Search

Objective: To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population., Design: Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model., Findings: In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures., Conclusions: Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To prevent tobacco use in Korea, the national quitline number was added to tobacco packages in December 2012, tobacco prices were raised by 80% in January 2015, and graphic health warning labels were placed on tobacco packages in December 2016. This study evaluated the association of these tobacco packaging and pricing policies with suicide mortality in Korea., Methods: Monthly mortality from suicide was obtained from Cause-of-Death Statistics in Korea from December 2007 to December 2019. Interrupted time-series analysis was performed using segmented Poisson regression models. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated adjusted for suicide prevention strategies., Results: Suicide mortality was 20 per 1,000,000 in December 2007 and showed a downward trend over the study period. After the implementation of tobacco packaging and pricing policies, suicide mortality immediately declined by - 0.09 percent points (95% CI =  - 0.19 to 0.01; P > 0.05) for the national quitline number, - 0.22 percent points (95% CI =  - 0.35 to - 0.09; P < 0.01) for tobacco prices, and - 0.30 percent points (95% CI =  - 0.49 to - 0.11; P < 0.01) for graphic health warning labels. The corresponding RRs for these post-implementation changes compared with the pre-implementation level were 0.91 (95% CI = 0.83 to 1.00), 0.80 (95% CI = 0.70 to 0.91), and 0.74 (95% CI = 0.61 to 0.90), respectively. Significant associations between tobacco control policies and suicide mortality were observed even when stratified by sex and region., Conclusions: The findings of this study provide new evidence for an association between tobacco control policies and deaths by suicide. An array of effective tobacco control policies should be considered for prevention programs targeting suicide., (© 2024. The Author(s).)

Background: The aim of this study was to estimate the carbon footprint and financial cost of decontaminating (steam sterilization) and packaging reusable surgical instruments, indicating how that burden might be reduced, enabling surgeons to drive action towards net-zero-carbon surgery., Methods: Carbon footprints were estimated using activity data and prospective machine-loading audit data at a typical UK in-hospital sterilization unit, with instruments wrapped individually in flexible pouches, or prepared as sets housed in single-use tray wraps or reusable rigid containers. Modelling was used to determine the impact of alternative machine loading, opening instruments during the operation, streamlining sets, use of alternative energy sources for decontamination, and alternative waste streams., Results: The carbon footprint of decontaminating and packaging instruments was lowest when instruments were part of sets (66-77 g CO2e per instrument), with a two- to three-fold increase when instruments were wrapped individually (189 g CO2e per instrument). Where 10 or fewer instruments were required for the operation, obtaining individually wrapped items was preferable to opening another set. The carbon footprint was determined significantly by machine loading and the number of instruments per machine slot. Carbon and financial costs increased with streamlining sets. High-temperature incineration of waste increased the carbon footprint of single-use packaging by 33-55 per cent, whereas recycling reduced this by 6-10 per cent. The absolute carbon footprint was dependent on the energy source used, but this did not alter the optimal processes to minimize that footprint., Conclusion: Carbon and financial savings can be made by preparing instruments as part of sets, integrating individually wrapped instruments into sets rather than streamlining them, efficient machine loading, and using low-carbon energy sources alongside recycling., (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.)

