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Over-the-counter (OTC) drugs have many benefits but also carry risks, such as adverse drug reactions, which are more prevalent in older adults. Because these products do not require the oversight of a physician or pharmacist, labeling plays a key role in communicating information required for their safe and effective use. Research suggests that current labels are not terribly effective at communicating potential risk. One reason for their lack of effectiveness is that few consumers attend to critical information (active ingredients and warnings) when making purchases. In two experiments, we used a change detection task to objectively evaluate how novel label designs that employ highlighting and a warning label placed on the package’s front impact attention to critical information among older participants (65 and older). The change detection task is a unique form of visual search which allowed us to assess the attentional priority of critical information among participants who were not explicitly instructed to search for this critical information. This unique aspect of the task is important given research suggesting that consumers rarely have the explicit goal of seeking out warnings and active ingredients when making OTC selections. Our results provide empirical support that both highlighting critical information and positioning it on the package’s front increase its attentional prioritization relative to current, commercial practice. Given that attending to the critical information is prerequisite to utilizing that information, strategies that elicit attention in this way are likely to reduce medication errors.

Identification and isolation of contagious individuals along with quarantine of close contacts, is critical for slowing the spread of COVID-19. Large-scale testing in a surveillance or screening capacity for asymptomatic carriers of COVID-19 provides both data on viral spread and the follow-up ability to rapidly test individuals during suspected outbreaks. The COVID-19 early detection program at Michigan State University has been utilizing large-scale testing in a surveillance or screening capacity since fall of 2020. The methods adapted here take advantage of the reliability, large sample volume, and self-collection benefits of saliva, paired with a cost-effective, reagent conserving two-dimensional pooling scheme. The process was designed to be adaptable to supply shortages, with many components of the kits and the assay easily substituted. The processes outlined for collecting and processing SARS-CoV-2 samples can be adapted to test for future viral pathogens reliably expressed in saliva. By providing this blueprint for universities or other organizations, preparedness plans for future viral outbreaks can be developed.

Background Over-the-counter (OTC) medication use is associated with risks of adverse drug reactions (ADRs), particularly among older adults. The Drug Facts Label (DFL) is supposed to provide consumers with information that would avoid ADRs, yet research suggests that consumers frequently fail to interact with this critical information. We postulate that emphasizing critical information by placing it on the front of the package may increase its usage. Before doing so, the most critical information from the DFL needs to be identified. Objectives This study aimed to determine which information from the DFL is most critical in reducing ADRs at the time of purchase or use by older adults. Methods A national survey of practicing pharmacists knowledgeable about OTC medication use by older adults asked participants to rank order the importance of the DFL sections to reduce ADRs in older adults. Open-ended questions focused on identifying ways of improving OTC medication labeling. Quantitative rankings were used to calculate the content validity ratio and analyzed using Wilcoxon signed rank tests. Qualitative results were categorized into themes. Results A total of 318 responses (12% response rate) were analyzed. There was high consensus that uses and purpose, active ingredient, warnings, and directions for use were the most important sections of the DFL. Within the warning section, 2 specific warnings, “Do not use” and “Ask a doctor or pharmacist,” were deemed most important. Similarly, qualitative themes focused on seeking health care provider assistance or were specific to age-related precautions. Conclusions Prioritizing warnings that highlight the importance of possible drug-drug and drug-disease precautions and the need to seek medical advice before taking OTC medications were deemed most critical. Moving this type of information to the front of the package may help reduce ADRs among older adults.

Background Settings where Emergency Medical Services (EMS) are provided to stabilize patients and transport them to locations better equipped to provide comprehensive care, “prehospital settings,” are not frequently considered when designing packaged products. Packaging design is an understudied area, potentially impacting both healthcare provider behavior and patient outcomes. Our objectives were to: 1) describe difficulties associated with packaging in prehospital settings 2) investigate the coping strategies used by paramedics when difficulties occurred, and 3) assess the potential impacts these difficulties had on patient care. Methods An online, cross-sectional survey was distributed via email using the National EMS Certification database maintained by the National Registry of Emergency Medical Technicians (NREMT) to a random sample of nationally-certified paramedics. Eligible respondents were aged 18 and older, employed as paramedics and had administered care in a prehospital setting within the previous 12 months. Survey items explored difficulties experienced and coping strategies used when difficulty was encountered identifying or opening medications and/or medical supplies. Descriptive statistics and logistic regression were calculated to analyse responses for trends. Results Of the 12,000 emails sent, 1,912 participants responded (response rate = 16%). After removing respondents who had not administered care within the past 12 months and partial surveys, data from 1,702 respondents were analysed. Nearly 20% of all respondents reported that they had experienced difficulties identifying (21.1%) or opening (20.5%) medications and identifying (17.0%) or opening (23.4%) medical supplies within the past year. Between 1.2% (identifying a medication) and 3.0% (opening supplies) of those included in the analysis indicated that reported difficulties had negatively impacted patient care. Common coping strategies reported to deal with difficulty opening included partner assistance, tool use (scissors, pens, and knives), and the use of teeth, all potential pathways for the transmission of microbes, conceivably further impacting outcomes. Conclusion More thoughtfully designed packaging for prehospital settings has the potential to benefit both EMS providers and the patients that they care for.

