'What the patient wants': an investigation of the methods of ascertaining patient values in evidence-based medicine and values-based practice.

PubMed

Wieten, Sarah

2018-02-01

Evidence-Based Medicine (EBM), Values-Based Practice (VBP) and Person-Centered Healthcare (PCH) are all concerned with the values in play in the clinical encounter. However, these recent movements are not in agreement about how to discover these relevant values. In some parts of EBM textbooks, the prescribed method for discovering values is through social science research on the average values in a particular population. VBP by contrast always investigates the individually held values of the different stakeholders in the particular clinical encounter, although the account has some other difficulties. I argue that although average values for populations might be very useful in informing questions of resource distribution and policy making, their use cannot replace the individual solicitation of patient (and other stakeholder) values in the clinical encounter. Because of the inconsistency of the EBM stance on values, the incompatibility of some versions of the EBM treatment of values with PCH, and EBM's attempt to transplant research methods from science into the realm of values, I must recommend the use of the VBP account of values discovery. © 2015 John Wiley & Sons, Ltd.

Implementing Value-Based Payment Reform: A Conceptual Framework and Case Examples.

PubMed

Conrad, Douglas A; Vaughn, Matthew; Grembowski, David; Marcus-Smith, Miriam

2016-08-01

This article develops a conceptual framework for implementation of value-based payment (VBP) reform and then draws on that framework to systematically examine six distinct multi-stakeholder coalition VBP initiatives in three different regions of the United States. The VBP initiatives deploy the following payment models: reference pricing, "shadow" primary care capitation, bundled payment, pay for performance, shared savings within accountable care organizations, and global payment. The conceptual framework synthesizes prior models of VBP implementation. It describes how context, project objectives, payment and care delivery strategies, and the barriers and facilitators to translating strategy into implementation affect VBP implementation and value for patients. We next apply the framework to six case examples of implementation, and conclude by discussing the implications of the case examples and the conceptual framework for future practice and research. © The Author(s) 2015.

77 FR 34326 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-11

... Purchasing (VBP) Program, we inadvertently omitted data from the table entitled ``Proposed Performance..., Proposed Hospital Inpatient Value- Based Purchasing (VBP) Program Adjustment Factors for FY 2013, as a... partial paragraph-- (1) Lines 2 and 3, the phrase ``all hospitals are expected to experience a decrease...

Convergence of decision rules for value-based pricing of new innovative drugs.

PubMed

Gandjour, Afschin

2015-04-01

Given the high costs of innovative new drugs, most European countries have introduced policies for price control, in particular value-based pricing (VBP) and international reference pricing. The purpose of this study is to describe how profit-maximizing manufacturers would optimally adjust their launch sequence to these policies and how VBP countries may best respond. To decide about the launching sequence, a manufacturer must consider a tradeoff between price and sales volume in any given country as well as the effect of price in a VBP country on the price in international reference pricing countries. Based on the manufacturer's rationale, it is best for VBP countries in Europe to implicitly collude in the long term and set cost-effectiveness thresholds at the level of the lowest acceptable VBP country. This way, international reference pricing countries would also converge towards the lowest acceptable threshold in Europe.

Introducing Value-Based Purchasing into TRICARE Reform

PubMed Central

Hosek, Susan D.; Sorbero, Melony E.; Martsolf, Grant; Kandrack, Ryan

2017-01-01

Abstract TRICARE, the health benefits program created for beneficiaries of the U.S. Department of Defense, covers health care provided in military treatment facilities and by civilian providers. Congress is now considering how to update TRICARE, which was first developed in the 1980s drawing on managed care concepts from civilian health plans. This article places TRICARE's current managed care strategy in historical context and describes recent innovations by private insurers and Medicare intended to enhance the value---cost and quality---of the care they purchase for their members. With this movement toward value-based purchasing as background, the authors evaluate two existing proposals for reform and describe an alternative approach that blends the existing proposals. PMID:28845347

Measuring Value in Internal Medicine Residency Training Hospitals Using Publicly Reported Measures.

PubMed

Schickedanz, Adam; Gupta, Reshma; Arora, Vineet M; Braddock, Clarence H

2018-03-01

Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.

The HackensackUMC Value-Based Care Model: Building Essentials for Value-Based Purchasing.

