Sustaining the community dispensation strategy of HIV antiretroviral through community participation

Background:The advent and widespread use of antiretroviral therapy(ART)has remarkably changed the paradigm of HIV infection,increasing substantially the lifespan and quality of life of people affected.Accordingly and responding to policy makers and international directives,many strategies were put in place in Cameroon to accelerate ART uptake,including the community dispensation of ART through community-based organizations(CBOs).Main body:In its strategic plan to curb the burden of HIV/AIDS and as part of accelerating and reinforcing the provision of ART to all people living with HIV(PLWH),Cameroon opted for different strategies including the dispensation of ART in the community through well identified and tutored CBOs.Actually,financing of ART in Cameroon is mainly the conjugation of resources from the Government and its technical and financial partners,basically the Global Funds supplemented by supports from the Unitaid initiative which allows PLWH residing in Cameroon to benefit from continuous ART without spending a dime.However,this external funding will end-up by 2020.Therefore,there is urgent need to think of alternative and efficient strategies to sustain the fight against HIV/AIDS in Cameroon,especially the provision of ART to patients through community dispensation.Some studies carried out in sub-Saharan African countries have shown that mutual health insurance seems to be a solution with great potential to improve access to quality care,mobilize the necessary funds,improve efficiency of the health sector,and promote dialogue and democratic governance in the health sector along with social and institutional development of the society.Conclusions:The pooling of associations of PLWH in Cameroon and other countries of sub-Saharan Africa in line with the Bamako Initiative constitutes a promising strategy that would undoubtedly help to offset the withdrawal of funding from external sources,and allow an appropriation of the fight against HIV/AIDS by those concerned at the first place.Nevertheless,other lines of research of financing could be explored in the economic sector.

Microcapillary cell extrusion deposition with picolitre dispensing resolution

Extrusion-based cell deposition has become a prominent technique for expanding bioprinting applications.However,the associated print resolution in the order of nanolitre or above has been a limiting factor.The demand for improving print resolution towards the scale of a single cell has driven the development of precision nozzle extrusion,although the benefits gained remain ambiguous.Here,aided by in situ imaging,we investigated the dynamics of cell organisation through an extrusion-based microcapillary tip with picolitre precision through in-air or immersion deposition.The microcapillary extrusion setup,termed‘Picodis’,was demonstrated by generating droplets of colouring inks immersed in an immiscible medium.Next,using 3T3 fibroblast cells as an experimental model,we demonstrated the deposition of cell suspension,and pre-aggregated cell pellets.Then,the dynamic organisation of cells within the microcapillary tip was described,along with cell ejection and deposition upon exiting the tip opening.The vision-assisted approach revealed that when dispersed in a culture medium,the movements of cells were distinctive based on the flow profiles and were purely driven by laminar fluid flow within a narrow tip.The primary process limitations were cell sedimentation,aggregation and compaction,along with trapped air bubbles.The use of picolitre-level resolution microcapillary extrusion,although it provides some level of control for a small number of cells,does not necessarily offer a reliable method when a specified number of cells are required.Our study provides insights into the process limitations of high-resolution cell ink extrusion,which may be useful for optimising biofabrication processes of cell-laden constructs for biomedical research.

Knowledge,attitude,and practices related to medication errors among nursing professionals:a questionnaire-based study in a tertiary care hospital

Objective:To evaluate the level of understanding(knowledge),beliefs(attitude),and behavior(practice)of staff nurses toward medication errors(MEs).Methods:Self-administered questionnaires were distributed to nursing professionals who had at least 1 year of work experience.Each questionnaire contained 19 items assessing“knowledge,”“attitude,”and“practice”attributes toward MEs.Results:Responses from 47 nursing respondents were included for the final analysis.The mean knowledge score was 3.8±1.1(out of 6);66%and 79%of the respondents had awareness of medication repor ting systems and interventions in preventing MEs,respectively.Lack of adequate knowledge in recognizing MEs(P=0.003),or presuming MEs are not as important enough to be reported(P=0.002),was considered as the major reason for under-repor ting of MEs.Nurses with higher knowledge score were against administration of medication through a different route than that prescribed by the physician(P=0.023),and tried to rectify an ME(P=0.020)and stayed with the patient until an oral medication had been swallowed(P=0.037).Conclusions:The nursing professionals were aware of the ME repor ting system and methods to prevent the occurrence of MEs.They also exhibited a positive attitude and followed optimal practices in controlling MEs.