Purpose Alcohol concentration has traditionally been labeled in the form of alcohol by volume (ABV). This format can cause difficulty in evaluating accuracy of a pour because it doesn’t directly connect with recommendations related to “standard drinks,” the approach used by the US CDC and others organizations which intend to facilitate responsible drinking behaviors. Strategies which more directly connect guidelines related to healthy drinking behaviors to alcohol labeling are needed. Objective Assess how a label identifying the number of standard drinks per container impacts the ability of undergraduate students to accurately pour a standard drink. Design This study employed a 3 x 2 x 2 experimental design. Undergraduates were asked to pour a standard drink from mock products from three alcohol categories (beer, wine and liquor); products were presented in two types of label (traditional ABV vs. standard drinks/container) at two concentrations of alcohol content (high and low). Results We calculated standardized pour errors (pour errors in standard drink units). Analysis of these standardized pour errors suggested that 1) people tended to underpour beverages of low concentration across product categories and overpour those high in concentration. 2) When the standard drink label was present, pour accuracy was improved, when compared with pours from containers affixed with ABV labels in low alcohol concentrations across all product categories (beer, wine and liquor). 3) For treatments that comprised high concentrations of alcohol, the standard drink label significantly increased accuracy only for beer. However, it is worth noting that beer with an ABV label was the condition with the most dramatic overpours, and these problematic overpours were dramatically reduced by the addition of a standard drink label. Conclusions Our work empirically supports the notion that Undergraduate students are better able to accurately assess and pour a standard drink of alcohol from bottles incorporating a label which includes standard drinks/container vs. those with traditional ABV labeling. That said, the effect is quite different for each alcohol category: beer, wine, and liquor and depends on whether the product is high or low in concentration of alcohol for its category; as such, policy makers should consider alcohol categories and concentrations from a public health perspective when recommending changes to labeling.

Drug manufacturers are expected to provide labeling information needed to yield safe and effective product use. However, it is not clear that consumers dose sunscreen, an over-the-counter drug, appropriately; in fact, existing evidence suggests underdosing as a common phenomenon. The objective of this study was to evaluate the effect of dispensing device and labeling on self-administered doses of sunscreen in young adults. To investigate those effects, a 2 × 2 factorial laboratory experiment crossing dispensing device (two levels) with labeling treatment (two levels) was conducted. Participants applied sunscreen from each of the four treatments; dosing concentration, measured in mg/cm2, served as the response variable. Participants ( n = 94) were recruited on the campuses of Michigan State University (East Lansing, MI) and California Polytechnic State University (San Luis Obispo, CA). Each participant applied sunscreen from each unique treatment to sites on their arms and legs (four applications). Postapplication, a survey was completed to characterize demographics, risk perception, and sunscreen use patterns. Results indicate participants applied approximately 30% less sunscreen from the pump bottles than the squeeze bottles (difference estimate of 0.3059 mg/cm2, standard error = 0.0607, p < .0001); there was no evidence of a difference based on label treatments. Post hoc recognition tests indicated only 55% of participants were able to recognize the two experimental labels they had viewed immediately following sunscreen application. Sunscreen application density was directly related to level of worry regarding skin cancer and frequency of sunscreen use (α = .05). Our results suggest the dispensing device used to deliver sunscreen impacts the dosage amount consumers apply.

Archived video footage from a previous task analysis study where children attempted to open prescription vials outfitted with 42 mm (diameter) push and turn closures was reviewed and grip postures were characterized based on a grip taxonomy presented by Rowson & Yoxall which investigated adult grips (2011). Video review was conducted to identify the types of grip postures children aged 3–5 years utilized when attempting to open continuous thread polypropylene vials outfitted with push and turn, child-resistant closures and compared with grip postures identified with the adults. Children tended to utilize only 3 grip postures (spherical, cylindrical, and pronated cylindrical grips), while adults utilized seven different postures. If children utilize a more limited set of grip postures when opening child resistant closures than their adult counterparts, this difference could be exploited when designing child resistant packaging systems. That said, our study utilized a limited number of CRC designs and confounds existed between the package sizes the children in the archived video footage attempted to open and those that served as the point of comparison which identified grip postures utilized by adults. As such, further investigation is needed across a range of package diameters. Potential implications for child-resistant packaging design are discussed.