Introduction: The burden of disease attributable to tobacco use in Latin America is very high. Our objective was to evaluate the 10-year potential impact of current legislation related to cigarette packaging and warnings and expected effects of moving to a higher level of strategies implementing cigarette plain packaging on health and cost outcomes in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, using a microsimulation model., Aims and Methods: We used a probabilistic state-transition microsimulation model, considering natural history, costs, and quality of life losses associated with main tobacco-related diseases. We followed up individuals in hypothetical cohorts and calculated health outcomes annually to obtain aggregated long-term population health outcomes and costs. We performed a literature review to estimate effects and analyzed studies and information from ministries, relevant organizations, and national surveys. We calibrated the model comparing the predicted disease-specific mortality rates with local statistics., Results: Current graphic warnings already in place in each country could avert, during 10 years, 69 369 deaths and 638 295 disease events, adding 1.2 million years of healthy life and saving USD 5.3 billion in the seven countries. If these countries implemented plain packaging strategies, additional 155 857 premature deaths and 4 133 858 events could be averted, adding 4.1 million healthy years of life and saving USD 13.6 billion in direct health care expenses of diseases attributable to smoking., Conclusions: Latin American countries should not delay the implementation of this strategy that will alleviate part of the enormous health and financial burden that tobacco poses on their economies and health care systems., Implications: Tobacco smoking is the single most preventable and premature mortality cause in the world. The Framework Convention on Tobacco Control, supported by the World Health Organization, introduced a package of evidence-based measures for tobacco control. This study adds evidence on the potential health effects and savings of implementing cigarette plain packaging in countries representing almost 80% of the Latin American population; findings are valuable resources for policy makers in the region., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: In 2009, New York City (NYC) restricted the sale of flavoured tobacco products. We assessed product availability as a proxy for potential non-compliance by analysing discarded cigar, cigarillo and blunt wrap packages in New York City., Methods: A discarded cigar package survey was conducted in 2016, in a stratified random sample of 94 block groups in NYC resulting in the collection of 886 discarded cigar packages. Each package was coded for brand name, flavour description (explicit and implicit) and size., Findings: Overall, 19.2% of the cigar packages were explicitly flavoured. An additional 9.4% of the packages reflected implicit flavours. Explicit flavoured cigar packages were at increased odds of being found in Staten Island (adjusted OR (AOR)=3.96, 95% CI=1.66 to 9.46), in packaging size of two or three (AOR=8.49, 95% CI=4.24 to 17.02) or four or more (AOR=4.26, 95% CI=1.95 to 9.30)., Conclusion: Nearly one out of three cigar packages were flavoured products suggesting a problematic level of non-compliance and continued availability. Potential non-compliance is likely fueled by licensed wholesalers and retailers who continue to sell restricted flavoured products. Some retailers may be unaware that implicitly named cigars are typically flavoured and are, therefore, illegal. This lack of awareness of implicit flavoured cigars may be exacerbated by NYC's lack of education or enforcement specific to implicitly flavoured tobacco products., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Plain packaging and minimum pack size legislation for tobacco products was introduced in the UK in May 2016, with a 1-year sell-off period until May 2017, during which both fully branded and plain packs of various sizes were legally available. This study investigates trends in prices of roll-your-own tobacco (RYO) before, during and after implementation of this legislation, and compares trends with those observed in the cigarette market., Methods: We used Nielsen Scantrack data for the period from March 2013 to June 2018 to describe trends in UK inflation-adjusted prices and volumes of both RYO and cigarettes, and linear regression to estimate changes in prices associated with the introduction of plain packaging and the minimum pack sizes of 30 g RYO and 20 cigarettes., Results: In contrast to a downward trend in cigarette sales volumes, RYO volumes rose throughout the study period. By the time plain packs accounted for 75% or more of sales, the average price of products sold in equivalent pack sizes had increased, relative to average prices in the year before implementation and with adjustment for tax changes, from 34.9 to 38.8 pence per gram for RYO (mean difference 4.26, 95% CI 3.99 to 4.53 pence, 12% increase), and from 38.6 to 41.13 pence for cigarettes (mean difference 2.53, 95% CI 2.24 to 2.83 pence, 7% increase) per cigarette., Conclusions: New legislation resulted in higher prices for RYO and manufactured cigarettes. However, sales volumes of RYO continued to increase throughout the study period, perhaps because RYO remains a less expensive means of smoking tobacco., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: Standardised packaging for factory made (FM) and roll your own (RYO) tobacco was fully implemented in the UK in May 2017. Around the same time, several changes to the tax system were applied (a Minimum Excise Tax (MET) for FM products and tax increases weighted towards RYO products). The tobacco industry claims that standardised packaging will lower prices (a disincentive for quitting) by commoditising the product, yet had itself taken advantage of the previous tax regime to achieve large profits from premium brands while also keeping some products' prices relatively low. Here we evaluate the impact of standardised packaging, the MET and the RYO focussed tax changes on price and industry profitability., Methods and Findings: Nielsen electronic point of sale (EPOS) data (May 2015 to April 2018) were used to calculate real (inflation adjusted) monthly price per stick overall, by cigarette type (FM and RYO) and by seven market segments. Trend estimation, using additive mixed models, assessed weighted average price (weighted by volume of sales) and tobacco industry net revenue changes. The beginning and end of the data series were compared in terms of: (a) average monthly price growth, (b) average monthly net revenue growth, and (c) undershifting and overshifting patterns after tax changes. FM and RYO real prices changed little over the 3-year period-overall prices rose by about 1p per stick. There was no evidence of commoditisation with prices of all FM segments (but not RYO) rising faster after the implementation of standardised packaging than immediately beforehand. The prices of the cheapest FM brands rose with the implementation of the MET. RYO price increases did not close the gap to FM pricing levels despite RYO focussed tax increases. Tax changes following the implementation of standardised packaging and the MET were more widely and quickly passed on to smokers in the form of higher prices than the tax change pre-implementation. The main limitations are first that because we do not know the exact mechanism by which Nielsen scales up sample data to provide UK estimates, we could only use data for a set three year period during which the same adjustments are made. Second, the tax and standardised packaging events were sometimes too close in time to separate their consequences statistically. Third, tobacco prices may also be affected by external factors such as changes in smokers' disposable income or availability of electronic nicotine delivery systems., Conclusions: There was no long-term lowering of tobacco prices after the implementation of standardised packaging as predicted by the industry. The introduction of the MET was successful in increasing the price of the cheapest FM cigarettes and narrowing the price gap between FM brands. The RYO tax increases were, however, insufficient to narrow the price gap between RYO and FM. Overall, undershifting became less extensive indicating that tobacco industry manipulation of the tax system which had previously kept cheap products available had declined. This suggests that standardised packaging and a MET will likely contribute to further declines in UK tobacco use., Competing Interests: The authors have declared that no competing interests exist.

