change is pollution, namely the high level carbon dioxide emissions. Besides other substances used by the most of the industries (oil, charcoal, fertilizers, etc., plastics are not to be ignored when talking about pollution. Plastic waste affects animals and humans, as well as their habitat. In this respect, food industry engages in preserving the good functioning of the environment by developing and using biodegradable and bio-based resources for food packaging. The aim of this literature review was to identify the optimal sustainable packaging solution used for berries. The results of the study pointed out that the most used environmentally friendly packaging technique is the one that involves modified atmosphere. In terms of packaging materials, the literature is limited when it comes to biodegradable/bio-based solutions. However, active packaging gains popularity among researchers, considering the endless possibilities to include sustainable compounds in a biopolymer based matrix, in order to prolong the shelf-life of berries or fruits in general.

Food-packaging interactions influencing quality and safety.

Science.gov (United States)

Hotchkiss, J H

1997-01-01

Interactions between foods and packaging can be detrimental to quality and/or safety. Changes in product flavour due to aroma sorption and the transfer of undesirable flavours from packaging to foods are important mechanisms of deterioration when foods are packaged in polymer-based materials. Careful consideration must be given to those factors affecting such interactions when selecting packaging materials in order to maximize product quality, safety, and shelf-life while minimizing undesirable changes. Product considerations include sensitivity to flavour and related deteriorations, colour changes, vitamin loss, microbial activity, and amount of flavour available. Storage considerations include temperature, time, and processing method. Polymer considerations include type of polymer and processing method, volume or mass of polymer to product ratio, and whether the interaction is Fickian or non-Fickian. Methodology to determine the extent of such interactions must be developed. Direct interactions between food and packaging are not necessarily detrimental. The same principles governing undesirable interactions can be used to affect desirable outcomes. Examples include films which directly intercept or absorb oxygen, inhibit microorganisms, remove undesirable flavours by sorption, or indicate safety and product shelf-life.

Cost and Predictors of Hospitalizations for Ambulatory Care - Sensitive Conditions Among Medicaid Enrollees in Comprehensive Managed Care Plans

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William N. Mkanta

2016-09-01

Full Text Available Introduction: Preventable hospitalizations are responsible for increasing the cost of health care and reflect ineffectiveness of the health services in the primary care setting. The objective of this study was to assess expenditure for hospitalizations and utilize expenditure differentials to determine factors associated with ambulatory care - sensitive conditions (ACSCs hospitalizations. Methods: A cross-sectional study of hospitalizations among Medicaid enrollees in comprehensive managed care plans in 2009 was conducted. A total of 25 581 patients were included in the analysis. Expenditures on hospitalizations were examined at the 50th, 75th, 90th, and 95th expenditure percentiles both at the bivariate level and in the logistic regression model to determine the impact of differing expenditure on ACSC hospitalizations. Results: Compared with patients without ACSC admissions, a larger proportion of patients with ACSC hospitalizations required advanced treatment or died on admission. Overall mean expenditures were higher for the ACSC group than for non-ACSC group (US$18 070 vs US$14 452. Whites and blacks had higher expenditures for ACSC hospitalization than Hispanics at all expenditure percentiles. Patient’s age remained a consistent predictor of ACSC hospitalization across all expenditure percentiles. Patients with ACSC were less likely to have a procedure on admission; however, the likelihood decreased as expenditure percentiles increased. At the median expenditure, blacks and Hispanics were more likely than other race/ethnic groups to have ACSC hospitalizations (odds ratio [OR]: 1.307, 95% confidence interval [CI]: 1.013-1.686 and OR 1.252, 95% CI: 1.060-1.479, respectively. Conclusion: Future review of delivery and monitoring of services at the primary care setting should include managed care plans in order to enhance access and overall quality of care for optimal utilization of the resources.

Controlled trial of a collaborative primary care team model for patients with diabetes and depression: Rationale and design for a comprehensive evaluation

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Johnson Jeffrey A

2012-08-01

Full Text Available Abstract Background When depression accompanies diabetes, it complicates treatment, portends worse outcomes and increases health care costs. A collaborative care case-management model, previously tested in an urban managed care organization in the US, achieved significant reduction of depressive symptoms, improved diabetes disease control and patient-reported outcomes, and saved money. While impressive, these findings need to be replicated and extended to other healthcare settings. Our objective is to comprehensively evaluate a collaborative care model for comorbid depression and type 2 diabetes within a Canadian primary care setting. Methods/design We initiated the TeamCare model in four Primary Care Networks in Northern Alberta. The intervention involves a nurse care manager guiding patient-centered care with family physicians and consultant physician specialists to monitor progress and develop tailored care plans. Patients eligible for the intervention will be identified using the Patient Health Questionnaire-9 as a screen for depressive symptoms. Care managers will then guide patients through three phases: 1 improving depressive symptoms, 2 improving blood glucose, blood pressure and cholesterol, and 3 improving lifestyle behaviors. We will employ the RE-AIM framework for a comprehensive and mixed-methods approach to our evaluation. Effectiveness will be assessed using a controlled “on-off” trial design, whereby eligible patients would be alternately enrolled in the TeamCare intervention or usual care on a monthly basis. All patients will be assessed at baseline, 6 and 12 months. Our primary analyses will be based on changes in two outcomes: depressive symptoms, and a multivariable, scaled marginal model for the combined outcome of global disease control (i.e., A1c, systolic blood pressure, LDL cholesterol. Our planned enrolment of 168 patients will provide greater than 80% power to observe clinically important improvements in all

Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study

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Saikia Udoy

2009-02-01

Full Text Available Abstract Background Due to the multifaceted aspect of child malnutrition, a comprehensive approach, taking social factors into account, has been frequently recommended in health literature. The Alma-Ata declaration explicitly outlined comprehensive primary health care as an approach that addresses the social, economic and political causes of poor health and nutrition. Iran as a signatory country to the Alma Ata Declaration has established primary health care since 1979 with significant progress on many health indicators during the last three decades. However, the primary health care system is still challenged to reduce inequity in conditions such as child malnutrition which trace back to social factors. This study aimed to explore the perceptions of the Iranian health stakeholders with respect to the Iranian primary health care performance and actions to move towards a comprehensive approach in addressing childhood malnutrition. Health stakeholders are defined as those who affect or can be affected by health system, for example health policy-makers, health providers or health service recipients. Methods Stakeholder analysis approach was undertaken using a qualitative research method. Different levels of stakeholders, including health policy-makers, health providers and community members were interviewed as either individuals or focus groups. Qualitative content analysis was used to interpret and compare/contrast the viewpoints of the study participants. Results The results demonstrated that fundamental differences exist in the perceptions of different health stakeholders in the understanding of comprehensive notion and action. Health policy-makers mainly believed in the need for a secure health management environment and the necessity for a whole of the government approach to enhance collaborative action. Community health workers, on the other hand, indicated that staff motivation, advocacy and involvement are the main challenges need to be

Safety Analysis Report - Packages, 9965, 9968, 9972-9975 Packages

International Nuclear Information System (INIS)

Blanton, P.

2000-01-01

This Safety Analysis Report for Packaging (SARP) documents the analysis and testing performed on four type B Packages: the 9972, 9973, 9974, and 9975 packages. Because all four packages have similar designs with very similar performance characteristics, all of them are presented in a single SARP. The performance evaluation presented in this SARP documents the compliance of the 9975 package with the regulatory safety requirements. Evaluations of the 9972, 9973, and 9974 packages support that of the 9975. To avoid confusion arising from the inclusion of four packages in a single document, the text segregates the data for each package in such a way that the reader interested in only one package can progress from Chapter 1 through Chapter 9. The directory at the beginning of each chapter identifies each section that should be read for a given package. Sections marked ''all'' are generic to all packages

Destructive examination of shipping package 9975-02644

Energy Technology Data Exchange (ETDEWEB)

Daugherty, W. L. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

2017-11-23

Destructive and non-destructive examinations have been performed on the components of shipping package 9975-02644 as part of a comprehensive SRS surveillance program for plutonium material stored in the K-Area Complex (KAC). During the field surveillance inspection of this package in KAC, three non-conforming conditions were noted: the axial gap of 1.389 inch exceeded the 1 inch maximum criterion, the exposed height of the lead shield was greater than the 4.65 inch maximum criterion, and the difference between the upper assembly inside height and the exposed height of the lead shield was less than the 0.425 inch minimum criterion. All three of these observations relate to axial shrinkage of the lower fiberboard assembly. In addition, liquid water (condensation) was observed on the interior of the drum lid, the thermal blanket and the air shield.

Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions

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Aaron L. Leppin

2015-01-01

Full Text Available An increasing proportion of healthcare resources in the United States are directed toward an expanding group of complex and multimorbid patients. Federal stakeholders have called for new models of care to meet the needs of these patients. Minimally Disruptive Medicine (MDM is a theory-based, patient-centered, and context-sensitive approach to care that focuses on achieving patient goals for life and health while imposing the smallest possible treatment burden on patients’ lives. The MDM Care Model is designed to be pragmatically comprehensive, meaning that it aims to address any and all factors that impact the implementation and effectiveness of care for patients with multiple chronic conditions. It comprises core activities that map to an underlying and testable theoretical framework. This encourages refinement and future study. Here, we present the conceptual rationale for and a practical approach to minimally disruptive care for patients with multiple chronic conditions. We introduce some of the specific tools and strategies that can be used to identify the right care for these patients and to put it into practice.

Quality assurance inspections in the transportation packaging supplier industry

International Nuclear Information System (INIS)

Jankovich, J.P.

1991-01-01

In this paper the quality assurance inspections of the transportation packaging supplier industry, conducted by the U.S. Nuclear Regulatory Commission (NRC) on a routine basis since 1989 are discussed. The term supplier is used to include designers, fabricators, and distributors that hold NRC approved Quality Assurance Programs and Certificates of Compliance for packagings to transport radioactive materials. The objective of the inspections is to provide assurance that transportation packagings are fabricated and procured in accordance with 10 CFR Parts 21 and 71 requirements. The inspections are conducted in a systematic and comprehensive manner, utilizing uniform inspection techniques in order to assure uniformity and comparability. During the April 1989 and May 1991 period approximately 21 inspections were conducted by the Transportation Branch, Office of Nuclear Material Safety and Safeguards of the NRC. The majority of the findings were identified in the areas of quality assurance procedures, control of special processes (e.g. welding, radiography), and maintenance of QA records

Efficiency of an intervention package for arterial hypertension ...

African Journals Online (AJOL)

. We implemented and evaluated the effectiveness of an intervention package comprising telecare as a mean for improving the outcomes of care for hypertension in Rural Sub-Saharan Africa. Methods: The study involved a telemedicine center ...

Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

Science.gov (United States)

2017-01-03

This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

Destructive Examination of Shipping Package 9975-02019

Energy Technology Data Exchange (ETDEWEB)

Daugherty, W. L. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

2016-06-13

Destructive and non-destructive examinations have been performed on the components of shipping package 9975-02019 as part of a comprehensive SRS surveillance program for plutonium material stored in the K-Area Complex (KAC). During the field surveillance inspection of this package in KAC, two non-conforming conditions were noted: the axial gap of 1.577 inch exceeded the 1 inch maximum criterion, and two areas of dried glue residue were noted on the upper fiberboard subassembly. This package was subsequently transferred to SRNL for more detailed inspection and destructive examination. In addition to the conditions noted in KAC, the following conditions were noted: - Numerous small spots of corrosion were observed along the bottom edge of the drum. - In addition to the smeared glue residue on the upper fiberboard subassembly, there was also a small dark stain. - Mold was present on the side and bottom of the lower fiberboard subassembly. Dark stains from elevated moisture content were also present in these areas. - A dark spot with possible light corrosion was observed on the primary containment vessel flange, and corresponding rub marks were observed on the secondary containment vessel ID. - The fiberboard thermal conductivity in the radial orientation was above the specified range. When the test was repeated with slightly lower moisture content, the result was acceptable. The moisture content for both tests was within a range typical of other packages in storage. The observed conditions must be fully evaluated by KAC to ensure the safety function of the package is being maintained. Several factors can contribute to the concentration of moisture in the fiberboard, including higher than average initial moisture content, higher internal temperature (due to internal heat load and placement within the array of packages), and the creation of additional moisture as the fiberboard begins to degrade.

Building Bivariate Tables: The compareGroups Package for R

Directory of Open Access Journals (Sweden)

Isaac Subirana

2014-05-01

Full Text Available The R package compareGroups provides functions meant to facilitate the construction of bivariate tables (descriptives of several variables for comparison between groups and generates reports in several formats (LATEX, HTML or plain text CSV. Moreover, bivariate tables can be viewed directly on the R console in a nice format. A graphical user interface (GUI has been implemented to build the bivariate tables more easily for those users who are not familiar with the R software. Some new functions and methods have been incorporated in the newest version of the compareGroups package (version 1.x to deal with time-to-event variables, stratifying tables, merging several tables, and revising the statistical methods used. The GUI interface also has been improved, making it much easier and more intuitive to set the inputs for building the bivariate tables. The ?rst version (version 0.x and this version were presented at the 2010 useR! conference (Sanz, Subirana, and Vila 2010 and the 2011 useR! conference (Sanz, Subirana, and Vila 2011, respectively. Package compareGroups is available from the Comprehensive R Archive Network at http://CRAN.R-project.org/package=compareGroups.

Providing inbuilt economic resilience options : an obligation of comprehensive cancer care.

Science.gov (United States)

Cross, Eva Reitschuler; Emanuel, Linda

2008-12-15

For many, a cancer death in the family is the immediately obvious part of what is actually a double devastation. Overwhelming financial damage also results for many families, from the cost of medical care and from the loss of earning power by the patient and family. For some families, the consequences may be multigenerational and can affect the health of the survivors. Although this situation is not limited to cancer, the authors argue that oncology can take a lead in attending to these consequences of cancer as an integral part of its commitment to comprehensive cancer care. They make this case for both the national and the international settings. They also articulate and illustrate the notion of inbuilt options for economic resilience (IERs), which the authors suggest the medical industry, and its cancer care sectors in particular, should be providing to all patients and their families if they are at risk for damaging financial losses. After describing key features to IER, the authors illustrate it with 1 type of approach for households of the terminally ill: hospice care with provision of supplementary training and certification to the family caregiver. Such programming could generate a low-technology, semiskilled healthcare service economy as trained family caregivers provide support to other households in need, thereby both providing a recovery option for themselves and reduced economic devastation to the households which, by receiving the services, can stay in the workforce. Finally, the authors call for invigorated research on the economic impact of cancer on families and for the modeling, demonstration, and study of options for economic resilience, including IER programs.

Ionising radiation effects on food packaging

International Nuclear Information System (INIS)

Ragni, P.; Segre, A. L.; Capitani, D.; Danesi, P.R.

2001-01-01

The main aim of any food irradiation treatment is to guarantee the best safe quality of the products, reducing the spreading risk ( c ross-contamination ) for several food-associated diseases. Actually, over 40 countries provide clearances for the treatment of about 45 different types of foodstuffs. EU has to homogenise the situation within the associated States. With the European directive 1999/2/EC Italy, as other EU countries, already has brought into force their regulations to comply. The current Italian regulation on irradiation treatment of foodstuffs is referred since 1996 as follows: a) potatoes, onions and garlic; b) spices, herbs and condiments microbial. The new (April 2001) Italian law allows the possibility to ask for special permission of treatment for other foodstuff which is possible to treat in other E.U. countries. Large majority of foods are submitted to irradiation treatment after they have been packaged. In Dutch cases the study of radiation effects on the package becomes crucial, also because polymeric materials may be affected by ionizing radiation. We performed our studies on several materials employed in food packaging, with a particular care to the role of anti-oxidant additives present in food packaging materials. The attention is pointed on the possible chemical-physical effects induced by radiation on foodstuff packaging. After irradiation in plastic materials two main effects may occur: degradation and cross-linking. The result depending on the comparative rates of the two actions. This kind of information was successfully obtained using NMR methods on a large number of polymers effectively used for the food packaging procedures

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

Science.gov (United States)

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Comprehensive stroke units: a review of comparative evidence and experience.

Science.gov (United States)

Chan, Daniel K Y; Cordato, Dennis; O'Rourke, Fintan; Chan, Daniel L; Pollack, Michael; Middleton, Sandy; Levi, Chris

2013-06-01

Stroke unit care offers significant benefits in survival and dependency when compared to general medical ward. Most stroke units are either acute or rehabilitation, but comprehensive (combined acute and rehabilitation) model (comprehensive stroke unit) is less common. To examine different levels of evidence of comprehensive stroke unit compared to other organized inpatient stroke care and share local experience of comprehensive stroke units. Cochrane Library and Medline (1980 to December 2010) review of English language articles comparing stroke units to alternative forms of stroke care delivery, different types of stroke unit models, and differences in processes of care within different stroke unit models. Different levels of comparative evidence of comprehensive stroke units to other models of stroke units are collected. There are no randomized controlled trials directly comparing comprehensive stroke units to other stroke unit models (either acute or rehabilitation). Comprehensive stroke units are associated with reduced length of stay and greatest reduction in combined death and dependency in a meta-analysis study when compared to other stroke unit models. Comprehensive stroke units also have better length of stay and functional outcome when compared to acute or rehabilitation stroke unit models in a cross-sectional study, and better length of stay in a 'before-and-after' comparative study. Components of stroke unit care that improve outcome are multifactorial and most probably include early mobilization. A comprehensive stroke unit model has been successfully implemented in metropolitan and rural hospital settings. Comprehensive stroke units are associated with reductions in length of stay and combined death and dependency and improved functional outcomes compared to other stroke unit models. A comprehensive stroke unit model is worth considering as the preferred model of stroke unit care in the planning and delivery of metropolitan and rural stroke services

Creating a Roadmap for Delivering Gender-sensitive Comprehensive Care for Women Veterans: Results of a National Expert Panel

NARCIS (Netherlands)

Kleijn, M.J.J. de; Lagro-Janssen, A.L.M.; Canelo, I.; Yano, E.M.

2015-01-01

BACKGROUND: Women Veterans are a significant minority of users of the VA healthcare system, limiting provider and staff experience meeting their needs in environments historically designed for men. The VA is nonetheless committed to ensuring that women Veterans have access to comprehensive care in

The basic benefit package: composition and exceptions to the rules. A case study.

NARCIS (Netherlands)

Kroneman, M.; Jong, J.D. de

2015-01-01

With the introduction of the Health Insurance Act in 2006 in the Netherlands, the basic package of the former sickness funds became valid for all citizens. The basic benefit package has been subject to change, responding to increasing health care expenditures, medical innovations and the economic

A Comprehensive Child Development Program; Title XX, Final Report.

Science.gov (United States)

Whatley, Juanita T.

This booklet describes the Comprehensive Child Day Care Program for the Atlanta Public School System, a Title XX Program. This program provided day care services for children of clients in various categories. The program goals for 1975-76 were geared toward providing comprehensive day care to encompass social services to the family and…

Current advance care planning practice in the Australian community: an online survey of home care package case managers and service managers.

Science.gov (United States)

Sellars, Marcus; Detering, Karen M; Silvester, William

2015-04-23

Advance care planning (ACP) is the process of planning for future healthcare that is facilitated by a trained healthcare professional, whereby a person's values, beliefs and treatment preferences are made known to guide clinical decision-making at a future time when they cannot communicate their decisions. Despite the potential benefits of ACP for community aged care clients the availability of ACP is unknown, but likely to be low. In Australia many of these clients receive services through Home Care Package (HCP) programs. This study aimed to explore current attitudes, knowledge and practice of advance care planning among HCP service managers and case managers. An invitation to take part in a cross-sectional online survey was distributed by email to all HCP services across Australia in November 2012. Descriptive analyses were used to examine overall patterns of responses to each survey item in the full sample. 120 (response rate 25%) service managers and 178 (response rate 18%) case managers completed the survey. Only 34% of services had written ACP policies and procedures in place and 48% of case managers had previously completed any ACP training. In addition, although most case managers (70%) had initiated an ACP discussion in the past 12 months and viewed ACP as part of their role, the majority of the conversations (80%) did not result in documentation of the client's wishes and most (85%) of the case managers who responded did not believe ACP was done well within their service. This survey shows low organisational ACP systems and support for case managers and a lack of a normative approach to ACP across Australian HCP services. As HCPs become more prevalent it is essential that a model of ACP is developed and evaluated in this setting, so that clients have the opportunity to discuss and document their future healthcare wishes if they choose to.

SU-E-T-673: Recent Developments and Comprehensive Validations of a GPU-Based Proton Monte Carlo Simulation Package, GPMC

International Nuclear Information System (INIS)

Qin, N; Tian, Z; Pompos, A; Jiang, S; Jia, X; Giantsoudi, D; Schuemann, J; Paganetti, H

2015-01-01

Purpose: A GPU-based Monte Carlo (MC) simulation package gPMC has been previously developed and high computational efficiency was achieved. This abstract reports our recent improvements on this package in terms of accuracy, functionality, and code portability. Methods: In the latest version of gPMC, nuclear interaction cross section database was updated to include data from TOPAS/Geant4. Inelastic interaction model, particularly the proton scattering angle distribution, was updated to improve overall simulation accuracy. Calculation of dose averaged LET (LETd) was implemented. gPMC was ported onto an OpenCL environment to enable portability across different computing devices (GPUs from different vendors and CPUs). We also performed comprehensive tests of the code accuracy. Dose from electro-magnetic (EM) interaction channel, primary and secondary proton doses and fluences were scored and compared with those computed by TOPAS. Results: In a homogeneous water phantom with 100 and 200 MeV beams, mean dose differences in EM channel computed by gPMC and by TOPAS were 0.28% and 0.65% of the corresponding maximum dose, respectively. With the Geant4 nuclear interaction cross section data, mean difference of primary proton dose was 0.84% for the 200 MeV case and 0.78% for the 100 MeV case. After updating inelastic interaction model, maximum difference of secondary proton fluence and dose were 0.08% and 0.5% for the 200 MeV beam, and 0.04% and 0.2% for the 100 MeV beam. In a test case with a 150MeV proton beam, the mean difference between LETd computed by gPMC and TOPAS was 0.96% within the proton range. With the OpenCL implementation, gPMC is executable on AMD and Nvidia GPUs, as well as on Intel CPU in single or multiple threads. Results on different platforms agreed within statistical uncertainty. Conclusion: Several improvements have been implemented in the latest version of gPMC, which enhanced its accuracy, functionality, and code portability

SU-E-T-673: Recent Developments and Comprehensive Validations of a GPU-Based Proton Monte Carlo Simulation Package, GPMC

Energy Technology Data Exchange (ETDEWEB)

Qin, N; Tian, Z; Pompos, A; Jiang, S; Jia, X [UT Southwestern Medical Center, Dallas, TX (United States); Giantsoudi, D; Schuemann, J; Paganetti, H [Massachusetts General Hospital, Boston, MA (United States)

2015-06-15

Purpose: A GPU-based Monte Carlo (MC) simulation package gPMC has been previously developed and high computational efficiency was achieved. This abstract reports our recent improvements on this package in terms of accuracy, functionality, and code portability. Methods: In the latest version of gPMC, nuclear interaction cross section database was updated to include data from TOPAS/Geant4. Inelastic interaction model, particularly the proton scattering angle distribution, was updated to improve overall simulation accuracy. Calculation of dose averaged LET (LETd) was implemented. gPMC was ported onto an OpenCL environment to enable portability across different computing devices (GPUs from different vendors and CPUs). We also performed comprehensive tests of the code accuracy. Dose from electro-magnetic (EM) interaction channel, primary and secondary proton doses and fluences were scored and compared with those computed by TOPAS. Results: In a homogeneous water phantom with 100 and 200 MeV beams, mean dose differences in EM channel computed by gPMC and by TOPAS were 0.28% and 0.65% of the corresponding maximum dose, respectively. With the Geant4 nuclear interaction cross section data, mean difference of primary proton dose was 0.84% for the 200 MeV case and 0.78% for the 100 MeV case. After updating inelastic interaction model, maximum difference of secondary proton fluence and dose were 0.08% and 0.5% for the 200 MeV beam, and 0.04% and 0.2% for the 100 MeV beam. In a test case with a 150MeV proton beam, the mean difference between LETd computed by gPMC and TOPAS was 0.96% within the proton range. With the OpenCL implementation, gPMC is executable on AMD and Nvidia GPUs, as well as on Intel CPU in single or multiple threads. Results on different platforms agreed within statistical uncertainty. Conclusion: Several improvements have been implemented in the latest version of gPMC, which enhanced its accuracy, functionality, and code portability.

Packaging Solutions : Delivering customer value through Logistical Packaging: A Case Study at Stora Enso Packaging

OpenAIRE

Shan, Kun; Julius, Joezer

2015-01-01

AbstractBackground;Despite of the significant role of packaging within logistics and supply chain management, packaging is infrequently studied as focal point in supply chain. Most of the previous logistics research studies tend to explain the integration between packaging and logistics through logistical packaging. In very rare cases, the studies mentioned about customer value. Therefore the major disadvantage of these studies is that, they didn’t consider logistical packaging and customer v...

Development of antifungal films based on low-density polyethylene and thyme oil for avocado packaging

CSIR Research Space (South Africa)

Kesavan Pillai, Sreejarani

2015-10-01

Full Text Available Trilayer low-density polyethylene (LDPE) films were prepared by incorporating varying concentrations of thyme oil, as the antifungal active additive for avocado packaging. A comprehensive thermal, structural, mechanical, and functional...

Type of oral solid medication packaging and medication preparation time in nursing homes: A direct observation study.

Science.gov (United States)

Cready, C M; Hudson, C; Dreyer, K

2017-12-01

Medication administration is a substantial portion of the workday in nursing homes, with the medication preparation step being the most time-consuming. However, little is known about how medication preparation time is affected by the type of packaging used for oral solid medications (ie, tablets/capsules). We examined the effects of two types of packaging. As fewer steps are associated with strip packaging compared to bingo card packaging, we hypothesized that the increase in medication preparation seconds per resident with each additional oral solid medication would be smaller when strip packaging was used. A total of 430 medication preparations conducted by eight nurses during the regularly scheduled morning medication administration period in two nursing homes-using strip packaging and bingo card packaging, respectively-were observed. Each medication preparation observation was matched to its corresponding medication administration record and observations averaged across resident. Using the resident sample (N=149), we estimated three regression models (adjusting the standard errors for the clustering of resident by nurse). The first model regressed medication preparation seconds on the number of oral solid medications. The second model added the type of packaging used and the control variables (type of unit [long-term care, post-acute care], the number of one-half pills and the dosage form diversity in the preparation). To test our hypothesis, the third model added an interaction term between the number of oral solid medications and the type of packaging used. As hypothesized, all else equal, the number of oral solid medications tended to increase medication preparation time per resident in both nursing homes, but the increase was smaller in the strip packaging nursing home (Ppackaging nursing home increased medication preparation by an average of 13 seconds (b=13.077), whereas each oral solid medication administered in the strip packaging nursing home

Examining leadership as a strategy to enhance health care service delivery in regional hospitals in South Africa

Science.gov (United States)

Govender, Sagaren; Gerwel Proches, Cecile N; Kader, Abdulla

2018-01-01

Background Four public hospitals in South Africa, which render both specialized and nonspecialized services to thousands of patients, were examined to determine the impact of leadership on health care service delivery. These hospitals were inundated by various problems that were impacting negatively on health care service delivery. Purpose This research study aimed to gain a comprehensive understanding of the challenges, complexities and constraints facing public health care in KwaZulu-Natal (KZN) and to examine leadership as a strategy to enhance healthcare service delivery with a particular focus on four regional hospitals in the KZN Province. Methods The mixed-method research approach was utilized. Purposive sampling and stratified random sampling were employed in the research setting, and in-depth, semistructured interviews and questionnaires were used to collect data. Data were analyzed using the Nvivo computer software package for in-depth interviews and the Statistical Package for the Social Sciences (SPSS) software for the quantitative analysis. Results The research findings showed that the current leadership framework adopted by the health care leaders in regional hospitals in KZN is weak and is contributing to poor health care service delivery. Conclusion This study, therefore, aimed to address the current challenges and weaknesses that are impacting negatively on health care service delivery in regional hospitals in the KZN Province and made recommendations for improvement. PMID:29535529

Packaging fluency

DEFF Research Database (Denmark)

Mocanu, Ana; Chrysochou, Polymeros; Bogomolova, Svetlana

2011-01-01

Research on packaging stresses the need for packaging design to read easily, presuming fast and accurate processing of product-related information. In this paper we define this property of packaging as “packaging fluency”. Based on the existing marketing and cognitive psychology literature on pac...

Effects of ionizing radiation on food packaging materials and quality

International Nuclear Information System (INIS)

Welle, F.; Franz, R.