Objective: Evaluate the ability of healthcare providers from the US to comprehend internationally standardized symbols placed on medical device packaging. Participants: Eighty-six healthcare providers attending the Association of Surgical Technologists (AST) Instructors' Forum (Savannah, GA February 2014), the 46th Annual AST National Conference (Denver, CO May 2014), or members of the same organization that responded to a targeted email blast. Measures: We adapted the comprehension portion of ISO 9186-1: 2007 to test 38 standardized symbols developed for the medical device industry. Participants were asked to provide an open-ended response regarding the meaning of each symbol. Survey responses were categorized into five levels of comprehension: correct, wrong, opposite, don't know or no response. Symbols receiving response rates of ≥85% in the correct category were considered successful. Conversely, if responses categorized as opposite were ≥5%, symbols were considered ‘critically confusing.’ Main Results: Six of 38 symbols were classified as ‘successful’; five of the six had text (in English) imbedded within. Three out of the 38 were categorized as ‘critically confusing’; they were not only misunderstood, but, in fact, interpreted to mean the opposite of what was intended by ≥5% of participants surveyed. Conclusions: Given that the medical device industry in the US has requested permission from the US Food and Drug Administration (FDA) to use stand-alone symbols to better harmonize with EU Directives, the exploration of healthcare providers' comprehension of the same is an important and timely topic. Our work suggests that symbols commonly incorporated into the labeling of medical devices may not be readily understood at present. As such, policy decisions should be carefully considered. Limitations: Although we provided participants with a general context of use (i.e. these symbols are used on medical devices), the specific part of the hospital, or type of procedure where the symbol would be found was not noted. Further research to evaluate symbol comprehension with specific context (e.g. IVD, general procedure, etc.) is recommended. Run order was presented consistently throughout the experiment in the same booklet. We tested whether or not this impacted results in two ways: (a) by correlating run order with mean performance to see if there was a trend through the data (toward improvement or decline) and (b) by assuming repeated measures from subjects to test if the subject response changes with time. Neither of these analyses suggested significant effects because of run order. Copyright © 2016 John Wiley & Sons, Ltd.

Over-the-counter (OTC) medication is a convenient, affordable way for older adults to treat a variety of conditions; older consumers use more OTCs per capita than other people for varied reasons. As with any medication, OTCs carry risks. Because the labels of OTCs are frequently the only information accessed by consumers, labels designed to communicate safety information are paramount for these products. Yet, available studies suggest that consumers do not regularly access the comprehensive information in the Drug Facts Label (DFL) when making purchase or use decisions, tending to rely on information found on the front of the package. Herein, we evaluate how four OTC label formats (standard; standard/highlight; critical warnings on front/highlighted; critical warnings on front not highlighted) affect how aging participants attend to critical information. Sixty-eight participants (65+) engaged a computer-based task answering yes/no questions that required use of labeling information about the warnings or active ingredients (AI). Results indicate that AI information is found accurately and relatively quickly compared to warning information and highlighting and placement on the front of the package had little effect. By contrast, warning information was found slowly and with low accuracy with the standard label, and highlighting and front of pack placement both significantly improved performance. These results suggest that novel labelling strategies could result in more effective, safer use of OTC medicines among older consumers and provide insights that could be used by regulators as they work to improve policy focused on improving mandates for OTC labeling.

Background: United States pharmacies repackage medications into multi-dose vials, enabling customized dosing for prescription drugs. Investment in infrastructure has made this the predominant approach to packaging for US prescriptions. Although recent changes to labeling now discourage the use of auxiliary labels (small stickers highlighting information germane to the safe and effective use), they are still allowed by USP, provided their use comes from an evidence-based perspective. Objectives: Evaluate how ‘interactive,’ placements of auxiliary labels (placement requiring physical manipulation of the warning to accomplish a task (e.g. opening)) garner attention as compared to those placed vertically or horizontally. Methods: Ninety-six participants were eye tracked while opening three prescription vials (each with an auxiliary warning label with a different placement: vertical, horizontal and interactive). Recall and recognition were tested subsequently. Linear mixed models were used to analyze the continuous variables while the binary response variables were analyzed using generalized linear mixed models. The effect of auxiliary labels was fitted as a fixed effect and the subject-to-subject variation was considered as a random effect in the model. Participants’ age, health literacy and sex were added to the models if their effect was statistically significant at alpha=0.05. Results: The placement of the warnings significantly impacted the time spent viewing the information they contained at alpha=0.05; people spent significantly longer on interactive placements (0.96; SD 0.13 seconds) than either, horizontal placements (0.27; SD 0.037 seconds) or those placed vertically (0.18 seconds; SD 0.035). Participants were equally as likely to see information presented in an interactive placement (90%; SD 3.8) or horizontal placement (78%; SD 05.5) but less likely to view warnings placed vertically (60%; SD 6.9). Free recall responses also supported the use of interactive placement (62%; SD 6.8 recall) as compared to horizontal placements which were 29%; SD 3.0 and 20%; SD 6.0 for vertical placements. Conclusions: Data provides evidence which suggests that interactive and horizontal placements out-perform auxiliary labels placed vertically on prescription vials with regard to garnering patient attention.