基督教右派的宗教观及其对布什政府外交的影响

基督教右派的宗教观由意识形态式宗教民族主义和神定时代论前千禧年主义构成,强调政治的宗教化和人类的原罪与无法自救。由于与美国共和党和布什总统本人关系密切,基督教右派的单线的和悲观的宗教观对布什政府的单边主义对外政策的形成和运行有着重要的影响。随着美国历史发展周期的更替,2008年前后将会成为基督教右派宗教观影响下的美国单边主义外交结束的开始。

美国福音派的前千禧年主义解经——以《末世迷踪》系列幻想小说为例

圣经中有很多富于天启色彩的经文,早期解读以寓意解经为主,19世纪以来美国福音派中出现了被称为'前千禧年主义时代论'的新解经方式,它将不同经卷中的经文串联起来,进行高度字面化、预言化的解读,《末世迷踪》系列幻想小说就是这种解经方式的典型代表。本文以《末世迷踪》系列幻想小说为切入点,从圣经中的天启文学传统、早期教父对天启经文的不同解读等方面全方位剖析前千禧年主义时代论,并指出前千禧年主义时代论的问题,以方便读者理解美国特有的圣经文学现象。

ORDER-PICKING OPTIMIZATION FOR AUTOMATED PICKING SYSTEM WITH PARALLEL DISPENSERS

Based on the characteristics of parallel dispensers in automated picking system, an order-picking optimization problem is presented. Firstly, the working principle of parallel dispensers is introduced, which implies the time cost of picking each order is influenced by the order-picking sequence. So the order-picking optimization problem can be classified as a dynamic traveling salesman problem （TSP）. Then a mathematical model of the problem is established and an improved max-min ant system （MMAS） is adopted to solve the model. The improvement includes two aspects. One is that the initial assignment of ants depends on a probabilistic formula instead of a random deployment; the other is that the heuristic factor is expressed by the extra picking time of each order instead of the total. At last, an actual simulation is made on an automated picking system with parallel dispensers. The simulation results proved the optimization value and the validity of improvement on MMAS.

RUN TO RUN CONTROL OF TIME-PRESSURE DISPENSING SYSTEM

In electronics packaging the time-pressure dispensing system is widely usedto squeeze the adhesive fluid in a syringe onto boards or substrates with the pressurized air.However, complexity of the process, which includes the air-fluid coupling and the nonlinearuncertainties, makes it difficult to have a consistent process performance. An integrated dispensingprocess model is first introduced and then its input-output regression relationship is used todesign a run to run control methodology for this process. The controller takes EWMA scheme and itsstability region is given. Experimental results verify the effectiveness of the proposed run to runcontrol method for dispensing process.

Fluid-based Slotting Optimization for Automated Order Picking System with Multiple Dispenser Types