1999-01-01

Tests have shown that ionizing radiation induces a characteristic smell in the packaging laminates which also affects the simulated foods used, which however were relatively neutral in flavour, so that the tests represent the worst case. The paper explains that due to the various additives used in the production of the plastic packaging materials, the same types of polymers may react differently to the ionizing radiation, so that the results obtained from the tests are not suitable for general application. It is recommended to very carefully select the suitable packaging material for given foods and intended irradiation processes. Aspects of particular importance are discusses. (orig./CB) [de

Green Composites Made of Bamboo Fabric and Poly (Lactic) Acid for Packaging Applications—A Review

Science.gov (United States)

Nurul Fazita, M.R.; Jayaraman, Krishnan; Bhattacharyya, Debes; Mohamad Haafiz, M.K.; Saurabh, Chaturbhuj K.; Hussin, M. Hazwan; H.P.S., Abdul Khalil

2016-01-01

Petroleum based thermoplastics are widely used in a range of applications, particularly in packaging. However, their usage has resulted in soaring pollutant emissions. Thus, researchers have been driven to seek environmentally friendly alternative packaging materials which are recyclable as well as biodegradable. Due to the excellent mechanical properties of natural fibres, they have been extensively used to reinforce biopolymers to produce biodegradable composites. A detailed understanding of the properties of such composite materials is vital for assessing their applicability to various products. The present review discusses several functional properties related to packaging applications in order to explore the potential of bamboo fibre fabric-poly (lactic) acid composites for packaging applications. Physical properties, heat deflection temperature, impact resistance, recyclability and biodegradability are important functional properties of packaging materials. In this review, we will also comprehensively discuss the chronological events and applications of natural fibre biopolymer composites. PMID:28773558

Comprehensive care of elderly patients with hip fracture: the orthogeriatric model

Directory of Open Access Journals (Sweden)

Carlo Frondini

2013-04-01

Full Text Available Introduction: Hip fractures in the elderly are a major source of morbidity and mortality. Interdisciplinary hospital care models proposed for the treatment of these patients include consultant teams, integrated orthopedic-geriatric care, and comprehensive geriatric-led care settings. A prospective interventional cohort study was conducted in 4 public hospitals in the Emilia-Romagna Region of Italy to compare the outcomes of these different care models. This report presents the preliminary results obtained with an orthogeriatric model in one of these centers, a large teaching hospital in Bologna. Materials and methods: Beginning in February 2008, all patients older than 75 years admitted to the University of Bologna’s Sant’Orsola-Malpighi Hospital for hip fractures were cared for in an orthogeriatric unit. The unit consisted of 10 beds in the orthopedic ward that were managed by a geriatric specialist and a multidisciplinary team, which met daily and included an orthopedic surgeon, a physiatrist, a nurse case-manager, staff nurses, a physical therapist, and a social worker. The management protocol included a thorough geriatric work-up to identify comorbidities and risk factors, systematic assessment and prevention of pain and acute disorientation, early verticalization and moblization, postacute rehabilitation therapy, family support, and regular follow-up after discharge. Preliminary results were compared with those achieved in the same orthopedic ward prior to the creation of the Orthogeriatric Unit. Results: During 2008, 226 elderly patients (mean age 86.2 + 5.5 years, 73.4% of whom were women, were admitted to the Orthogeriatric Unit for hip fractures. The mean Charlson comorbidity index of this cohort was 3.0 + 1.8. Half the patients had Activity of Daily Living scores < 4, and cognitive impairment was common (mean score on Short Portable Mental Status Questionnaire: 5.9 + 3.2. Compared with figures obtained in the hospital�

Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas

DEFF Research Database (Denmark)

Duda, Stephany N; Farr, Amanda M; Lindegren, Mary Lou

2014-01-01

in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed...... a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. RESULTS: Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating...... services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics...

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

Directory of Open Access Journals (Sweden)

Janya McCalman

2018-03-01

Full Text Available Continuous quality improvement (CQI processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

Science.gov (United States)

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271

Microelectronic packaging

CERN Document Server

Datta, M; Schultze, J Walter

2004-01-01

Microelectronic Packaging analyzes the massive impact of electrochemical technologies on various levels of microelectronic packaging. Traditionally, interconnections within a chip were considered outside the realm of packaging technologies, but this book emphasizes the importance of chip wiring as a key aspect of microelectronic packaging, and focuses on electrochemical processing as an enabler of advanced chip metallization.Divided into five parts, the book begins by outlining the basics of electrochemical processing, defining the microelectronic packaging hierarchy, and emphasizing the impac

Civilian use transport of radioactive substances on public road. Volume 1: Shipment accreditation and approval requests. Guide Nr 7, Revision 2 of 15 February 2016. Volume 2: safety file of package models, European guide 'Package Design Safety Report'. Civilian use transport of radioactive packages or substances on public road. Volume 3: Compliance of package models not subject to accreditation. Guide Nr 7, Revision 7 of the 2015/11/13

International Nuclear Information System (INIS)

2016-01-01

After having recalled the regulatory context and sanctions susceptible to be applied, the first volume presents the accreditation process for a package model: file content, tests programme, safety file, certification studies, documents to be produced, accreditation prorogation request, accreditation extension or package model modifications, instruction delays. Some peculiar cases are described. Models of accreditation certificate are provided, and obligations concerning packaging design, fabrication, use and maintenance are briefly discussed. The second volume is a European technical guide which is intended to assist in the preparation of the Package Design Safety Report (PDSR) to demonstrate compliance of a package design for the transport of radioactive material with the regulatory requirements. It covers package designs requiring competent authority approval, and also covers package designs not requiring competent authority approval. In its first two chapters, this document provides a generic structure and contents of a PDSR which applies to all package types. The contents are described in a comprehensive way to cover all important aspects. Some of these aspects may not be applicable to specific package type and details can be found in the annexes which provide further guidance for the scope of the contents of a PDSR, specifically for each package type. The third volume presents recommendations made by the ASN for all stakeholders to guarantee the compliance to regulation of package models which are 'not submitted to competent authority approval'. After an indication and a comment of the regulatory context, it presents requirements to be applied for the design of those package models, and then describes and comments the structure and content of a safety file for such package models (generalities, authorised contents, packaging description, safety demonstration, receipt, use and maintenance instruction, management system). The last part presents the

Health Information Technology Evaluation Framework (HITREF) Comprehensiveness as Assessed in Electronic Point-of-Care Documentation Systems Evaluations.

Science.gov (United States)

Sockolow, Paulina S; Bowles, Kathryn H; Rogers, Michelle

2015-01-01

We assessed the Health Information Technology (HIT) Reference-based Evaluation Framework (HITREF) comprehensiveness in two HIT evaluations in settings different from that in which the HITREF was developed. Clinician satisfaction themes that emerged from clinician interviews in the home care and the hospital studies were compared to the framework components. Across both studies, respondents commented on 12 of the 20 HITREF components within 5 of the 6 HITREF concepts. No new components emerged that were missing from the HITREF providing evidence that the HITREF is a comprehensive framework. HITREF use in a range of HIT evaluations by researchers new to the HITREF demonstrates that it can be used as intended. Therefore, we continue to recommend the HITREF as a comprehensive, research-based HIT evaluation framework to increase the capacity of informatics evaluators' use of best practice and evidence-based practice to support the credibility of their findings for fulfilling the purpose of program evaluation.

Measuring comprehensive outcomes in palliative care: validation of the Korean version of the Good Death Inventory.

Science.gov (United States)

Shin, Dong Wook; Choi, JiEun; Miyashita, Mitsunori; Choi, Jin Young; Kang, Jina; Baik, Young Ji; Mo, Ha Na; Choi, Jong Soon; Son, Young Sun; Lee, Hae Sook

2011-10-01

No systematic or comprehensive attempts have yet been made to assess quality of death as an indicator of palliative care outcomes in Korea, and no validated instruments exist for the assessment of a good death in Koreans. This study examined the validity and reliability of the Korean version of the Good Death Inventory (GDI), which was developed in Japan to evaluate the quality of death from the perspective of bereaved family members. Forward and backward translations and a pilot test were conducted. In a multicenter cross-sectional survey, a questionnaire packet, including the GDI, overall quality of life during the last week, and overall satisfaction with care, was mailed to bereaved family members (n=501) of patients who had died from cancer two to six months before the study. Descriptive analyses were performed, including response rate, mean, median, skewness, and kurtosis for each item. The reliability of the GDI was tested by Cronbach's alpha. The dimensional structure was assessed using confirmatory factor analyses. Concurrent validity was tested by correlation with the overall quality of life and overall satisfaction with care. Participants were able to complete the GDI, and the compliance rates were satisfactory. Cronbach's alpha coefficient for internal consistency was 0.93 overall and ranged from 0.69 to 0.94 for subdomains. The hypothesized 18-factor model of a good death appeared to fit the data (goodness of fit index [GFI]=0.964; adjusted GFI index=0.960; normal fit index=0.952). The overall scores on the GDI correlated with patients' quality of life (0.56; P<0.001) and overall satisfaction with care (0.44; P<0.001). The Korean version of the GDI is a reliable and valid measure of the comprehensive outcomes of palliative care from the perspective of bereaved Korean family members. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

The Packaging Handbook -- A guide to package design

International Nuclear Information System (INIS)

Shappert, L.B.

1995-01-01

The Packaging Handbook is a compilation of 14 technical chapters and five appendices that address the life cycle of a packaging which is intended to transport radioactive material by any transport mode in normal commerce. Although many topics are discussed in depth, this document focuses on the design aspects of a packaging. The Handbook, which is being prepared under the direction of the US Department of Energy, is intended to provide a wealth of technical guidance that will give designers a better understanding of the regulatory approval process, preferences of regulators in specific aspects of packaging design, and the types of analyses that should be seriously considered when developing the packaging design. Even though the Handbook is concerned with all packagings, most of the emphasis is placed on large packagings that are capable of transporting large radioactive sources that are also fissile (e.g., spent fuel). These are the types of packagings that must address the widest range of technical topics in order to meet domestic and international regulations. Most of the chapters in the Handbook have been drafted and submitted to the Oak Ridge National Laboratory for editing; the majority of these have been edited. This report summarizes the contents

Benchmarking comprehensive cancer care

NARCIS (Netherlands)

Wind, Anke

2017-01-01

The number of cancer patients and survivors is steadily increasing and despite or perhaps because of rapid improvements in diagnostics and therapeutics, important inequalities in cancer survival exist within and between different countries in Europe. Improving the quality of care is part of the

Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

Science.gov (United States)

Ekerstad, Niklas; Karlson, Björn W; Dahlin Ivanoff, Synneve; Landahl, Sten; Andersson, David; Heintz, Emelie; Husberg, Magnus; Alwin, Jenny

2017-01-01

The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. This is a clinical, prospective, randomized, controlled, one-center intervention study. This study was conducted in a large county hospital in western Sweden. The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14-0.79), ambulation (OR =0.19, 95% CI =0.1-0.37), dexterity (OR =0.38, 95% CI =0.19-0.75), emotion (OR =0.43, 95% CI =0.22-0.84), cognition (OR = 0.076, 95% CI =0.033-0.18) and pain (OR =0.28, 95% CI =0.15-0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32-0.96), and the two groups did not differ significantly in terms of hospital care costs ( P >0.05). Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost.

Bridging the gap in ageing: Translating policies into practice in Malaysian Primary Care

Directory of Open Access Journals (Sweden)

Ambigga Krishnapillai S

2011-03-01

Full Text Available Abstract Population ageing is poised to become a major challenge to the health system as Malaysia progresses to becoming a developed nation by 2020. This article aims to review the various ageing policy frameworks available globally; compare aged care policies and health services in Malaysia with Australia; and discuss various issues and challenges in translating these policies into practice in the Malaysian primary care system. Fundamental solutions identified to bridge the gap include restructuring of the health care system, development of comprehensive benefit packages for older people under the national health financing scheme, training of the primary care workforce, effective use of electronic medical records and clinical guidelines; and empowering older people and their caregivers with knowledge, skills and positive attitudes to ageing and self care. Ultimately, family medicine specialists must become the agents for change to lead multidisciplinary teams and work with various agencies to ensure that better coordination, continuity and quality of care are eventually delivered to older patients across time and settings.

Assessment and Management of Psychosocial Needs: Social Work Utilization in Comprehensive Cleft Team Care.

Science.gov (United States)

Kaye, Alison; Lybrand, Sandra; Chew, William L

2018-01-01

To determine family-reported psychosocial stressors and social worker assessments and interventions within a comprehensive cleft team. Single-institution prospective provider-completed survey. Four hundred one families seen by cleft team social worker over a 7-month period. Most families (n = 331; 83%) participated in the team social work assessment. At least 1 active psychosocial stressor was reported by 238 (72%) families, with 63 (19%) families reported 3 or more stressors. There were 34 types of stressors reported. Most common were financial strain, young age of patient, new cleft diagnosis, and distance from clinic (57% of families live over an hour away). Family structure and home environment were assessed in detail for 288 (87%) families. Detailed assessments for access to care and behavioral/developmental issues also figured prominently. Social work interventions were provided in 264 (80%) of the visits, of which 91 were for families of new patients with over half who had infants less than 3 months old. Of the 643 interventions provided, the most frequent were parent mental health screens and counseling, early intervention referrals, transportation assistance, securing local hotel discounts, orthodontic referrals, and orthodontic cost coverage. Approximately 10% of encounters required follow-up contact related to the psychosocial concerns identified in clinic. The inclusion of a cleft team social worker is a critical component of comprehensive cleft team care as evidenced by the large proportion of families who required assistance. Ongoing social work assessments are recommended for each patient to help address the variety of psychosocial stressors families face.

An essential hospital package for South Africa--selection criteria, costs and affordability.

Science.gov (United States)

Söderlund, N

1999-07-01

In 1995 the Committee of Enquiry into National Health Insurance (NHI) recommended that formally employed individuals and their employers be required to fund at least a minimum package of hospital cover for workers and their dependents. This has recently been echoed in a Department of Health policy paper on social health insurance. This research aims to define and cost a minimum package of essential hospital care for competing (public and private) health insurers in South Africa. CRITERIA FOR PACKAGE DEFINITION: Based on the objectives implict in the NHI Committee report, the following criteria were used to define the essential package: (i) the extent to which there was another appropriate responsible party who should pay for treatment; (ii) the degree of discretion in deciding whether or not to provide treatment (roughly equivalent to 'urgency'); and (iii) the cost and effectiveness of treatment. On the basis of the above criteria, 396 out of 598 possible interventions were included in the package. Using local mine hospital and private sector utilisation rates and mine hospital cost data, it was estimated that the essential inpatient package would cost around R502 per enrollee per year, using 1998 prices, for a working age population and their dependents. Age-sex standardised outpatient care costs in the mine hospital population studied were estimated at R183 per person per year. It was therefore estimated that the total inpatient and outpatient hospital package would cost around R685 per person per year. The results presented in this paper are intended to inform the process of defining a national essential hospital benefit package. Assuming that contributions were proportionally related to income, and that costs should not exceed 6% of wages, the package should be affordable to all of those earning above R20,000 per year. Significant additional work is required, firstly at a technical level to assess the appropriateness of the prioritization approach used here

gamboostLSS: An R Package for Model Building and Variable Selection in the GAMLSS Framework

Directory of Open Access Journals (Sweden)

Benjamin Hofner

2016-10-01

Full Text Available Generalized additive models for location, scale and shape are a flexible class of regression models that allow to model multiple parameters of a distribution function, such as the mean and the standard deviation, simultaneously. With the R package gamboostLSS, we provide a boosting method to fit these models. Variable selection and model choice are naturally available within this regularized regression framework. To introduce and illustrate the R package gamboostLSS and its infrastructure, we use a data set on stunted growth in India. In addition to the specification and application of the model itself, we present a variety of convenience functions, including methods for tuning parameter selection, prediction and visualization of results. The package gamboostLSS is available from the Comprehensive R Archive Network (CRAN at https://CRAN.R-project.org/package=gamboostLSS.

Comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination to prevent functional decline in community-dwelling older persons: protocol of a cluster randomized trial

Directory of Open Access Journals (Sweden)

Suijker Jacqueline J

2012-04-01

Full Text Available Abstract Background Functional decline in community-dwelling older persons is associated with the loss of independence, the need for hospital and nursing-home care and premature death. The effectiveness of multifactorial interventions in preventing functional decline remains controversial. The aim of this study is to investigate whether functional decline in community-dwelling older persons can be delayed or prevented by a comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination. Methods/Design In a cluster randomized controlled trial, with the general practice as the unit of randomization, 1281 participants from 25 general practices will be enrolled in each condition to compare the intervention with usual care. The intervention will focus on older persons who are at increased risk for functional decline, identified by an Identification of Seniors at Risk Primary Care (ISAR-PC score (≥ 2. These older persons will receive a comprehensive geriatric assessment, an individually tailored care and treatment plan, consisting of multifactorial, evidence-based interventions and subsequent nurse-led care coordination. The control group will receive 'care as usual' by the general practitioner (GP. The main outcome after 12 months is the level of physical functioning on the modified Katz-15 index score. The secondary outcomes are health-related quality of life, psychological and social functioning, healthcare utilization and institutionalization. Furthermore, a process evaluation and cost-effectiveness analysis will be performed. Discussion This study will provide new knowledge regarding the effectiveness and feasibility of a comprehensive geriatric assessment, multifactorial interventions and nurse-led elderly care in general practice. Trial registration NTR2653 Grant Unrestricted grant 'The Netherlands Organisation for Health Research and development' no 313020201

Women's views of postnatal care in the context of the increasing pressure on postnatal beds in Australia.

Science.gov (United States)

McLachlan, Helen L; Gold, Lisa; Forster, Della A; Yelland, Jane; Rayner, Joanne; Rayner, Sharon

2009-12-01

Despite limited evidence evaluating early postnatal discharge, length of hospital stay has declined dramatically in Australia since the 1980s. The recent rising birth rate in Victoria, Australia has increased pressure on hospital beds, and many services have responded by discharging women earlier than planned, often with little preparation during pregnancy. We aimed to explore the views of women and their partners regarding a number of theoretical postnatal care 'packages' that could provide an alternative approach to early postnatal care. Eight focus groups and four interviews were held in rural and metropolitan Victoria in 2006 with participants who had experienced a mix of public and private maternity care. These included 8 pregnant women, 42 recent mothers and 2 male partners. All were fluent in English. Focus groups explored participants' experiences and/or expectations of early postnatal care in hospital and at home and their views of alternative packages of postnatal care where location of care shifted from hospital to home and/or hotel. This paper describes the packages and explores and describes what 'value' women placed on the various components of care. Overall, women expressed a preference for what they had experienced or expected, which may be explained by the 'what is must be best' phenomenon where women place value on the status quo. They generally did not respond favourably towards the alternative postnatal care packages, with concerns about any shorter length of hospital stay, especially for first time mothers. Women were concerned about the safety and wellbeing of their new baby and reported that they lacked confidence in their ability to care for their baby. The physical presence and availability of professional support was seen to alleviate these concerns, especially for first time mothers. Participants did not believe that increased domiciliary visits compensated for forgoing the perceived security and value of staying in hospital. Women

Microbiology of minimally processed, modified atmosphere packaged chicory endive

NARCIS (Netherlands)

Bennik, M.H.J.; Peppelenbos, H.W.; Ngyuen-The, C.; Carlin, F.; Smid, E.J.; Gorris, L.G.M.

1996-01-01

Modified-atmosphere packaging (MAP) and subsequent storage at refrigeration temperature has been developed over the last decade as an adequate technique to prolong high quality shelf-life of minimally processed vegetables. The MAP system employed should be carefully tailored to the physiological and

"Teaching Case": ComprehensiveCare and the Stalled Adoption of an Electronic Health Records System: IT Governance and Employee Succession

Science.gov (United States)

Gomillion, David L.

2017-01-01

ComprehensiveCare, a multi-specialty healthcare organization, struggles to implement Electronic Health Records. The first adoption failed outright because the customizations made the system unusable. The second attempted adoption has not officially failed yet, but the system fails to live up to the expectations. It lingers on the edge of…

How To Tutor Students with Reading Comprehension Problems.

Science.gov (United States)

Parker, Richard; Hasbrouck, Jan E.; Denton, Carolyn

2002-01-01

Suggestions for tutoring students with reading comprehension problems include careful selection of books with readable text segments, use of comprehension strategies such as paraphrasing brief sections, and reading to find specific information. Several reading comprehension strategies for students are summarized. (Contains 7 references.) (DB)

Assessment of the Quality of Delivered Care for Iranian patients with Rheumatoid Arthritis by Using Comprehensive Quality Measurement Model in Health Care (CQMH

Directory of Open Access Journals (Sweden)

Saeed Karimi

2015-12-01

Full Text Available Introduction: Quality of care has become increasingly critical in the evaluation of healthcare and healthcare services. The aim of this study was to assess quality of delivered care among patients with rheumatoid arthritis using a model of Comprehensive Quality Measurement in Health Care (CQMH. Methods: This cross-sectional study was conducted on 172 patients with rheumatoid arthritis (RA who were received care from private clinics of Isfahan University of medical sciences in 2013. CQMH questionnaires were used for assessing the quality of care. Data were analyzed using SPSS for Windows. Results: The mean scores of Quality Index, Service Quality (SQ, Technical Quality (TQ, and Costumer Quality (CQ were 72.70, 79.09, 68.54 and 70.25 out of 100, respectively. For CQ only 19.8% of participations staying the course of action even under stress and financial constraints, there is a significant gap between what RA care they received with what was recommended in the guideline for TQ. Scores of service quality was low in majority of aspects especially in "availability of support group" section. Conclusion: Study shows paradoxical findings and expresses that quality scores of service delivery for patients with arthritis rheumatoid from patient's perspective is relatively low. Therefore, for fixing this paradoxical problem, improving the participation of patients and their family and empowering them for self-management and decision should be regarded by health systems.

Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: a comprehensive approach.

Science.gov (United States)

Birkhead, Guthrie S; Klein, Susan J; Candelas, Alma R; O'Connell, Daniel A; Rothman, Jeffrey R; Feldman, Ira S; Tsui, Dennis S; Cotroneo, Richard A; Flanigan, Colleen A

2007-10-01

New York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs' needs are required. A HCV strategic plan has stressed integration. HCV prevention and care are integrated within health and human service settings, including HIV/AIDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development. IDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain. A comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV-HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential.

MEMS packaging

CERN Document Server

Hsu , Tai-Ran

2004-01-01

MEMS Packaging discusses the prevalent practices and enabling techniques in assembly, packaging and testing of microelectromechanical systems (MEMS). The entire spectrum of assembly, packaging and testing of MEMS and microsystems, from essential enabling technologies to applications in key industries of life sciences, telecommunications and aerospace engineering is covered. Other topics included are bonding and sealing of microcomponents, process flow of MEMS and microsystems packaging, automated microassembly, and testing and design for testing.The Institution of Engineering and Technology is

Packaging design criteria for the Hanford Ecorok Packaging

International Nuclear Information System (INIS)

Mercado, M.S.

1996-01-01

The Hanford Ecorok Packaging (HEP) will be used to ship contaminated water purification filters from K Basins to the Central Waste Complex. This packaging design criteria documents the design of the HEP, its intended use, and the transportation safety criteria it is required to meet. This information will serve as a basis for the safety analysis report for packaging

PyPathway: Python Package for Biological Network Analysis and Visualization.

Science.gov (United States)

Xu, Yang; Luo, Xiao-Chun

2018-05-01

Life science studies represent one of the biggest generators of large data sets, mainly because of rapid sequencing technological advances. Biological networks including interactive networks and human curated pathways are essential to understand these high-throughput data sets. Biological network analysis offers a method to explore systematically not only the molecular complexity of a particular disease but also the molecular relationships among apparently distinct phenotypes. Currently, several packages for Python community have been developed, such as BioPython and Goatools. However, tools to perform comprehensive network analysis and visualization are still needed. Here, we have developed PyPathway, an extensible free and open source Python package for functional enrichment analysis, network modeling, and network visualization. The network process module supports various interaction network and pathway databases such as Reactome, WikiPathway, STRING, and BioGRID. The network analysis module implements overrepresentation analysis, gene set enrichment analysis, network-based enrichment, and de novo network modeling. Finally, the visualization and data publishing modules enable users to share their analysis by using an easy web application. For package availability, see the first Reference.

Work Experiences of Patients Receiving Palliative Care at a Comprehensive Cancer Center: Exploratory Analysis.

Science.gov (United States)

Glare, Paul A; Nikolova, Tanya; Alickaj, Alberta; Patil, Sujata; Blinder, Victoria

2017-07-01

Employment-related issues have been largely overlooked in cancer patients needing palliative care. These issues may become more relevant as cancer evolves into more of a chronic illness and palliative care is provided independent of stage or prognosis. To characterize the employment situations of working-age palliative care patients. Cross-sectional survey setting/subjects: Consecutive sample of 112 patients followed in palliative care outpatient clinics at a comprehensive cancer center. Thirty-seven-item self-report questionnaire covering demographics, clinical status, and work experiences since diagnosis. The commonest cancer diagnoses were breast, colorectal, gynecological, and lung. Eighty-one percent had active disease. Seventy-four percent were on treatment. Eighty percent recalled being employed at the time of diagnosis, with 65% working full time. At the time of the survey, 44% were employed and 26% were working full time. Most participants said work was important, made them feel normal, and helped them feel they were "beating the cancer". Factors associated with being employed included male gender, self-employed, and taking less than three months off work. Respondents with pain and/or other symptoms were significantly less likely to be working. On multivariate analysis, only pain (odds ratio [OR] 8.16, p gender (OR 2.07), self-employed (OR 3.07), and current chemotherapy (OR 1.81) were included in the model, but were not statistically significant in this small sample. Work may be an important issue for some palliative care patients. Additional research is needed to facilitate ongoing employment for those who wish or need to continue working.

Supplementary material for the report 'Economic/climate recovery scorecards. How climate friendly are the economic recovery packages?'

International Nuclear Information System (INIS)

Hoehne, N.; Eisbrenner, K.; Phylipsen, D.; Burck, J.; Van der Straeten, L.

2009-03-01

As global leaders head to the G20 summit to consider solutions to the current global economic crisis, a new report prepared by Ecofys and Germanwatch for WWF and E3G reveals that many of the economic recovery packages being discussed are a missed opportunity in terms of stimulating a green recovery, and actually run the risk of locking the world into a high-carbon future. The report provides the most detailed and comprehensive analysis to date of the proposed 'stimulus' packages of five key countries - France, Germany, Italy, the UK and the US - as well as the package agreed by the European Union as a whole.

Effects of a just-in-time educational intervention placed on wound dressing packages: a multicenter randomized controlled trial.

Science.gov (United States)

Kent, Dea J

2010-01-01

I compared the effects of a just-in-time educational intervention (educational materials for dressing application attached to the manufacturer's dressing package) to traditional wound care education on reported confidence and dressing application in a simulated model. Nurses from a variety of backgrounds were recruited for this study. The nurses possessed all levels of education ranging from licensed practical nurse to master of science in nursing. Both novice and seasoned nurses were included, with no stipulations regarding years of nursing experience. Exclusion criteria included nurses who spent less than 50% of their time in direct patient care and nurses with advanced wound care training and/or certification (CWOCN, CWON). Study settings included community-based acute care facilities, critical access hospitals, long-term care facilities, long-term acute care facilities, and home care agencies. No level 1 trauma centers were included in the study for geographical reasons. Participants were randomly allocated to control or intervention groups. Each participant completed the Kent Dressing Confidence Assessment tool. Subjects were then asked to apply the dressing to a wound model under the observation of either the principal investigator or a trained observer, who scored the accuracy of dressing application according to established criteria. None of the 139 nurses who received traditional dressing packaging were able to apply the dressing to a wound model correctly. In contrast, 88% of the nurses who received the package with the educational guide attached to it were able to apply the dressing to a wound model correctly (χ2 = 107.22, df = 1, P = .0001). Nurses who received the dressing package with the attached educational guide agreed that this feature gave them confidence to correctly apply the dressing (88%), while no nurse agreed that the traditional package gave him or her the confidence to apply the dressing correctly (χ2 = 147.47, df = 4, P just

The Comparative Analysis of Packaging Design Element to Purchasing Decision Between Coca Cola and Big Cola in Manado

OpenAIRE

Gessal, Putri

2013-01-01

Packaging can play a very interesting role in the success or failure of a product. Its success depends a lot on how it is designed by its creators. Packaging function to protect the contents of a product lies within the package design. It has the power to influence your choices, and with its carefully thought-out aesthetics can affect your emotions. This aim of the study comparative analysis of packaging design element to purchase decision between Coca Cola and Big Cola with packaging element...

A Comprehensive Theory of Integration.

Science.gov (United States)

Singer, Sara J; Kerrissey, Michaela; Friedberg, Mark; Phillips, Russell

2018-03-01

Efforts to transform health care delivery to improve care have increasingly focused on care integration. However, variation in how integration is defined has complicated efforts to design, synthesize, and compare studies of integration in health care. Evaluations of integration initiatives would be enhanced by describing them according to clear definitions of integration and specifying which empirical relationships they seek to test-whether among types of integration or between integration and outcomes of care. Drawing on previous work, we present a comprehensive theoretical model of relationships between types of integration and propose how to measure them.

The role of waste package specifications as a forerunner to ILW repository conditions for acceptance

International Nuclear Information System (INIS)

Barlow, S.V.; Palmer, J.D.

1998-01-01

In the absence of a finalized repository site, design or associated safety case, Nirex is not in a position to issue conditions for acceptance. Nirex has therefore developed a strategy which facilitates packaging of intermediate level waste by providing guidance through waste package specifications, supported by the formal assessment of specific packaging proposals on a case-by-case basis. The waste package specifications are comprehensive and cover all aspects of the waste package including dimensions and other key features, performance standards, wasteform, quality assurance, and data recording requirements. The waste package specifications will be subject to periodic review as repository design and safety cases are finalized and will progressively become site- and design-specific. The waste package specifications will eventually form the basis for conditions for acceptance. The strategy described in this paper has been successfully followed by Nirex and customers for the past ten years and has permitted wastes to be packaged for a deep repository with confidence in the absence of a finalized site and safety cases for the repository. Because the process has its basis in a generic repository concept, it remains robust, despite the increased uncertainty following the March 1997 Secretary of State's decision, as to the siting and time-scale of a deep waste repository, and continues to be an important component of the UK's waste management strategy. (author)

Packaging microservices

DEFF Research Database (Denmark)

Montesi, Fabrizio; Thrane, Dan Sebastian

2017-01-01

We describe a first proposal for a new packaging system for microservices based on the Jolie programming language, called the Jolie Package Manager (JPM). Its main features revolve around service interfaces, which make the functionalities that a service provides and depends on explicit. For the f......We describe a first proposal for a new packaging system for microservices based on the Jolie programming language, called the Jolie Package Manager (JPM). Its main features revolve around service interfaces, which make the functionalities that a service provides and depends on explicit...

Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review.

Science.gov (United States)

Shahid, Shaouli; Taylor, Emma V; Cheetham, Shelley; Woods, John A; Aoun, Samar M; Thompson, Sandra C

2018-05-08

Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples' preferences, needs, opportunities and barriers to palliative care. A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly's hierarchy of evidence-for-practice in qualitative research. Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples' experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. The results provide a comprehensive overview of identified effective practices with regards to

The effect of professional identity on comprehensiveness in strategic decision making: physician executives in the Canadian health care context.

Science.gov (United States)

Karmali, Shazia

2012-01-01

This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting. Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives. This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives. This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.

The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial.