Over-the-counter medicines (OTCs) provide many benefits, including increased access, independence, flexibility and affordability. Despite their advantages, OTCs carry risks like catalyzing an Adverse Drug Reaction (ADR) (e.g. drug-drug or drug-diagnosis interactions). The risk of ADRs is particularly pronounced in older consumers, who tend to consume more OTCs and have higher rates of polypharmacy than other age groups. While OTC labels are required to contain critical information designed to minimize ADRs, evidence suggests that a lack of engagement with key information on OTC labels is endemic and problematic, particularly among older consumers. Our lab has conducted several studies which objectively evaluate information processing in older adults making OTC selections. We investigate what information older consumers access when making decisions, and leverage basic research in visual cognition to develop and objectively evaluate the ability of varied OTC label designs to attract attention to critical information in an attempt to design safer labels.

Objectives (1) To assess whether Front-of-Pack (FOP) nutrition labels garner attention more readily than more complete, mandated nutrition information (the Nutrition Facts Panel (NFP), required in the US), and (2) To determine whether label design characteristics, specifically, color coding and/or coding with facial icons, increase attention to the FOP label. Methods In two experiments, we tracked the allocation of attention while participants (n = 125) viewed novel and commercial packages with varied FOP designs using a change detection methodology. Results We found empirical evidence that FOP labels are attended more often, and earlier, than the currently mandated NFP, and that this benefit is due both to its placement on the front of the package and to the design characteristics of the FOP. Specifically, the use of color in FOPs increased attention to the label, but there was no evidence that coding information via facial icons impacted attention. Conclusions Our work supports a growing body of evidence supporting the use of FOP labels to attract attention to nutritional information. Findings may be relevant to inform policy decisions on labeling standards.

Loss of hand function can have adverse effects on an individual's ability to maintain independence. The ability to perform daily activities, such as food preparation and medication delivery, is dependent on the hand's ability to grasp and manipulate objects. Therefore, the goal of this research was to demonstrate that three dimensional (3D) modeling of hand function can be used to improve the accessibility of handheld objects for individuals with reduced functionality through informed design. Individual models of hand functionality were created for 43 participants and group models were developed for groups of individuals without (Healthy) and with reduced functionality due to arthritis (RFA) of the hand. Cylindrical models representative of auto-injectors of varying diameters were analyzed in 3D space relative to hand function. The individual model mappings showed the cylinder diameter with the highest mapped functional values varied depending on the type of functional weighting chosen: kinematic redundancy of fingertip pad positional placement, fingertip pad orientation, or finger force directionality. The group mappings showed that for a cylinder to be grasped in a power grasp by at least 75% of the Healthy or RFA groups, a diameter of 40 mm was required. This research utilizes a new hand model to objectively compare design parameters across three different kinematic factors of hand function and across groups with different functional abilities. The ability to conduct these comparisons enables the creation of designs that are universal to all – including accommodation of individuals with limits in their functional abilities.

Healthcare-associated infections are a serious worldwide health concern. Although contaminated medical devices are an avenue for infection, little research has evaluated the techniques used to open sterile packages. The goal of this study was to develop a method to quantify aspects of the package opening process in accordance with opening guidelines and then to demonstrate this methodology through a small sample of clinicians opening two sizes of pouch-style packages. Using motion capture techniques, a method was designed to quantify 11 parameters associated with the opening process. The method was then tested with nine healthcare professionals. Results indicated that all participants crossed the sterile field when opening packages. When opening large packages, participants spent significantly more time over the simulated sterile field and there was a trend towards more manipulations as compared to opening smaller packages. This methodology can be used to quantify the opening process, compare opening practices, and for assessment during the learning process.

