Wyke, Sally; Mays, Nicholas; Street, Andrew; Bevan, Gwyn; McLeod, Hugh; Goodwin, Nick
Until relatively recently, general practitioners (GPs) have been allowed to work independently, with no requirement to consider the resource implications of their referral and prescribing decisions. In order to align the interests of GPs with the overall objectives of health systems a number of countries have introduced primary care based capitation, funds pooling and budget holding either as experiments or as an overall policy. Are these experiments and policies likely to work? This paper presents evidence from the UK total purchasing experiment, which was the first major quasi-market development in the NHS to be independently evaluated from the outset. Total purchasing gave volunteer groups of practices freedom to purchase all hospital and community health services for their patients. The evidence suggests that whilst GPs have great potential as purchasers, they also have considerable limitations. The expectation that they will be able to improve the quality of patient experience of care, or to alter the use of resources, may not be generally realised. GP-based purchasing may be more appropriate where the task is to alter the balance or location of care between hospital and extramural settings. However, budgetary incentives are not 'magic potions' which have similar effects on behaviour wherever they are introduced. Holding budgets and having independent contracts, while important pre-requisites for being taken seriously in a quasi-market, were not sufficient for effective total purchasing. The paper concludes that health systems should not only value innovation and experimentation and encourage learning from evaluative research; they should also recognise the importance of supportive circumstances for any innovation to effect real and sustained change.
Van Houtven, Courtney Harold; Coe, Norma B.; Konetzka, R. Tamara
While it has long been assumed that family structure and potential sources of informal care play a large role in the purchase decisions for long-term care insurance (LTCI), current empirical evidence is inconclusive. Our study examines the relationship between family structure and LTCI purchase and addresses several major limitations of the prior literature by using a long panel of data and considering modern family relationships, such as presence of stepchildren. We find that family structure characteristics from one’s own generation, particularly about one’s spouse, are associated with purchase, but that few family structure attributes from the younger generation have an influence. Family factors that may indicate future caregiver supply are negatively associated with purchase: having a coresidential child, signaling close proximity, and having a currently working spouse, signaling a healthy and able spouse, that LTC planning has not occurred yet, or that there is less need for asset protection afforded by LTCI. Dynamic factors, such as increasing wealth or turning 65, are associated with higher likelihood of LTCI purchase. PMID:25760583
Di Palma, Amelia
2015 dissertation for MA in International Marketing Management. Selected by academic staff as a good example of a masters level dissertation. \\ud \\ud Purpose – The purpose of this paper is investigating which factors influence consumers’ purchase behaviour of skin care online, and what impact online trust has on mitigating the effects of risk normally associated with shopping online. The study explores industry specific variables and their effects on online consumer behaviour. The study also ...
Ebben, Steven F; Gieras, Izabella A; Gosbee, Laura Lin
Since the Institute of Medicine's well-publicized 1999 report To Err is Human, the healthcare patient safety movement has grown at an exponential pace. However, much more can be done to advance patient safety from a care process design vantage point-improving safety through effective care processes and technology integration. While progress is being made, the chasm between technology developers and caregivers remains a profound void. Why hasn't more been done to expand our view of patient safety to include technology design? Healthcare organizations have not consolidated their purchasing power to expect improved designs. This article will (1) provide an assessment of the present state of healthcare technology management and (2) provide recommendations for collaborative design of safe healthcare delivery systems.
Preston, Stephanie A; Brown, Murray P; Chmielewski, Terese L; Trumble, Troy N; Zimmel, Dana N; Hernandez, Jorge A
To determine the effects of yearling sale purchase price, exercise history, lameness, and athletic performance (speed) on purchase price of 2-year-old in-training Thoroughbreds and to compare the distance exercised within 60 days prior to 2-year-old in-training sales between horses with high yearling sale purchase prices versus those with low yearling sale purchase prices and between horses with lameness during training and those without lameness during training. Prospective study. 51 Thoroughbreds. Thoroughbreds purchased at a yearling sale were trained prior to resale at 2-year-old in-training sales. Amount of exercise and lameness status during training and speed of horses at 2-year-old in-training sales were determined. Data were analyzed via the Wilcoxon rank sum test and ANOVA. Median purchase price of horses at 2-year-old in-training sales was $37,000. The 2-year-old in-training sale purchase price was associated with yearling sale purchase price and distance galloped within 60 days prior to and speed recorded at 2-year-old in-training sales. Horses with high yearling sale purchase prices typically had high 2-year-old in-training sale purchase prices, had low distances galloped within 60 days prior to 2-year-old in-training sales, and were classified as fast at 2-year-old in-training sales. Lameness alone was not associated with 2-year-old in-training sales purchase price. However, lameness was associated with a low distance galloped before 2-year-old in-training sales, particularly for horses with a high yearling sale purchase price; this finding suggested that yearling sale purchase price can affect training management decisions for horses with lameness.
Eagan, Patrick D; Kaiser, Barb
Environmental purchasing represents an innovative approach to mercury control for the health care sector in the United States. The U.S. health care sector creates significant environmental impacts, including the release of toxic substances such as mercury. Our goal in this study was to provide the health care industry with a method of identifying the environmental impacts associated with the products they use. The Health Care Environmental Purchasing Tool (HCEPT) was developed and tested at n...
Fogel, Joshua; Zidile, Chaya
Individuals are increasingly purchasing contact lenses over the Internet. No studies exist regarding Internet purchase of contact lenses and eye care health practices. One hundred fifty-one college students were surveyed regarding contact lenses purchase category (doctor's office, store, Internet). Pearson chi-square analyses compared purchase category with responses regarding U.S. Food and Drug Administration (FDA) recommendations for purchasing contact lenses online. Analysis of variance compared contact lenses purchase category with the Time Pressure Scale (TPS). Also, correlation analyses compared the TPS with Internet eye-health statements. Contact lens purchase categories included doctor's office (43.0%), store (55.0%), and Internet (22.5%), with individuals purchasing at multiple venues. With regard to the FDA recommendations, those who purchased contact lenses at a doctor's office more often adhered to the recommendations, whereas those who purchased contact lenses at a store or the Internet did so less often. Those who purchased contact lenses over the Internet had significantly higher TPS scores. In addition, higher TPS scores were significantly correlated with various statements regarding the Internet. Those who purchase contact lenses via the Internet or store do not follow a number of FDA contact lenses recommendations. Also, those with higher TPS scores trust possible non-evidence-based contact lenses Internet information. Implications with regard to the Fairness to Contact Lens Consumers Act are discussed.
Lo Sasso, A T; Perloff, L; Schield, J; Murphy, J J; Mortimer, J D; Budetti, P P
We explore the extent of "responsible purchasing" by employers--the degree to which employers collect and use nonfinancial information in selecting and managing employee health plans. Most firms believe that they have some responsibility for assessing the quality of the health plans they offer. Some pay attention to plan characteristics such as the ability to provide adequate access to providers and services and scores on enrollee satisfaction surveys. A more limited but still notable number of firms take specific actions based on responsible purchasing information. Because of countervailing pressures, however, it is not clear whether or not the firms most involved in responsible purchasing are signaling a developing trend.
Ford, Eric W; Scanlon, Dennis P
Double-digit health care inflation, coupled with widespread reports of poor care quality and deadly medical errors, has caused private sector employers to reevaluate their health benefits purchasing strategies, with a focus on supply chain management approaches. In other industries, this strategy has proven to be an effective method for simultaneously reducing costs and increasing quality. This article describes four current applications of supply chain management network methodologies to health care systems and identifies potential ways to improve purchasers' return on investment. In particular, information exchanges, purchase decision, and payment agreement components of integrated supply chains are described. First, visual depictions of the health care supply chain are developed from a purchaser's perspective. Next, five nationwide programs designed to realign incentives and rewards across the health care supply chain are described. Although several nationwide efforts are gaining traction in the marketplace, at this time, no cost reduction and quality improvement program initiative appears to systematically align the entire health care supply chain from providers to purchasers, raising doubt about the ability of supply chain management network techniques to significantly impact the health care marketplace in the short run. Current individual efforts to coordinate the health care supply chain do not act on all of the actors necessary to improve outcomes, promote safety, and control costs. Nevertheless, there are indications that several of the individual efforts are coming together. If national efforts touching on all critical elements can coordinate with purchasers, then the health care supply chain's performance may improve significantly.
Ayalon, Liat; Gross, Revital; Yaari, Aviv; Feldhamer, Elan; Balicer, Ran; Goldfracht, Margalit
This study analyzed the role of patient and physician characteristics associated with the purchase of antidepressant or antianxiety medications in Israel, a country that has a universal health care system. A national sample of 30,000 primary care patients over the age of 22 was randomly drawn from the registry of the largest health care fund in Israel. Data concerning medication purchase between January and December 2006 were extracted. Physician and patient characteristics were merged with Israel's unique identification number. Multilevel analysis was conducted to identify patient- and physician-level predictors of medication purchase. Overall, 19% (N = 4,762) of the sample purchased antidepressant or antianxiety medications. Individuals with greater general medical and psychiatric comorbidity were more likely to purchase antidepressant or antianxiety medications. Older adults, women, those of higher socioeconomic status, and immigrants (with the exception of Jews born in Asia or Africa) were also more likely to purchase medications. Arabs and Jews born in Asia and Africa were less likely to purchase medications even after all other variables were accounted for. Physician characteristics were minimally associated with the purchase of medications. The findings demonstrate that despite universal health care access, there were variations by population groups. Educational efforts should target patients as well as physicians.
Curry, Leslie A; Robison, Julie; Shugrue, Noreen; Keenan, Patricia; Kapp, Marshall B
Although prior research suggests that economic, behavioral, and psychosocial factors influence decisions not to purchase long-term care insurance, few studies have examined the interplay among these factors in depth and from the consumer's point of view. This study was intended to further illuminate these considerations, generate hypotheses about non-purchasing decisions, and inform the design of policies that are responsive to concerns and preferences of potential purchasers. Qualitative study using 32 in-depth interviews and 6 focus groups, following a grounded theory approach. Five themes characterize decisions not to purchase long-term care insurance: (a) the determination that a policy is "too costly" reflects highly individualized and complex trade-offs not solely economic in nature, (b) non-purchasers are skeptical about the viability and integrity of private insurance companies and seek an unbiased source of information, (c) family dynamics play an important role in insurance decisions, (d) contemplating personal risk for long-term care triggers psychological responses that have implications for decision making, and (e) non-purchasers feel inadequately informed and overwhelmed by the process of deciding whether to purchase long-term care insurance. States are seeking to offset escalating Medicaid long-term care expenditures through a variety of policy mechanisms, including stimulating individual purchase of long-term care insurance. Findings suggest that economic incentives such as lowering premiums will be necessary but not sufficient to attract appropriate candidates. Attention to behavioral and psychosocial factors is essential to designing incentives that are responsive to concerns and preferences of potential purchasers.
Maxwell, James; Temin, Peter
The theory of managed competition has found favor with many health policy analysts and academic economists alike. Three characteristics--consumer choice, defined contribution, and dissemination of information--signal managed competition strategy. By requiring private employers to provide their employees with a choice of health carriers, a fixed-dollar strategy (defined contribution), and quality information to make appropriate choices among carriers, managed competition offers to remedy imperfections in both the consumer and provider sides of the market for health insurance. In an extensive survey of health care purchasing practices among Fortune 500 companies we found that major companies are not using the managed competition approach to health care purchasing. Instead, most of the companies surveyed are purchasing health care in the same way as they do other inputs to production--a pattern we call industrial purchasing.
Full Text Available Fourteen vendors are currently selling depression care management products to US employers after randomized trials demonstrate improved work outcomes. The research team interviewed 10 (71.4% of these vendors to compare their products to four key components of interventions demonstrated to improve work outcomes. Five of 10 depression products incorporate all four key components, three of which are sold by health maintenance organizations (HMOs; however, HMOs did not deliver these components at the recommended intensity and/or duration. Only one product delivered by a disease management company delivered all four components of care at the recommended intensity and duration. This “voltage drop,” which we anticipate will increase with product implementation, suggests that every delivery system should carefully evaluate the design of its depression product before implementation for its capacity to deliver evidence-based care, repeating these evaluations as new evidence emerges.
Voils, Corrine I.; Coe, Norma B.; Konetzka, R. Tamara; Boles, Jillian; Van Houtven, Courtney Harold
Abstract Purpose of the Study: Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents’ LTC preferences and plans, including LTCI purchase? Design and Methods: We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method. Results: Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home. Implications: Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake. PMID:25209446
Sperber, Nina R; Voils, Corrine I; Coe, Norma B; Konetzka, R Tamara; Boles, Jillian; Van Houtven, Courtney Harold
Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents' LTC preferences and plans, including LTCI purchase? We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method. Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home. Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
Curry, Leslie A.; Robison, Julie; Shugrue, Noreen; Keenan, Patricia; Kapp, Marshall B.
Purpose: Although prior research suggests that economic, behavioral, and psychosocial factors influence decisions not to purchase long-term care insurance, few studies have examined the interplay among these factors in depth and from the consumer's point of view. This study was intended to further illuminate these considerations, generate…
Bumrungkitjareon, Tipaporn; Tanasansopin, Suveera
Title: Purchasing Intentions of Young Thai Male towards Men's Skin Care Products Problem: Men concern more about their image than ever before. This behavior is becoming a new trend in cosmetic market. Moreover, Thailand is one of the fast growing cosmetics industry, particularly male skin care market within countries in Asia-Pacific region. However, most of the literatures have just studied on women cosmetic products. There are a few studies within male cosmetic market, despite the demands of...
Girchenko, P; Ompad, D C; Kulchynska, R; Bikmukhametov, D; Dugin, S; Gensburg, L
Commercial sex workers (CSWs) in the Russian Federation are at high risk of HIV infection and transmission as a result of unsafe sexual and injecting behaviors. Their clients might be at increased risk of acquiring HIV; however, little is known about the population of men purchasing sex services. This study aims to investigate factors associated with a history of purchasing sex services by men in Saint Petersburg and Leningrad Oblast, Russian Federation. Data were collected as part of a cross-sectional study offering free anonymous rapid HIV testing in Saint Petersburg and Leningrad Oblast in 2014; in total, 3565 men aged 18 years and older provided information about their behaviors associated with risk of acquiring HIV during face-to-face interviews. Prevalence of CSW use in our study was 23.9%. Multivariable analyses using log-binomial regression were stratified by self-reported HIV testing during the 12 months preceding the study interview. In both strata, older age, multiple sex partners, and a history of sex with an injection drug user (IDU) were associated with an elevated prevalence ratio (PR) for history of purchasing sex services, although the strength of the association differed by strata. Among men who reported recent HIV testing, condom use (PR = 1.22, 90% confidence interval (CI) 1.0, 1.48) was associated with a history of purchasing sex services, and among men who did not report recent HIV testing, having a consistent sex partner was associated with purchasing sex services (PR = 1.23, 90% CI 1.1, 1.37). The high prevalence of CSW service use and associations found in this study raise serious concerns about potential for sexual HIV transmission and should be investigated more closely.
Siles González, José; Ruiz, Maria del Carmen Solano
The aim of this study was to clarify the role of aesthetics in the organization and motivation of care through history. The guiding questions were: What values and aesthetic feelings have supported and motivated pre-professional and professional care? and Based on what structures has pre-professional and professional care been historically socialized? Primary and secondary sources were consulted, selected according to established criteria with a view to avoiding search and selection bias. Data analysis was guided by the categories: "habitus" and "logical conformism". It was found that the relation between social structures and pre-professionals (motherhood, religiosity) and professional aesthetic standards (professionalism, technologism) of care through history is evidenced in the caregiving activity of the functional unit, in the functional framework and the functional element. In conclusion, in social structures, through the socialization process, "logical conformism" and "habitus" constitute the aesthetic standards of care through feelings like motherhood, religiosity, professionalism, technologism and humanism.
Gupta, Aparna; Li, Lepeng
The level of need and costs of obtaining long-term care (LTC) during retired life require that planning for it is an integral part of retirement planning. In this paper, we divide retirement planning into two phases, pre-retirement and post-retirement. On the basis of four interrelated models for health evolution, wealth evolution, LTC insurance premium and coverage, and LTC cost structure, a framework for optimal LTC insurance purchase decisions in the pre-retirement phase is developed. Optimal decisions are obtained by developing a trade-off between post-retirement LTC costs and LTC insurance premiums and coverage. Two-way branching models are used to model stochastic health events and asset returns. The resulting optimization problem is formulated as a dynamic programming problem. We compare the optimal decision under two insurance purchase scenarios: one assumes that insurance is purchased for good and other assumes it may be purchased, relinquished and re-purchased. Sensitivity analysis is performed for the retirement age.
Eagan, Patrick D; Kaiser, Barb
Environmental purchasing represents an innovative approach to mercury control for the health care sector in the United States. The U.S. health care sector creates significant environmental impacts, including the release of toxic substances such as mercury. Our goal in this study was to provide the health care industry with a method of identifying the environmental impacts associated with the products they use. The Health Care Environmental Purchasing Tool (HCEPT) was developed and tested at nine health care facilities in the Great Lakes region of the United States. As a result, more than 1 kg of mercury was removed from four facilities. The complexity of the supply chain inhibits a direct environmental information exchange between health-care decision makers and suppliers. However, a dialogue is starting within the health care supply chain to address environmental issues. The HCEPT has been shown to assist health care facilities with that dialogue by identifying products that have environmental consequences. This promising tool is now available for further experimentation and modification, to facilitate overall environmental improvement, and to provide a systematic method for environmental assessment of health care products. PMID:12204816
Maxwell, James; Temin, Peter; Zaman, Saminaz
This paper is the first to compare health care purchasing in the retail versus other sectors of the Fortune 500. Employing millions of low-wage workers, the retail sector is the largest employer of uninsured workers in the economy. We found that retail companies are using the same competitive bidding process that other companies use to obtain a given level of coverage for the lowest possible cost. However, they are more price oriented than other Fortune 500 companies are. The most striking disparity lies in the nearly fivefold difference in offer rates for health care coverage. This shows that the economy's bifurcation in health benefits extends even to the nation's largest companies.
Habicht, Triin; Habicht, Jarno; van Ginneken, Ewout
As of 2014, the Estonian Health Insurance Fund has adopted new purchasing procedures and criteria, which it now has started to implement in specialist care. Main changes include (1) redefined access criteria based on population need rather than historical supply, which aim to achieve more equal access of providers and specialties; (2) stricter definition and use of optimal workload criteria to increase the concentration of specialist care (3) better consideration of patient movement; and (4) an increased emphasis on quality to foster quality improvement. The new criteria were first used in the contract cycle that started in 2014 and resulted in fewer contracted providers for a similar volume of care compared to the previous contract cycle. This implies that provision of specialized care has become concentrated at fewer providers. It is too early to draw firm conclusions on the impact on care quality or on actors, but the process has sparked debate on the role of selective contracting and the role of public and private providers in Estonian health care. Lastly, the Estonian experience may hold important lessons for other countries looking to overcome inequalities in access while concentrating care and improving care quality. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Lin, Haizhen; Prince, Jeffrey T
To assess three possible determinants of individuals' response in their private insurance purchases to the availability of the Partnership for Long-Term Care (PLTC) insurance program: bequest motives, financial literacy, and program awareness. The health and retirement study (HRS) merged with data on states' implementation of the PLTC program. Individual-level decision on private long-term care insurance is regressed on whether the PLTC program is being implemented for a given state-year, asset dummies, policy determinant variable, two-way and three-way interactions of these variables, and other controls, using fixed effects panel regression. Analysis used a sample between 50 and 69 years of age from 2002 to 2010, resulting in 12,695 unique individuals with a total of 39,151 observations. We find mild evidence that intent to bequest influences individual purchase of insurance. We also find that program awareness is necessary for response, while financial literacy notably increases responsiveness. Increasing response to the PLTC program among the middle class (the stated target group) requires increased efforts to create awareness of the program's existence and increased education about the program's benefits, and more generally, about long-term care risks and needs. © Health Research and Educational Trust.
Otten, Jennifer J; Hirsch, Tad; Lim, Catherine
With the majority of US children enrolled in some form of early care and education, the settings for early care and education represent a valuable opportunity to positively impact young children's diets and their interactions with food. Little evidence exists on how early care and education providers make food purchasing and service decisions for this population of young children. Our aim was to explore the factors that influence early care and education providers' food purchasing and service decisions. A qualitative design consisting of individual, in-person, and semi-structured interviews with providers and on-site observations was used. Sixteen early care and education providers-selected across a variety of characteristics that might affect food selection (eg, size of site, participation in reimbursement programs, presence of staff assigned to foodservice) using maximum variation purposive sampling-based in the Puget Sound region, Washington, were interviewed from June to September 2014. Provider perspectives on food purchasing and service decisions. Inductive analysis of transcribed interviews using TAMS Analyzer software (GPL version 2, 2012) to identify themes. Ten main influencers emerged from the data. These were grouped into four categories based on an ecological framework: macro-level environments (ie, regulations; suppliers and vendors, including stores); physical environment and settings (ie, organizational mission, budget, and structure; the facility itself); social environments (ie, professional networks; peers; the site-specific parent and child community); and individual factors at both a provider and child-level (ie, providers' skills, behaviors, motivations, attitudes, knowledge, and values; child food preferences; and, child allergies). A model was then developed to identify potential pathways of intervention and underscore the need for a comprehensive approach to improve early care and education nutrition. This study suggests that a more
Wooten, Nikki R; Brittingham, Jordan A; Pitner, Ronald O; Tavakoli, Abbas S; Jeffery, Diana D; Haddock, K Sue
Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78
McGarry, Brian E; Tempkin-Greener, Helena; Grabowski, David C; Chapman, Benjamin P; Li, Yue
To determine the impact of consumer decision-making abilities on making a long-term care insurance (LTCi) purchasing decision that is consistent with normative economic predictions regarding policy ownership. Using data from the Health and Retirement Study, multivariate analyses are implemented to estimate the effect of decision-making ability factors on owning LTCi. Stratified multivariate analyses are used to examine the effect of decision-making abilities on the likelihood of adhering to economic predictions of LTCi ownership. In the full sample, better cognitive capacity was found to significantly increase the odds of ownership. When the sample was stratified based on expected LTCi ownership status, cognitive capacity was positively associated with ownership among those predicted to own and negatively associated with ownership among those predicted not to own who could likely afford a policy. Consumer decision-making abilities, specifically cognitive capacity, are an important determinant of LTCi decision outcomes. Deficits in this ability may prevent individuals from successfully preparing for future long-term care expenses. Policy makers should consider changes that reduce the cognitive burden of this choice, including the standardization of the LTCi market, the provision of consumer decision aids, and alternatives to voluntary and private insuring mechanisms.
Chinese customers and those in the rest of world share the same two principal concerns about e-commerce: inadequate information from website and inadequate legal protection for Internet purchases. This study shows that trust, information adequacy and Otakus' characteristics have a significant effect on online purchase intention. Moreover, Otakus' characteristics demonstrate an interference effect on purchasing intention online for the influential factors: information provision and trust in the website.
Kumar, N; Cohen, M A; Bishop, C E; Wallack, S S
This article examines the factors related to an individual's decision to purchase a given amount of long-term care insurance coverage. DATA SOURCE AND STUDY SETTING: Primary data analyses were conducted on an estimation sample of 6,545 individuals who had purchased long-term care (LTC) insurance policies in late 1990 and early 1991, and 1,248 individuals who had been approached by agents but chose not to buy such insurance. Companies contributing the two samples represented 45 percent of total sales during the study year. A two-stage logit-OLS (ordinary least squares) choice-based sampling model was used to examine the relationship between the expected value of purchased coverage and explanatory variables that included: demographic traits, attitudes, risk premium, nursing home bed supply, and Medicaid program configurations. Mail surveys were used to collect information about individuals' reasons for purchase, attitudes about long-term care, and demographic characteristics. Through an identification code, information on the policy designs chosen by these individuals was linked to each of the returned mail surveys. The response rate to the survey was about 60 percent. The model explains about 47 percent of the variance in the dependent variable-expected value of policy coverage. Important variables negatively associated with the dependent variable include advancing age, being married, and having less than a college education. Variables positively related include being male, having more income, and having increasing expected LTC costs. Medicaid program configuration also influences the level of benefits purchased: state reimbursement rates and the presence of comprehensive estate recovery programs are both positively related to the expected value of purchased benefits. Finally, as the difference between the premium charged and the actuarially fair premium increases, individuals buy less coverage. An important finding with implications for policymakers is that changes
The history of science has many functions. Historians should consider how their work contributes to various functions, going beyond a simple desire to understand the past correctly. There are both internal and external functions of the history of science in relation to science itself; I focus here on the internal, as they tend to be neglected these days. The internal functions can be divided into orthodox and complementary. The orthodox function is to assist with the understanding of the content and methods of science as it is now practised. The complementary function is to generate and improve scientific knowledge where current science itself fails to do so. Complementary functions of the history of science include the raising of critical awareness, and the recovery and extension of past scientific knowledge that has become forgotten or neglected. These complementary functions are illustrated with some concrete examples.
Klug, Hope; Bonsall, Michael B
Patterns of parental care are strikingly diverse in nature, and parental care is thought to have evolved repeatedly multiple times. Surprisingly, relatively little is known about the most general conditions that lead to the origin of parental care. Here, we use a theoretical approach to explore the basic life-history conditions (i.e., stage-specific mortality and maturation rates, reproductive rates) that are most likely to favor the evolution of some form of parental care from a state of no care. We focus on parental care of eggs and eggs and juveniles and consider varying magnitudes of the benefits of care. Our results suggest that parental care can evolve under a range of life-history conditions, but in general will be most strongly favored when egg death rate in the absence of care is high, juvenile survival in the absence of care is low (for the scenario in which care extends into the juvenile stage), adult death rate is relatively high, egg maturation rate is low, and the duration of the juvenile stage is relatively short. Additionally, parental care has the potential to be favored at a broad range of adult reproductive rates. The relative importance of these life-history conditions in favoring or limiting the evolution of care depends on the magnitude of the benefits of care, the relationship between initial egg allocation and subsequent offspring survival, and whether care extends into the juvenile stage. The results of our model provide a general set of predictions regarding when we would expect parental care to evolve from a state of no care, and in conjunction with other work on the topic, will enhance our understanding of the evolutionary dynamics of parental care and facilitate comparative analyses.
Bastani, Peivand; Samadbeik, Mahnaz; Dinarvand, Rassoul; Kashefian-Naeeini, Sara; Vatankhah, Soudabeh
Iranian health sector encountered many challenges in resource allocation and health service purchasing during the past decades, the aim of this study was to determine the main challenges of the present process of health service purchasing for national policymakers and other developing countries with the same setting. It was a qualitative study carried out via the complete content analysis of all relevant national documents from 2007 to 2014. In order to retrieve the related documents, we searched the official websites related to the Ministry of Health and Medical Education, four main Iranian insurance organizations, the Health Committee of the Parliament Profile, strategic vice president's site and Supreme Insurance Council. After recognition of documents, their credibility and authenticity were evaluated in terms of their publication or adjustment. For the analysis of documents, the four step-Scott method was used applying MAXQDA version 10. Findings illustrated that health service purchase challenges in the country can be classified in 6 main themes of policy-making, executive, intersectional, natural, legal and informational challenges with 26 subthemes. Furthermore, 5 themes of Basic Benefit Package, Reimbursement,Decision making, Technology and Contract are considered as the main Challenges in pharmaceutical purchasing area containing 13 relevant subthemes. It seems that according to documents, Iran has faced many structural and procedural problems with the purchase of the best health interventions. So it is highly recommended to consider consequences derived from the present challenges and try to use these evidences in their policy making process to decrease the existed problems and move to better procurement of health interventions.
Bell, Sue Anne; Seng, Julia
Objective To test the hypothesis that childhood maltreatment history would be associated with inadequate prenatal care utilization. Design A post-hoc analysis of a prospective cohort study of the effects of post traumatic stress disorder (PTSD) on pregnancy outcomes. Setting Recruitment took place via prenatal clinics from three academic health systems in southeast Michigan. Participants This analysis included 467 diverse, nulliparous, English-speaking adult women expecting their first infants. Methods Data were gathered from structured telephone interviews at two time points in pregnancy and from prenatal medical records. Results Contrary to our hypothesis, history of childhood maltreatment was associated with better likelihood of using adequate prenatal care. Risk for inadequate prenatal care occurred in association with the posttraumatic stress and interpersonal sensitivity that can result from maltreatment, with low alliance with the maternity care provider, and with public insurance coverage. Prior mental health treatment was associated with using adequate prenatal care. Conclusion When childhood maltreatment survivors were resilient or have used mental health treatment, they were more likely to utilize adequate prenatal care. The maternity care relationship or service delivery model (e.g., no continuity of care) as well as structural factors may adversely affect utilization among PTSD-affected survivors. Since inadequate care was associated with adverse outcomes, further studies of these modifiable factors are warranted. PMID:23772546
As more consumers join managed care organizations, the personal bond between patient and physician or medical group has been transformed into an economic relationship driven chiefly by the price of health care services. Managed care organizations now face the same pressures as the airline and retail industries: To gain and retain client loyalty through product differentiation and consistently high levels of service. How do managed health care plans create and maintain loyalty among their members? What is the value proposition that consumers will respond to in this era of managed care? Discussion will focus on the consumer as the critical variable in the economic model of a health care system and how the consumer will impact the continued evolution of managed care.
Full Text Available The intention to purchase green products is the tendency of a person who prefers to purchase a product with optimal environmental characteristics rather than usual products. Nowadays, the environment is very important and maintaining it is a vital issue for all groups of people, whether in the customer's position or in the distributor’s position. However, in spite of the increased environmental awareness among consumers and encouragements made by producers for them to buy green products, we require further investigation in this area in order to increase green purchasing among different group of people. The main objective of this study is to investigate the impact of the environmental attitude on the decision to purchase a green product with the mediating role of environmental concerns and care for green products. This research is an applied research, and correlational-descriptive in terms of data analysis. The research population includes consumers from Bushehr city, sampled based on availability. In this research, 300 questionnaires were distributed among consumers. Structural equation modeling was used to analyze the data. The findings of this research showed that the environmental attitude of customers has significant and positive impact on caring for green products and environmental concerns. In addition, environmental concerns and care for green products have a significant and positive impact on green purchasing decision.
den Exter, A
Armenia, the former Soviet republic, is switching its economy to a more market driven system. Where health care is concerned, the previous government planned to introduce an independent State Health Agency managing the available funds. At the same time, this Agency would be authorised to contract with former state hospitals and individual providers. The underlying idea was a partial withdrawal by the state from both the provision and financing of health care. However, since the financing system continued to be based on general taxation, the state's role has remained largely unchanged in this respect. This situation has created new difficulties. To solve the variety of emerging problems, the Armenian government requested technical support from the World Bank. As a member of a multi-disciplinary team, the author will describe some major legal aspects of the underlying health policy reform plan and will conclude that the Agency's establishment will give an important impetus to the Armenian health care legislative reform process.
Personal care products (PCPs) are used for beautification and personal hygiene, and because they are applied to the skin, hair, and mouth, they provide an efficient delivery vehicle for chemicals into our bodies. Although efforts have been made to enumerate the chemicals in indiv...
Munro, Michelle L.; Rietz, Melissa Foster
This paper proposes a framework for assessing the unmet needs of rape survivors during pregnancy based on the Sexual Assault Nurse Examiner (SANE) practice level theory and an empirical exploration of rape survivors’ health status in pregnancy via a secondary analysis. Our findings indicate that there may be unmet needs in pregnancy related to all five post-assault comprehensive care components: (1) physical care, (2) pregnancy prevention, (3) sexually transmitted infection screening, (4) psychological care, and (5) legal care. Rape history and its current impact on the survivor predicted somatic disorders, substance use, unwanted pregnancy, infections, posttraumatic stress disorder, and recent abuse. PMID:23215990
Saleem, Bilal; Recker, Alena
The purpose of this study was to examine the effect of different types of consumer knowledge and values on their attitude towards buying organic personal care products and their purchase intentions of organic personal care products. The aim was to make a theoretical contribution to the research area of consumer behaviour in the context of organic products. As no research had been conducted on how different types of consumers’ knowledge affect their attitudes towards buying organic products an...
Montagu, Dominic; Goodman, Catherine
The private for-profit sector's prominence in health-care delivery, and concern about its failures to deliver social benefit, has driven a search for interventions to improve the sector's functioning. We review evidence for the effectiveness and limitations of such private sector interventions in low-income and middle-income countries. Few robust assessments are available, but some conclusions are possible. Prohibiting the private sector is very unlikely to succeed, and regulatory approaches face persistent challenges in many low-income and middle-income countries. Attention is therefore turning to interventions that encourage private providers to improve quality and coverage (while advancing their financial interests) such as social marketing, social franchising, vouchers, and contracting. However, evidence about the effect on clinical quality, coverage, equity, and cost-effectiveness is inadequate. Other challenges concern scalability and scope, indicating the limitations of such interventions as a basis for universal health coverage, though interventions can address focused problems on a restricted scale. Copyright © 2016 Elsevier Ltd. All rights reserved.
Johnson, Todd R; Zhang, Jiajie; Patel, Vimla L; Keselman, Alla; Tang, Xiaozhou; Brixey, Juliana J; Paige, Danielle; Turley, James P
To examine how patient safety considerations are incorporated into medical device purchase decisions, individuals involved in recent infusion pump purchasing decisions at three different health care...
Klug, Hope; Bonsall, Michael B; Alonzo, Suzanne H
The evolution of maternal, paternal, and bi-parental care has been the focus of a great deal of research. Males and females vary in basic life-history characteristics (e.g., stage-specific mortality, maturation) in ways that are unrelated to parental investment. Surprisingly, few studies have examined the effect of this variation in male and female life history on the evolution of care. Here, we use a theoretical approach to determine the sex-specific life-history characteristics that give rise to the origin of paternal, maternal, or bi-parental care from an ancestral state of no care. Females initially invest more into each egg than males. Despite this inherent difference between the sexes, paternal, maternal, and bi-parental care are equally likely when males and females are otherwise similar. Thus, sex differences in initial zygotic investment do not explain the origin of one pattern of care over another. However, sex differences in adult mortality, egg maturation rate, and juvenile survival affect the pattern of care that will be most likely to evolve. Maternal care is more likely if female adult mortality is high, whereas paternal care is more likely if male adult mortality is high. These findings suggest that basic life-history differences between the sexes can alone explain the origin of maternal, paternal, and bi-parental care. As a result, the influence of life-history characteristics should be considered as a baseline scenario in studies examining the origin of care.
Roos, Leslie E; Distasio, Jino; Bolton, Shay-Lee; Katz, Laurence Y; Afifi, Tracie O; Isaak, Corinne; Goering, Paula; Bruce, Lucille; Sareen, Jitender
Multiple studies of homeless persons report an increased prevalence of a history in-care, but there is a dearth of information on associated outcomes or relevant demographic profiles. This information is critical to understanding if certain individuals are at elevated risk or might benefit from specific intervention. Here, we investigate how a history in-care relates to demographics and multiple outcome measures in a homeless population with mental illness. Using the Mini International Neuropsychiatric Interview (MINI), the Short-Form 12, and a trauma questionnaire, we investigated baseline differences in demographics and length of homelessness in the At Home/Chez Soi Trial (N=504) Winnipeg homeless population with and without a history in-care. Approximately 50% of the homeless sample reported a history in-care. This group was significantly more likely to be young, female, married or cohabitating, of Aboriginal heritage, have less education, and have longer lifetime homelessness. Individuals of Aboriginal heritage with a history in-care were significantly more likely to report a familial history of residential school. Individuals with a history in-care experienced different prevalence rates of Axis 1 mental disorders. Those with a history in-care also reported significantly more traumatic events (particularly interpersonal). A distinctive high-risk profile emerged for individuals with a history in-care. Sociocultural factors of colonization and intergenerational transmission of trauma appear to be particularly relevant in the trajectories for individuals of Aboriginal heritage. Given the high prevalence of a history in-care, interventions and policy should reflect the specific vulnerability of this population, particularly in regards to trauma-informed services. Copyright © 2013 Elsevier Ltd. All rights reserved.
Lareau, Suzanne C; Mealer, Meredith
Pulmonary critical care nurses have played a prominent role in the ICUs from the inception of critical care units. This article describes how the history of pulmonary critical care nursing has evolved and discusses a few of the challenges in the years to come: stress imposed by working in a critical care environment, enhancing the care of patients by altering patterns of sedation and promoting early mobilization, and dealing with increasing infection rates.
van Mil, J.W F
The evolving concept of Pharmaceutical Care knows different interpretations in a different countries. In the Netherlands community pharmacists already perform several functions which may be part of the Pharmaceutical Care concept. The Dutch concept of Pharmaceutical care is tested in the TOM and
Thériault, François L; Colman, Ian
Many adults suffering from mental disorders never receive the care they need. The role of family and friends in overcoming mental health treatment barriers is poorly understood. We investigated the association between awareness of lifetime mental health treatment history in one's family or friends, and likelihood of having recently received mental health care for oneself. Using Canadian Community Health Survey 2012-Mental Health data, we defined care seekers as individuals who talked about mental health issues to at least one health professional in the past 12 months. Seekers were matched to non-seekers based on estimated care seeking propensity, and 1933 matched pairs were created. Reported awareness of lifetime treatment history in family and friends was compared between seekers and non-seekers. There were no differences in the distribution of any confounder of interest between seekers and non-seekers. 73% of seekers were aware of treatment history in family or friends, compared to only 56% of non-seekers (RR 1.3; 95% CI 1.2, 1.3). Awareness of treatment history in family members had nearly identical associations with care seeking as awareness of treatment history in friends. We have found a social clustering of mental health care seeking behavior; individuals who were aware of lifetime treatment history in family or friends were more likely to have recently sought care for themselves. These novel results are consistent with a social learning model of care seeking behavior, and could inform efforts to bridge the current mental health treatment gap.
Glintborg, Bente; Andersen, S K; Poulsen, H E
Incomplete medication lists increase the risk of medication errors and adverse drug effects. In Denmark, dispensing data and pharmacy records are available directly online to treating physicians. We aimed (1) to describe if use of pharmacy records improved the medication history among patients...... consulting their general practitioner and (2) to characterise inconsistencies between the medication history reported by the patient and the general practitioner's recordings....
Glintborg, Bente; Andersen, S K; Poulsen, H E
Incomplete medication lists increase the risk of medication errors and adverse drug effects. In Denmark, dispensing data and pharmacy records are available directly online to treating physicians. We aimed (1) to describe if use of pharmacy records improved the medication history among patients co...
Denise Luciana Rieg
Full Text Available This paper presents the results of a survey about the influence of the seller’s performance on the consumer purchase of clothes and personal care, toiletries and cosmetics (HPPC and to compare their results. This study has an exploratory, quantitative and descriptive nature. The samples surveyed were made up of students enrolled in engineering courses of a university located in the State of São Paulo, Brazil. In the case of clothes market, a survey with a sample of 329 respondents was performed through a structured questionnaire. Regarding PHPC, the number of respondents was 317. We used descriptive statistics to describe the basic features of the data and the nonparametric Mann-Whitney test to compare the two sample results (significance level of 5%. The results indicate that, in both sectors, the majority of respondents go to specific stores to carry their purchases. Price, seller’s performance, style and brands are the main factors influencing the consumers’ decision about which store to buy. It was also found that the seller’s performance influences the costumers’ buying decision process and loyalty. Aspects of credibility, interest in customer needs, product knowledge, courtesy and attention were aspects of seller’s performance considered the most important by respondents in both sectors.
Puri, Nitin; Puri, Vinod; Dellinger, R P
Critical care medicine is a young specialty and since its inception has been heavily reliant upon technology. Invasive monitoring has its humble beginnings in the continuous monitoring of heart rate and rhythm. From the development of right heart catheterization to the adaption of the echocardiogram for use in shock, intensivists have used technology to monitor hemodynamics. The care of the critically ill has been buoyed by investigators who sought to offer renal replacement therapy to unstable patients and worked to improve the monitoring of oxygen saturation. The evolution of mechanical ventilation for the critically ill embodies innumerable technological advances. More recently, critical care has insisted upon rigorous testing and cost-benefit analysis of technological advances.
Villadsen, Jakob Waag; Hviid, Pernille
that make up the Danish tradition and its pedagogical methodologies and practices. Yet, due to a strong present-day educational perspective within the center-based child care, along with the application of standardized and evidence-based programs and evaluations, the pedagogical tradition is fundamentally......In this chapter we investigate the role of children’s engagements in pedagogical practices within the field of center-based child care. Based on a historical analysis, it is argued that children’s engagements have played a central and crucial part throughout the varied pedagogical approaches...
Joannna is in the first trimester of her first pregnancy. She has seen her General Practitioner who gave her some general advice about what she should and should not be eating. Aware of her previous medical history, the GP told Joanna to go to the reception desk and to make an appointment for the community midwife to visit her at home to undertake the 'booking'. A week later she received a package of information and a letter from the midwife confirming the appointment time and asking Joanna to produce an early morning specimen of urine (EMSU) on the day of the visit.