Background: Small/kiddie cigarette packs consist of less than 20 cigarette sticks. Kiddie packs were recently proposed to be reintroduced by the tobacco industry with an excuse to prevent consumers from buying illicit cigarettes. By reintroducing kiddie packs, cigarettes will inevitably be more affordable and this would appeal to lower-income consumers especially teens. In this systematic review, we aimed to identify the impact of kiddie packs on smoking, specifically on smoking initiation, the urge/tendency to buy cigarettes and attempts to reduce cigarette consumption., Methods: This systematic review will be based on the review of original articles on the impact of kiddie packs on smoking. There is no restriction on the publication dates. The Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Web of Science and Scopus will be searched to retrieve potential original articles. Additional records identified through other sources: Google Scholar, as well as Journal of Substance Use and Tobacco Control, are also to be searched. These will include original articles in any language which included all study designs (randomised controlled trials, quasi experimental and experimental studies, observational cross-sectional and cohort studies) comparing kiddie packs with regular cigarette packs. The primary outcomes of interest will be initiation of smoking and urge/tendency to buy cigarettes in the general population and attempts to reduce cigarette consumption among current smokers. Secondary outcomes will be the prevalence of smoking using kiddie packs among the current smokers., Discussion: This systematic review will provide evidence to support the impact of kiddie packs on smoking in terms of smoking initiation, smoking prevalence, urge/tendency to purchase cigarettes and attempts to reduce cigarette consumption. The findings from this review could be helpful to policymakers in regulating kiddie packs to control the consumption of tobacco., Systematic Review Registration: PROSPERO CRD42018102325.

Objective: Despite claims by tobacco companies that plain packaging would lead to lower cigarette prices, recommended and observed real cigarette prices in Australia rose in the 9-11 months after plain packaging was introduced. However, little is known about trends in prices longer term. In this report, we assess whether inflation (Consumer Price Index; CPI) and tax adjusted ('CPI-tax-adjusted') prices of the market-leading Australian cigarette brand changed in the 3-year period after plain packaging, and whether price changes were associated with retailer characteristics., Method: Cigarette prices were ascertained from a panel of tobacco retailers at three time points: (1) in November 2012 (n=857) (before full implementation of plain packaging, compulsory in retail outlets from December 2012), (2) between October 2014 and February 2015 (n=789) and (3) between November 2015 and March 2016 (n=579). Generalised estimating equations were used to estimate percentage change in mean CPI/tax-adjusted cigarette prices over time., Results: CPI/tax-adjusted adjusted mean stick prices rose by 13.7% (95% CI 13.0 to 16.0) and 15.2% (95% CI 14.3 to 16.0) at 2.1 and 3.1 years after plain packaging was introduced, respectively. Increases in mean CPI/tax-adjusted stick prices varied by outlet type (p<0.001), socioeconomic status (p=0.013) and remoteness of retailer's area (p=0.028) and whether twin packs were sold (p=0.009)., Conclusions: Contrary to tobacco company predictions of a fall in prices, the price of the market-leading Australian cigarette brand increased significantly in the 3 years after plain packaging was introduced, and these increases were above the combined effects of inflation and increases in excise/customs duty., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Background: There are no independent studies measuring the availability of premium brand counterfeit cigarettes in New York City from licensed retailers., Methods: We forensically analyzed the cigarette packaging of Marlboro Gold (n = 1021) purchased from licensed tobacco retailers in New York City, using ultraviolet irradiation and light microscopy to determine whether they were counterfeit., Results: We find that while only 0.5% (n = 5) of our sample exhibits at least one characteristic synonymous with counterfeit packaging, none of our packs can be conclusively classified as counterfeit., Conclusions: We do not find any counterfeit Marlboro Gold packs purchased at full price from licensed cigarette retailers throughout New York City. Future research using test purchases should include other venues (eg, street and online) and specifically ask for discounts to ascertain the overall presence of counterfeit cigarettes., Implications: This is the first study to independently measure the availability of counterfeit cigarette packs purchased at full price from licensed retailers in New York City. We find that none of the Marlboro Gold packs purchased from licensed cigarette retailers are counterfeit., (© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Pallet is a very important innovation in logistics industry. Pallets are so widely used that we can find them in nearly every logistical operation scenario. In order to manage pallets efficiently, researchers have developed several pallet management strategies (PMS). The most common and widely accepted PMS includes extensive management of pallets (EMP), transfer of pallet's ownership (TPO), and pallet rent (PR). This paper addresses mainly on how to help pallet managers choose a certain kind of PMS from the perspective of supply chain cost. Firstly, cost models of three kinds of PMS are presented. Secondly, all parameters involved in the models are valued based on data that is collected from industry survey. The results show that the cost of PR is constantly lower than EMP, and also lower than TPO when the operation period is no more than 37 months. Finally, the effect of several important parameters on the cost is studied by sensitivity analysis. The selection strategies of PMS are proposed based on the results., Competing Interests: One or more of the authors are employed by a commercial company: Inner Mongolia Branch of Agricultural Bank of China (Chunhua Chen). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Competing Interests: Competing interests: TD is an Associate Editor of Tobacco Control with respect to Product Marketing and Promotion. He has served as an expert witness in tobacco litigation including for the governments of Alberta and Nova Scotia in Canada whose policies regarding the retail display and promotion of tobacco products were challenged on constitutional grounds.