Objectives The goal of this research was to evaluate how material curl, package structure and handling of pouches containing medical devices affect rates of contact between non-sterile surfaces and sterile devices during aseptic transfer. Methods One hundred and thirty-six individuals with practical experience in aseptic technique were recruited. Participants were asked to present the contents of four different pouch designs (a standard, one designed to curl in, another to curl out and one that incorporated a tab) using two transfer techniques. During the first block of trials “standard technique” was used; participants presented using their typical methods to the sterile field. Trials in the second block employed “modified technique”; participants were instructed to grab the package at the top center and present package contents using a single, fluid motion. The outside of the pouch and the backs of the participants’ hands were coated using a simulated contaminant before each trial. The simulant was undetectable in the visible spectrum, but fluoresced under a black light. The dependent variable was recorded in a binary fashion and analyzed using a generalized linear mixed model. Results Participants were between 20–57 and the averaged year 5.1 years of experience in aseptic technique. The data analysis was based on generalized linear mixed effects (GLMM) model, which accommodates the repeated measurements within the same participant. The effect of the pouch design was significant (P‹0.001), but the effect of aseptic technique did not suggest significance (P = 0.088). Specifically, pouches designed with the material curled outward resulted in significantly fewer contacts with non-sterile surfaces than the other styles, including the inward, tab, and standard styles; this was true regardless of the used aseptic technique, standard (P = 0.0171, P = 0.0466, P = 0.0061, respectively) or modified (P‹0.0001 for all comparisons)). Conclusion Results presented here contribute to a growing body of knowledge that investigates packaging as a potential route of contamination for sterile devices during aseptic presentation. Specifically, we provide insights regarding how both package design and opening technique can be informed in ways that build safety into the healthcare system.

The term affordance describes an object's utilitarian function or actionable possibilities. Product designers have taken great interest in the concept of affordances because of the bridge they provide relating to design, the interpretation of design and, ultimately, functionality in the hands of consumers. These concepts have been widely studied and applied in the field of psychology but have had limited formal application to packaging design and evaluation. We believe that the concepts related to affordances will reveal novel opportunities for packaging innovation. To catalyse this, presented work had the following objectives: (a) to propose a method by which packaging designers can purposefully consider affordances during the design process; (b) to explain this method in the context of a packaging-related case study; and (c) to measure the effect on package usability when an affordance-based design approach is employed. © 2014 The Authors. Packaging Technology and Science published by John Wiley & Sons Ltd.

The relative efficacy of secondary packaging on the prevention of microbial ingress into sterile medical device trays was examined. Sterile device trays were aseptically filled with growth medium, exposed to microbial challenge, incubated, and inspected for growth. During microbial challenge, all package systems were subjected to a pressure differential that simulated those experienced during distribution. Penetration rates were significantly decreased (P = 0.01) when unlidded trays were packaged in pouches (0/39), compared to those in cartons (37/39). Similarly, the number of colony forming units (CFU) present was greater for unlidded trays packaged in cartons, compared to those in pouches (P = 0.03). To further explore the efficacy of cartons as a barrier to microbial ingress, lidded trays with a single 100 μm breach were packaged in cartons and subjected to the same methodologies; approximately 15% exhibited growth. When compared to unlidded trays, penetration rates (P

PURPOSE Effective standardization of medical device labels requires objective study of varied designs. Insufficient empirical evidence exists regarding how practitioners utilize and view labeling. OBJECTIVE Measure the effect of graphic elements (boxing information, grouping information, symbol use and color-coding) to optimize a label for comparison with those typical of commercial medical devices. DESIGN Participants viewed 54 trials on a computer screen. Trials were comprised of two labels that were identical with regard to graphics, but differed in one aspect of information (e.g., one had latex, the other did not). Participants were instructed to select the label along a given criteria (e.g., latex containing) as quickly as possible. Dependent variables were binary (correct selection) and continuous (time to correct selection). PARTICIPANTS Eighty-nine healthcare professionals were recruited at Association of Surgical Technologists (AST) conferences, and using a targeted e-mail of AST members. RESULTS Symbol presence, color coding and grouping critical pieces of information all significantly improved selection rates and sped time to correct selection (α = 0.05). Conversely, when critical information was graphically boxed, probability of correct selection and time to selection were impaired (α = 0.05). Subsequently, responses from trials containing optimal treatments (color coded, critical information grouped with symbols) were compared to two labels created based on a review of those commercially available. Optimal labels yielded a significant positive benefit regarding the probability of correct choice ((P

SUMMARY The market for fruits and vegetables has received considerable interest in recent years, with much of its growth attributed to consumer interest in nutrition and health. Quality has been indicated to be the most important factor in produce sales, and appearance is of noted significance with regard to perceived quality. The broad objectives of this research were to identify the impact of simultaneous colour contrast (i.e. the produce viewed through a mesh bag) on (a) attentive behaviours as measured by eye tracking and (b) perceived quality, visual appeal and purchase intention as measured with a Likert scale. To accomplish these objectives, six different types of produce (red apples, oranges, lemons, green apples, purple onions and white onions) were photographed with four differently coloured mesh treatments: the same (as the produce), complementary, complementary-analogous and analogous. Visual stimuli were then presented during the eye tracking study and in a subsequent questionnaire. Colour contrast was found to have a significant effect on both resultant eye tracking variables [number of visual fixations (p