Full Text Available The study presented herein represents a field with good present and future perspectives, especially because real estate property is not under the incidence of a single normative act regarding the sale-purchase agreement of such goods, and given the fact that there are specific legal provisions with respect to various real estate categories and the localization of such property. The article deals with the sale-purchase agreement of various real estate categories, such as fields, buildings, the correspondent lots, urban area, farm, and forests fields, focusing on some particularities. A special care is attributed to examining the applicable laws with regard to the purchase agreements of field lands, the special conditions to be taken into account, the persons that may act as buyers, including foreigners, those without citizenship, and legal persons of a nationality other than Romanian. Finally, a special concern is given to the formalities required for legally exerting the pre-emptive right and the applicable sanctions in that respect.
Gilbert, James D J; Manica, Andrea
Insect parental care is extensive and varied, but its life-history implications have never been comparatively tested. Using original and literature data, we tested predictions about egg size, egg number (lifetime fecundity), and body size under different parental care modes across a phylogeny of 287 insect species. Life-history theory and both comparative and intraspecific evidence from ectotherms suggest parental care should select for bigger, fewer eggs, but that allometric scaling of egg size and lifetime fecundity may depend on whether care consists of provisioning (density-dependent offspring survival) or merely guarding (density-independent offspring survival). Against expectation, egg size was indistinguishable among parental care modes, covarying only with body size. This refutes most theory of egg size evolution under parental care. Lifetime fecundity scaled differently depending on parental investment-positively under no care and guarding, as in most ectotherms, but negatively under provisioning. Reproductive allocation in provisioning insects resembled that in mammals and birds, also groups with obligate provisioning. We propose that the metabolic demands of multiple offspring must scale with species body size more steeply than the parent's provisioning capacity, resulting in larger females laying fewer eggs. These patterns lay the groundwork for a more general understanding of parental care and life history.
Wren, Maev-Ann; Connolly, Sheelah
The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.
Siles González, José; Solano Ruiz, Maria Del Carmen
The objective of this study is to describe the evolution of palliative care in order to reflect on the possibility of its origin in primitive cultures and their relationship with the beginnings of the cult of the dead. It describes the change in the symbolic structures and social interactions involved in palliative care during prehistory: functional unit, functional framework and functional element. The theoretical framework is based on cultural history, the dialectical structural model and symbolic interactionism. Categorization techniques, cultural history and dialectic structuralism analyses were performed. Palliative care existed in primitive societies, mostly associated with the rites of passage with a high symbolic content. The social structures - functional unit, functional framework and functional element - are the pillars that supported palliative care in prehistory societies.
Custers, Thomas; Hurley, Jeremiah; Klazinga, Niek S.; Brown, Adalsteinn D.
Background: The Ontario health care system is devolving planning and funding authority to community based organizations and moving from steering through rules and regulations to steering on performance. As part of this transformation, the Ontario Ministry of Health and Long-Term Care (MOHLTC) are
Klug, Hope; Bonsall, Michael B; Alonzo, Suzanne H
Evolutionary transitions among maternal, paternal, and bi-parental care have been common in many animal groups. We use a mathematical model to examine the effect of male and female life-history characteristics (stage-specific maturation and mortality) on evolutionary transitions among maternal, paternal, and bi-parental care. When males and females are relatively similar - that is, when females initially invest relatively little into eggs and both sexes have similar mortality and maturation - transitions among different patterns of care are unlikely to be strongly favored. As males and females become more different, transitions are more likely. If females initially invest heavily into eggs and this reduces their expected future reproductive success, transitions to increased maternal care (paternal → maternal, paternal → bi-parental, bi-parental → maternal) are favored. This effect of anisogamy (i.e., the fact that females initially invest more into each individual zygote than males) might help explain the predominance of maternal care in nature and differs from previous work that found no effect of anisogamy on the origin of different sex-specific patterns of care from an ancestral state of no care. When male mortality is high or male egg maturation rate is low, males have reduced future reproductive potential and transitions to increased paternal care (maternal → paternal, bi-parental → paternal, maternal → bi-parental) are favored. Offspring need (i.e., low offspring survival in the absence of care) also plays a role in transitions to paternal care. In general, basic life-history differences between the sexes can drive evolutionary transitions among different sex-specific patterns of care. The finding that simple life-history differences can alone lead to transitions among maternal and paternal care suggests that the effect of inter-sexual life-history differences should be considered as a baseline scenario when attempting to understand how other
In pronouncements of early childhood education and care (ECEC) policy the importance of quality appears as a seemingly irrefutable concept. Yet, attention to ECEC policy history reveals tensions between discourses that construct quality in ways that endure whereas other ways are ostensibly forgotten. Drawing on a Foucauldian-influenced…
Larsson, Åsa; Hilli, Yvonne
The midwifery profession in Sweden has a history since the early 1700s when government training for midwives began. Midwifery is historically well described, but the idea of caring within midwifery is not described. The aim was to describe the patterns of ideas of caring as they appeared in midwifery during the first half of the 20th century. This study has a hermeneutic approach and the method is history of ideas. Sources of material are taken from the journal Jordemodern (Midwifery), textbooks for midwives, and midwifery regulations. The study has a caring science perspective according to Eriksson. This study is conducted in accordance with the ethical guidelines for good scientific practice issued by The Finnish Advisory Board on Research Integrity. The special demands on approach to the analyzed text in history of ideas have been met. Three themes were identified: Serving as a way of life, Acting in a redemptive spirit, and Having independence with heavy responsibility. The various themes are not refined, but current ideas are woven into the weave that were characteristic of midwifery during the first half of the 20th century. History of ideas is a fruitful method for understanding and re-finding valuable cultural goods. We can once more stress the manner of being within the midwife's profession where inner values, ethos, shape the manner of conduct in the care of women in childbirth. © The Author(s) 2016.
Santos, Neuma; Veiga, Patrícia; Andrade, Renata
The history and physical examination are part of data collection of the Nursing Process. Its implementation is aimed at individualized care, holistic, humane and scientific foundation. The literature review was carried out in indexed databases as LILACS and SciELO, books and journals available in local libraries as published between the years 2000 to 2009. The aim is to describe the importance of clinical history and physical examination in the care provided by nurses. The results of this research will enable nursing students and health professionals can better understand the importance of history taking and physical examination to their professional practice, implement properly all stages of NAS and arouse interest in research on this topic.
Hanghøj, Astrid; Mols, Niels Peter
In this paper we develop a number of hypotheses relating four purchasing capabilities to two measures of purchasings contribution to innovation. The hypotheses are tested with data collected through a websurvey completed by 321 purchasing professionals in Danish production companies. Our results...... show that integrative, relational, innovative,and intelligence capabilities are positively related to innovation. However, relational capabilities are not found to have significant effect on purchasings contribution to supply and practice innovation, i.e. new markets, new suppliers, and new purchasing...... practices. The relationship between intelligence capabilities and purchasings contribution to product and production innovations depends on the level of innovation capabilities....
Gelderman, C.J.; Weele, van A.J.
Purchasing portfolio models have caused considerable controversy in literature. Many advantages and disadvantages have been put forward, revealing a strong disagreement on the merits of portfolio models. This study addresses the question whether or not the use of purchasing portfolio models should
U.S. Environmental Protection Agency — Amounts of fertilizer P2O5 purchased by states in individual years 2003, 2005, 2007, 2009 and 2011, and the % change in average amounts purchased per year from...
U.S. Environmental Protection Agency — Amounts of fertilizer nitrogen (N) purchased by states in individual years 2003, 2005, 2007, 2009 and 2011, and the % change in average amounts purchased per year...
Telgen, Jan; Lamming, R.C.; Grickus, I.
Automation is finding its way in the world of purchasing. This development could evoke dramatic effects in the long term, not only on purchasing but even on the market place itself. Nowadays, EDI and CD-ROM are examples of automation applications that purchasing departments use frequently. Internet
Tzimenatos, Leah; Kim, Emily; Kuppermann, Nathan
In this article, we review the history and progress of a large multicenter research network pertaining to emergency medical services for children. We describe the history, organization, infrastructure, and research agenda of the Pediatric Emergency Care Applied Research Network and highlight some of the important accomplishments since its inception. We also describe the network's strategy to grow its research portfolio, train new investigators, and study how to translate new evidence into practice. This strategy ensures not only the sustainability of the network in the future but the growth of research in emergency medical services for children in general.
Full Text Available Abstract Background Depressive disorders are commonly managed in primary care and family physicians are ideally placed to serve as central providers to these patients. Around the world, the prevalence of depressive disorders in patients presenting to primary care is between 10-20%, of which around 50% remain undiagnosed. In Hong Kong, many barriers exist preventing the optimal treatment and management of patients with depressive disorders. The pathways of care, the long term outcomes and the factors affecting prognosis of these patients requires closer examination. Methods/Design The aim of this study is to examine the prevalence, incidence and natural history of depressive disorders in primary care and the factors influencing diagnosis, management and outcomes using a cross-sectional study followed by a longitudinal cohort study. Doctors working in primary care settings across Hong Kong have been invited to participate in this study. On one day each month over twelve months, patients in the doctor's waiting room are invited to complete a questionnaire containing items on socio-demography, co-morbidity, family history, previous doctor-diagnosed mental illness, recent mental and other health care utilization, symptoms of depression and health-related quality of life. Following the consultation, the doctors provide information regarding presenting problem, whether they think the patient has depression, and if so, whether the diagnosis is new or old, and the duration of the depressive illness if not a new diagnosis. If the doctor detects a depressive disorder, they are asked to provide information regarding patient management. Patients who consent are followed up by telephone at 2, 12, 26 and 52 weeks. Discussion The study will provide information regarding cross-sectional prevalence, 12 month incidence, remission rate, outcomes and factors affecting outcomes of patients with depressive disorders in primary care. The epidemiology, outcomes
To help you find the resource that is right for your organization, EPA conducted a scan of the landscape and developed summary profiles of some of the leading sources of sustainable purchasing guidance around the globe.
To help you find the resource that is right for your organization, EPA conducted a scan of the landscape and developed summary profiles of some of the leading sources of sustainable purchasing guidance around the globe.
Esmaeilpour Majid; Bahmiary Elahe
The intention to purchase green products is the tendency of a person who prefers to purchase a product with optimal environmental characteristics rather than usual products. Nowadays, the environment is very important and maintaining it is a vital issue for all groups of people, whether in the customer's position or in the distributor’s position. However, in spite of the increased environmental awareness among consumers and encouragements made by producers for them to buy green products, we r...
von Bonsdorff, Mikaela B; Rantanen, Taina; Leinonen, Raija
persons aged 66-98 years at death, who, on average 5.8 years prior to death, had participated in an interview about their current and earlier physical activity. Data on the use of care in the last year of life are register-based data and complete. RESULTS: Men needed on average 96 days (SD 7.0) and women.......06-2.43), than for those who had been consistently active from midlife onward, whereas use of hospital care did not correlate with physical activity history. CONCLUSION: People who had been physically active since midlife needed less end-of-life inpatient care but patterns differed between men and women....... had been consistently physically active, whereas use of long-term care did not correlate with physical activity history. Among women, the risk for long-term care was higher for those who had been sedentary (IRR 2.03, 95% CI 1.28-3.21) or only occasionally physically active (IRR 1.60, 95% CI 1...
Nathan, Paul; Ahluwalia, Aneeta; Chorley, Wendy
Breast cancer is the most common cancer diagnosed in women, both in the UK and worldwide. A small proportion of women are at very high risk of breast cancer, having a particularly strong family history. The National Institute for Health and Clinical Excellence (NICE) has advised that practitioners should not, in most instances, actively seek to identify women with a family history of breast cancer. An audit was undertaken at an urban primary care practice of 15,000 patients, using a paper-based, self-administered questionnaire sent to patients identified with a personal history of breast cancer. The aim of this audit was to determine whether using targeted screening of relatives of patients with breast cancer to identify familial cancer risk is worthwhile in primary care. Since these patients might already expected to have been risk assessed following their initial diagnosis, this audit acts as a quality improvement exercise. The audit used a validated family history questionnaire and risk assessment tool as a screening approach for identifying and grading familial risk in line with the NICE guidelines, to guide referral to the familial cancer screening service. The response rate to family history questionnaires was 54 % and the majority of patients responded positively to their practitioner seeking to identify familial cancer risks in their family. Of the 57 returned questionnaires, over a half (54 %) contained pedigrees with individuals eligible for referral. Patients and their relatives who are often registered with the practice welcome the discussion. An appropriate referral can therefore be made. The findings suggest a role for primary care practitioners in the identification of those at higher familial risk. However integrated systems and processes need designing to facilitate this work.
Birt, Linda; Emery, Jon D; Prevost, A Toby; Sutton, Stephen; Walter, Fiona M
Routine family history risk assessment for chronic diseases could enable primary care practitioners to efficiently identify at-risk patients and promote preventive management strategies. To investigate patients' understanding and responses to family history risk assessment in primary care. A mixed methods study set in 10 Eastern England general practices. Participants in a family history questionnaire validation study were triaged into population or increased risk for four chronic diseases (type 2 diabetes, cardiovascular disease, breast cancer, colorectal cancer). Questionnaires completed immediately prior to the family history consultation (baseline) and 4 weeks later (follow-up) assessed the psychological impact, including State-Trait Anxiety Inventory scores. Semi-structured interviews explored the meaning participants gave to their personal familial disease risk. Four hundred and fifty-three participants completed both baseline and follow-up questionnaires and 30 were interviewed. At follow-up, there was no increase in anxiety among either group, or differences between the groups [difference in mean change 0.02, 95% confidence interval -2.04, 2.08, P = 0.98]. There were no significant changes over time in self-rated health in either group. At follow-up, participants at increased risk (n = 153) were more likely to have recent changes to behaviour and they had stronger intentions to make changes to diet (P = 0.001), physical activity (P = 0.006) and to seek further information in the future than those at population risk (n = 300; P assessment for familial risk of chronic diseases may be undertaken in primary care without causing anxiety or reducing self-rated health. Patient responses to family history risk assessment may inform promotion of preventive management strategies. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
The first part of the article looks into the contribution of Christianity to health care in the Middle Ages. In those times, monasteries used to take care of the sick, pilgrims, and travellers. The second part brings interesting information about health care institutions from the church history of Rijeka. Local circumstances favoured setting up an infirmary in St Sebastian's street. Adjacent to the Church of the Assumption was the asylum of the Holy Spirit; the name had remained with the town hospital of Rijeka until 1945. Four fraternities played a major role in local health care: St Mary's, St Michael's, St Vitus', and St John's. Their members helped each other and took care of the weak and the sick. The lazarets of Rijeka, one in Mandrać and the other in Martinšćica, had their own chapels and organised pastoral care. The first bishop of Rijeka, Isidoro Sain, established the Vicariate of St Joseph in the town hospital on 1 January 1928. Health care in Rijeka had strong ties with the Sisters of Mercy, who arrived in the town in 1858 and have been working in a variety of healthcare institutions to this day.
Milliron, Brandy-Joe; Woolf, Kathleen; Appelhans, Bradley M.
Objective: This study tested the efficacy of a multicomponent supermarket point-of-purchase intervention featuring in-person nutrition education on the nutrient composition of food purchases. Design: The design was a randomized trial comparing the intervention with usual care (no treatment). Setting and Participants: A supermarket in a…
US utilities are required to report to the Secretary of Energy annually the country of origin and the seller of any uranium or enriched uranium purchased or imported into the US, as well as the country of origin and seller of any enrichment services purchased by the utility. This report compiles these data and also contains a glossary of terms and additional purchase information covering average price and contract duration. 3 tabs
Skjøtt-Larsen, Tage; Bagchi, Prabir K.
The purpose of this paper is to develop a knowledge and understanding of purchasing practices of SMEs in Denmark. The paper is based on the results from a survey among 94 Danish SMEs, mainly within machinery, electronics and electrical, transportation equipment, and medical equipment industries....... The results are compared with a similar study encompassing 224 SMEs in Indiana, USA. First, the level of purchasing complexity is discussed. There are similarities between the two surveys in terms of purchasing's influence on product quality and productivity, and percentage of total costs. However, the degree...... on the results from the two surveys, we discuss the managerial and research implications for purchasing practices in SMEs....
Purchasing in groups is a concept that is becoming increasingly popular in both the private and public sector. Often, the advantages such as lower purchase pricese, learning from each other, and reduced transaction costs outweigh set-up and management costs and drawbacks such as disclosure of
Groote Schaarsberg, M.; Borm, P.E.M.; Hamers, H.J.M.; Reijnierse, J.H.
Abstract: This paper introduces a new class of interactive cooperative purchasing situations and provides an explicit alternative characterization of the nucleolus of cooperative games, which offers an alternative to Kohlberg (1971). In our cooperative purchasing situation, the unit price of a
Wilson, B J; Carroll, J C; Allanson, J; Little, J; Etchegary, H; Avard, D; Potter, B K; Castle, D; Grimshaw, J M; Chakraborty, P
Family health history (FHH) has potential value in many health care settings. This review discusses the potential uses of FHH information in primary care and the need for tools to be designed accordingly. We developed a framework in which the attributes of FHH tools are mapped against these different purposes. It contains 7 attributes mapped against 5 purposes. In considering different FHH tool purposes, it is apparent that different attributes become more or less important, and that tools for different purposes require different implementation and evaluation strategies. The context in which a tool is used is also relevant to its effectiveness. For FHH tools, it is unlikely that 'one size fits all', although appreciation of different purposes, users and contexts should facilitate the development of different applications from single FHH platforms. Copyright © 2012 S. Karger AG, Basel.
Juliana Jobim Jardim
Full Text Available This literature review reports the history and the current market of oral home-care products. It provides information extending from the products used by our ancestors to those currently available, as well as on the changes in the supply and consumption of these products. Although the scientific knowledge about oral diseases has improved greatly in recent years, our ancestors had already been concerned with cleaning their teeth. A variety of rudimentary products and devices were used since before recorded history, like chewing sticks, tree twigs, bird feathers, animal bones, tooth powder and home-made mouth rinses. Today, due to technological improvements of the cosmetic industry and market competition, home-use oral care products available in the marketplace offer a great variety of options. An increase in the consumption of oral care products has been observed in the last decades. Estimates show that Latin America observed a 12% increase in hygiene and beauty products sales between 2002 and 2003, whereas the observed global rate was approximately 2%. A significant increase in the per capita consumption of toothpaste, toothbrush, mouthrinse and dental floss has been estimated from 1992 to 2002, respectively at rates of 38.3%, 138.3%, 618.8% and 177.2%. Pertaining to this increased supply and consumption of oral care products, some related questions remain unanswered, like the occurrence of changes in disease behavior due to the use of new compounds, their actual efficacy and correct indications, and the extent of the benefits to oral health derived from consuming more products.
Mascia, Daniele; Piconi, Ilaria
Organizational studies widely acknowledge the importance of the relationship between CEO's career histories and managerial performance. Although the health care management literature largely explores the role of CEOs, whether and how top managers' career histories affect their own performance remains still unknown in this industry. The aim of this study was to investigate the career histories of health care CEOs and to explore their impact on managerial performance. Primary data were collected from a sample of 124 CEOs leading health care organizations in the Italian National Health Service in 2008. Biographic data were accessed to gather information about relevant CEOs' demographics and their career histories. The relevance of CEOs' prior experience was considered, taking into account the prominence of health care organizations in which they passed through in their career histories. Regression analyses were employed to assess the impact of CEOs' career histories on their managerial performance. Top managers already appointed as CEOs were more likely to achieve higher levels of performance. Careers with long tenure within the National Health Service appear to increase managerial performance. Those CEOs who accumulated prior experience in a large number of health care structures and who spent time working at the most prominent hospitals were also more likely to achieve higher levels of managerial performance. In health care, a CEO's career history does impact his or her managerial performance. Specifically, patterns of career that imply higher mobility across health care organizations are important. Although interorganizational mobility is significant for CEO performance, the same does not hold for mobility across industries. These findings contribute to the current debate about the need for management renovation within health care organizations.
In order to be able to provide informed, effective and responsive mental health care and to do so in an evidence-based, collaborative and recovery-focused way with those who use mental health services, there is a recognition of the need for mental health professionals to possess sophisticated critical thinking capabilities. This article will therefore propose that such capabilities can be productively situated within the context of the work of the French philosopher Michel Foucault, one of the most challenging, innovative and influential thinkers of the 20th century. However, rather than focusing exclusively upon the content of Foucault's work, it will be suggested that it is possible to discern a general methodological approach across that work, a methodological approach that he refers to as "the history of the present." In doing so, Foucault's history of the present can be understood as a productive, albeit provisional, framework in which to orientate the purpose and process of critical thinking for mental health professionals by emphasizing the need to both historicize and politicize the theoretical perspectives and therapeutic practices that characterize contemporary mental health care. © 2016 John Wiley & Sons Ltd.
Montgomery County of Maryland — This dataset contains a list of items in case units by category and supplier that have been purchased by the Department of Liquor Control in the past month. Update...
Agbaje Astrid B
Full Text Available Abstract Background The CDC's Family History Public Health Initiative encourages adoption and increase awareness of family health history. To meet these goals and develop a personalized medicine implementation science research agenda, the Genomedical Connection is using an implementation research (T3 research framework to develop and integrate a self-administered computerized family history system with built-in decision support into 2 primary care clinics in North Carolina. Methods/Design The family health history system collects a three generation family history on 48 conditions and provides decision support (pedigree and tabular family history, provider recommendation report and patient summary report for 4 pilot conditions: breast cancer, ovarian cancer, colon cancer, and thrombosis. All adult English-speaking, non-adopted, patients scheduled for well-visits are invited to complete the family health system prior to their appointment. Decision support documents are entered into the medical record and available to provider's prior to the appointment. In order to optimize integration, components were piloted by stakeholders prior to and during implementation. Primary outcomes are change in appropriate testing for hereditary thrombophilia and screening for breast cancer, colon cancer, and ovarian cancer one year after study enrollment. Secondary outcomes include implementation measures related to the benefits and burdens of the family health system and its impact on clinic workflow, patients' risk perception, and intention to change health related behaviors. Outcomes are assessed through chart review, patient surveys at baseline and follow-up, and provider surveys. Clinical validity of the decision support is calculated by comparing its recommendations to those made by a genetic counselor reviewing the same pedigree; and clinical utility is demonstrated through reclassification rates and changes in appropriate screening (the primary outcome
Manager of about 50000 public lighting areas, the inter-cities energy syndicate of Loire (SIEL) has started in 2003 a procedure in order to chose his electric power supplier conformably with the new rules of public electricity purchase and with the new organization of the electricity market. This article presents this approach and its experience feedback, concretized by the European call for bids launched by SIEL for the annual purchase of about 186 GWh of electric power. (J.S.)
Vörösmarty, Gyöngyi; Dobos, Imre; Tátrai, Tünde
Sustainability issues in purchasing are receiving greater attention. Literature is rapidly growing, with several research programs being initiated to investigate the topic. This study presents the results of a research project which aims to reveal and structure the motivating forces leading companies to make efforts in sustainability purchasing and the means used to attain achievements in some fields of sustainability. Results presented in the literature are scattered in terms of ...
W.R BUCKINX; D. VAN DEN POEL
This empirical study investigates the contribution of different types of predictors to the purchasing behaviour at an online store. We use logit modelling to predict whether or not a purchase is made during the next visit to the website using both forward and backward variable-selection techniques, as well as Furnival and Wilson’s global score search algorithm to find the best subset of predictors. We contribute to the literature by using variables from four different categories in predicting...
Wetrich, J G
The various types and operational methods of purchasing groups are described, and evaluation of groups is discussed. Since group purchasing is increasing in popularity as a method of controlling drug costs, community and hospital pharmacy managers may need to evaluate various groups to determine the appropriateness of their services. Groups are categorized as independent, system based, or alliance or association based. Instead of "purchasing," some groups develop contracts for hospitals, which then purchase directly from the vendor. Aside from this basic difference between groups that purchase and groups that contract, comparisons among groups are difficult because of the wide variation in sizes and services. Competition developing from diversification among groups has led to "super groups," formed from local and regional groups. In evaluating groups, advantages and disadvantages germane to accomplishing the member's objectives must be considered. To ensure a group's success, members must be committed and support the group's philosophies; hospital pharmacists must help to establish a strong formulary system. To select vendors, groups should develop formal qualification and selection criteria and should not base a decision solely on price. The method of solicitation (bidding or negotiating), as well as the role of the prime vendor, should be studied. Legal implications of group purchasing, especially in the areas of administrative fees and drug diversion, must also be considered. The most advantageous group for each organization will include members with common missions and will be able to implement strategies for future success.
Full Text Available The potential to use data on family history of premature disease to assess disease risk is increasingly recognised, particularly in scoring risk for coronary heart disease (CHD. However the quality of family health information in primary care records is unclear.To assess the availability and quality of family history of CHD documented in electronic primary care records.Cross-sectional study.537 UK family practices contributing to The Health Improvement Network database.Data were obtained from patients aged 20 years or more, registered with their current practice between 1(st January 1998 and 31(st December 2008, for at least one year. The availability and quality of recorded CHD family history was assessed using multilevel logistic and ordinal logistic regression respectively.In a cross-section of 1,504,535 patients, 19% had a positive or negative family history of CHD recorded. Multilevel logistic regression showed patients aged 50-59 had higher odds of having their family history recorded compared to those aged 20-29 (OR:1.23 (1.21 to 1.25, however most deprived patients had lower odds compared to those least deprived (OR: 0.86 (0.85 to 0.88. Of the 140,058 patients with a positive family history recorded (9% of total cohort, age of onset was available in 45%; with data specifying both age of onset and relative affected available in only 11% of records. Multilevel ordinal logistic regression confirmed no statistical association between the quality of family history recording and age, gender, deprivation and year of registration.Family history of CHD is documented in a small proportion of primary care records; and where positive family history is documented the details are insufficient to assess familial risk or populate cardiovascular risk assessment tools. Data capture needs to be improved particularly for more disadvantaged patients who may be most likely to benefit from CHD risk assessment.
Dhiman, Paula; Kai, Joe; Horsfall, Laura; Walters, Kate; Qureshi, Nadeem
The potential to use data on family history of premature disease to assess disease risk is increasingly recognised, particularly in scoring risk for coronary heart disease (CHD). However the quality of family health information in primary care records is unclear. To assess the availability and quality of family history of CHD documented in electronic primary care records. Cross-sectional study. 537 UK family practices contributing to The Health Improvement Network database. Data were obtained from patients aged 20 years or more, registered with their current practice between 1(st) January 1998 and 31(st) December 2008, for at least one year. The availability and quality of recorded CHD family history was assessed using multilevel logistic and ordinal logistic regression respectively. In a cross-section of 1,504,535 patients, 19% had a positive or negative family history of CHD recorded. Multilevel logistic regression showed patients aged 50-59 had higher odds of having their family history recorded compared to those aged 20-29 (OR:1.23 (1.21 to 1.25)), however most deprived patients had lower odds compared to those least deprived (OR: 0.86 (0.85 to 0.88)). Of the 140,058 patients with a positive family history recorded (9% of total cohort), age of onset was available in 45%; with data specifying both age of onset and relative affected available in only 11% of records. Multilevel ordinal logistic regression confirmed no statistical association between the quality of family history recording and age, gender, deprivation and year of registration. Family history of CHD is documented in a small proportion of primary care records; and where positive family history is documented the details are insufficient to assess familial risk or populate cardiovascular risk assessment tools. Data capture needs to be improved particularly for more disadvantaged patients who may be most likely to benefit from CHD risk assessment.
Data reported by domestic nuclear utility companies in their responses to the 1991 through 1993 ''Uranium Industry Annual Survey,'' Form EIA-858, Schedule B,'' Uranium Marketing Activities,'' are provided in response to the requirements in the Energy Policy Act 1992. Appendix A contains an explanation of Form EIA-858 survey methodologies with emphasis on the processing of Schedule B data. Additional information published in this report not included in Uranium Purchases Report 1992, includes a new data table. Presented in Table 1 are US utility purchases of uranium and enrichment services by origin country. Also, this report contains additional purchase information covering average price and contract duration. Table 2 is an update of Table 1 and Table 3 is an update of Table 2 from the previous year's report. The report contains a glossary of terms
Data reported by domestic nuclear utility companies in their responses to the 1991 and 1992 ''Uranium Industry Annual Survey,'' Form EIA-858, Schedule B ''Uranium Marketing Activities,are provided in response to the requirements in the Energy Policy Act 1992. Data on utility uranium purchases and imports are shown on Table 1. Utility enrichment feed deliveries and secondary market acquisitions of uranium equivalent of US DOE separative work units are shown on Table 2. Appendix A contains a listing of firms that sold uranium to US utilities during 1992 under new domestic purchase contracts. Appendix B contains a similar listing of firms that sold uranium to US utilities during 1992 under new import purchase contracts. Appendix C contains an explanation of Form EIA-858 survey methodologies with emphasis on the processing of Schedule B data
Watt, Melissa H; Dennis, Alexis C; Choi, Karmel W; Ciya, Nonceba; Joska, John A; Robertson, Corne; Sikkema, Kathleen J
South African women have disproportionately high rates of both sexual trauma and HIV. To understand how sexual trauma impacts HIV care engagement, we conducted in-depth qualitative interviews with 15 HIV-infected women with sexual trauma histories, recruited from a public clinic in Cape Town. Interviews explored trauma narratives, coping behaviors and care engagement, and transcripts were analyzed using a constant comparison method. Participants reported multiple and complex traumas across their lifetimes. Sexual trauma hindered HIV care engagement, especially immediately following HIV diagnosis, and there were indications that sexual trauma may interfere with future care engagement, via traumatic stress symptoms including avoidance. Disclosure of sexual trauma was limited; no women had disclosed to an HIV provider. Routine screening for sexual trauma in HIV care settings may help to identify individuals at risk of poor care engagement. Efficacious treatments are needed to address the psychological and behavioral sequelae of trauma.
Maclean, Miriam J; Taylor, Catherine L; O'Donnell, Melissa
Studies generally show children who have entered out-of-home care have worse educational outcomes than the general population, although recent research suggests maltreatment and other adversities are major contributing factors. Children's out-of-home care experiences vary and may affect their outcomes. This study examined the influence of placement stability, reunification, type of care, time in care and age at entry to care on children's educational outcomes. We conducted a population-based record-linkage study of children born in Western Australia between 1990 and 2010 who sat State or national Year 3 reading achievement tests (N=235,045 children, including 2160 children with a history of out-of-home care). Children's educational outcomes varied with many aspects of their care experience. Children placed in residential care were particularly likely to have low scores, with an unadjusted OR 6.81, 95% CI[4.94, 9.39] for low reading scores, which was partially attenuated after adjusting for background risk factors but remained significant (OR=1.50, 95% CIs [1.08, 2.08]). Reading scores were also lower for children who had experienced changes in care arrangements in the year of the test. A dose-response effect for multiple placements was expected but not found. Older age at entering care was also associated with worse reading scores. Different characteristics of a child's care history were interwoven with each other as well as child, family and neighbourhood characteristics, highlighting a need for caution in attributing causality. Although the level of educational difficulties varied, the findings suggest a widespread need for additional educational support for children who have entered care, including after reunification. Copyright © 2017 Elsevier Ltd. All rights reserved.
Wood, M E; Flynn, B S; Stockdale, A
Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management. Copyright © 2013 S. Karger AG, Basel.
This article examines the valuable role of group purchasing organizations (GPOs) in hospital purchasing in the United States. For over 100 years old GPOs have helped hospitals and other health care providers realize savings and create contracting efficiencies by aggregating purchasing volume to negotiate discounts with manufacturers, distributors and other vendors. The US has recently enacted a series of healthcare reforms to correct some of the historical concerns regarding cost, quality and access. GPOs are expected to continue to play a critical role in the business of hospital purchasing and may potential export that other countries may wish to examine.
A course was developed to provide data to buyers of new bicycles so they could make an informed decision about their purchases. The instructional systems design process (analysis, design, development, implementation, and evaluation) was used to analyze the need for a training course on buying and fitting a bicycle. Information was collected…
Wagemakers, H.P.; Luijsterburg, P.A.; Boks, S.S.; Heintjes, E.M.; Berger, M.Y.; Verhaar, J.A.; Koes, B.W.; Bierma-Zeinstra, S.M.
Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BK, Bierma-Zeinstra SM. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care. Arch Phys Med Rehabil 2010;91:1452-9. Objective: To
Gabrielli, Joy; Jackson, Yo; Brown, Shaquanna
Substance use (SU) in youth remains a significant public health concern and a risk factor for morbidity and mortality in adolescents. The present study offers examination of the association between severity and chronicity of maltreatment history and SU in youth in foster care. Two hundred and ten (48% female) foster youth with a mean age of 12.71 years (SD = 2.95 years) completed surveys using an audio-computer-assisted self-interview program. Results revealed 31% of participants reported past-year SU, and substance users had a mean CRAFFT score of 3.43 (SD = 1.90). Reported age of SU onset was 11.08 years (SD = 2.21 years). The SU measurement model demonstrated excellent fit in this sample. Accounting for both youth age and youth placement type, the structural model with maltreatment predicting SU severity demonstrated strong model fit with a significant path between maltreatment and SU. Youth in residential facilities and older youth had higher rates of use than those residing in traditional foster home environments and younger youth. Findings provide additional support for the link between maltreatment experiences and SU severity in foster youth and suggest the need for screening and intervention services appropriate for this high-risk population. © The Author(s) 2016.
Weele, van A.J.; Rozemeijer, F.A.; Rietveld, G.; Lamming, R.C.
How does purchasing develops as a discipline over time in large international organisations? What are the drivers and enablers behind the development of purchasing? Is there an ideal growthpath for purchasing in organisations? These subjects are discussed in this paper by, firstly, providing an
Stekelenborg, van R.H.A.; Boer, de L.; Cox, A.; Lamming, R.
The new business environment has confronted purchasing with an increasingly dynamic and un-predictable environment. While purchasing fonnerly could afford to be reactive to changes in demand specifications, supply markets and supply performance results, the new business environment requires
Maradiegue, Ann H; Khan, Fakiha
This study explored the adequacy of depression screening in a community health center. The medical charts of individuals (N = 90) enrolled at a community health center were randomly selected, reviewed, and compared to current standard-of-care guidelines for four elements: family history, screening for depression, control of chronic illnesses, and missed opportunities for preventive care. Family history documentation collected by the providers was limited and 44.4% had no family history. There was no routine depression screening process, although 48.9% of the clients had red flags (warning signals) for depression. Laboratory values used for screening control of chronic disease in the medical records were: fasting glucose levels ⩽100 mg/dL (46%), total cholesterol levels ⩽200 mg/dL (38%), and blood pressure ⩽120/80 mmHg (23%). The results highlight the need to focus on depression screening as part of preventive care and the management of chronic disease in the primary care setting. Copyright 2013, SLACK Incorporated.
Samir B. Kassar
Full Text Available Objective: To identify risk factors for neonatal mortality, focusing on factors related to assistance care during the prenatal period, childbirth, and maternal reproductive history. Methods: This was a case-control study conducted in Maceió, Northeastern Brazil. The sample consisted of 136 cases and 272 controls selected from official Brazilian databases. The cases consisted of all infants who died before 28 days of life, selected from the Mortality Information System, and the controls were survivors during this period, selected from the Information System on Live Births, by random drawing among children born on the same date of the case. Household interviews were conducted with mothers. Results: The logistic regression analysis identified the following as determining factors for death in the neonatal period: mothers with a history of previous children who died in the first year of life (OR = 3.08, hospitalization during pregnancy (OR = 2.48, inadequate prenatal care (OR = 2.49, lack of ultrasound examination during prenatal care (OR = 3.89, transfer of the newborn to another unit after birth (OR = 5.06, admittance of the newborn at the ICU (OR = 5.00, and low birth weight (OR = 2.57. Among the socioeconomic conditions, there was a greater chance for neonatal mortality in homes with fewer residents (OR = 1.73 and with no children younger than five years (OR = 10.10. Conclusion: Several factors that were associated with neonatal mortality in this study may be due to inadequate care during the prenatal period and childbirth, and inadequate newborn care, all of which can be modified. Resumo: Objetivo: Identificar fatores de risco para mortalidade neonatal, com especial atenção aos fatores assistenciais relacionados com os cuidados durante o período pré-natal, parto e história reprodutiva materna. Métodos: Trata-se de um estudo caso-controle realizado em Maceió, Nordeste do Brasil. A amostra consistiu de 136 casos e 272
Overholser, Linda S; Moss, Kerry M; Kilbourn, Kristin; Risendal, Betsy; Jones, Alison F; Greffe, Brian S; Garrington, Timothy; Leonardi-Warren, Kristin; Yamashita, Traci E; Kutner, Jean S
Describe the development and evolution of a primary-care-based, multidisciplinary clinic to support the ongoing care of adult survivors of childhood cancer. A consultative clinic for adult survivors of childhood cancer has been developed that is located in an adult, academic internal medicine setting and is based on a long-term follow-up clinic model available at Children's Hospital Colorado. The clinic opened in July 2008. One hundred thirty-five patients have been seen as of April 2014. Referrals and clinic capacity have gradually increased over time, and a template has been developed in the electronic medical record to help facilitate completion of individualized care plan letters. A primary care-based, multidisciplinary consultative clinic for adults with a history of childhood cancer survivor is feasible and actively engages adult primary care resources to provide risk-based care for long-term pediatric cancer survivors. This model of care planning can help support adult survivors of pediatric cancer and their primary care providers in non-academic, community settings as well. Copyright © 2015 Elsevier Inc. All rights reserved.
Klasa, Katarzyna; Greer, Scott L; van Ginneken, Ewout
Strategic purchasing of health care services is widely recommended as a policy instrument. We conducted a review of literature of material drawn from the European Observatory on Health Systems and Policies Health Systems in Transition series, other European Observatory databases, and selected country-specific literature to augment the comparative analysis by providing the most recent healthcare trends in ten selected countries. There is little evidence of purchasing being strategic according to any of the established definitions. There is little or no literature suggesting that existing purchasing mechanisms in Europe deliver improved population health, citizen empowerment, stronger governance and stewardship, or develop purchaser organization and capacity. Strategic purchasing has not generally been implemented. Policymakers considering adopting strategic purchasing policies should be aware of this systemic implementation problem. Policymakers in systems with strategic purchasing built into policy should not assume that a purchasing system is strategic or that it is delivering any expected objectives. However, there are individual components of strategic purchasing that are worth pursuing and can provide benefits to health systems. Copyright © 2018. Published by Elsevier B.V.
Jianqiang Zhang; Weijun Zhong; Shue Mei
This paper develops a two-period sales model to investigate the competitive effects of purchase-based targeted advertising. In the model, two competing firms gain consumer information during the first period sales, which allows them to target advertising based on consumer purchase history. Advertising is assumed to be persuasive in terms of consumer valuation enhancing and product differentiation increasing. The authors find that the firmâ€™s ability to target can damage industry profits, con...
Ratliff, Patricia; Berryman, Pauline
Systems of coordinating child care services are analyzed as a guide to organizing. Federal Community Child Care (4-C) are the focus of the analysis. In Part I, evolution of coordination, an initial steering committee is followed through its various phases of expansion--initial impetus, visibility, staffing patterns, parent involvement, community…
purchasing and competences required undertaking these activities. Four overall purchasing competence areas were identified. Hence, four propositions related to the purchasing competence were developed by iteratively combining elements from the purchasing literature with an empirical inquiry in an offshore...
Leister,Nathalie; Riesco,Maria Luiza Gonzalez
This study's objective was to gain a greater understanding of the changes that took place in the childbirth care model from the experience of women who gave birth in the State of Sao Paulo, Brazil from the 1940s to the 1980s. This is a descriptive study conducted with 20 women using the Thematic Oral History method. Data were collected through unstructured interviews. The theme extracted from the interviews was "The experience of childbirth". The results indicate a time and generational demar...
Picard, Matthieu; Bégin, Philippe; Bouchard, Hugues; Cloutier, Jonathan; Lacombe-Barrios, Jonathan; Paradis, Jean; Des Roches, Anne; Laufer, Brian; Paradis, Louis
Prescribing antibiotics to patients with a history of penicillin allergy is common in clinical practice. Opting for non-beta-lactam antibiotics has its inconveniences and is often unnecessary, because most of these patients are in fact not allergic. This study aimed to determine how physicians in a large Canadian tertiary-care academic hospital without allergists on staff treat patients with a history of penicillin allergy. A retrospective study was conducted during a 1-year period among all patients hospitalized in the intensive care unit, coronary care unit, and internal medicine wards. Files of patients with a record of penicillin allergy were reviewed to assess the need for antibiotics during their hospitalization and the decision-making process underlying the choice of antibiotic. The additional costs of alternative antibiotics were calculated. The files of 1738 patients admitted over a 1-year period were hand reviewed. A history of penicillin allergy was found in 172 patients (9.9%). The allergic reaction was described in only 30% of cases and left unmentioned in 20.7%. Beta-lactam antibiotics were used on 56 occasions despite a history of penicillin allergy. The use of alternative antibiotics in place of the beta-lactam standard of care carried an additional cost of $15,672 Canadian. Alleged penicillin allergy is common among hospitalized patients and leads to substantial additional costs. Poor documentation of penicillin allergy likely reflects a lack of knowledge on this issue in the medical community, which impairs optimal treatment of these patients. Increased education on this matter is needed, and allergists on staff could be part of the solution. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Hechter, Rulin C; Chao, Chun; Sy, Lina S; Ackerson, Bradley K; Slezak, Jeff M; Sidell, Margo A; Jacobsen, Steven J
We examined whether maternal utilization of preventive care and history of sexually transmitted infections (STIs) predicted quadrivalent human papillomavirus vaccine (HPV4) uptake among adolescent boys 1 year following the recommendation for permissive use of HPV4 for males. We linked maternal information with electronic health records of 254 489 boys aged 9 to 17 years who enrolled in Kaiser Permanente Southern California health plan from October 21, 2009, through December 21, 2010. We used multivariable Poisson regression with robust error variance to examine whether HPV4 initiation was associated with maternal uptake of influenza vaccine, Papanicolaou (Pap) screening, and history of STIs. We identified a modest but statistically significant association between initiation of HPV4 series and maternal receipt of influenza vaccine (rate ratio [RR] = 1.16; 95% confidence interval [CI] = 1.07, 1.26) and Pap screening (RR = 1.13; 95% CI = 1.01, 1.26). Boys whose mothers had a history of genital warts were more likely to initiate HPV4 (RR = 1.47; 95% CI = 0.93, 2.34), although the association did not reach statistical significance (P = .1). Maternal utilization of preventive care and history of genital warts may influence HPV4 uptake among adolescent boys. The important role of maternal health characteristics and health behaviors needs be considered in intervention efforts to increase vaccine uptake among boys.