Science.gov (United States)

Flikweert, Elvira R; Izaks, Gerbrand J; Knobben, Bas A S; Stevens, Martin; Wendt, Klaus

2014-05-30

Hip fractures frequently occur in older persons and severely decrease life expectancy and independence. Several care pathways have been developed to lower the risk of negative outcomes but most pathways are limited to only one aspect of care. The aim of this study was therefore to develop a comprehensive care pathway for older persons with a hip fracture and to conduct a preliminary analysis of its effect. A comprehensive multidisciplinary care pathway for patients aged 60 years or older with a hip fracture was developed by a multidisciplinary team. The new care pathway was evaluated in a clinical trial with historical controls. The data of the intervention group were collected prospectively. The intervention group included all patients with a hip fracture who were admitted to University Medical Center Groningen between 1 July 2009 and 1 July 2011. The data of the control group were collected retrospectively. The control group comprised all patients with a hip fracture who were admitted between 1 January 2006 and 1 January 2008. The groups were compared with the independent sample t-test, the Mann-Whitney U-test or the Chi-squared test (Phi test). The effect of the intervention on fasting time and length of stay was adjusted by linear regression analysis for differences between the intervention and control group. The intervention group included 256 persons (women, 68%; mean age (SD), 78 (9) years) and the control group 145 persons (women, 72%; mean age (SD), 80 (10) years). Median preoperative fasting time and median length of hospital stay were significantly lower in the intervention group: 9 vs. 17 hours (p < 0.001), and 7 vs. 11 days (p < 0.001), respectively. A similar result was found after adjustment for age, gender, living condition and American Society of Anesthesiologists (ASA) classification. In-hospital mortality was also lower in the intervention group: 2% vs. 6% (p < 0.05). There were no statistically significant differences in other

SSD for R: A Comprehensive Statistical Package to Analyze Single-System Data

Science.gov (United States)

Auerbach, Charles; Schudrich, Wendy Zeitlin

2013-01-01

The need for statistical analysis in single-subject designs presents a challenge, as analytical methods that are applied to group comparison studies are often not appropriate in single-subject research. "SSD for R" is a robust set of statistical functions with wide applicability to single-subject research. It is a comprehensive package…

Comparing comprehensive care and departmental clinical education models: students' perceptions at the University of Tennessee College of Dentistry.

Science.gov (United States)

Dehghan, Mojdeh; Harrison, Janet; Langham, Sue; Scarbecz, Mark; Amini, Mehdi

2015-02-01

In summer 2012, the University of Tennessee Health Science Center College of Dentistry transitioned from a departmental clinical education model to a comprehensive care/group leader model. The aim of this study was to investigate the perspectives of the fourth-year class of dental students who, because the transition took place during their training, had experienced treating patients under both educational models. To achieve this objective, a questionnaire was designed to assess the students' opinions on the efficiency of their effort, availability of specialty faculty, stress, collaboration with classmates, and availability of exposure to different practice styles and techniques under the two systems. The students were also given an opportunity to provide open-ended feedback on the shortcomings and advantages of the systems. The Class of 2013 had 81 students, 55 of whom participated in the survey for a response rate of 67.9%. The majority (86%) of the respondents preferred the comprehensive care model and reported feeling that, in it, they were able to accomplish more comprehensive dentistry with greater consistency of supervision from faculty in a more patient-centered environment than in the departmental model. However, 56 percent considered having the same group leader for two years a disadvantage and recommended rotation of at least one group leader every six months. The results of this survey can help this college and other dental schools that are seeking to optimize their educational model to best serve students' educational experience and the dental needs of their patient population.

Evaluation of use of reading comprehension strategies to improve reading comprehension of adult college students with acquired brain injury.

Science.gov (United States)

Griffiths, Gina G; Sohlberg, McKay Moore; Kirk, Cecilia; Fickas, Stephen; Biancarosa, Gina

2016-01-01

Adults with mild to moderate acquired brain injury (ABI) often pursue post-secondary or professional education after their injuries in order to enter or re-enter the job market. An increasing number of these adults report problems with reading-to-learn. The problem is particularly concerning given the growing population of adult survivors of ABI. Despite the rising need, empirical evaluation of reading comprehension interventions for adults with ABI is scarce. This study used a within-subject design to evaluate whether adult college students with ABI with no more than moderate cognitive impairments benefited from using reading comprehension strategies to improve comprehension of expository text. Integrating empirical support from the cognitive rehabilitation and special education literature, the researchers designed a multi-component reading comprehension strategy package. Participants read chapters from an introductory-level college anthropology textbook in two different conditions: strategy and no-strategy. The results indicated that reading comprehension strategy use was associated with recall of more correct information units in immediate and delayed free recall tasks; more efficient recall in the delayed free recall task; and increased accuracy recognising statements from a sentence verification task designed to reflect the local and global coherence of the text. The findings support further research into using reading comprehension strategies as an intervention approach for the adult ABI population. Future research needs include identifying how to match particular reading comprehension strategies to individuals, examining whether reading comprehension performance improves further through the incorporation of systematic training, and evaluating texts from a range of disciplines and genres.

PRIDE Surveillance Projects Data Packaging Project, Information Package Specification Version 1.0

Energy Technology Data Exchange (ETDEWEB)

Kelleher, D.M.; Shipp, R. L.; Mason, J. D.

2009-09-28

This document contains a specification for a standard XML document format called an information package that can be used to store information and the context required to understand and use that information in information management systems and other types of information archives. An information package consists of packaged information, a set of information metadata that describes the packaged information, and an XML signature that protects the packaged information. The information package described in this specification was designed to be used to store Department of Energy (DOE) and National Nuclear Security Administration (NNSA) information and includes the metadata required for that information: a unique package identifier, information marking that conforms to DOE and NNSA requirements, and access control metadata. Information package metadata can also include information search terms, package history, and notes. Packaged information can be text content, binary content, and the contents of files and other containers. A single information package can contain multiple types of information. All content not in a text form compatible with XML must be in a text encoding such as base64. Package information is protected by a digital XML signature that can be used to determine whether the information has changed since it was signed and to identify the source of the information. This specification has been tested but has not been used to create production information packages. The authors expect that gaps and unclear requirements in this specification will be identified as this specification is used to create information packages and as information stored in information packages is used. The authors expect to issue revised versions of this specification as needed to address these issues.

Awareness of FDA-mandated cigarette packaging changes among smokers of 'light' cigarettes.

Science.gov (United States)

Falcone, M; Bansal-Travers, M; Sanborn, P M; Tang, K Z; Strasser, A A

2015-02-01

Previous research has clearly demonstrated that smokers associate cigarette descriptors such as 'light', 'ultra-light' and 'low tar' with reduced health risks, despite evidence showing that cigarettes with these descriptor terms do not present lower health risk. In June 2010, regulations implemented by the US Food and Drug Administration went into effect to ban the use of 'light', 'mild' and 'low' on cigarette packaging. We surveyed smokers participating in human laboratory studies at our Center in Philadelphia, PA, USA shortly after the ban went into effect to determine the extent of awareness of recent cigarette packaging changes among smokers of light cigarettes. In our sample of 266 smokers, 76 reported smoking light cigarettes, but fewer than half of these smokers reported noticing changes to their cigarette packaging. Simple removal of a few misleading terms may be too subtle of a change to register with consumers of so-called 'low tar' cigarettes; more comprehensive regulation of cigarette packaging design may be necessary to gain smokers' attention and minimize misperceptions associated with tobacco pack design characteristics and color. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

A systematic review of essential obstetric and newborn care capacity building in rural sub-Saharan Africa.

Science.gov (United States)

Ni Bhuinneain, G M; McCarthy, F P

2015-01-01

Progress in maternal survival in sub-Saharan Africa has been poor since the Millennium Declaration. This systematic review aims to investigate the presence and rigour of evidence for effective capacity building for Essential Obstetric and Newborn Care (EONC) to reduce maternal mortality in rural, sub-Saharan Africa, where maternal mortality ratios are highest globally. MEDLINE (1990-January 2014), EMBASE (1990-January 2014), and the Cochrane Library were included in our search. Key developing world issues of The Lancet and the British Journal of Obstetrics and Gynaecology, African Ministry of Health websites, and the WHO reproductive health library were searched by hand. Studies investigating essential obstetric and newborn care packages in basic and comprehensive care facilities, at community and institutional level, in rural sub-Saharan Africa were included. Studies were included if they reported on healthcare worker performance, access to care, community behavioural change, and emergency obstetric and newborn care. Data were extracted and all relevant studies independently appraised using structured abstraction and appraisal tools. There is moderate evidence to support the training of healthcare workers of differing cadres in the provision of emergency obstetric and newborn services to reduce institutional maternal mortality and case-fatality rates in rural sub-Saharan Africa. Community schemes that sensitise and enable access to maternal health services result in a modest rise in facility birth and skilled birth attendance in this rural setting. Essential Obstetric and Newborn Care has merit as an intervention package to reduce maternal mortality in rural sub-Saharan Africa. © 2014 Royal College of Obstetricians and Gynaecologists.

Preferences for benefit packages for community-based health insurance: an exploratory study in Nigeria

Directory of Open Access Journals (Sweden)

Nnenna Tasie

2010-06-01

Full Text Available Abstract Background It is important that community-based health insurance (CBHI schemes are designed in such a way as to ensure the relevance of the benefit packages to potential clients. Hence, this paper provides an understanding of the preferred benefit packages by different economic status groups as well as urban and rural dwellers for CBHI in Southeast Nigeria. Methods The study took place in rural, urban and semi-urban communities of south-east Nigeria. A questionnaire was used to collect information from 3070 randomly picked household heads. Focus group discussions were used to collect qualitative data. Data was examined for links between preferences for benefit packages with SES and geographic residence of the respondents. Results Respondents in the rural areas and in the lower SES preferred a comprehensive benefit package which includes all inpatient, outpatient and emergencies services, while those in urban areas as well as those in the higher SES group showed a preference for benefit packages which will cover only basic disease control interventions. Conclusion Equity concerns in preferences for services to be offered by the CBHI scheme should be addressed for CBHI to succeed in different contexts.

Preferences for benefit packages for community-based health insurance: an exploratory study in Nigeria.

Science.gov (United States)

Onwujekwe, Obinna; Onoka, Chima; Uguru, Nkoli; Nnenna, Tasie; Uzochukwu, Benjamin; Eze, Soludo; Kirigia, Joses; Petu, Amos

2010-06-12

It is important that community-based health insurance (CBHI) schemes are designed in such a way as to ensure the relevance of the benefit packages to potential clients. Hence, this paper provides an understanding of the preferred benefit packages by different economic status groups as well as urban and rural dwellers for CBHI in Southeast Nigeria. The study took place in rural, urban and semi-urban communities of south-east Nigeria. A questionnaire was used to collect information from 3070 randomly picked household heads. Focus group discussions were used to collect qualitative data. Data was examined for links between preferences for benefit packages with SES and geographic residence of the respondents. Respondents in the rural areas and in the lower SES preferred a comprehensive benefit package which includes all inpatient, outpatient and emergencies services, while those in urban areas as well as those in the higher SES group showed a preference for benefit packages which will cover only basic disease control interventions. Equity concerns in preferences for services to be offered by the CBHI scheme should be addressed for CBHI to succeed in different contexts.

Health literacy in the urgent care setting: What factors impact consumer comprehension of health information?

Science.gov (United States)

Alberti, Traci L; Morris, Nancy J

2017-05-01

An increasing number of Americans are using urgent care (UC) clinics due to: improved health insurance coverage, the need to decrease cost, primary care offices with limited appointment availability, and a desire for convenient care. Patients are treated by providers they may not know for episodic illness or injuries while in pain or not feeling well. Treatment instructions and follow-up directions are provided quickly. To examine health literacy in the adult UC population and identify patient characteristics associated with health literacy risk. As part of a larger cross-sectional study, UC patients seen between October 2013 and January 2014 completed a demographic questionnaire and the Newest Vital Sign. Descriptive, nonparametric analyses, and a multinomial logistic regression were done to assess health literacy, associated and predictive factors. A total of 57.5% of 285 participants had adequate health literacy. The likelihood of limited health literacy was associated with increased age (p literacy is common in a suburban UC setting, increasing the risk that consumers may not understand vital health information. Clear provider communication and confirmation of comprehension of discharge instructions for self-management is essential to optimize outcomes for UC patients. ©2017 American Association of Nurse Practitioners.

In-Package Chemistry Abstraction

Energy Technology Data Exchange (ETDEWEB)

P.S. Domski

2003-07-21

The work associated with the development of this model report was performed in accordance with the requirements established in ''Technical Work Plan for Waste Form Degradation Modeling, Testing, and Analyses in Support of SR and LA'' (BSC 2002a). The in-package chemistry model and in-package chemistry model abstraction are developed to predict the bulk chemistry inside of a failed waste package and to provide simplified expressions of that chemistry. The purpose of this work is to provide the abstraction model to the Performance Assessment Project and the Waste Form Department for development of geochemical models of the waste package interior. The scope of this model report is to describe the development and validation of the in-package chemistry model and in-package chemistry model abstraction. The in-package chemistry model will consider chemical interactions of water with the waste package materials and the waste form for commercial spent nuclear fuel (CSNF) and codisposed high-level waste glass (HLWG) and N Reactor spent fuel (CDNR). The in-package chemistry model includes two sub-models, the first a water vapor condensation (WVC) model, where water enters a waste package as vapor and forms a film on the waste package components with subsequent film reactions with the waste package materials and waste form--this is a no-flow model, the reacted fluids do not exit the waste package via advection. The second sub-model of the in-package chemistry model is the seepage dripping model (SDM), where water, water that may have seeped into the repository from the surrounding rock, enters a failed waste package and reacts with the waste package components and waste form, and then exits the waste package with no accumulation of reacted water in the waste package. Both of the submodels of the in-package chemistry model are film models in contrast to past in-package chemistry models where all of the waste package pore space was filled with water. The

In-Package Chemistry Abstraction

International Nuclear Information System (INIS)

P.S. Domski

2003-01-01

The work associated with the development of this model report was performed in accordance with the requirements established in ''Technical Work Plan for Waste Form Degradation Modeling, Testing, and Analyses in Support of SR and LA'' (BSC 2002a). The in-package chemistry model and in-package chemistry model abstraction are developed to predict the bulk chemistry inside of a failed waste package and to provide simplified expressions of that chemistry. The purpose of this work is to provide the abstraction model to the Performance Assessment Project and the Waste Form Department for development of geochemical models of the waste package interior. The scope of this model report is to describe the development and validation of the in-package chemistry model and in-package chemistry model abstraction. The in-package chemistry model will consider chemical interactions of water with the waste package materials and the waste form for commercial spent nuclear fuel (CSNF) and codisposed high-level waste glass (HLWG) and N Reactor spent fuel (CDNR). The in-package chemistry model includes two sub-models, the first a water vapor condensation (WVC) model, where water enters a waste package as vapor and forms a film on the waste package components with subsequent film reactions with the waste package materials and waste form--this is a no-flow model, the reacted fluids do not exit the waste package via advection. The second sub-model of the in-package chemistry model is the seepage dripping model (SDM), where water, water that may have seeped into the repository from the surrounding rock, enters a failed waste package and reacts with the waste package components and waste form, and then exits the waste package with no accumulation of reacted water in the waste package. Both of the submodels of the in-package chemistry model are film models in contrast to past in-package chemistry models where all of the waste package pore space was filled with water. The current in-package

R package CityWaterBalance | Science Inventory | US EPA

Science.gov (United States)

CityWaterBalance provides a reproducible workflow for studying an urban water system. The network of urban water flows and storages can be modeled and visualized. Any city may be modeled with preassembled data, but data for US cities can be gathered via web services using this package and dependencies, geoknife and dataRetrieval. Urban water flows are difficult to comprehensively quantify. Although many important data sources are openly available, they are published by a variety of agencies in different formats, units, spatial and temporal resolutions. Increasingly, open data are made available via web services, which allow for automated, current retrievals. Integrating data streams and estimating the values of unmeasured urban water flows, however, remains needlessly time-consuming. In order to streamline a reproducible analysis, we have developed the CityWaterBalance package for the open source R language. The CityWaterBalance package for R is based on a simple model of the network of urban water flows and storages. The model may be run with data that has been pre-assembled by the user, or data can be retrieved by functions in CityWaterBalance and dependencies. CityWaterBalance can be used to quickly assemble a quantitative portrait of any urban water system. The systemic effects of water management decisions can be readily explored. Much of the data acquisition process for US cities can already be automated, while the package serves as a place-hold

Advancements in meat packaging.

Science.gov (United States)

McMillin, Kenneth W

2017-10-01

Packaging of meat provides the same or similar benefits for raw chilled and processed meats as other types of food packaging. Although air-permeable packaging is most prevalent for raw chilled red meat, vacuum and modified atmosphere packaging offer longer shelf life. The major advancements in meat packaging have been in the widely used plastic polymers while biobased materials and their integration into composite packaging are receiving much attention for functionality and sustainability. At this time, active and intelligent packaging are not widely used for antioxidant, antimicrobial, and other functions to stabilize and enhance meat properties although many options are being developed and investigated. The advances being made in nanotechnology will be incorporated into food packaging and presumably into meat packaging when appropriate and useful. Intelligent packaging using sensors for transmission of desired information and prompting of subsequent changes in packaging materials, environments or the products to maintain safety and quality are still in developmental stages. Copyright © 2017 Elsevier Ltd. All rights reserved.

A rehabilitation model as key to comprehensive care in the era of HIV as a chronic disease in South Africa.

Science.gov (United States)

Chetty, Verusia; Hanass-Hancock, Jill

2016-01-01

In the era of widespread access to antiretroviral therapy, people living with HIV survive; however, this comes with new experiences of comorbidities and HIV-related disability posing new challenges to rehabilitation professionals and an already fragile health system in Southern Africa. Public health approaches to HIV need to include not only prevention, treatment and support but also rehabilitation. While some well-resourced countries have developed rehabilitation approaches for HIV, resource-poor settings of Southern Africa lack a model of care that includes rehabilitation approaches providing accessible and comprehensive care for people living with HIV. In this study, a learning in action approach was used to conceptualize a comprehensive model of care that addresses HIV-related disability and a feasible rehabilitation framework for resource-poor settings. The study used qualitative methods in the form of a focus group discussion with thirty participants including people living with HIV, the multidisciplinary healthcare team and community outreach partners at a semi-rural health facility in South Africa. The discussion focused on barriers and enablers of access to rehabilitation. Participants identified barriers at various levels, including transport, physical access, financial constraints and poor multi-stakeholder team interaction. The results of the group discussions informed the design of an inclusive model of HIV care. This model was further informed by established integrated rehabilitation models. Participants emphasized that objectives need to respond to policy, improve access to patient-centered care and maintain a multidisciplinary team approach. They proposed that guiding principles should include efficient communication, collaboration of all stakeholders and leadership in teams to enable staff to implement the model. Training of professional staff and lay personnel within task-shifting approaches was seen as an essential enabler to implementation. The

Color in packaging design : Case: ZheJiang JinSheng packaging Co,Ltd

OpenAIRE

Hu, Cuicui

2010-01-01

Color occupies an important position in packaging design, with the improvement of living standard, the higher requirement of color design in packaging. The aim of this thesis was to discuss key issues concerning aesthetics of packaging design. Topics will include an overview of the packaging design, the influence factor of packaging design, and introduce the aesthetics from packaging aspect. This thesis will also identify common problems of the production process, and list the phases of ho...

Packaging for Sustainability

CERN Document Server

Lewis, Helen; Fitzpatrick, Leanne

2012-01-01

The packaging industry is under pressure from regulators, customers and other stakeholders to improve packaging’s sustainability by reducing its environmental and societal impacts. This is a considerable challenge because of the complex interactions between products and their packaging, and the many roles that packaging plays in the supply chain. Packaging for Sustainability is a concise and readable handbook for practitioners who are trying to implement sustainability strategies for packaging. Industry case studies are used throughout the book to illustrate possible applications and scenarios. Packaging for Sustainability draws on the expertise of researchers and industry practitioners to provide information on business benefits, environmental issues and priorities, environmental evaluation tools, design for environment, marketing strategies, and challenges for the future.

CDIAC catalog of numeric data packages and computer model packages

International Nuclear Information System (INIS)

Boden, T.A.; Stoss, F.W.

1993-05-01

The Carbon Dioxide Information Analysis Center acquires, quality-assures, and distributes to the scientific community numeric data packages (NDPs) and computer model packages (CMPs) dealing with topics related to atmospheric trace-gas concentrations and global climate change. These packages include data on historic and present atmospheric CO 2 and CH 4 concentrations, historic and present oceanic CO 2 concentrations, historic weather and climate around the world, sea-level rise, storm occurrences, volcanic dust in the atmosphere, sources of atmospheric CO 2 , plants' response to elevated CO 2 levels, sunspot occurrences, and many other indicators of, contributors to, or components of climate change. This catalog describes the packages presently offered by CDIAC, reviews the processes used by CDIAC to assure the quality of the data contained in these packages, notes the media on which each package is available, describes the documentation that accompanies each package, and provides ordering information. Numeric data are available in the printed NDPs and CMPs, in CD-ROM format, and from an anonymous FTP area via Internet. All CDIAC information products are available at no cost

Implementing electronic health records (EHRs): health care provider perceptions before and after transition from a local basic EHR to a commercial comprehensive EHR.

Science.gov (United States)

Krousel-Wood, Marie; McCoy, Allison B; Ahia, Chad; Holt, Elizabeth W; Trapani, Donnalee N; Luo, Qingyang; Price-Haywood, Eboni G; Thomas, Eric J; Sittig, Dean F; Milani, Richard V

2018-06-01

We assessed changes in the percentage of providers with positive perceptions of electronic health record (EHR) benefit before and after transition from a local basic to a commercial comprehensive EHR. Changes in the percentage of providers with positive perceptions of EHR benefit were captured via a survey of academic health care providers before (baseline) and at 6-12 months (short term) and 12-24 months (long term) after the transition. We analyzed 32 items for the overall group and by practice setting, provider age, and specialty using separate multivariable-adjusted random effects logistic regression models. A total of 223 providers completed all 3 surveys (30% response rate): 85.6% had outpatient practices, 56.5% were >45 years old, and 23.8% were primary care providers. The percentage of providers with positive perceptions significantly increased from baseline to long-term follow-up for patient communication, hospital transitions - access to clinical information, preventive care delivery, preventive care prompt, preventive lab prompt, satisfaction with system reliability, and sharing medical information (P commercial comprehensive EHR, items with significant increases and significant decreases in the percentage of providers with positive perceptions of EHR benefit were identified, overall and by subgroup.

Melanie II--a third-generation software package for analysis of two-dimensional electrophoresis images: II. Algorithms.

Science.gov (United States)

Appel, R D; Vargas, J R; Palagi, P M; Walther, D; Hochstrasser, D F

1997-12-01

After two generations of software systems for the analysis of two-dimensional electrophoresis (2-DE) images, a third generation of such software packages has recently emerged that combines state-of-the-art graphical user interfaces with comprehensive spot data analysis capabilities. A key characteristic common to most of these software packages is that many of their tools are implementations of algorithms that resulted from research areas such as image processing, vision, artificial intelligence or machine learning. This article presents the main algorithms implemented in the Melanie II 2-D PAGE software package. The applications of these algorithms, embodied as the feature of the program, are explained in an accompanying article (R. D. Appel et al.; Electrophoresis 1997, 18, 2724-2734).

Packaging strategies for printed circuit board components. Volume I, materials & thermal stresses.

Energy Technology Data Exchange (ETDEWEB)

Neilsen, Michael K. (Kansas City Plant, Kansas City, MO); Austin, Kevin N.; Adolf, Douglas Brian; Spangler, Scott W.; Neidigk, Matthew Aaron; Chambers, Robert S.

2011-09-01

Decisions on material selections for electronics packaging can be quite complicated by the need to balance the criteria to withstand severe impacts yet survive deep thermal cycles intact. Many times, material choices are based on historical precedence perhaps ignorant of whether those initial choices were carefully investigated or whether the requirements on the new component match those of previous units. The goal of this program focuses on developing both increased intuition for generic packaging guidelines and computational methodologies for optimizing packaging in specific components. Initial efforts centered on characterization of classes of materials common to packaging strategies and computational analyses of stresses generated during thermal cycling to identify strengths and weaknesses of various material choices. Future studies will analyze the same example problems incorporating the effects of curing stresses as needed and analyzing dynamic loadings to compare trends with the quasi-static conclusions.

A comprehensive plant-wide assessment of Amcor PET Packaging at Fairfield, California

Energy Technology Data Exchange (ETDEWEB)

Kevin Losh; Hui Choi; Yin Yin Wu; Bryan W. Hackett; Ahmad R. Ganji

2008-02-29

This report includes the results of the plant-wide assessment of AMCOR PET plants in Fairfield, City of Commerce, and Lathrop California. The project (except the assessment of Lathrop plant) was a cost shared effort between US Department of Energy through Golden Field Office, Golden CO and AMCOR PET Packaging Co. The DOE share of the plant-wide assessment cost was awarded to AMCOR PET in response to the RFP DE-PS36-05GO95009, the 2005 round of funding for “Plant-Wide Energy Efficiency Opportunity Assessments.” The plant-wide assessment included the processes, electrical and gas equipment. Current production practices have been evaluated against best practice standards, as well as utilization of modern technology to improve energy efficiency, reduce the wastes, and improve productivity.

Employer Child Care Resources: A Guide to Developing Effective Child Care Programs and Policies.

Science.gov (United States)

Women's Bureau (DOL), Washington, DC.

Increasing numbers of employers are responding to employee child care needs by revising their benefit packages, work schedules, and recruitment plans to include child care options. This guide details ways to develop effective child care programs and policies. Section 1 of the guide describes employees' growing child care needs and employers'…

Carbon Monoxide in Meat and Fish Packaging: Advantages and Limits

Science.gov (United States)

Roncalés, Pedro

2018-01-01

Due to increased demands for greater expectation in relation to quality, convenience, safety and extended shelf-life, combined with growing demand from retailers for cost-effective extensions of fresh muscle foods’ shelf-life, the food packaging industry quickly developed to meet these expectations. During the last few decades, modified atmosphere packaging (MAP) of foods has been a promising area of research, but much remains to be known regarding the use of unconventional gases such carbon monoxide (CO). The use of CO for meat and seafood packaging is not allowed in most countries due to the potential toxic effect, and its use is controversial in some countries. The commercial application of CO in food packaging was not then considered feasible because of possible environmental hazards for workers. CO has previously been reported to mask muscle foods’ spoilage, and this was the primary concern raised for the prohibition, as this may mislead consumers. This review was undertaken to present the most comprehensive and current overview of the widely-available, scattered information about the use of CO in the preservation of muscle foods. The advantages of CO and its industrial limits are presented and discussed. The most recent literature on the consumer safety issues related to the use of CO and consumer acceptance of CO especially in meat packaging systems were also discussed. Recommendations and future prospects were addressed for food industries, consumers and regulators on what would be a “best practice” in the use of CO in food packaging. All this promotes high ethical standards in commercial communications by means of effective regulation, for the benefit of consumers and businesses in the world, and this implies that industrialized countries and members of their regulatory agencies must develop a coherent and robust systems of regulation and control that can respond effectively to new challenges. PMID:29360803

Carbon Monoxide in Meat and Fish Packaging: Advantages and Limits

Directory of Open Access Journals (Sweden)

Djamel Djenane

2018-01-01

Full Text Available Due to increased demands for greater expectation in relation to quality, convenience, safety and extended shelf-life, combined with growing demand from retailers for cost-effective extensions of fresh muscle foods’ shelf-life, the food packaging industry quickly developed to meet these expectations. During the last few decades, modified atmosphere packaging (MAP of foods has been a promising area of research, but much remains to be known regarding the use of unconventional gases such carbon monoxide (CO. The use of CO for meat and seafood packaging is not allowed in most countries due to the potential toxic effect, and its use is controversial in some countries. The commercial application of CO in food packaging was not then considered feasible because of possible environmental hazards for workers. CO has previously been reported to mask muscle foods’ spoilage, and this was the primary concern raised for the prohibition, as this may mislead consumers. This review was undertaken to present the most comprehensive and current overview of the widely-available, scattered information about the use of CO in the preservation of muscle foods. The advantages of CO and its industrial limits are presented and discussed. The most recent literature on the consumer safety issues related to the use of CO and consumer acceptance of CO especially in meat packaging systems were also discussed. Recommendations and future prospects were addressed for food industries, consumers and regulators on what would be a “best practice” in the use of CO in food packaging. All this promotes high ethical standards in commercial communications by means of effective regulation, for the benefit of consumers and businesses in the world, and this implies that industrialized countries and members of their regulatory agencies must develop a coherent and robust systems of regulation and control that can respond effectively to new challenges.

Edible packaging materials.

Science.gov (United States)

Janjarasskul, Theeranun; Krochta, John M

2010-01-01

Research groups and the food and pharmaceutical industries recognize edible packaging as a useful alternative or addition to conventional packaging to reduce waste and to create novel applications for improving product stability, quality, safety, variety, and convenience for consumers. Recent studies have explored the ability of biopolymer-based food packaging materials to carry and control-release active compounds. As diverse edible packaging materials derived from various by-products or waste from food industry are being developed, the dry thermoplastic process is advancing rapidly as a feasible commercial edible packaging manufacturing process. The employment of nanocomposite concepts to edible packaging materials promises to improve barrier and mechanical properties and facilitate effective incorporation of bioactive ingredients and other designed functions. In addition to the need for a more fundamental understanding to enable design to desired specifications, edible packaging has to overcome challenges such as regulatory requirements, consumer acceptance, and scaling-up research concepts to commercial applications.

Modeling the Potential Economic Impact of the Medicare Comprehensive Care for Joint Replacement Episode-Based Payment Model.

Science.gov (United States)

Maniya, Omar Z; Mather, Richard C; Attarian, David E; Mistry, Bipin; Chopra, Aneesh; Strickland, Matt; Schulman, Kevin A

2017-11-01

The Medicare program has initiated Comprehensive Care for Joint Replacement (CJR), a bundled payment mandate for lower extremity joint replacements. We sought to determine the degree to which hospitals will invest in care redesign in response to CJR, and to project its economic impacts. We defined 4 potential hospital management strategies to address CJR: no action, light care management, heavy care management, and heavy care management with contracting. For each of 798 hospitals included in CJR, we used hospital-specific volume, cost, and quality data to determine the hospital's economically dominant strategy. We aggregated data to assess the percentage of hospitals pursuing each strategy; savings to the health care system; and costs and percentages of CJR-derived revenues gained or lost for Medicare, hospitals, and postacute care facilities. In the model, 83.1% of hospitals (range 55.0%-100.0%) were expected to take no action in response to CJR, and 16.1% of hospitals (range 0.0%-45.0%) were expected to pursue heavy care management with contracting. Overall, CJR is projected to reduce health care expenditures by 0.5% (range 0.0%-4.1%) or $14 million (range $0-$119 million). Medicare is expected to save 2.2% (range 2.2%-2.2%), hospitals are projected to lose 3.7% (range 4.7% loss to 3.8% gain), and postacute care facilities are expected to lose 6.5% (range 0.0%-12.8%). Hospital administrative costs are projected to increase by $63 million (range $0-$148 million). CJR is projected to have a negligible impact on total health care expenditures for lower extremity joint replacements. Further research will be required to assess the actual care management strategies adopted by CJR hospitals. Copyright © 2017 Elsevier Inc. All rights reserved.