Background Opening glass jars has been noted to be particularly problematic for consumers, leading to many studies related to the opening process. However, most studies place restrictions on jar opening by forcing the jar to remain on the counter or by requiring a specific hand on the closure. Objective The objectives of this research were (i) to evaluate the effect of restrained and unrestrained conditions on kinematics of jar opening, (ii) to evaluate the effects of jar diameter on kinematics and (iii) to evaluate how user characteristics (e.g. hand size) are associated with kinematics. Methods Kinematic data were collected from 21 participants during two opening conditions using jars with two diameters. Condition 1 restrained the participant by requiring that the jar maintain contact with the counter during the opening procedure. Condition 2 was termed unrestrained and allowed the user to open the jar with no requirements on jar or hand location. Results When restrained to a counter, the closure hand produced significantly more rotation compared with the closure hand in the unrestrained condition. Differences were not found in the opening motions when comparing jar diameters. However, hand breadth and length were related to the magnitude of rotation of the closure hand. Conclusions Placing restrictions on the participant, the orientation or location of the jar aids data analysis but may yield results that are not indicative of the user's actual jar opening process. Impositions on user positioning should be carefully considered in studies investigating the opening process of glass jars. Copyright © 2012 John Wiley & Sons, Ltd.

This study introduces the use of change detection, a technique used in cognitive psychology to measure attentional scan paths, as a way to objectively evaluate the prominence of varied label elements. There are two major objectives related to this work: (a) to develop change detection software and methodology for label use; and (b) to compare the relative prominence of different label elements on a beverage container. Six label elements (i.e. treatments) were analysed, namely: the manufacturer name, the product name and a warning dot with text in three colours. Study results suggest that experimental set-up can significantly impact results, specifically the position of the change (p = 0.0078) and the order of appearance (p = 0.069). This is not only important from an experimental design perspective, but also could lead to insights regarding the attentive behaviours of people as they purchase, select and use products. With regard to the elements of the labels tested, we identified a significant difference on time to detect a change (p < 0.0001). Time required for the manufacturer's name, Asahi Breweries, was significantly longer than for any of the other label elements (p < 0.0001). Pairwise comparisons indicated that for the warning dot, red text was located marginally faster than the warning printed in black (p = 0.0566). Change detection offers the promise to objectively evaluate the relative prominence of a label (or a scene) but is quicker and cheaper than other methods, such as eye tracking, that are currently utilized for this purpose. Copyright © 2010 John Wiley & Sons, Ltd.

The ease with which a container can be accessed or its ‘openability’ is becoming more of an issue for manufacturers and consumers as the average age of the population increases. Ageing brings with it a range of issues including a loss of strength and reduced dexterity. This paper aimed to look at the relationship between diameter, torque and age for standard consumer closures using a torque-measuring device. The results of the investigation show that larger-diameter jars (85 mm) require much higher opening forces than smaller ones (75 mm and below). Smaller jars require lower opening torques, although the force required to open many jars is still higher than many elderly people are able to generate.

Large classes present many challenges in higher education. New digital technologies, such as interactive student response systems (SRSs), are promising tools for large classes. SRSs facilitate interaction between faculty members and students on an on-going basis by allowing instructors to ask multiple-choice, true/false and numerical questions during class and then analyse and display the student responses in real time. In general, SRSs consist of three basic components: a student input device (clicker), operating system software loaded onto the classroom computer, and an overhead projection system to display the questions asked and the distribution of student responses. SRSs have already been used in classrooms in a variety of fields; however, to our knowledge, they have not been used previously in packaging education. This article describes the introduction of an SRS in two packaging classes at the School of Packaging at Michigan State University. The SRS implementation is discussed and faculty and student comments and responses regarding the SRS are reported. The system motivated student participation and attendance for both classes: 75% of student respondents stated that the SRS motivated them to attend class; 57% of student respondents reported that the SRS enhanced their classroom experience; and 56% of the student respondents indicated that the system helped them to comprehend the material better. These numbers are supported by the vast majority of research studies, which indicate improved attendance, participation and comprehension when using SRSs for large classrooms. Copyright © 2006 John Wiley & Sons, Ltd.