PubMed

Douglas, Claudia; Aroh, Dianne; Colella, Joan; Quadri, Mohammed

2016-01-01

The Affordable Care Act, 2010, and the subsequent shift from a quantity-focus to a value-centric reimbursement model led our organization to create the HackensackUMC Value-Based Care Model to improve our process capability and performance to meet and sustain the triple aims of value-based purchasing: higher quality, lower cost, and consumer perception. This article describes the basics of our model and illustrates how we used it to reduce the costs of our patient sitter program.

Moving healthcare quality forward with nursing-sensitive value-based purchasing.

PubMed

Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth

2012-12-01

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.

Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing

PubMed Central

Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth

2012-01-01

Purpose: To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Design and Methods: 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. Findings: 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. Conclusions: 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. Clinical Relevance: 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. PMID:23066956

76 FR 2453 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

... requirements under the Hospital IQR program in the FY 2006 IPPS final rule (70 FR 47420). C. Hospital Inpatient... it was amended by section 3001(a)(2)(C) of the Affordable Care Act, required that the Secretary... discharge of 1%, as required by section 1886(o)(7). Section 1886(o)(1)(C) provides that the Hospital VBP...

Value-based purchasing and hospital acquired conditions: are we seeing improvement?

PubMed

Spaulding, Aaron; Zhao, Mei; Haley, D Rob

2014-12-01

To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

77 FR 217 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-04

... Donald Howard, (410) 786-6764, Hospital Value-Based Purchasing (VBP) Program Issues. SUPPLEMENTARY... analyses performed by Brandeis University and Mathematica Policy Research together despite their slightly...

Value-based formulas for purchasing. PEHP's designated service provider program: value-based purchasing through global fees.

PubMed

Emery, D W

1997-01-01

In many circles, managed care and capitation have become synonymous; unfortunately, the assumptions informing capitation are based on a flawed unidimensional model of risk. PEHP of Utah has rejected the unidimensional model and has therefore embraced a multidimensional model of risk that suggests that global fees are the optimal purchasing modality. A globally priced episode of care forms a natural unit of analysis that enhances purchasing clarity, allows providers to more efficiently focus on the Marginal Rate of Technical Substitution, and conforms to the multidimensional reality of risk. Most importantly, global fees simultaneously maximize patient choice and provider cost consciousness.

Value-based purchasing of medical devices.

PubMed

Obremskey, William T; Dail, Teresa; Jahangir, A Alex

2012-04-01

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.

Physician-Owned Surgical Hospitals Outperform Other Hospitals in Medicare Value-Based Purchasing Program.

PubMed

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-10-01

The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals and creates financial incentives for quality improvement and fosters increased transparency. Limited information is available comparing hospital performance across health care business models. The 2015 Hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Of 3,089 hospitals with total performance scores, categories of representative health care business models included 104 physician-owned surgical hospitals, 111 University HealthSystem Consortium, 14 US News & World Report Honor Roll hospitals, 33 Kaiser Permanente, and 124 Pioneer accountable care organization affiliated hospitals. Estimated mean total performance scores for physician-owned surgical hospitals (64.4; 95% CI, 61.83-66.38) and Kaiser Permanente (60.79; 95% CI, 56.56-65.03) were significantly higher compared with all remaining hospitals, and University HealthSystem Consortium members (36.8; 95% CI, 34.51-39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included physician-owned surgical hospitals (mean 2.32; p < 0.0001), US News & World Report honorees (mean 2.24; p = 0.0140), and University HealthSystem Consortium members (mean 1.99; p < 0.0001), and Kaiser Permanente hospitals had lower case mix value (mean 1.54; p < 0.0001). Re-estimation of total performance scores did not change the original results after adjustment for differences in hospital case mix index. The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals can guide value improvement and policy-making decisions for all Medicare Value-Based

Physician-owned Surgical Hospitals Outperform Other Hospitals in the Medicare Value-based Purchasing Program

PubMed Central

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-01-01

Background The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals while creating financial incentives for quality improvement and fostering increased transparency. Limited information is available comparing hospital performance across healthcare business models. Study Design 2015 hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Results Of 3089 hospitals with Total Performance Scores (TPS), categories of representative healthcare business models included 104 Physician-owned Surgical Hospitals (POSH), 111 University HealthSystem Consortium (UHC), 14 US News & World Report Honor Roll (USNWR) Hospitals, 33 Kaiser Permanente, and 124 Pioneer Accountable Care Organization affiliated hospitals. Estimated mean TPS for POSH (64.4, 95% CI 61.83, 66.38) and Kaiser (60.79, 95% CI 56.56, 65.03) were significantly higher compared to all remaining hospitals while UHC members (36.8, 95% CI 34.51, 39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included POSH (mean 2.32, p<0.0001), USNWR honorees (mean 2.24, p 0.0140) and UHC members (mean =1.99, p<0.0001) while Kaiser Permanente hospitals had lower case mix value (mean =1.54, p<0.0001). Re-estimation of TPS did not change the original results after adjustment for differences in hospital case mix index. Conclusions The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals may guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. PMID:27502368

Uncovering values-based practice: VBP's implicit commitments to subjectivism and relativism.