This study was conducted using a hedonic pricing model to evaluate consumer preference for packaging and contents in five Asian countries: Japan, Indonesia, Singapore, Taiwan, and China. Results revealed that the marginal rate of substitution (MRS) of packaging for contents differs significantly among countries: 17.7 for Singapore, 8.58 for China, 2.71 for Taiwan, 1.65 for Japan and not significant for Indonesia. Share of Willingness-to-pay (WTP) for packaging accounted for 52.8% of the WTP for sales unit of a representative product in Japan and 46.2% in Taiwan, which were significantly higher than the results for Singapore (32.6%) and China (18.2%). Results showed that the higher the share of packaging in the WTP for a product, the higher the relative packaging weight per unit weight of contents. These results suggest that the relative demand for packaging to contents differs among countries. The results underscore the necessity of choosing suitable policy instruments and marketing strategies for different countries., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This study investigated how information, typically presented on wine back-labels or wine company websites, influences consumers' expected liking, informed liking, wine-evoked emotions and willingness to pay for Australian white wines. Regular white wine consumers (n=126) evaluated the same set of three commercially available white wines (mono-varietal Chardonnay, Riesling, Sauvignon Blanc) under three information levels. Session 1, blind tasting (no information provided) and Session 2, informed tasting (held at least 1week later) with both basic (sensory description of the wines) and elaborate (sensory plus high wine quality and favourable winery information) descriptions followed by liking, wine-evoked emotions (measured with the Australian Wine Evoked Emotions Lexicon (AWEEL)) and willingness to pay evaluations. Before tasting the wine in session 2, consumers also rated expected liking. Results showed that information level had a significant effect on all investigated variables. The elaborate information level evoked higher expectations before tasting the wines, plus resulted in higher liking ratings, elicitation of more intense positive (e.g. contented, happy and warm-hearted) and less intense negative emotions (e.g. embarrassed and unfulfilled), and a substantial increase in willingness to pay after tasting the wines compared to the blind condition, with the basic condition ranging in-between. These results were consistent across the three wine samples. Furthermore, if the liking rating after tasting the wines matched the expected liking or exceeded the expectations by 1 point on a 9-point hedonic scale, participants felt the most intense positive emotions and the least intense negative emotions. Whereas, if the expectations were not met or the actual liking exceeded the expectations by >2 points, participants felt less intense positive and more intense negative emotions. This highlights not only the importance of well written and accurate wine descriptions, but also that information can influence consumers' wine drinking experience and behaviour., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Nanomanufacturing-the fabrication of macroscopic products from well-defined nanoscale building blocks-in a truly scalable and versatile manner is still far from our current reality. Here, we describe the barriers to large-scale nanomanufacturing and identify routes to overcome them. We argue for nanomanufacturing systems consisting of an iterative sequence of synthesis/assembly and separation/sorting unit operations, analogous to those used in chemicals manufacturing. In addition to performance and economic considerations, phenomena unique to the nanoscale must guide the design of each unit operation and the overall process flow. We identify and discuss four key nanomanufacturing process design needs: (a) appropriately selected process break points, (b) synthesis techniques appropriate for large-scale manufacturing,, ((c) new structure- and property-based separations, and (d) advances in stabilization and packaging.)

An understanding of the environmental impacts and costs related to waste collection is needed to ensure that existing waste collection schemes are the most appropriate with regard to both environment and cost. This paper is Part II of a three-part study of a mixed packaging waste collection system (curbside plus bring collection). Here, the mixed collection system is compared to an exclusive curbside system and an exclusive bring system. The scenarios were assessed using life cycle assessment and an assessment of costs to the waste management company. The analysis focuses on the collection itself so as to be relevant to waste managers and decision-makers who are involved only in this step of the packaging life cycle. The results show that the bring system has lower environmental impacts and lower economic costs, and is capable of reducing the environmental impacts of the mixed system. However, a sensitivity analysis shows that these results could differ if the curbside collection were to be optimized. From economic and environmental perspectives, the mixed system has few advantages., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Transnational tobacco companies (TTCs) submitted evidence to the 2012 UK Consultation on standardised packaging (SP) to argue the policy will have detrimental economic impacts and increase illicit tobacco trade., Methods: A content analysis of the four TTC submissions to the consultation assessed the relevance and quality of evidence TTCs cited to support their arguments. Investigative research was used to determine whether the cited evidence was industry connected. Fisher's exact tests were used to compare the relevance and quality of industry-connected and independent from the industry evidence. The extent to which TTCs disclosed financial conflicts of interest (COI) when citing evidence was examined., Results: We obtained 74 pieces of TTC-cited evidence. The quality of the evidence was poor. TTCs cited no independent, peer-reviewed evidence that supported their arguments. Nearly half of the evidence was industry-connected (47%, 35/74). None of this industry-connected evidence was published in peer-reviewed journals (0/35) and 66% (23/35) of it was opinion only. Industry-connected evidence was of significantly poorer quality than independent evidence (p<0.001). COIs were not disclosed by TTCs in 91% (32/35) of cases., Conclusions: In the absence of peer-reviewed research to support their arguments, TTCs relied on evidence they commissioned and the opinions of TTC-connected third-parties. Such connections were not disclosed by TTCs when citing this evidence and were time consuming to uncover. In line with Article 5.3 of the Framework Convention on Tobacco Control and broader transparency initiatives, TTCs should be required to disclose their funding of all third-parties and any COIs when citing evidence., (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.)