Package integrity is of paramount importance to the medical device industry. As healthcare costs soar and integrity testers become more and more sensitive, concern with the question ‘what hole size allows microbial penetration into device packages?’ is re-ignited. However, producing a consistent and measurable defect in the microcosm presents challenges. Varying techniques are currently employed to produce these defects. Use of an excimer laser is one of the most precise and accurate techniques, and holes ‘certified’ to be a given size can be purchased at a significant cost. To verify the accuracy and precision of holes drilled with an excimer laser, researchers measured laser-drilled ‘exit’ and ‘entry’ holes in glycol-modified polyetheylene terephthalate (PETG) trays using scanning electron microscopy (SEM) and confocal microscopy. This data and the certification data provided by the laser driller were analysed using a mixed-model analysis of variance (ANOVA). Both the effect of measuring technique and hole side (entry vs. exit) were found to be significant. These significant differences have the potential to impact the question that the industry faces with regard to penetration threshold. This suggests that a shift in thinking is needed. Perhaps it would be better if the industry stops thinking about hole size and begins to think in terms of what researchers have referred to as the ‘effective hole’, which is defined as the volume of gas that will flow through a hole of defined size per unit time. Copyright © 2005 John Wiley & Sons, Ltd.

This study investigates the coverage of federally mandated information on over-the-counter (OTC) drug labels by electronic article surveillance (EAS) tags applied to the exterior of cartons. Using adult-strength analgesics containing acetaminophen as a case study, researchers investigated the issue in Houston, Texas (24 stores) and Lansing, Michigan (33 stores). The information obscured by EAS tags was identified and classified for a total of 849 packages using a standardized data collection instrument. The results indicated that 293 packages examined, or 34.5%, had information mandated by the US Food and Drug Administration (US FDA) fully or partially obscured by the EAS tags. Retailers and manufacturers should be aware of such practices to reduce potential liability. Recommendations for improving EAS tag usage on OTC products are presented. Copyright © 2004 John Wiley & Sons, Ltd.

The Food and Drug Administration (FDA) has recently attempted to improve the safety of over-the-counter (OTC) drugs by creating a regulation aimed at redesigning their labels. One portion of this regulation attempts to improve the legibility of OTC labels by individually specifying certain elements of their design. The FDA's approach looks at the elements of label design as distinct entities that can be isolated and manipulated to improve legibility. Reality does not match the simplicity of this approach. Legibility is the overall goal in a complex system of interrelated elements that come together to create a message. This research challenges the regulation by using an instrument that measures what is truly important: the legibility of the label.

In 1999 the US Food and Drug Administration published a regulation in an attempt to ensure the legibility of OTC drugs, specifying, among other things, a minimum type size of 6 points. This is problematic because different typefaces of the same size vary widely in type heights and, presumably, legibility. We hypothesized that specifying a minimum x-height, the height of the lowercase x, would produce more consistent legibility than the minimum type size specified within the regulation. Twenty-six subjects viewed two groups of typefaces using the Lockhart Legibility Instrument to quantify legibility. The first group contained typefaces that were all 6 points, but, by nature of their design, varied greatly in their x-heights. The second group was made from the same set of typefaces, but these were manipulated so that their x-heights were equal to the average x-height of group 1. A likelihood ratio test indicated that the group that varied in x-height, group 1, produced significantly more variable results than the group with equal x-heights, group 2. This indicates that specifying a minimum type size may not be the best approach for producing consistent legibility. Copyright © 2003 John Wiley & Sons, Ltd.

Tallman lettering, capitalizing the dissimilar portions of easily confused drug names, is one strategy for reducing medication errors. We assessed the efficacy of Tallman lettering in a visually complex environment using a change detection method with healthcare providers and laypeople. In addition, the effect of familiarity with the drug name was assessed using a subset of responses collected from healthcare providers. Both healthcare providers and laypeople detected changes in confusable pairs of drug names more often (P 0.0001) and more quickly (P 0.05) when changes were presented in Tallman lettering, though the benefits were more pronounced for healthcare providers (p 0.05). Familiarity with both drug names in a confusable pair mitigated the benefit of Tallman lettering. Results are discussed in terms of bottom-up and top-down attentional systems for processing of information in the context of the varied healthcare environments.

Research on the ways older people use prescription medications (Rx) is a mainstay of the gerontological literature because use of Rx medications is common, and appropriate use is central to effective management of chronic disease. But older adults are also major consumers of over-the-counter (OTC) medications, which can be equally significant for self-care. Nearly half of older adults aged 75-85, for example, are regular users of an OTC product. Ensuring that consumers safely and effectively use OTC products is critical in order to minimize potential drug-drug interactions and unintentional misuse. Yet we know surprisingly little about the ways older adults select OTC medications and decide when to start or stop use, how older people actually take these medications, or how involved clinicians and family members are in older adult OTC behavior. Research in this area is critical for developing interventions to help ensure safe and appropriate OTC use. For this reason, The Gerontological Society of America (GSA), in partnership with the Consumer Healthcare Products Association (CHPA), convened a summit of experts to set an agenda for research in OTC behaviors among older adults. The panel suggested a need for research in 5 key areas: Health literacy and OTC behavior, decision making and OTC use, the role of clinicians in OTC medication behavior, older adult OTC behavior and family care, and technologies to promote optimal use of OTC medications.