Plum, Christian Edinger Munk; Neergaard Jensen, Peter; Pisinger, David
The cost for bunker fuel represents a major part of the daily running costs of liner shipping vessels. The vessels, sailing on a fixed roundtrip of ports, can lift bunker at these ports, having differing and fluctuating prices. The stock of bunker on a vessel is subject to a number of operational...... optimally to reduce overall costs. The Bunker Purchasing with Contracts Problem has been formulated as a mixed integer programme, which has been Dantzig-Wolfe decomposed. To solve it, a novel column generation algorithm has been developed. The algorithm has been run on a series of real-world instances...
Up until the 1950s, the history of mathematics was an integral part of the history of science. To George Sarton and his contemporaries, mathematics was the rational skeleton that organized science and held it together, and its history was a fundamental component of the broader history of science. But when historians began focusing on the cultural roots of science rather than its rational structure, the study of mathematics was marginalized and ultimately excluded from the history of science. The alienation between the two fields is detrimental to both, and in recent years there has been a sustained effort to reestablish meaningful communication between the two. This time, however, mathematics is seen not as the static skeleton of science but, instead, as a dynamic and historically evolving field in its own right-just like science itself. The new approach allows for a culturally sensitive study of mathematics, as well as a new and fruitful relationship between the history of science and the history of mathematics. The essays in this Focus section offer a sampling of the new approaches, opening the way to a rapprochement between fields that have gone their separate ways but should by rights be closely interconnected.
In this dissertation, we discuss how buyers practice purchasing strategies in an asymmetric power situation favoring suppliers, and how their purchasing strategies practiced impact their purchasing power and buyer-supplier relationships. Organizations enter exchange relationships to access required resources not produced internally, and are exposed to uncertainty from not being able to fully control or predict flow of resources. Consequently they become dependent on their partners. Their leve...
Emre S. Ozmen
Full Text Available Although micro companies overpower the small and medium enterprise (SME segment, generalizations are often with medium size companies, and therefore, there are many unknowns, especially when it comes to its buying behavior. Conformist studies and industry practices assume SMEs to be “normative” or “conservative” buyers; however, this hypothesis is untested. This article aims to scrutinize the reality, and proposes a unified model that rejects pre-containerization in buying behavior typologies, as well as selectiveness in terms of audience type, whether it is corporate, SME, or consumer. While replacing researchers’ perceptions with the audience’s, the model yields actual knowledge that can lead to audience’s beliefs in lieu of the opposite, which is used to mislead stakeholders. The study shows that SMEs also buy like individuals and spend in a similar way to consumers’, including not only “normative” and “conservative” but also “negligent” and “impulse” zones. From the research-implications perspective, future studies by behaviorists can explore why SMEs purchase in this way. Marketers may benefit from the finding that SMEs buy like individuals. In addition, SMEs may want to be conscious of their purchasing habits, and—utilizing the newly introduced “risk score” frontier—policymakers should assess the consequences of these habits at the macro level.
Fluke, John D; Goldman, Philip S; Shriberg, Janet; Hillis, Susan D; Yun, Katherine; Allison, Susannah; Light, Enid
This article reviews the available evidence regarding the efficacy, effectiveness, ethics, and sustainability of approaches to strengthen systems to care for and protect children living outside family care in low- and middle-income countries. For trafficked children, children of and on the street, children of conflict/disaster, and institutionalized children, a systems framework approach was used to organize the topic of sustainable approaches in low- and middle-income countries and addresses the following: legislation, policies, and regulations; system structures and functions (formal and informal); and continuum of care and services. The article draws on the findings of a focal group convened by the U.S. Government Evidence Summit: Protecting Children Outside of Family Care (December 12-13, 2011, Washington, DC), tasked with reviewing the literature on systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care in low- and middle-income country contexts. The specific methodology for the review is described in the commentary paper (Higgs, Zlidar, & Balster, 2012) that accompanies these papers. For the most part, the evidence base in support of sustainable long-term care for the populations of interest is relatively weak, with some stronger but unreplicated studies. Some populations have been studied more thoroughly than others, and there are many gaps. Most of the existing studies identify population characteristics, needs, and consequences of a lack of systemic services to promote family-like care. There is some evidence of the effectiveness of laws and policies, as well as some evidence of service effectiveness, in improving outcomes for children outside of family care. Despite the weaknesses and gaps of the existing research, there is a foundation of research for going forward, which should focus on developing and implementing systems for these most vulnerable children. The
Galvanese, Ana Tereza Costa; D'Oliveira, Ana Flávia Pires Lucas; Lima, Elizabeth Maria Freire de Araújo; Pereira, Lygia Maria de França; Nascimento, Ana Paula; Nascimento, Andréia de Fátima
By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater São Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.
Wicks, E K; Curtis, R E; Haugh, K
In order to function effectively in post-reform healthcare markets, behavioral healthcare professionals must understand and interact with health purchasing alliances. Healthcare reform initiatives based upon the principles of managed competition envision an important role for cooperative health purchasing organizations, or "health alliances," that collect premiums and contract with health plans for the provision of comprehensive health services delivered within the framework of a standardized benefit package. Health purchasing alliances have already been implemented in eight states, and this trend is expected to grow. The following article illustrates the structure and authority of the health alliances that are already in operation, and is presented here to give Behavioral Healthcare Tomorrow journal readers an up-to-date overview of reforming healthcare markets. This matrix arrays recent state laws which we identify as clearly including components of managed competition or purchasing alliances. Other states undoubtedly have elements of reform that include some aspects of these concepts. For example, under legislation, a Vermont health care authority was established and, among other things, charged with developing two comprehensive reform proposals, one of which will involve multipayors and the other a single-payor system. Options will likely embody many of the activities of alliances. Vermont is not included in this matrix because these provisions are still in the developmental stage.
Morgan, Mary Ann
To discuss the history of cancer survivorship, related quality-of-life issues, and cancer survivorship care plans (CSCPs). CINAHL, PubMed, published articles, and Web sites. A cancer survivor is an individual who has been diagnosed with cancer, regardless of when that diagnosis was received, who is still living. Cancer survivorship is complex and involves many aspects of care. Major areas of concern for survivors are recurrence, secondary malignancies, and long-term treatment sequelae that affect quality of life. Four essential components of survivorship care are prevention, surveillance, intervention, and coordination. A CSCP should address the survivor's long-term care, such as type of cancer, treatments received, potential side effects, and recommendations for follow-up. It should include preventive practices, how to maintain health and well-being, information on legal protections regarding employment and health insurance, and psychosocial services in the community. Survivorship care for patients with cancer requires a multidisciplinary effort and team approach. Enhanced knowledge of long-term complications of survivorship is needed for healthcare providers. Further research on evidence-based practice for cancer survivorship care also is necessary. Nurses can review CSCPs with patients, instruct them when to seek treatment, promote recommended surveillance protocols, and encourage behaviors that lead to cancer prevention and promote well-being for cancer survivors.
Chin Weng; Lam Cindy LK; Wong Samuel YS; Lo Yvonne YC; Fong Daniel YT; Lam Tai; Lee Peter WH; Wong Josephine WS; Chiu Billy CF; Chan Kit TY
Abstract Background Depressive disorders are commonly managed in primary care and family physicians are ideally placed to serve as central providers to these patients. Around the world, the prevalence of depressive disorders in patients presenting to primary care is between 10-20%, of which around 50% remain undiagnosed. In Hong Kong, many barriers exist preventing the optimal treatment and management of patients with depressive disorders. The pathways of care, the long term outcomes and the ...
The principal objective of the project was to participate in the definition of a new IEA task concerning solar procurement (''the Task'') and to assess whether involvement in the task would be in the interest of the UK active solar heating industry. The project also aimed to assess the importance of large scale solar purchasing to UK active solar heating market development and to evaluate the level of interest in large scale solar purchasing amongst potential large scale purchasers (in particular housing associations and housing developers). A further aim of the project was to consider means of stimulating large scale active solar heating purchasing activity within the UK. (author)
Solar Thermal water heating has made little market penetration in some European countries. The main barriers to market development are: Long payback periods for the technology; Difficulties for the end-user in meeting the initial capital costs of the installation; Lack of confidence in the delivered energy that can be expected from the technology. The third barrier has been addressed using the concept of Guaranteed Solar Results (GSR). This project has addressed the other two main barriers using the concept of Solar Results Purchasing, (SRP) which combines GSR with Third Party Financing. The work was carried out in the UK, France, and Spain. The project used a uniform approach across the three countries. Each team calculated solar performance using an English version of the SOLO programme developed by TECSOL in France to encode the methodology for GSR model contracts. (author)
Solar Thermal water heating has made little market penetration in some European countries. The main barriers to market development are: Long payback periods for the technology; Difficulties for the end-user in meeting the initial capital costs of the installation; Lack of confidence in the delivered energy that can be expected from the technology. The third barrier has been addressed using the concept of Guaranteed Solar Results (GSR). This project has addressed the other two main barriers using the concept of Solar Results Purchasing, (SRP) which combines GSR with Third Party Financing. The work was carried out in the UK, France, and Spain. The project used a uniform approach across the three countries. Each team calculated solar performance using an English version of the SOLO programme developed by TECSOL in France to encode the methodology for GSR model contracts. (author)
Kartal, Mehtap; Ozcakar, Nilgun; Hatipoglu, Sehnaz; Tan, Makbule Neslisah; Guldal, Azize Dilek
Screening recommendations of physicians are important for women to raise awareness about their risk factors and to promote appropriate screening behaviors. However, it seems challenging for primary care physicians (PCPs) to balance disease prevention and diagnosis, treatment. The objective of this study was to describe physicians' breast cancer consultancy practice including family history, cancer prevention issues for the women they care. This cross-sectional study included 577 women aged above 45 years, free of breast cancer, during their visits to their PCPs. Nearly half of the women reported their visit to PCPs for an annual examination during the year. Among them, 36.1% had first-degree relatives with cancer and 7.3% with breast cancer. But they reported to be asked about family history of cancer and informed about cancer prevention issues 35.1 and 26.4%, respectively. Cancer still seems to be a hard issue to be discussed, even with women visiting PCPs for annual examination. Asking first-degree relative with breast cancer can give PCPs the chance of determining women with increased risk and support women's appropriate understanding of their own risk in relation to their family history. This routine can make shared-decision making for developing person-centered approach for breast cancer screening possible. Further studies are needed for better understanding of loss of consultancy leadership of physicians for breast cancer.
Hinrichs, Saba; Dickerson, Terry; Clarkson, John
This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.
Maynes, E. Scott; Maynes, Blanche R.
This case study of a used car purchase illuminates the concepts and principles that should guide purchase decisions. It suggests that consumers should be aware there is little correlation between price and quality; competent shopping yields better quality; and consumers must decide their preferred trade-off between price and quality. (SK)
Shahyar Michael Gharacholou
Conclusion: Inpatient GEM was associated with better maintenance of physical function and basic ADLs at hospital discharge; however, no differences in HRQOL or survival were observed between GEM and UC at 1 year post randomization. Restructuring inpatient care models to incorporate inpatient GEM principles may be one method to optimize health-care delivery.
Lum, Jarrad A G; Powell, Martine; Snow, Pamela C
This study examined the extent to which maltreatment history and the characteristics of out-of-home care correlated with the language and social skills of maltreated children. Participants in this study were 82 maltreated children aged between 5 and 12 years of age. All children were residing with state-designated carers in out-of-home-care. The children were presented with standardised tests assessing language and social skills. Results showed that the sample performed significantly below the normative mean on both tests. Correlation analyses showed social skills, but not language skills were correlated with aspects of maltreatment history. The education level of the state-designated carer/s was correlated with the children's language skills; higher education level was associated with higher language skills. The study provides evidence that at the group level, language and social skills are poor in maltreated children. However, gains in language skills might be made via the out-of-home-care environment. Improvements in the social skills of maltreated children may require additional support. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
LoSasso, Alisa Alfonsi; Lamberton, Courtney E; Sammon, Mary; Berg, Katherine T; Caruso, John W; Cass, Jonathan; Hojat, Mohammadreza
To examine whether an intervention on proper use of electronic medical records (EMRs) in patient care could help improve medical students' empathic engagement, and to test the hypothesis that the training would reduce communication hurdles in clinical encounters. Seventy third-year medical students from the Sidney Kimmel Medical College at Thomas Jefferson University were randomly divided into intervention and control groups during their six-week pediatric clerkship in 2012-2013. The intervention group received a one-hour training session on EMR-specific communication skills, including discussion of EMR use, the SALTED mnemonic and technique (Set-up, Ask, Listen, Type, Exceptions, Documentation), and role-plays. Both groups completed the Jefferson Scale of Empathy (JSE) at the clerkship's start and end. At clerkship's end, faculty and standardized patients (SPs) rated students' empathic engagement in SP encounters, using the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and their history-taking and communication skills. Faculty mean ratings on the JSPPPE, history-taking skills, and communication skills were significantly higher for the intervention group than the control group. SP mean ratings on history-taking skills were significantly higher for the intervention group than the control group. Both groups' JSE mean scores increased pretest to posttest, but the changes were not significant. The intervention group's posttest JSE mean score was higher than the control group's, but the difference was not significant. The findings suggest that a simple intervention providing specialized training in EMR-specific communication can improve medical students' empathic engagement in patient care, history-taking skills, and communication skills.
According to national and international guidelines, schools should promote historical thinking and foster moral values. Scholars have debated, but not analysed in depth in practice, whether history education can and should hold a normative dimension. This study analyses current human rights education in two Swedish senior high school groups, in…
The Guide for Purchasing Green Power is a comprehensive guide for current and potential buyers of green power with information about green power purchasing. The Guide is created cooperatively between the EPA, the U.S. Department of Energy, the World Resou
de Boer, L.; Telgen, Jan
The purchasing function is of great importance for the business community as well as for governmental organizations. In industrial companies purchasing already accounts for 60 to 90 percent of total turnover. This share is expected to grow as companies tend to increasingly outsource their non-core
Khan-Mayberry, Noreen; Bassett, Stephanie
This slide presentation reviews the work of the Animal Care Program (ACP). Animals have been used early in space exploration to ascertain if it were possible to launch a manned spacecraft. The program is currently involved in many studies that assist in enhancing the scientific knowledge of the effect of space travel. The responsibilities of the ACP are: (1) Organize and supervise animal care operations & activities (research, testing & demonstration). (2) Maintain full accreditation by the International Association for the Assessment and Accreditation of Laboratory Animal Care (AAALAC) (3) Ensure protocol compliance with IACUC recommendations (4) Training astronauts for in-flight animal experiments (5) Maintain accurate & timely records for all animal research testing approved by JSC IACUC (6) Organize IACUC meetings and assist IACUC members (7) Coordinate IACUC review of the Institutional Program for Humane Care and Use of Animals (every 6 mos)
Bridgeman, Mary Barna; Abazia, Daniel T
The authors review the historical use of medicinal cannabis and discuss the agent's pharmacology and pharmacokinetics, select evidence on medicinal uses, and the implications of evolving regulations on the acute care hospital setting.
Bridgeman, Mary Barna; Abazia, Daniel T.
The authors review the historical use of medicinal cannabis and discuss the agent?s pharmacology and pharmacokinetics, select evidence on medicinal uses, and the implications of evolving regulations on the acute care hospital setting.
Albertyn, R; Berg, A; Numanoglu, A; Rode, H
Burns are very common in sub-Saharan Africa and are considered to be a major health care problem. The management of burns in many African countries is challenged by limited financial resources, inaccessible health care facilities, lack of trained professionals and superstition. These limitations are related to the many burned patients seeking treatment from traditional healers. The use of traditional remedies, plant and animal products are seen as an important aspect of burn management as it is both an affordable and respected treatment modality. Despite its popularity, the use of traditional burn care remedies is faced with many challenges as little research has been done on its effectiveness, dosage and adverse reactions. This paper reviewed the traditions and customs associated with traditional burn care as well as the use of plant, animal and mineral products used by traditional healers. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.
Syurina, Elena V; Gerritsen, Anne-Marie Jm; Hens, Kristien; Feron, Frans Jm
Family history (FH) in Preventive Primary Pediatric Care is to identify children at risk for complex diseases and provide personal preventive strategies. This study was to assess parents' opinion on FH collection. Semi-structured interviews were conducted. Among issues addressed were: former experiences with FH, knowledge about FH, family definition and sharing information about FH. The importance of FH for participants depended on their knowledge, perceived family health status and former experiences. After insight into FH, parents shift to believing it to be important, but certain barriers exist in reporting FH. Parents suggest that the importance of FH should be more emphasized and more trusting relationship with Preventive Primary Pediatric Care should be invested in.
Elizabeth A Phelan
Full Text Available A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ with a history of repeated falls or fall-related healthcare use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79±8 years; 68% were female, and 10% were non-white. They averaged 6 primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall risk factors varied from 24% (for home safety to 78% (for vitamin D. An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21% and home safety (24%. Use of a structured visit note template independently predicted assessment of fall risk factors (P=0.003. Geriatrics specialists were more likely to use a structured note template (p=.04 and perform more fall risk factor assessments (4.6 vs. 3.6, p=.007 than general internists. These results suggest opportunities for improving multifactorial fall risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice.
Swindle, Taren M; Patterson, Zachary; Boden, Carrie J
Studies on factors associated with nutrition practices in early care and education settings often focus on sociodemographic and programmatic characteristics. This qualitative study adapted and applied Belsky's determinants of parenting model to inform a broader exploration of Early Care and Education Teachers (ECETs) practices. Qualitative cross-sectional study with ECETs. The researchers interviewed ECETs in their communities across a Southern state. Purposive sampling was employed to recruit ECETs (n = 28) from Head Start or state-funded centers serving low-income families. Developmental histories of ECETs regarding food and nutrition, beliefs about child nutrition, and teaching interactions related to food. Qualitative interviews were coded using a deductive content analysis approach. Three distinct interrelationships were observed across the themes. First, rules and routines regarding food and mealtime in the educators' childhood often aligned with educator beliefs and behaviors at meals in their classroom. Second, some ECETs described motivations to leave a healthy food legacy for children in their class. Finally, an experience of food insecurity appeared in narratives that also emphasized making sure children got enough through various strategies. The influence of ECET developmental histories and their related beliefs can be addressed through professional development and ongoing support. Future study should quantify model constructs in a larger sample and study their relationships over time. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
A brief history of care for handicapped individuals on Guam is traced from early refusal to acknowledge their existence, to their increased visibility and current efforts toward least restrictive placement for education and care. It is explained that societal attitudes toward the handicapped in Guam are characterized by pity, neglect and repulsion…
The paper is a survey of PPP theory and evidence prepared for the New Palgrave dictionary of economics. Following a statement of the absolute and relative versions of the theory, there is a brief sketch of the history of thought with emphasis on Cassel and the monetary approach. A theoretical part distinguishes structural and transitory deviations from PPP. The main basis for structural deviations is the Ricardo-Harrod-Balassa-Samuelson model of productivity differentials that affect the real...
The stages of life are now many, each having its own boundaries, logic, and a prescribed perspective of appropriate relations amongst and between members of the many stages. Just as there is a developing curriculum for the young, there is a developing curriculum in the area of elder care. Within the paradigm of staged human development, the end…
It was on the eve of the French Revolution, with the trend for health and philanthropy, that the focus on the health of prisoners, including their mental health, started to evolve. However, psychiatric care for prisoners only became widespread after the Second World War.
American Library Association, Chicago, IL.
This book discusses issues to consider when purchasing an encyclopedia and provides reviews of eight print encyclopedias, six CD-ROM encyclopedias, and one online encyclopedia. Each review provides an address and discusses the history, scope and treatment, and quality and currency of the encyclopedia; for CD-ROM encyclopedias, the database…
Varga, Colleen M; Haibach, Michael A; Rowan, Anderson B; Haibach, Jeffrey P
Increasing numbers of U.S. service members access mental health care while deployed and at home station. Multiple deployments carry with them a higher risk of exposure to combat as well as the impact of cumulative stressors associated with separation from family, hostile environments, and high operations tempo. However, mental health care resources continue to be underutilized, potentially because of higher levels of stigma regarding mental health care and concerns about career impact among service members. Some studies indicate that service members who have previously sought mental health care are likely to continue to do so proactively as needed. This study examined the associations between prior deployments, prior mental health treatment, and subsequent career-impacting recommendations (e.g., duty limitations and medical evacuation) among deployed service members seeking mental health care. Materials and. This study is a retrospective review of clinical records from three U.S. military Combat and Operational Stress Control units in Afghanistan. Data were drawn from the mental health records of 1,639 Army service members presenting for outpatient mental health services while deployed in Afghanistan from years 2006 to 2008. In an unadjusted logistic regression model, service members with at least one prior deployment had a 38% greater odds (odds ratio [OR] = 1.38, 95% confidence interval [95% CI] 1.06, 1.80; p mental health treatment had a 57% lower odds (OR = 0.43, 95% CI 0.34, 0.56; p mental health treatment. After adjusting for demographics and number of prior deployments, service members with prior mental health treatment had a 58% lower odds (OR = 0.42, 95% CI 0.33, 0.56; p mental health treatment. Among service members who had a clinical mental health encounter, prior deployment was not associated with career-impacting recommendations and prior mental health treatment appeared to be protective against career-impacting recommendations. These results are in
Patcharanarumol, Walaiporn; Panichkriangkrai, Warisa; Sommanuttaweechai, Angkana; Hanson, Kara; Wanwong, Yaowaluk; Tangcharoensathien, Viroj
Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand's two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants. The Comptroller General Department (CGD) of Ministry of Finance manages CSMBS as one among civil servant welfare programmes. Their purchasing is passive. Fee for service payment for outpatient care has resulted in rapid cost escalation and overspending of their annual budget. In contrast, National Health Security Office (NHSO) manages purchasing for UCS, which undertakes a range of strategic purchasing actions, including applying closed ended provider payment, promoting primary healthcare's gate keeping functions, exercising collective purchasing power and engaging views of members in decision making process. This difference in purchasing arrangements resulted in expenditure per CSMBS member being 4 times higher than UCS in 2014. The governance of the purchaser organization, the design of the purchasing arrangements including incentives and use of information, and the institutional capacities to implement purchasing functions are essential for effective strategic purchasing which can improve health system efficiency as a whole.
Amabile Teresa de Lima Neves; Maria Daniela Corrêa de Macedo
This paper addresses the experience report of accompanying an elderly woman attended by the Specialized Home Care Service (SEAD) of the social assistance network of the municipality of Vitoria, Espirito Santo state, Brazil. Through the Social Assistance Specialized Reference Center (CREAS), SEAD is offered to people with disabilities and older people with some degree of dependency and under situation of violation of human rights, as well as to their caregivers and family. In order to contextu...
National Oceanic and Atmospheric Administration, Department of Commerce — The Commonwealth of Northern Mariana Islands (CNMI), Division of Fish and Wildlife (DFW) collects 'Trip Ticket' or purchase invoice data from vendors that buy fish...
To help you find the resource that is right for your organization, EPA conducted a scan of the landscape and developed summary profiles of some of the leading sources of sustainable purchasing guidance around the globe.
U.S. Department of Health & Human Services — Hospital Value-Based Purchasing (VBP) is part of the Centers for Medicare and Medicaid Services (CMS) long-standing effort to link Medicares payment system to a...
Oct 2, 2011 ... reject the unit root hypothesis in real exchange rates may simply be due to the shortness ..... Violations of Purchasing Power Parity and Their Implications for Efficient ... Official Intervention in the Foreign Exchange Market:.
National Oceanic and Atmospheric Administration, Department of Commerce — DAWR collects Trip Ticket or purchase invoice data from vendors that buy fish directly from the fishermen. Similar to the trip ticket system in Saipan, this is a...
Weele, van A.J.
Increasingly, as European manufacturers face fierce competition from new Asian sources, suppliers are looked to as sources of competitive advantage. This article discusses the strategic role that differentiated purchasing and supply management represents in support of companies overall
Phelan, Elizabeth A.; Aerts, Sally; Dowler, David; Eckstrom, Elizabeth; Casey, Colleen M.
A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice. PMID:27660753
Phelan, Elizabeth A; Aerts, Sally; Dowler, David; Eckstrom, Elizabeth; Casey, Colleen M
A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice.
Carosella, Ann Marie; Ossip-Klein, Deborah J; Watt, Celia A; Podgorski, Carol
In the absence of empirical literature from the resident perspective, this study provided a first assessment of smoking history, knowledge of the risks of smoking, the risks of environmental tobacco exposure, and the benefits of quitting among older (age 50+) nursing home unit residents, as well as readiness to quit, barriers to quitting, frequency of cessation advice by healthcare givers, and quit-attempt history of residents who smoke. Subjects were 25 smokers and 70 non-smokers housed on long-term nursing home units in a county hospital. Results indicated that smoking status for the majority of residents was similar to when they were admitted, although smokers smoked fewer cigarettes (M = 11.6, SD = 9.2) than prior to admission (M = 18.6, SD = 11.8). Smokers were less likely than non-smokers to agree that smoking is harmful to their health. Both smokers and non-smokers were not well informed of the dangers of passive smoke exposure. The majority of smokers were in precontemplation (no interest in quitting within the next 6 months). Fewer than half of residents who smoked reported receiving cessation advice from physicians (40%) or nurses (36%), and no in-house cessation programs were available. These results suggest gaps in knowledge and resources for smoking cessation in this setting and an opportunity for intervention. This study begins to build an evidence base from the residents' perspective that can be used by healthcare providers, administrators, and policy makers in addressing smoking in the nursing home.
Kennedy, Grace A; Forman, Sara F; Woods, Elizabeth R; Hergenroeder, Albert C; Mammel, Kathleen A; Fisher, Martin M; Ornstein, Rollyn M; Callahan, S Todd; Golden, Neville H; Kapphahn, Cynthia J; Garber, Andrea K; Rome, Ellen S; Richmond, Tracy K
Previous research has indicated that patients with anorexia nervosa (AN) or atypical AN with premorbid history of overweight/obesity have greater weight loss and longer illness duration than patients with no such history. However, little is known about the association of premorbid overweight/obesity and receiving inpatient medical care during treatment for an eating disorder. Using logistic regression, we sought to determine if history of overweight/obesity was associated with receiving inpatient medical care in a sample of 522 patients (mean age 15.5 years, 88% female) with AN/atypical AN. Binary results demonstrated greater percent weight loss (27.4% vs. 16.2%) and higher percent median body mass index (%mBMI, 99.8% vs. 85.2%) at presentation in those with a history of overweight/obesity (p obesity was associated with lower odds of receiving inpatient medical care (odds ratio .60 [95% confidence interval: .45-.80]) at 1-year follow-up. However, these associations were no longer significant after adjusting for %mBMI. Mediation results suggest that %mBMI fully mediates the relationship between history of overweight/obesity and inpatient medical care, in that those with a history of overweight/obesity are less likely to receive care due to presenting at a higher weight. Our findings suggest that, despite greater degree of weight loss and no difference in duration of illness, participants with a history of overweight/obesity are less likely to receive inpatient medical care. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Hudson, Angela L; Nandy, Karabi
The purpose of this study was to compare prevalence of substance use, high-risk sexual behaviors, and depression symptoms between homeless youth with and without a history of foster care placement. Approximately 26,000 young persons exit foster care annually in the United States. Once they 'age out' of foster care, however, many young persons do not have access to comprehensive health care. They also are at risk for substance abuse, homelessness, or mental illness. Because persons with a history of foster care are at risk for negative psycho-social outcomes, it is unclear if these young people might be different than homeless youth without this history. The design is descriptive and cross-sectional. A total of 156 homeless young persons, of whom 44 had a history of foster care placement, were recruited from a drop-in center that caters to homeless youth and young adults. The sample was majority male and white; ages were 16-25. Significantly higher proportion of homeless former foster youth used methamphetamine within the last six months compared to non-fostered homeless youth p = 0.03). Homeless former foster youth were significantly older (p = 0.02) and less educated (p = 0.02) than their homeless counterparts without a history of foster care placement. Prevalence of using tobacco, marijuana, alcohol, crack cocaine, and powder cocaine were similar for both groups. Although not significant, a higher proportion of homeless former foster youth reported trading sex for money or drugs compared to non-fostered, homeless youth (19% versus 12% [trading sex for money], and 26% versus 14% [trading sex for drugs], respectively. Findings from this study show that, in general, homelessness is a negative outcome, irrespective of having a foster care history. However, those with that history need continued support when transitioning to independent living, such as access to health care, and encouragement to further their education. It is important that nurses, who serve homeless
Maxwell, James; Temin, Peter; Petigara, Tanaz
State governments are influential purchasers of health benefits but have not been studied extensively. In a recent survey of senior benefit managers, we examine the extent to which states have followed the private-sector approach to purchasing health care. We found that states have adopted "industrial purchasing" practices similar to those of large private employers but offer greater choice of carriers and pay a higher percentage of premiums. Unions continue to influence health care purchasing in both the public and private sectors. Double-digit increases in health costs and the current budget crisis may force states to align their purchasing practices with the private sector to cut costs.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer shall establish and maintain procedures to ensure that all purchased or otherwise received product and...
Reisenwitz, T H; Wimbish, G J
The elderly or senior citizen is a large and growing market segment that purchases a disproportionate amount of health care products, particularly nonprescription products. This study attempts to examine the elderly's level of involvement (high versus low) and their purchase decision process regarding nonprescription or over-the-counter (OTC) products. Frequencies and percentages are calculated to indicate level of involvement as well as purchase decision behavior. Previous research is critiqued and managerial implications are discussed.
Jena, Subhransu S; Alexander, Mathew; Aaron, Sanjith; Mathew, Vivek; Thomas, Maya Mary; Patil, Anil K; Sivadasan, Ajith; Muthusamy, Karthik; Mani, Sunithi; Rebekah, J Grace
Multiple sclerosis (MS) has a spectrum of heterogeneity, as seen in western and eastern hemispheres, in the clinical features, topography of involvement and differences in natural history. To study the clinical spectrum, imaging, and electrophysiological as well as cerebrospinal fluid (CSF) characteristics and correlate them with outcome. Retrospective analysis of MS patients during a period of 20 years. Cases were selected according to recent McDonald's criteria (2010), They were managed in the Department of Neurology, Christian Medical College, Vellore. Chi-square and Fisher's exact tests were used for categorical variables. Multiple binary logistic regressions were done to assess significance. Kaplan-Meier curves were drawn to estimate the time to irreversible disability. A total of 157 patients with female preponderance (55%) were included. The inter quartile range duration of follow-up was 9.1 (8.2, 11) years for 114 patients, who were included for final outcome analysis. Relapsing remitting MS (RRMS) (54.1%) was the most common type of MS seen. RRMS had a significantly better outcome (odds ratio: 0.12, 95% confidence interval: 0.02-0.57, P = 0.008) compared to progressive form of MS (primary progressive, secondary progressive). The Expanded Disability Status Scale score of patients at presentation and at final follow-up was 4.4 ± 1.31 and 4.1 ± 2.31, respectively. During the first presentation, polysymptomatic manifestations like motor and sphincteric involvement, incomplete recovery from the first attack; and, during the disease course, bowel, bladder, cerebellar and pyramidal affliction, predicted a worse outcome. A high incidence of optico-spinal presentation, predominance of RRMS and a low yield on cerebrospinal fluid (CSF) studies are the major findings of our study. A notable feature was the analysis of prognostic markers of disability.
De San Miguel, Kristen; Lewin, Gill; Burton, Elissa; Toye, Christine; Boldy, Duncan; Howat, Peter
Personal alarms support independent living and have the potential to reduce serious consequences after a fall or during a medical emergency. While some Australian states have government funded personal alarm programs, others do not; but user-pays services are available. Although several studies have examined the profiles of alarm users, little is known about the risk profile of non-users. Specifically, whether there are "at risk" individuals who are unable, or choose not to purchase a service, who experience a home-based emergency in which an alarm could have mitigated an adverse outcome. This study aimed to describe the 'risk profile' of purchasers and non-purchasers of alarms; explore the reasons behind the decision to purchase or not to purchase and identify how often emergency assistance was needed and why. Purchasers and non-purchasers were followed for one year in this prospective cohort study. Demographic, decision-making and risk factor data were collected at an initial face-to-face interview, while information about emergencies was collected by monthly calls. One hundred and fifty-seven purchasers and sixty-five non-purchasers completed the study. The risk profiles between the groups were similar in terms of gender, living arrangements, fall history and medical conditions. Purchasers (Mean = 82.6 years) were significantly older than non-purchasers (Mean = 79.3 years), (t(220) = -3.38, p = 0.000) and more functionally dependent on the IADL (z = -2.57, p = 0.010) and ADL (z = -2.45 p = 0.014) function scores. Non-purchasers (Mean = 8.04, SD = 3.57) were more socially isolated with significantly fewer family networks than purchasers (Mean = 9.46, SD = 3.25) (t(220) = -2.86, p = 0.005). Both groups experienced similarly high numbers of emergencies, 38.2 % of purchasers and 41.5 % of non-purchasers had at least one emergency where an alarm could have assisted. Main reasons for non-purchase were: cost (77 %), limited alarm range (51 %), no need (39 %) and lack
Lu, Chueh-Fen; Tung, Ching-Chuan; Ely, Linda
Sponsored by the pilot overseas internships project of the Ministry of Education, Taiwan, the authors and ten undergraduate students from Taiwan visited several mental health facilities in Virginia for one month. These facilities included the Catawba State Hospital, Salem Veteran Affairs Medical Center, Carilion Saint Albans Behavioral Health (New River Valley Medical Center), Warm Hearth Village, Adult & Child Family Counseling private outpatient clinic, the Free Clinic of the New River Valley, New Life Clubhouse, and Self-Government Program for Assertive Community Treatment. In-depth dialogue and participation in nursing care under the supervision of registered nurses facilitated the authors' reflection on mental health care and the roles and functions of Taiwanese nurse practitioners. The present article adopts a macro view in order to compare the related issues between Taiwan and Virginia, including: geographic features, history, culture of health-seeking behavior, healthcare insurance, and the relationships among various professionals. How these issues relate to social-cultural background and how the overall healthcare environment impacts upon the roles of nurse practitioners in Taiwan are rarely discussed in literature. We expect that this cross-cultural contrast and reflection will elicit a better understanding of how these factors have shaped and affected the roles of Taiwanese nurse practitioners. Further, suggestions about how to improve the nursing profession in Taiwan are presented.
Amabile Teresa de Lima Neves
Full Text Available This paper addresses the experience report of accompanying an elderly woman attended by the Specialized Home Care Service (SEAD of the social assistance network of the municipality of Vitoria, Espirito Santo state, Brazil. Through the Social Assistance Specialized Reference Center (CREAS, SEAD is offered to people with disabilities and older people with some degree of dependency and under situation of violation of human rights, as well as to their caregivers and family. In order to contextualize the experience, we intend to explain this specialized service and its particularities with regard to the General Social Assistance Service (SUAS, the National Social Assistance Policy (PNAS, and the state of Espirito Santo - pioneer in its implementation at national level. Also, the debate on the role of Occupational Therapy in this service will be studied more comprehensively in an attempt to address and discuss the methodologies and interventions used by this professional area in this case study, contributing to the literature dedicated to Social Occupational Therapy.
Many in health care may still be technology-shy, but there are big savings to be found in business-to-business e-commerce. Some experts estimate that electronic purchasing can trim 18 to 45 percent of costs out of the health care supply chain. That could revolutionize the $140 billion supply industry--but only if buyers and sellers can get on the same page. A whole host of companies are springing up to make that link. It won't be easy. "Anyone can do online ordering," says Joseph Miccio of NCI Consulting. "The real challenge for these vendors is to simultaneously connect all the players in the supply chain through a common database."
Umapathy, Chandraprakash; Raina, Amit; Saligram, Shreyas; Tang, Gong; Papachristou, Georgios I; Rabinovitz, Mordechai; Chennat, Jennifer; Zeh, Herbert; Zureikat, Amer H; Hogg, Melissa E; Lee, Kenneth K; Saul, Melissa I; Whitcomb, David C; Slivka, Adam; Yadav, Dhiraj
Most studies of acute necrotizing pancreatitis (ANP) focus on short-term outcomes. We evaluated long-term survival and outcomes following ANP. Patients treated for ANP at the University of Pittsburgh Medical Center from 2001 to 2008 were studied. Data on presentation and course during initial hospitalization and follow-up (median 34 months) was extracted. Mean age of patients (n = 167) was 53 ± 16 years; 70 % were male, 94 % white, 71 % transfers, 52 % biliary etiology, and 78 % had first-attack of acute pancreatitis. Majority had severe disease with high Acute Physiology and Chronic Health Evaluation II (APACHE-II) score (median 11), length of stay (median 26 days), intensive care unit (ICU) admission (87 %), presence of systemic inflammatory response syndrome (SIRS) (90 %), persistent organ failure (60 %), and infected necrosis (50 %). Intervention was needed in 74 %. Eighteen (10.8 %) patients died during index hospitalization, 9 (5.4 %) during the first year, and 13 (7.8 %) after 1 year. Median survival was significantly shorter when compared with age- and sex-matched US general population (9.1 vs. 26.1 years, p 50 % necrosis (HR 3.8) were independent predictors of death at 1 year. In eligible patients, new-onset diabetes, oral pancreatic enzyme replacement therapy, and disability were noted in 45, 25, and 53 %, respectively. ANP significantly impacts long-term survival. A high proportion of patients develop functional derangement and disability following ANP.
Despite a booming economy, the number of uninsured Americans is rising. It hit nearly 42 million in 1996. Many of the uninsured work at businesses with fewer than 50 employees. Because small firms have traditionally found it difficult to provide health benefits, purchasing cooperatives have grown in scope and size across the country in recent years. By bringing small businesses together to buy insurance as a group, these organizations can help employers provide greater choice to their workers at a lower cost. However, to operate well in the insurance market, purchasing cooperatives must be well-designed and provided with adequate legal protections.
Lidegaard, Nina; Boer, Harry; Munkgaard Møller, Morten
mature role in corporate strategy. These changes have serious implications for the purchasing process, its characteristics and organisation. Previous research indicates that none of the prevailing solutions, functional departments and cross-functional teams, embedded in a centralised, decentralised...... or hybrid overall structure, deliver the expected results. Contingency theory predicts that the success of a firm depends on the fit among characteristics of, amongst others, the firm’s processes and organisational structure. The objective of this paper is to propose and illustrate a processbased...... typological theory of purchasing and (strategic) sourcing organisation....
... Can’t Grandma Remember My Name? Artwork for Purchase Support Articles Ten Signs of Caregiver Stress Therapeutic ... loved one with Alzheimer’s may be a difficult decision. It is best to make decisions about care ...