Slotting strategy heavily influences the throughput and operational cost of automated order picking system with multiple dispenser types, which is called the complex automated order picking system （CAOPS）. Existing research either focuses on one aspect of the slotting optimization problem or only considers one part of CAOPS, such as the Low-volume Dispensers, to develop corresponding slotting strategies. In order to provide a comprehensive and systemic approach, a fluid-based slotting strategy is proposed in this paper. The configuration of CAOPS is presented with specific reference to its fast-picking and restocking subsystems. Based on extended fluid model, a nonlinear mathematical programming model is developed to determine the optimal volume allotted to each stock keeping unit （SKU） in a certain mode by minimize the restocking cost of that mode. Conclusion from the allocation model is specified for the storage modules of high-volume dispensers and low-volume dispensers. Optimal allocation of storage resources in the fast-picking area of CAOPS is then discussed with the aim of identifying the optimal space of each picking mode. The SKU assignment problem referring to the total restocking cost of CAOPS is analyzed and a greedy heuristic with low time complexity is developed according to the characteristics of CAOPS. Real life application from the tobacco industry is presented in order to exemplify the proposed slotting strategy and assess the effectiveness of the developed methodology. Entry-item-quantity （EIQ） based experiential solutions and proposed-model-based near-optimal solutions are compared. The comparison results show that the proposed strategy generates a savings of over 18% referring to the total restocking cost over one-year period. The strategy proposed in this paper, which can handle the multiple dispenser types, provides a practical quantitative slotting method for CAOPS and can help picking-system-designers make slotting decisions efficiently and effectively.

Analysis of the application and practice of PDCA cycle in management of the naked medicine dispensing——the quality and safety of the drug

Objective:To explore the application of plan–do–check–action(PDCA)cycle in the management of the naked medicine dispensing about the automatic package and to analyze the practice improved in the quality of naked medicine dispensing medicine management.Methods:The PDCA theory was used to analyze the data,to find out the causes of the problem,and to formulate the corresponding countermeasures to intervene.The data of the naked medicine/adverse drug events satisfaction degree of the inpatients in 18 inpatient departments given for the adoption of PDCA cycle in January 2017 were set as the observation group.The number of the naked medicine/adverse drug events satisfaction degree of patients in 18 inpatient departments before adoption of PDCA cycle in December 2016 was set as the control group.The number of the naked medicine/adverse drug events satisfaction degree of patients in 18 inpatient departments before and after adoption of PDCA cycle was observed and analyzed.Results:The number of the naked medicine/adverse drug events after implementing the method of PDCA cycle management rate was significantly lower than before the implementation method of PDCA cycle management,and the difference had statistical significance(P<0.05).The satisfaction degree of the inpatients after implementing the method of PDCA cycle management rate was significantly higher than that before the implementation method of PDCA cycle management,and the difference had statistical significance(P<0.05).Conclusion:Application of PDCA cycle in the management of the naked medicine dispensing about the automatic package can help to reduce the adverse drug events,to improve the safety of drug treatment,and to increase the patients’satisfaction degree.

Modeling and Control of Time-pressure Dispensing for Semiconductor Manufacturing

To improve the consistency of the adhesive amount dispensed by the time-pressure dispenser for semiconductor manufacturing, a non-Newtonian fluid flow rate model is developed to represent and estimate the adhesive amount dispensed in each cycle. Taking account of gas compressibility, an intelligent model-based control strategy is proposed to compensate the deviation of adhesive amount dispensed from the desired one. Both simulations and experiments show that the dispensing consistency is greatly improved by using the model-based control strategy developed in this paper.

Run by Run Control of Time-pressure Dispensing for Electronics Encapsulation

To alleviate the influence of gas compressibility on the process performance of time-pressure dispensing for electronics encapsulation,a predictive model is developed based on power-law fluid to estimate the encapsulant amount dispensed.Based on the simple and effective model,a run by run (RbR) supervisory control scheme is delivered to compensate the variation resulting from gas volume change in the syringe.Both simulation and experiment have shown that the dispensing consistency has been greatly improved with the model-based RbR control strategy developed in this paper.