Introduction: Studies have highlighted the advantages and disadvantages of woven and non-woven fabrics. The present study assessed the change in resterilisation proportion after introduction of non-woven fabric for packaging of instruments and to evaluate the cost-effectiveness of non-woven fabrics compared with woven fabrics., Materials and Methods: The present study is a secondary data analysis of resterilisation data collected from November 2009 to August 2013. We calculated the proportions (and their 95% confidence intervals) of resterilisation done every month. The proportion over time was compared using a Chi-square test for trend. We used linear regression analysis to adjust for the number of surgeries performed every month. We also compared the cost of woven and non-woven fabrics., Results: Of the total 117,335 surgical packets prepared during the study period, 1900 were resterilised; thus, the overall proportion was 1.62% (95% CI: 1.55% to 1.69%). The resterilisation proportion was 8.95% (95% CI: 7.73% to 10.17%) in November 2009 and was 0.38% (95% CI: 0.16% to 0.62%) in August 2013 (P < 0.001). After adjusting for the total number of surgeries conducted every month, we found that the number of packets resterilised reduced every month (per month reduction: -1.97, 95% CI: -2.76 to -1.18). The total cost (initial preparation and resterilisation) for 100 units of woven fabric is INR 6359.41 per month (confidence limit estimates: 6228.20 to 6430.62) and for non-woven fabric was INR 6208.50 (confidence limit estimate: INR 6194.90 to 6223.35) (P < 0.01)., Conclusions: The introduction of non-woven spunbond-meltblown-spunbond fabrics did reduce the proportion of resterilisation of packaged instruments. The decline was sharp and sustained over time, even after accounting for the change in the number of procedures. Furthermore, though the switch from woven to non-woven fabric was cost-effective in our situation, it may not be directly translated to other scenarios.

Objective: We aimed to assess change in the availability of illicit tobacco in small mixed business retail outlets following the December 2012 introduction of plain packaging in Australia., Methods: 303 small retail outlets were visited in June and September 2012 (baseline months), and in December 2012 and February, April and July 2013. Fieldworkers requested a particular low-cost brand of cigarettes and then pressed the retailer for an 'even cheaper' brand. The cheapest pack of cigarettes offered was purchased and later examined to assess any divergence from prescribed Australian packaging regulations. The price paid was compared with tax liability and recommended retail price for the particular brand and pack size. In a sub-set of 179 stores, fieldworkers then asked the retailer about availability of unbranded (chop-chop) tobacco., Results: Thirteen (2.2%) of 598 packs purchased pre-plain packaging were either non-compliant with Australian health warnings and/or suspiciously priced. Four packs (1.3%) of 297 met either or both criteria in the December implementation month, and five (0.6%) of 878 did so in the three collection months following implementation. Chop-chop was offered upon enquiry on 0.6% (n=2) of 338 occasions prior to implementation, 0.6% (n=1) of 170 occasions in the December 2012 implementation month, and 0.6% (n=3) of 514 occasions postimplementation. The likelihood of a 'positive' response (either an offer to sell or information about where unbranded tobacco may be purchased) did not differ across preimplementation, during-implementation and postimplementation waves., Conclusions: Overall, packs judged likely to be illicit were sold in response to requests for cheapest available packs on fewer than one percent of occasions. Offers to sell unbranded tobacco were rare. No change in availability of illicit tobacco was observed following implementation of plain packaging., (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.)

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.

Background: Trends in orthopaedic surgery have seen a migration towards using individually packaged screws (IPS). The manufacturers claim IPS improves sterility, traceability, and avoids the effects of repeated sterilisation. In recent times there has been increasing pressure on the NHS to be more cost-efficient. Challenging decisions must be made to make cost-efficient choices without comprising the quality of care provided., Aim: This study investigates the cost-benefit of IPS compared to the conventional screw rack stored screws (SRSS)., Methods: A single-centred observational study was carried out in a district general hospital between February and March 2013. One-hundred and forty-seven screws were requested intra-operatively and the screw acquisition time was measured with a digital handheld timer. Screw acquisition time was defined as the time taken from the initial verbal request to when the screw was mounted ready for use. The screws were categorised into two groups: SRSS and IPS., Results: The mean screw acquisition time for the SRSS group (n = 94) was 6.6 s (S.D ± 2.5). The mean screw acquisition time for the IPS group (n = 53) was 102.1 s (S.D ± 25.7). The mean difference between SRSS and IPS was 96 s (95%CI 90.3-100.8; p < 0.001)., Conclusion: Our study suggests that the use of IPS significantly (p < 0.001) increases the operation duration and costs compared to SRSS. Based on ankle ORIF procedures alone, the use of IPS could potentially increase department spending by approximately £76,680 per year., (Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