Utilization and purchase of medical care services in Mexico by residents in the United States of America, 1998-1999 Utilización y compra de servicios médicos en México por personas que viven en los Estados Unidos de América, 1998-1999
Luis G. Escobedo
Full Text Available OBJECTIVES: We assessed self-reported frequency of purchase of medications and medical care services in Mexico by southern New Mexico (United States, [U.S.] residents in relation to their medical insurance coverage. METHODS: We analyzed data obtained in 1998 and 1999 from a health interview survey of residents in a six-county region of southern New Mexico, using prevalence and logistic regression methods for complex survey data. RESULTS: About 22% of southern New Mexico residents had purchased medications and 11% had sought medical care in Mexico at least once during the year preceding the survey. When we adjusted for the effects of other variables, persons able to pay for services out of pocket and those who were uninsured were more likely than persons who were fully covered to purchase medications or medical care in Mexico. CONCLUSIONS: Large numbers of people residing near the border in New Mexico traveled south to Mexico to purchase medications and medical care. Lack of medical insurance was associated with higher frequencies of these purchases. There seems to be a need to establish relationships between U.S. private and public care plans and Mexican medical care providers to identify appropriate mechanisms for U.S. residents to purchase medical care in Mexico.OBJETIVOS: Evaluamos la frecuencia con que habitantes del sur del estado de Nuevo México, Estados Unidos, autoinformaron de la frecuencia con que compraban medicamentos y servicios médicos en México y examinamos dicha frecuencia a la luz de su cobertura con un seguro médico. MÉTODOS: Analizamos los datos obtenidos en 1998 y 1999 mediante una entrevista de salud de residentes de una región de seis condados en Nuevo México, usando métodos de prevalencia y regresión logística para datos de encuesta complejos. RESULTADOS: Cerca de 22% de los residentes de la parte sur del estado de Nuevo México habían comprado medicinas y 11% habían buscado atención médica en México por lo
Wang, Catharine; Sen, Ananda; Plegue, Melissa; Ruffin, Mack T; O'Neill, Suzanne M; Rubinstein, Wendy S; Acheson, Louise S
This study examines the impact of Family Healthware™ on communication behaviors; specifically, communication with family members and health care providers about family health history. A total of 3786 participants were enrolled in the Family Healthware™ Impact Trial (FHITr) in the United States from 2005-7. The trial employed a two-arm cluster-randomized design, with primary care practices serving as the unit of randomization. Using generalized estimating equations (GEE), analyses focused on communication behaviors at 6month follow-up, adjusting for age, site and practice clustering. A significant interaction was observed between study arm and baseline communication status for the family communication outcomes (p'scommunicating at baseline and those who were not. Among participants who were not communicating at baseline, intervention participants had higher odds of communicating with family members about family history risk (OR=1.24, p=0.042) and actively collecting family history information at follow-up (OR=2.67, p=0.026). Family Healthware™ did not have a significant effect on family communication among those already communicating at baseline, or on provider communication, regardless of baseline communication status. Greater communication was observed among those at increased familial risk for a greater number of diseases. Family Healthware™ prompted more communication about family history with family members, among those who were not previously communicating. Efforts are needed to identify approaches to encourage greater sharing of family history information, particularly with health care providers. Copyright © 2015 Elsevier Inc. All rights reserved.
Wang, Catharine; Sen, Ananda; Plegue, Melissa; Ruffin, Mack T.; O'Neill, Suzanne M.; Rubinstein, Wendy S.; Acheson, Louise S.
Objective This study examines the impact of Family Healthware™ on communication behaviors; specifically, communication with family members and health care providers about family health history. Methods A total of 3786 participants were enrolled in the Family Healthware™ Impact Trial (FHITr) in the United States from 2005-7. The trial employed a two-arm cluster-randomized design, with primary care practices serving as the unit of randomization. Using generalized estimating equations (GEE), analyses focused on communication behaviors at 6 month follow-up, adjusting for age, site and practice clustering. Results A significant interaction was observed between study arm and baseline communication status for the family communication outcomes (psfamily members about family history risk (OR=1.24, p=0.042) and actively collecting family history information at follow-up (OR=2.67, p=0.026). Family Healthware™ did not have a significant effect on family communication among those already communicating at baseline, or on provider communication, regardless of baseline communication status. Greater communication was observed among those at increased familial risk for a greater number of diseases. Conclusion Family Healthware™ prompted more communication about family history with family members, among those who were not previously communicating. Efforts are needed to identify approaches to encourage greater sharing of family history information, particularly with health care providers. PMID:25901453
School administrators are faced with a wide variety of choices and a huge market when it comes to products and technology. According to a report issued in March by market research firm Compass Intelligence, school districts spend over $18 billion annually on IT-related purchases, and the market is projected to grow to nearly $21 billion by 2015.…
The author discusses Houston Lighting and Power Company's procedure for purchasing power from cogenerators. By way of introduction, HL and P is the eighth largest electric utility in the United States in terms of kilowatt-hour sales and the second largest purchaser of natural gas in the nation. HL and P is also the principal utility providing electric service to the massive petrochemical industry in Southeast Texas. Of the 4,800 MW of cogeneration available, HL and P buys 945 MW under firm contracts, wheel 1,600 MW to other utilities, buy 400 MW under non-firm contracts and the balance is self-generation used to displace power which would otherwise be purchased from HL and P. With all this cogeneration capacity available, the problem until recently has been managing the surplus. HL and P now is finding itself in the unaccustomed position of needing to buy additional power or build plants to meet the modest growth it forecasts for Houston. The need for additional capacity coincides with the expiration of cogeneration contracts in 1993 and 1994. To meet this capacity need, they are determined to avoid buying cogeneration at a very high price and on delivery terms which do not reflect realistic benefits to their electric customers. The paper gives information on the background on PUC regulations and legislation, then briefly reviews the procedure for purchase of cogenerated power in Texas
Wicks, E K; Curtis, R E; Haugh, K
HIPCs, or health care purchasing cooperatives, are attracting widespread interest as a key element of the managed competition approach to health reform. HIPCs perform several useful roles for individuals and small employers unable to obtain health insurance coverage in the current system by spreading risk more evenly and purchasing coverage in a given region or market area. While HIPCs are generally associated with managed competition, they are also compatible with reform strategies that require employers to pay for coverage or those that provide incentives for expanded coverage.
Muhammet Ali TİLTAY; Behçet Yalın ÖZKARA
Nonprofit organizations provide products and services via online shopping websites in order to procure financial sources. The consumers that purchase these products and services both make donations and fulfill their needs. This study examines the role of donation motivations and online purchase elements on purchase intention. The study, which has been conducted via taking the online store of the Foundation for Children with Leukemia, lsvdukkan.com, has found out that the online purchase eleme...
Obremskey, William T; Dail, Teresa; Jahangir, A Alex
Health care in the United States is known for its continued innovation and production of new devices and techniques. While the intention of these devices is to improve the delivery and outcome of patient care, they do not always achieve this goal. As new technologies enter the market, hospitals and physicians must determine which of these new devices to incorporate into practice, and it is important these devices bring value to patient care. We provide a model of a physician-engaged process to decrease cost and increase review of physician preference items. We describe the challenges, implementation, and outcomes of cost reduction and product stabilization of a value-based process for purchasing medical devices at a major academic medical center. We implemented a physician-driven committee that standardized and utilized evidence-based, clinically sound, and financially responsible methods for introducing or consolidating new supplies, devices, and technology for patient care. This committee worked with institutional finance and administrative leaders to accomplish its goals. Utilizing this physician-driven committee, we provided access to new products, standardized some products, decreased costs of physician preference items 11% to 26% across service lines, and achieved savings of greater than $8 million per year. The implementation of a facility-based technology assessment committee that critically evaluates new technology can decrease hospital costs on implants and standardize some product lines.
... 2706 of PPACA CPT and RUC Advisor Fellowship Appeals Verification of Benefits Medicare Medicare News MACRA Advance ... JMPT Annual Reports Archives: ACA News Digital Edition Advertising Opportunities Social Media ACA Blogs Podcasts Newsroom Letters ...
aimed at identifying the factors that influence women's decisions to purchase specific .... influence of all the factors influencing their decision to purchase a selected .... one free” promotions seemed to have had the greatest influence on this ...
Purchasing is one of the important aspects to ensure the safety and quality of the nuclear power plant. This paper, combining the purchasing peculiarity and purchasing process of Haiyang nuclear power project, summarizes experiences of Haiyang nuclear power project in promoting its purchasing management level in aspects of purchasing method choosing, purchasing plan management, purchasing process optimization, purchasing contract implementation and purchasing surveillance, etc. (author)
Bejaei, M; Wiseman, K; Cheng, K M
Consumers' interest in specialty eggs appears to be growing in Europe and North America. The objective of this research was to develop logistic regression models that utilise purchaser attributes and demographics to predict the probability of a consumer purchasing a specific type of table egg including regular (white and brown), non-caged (free-run, free-range and organic) or nutrient-enhanced eggs. These purchase prediction models, together with the purchasers' attributes, can be used to assess market opportunities of different egg types specifically in British Columbia (BC). An online survey was used to gather data for the models. A total of 702 completed questionnaires were submitted by BC residents. Selected independent variables included in the logistic regression to develop models for different egg types to predict the probability of a consumer purchasing a specific type of table egg. The variables used in the model accounted for 54% and 49% of variances in the purchase of regular and non-caged eggs, respectively. Research results indicate that consumers of different egg types exhibit a set of unique and statistically significant characteristics and/or demographics. For example, consumers of regular eggs were less educated, older, price sensitive, major chain store buyers, and store flyer users, and had lower awareness about different types of eggs and less concern regarding animal welfare issues. However, most of the non-caged egg consumers were less concerned about price, had higher awareness about different types of table eggs, purchased their eggs from local/organic grocery stores, farm gates or farmers markets, and they were more concerned about care and feeding of hens compared to consumers of other eggs types.
... 39 Postal Service 1 2010-07-01 2010-07-01 false Purchasing policy. 601.100 Section 601.100 Postal Service UNITED STATES POSTAL SERVICE PROCUREMENT SYSTEM FOR THE U.S. POSTAL SERVICE: INTELLECTUAL PROPERTY RIGHTS OTHER THAN PATENTS PURCHASING OF PROPERTY AND SERVICES § 601.100 Purchasing policy. The Postal...
New York State Education Dept., Albany.
Purchasing, one of the most highly specialized activities in school administration, involves securing material or service in the right quantity and quality, at the right time, and for the right price. This handbook, intended as a guide for purchasing agents, details principles essential for operating a school purchasing office in New York State.…
This manual is intended to help create and sustain good relations between purchasers and suppliers of foods and related products. It is designed to guide anyone involved in the purchasing function: purchasing officers and managers in medium and large establishments, food and beverage managers, catering managers, chefs, caterers, restaurateurs,…
... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Purchase guidelines. 813.202 Section 813.202 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS CONTRACTING... Threshold 813.202 Purchase guidelines. Open market micro-purchases shall be equitably distributed among all...
Full Text Available The current research aims to investigate various factors that influence consumers’ intention of buying foreign products. The data were collected by means of self-structured questionnaires from a total of 260 Bangladeshi consumers residing in the two major cities of the country, Dhaka and Chittagong. At the initial stage, statistical analyses, particularly descriptive analysis as well as exploratory factor analysis, were conducted using SPSS, after which structural equation modeling was run by using AMOS. The findings have established that brand image and quality of foreign products carry significant positive influence on purchase intention of foreign products. However, religiosity leaves a significant negative effect on the purchase intention of foreign products. Furthermore, findings have also revealed that the image of the country of origin carries a significant positive effect on brand image but ethnocentrism carries a significant negative effect on perceptions about the quality of foreign products in their purchase intention. The major contribution of the current study is that it focuses on Bangladesh, as there is a vacuum in contemporary literature on this topic in the context of Bangladeshi consumers. The findings derived from the study could facilitate marketers in the creation of effective marketing strategies and at the same time are also valuable for academicians as well as consumers at large.
Muhammet Ali TİLTAY
Full Text Available Nonprofit organizations provide products and services via online shopping websites in order to procure financial sources. The consumers that purchase these products and services both make donations and fulfill their needs. This study examines the role of donation motivations and online purchase elements on purchase intention. The study, which has been conducted via taking the online store of the Foundation for Children with Leukemia, lsvdukkan.com, has found out that the online purchase elements (trust, usefulness, interactivity and altruism motivation are effective on purchase intention. The results of the study will be able to create effective sale strategies for the online stores of nonprofit organizations.
... purchasing credit union may have years of experience dealing with only one or a few originators. These credit...; Purchase, Sale and Pledge of Eligible Obligations; Purchase of Assets and Assumption of Liabilities AGENCY... reorganize the loan participation rule and focus on the purchase side of loan participation transactions. The...
Shpancer, Noam; Schweitzer, Stefanie N.
Data were collected over a 15-year span from three comparable cohorts of students at a Midwestern university about their childcare histories and current attitudes towards non-parental childcare and maternal employment. Across cohorts, a history of non-parental childcare predicted adult attitudes towards non-parental childcare and maternal…
Cohen, Mervyn D.; Alam, Khurshaid
Lack of clinical history on radiology requisitions is a universal problem. We describe a simple Web-based system that readily provides radiology-relevant clinical history to the radiologist reading radiographs of intensive care unit (ICU) patients. Along with the relevant history, which includes primary and secondary diagnoses, disease progression and complications, the system provides the patient's name, record number and hospital location. This information is immediately available to reporting radiologists. New clinical information is immediately entered on-line by the radiologists as they are reviewing images. After patient discharge, the data are stored and immediately available if the patient is readmitted. The system has been in routine clinical use in our hospital for nearly 2 years. (orig.)
Worsley, Anthony; Wang, Wei C; Burton, Melissa
Consumer support for pro environmental food policies and food purchasing are important for the adoption of successful environmental policies. This paper examines consumers' views of food policy options as their predisposition to purchase pro environmental foods along with their likely demographic, educational and cognitive antecedents including food and environmental concerns and universalism values (relating to care for others and the environment). An online survey to assess these constructs was conducted among 2204 Australian adults in November 2011. The findings showed strong levels of support for both environmental food policies (50%-78% support) and pro environmental food purchasing (51%-69% intending to purchase pro environmental foods). Confirmatory factor analysis and structural equation modelling showed that different cognitive mediators exist along pathways between demographics and the two outcome variables. Support for food policy was positively related to food and environment concerns (std. Beta = 0.25), universalism (0.41), perceived control (0.07), and regulatory issues (0.64 but negatively with food security issues (-0.37). Environment purchasing intentions were positively linked to food and nutrition concerns (0.13), food and environment concerns (0.24), food safety concerns (0.19), food and animal welfare concerns (0.16), universalism (0.25), female gender (0.05), education (0.04), and perceived influence over the food system (0.17). In addition, health study in years 11 and 12 was positively related to the beginning of both of these pathways (0.07 for each). The results are discussed in relation to the opportunities that communications based on the mediating variables offer for the promotion of environmental food policies and purchasing. Copyright © 2015 Elsevier Ltd. All rights reserved.
Ruiter, J.S.; Berkenbosch-Nieuwhof, K.; van den Berg, M.P.; van Dijk, R.; Middel, B.; van Tintelen, J.P.
In potentially inherited cardiac diseases, the family history is of great importance. We looked at the way cardiologists take a family history in patients with idiopathic dilated cardiomyopathy (DCM) or long QT syndrome (LQTS) and whether this led to screening of relatives or other follow-up. We
Full Text Available Background. Medical histories are a crucially important diagnostic tool. Elderly patients represent a large and increasing group of emergency patients. Due to cognitive deficits, taking a reliable medical history in this patient group can be difficult. We sought to evaluate the medical history-taking in emergency patients above 75 years of age with respect to duration and completeness. Methods. Anonymous data of consecutive patients were recorded. Times for the defined basic medical history-taking were documented, as were the availability of other sources and times to assess these. Results. Data of 104 patients were included in the analysis. In a quarter of patients (25%, n=26 no complete basic medical history could be obtained. In the group of patients where complete data could be gathered, only 16 patients were able to provide all necessary information on their own. Including other sources like relatives or GPs prolonged the time until complete medical history from 7.3 minutes (patient only to 26.4 (+relatives and 56.3 (+GP minutes. Conclusions. Medical histories are important diagnostic tools in the emergency setting and are prolonged in the elderly, especially if additional documentation and third parties need to be involved. New technologies like emergency medical cards might help to improve the availability of important patient data but implementation of these technologies is costly and faces data protection issues.
Full Text Available The volume of corporate social responsibility (CSR activities is increasing worldwide; the European Union considers CSR to be one of the ways to achieve the most competitive economy and CSR awareness is also rising among companies in the Czech Republic, their customers, and the public. Bearing this in mind, Fairtrade goods, a subset of CSR and sustainable development, is an attractive step for vendors to take towards their customers. In this paper, we try to learn who the buyers of Fairtrade products are and what their motivation is in order to help Fairtrade dealers know their target group better, while at the same time helping expand this target group for organizations such as Fairtrade Czech Republic. We utilize an empirical survey and employ both univariate and bivariate statistical analyses (descriptives, associations, correlations for this purpose. While some previous findings were confirmed, such as (the influence of age and education on Fairtrade purchasing behavior, moral principles and quality of the product being stated as the most important motives to buy Fairtrade products, the significance of the Fairtrade logo and certificate for the buyers’ awareness one was disproved. According to the gathered data, the economic situation of a household does not affect Fairtrade purchasing behavior.
This guide is intended for small to medium commercial customers in Alberta and explains new options for purchasing electricity. Small to medium customers include corner stores, community centres, schools, small office buildings, and light industrial businesses. In the 1990s, private power producers in Alberta built 3,000 megawatts of new generation, adding 30 per cent more supply to the power grid in the province. Prices in the deregulated electricity market have fluctuated with natural gas prices, changing weather and changing power demands. The competitive electricity market was opened on January 1, 2001 in Alberta, offering consumers purchasing choices such as green power, multi-year contracts, or electricity rates under the Regulated Rate Option (RRO). The RRO was a transition mechanism that will end by December 31, 2003 at which time, small to medium commercial customers will have the option to shop around for competitive electricity contracts that provide a fixed price of power over time, or they can opt to stay with their current supplier and receive a regulated flow-through of market prices. Under the flow-through option, risk of future deferral charges is reduced, but electricity prices will probably change between billing periods. 1 fig
Karan Singh Thagunna
Full Text Available The purpose of this study is to identify the various dimensions of buying behavior of Nepalese women while making purchasing decisions. A total of 100 women of different background were surveyed through a questionnaire consisting of 22 questions related to the buying behavior. Various factors such as Value Identification, Customer Service and Lifestyle are most influential for Nepalese women’s purchasing decisions. So, by providing, at affordable price, high value product that match the personality of the targeted women and by providing superior customer care, Nepalese women can be attracted easily. Besides these, price, brand awareness and accurate information also influence their buying behavior to a certain extent. Age also plays a role in the purchasing decisions she makes, since women of different age group behave differently while purchasing items for their homes, for their offices or for personal use. Difference in the demographic factors such as personal status, religious belief, occupation and income level however do not bring difference in the buying behavior of Nepalese women, in general.
Kamravamanesh, Mastaneh; Kohan, Shahnaz; Rezavand, Negin; Farajzadegan, Ziba
Long-term postpartum follow-up is of great importance since women with preeclampsia history are at high risk of upcoming health complications. However, postpartum follow-up rates are poor. According to evidences, preeclampsia is not just a transient health problem; rather it causes short term and long term complications, which affect women's life for years after delivery. Although it seems the problem is solved by the end of pregnancy, the follow-up of subjects should not be stopped after delivery. Postpartum is the best possible time to provide necessary care to these women who are at the risk of future complications. Due to importance of well-designed follow-up plan for women suffering preeclampsia, this study will carry out to provide a postpartum follow-up health care program for subjected women. This study is a qualitative-quantitative mixed sequencing exploratory study that consists of three consecutive phases. In this study, following a qualitative approach, the researcher will explain the needs and strategies related to promoting the health of women with preeclampsia history in the postpartum period. By entering the second phase, the researcher will design a comprehensive follow-up health care program in the postpartum period in which, in addition to using the qualitative study results, related papers and texts will be also used. The proposed program is designed by a panel of experts based on prioritization guidelines. Finally, after passing different stages of program finalizing, its effectiveness on the lifestyle of women with preeclampsia history will be investigated in a semi-experimental study in the third phase of the study. It is expected conducting a mixed method study to design and execute an interventional program to follow up women with preeclampsia history improve their health status and well-being, while reducing their health care costs through prevention in various levels within the current structure of health care services. If this program is
Chockalingam Senthil Nathan
Full Text Available The present study was created in order to customise the marketing mix for non-purchasers of eco-friendly products by studying their perspectives on the introduction of eco-friendly variants of the regular products that they are using in particular product categories (personal care and home care. Overall previous literature reviews in this area imply that there is a gap in the scientific literature on the marketing mix formulation for converting non-purchasers into purchasers of eco-friendly products to augment eco-friendly product sales and adopt green marketing. As literature reviews had clearly indicated that green purchasers have a very low percentage when compared to non-purchasers, the purpose is to create new opportunities for successful green marketing as the study tries to convert non-purchasers into purchasers. We used descriptive research design to study a sample of 885 respondents, who were surveyed in 2 cities in the Tamil Nadu state in India, to acquire an in-depth understanding of consumer behaviour that would enable the consumption of eco-friendly products among non-purchasers. The results reveal the marketing mix requirement and the eco-friendly aspects needed by the non-purchasers in order to buy the eco-friendly variants. The research sheds light on the product, price and promotion components that will attract non-purchases of eco-friendly products to buy eco-friendly products, thus facilitating green marketing mix adaptation. The study will provide valuable input for further research in formulating the marketing mix necessary to enable consumption of eco-friendly products in different geographical locations and various product categories.
Zielke, Stephan; Dobbelstein, Thomas
Purpose – The purpose of this paper is to identify factors influencing customers’ willingness to purchase new store brands. Design/methodology/approach – The paper develops a 3 £ 3 design to investigate the impact of price and quality positioning on the willingness to purchase new store brands in five product groups. A total of 990 respondents completed a questionnaire about store brand perception, aspects of purchasing behavior and willingness to buy. Data are analyzed with analysis...
ELENA SIMA; GEORGE BĂLAN
The partnership is now increasingly used in all areas thanks to the synergy it implies and of the benefits demonstrated. And in today's economy benefits of the partnership are widely recognized. Partnership in purchase makes no exception. This paper presents the benefits of a partnership-based purchases compared to those of traditional purchasing. Less well known is that a partnership built and/or implemented incorrectly and may result in additional costs and thus lead to disadvantages for...
Kuriakose, K.K.; Subramani, M.G.
The details of a computer-based purchase management system developed to meet the specific requirements of Madras Regional Purchase Unit (MRPU) is given. Howe ver it can be easily modified to meet the requirements of any other purchase department. It covers various operations of MRPU starting from indent processing to preparation of purchase orders and reminders. In order to enable timely management action and control facilities are provided to generate the necessary management information reports. The scope for further work is also discussed. The system is completely menu driven and user friendly. Appendix A and B contains the menu implemented and the sample outputs respectively. (author)
Full Text Available The distribution of library purchasing consortia across the United Kingdom is uneven and sector-dependent. Only higher education libraries show a well developed regional infrastructure of purchasing consortia covering virtually all eligible libraries. While there are clear sectoral disparities amongst the library purchasing consortia surveyed, the size of consortium expenditure seems to determine whether procurement professionals are involved. Thus in those whose spend consistently exceeds European Commission guidelines’ thresholds, the involvement of purchasing professionals is much more likely, and also crucial to the successful navigation of such procedures.
Bals, Lydia; Laine, Jari; Mugurusi, Godfrey
this challenge, a comprehensive contingency framework of PSO structures is presented. The framework is based on existing literature on PSO contingency factors as well as analysis of two case companies. The findings highlight the importance of taking a contingency perspective for understanding the PSO...... and combining a detailed view of macro-level structural dimensions with micro-level characteristics. These macro-level dimensions comprise category, business unit, geography and activity. The micro-level characteristics comprise centralization, formalization, specialization, participation and standardization....... From a theoretical perspective, the contingency framework opens up insights that can be leveraged in future studies in the fields of hybrid PSOs, global sourcing organizations, and International Purchasing Offices (IPOs). From a practical standpoint, an assessment of external and internal contingencies...
Peck, Joann; Childers, Terry
What is the role of touch in consumer behavior? Consumers are especially motivated to touch some products before buying them, and for some people, those high in "desire to touch", touching before buying is especially important. In addition, some situations encourage consumers to touch goods before purchasing them. How do these relate to impulse purchases? People high in their "desire to touch" are more likely to make impulse purchases. Point-of-purchase signs that encourage touching a product...
Alcohol is a common target of counterfeiting in Russia. Counterfeit alcohol is defined here as the manufacture, distribution, unauthorized placement (forgery) of protected commodity trademarks, and infringement of the exclusive rights of the registered trademark holders of alcoholic beverages. It is often argued that the expansion of the counterfeit product market is due to the steady demand of economically disadvantaged people for low-priced goods. The situation becomes more complicated once deceptive and nondeceptive forms of counterfeiting are taken into account. This study aimed to identify markers of risky behavior associated with the purchase of counterfeit alcohol in Russia. The analysis relied on consumer self-reports of alcohol use and purchase collected nationwide by the Russia Longitudinal Monitoring Survey (RLMS-HSE) in 2012 to 2014. I used a generalized linear mixed-model logistic regression to identify predictors of risky behavior by consumers who purchased counterfeit alcohol, either knowingly or unknowingly, during the 30 days preceding the survey. Purchases of counterfeit alcohol declined slightly from 2012 to 2014, mainly due to a decrease in consumers mistakenly purchasing counterfeit products. Predictors of counterfeit alcohol purchases differed between consumers who knowingly and unknowingly purchased counterfeit products. Nondeceptive purchase of counterfeit alcohol was related primarily to an indifference to alcohol brands. Consumers with social networks that include drinkers of nonbeverage alcohol and producers of homemade alcohol were highly likely to consume counterfeit alcohol deliberately. Problem drinking was significantly associated with a higher risk of both deceptive and nondeceptive purchases of counterfeit alcohol. Poverty largely contributed to nondeceptive counterfeiting. The literature has overestimated the impact of low prices on counterfeit alcohol consumption. Problem drinking and membership in social networks of consumers
Mehta, Sandhya; Ghosh, Sabyasachi; Sander, Stephen; Kuti, Effie; Mountford, William K
Multiple studies have reported that type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular diseases (CVD), and presence of T2DM and CVD increases risk of death. There is growing interest in examining the effects of antidiabetic treatments on the reduction of cardiovascular events in T2DM adults with a history of CVD and thus at higher risk of cardiovascular events. To estimate the incremental all-cause health care utilization and costs among adults with T2DM and a history of CVD compared with adults without a history of CVD, using a national linked electronic medical records (EMR) and claims database. Adults aged ≥ 18 years with evidence of at least 1 T2DM-related diagnosis code or antidiabetic medication (date of earliest occurrence was defined as the index date) in calendar year 2012 were identified. The population was divided into 2 cohorts (with and without a history of CVD) and followed until the end of their enrollment coverage, death, or 12 months, whichever came first. Multivariable generalized linear models were used to assess differences in health care utilization and per patient per month (PPPM) total costs (plan- and patient-paid amount for health care services) between the 2 groups during the post-index year, while adjusting for an a priori list of demographic and clinical characteristics. A total of 138,018 adults with T2DM was identified, of which 16,547 (12%) had a history of CVD. The unadjusted resource utilization (outpatient: 27.5 vs. 17.8; emergency room [ER]: 0.8 vs. 0.4; inpatient: 0.4 vs. 0.2 days; and total unique drug prescriptions: 10.1 vs. 8.3) and PPPM total health care costs ($2,655.1 vs. $1,435.0) were significantly higher in T2DM adults with a history of CVD versus T2DM adults without a history of CVD. The adjusted models revealed that T2DM adults with a history of CVD had a 31% higher number of ER visits (rate ratio [RR] = 1.31, 95% CI = 1.25-1.37); 27% more inpatient visits (RR = 1.27, 95% CI = 1.21-1.34); 15
Alibekova, Raushan; Huang, Jian-Pei; Chen, Yi-Hua
Objectives To investigate the effects of various measures of prenatal care on adverse pregnancy outcomes in women with a history of infertility. Study Design A retrospective cohort study. Methods Data were derived by linking 2 large nationwide population-based datasets, the National Health Insurance Research Database and Taiwan Birth Certificate Registry. The study sample included 15,056 women with an infertility diagnosis and 60,224 randomly selected women without infertility matched to the study sample by maternal age. A conditional logistic regression analysis was performed for the analysis. Results Women diagnosed with infertility respectively had 1.39 (95% CI, 1.06~1.83), 1.15 (95% CI, 1.08~1.24), 1.13 (95% CI, 1.08~1.18), and 1.08 (95% CI, 1.05~1.12) higher odds of having very low birth weight (VLBW) babies, preterm births, labor complications, and cesarean sections (CSs) compared to women without infertility. Inadequate numbers of total and major prenatal visits and late initiation of prenatal care increased the risks of adverse pregnancy outcomes in women with infertility, especially the risk of a VLBW baby. However, no significant associations were found for the risks of adverse birth outcomes in infertile women with adequate prenatal care compared to fertile women with adequate care. Conclusions Study findings suggest that adequate prenatal care can reduce the risk of adverse pregnancy outcomes in women with infertility. PMID:24358347
Tanenbaum, Sandra J
Value-based purchasing (VBP) is a widely favored strategy for improving the US health care system. The meaning of value that predominates in VBP schemes is (1) conformance to selected process and/or outcome metrics, and sometimes (2) such conformance at the lowest possible cost. In other words, VBP schemes choose some number of "quality indicators" and financially incent providers to meet them (and not others). Process measures are usually based on clinical science that cannot determine the effects of a process on individual patients or patients with comorbidities, and do not necessarily measure effects that patients value; additionally, there is no provision for different patients valuing different things. Proximate outcome measures may or may not predict distal ones, and the more distal the outcome, the less reliably it can be attributed to health care. Outcome measures may be quite rudimentary, such as mortality rates, or highly contestable: survival or function after prostate surgery? When cost is an element of value-based purchasing, it is the cost to the value-based payer and not to other payers or patients' families. The greatest value of value-based purchasing may not be to patients or even payers, but to policy makers seeking a morally justifiable alternative to politically contested regulatory policies. Copyright © 2016 by Duke University Press.
Gelderman, C.J.; Weele, van A.J.
Purchasing portfolio models have spawned considerable discussion in the literature. Many advantages and disadvantages have been put forward, revealing considerable divergence in opinion on the merits of portfolio models. This study addresses the question of whether or not the use of purchasing
This paper reports a pilot study on the relative importance of supplier selection criteria as rated by seafood purchasers for Chinese supermarkets. A sample of 192 supermarkets in Beijing, Shanghai, Guangzhou and Chengdu participated in the study. The purchasers rated product quality as the most...
Wynstra, J.Y.F.; Weggeman, M.C.D.P.; Weele, van A.J.
With increasing outsourcing and the growing importance of product innovation as a means for creating competitive advantage, the integration of purchasing and product development processes has become a key issue for many firms. Although, consequently, the integration of purchasing and suppliers in
Schotanus, Fredo; Telgen, Jan; de Boer, L.
In this article, we identify critical success factors for managing small and intensive purchasing groups by comparing successful and unsuccessful purchasing groups in a large-scale survey. The analysis of our data set suggests the following success factors: no enforced participation, sufficient
... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Purchase guidelines. 13.202 Section 13.202 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING... Threshold 13.202 Purchase guidelines. (a) Solicitation, evaluation of quotations, and award. (1) To the...
... 7 Agriculture 10 2010-01-01 2010-01-01 false Lamb purchases. 1280.217 Section 1280.217 Agriculture... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE LAMB PROMOTION, RESEARCH, AND INFORMATION ORDER Lamb Promotion, Research, and Information Order Assessments § 1280.217 Lamb purchases. (a...
Syurina, Elena V.; Hens, Kristien; Feron, Frans J M
Introduction: Many childhood-onset diseases and developmental disorders have a strong genetic basis. However, up till now, the knowledge of this genetic component within multifactorial diseases is not frequently used in paediatric practice. A good family history collection can facilitate the link
Probability theory is at the base of modern concepts of risk assessment in mental health. The aim of the current paper is to review the key developments in the early history of probability theory in order to enrich our understanding of current risk assessment practices.
Ruiter, Jolien S; Berkenbosch-Nieuwhof, Karin; van den Berg, Maarten P; van Dijk, Rene; Middel, Berrie; van Tintelen, J Peter
In potentially inherited cardiac diseases, the family history is of great importance. We looked at the way cardiologists take a family history in patients with idiopathic dilated cardiomyopathy (DCM) or long QT syndrome (LQTS) and whether this led to screening of relatives or other follow-up. We performed retrospective cross-sectional analyses of adult index patients with DCM or LQTS in a general hospital (GH) or a University Medical Center (UMC). We identified 82 index patients with DCM (34 GH; 48 UMC) and 20 with LQTS (all UMC) between 1996 and 2005. Mean follow-up was 58 months. A family history was recorded in 90% of both LQTS and DCM patients most of the cases restricted to first-degree family members. The genetic aspects, counseling and screening of family members was discussed significantly more often with LQTS than DCM patients (all P family members, DNA analysis and referral) was performed significantly more often in LQTS than DCM patients. Cardiologists in the UMC referred DCM index patients for genetic counseling more often than those in the GH (25% vs. 6%; P familial. Since early recognition and treatment may reduce morbidity and mortality we recommend cardiologists take a more thorough family history and always consider referring to a clinical genetics department in such index patients. (c) 2010 Wiley-Liss, Inc.
Shepherd, Daniel; Csako, Rita; Landon, Jason; Goedeke, Sonja; Ty, Kelly
Parenting a child with autism spectrum disorder (ASD) can be stressful. Understanding parent's perceptions of their stress and their child's ASD-related symptoms is important for both the well-being of parent and child and for other reasons, such as intervention adherence and diagnostic accuracy. We report parent (N = 570) ratings of both their ASD Care-Related Stress scores and their child's symptoms in relation to the child's exposure to five mainstream ASD interventions. Differences across intervention history in the way parents perceive their child's symptoms and rate the stressfulness of performing ASD-related parenting duties were found.
Puddu, M.; Delnoij, D.; McKee, M.; Bachinger, E.; Gurtner, F.; Brand, H.; Busse, R.
Background: Health systems need to address the needs of populations, rather than simply groups of individuals. For third-party payers this implies active purchasing of care, determining the health needs of those for whom they are responsible and defining models of care that meet these needs. This
Roddy, Juliette; Steinmiller, Caren L; Greenwald, Mark K
Semi-structured interviews were used to assess behavioral economic drug demand in heroin dependent research volunteers. Findings on drug price, competing purchases, and past 30-day income and consumption, established in a previous study, are replicated. We extended these findings by having participants indicate whether hypothetical environmental changes would alter heroin purchasing. Participants (n = 109) reported they would significantly (p purchasing amounts (DPA) from past 30-day levels (M = $60/day) if: (a) they encountered a 33% decrease in income (DPA = $34), (b) family/friends no longer paid their living expenses (DPA = $32), or (c) they faced four-fold greater likelihood of police arrest at their purchasing location (DPA = $42). Participants in higher income quartiles (who purchase more heroin) show greater DPA reductions (but would still buy more heroin) than those in lower income quartiles. For participants receiving government aid (n = 31), heroin purchasing would decrease if those subsidies were eliminated (DPA = $28). Compared to participants whose urine tested negative for cocaine (n = 31), cocaine-positive subjects (n = 32) reported more efficient heroin purchasing, that is, they live closer to their primary dealer; are more likely to have heroin delivered or walk to obtain it (and less likely to ride the bus), thus reducing purchasing time (52 vs. 31 min, respectively); and purchase more heroin per episode. These simulation results have treatment and policy implications: Daily heroin users' purchasing repertoire is very cost-effective, more so for those also using cocaine, and only potent environmental changes (income reductions or increased legal sanctions) may impact this behavior. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
Marchisotto, Mary Jane; Harada, Laurie; Kamdar, Opal; Smith, Bridget M; Waserman, Susan; Sicherer, Scott; Allen, Katie; Muraro, Antonella; Taylor, Steve; Gupta, Ruchi S
Mandatory labeling of products with top allergens has improved food safety for consumers. Precautionary allergen labeling (PAL), such as "may contain" or "manufactured on shared equipment," are voluntarily placed by the food industry. To establish knowledge of PAL and its impact on purchasing habits by food-allergic consumers in North America. Food Allergy Research & Education and Food Allergy Canada surveyed consumers in the United States and Canada on purchasing habits of food products featuring different types of PAL. Associations between respondents' purchasing behaviors and individual characteristics were estimated using multiple logistic regression. Of 6684 participants, 84.3% (n = 5634) were caregivers of a food-allergic child and 22.4% had food allergy themselves. Seventy-one percent reported a history of experiencing a severe allergic reaction. Buying practices varied on the basis of PAL wording; 11% of respondents purchased food with "may contain" labeling, whereas 40% purchased food that used "manufactured in a facility that also processes." Twenty-nine percent of respondents were unaware that the law requires labeling of priority food allergens. Forty-six percent were either unsure or incorrectly believed that PAL is required by law. Thirty-seven percent of respondents thought PAL was based on the amount of allergen present. History of a severe allergic reaction decreased the odds of purchasing foods with PAL. Almost half of consumers falsely believed that PAL was required by law. Up to 40% surveyed consumers purchased products with PAL. Understanding of PAL is poor, and improved awareness and guidelines are needed to help food-allergic consumers purchase food safely. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
The challenges facing Ontario consumers in the year 2000 regarding the purchase of electricity are the focus of this paper. As Ontario's electric power industry changes from a monopoly based public service to a competition-driven supply and demand marketplace, consumers in the province will be faced with the complex and difficult task of buying electricity in an open market. Electricity products will be available as commodities in a desegregated state. That is, consumers will be able to buy electricity from a power generator, as well as arranging its transportation and distribution. Consumers will have to understand the cost factors involved and the components which factor into the pricing of electricity. In this context, the paper defines electricity as a commodity and discusses issues such as supply and demand (given that electricity cannot be stored), energy losses, regional markets, impact of externalities, demand elasticity, and hourly pricing. Non-commodity cost factors such as stranded debt, ancillary services, infrastructure and personnel, metering, electricity trading and futures contracts are also reviewed. 19 refs., 2 figs
Santos, Luciana Angélica Vieira; Lara, Maristela Oliveira; Lima, Renata Caroline Ribeiro; Rocha, André Freire; Rocha, Euza Mara; Glória, José Cristiano Ramos; Ribeiro, Gabriela de Cássia
The scope of this research was to analyze the gestational history and prenatal care characteristics of adolescent and adult mothers in a maternity hospital located in a city in Minas Gerais, which is a hospital of reference in the macro-region of health of Jequitinhonha. It involved a descriptive cross-sectional study. A total of 327 mothers were interviewed between May 2013 and March 2014 using a semi-structured questionnaire. With a sample of 255, the number of adult women was predominant. With respect to prenatal care, 324 pregnant women had medical appointments. In terms of the location for prenatal care, 79.2% of adolescents were attended in the public health service, while that percentage was 60.4% among adult women. Regarding the type of birth, 54.7% of mothers had normal delivery and 45% had cesarean section. Among adolescents, there was a higher percentage of normal delivery compared to adult women and this data had a statistically significant relationship with the age of the pregnant women. With respect to gestational age at birth, 85.9% had full-term deliveries, 13.5% had preterm delivery and 0.6% had post-term delivery. It was revealed that adolescent mothers were at a disadvantage compared to the other mothers in terms of both socioeconomic characteristics and prenatal care received.
I examine why South Africa's pioneering Pholela model of primary health care, dating from the 1940s, held such appeal for the country's new policymakers after 1994, and why those policymakers have failed to make it the basis of an effective public health care system since then. In the 1940s, the innovative Pholela experiment had served as such a model, to be replicated gradually throughout the country until a new health care system in its image was finally in place. However, this vision was dashed by the hostility of the mainstream medical profession and, after 1948, even more so by the new apartheid government, causing the idea to wither and become no more than a vanishing memory. In the 1990s, the model resurfaced as part of the country's transition to democracy, eliciting great enthusiasm among a new generation of health policymakers. I conclude by looking at the fate to date of this second coming of the Pholela experiment.
Vesimaeki, P.; Lampinen, J.
Models, designed for planning and optimisation of the purchase of energy, combined with high-quality expertise have an impact on the costs of energy companies. Optimisation has a significant role in power plant investments and in planning the power distribution of wholesale electric power. After the liberation of the electricity markets, the planning of the electricity purchase and the optimisation have obtained totally new roles in estimating the cost effects of present and new customers. Electrowatt-Ekono has developed a windows-based COPSIM software for planning of electric power purchase. The software is in active use in Electrowatt-Ekono. The energy purchase is optimised on yearly basis or on a shorter period by one hour steps based on hourly variation of energy purchase, power plant characteristics, power consumption rates and the prices of the fuels, power and heat. COPSIM takes the effect of external temperature on the power generation of backpressure and gas turbine plants into account. The software optimises also the power distribution of wholesale power. By the software it is possible to model different types of power plants, purchase of power, power sales, different power plant shares, thermal power stations, purchase and sales of heat, heat storage and heat transfer between different heating networks
Full Text Available The purpose of this paper is to determine which variables influence consumers’ intentions towards purchasing natural cosmetics. Several variables are included in the regression analysis such as age, gender, consumers’ purchase tendency towards organic food, consumers’ new natural cosmetics brands and consumers’ tendency towards health consciousness. The data was collected through an online survey questionnaire using the purposive sample of 204 consumers from the Dubrovnik-Neretva County in March and April of 2015. Various statistical analyses were used such as binary logistic regression and correlation analysis. Binary logistic regression results show that gender, consumers’ purchase tendency towards organic food and consumers’ purchase tendency towards new natural cosmetics brands have an influence on consumer purchase intentions. However, consumers’ tendency towards health consciousness has no influence on consumers’ intentions towards purchasing natural cosmetics. Results of the correlation analysis indicate that there is a strong positive correlation between purchase intentions towards natural cosmetics and consumer references of natural cosmetics. The findings may be useful to online retailers, as well as marketers and practitioners to recognize and better understand the new trends that occur in the industry of natural cosmetics.