Active Packaging Coatings

Directory of Open Access Journals (Sweden)

Luis J. Bastarrachea

2015-11-01

Full Text Available Active food packaging involves the packaging of foods with materials that provide an enhanced functionality, such as antimicrobial, antioxidant or biocatalytic functions. This can be achieved through the incorporation of active compounds into the matrix of the commonly used packaging materials, or by the application of coatings with the corresponding functionality through surface modification. The latter option offers the advantage of preserving the packaging materials’ bulk properties nearly intact. Herein, different coating technologies like embedding for controlled release, immobilization, layer-by-layer deposition, and photografting are explained and their potential application for active food packaging is explored and discussed.

Safety Analysis Report for packaging (onsite) steel waste package

International Nuclear Information System (INIS)

BOEHNKE, W.M.

2000-01-01

The steel waste package is used primarily for the shipment of remote-handled radioactive waste from the 324 Building to the 200 Area for interim storage. The steel waste package is authorized for shipment of transuranic isotopes. The maximum allowable radioactive material that is authorized is 500,000 Ci. This exceeds the highway route controlled quantity (3,000 A 2 s) and is a type B packaging

Waste Package and Material Testing for the Proposed Yucca Mountain High Level Waste Repository

International Nuclear Information System (INIS)

Doering, Thomas; Pasupathi, V.

2002-01-01

Over the repository lifetime, the waste package containment barriers will perform various functions that will change with time. During the operational period, the barriers will function as vessels for handling, emplacement, and waste retrieval (if necessary). During the years following repository closure, the containment barriers will be relied upon to provide substantially complete containment, through 10,000 years and beyond. Following the substantially complete containment phase, the barriers and the waste package internal structures help minimize release of radionuclides by aqueous- and gaseous-phase transport. These requirements have lead to a defense-in-depth design philosophy. A multi-barrier design will result in a lower breach rate distributed over a longer period of time, thereby ensuring the regulatory requirements are met. The design of the Engineered Barrier System (EBS) has evolved. The initial waste package design was a thin walled package, 3/8 inch of stainless steel 304, that had very limited capacity, (3 PWR and 4 BWR assemblies) and performance characteristics, 300 to 1,000 years. This design required over 35,000 waste packages compared to today's design of just over 10,000 waste packages. The waste package designs are now based on a defense-in-depth/multi-barrier philosophy and have a capacity similar to the standard storage and rail transported spent nuclear fuel casks. Concurrent with the development of the design of the waste packages, a comprehensive waste package materials testing program has been undertaken to support the selection of containment barrier materials and to develop predictive models for the long-term behavior of these materials under expected repository conditions. The testing program includes both long-term and short-term tests and the results from these tests combination with the data published in the open literature are being used to develop models for predicting performance of the waste packages

PRIDE Surveillance Projects Data Packaging Project Information Package Specification Version 1.1

Energy Technology Data Exchange (ETDEWEB)

Kelleher, D. M.; Shipp, R. L.; Mason, J. D.

2010-08-31

Information Package Specification version 1.1 describes an XML document format called an information package that can be used to store information in information management systems and other information archives. An information package consists of package information, the context required to understand and use that information, package metadata that describes the information, and XML signatures that protect the information. The information package described in this specification was designed to store Department of Energy (DOE) and National Nuclear Security Administration (NNSA) information and includes the metadata required for that information: a unique package identifier, information marking that conforms to DOE and NNSA requirements, and access control metadata. It is an implementation of the Open Archival Information System (OAIS) Reference Model archival information package tailored to meet NNSA information storage requirements and designed to be used in the computing environments at the Y-12 National Security Complex and at other NNSA sites.

HPLOT: the graphics interface package for the HBOOK histogramming package

International Nuclear Information System (INIS)

Watkins, H.

1978-01-01

The subroutine package HPLOT described in this report, enables the CERN histogramming package HBOOK to produce high-quality pictures by means of high-resolution devices such as plotters. HPLOT can be implemented on any scientific computing system with a Fortran IV compiler and can be interfaced with any graphics package; spectral routines in addition to the basic ones enable users to embellish their histograms. Examples are also given of the use of HPLOT as a graphics package for plotting simple pictures without histograms. (Auth.)

Package

Directory of Open Access Journals (Sweden)

Arsić Zoran

2013-01-01

Full Text Available It is duty of the seller to pack the goods in a manner which assures their safe arrival and enables their handling in transit and at the place of destination. The problem of packing is relevant in two main respects. First of all the buyer is in certain circumstances entitled to refuse acceptance of the goods if they are not properly packed. Second, the package is relevant to calculation of price and freight based on weight. In the case of export trade, the package should conform to the legislation in the country of destination. The impact of package on environment is regulated by environment protection regulation of Republic if Serbia.

Packaging-radiation disinfestation relationships

International Nuclear Information System (INIS)

Highland, H.A.

1985-01-01

Foods that are susceptible to insect infestation can be irradiated to destroy the infestation; however, the food must be kept essentially insect-free until consumed, or it must be disinfested again, perhaps repeatedly. Insect-resistant packages can be used to prevent reinfestation, but there are certain requirements that must be fulfilled before a package can be made insect resistant. These include the use of insect-light construction and packaging materials that resist boring insects. The relative insect resistance of various packages and packaging materials is discussed, as are behavior traits such as egressive boring that enables insects to escape from packages and the ability of insects to climb on various packaging materials. Some successful and unsuccessful attempts to make various types of packages insect resistant are discussed, as are factors that must be considered in the selection or development of insect-resistant packages for radiation disinfested foods. The latter factors include biological and physical environments, length of storage periods, stresses on packages during shipment, types of storage facilities, governmental regulations, health requirements, and others

Packaging and labeling of pharmaceutical products obtained from the internet.

Science.gov (United States)

Veronin, Michael

2011-02-15

package, while 28 products did not have labels affixed to the drug product. In all, 39 of the 41 drug products' packaging would not meet the US guidelines. Aside from the Canadian product, only 1 product from Mexico was dispensed in a container that would meet guidelines established in the United States. In total, 35 products were not dispensed in plastic vials but were dispensed in unit dose packages, paper envelopes with loose dosage forms, blister packs of drugs held together with rubber bands, or a combination of these packaging forms. Results suggest that labeling and packaging standards for international generic drug products are not equivalent to labeling and packaging standards in the United States. This suggests dissimilar and substandard distribution processes compared with those in the United States, which in turn presents a challenge to patient comprehension and health literacy and may affect patient adherence to drug treatment regimens. These findings have strong implications for drug product quality, patient outcomes, therapeutic effectiveness, and safety.

Packaging Printing Today

Directory of Open Access Journals (Sweden)

Stanislav Bolanča

2015-12-01

Full Text Available Printing packaging covers today about 50% of all the printing products. Among the printing products there are printing on labels, printing on flexible packaging, printing on folding boxes, printing on the boxes of corrugated board, printing on glass packaging, synthetic and metal ones. The mentioned packaging are printed in flexo printing technique, offset printing technique, intaglio halftone process, silk – screen printing, ink ball printing, digital printing and hybrid printing process. The possibilities of particular printing techniques for optimal production of the determined packaging were studied in the paper. The problem was viewed from the technological and economical aspect. The possible printing quality and the time necessary for the printing realization were taken as key parameters. An important segment of the production and the way of life is alocation value and it had also found its place in this paper. The events in the field of packaging printing in the whole world were analyzed. The trends of technique developments and the printing technology for packaging printing in near future were also discussed.

Packaged die heater

Science.gov (United States)

Spielberger, Richard; Ohme, Bruce Walker; Jensen, Ronald J.

2011-06-21

A heater for heating packaged die for burn-in and heat testing is described. The heater may be a ceramic-type heater with a metal filament. The heater may be incorporated into the integrated circuit package as an additional ceramic layer of the package, or may be an external heater placed in contact with the package to heat the die. Many different types of integrated circuit packages may be accommodated. The method provides increased energy efficiency for heating the die while reducing temperature stresses on testing equipment. The method allows the use of multiple heaters to heat die to different temperatures. Faulty die may be heated to weaken die attach material to facilitate removal of the die. The heater filament or a separate temperature thermistor located in the package may be used to accurately measure die temperature.

Safety Analysis Report for packaging (onsite) steel waste package

Energy Technology Data Exchange (ETDEWEB)

BOEHNKE, W.M.

2000-07-13

The steel waste package is used primarily for the shipment of remote-handled radioactive waste from the 324 Building to the 200 Area for interim storage. The steel waste package is authorized for shipment of transuranic isotopes. The maximum allowable radioactive material that is authorized is 500,000 Ci. This exceeds the highway route controlled quantity (3,000 A{sub 2}s) and is a type B packaging.

Packaging Printing Today

OpenAIRE

Stanislav Bolanča; Igor Majnarić; Kristijan Golubović

2015-01-01

Printing packaging covers today about 50% of all the printing products. Among the printing products there are printing on labels, printing on flexible packaging, printing on folding boxes, printing on the boxes of corrugated board, printing on glass packaging, synthetic and metal ones. The mentioned packaging are printed in flexo printing technique, offset printing technique, intaglio halftone process, silk – screen printing, ink ball printing, digital printing and hybrid printing process. T...

Thermal Management of Power Semiconductor Packages - Matching Cooling Technologies with Packaging Technologies (Presentation)

Energy Technology Data Exchange (ETDEWEB)

Bennion, K.; Moreno, G.

2010-04-27

Heat removal for power semiconductor devices is critical for robust operation. Because there are different packaging options, different thermal management technologies, and a range of applications, there is a need for a methodology to match cooling technologies and package configurations to target applications. To meet this need, a methodology was developed to compare the sensitivity of cooling technologies on the overall package thermal performance over a range of power semiconductor packaging configurations. The results provide insight into the trade-offs associated with cooling technologies and package configurations. The approach provides a method for comparing new developments in power semiconductor packages and identifying potential thermal control technologies for the package. The results can help users select the appropriate combination of packaging configuration and cooling technology for the desired application.

Safety analysis report for packaging onsite long-length contaminated equipment transport system

International Nuclear Information System (INIS)

McCormick, W.A.

1997-01-01

This safety analysis report for packaging describes the components of the long-length contaminated equipment (LLCE) transport system (TS) and provides the analyses, evaluations, and associated operational controls necessary for the safe use of the LLCE TS on the Hanford Site. The LLCE TS will provide a standardized, comprehensive approach for the disposal of approximately 98% of LLCE scheduled to be removed from the 200 Area waste tanks

Safety analysis report for packaging, onsite, long-length contaminated equipment transport system

Energy Technology Data Exchange (ETDEWEB)

McCormick, W.A.

1997-05-09

This safety analysis report for packaging describes the components of the long-length contaminated equipment (LLCE) transport system (TS) and provides the analyses, evaluations, and associated operational controls necessary for the safe use of the LLCE TS on the Hanford Site. The LLCE TS will provide a standardized, comprehensive approach for the disposal of approximately 98% of LLCE scheduled to be removed from the 200 Area waste tanks.

NRF TRIGA packaging

International Nuclear Information System (INIS)

Clements, M.D.

1995-11-01

Training Reactor Isotopes, General Atomics (TRIGA reg-sign) Reactors are in use at four US Department of Energy (DOE) complex facilities and at least 23 university, commercial, or government facilities. The development of the Neutron Radiography Facility (NRF) TRIGA packaging system began in October 1993. The Hanford Site NRF is being shut down and requires an operationally user-friendly transportation and storage packaging system for removal of the TRIGA fuel elements. The NRF TRIGA packaging system is designed to remotely remove the fuel from the reactor and transport the fuel to interim storage (up to 50 years) on the Hanford Site. The packaging system consists of a cask and an overpack. The overpack is used only for transport and is not necessary for storage. Based upon the cask's small size and light weight, small TRIGA reactors will find it versatile for numerous refueling and fuel storage needs. The NRF TRIGA packaging design also provides the basis for developing a certifiable and economical packaging system for other TRIGA reactor facilities. The small size of the NRF TRIGA cask also accommodates placing the cask into a larger certified packaging for offsite transport. The Westinghouse Hanford Company NRF TRIGA packaging, as described herein can serve other DOE sites for their onsite use, and the design can be adapted to serve university reactor facilities, handling a variety of fuel payloads

Penelitian Persepsi Kemasan Produk Skin Care Wanita dengan Pendekatan Teori Semantik

Directory of Open Access Journals (Sweden)

Devanny Gumulya

2016-12-01

Full Text Available Di Indonesia, penelitian mengenai desain kemasan masih sangat minim, akibatnya pada saat mengembangkan desain kemasan, desainer menggunakan insting pribadinya untuk mendesain. Di sisi lain, industri produk perawatan kulit bertumbuh pesat, seringkali ditemukan perusahaan mengganti kemasannya secara berkala, maka penelitian internasional banyak dilakukan di desain kemasan. Oleh karena itu, penelitian skala lokal perlu dilakukan untuk meneliti persepsi konsumen pada kemasan produk dengan menggunakan pendekatan teori semantik, apakah kemasan yang ada sudah menyampaikan manfaat produk secara efektif. Metode penelitian yang digunakan adalah penyebaran kuisoner semi terstruktur menggabungkan metode kualitatif dan kuantitatif. Brand yang dipilih adalah Martha Tilaar, Sariayu, Viva, dan Citra. Hasil akhir yang ingin dicapai dari penelitian ini adalah rekomendasi desain kemasan yang menarik konsumen.Kata Kunci: desain kemasan; desain produk; persepsi; teori semantik.Research in Packaging Perception of Woman Skin Care Products with Semantic Theory ApproachIn Indonesia, little research has been done in view of packaging design recommendations. As a result, when developing packagings, designers use their own personal judgment. Meanwhile, skin care products are a fast growing industry in which we often find brands changing their packagings very frequently. Internationally, a great deal of research has been done on this subject. However, local research is needed for evaluating consumer perception of Indonesian skin-care packagings using a semantic theory approach, to find out whether existing packagings convey the products’ benefits effectively. A combination of qualitative and quantitative data from semi-structured questionnaires provided experiential data reflecting the research subjects’ engagement in perceiving a range of packaging samples from selected Indonesian skin-care brands. Based on this research, recommendations for future packaging design can

ldr: An R Software Package for Likelihood-Based Su?cient Dimension Reduction

Directory of Open Access Journals (Sweden)

Kofi Placid Adragni

2014-11-01

Full Text Available In regression settings, a su?cient dimension reduction (SDR method seeks the core information in a p-vector predictor that completely captures its relationship with a response. The reduced predictor may reside in a lower dimension d < p, improving ability to visualize data and predict future observations, and mitigating dimensionality issues when carrying out further analysis. We introduce ldr, a new R software package that implements three recently proposed likelihood-based methods for SDR: covariance reduction, likelihood acquired directions, and principal fitted components. All three methods reduce the dimensionality of the data by pro jection into lower dimensional subspaces. The package also implements a variable screening method built upon principal ?tted components which makes use of ?exible basis functions to capture the dependencies between the predictors and the response. Examples are given to demonstrate likelihood-based SDR analyses using ldr, including estimation of the dimension of reduction subspaces and selection of basis functions. The ldr package provides a framework that we hope to grow into a comprehensive library of likelihood-based SDR methodologies.

Critical Under-Reporting of Hernia Mesh Properties and Development of a Novel Package Label.

Science.gov (United States)

Kahan, Lindsey G; Blatnik, Jeffrey A

2018-02-01

With an array of hernia meshes with varying properties, intraoperative decision making for the optimal mesh is critical. Although meshes are subjected to regulatory review through the Food and Drug Administration, it is unknown whether mesh properties are visually accessible. To facilitate greater knowledge for the surgeon on mesh choice, we aimed to comprehensively analyze hernia mesh packaging and regulations. Labeling guidelines and 510(k) requirements across Food and Drug Administration-regulated products were analyzed and compared with mesh packaging. Packages and Instructions for Use were analyzed for commonly available hernia meshes. Literature review was conducted to understand recommended guidelines for mesh products. A novel hernia mesh packaging label was designed to rectify under-reporting. We found that food labels undergo critical scrutiny and detailed specifications, yet medical devices are not subjected to similar guidelines. The highest reported property on packages was the presence of a barrier (80%), and the lowest reported property was barrier composition (33%). For Instructions for Use, the lowest reported properties were mechanics (31%) and thickness (11%), both of which were not reported on packaging. Descriptive terms for pore size and mechanics were reported inconsistently. To overcome this under-reporting of properties, we propose a novel packaging label with properties chosen from regulatory guidelines, packaging analysis, and literature review. Although standardized terminology has been proposed in literature, property knowledge has not adequately permeated surgery, industry, or regulatory guidelines. There is extreme under-reporting and lack of consistency of clinically important mesh properties. Standardized packaging labels will provide accessibility of these properties and aim to bring standardized terminology into practice. With an increase in access to important properties, this can facilitate intraoperative decision making on a

Community-Dwelling People Screened Positive for Dementia in Primary Care: A Comprehensive, Multivariate Descriptive Analysis Using Data from the DelpHi-Study.

Science.gov (United States)

Thyrian, Jochen René; Eichler, Tilly; Michalowsky, Bernhard; Wucherer, Diana; Reimann, Melanie; Hertel, Johannes; Richter, Steffen; Dreier, Adina; Hoffmann, Wolfgang

2016-03-30

Efficient help and care for people with dementia (PWD) is dependent on knowledge about PWD in primary care. This analysis comprehensively describes community-dwelling PWD in primary care with respect to various dementia care specific variables. The analyses are based on baseline data of the ongoing general practitioner-based, randomized, controlled intervention trial DelpHi-MV (Dementia: life- and person-centered help). 6,838 patients were screened for dementia in 136 GP practices; 17.1% were screened positive, 54.4% of those agreed to participate and data could be assessed in n = 516 subjects. We assessed age, sex, living situation, cognitive status, functional status, level of impairment, comorbidities, formal diagnosis of dementia, depression, neuropsychiatric symptoms, quality of life, utilization of medical support, and pharmacological therapy. Concerning clinical-, dementia-, and health-related variables, the sample under examination was on average mildly cognitively and functionally impaired (MMSE, m = 22.2; BADL, m = 3.7). A level of care was assigned in 38.0%. Depression was identified in 15.4% and other frequent comorbidities were high blood pressure (83.3%), coronary heart diseases (37.1%), cerebrovascular diseases (22.3%), among others. In 48.6%, neuropsychiatric symptoms were present in a clinically relevant severity. Pharmacological treatment with antidementia medication was received by 25.8% and antidepressant medication by 14.0%. Utilization of services was generally low. The comprehensive description of people screened positive for dementia in primary care reveals a complex and unique population of patients. They are considerably underdiagnosed and in their majority mildly to moderately affected. More in-depth analyses are needed to study relations, associations and interactions between different variables.

pubmed.mineR: an R package with text-mining algorithms to analyse PubMed abstracts.

Science.gov (United States)

Rani, Jyoti; Shah, A B Rauf; Ramachandran, Srinivasan

2015-10-01

The PubMed literature database is a valuable source of information for scientific research. It is rich in biomedical literature with more than 24 million citations. Data-mining of voluminous literature is a challenging task. Although several text-mining algorithms have been developed in recent years with focus on data visualization, they have limitations such as speed, are rigid and are not available in the open source. We have developed an R package, pubmed.mineR, wherein we have combined the advantages of existing algorithms, overcome their limitations, and offer user flexibility and link with other packages in Bioconductor and the Comprehensive R Network (CRAN) in order to expand the user capabilities for executing multifaceted approaches. Three case studies are presented, namely, 'Evolving role of diabetes educators', 'Cancer risk assessment' and 'Dynamic concepts on disease and comorbidity' to illustrate the use of pubmed.mineR. The package generally runs fast with small elapsed times in regular workstations even on large corpus sizes and with compute intensive functions. The pubmed.mineR is available at http://cran.rproject. org/web/packages/pubmed.mineR.

Packaging for Food Service

Science.gov (United States)

Stilwell, E. J.

1985-01-01

Most of the key areas of concern in packaging the three principle food forms for the space station were covered. It can be generally concluded that there are no significant voids in packaging materials availability or in current packaging technology. However, it must also be concluded that the process by which packaging decisions are made for the space station feeding program will be very synergistic. Packaging selection will depend heavily on the preparation mechanics, the preferred presentation and the achievable disposal systems. It will be important that packaging be considered as an integral part of each decision as these systems are developed.

Waste Package Lifting Calculation

International Nuclear Information System (INIS)

H. Marr

2000-01-01

The objective of this calculation is to evaluate the structural response of the waste package during the horizontal and vertical lifting operations in order to support the waste package lifting feature design. The scope of this calculation includes the evaluation of the 21 PWR UCF (pressurized water reactor uncanistered fuel) waste package, naval waste package, 5 DHLW/DOE SNF (defense high-level waste/Department of Energy spent nuclear fuel)--short waste package, and 44 BWR (boiling water reactor) UCF waste package. Procedure AP-3.12Q, Revision 0, ICN 0, calculations, is used to develop and document this calculation

Certification of packagings: compliance with DOT specification 7A packaging requirements

International Nuclear Information System (INIS)

Edling, D.A.

1976-01-01

A study was conducted to determine which of the packagings currently listed in CFR 49 Section 173.395 a.1-5, meet the Specification 7A requirements (CFR 49 Section 173.350). According to DOT HM-111 the present listing of various authorized DOT specifications in Section 173.394 and Section 173.395 (Type A containers) of ICC Tariff No. 27 would be deleted with complete reliance being placed on the use of DOT 7A, Type A general packaging specification. Each user of a Specification 7A package would be required to document and maintain on file for one year a written record of his determination of compliance with the DOT Specification 7A performance requirements. All the specification packagings listed in CFR 49 Section 173.395a.1-5 were tested and shown to meet the Specification 7A criteria; however, in many cases qualifications were placed on their use. Forty-nine specification packagings were tested and shown to meet the DOT Specification 7A performance requirements and since there were several styles of some specific packagings, this amounts to greater than 80 packagings. The extensive testing generally indicated a high degree of containment integrity in the packagings tested and the documentation discussed is a valuable tool for shippers of Type A quantities of radioactive materials

Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer.

Science.gov (United States)

Ugalde, Anna; O'Callaghan, Clare; Byard, Clem; Brean, Samantha; MacKay, Jenelle; Boltong, Anna; Davoren, Sondra; Lawson, Deborah; Parente, Phillip; Michael, Natasha; Livingston, Patricia

2018-05-11

While advance care planning holds promise, uptake is variable and it is unclear how well people engage with or comprehend advance care planning. The objective of this study was to explore how people with cancer comprehended advance care plans and examine how accurately advance care planning documentation represented patient wishes. This study used a qualitative descriptive design. Data collection comprised interviews and an examination of participants' existing advance care planning documentation. Participants included those who had any diagnosis of cancer with an advance care plan recorded: Refusal of Treatment Certificate, Statement of Choices, and/or Enduring Power of Attorney (Medical Treatment) at one cancer treatment centre. Fourteen participants were involved in the study. Twelve participants were female (86%). The mean age was 77 (range: 61-91), and participants had completed their advance care planning documentation between 8 and 72 weeks prior to the interview (mean 33 weeks). Three themes were evident from the data: incomplete advance care planning understanding and confidence, limited congruence for attitude and documentation, advance care planning can enable peace of mind. Complete advance care planning understanding was unusual; most participants demonstrated partial comprehension of their own advance care plan, and some indicated very limited understanding. Participants' attitudes and their written document congruence were limited, but advance care planning was seen as helpful. This study highlighted advance care planning was not a completely accurate representation of patient wishes. There is opportunity to improve how patients comprehend their own advance care planning documentation.

Logistic Regression with Multiple Random Effects: A Simulation Study of Estimation Methods and Statistical Packages.

Science.gov (United States)

Kim, Yoonsang; Choi, Young-Ku; Emery, Sherry

2013-08-01

Several statistical packages are capable of estimating generalized linear mixed models and these packages provide one or more of three estimation methods: penalized quasi-likelihood, Laplace, and Gauss-Hermite. Many studies have investigated these methods' performance for the mixed-effects logistic regression model. However, the authors focused on models with one or two random effects and assumed a simple covariance structure between them, which may not be realistic. When there are multiple correlated random effects in a model, the computation becomes intensive, and often an algorithm fails to converge. Moreover, in our analysis of smoking status and exposure to anti-tobacco advertisements, we have observed that when a model included multiple random effects, parameter estimates varied considerably from one statistical package to another even when using the same estimation method. This article presents a comprehensive review of the advantages and disadvantages of each estimation method. In addition, we compare the performances of the three methods across statistical packages via simulation, which involves two- and three-level logistic regression models with at least three correlated random effects. We apply our findings to a real dataset. Our results suggest that two packages-SAS GLIMMIX Laplace and SuperMix Gaussian quadrature-perform well in terms of accuracy, precision, convergence rates, and computing speed. We also discuss the strengths and weaknesses of the two packages in regard to sample sizes.

The effect of nurse navigation on timeliness of breast cancer care at an academic comprehensive cancer center.

Science.gov (United States)

Basu, Mohua; Linebarger, Jared; Gabram, Sheryl G A; Patterson, Sharla Gayle; Amin, Miral; Ward, Kevin C

2013-07-15

A patient navigation process is required for accreditation by the National Accreditation Program for Breast Centers (NAPBC). Patient navigation has previously been shown to improve timely diagnosis in patients with breast cancer. This study sought to assess the effect of nurse navigation on timeliness of care following the diagnosis of breast cancer by comparing patients who were treated in a comprehensive cancer center with and without the assistance of nurse navigation. Navigation services were initiated at an NAPBC-accredited comprehensive breast center in July 2010. Two 9-month study intervals were chosen for comparison of timeliness of care: October 2009 through June 2010 and October 2010 through June 2011. All patients with breast cancer diagnosed in the cancer center with stage 0 to III disease during the 2 study periods were identified by retrospective cancer registry review. Time from diagnosis to initial oncology consultation was measured in business days, excluding holidays and weekends. Overall, 176 patients met inclusion criteria: 100 patients prior to and 76 patients following nurse navigation implementation. Nurse navigation was found to significantly shorten time to consultation for patients older than 60 years (B = -4.90, P = .0002). There was no change in timeliness for patients 31 to 60 years of age. Short-term analysis following navigation implementation showed decreased time to consultation for older patients, but not younger patients. Further studies are indicated to assess the long-term effects and durability of this quality improvement initiative. © 2013 American Cancer Society.

Anhydrous Ammonia Training Module. Trainer's Package. Participant's Package.

Science.gov (United States)

Beaudin, Bart; And Others

This document contains a trainer's and a participant's package for teaching employees on site safe handling procedures for working with anhydrous ammonia, especially on farms. The trainer's package includes the following: a description of the module; a competency; objectives; suggested instructional aids; a training outline (or lesson plan) for…

Medical Care in a Free Clinic: A Comprehensive Evaluation of Patient Experience, Incentives, and Barriers to Optimal Medical Care with Consideration of a Facility Fee.

Science.gov (United States)

Birs, Antoinette; Liu, Xinwei; Nash, Bee; Sullivan, Sara; Garris, Stephanie; Hardy, Marvin; Lee, Michael; Simms-Cendan, Judith; Pasarica, Magdalena

2016-02-19

Free and charitable clinics are important contributors to the health of the United States population. Recently, funding for these clinics has been declining, and it is, therefore, useful to identify what qualities patients value the most in clinics in an effort to allocate funding wisely. In order to identify targets and incentives for improvement of patients' health, we performed a comprehensive analysis of patients' experience at a free clinic by analyzing a patient survey (N=94). The survey also assessed patient opinions of a small facility fee, which could be used to offset the decrease in funds. Interestingly, our patients believed it is appropriate to be charged a facility fee (78%) because it increases involvement in their care (r = 0.69, p fee. Barriers include affordable housing, transportation, medication, and accessible information. In order to improve medical care in the uninsured population, our study suggested that we need to: 1) offer continuity of medical care; 2) offer affordable preventive health screenings; 3) support affordable transportation, housing, and medications; and 4) consider including a facility fee.

Compensation packages: a strategic tool for employees’ performance and retention

Directory of Open Access Journals (Sweden)

Omotayo Adewale OSIBANJO

2014-02-01

Full Text Available The rate at which employees in private universities in Nigeria jump from one university to the other is becoming more disturbing and this could be as a result of compensation packages of different universities to attract competent employees. The aim of this study was to examine the effect of compensation packages on employees’ job performance and retention in a selected private University in Ogun State, South-West Nigeria. A model was developed and tested using one hundred and eleven valid questionnaires which were completed by academics and non-academic staff of the university. The collected data were carefully analyzed using simple percentage supported by structural equation modelling to test the hypotheses and relationships that may exist among the variables under consideration. The results showed strong relationship between compensation packages and employees’ performance and retention. The summary of the findings indicates that there is strong correlation between the tested dependent and independent variables (salary, bonus, incentives, allowances, and fringe benefits. However, management and decision makers should endeavour to review compensation packages at various levels in order to earn employees’ satisfaction and prevention of high labour turnover among the members of staff.

Green Packaging Development. : A way to efficient, effective and more environmental friendly packaging solutions.

OpenAIRE

Mian Muhammad, Masoud

2011-01-01

Growing pressure on the packaging design to enhance the environmental and logistics performance of a packaging system stresses the packaging designers to search new design strategies that not only fulfill logistics requirements in the supply chain, but also reduce the CO 2emissions during the packaging life cycle. This thesis focuses on the packaging design process and suggests some improvements by considering its logistics performance and CO 2emissions. A Green packaging development model wa...

Developing a managed care delivery system in New York State for Medicaid recipients with HIV.