This paper describes and examines the schemes established in five EU countries for the recycling of packaging waste. The changes in packaging waste management were mainly implemented since the Directive 94/62/EC on packaging and packaging waste entered into force. The analysis of the five systems allowed the authors to identify very different approaches to cope with the same problem: meet the recovery and recycling targets imposed by EU law. Packaging waste is a responsibility of the industry. However, local governments are generally in charge of waste management, particularly in countries with Green Dot schemes or similar extended producer responsibility systems. This leads to the need of establishing a system of financial transfers between the industry and the local governments (particularly regarding the extra costs involved with selective collection and sorting). Using the same methodological approach, the authors also compare the costs and benefits of recycling from the perspective of local public authorities for France, Portugal and Romania. Since the purpose of the current paper is to take note of who is paying for the incremental costs of recycling and whether the industry (i.e. the consumer) is paying for the net financial costs of packaging waste management, environmental impacts are not included in the analysis. The work carried out in this paper highlights some aspects that are prone to be improved and raises several questions that will require further research. In the three countries analyzed more closely in this paper the industry is not paying the net financial cost of packaging waste management. In fact, if the savings attained by diverting packaging waste from other treatment (e.g. landfilling) and the public subsidies to the investment on the "recycling system" are not considered, it seems that the industry should increase the financial support to local authorities (by 125% in France, 50% in Portugal and 170% in Romania). However, in France and Portugal the industry is paying local authorities more than just the incremental costs of recycling (full costs of selective collection and sorting minus the avoided costs). To provide a more definitive judgment on the fairness of the systems it will be necessary to assess the cost efficiency of waste management operators (and judge whether operators are claiming costs or eliciting "prices")., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: We aimed to assess change in cigarette pack retrieval time in small retail outlets following the introduction of plain packaging in Australia in 1 December 2012., Methods: A sample of 303 milk bars, convenience stores, petrol stations and newsagents was selected in four capital cities, stratified by area socioeconomic status. In June and September (baseline months), the first 2 weeks of December 2012, and February 2013, stores were visited by trained fieldworkers who requested a cigarette pack of a pre-determined brand, variant and pack size, unobtrusively recording the time from the end of the request to when the pack was scanned or placed on the counter., Results: In multivariate analysis, December retrieval time (12.43 s) did not differ from June (10.91 s; p=0.410) or February (10.37 s; p=0.382), but was slower than September (9.84 s; p=0.024). In December, retrieval time declined as days after plain packaging implementation increased (β=-0.21, p=0.011), returning to the baseline range by the second week of implementation. This pattern was not observed in baseline months or in February. Sensitivity analyses showed that results were robust to the variability in purchasing circumstances in tobacco retail outlets., Conclusions: Retailers quickly gained experience with the new plain packaging legislation, evidenced by retrieval time having returned to the baseline range by the second week of implementation and remaining so several months later. The long retrieval times predicted by tobacco industry-funded retailer groups and the consequent costs they predicted would fall upon small retailers from plain packaging are unlikely to eventuate.

Fresh-cut iceberg lettuce inoculated with Escherichia coli O157:H7 was submitted to chlorine washing (150 mg/mL) and modified atmosphere packaging on laboratory scale. Populations of E. coli O157:H7 were assessed in fresh-cut lettuce stored at 4, 8, 13 and 16 °C using 6-8 replicates in each analysis point in order to capture experimental variability. The pathogen was able to grow at temperatures ≥8 °C, although at low temperatures, growth data presented a high variability between replicates. Indeed, at 8 °C after 15 days, some replicates did not show growth while other replicates did present an increase. A growth primary model was fitted to the raw growth data to estimate lag time and maximum growth rate. The prediction and confidence bands for the fitted growth models were estimated based on Monte-Carlo method. The estimated maximum growth rates (log cfu/day) corresponded to 0.14 (95% CI: 0.06-0.31), 0.55 (95% CI: 0.17-1.20) and 1.43 (95% CI: 0.82-2.15) for 8, 13 and 16 °C, respectively. A square-root secondary model was satisfactorily derived from the estimated growth rates (R(2) > 0.80; Bf = 0.97; Af = 1.46). Predictive models and data obtained in this study are intended to improve quantitative risk assessment studies for E. coli O157:H7 in leafy green products., (Copyright © 2012. Published by Elsevier Ltd.)

Plain (unbranded) packaging for cigarettes is at the top of the tobacco control agenda in both Australia and Europe. The evidence suggests that it will benefit public health by decreasing the appeal of tobacco products and increasing the power of the health warning. The tobacco industry instead argues that plain packaging would make it easier to counterfeit cigarettes, which would both confuse consumers and reduce price; thereby increasing consumption. Using focus group research we examined young adult smokers (N = 54) perceptions of, and ability to recognize, illicit tobacco and the possible impact of plain packaging on illicit tobacco purchasing behaviour. We found that the pack has no impact on the decision to buy illicit tobacco. Smokers were easily able to identify counterfeit cigarettes, not least by the pack, and buy it knowingly and in the full expectation that it will be inferior in quality. Illicit tobacco purchase, including that for counterfeit tobacco, was instead driven by availability and price. Given the extremely low manufacturing cost, per pack, of certain types of illicit cigarettes, it is difficult to envisage how plain packaging would alter the price of illicit tobacco in any meaningful way. The findings therefore suggest that a move to plain packaging would have no impact on young adult smokers' purchase behaviour.