Atherton, H L; Steels, S L
Knowledge and understanding of how eugenics has historically affected the lives of people with intellectual disabilities is vital if professionals are to mount an effective defence against its contemporary influences. An online survey of European providers of health, social care and pedagogical education and training courses was undertaken to find out how the history of eugenics is taught to those wishing to work in services for people with intellectual disabilities. Two hundred and six educational providers were contacted with a response rate of 35.9% (n = 74). Findings showed that the majority of educational providers recognize the importance of including the history of eugenics in their courses, although fewer feel confident that it is sufficiently well covered to prepare future professionals for their role as protector. Course content differs on both the emphasis given to the different components of this history, time dedicated to its delivery and the extent to which it is used to inform legal and ethical debate. Specific recommendations for developing the way in which this subject area is taught are outlined. © The Author(s) 2015.
Premkumar, Ashish; Raad, Kareem; Haidar, Mona H
The critiques leveled towards medical humanitarianism by the social sciences have yet to be felt in medical education. The elevation of biological suffering, at the detriment of sociopolitical contextualization, has been shown to clearly impact both acute and long-term care of individuals and communities. With many medical students spending a portion of their educational time in global learning experiences, exposure to humanitarianism and its consequences becomes a unique component of biomedical education. How does the medical field reconcile global health education with the critiques of humanitarianism? This paper argues that the medical response to humanitarian reason should begin at the level of a social history. Using experiential data culled from fieldwork with Palestinian and Syrian refugees in Lebanon, the authors argue that an expanded social history, combined with knowledge derived from the social sciences, can have significant clinical implications. The ability to contextualize an individual's disease and life within a complex sociopolitical framework means that students must draw on disciplines as varied as anthropology, sociology, and political history to further their knowledge base. Moreover, situating these educational goals within the framework of physician advocacy can build a strong base in medical education from both a biomedical and activist perspective.
... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Contractor purchasing... SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Management and Operating Contractor Purchasing 970.4402 Contractor purchasing system. ...
Full Text Available This study aims to examine the correlation among perceived benefits, perceived risks and perceived website quality towards online purchasing intention with one of the online store in Singapore. This study used online questionnaire survey to collect 180 completed responses of male and female Singaporean aged 20 and above. The findings showed that there was a significant correlation between perceived benefits, perceived website quality and online purchasing intention while there was no significant correlation between perceived risks and online purchasing intention. Implication and limitation of this study also discussed.
Conclusions Our review shows that for CAHTS to be adopted in mainstream health care, important changes should take place in how we conceive, plan and conduct primary and secondary research on the topic so that we provide the framework for a comprehensive evaluation that will lead to an evidence base to inform policy and practice.
Almas, Alisa N.; Degnan, Kathryn A.; Nelson, Charles A.; Zeanah, Charles H.; Fox, Nathan A.
Young children removed from institutions and placed into foster care or adoptive homes have been shown to experience significant gains in IQ relative to children who remain in institutions. Less is known about the long-term impact of severe early deprivation on development in late childhood. Data are presented from a follow-up of children at 12…
Steenbakkers, Anne; Ellingsen, Ingunn; van der Steen, Stephanie; Grietens, Hans
Youth in family foster care who have experienced sexual abuse have specific psychosocial needs. However, youth themselves are rarely asked about their needs, and it is unknown if caretakers recognize these needs as such. Using Q-methodology, this study aimed to describe what youth consider their
Using as a case study the forensic comparison of images for purposes of identification, this essay considers how the history, philosophy and sociology of science might help courts to improve their responses to scientific and technical forms of expert opinion evidence in ways that are more consistent with legal system goals and values. It places an emphasis on the need for more sophisticated models of science and expertise that are capable of helping judges to identify sufficiently reliable types of expert evidence and to reflexively incorporate the weakness of trial safeguards and personnel into their admissibility decision making. Copyright © 2013. Published by Elsevier Ltd.
Post purchase regret is a negative emotion of consumer after evaluating the purchase decision has been made, the evaluation is conducted based on the outcome and process of consumer decision making. This study was a comparative quantitative study aimed to determine differences on post purchase regret based on unplanned and substitute purchasing behavior. The research hypothesis was the differences in post purchase regret based on unplanned behavior and substitute purchasing. The study involve...
Park, Timothy A.; Florkowski, Wojciech J.
A generalized Heckman model of purchase decisions incorporating perceived consumer quality attributes, ease of purchase, and familiarity with marketing outlets as factors influencing pecan purchases is estimated. Marketing efforts that encourage consumers to expand expenditures on nut products increase both the probability of pecan purchases and the amount purchased. Consumers who use all types of nuts in a wider variety of foods tend to purchase pecans more frequently. A diverse set of marke...
Vegter, Geert J.
Finding purchase activity patterns in Small & Medium Enterprises in a research program to enable SMEs to improve their purchase and company performance. Posterpresentatie KCO conferentie, 16 november 2015.
In this technology education activity, students learn the importance of advertising, conduct a day-long survey of advertising strategies, and design and produce a tabletop point-of-purchase advertisement. (JOW)
Green Power Partnership webinar examining the use of an aggregated model for renewable energy purchases which can lead to significant energy, environmental and financial benefits by addressing administrative cost barriers and leveraging the shared purchasi
Project #OA-FY13-0116, April 11, 2013. The U.S. Environmental Protection Agency, Office of Inspector General, is beginning the fieldwork phase of its audit of the agency’s purchase card and convenience check programs.
J. Loef (Joost); G. Antonides (Gerrit); W.F. van Raaij (Fred)
textabstractSeveral authors have proposed frameworks to help advertisers predict and plan advertising effectiveness. Rossiter and Percy's advertising grid (1997) recommends that the ad appeal should match the purchase motivation or attitude base. They suggest that for utilitarian brands
Full Text Available The influence of the brand on purchase decision has been and is still extensively studied by marketers, researchers, economists, manufacturers (especially the multinational companies. In the present study we aimed to find out if the brand influences the purchase decision of consumers in general (brand products/services. A survey has been conducted in September 2016 on a number of 225 people, residents of Tîrgu Mureş city, from Romania, aged between 15 and 65+. The collected data were analyzed to comply with the obiectives and also to draw conclusions. From the study it is reveal that the purchase decision of a potencial buyer is influenced by a number of factors, in particularly by the quality and price. We chose to study the influence of brand on purchase decision, a very topical subject that can never be fully exhausted.
Khairil Anwar Abu Kassim; Mohd Hafzi Md Isa; Yahaya Ahmad; Intan Osman; Lawrence Arokiasamy
In Malaysia, the car safety level has been elevated through regulations and a consumer-based approach, i.e. the New Car Assessment Program in Southeast Asian Countries (ASEAN NCAP). Nevertheless, the availability of information on consumers' car purchasing decisions towards safety is still limited in Malaysia. Thus, this study was aimed at evaluating consumers' purchasing decisions of their present cars and investigating their awareness of ASEAN NCAP. Self-administered questionnaires were dis...
Mørk, Eirik; Solheim, Kristian Hauge
This paper focuses on Purchasing Social Responsibility (PSR). Suppliers play an important role in the overall corporate social responsibility (CSR) efforts of the purchasing firm. The purpose of this paper is to explore potential firm performance effects from PSR, which contributes to an area of research that is limited at this point. The aim is to develop a survey instrument based on a set of formulated hypotheses and a conceptual framework. These are grounded in a literature review of core ...
Predrag Jovanović; Tamara Vlastelica; Slavica Cicvarić Kostić
Companies use various appeals in their advertising practice to impact consumers’ attitudes and purchase intention by an advertisement. Advertising appeals can be divided into rational or emotional, depending on whether companies want to influence the rational or the emotional motives of the consumer to purchase of the advertised product. Since there is no general pattern for the use of appeals and the success of an advertising message, this study aims to explore the impact of the emotional an...
Matić, Matea; Puh, Barbara
The purpose of this paper is to determine which variables influence consumers’ intentions towards purchasing natural cosmetics. Several variables are included in the regression analysis such as age, gender, consumers’ purchase tendency towards organic food, consumers’ new natural cosmetics brands and consumers’ tendency towards health consciousness. The data was collected through an online survey questionnaire using the purposive sample of 204 consumers from the Dubrovnik-Neretva County in Ma...
Zhang, Zhibai; Bian, Zhicun
Different from popular studies that focus on relative purchasing power parity, we study absolute purchasing power parity (APPP) in 21 main industrial countries. Three databases are used. Both the whole period and the sub-period are analyzed. The empirical proof shows that the phenomenon that APPP holds is common, and the phenomenon that APPP does not hold is also common. In addition, some country pairs and the pooled country data indicate that the nearer the GDPPs of two countries are, the mo...
Qian Liu; Garrett J. van Ryzin
Dynamic pricing offers the potential to increase revenues. At the same time, it creates an incentive for customers to strategize over the timing of their purchases. A firm should ideally account for this behavior when making its pricing and stocking decisions. In particular, we investigate whether it is optimal for a firm to create rationing risk by deliberately understocking products. Then, the resulting threat of shortages creates an incentive for customers to purchase early at higher price...
XIANGPEI HU; HUIMIN WANG; YUNZENG WANG
Costs of many items drop systematically throughout their life-cycles, due to advances in technology and competition. Motivated by the management of service parts for some high-tech products, this paper studies inventory decisions for such items. In a periodic review setting with stochastic demand, we model the purchasing costs of successive periods as a stochastic and decreasing sequence. Unit selling price of the item is determined as some mark-up of the purchasing cost and, hence, will chan...
Bals, Lydia; Turkulainen, Virpi
This paper addresses one of the focal issues in purchasing and supply management – global sourcing – from an organizational design perspective. In particular, we elaborate the traditional classification of global sourcing organization designs into centralized, decentralized, and hybrid models. We...... organization we can identify organization designs beyond the classical centralization-decentralization continuum. We also provide explanations for the observed organization design at GCC. The study contributes to research on purchasing and supply management as well as research on organization design....
Robinson, James C
Innovation in medical technology generates a remarkable supply of new drugs, devices, and diagnostics that improve health, reduce risks, and extend life. But these technologies are too often used on the wrong patient, in the wrong setting, or at an unaffordable price. The only way to moderate the growth in health care costs without undermining the dynamic of medical innovation is to improve the process of assessing, pricing, prescribing, and using new technologies. Purchasing Medical Innovation analyzes the contemporary revolution in the purchasing of health care technology, with a focus on th
Poulos, P.W. Jr.
Adequate radiographic evaluation of the horse relevant to purchase examination requires the successful integration of technique, interpretation, and reporting. A thorough knowledge of lameness and disease can be masked by incorrect interpretation resulting from poor-quality films or an incomplete examination. Thus, care must be taken to produce an adequate number of high-quality films on which to base a report, which allows you to describe changes that are present. This information, coupled with your physical examination, other laboratory data, and the knowledge of the expressed use of the horse will allow you to advise prospective owners on the decision that they will ultimately make
McCue, M J; Furst, R W
This article focuses on the preacquisition financial condition of not-for-profit hospitals acquired by investor-owned hospital chains. Financial ratios are used to determine if not-for-profit hospitals acquired by investor-owned hospital systems have common financial characteristics which make them a likely target for a takeover. The results indicate that during the time period studied, investor-owned hospital systems did tend to purchase hospitals with common financial characteristics and that these characteristics provide a reasonable description of a financially distressed hospital. This finding has important consequences for our health care delivery system. PMID:3771232
Sikkema, Kathleen J; Choi, Karmel W; Robertson, Corne; Knettel, Brandon A; Ciya, Nonceba; Knippler, Elizabeth T; Watt, Melissa H; Joska, John A
This paper describes the development and preliminary trial run of ImpACT (Improving AIDS Care after Trauma), a brief coping intervention to address traumatic stress and HIV care engagement among South African women with sexual trauma histories. We engaged in an iterative process to culturally adapt a cognitive-behavioral intervention for delivery within a South African primary care clinic. This process involved three phases: (a) preliminary intervention development, drawing on content from a prior evidence-based intervention; (b) contextual adaptation of the curriculum through formative data collection using a multi-method qualitative approach; and (c) pre-testing of trauma screening procedures and a subsequent trial run of the intervention. Feedback from key informant interviews and patient in-depth interviews guided the refinement of session content and adaptation of key intervention elements, including culturally relevant visuals, metaphors, and interactive exercises. The trial run curriculum consisted of four individual sessions and two group sessions. Strong session attendance during the trial run supported the feasibility of ImpACT. Participants responded positively to the logistics of the intervention delivery and the majority of session content. Trial run feedback helped to further refine intervention content and delivery towards a pilot randomized clinical trial to assess the feasibility and potential efficacy of this intervention. Copyright © 2018 Elsevier Ltd. All rights reserved.
... for specific medical advice or before making any purchasing decisions involving their care. National Limb Loss Resource ... Events Calendar Search Our Site Donate Memorial/Honor Gift Ways to Give Workplace Giving Program Donate Now ...
Klassen, Brian J; Porcerelli, John H; Sklar, Elyse R; Markova, Tsveti
Screening for psychosocial problems is an effective way to identify children who need further evaluation, and many brief, psychometrically strong measures exist for this purpose. More research is needed, however, about the performance of these measures in special populations who are familiar to primary care settings. The purpose of this study was to examine and compare maternal ratings on the Pediatric Symptom Checklist (PSC) between low-income, urban mothers who had suffered intimate partner violence (IPV) in the past year (n = 23) and a demographically-matched comparison group of mothers (n = 23). Victims of violence rated their children as having significantly more problems in a number of categories (Total PSC Score, Externalizing, and Internalizing) than did mothers in the comparison group. The PSC shows promise as an adequate screening tool for psychosocial problems in the children of women who have suffered IPV, but more research is needed.
... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Option To Purchase....207-5 Option To Purchase Equipment. As prescribed in 7.404, insert a clause substantially the same as the following: Option To Purchase Equipment (FEB 1995) (a) The Government may purchase the equipment...
... 7 Agriculture 11 2010-01-01 2010-01-01 false Purchasing special equipment. 1753.68 Section 1753.68... AGRICULTURE TELECOMMUNICATIONS SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Purchase and Installation of Special Equipment § 1753.68 Purchasing special equipment. (a) General. (1) Equipment purchases are...
... purchaser has a satisfactory record of integrity and business ethics; (5) The purchaser has or is able to... and governmental business commitments; (3) The purchaser has a satisfactory performance record on... applicable laws and regulations. (c) If the prospective purchaser is a small business concern and the...
Shook Mei Chan; Siohong Tih
Background: The purpose of this research is to examine a path model and the mediating effect of perceived communication convenience towards explaining industrial purchasing personnel’s Internet adoption for business purchasing related activities. It involves sequencing paths examining the predictive effect of perceived Internet skills and supplier support on perceived communication convenience. Consequently, perceived communication convenience would influence Internet adoption as commun...
Kimberly A Rosvall
Full Text Available Research on male animals suggests that the hormone testosterone plays a central role in mediating the trade-off between mating effort and parental effort. However, the direct links between testosterone, intrasexual aggression and parental care are remarkably mixed across species. Previous attempts to reconcile these patterns suggest that selection favors behavioral insensitivity to testosterone when paternal care is essential to reproductive success and when breeding seasons are especially short. Females also secrete testosterone, though the degree to which similar testosterone-mediated trade-offs occur in females is much less clear. Here, I ask whether testosterone mediates trade-offs between aggression and incubation in females, and whether patterns of female sensitivity to testosterone relate to female life history, as is often the case in males. I experimentally elevated testosterone in free-living, incubating female tree swallows (Tachycineta bicolor, a songbird with a short breeding season during which female incubation and intrasexual aggression are both essential to female reproductive success. Testosterone-treated females showed significantly elevated aggression, reduced incubation temperatures, and reduced hatching success, relative to controls. Thus, prolonged testosterone elevation during incubation was detrimental to reproductive success, but females nonetheless showed behavioral sensitivity to testosterone. These findings suggest that the relative importance of both mating effort and parental effort may be central to understanding patterns of behavioral sensitivity in both sexes.
Little is known about maltreatment among foster youth transitioning to adulthood. Multiple entries into out-of-home care and unsuccessful attempts at reunification may nevertheless reflect extended exposure to chronic maltreatment and multiple types of victimization. This study used administrative data from the Illinois Department of Children and Family Services to identify all unduplicated allegations of maltreatment in a cohort of 801 foster youth transitioning to adulthood in the state of Illinois. A latent variable modeling approach generated profiles of maltreatment based on substantiated and unsubstantiated reports of maltreatment taken from state administrative data. Four indicators of maltreatment were included in the latent class analysis: multiple types of maltreatment, predominant type of maltreatment, chronicity, and number of different perpetrators. The analysis identified four subpopulations of foster youth in relation to maltreatment. Study findings highlight the heterogeneity of maltreatment in the lives of foster youth transitioning to adulthood and draw attention to a need to raise awareness among service providers to screen for chronic maltreatment and multiple types of victimization. © The Author(s) 2014.
This study considers consumer purchase behaviour toward environmentally friendly products in Japan and focuses on factors which can influence environmentally responsible purchase decision making. The modified theory of planned behaviour based on previous research in the area of environmentally responsible purchase behaviour and ethical purchase decision making is applied to examine factors affecting the purchase decision making and key findings from the present study are highlighted. It can b...
Khairil Anwar Abu Kassim
Full Text Available In Malaysia, the car safety level has been elevated through regulations and a consumer-based approach, i.e. the New Car Assessment Program in Southeast Asian Countries (ASEAN NCAP. Nevertheless, the availability of information on consumers’ car purchasing decisions towards safety is still limited in Malaysia. Thus, this study was aimed at evaluating consumers’ purchasing decisions of their present cars and investigating their awareness of ASEAN NCAP. Self-administered questionnaires were distributed among consumers visiting different car showrooms and dealer shops. The findings suggest that safety was considered as one of the top three factors by the respondents when purchasing their present cars. Awareness of ASEAN NCAP has increased as compared to a previous study. This information is essential for policy makers, manufacturers and other stakeholders to assist in setting priorities with regard to the promotion of car safety in the country.
Full Text Available The partnership is now increasingly used in all areas thanks to the synergy it implies and of the benefits demonstrated. And in today's economy benefits of the partnership are widely recognized. Partnership in purchase makes no exception. This paper presents the benefits of a partnership-based purchases compared to those of traditional purchasing. Less well known is that a partnership built and/or implemented incorrectly and may result in additional costs and thus lead to disadvantages for both companies. For this reason, the paper aims to present what a partnership is, to show which steps should be taken to build a successful partnership and to exemplify through companies which have implemented correctly this type of collaboration, obtaining exceptional results.
Full Text Available Abstract Background Blood pressure (BP lowering in people who have had a stroke or transient ischaemic attack (TIA leads to reduced risk of further stroke. However, it is not clear what the target BP should be, since intensification of therapy may lead to additional adverse effects. PAST BP will determine whether more intensive BP targets can be achieved in a primary care setting, and whether more intensive therapy is associated with adverse effects on quality of life. Methods/Design This is a randomised controlled trial (RCT in patients with a past history of stroke or TIA. Patients will be randomised to two groups and will either have their blood pressure (BP lowered intensively to a target of 130 mmHg systolic, (or by 10 mmHg if the baseline systolic pressure is between 125 and 140 mmHg compared to a standard group where the BP will be reduced to a target of 140 mmHg systolic. Patients will be managed by their practice at 1-3 month intervals depending on level of BP and followed-up by the research team at six monthly intervals for 12 months. 610 patients will be recruited from approximately 50 general practices. The following exclusion criteria will be applied: systolic BP The primary outcome will be change in systolic BP over twelve months. Secondary outcomes include quality of life, adverse events and cardiovascular events. In-depth interviews with 30 patients and 20 health care practitioners will be undertaken to investigate patient and healthcare professionals understanding and views of BP management. Discussion The results of this trial will inform whether intensive blood pressure targets can be achieved in people who have had a stroke or TIA in primary care, and help determine whether or not further research is required before recommending such targets for this population. Trial Registration ISRCTN29062286
Chalmers, Robin L; Wagner, Heidi; Kinoshita, Beth; Sorbara, Luigina; Mitchell, G Lynn; Lam, Dawn; Richdale, Kathryn; Zimmerman, Aaron
To compare the habits of United States (US) soft contact lens (SCL) wearers who bought SCLs from their eye care practitioner (ECP), on the internet/telephone, or at retail (not where they were examined) to test the effect of proximity to the prescriber on SCL wear and care practices. Adult SCL wearers completed an adapted Contact Lens Risk Survey (CLRS) online that queried items related to risk factors for SCL-related complications. Responses from subjects who purchased at the ECP, via the internet/telephone, or at a retail store were compared (Chi-Square). Purchase sources were: ECP 646 (67%, 44±12 yrs, 17% male), Retail 104 (11%, 45±13 yrs, 28% male), and Internet/telephone 218 (23%, 45±12 yrs, 18% male); age (p=0.51), gender (p=0.021). Internet purchasers had fewer annual eye exams (79% ECP, 83% retail, 66% internet/telephone, p=0.007), purchased more hydrogel SCLs (34% ECP, 29% retail, 45% internet/telephone, p=0.0034), and paid for SCLs with insurance less often (39% ECP, 29% retail, 19% internet/telephone, p0.05). In this sample, the purchase location of SCL wearers had limited impact on known risk factors for SCL-related complications. Internet purchasers reported less frequent eye exams and were more likely to be wearing hydrogel SCLs. Closer access to the ECP through in-office SCL purchase did not improve SCL habits or reduce the prevalence of risk behaviors. Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Sri Rejeki Ekasasi
Full Text Available AbstractThe research aimed to investigate the influence of extrinsic cues and intrinsic cues and risk aversion towards purchase intention and post-purchase feeling of counterfeited computer software and music CD. This research study collected data from two populations which are students and employee. Approximately 128 respondents involved to give respond for the survey. The analysis using Structural Equation Model (SEM show that product cues and risk aversion give different significant impact towards purchase intention and post-purchase feeling of counterfeited computer software and music CD. The research concluded that risk aversion and extrinsic cues has a significant influence to purchase intention of counterfeited computer software while it does not appear similar result to music CD. Moreover, the study revealed that for both counterfeited computer software and music CD, the purchase intention is proven to have negative significant influence towards post-purchase feelings.Keywords: risk aversion, extrinsic cues, intrinsic cues, purchase intention, post-purchase feelingsAbstrakTujuan dari penelitian ini adalah untuk melihat pengaruh atribut ekstrinsik dan intrinsic produk serta aspek menolak resiko terhadap niat beli dan perasaan paska beli software computer dan CD music bajakan. Penelitian ini diharapkan akan memperoleh sebuah model dengan pendekatan cultural dan strategi bisnis untuk memblokir atau mengurangi produk bajakan yang dapat diakses konsumen di pasar. Data primer akan dikumpulkan dari dua populasi, kelompok mahasiswa dan kelompok pekerja, dari empat kota besar di Indonesia yaitu Jakarta, Semarang, Surabaya, dan Yogyakarta. Lebih kurang 128 responden terlibat dalam penelitian ini. Hasil penelitian menunjukkan bahwa aspek atribut produk yang bersifat ekstrinsik dan aspek menolak resiko terbukti memiliki hubungan signifikan mempengaruhi niat beli software computer, akan tetapi lain tidak demikian pada niat beli CD music bajakan
Cohen, D A; Lesser, L I
The point of purchase is when people may make poor and impulsive decisions about what and how much to buy and consume. Because point of purchase strategies frequently work through non-cognitive processes, people are often unable to recognize and resist them. Because people lack insight into how marketing practices interfere with their ability to routinely eat healthy, balanced diets, public health entities should protect consumers from potentially harmful point of purchase strategies. We describe four point of purchase policy options including standardized portion sizes; standards for meals that are sold as a bundle, e.g. 'combo meals'; placement and marketing restrictions on highly processed low-nutrient foods; and explicit warning labels. Adoption of such policies could contribute significantly to the prevention of obesity and diet-related chronic diseases. We also discuss how the policies could be implemented, along with who might favour or oppose them. Many of the policies can be implemented locally, while preserving consumer choice. © 2016 World Obesity.
Full Text Available Companies use various appeals in their advertising practice to impact consumers’ attitudes and purchase intention by an advertisement. Advertising appeals can be divided into rational or emotional, depending on whether companies want to influence the rational or the emotional motives of the consumer to purchase of the advertised product. Since there is no general pattern for the use of appeals and the success of an advertising message, this study aims to explore the impact of the emotional and rational advertising appeals on the purchase intention. The results of the empirical research, conducted using the focus groups method, are shown in this paper and the focus group participants were members of the student population.The research results indicate that different advertising appeals may have a different impact on the consumer’s purchase intention; in case of women, the emotional appeal has a stronger impact while for men it is the rational appeal, while “fear appeal” proved to be effective to a certain point, after which it causes selective perception and rejection. This implies that depending on the product, its purpose and target group, advertisers can choose the type of appeal, combination of the appeals and their creative presentation, based on the empirical confirmation of the efficiency the approach.
Salmon, Stefanie J.; Adriaanse, Marieke A.; Fennis, Bob M.; De Vet, Emely; De Ridder, Denise T D
The aim of the present research is to examine the relation between depletion sensitivity - a novel construct referring to the speed or ease by which one's self-control resources are drained - and snack purchase behavior. In addition, interactions between depletion sensitivity and the goal to lose
Full Text Available Fish consumption is a key component in production and marketing decisions. Fish consumers play a key role because fishermen and distributors recognize their purchase choices as a determinant to their operation. Consumers make buying decisions according to market conditions and to various attributes of the product, namely the specie, the form, the place of purchase, the size and the quality. This study is aimed at providing information on Oman consumers’ attitudes and preferences for fish purchase form and market outlets using an information-processing model. It identifies factors for predicting changes in market demand for fish products and services as a result of changes in consumers attributes. Results indicate that on-shore fish markets are the most preferred outlets for the coastal population while retailers and Oman National Fisheries Company are the commonly used outlets. Results also show that whole fish is the most preferred form of purchase for both rural and urban medium to low-income consumers while a large proportion of high-income consumers in urban regions prefer mainly sliced fish. Market development efforts should focus on the organization of on-shore fish markets in coastal regions, and retailers and Oman Fisheries Company’s outlets in the inland areas. Forms other than whole fish may be promoted for sale in supermarkets and specialized shops for the urban high-income consumers group..
Keyes-Evans, O; Woods, A
There may be scope for providers of occupational health (OH) services to improve their communication and marketing to those who purchase their services, but the research literature contains little information about purchasers' perceptions of OH. There is no documented overview that fully captures the purchasers' perspective. To explore current and potential purchasers' thinking about OH. Iterative purposive sampling was carried out to identify participants for semi-structured interviews. Respondents were obtained through progressively wider networking, starting with personal and organizational contacts and networking events. This was continued until no major new information was appearing. Health issues were not always recognized as related to OH. Some respondents had little understanding of OH or perceived it with very negative connotations. Some also sought information at first from the internet and personal contacts. The giving of expert advice on a situation was generally seen as a central feature of OH services. Most believed OH included sickness absence management. Respondents spoke of problems such as insufficient, inappropriate or partisan recommendations and also process or turnaround time problems. Clarity and building good working relationships were identified as positive factors. OH providers should review their various activities to address these points, as well as reviewing the knowledge and skills that their staff can contribute.
Hyland, A; Bauer, J E; Li, Q; Abrams, S M; Higbee, C; Peppone, L; Cummings, K M
To examine cigarette purchasing patterns of current smokers and to determine the effects of cigarette price on use of cheaper sources, discount/generic cigarettes, and coupons. Higher cigarette prices result in decreased cigarette consumption, but price sensitive smokers may seek lower priced or tax-free cigarette sources, especially if they are readily available. This price avoidance behaviour costs states excise tax money and dampens the health impact of higher cigarette prices. Telephone survey data from 3602 US smokers who were originally in the COMMIT (community intervention trial for smoking cessation) study were analysed to assess cigarette purchase patterns, use of discount/generic cigarettes, and use of coupons. 59% reported engaging in a high price avoidance strategy, including 34% who regularly purchase from a low or untaxed venue, 28% who smoke a discount/generic cigarette brand, and 18% who report using cigarette coupons more frequently that they did five years ago. The report of engaging in a price avoidance strategy was associated with living within 40 miles of a state or Indian reservation with lower cigarette excise taxes, higher average cigarette consumption, white, non-Hispanic race/ethnicity, and female sex. Data from this study indicate that most smokers are price sensitive and seek out measures to purchase less expensive cigarettes, which may decrease future cessation efforts.
Parental influence on consumer and purchase behaviour of Generation Y. 21 ... Department of Marketing Management. University of Pretoria ... The decision, however, in making ... exactly what role social environment and ... influences on the younger Generation Y are very .... as parents, peers, the mass media, retail stores,.
C.G. Koedijk (Kees); B. Tims (Ben); M.A. van Dijk (Mathijs)
textabstractThis paper analyzes the properties of multivariate tests of purchasing power parity (PPP) that fail to take heterogeneity in the speed of mean reversion across real exchange rates into account. We compare the performance of homogeneous and heterogeneous unit root testing methodologies.
C.G. Koedijk (Kees); B. Tims (Ben); M.A. van Dijk (Mathijs)
textabstractThis paper analyzes purchasing power parity (PPP) for the euro area. We study the impact of the introduction of the euro in 1999 on the behavior of real exchange rates. We test the PPP hypothesis for a panel of real exchange rates within the euro area over the period 1973-2003. Our
Robinson, Ray; Jakubowski, Elke; Figueras, Josep
... as they formulate purchasing strategies so that they can increase effectiveness and improve performance in their own national context An assessment of the intersecting roles of citizens, the government and the providers * * * Written by leading health policy analysts, this book is essential reading for health policy makers, planners and managers as well as resear...
Gregory, M M
Based on the preceding factors, a profile can be made for each light. The profile should include the following information: product literature with detailed information about the light, the average score from each of the six categories on the questionnaire, a summary of positive and negative comments from the questionnaire (recurring comments can identify significant factors), recommendations from other hospitals using the light, warranty and service information and any pertinent information about the vendor and manufacturer, information or comments from the clinical engineer, the purchasing agent, and the architect/engineer, and information about possible purchase agreements. Once the profiles of the lights are finished, present them to the OR committee or group charged with making the final decision. The information will enable the group to compare the lights and will serve as a basis for either the final purchase or a detailed bid specification. If cost is a major factor in the decision, the evaluation results can be used to justify purchasing lights that are more expensive but that the users believe are clearly superior. This constitutes the "professional justification" that some government institutions require to circumvent regulations that require buying the low-bid product. Although the result of this selection process is clearly a subjective decision, it is an informed subjective decision. Once the lights are installed, the staff members' satisfaction with the lights will not be based on objective criteria but on the same subjective opinions that were used to justify the selection.
... GNND Sales Program: (a) The person must be employed as a law enforcement officer (as described in § 291... in § 291.530) at the time he/she submits a bid to purchase a home through the program and at the time... to continue employment as a law enforcement officer (as described in § 291.520), teacher (as...
Dillingh, Rik; Kooreman, Peter; Potters, Jan
This paper provides new field evidence on the role of probability numeracy in health insurance purchase. Our regression results, based on rich survey panel data, indicate that the expenditure on two out of three measures of health insurance first rises with probability numeracy and then falls again.
Mulder, M.; Wesselink, R.; Bruijstens, H.Chr.J.
The study reported in this article is based on theories about job and competence analysis and a project in which job profiles were developed that were aimed at providing a framework of reference for evaluating in-service training programmes for purchasing professionals (professional buyers of goods
Risk Factors for Wheezing, Eczema and Rhinoconjunctivitis in the Previous 12 Months among Six-Year-Old Children in Himeji City, Japan: Food Allergy, Older Siblings, Day-Care Attendance and Parental Allergy History
Conclusions: Among Japanese children, food allergy and parents' history of allergy are risk factors for WP, ES or RS. However, early day-care attendance and presence of older siblings might be protective factors against RS. Infections in early life may affect the prevalence of rhinoconjunctivitis in six-year-old children.
Ludmer, Jaclyn A; Jamieson, Brittany; Gonzalez, Andrea; Levitan, Robert; Kennedy, James; Villani, Vanessa; Masellis, Mario; Basile, Vincenzo S; Atkinson, Leslie
A mother's cortisol secretion is importantly associated with her own mental health and her infant's cortisol secretion. This study investigated the influences of maternal history of care and maternal DRD2, SLC6A3, and OXTR genotypes on maternal cortisol in the context of infant stress. A community sample of 296 mother-infant dyads completed a maternal separation at infant age 17 months. Maternal salivary cortisol, buccal cells, and self-reported history of care were collected. Multilevel models revealed that history of care had a greater influence on maternal baseline cortisol (but not cortisol trajectory) for mothers with more plasticity alleles of SLC6A3 (10R) and OXTR (G), relative to mothers with fewer or no plasticity alleles. Findings indicate that a mother's history of care is related to her cortisol secretion in anticipation of infant stress, but that this relation depends on her genetic characteristics. Findings are discussed in relation to the maternal protective system and anticipatory cortisol secretion. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available This study proposes an integrated model that combines the Theory of Reasoned Action (TRA and two categories of variables, personal and marketing, to investigate the attitudinal and behavioral decision factors to purchase green products. The model derived and tested via structural equation modeling on a sample of 374 consumers from the Guilan province in Iran. The results show that attitude is explained by consumers’ environmental concern, quality of green products, green advertising and green labeling. The results of the structural equation analysis indicate that attitude positively influences intention to purchase green products. Green purchasing intention also influences on green purchasing behavior. This paper also discusses the implications of the results for marketers and researchers.
To justify the applicability of previous researches of online purchase in the Eastern culture, 237 samples in Taiwan are examined with questionnaire adapted from previous researches. Based on the assumption of rational behaviour that online purchase intention leads to behaviour, factors influencing them are examined and discussed. The result indicates that demographic attributes, perceived consequence, conspicuous meaning, information sources and reference group are confirmed to impact online...
Munge, Kenneth; Mulupi, Stephen; Barasa, Edwine W; Chuma, Jane
Purchasing refers to the process by which pooled funds are paid to providers in order to deliver a set of health care interventions. Very little is known about purchasing arrangements in low- and middle-income countries (LMICs), and certainly not in Kenya. This study aimed to critically analyse purchasing arrangements in Kenya, using the National Hospital Insurance Fund (NHIF) as a case study. We applied a principal-agent relationship framework, which identifies three pairs of principal-agent relationships (government-purchaser, purchaser-provider, and citizen-purchaser) and specific actions required within them to achieve strategic purchasing. A qualitative case study approach was applied. Data were collected through document reviews (statutes, policy and regulatory documents) and in-depth interviews (n=62) with key informants including NHIF officials, Ministry of Health (MoH) officials, insurance industry actors, and health service providers. Documents were summarised using standardised forms. Interviews were recorded, transcribed verbatim, and analysed using a thematic framework approach. The regulatory and policy framework for strategic purchasing in Kenya was weak and there was no clear accountability mechanism between the NHIF and the MoH. Accountability mechanisms within the NHIF have developed over time, but these emphasized financial performance over other aspects of purchasing. The processes for contracting, monitoring, and paying providers do not promote equity, quality, and efficiency. This was partly due to geographical distribution of providers, but also due to limited capacity within the NHIF. There are some mechanisms for assessing needs, preferences, and values to inform design of the benefit package, and while channels to engage beneficiaries exist, they do not always function appropriately and awareness of these channels to the beneficiaries is limited. Addressing the gaps in the NHIF's purchasing performance requires a number of approaches
Full Text Available The study assesses post-purchase advertisement readership behaviour and repeat purchase intentions of motor vehicle consumers. The aim is to determine the prevalence of selective exposure, and the impact of motor vehicle features and dissonance respectively. The empirical analysis was undertaken on a sample of 200 new motor vehicle buyers The results indicate that the majority of consumers do not engage in post-purchase selective advertisement readership behaviour. Furthermore, whilst motor vehicle features (make, model, dealership, month of purchases/ time lapse after purchases do not influence consumers' repeat purchase intentions, reported dissonance and the magnitude of cognitive dissonance experienced have a significant impact. Opsomming Hierdie studie evalueer die reaksie van verbruikers op advertensies nadat hulle n voertuig aangekoop het. Die doel was om vas te stel in watter n mate verbruikers selektiefis met advertensies en watter effek voertuig-eienskappe en dissonansie op die moontlikheid het om weer dieselfde voertuig te koop. Die empiriese anahse is mtgevoer op n steekproefvan 200 eicnaars van nuwe voertuie. Uit die resultate blyk dit dat die meerderheid van verbruikers me advertensies selektief lees nan aankoop me.Verder blyk dit dat die eienskappe vann motorvoertmg fabnkaat, model handelaar, maand van aankoop/tydsverloop na aankoop nie n verbruiker beinvloed om dieselfde voertuig weer te koop nie. Gerapporteerde dissonansie en die omvang van kognitiewe dissonansie na n aankoop, blyk tog 'n betekenisvolle impak te he.
Rost, Kathryn M; Marshall, Donna; Xu, Stanley
Employers can purchase high quality depression products that provide the type, intensity and duration of depression care management shown to improve work outcomes sufficiently for many employers to achieve a return on investment. The purpose of this randomized controlled trial was to test an intervention to encourage employers to purchase a high quality depression product for their workforce. Twenty nine organizations recruited senior health benefit professional members representing public or private employers who had not yet purchased a depression product for all 100+ workers in their company. The research team used randomization blocked by company size to assign eligible employers to: (1) a presentation encouraging employers to purchase a high quality depression product accompanied by a scientifically-derived return on investment estimate, or (2) a presentation encouraging employers to work with their most subscribed health plan to improve depression treatment quality indicators. Two hundred ninety three employers (82.3% of 356) completed baseline data immediately before learning that 140 employers had been randomized to the evidence-based (EB) depression product presentation and 153 had been randomized to the usual care (UC) depression treatment quality indicator presentation. Analysis of 250 (85.3% of 293) employers who completed web-based interviews at 12 and/or 24 months was conducted to determine presentation impact on depression product appraisal and purchasing behavior. The intervention had no impact on depression product appraisal in 232 subjects (F = 2.36, p = .07) or depression product purchasing (chisquare = 1.82, p = .44) in 250 subjects. Depression product appraisal increased in companies with greater health benefit generosity whose benefit professionals were male. Depression product purchasing behavior increased in small companies compared to large companies, companies who knew a vendor that sold depression products at baseline, companies with
Koppel, Sjaanie; Charlton, Judith; Fildes, Brian; Fitzharris, Michael
Whilst there has been a significant increase in the amount of consumer interest in the safety performance of privately owned vehicles, the role that it plays in consumers' purchase decisions is poorly understood. The aims of the current study were to determine: how important vehicle safety is in the new vehicle purchase process; what importance consumers place on safety options/features relative to other convenience and comfort features, and how consumers conceptualise vehicle safety. In addition, the study aimed to investigate the key parameters associated with ranking 'vehicle safety' as the most important consideration in the new vehicle purchase. Participants recruited in Sweden and Spain completed a questionnaire about their new vehicle purchase. The findings from the questionnaire indicated that participants ranked safety-related factors (e.g., EuroNCAP (or other) safety ratings) as more important in the new vehicle purchase process than other vehicle factors (e.g., price, reliability etc.). Similarly, participants ranked safety-related features (e.g., advanced braking systems, front passenger airbags etc.) as more important than non-safety-related features (e.g., route navigation systems, air-conditioning etc.). Consistent with previous research, most participants equated vehicle safety with the presence of specific vehicle safety features or technologies rather than vehicle crash safety/test results or crashworthiness. The key parameters associated with ranking 'vehicle safety' as the most important consideration in the new vehicle purchase were: use of EuroNCAP, gender and education level, age, drivers' concern about crash involvement, first vehicle purchase, annual driving distance, person for whom the vehicle was purchased, and traffic infringement history. The findings from this study are important for policy makers, manufacturers and other stakeholders to assist in setting priorities with regard to the promotion and publicity of vehicle safety features
The goal of this report is to help Federal facilities integrate green purchasing into their EMS. The intended audience includes those tasked with implementing an EMS, reducing environmental impacts, meeting green purchasing requirements.
Baldwin, Laura H; Ausink, John A; Campbell, Nancy F; Drew, John G; Roll, Jr, Charles R
.... First, the contracting community did not have a comprehensive, detailed database of contingency purchases that would allow analyses of the types and amounts of goods and services purchased to support...
Consumer-purchasing Motives in Nigerian Cellular Phone Market: An Empirical Investigation. ... Nigerian consumers to identify their motives for purchasing new mobile phones on one hand, and factors affecting operator choice on the other.
This webinar will cover EPA’s effort to simplify green purchasing through recommendations of specifications, standards, and ecolabels. EPA’s work in this area is intended to help federal purchasers identify and procure environmentally sustainable products.
.... In constructing this model, several factors were considered, including: The purchase cost of computer equipment, annual lease payments, depreciation costs, the opportunity cost of purchasing, tax revenue implications and various leasing terms...
Tate, W.L.; Ellram, L.M.; Bals, L.; Hartmann, E.; Valk, van der W.