Science.gov (United States)

Feldman, I; Cruz, H; DeLorenzo, J; Hidalgo, J; Plavin, H; Whitaker, J

1999-11-01

In the state of New York, models of care known as HIV Special Needs Plans (HIV SNPs) are being developed to meet the unique health and medical needs of Medicaid recipients with HIV. Establishing managed care plans for the 80,000 to 100,000 HIV-infected Medicaid recipients residing in the state has required considerable effort, including distributing planning grants to solicit information and recommendations regarding program and fiscal policy; convening a workgroup to facilitate discussions between the state and the provider and consumer communities; conducting a longitudinal survey to assess the impact of managed care on persons with HIV; and developing a longitudinal, person-based, encounter-level database representing the clinical and service utilization histories of more than 100,000 patients for state fiscal years 1990 to 1996. The key fiscal issues identified and discussed were capitation rates, initial capitalization levels, and risk-adjustment mechanisms. Other pertinent issues included the importance of a benefits package supporting a comprehensive, integrated continuum of state-of-the-art services; marketing and enrollment; attention to provider and consumer training and education needs; and interdependence of financial reimbursement and benefits packages. From our experience in New York State, we conclude that a successful model of Medicaid managed care for persons with HIV should build on the existing infrastructure of services, using a collaborative process among government agencies, healthcare providers, and HIV/AIDS consumer communities. A future challenge lies in the implementation of the HIV SNP model and evaluation of its soundness and ability to ensure quality healthcare services.

The importance of cigarette packaging in a 'dark' market: the 'Silk Cut' experience.

Science.gov (United States)

Moodie, Crawford; Angus, Kathryn; Ford, Allison

2014-05-01

In a growing number of countries tobacco companies are severely restricted in how they can legally market their products. In these 'dark' markets the role of packaging as a promotional and communications tool becomes more pronounced. How packaging is used for the most expensive cigarette brands in dark markets has received limited attention however, even though these 'premium' cigarette brands significantly impact upon the profitability of tobacco companies. We outline, using retail trade press journals, how packaging was used for premium brand 'Silk Cut' in the UK from 2004 to 2011, following a comprehensive ban on tobacco advertising, promotions and sponsorship. From 2004 to 2008 packaging was used to help launch two new variants and during this period Silk Cut market share of the premium sector grew by 1.1%. Overall share of the cigarette market for the Silk Cut house (brand family) fell however due to the continuing decline of the premium sector. From 2008 to 2011 changes to the packaging were much more frequent, including the repeated use of limited-edition designs, and modifications to pack shape, texture, style of opening, cellophane, foil and inner frame. Silk Cut's share of the premium sector grew a further 2.9% from 2008 to 2011, and overall cigarette market share increased. That a premium brand can report any level of growth within such a hostile market, where most advertising, promotion and sponsorship is banned, taxation is among the highest in the world, and in the midst of a recession, is testament to the value of packaging.

Women's maternity care needs and related service models in rural areas: A comprehensive systematic review of qualitative evidence.

Science.gov (United States)

Hoang, Ha; Le, Quynh; Ogden, Kathryn

2014-12-01

Understanding the needs of rural women in maternity care and service models available to them is significant for the development of effective policies and the sustainability of rural communities. Nevertheless, no systematic review of studies addressing these needs has been conducted. To synthesise the best available evidence on the experiences of women's needs in maternity care and existing service models in rural areas. Literature search of ten electronic databases, digital theses, and reference lists of relevant studies applying inclusion/exclusion criteria was conducted. Selected papers were assessed using standardised critical appraisal instruments from JBI-QARI. Data extracted from these studies were synthesised using thematic synthesis. 12 studies met the inclusion criteria. There were three main themes and several sub-themes identified. A comprehensive set of the maternity care expectations of rural women was reported in this review including safety (7), continuity of care (6) and quality of care (6), and informed choices needs (4). In addition, challenges in accessing maternity services also emerged from the literature such as access (6), risk of travelling (9) and associated cost of travel (9). Four models of maternity care examined in the literature were medically led care (5), GP-led care (4), midwifery-led care (7) and home birth (6). The systematic review demonstrates the importance of including well-conducted qualitative studies in informing the development of evidence-based policies to address women's maternity care needs and inform service models. Synthesising the findings from qualitative studies offers important insight for informing effective public health policy. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Report on geotechnical tests with model structures Work Package - Deliverable number: WP 7.2 – D72.2

DEFF Research Database (Denmark)

Gintautas, Tomas; Sørensen, John Dalsgaard

2017-01-01

This report aims to give a comprehensive summary of the geotechnical tests with model structures that have been performed in work package 7.2 task 7.2.2 within the IRPWIND project. The large-scale tests are intended to determine soil-structure interaction effects in order to support probabilistic...... calculations of the reliability of offshore wind turbine support structures. These calculations are mainly performed in work package 7.4 of the IRPWIND project. However, this report already includes the development of a probabilistic model for the axial bearing capacity / resistance that is obtained using...

The Comprehensive Health Education Workers Project and Caring Professionals as Asset-Builders

Science.gov (United States)

Lévesque, Michel

2017-01-01

The Comprehensive Health Education Workers (CHEW) Project is a community-based initiative that educates sexual and gender minority (SGM or LGBTQ) young people about comprehensive--mental, physical, sexual, and social--health and that supports their comprehensive health needs with other services. Since October 2014, CHEW Project staff have served…

Local understandings of care during delivery and postnatal period to inform home based package of newborn care interventions in rural Ethiopia: a qualitative study.

Science.gov (United States)

Degefie, Tedbabe; Amare, Yared; Mulligan, Brian

2014-05-19

Despite a substantial decrease in child mortality in Ethiopia over the past decade, neonatal mortality remains unchanged (37/1000 live-births). This paper describes a qualitative study on beliefs and practices on immediate newborn and postnatal care in four rural communities of Ethiopia conducted to inform development of a package of community-based interventions targeting newborns. The study team conducted eight key informant interviews (KII) with grandmothers, 27 in-depth interviews (IDI) with mothers; seven IDI with traditional birth attendants (TBA) and 15IDI with fathers, from four purposively selected communities located in Sidama Zone of Southern Nationalities, Nations, and Peoples (SNNP) Region and in East Shewa and West Arsi Zones of Oromia Region. In the study communities deliveries occurred at home. After cutting the umbilical cord, the baby is put to the side of the mother, not uncommonly with no cloth covering. This is largely due to attendants focusing on delivery of the placenta which is reinforced by the belief that the placenta is the 'house' or 'blanket' of the baby and that any "harm" caused to the placenta will transfer to the newborn. Applying butter or ointment to the cord "to speed drying" is common practice. Initiation of breastfeeding is often delayed and women commonly report discarding colostrum before initiating breastfeeding. Sub-optimal breastfeeding practices continue, due to perceived inadequate maternal nutrition and breast milk often leading to the provision of herbal drinks. Poor thermal care is also demonstrated through lack of continued skin-to-skin contact, exposure of newborns to smoke, frequent bathing-often with cold water baths for low-birth weight or small babies; and, poor hygienic practices are reported, particularly hand washing prior to contact with the newborn. Cultural beliefs and newborn care practices do not conform to recommended standards. Local perspectives related to newborn care practices should inform

Effect of a comprehensive plan for periodontal disease care on oral health-related quality of life in patients with periodontal disease in Taiwan.

Science.gov (United States)

Wang, Tze-Fang; Fang, Chun-Han; Hsiao, Kai-Jong; Chou, Chyuan

2018-02-01

A comprehensive plan for periodontal disease (PD) care in Taiwan provides non-surgical and supportive periodontal treatment. The aim of this study was to determine whether the care plan could improve the oral health-related quality of life of patients with PD.This study was conducted by purposive sampling and a quasi-experimental design. Patients with PD were assigned to either comprehensive periodontal treatment (n = 32) or a simple cleaning regimen (n = 32). Their oral health-related quality of life (OHRQoL) was measured using the Taiwanese version of the Brief World Health Organization Quality of Life (WHOQOL-BREF) scale (general QoL) and the Oral Health Impact Profile (OHIP-14) (OHRQoL). Both scales were completed 14, 28, and 90 days after the initial assessment. The extent of PD in the experimental group was determined again at the end of the study.On the 28-item WHOQOL-BREF scale, the scores of the experimental group were higher than those of the control group on 5 items and the environmental domain at 14 days. There was a significant improvement in the experimental group on 2 items at 28 days and at 90 days after periodontal treatment (both P improvement in the experimental group in total score at 28 and 90 days after periodontal treatment (both P plan for PD care showed some improvement in QoL, including in the environmental domain, and on the total score for OHRQoL. Comprehensive periodontal treatment also alleviated periodontal symptoms.

IN-PACKAGE CHEMISTRY ABSTRACTION

Energy Technology Data Exchange (ETDEWEB)

E. Thomas

2005-07-14

This report was developed in accordance with the requirements in ''Technical Work Plan for Postclosure Waste Form Modeling'' (BSC 2005 [DIRS 173246]). The purpose of the in-package chemistry model is to predict the bulk chemistry inside of a breached waste package and to provide simplified expressions of that chemistry as a function of time after breach to Total Systems Performance Assessment for the License Application (TSPA-LA). The scope of this report is to describe the development and validation of the in-package chemistry model. The in-package model is a combination of two models, a batch reactor model, which uses the EQ3/6 geochemistry-modeling tool, and a surface complexation model, which is applied to the results of the batch reactor model. The batch reactor model considers chemical interactions of water with the waste package materials, and the waste form for commercial spent nuclear fuel (CSNF) waste packages and codisposed (CDSP) waste packages containing high-level waste glass (HLWG) and DOE spent fuel. The surface complexation model includes the impact of fluid-surface interactions (i.e., surface complexation) on the resulting fluid composition. The model examines two types of water influx: (1) the condensation of water vapor diffusing into the waste package, and (2) seepage water entering the waste package as a liquid from the drift. (1) Vapor-Influx Case: The condensation of vapor onto the waste package internals is simulated as pure H{sub 2}O and enters at a rate determined by the water vapor pressure for representative temperature and relative humidity conditions. (2) Liquid-Influx Case: The water entering a waste package from the drift is simulated as typical groundwater and enters at a rate determined by the amount of seepage available to flow through openings in a breached waste package.

IN-PACKAGE CHEMISTRY ABSTRACTION

International Nuclear Information System (INIS)

E. Thomas

2005-01-01

This report was developed in accordance with the requirements in ''Technical Work Plan for Postclosure Waste Form Modeling'' (BSC 2005 [DIRS 173246]). The purpose of the in-package chemistry model is to predict the bulk chemistry inside of a breached waste package and to provide simplified expressions of that chemistry as a function of time after breach to Total Systems Performance Assessment for the License Application (TSPA-LA). The scope of this report is to describe the development and validation of the in-package chemistry model. The in-package model is a combination of two models, a batch reactor model, which uses the EQ3/6 geochemistry-modeling tool, and a surface complexation model, which is applied to the results of the batch reactor model. The batch reactor model considers chemical interactions of water with the waste package materials, and the waste form for commercial spent nuclear fuel (CSNF) waste packages and codisposed (CDSP) waste packages containing high-level waste glass (HLWG) and DOE spent fuel. The surface complexation model includes the impact of fluid-surface interactions (i.e., surface complexation) on the resulting fluid composition. The model examines two types of water influx: (1) the condensation of water vapor diffusing into the waste package, and (2) seepage water entering the waste package as a liquid from the drift. (1) Vapor-Influx Case: The condensation of vapor onto the waste package internals is simulated as pure H 2 O and enters at a rate determined by the water vapor pressure for representative temperature and relative humidity conditions. (2) Liquid-Influx Case: The water entering a waste package from the drift is simulated as typical groundwater and enters at a rate determined by the amount of seepage available to flow through openings in a breached waste package

Impact of comprehensive insurance parity on follow-up care after psychiatric inpatient treatment in Oregon.

Science.gov (United States)

Wallace, Neal T; McConnell, K John

2013-10-01

This study assessed the impact of Oregon's 2007 parity law, which required behavioral health insurance parity, on rates of follow-up care provided within 30 days of psychiatric inpatient care. Data sources were claims (2005-2008) for 737 individuals with inpatient stays for a mental disorder who were continuously enrolled in insurance plans affected by the parity law (intervention group) or in commercial, self-insured plans that were not affected by the law (control group). A difference-in-difference analysis was used to compare rates of follow-up care before and after the parity law between discharges of individuals in the intervention group and the control group and between discharges of individuals in the intervention group who had or had not met preparity quantitative coverage limits during a coverage year. Estimates of the marginal effects of the parity law were adjusted for gender, discharge diagnosis, relationship to policy holder, and calendar quarter of discharge. The study included 353 discharges in the intervention group and 535 discharges in the control group. After the parity law, follow-up rates increased by 11% (p=.042) overall and by 20% for discharges of individuals who had met coverage limits (p=.028). The Oregon parity law was associated with a large increase in the rate of follow-up care, predominantly for discharges of individuals who had met preparity quantitative coverage limits. Given similarities between the law and the 2008 Mental Health Parity and Addiction Equity Act, the results may portend a national effect of more comprehensive parity laws.

Hazardous materials package performance regulations

International Nuclear Information System (INIS)

Russell, N.A.; Glass, R.E.; McClure, J.D.; Finley, N.C.

1992-01-01

The hazardous materials (hazmat) packaging development and certification process is currently defined by two different regulatory philosophies, one based on specification packagings and the other based on performance standards. With specification packagings, a packaging is constructed according to an agreed set of design specifications. In contrast, performance standards do not specify the packaging design; they specify performance standards that a packaging design must be able to pass before it can be certified for transport. The packaging can be designed according to individual needs as long as it meets these performance standards. Performance standards have been used nationally and internationally for about 40 years to certify radioactive materials (RAM) packagings. It is reasonable to state that for RAM transport, performance specifications have maintained transport safety. A committee of United Nation's experts recommended the performance standard philosophy as the preferred regulation method for hazmat packaging. Performance standards for hazmat packagings smaller than 118 gallons have been adopted in 49CFR178. Packagings for materials that are classified as toxic-by-inhalation must comply with the performance standards by October 1, 1993, and packagings for all other classes of hazardous materials covered must comply by October 1, 1996. For packages containing bulk (in excess of 188 gallons) quantities of materials that are extremely toxic by inhalation, there currently are no performance requirements. This paper discusses a Hazmat Packaging Performance Evaluation (HPPE) project to look at the subset of bulk packagings that are larger than 2000 gallons. The objectives of this project are the evaluate current hazmat specification packagings and develop supporting documentation for determining performance requirements for packagings in excess of 2000 gallons that transport hazardous materials that have been classified as extremely toxic by inhalation (METBI)

Lithium niobate packaging challenges

International Nuclear Information System (INIS)

Murphy, E.J.; Holmes, R.J.; Jander, R.B.; Schelling, A.W.

1988-01-01

The use of lithium niobate integrated optic devices outside of the research laboratory is predicated on the development of a sound packaging method. The authors present a discussion of the many issues that face the development of a viable, robust packaging technology. The authors emphasize the interaction of lithium niobate's physical properties with available packaging materials and technologies. The broad range of properties (i.e. electro-optic, piezo-electric, pyro-electric, photorefractive...) that make lithium niobate an interesting material in many device applications also make it a packaging challenge. The package design, materials and packaging technologies must isolate the device from the environment so that lithium niobate's properties do not adversely affect the device performance

User friendly packaging

DEFF Research Database (Denmark)

Geert Jensen, Birgitte

2010-01-01

Most consumers have experienced occasional problems with opening packaging. Tomato sauce from the tinned mackerel splattered all over the kitchen counter, the unrelenting pickle jar lid, and the package of sliced ham that cannot be opened without a knife or a pair of scissors. The research project...... “User-friendly Packaging” aims to create a platform for developing more user-friendly packaging. One intended outcome of the project is a guideline that industry can use in development efforts. The project also points the way for more extended collaboration between companies and design researchers. How...... can design research help industry in packaging innovation?...

Context updating during sentence comprehension: the effect of aboutness topic.

Science.gov (United States)

Burmester, Juliane; Spalek, Katharina; Wartenburger, Isabell

2014-10-01

To communicate efficiently, speakers typically link their utterances to the discourse environment and adapt their utterances to the listener's discourse representation. Information structure describes how linguistic information is packaged within a discourse to optimize information transfer. The present study investigates the nature and time course of context integration (i.e., aboutness topic vs. neutral context) on the comprehension of German declarative sentences with either subject-before-object (SO) or object-before-subject (OS) word order using offline comprehensibility judgments and online event-related potentials (ERPs). Comprehensibility judgments revealed that the topic context selectively facilitated comprehension of stories containing OS (i.e., non-canonical) sentences. In the ERPs, the topic context effect was reflected in a less pronounced late positivity at the sentence-initial object. In line with the Syntax-Discourse Model, we argue that these context-induced effects are attributable to reduced processing costs for updating the current discourse model. The results support recent approaches of neurocognitive models of discourse processing. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Antimicrobial Substances for Food Packaging Products: The Current Situation.

Science.gov (United States)

Pellerito, Alessandra; Ameen, Sara M; Micali, Maria; Caruso, Giorgia

2018-04-04

Antimicrobial substances are widely used in many anthropic activities, including sanitary and military services for the human population. These compounds are also known to be used in food production, agricultural activities, and partially correlated industrial sectors. However, there are concerns regarding the link between the abuse of antimicrobial agents in these ambits and the possible detection of antibiotic-resistant microorganisms. Modern food and beverage products are generally found on the market as prepackaged units, with several exceptions. Consequently, positive and negative features of a specific food or beverage should be considered as the result of the synergic action of different components, including the container (or the assembled sum of packaging materials). At present, the meaning of food container also includes the creation and development of new packaging materials that are potentially able to interact with the contained food. "Active" packaging systems can be realized with antimicrobial substances. On the other hand, a careful evaluation of risks and advantages correlated with antimicrobial agents is needed because of possible negative and/or unexpected failures.

Packaging Review Guide for Reviewing Safety Analysis Reports for Packagings

Energy Technology Data Exchange (ETDEWEB)

DiSabatino, A; Biswas, D; DeMicco, M; Fisher, L E; Hafner, R; Haslam, J; Mok, G; Patel, C; Russell, E

2007-04-12

This Packaging Review Guide (PRG) provides guidance for Department of Energy (DOE) review and approval of packagings to transport fissile and Type B quantities of radioactive material. It fulfills, in part, the requirements of DOE Order 460.1B for the Headquarters Certifying Official to establish standards and to provide guidance for the preparation of Safety Analysis Reports for Packagings (SARPs). This PRG is intended for use by the Headquarters Certifying Official and his or her review staff, DOE Secretarial offices, operations/field offices, and applicants for DOE packaging approval. This PRG is generally organized at the section level in a format similar to that recommended in Regulatory Guide 7.9 (RG 7.9). One notable exception is the addition of Section 9 (Quality Assurance), which is not included as a separate chapter in RG 7.9. Within each section, this PRG addresses the technical and regulatory bases for the review, the manner in which the review is accomplished, and findings that are generally applicable for a package that meets the approval standards. This Packaging Review Guide (PRG) provides guidance for DOE review and approval of packagings to transport fissile and Type B quantities of radioactive material. It fulfills, in part, the requirements of DOE O 460.1B for the Headquarters Certifying Official to establish standards and to provide guidance for the preparation of Safety Analysis Reports for Packagings (SARPs). This PRG is intended for use by the Headquarters Certifying Official and his review staff, DOE Secretarial offices, operations/field offices, and applicants for DOE packaging approval. The primary objectives of this PRG are to: (1) Summarize the regulatory requirements for package approval; (2) Describe the technical review procedures by which DOE determines that these requirements have been satisfied; (3) Establish and maintain the quality and uniformity of reviews; (4) Define the base from which to evaluate proposed changes in scope

DNA Packaging by λ-Like Bacteriophages: Mutations Broadening the Packaging Specificity of Terminase, the λ-Packaging Enzyme

OpenAIRE

Feiss, Michael; Reynolds, Erin; Schrock, Morgan; Sippy, Jean

2010-01-01

The DNA-packaging specificities of phages λ and 21 depend on the specific DNA interactions of the small terminase subunits, which have support helix-turn-recognition helix-wing DNA-binding motifs. λ-Terminase with the recognition helix of 21 preferentially packages 21 DNA. This chimeric terminase's ability to package λDNA is reduced ∼20-fold. Phage λ with the chimeric terminase is unable to form plaques, but pseudorevertants are readily obtained. Some pseudorevertants have trans-acting suppre...

The paradox of packaging optimization – a characterization of packaging source reduction in the Netherlands

NARCIS (Netherlands)

van Sluisveld, M.A.E.; Worrell, E.

2013-01-01

The European Council Directive 94/62/EC for Packaging and Packaging Waste requires that Member States implement packaging waste prevention measures. However, consumption and subsequently packaging waste figures are still growing annually. It suggests that policies to accomplish packaging waste

MendelianRandomization: an R package for performing Mendelian randomization analyses using summarized data.

Science.gov (United States)

Yavorska, Olena O; Burgess, Stephen

2017-12-01

MendelianRandomization is a software package for the R open-source software environment that performs Mendelian randomization analyses using summarized data. The core functionality is to implement the inverse-variance weighted, MR-Egger and weighted median methods for multiple genetic variants. Several options are available to the user, such as the use of robust regression, fixed- or random-effects models and the penalization of weights for genetic variants with heterogeneous causal estimates. Extensions to these methods, such as allowing for variants to be correlated, can be chosen if appropriate. Graphical commands allow summarized data to be displayed in an interactive graph, or the plotting of causal estimates from multiple methods, for comparison. Although the main method of data entry is directly by the user, there is also an option for allowing summarized data to be incorporated from the PhenoScanner database of genotype-phenotype associations. We hope to develop this feature in future versions of the package. The R software environment is available for download from [https://www.r-project.org/]. The MendelianRandomization package can be downloaded from the Comprehensive R Archive Network (CRAN) within R, or directly from [https://cran.r-project.org/web/packages/MendelianRandomization/]. Both R and the MendelianRandomization package are released under GNU General Public Licenses (GPL-2|GPL-3). © The Author 2017. Published by Oxford University Press on behalf of the International Epidemiological Association.

An in-depth mixed-methods approach to Ryan White HIV/AIDS care program comprehensive needs assessment from the Northeast Georgia Public Health District: the significance of patient privacy, psychological health, and social stigma to care.

Science.gov (United States)

Huff, Amber; Chumbler, Neale; Cherry, Colleen O'Brien; Hill, Miranda; Veguilla, Vic

2015-04-01

We apply a social-ecological interpretive framework to understanding relationships among patient privacy, psychological health, social stigma, and continuity in care in the HIV treatment cascade in the rural southeastern US. This research was conducted as part of the 2013 comprehensive needs assessment for the Northeast Georgia Ryan White Consortium using an anthropologically informed mixed-methods design, and a deductive-inductive approach to thematic analysis of qualitative data obtained in interviews and focus groups with service providers and service utilizers. Our comprehensive needs assessment yielded two key components. First, we identified salient phenomena influencing introduction to, retention among, and satisfaction of patients in the Ryan White-coordinated treatment cascade in NE-GA. Second, we formulated actionable recommendations around leverage points identified in the current district-wide system of care. Results highlight spatial, institutional, and interpersonal aspects of the system of care that intersect around issues of patient privacy, psychological health, and social stigma. These intersections constitute pathways by which persons living with HIV are exposed to stigma and other negative social signals regarding their health status without sufficient access to behavioral health services. These negative issues, in turn, can erect significant barriers to long-term continuity in care. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Comprehension of hazard pictograms of chemical products among cleaning workers].

Science.gov (United States)

Martí Fernández, Francesc; van der Haar, Rudolf; López López, Juan Carlos; Portell, Mariona; Torner Solé, Anna

2015-01-01

To assess the comprehension among cleaning workers of the hazard pictograms as defined by the Globally Harmonized System (GHS) of the United Nations, concerning the classification, labeling and packaging of substances and mixtures. A sample of 118 workers was surveyed on their perception of the GHS hazard pictograms. Comprehensibility was measured by the percentage of correct answers and the degree to which they reflected International Organization for Standardization and American National Standards Institute standards for minimum level of comprehension. The influence of different variables to predict comprehension capacity was assessed using a logistic regression model. Three groups of pictograms could be distinguished which were statistically differentiated by their comprehensibility. Pictograms reflecting "acute toxicity" and "flammable", were described correctly by 94% and 95% of the surveyed population, respectively. For pictograms reflecting "systemic toxicity", "corrosive", "warning", "environment" and "explosive" the frequency of correct answers ranged from 48% to 64%, whereas those for pictograms "oxidizing" and "compressed gas" were interpreted correctly by only 7% of respondents. Prognostic factors for poor comprehension included: not being familiar with the pictograms, not having received training on safe use of chemical products, being an immigrant and being 54 years of age or older. Only two pictograms exceeded minimum standards for comprehension. Training, a tool proven to be effective to improve the correct interpretation of danger symbols, should be encouraged, especially in those groups with greater comprehension difficulties. Copyright belongs to the Societat Catalana de Salut Laboral.

Prevention policies addressing packaging and packaging waste: Some emerging trends.

Science.gov (United States)

Tencati, Antonio; Pogutz, Stefano; Moda, Beatrice; Brambilla, Matteo; Cacia, Claudia

2016-10-01

Packaging waste is a major issue in several countries. Representing in industrialized countries around 30-35% of municipal solid waste yearly generated, this waste stream has steadily grown over the years even if, especially in Europe, specific recycling and recovery targets have been fixed. Therefore, an increasing attention starts to be devoted to prevention measures and interventions. Filling a gap in the current literature, this explorative paper is a first attempt to map the increasingly important phenomenon of prevention policies in the packaging sector. Through a theoretical sampling, 11 countries/states (7 in and 4 outside Europe) have been selected and analyzed by gathering and studying primary and secondary data. Results show evidence of three specific trends in packaging waste prevention policies: fostering the adoption of measures directed at improving packaging design and production through an extensive use of the life cycle assessment; raising the awareness of final consumers by increasing the accountability of firms; promoting collaborative efforts along the packaging supply chains. Copyright © 2016 Elsevier Ltd. All rights reserved.

Food packages for Space Shuttle

Science.gov (United States)

Fohey, M. F.; Sauer, R. L.; Westover, J. B.; Rockafeller, E. F.

1978-01-01

The paper reviews food packaging techniques used in space flight missions and describes the system developed for the Space Shuttle. Attention is directed to bite-size food cubes used in Gemini, Gemini rehydratable food packages, Apollo spoon-bowl rehydratable packages, thermostabilized flex pouch for Apollo, tear-top commercial food cans used in Skylab, polyethylene beverage containers, Skylab rehydratable food package, Space Shuttle food package configuration, duck-bill septum rehydration device, and a drinking/dispensing nozzle for Space Shuttle liquids. Constraints and testing of packaging is considered, a comparison of food package materials is presented, and typical Shuttle foods and beverages are listed.

In-Package Chemistry Abstraction

Energy Technology Data Exchange (ETDEWEB)

E. Thomas

2004-11-09

This report was developed in accordance with the requirements in ''Technical Work Plan for: Regulatory Integration Modeling and Analysis of the Waste Form and Waste Package'' (BSC 2004 [DIRS 171583]). The purpose of the in-package chemistry model is to predict the bulk chemistry inside of a breached waste package and to provide simplified expressions of that chemistry as function of time after breach to Total Systems Performance Assessment for the License Application (TSPA-LA). The scope of this report is to describe the development and validation of the in-package chemistry model. The in-package model is a combination of two models, a batch reactor model that uses the EQ3/6 geochemistry-modeling tool, and a surface complexation model that is applied to the results of the batch reactor model. The batch reactor model considers chemical interactions of water with the waste package materials and the waste form for commercial spent nuclear fuel (CSNF) waste packages and codisposed waste packages that contain both high-level waste glass (HLWG) and DOE spent fuel. The surface complexation model includes the impact of fluid-surface interactions (i.e., surface complexation) on the resulting fluid composition. The model examines two types of water influx: (1) the condensation of water vapor that diffuses into the waste package, and (2) seepage water that enters the waste package from the drift as a liquid. (1) Vapor Influx Case: The condensation of vapor onto the waste package internals is simulated as pure H2O and enters at a rate determined by the water vapor pressure for representative temperature and relative humidity conditions. (2) Water Influx Case: The water entering a waste package from the drift is simulated as typical groundwater and enters at a rate determined by the amount of seepage available to flow through openings in a breached waste package. TSPA-LA uses the vapor influx case for the nominal scenario for simulations where the waste

In-Package Chemistry Abstraction

International Nuclear Information System (INIS)

E. Thomas

2004-01-01

This report was developed in accordance with the requirements in ''Technical Work Plan for: Regulatory Integration Modeling and Analysis of the Waste Form and Waste Package'' (BSC 2004 [DIRS 171583]). The purpose of the in-package chemistry model is to predict the bulk chemistry inside of a breached waste package and to provide simplified expressions of that chemistry as function of time after breach to Total Systems Performance Assessment for the License Application (TSPA-LA). The scope of this report is to describe the development and validation of the in-package chemistry model. The in-package model is a combination of two models, a batch reactor model that uses the EQ3/6 geochemistry-modeling tool, and a surface complexation model that is applied to the results of the batch reactor model. The batch reactor model considers chemical interactions of water with the waste package materials and the waste form for commercial spent nuclear fuel (CSNF) waste packages and codisposed waste packages that contain both high-level waste glass (HLWG) and DOE spent fuel. The surface complexation model includes the impact of fluid-surface interactions (i.e., surface complexation) on the resulting fluid composition. The model examines two types of water influx: (1) the condensation of water vapor that diffuses into the waste package, and (2) seepage water that enters the waste package from the drift as a liquid. (1) Vapor Influx Case: The condensation of vapor onto the waste package internals is simulated as pure H2O and enters at a rate determined by the water vapor pressure for representative temperature and relative humidity conditions. (2) Water Influx Case: The water entering a waste package from the drift is simulated as typical groundwater and enters at a rate determined by the amount of seepage available to flow through openings in a breached waste package. TSPA-LA uses the vapor influx case for the nominal scenario for simulations where the waste package has been

Radioactive material packaging performance testing

International Nuclear Information System (INIS)

Romano, T.; Cruse, J.M.