This article discusses the intersection of science and culture in the marketplace and explores the ways in which radium quack and medicinal products were packaged and labelled in the early twentieth century US. Although there is an interesting growing body of literature by art historians on package design, historians of science and medicine have paid little to no attention to the ways scientific and medical objects that were turned into commodities were packaged and commercialized. Thinking about packages not as mere containers but as multifunctional tools adds to historical accounts of science as a sociocultural enterprise and reminds us that science has always been part of consumer culture. This paper suggests that far from being receptacles that preserve their content and facilitate their transportation, bottles and boxes that contained radium products functioned as commercial and epistemic devices. It was the 1906 Pure Food and Drug Act that enforced such functions. Packages worked as commercial devices in the sense that they were used to boost sales. In addition, 'epistemic' points to the fact that the package is an artefact that ascribes meaning to and shapes its content while at the same time working as a device for distinguishing between patent and orthodox medicines.

To improve and maintain medical safety and quality, it is necessary to construct and manage a safe and economical medical system. Almost five years have passed since single-pack dental hygienic materials were introduced into daily clinical practice in the University Hospital, Faculty of Dentistry, Tokyo Medical and Dental University. The costs of purchasing hygienic materials themselves are higher when using outsourced sterilized single packed ones, compared with when using intra-murally sterilized ones in the past. Proper usage of single-pack hygienic materials sterilized with Ethylene Oxide Gas (EOG) would reduce waste of unused materials and save labor for staff in the Section of Central Supplies. Financially, the use of hygienic materials could be reduced if single-pack dental hygienic materials by outsourcing were introduced into the hospital, because all costs for sterilizing hygienic materials in the hospital could be eliminated.

A cost-effective, miniaturized and biocompatible packaging method for medical devices is proposed, resulting in a small, soft and comfortable implantable package. Towards this end, the barrier materials and fabrication process for the individual die encapsulation are largely explored. We demonstrate that various common clean room materials are good candidates for preventing metal leaching into body. In accelerated tests at higher temperature, several conductive barrier materials are damaged by the test bio-fluid, suggesting insufficient resistance to body fluids in long term. Covering electrodes by noble metals will solve this problem. For metallization, noble metals as Pt are best candidates. CoO calculations showed that selective plating of Pt is more cost-effective than sputtering. To reduce the cost of a sputter process, Pt recycling is very important.

The content of hazardous components in Waste arising from Electrical and Electronic Equipment (WEEE) is a major concern that urges governments and industry to take measures to ensure proper treatment and disposal. Thus, the European Union issued directives to encourage reuse, recycling and other proper forms of recovery of such waste while companies and academics are still studying methods and technologies for optimizing recovery processes. This paper presents an analysis of the logistics process assuring the correct collection, handling, transportation and storing of WEEE. The experience comes from an Italian WEEE treatment plant (TRED Carpi S.r.l.) where a new kind of container has been introduced in order to improve the logistics system. An evaluation framework is described and used in order to compare different system configurations and assess the advantages emerging from adopting proper equipments for WEEE transport and handling.

The Taiwan Environmental Protection Administration (Taiwan EPA) launched a national Extended Producer Responsibility (EPR) system after integrating eight private recycling organizations in 1998. After that, the environmental performance of the EPR system brought a lot of attention to policy makers. Many studies show positive environmental effects of the EPR system in Taiwan. However, there are controversial questions remained, such as whether the performance indicators used are the right choice to estimate the environmental effects of the recycling policy? Can those estimated results really reflect the performance of the system? This paper would therefore like to more accurately evaluate the performance indicators of the EPR system based on data observed over the past decade in Taiwan. In the process of evaluating the performance indicators, we have found that the collection rates for durable goods are often ignored in countries that pursue a zero waste policy. This may affect the actual recycling outcome and resource direction targeted by producers. However, in order for the collection rate to be adopted as a policy indicator, how to estimate the amounts of retired or waste products during a period is critical. In this paper, we estimate the collection rate for electrical and electronic waste by using the survival analysis and ownership data analysis approaches. We also provide a comparison of both approaches and put forward suggestions for directions in the future in solid waste management.

Background: The international trend towards comprehensive bans on tobacco advertising has seen the tobacco industry become increasingly innovative in its approach to marketing. Further fuelling this innovation is the rapid evolution and accessibility of web-based technology. The internet, as a relatively unregulated marketing environment, provides many opportunities for tobacco companies to pursue their promotional ambitions., Methods: In this paper, "open source marketing" is considered as a vehicle that has been appropriated by the tobacco industry, through a case study of efforts to design the packaging for the Camel Signature Blends range of cigarettes. Four sources are used to explore this case study including a marketing literature search, a web-based content search via the Google search engine, interviews with advertising trade informants and an analysis of the Camel brand website., Results: RJ Reynolds (RJR) has proven to be particularly innovative in designing cigarette packaging. RJR engaged with thousands of consumers through their Camel brand website to design four new cigarette flavours and packages. While the Camel Signature Blends packaging designs were subsequently modified for the retail market due to problems arising with their cartoon-like imagery, important lessons arise on how the internet blurs the line between marketing and market research., Conclusions: Open source marketing has the potential to exploit advertising ban loopholes and stretch legal definitions in order to generate positive word of mouth about tobacco products. There are also lessons in the open source marketing movement for more effective tobacco control measures including interactive social marketing campaigns and requiring plain packaging of tobacco products.