The purchase of business services has become an important part of organizations' acquisition of external resources, and is therefore receiving growing scholarly attention. The supply management function is increasingly supporting more complex service purchases, including a wide range of marketing
The importance of children in purchase decision making has grown over the years. They not only make purchase decisions for personal consumption but they also influence family purchase decision-making (Kaur and Singh, 2006). This research looks at available literature, which is discussed with respect to children influence on product categories, decision-making stages, socialising agents like parents, peers and media and role of family communication in purchase decision making. Demographic vari...
Full Text Available This article presents some selected logistic strategies concerning purchasing process in production companies. Costs referring to realizing and organizing purchasing process are a substantial part of total costs of a company. In order to make a company’s purchasing and supply processes efficient, it is necessary to take some steps to prepare purchasing strategy. This operation was the reason for presenting the subject in this study.
Grzybowska, K.; Gajdzik, B.
This article presents some selected logistic strategies concerning purchasing process in production companies. Costs referring to realizing and organizing purchasing process are a substantial part of total costs of a company. In order to make a company’s purchasing and supply processes efficient, it is necessary to take some steps to prepare purchasing strategy. This operation was the reason for presenting the subject in this study.
Joseph Abramson; Peggy D. Brewer
The purchase of a new automobile is often cited as the quintessence of a high involvement purchase decision; the financial risks and personal relevance of the purchase dictate that car buyers put forth much effort before making a decision. In this research such efforts as dealers shopped, brands shopped, and information sources used are studied in a large sample of new car buyers in West Virginia. The purchase behavior of respondents in this study seems more like low-involvement than high inv...
Moital, Miguel; Vaughan, Roger; Edwards, Jonathan; Peres, Rita
More than 10 years on since the launch of the Internet, there are clear differential levels of adoption of the Internet for purchasing leisure travel across countries. In some countries, such as Portugal, only a minority of travel purchasing is conducted over the Internet. This paper aims to contribute to a greater understanding of adoption of purchasing over the Internet by evaluating the determinants of intention to adopt the Internet for purchasing leisure travel. A number of variables are...
Purchasing management is a relatively new scientific research field, partly due to the fact that purchasing has only recently been recognized as a factor of strategic importance to an organization. In this thesis, the author focuses on a selection of strategic and tactical purchasing decision problems. New quantitative models are developed for these decision problems using a range of mathematical techniques, thereby contributing to the further development of purchasing theory and its appliati...
Full Text Available A two-dimensional scale, called ECID Scale, is presented in this paper. The scale is based on a comprehensive model and captures the two antecedent factors of purchase-related involvement, namely whether motivation is intrinsic or extrinsic and whether risk is perceived as low or high. The procedure of scale development and item selection is described. The scale turns out to perform well in terms of validity, reliability, and objectivity despite the use of a small set of items – four each – allowing for simultaneous measurements of up to ten purchases per respondent. The procedure of administering the scale is described so that it can now easily be applied by both, scholars and practitioners. Finally, managerial implications of data received from its application which provide insights into possible strategic marketing conclusions are discussed.
Hallett, Andrew Hughes
Large-scale asset purchase programmes are a form of monetary policy in which market interest rates are reduced by different amounts at different maturities – and lower them at the long rates that affect investment and consumption decisions. They are designed to stimulate spending by increasing...... liquidity, raising asset prices, creating wealth effects, lowering borrowing costs and increasing investment. Corporate bond purchases (CSPP) are complementary to, not an alternative to standard QE policies. They increase the impact of QE policies; widen the pool of (potentially) high quality assets...... that can be used (itself a risk reducing measure that reduces the pressure on reserves); and make it easier to steer economic performance by reducing risk premia, that is sectoral or regional interest spreads. That not only reduces average borrowing costs; it delivers better economic performance where...
Mauchle, P.; Ritz, Ch.
This final report for the Swiss Federal Office of Energy (SFOE) takes a look at how full-cost pricing should be considered when purchasing electric motors. The authors consider it essential that the overall life-cycle costs are carefully considered. This also guarantees economical operation and enables users to avoid unexpected costs throughout the service life of the motor. The aim of this project was to provide industrial companies with suitable tools for calculating the overall life-cycle costs of motors at the time of their acquisition. These tools take the form of a sample 'Call for Tender' for motors along with software for calculating life-cycle costs. The factors involved, such as investment, installation costs, energy and environmental costs as well as operational, maintenance and disposal costs are examined.
Vinod Sharma; J. Sonwalkar; Maohar Kapse
Purpose: The concern for climate change and global warming is increasing at global level which results in stimulating the interest of firms toward environmental protection and sustainable development. Many firms have started developing green products to meet the demand of environmentally conscious consumers. These firms are now interested in finding the determinants of environmentally conscious consumers’ behaviour in order to develop effective marketing strategy to ensure the green purchase ...
Historically, Purchasing Power Parity (henceforth PPP) provides the simplest explanation of long-run exchange rate determination, according to which the equilibrium exchange rate between domestic and foreign currencies equals the ratio between domestic and foreign prices. A few years ago, PPP validity theory seemed like a fairly dull research topic. On the one hand the unavoidable effects of floating exchange rates made it obvious to even its most stubborn defenders that PPP is not a short-ru...
Abstract. After the collapse of the Bretton Woods system, the evidence on the purchasing power parity (PPP) in the long run is still a matter of debate. The difficulties of the problem are the possible nonstationarity of relative price indices and nominal exchange rates. The traditional ways to deal with nonstationarity such as unit root model and cointegration have some problems. In this paper, to deal with nonstationarity, we apply the Hodrick－Prescott (HP) trend-cycle filter in real busine...
Rice, Beth W.; Strohbehn, Catherine; Shelly, Mark C.; Arendt, Susan; Gregoire, Mary
Purpose/Objectives: The purpose of this study was to compare food cost and public school foodservice directors' satisfaction between districts participating in school foodservice cooperatives or group purchasing arrangements and districts purchasing independently. It also assessed the prevalence of purchasing cooperatives in school foodservice and…
... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Purchase of System institution assets... SUPPLEMENTAL STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE FARM CREDIT SYSTEM INSURANCE CORPORATION § 4001.105 Purchase of System institution assets. (a) Prohibition on purchasing assets owned by a System...
... ETHICAL CONDUCT FOR EMPLOYEES OF THE FARM CREDIT ADMINISTRATION § 4101.105 Purchase of System institution assets. (a) Prohibition on purchasing assets owned by a System institution. No covered employee, or... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Purchase of System institution assets...
Taksler, Glen B; Elbel, Brian
Background Studies rarely find fewer calories purchased following calorie labeling implementation. However, few studies consider whether estimates of the number of calories purchased improved following calorie labeling legislation. Findings Researchers surveyed customers and collected purchase receipts at fast food restaurants in the United States cities of Philadelphia (which implemented calorie labeling policies) and Baltimore (a matched comparison city) in December 2009 (pre-implementation...
The TS – AB* - AT* Purchasing Offices and the Purchasing Pool have moved to Building 5 – 2nd and *3rd floors. The phone and fax numbers are unchanged. We apologize for any inconvenience caused by the move. Thank you for your understanding. Finance Department – Purchasing Service.
Purchasing management is a relatively new scientific research field, partly due to the fact that purchasing has only recently been recognized as a factor of strategic importance to an organization. In this thesis, the author focuses on a selection of strategic and tactical purchasing decision
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Disclosure to purchasers. 120.641 Section 120.641 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Miscellaneous Provisions § 120.641 Disclosure to purchasers. (a) Information to purchaser. Prior...
de Boer, L.; Looman, Arnold; Ruffini, F.A.J.
This article presents a method for redesigning the ordering and inventory management methodologies for purchased parts in a manufacturing firm. The method takes the perspective of the purchasing and logistics manager, defines clusters of purchased items, and subsequently assigns each cluster to a
Background: Health workers' purchasing power is an important consideration in the development of strategies for health workforce development. This work explores the purchasing power variation of Mozambican public sector health workers, between 1999 and 2007. In general, the calculated purchasing power increased ...
... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Contractor purchasing... for Management and Operating Contracts 970.5244-1 Contractor purchasing system. As prescribed in 970.4403 insert the following clause: Contractor Purchasing System (AUG 2009) (a) General. The Contractor...
... purchase plan must conform to the definition of a pension plan in paragraph (b)(1)(i) of § 1.401-1, or the.... Accordingly, even though a qualified bond purchase plan is designed as a pension plan, it need not provide... apply in a nondiscriminatory manner. (ii) A qualified bond purchase plan which is designed as a pension...
... AGED, BLIND, AND DISABLED Determining Disability and Blindness Standards for the Type of Referral and for Report Content § 416.919f Type of purchased examinations. We will purchase only the specific... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Type of purchased examinations. 416.919f...
... DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Standards for the Type of Referral and for Report Content § 404.1519f Type of purchased examinations. We will purchase only the specific... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Type of purchased examinations. 404.1519f...
Schotanus, Fredo; Telgen, Jan; Wynstra, J.Y.F.; Dittrich, K.; Jaspers, F.P.H.
Our main objective is to classify different forms of cooperative purchasing, i.e. purchasing groups. Based on a literature review, empirical findings, and new institutional economics we employ a classification: the highway matrix. In this matrix we distinguish five forms of cooperative purchasing
... 7 Agriculture 7 2010-01-01 2010-01-01 false Wheat purchased for export. 782.18 Section 782.18... § 782.18 Wheat purchased for export. (a) This section applies to an importer or subsequent buyer who imports or purchases Canadian-produced wheat for the purpose of export to a foreign country or...
Bonneville Power Administration (BPA) is obligated to supply electric power to its contractual customers. Based on a forecast of growing customer loads and assuming Critical Period water conditions in the Columbia River Basin, BPA is planning to meet a firm energy deficit during the four operating years (OY) 1992 through 1995, i.e., August 1991 through July 1995. BPA has executed several power purchase agreements to cover the projected OY 1992 deficit. The proposed action is to extend two existing one-year power purchase agreements for an additional three years to cover the four-year Critical Period energy deficit. The extension of these two one-year power purchase agreements would: (1) increase BPA's firm energy load-carrying capability; (2) allow BPA to meet its firm energy contractual commitments over the remaining three years of the four-year Critical Period from August 1, 1992, to July 31, 1995; (3) provide flexibility for BPA's use of hydroelectric resources over the Critical Period; and (4) increase system reliability. Under Critical Period water conditions, absent the proposed action, projected loads would exceed the capability of the Federal power system to serve those loads. The purpose of BPA's proposed action is to assure consistency with its statutory responsibilities, including those found in the Pacific Northwest Electric Power Planning and Conservation Act (Northwest Power Act)
Full Text Available At food purchase consumer is affected by several factors. In this work analysis of consumer behavior at chocolate purchase was performed involving 277 respondents. Statistical testing of results was performed by Chi - Square statistic, correlations have been tested with use of the Cramer's coefficient. It was found, that 86% of respondents consume chocolate. Factors affecting respondents at purchase were recommendations of friends, acquaintances (32%, brand of chocolate (24%, price (16%, personal experience (12%, health restrictions and allergies (11%. Less important factors when choosing chocolates are flavor (4%, nutritional quality (3%, country of origin (2% and chocolate packaging (1%. In the consumption of chocolate moderate correlation among various categories of economic activity of respondents was confirmed. Chocolate was consumed mainly by respondents whose monthly income ranges from 801 to 1001 €. We found that consumers prefer milk chocolate followed by dark and white at the end. In terms of gender the most commonly was chocolate consumed by women, once to three times a week. The same frequency of chocolate consumption dominates at the categories of students and employee. Expenses frequently spent to buy chocolates were from 1-3 € per week by young people (18-23 years and middle age generation of people (46-55 years. Normal 0 21 false false false CS JA X-NONE
Rowlands, I.; Scott, D.; Parker, P.
Electricity markets around the world are being opened to competition and environmental concerns are prompting consumers to consider buying electricity that has been generated by renewable energy sources such as solar or wind power. This report profiles the potential purchaser of such green electricity. It presents 3 sets of hypotheses, each drawing upon the literature on green product purchasers. It is suggested that those who are willing to pay higher premiums for green electricity are likely to have certain demographic characteristics and social values. This study is based on a case-study of a survey conducted in the Waterloo region of southern Ontario, Canada, the objective of which was to determine what kind of people are potential green electricity purchasers. Results were presented to power managers and marketers. A 158-item survey was sent to 1,110 individuals, between September 2000 and April 2001. A total of 474 questionnaires were answered, for a response rate of 43 per cent. It was noted that although the response rate was high, the survey may not be representative because the respondents were older, better educated, and wealthier than the general population. In addition, the respondents had previously indicated they were willing to pay $25 for a home energy evaluation, suggesting a special interest in issues regarding energy and the environment. It was determined that attitudinal characteristics, such as liberalism and perceived consumer effectiveness, ideally identify the potential green electricity buyer. 34 refs., 5 tabs
Gao, Lei; Guo, Jin-Li; Fan, Chao; Liu, Xue-Jiao
As a major part of the daily operation in an enterprise, purchasing frequency is in constant change. Recent approaches on the human dynamics can provide some new insights into the economic behavior of companies in the supply chain. This paper captures the attributes of creation times of purchase orders to an individual vendor, as well as to all vendors, and further investigates whether they have some kind of dynamics by applying logarithmic binning to the construction of distribution plots. It’s found that the former displays a power-law distribution with approximate exponent 2.0, while the latter is fitted by a mixture distribution with both power-law and exponential characteristics. Obviously, two distinctive characteristics are presented for the interval time distribution from the perspective of individual dynamics and group dynamics. Actually, this mixing feature can be attributed to the fitting deviations as they are negligible for individual dynamics, but those of different vendors are cumulated and then lead to an exponential factor for group dynamics. To better describe the mechanism generating the heterogeneity of the purchase order assignment process from the objective company to all its vendors, a model driven by product life cycle is introduced, and then the analytical distribution and the simulation result are obtained, which are in good agreement with the empirical data.
Salmon, Stefanie J; Adriaanse, Marieke A; Fennis, Bob M; De Vet, Emely; De Ridder, Denise T D
The aim of the present research is to examine the relation between depletion sensitivity - a novel construct referring to the speed or ease by which one's self-control resources are drained - and snack purchase behavior. In addition, interactions between depletion sensitivity and the goal to lose weight on snack purchase behavior were explored. Participants included in the study were instructed to report every snack they bought over the course of one week. The dependent variables were the number of healthy and unhealthy snacks purchased. The results of the present study demonstrate that depletion sensitivity predicts the amount of unhealthy (but not healthy) snacks bought. The more sensitive people are to depletion, the more unhealthy snacks they buy. Moreover, there was some tentative evidence that this relation is more pronounced for people with a weak as opposed to a strong goal to lose weight, suggesting that a strong goal to lose weight may function as a motivational buffer against self-control failures. All in all, these findings provide evidence for the external validity of depletion sensitivity and the relevance of this construct in the domain of eating behavior. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available Green environmental issues have been of topical interest to both researchers and industrialists for some time now. Research on green brands is relatively limited, especially in developing countries, such as Ghana. This study is therefore designed to determine the relationship between customer awareness of green brand issues and their everyday purchase intentions. Using quantitative techniques, the study interviewed 316 people, conveniently selected from various shopping points in Accra. The study found that, the overwhelming majority of respondents though familiar with green issues did not concern themselves with green issues in their everyday purchase decisions. Again, majority of respondents (54% familiar with environmental issues confirmed they would not switch from their preferred brands to less fancied brands even if the less fancied brands were more environmentally friendly. It was also confirmed in the study that price, brand name and convenience, performed better than customer concerns for green issues, in influencing respondents’ purchase decisions. It would therefore be strategically significance if advocates, policy makers and business leaders reduce the cost of green products to the final consumer, intensive public education campaigns, coupled with strategic brand building efforts to enhance the level of green brand consumption.
Dewi Sri Rejeki
Full Text Available The purpose of this study is to determine the influence of perceived risk to purchase intention private label products in Indonesia modern market. This study used primary data sources obtained directly by distributing questionnaires using purposive sampling techniques, gathered 200 respondents with minimum criteria of period at least 18 years while maximum of period is > 61 years and have bought private label products. The dependent variable in this study is purchase intention, while independent variables are considered functional risk, perceived financial risk, physical risk, and perception of psychological risk. Data analysis use Structural Equation Modeling (SEM. The results indicate that there was a negative effect on financial risk, the perceived physical risk to buy an interest in functional perception, the psychological risk has no effect on purchase intention on private label product. The implications for the manager is to increase consumer buying intentions by taking into account factors such as perceptions of financial risk and perceptions of physical risk.
The current policy of guaranteed purchase prices applied to photovoltaic power lacks rationality: prices are not graduated, commitment times are too long, there is no capping to capacity developed, subsidies (tax credit, direct subsidy, etc) are complex and give too favourable a return time. The lack of differentiation between products may also delay the emergence of new PV technologies. As a result, it is legitimate to envisage a cost/benefit analysis of future subsidies and to wonder about Frances ability, as a second rank player, to catch up with the leaders (Germany, Japan, United States). The report does not criticize policy based on purchase prices in itself: this is suitable or technology close to commercial operation in that it guarantees stable terms close to wholesale electricity market prices. It does, however, criticize adequacy in terms of less advanced PV technology, which results in purchase prices five times that of wind power. The report proposes re-targeting the system to take account of the significant stakes in PV power. Costly incentives for installing land PV cells and units should be quickly reduced, while industrial demonstration budgets deserve increases to further the development of new technologies (improved crystal silicon and thin layers). The demonstration phase and industrial development should be the primary focus, where a large part of potentially promising reductions in costs are likely to be achieved. (author)
Full Text Available This paper presents research findings based on the research conducted on a representative sample of respondents using a highly structured questionnaire. The first part of the paper focuses on the theoretical background and overview of the research results related to the research problem in the world and in Croatia. The results of the research which has been conducted indicate that respondents are not familiar with the definition of organic food. Furthermore, the paper elaborates on the Croatian consumers’ perception of organic food and conventional food. The research on organic food purchase places a special emphasis on regular buyers of organic food who were asked to evaluate the importance of individual characteristics in choosing a place of sale for organic food. Based on the hierarchical regression analysis, the frequency of organic food purchases by regular buyers was found to correlate with the perception of organic food and the importance of characteristics of a place of sale for organic food. The research also identified the main reasons for not buying organic food, and it sets out the guidelines which may be useful to organic producers, marketers and retailers in encouraging further purchases of organic food.
Campbell, Kay N
History, Passion, and Performance was chosen as the theme for the 75th anniversary of the American Association of Occupational Health Nurses (AAOHN) kickoff. The American Association of Occupational Health Nurses has a long history created by passionate, dedicated members. This article highlights historical foundations of the Association, describes the occupational health nurse's passion to drive quality care for workers and discusses future professional and organizational challenges.
Camargo, David O; Gomez, Clara; Martinez, Teresa
They are multiple the indexes of severity that have been carried out to value the predict and the quality of a patient's life, especially when this it enters to the unit of intensive care (UIC); however, the oncologic patient presents particularities in their mobility, that it supposes a different behavior in the results of the Indexes. Presently work is compared the Apache scale and the oncologic history like morbid mortality as predictors in the UCI. 207 patients were included that entered the UCI between September of 1996 and December of 1997. It was a mortality of 29%, the stay of most of this group of patient smaller than 24 hours or bigger than 8 days. To the entrance, 50% of the patients presented superior averages at 15 in the Apache Scale and at the 48 hours, alone 30.4% continued with this value. The patients with hematologic neoplasia presented superior average at 15 in 87%, with a mortality of 63.3% with average between 15 and 24 to the entrance, the risk of dying was 9.8 times but that with inferior average. In the hematologic patient, the risk of dying was 5.7 times but regarding the solid tumors. The system but altered it was the breathing one, with an increase in the risk of dying from 2,8 times for each increment utility in the scale. Contrary to described in the literature, the oncologic diagnoses and the neoplasia statistic they didn't influence in the mortality of the patients
Hartle, James B.
The predictions of the Bohmian and the decoherent (or consistent) histories formulations of the quantum mechanics of a closed system are compared for histories--sequences of alternatives at a series of times. For certain kinds of histories, Bohmian mechanics and decoherent histories may both be formulated in the same mathematical framework within which they can be compared. In that framework, Bohmian mechanics and decoherent histories represent a given history by different operators. Their predictions for the probabilities of histories of a closed system therefore generally differ. However, in an idealized model of measurement, the predictions of Bohmian mechanics and decoherent histories coincide for the probabilities of records of measurement outcomes. The formulations are thus difficult to distinguish experimentally. They may differ in their accounts of the past history of the Universe in quantum cosmology
In 2002, she began working as alecturer at Minzu University of China.Now, she teaches English, historicalliterature, ancient Chinese history,historical theory and method, ancientsocial history of China, ancient palacepolitical history of China and the historyof the Sui and Tang dynasties and thePeriod of Five Dynasties.
Kumar, Amit; Killingsworth, Matthew A; Gilovich, Thomas
Experiential purchases (money spent on doing) tend to provide more enduring happiness than material purchases (money spent on having). Although most research comparing these two types of purchases has focused on their downstream hedonic consequences, the present research investigated hedonic differences that occur before consumption. We argue that waiting for experiences tends to be more positive than waiting for possessions. Four studies demonstrate that people derive more happiness from the anticipation of experiential purchases and that waiting for an experience tends to be more pleasurable and exciting than waiting to receive a material good. We found these effects in studies using questionnaires involving a variety of actual planned purchases, in a large-scale experience-sampling study, and in an archival analysis of news stories about people waiting in line to make a purchase. Consumers derive value from anticipation, and that value tends to be greater for experiential than for material purchases. © The Author(s) 2014.
objective of this paper is to examine factors influencing outpatient care demand in ..... Endogeneity of health insurance arises because the decision to purchase health ... insurance plan, or by purchasing privately a generous coverage. Existing ...
Working within the HPO (History Projection Operator) Consistent Histories formalism, we follow the work of Savvidou on (scalar) field theory [J. Math. Phys. 43, 3053 (2002)] and that of Savvidou and Anastopoulos on (first-class) constrained systems [Class. Quantum Gravt. 17, 2463 (2000)] to write a histories theory (both classical and quantum) of Electromagnetism. We focus particularly on the foliation-dependence of the histories phase space/Hilbert space and the action thereon of the two Poincare groups that arise in histories field theory. We quantize in the spirit of the Dirac scheme for constrained systems
The aim of this study is to describe the entire bentonite purchasing process accurately. This will enable efficient and focused use of information related to the purchasing phase and to each individual bentonite batch. This work continues from the work started in the report by Ahonen et al. (2008), Quality Assurance of the Bentonite Material, Posiva Working Report 2008-33. The current work includes a short enquiry for all relevant and at the time known producers or re-sellers of bentonite. Questions about relevant products suitable for civil engineering use, more specifically nuclear waste disposal site use, were asked together with test methods, typical test results and test standards. The following aspects and opinions have been processed from the results that were obtained during the project. Each seller/producer has a quality management system, QMS (typically ISO 9001), and ability to perform the basic tests, but there is not an established common set of properties to be tested. Some producers are willing to test according to customers' specifications. Posiva could arrange a network of capable laboratories to carry out tests according to its selected standards. This activity should then be accredited with a reasonable testing volume. Before starting the purchase of bentonite at a large scale, Posiva should go through negotiations and audits with each seller in order to make sure that both parties are testing with the same methods and both understand the range where the values of key parameters may lie. A database is needed for gathering statistically relevant information from the bentonite material parameters over the long run. This is needed for determining the limits within which the material parameters should remain in order to be acceptable. Posiva is encouraged to create a process to optimize the test types and the amount of tests should be identified for immediate and long term use. This process ensures the required quality and costs involved. (orig.)
... you stay in touch with family and friends, purchase goods and services, and even search for information ... history may not be considered. The computer-driven decision-making model may not be optimal if you ...
Full Text Available Masanobu Okayama,1,2 Taro Takeshima,2 Masanori Harada,3 Ryusuke Ae,4 Eiji Kajii2 1Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Hyogo, 2Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, 3Department of Support of Rural Medicine, Yamaguchi Grand Medical Center, Hofu, Yamaguchi, 4Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan Objective: Disclosing genetic testing results may contribute to the prevention and management of many common diseases. However, whether the presence of a disease influences these effects is unclear. This study aimed to clarify the difference in the effects of disclosing genetic testing results of the risk for developing salt-sensitive hypertension on the behavioral modifications with respect to salt intake in hypertensive and nonhypertensive patients.Methods: A cross-sectional study using a self-administered questionnaire was conducted for outpatients aged >20 years (N=2,237 at six primary care clinics and hospitals in Japan. The main factors assessed were medical histories of hypertension, salt preferences, reduced salt intakes, and behavior modifications for reducing salt intake. Behavioral modifications of participants were assessed using their behavior stages before and after disclosure of the hypothetical genetic testing results. Results: Of the 2,237 participants, 1,644 (73.5% responded to the survey. Of these respondents, 558 (33.9% patients were hypertensive and 1,086 (66.1% were nonhypertensive. After being notified of the result “If with genetic risk”, the nonhypertensive participants were more likely to make positive behavioral modifications compared to the hypertensive patients among all participants and in those aged <65 years (adjusted relative ratio [ad-RR], 1.76; 95% confidence interval, 1.12−2.76 and ad-RR, 1
Full Text Available In building companies process of product and service purchase is one of the main processes of quality management system . Because ofshort time-limits of contract realization, high specialization of works, necessity of fulfillment of high quality requirements and assurance of profitable financial effects the management of purchase process becomes very important element of work of the building company. The serious problem in creating and keeping the efficient system of purchase management is special type of purchase in building companies. Particular investments are realized in different country regions, objects are built based on the individual design documentations and each building becomes independent organization unit that organize purchase necessary for investment realization.An example of the management system of purchase process in building company is described in the paper. Just In Time system is widelyused during the realization of building investment. This system is especially useful in buildings because some investments, especially inbig cities, are characterized by restriction in building site. This makes impossible storing the products. In such cases close synchronization between times of delivery and requirements of purchase schedule and schedule of building realization is very important. Criteria of supplier selection as well as the methods of choosing the supplier are also presented in the paper. Special attention is paid to necessity of valuation of the purchase efficiency and the purchase risk. Basic coefficients of purchase efficiency are also described in the paper.
Mehden, P. von der.
The purpose of the purchase card system (P-Card System) is to apply enhanced acquisition tools for increased return on ERC internal resources, and to reduce the cost of off-the-shelf commercial items through the use of credit cards by authorized personnel. The P-Card may be used to make transactions either over the counter, by mail, or via telephone. For Project employees, the P-Card provides and easier, direct method of acquisition that requires less process time than requisitioning. The P-C eliminates the involvement of the procurement organization in low value-added acquisitions and low-risk transactions. Controller reduces the expenditure of resources in the support of low dollar value products and services acquisition. The P- Card System has been initiated in agreement with American Express Travel Related Services, Inc.; the credit card is and American Express Corporate Purchasing Card. The integrated network application for cardholder reconciliation and reallocation of costs was originally government furnished software developed by the U.S. DOE. Currently, the software application (version 3.0 and beyond) is copyrighted by a Bechtel Hanford, Inc. subcontractor
Purchasing management is often approached as a qualitative art. Experience, insight and managerial qualities may indeed make useful contributions. However, in addition to this, the possibilities of an approach based on hard data and figures should not be underestimated. This does not only apply to
Van Poucke, E.; Weele, van A.J.; Matthyssens, P.
So far, academic literature has paid extensive attention to the importance of purchasing development within the context of the current business environment, emphasizing value creation and delivery and integrated supply chain management. In addition, the contribution of purchasing’s (internal
..., a FICU purchasing a loan participation pool might perform statistical sampling in evaluating the..., since 2007, FISCUs- overall experienced a higher delinquency rate in their loan participation portfolios. At year-end 2010, the delinquency rate for the FISCU-participated portfolio was 4.11 percent...
and limited learning outcomes from one project to another. Furthermore, the study reveals the importance of a more holistic approach to project purchasing practices by focusing on the entire life cycle of a project. Managerially it helps selling companies to understand the peculiar buying phases...
Glinos, Irene A; Baeten, Rita; Maarse, Hans
Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting. Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame. We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of patient flows. The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.
Cotler, Jordan; Wilczek, Frank
We introduce quantum history states and their mathematical framework, thereby reinterpreting and extending the consistent histories approach to quantum theory. Through thought experiments, we demonstrate that our formalism allows us to analyze a quantum version of history in which we reconstruct the past by observations. In particular, we can pass from measurements to inferences about ‘what happened’ in a way that is sensible and free of paradox. Our framework allows for a richer understanding of the temporal structure of quantum theory, and we construct history states that embody peculiar, non-classical correlations in time. (paper)
Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth
To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. © 2012 Sigma Theta Tau International.
Users of CERN's Purchasing Service are encouraged to visit the new Purchasing Service web page, accessible from the CERN homepage or directly at: http://spl-purchasing.web.cern.ch/spl-purchasing/ There, you will find answers to questions such as: Who are the buyers? What do I need to know before creating a DAI? How many offers do I need? Where shall I send the offer I received? I know the amount of my future requirement, how do I proceed? How are contracts adjudicated at CERN? Which exhibitions and visits of Member State companies are foreseen in the future? A company I know is interested in making a presentation at CERN, who should they contact? Additionally, you will find information concerning: The Purchasing procedures Market Surveys and Invitations to Tender The Industrial Liaison Officers appointed in each Member State The Purchasing Broker at CERN
Full Text Available Studies examining the factors that affect the online purchasing behavior of consumers are rare, despite the prospective advance of e-commerce in Malaysia. The present study examines particular factors that influence the attitude of potential consumers to purchase online by using the attributes from the diffusion of innovations theory of Rogers, the attribute of perception of risk, and the subjective norms toward online purchasing. Consumers’ perceived risks of online shopping have become a vital subject in research because they directly influence users’ attitude toward online purchasing. The structural equation modeling method was used to analyze the data gathered on students using e-commerce, and, thus, to validate the model. According to the results, consumers’ attitude toward online purchasing affects the intention toward online purchasing. The other influential factors are compatibility, relative advantage, and subjective norm.
Shackley, P; Healey, A
The focus of this paper is the extent to which the purchaser-provider split and the creation of a market in the provision of health care can be expected to bring about greater efficiency within the new NHS. The starting point is a theoretical discussion of markets and competition. In particular, emphasis is placed upon the economic model of perfect competition. It is argued that because of the existence of externalities, uncertainty and a lack of perfect information, an unregulated market in health care will almost certainly fail. In view of this, the imperfect provider markets of monopoly and contestable markets, which are of particular relevance to health care, are discussed. A description of the new health care market and the principal actors within it is followed by an evaluation of the new health care market. It is argued that in view of the restrictions to competition that exist between providers, some form of price regulation will be necessary to prevent monopolistic behaviour in the hospital sector. Regulation of purchasers is also suggested as a means of improving efficiency. It is concluded that competition may be a necessary condition for increased efficiency in health care provision, but is not sufficient in itself. Other incentives in the hospital sector are necessary to assist the market process and to enhance its impact on efficiency.
Fisher, Eric O'N.
This paper analyzes purchasing power parity and uncovered interest parity in the laboratory. It finds strong evidence that purchasing power parity, covered interest parity, and uncovered interest parity hold. Subjects are endowed with an intrinsically useless (green) currency that can be used to purchase another useless (red) currency. Green goods can be bought only with green currency, and red goods can be bought only with red currency. The foreign exchange markets are organized as call mark...
Ho, Yi-Hui; Lin, Chieh-Yu
Purpose- Negotiation occurs all the time in purchasing practices ofbusinesses, and is inevitable for purchasing professionals when encounteringpurchasing conflict. Ethical negotiation is considered the vital requirement inmaintaining long-term and close buyer-supplier relationships. This study aimsto explore the relationship between mindfulness and unethical negotiation. Methodology- This study will take purchasing professionals inTaiwan as research subjects to investigate the relationship be...
Ogunnaike, Olaleke Olusye; Kehinde, Oladele Joseph; Omoyayi, Oluwadamilola Oluwatosin; Popoola, Oluwamakinde Oluwamayowa; Amoruwa, Andrew
Assessing the customer perspective of brand equity will provide deep understanding of how brands influence purchase behaviour of customers. The purpose of this paper is to formulate a conceptual framework that will provide an understanding of the relationship existing between the elements of brand equity and that of purchase behaviour. The adoption of Aaker’s brand equity model will serve as a guide for conceiving associations between brand equity and purchase behaviour for this study. Litera...
Marzieh Zendehdel; Laily Hj Paim; Syuhaily Bint Osman
Studies examining the factors that affect the online purchasing behavior of consumers are rare, despite the prospective advance of e-commerce in Malaysia. The present study examines particular factors that influence the attitude of potential consumers to purchase online by using the attributes from the diffusion of innovations theory of Rogers, the attribute of perception of risk, and the subjective norms toward online purchasing. Consumers’ perceived risks of online shopping have become a vi...
In the 5 Questions book series, this volume presents a range of leading scholars in Intellectual History and the History of Ideas through their answers to a brief questionnaire. Respondents include Michael Friedman, Jacques le Goff, Hans Ulrich Gumbrecht, Jonathan Israel, Phiip Pettit, John Pocock...
Tomaszewski, K; Motwani, J
A large sum of money is spent annually by salespeople on gifts and favors for purchasing executives. The provision of gifts and favors to buyers remains a common practice despite the fact that it often leads to ethical conflicts for purchasing executives, sales managers, and salespeople. This paper investigates the perceptions of 51 purchasing executives of midwest hospitals regarding their behavior towards certain buying practices, the favors offered by vendors, favors actually accepted, as well as purchasers' discomfort and repayment levels regarding indebtedness. Based on the data analysis, this paper provides conclusions and directions for future research.
Full Text Available This research aimed to measure factors influencing purchase willingness and purchase unwillingness on Israeli products. Four predictor variables including consumer animosity, product judgment, boycott participation, and boycott motivation were used. Data were collected by an online survey, and it attracted 337 participants. Three stages of data analysis were applied, those were exploratory analyses, confirmatory factor analyses, and Structural Equation Model (SEM. In total, there were seven hypotheses tested. This research finds a significant impact of animosity on product judgment, boycott participation, and boycott motivation. Furthermore, product judgment and boycott participation significantly affect purchase willingness. Meanwhile, boycott participation and boycott motivation significantly affect purchase unwillingness.
The Nigerian Journal of Economic History (NJEH) seeks to promote the scholarly study of Africa's and the developing world's past economic issues and events from a diversity of perspectives notably those of History, Economics, and other relevant disciplines. The Journal, which encourages careful formulation of issues and ...
Anton Agus Setyawan
Full Text Available This study explores purchase intention of Syariah financial product. The purpose of the study is to identify factors of consumer’s intention to use Syariah financial product. Framework of the study is TRA model proposed by Ajzen and Fishbein (1980. The design of this study is qualitative approach. This study employs focus group discussion and in depth interview in data collection. Focus group discussion in this study involves 6 Syariah financial products. In depth interview has been accomplished with 3 different managers from Syariah financial institutions. Findings in this study are consumers evaluate Syariah financial product by comparing benefits of the product with conventional financial products. The concept of non economic benefit and religious aspect is also discussed in this study.
Electronic commerce could be the most important strategy exercised by utilities involved in transmission and distribution in the next five to ten years. One key element of electronic commerce is electronic data interchange (EDI). EDI is the direct, standardized computer-to-computer exchange of business documents, such as purchase orders, invoices, payments and inventory analysis between trading partners. EDI enables business documents delivery in seconds instead of days. Inventory has been a big expense for utilities, especially in the transmission and distribution area. In order to provide and restore electrical service to customers, utilities have been required to stock high levels of many different items. At times, warehouse personnel have had difficulty determining the minimum quantity needed for a particular part so items are stocked just-in-case.Electronic commerce will allow utilities to more accurately determine minimum stocking requirements and reduce inventory without sacrificing customer service.
Borah Bijan J
Full Text Available Abstract Background Medicare hospital Value-based purchasing (VBP program that links Medicare payments to quality of care will become effective from 2013. It is unclear whether specific hospital characteristics are associated with a hospital’s VBP score, and consequently incentive payments. The objective of the study was to assess the association of hospital characteristics with (i the mean VBP score, and (ii specific percentiles of the VBP score distribution. The secondary objective was to quantify the associations of hospital characteristics with the VBP score components: clinical process of care (CPC score and patient satisfaction score. Methods Observational analysis that used data from three sources: Medicare Hospital Compare Database, American Hospital Association 2010 Annual Survey and Medicare Impact File. The final study sample included 2,491 U.S. acute care hospitals eligible for the VBP program. The association of hospital characteristics with the mean VBP score and specific VBP score percentiles were assessed by ordinary least square (OLS regression and quantile regression (QR, respectively. Results VBP score had substantial variations, with mean score of 30 and 60 in the first and fourth quartiles of the VBP score distribution. For-profit status (vs. non-profit, smaller bed size (vs. 100–199 beds, East South Central region (vs. New England region and the report of specific CPC measures (discharge instructions, timely provision of antibiotics and beta blockers, and serum glucose controls in cardiac surgery patients were positively associated with mean VBP scores (p Conclusions Although hospitals serving the poor and the elderly are more likely to score lower under the VBP program, the correlation appears small. Profit status, geographic regions, number and type of CPC measures reported explain the most variation among scores.
This thesis examines the way online browsing and online or in-store purchasing behaviours evolve across the purchases customers make from a brand, and how this is influenced by the marketing communications that customers receive from that brand and its competitors. A sample of customers of three different retail brands are tracked over a two year period, and changes to browsing and purchase behaviour are observed. A model is developed which predicts the way customers are most likely to evolve...
Atkinson, Louise F; Palmer, Michelle A
Nutritionally promoted foods are now available at fast-food establishments. Little is known about their popularity, who is purchasing them, or their impact on dietary intake. Our study aimed to determine: how often nutritionally promoted fast foods were purchased; the demographic characteristics of people purchasing these foods; and if purchasing these foods resulted in reduced energy, and increased vegetable, content of lunches compared with those who purchased traditional fast foods. A survey collecting lunchtime fast-food purchases and demographic details was administered over two months. Nutritionally promoted products included the McDonalds' 'Heart Foundation Tick Approved' range and Subway's 'Six grams of fat or less' range. Energy and vegetable contents were estimated using information from fast-food companies' websites. Differences in demographics, energy and vegetable contents between individuals purchasing nutritionally promoted and traditional lunches were assessed using χ2 and t tests. Queensland, Australia. Lunchtime diners aged over 16 years at Subway and McDonalds. Surveys were collected from 927 respondents (58 % male, median age 25 (range 16-84) years; 73 % response rate). Only 3 % (n 24/910) of respondents who ordered a main option had purchased a nutritionally promoted item. Purchasers of nutritionally promoted foods were ∼13 years older, predominantly female (79 %), and more often reported involvement in a health-related profession (29 % v. 11 %) than purchasers of traditional foods (P < 0·05). Purchasers of nutritionally promoted foods ordered 1·5 fewer megajoules and 0·6 more vegetable servings than purchasers of traditional foods (P < 0·05). Nutritionally promoted fast foods may reduce lunchtime energy content, however these foods were infrequently chosen.
Viot , Catherine; Le Roux , André; Kremer , Florence
International audience; Counterfeiting is a major issue for companies, public institutions and consumers. Despite extensive literature on the subject in marketing, an instrument for measuring the wide variety of the determinants of attitude towards and intention to purchase counterfeit products is lacking. A second-order model comprising thirteen determinants, grouped into three latent constructs, is validated. This model includes a dimension related to the societal consequences of counterfei...
Zenner, Silvia; Wirthgen, Bernd; Altmann, M.
The paper presented the methodic as well as selected results of own empiric research (face-to-face questionings in seven different questioning regions, n = 1488) to the analysis of the shopping behaviour and the attitudes towards direct purchase. To the analysis of the buying patterns a Kaufverhaltensindex (KVI) was introduced. In the regional comparison will be clear that the questioning regions of Baden-Württemberg and North Rhine-Westphalia show KVI by far highest, while the eastern questi...
Clark, C S; Schuster, T B
This article explores recent innovative activity by managed care payor plans nationwide with particular emphasis on emerging, new relationships between the plans and their purchasers, enrollees, provider panels, and competitors. Because they already practice what advocates of health care reform are now preaching, many managed care plans are leading the charge to transform our health care delivery and financing systems.
Your family history includes health information about you and your close relatives. Families have many factors in common, including their genes, ... as heart disease, stroke, and cancer. Having a family member with a disease raises your risk, but ...
Pastores, Stephen M; O'Connor, Michael F; Kleinpell, Ruth M; Napolitano, Lena; Ward, Nicholas; Bailey, Heatherlee; Mollenkopf, Fred P; Coopersmith, Craig M
The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units. A multidisciplinary group of professionals with expertise in critical care education and clinical practice. Relevant medical literature was accessed through a systematic MEDLINE search and by requesting references from all task force members. Material published by the Accreditation Council for Graduate Medical Education and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force corresponded by electronic mail and held several conference calls to finalize this report. The new rules mandate that all first-year residents work no more than 16 hrs continuously, preserving the 80-hr limit on the resident workweek and 10-hr period between duty periods. More senior trainees may work a maximum of 24 hrs continuously, with an additional 4 hrs permitted for handoffs. Strategic napping is strongly suggested for trainees working longer shifts. Compliance with the new Accreditation Council for Graduate Medical Education duty-hour standards will compel workflow restructuring in intensive care units, which depend on residents to provide a substantial portion of care. Potential solutions include expanded utilization of nurse practitioners and physician assistants, telemedicine, offering critical care training positions to emergency medicine residents, and partnerships with hospitalists. Additional research will be necessary to evaluate the impact of the new standards on patient safety, continuity of care, resident learning, and staffing in the intensive care unit.