An automated dispensing system for improving medication timing in the emergency department

BACKGROUND:Numerous medical conditions require timely medication administration in the emergency department(ED).Automated dispensing systems(ADSs)store premixed common doses at the point-of-care to minimize time to administration,but the use of such automation to improved time to medication administration has not been studied.Since vancomycin is a commonly used empiric antimicrobial,we sought to quantify the effect of using an ADS on time to drug delivery in patients presenting to the ED.The study aimed to determine the efficacy of utilizing an ADS to improve time to administration of vancomycin and determine any negative effects on dosing appropriateness.METHODS:The institional review board approved the retrospective quality improvement study took place in a single,urban academic tertiary care ED with an annual census of 80 000.Study subjects were all patients receiving vancomycin for the management of sepsis between March 1 to September 30,2008 and the same time period in 2009.The primary outcome was the proportion of patients who received vancomycin within one hour of bed placement and the secondary outcome was dosing appropriateness.RESULTS:Sixty-three patients had weight and dosing information available(29 before and 34after intervention)and were included in the study.Before intervention,no patient received vancomycin in less than 60 minutes,while after intervention 14.7%of the patients received it in less than 60minutes(difference in proportions 14.7%,95%CI 0.39%-30.0%,P=0.04).A similar proportion of the patients received correct dosing before and after intervention(44.8%vs.41.2%,difference in proportions 3.7%,95%CI-20.0%-26.7%,P=0.770).CONCLUSION:The use of an ADS may improve the timing of medication administration in patients presenting to the ED without affecting dosing appropriateness.

A Literature Review: Pharmaceutical Care an Evolving Role at Community Pharmacies in Pakistan

The aim of this paper is to highlight the role of pharmaceutical care at community pharmacies in Pakistan. The paper draws on the literature related to current dispensing practices at community pharmacies in developing countries as well as in Pakistan. There are approximately 63,000 community pharmacies in Pakistan, and according to an estimate, 80% of the medicines are being distributed through this channel to majority of the population. They often lack adequate facilities, staffing and equipments. Absence of pharmacists and their roles being performed by the non-qualified personnel working at community pharmacies are a common practice. There are 8102 pharmacists who are categorized as a category, 31,000 pharmacy technicians categorized in B & C category in the country. There is a shortage of pharmacists who could be engaged for ensuring good pharmacy practices. There are only ten percent of the total pharmacists who work at community pharmacies in the country according to the Pharmacy Council of Pakistan. All kind of medicines are freely available irrespective of their status as prescription or over the counter drugs. The paper highlights that the professional role of pharmacist in hospitals and community pharmacies is switching from dispensing and sale of drugs, to patient counselling. But, the concept of pharmaceutical care at community pharmacies has not been acknowledged yet in Pakistan. The process of prescription handling is poor and patients are often treated without a proper prescription. Prescription validation, drug labeling and patient counseling are the missing components in effective patient management at the community pharmacies. The paper concludes that although laws exist, but due to lack of accountability and weak regulatory framework their proper implementation is not witnessed. Moreover, due to lack of research and evidence related to problems in dispensing practices in healthcare system of Pakistan, the counteractive actions for resolving these problems are limited.

Development of non-shrinkable ceramic composites for use in high-power microwave tubes

Al_2O_3–CaO–SiC-based ceramic composites with four different compositions were sintered at 1700℃ for 3 h in an air furnace. The phase analysis, microstructural characterization, and elemental composition determination of the developed composites were performed by X-ray diffraction(XRD), field-emission scanning electron microscopy(FESEM), and energy-dispersive X-ray(EDAX) analysis, respectively. The shrinkage, thermal properties, and electrical resistivity of the composites were also studied. The experimental results showed the effects of adding silicon carbide and calcia to alumina on the thermal, electrical, and shrinkage properties of the resultant composites. Among the four investigated ceramic composites, the one composed of 99 wt% alumina, 0.5 wt% CaO, and 0.5 wt% SiC exhibited the best characteristics for use as a potting material in a dispenser cathode of a microwave tube. The material exhibited slight expansion instead of shrinkage during drying or firing. Other properties of the composite powder, such as its thermal properties and electrical resistivity, were comparable to those of a commercial alumina powder.

A NEW Ba-W DISPENSER CATHODE IMPREGNATED WITH BARIUM YTTERBATE

A new kind of Ba-W dispenser cathode impregnated with barium ytterbate has been deve-loped.It has good properties;high coefficient of secondary emission,strong ability of resisting oxygenpoisoning,high thermionic emission current density and more uniform emission on the cathode surface.The cathode is suitable for using as an electron emitter for microwave tubes,especially magnetrons.