The human hand has a wide range of possible functional abilities that can change with age, disease, and injury, and can vary from individual to individual and subsequently can affect a person's quality of life. The objective of this work was to develop a theoretical model of the space that is reachable by the hand, weighted to represent three types of functionality, and to compare this model to an experimental data set obtained from a healthy hand population. A theoretical model, termed the Weighted Fingertip Space, was developed using 50th percentile published hand data and ranges of finger motion. The functional abilities calculated in the model were the abilities to position the fingertip pad, orient the fingertip pad, and apply directional forces through the fingertip pad at all the reachable points in space with respect to the palm. Following the development of this theoretical model, experimental data sets from nine individuals with healthy hands were obtained through motion capture techniques. The experimental data were then compared to the theoretical model. Comparisons between a 50th percentile theoretical model and a subject with a similar sized hand showed good agreement in weighting parameters and overall size and shape of the model spaces. The experimental data set from the entire sample, which ranged from the 2nd to 95th percentile hand sizes, showed resultant models that, on average, reached smaller volumes of space, but yielded higher values of the functional measures within those volumes. Additionally, in comparison to the theoretical model, the variability of the experimental models showed that small changes in hand dimensions and ranges of motion of the finger joints had a large influence in the functional measures of the model. Combined, these results suggest that the modeling technique can calculate functional ability of the hand, but should be used on an individualized basis for evaluating changes in function (e.g., rehabilitation). Further, scaling to hand size has the potential to yield “average” models for larger population samples.

The labeling of over-the-counter (OTC) drugs is critical to their safe and effective use, and certain warnings are meant to be read at the point of purchase (POP). Examples include ( i ) warnings that alert consumers to the fact that the package is not child-resistant and ( ii ) warnings that alert consumers to potential product tampering. U.S. law mandates these warnings be “conspicuous” and “prominent” so that it is likely that consumers will read them before leaving the store. Our objective was to quantify the relative prominence and conspicuousness of these warnings. Sixty-one participants reviewed the packages of 5 commercially available analgesics to evaluate the prominence and conspicuousness of these warnings. Evaluated data included ( i ) the time spent examining the warnings compared with other areas of the label (using a bright pupil eye tracker), ( ii ) the ability to recall information from the OTCs viewed, and ( iii ) the legibility of the warnings relative to other elements of the labels (as measured by ASTM D7298-06). Eye-tracking data indicated that warnings were viewed by fewer participants and for less time than other elements of the packages. Recall and legibility data also indicated that the warning statements compared unfavorably with other elements of the labels tested. Evidence presented in this study suggests that 2 required warnings on 5 different OTCs are not prominent or conspicuous when compared with other elements of tested labels.

The research theorizes that there are three styles of hand movement when removing a lug closure from a glass jar; lid hand movement alone, jar hand movement alone, or the movement of both hands. However, it is hypothesized that experimental set up will significantly impact how participants move as they remove jar lids; that an unrestrained subject will move differently from one restrained for ease of experimental set up. Each study participant will open glass jars with lug style closures in two fashions: restrained, so that the test jar remains on the table, and unrestrained.

It is critical that packages containing sterile medical devices maintain a sterile barrier until the device is used. In 1995, a study conducted by the Health Industry Manufacturers Association (HIMA) compared a whole-package microbial challenge test to physical integrity testing [1]; published results indicated the superiority of physical tests. This paper discusses the problems with the classic approach to whole-package microbial challenge, outlines a new whole-package microbial challenge test, and details the work done to begin to illustrate its effectiveness. The project aim is the creation of a new methodology for microbial challenge testing of medical device packages that reduces the chance of false positives that were commonly observed with the previous technique. The proposed method involves aseptically filling sterile, sealed packages with growth media, challenging them with microbes, incubating the package, and then conducting colony counts to determine package contamination. Results suggest that the proposed technique does not have the false positives that were associated with historical microbial challenge testing. False positives are a serious problem, as they indicate that a package has not maintained its sterile barrier when, indeed, it has. This can lead manufacturers to false assumptions about production and the package, potentially resulting in increased costs for healthcare providers and patients. Research presented here represents the first step in creating a standardized methodology for whole-package microbial challenge testing. Currently, such a test does not exist. While there are numerous physical integrity tests that a manufacturer of medical devices can employ to verify the integrity of packages before release to the market, a need exists for a standardized whole-package microbial challenge test that overcomes the difficulties associated with those of the past.