Elbers, Paul W G; Van Regenmortel, Niels; Gatz, Rainer
Acidbase.org has been serving the critical care community for over a decade. The backbone of this online resource consists of Peter Stewart's original text "How to understand Acid-Base" which is freely available to everyone. In addition, Stewart's Textbook of Acid Base, which puts the theory in today's clinical context is available for purchase from the website. However, many intensivists use acidbase.org on a daily basis for its educational content and in particular for its analysis module. This review provides an overview of the history of the website, a tutorial and descriptive statistics of over 10,000 queries submitted to the analysis module.
Kimball, Suzanne H.
An individual over age 18 can purchase a hearing aid online or through mail order if they sign a waiver declining a medical evaluation, while those under 18 are required to be seen by a physician to obtain medical consent. However, in many states there is nothing to prevent a parent or caregiver from purchasing hearing aids for their child from a…
Schotanus, Fredo; Telgen, Jan
This paper develops a typology for purchasing groups. In the typology, five main forms of cooperative purchasing are distinguished based on seven main dimensions. The forms are positioned in a matrix according to two distinguishing dimensions. These two dimensions are the ‘influence by all members
Ebben, Mark; de Boer, L.; Sitar-Pop, C.E.; Yucesan, E.; Chen, C.H.; Snowdon, J.L.; Charnes, J.M.
In this paper we present a multi-agent simulation model to investigate purchasing activities in an organizational environment. The starting point is the observation that the majority of purchasing activities in organizations are usually performed without any involvement of the organization's
... § 223.62 Timber purchaser road construction credit. Appraisal may also establish stumpage value as if... timber is appraised and sold on such basis, purchaser credit for road construction, not to exceed the estimated construction cost of such roads or other developments specified in the timber sale contract, shall...
Groote Schaarsberg, M.
Three chapters of this dissertation deal with three different types of interactive purchasing situations, in which multiple buying organizations interact with similar (or possibly the same) suppliers for the procurement of the same commodity. Decisions to be made in interactive purchasing concern if
... persons; and to develop further the basis for the Postal Service's purchasing decisions and the... decision process. The SDR Official will promptly provide a copy of a disagreement to the contracting... POSTAL SERVICE 39 CFR Part 601 Purchasing of Property and Services AGENCY: Postal Service TM...
Zucker, Robert M; Chua, Michael
The purchase of a confocal microscope is a difficult decision. Many factors need to be considered, which include hardware, software, company, support, service, and price. These issues are discussed to help guide the purchasing process. © 2010 by John Wiley & Sons, Inc.
... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Purchases, sales, and exchanges. 2634.303 Section 2634.303 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS EXECUTIVE BRANCH....303 Purchases, sales, and exchanges. (a) In general. Except as indicated in § 2634.308(b) of this...
One of thirteen individualized courses included in a marketing curriculum, this course covers buying merchandise for resale, selecting vendors, bargaining for prices, and purchasing supplies for commercial food and beverage service establishments. The course is comprised of two units: (1) Merchandise Buying and (2) Food and Beverage Purchasing.…
Bevelander, K.E.; Anschutz, D.J.; Engels, R.C.M.E.
Ample experimental research has demonstrated the impact of peer influence on food intake in adolescents and adults. However, none of these studies focused social modeling effects on food purchases in supermarkets. This study investigated whether the food purchase behavior of a confederate peer would
... Section 50.13 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.13 Offer, purchase, and renewal. An insurer is deemed to be in compliance with the requirement of providing disclosure “at the time of offer, purchase...
Masteroppgave i økonomi og administrasjon - Universitetet i Agder 2009 This study investigated the applicability of the Theory of Planned Behavior in predicting women consumers on their intention towards purchasing green food products among 406 participants. Using linear regression, five independent variables had been examined: attitude towards green food products, subjective norms, perceived behavioral control, and perceived difficulty in predicting purchase intention. The ...
Valk, van der W.; Rozemeijer, F.A.
Abstract: Purpose – This paper aims to uncover the specific difficulties associated with buying services and proposes a structured purchasing process which can help organisational buyers to overcome the problems associated with services purchasing. Design/methodology/approach – The authors
Clemens, Robert A.
Purchasing is a practical science and one of the most highly specialized activities of the school administration. Simply stated, it is the process of having the right material or service from the right source, in the right quantity, at the right place, at the right time, and at the right price. The purchasing agent is faced with a formidable task…
... 49 Transportation 7 2010-10-01 2010-10-01 false CARS Purchaser Survey D Appendix D to Part 599 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... RECYCLE AND SAVE ACT PROGRAM Pt. 599, App. D Appendix D to Part 599—CARS Purchaser Survey ER29JY09.008 ...
van der Heijden, J.G.M.; Verhagen, T.
This paper explores factors that influence consumer's intentions to purchase online at an electronic commerce website. Specifically, we investigate online purchase intention using two different perspectives: a technology-oriented perspective and a trust-oriented perspective. We summarise and review
Yeh, Jong Chao; Liao, Chih-Hsiang
Environmental chemical agents such as pesticides can be purchased easily at a relatively low price, and this has resulted in high concern of environmental toxicity to human health, due to their persistence in various environmental bodies. Hence, this study aims to propose important factors influencing pesticide purchase intentions, including consumers' perceptions of the brand image and the ecological health risk. Since consumers are primary users, the seller knows the product's features but not the psychology of those who purchase it. Therefore, we attempted to clarify purchase intentions and perceptions using structural equation modeling techniques to empirically analyze survey data from 324 pesticide consumers in Taiwan. Our results demonstrate that perceived brand image positively affects perceived quality of a product, whereas perceived risk negatively affects perceived quality and purchase intentions. Furthermore, this study provides evidence that perceived quality positively affects purchase intentions. These relationships suggest that perceived quality mediates both the positive association between brand image and purchase intentions and the negative association between perceived risk and purchase intentions. Based on such outcomes, we propose that consumers need to be informed of pesticides related to costs and environmental benefits.
... 7 Agriculture 7 2010-01-01 2010-01-01 false Risk management purchase requirements. 760.104 Section... Agricultural Disaster Assistance Programs § 760.104 Risk management purchase requirements. (a) To be eligible... available from the USDA Risk Management Agency (RMA)) obtained catastrophic coverage or better under a...
It is not easy to lay prejudices aside, to find and face the facts, and to let the chips fall where they may. There is no need to wait for improvements in technology before beginning to use outcomes monitoring to guide the business exchange between purchasers and providers. Although future technological improvements will greatly improve the capacity to use objective data to differentiate among providers and to identify strengths and weaknesses within a health care organization, reasonable methods are available today to undertake these important tasks. All that is needed is the courage and willingness to embrace them. The future belongs to purchaser and provider organizations that are willing to seek enlightenment rather than blame.
Lyng, Ran Sun; Zhou, Jie
around 61% of them to down payments when buying a house. Liquid wealth stay low after a house purchase and start to increase 3 years later; (ii) the risky asset participation rate drops 2 percentage points – a 6.2% decline – at the year of house purchase. The drop is larger for households with wealth...... above the median level; and (iii) conditional on participation, the risky asset share decreases and reaches the lowest point 1 year before a house purchase, but it jumps immediately after. This suggests that of the three channels identified in the literature that could affect the conditional risky share......We study the temporal patterns of household portfolio choice of liquid wealth over a 7-year period around house purchase, using unique administrative panel data from Denmark. We find that (i) households accumulate significantly more liquid wealth in a few years before a house purchase and convert...
The purchasing agent for Canadian Occidental Chemicals described his experiences in the purchase of electricity under the new circumstances of competition. Electrical power costs for Canadian Occidental's manufacturing operation were described as a key consideration in expanding their chlorate production. The ideal purchasing scheme was described from the purchaser's standpoint. A list of what purchasers wish to gain from increased supplier choices was provided. The behaviour of the electricity suppliers that provide power to CanadianOccidental was described since changes in British Columbia's electric power regulations were enacted. Electric utility marketing practices in Ontario, Manitoba and Alberta were noted in comparison. It was prophesized that deeregulation will ultimately benefit consumers and provincial economies, by transforming the power industry into a customer driven industry
Prete, M Irene; Guido, Gianluigi; Pichierri, Marco
The authors hypothesize a concept, Consumer Hypnotic-Like Suggestibility (CHLS), defined as an altered state of consciousness, as a state causing a tendency to respond positively to messages aimed at inducing consumers to make unplanned purchases. This study aims to investigate the associations of CHLS with interpersonal variables and compulsive purchasing--a frequent and uncontrollable preoccupation with buying or impulses to buy. A study was conducted on a sample of 232 subjects (n = 111 men; M age = 41 yr.), through the administration of a questionnaire, which measured: CHLS, compulsive purchasing, consumer susceptibility to interpersonal influence (the necessity to enhance one's image in the opinion of others through the consumption of products), and consumer atmospherics, i.e., environmental stimuli known to influence purchasing decisions. Modeling and mediation analyses suggested that internal and external drivers--Consumer Susceptibility to Interpersonal Influence and atmospherics--are positively related to CHLS which affects compulsive purchasing.
Sudzina, Frantisek; Pavlicek, Antonin
influence whether customers are more prone to purchase problematic goods and services on deal sites, i.e. to experience problems with purchased coupons. Methodology/Approach: The research was conducted in the Czech Republic using an on-line questionnaire. Respondents were university students. Data were...... and mistrust. All these statements were measured on a Likert scale. Additional independent variables are age, and gender. In the first model, the dependent variable is if and if so, what problem the respondent experienced with purchased goods or services, such as the company did not exist, it was not possible...... cases. In the second model, the dependent variable is the percentage (predefined intervals) of problematic purchases. Ordinal logistic regression was used to test the model. In the third model, the dependent variable is if the purchased goods or services were of lower quality. Binomial logistic...
Thomas, Rebecca; Millar, Murray
Experiential purchases are differentiated from material purchases in terms of objective; experiential purchases serve the purpose of acquiring a life experience, while material purchases serve the purpose of acquiring an object. Research has demonstrated that experiential purchases are associated with more happiness than material purchases. The current study investigated two explanations for this relationship that focused on the how the purchase influenced the self and how the purchase influenced interpersonal relationships. In addition, the study explored whether social economic status would influence the strength of the relationship between the type of purchase and happiness. Participants were required to recall either a recent experiential or material purchase and rate their happiness with the purchase. Then participants completed scales designed to measure the purchase's impact on the self and interpersonal relationships. Last, participants completed a scale to measure social economic status. It was found that Impacts on the Self mediated the relationship between purchase type and happiness and Socioeconomic Status moderated the relationship.
operation. This site remains as a history of the center, but will not be actively maintained. University of . Crystals are made up of layers, or "planes" of atoms, perfectly stacked in an ordered pattern . Because this surface has been cut at a slight angle to the crystal planes, it appears "stepped"
Xu, Weiwei; van de Ven, Wynand P M M
In its 2009 blue print of healthcare reform, the Chinese government aimed to create a competitive health insurance market in order to increase efficiency in the health insurance sector. A major advantage of a competitive health insurance market is that insurers are stimulated to act as well-motivated prudent purchasers of healthcare on behalf of their enrolees, and that consumers can choose among these purchasers. To emphasize the insurers' role of purchasers of care we denote them, as well as other entities that can fulfil this role (e.g. fundholding community health centres), as 'Mutual Healthcare Purchasers' (MHPs). As feasible proposals for creating competition in China's health insurance sector have yet to be made, we suggest two potential approaches to create competition among MHPs: (1) separating finance and operation of social health insurance and allowing consumer choice among operators of social health insurance schemes; (2) allowing consumer choice among fund-holding community health centres. Although the benefits of competition are widely accepted in China, the problematic consequences of a free competitive health insurance market - especially in relation to affordability and accessibility - are generally neglected. To solve the problems of lack of affordability and inaccessibility that would occur in the case of unregulated competition among MHPs, at least the following regulations are proposed to the Chinese policy makers: a 'standard benefit package' for basic health insurance, a 'risk-equalization scheme', and 'open enrolment'. Potential obstacles for implementing a risk equalization scheme are examined based on theoretical arguments and international experiences. We conclude that allowing consumer choice among MHPs and implementing a risk equalization scheme in China is politically and technically complex. Therefore, the Chinese government should prepare carefully for a market-oriented reform in its healthcare sector and adopt a strategic approach
Bell, D.R.; Corsten, D.; Knox, G.A.H.
Many retailers believe that a majority of purchases are unplanned, so they spend heavily on in-store marketing to stimulate these types of purchases. At the same time, the effects of “preshopping” factors—the shoppers' overall trip goals, store-specific shopping objectives, and prior marketing
... HEARINGS PROCEDURES Purchase at Probate § 30.164 What must I do to purchase at probate? Any eligible purchaser must submit a written request to OHA to purchase at probate before the decision or order is issued. ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false What must I do to purchase at probate? 30...
Gajewski, Patrick D; Drizinsky, Jessica; Zülch, Joachim; Falkenstein, Michael
Decision making in economic context is an everyday activity but its neuronal correlates are poorly understood. The present study aimed at investigating the electrophysiological brain activity during simulated purchase decisions of technical products for a lower or higher price relative to a mean price estimated in a pilot study. Expectedly, participants mostly decided to buy a product when it was cheap and not to buy when it was expensive. However, in some trials they made counter-conformity decisions to buy a product for a higher than the average price or not to buy it despite an attractive price. These responses took more time and the variability of the response latency was enhanced relative to conformity responses. ERPs showed enhanced conflict related fronto-central N2 during both types of counter-conformity compared to conformity decisions. A reverse pattern was found for the P3a and P3b. The response-locked P3 (r-P3) was larger and the subsequent CNV smaller for counter-conformity than conformity decisions. We assume that counter-conformity decisions elevate the response threshold (larger N2), intensify response evaluation (r-P3) and attenuate the preparation for the next trial (CNV). These effects were discussed in the framework of the functional role of the fronto-parietal cortex in economic decision making.
Patrick Darius Gajewski
Full Text Available Decision making in economic context is an everyday activity but its neuronal correlates are poorly understood. The present study aimed at investigating the electrophysiological brain activity during simulated purchase decisions of technical products for a lower or higher price relative to a mean price estimated in a pilot study. Expectedly, participants mostly decided to buy a product when it was cheap and not to buy when it was expensive. But in some trials they made counter-conformity decisions to buy a product for more money than the average price or not to buy a product despite an attractive price. These responses took more time and the variability of the response latency was enhanced relative to conformity responses. ERPs showed enhanced conflict related fronto-central N2 during both types of counter-conformity compared to conformity decisions. A reverse pattern was found for the P3a and P3b. The response-locked P3 (r-P3 was larger and the subsequent CNV smaller for counter-conformity than conformity decisions. We assume that counter-conformity decisions elevate the response threshold (larger N2, intensify response evaluation (r-P3 and attenuate the preparation for the next trial (CNV. These effects were discussed in the framework of the functional role of the fronto-parietal cortex in economic decision making.
Schmidt, Axel J; Marcus, Ulrich
In Germany, testing and treatment of sexually transmissible infections (STIs) services are not provided by one medical discipline, but rather dispersed among many different providers. Common STIs like gonorrhoea or Chlamydia infection are not routinely reported. Although men who have sex with men (MSM) are particularly vulnerable to STIs, respective health care utilization among MSM is largely unknown. A sexual behaviour survey among MSM was conducted in 2006. Questions on self-reported sexual behaviour, STI-related health care consultation and barriers to access, coverage of vaccination against hepatitis, screening for asymptomatic STIs, self-reported history of STIs, and partner notification were analysed. Analysis was stratified by HIV-serostatus (3,511 HIV-negative/unknown versus 874 positive). General Practitioners, particularly gay doctors, were preferred for STI-related health care. Low threshold testing in sex-associated venues was acceptable for most respondents. Shame and fear of homophobic reactions were the main barriers for STI-testing. More than half of the respondents reported vaccination against hepatitis A/B. HIV-positive MSM reported screening offers for STIs three to seven times more often than HIV-negative or untested MSM. Unlike testing for syphilis or hepatitis C, screening for asymptomatic pharyngeal and rectal infections was rarely offered. STIs in the previous twelve months were reported by 7.1% of HIV-negative/untested, and 34.7% of HIV-positive respondents. Self-reported histories of STIs in MSM convenience samples differ significantly by HIV-serostatus. Higher rates of STIs among HIV-positive MSM may partly be explained by more testing. Communication between health care providers and their clients about sexuality, sexual practices, and sexual risks should be improved. A comprehensive STI screening policy for MSM is needed.
Wright, Mona A; Wintemute, Garen J
Federal law prohibits firearm possession by felons and certain others. Little is known about criminal activity resulting in new ineligibility to possess firearms among persons who have previously purchased them. Cohort study of handgun purchasers ages 21 to 49 in California in 1991, 2,761 with a non-prohibiting criminal history at the time of purchase and 4,495 with no prior criminal record, followed for up to 5 years. The primary outcome measures were the incidence and relative risk of conviction for a felony or violent misdemeanor resulting in ineligibility to possess firearms under (a) California law or (b) federal law. Secondary measures were the incidence and relative risk of conviction for murder, forcible rape, robbery, or aggravated assault; and of arrest for any crime. A new conviction for a felony or violent misdemeanor leading to ineligibility to possess firearms under federal law was identified for 0.9% of subjects with no prior criminal history and 4.5% of those with 1 or more prior convictions (hazard ratio, 5.1; 95% confidence interval, 3.3-7.7). Risk was related inversely to age and directly to the extent of the prior criminal history; incidence rates varied by a factor of 200 or more among subgroups based on these characteristics. Among legal purchasers of handguns, the incidence of new felonious and violent criminal activity resulting in ineligibility to possess firearms is low for those with no prior criminal history but is substantially higher for those with a prior criminal record and is affected by demographic characteristics.
Gaiser, Hilary; Ho, Connie; Janier, Nicole; Wee, Amy; Johnson, Catherine; Watanabe, Ronald
To describe practitioner experiences regarding ocular complications in patients wearing decorative contact lenses, and to investigate the compliance of unauthorized distributors of decorative contact lenses to current Food and Drug Administration (FDA) and Federal Trade Commission (FTC) regulations. Also, to provide data to support a more targeted public health approach to reducing the incidence of illegal contact lens sales and associated ocular complications. An institutional review board-approved online survey was distributed through mass email to a list of 98 optometrists in the Boston, MA area. Concurrently, an empirical evaluation of independent, online decorative contact lens sellers who were not associated with FDA-approved contact lens manufacturers was performed to determine their adherence to FDA and FTC guidelines. The first 18 noncoincidental websites that resulted from a Google search for "costume contact lens sellers" and "cosmetic contact lens sellers" were examined as to the brands and parameters of lenses being sold, whether or not a valid prescription was required or verified, and if consumer education was provided. Twenty-two optometrists completed the online survey. Seventy-seven percent of respondents reported having patients with complications from decorative contact lenses that were purchased both legally and illegally. The most common age group for complications was 18 to 25 years (61%). One third of complications were seen in first-time lens wearers, half of whom never received proper care instructions or were unaware that care instructions existed. One quarter of the lenses were purchased illegally with unlicensed stores being the most common place of purchase. Of the 18 online sites examined, 72% of sellers failed to adhere to FTC and FDA regulations. A significant number of individuals who obtain contact lenses illegally from unauthorized sources are young adults. Most unauthorized sellers reviewed did not adhere to the proper protocol
Slotkin, Jonathan R; Ross, Olivia A; Newman, Eric D; Comrey, Janet L; Watson, Victoria; Lee, Rachel V; Brosious, Megan M; Gerrity, Gloria; Davis, Scott M; Paul, Jacquelyn; Miller, E Lynn; Feinberg, David T; Toms, Steven A
One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer-purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change. Copyright © 2017 by the Congress of Neurological Surgeons.
de Graaf, Sophie; Van Loo, Ellen J; Bijttebier, Jo; Vanhonacker, Filiep; Lauwers, Ludwig; Tuyttens, Frank A M; Verbeke, Wim
Concern about the welfare of production animals is growing among various stakeholders, including the general public. Citizens can influence the market for premium welfare products by expressing public concerns, and consumers-the actors who actually purchase products-can do so through their purchasing behavior. However, current market shares for premium welfare products are small in Europe. To better align purchase behavior with public and individuals' concerns, insight is needed into determinants that influence the intention to purchase premium welfare products. A cross-sectional online survey of 787 Flemish milk consumers was conducted to investigate attitudes toward and intention to purchase animal-friendly milk. More than half of the sample (52.5%) expressed the intention to purchase animal-friendly milk. Linear regression modeling indicated that intention was positively influenced by (1) higher perceived product benefits from animal-friendly milk (milk with more health benefits and higher quality); (2) higher personal importance of extrinsic product attributes such as local production and country of origin; (3) higher personal importance of animal welfare; (4) a more natural living oriented attitude toward cows; and (5) a more positive general attitude toward milk. Intention was negatively influenced by (1) a stronger business-oriented attitude toward cows; and (2) by a higher personal importance attached to price. These insights in key components of purchase intention can assist producers, the dairy industry, and retailers to position and market animal-friendly milk. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.
Pawson, Eric; Christensen, Andreas Aagaard
Environmental history is an interdisciplinary pursuit that has developed as a form of conscience to counter an increasingly powerful, forward-looking liberal theory of the environment. It deals with the relations between environmental ideas and materialities, from the work of the geographers George...... risks”. These are exposed by environmental history’s focus on long-run analysis and its narrative form that identifies the stories that we tell ourselves about nature. How a better understanding of past environmental transformations helps to analyse society and agency, and what this can mean...... for solutions and policies, is the agenda for an engaged environmental history from now on....
Lassen, Henrik Roesgaard
have been written by Andersen. In several chapters the curiously forgotten history of fire-lighting technology is outlined, and it is demonstrated that "Tællelyset" is written by a person with a modern perspective on how to light a candle - among other things. The central argument in the book springs...... from a point-by-point tracing of 'the origins and history' of Hans Christian Andersen's famous fairy tales. Where did the come from? How did they become the iconic texts that we know today? On this background it becomes quite clear that "Tællelyset" is a modern pastiche and not a genuine Hans Christian...
Yokoyama, Ryoichi; Nozawa, Takayuki; Sugiura, Motoaki; Yomogida, Yukihito; Takeuchi, Hikaru; Akimoto, Yoritaka; Shibuya, Satoru; Kawashima, Ryuta
Social considerations significantly influence daily purchase decisions, and the perception of social risk (i.e., the anticipated disapproval of others) is crucial in dissuading consumers from making purchases. However, the neural basis for consumers' perception of social risk remains undiscovered, and this novel study clarifies the relevant neural processes. A total of 26 volunteers were scanned while they evaluated purchase intention of products (purchase intention task) and their anticipation of others' disapproval for possessing a product (social risk task), using functional magnetic resonance imaging (fMRI). The fMRI data from the purchase intention task was used to identify the brain region associated with perception of social risk during purchase decision making by using subjective social risk ratings for a parametric modulation analysis. Furthermore, we aimed to explore if there was a difference between participants' purchase decisions and their explicit evaluations of social risk, with reference to the neural activity associated with social risk perception. For this, subjective social risk ratings were used for a parametric modulation analysis on fMRI data from the social risk task. Analysis of the purchase intention task revealed a significant positive correlation between ratings of social risk and activity in the anterior insula, an area of the brain that is known as part of the emotion-related network. Analysis of the social risk task revealed a significant positive correlation between ratings of social risk and activity in the temporal parietal junction and the medial prefrontal cortex, which are known as theory-of-mind regions. Our results suggest that the anterior insula processes consumers' social risk implicitly to prompt consumers not to buy socially unacceptable products, whereas ToM-related regions process such risk explicitly in considering the anticipated disapproval of others. These findings may prove helpful in understanding the mental
Ariff, Mohd Shoki Md; Sze Yan, Ng; Zakuan, Norhayati; Zaidi Bahari, Ahamad; Jusoh, Ahmad
The growing use of internet and online purchasing among young consumers in Malaysia provides a huge prospect in e-commerce market, specifically for B2C segment. In this market, if E-marketers know the web-based factors affecting online buyers' behaviour, and the effect of these factors on behaviour of online consumers, then they can develop their marketing strategies to convert potential customers into active one, while retaining existing online customers. Review of previous studies related to the online purchasing behaviour in B2C market has point out that the conceptualization and empirical validation of the online purchasing behaviour of Information and Communication Technology (ICT) literate users, or ICT professional, in Malaysia has not been clearly addressed. This paper focuses on (i) web-based factors which online buyers (ICT professional) keep in mind while shopping online; and (ii) the effect of web-based factors on online purchasing behaviour. Based on the extensive literature review, a conceptual framework of 24 items of five factors was constructed to determine web-based factors affecting online purchasing behaviour of ICT professional. Analysis of data was performed based on the 310 questionnaires, which were collected using a stratified random sampling method, from ICT undergraduate students in a public university in Malaysia. The Exploratory factor analysis performed showed that five factors affecting online purchase behaviour are Information Quality, Fulfilment/Reliability/Customer Service, Website Design, Quick and Details, and Privacy/Security. The result of Multiple Regression Analysis indicated that Information Quality, Quick and Details, and Privacy/Security affect positively online purchase behaviour. The results provide a usable model for measuring web-based factors affecting buyers' online purchase behaviour in B2C market, as well as for online shopping companies to focus on the factors that will increase customers' online purchase.
Ariff, Mohd Shoki Md; Yan, Ng Sze; Zakuan, Norhayati; Bahari, Ahamad Zaidi; Jusoh, Ahmad
The growing use of internet and online purchasing among young consumers in Malaysia provides a huge prospect in e-commerce market, specifically for B2C segment. In this market, if E-marketers know the web-based factors affecting online buyers' behaviour, and the effect of these factors on behaviour of online consumers, then they can develop their marketing strategies to convert potential customers into active one, while retaining existing online customers. Review of previous studies related to the online purchasing behaviour in B2C market has point out that the conceptualization and empirical validation of the online purchasing behaviour of Information and Communication Technology (ICT) literate users, or ICT professional, in Malaysia has not been clearly addressed. This paper focuses on (i) web-based factors which online buyers (ICT professional) keep in mind while shopping online; and (ii) the effect of web-based factors on online purchasing behaviour. Based on the extensive literature review, a conceptual framework of 24 items of five factors was constructed to determine web-based factors affecting online purchasing behaviour of ICT professional. Analysis of data was performed based on the 310 questionnaires, which were collected using a stratified random sampling method, from ICT undergraduate students in a public university in Malaysia. The Exploratory factor analysis performed showed that five factors affecting online purchase behaviour are Information Quality, Fulfilment/Reliability/Customer Service, Website Design, Quick and Details, and Privacy/Security. The result of Multiple Regression Analysis indicated that Information Quality, Quick and Details, and Privacy/Security affect positively online purchase behaviour. The results provide a usable model for measuring web-based factors affecting buyers' online purchase behaviour in B2C market, as well as for online shopping companies to focus on the factors that will increase customers' online purchase.
...; Information Collection; Contractors' Purchasing Systems Reviews AGENCY: Department of Defense (DOD), General... collection requirement concerning contractors' purchasing systems reviews. Public comments are particularly... Information Collection 9000- 0132, Contractors' Purchasing Systems Reviews, by any of the following methods...
Full Text Available This paper presents a study to determine the role of commercialization on purchase intention in auto industry. The study designs a questionnaire in Likert scale and distributes it among some randomly selected people who lived in city of Tehran, Iran. The study investigates the effects of four factors including competitive condition, product development strategy, competitive advantage and economic growth on customers’ intention to purchase. Using structural equation modeling the study has determined a positive and meaningful relationship between each four components and purchase intention. In our study, the highest impact belongs to competitive condition followed by product development strategy.
As electric utilities increase their reliance on the long-term power purchase as an alternative to utility-owned generation, the appropriate rate treatment of the costs established in the purchase agreement assumes growing importance. In the November 9, 1989, issue, the authors examined the recent trend among state regulators to treat the long-term purchase in a manner similar to the addition by a utility of a new plant, including a full-scale prudence review. This installment will review recent rulings on the related issue of rate recovery of long-term capacity costs through the fuel cost adjustment clause
Hall, Homer J.
Four case histories were studied in an on-going project to develop a method for user selection of purchased scientific and technical information services. The issues involved were: (1) the value of computer search services to a small branch of a company technical library; (2) the special decision-making factors used for selecting items of very…
Full Text Available Being aware of the tradition of research on spirituality in theology and the existence of detailed publications and research concerning psychology of religion and religiosity in psychology as well as other sciences in Poland, the authors propose the recognition and adaptation of the FICA tool for spirituality research. The belief in the importance of deepening the knowledge and providing tools to research spirituality of human existence results from a long practice of the authors in palliative and hospital care. Understanding a difficulty in operationalizing the category of spirituality, they attempted at searching for a method that would be applicable to persons at the end of their lives as well as to all the suffering. Having analyzed the research tools built by Polish science as well as available ones on religiosity and spirituality the following paper aims at presenting the unknown FICA tool (F – Faith and Believe, I – Importance, C – Community, A – Address in Care in Poland by Prof. Dr. Christina M. Puchalski, USA, being adapted to Polish practice. The tool presented allows for the evaluation of spiritual experience of persons taken medical and social care of by every member of multidisciplinary team of professionals. Since the FICA tool is a qualitative scale it does not need a normalization and standardization methodology. However, a cultural adaptation is crucial in order to make the practical tool become help in answering spiritual and existential questions posed by patients to workers and voluntaries engaged in the process of Care.
Havlicek, Judy; Courtney, Mark E
This study compared official investigated reports of child maltreatment with retrospective self-reports prior to and during out-of-home care for a sample of foster youth who reached the age of majority in out-of-home care in Illinois. Using matched administrative and self-reported data for 474 youth who completed a baseline interview in the Midwest Evaluation of Adult Functioning of Former Foster Youth (i.e. the Midwest study) at ages 17-18, and 386 youth who completed a follow up interview at age 19, this study finds that official reports and self-reports of maltreatment prior to and during out-of-home care differ significantly. Findings from this study add insight into measurement discrepancies, and help to inform understanding of the extent of maltreatment experienced by this sub-sample of young people exiting out-of-home care in adulthood. Study findings have implications for independent living policy and practice in child welfare. Copyright © 2015 Elsevier Ltd. All rights reserved.
Atherton, H. L.; Steels, S. L.
Knowledge and understanding of how eugenics has historically affected the lives of people with intellectual disabilities is vital if professionals are to mount an effective defence against its contemporary influences. An online survey of European providers of health, social care and pedagogical education and training courses was undertaken to find…
Hansen, Per H.
This article argues that a cultural and narrative perspective can enrich the business history field, encourage new and different questions and answers, and provide new ways of thinking about methods and empirical material. It discusses what culture is and how it relates to narratives. Taking...
Bjørn, Anders; Owsianiak, Mikołaj; Molin, Christine
The idea of LCA was conceived in the 1960s when environmental degradation and in particular the limited access to resources started becoming a concern. This chapter gives a brief summary of the history of LCA since then with a focus on the fields of methodological development, application...
Ramirez, Catherine Clark
Suggests that the telling of vivid stories can help engage elementary students' emotions and increase the chances of fostering an interest in Texas history. Suggests that incorporating elements of the process approach to writing can merge with social studies objectives in creating a curriculum for wisdom. (RS)
Krumme, Alexis A; Sanfélix-Gimeno, Gabriel; Franklin, Jessica M; Isaman, Danielle L; Mahesri, Mufaddal; Matlin, Olga S; Shrank, William H; Brennan, Troyen A; Brill, Gregory; Choudhry, Niteesh K
The use of retail purchasing data may improve adherence prediction over approaches using healthcare insurance claims alone. Retrospective. A cohort of patients who received prescription medication benefits through CVS Caremark, used a CVS Pharmacy ExtraCare Health Care (ECHC) loyalty card, and initiated a statin medication in 2011. We evaluated associations between retail purchasing patterns and optimal adherence to statins in the 12 subsequent months. Among 11 010 statin initiators, 43% were optimally adherent at 12 months of follow-up. Greater numbers of store visits per month and dollar amount per visit were positively associated with optimal adherence, as was making a purchase on the same day as filling a prescription (ppurchase variables had low discriminative ability (C-statistic: 0.563), while models with both clinical and retail purchase variables achieved a C-statistic of 0.617. While the use of retail purchases may improve the discriminative ability of claims-based approaches, these data alone appear inadequate for adherence prediction, even with the addition of more complex analytical approaches. Nevertheless, associations between retail purchasing behaviours and adherence could inform the development of quality improvement interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Piernas, Carmen; Ng, Shu Wen; Mendez, Michelle A.; Gordon-Larsen, Penny; Popkin, Barry M.
Investigating the association between consumption of sweetened beverages and dietary quality is challenging because issues such as reverse causality and unmeasured confounding might result in biased and inconsistent estimates. Using a dynamic panel model with instrumental variables to address those issues, we examined the independent associations of beverages sweetened with caloric and low-calorie sweeteners with dietary quality and food-purchasing patterns. We analyzed purchase data from the Homescan survey, an ongoing, longitudinal, nationally representative US survey, from 2000 to 2010 (n = 34,294). Our model included lagged measures of dietary quality and beverage purchases (servings/day in the previous year) as exposures to predict the outcomes (macronutrient (kilocalories per capita per day; %), total energy, and food purchases) in the next year after adjustment for other sociodemographic covariates. Despite secular declines in purchases (kilocalories per capita per day) from all sources, each 1-serving/day increase in consumption of either beverage type resulted in higher purchases of total daily kilocalories and kilocalories from food, carbohydrates, total sugar, and total fat. Each 1-serving/day increase in consumption of either beverage was associated with more purchases of caloric-sweetened desserts or sweeteners, which accounted for a substantial proportion of the increase in total kilocalories. We concluded that consumers of both beverages sweetened with low-calorie sweeteners and beverages sweetened with caloric sweeteners had poorer dietary quality, exhibited higher energy from all purchases, sugar, and fat, and purchased more caloric-sweetened desserts/caloric sweeteners compared with nonconsumers. PMID:25834139
Piernas, Carmen; Ng, Shu Wen; Mendez, Michelle A; Gordon-Larsen, Penny; Popkin, Barry M
Investigating the association between consumption of sweetened beverages and dietary quality is challenging because issues such as reverse causality and unmeasured confounding might result in biased and inconsistent estimates. Using a dynamic panel model with instrumental variables to address those issues, we examined the independent associations of beverages sweetened with caloric and low-calorie sweeteners with dietary quality and food-purchasing patterns. We analyzed purchase data from the Homescan survey, an ongoing, longitudinal, nationally representative US survey, from 2000 to 2010 (n = 34,294). Our model included lagged measures of dietary quality and beverage purchases (servings/day in the previous year) as exposures to predict the outcomes (macronutrient (kilocalories per capita per day; %), total energy, and food purchases) in the next year after adjustment for other sociodemographic covariates. Despite secular declines in purchases (kilocalories per capita per day) from all sources, each 1-serving/day increase in consumption of either beverage type resulted in higher purchases of total daily kilocalories and kilocalories from food, carbohydrates, total sugar, and total fat. Each 1-serving/day increase in consumption of either beverage was associated with more purchases of caloric-sweetened desserts or sweeteners, which accounted for a substantial proportion of the increase in total kilocalories. We concluded that consumers of both beverages sweetened with low-calorie sweeteners and beverages sweetened with caloric sweeteners had poorer dietary quality, exhibited higher energy from all purchases, sugar, and fat, and purchased more caloric-sweetened desserts/caloric sweeteners compared with nonconsumers. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: email@example.com.
Nooraini Mohamad Sheriff
Full Text Available The intangible nature of education is one contributor to consumers’ perception of risk prior to their purchase and consumption. This risk includes: functional risk, financial risk, temporal risk, physical risk, psychological risk and social risk. The presence of these risks often makes consumer evaluation prior to purchase and consumption difficult. Invoking a service guarantee is a platform available to enable higher educational institutions to minimize such risk perception so as to induce purchase. Specifically, service guarantee for higher education entails the application of teaching performance guarantee. This form of guarantee focuses on two important customer groups of higher educational institutions namely, students and faculty members, and focuses only on a specific performance aspect such as instructor’s performance. Thus, if students are dissatisfied with an instructor’s performance they are entitled to receive their money back. The imposition of such a teaching performance guarantee would implicate instructor’s accountability for certain aspects of their performance. It also establishes a mechanism to solicit feedback to better understand why and how instructors fail. Consequently, service performance guarantee creates a high level of customer focus and signals instructors’ care towards students
EPA developed this guidance to help ensure you meet EPA requirements when making such necessary purchases. With very few exceptions, you must follow a competitive process when you use EPA grant funds to acquire equipment and professional services.
Smed, Sinne; Edenbrandt, Anna Kristina; Koch-Hansen, Pia
and in the Netherlands. Design/methodology/approach We estimate probit models using a representative panel of households registering all their daily purchases during a year, three years after the introduction of a nutrition symbol in Denmark and the Netherlands (the Keyhole and the Choices). The purchase data is matched...... with information about labelling status. Other product and purchase characteristics, such as store-type and organic, are controlled for. Findings Households with children tend to have a lower probability of purchasing labelled products compared to other household types, while urbanity increases the probability...... that other aspects as the underlying attitudes and general health awareness may be of greater importance in identifying these consumers. Originality/value There is a lack of studies analyzing the effect of Front-of-Pack symbols on households’ product choices based on observed data as most previous studies...
selected sheep purchased for various purposes were studied. The study methods ... household economy in many countries. Ethiopia has ... Among these are mentioned skull morphology and size, body length, wither height, ear and tail length ...
.... We prepared this summary report at the request of the Director, Defense Procurement to provide a central repository of purchase card audit report findings and to identify misuse trends and problems...
Hutchison, Jennifer; Thomas, Nicole A; Elias, Lorin
It has been reliably shown that light is assumed to come from above. There is also some suggestion that light from the left might be preferred. Leftward lighting biases have been observed across various mediums such as paintings, portraits, photographs, and advertisements. As advertisements are used to persuade the public to purchase products, it was of interest to better understand whether leftward lighting would influence future intention to purchase. Participants gave preference ratings for pairs of advertisements with opposing lighting directions. Attitude towards the advertisement and the brand as well as future purchase intention was then rated. Overall, participants indicated that they preferred advertisements with leftward lighting and were more likely to purchase these products in the future than when the same products were lit from the right. Findings are consistent with previously observed leftward lighting biases and suggest that advertisements with a leftward lighting bias might be more effective.
Full Text Available This research analyzed the effects of service quality and customer experience to customer satisfaction and its impact on purchase intention of costumer internet services in West Jakarta. This research used hypothesis testing as a research design. The primary data were obtained through questionnaire distributed to 180 respondents who should be users of internet services from Telkomsel, Telkomsel Grapari West Jakarta. Data was anlyzed by Structural Equation Method (SEM. The results showed there were positives service qualities and customer experience effects to customer satisfaction. There were positive customer satisfaction effects to purchase intention. There were positive effects of service quality and customer experience to purchase intention. Implications for managers are to increase purchase intention through fulfilled customer satisfaction led from good service quality and customer experience. For reasearch, it can be done in other service providers and by adding extra variables, such as coporate image and brand trust.
Dwi Meilia Fitriyani
Full Text Available The paper aimed to get insight of consumer involvement in purchasing behavior towards ONS (Oral Nutritional Supplements for children. By implementing an online survey with sample size of 100, the research investigated the factors (motivation and stimulus factor influencing consumer involvement and the causality between consumer involvement with the product knowledge as well as purchasing behavior. The research tool used was a 5-points Likert questionnaire in which respondents were asked to show their agreements about 40 items of 5 constructs. A partial least square - structural equation modeling by Smart-PLS software used to test the model. The results of this research also comes to conclusion that motivation and stimulus factor had significant affects on consumer involvement, consumer involvement had significant influence to product knowledge as well as ONS purchasing behavior, however product knowledge did not have significant affects on purchasing behavior. The results also showed that the product involvement has an important influence on consumers behavior.
... PROCEEDINGS) POLICY STATEMENTS STATEMENTS OF GENERAL POLICY Policies Relating to Rates and Tariffs § 399.39... for this purpose. It is the policy of the Board not to recognize equipment purchase deposits in an air...
Factors influencing women\\'s decisions to purchase specific children\\'s ... they had selected a children's multi-nutrient supplement with the intention of buying it. ... Price, performance and brand loyalty, affect and normative factors were most ...
Ulbinaite, Aurelija; Kucinskiene, Marija; Le Moullec, Yannick
This paper deals with the examination of insurance consumer behaviour in Lithuania. The purpose of the work is to determine the factors that explain the insurance service purchase decision of the Lithuanian citizens. To this end, a structured 5-point Likert scale questionnaire-based survey...... is employed to collect data. A research model composed of two main stages (purchase inclination and decision) is proposed. Factor analysis and multiple regression analysis are used to determine how the factors are formed and what their relative weights are. Five factors are identified: the acceptability...... to decide to actually purchase them; the higher degree or education acquired by the individuals, the fewer factors impact their insurance purchase decision: masters and doctors of science evaluate only the insurance service provider’s competence, while bachelors, besides the insurer’s competence, are also...