This paper uses supermarket scanner data to estimate brand- and packaging-specific own- and cross-price elasticities for beer. We find that brand- and packaging-specific beer sales are highly price elastic. Cross-price elasticity estimates suggest that individuals are more likely to buy a higher-volume package of the same brand of beer than they are to switch brands. Policy simulations suggest that regulation of volume-based price discounts is potentially more effective than a tax increase at reducing beer consumption. Our results suggest that volume-based price discounting induces people to buy larger-volume packages of beer and may lead to an increased overall beer consumption., ((c) 2008 John Wiley & Sons, Ltd.)

Material selection has significant implications on the design and cost of horizontal-form-fill-seal packaging machinery. To avoid excessive costs, machine redesigns and project delays, material selection must be reconciled early in the project and revisited throughout the construction of the machine.

Injuries and the resultant costs of injuries in today's healthcare environment are driving the need for healthcare to adopt measures to improve workplace safety for employees and increase safety for patients. Many imaging departments and facilities have implemented or are implementing safer engineering controls in an attempt to improve workplace safety. Newer options in contrast media packaging can provide alternative options engineered to improve workplace safety, avoiding risks with hidden physical and financial costs.

The tobacco industry has exploited many sophisticated marketing practices. In 1914 in Krakow producer of filters and paper for cigarette wraps published a book devoted to Polish nation history, which was dispensed free among peasants and workers. Advertisements created an association between choosing products from NORIS company and patriotism.

Background: Materials for wrapping sterile items continue to evolve, but evaluation of such products under clinical conditions is rare. The purpose of the current study was to test a new product before introducing it to the hospital's sterilizing processing unit., Methods: Four hundred packs containing 1199 items were prepared. Half were wrapped in linen and Kimguard sterile wrap (Kimberley-Clark Australia Pty, Ltd; Queensland, Australia), and half were wrapped in Kimguard One-Step sterile wrap (Kimberley-Clark). They were stored on shelves in 4 areas in the hospital. Items from the packs were periodically tested in the laboratory to evaluate shelf life. Time of wrapping was measured on a series of 50 packs (25 using each product), wrapped by 1 experienced person. These were unwrapped by an operating room nurse, and, again, the process was timed., Results: Bacteria were cultured from 20 (1.7%) of the 1157 test items. There were no differences on this measure between the 2 products (P = .64). Coagulase-negative Staphylococcus was the most frequent isolate, accounting for 40% of the positive results. The average time taken to wrap the test tray with the double wrap was 56.4 seconds compared with 32.4 seconds with the single wrap (P < or = .000). Unwrapping the single pack (5.02 seconds) was also faster than unwrapping the double-wrap pack (6.92 seconds; P = .000)., Conclusions: Wrapping sterile items using Kimguard one-step sterile wrap carries no greater risk of bacterial contamination than double-wrap methods and may lead to significant cost savings in both labor (time to wrap) and consumables (linen and recycling costs).

The never-ending need to reduce costs and the emergence of new products that are a hybridisation of medical device and pharmaceutical technologies are two major challenges facing today's medical device industry. In both cases device manufacturers may find ready solutions by simply looking beyond their traditional borders.

Background: Frozen blood components are shipped on dry ice. The lower temperature (-70 degrees C in contrast to usual storage at -30 degrees C) and shipping conditions may cause a rent in the storage bag, breaking sterility and rendering the unit useless. The rate of loss can reach 50 to 80 percent. To identify those bags with lower probability of breaking during shipment, the thermal and physical properties of blood storage bags were examined., Study Design and Methods: Blood storage bags were obtained from several manufacturers and were of the following compositions: PVC with citrate, di-2-ethylhexylphthalate (DEHP), or tri-2-ethylhexyl-tri-mellitate (TEHTM) plasticizer; polyolefin (PO); poly(ethylene-co-vinyl acetate) (EVA); or fluorinated polyethylene propylene (FEP). The glass transition temperature (Tg) of each storage bag was determined. Bag thickness and measures of material strength (tensile modulus [MT] and time to achieve 0.5 percent strain [T0.5%]) were evaluated. M(T) and T0.5% measurements were made at 25 and -70 degrees C. Response to applied force at -70 degrees C was measured using an impact testing device and a drop test., Results: The Tg of the bags fell into two groups: 70 to 105 degrees C (PO, FEP) and -50 to -17 degrees C (PVC with plasticizer, EVA). Bag thickness ranged from 0.14 to 0.41 mm. Compared to other materials, the ratios of M(T) and T0.5% for PVC bags were increased (p < or = 0.001) indicating that structural changes for PVC were more pronounced upon cooling from 25 to -70 degrees C. Bags containing EVA were more shock resistant, resulting in the lowest rate of breakage (10% breakage) when compared with PO (60% breakage, p = 0.0573) or PVC (100% breakage, p = 0.0001)., Conclusions: Blood storage bags made of EVA appear better suited for shipping frozen blood components on dry ice and are cost-effective replacements for PVC bags. For the identification of blood storage bags meeting specific storage requirements, physical and thermal analyses of blood storage bags may be useful and remove empiricism from the process.

Balancing cost and performance in packaging is critical. This article outlines techniques to assist in this whilst delivering added value and product differentiation. The techniques include a rigorous statistical process capable of delivering cost reduction and improved quality and a computer modelling process that can save time when validating new packaging options.

Consistent peel strength without fibre tear has been a difficult property to obtain. This article discusses a range of peel options and compares the seals formed between different materials and a new grade of packaging material.