1991-02-01

To provide uniform packaging of hazardous materials on an international level, the United Nations has developed packaging recommendations that have been implemented worldwide. The United Nations packaging recommendations are performance oriented, allowing for a wide variety of package materials and systems. As a result of this international standard, efforts in the United States are being directed toward use of performance-oriented packaging and elimination of specification (designed) packaging. This presentation will focus on trends, design evaluation, and performance testing of radioactive material packaging. The impacts of US Department of Transportation Dockets HM-181 and HM-169A on specification and low-specific activity radioactive material packaging requirements are briefly discussed. The US Department of Energy's program for evaluating radioactive material packings per US Department of Transportation Specification 7A Type A requirements, is used as the basis for discussing low-activity packaging performance test requirements. High-activity package testing requirements are presented with examples of testing performed at the Hanford Site that is operated by Westinghouse Hanford Company for the US Department of Energy. 5 refs., 2 tabs

A blended learning approach to teaching CVAD care and maintenance.

Science.gov (United States)

Hainey, Karen; Kelly, Linda J; Green, Audrey

2017-01-26

Nurses working within both acute and primary care settings are required to care for and maintain central venous access devices (CVADs). To support these nurses in practice, a higher education institution and local health board developed and delivered CVAD workshops, which were supported by a workbook and competency portfolio. Following positive evaluation of the workshops, an electronic learning (e-learning) package was also introduced to further support this clinical skill in practice. To ascertain whether this blended learning approach to teaching CVAD care and maintenance prepared nurses for practice, the learning package was evaluated through the use of electronic questionnaires. Results highlighted that the introduction of the e-learning package supported nurses' practice, and increased their confidence around correct clinical procedures.

u-CARE: user-friendly Comprehensive Antibiotic resistance Repository of Escherichia coli.

Science.gov (United States)

Saha, Saurav B; Uttam, Vishwas; Verma, Vivek

2015-08-01

Despite medical advancements, Escherichia coli-associated infections remain a major public health concern and although an abundant information about E. coli and its antibiotic resistance mechanisms is available, no effective tool exists that integrates gene and genomic data in context to drug resistance, thus raising a need to develop a repository that facilitates integration and assimilation of factors governing drug resistance in E. coli. User-friendly Comprehensive Antibiotic resistance Repository of Escherichia coli (u-CARE) is a manually curated catalogue of 52 antibiotics with reported resistance, 107 genes, transcription factors and single nucleotide polymorphism (SNPs) involved in multiple drug resistance of this pathogen. Each gene page provides detailed information about its resistance mechanisms, while antibiotic page consists of summary, chemical description and structural descriptors with links to external public databases like GO, CDD, DEG, Ecocyc, KEGG, Drug Bank, PubChem and UniProt. Moreover, the database integrates this reductive information to holistic data such as strain-specific and segment-specific pathogenic islands and operons. In addition, the database offers rich user interface for the visualisation and retrieval of information using various search criteria such as sequence, keyword, image and class search. u-CARE is aimed to cater to the needs of researchers working in the field of antimicrobial drug resistance with minimal knowledge of bioinformatics. This database is also intended as a guide book to medical practitioners to avoid use of antibiotics against which resistance has already been reported in E. coli. The database is available from: http://www.e-bioinformatics.net/ucare. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Integrated care: a comprehensive bibliometric analysis and literature review

Directory of Open Access Journals (Sweden)

Xiaowei Sun

2014-06-01

Full Text Available Introduction: Integrated care could not only fix up fragmented health care but also improve the continuity of care and the quality of life. Despite the volume and variety of publications, little is known about how ‘integrated care’ has developed. There is a need for a systematic bibliometric analysis on studying the important features of the integrated care literature.Aim: To investigate the growth pattern, core journals and jurisdictions and identify the key research domains of integrated care.Methods: We searched Medline/PubMed using the search strategy ‘(delivery of health care, integrated [MeSH Terms] OR integrated care [Title/Abstract]’ without time and language limits. Second, we extracted the publishing year, journals, jurisdictions and keywords of the retrieved articles. Finally, descriptive statistical analysis by the Bibliographic Item Co-occurrence Matrix Builder and hierarchical clustering by SPSS were used.Results: As many as 9090 articles were retrieved. Results included: (1 the cumulative numbers of the publications on integrated care rose perpendicularly after 1993; (2 all documents were recorded by 1646 kinds of journals. There were 28 core journals; (3 the USA is the predominant publishing country; and (4 there are six key domains including: the definition/models of integrated care, interdisciplinary patient care team, disease management for chronically ill patients, types of health care organizations and policy, information system integration and legislation/jurisprudence.Discussion and conclusion: Integrated care literature has been most evident in developed countries. International Journal of Integrated Care is highly recommended in this research area. The bibliometric analysis and identification of publication hotspots provides researchers and practitioners with core target journals, as well as an overview of the field for further research in integrated care.

[Psychology and sexology are essential, from diagnosis to comprehensive care of endometriosis].

Science.gov (United States)

Leroy, A; Azaïs, H; Garabedian, C; Bregegere, S; Rubod, C; Collier, F

2016-06-01

Endometriosis, defined by the presence of endometrial tissue outside the uterine cavity, is a common but often under diagnosed pathology. The clinical manifestations are varied (chronic pelvic pain, urinary or gastrointestinal symptoms) and can sometimes be very frustrated, delaying the diagnosis. This delay in diagnosis can be a high source of stress responsible for an important psychological impact in these patients, having a sense of misunderstanding and neglect of the medical profession. This climate of stress and anxiety can cause alteration of behavior including sexual disorders. In addition, endometriosis can be revealed as part of an infertility evaluation, and the patient and the couple can already be affected by this situation. The clinical and psychological impact of endometriosis inevitably leads to an impairment of patient's quality of life and sexuality. The objective of this article is to show the psychological consequences of endometriosis and its impact on sexuality, in order to highlight this essential aspect for a comprehensive care of patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Experimental and theoretical analyses of package-on-package structure under three-point bending loading

International Nuclear Information System (INIS)

Jia Su; Wang Xi-Shu; Ren Huai-Hui

2012-01-01

High density packaging is developing toward miniaturization and integration, which causes many difficulties in designing, manufacturing, and reliability testing. Package-on-Package (PoP) is a promising three-dimensional high-density packaging method that integrates a chip scale package (CSP) in the top package and a fine-pitch ball grid array (FBGA) in the bottom package. In this paper, in-situ scanning electron microscopy (SEM) observation is carried out to detect the deformation and damage of the PoP structure under three-point bending loading. The results indicate that the cracks occur in the die of the top package, then cause the crack deflection and bridging in the die attaching layer. Furthermore, the mechanical principles are used to analyse the cracking process of the PoP structure based on the multi-layer laminating hypothesis and the theoretical analysis results are found to be in good agreement with the experimental results. (condensed matter: structural, mechanical, and thermal properties)

WASTE PACKAGE TRANSPORTER DESIGN

International Nuclear Information System (INIS)

Weddle, D.C.; Novotny, R.; Cron, J.

1998-01-01

The purpose of this Design Analysis is to develop preliminary design of the waste package transporter used for waste package (WP) transport and related functions in the subsurface repository. This analysis refines the conceptual design that was started in Phase I of the Viability Assessment. This analysis supports the development of a reliable emplacement concept and a retrieval concept for license application design. The scope of this analysis includes the following activities: (1) Assess features of the transporter design and evaluate alternative design solutions for mechanical components. (2) Develop mechanical equipment details for the transporter. (3) Prepare a preliminary structural evaluation for the transporter. (4) Identify and recommend the equipment design for waste package transport and related functions. (5) Investigate transport equipment interface tolerances. This analysis supports the development of the waste package transporter for the transport, emplacement, and retrieval of packaged radioactive waste forms in the subsurface repository. Once the waste containers are closed and accepted, the packaged radioactive waste forms are termed waste packages (WP). This terminology was finalized as this analysis neared completion; therefore, the term disposal container is used in several references (i.e., the System Description Document (SDD)) (Ref. 5.6). In this analysis and the applicable reference documents, the term ''disposal container'' is synonymous with ''waste package''

Comparison and Analysis of Evaluation System of Child Care Program in Primary Health Care System in the East Azerbaijan Province Based on Comprehensive Evaluation Model (CIPP

Directory of Open Access Journals (Sweden)

Yalda Mousa Zadeh

2015-08-01

Full Text Available Background and objectives: Planning plays an important role in improving children's health and an evaluation system is necessary to planning. The purpose of this study was comparing and analyzing evaluation system of child care program in primary health care system in the Eastern Azerbaijan province based on Comprehensive Evaluation Model (CIPP. Material and Methods : This is a cross sectional study. The process includes a review of current evaluation system, comparison and analysis of the system based on a comprehensive model and to assess and identify the strengths and weaknesses of the current systems. The quantitative methods (such as brainstorming, observation and interview and consensus of study group about the results of the study were used for analyzing and interpreting results. Results: It showed that not enough attention was paid to the context and performance and the content of evaluation just includes inputs and processes based on the finding. Specific criteria and impact were considered in four areas (context, input, process and outcome and all levels which were according to the proposal and based on the CIPP model. Conclusion: Evaluation is a control process tool by higher levels and self-assessment by service provider is not considered in the current system. Evaluation includes quantitative aspects and not the quality of process. So, it is recommended that forecasting system that utilizes evaluation will result in improving future planning and a scientific model to be used in designing evaluation program. ​

Continuing professional development for volunteers working in palliative care in a tertiary care cancer institute in India: A cross-sectional observational study of educational needs

Directory of Open Access Journals (Sweden)

Jayita Kedar Deodhar

2015-01-01

Full Text Available Context: Training programs for volunteers prior to their working in palliative care are well-established in India. However, few studies report on continuing professional development programs for this group. Aims: To conduct a preliminary assessment of educational needs of volunteers working in palliative care for developing a structured formal continuing professional development program for this group. Settings and Design: Cross-sectional observational study conducted in the Department of Palliative Medicine of a tertiary care cancer institute in India. Materials and Methods: Participant volunteers completed a questionnaire, noting previous training, years of experience, and a comprehensive list of topics for inclusion in this program, rated in order of importance according to them. Statistical Analysis Used: Descriptive statistics for overall data and Chi-square tests for categorical variables for group comparisons were applied using Statistical Package for Social Sciences version 18. Results: Fourteen out of 17 volunteers completed the questionnaire, seven having 5-10-years experience in working in palliative care. A need for continuing professional development program was felt by all participants. Communication skills, more for children and elderly specific issues were given highest priority. Spiritual-existential aspects and self-care were rated lower in importance than psychological, physical, and social aspects in palliative care. More experienced volunteers (>5 years of experience felt the need for self-care as a topic in the program than those with less (<5-years experience ( P < 0.05. Conclusions: Understanding palliative care volunteers′ educational needs is essential for developing a structured formal continuing professional development program and should include self-care as a significant component.

Components of Adenovirus Genome Packaging

Science.gov (United States)

Ahi, Yadvinder S.; Mittal, Suresh K.

2016-01-01

Adenoviruses (AdVs) are icosahedral viruses with double-stranded DNA (dsDNA) genomes. Genome packaging in AdV is thought to be similar to that seen in dsDNA containing icosahedral bacteriophages and herpesviruses. Specific recognition of the AdV genome is mediated by a packaging domain located close to the left end of the viral genome and is mediated by the viral packaging machinery. Our understanding of the role of various components of the viral packaging machinery in AdV genome packaging has greatly advanced in recent years. Characterization of empty capsids assembled in the absence of one or more components involved in packaging, identification of the unique vertex, and demonstration of the role of IVa2, the putative packaging ATPase, in genome packaging have provided compelling evidence that AdVs follow a sequential assembly pathway. This review provides a detailed discussion on the functions of the various viral and cellular factors involved in AdV genome packaging. We conclude by briefly discussing the roles of the empty capsids, assembly intermediates, scaffolding proteins, portal vertex and DNA encapsidating enzymes in AdV assembly and packaging. PMID:27721809

Sibanye Methods for Prevention Packages Program Project Protocol: Pilot Study of HIV Prevention Interventions for Men Who Have Sex With Men in South Africa.

Science.gov (United States)

McNaghten, Ad; Kearns, Rachel; Siegler, Aaron J; Phaswana-Mafuya, Nancy; Bekker, Linda-Gail; Stephenson, Rob; Baral, Stefan D; Brookmeyer, Ron; Yah, Clarence S; Lambert, Andrew J; Brown, Benjamin; Rosenberg, Eli; Blalock Tharp, Mondie; de Voux, Alex; Beyrer, Chris; Sullivan, Patrick S

2014-10-16

Human immunodeficiency virus (HIV) prevention intervention programs and related research for men who have sex with men (MSM) in the southern African region remain limited, despite the emergence of a severe epidemic among this group. With a lack of understanding of their social and sexual lives and HIV risks, and with MSM being a hidden and stigmatized group in the region, optimized HIV prevention packages for southern African MSM are an urgent public health and research priority. The objective of the Sibanye Health Project is to develop and evaluate a combination package of biomedical, behavioral, and community-level HIV prevention interventions and services for MSM in South Africa. The project consists of three phases: (1) a comprehensive literature review and summary of current HIV prevention interventions (Phase I), (2) agent-based mathematical modeling of HIV transmission in southern African MSM (Phase II), and (3) formative and stigma-related qualitative research, community engagement, training on providing health care to MSM, and the pilot study (Phase III). The pilot study is a prospective one-year study of 200 men in Cape Town and Port Elizabeth, South Africa. The study will assess a package of HIV prevention services, including condom and condom-compatible lubricant choices, risk-reduction counseling, couples HIV testing and counseling, pre-exposure prophylaxis (PrEP) for eligible men, and non-occupational post-exposure prophylaxis for men with a high risk exposure. The pilot study will begin in October 2014. Preliminary results from all components but the pilot study are available. We developed a literature review database with meta-data extracted from 3800 documents from 67 countries. Modeling results indicate that regular HIV testing and promotion of condom use can significantly impact new HIV infections among South African MSM, even in the context of high coverage of early treatment of HIV-positive men and high coverage of PrEP for at-risk HIV

Genome packaging in viruses

OpenAIRE

Sun, Siyang; Rao, Venigalla B.; Rossmann, Michael G.

2010-01-01

Genome packaging is a fundamental process in a viral life cycle. Many viruses assemble preformed capsids into which the genomic material is subsequently packaged. These viruses use a packaging motor protein that is driven by the hydrolysis of ATP to condense the nucleic acids into a confined space. How these motor proteins package viral genomes had been poorly understood until recently, when a few X-ray crystal structures and cryo-electron microscopy structures became available. Here we discu...

Obstacles to comprehensive dental care in patients with sustained limitations of their decision-making abilities: findings from a Delphi study.

Science.gov (United States)

Blaizot, Alessandra; Catteau, Céline; Delfosse, Caroline; Hamel, Olivier; Trentesaux, Thomas

2018-06-01

The objective of this study was to explore the therapeutic limitations experienced by a panel of special-care dentists in France when treating patients with sustained limitations of their decision-making abilities. We used a Delphi technique conducted in three rounds from 01 June 2014 to 30 September 2015. A first questionnaire comprising open-ended questions was addressed to 72 panellists. A content analysis of the returned questionnaires served to draft a second questionnaire comprising closed-ended questions; this was sent to the 28 panellists who responded in the first round. A third questionnaire was sent to the 20 panellists who responded in the second round to give them an opportunity to reconsider their response in the context of the second-round response group. Sixteen panellists answered the last round. A large majority agreed on the importance of providing comprehensive care, but they encountered obstacles at two time points: (i) when proposing the care; and (ii) when setting it up. The panel put forward recommendations in two main areas: (i) the training of those involved in oral health decisions; and (ii) dental care management and organization of the care system. The study provided a foundation for building future orientations in health care for patients with limited decision-making abilities. © 2018 Eur J Oral Sci.

Comprehensive Die Shear Test of Silicon Packages Bonded by Thermocompression of Al Layers with Thin Sn Capping or Insertions

Directory of Open Access Journals (Sweden)

Shiro Satoh

2018-04-01

Full Text Available Thermocompression bonding for wafer-level hermetic packaging was demonstrated at the lowest temperature of 370 to 390 °C ever reported using Al films with thin Sn capping or insertions as bonding layer. For shrinking the chip size of MEMS (micro electro mechanical systems, a smaller size of wafer-level packaging and MEMS–ASIC (application specific integrated circuit integration are of great importance. Metal-based bonding under the temperature of CMOS (complementary metal-oxide-semiconductor backend process is a key technology, and Al is one of the best candidates for bonding metal in terms of CMOS compatibility. In this study, after the thermocompression bonding of two substrates, the shear fracture strength of dies was measured by a bonding tester, and the shear-fractured surfaces were observed by SEM (scanning electron microscope, EDX (energy dispersive X-ray spectrometry, and a surface profiler to clarify where the shear fracture took place. We confirmed two kinds of fracture mode. One mode is Si bulk fracture mode, where the die shear strength is 41.6 to 209 MPa, proportionally depending on the area of Si fracture. The other mode is bonding interface fracture mode, where the die shear strength is 32.8 to 97.4 MPa. Regardless of the fracture modes, the minimum die shear strength is practical for wafer-level MEMS packaging.

Logistic Regression with Multiple Random Effects: A Simulation Study of Estimation Methods and Statistical Packages

Science.gov (United States)

Kim, Yoonsang; Emery, Sherry

2013-01-01

Several statistical packages are capable of estimating generalized linear mixed models and these packages provide one or more of three estimation methods: penalized quasi-likelihood, Laplace, and Gauss-Hermite. Many studies have investigated these methods’ performance for the mixed-effects logistic regression model. However, the authors focused on models with one or two random effects and assumed a simple covariance structure between them, which may not be realistic. When there are multiple correlated random effects in a model, the computation becomes intensive, and often an algorithm fails to converge. Moreover, in our analysis of smoking status and exposure to anti-tobacco advertisements, we have observed that when a model included multiple random effects, parameter estimates varied considerably from one statistical package to another even when using the same estimation method. This article presents a comprehensive review of the advantages and disadvantages of each estimation method. In addition, we compare the performances of the three methods across statistical packages via simulation, which involves two- and three-level logistic regression models with at least three correlated random effects. We apply our findings to a real dataset. Our results suggest that two packages—SAS GLIMMIX Laplace and SuperMix Gaussian quadrature—perform well in terms of accuracy, precision, convergence rates, and computing speed. We also discuss the strengths and weaknesses of the two packages in regard to sample sizes. PMID:24288415

Food packaging history and innovations.

Science.gov (United States)

Risch, Sara J

2009-09-23

Food packaging has evolved from simply a container to hold food to something today that can play an active role in food quality. Many packages are still simply containers, but they have properties that have been developed to protect the food. These include barriers to oxygen, moisture, and flavors. Active packaging, or that which plays an active role in food quality, includes some microwave packaging as well as packaging that has absorbers built in to remove oxygen from the atmosphere surrounding the product or to provide antimicrobials to the surface of the food. Packaging has allowed access to many foods year-round that otherwise could not be preserved. It is interesting to note that some packages have actually allowed the creation of new categories in the supermarket. Examples include microwave popcorn and fresh-cut produce, which owe their existence to the unique packaging that has been developed.

Trends in Food Packaging.

Science.gov (United States)

Ott, Dana B.

1988-01-01

This article discusses developments in food packaging, processing, and preservation techniques in terms of packaging materials, technologies, consumer benefits, and current and potential food product applications. Covers implications due to consumer life-style changes, cost-effectiveness of packaging materials, and the ecological impact of…

WASTE PACKAGE TRANSPORTER DESIGN

Energy Technology Data Exchange (ETDEWEB)

D.C. Weddle; R. Novotny; J. Cron

1998-09-23

The purpose of this Design Analysis is to develop preliminary design of the waste package transporter used for waste package (WP) transport and related functions in the subsurface repository. This analysis refines the conceptual design that was started in Phase I of the Viability Assessment. This analysis supports the development of a reliable emplacement concept and a retrieval concept for license application design. The scope of this analysis includes the following activities: (1) Assess features of the transporter design and evaluate alternative design solutions for mechanical components. (2) Develop mechanical equipment details for the transporter. (3) Prepare a preliminary structural evaluation for the transporter. (4) Identify and recommend the equipment design for waste package transport and related functions. (5) Investigate transport equipment interface tolerances. This analysis supports the development of the waste package transporter for the transport, emplacement, and retrieval of packaged radioactive waste forms in the subsurface repository. Once the waste containers are closed and accepted, the packaged radioactive waste forms are termed waste packages (WP). This terminology was finalized as this analysis neared completion; therefore, the term disposal container is used in several references (i.e., the System Description Document (SDD)) (Ref. 5.6). In this analysis and the applicable reference documents, the term ''disposal container'' is synonymous with ''waste package''.

The Innovative Approaches to Packaging – Comparison Analysis of Intelligent and Active Packaging Perceptions in Slovakia

Directory of Open Access Journals (Sweden)

Loucanova Erika

2017-06-01

Full Text Available Packaging has always served a practical function - to hold goods together and protect it when moving toward the customer through distribution channel. Today packaging is also a container for promoting the product and making it easier and safer to use. The sheer importance of packaging functions is still growing and consequently the interest of the company is to access to the packaging more innovative and creative. The paper deals with the innovative approaches to packaging resulting in the creation of packaging with interactive active features in the form of active and intelligent packaging. Using comparative analysis, we monitored the perception of the active packaging functions in comparison to intelligent packaging function among different age categories. We identified the age categories which are most interested in these functions.

Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis.

Science.gov (United States)

Veinot, Tiffany C; Senteio, Charles R; Hanauer, David; Lowery, Julie C

2018-06-01

To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research. The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process. The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations. The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians.

ATACseqQC: a Bioconductor package for post-alignment quality assessment of ATAC-seq data.

Science.gov (United States)

Ou, Jianhong; Liu, Haibo; Yu, Jun; Kelliher, Michelle A; Castilla, Lucio H; Lawson, Nathan D; Zhu, Lihua Julie

2018-03-01

ATAC-seq (Assays for Transposase-Accessible Chromatin using sequencing) is a recently developed technique for genome-wide analysis of chromatin accessibility. Compared to earlier methods for assaying chromatin accessibility, ATAC-seq is faster and easier to perform, does not require cross-linking, has higher signal to noise ratio, and can be performed on small cell numbers. However, to ensure a successful ATAC-seq experiment, step-by-step quality assurance processes, including both wet lab quality control and in silico quality assessment, are essential. While several tools have been developed or adopted for assessing read quality, identifying nucleosome occupancy and accessible regions from ATAC-seq data, none of the tools provide a comprehensive set of functionalities for preprocessing and quality assessment of aligned ATAC-seq datasets. We have developed a Bioconductor package, ATACseqQC, for easily generating various diagnostic plots to help researchers quickly assess the quality of their ATAC-seq data. In addition, this package contains functions to preprocess aligned ATAC-seq data for subsequent peak calling. Here we demonstrate the utilities of our package using 25 publicly available ATAC-seq datasets from four studies. We also provide guidelines on what the diagnostic plots should look like for an ideal ATAC-seq dataset. This software package has been used successfully for preprocessing and assessing several in-house and public ATAC-seq datasets. Diagnostic plots generated by this package will facilitate the quality assessment of ATAC-seq data, and help researchers to evaluate their own ATAC-seq experiments as well as select high-quality ATAC-seq datasets from public repositories such as GEO to avoid generating hypotheses or drawing conclusions from low-quality ATAC-seq experiments. The software, source code, and documentation are freely available as a Bioconductor package at https://bioconductor.org/packages/release/bioc/html/ATACseqQC.html .

Applications of Active Packaging in Breads

Directory of Open Access Journals (Sweden)

Ali Göncü

2017-10-01

Full Text Available Changes on consumer preferences lead to innovations and improvements in new packaging technologies. With these new developments passive packaging technologies aiming to protect food nowadays have left their place to active and intelligent packaging technologies that have other various functions beside protection of food. Active packaging is defined as an innovative packaging type and its usage increases the shelf life of food significantly. Applications of active packaging have begun to be used for packaging of breads. In this study active packaging applications in breads have been reviewed.

Food Packaging Materials

Science.gov (United States)

1978-01-01

The photos show a few of the food products packaged in Alure, a metallized plastic material developed and manufactured by St. Regis Paper Company's Flexible Packaging Division, Dallas, Texas. The material incorporates a metallized film originally developed for space applications. Among the suppliers of the film to St. Regis is King-Seeley Thermos Company, Winchester, Ma'ssachusetts. Initially used by NASA as a signal-bouncing reflective coating for the Echo 1 communications satellite, the film was developed by a company later absorbed by King-Seeley. The metallized film was also used as insulating material for components of a number of other spacecraft. St. Regis developed Alure to meet a multiple packaging material need: good eye appeal, product protection for long periods and the ability to be used successfully on a wide variety of food packaging equipment. When the cost of aluminum foil skyrocketed, packagers sought substitute metallized materials but experiments with a number of them uncovered problems; some were too expensive, some did not adequately protect the product, some were difficult for the machinery to handle. Alure offers a solution. St. Regis created Alure by sandwiching the metallized film between layers of plastics. The resulting laminated metallized material has the superior eye appeal of foil but is less expensive and more easily machined. Alure effectively blocks out light, moisture and oxygen and therefore gives the packaged food long shelf life. A major packaging firm conducted its own tests of the material and confirmed the advantages of machinability and shelf life, adding that it runs faster on machines than materials used in the past and it decreases product waste; the net effect is increased productivity.

Improved Information and Educational Messages on Outer Packaging of Micronutrient Powders Distributed in Indonesia Increase Caregiver Knowledge and Adherence to Recommended Use.

Science.gov (United States)

Sutrisna, Aang; Vossenaar, Marieke; Poonawala, Alia; Mallipu, Agnes; Izwardy, Doddy; Menon, Ravi; Tumilowicz, Alison

2018-06-08

The objective of this study was to examine the influence of improved information and educational messages on outer packaging of a micronutrient powder (MNP), locally known as “ Taburia ”, on knowledge and adherence to recommended use. A community-based cluster randomized controlled trial was conducted among 1149 caregivers and their children aged 6⁻36 months. Caregiver⁻child dyads were randomized by their villages to receive 30 sachets of Taburia with the: (i) original outer packaging; (ii) improved outer packaging; or (iii) improved outer packaging combined with cooking demonstrations. Adherence to Taburia use was assessed through caregiver interviews and observation of unused sachets during home visits; “high” adherence was defined as consuming 13⁻17 sachets in the previous month. Data collection included surveys and focus groups discussions. The majority of caregivers (>80%) preferred the improved packaging because it was more attractive and contained more comprehensive information. Caregivers who received the improved packaging had better knowledge regarding the recommended use of Taburia ( p influencers of recommended MNP use by caregivers.

"Teaching Case": ComprehensiveCare and the Re-Adoption of an Electronic Health Records System: Preparing for a Successful Adoption after a Failed Attempt

Science.gov (United States)

Gomillion, David L.

2017-01-01

After a prior failed adoption, ComprehensiveCare plans for a second attempt in adopting Electronic Health Records. The owner-physicians on the board of directors have replaced the administrator due in part to the missteps of the prior adoption. William Shoemaker, the new administrator, must grapple with several important decisions to provide the…

Spiritual Care Training for Mothers of Children with Cancer: Effects on Quality of Care and Mental Health of Caregivers.

Science.gov (United States)

Borjalilu, Somaieh; Shahidi, Shahriar; Mazaheri, Mohammad Ali; Emami, Amir Hossein

2016-01-01

The purpose of this study was to explore the effectiveness of a spiritual care training package in maternal caregivers of children with cancer. This study was a quasi-experimental study with pretest and posttest design consisting of a sample of 42 mothers of children diagnosed as having cancer. Participants were randomly assigned to either an experimental or a control group. The training package consisted of seven group training sessions offered in a children's hospital in Tehran. All mothers completed the Spirituality and Spiritual Care Rating Scale (SSCRS) and the Depression, Anxiety and Stress Scale (DASS-21) at pre and post test and after a three month follow up. There was significant difference between anxiety and spiritual, religious, Personalized care and total scores spiritual care between the intervention and control groups at follow-up (Pspiritual care training program promotes spirituality, personalized care, religiosity and spiritual care as well as decreasing anxiety in mothers of children with cancer and decreases anxiety. It may be concluded that spiritual care training could be used effectively in reducing distressful spiritual challenges in mothers of children with cancer.

Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.

Science.gov (United States)

Valentijn, Pim P; Schepman, Sanneke M; Opheij, Wilfrid; Bruijnzeels, Marc A

2013-01-01

Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care. The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method) and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework. The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration), meso (professional and organisational integration) and macro (system integration) level. Functional and normative integration ensure connectivity between the levels. The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective.

Plasma physics plotting package

International Nuclear Information System (INIS)

Hyman, D.H.

1981-02-01

We describe a package of plotting routines that do up to six two- or three-dimensional plots on a frame with minimal loss of resolution. The package now runs on a PDP-10 with PLOT-10 TCS primitives and on a Control Data Corporation-7600 and a Cray-1 with TV80LIB primitives on the National Magnetic Fusion Energy Computer Center network. The package is portable to other graphics systems because only the primitive plot calls are used from the underlying system's graphics package

Active food packaging technologies.

Science.gov (United States)

Ozdemir, Murat; Floros, John D

2004-01-01

Active packaging technologies offer new opportunities for the food industry, in the preservation of foods. Important active packaging systems currently known to date, including oxygen scavengers, carbon dioxide emitters/absorbers, moisture absorbers, ethylene absorbers, ethanol emitters, flavor releasing/absorbing systems, time-temperature indicators, and antimicrobial containing films, are reviewed. The principle of operation of each active system is briefly explained. Recent technological advances in active packaging are discussed, and food related applications are presented. The effects of active packaging systems on food quality and safety are cited.

Naval Waste Package Design Report

International Nuclear Information System (INIS)

M.M. Lewis

2004-01-01

A design methodology for the waste packages and ancillary components, viz., the emplacement pallets and drip shields, has been developed to provide designs that satisfy the safety and operational requirements of the Yucca Mountain Project. This methodology is described in the ''Waste Package Design Methodology Report'' Mecham 2004 [DIRS 166168]. To demonstrate the practicability of this design methodology, four waste package design configurations have been selected to illustrate the application of the methodology. These four design configurations are the 21-pressurized water reactor (PWR) Absorber Plate waste package, the 44-boiling water reactor (BWR) waste package, the 5-defense high-level waste (DHLW)/United States (U.S.) Department of Energy (DOE) spent nuclear fuel (SNF) Co-disposal Short waste package, and the Naval Canistered SNF Long waste package. Also included in this demonstration is the emplacement pallet and continuous drip shield. The purpose of this report is to document how that design methodology has been applied to the waste package design configurations intended to accommodate naval canistered SNF. This demonstrates that the design methodology can be applied successfully to this waste package design configuration and support the License Application for construction of the repository

49 CFR 173.24 - General requirements for packagings and packages.

Science.gov (United States)

2010-10-01

... identifiable (without the use of instruments) release of hazardous materials to the environment; (2) The effectiveness of the package will not be substantially reduced; for example, impact resistance, strength... significant chemical or galvanic reaction between the materials and contents of the package. (3) Plastic...