PubMed

Cassidy, Ben

2013-06-01

Despite assertions to the contrary, KWM Fulford's values-based practice is implicitly committed to subjectivism when it comes to reasoning about values. This renders the approach unworkable. The act of merely uncovering underlying values is not enough to effect change and, therefore, resolve problems if we have no way, even in principle, of determining which values are right and which are wrong. Fulford's only departure from subjectivism about value is his commitment to 'framework values', which seems grounded in a version of ethical relativism. I argue that we need to reject both subjectivism and relativism if progress within ethical discussions about practice is to be meaningful and a real possibility. © 2013 John Wiley & Sons Ltd.

A case study of ex ante, value-based price and reimbursement decision-making: TLV and rimonabant in Sweden.

PubMed

Persson, Ulf; Willis, Michael; Odegaard, Knut

2010-04-01

Value-based pricing (VBP) is a method of setting prices for products based on perceived benefits to the consumer. When information is symmetric and freely available and agency is perfect, VBP is efficient and desirable. Because of substantial information asymmetries, medical insurance distortions, and the prescribing monopoly of physicians, VBP is rare for prescription drugs, though a number of countries have recently moved in this direction. Because the potential benefits can be sizable, it is high time for a review of actual VBP-based decision-making in practice. Sweden, with its pharmaceutical benefits board (TLV), was an early adopter of VBP decision-making. We illustrate actual decision-making, thus, using the case of Acomplia for the treatment of obesity in Sweden, with and without the presence of co-morbid conditions. This example has a number of features that will be useful in illustrating the strengths and weaknesses of VBP in actual practice, including multiple indications, a need for not just one but two economic simulation models, considerable sub-group analysis, and requirements for additional evidence development. TLV concluded, in 2006, that Acomplia was cost-effective for patients with a body mass index (BMI) exceeding 35 kg/m2 and patients with a BMI exceeding 28 kg/m2 and either dyslipidemia or type 2 diabetes. Because of uncertainty in some of the underlying assumptions, reimbursement was granted only until 31 December 2008, at which time the manufacturer would be required to submit additional documentation of the long-term effects and cost-effectiveness in order to obtain continued reimbursement. Deciding on reimbursement coverage for pharmaceutical products is difficult. Ex ante VBP assessment is a form of risk sharing, which has been used by TLV to speed up reimbursement and dispersion of effective new drugs despite uncertainty in their true cost-effectiveness. Manufacturers are often asked in return to generate additional health economic

Executive summary: value-based purchasing and technology assessment in orthopaedics.

PubMed

Ranawat, Anil S; Nunley, Ryan; Bozic, Kevin

2009-10-01

As US healthcare expenditures continue to rise, reform has shifted from spending controls to value-based purchasing. This paradigm shift is a drastic change on how health care is delivered and reimbursed. For the shift to work, policymakers and physicians must restructure the present system by using initiatives such as process reengineering, insurance and payment reforms, physician reeducation, data and quality measurements, and technology assessments. Value, as defined in economic terms, will be a critical concept in modern healthcare reform. We summarize the conclusions of this ABJS Carl T. Brighton Workshop on healthcare reform.

VBP15, a novel dissociative steroid compound, reduces NFκB-induced expression of inflammatory cytokines in vitro and symptoms of murine trinitrobenzene sulfonic acid-induced colitis.