This type of e-marketing affects consumer on its purchase intention of product or service. ... influence and how these factors influence the buying decisions of consumers. ... This paper is expedient for marketers in creating effective promotional ...
... costs incurred at the Site, the settlement would require the Purchasers to, among other things, conduct... available only in hard copy form. Additionally, the PPA Amendment and additional background information are...
that could inform such strategic purchasing decisions. 14 We used the unique contract identification number to check for cross -organization...beds, mattresses, dressers , footlockers) Other (stools, rugs, seats, cabinets, tables, folding chairs, paintings) Generators Various power generators
ISSN 0378-5254 Journal of Family Ecology and Consumer Sciences, Vol 27: No 2, 1999. 85. Purchasing ... Although the pro- curement process for all types of food service units, ... Clients are more satisfied and management control improves ...
Several factors from literature such as comfort, advertising, brand, price, style and quality have ... A sample (N=120) of University of Botswana sport marketing students ... purchasing preferences in order to develop better marketing strategies.
Trude, S; Ginsburg, P B
Bipartisan interest is growing in Congress for using federal tax credits to help low-income families buy health insurance. Regardless of the approach taken, tax credit policies must address risk selection issues to ensure coverage for the chronically ill. Proposals that link tax credits to purchasing pools would avoid risk selection by grouping risks similar to the way large employers do. Voluntary purchasing pools have had only limited success, however. This Issue Brief discusses linking tax credits to purchasing pools. It uses information from the Center for Studying Health System Change's (HSC) site visits to 12 communities as well as other research to assess the role of purchasing pools nationwide and the key issues and implications of linking tax credits and pools.
... Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT..., purchased in the aggregate by group to the extent practical. These procurements are designed to obtain the...
... price quotations, and the like may be used to minimize paperwork. Retention in the purchase files of these documents and of written quotations received, or references to catalogs or printed price lists...
Full Text Available Objective: This study aimed to produce current data regarding behavioural aspects of non-prescription (over-the-counter medicine purchases, in light of changes in the pharmaceutical market and increasing provision of professional services in pharmacies.Methods: Data were collected in 15 community pharmacies in South-East Queensland, Australia, over 540 hours in five days in August, 2006. The method, previously validated, involved documentation of both observational and interview data. Fifteen trained researchers were stationed in a selected pharmacy each to unobtrusively observe all eligible sales of non-prescription medicines, and, where possible, interview the purchasers post-sale. Non-response was supplemented by observational data and recall by the salesperson. The data included details of the purchase and purchasing behaviour, while new questions addressed issues of topical importance, including customers’ privacy concerns. A selection of the analyses is reported here.Results: In total, 3470 purchases were documented (135-479 per pharmacy, with customers of 67.5% of purchases (74.7% excluding an outlier pharmacy participating in the survey. Customers averaged 1.2 non-prescription medicines per transaction. Two-thirds (67.2% of customers were female, and 38.8% of the customers were aged 31-45 years. Analgesics and respiratory medicines accounted for two-thirds of the sales data (33.4% and 32.4%, respectively. Intended-brand purchases comprised 71% of purchases (2004/2824; in-store substitution then occurred in 8.8% of these cases, mainly following recommendations by pharmacy staff. Medicines intended for self-use comprised 62.9% of purchases (1752/2785. First-time purchases (30.8%, 799/2594 were more commonly influenced by pharmacy staff than by advertising.Conclusions: This study used validated methods adapted to a changing marketplace, thus providing data that both confirm and add to knowledge surrounding medicine purchases. Despite the
Aubry, P; Gaüzère, B-A
In 1498, the Portuguese crossed the Cape of Good Hope. It was not until the period of 1633 and 1666, dates of the founding, respectively, of the Compagnie de l'Orient and the Compagnie des Indes orientales, that the way was definitively opened for trade between France and India. Because so many sailors developed scurvy after voyages that lasted 4 to 5 months, the French settled on Bourbon Island (Réunion) and Ile de France (Mauritius), to provide them with medical care. Created in 1689 by Louis XIV, the Navy Health Service was responsible for health in the colonies until it was replaced in 1890 by the Colonial Health Service. European medicine began its slow diffusion around the Indian Ocean in Pondicherry (India). The naval doctors reported their experiences in the Archives de médecine navale (1864-1889), and the colonial doctors afterwards in the Archives de médecine navale et coloniale (1890-1896). The health system in Madagascar developed strongly during 19(th) and 20(th) centuries, and the subsequent development of health care in the other Indian Ocean islands became closely linked to that of Madagascar. On Bourbon, the two navy hospitals in Saint-Paul and Saint-Denis treated only naval and military personnel. The colony had no hospital providing care for civilians and poor people until three civilian doctors opened a maison de santé (health house) in 1846.
Lunde Jørgensen, Ida
The paper engages with the larger question of how cultural heritage becomes taken for granted and offers a complimentary view to the anthropological ʻCopenhagen School’ of business history, one that draws attention to the way corporate wealth directly and indirectly influences the culture available...
Hussain, Riaz; Ali, Mazhar
This paper aimed at identifying the effects of atmosphere on the consumer purchase intention in international retail chain outlets of Karachi, Pakistan. This was the first study, which investigated the collective impact of atmospheric variables at one point in time on purchase intention. This research was causal in nature. A sample of 300 consumers was taken who usually visited these outlets. Data was collected through a well-structured questionnaire and analyzed through regression a...
Thornton, Lukar E; Kavanagh, A M
In this study, an instrument was created to measure the healthy and unhealthy characteristics of food environments and investigate associations between the whole of the food environment and fast food consumption. In consultation with other academic researchers in this field, food stores were categorised to either healthy or unhealthy and weighted (between +10 and -10) by their likely contribution to healthy/unhealthy eating practices. A healthy and unhealthy food environment score (FES) was created using these weightings. Using a cross-sectional study design, multilevel multinomial regression was used to estimate the effects of the whole food environment on the fast food purchasing habits of 2547 individuals. Respondents in areas with the highest tertile of the healthy FES had a lower likelihood of purchasing fast food both infrequently and frequently compared with respondents who never purchased, however only infrequent purchasing remained significant when simultaneously modelled with the unhealthy FES (odds ratio (OR) 0.52; 95% confidence interval (CI) 0.32-0.83). Although a lower likelihood of frequent fast food purchasing was also associated with living in the highest tertile of the unhealthy FES, no association remained once the healthy FES was included in the models. In our binary models, respondents living in areas with a higher unhealthy FES than healthy FES were more likely to purchase fast food infrequently (OR 1.35; 95% CI 1.00-1.82) however no association was found for frequent purchasing. Our study provides some evidence to suggest that healthier food environments may discourage fast food purchasing.
Klöckner, Christian; Ohms, Sylvia
Purpose – The purpose of this paper is to apply a structured approach to understand the importance of personal ecological norms in purchasing organic food. The norm‐activation‐model by Schwartz is used to predict self‐reported and observed purchase behaviour of organic milk. Design/methodology/approach – The paper reports the results of a field study with 63 customers of a German supermarket. A combination of covert observation and in‐store interviews was applied to obtain reli...
Bakara, Frisca Oktoviani
Television advertising has become a new force capable of influencing the audience to do what the advertisers want, and teenagers are very promising target for producers. This study investigated the influence of television advertising on teenagers purchase decision in Manado. This research aims to analyze (1) what is the impact of television advertising (Brand Preference, Peer Group, and Pester Power) on teenagers purchase decision; (2) which impact of television advertising (Brand Preference,...
樋口, 匡貴; 中村, 菜々子
Properly using condoms is one of the most effective types of protection against HIV. To clarify the contents of normative beliefs regarding purchasing and using condoms, 390 undergraduate student volunteers were surveyed. The exploratory and confirmatory factor analyses revealed that both males and females held two types of normative beliefs, namely formal normative beliefs and informal normative beliefs, regarding purchasing and using condoms. Formal normative beliefs were concerned with the...
Decision-making is more complex and even more important for consumers today than in the past. Today’s consumers has a wealth of information sources to their disposal, through advertising, news articles, direct mailings and word of mouth , in addition, there is a variety of stores and shopping malls that has broaden the sphere for consumer choice, and in the process complicated decision - making. Consumers purchase intentions and decision that lead to the purchase are closely related to their ...
Fitriyani, Dwi Meilia; Yuliati, Lilik Noor; Simanjuntak, Megawati
The paper aimed to get insight of consumer involvement in purchasing behavior towards ONS (Oral Nutritional Supplements) for children. By implementing an online survey with sample size of 100, the research investigated the factors (motivation and stimulus factor) influencing consumer involvement and the causality between consumer involvement with the product knowledge as well as purchasing behavior. The research tool used was a 5-points Likert questionnaire in which respondents were asked to ...
AĞAOĞLU, Mustafa; YURTKORU, Emine Serra; ŞAHİN, Yusuf
The purpose of this study is to analyze the factors, ethical behavior, product involvement, attitude, perceived sacrifice, and perceived benefit, impact on purchase intention in music industry. A model is constructed and tested empirically. A sample of 255 individuals are collected and a multi-item questionnaire is used. It is found that purchase intention is relatively low for both CD/DVD and digital music whereas illegal downloading is perceived as an acceptable behavior in the society. The...
The research is aimed at elicit attention to present marketing environment in Nigeria and as regard the importance of consumer purchasing behavior and this is also to ascertain if product brand, taste, personal income, and price and the what relationship it also have on consumer behavior toward Etisalat product. However, every company must develop new products that suite consumer pur-chase decision. This informed behavior affects how certain consumers react to new products and thereby af...
Bøe, Kenneth; Bjørnstad, Tord Røise
The importance of marketing and information flow is growing every year, and in increasingly competitive markets, it is more important than ever for brands to be present in the customers mind in the purchase decision. Therefore, to build and maintain brand awareness is important as this is the first step in creating brand equity. Most studies have focused on building brand awareness for products with high purchase frequency. In this thesis, it is identified drivers of brand awareness for pr...
Asma javed*, Dr Wasif Ali Waseer, Dr Babak Mehmood
The fast growth of online transaction and e-commerce inspired many companies to setup their business on web pages. It is fact that online purchasing is still poor as compared to other online activities. Research study will explore factors that affect consumer’s virtual purchase intention. Theory of Planned Behavior (TPB), Theory of Reasoned Action (TRA), and Theory Acceptance Model (TAM) are the groundwork theories that are used in research to investigate those factors that affect the virtual...
Grant, E A; Giniat, E J
Mergers and acquisitions are risk transactions. Therefore, a well-planned and executed purchase investigation that considers financial, personnel, legal and risk management, third-party payer, and medical staff issues is imperative. Organizations that can successfully complete a purchase investigation will be able to make better informed, lower risk, financial decisions, and will have a competitive advantage in achieving strategic goals. This article is the third in a series on mergers and acquisitions. Other articles will include legal issues and capital planning.
Chen, Chao-Chien; Lin, Shih-Yen; Cheng, Chia-Hsin; Tsai, Chia-Ching
The main purpose of this study is to investigate the impact of service quality and corporate social responsibility (CSR) on customer satisfaction, and customer satisfaction toward post-purchase intentions from sheltered employment institutions. Work experience plays an important role in career development for those people with intellectual disabilities. When they are not yet capable of obtaining a job in the open market, they must receive job training and daily care in sheltered employment institutions. If the sheltered employment institutions cannot operate properly, they will greatly affect intellectual disabilities. From the study of "Children Are Us Bakeries and Restaurants" sheltered employment institutions are one kind of food service business that has been found to request and improve service quality and execution of CSR. These are two main factors which can enhance brand value and create a good reputation for sheltered employment institutions. The questionnaire results indicate that perceived service quality has a positive relationship with customer satisfaction and the reliability dimension is the most important factor for customers to assess service quality. Meanwhile, correlation analysis shows that customer satisfaction regarding service quality influences post-purchase intentions, indicating that friendly and helpful employees can please customers and enhance their satisfaction level and also induce positive post-purchase intentions of consumers. Regarding the CSR of "Children Are Us Bakeries and Restaurants" sheltered employment institutions, the analysis reveals a statistical significance: the greater customer satisfaction of CSR, the higher the post-purchase intention. In addition, in the work, paired-sample t test analysis reveals there is a significant difference (pperceived" and "expected" responses. In summary, since those with intellectual disabilities usually are enthusiastic at work and do their best to provide good service and execute CSR
Ferrinho, Fátima; Amaral, Marta; Russo, Giuliano; Ferrinho, Paulo
Health workers' purchasing power is an important consideration in the development of strategies for health workforce development. This work explores the purchasing power variation of Mozambican public sector health workers, between 1999 and 2007. In general, the calculated purchasing power increased for most careers under study, and the highest percentage increase was observed for the lowest remuneration careers, contributing in this way for a relative reduction in the difference between the higher and the lower salaries. This was done through a simple and easy-to-apply methodology to estimate salaries' capitalization rate, by means of the accumulated inflation rate, after taking wage revisions into account. All the career categories in the Ministry of Health and affiliated public sector institutions were considered. Health workers' purchasing power is an important consideration in the development of strategies for health workforce development. This work explores the purchasing power variation of Mozambican public sector health workers, between 1999 and 2007. In general, the calculated purchasing power increased for most careers under study, and the highest percentage increase was observed for the lowest remuneration careers, contributing in this way for a relative reduction in the difference between the higher and the lower salaries. These results seem to contradict a commonly held assumption that health sector pay has deteriorated over the years, and with substantial damage for the poorest. Further studies appear to be needed to design a more accurate methodology to better understand the evolution and impact of public sector health workers' remunerations across the years.
Ji, Ling; Liang, Sai; Qu, Shen; Zhang, Yanxia; Xu, Ming; Jia, Xiaoping; Jia, Yingtao; Niu, Dongxiao; Yuan, Jiahai; Hou, Yong; Wang, Haikun; Chiu, Anthony S.F.; Hu, Xiaojun
Highlights: • A new accounting framework is proposed for GHG emission factors of power grids. • Three cases are used to demonstrate the proposed framework. • Comparisons with previous system boundaries approve the necessity. - Abstract: Electricity trade among power grids leads to difficulties in measuring greenhouse gas (GHG) emission factors of purchased electricity. Traditional methods assume either electricity purchased from a grid is entirely produced locally (Boundary I) or imported electricity is entirely produced by the exporting grid (Boundary II) (in fact a blend of electricity produced by many grids). Both methods ignore the fact that electricity can be indirectly traded between grids. Failing to capture such indirect electricity trade can underestimate or overestimate GHG emissions of purchased electricity in interconnected grid networks, potentially leading to incorrectly accounting for the effects of emission reduction policies involving purchased electricity. We propose a “Boundary III” framework to account for emissions both directly and indirectly caused by purchased electricity in interconnected gird networks. We use three case studies on a national grid network, an Eurasian Continent grid network, and North Europe grid network to demonstrate the proposed Boundary III emission factors. We found that the difference on GHG emissions of purchased electricity estimated using different emission factors can be considerably large. We suggest to standardize the choice of different emission factors based on how interconnected the local grid is with other grids.
Preuss, Nora; Mast, Fred W; Hasler, Gregor
Purchases are driven by consumers' product preferences and price considerations. Using caloric vestibular stimulation (CVS), we investigated the role of vestibular-affective circuits in purchase decision-making. CVS is an effective noninvasive brain stimulation method, which activates vestibular and overlapping emotional circuits (e.g., the insular cortex and the anterior cingulate cortex (ACC)). Subjects were exposed to CVS and sham stimulation while they performed two purchase decision-making tasks. In Experiment 1 subjects had to decide whether to purchase or not. CVS significantly reduced probability of buying a product. In Experiment 2 subjects had to rate desirability of the products and willingness to pay (WTP) while they were exposed to CVS and sham stimulation. CVS modulated desirability of the products but not WTP. The results suggest that CVS interfered with emotional circuits and thus attenuated the pleasant and rewarding effect of acquisition, which in turn reduced purchase probability. The present findings contribute to the rapidly growing literature on the neural basis of purchase decision-making.
Chapman, Colin D; Nilsson, Emil K; Nilsson, Victor C; Cedernaes, Jonathan; Rångtell, Frida H; Vogel, Heike; Dickson, Suzanne L; Broman, Jan-Erik; Hogenkamp, Pleunie S; Schiöth, Helgi B; Benedict, Christian
To investigate if acute sleep deprivation affects food purchasing choices in a mock supermarket. On the morning after one night of total sleep deprivation (TSD) or after one night of sleep, 14 normal-weight men were given a fixed budget (300 SEK-approximately 50 USD). They were instructed to purchase as much as they could out of a possible 40 items, including 20 high-caloric foods (>2 kcal/g) and 20 low-caloric foods (foods were then varied (75%, 100% (reference price), and 125%) to determine if TSD affects the flexibility of food purchasing. Before the task, participants received a standardized breakfast, thereby minimizing the potential confound produced by hunger. In addition, morning plasma concentrations of the orexigenic hormone ghrelin were measured under fasting conditions. Independent of both type of food offered and price condition, sleep-deprived men purchased significantly more calories (+9%) and grams (+18%) of food than they did after one night of sleep (both P food purchasing. This experiment demonstrates that acute sleep loss alters food purchasing behavior in men. Copyright © 2013 The Obesity Society.
Cansu Tor Kadioglu
Full Text Available The economic, social, and cultural changes in the modern world have made adolescents between the ages of 12 and 18 important influences on family purchasing decisions. No longer solely users of products and services, adolescents now influence purchasing decisions and have attracted the attention of marketers and researchers. The purpose of this study is to analyze changes in the influence of adolescents aged between 12 and 18 on family purchasing decisions depending on socio-economic and demographic factors. This study aims to determine whether changes occur regarding different product groups by establishing at which stage of the decision process adolescent influence predominates. To achieve this goal, a survey method was used as a data collection tool. Using the convenience sampling method, adolescents within the age range of 12 and 18 were interviewed in Mersin, Turkey. The research results indicate that the influence of adolescents on family purchasing decisions occurs at different stages and depends on the type of product to be purchased. The analysis further shows that adolescents’ age, gender, and number of siblings, and the family's total income, the father's level of education, and the mother's employment status also affect adolescent influence on family purchasing decisions.
Lesser, Lenard I; Kayekjian, Karen C; Velasquez, Paz; Tseng, Chi-Hong; Brook, Robert H; Cohen, Deborah A
To assess whether adolescents purchasing food at a restaurant marketed as "healthy" (Subway) purchase fewer calories than at a competing chain (McDonald's). We studied 97 adolescents who purchased a meal at both restaurants on different days, using each participant as his or her control. We compared the difference in calories purchased by adolescents at McDonald's and Subway in a diverse area of Los Angeles, CA. Adolescents purchased an average of 1,038 calories (standard error of the mean [SEM]: 41) at McDonald's and 955 calories (SEM 39) at Subway. The difference of 83 calories (95% confidence interval [CI]: -20 to 186) was not statistically significant (p = .11). At McDonald's, participants purchased significantly more calories from drinks (151 vs. 61, p McDonald's vs. 35 at Subway, p McDonald's (.15 vs. .57 cups, p McDonald's. Although Subway meals had more vegetables, meals from both restaurants are likely to contribute to overeating. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Epstein, Leonard H; Handley, Elizabeth A; Dearing, Kelly K; Cho, David D; Roemmich, James N; Paluch, Rocco A; Raja, Samina; Pak, Youngju; Spring, Bonnie
One way to increase choice of healthy over unhealthy behaviors is to increase the cost of less healthy alternatives or reduce the cost of healthier alternatives. The influence of price on purchases of healthy and unhealthy foods was evaluated in two laboratory experiments. In Experiment 1, thirty-two 10- to 12-year-old youth were given $5.00 and allowed to purchase multiple portions of a healthy food (fruit or vegetable) and a less healthy food (higher-fat snack). The price of one type of food varied from $0.50 to $2.50, while the price of the other type was held at $1.00. Increasing the price of a type of food reduced purchases of that type of food, but did not lead to substitution with the alternative type of food. In Experiment 2, twenty 10- to 14-year-old youth were given $1.00, $3.00, and $5.00 to purchase healthy and unhealthy foods. The price of each food was raised and lowered by 25% and 50%. Raising the price of healthy or unhealthy foods resulted in decreased purchases of those foods, and income available interacted with price to predict the pattern of substitution of alternative foods. These results show the potential for controlled laboratory studies of price and food purchases, and show that the substitution of healthier for unhealthy food is related to available money.
Full Text Available In a developing economy, the acceptability of e–retailing is not very new, but the potential of online marketing in market research and analysis is still largely unexplored. This article is an attempt to understand the psyche of Indian online consumers. As consumers have their own preconceived notions toward this growing purchasing environment, it becomes important for e-retailers to understand the consumers’ perceptions and attitudes toward online purchases. This paper integrates the dimensions of the risks and benefits with the Theory of Planned Behavior (TPB to understand how consumers adopt their online purchase processes. Four hundred and sixty-eight valid responses were analyzed using structural equation modeling on AMOS 21 to identify the relationship between the different factors and the intention to purchase online. The paper concludes that consumers’ purchase intentions are jointly determined by their attitude towards online purchases and the subjective norm. Furthermore, their attitude is determined by the sub-dimensions of perceived benefits (hedonic benefit, convenience benefit, economic benefit and variety and the sub-dimensions of perceived risk (product risk and financial risk.
During the last half century, advances in geomorphology-abetted by conceptual and technical developments in geophysics, geochemistry, remote sensing, geodesy, computing and ecology-have enhanced the potential value of fluvial history for reconstructing erosional and depositional sequences on the Earth and on Mars and for evaluating climatic and tectonic changes, the impact of fluvial processes on human settlement and health, and the problems faced in managing unstable fluvial systems. This journal is © 2012 The Royal Society
There was a time when almost all Western geography could be termed environmental history. In the late nineteenth century, physical geographers explained landscapes by describing how they had evolved. Likewise, human geographers saw society as shaped by the directing hands of the environment. By the 1960s this had very much changed. Process studies shortened the temporal framework in geographical explanation and cut the cord between nature and society. Now, physical and human...
Koppel, Sjaan; Clark, Belinda; Hoareau, Effie; Charlton, Judith L; Newstead, Stuart V
and their family from a crash, their traffic infringement history, and whether they had children. These findings are consistent with previous research that suggests that, though older consumers highlight the importance of safety features (i.e., seat belts, air bags, braking), they often downplay the role of safety in their vehicle purchasing process and are more likely to equate vehicle safety with the presence of specific vehicle safety features or technologies rather than the vehicle's crash safety/test results or crashworthiness. The findings from this study provide a foundation to support further research in this area that can be used by policy makers, manufacturers, and other stakeholders to better target the promotion and publicity of vehicle safety features to particular consumer groups (such as older consumers). Better targeted campaigns may help to emphasize the value of safety features and their role in reducing the risk of injury/death. If older consumers are better informed of the benefits of safety features when purchasing a vehicle, a further reduction in injuries and deaths related to motor vehicle crashes may be realized.
Jerram, Soline; Fox, Ann
The role of nursing in the NHS commissioning structure in England is developing. Since April 2013 more than 200 clinical commissioning groups (CCGs), which comprise all GP practices in the locality, have taken on responsibility for health budgets in their areas. This article describes the challenges ahead and nurses' responsibilities in CCGs when working with local citizens and across the health and social care system to assure the delivery of high quality, safe services.
The YRG Centre for AIDS Research and Education (CARE) in Chennai, India runs an integrated care program ensuring appropriate and affordable care to everyone who needs it. The program includes both voluntary counseling/testing and hospital/home-based care. YRG CARE developed several strategies for the care program, which include 1) different fees for an HIV test, 2) free counseling service, 3) different charges for other care services, 4) a subsidized pharmacy (involving purchasing drugs directly from manufacturers and wholesalers, ordering free samples from manufacturers, and acquiring drugs through the drug component of its clinical research projects, from overseas hospitals, and from YRG CARE hospital and community-based patients who have not used them), and 5) subsidized meals.
Full Text Available Background: Over-the-counter medicines (OTC are widely available and can be purchased without a prescription. Their availability means that a customer may choose to purchase them without the involvement of a pharmacy/pharmacist. It is important to understand customer OTC purchasing perceptions and behaviour from a pharmacy to better understand the needs and opportunities in this space. Objective: This study aimed to examine customers’ key expectations and what they value when purchasing OTC and how the effect of health status/stress and perceived risks/benefits of purchasing OTCs from a pharmacy may influence their OTC shopping behaviour. Methods: Customers from two metropolitan pharmacies across two different suburbs in Brisbane, Queensland, Australia completed a self-administered questionnaire. Data collection was conducted over a six-week period. The questionnaire examined demographics, current level of health and stress, as well as a range of questions (seven-point Likert-scale examining perceived benefits and risks, what they value, trust and expect when purchasing OTC. Results: A total of 86 customers from a broad range of demographics were captured in this study. When asked about their current health state, 41% and 23% respectively indicated that they were stressed and tense when they arrived at the pharmacy but many were feeling well (38%. Most customers strongly agreed/agreed that trust in the advice from a pharmacy (96%, trust in the products (73%, and the altruistic approach of a pharmacy (95% were critical to them. Further, 82% and 78% respectively disagreed that time pressures or costs were concerns, despite many feeling tense and stressed when they came in. When asked where they intend to buy their future OTC, 89% indicated pharmacy instead of a supermarket. Conclusions: High levels of trust, confidence and sense of altruism and care were key factors for customers buying OTC from a pharmacy, regardless of time pressures, costs or
Chan, Vincent; Tran, Hung
Over-the-counter medicines (OTC) are widely available and can be purchased without a prescription. Their availability means that a customer may choose to purchase them without the involvement of a pharmacy/pharmacist. It is important to understand customer OTC purchasing perceptions and behaviour from a pharmacy to better understand the needs and opportunities in this space. This study aimed to examine customers' key expectations and what they value when purchasing OTC and how the effect of health status/stress and perceived risks/benefits of purchasing OTCs from a pharmacy may influence their OTC shopping behaviour. Customers from two metropolitan pharmacies across two different suburbs in Brisbane, Queensland, Australia completed a self-administered questionnaire. Data collection was conducted over a six-week period. The questionnaire examined demographics, current level of health and stress, as well as a range of questions (seven-point Likert-scale) examining perceived benefits and risks, what they value, trust and expect when purchasing OTC. A total of 86 customers from a broad range of demographics were captured in this study. When asked about their current health state, 41% and 23% respectively indicated that they were stressed and tense when they arrived at the pharmacy but many were feeling well (38%). Most customers strongly agreed/agreed that trust in the advice from a pharmacy (96%), trust in the products (73%), and the altruistic approach of a pharmacy (95%) were critical to them. Further, 82% and 78% respectively disagreed that time pressures or costs were concerns, despite many feeling tense and stressed when they came in. When asked where they intend to buy their future OTC, 89% indicated pharmacy instead of a supermarket. High levels of trust, confidence and sense of altruism and care were key factors for customers buying OTC from a pharmacy, regardless of time pressures, costs or existing levels of stress and health.
Sifaneck, Stephen J.; Ream, Geoffrey L.; Johnson, Bruce D.; Dunlap, Eloise
This paper documents the bifurcation of the market for commercial marijuana from the market for designer marijuana in New York City. Commercial marijuana is usually grown outdoors, imported to NYC, and of average quality. By contrast, several strains of designer marijuana are usually grown indoors from specially-bred strains and carefully handled for maximum quality. The mechanisms for selling include street/park sellers, delivery services, private sales, and storefronts. Retail sales units vary from $5 to $50 and more, but the actual weights and price per gram of retail marijuana purchases lacks scientific precision. Ethnographic staff recruited marijuana purchasers who used digital scales to weigh a purposive sample of 99 marijuana purchases. Results indicate clear differences in price per gram between the purchases of commercial (avg. $8.20/gram) and designer (avg. $18.02/gram) marijuana. Designer purchases are more likely to be made by whites, downtown (Lower East Side/Union Square area), via delivery services, and in units of $10 bags, $50 cubes, and eighth and quarter ounces. Commercial marijuana purchases are more likely to be made by blacks, uptown (Harlem), via street dealers, and in units of $5 and $20 bags. Imported commercial types Arizona and Chocolate were only found uptown, while designer brand names describing actual strains like Sour Diesel and White Widow were only found downtown. Findings indicate clear divisions between commercial and designer marijuana markets in New York City. The extent that these differences may be based upon different THC potencies is a matter for future research. PMID:17055670
Hughes, Bill; Wilson, Greg
3D printing is recognized as a collection of technologies known as rapid prototyping, solid freeform fabrication, and most commonly, additive manufacturing (AM). With these emerging technologies it is possible to print (but not limited to): architectural models, discontinued car-part foundry patterns, industry-wide prototypes, human tissues, the…
Wintemute, Garen J; Kass, Philip H; Stewart, Susan L; Cerdá, Magdalena; Gruenewald, Paul J
Background and objective Alcohol abuse is common in the USA and is a well-established risk factor for violence. Other drug use and criminal activity are risk factors as well and frequently occur together with alcohol abuse. Firearm ownership is also common; there are >50 million firearm owners in the USA. This study assesses the relationships between alcohol and drug abuse and future violence among firearm owners, which no prior research has done. Design and study population This records-based retrospective cohort study will involve all persons who legally purchased handguns in California in 2001—approximately 116 000 individuals—with follow-up through the end of 2013. Methods The principal exposures include prior convictions for alcohol-related and drug-related offenses. The primary outcome measure is an arrest following handgun purchase for a violent Crime Index offense: homicide, rape, robbery or aggravated assault. Subjects will be considered at risk for outcome events for only as long as their residence in California can be established independently of outcome events. Covariates include individual characteristics (eg, age, sex, criminal history, firearm purchase history) and community characteristics (eg, demographics, socioeconomic measures, firearm ownership and alcohol outlet density). We will employ survival analytic methods, expressing effects as HRs. Discussion The results of this large-scale study are likely to be generalisable and to have important implications for violence prevention policies and programmes. PMID:26498316
Pechey, Rachel; Monsivais, Pablo
Both SES and supermarket choice have been associated with diet quality. This study aimed to assess the contributions of supermarket choice and shopping behaviors to the healthfulness of purchases and social patterning in purchases. Observational panel data on purchases of fruit and vegetables and less-healthy foods/beverages from 2010 were obtained for 24,879 households, stratified by occupational social class (analyzed in 2014). Households' supermarket choice was determined by whether they ever visited market-defined high- or low-price supermarkets. Analyses also explored extent of use within supermarket choice groups. Shopping behaviors included trip frequency, trip size, and number of store chains visited. Households using low-price (and not high-price) supermarkets purchased significantly lower percentages of energy from fruit and vegetables and higher percentages of energy from less-healthy foods/beverages than households using high-price (and not low-price) supermarkets. When controlling for SES and shopping behaviors, the effect of supermarket choice was reduced but remained significant for both fruit and vegetables and less-healthy foods/beverages. The extent of use of low- or high-price supermarkets had limited effects on outcomes. More-frequent trips and fewer small trips were associated with healthier purchasing for both outcomes; visiting more store chains was associated with higher percentages of energy from fruit and vegetables. Although both supermarket choice and shopping behaviors are associated with healthfulness of purchases, neither appears to contribute to socioeconomic differences. Moreover, differences between supermarket environments may not be primary drivers of the relationship between supermarket choice and healthfulness of purchases. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
At first sight - How is SME purchasing organised? : Discussing research process, the role of customer strategies & personality of owners and purchasing improvement, based on students’ purchasing case studies within four Dutch manufacturing Small and Medium-sized Enterprises
Staal, Anne; Walhof, Gert
Paper for the WION - Werkgemeenschap Inkoop Onderzoek Nederland - 2015, 3rd version. Purchasing within Small and Medium-sized Enterprises (SMEs) is important for the overall SME firm performance. However, purchasing within SMEs is not the same as purchasing within larger organisations and there is
The art of history teaching is at a crossroads. Recent scholarship focuses on the need to change the teaching of history so students can better learn history, and insists that history teachers must move beyond traditional structures and methods of teaching in order to improve their students' abilities to think with history. This article presents…
Banta, David; Jonsson, Egon; Childs, Paul
The International Society for Technology Assessment in Health Care (ISTAHC) was formed in 1985. It grew out of the increasing awareness of the international dimensions of health technology assessment (HTA) and the need for new communication methods at the international level. The main function of ISTAHC was to present an annual conference, which gradually grew in size, and also to generally improve in quality from to year. ISTAHC overextended itself financially early in the first decade of the 2000s and had to cease its existence. A new society, Health Technology Assessment international (HTAi), based on many of the same ideas and people, grew up beginning in the year 2003. The two societies have played a large role in making the field of HTA visible to people around the world and providing a forum for discussion on the methods and role of HTA.
... POINT OF PURCHASE OF PERFORMANCE AND TECHNICAL DATA § 1401.5 Providing performance and technical data to... the time of original purchase and to the first purchaser for purposes other than resale. The data... to be read and understood by ordinary individuals under normal conditions of purchase. This...
Allen M. Brackley; Valerie Barber
This study surveys 204 consumers and purchasing agents and reports their reaction to terms used to describe forest products from southeast Alaska. Although 67 percent of the respondents would purchase products from old-growth trees, purchasing agents were more likely to refuse to purchase such products (negative response from 12 percent of consumers vs. 29 percent for...
Uçar, Asli; Ozdoğan, Yahya; Ozçelik, Ayşe Özfer
This study was conducted in the Ankara Province of Turkey to determine the attitudes of adult consumers toward food consumption and purchasing activities. The data were collected by conducting face-to-face interviews with 700 adults working in ministries (government office) to fill in a questionnaire prepared especially for this purpose. The responses to the questionnaire were evaluated by assigning points for the "food-consumption-and-purchasing attitudes" of each respondent based on their replies. These food-consumption-and-purchasing attitude points have been then analyzed in terms of the gender, age, and educational level of the adults involved. The results showed that women, the 30-39 age group, and university graduates have a higher score of food-consumption-and-purchasing attitude points than do men, the age group comprising respondents < 30 and ≥ 40 years of age, and those with lower education levels, respectively. A statistically significantly relation was observed between food-consumption-and-purchasing attitude points and age.
Tiedemann, K.; Nelson, D.
Energy conservation programs have relied heavily on incentives and regulatory standards to reduce residential energy consumption. However, in the changing market environment characterized by competitive pressures, alternative mechanisms such as marketing and promotions may increase substantially in importance compared to the demand-side management programs which have been the focus of most research. This paper describes the role of marketing and promotions in encouraging energy efficiency at the household level in British Columbia. The paper examines three related issues: first, the purchase process for energy-related products; second, the criteria used by customers in making purchase decisions; and third, the impact and effectiveness of alternative marketing tools. A key finding is the energy-related purchases do not fall into the impulse purchase category. There are two reasons for this: first, most of these products require installation and this requires a high level of commitment on the part of the purchaser; second, many energy-related products require a significant outlay of funds and this reduces impulse buying.
Full Text Available The issues of energy crisis, environmental degradation, and climate change present a severe challenge to the sustainable development in China. The development of green building (GB is considered one of the most popular strategies toward a sustainable construction industry. Apart from advanced green technologies, consumers’ purchasing intention toward green housing (GH plays a crucial role in the large-scale promotion of GB. However, which determinants significantly affect consumers’ purchasing intention remain unclear, especially for the young generation in developing countries. This study attempts to investigate young consumers’ purchasing intention of GH in China. On the basis of extended theory of planned behavior (TPB, seven constructs are identified, and nine hypotheses are proposed. A total of 241 responses were collected from the questionnaire survey, and structural equation modeling was employed to test the proposed hypotheses. Governmental incentives are affirmed to be the most important determinant, followed by consumers’ attitude toward behavior and subjective norm. Perceived behavioral control is an insignificant determinant for young consumers to purchase GH. In addition, subjective knowledge has an indirect effect through attitude toward behavior. Environmental concern also confirms an indirect effect through attitude toward behavior and subjective norm toward purchasing intention, respectively. Thus, the government is implied to play a crucial role in GH promotion at this stage.
Taksler, Glen B; Elbel, Brian
Studies rarely find fewer calories purchased following calorie labeling implementation. However, few studies consider whether estimates of the number of calories purchased improved following calorie labeling legislation. Researchers surveyed customers and collected purchase receipts at fast food restaurants in the United States cities of Philadelphia (which implemented calorie labeling policies) and Baltimore (a matched comparison city) in December 2009 (pre-implementation) and June 2010 (post-implementation). A difference-in-difference design was used to examine the difference between estimated and actual calories purchased, and the odds of underestimating calories.Participants in both cities, both pre- and post-calorie labeling, tended to underestimate calories purchased, by an average 216-409 calories. Adjusted difference-in-differences in estimated-actual calories were significant for individuals who ordered small meals and those with some college education (accuracy in Philadelphia improved by 78 and 231 calories, respectively, relative to Baltimore, p = 0.03-0.04). However, categorical accuracy was similar; the adjusted odds ratio [AOR] for underestimation by >100 calories was 0.90 (p = 0.48) in difference-in-difference models. Accuracy was most improved for subjects with a BA or higher education (AOR = 0.25, p calories varied by subgroup, suggesting that at some level, consumers may incorporate labeling information.
Shea Lee, Tan; Ariff, Mohd Shoki Md; Zakuan, Norhayati; Sulaiman, Zuraidah; Zameri Mat Saman, Muhamad
The increase adoption of Internet among young users in Malaysia provides high prospect for online seller. Young users aged between 18 and 25 years old are important to online sellers because they are actively involved in online purchasing and this group of online buyers is expected to dominate future online market. Therefore, examining online sellers’ website quality and online buyers’ purchase intention is crucial. Based on the Theory of planned behavior (TPB), a conceptual model of online sellers’ website quality and purchase intention of online buyers was developed. E-tailQ instrument was adapted in this study which composed of website design, reliability/fulfillment, security, privacy & trust, and customer service. Using online questionnaire and convenience sampling procedure, primary data were obtained from 240 online buyers aged between 18 to 25 years old. It was discovered that website design, website reliability/fulfillment, website security, privacy & trust, and website customer service positively and significantly influence intention of online buyers to continuously purchase via online channels. This study concludes that online sellers’ website quality is important in predicting online buyers’ purchase intention. Recommendation and implication of this study were discussed focusing on how online sellers should improve their website quality to stay competitive in online business.
Fenn, P; Rickman, N; McGuire, A
We present a formal model of the relationship between a health care purchaser and a provider drawing on the recent experience of explicit contracting in the UK health sector. Specifically we model the contractual relationships emerging between District Health Authorities, who are presently the dominant health care purchasers, and the providers of hospital care. The comparative static analysis implies that the transaction cost of using non-local hospitals, the expected patient demand, the extent of excess capacity in local hospitals, and the proportion of that excess capacity expected to be lost to competitive purchasers, are all important determinants of the choice of contract.
Wild, C; Puig, S
In the context of increasing economic pressure upon on hospital budgets, it is inevitable that central and standardized purchasing of pharmaceuticals must be considered. It was the aim of this assessment to analyse the many different non-ionic contrast media/CM products on the actual "clinical relevance of the differences" in order to give advice for a more concerted purchasing of CM. The assessment was commissioned by a large scale Austrian hospital cooperation; it can be regarded as the beginning of a broad strategy against the many new, only rarely innovative, but nevertheless patent-protected pharmaceuticals. Eight different non-ionic contrast media - used in routine care - were compared for their physico-chemical characteristics: osmolality, nephrotoxicity, viscosity, hydrophilicity and electric charge. In a systematic review 193 publications were analysed. The examined CM show similar pharmacokinetic and -dynamic attributes, and no differences of clinical relevance. An optimisation of purchasing pharmaceuticals by standardisation of the range of products takes place in the context of common strategies of producers and buying agents in marketing-economies. The strategies of the pharmaceutical industry (patent protection of me-too drugs, high-price-policy, extensive marketing of up to 40 % of revenue) and the counter-strategies of the central hospital purchasers (market concentration, drug commissions, institutional measures to disentangle interests) are presented - exemplified by contrast media - in this article.
Thyssen, J P; Menné, T; Lidén, C; White, I R; White, J; Spiewak, R; Johansen, J D
Nickel allergy is frequent and cause morbidity and increased health care costs. The aim of this study was to determine the proportion of inexpensive earrings randomly purchased from stores and street markets in two capitals that gave positive dimethylglyoxime (DMG) test reactions and to determine whether the degree of nickel release was related to shop category. Random inexpensive metallic earrings were purchased from stores and vendors in London and Warsaw. A qualitative investigation of nickel release by using the DMG test was performed. DMG testing revealed that respectively 15.1% (n=205) and 18.4% (n=206) of earrings purchased in London and Warsaw released nickel as indicated by positive test outcomes. Stratification by store category showed that DMG test-positive jewellery were mainly purchased from street markets and from stores that were not part of national or international chains. Despite the EU Nickel Directive having resulted in decreasing prevalence of nickel allergy, a large proportion of inexpensive earrings still release nickel in concentrations that may result in nickel allergy and dermatitis. Authorities should prioritize information campaigns and random inspections as a legislation that is not followed is of limited value. © 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.