SENSITIVITY OF THE CONCENTRATION CHANGE OF DYE DISPENSING USING COMPUTER SYSTEMS

This paper employs computer colour generation,and match prediction systems and aims tofind the most critical change of dye concentration corresponding to changes of Hue,or Chroma,orLightness of 1 unit just visible colour difference,thus investigating the required accuracy level fordyeing dispensing.This leads to the selection of one critical colour-difference dimension of threefrom CMC (1:c) measurement.The results reveal that the concentration change in dye dispensing ismost critical for change of Hue in a computer controlled system.The formula describing the rela-tionship Of △E and △H in CMC (2:1) measurement is selected for further investigation.

Directional Dispensing of KE-Rod

With the numerical simulation and high-speed camera, a series of images of dispensing of rod from different devices were obtained. The process of dispensing of rods driven by aiming explosive charge and the influence of different structures on dispensing velocity and angle of KE-rod were studied through analyzing the images. All these can be helpful for the design of new concept anti tactical ballistic missile(ATBM) KE-rod warheads.

H_2 Output Feedback Control for Airborne Dispenser Uncertain Generalized System

The problem of H2 output feedback control for generalized system with structural uncertainties is studied using linear matrix inequality approach. A sufficient condition Of linear matrix inequality is presented such that the closed-loop system is stable and satisfies H2 performance for all admissible uncertainties. Furthermore, the solution of the controller is given. An H2 output feedback controller is designed in the airborne dispenser pitch channel, and the simulation results show that the controller is effective.

RCS Reduction of Airborne Dispenser

The radar cross section (RCS) of dispenser and its components is computed by graphical electromagnetic computing (GRECO) method, which bases on physical optics (PO) method. A satisfied agreement is gotten between computed and measured results outdoor. The results show that the main scattering source of the dispenser is the mirror reflecting of the body; in the most crucial nose-on region, the nose mirror reflecting plays important role; the corner reflecting is important to the fins' RCS. The corresponding measures to reduce dispenser's RCS are proposed. It is indicated that to reduce RCS, shaping should be adopts first, while aerodynamic characteristics and stealth characteristics should be considered synthetically during the design of dispenser.

Importance of labelling and patient knowledge to ensure proper care during drug dispensing: A case study from a tertiary hospital in Ethiopia

Correct drug labelling is central for ensuring proper drug dispensing and thus for patient safety. Labelling errors may result in adverse health outcomes. The objective of this study was, therefore, to assess the effect of labelling on the quality of drug dispensing and patient knowledge about dispensed drugs in Jimma University model and specialized hospital outpatient Pharmacies. Individual packages with prescribed drugs were examined using pretested questionnaire and observational check lists during the dispensing process. Patients’ knowledge about drugs dispensed to them was assessed at the exit interview using a pretested questionnaire. Out of 743 prescribed drugs, 682 (91.8%) were dispensed to 426 patients. The average labelling score (range from 0 to 6) of dispensed drugs in Model and Outpatient pharmacy was 2.00 (95% CI 1.97 to 2.04) and 1.73 (95% CI 1.6 to 1.8) respectively, with overall average labelling score of 1.90 (95% CI 1.84 to 1.91). The average patient knowledge score (range from 0 t0 5) was 3.45 (95% CI 3.31 to 3.59) and 3.5 (95% CI 3.35 to 3.64) for model and outpatient pharmacy, respectively, while the overall average knowledge score was 3.46 (95% CI 3.37 to 3.57). Major labelling problems were absence of patient’s name and dose followed by frequency of administration, duration of treatment, and the reason for prescription. Literacy status of patients had a significant effect on their knowledge (p 0.05). We recommend that corrective measures targeting both, labelling and patients’ knowledge should be implemented to improve the patients’ safety and drug therapy adherence.