Packaging systems for animal origin food

Directory of Open Access Journals (Sweden)

2011-03-01

Full Text Available The main task of food packaging is to protect the product during storage and transport against the action of biological, chemical and mechanical factors. The paper presents packaging systems for food of animal origin. Vacuum and modified atmosphere packagings were characterised together with novel types of packagings, referred to as intelligent packaging and active packaging. The aim of this paper was to present all advantages and disadvantages of packaging used for meat products. Such list enables to choose the optimal type of packaging for given assortment of food and specific conditions of the transport and storing.

A multi-criteria decision making approach for the selection of a flexible packaging equipment

Directory of Open Access Journals (Sweden)

Cristea Ciprian

2017-01-01

Full Text Available Flexible packaging is one of the fastest growing segments of the packaging industry, combining paper, plastic film and aluminum foil to deliver a broad array of products for food and beverage, personal care products, and pharmaceutical industries. In order to preserve the quality and safety of the product contained in them, there are currently a variety of flexible packaging equipment options available. However their relative costs and performance differ. This study proposes an application of a ranking methodology to assess a selection of the most suitable flexible packaging equipment. The adequate criteria in the selection of equipment have been identified, and the considered options are assessed, considering the decision maker’s preferences and existing constraints. The options are ranked in terms of their suitability for selecting equipment by using the Electre III method. The results obtained from the simulation experiment highlight the effectiveness of the model in outranking different options in the process of equipment selection.

Energy use and life cycle greenhouse gas emissions of drones for commercial package delivery.

Science.gov (United States)

Stolaroff, Joshuah K; Samaras, Constantine; O'Neill, Emma R; Lubers, Alia; Mitchell, Alexandra S; Ceperley, Daniel

2018-02-13

The use of automated, unmanned aerial vehicles (drones) to deliver commercial packages is poised to become a new industry, significantly shifting energy use in the freight sector. Here we find the current practical range of multi-copters to be about 4 km with current battery technology, requiring a new network of urban warehouses or waystations as support. We show that, although drones consume less energy per package-km than delivery trucks, the additional warehouse energy required and the longer distances traveled by drones per package greatly increase the life-cycle impacts. Still, in most cases examined, the impacts of package delivery by small drone are lower than ground-based delivery. Results suggest that, if carefully deployed, drone-based delivery could reduce greenhouse gas emissions and energy use in the freight sector. To realize the environmental benefits of drone delivery, regulators and firms should focus on minimizing extra warehousing and limiting the size of drones.

Merganser Download Package

Data.gov (United States)

U.S. Environmental Protection Agency — This data download package contains an Esri 10.0 MXD, file geodatabase and copy of this FGDC metadata record. The data in this package are used in support of the...

Modular assembly of chimeric phi29 packaging RNAs that support DNA packaging.

Science.gov (United States)

Fang, Yun; Shu, Dan; Xiao, Feng; Guo, Peixuan; Qin, Peter Z

2008-08-08

The bacteriophage phi29 DNA packaging motor is a protein/RNA complex that can produce strong force to condense the linear-double-stranded DNA genome into a pre-formed protein capsid. The RNA component, called the packaging RNA (pRNA), utilizes magnesium-dependent inter-molecular base-pairing interactions to form ring-shaped complexes. The pRNA is a class of non-coding RNA, interacting with phi29 motor proteins to enable DNA packaging. Here, we report a two-piece chimeric pRNA construct that is fully competent in interacting with partner pRNA to form ring-shaped complexes, in packaging DNA via the motor, and in assembling infectious phi29 virions in vitro. This is the first example of a fully functional pRNA assembled using two non-covalently interacting fragments. The results support the notion of modular pRNA architecture in the phi29 packaging motor.

Limits of variation, specific infectivity, and genome packaging of massively recoded poliovirus genomes.

Science.gov (United States)

Song, Yutong; Gorbatsevych, Oleksandr; Liu, Ying; Mugavero, JoAnn; Shen, Sam H; Ward, Charles B; Asare, Emmanuel; Jiang, Ping; Paul, Aniko V; Mueller, Steffen; Wimmer, Eckard

2017-10-10

Computer design and chemical synthesis generated viable variants of poliovirus type 1 (PV1), whose ORF (6,189 nucleotides) carried up to 1,297 "Max" mutations (excess of overrepresented synonymous codon pairs) or up to 2,104 "SD" mutations (randomly scrambled synonymous codons). "Min" variants (excess of underrepresented synonymous codon pairs) are nonviable except for P2 Min , a variant temperature-sensitive at 33 and 39.5 °C. Compared with WT PV1, P2 Min displayed a vastly reduced specific infectivity (si) (WT, 1 PFU/118 particles vs. P2 Min , 1 PFU/35,000 particles), a phenotype that will be discussed broadly. Si of haploid PV presents cellular infectivity of a single genotype. We performed a comprehensive analysis of sequence and structures of the PV genome to determine if evolutionary conserved cis-acting packaging signal(s) were preserved after recoding. We showed that conserved synonymous sites and/or local secondary structures that might play a role in determining packaging specificity do not survive codon pair recoding. This makes it unlikely that numerous "cryptic, sequence-degenerate, dispersed RNA packaging signals mapping along the entire viral genome" [Patel N, et al. (2017) Nat Microbiol 2:17098] play the critical role in poliovirus packaging specificity. Considering all available evidence, we propose a two-step assembly strategy for +ssRNA viruses: step I, acquisition of packaging specificity, either ( a ) by specific recognition between capsid protein(s) and replication proteins (poliovirus), or ( b ) by the high affinity interaction of a single RNA packaging signal (PS) with capsid protein(s) (most +ssRNA viruses so far studied); step II, cocondensation of genome/capsid precursors in which an array of hairpin structures plays a role in virion formation.

Do package inserts reflect symptoms experienced in practice?: assessment using an automated phone pharmacovigilance system with varenicline and zolpidem in a primary care setting.

Science.gov (United States)

Haas, Jennifer S; Amato, Mary; Marinacci, Lucas; Orav, E John; Schiff, Gordon D; Bates, David W

2012-08-01

While the US FDA maintains a voluntary reporting system, postmarketing adverse drug events (ADEs) are underreported, and this case report-based system does not allow accurate determination of incidence. The aim of the study was to assess the usefulness of an automated phone pharmacovigilance system for ambulatory patients by comparing systematically collected, patient-reported symptoms to reflect possible ADEs with those reported on the package inserts of two drugs with postmarketing safety concerns, varenicline and zolpidem. English-speaking adults who received a prescription for zolpidem (n = 370) or varenicline (n = 107) from a primary care physician at one of 11 participating clinics, and who participated in the pharmacovigilance system during 2008-2010, were included in the study. Patients were called approximately 4 weeks following their visit and asked to complete a standard script that asked about adherence and pre-specified symptoms. The main outcome measures were elicited rates of pre-specified symptoms or possible ADEs. Compared with the package insert, patients taking zolpidem were significantly (p zolpidem were not detected. These data highlight the potential value of, and innovative ways of collecting, information about possible ADEs directly from patients.

MINUIT package parallelization and applications using the RooFit package

International Nuclear Information System (INIS)

Lazzaro, Alfio; Moneta, Lorenzo

2010-01-01

The fitting procedures are based on numerical minimization of functions. The MINUIT package is the most common package used for such procedures in High Energy Physics community. The main algorithm in this package, MIGRAD, searches the minimum of a function using the gradient information. For each minimization iteration, MIGRAD requires the calculation of the derivative for each free parameter of the function to be minimized. Minimization is required for data analysis problems based on the maximum likelihood technique. The calculation of complex likelihood functions, with several free parameters, many independent variables and large data samples, can be very CPU-time consuming. Then, the minimization process requires the calculation of the likelihood functions several times for each minimization iteration. In this paper we will show how MIGRAD algorithm and the likelihood function calculation can be easily parallelized using Message Passing Interface techniques. We will present the speed-up improvements obtained in typical physics applications such as complex maximum likelihood fits using the RooFit package.

Inventory of measures, typology of non-intentional effects and a framework for policy packaging

DEFF Research Database (Denmark)

Givoni, Moshe; Macmillan, James; Gudmundsson, Henrik

2010-01-01

-making at the European level. Specifically, this deliverable aims to further methodological advancement with respect to the identification, classification, ex-ante prevention and ex-post mitigation of policies‘ unintended effects, and the systematic manner in which individual policy measures may be combined so...... as to improve their effectiveness, acceptability and feasibility. Overall, we argue that policy packaging can offer a far greater potential for achieving policy targets and objectives than single policy measures deployed in isolation. Yet, a careful and relatively well designed process must be undertaken...... for such packages to be effective....

Waste package performance analysis

International Nuclear Information System (INIS)

Lester, D.H.; Stula, R.T.; Kirstein, B.E.

1982-01-01

A performance assessment model for multiple barrier packages containing unreprocessed spent fuel has been applied to several package designs. The resulting preliminary assessments were intended for use in making decisions about package development programs. A computer model called BARIER estimates the package life and subsequent rate of release of selected nuclides. The model accounts for temperature, pressure (and resulting stresses), bulk and localized corrosion, and nuclide retardation by the backfill after water intrusion into the waste form. The assessment model assumes a post-closure, flooded, geologic repository. Calculations indicated that, within the bounds of model assumptions, packages could last for several hundred years. Intact backfills of appropriate design may be capable of nuclide release delay times on the order of 10 7 yr for uranium, plutonium, and americium. 8 references, 6 figures, 9 tables

Oral Health Care Delivery Within the Accountable Care Organization.

Science.gov (United States)

Blue, Christine; Riggs, Sheila

2016-06-01

The accountable care organization (ACO) provides an opportunity to strategically design a comprehensive health system in which oral health works within primary care. A dental hygienist/therapist within the ACO represents value-based health care in action. Inspired by health care reform efforts in Minnesota, a vision of an accountable care organization that integrates oral health into primary health care was developed. Dental hygienists and dental therapists can help accelerate the integration of oral health into primary care, particularly in light of the compelling evidence confirming the cost-effectiveness of care delivered by an allied workforce. A dental insurance Chief Operating Officer and a dental hygiene educator used their unique perspectives and experience to describe the potential of an interdisciplinary team-based approach to individual and population health, including oral health, via an accountable care community. The principles of the patient-centered medical home and the vision for accountable care communities present a paradigm shift from a curative system of care to a prevention-based system that encompasses the behavioral, social, nutritional, economic, and environmental factors that impact health and well-being. Oral health measures embedded in the spectrum of general health care have the potential to ensure a truly comprehensive healthcare system. Published by Elsevier Inc.

Education and Health: a necessary dialogue policies of comprehensive care for people with disabilities

Directory of Open Access Journals (Sweden)

Nelma Alves Marques Pintor

2012-08-01

Full Text Available This work aims to reflect on the importance of dialogue between education and health, basic thought of as public policy in the context of comprehensive care to people with disabilities. These findings emphasize the difficulty faced by these areas to establish a dialogue that results in convergent planning intersectoral action for health promotion, quality of life and social and educational inclusion of disabled people, especially the mentally handicapped. Based on studies of Brazilian authors seek to clarify some facts that underscore the need for dialogue and do not justify the perpetuation of the gap between these fields of knowledge. Presents the partial results of an experience of intersectionality between these areas in the municipal schools of Niterói (Rio de Janeiro, Brazil with students with disabilities, which stresses the absence of a culture of popular participation in local public policies.

Comparative Packaging Study

Science.gov (United States)

Perchonok, Michele H.; Oziomek, Thomas V.

2009-01-01

Future long duration manned space flights beyond low earth orbit will require the food system to remain safe, acceptable and nutritious. Development of high barrier food packaging will enable this requirement by preventing the ingress and egress of gases and moisture. New high barrier food packaging materials have been identified through a trade study. Practical application of this packaging material within a shelf life test will allow for better determination of whether this material will allow the food system to meet given requirements after the package has undergone processing. The reason to conduct shelf life testing, using a variety of packaging materials, stems from the need to preserve food used for mission durations of several years. Chemical reactions that take place during longer durations may decrease food quality to a point where crew physical or psychological well-being is compromised. This can result in a reduction or loss of mission success. The rate of chemical reactions, including oxidative rancidity and staling, can be controlled by limiting the reactants, reducing the amount of energy available to drive the reaction, and minimizing the amount of water available. Water not only acts as a media for microbial growth, but also as a reactant and means by which two reactants may come into contact with each other. The objective of this study is to evaluate three packaging materials for potential use in long duration space exploration missions.

Intelligent food packaging - research and development

Directory of Open Access Journals (Sweden)

Renata Dobrucka

2015-03-01

Full Text Available Packaging also fosters effective marketing of the food through distribution and sale channels. It is of the utmost importance to optimize the protection of the food, a great quality and appearance - better than typical packaged foods. In recent years, intelligent packaging became very popular. Intelligent packaging is becoming more and more widely used for food products. Application of this type of solution contributes to improvement of the quality consumer life undoubtedly. Intelligent packaging refers to a package that can sense environmental changes, and in turn, informs the users about the changes. These packaging systems contain devices that are capable of sensing and providing information about the functions and properties of the packaged foods. Also, this paper will review intelligent packaging technologies and describe different types of indicators (time-temperature indicators, freshness indicators.

Creative Thinking Package

Science.gov (United States)

Jones, Clive

1972-01-01

A look at the latest package from a British managment training organization, which explains and demonstrates creative thinking techniques, including brainstorming. The package, designed for groups of twelve or more, consists of tapes, visuals, and associated exercises. (Editor/JB)

Competent authority approval of package designs in the United Kingdom

International Nuclear Information System (INIS)

Morgan-Warren, E.J.

1999-01-01

Type B packages and all packages containing fissile material, as well as special form radioactive materials, special arrangements and certain shipments, are required to be approved by the competent authority. In the United Kingdom competent authority approval is carried out on behalf of the Secretary of State by the Radioactive Materials Transport Division (RMTD) of the Department of the Environment, Transport and the Regions (DETR). Competent authority approval of a package design is given only after a detailed assessment of the design by the specialist staff of RMTD. There are three facets to the assessment procedure, namely engineering, criticality and radiation protection, and quality assurance. The engineering assessor ensures that the designer has demonstrated the integrity of the containment and shielding systems under the regulatory conditions. The criticality assessor examines criticality safety and radiation protection measures, and together with the engineering assessor, decides whether this is maintained under regulatory conditions. The quality assurance assessor verifies that the applicant has established the necessary controls to ensure that the design requirements are met. The applicant is responsible for making the case for approval, but the assessment is facilitated if the competent authority is involved with the designer at an early stage in development and during the construction of any test prototype. When a regulatory test programme is required, it is designed and carried out by the applicant, but agreed and witnessed by representatives of RMTD. Following the test programme, the applicant submits a formal application, supported by a design safety report (DSR). The DSR provides a full analysis of the design and the test results, including the behaviour of the package under normal and accident conditions of transport, the manufacturing and maintenance procedures, quality assurance and the emergency provisions for the operation of the package

Perspectives on the Elements of Packaging Design : A Qualitative Study on the Communication of Packaging

OpenAIRE

Alervall, Viktoria; Saied, Juan Sdiq

2013-01-01

Background: In today’s markets almost all products we buy come packaged. We use packaging to protect, contain and identify products. Furthermore if this is executed in a skillful way consumers often choose products based on packaging. The work of a designer and marketer is therefore extremely valuable when it comes to the design of a package. Problem: How are packages used to communicate marketing information? Purpose: The focus of this thesis is to identify differences and similarities of a ...

21 CFR 355.20 - Packaging conditions.

Science.gov (United States)

2010-04-01

... conditions. (a) Package size limitation. Due to the toxicity associated with fluoride active ingredients, the... (toothpastes and tooth powders) packages shall not contain more than 276 milligrams (mg) total fluorine per... packages shall not contain more than 120 mg total fluorine per package. (3) Exception. Package size...

19 CFR 191.13 - Packaging materials.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Packaging materials. 191.13 Section 191.13 Customs... (CONTINUED) DRAWBACK General Provisions § 191.13 Packaging materials. (a) Imported packaging material... packaging material when used to package or repackage merchandise or articles exported or destroyed pursuant...

Warpage of QFN Package in Post Mold Cure Process of integrated circuit packaging

Science.gov (United States)

Sriwithoon, Nattha; Ugsornrat, Kessararat; Srisuwitthanon, Warayoot; Thonglor, Panakamon

2017-09-01

This research studied about warpage of QFN package in post mold cure process of integrated circuit (IC) packages using pre-plated (PPF) leadframe. For IC package, epoxy molding compound (EMC) are molded by cross linking of compound stiffness but incomplete crosslinked network and leading the fully cured thermoset by post mold cure (PMC) process. The cure temperature of PMC can change microstructure of EMC in term of stress inside the package and effect to warpage of the package due to coefficient of thermal expansion (CTE) between EMC and leadframe. In experiment, cure temperatures were varied to check the effect of internal stress due to different cure temperature after completed post mold cure for TDFN 2×3 8L. The cure temperature were varied with 180 °C, 170 °C, 160 °C, and 150°C with cure time 4 and 6 hours, respectively. For analysis, the TDFN 2×3 8L packages were analyzed the warpage by thickness gauge and scanning acoustic microscope (SAM) after take the test samples out from the oven cure. The results confirmed that effect of different CTE between EMC and leadframe due to different cure temperature resulting to warpage of the TDFN 2×3 8L packages.

CYPROS - Cybernetic Program Packages

Directory of Open Access Journals (Sweden)

Arne Tyssø

1980-10-01

Full Text Available CYPROS is an interactive program system consisting of a number of special purpose packages for simulation, identification, parameter estimation and control system design. The programming language is standard FORTRAN IV and the system is implemented on a medium size computer system (Nord-10. The system is interactive and program control is obtained by the use of numeric terminals. Output is rapidly examined by extensive use of video colour graphics. The subroutines included in the packages are designed and documented according to standardization rules given by the SCL (Scandinavian Control Library organization. This simplifies the exchange of subroutines throughout the SCL system. Also, this makes the packages attractive for implementation by industrial users. In the simulation package, different integration methods are available and it can be easily used for off-line, as well as real time, simulation problems. The identification package consists of programs for single-input/single-output and multivariablc problems. Both transfer function models and state space models can be handled. Optimal test signals can be designed. The control package consists of programs based on multivariable time domain and frequency domain methods for analysis and design. In addition, there is a package for matrix and time series manipulation. CYPROS has been applied successfully to industrial problems of various kinds, and parts of the system have already been implemented on different computers in industry. This paper will, in some detail, describe the use and the contents of the packages and some examples of application will be discussed.

Characterization of integrated circuit packaging materials

CERN Document Server

Moore, Thomas

1993-01-01

Chapters in this volume address important characteristics of IC packages. Analytical techniques appropriate for IC package characterization are demonstrated through examples of the measurement of critical performance parameters and the analysis of key technological problems of IC packages. Issues are discussed which affect a variety of package types, including plastic surface-mount packages, hermetic packages, and advanced designs such as flip-chip, chip-on-board and multi-chip models.

Science packages

Science.gov (United States)

1997-01-01

Primary science teachers in Scotland have a new updating method at their disposal with the launch of a package of CDi (Compact Discs Interactive) materials developed by the BBC and the Scottish Office. These were a response to the claim that many primary teachers felt they had been inadequately trained in science and lacked the confidence to teach it properly. Consequently they felt the need for more in-service training to equip them with the personal understanding required. The pack contains five disks and a printed user's guide divided up as follows: disk 1 Investigations; disk 2 Developing understanding; disks 3,4,5 Primary Science staff development videos. It was produced by the Scottish Interactive Technology Centre (Moray House Institute) and is available from BBC Education at £149.99 including VAT. Free Internet distribution of science education materials has also begun as part of the Global Schoolhouse (GSH) scheme. The US National Science Teachers' Association (NSTA) and Microsoft Corporation are making available field-tested comprehensive curriculum material including 'Micro-units' on more than 80 topics in biology, chemistry, earth and space science and physics. The latter are the work of the Scope, Sequence and Coordination of High School Science project, which can be found at http://www.gsh.org/NSTA_SSandC/. More information on NSTA can be obtained from its Web site at http://www.nsta.org.

Verbal versus Numerical Probabilities: Does Format Presentation of Probabilistic Information regarding Breast Cancer Screening Affect Women's Comprehension?

Science.gov (United States)

Vahabi, Mandana

2010-01-01

Objective: To test whether the format in which women receive probabilistic information about breast cancer and mammography affects their comprehension. Methods: A convenience sample of 180 women received pre-assembled randomized packages containing a breast health information brochure, with probabilities presented in either verbal or numeric…

Quality assurance of radioactive waste packages by computerized tomography

International Nuclear Information System (INIS)

Reimers, P.

1992-01-01

According to task 3 'Testing and Evaluation of Conditioned Waste and Technical Barriers' quality assurance is a main scope of research concerned with the handling of radioactive waste. It was provided to characterize medium and high active waste by standard test methods which have been developed and experienced in this contract. Quality evaluation of radioactive waste packages is preferentially done by non-destructive testing methods. The main task of this contract was the elaboration of specific non-destructive testing methods for conditioned and sealed waste packages as well as for the matrix materials themselves (e.g. bitumen, concrete, ceramics and glass). CT with X-rays turned out to be one of the best methods for the comprehensive non-destructive characterization of the physical and technical properties of the above described test objects. The method is especially suitable for the non-destructive evaluation of the absolute density value, of the density distribution, of the gamma activity distribution, of the localization of voids, cracks and inclusions, of the visualization of swelling, shrinkage and phase precipitations, as well as the detection of liquid phases in bentonite and cemented waste. 9 refs., 10 figs., 2 tabs

The ZOOM minimization package

International Nuclear Information System (INIS)

Fischler, Mark S.; Sachs, D.

2004-01-01

A new object-oriented Minimization package is available for distribution in the same manner as CLHEP. This package, designed for use in HEP applications, has all the capabilities of Minuit, but is a re-write from scratch, adhering to modern C++ design principles. A primary goal of this package is extensibility in several directions, so that its capabilities can be kept fresh with as little maintenance effort as possible. This package is distinguished by the priority that was assigned to C++ design issues, and the focus on producing an extensible system that will resist becoming obsolete

Packaging Concerns/Techniques for Large Devices

Science.gov (United States)

Sampson, Michael J.

2009-01-01

This slide presentation reviews packaging challenges and options for electronic parts. The presentation includes information about non-hermetic packages, space challenges for packaging and complex package variations.

Experimental study on transportation safety of package in side collision of heavy duty truck

International Nuclear Information System (INIS)

Suga, M.; Sasaki, T.

1989-01-01

The accidents in road transportation of package may be collision, fall and fire. It is necessary to examine all cases very carefully because collision might be caused by other vehicle. Collisions are classified into head-on collision, rear-end collision, side collision. A lot of experiments and analyses are reported on head-on collision, so the behavior of vehicle and package may be predicted without difficulty. Rear-end collisions bring about less impact and may be applied corresponding to the head-on collisions. About side collisions, few experiments or analyses are reported, and most of them are about passenger cars not about trucks. So it becomes important to study the transportation safety of package carried on a heavy duty truck when hit on the side by another truck similar in size

Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.

NARCIS (Netherlands)

Valentijn, P.P.; Schepman, S.M.; Opheij, W.; Bruijnzeels, M.A.

2013-01-01

Introduction: Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to

Packaging and transport of radioisotopes

International Nuclear Information System (INIS)

Taylor, C.B.G.

1976-01-01

The importance of radioisotope traffic is emphasized. More than a million packages are being transported each year, mostly for medical uses. The involvement of public transport services and the incidental dose to the public (which is very small) are appreciably greater than for movements connected with the nuclear fuel cycle. Modern isotope packages are described, and an outline given of the problems of a large radioisotope manufacturer who has to package many different types of product. Difficulties caused by recent uncoordinated restrictions on the use of passenger aircraft are mentioned. Some specific problems relating to radioisotope packaging are discussed. These include the crush resistance of Type A packages, the closure of steel drums, the design of secure closures for large containers, the Type A packaging of liquids, leak tightness criteria of Type B packages, and the use of 'unit load' overpacks to consign a group of individually approved packages together as a single shipment. Reference is made to recent studies of the impact of radioisotope shipments on the environment. Cost/benefit analysis is important in this field - an important public debate is only just beginning. (author)

Safety Analysis Report - Packages, 9965, 9968, 9972-9975 Packages

International Nuclear Information System (INIS)

Van Alstine, M.N.

1999-01-01

This Safety Analysis Report for Packaging (SARP) documents the performance of the 9965 B, 9968 B, 9972 B(U), 9973 B(U), 9974 B(U), and 9975 B(U) packages in satisfying the regulatory safety requirements of the Code of Federal Regulations (CFR) 711 and the International Atomic Energy Agency (IAEA) Safety Series No. 6, Regulations for the Safe Transport of Radioactive Material, 1985 edition2. Results of the analysis and testing performed on the 9965 B, 9968 B, 9972 B(U), 9973 B(U), 9974 B(U), and 9975 B(U) packages are presented in this SARP, which was prepared in accordance with U.S. Department of energy (DOE) Order 5480.33 and in the format specified in the Nuclear Regulatory Commission (NRC) Regulatory Guides 7.94 and 7.10.5

Safety analysis report - packages 9965, 9968, 9972-9975 packages

International Nuclear Information System (INIS)

Van Alstine, M.N.

1997-10-01

This Safety Analysis Report for Packaging (SARP) documents the performance of the 9965 B( ), 9968 B( ), 9972 B(U), 9973 B(U), 9974 B(U), and 9975 B(U) packages in satisfying the regulatory safety requirements of the Code of Federal Regulations (CFR) 10 CFR 71 and the International Atomic Energy Agency (IAEA) Safety Series No. 6, Regulations for the Safe Transport of Radioactive Material, 1985 edition. Results of the analysis and testing performed on the 9965 B(), 9968 B(), 9972 B(U), 9973 B(U), and 9975 B(U) packages are presented in this SARP, which was prepared in accordance with U.S. Department of Energy (DOE) Order 5480.3 and in the format specified in the Nuclear Regulatory Commission (NRC) Regulatory Guides 7.9 and 7.10

Consumer and health literacy: The need to better design tobacco-cessation product packaging, labels, and inserts.

Science.gov (United States)

Weiss, Stephanie M; Smith-Simone, Stephanie Y

2010-03-01

Tobacco-cessation product packaging and instruction materials may not be appropriate for some smokers and may contribute to the underuse and misuse of evidence-based treatments. The dual goals of this project are to analyze literacy levels of Food and Drug Administration (FDA)-approved and non-approved tobacco-cessation product packaging, directions, and claims, and to identify and categorize claims found on product packaging. The Campaign for Tobacco Free Kids (CTFK) maintains the Quitting and Reducing Tobacco Use Inventory of Products (QuiTIP) database, which catalogs products marketed and sold to consumers to reduce or quit use of tobacco products. It also includes all medications approved by the FDA for tobacco cessation as well as a sample of non-approved products such as homeopathic, herbal, nutritional, or dietary supplements commonly marketed as either cessation aids or alternative tobacco/nicotine products. This paper assesses the reading levels required to understand product packaging, labeling, and instructions using the Simple Measure of Gobbledygook (SMOG) and identifies claims on the product package labels using standard qualitative methods. Key findings show that the average reading levels needed to understand instructions for both FDA-approved and non-approved cessation products are above the reading levels recommended to ensure maximum comprehension. Improving the packaging and directions of evidence-based tobacco-cessation products so that they are preferably at or below a fifth-grade reading level, along with using consumer-based design principles to develop packaging, may help smokers take advantage of and correctly use products that will greatly increase their chances of successful quitting. 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Healthy package, healthy product? Effects of packaging design as a function of purchase setting

NARCIS (Netherlands)

van Rompay, Thomas Johannes Lucas; Deterink, Florien; Fenko, Anna

2016-01-01

Inspired by research testifying to the influence of visual packaging appearance and meaning portrayal on food evaluation, here it is argued that effects of packaging design vary depending on purchase context. Realistic packaging variants for a fictitious yoghurt brand varying in health connotation

Integrated Approach to Industrial Packaging Design

Science.gov (United States)

Vorobeva, O.

2017-11-01

The article reviews studies in the field of industrial packaging design. The major factors which influence technological, ergonomic, economic and ecological features of packaging are established. The main modern trends in packaging design are defined, the principles of marketing communications and their influence on consumers’ consciousness are indicated, and the function of packaging as a transmitter of brand values is specified. Peculiarities of packaging technology and printing techniques in modern printing industry are considered. The role of designers in the stage-by-stage development of the construction, form and graphic design concept of packaging is defined. The examples of authentic packaging are given and the mention of the tetrahedron packaging history is made. At the end of the article, conclusions on the key research aspects are made.

Directory of certificates of compliance for radioactive materials packages. Summary report of NRC approved packages

International Nuclear Information System (INIS)

1979-10-01

This directory contains a Summary Report of NRC Approved Packages for radioactive material packages effective September 14, 1979. Purpose of this directory is to make available a convenient source of information on packagings which have been approved by the US Nuclear Regulatory Commission. To assist in identifying packaging, an index by Model Number and corresponding Certificate of Compliance number is included at the back of each volume of the directory. The Summary Report includes a listing of all users of each package design prior to the publication date of the directory

Directory of certificates of compliance for radioactive materials packages. Summary report of NRC approved packages

Energy Technology Data Exchange (ETDEWEB)

None

1979-10-01

This directory contains a Summary Report of NRC Approved Packages for radioactive material packages effective September 14, 1979. Purpose of this directory is to make available a convenient source of information on packagings which have been approved by the US Nuclear Regulatory Commission. To assist in identifying packaging, an index by Model Number and corresponding Certificate of Compliance number is included at the back of each volume of the directory. The Summary Report includes a listing of all users of each package design prior to the publication date of the directory.

Directory of Certificates of Compliance for Radioactive Materials Packages: Report of NRC approved packages

International Nuclear Information System (INIS)

1988-12-01

This directory contains a Report of the US Nuclear Regulatory Commission's Approved Packages (Volume 1), all Certificates of Compliance (Volume 2), and a Report of NRC Approved Quality Assurance Programs (Volume 3) for Radioactive Material Packages effective October 1, 1988. The purpose of this directory is to make available a convenient source of information on packagings which have been approved by the US Nuclear Regulatory Commission. To assist in identifying packaging, an index by Model Number and corresponding Certificate of Compliance Number is included at the front of Volume 2 of the directory. A listing by packaging types is included in the back of Volume 2. An alphabetical listing by Company name is included in the back of Volume 3 for approved QA programs. The Reports include a listing of all users of each package design and approved QA programs prior to the publication date of the directory

Directory of certificates of compliance for radioactive materials packages, Report of NRC approved packages

International Nuclear Information System (INIS)

1990-10-01

This directory contains a Report of the US Nuclear Regulatory Commission's Approved Packages (Volume 1), Certificates of Compliance (Volume 2), and a Report of NRC Approved Quality Assurance Programs (Volume 3) for Radioactive Materials Packages effective October 1, 1990. The purpose of this directory is to make available a convenient source of information on packagings which have been approved by the US Nuclear Regulatory Commission. To assist in identifying packaging, an index by Model Number and corresponding Certificate of Compliance Number is included at the front of Volume 2 of the directory. A listing by packaging types is included in the back of Volume 2. An alphabetical listing by Company name is included in the back of Volume 3 for approved QA programs. The Reports include a listing of all users of each package design and approved QA programs prior to the publication date of the directory

[Organisational diagnosis of a home care-coordinating unit in oncology: which choices for the comprehensive cancer center of Lyon?].

Science.gov (United States)

Chvetzoff, Gisèle; Chvetzoff, Roland; Devaux, Yves; Teil, A; Chalencon, J; Lancry, L; Kante, V; Poncelas, C; Sontag, P; Tretiakoff, C; Philip, T

2006-10-01

Lyon comprehensive cancer center developed a home care-coordinating unit (HCCU) allowing a wide range of cancer care at home. We present the results of an organisational and strategical analysis of the unit, in relation with internal and external contexts. We describe the functioning of the unit, modelled from the daily follow-up of professionnels. Patient discharge is initiated by the oncologist at the inpatient clinic, at the day-hospital or at outpatient visit. After consent of the patient and relatives, the HCCU (nurses and medical oncologists) evaluates patient's needs, organises hospital discharge (contacts with community nurses and general practitioner, supply of medical appliances and drugs), and provides follow-up and counselling to patient and caregivers. The HCCU works in a challenging environment, with both partners and competitors. Within the hospital, it collaborates with all other units. Outside the hospital, partners are, besides patients themselves; general practitioners and community nurses home care agencies and network services, private medical appliance providers, and public health authorities. The unit might evolve towards formal home hospitalisation or community-hospital network. Collaboration of both structure closely associated with hospital could allow to provide continuous and graduated care by the same caregivers even if administrative structures change.

Safety analysis report for packages: packaging of fissile and other radioactive materials. Final report

International Nuclear Information System (INIS)

Chalfant, G.G.

1984-01-01

The 9965, 9966, 9967, and 9968 packages are designed for surface shipment of fissile and other radioactive materials where a high degree of containment (either single or double) is required. Provisions are made to add shielding material to the packaging as required. The package was physically tested to demonstrate that it meets the criteria specified in USDOE Order No. 5480.1, chapter III, dated 5/1/81, which invokes Title 10, Code of Federal Regulations, Part 71 (10 CFR 71), Packing and Transportation of Radioactive Material, and Title 49, Code of Federal Regulations, Part 100-179, Transportation. By restricting the maximum normal operating pressure of the packages to less than 7 kg/cm 2 (gauge) (99 to 54 psig), the packages will comply with Type B(U) regulations of the International Atomic Energy Agency (IAEA) in its Regulations for the Safe Transport of Radioactive Materials, Safety Series No. 6, 1973 Revised Edition, and may be used for export and import shipments. These packages have been assessed for transport of up to 14.5 kilograms of uranium, excluding uranium-233, or 4.4 kilograms of plutonium metal, oxides, or scrap having a maximum radioactive decay energy of 30 watts. Specific maximum package contents are given. This quantity and the configuration of uranium or plutonium metal cannot be made critical by any combination of hydrogeneous reflection and moderation regardless of the condition of the package. For a uranium-233 shipment, a separate criticality evaluation for the specific package is required

Use of pre-packaged chloroquine for the home management of presumed malaria in Malagasy children

Directory of Open Access Journals (Sweden)

Malvy Denis

2006-09-01

Full Text Available Abstract Objective The main objective of this study was to assess the quality of home malaria management with pre-packaged chloroquine in two areas in the Moramanga district of Madagascar. The knowledge, attitude and practices of care providers in terms of home treatment options were evaluated and compared. The availability of treatment options by studying retailers and community-based service providers was also investigated. Methods A cross-sectional investigation in two communities, in the hamlets and villages located close to carers, retailers, community-based service providers and primary health centres was carried out. Results Carers in the two districts were equally well aware of the use of pre-packaged chloroquine. Their first response to the onset of fever was to treat children with this antimalarial drug at home. The dose administered and treatment compliance were entirely satisfactory (100% with pre-packaged chloroquine and rarely satisfactory (1.6% to 4.5% with non pre-packaged chloroquine. In cases of treatment failure, the carers took patients to health centres. Chloroquine was supplied principally by private pharmacies and travelling salesmen selling unpackaged chloroquine tablets. Non pre-packaged chloroquine was the most common drug used at health centres. The frequency of positive rapid malaria tests (P = 0.01 was significantly higher in children treated with non pre-packaged chloroquine (38% than in children treated with pre-packaged chloroquine (1.3%. Conclusion Home malaria management should be improved in Madagascar. Efforts should focus on communication, the training of community-based service providers, access to pre-packaged drugs and the gradual withdrawal of pre-packaged chloroquine and its replacement by pre-packaged artemisinin-based combination therapies.

Ensuring socially responsible packaging design

DEFF Research Database (Denmark)

Geert Jensen, Birgitte

Most consumers have experienced occasional problems with opening packaging. Tomato sauce from the tinned mackerel splattered all over the kitchen counter, the unrelenting pickle jar lid, and the package of sliced ham that cannot be opened without a knife or a pair of scissors. The research project...... "User‐friendly Packaging" aims to create a platform for developing more user‐friendly packaging. One intended outcome of the project is a guideline that industry can use in development efforts. The project also points the way for more extended collaboration between companies and design researchers. How...... can design research help industry in packaging innovation?...

Packaging based on polymeric materials

Directory of Open Access Journals (Sweden)

Jovanović Slobodan M.

2005-01-01

Full Text Available In the past two years the consumption of common in the developed countries world wide (high tonnage polymers for packaging has approached a value of 50 wt.%. In the same period more than 50% of the packaging units on the world market were made of polymeric materials despite the fact that polymeric materials present 17 wt.% of all packaging materials. The basic properties of polymeric materials and their environmental and economical advantages, providing them such a position among packaging materials, are presented in this article. Recycling methods, as well as the development trends of polymeric packaging materials are also presented.

Advanced flip chip packaging

CERN Document Server

Lai, Yi-Shao; Wong, CP

2013-01-01

Advanced Flip Chip Packaging presents past, present and future advances and trends in areas such as substrate technology, material development, and assembly processes. Flip chip packaging is now in widespread use in computing, communications, consumer and automotive electronics, and the demand for flip chip technology is continuing to grow in order to meet the need for products that offer better performance, are smaller, and are environmentally sustainable. This book also: Offers broad-ranging chapters with a focus on IC-package-system integration Provides viewpoints from leading industry executives and experts Details state-of-the-art achievements in process technologies and scientific research Presents a clear development history and touches on trends in the industry while also discussing up-to-date technology information Advanced Flip Chip Packaging is an ideal book for engineers, researchers, and graduate students interested in the field of flip chip packaging.

Consumer perceptions of cigarette pack design in France: a comparison of regular, limited edition and plain packaging.

Science.gov (United States)

Gallopel-Morvan, Karine; Moodie, Crawford; Hammond, David; Eker, Figen; Beguinot, Emmanuelle; Martinet, Yves

2012-09-01

In the face of comprehensive bans on the marketing of tobacco products, packaging has become an increasingly important promotional tool for the tobacco industry. A ban on the use of branding on tobacco packaging, known as 'plain' packaging, has emerged as a promising regulatory strategy. The current study sought to examine perceptions of cigarette packaging among adults in France. Adult smokers and non-smokers (N=836) were surveyed using computer-assisted personal interviewing to assess perceptions of pack design by comparing 'regular' branded packs and 'limited edition' packs (with novel designs or innovations) with 'plain' versions of these packs with all branding, including colour, removed. Plain packs (PP) were less likely than regular packs, and particularly limited edition packs, to be considered attractive, attention grabbing and likely to motivate youth purchase. PPs were also rated as the most effective in convincing non-smokers not to start and smokers to reduce consumption and quit. Logistic regression showed that smokers motivated to quit, in comparison to smokers not motivated to quit, were significantly more likely to consider the PPs as the packs most likely to motivate cessation. Novel cigarette packaging, in the form of limited edition packs, had the highest ratings of consumer appeal, ahead of regular branded packs and also PPs. Interestingly, PPs were perceived to be the packs most likely to promote cessation among those adults with quitting intentions. Plain packaging, therefore, may be a means of helping existing adult smokers motivated to quit to do so.

Enabling More than Moore: Accelerated Reliability Testing and Risk Analysis for Advanced Electronics Packaging

Science.gov (United States)

Ghaffarian, Reza; Evans, John W.

2014-01-01

For five decades, the semiconductor industry has distinguished itself by the rapid pace of improvement in miniaturization of electronics products-Moore's Law. Now, scaling hits a brick wall, a paradigm shift. The industry roadmaps recognized the scaling limitation and project that packaging technologies will meet further miniaturization needs or ak.a "More than Moore". This paper presents packaging technology trends and accelerated reliability testing methods currently being practiced. Then, it presents industry status on key advanced electronic packages, factors affecting accelerated solder joint reliability of area array packages, and IPC/JEDEC/Mil specifications for characterizations of assemblies under accelerated thermal and mechanical loading. Finally, it presents an examples demonstrating how Accelerated Testing and Analysis have been effectively employed in the development of complex spacecraft thereby reducing risk. Quantitative assessments necessarily involve the mathematics of probability and statistics. In addition, accelerated tests need to be designed which consider the desired risk posture and schedule for particular project. Such assessments relieve risks without imposing additional costs. and constraints that are not value added for a particular mission. Furthermore, in the course of development of complex systems, variances and defects will inevitably present themselves and require a decision concerning their disposition, necessitating quantitative assessments. In summary, this paper presents a comprehensive view point, from technology to systems, including the benefits and impact of accelerated testing in offsetting risk.

Prevalence and determinants of comprehensive eye care in a group of patients with diabetes: a cross-sectional study in a sub-Saharan African setting.

Science.gov (United States)

Jingi, Ahmadou M; Noubiap, Jean Jacques; Bilong, Yannick; Tankeu, Aurel T; Ebana Mvogo, Côme

2018-02-27

We aimed to investigate the determinants of comprehensive eye examination in diabetes patients. We conducted a cross-sectional study at the eye department of the Douala General Hospital. Adult patients with diabetes were consecutively interviewed on the history of their diabetes. Main outcomes were a first ever comprehensive eye examination including fundoscopy, and diagnosis-to-fundoscopy time. 52 patients were included of whom 59.6% were males with a mean age of 55.9 ± 10.9 years. 51.9% have had counselling on the risk of visual impairment and blindness due to diabetes, and 61.5% [95% CI 47-74.7] have had a comprehensive eye examination. Of those with a first ever fundoscopy, only 21.9% had the test performed within 1 year of diagnosis. Thus, after an average of 10 years of the diagnosis of diabetes, 13.5% (7/52) of patients have had a comprehensive eye examination within 1 year of diagnosis. Only dose with duration of diabetes of more than 10 years were 7-24 times more likely to have a comprehensive eye examination. In summary, patients with diabetes in this low-income setting do not receive a comprehensive eye care as recommended. Most patients will get an eye examination at least 10 years after the diagnosis of diabetes.

Challenges in the Packaging of MEMS

Energy Technology Data Exchange (ETDEWEB)

Malshe, A.P.; Singh, S.B.; Eaton, W.P.; O' Neal, C.; Brown, W.D.; Miller, W.M.

1999-03-26

The packaging of Micro-Electro-Mechanical Systems (MEMS) is a field of great importance to anyone using or manufacturing sensors, consumer products, or military applications. Currently much work has been done in the design and fabrication of MEMS devices but insufficient research and few publications have been completed on the packaging of these devices. This is despite the fact that packaging is a very large percentage of the total cost of MEMS devices. The main difference between IC packaging and MEMS packaging is that MEMS packaging is almost always application specific and greatly affected by its environment and packaging techniques such as die handling, die attach processes, and lid sealing. Many of these aspects are directly related to the materials used in the packaging processes. MEMS devices that are functional in wafer form can be rendered inoperable after packaging. MEMS dies must be handled only from the chip sides so features on the top surface are not damaged. This eliminates most current die pick-and-place fixtures. Die attach materials are key to MEMS packaging. Using hard die attach solders can create high stresses in the MEMS devices, which can affect their operation greatly. Low-stress epoxies can be high-outgassing, which can also affect device performance. Also, a low modulus die attach can allow the die to move during ultrasonic wirebonding resulting to low wirebond strength. Another source of residual stress is the lid sealing process. Most MEMS based sensors and devices require a hermetically sealed package. This can be done by parallel seam welding the package lid, but at the cost of further induced stress on the die. Another issue of MEMS packaging is the media compatibility of the packaged device. MEMS unlike ICS often interface with their environment, which could be high pressure or corrosive. The main conclusion we can draw about MEMS packaging is that the package affects the performance and reliability of the MEMS devices. There is a

Has Chiranjeevi Yojana changed the geographic availability of free comprehensive emergency obstetric care services in Gujarat, India?

Directory of Open Access Journals (Sweden)

Kranti Suresh Vora

2015-10-01

Full Text Available Background: The high rate of maternal mortality in India is of grave concern. Poor rural Indian women are most vulnerable to preventable maternal deaths primarily because they have limited availability of affordable emergency obstetric care (EmOC within reasonable geographic proximity. Scarcity of obstetricians in the public sector combined with financial barriers to accessing private sector obstetrician services preclude this underserved population from availing lifesaving functions of comprehensive EmOC such as C-section. In order to overcome this limitation, Government of Gujarat initiated a unique public–private partnership program called Chiranjeevi Yojana (CY in 2005. The program envisaged leveraging private sector providers to increase availability and thereby accessibility of EmOC care for vulnerable sections of society. Under CY, private sector providers render obstetric care services to poor women at no cost to patients. This paper examines the CY's effectiveness in improving availability of CEmOC services between 2006 and 2012 in three districts of Gujarat, India. Methods: Primary data on facility locations, EmOC functionality, and obstetric bed availability were collected in the years 2012 and 2013 in three study districts. Secondary data from Census 2001 and 2011 were used along with required geographic information from Topo sheets and Google Earth maps. ArcGIS version 10 was used to analyze the availability of services using two-step floating catchment area (2SFCA method. Results: Our analysis suggests that the availability of CEmOC services within reasonable travel distance has greatly improved in all three study districts as a result of CY. We also show that the declining participation of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability of providers for several villages was reduced. Spatial and temporal analyses in this paper provide a comprehensive

CH Packaging Program Guidance

International Nuclear Information System (INIS)

2006-01-01

The purpose of this document is to provide the technical requirements for preparation for use, operation, inspection, and maintenance of a Transuranic Package Transporter Model II (TRUPACT-II), a HalfPACT shipping package, and directly related components. This document complies with the minimum requirements as specified in the TRUPACT-II Safety Analysis Report for Packaging (SARP), HalfPACT SARP, and U.S. Nuclear Regulatory Commission (NRC) Certificates of Compliance (C of C) 9218 and 9279, respectively. In the event of a conflict between this document and the SARP or C of C, the C of C shall govern. The C of Cs state: 'each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, Operating Procedures, of the application.' They further state: 'each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, Acceptance Tests and Maintenance Program of the Application.' Chapter 9.0 of the SARP charges the U.S. Department of Energy (DOE) or the Waste Isolation Pilot Plant| (WIPP) management and operating (M and O) contractor with assuring packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC-approved, users need to be familiar with Title 10 Code of Federal Regulations(CFR) 71.8. Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the Carlsbad Field Office (CBFO) shall be notified immediately. The CBFO will evaluate the issue and notify the NRC if required.In accordance with 10 CFR Part 71, certificate holders, packaging users, and contractors or subcontractors who use, design, fabricate, test, maintain, or modify the packaging shall post copies of (1) 10 CFR Part 21 regulations, (2) Section 206 of the Energy Reorganization Act of 1974, and (3) NRC Form 3, Notice to Employees. These documents must be posted in a conspicuous location where the activities subject to these regulations

CH Packaging Program Guidance

International Nuclear Information System (INIS)

2007-01-01

The purpose of this document is to provide the technical requirements for preparation for use, operation, inspection, and maintenance of a Transuranic Package Transporter Model II (TRUPACT-II), a HalfPACT shipping package, and directly related components. This document complies with the minimum requirements as specified in the TRUPACT-II Safety Analysis Report for Packaging (SARP), HalfPACT SARP, and U.S. Nuclear Regulatory Commission (NRC) Certificates of Compliance (C of C) 9218 and 9279, respectively. In the event of a conflict between this document and the SARP or C of C, the C of C shall govern. The C of Cs state: 'each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, Operating Procedures, of the application.' They further state: 'each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, Acceptance Tests and Maintenance Program of the Application.' Chapter 9.0 of the SARP charges the U.S. Department of Energy (DOE) or the Waste Isolation Pilot Plant (WIPP) management and operating (M and O) contractor with assuring packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC-approved, users need to be familiar with Title 10 Code of Federal Regulations (CFR) 71.8. Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the Carlsbad Field Office (CBFO) shall be notified immediately. The CBFO will evaluate the issue and notify the NRC if required.In accordance with 10 CFR Part 71, certificate holders, packaging users, and contractors or subcontractors who use, design, fabricate, test, maintain, or modify the packaging shall post copies of (1) 10 CFR Part 21 regulations, (2) Section 206 of the Energy Reorganization Act of 1974, and (3) NRC Form 3, Notice to Employees. These documents must be posted in a conspicuous location where the activities subject to these regulations

User friendly packaging

DEFF Research Database (Denmark)

Geert Jensen, Birgitte

2010-01-01

Most consumers have experienced occasional problems with opening packaging. Tomato sauce from the tinned mackerel splattered all over the kitchen counter, the unrelenting pickle jar lid, and the package of sliced ham that cannot be opened without a knife or a pair of scissors. The research project...

Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices.

Science.gov (United States)

Arbogast, James W; Moore-Schiltz, Laura; Jarvis, William R; Harpster-Hagen, Amanda; Hughes, Jillian; Parker, Albert

2016-06-01

The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.

Packaging of control system software

International Nuclear Information System (INIS)

Zagar, K.; Kobal, M.; Saje, N.; Zagar, A.; Sabjan, R.; Di Maio, F.; Stepanov, D.

2012-01-01

Control system software consists of several parts - the core of the control system, drivers for integration of devices, configuration for user interfaces, alarm system, etc. Once the software is developed and configured, it must be installed to computers where it runs. Usually, it is installed on an operating system whose services it needs, and also in some cases dynamically links with the libraries it provides. Operating system can be quite complex itself - for example, a typical Linux distribution consists of several thousand packages. To manage this complexity, we have decided to rely on Red Hat Package Management system (RPM) to package control system software, and also ensure it is properly installed (i.e., that dependencies are also installed, and that scripts are run after installation if any additional actions need to be performed). As dozens of RPM packages need to be prepared, we are reducing the amount of effort and improving consistency between packages through a Maven-based infrastructure that assists in packaging (e.g., automated generation of RPM SPEC files, including automated identification of dependencies). So far, we have used it to package EPICS, Control System Studio (CSS) and several device drivers. We perform extensive testing on Red Hat Enterprise Linux 5.5, but we have also verified that packaging works on CentOS and Scientific Linux. In this article, we describe in greater detail the systematic system of packaging we are using, and its particular application for the ITER CODAC Core System. (authors)

Sensory impacts of food-packaging interactions.

Science.gov (United States)

Duncan, Susan E; Webster, Janet B

2009-01-01

Sensory changes in food products result from intentional or unintentional interactions with packaging materials and from failure of materials to protect product integrity or quality. Resolving sensory issues related to plastic food packaging involves knowledge provided by sensory scientists, materials scientists, packaging manufacturers, food processors, and consumers. Effective communication among scientists and engineers from different disciplines and industries can help scientists understand package-product interactions. Very limited published literature describes sensory perceptions associated with food-package interactions. This article discusses sensory impacts, with emphasis on oxidation reactions, associated with the interaction of food and materials, including taints, scalping, changes in food quality as a function of packaging, and examples of material innovations for smart packaging that can improve sensory quality of foods and beverages. Sensory evaluation is an important tool for improved package selection and development of new materials.

Plutonium stabilization and packaging system

International Nuclear Information System (INIS)

1996-01-01

This document describes the functional design of the Plutonium Stabilization and Packaging System (Pu SPS). The objective of this system is to stabilize and package plutonium metals and oxides of greater than 50% wt, as well as other selected isotopes, in accordance with the requirements of the DOE standard for safe storage of these materials for 50 years. This system will support completion of stabilization and packaging campaigns of the inventory at a number of affected sites before the year 2002. The package will be standard for all sites and will provide a minimum of two uncontaminated, organics free confinement barriers for the packaged material

RH Packaging Operations Manual

International Nuclear Information System (INIS)

Washington TRU Solutions LLC

2003-01-01

This procedure provides operating instructions for the RH-TRU 72-B Road Cask, Waste Shipping Package. In this document, ''Packaging'' refers to the assembly of components necessary to ensure compliance with the packaging requirements (not loaded with a payload). ''Package'' refers to a Type B packaging that, with its radioactive contents, is designed to retain the integrity of its containment and shielding when subject to the normal conditions of transport and hypothetical accident test conditions set forth in 10 CFR Part 71. Loading of the RH 72-B cask can be done two ways, on the RH cask trailer in the vertical position or by removing the cask from the trailer and loading it in a facility designed for remote-handling (RH). Before loading the 72-B cask, loading procedures and changes to the loading procedures for the 72-B cask must be sent to CBFO at sitedocuments at wipp.ws for approval

Building a comprehensive geriatric health care system: a case study.

Science.gov (United States)

Bleiweiss, L; Simson, S

1976-01-01

This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.

MARS software package status

International Nuclear Information System (INIS)

Azhgirej, I.L.; Talanov, V.V.

2000-01-01

The MARS software package is intended for simulating the nuclear-electromagnetic cascades and the secondary neutrons and muons transport in the heterogeneous medium of arbitrary complexity in the magnetic fields presence. The inclusive approach to describing the particle production in the nuclear and electromagnetic interactions and by the unstable particles decay is realized in the package. The MARS software package was actively applied for solving various radiation physical problems [ru

CH Packaging Program Guidance

International Nuclear Information System (INIS)

Washington TRU Solutions LLC

2003-01-01

The purpose of this document is to provide the technical requirements for preparation for use, operation, inspection, and maintenance of a Transuranic Package Transporter Model II (TRUPACT-II), a HalfPACT shipping package, and directly related components. This document complies with the minimum requirements as specified in the TRUPACT-II Safety Analysis Report for Packaging (SARP), HalfPACT SARP, and Nuclear Regulatory Commission (NRC) Certificates of Compliance (C of C) 9218 and 9279, respectively. In the event of a conflict between this document and the SARP or C of C, the C of C shall govern. The C of Cs state: ''each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, Operating Procedures, of the application.'' They further state: ''each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, Acceptance Tests and Maintenance Program of the Application.'' Chapter 9.0 of the SARP charges the WIPP management and operating (M and O) contractor with assuring packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC-approved, users need to be familiar with 10 CFR 71.11. Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the Carlsbad Field Office (CBFO) shall be notified immediately. CBFO will evaluate the issue and notify the NRC if required. This document provides the instructions to be followed to operate, maintain, and test the TRUPACT-II and HalfPACT packaging. The intent of these instructions is to standardize operations. All users will follow these instructions or equivalent instructions that assure operations are safe and meet the requirements of the SARPs

CH Packaging Program Guidance

International Nuclear Information System (INIS)

Washington TRU Solutions LLC

2002-01-01

The purpose of this document is to provide the technical requirements for preparation for use, operation, inspection, and maintenance of a Transuranic Package Transporter Model II (TRUPACT-II), a HalfPACT Shipping Package, and directly related components. This document complies with the minimum requirements as specified in TRUPACT-II Safety Analysis Report for Packaging (SARP), HalfPACT SARP, and Nuclear Regulatory Commission (NRC) Certificates of Compliance (C of C) 9218 and 9279, respectively. In the event there is a conflict between this document and the SARP or C of C, the SARP and/or C of C shall govern. C of Cs state: ''each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, Operating Procedures, of the application.'' They further state: ''each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, Acceptance Tests and Maintenance Program of the Application.'' Chapter 9.0 of the SAR P charges the WIPP Management and Operation (M and O) contractor with assuring packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC-approved, users need to be familiar with 10 CFR 71.11. Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the Carlsbad Field Office (CBFO) shall be notified immediately. CBFO will evaluate the issue and notify the NRC if required. This document details the instructions to be followed to operate, maintain, and test the TRUPACT-II and HalfPACT packaging. The intent of these instructions is to standardize these operations. All users will follow these instructions or equivalent instructions that assure operations are safe and meet the requirements of the SARPs

Consumer response to packaging design

NARCIS (Netherlands)

Steenis, Nigel D.; Herpen, van Erica; Lans, van der Ivo A.; Ligthart, Tom N.; Trijp, van Hans C.M.

2017-01-01

Building on theories of cue utilization, this paper investigates whether and how packaging sustainability influences consumer perceptions, inferences and attitudes towards packaged products. A framework is tested in an empirical study among 249 students using soup products varying in packaging

Natural biopolimers in organic food packaging

Science.gov (United States)

Wieczynska, Justyna; Cavoski, Ivana; Chami, Ziad Al; Mondelli, Donato; Di Donato, Paola; Di Terlizzi, Biagio

2014-05-01

Concerns on environmental and waste problems caused by use of non-biodegradable and non-renewable based plastic packaging have caused an increase interest in developing biodegradable packaging using renewable natural biopolymers. Recently, different types of biopolymers like starch, cellulose, chitosan, casein, whey protein, collagen, egg white, soybean protein, corn zein, gelatin and wheat gluten have attracted considerable attention as potential food packaging materials. Recyclable or biodegradable packaging material in organic processing standards is preferable where possible but specific principles of packaging are not precisely defined and standards have to be assessed. There is evidence that consumers of organic products have specific expectations not only with respect to quality characteristics of processed food but also in social and environmental aspects of food production. Growing consumer sophistication is leading to a proliferation in food eco-label like carbon footprint. Biopolymers based packaging for organic products can help to create a green industry. Moreover, biopolymers can be appropriate materials for the development of an active surfaces designed to deliver incorporated natural antimicrobials into environment surrounding packaged food. Active packaging is an innovative mode of packaging in which the product and the environment interact to prolong shelf life or enhance safety or sensory properties, while maintaining the quality of the product. The work will discuss the various techniques that have been used for development of an active antimicrobial biodegradable packaging materials focusing on a recent findings in research studies. With the current focus on exploring a new generation of biopolymer-based food packaging materials with possible applications in organic food packaging. Keywords: organic food, active packaging, biopolymers , green technology

Physical and chemical characteristics of cashew nut flour stored and packaged with different packages

Directory of Open Access Journals (Sweden)

Bruna Carolina GADANI

Full Text Available Abstract The aim of this study was to evaluate the physical and chemical changes in cashew nut flour under different packaging and storage conditions. The flour samples were characterized according to their chemical composition, packaged in polystyrene trays associated with covering chloride polyvinyl (PVC, plastic pot of polyethylene terephthalate (PET, plastic packaging polyethylene (POL and without coating polystyrene trays (CON. All packages were stored for 225 days, evaluating every 45 days the moisture content of the flour as well as extracting their oil by the cold method for characterization on the following indexes: acidity, saponification, iodine, peroxide and refraction. There was slight and gradual increase in the moisture content from the 45th to the 225th day, especially for products packaged in PVC and without coating polystyrene trays (CON. The oil saponification indexes showed gradual decrease during storage, especially in flour without packaging (CON. There was a gradual increase in the iodine index until the 135th day, followed by decay. The acidity and peroxide indexes increased along with the storage time. However packages with lower oxygen and moisture permeability, such as PET and POL, minimized such changes, being therefore the most suitable for long-term storage.

CH Packaging Program Guidance

International Nuclear Information System (INIS)

2008-01-01

The purpose of this document is to provide the technical requirements for preparation for use, operation, inspection, and maintenance of a Transuranic Package Transporter Model II (TRUPACT-II), a HalfPACT shipping package, and directly related components. This document complies with the minimum requirements as specified in the TRUPACT-II Safety Analysis Report for Packaging (SARP), HalfPACT SARP, and U.S. Nuclear Regulatory Commission (NRC) Certificates of Compliance (C of C) 9218 and 9279, respectively. In the event of a conflict between this document and the SARP or C of C, the C of C shall govern. The C of Cs state: 'each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, Operating Procedures, of the pplication.' They further state: 'each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, Acceptance Tests and Maintenance Program of the Application.' Chapter 9.0 of the SARP charges the U.S. Department of Energy (DOE) or the Waste Isolation Pilot Plant (WIPP) management and operating (M and O) contractor with assuring packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC-approved, users need to be familiar with Title 10 Code of Federal Regulations (CFR) 71.8. Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the Carlsbad Field Office (CBFO) shall be notified immediately. The CBFO will evaluate the issue and notify the NRC if required. In accordance with 10 CFR Part 71, certificate holders, packaging users, and contractors or subcontractors who use, design, fabricate, test, maintain, or modify the packaging shall post copies of (1) 10 CFR Part 21 regulations, (2) Section 206 of the Energy Reorganization Act of 1974, and (3) NRC Form 3, Notice to Employees. These documents must be posted in a conspicuous location where the activities subject to these regulations