PubMed

Damsker, Jesse M; Conklin, Laurie S; Sadri, Soheil; Dillingham, Blythe C; Panchapakesan, Karuna; Heier, Christopher R; McCall, John M; Sandler, Anthony D

2016-09-01

The goal of this study was to assess the capacity of VBP15, a dissociative steroidal compound, to reduce pro-inflammatory cytokine expression in vitro, to reduce symptoms of colitis in the trinitrobenzene sulfonic acid-induced murine model, and to assess the effect of VBP15 on growth stunting in juvenile mice. In vitro studies were performed in primary human intestinal epithelial cells. Colitis was induced in mice by administering trinitrobenzene sulfonic acid. Growth stunting studies were performed in wild type outbred mice. Cells were treated with VBP15 or prednisolone (10 μM) for 24 h. Mice were subjected to 3 days of VBP15 (30 mg/kg) or prednisolone (30 mg/kg) in the colitis study. In the growth stunting study, mice were subjected to VBP15 (10, 30, 45 mg/kg) or prednisolone (10 mg/kg) for 5 weeks. Cytokines were measured by PCR and via Luminex. Colitis symptoms were evaluated by assessing weight loss, intestinal blood, and stool consistency. Growth stunting was assessed using an electronic caliper. VBP15 significantly reduced the in vitro production of CCL5 (p < 0.001) IL-6 (p < 0.001), IL-8 (p < 0.05) and reduced colitis symptoms (p < 0.05). VBP15 caused less growth stunting than prednisolone (p < 0.001) in juvenile mice. VBP15 may reduce symptoms of IBD, while decreasing or avoiding detrimental side effects.

The VBP and a1/EBP leucine zipper factors bind overlapping subsets of avian retroviral long terminal repeat CCAAT/enhancer elements.

PubMed

Smith, C D; Baglia, L A; Curristin, S M; Ruddell, A

1994-10-01

Two long terminal repeat (LTR) enhancer-binding proteins which may regulate high rates of avian leukosis virus (ALV) LTR-enhanced c-myc transcription during bursal lymphomagenesis have been identified (A. Ruddell, M. Linial, and M. Groudine, Mol. Cell. Biol. 9:5660-5668, 1989). The genes encoding the a1/EBP and a3/EBP binding factors were cloned by expression screening of a lambda gt11 cDNA library from chicken bursal lymphoma cells. The a1/EBP cDNA encodes a novel leucine zipper transcription factor (W. Bowers and A. Ruddell, J. Virol. 66:6578-6586, 1992). The partial a3/EBP cDNA clone encodes amino acids 84 to 313 of vitellogenin gene-binding protein (VBP), a leucine zipper factor that binds the avian vitellogenin II gene promoter (S. Iyer, D. Davis, and J. Burch, Mol. Cell. Biol. 11:4863-4875, 1991). Multiple VBP mRNAs are expressed in B cells in a pattern identical to that previously observed for VBP in other cell types. The LTR-binding activities of VBP, a1/EBP, and B-cell nuclear extract protein were compared and mapped by gel shift, DNase I footprinting, and methylation interference assays. The purified VBP and a1/EBP bacterial fusion proteins bind overlapping but distinct subsets of CCAAT/enhancer elements in the closely related ALV and Rous sarcoma virus (RSV) LTR enhancers. Protein binding to these CCAAT/enhancer elements accounts for most of the labile LTR enhancer-binding activity observed in B-cell nuclear extracts. VBP and a1/EBP could mediate the high rates of ALV and RSV LTR-enhanced transcription in bursal lymphoma cells and many other cell types.

The current state of nursing performance measurement, public reporting, and value-based purchasing.

PubMed

Kurtzman, Ellen T; Dawson, Ellen M; Johnson, Jean E

2008-08-01

Over the last decade, there has been a substantial investment in holding health care providers accountable for the quality of care provided in hospitals and other settings of care. This investment has been realized through the proliferation of national policies that address performance measurement, public reporting, and value-based purchasing. Although nurses represent the largest segment of the health care workforce and despite their acknowledged role in patient safety and health care outcomes, they have been largely absent from policy setting in these areas. This article provides an analysis of current nursing performance measurement and public reporting initiatives and presents a summary of emerging trends in value-based purchasing, with an emphasis on activities in the United States. The article synthesizes issues of relevance to advancing the current climate for nursing quality and concludes with key issues for future policy setting.

Valuing Trial Designs from a Pharmaceutical Perspective Using Value-Based Pricing.

PubMed

Breeze, Penny; Brennan, Alan

2015-11-01

Our aim was to adapt the traditional framework for expected net benefit of sampling (ENBS) to be more compatible with drug development trials from the pharmaceutical perspective. We modify the traditional framework for conducting ENBS and assume that the price of the drug is conditional on the trial outcomes. We use a value-based pricing (VBP) criterion to determine price conditional on trial data using Bayesian updating of cost-effectiveness (CE) model parameters. We assume that there is a threshold price below which the company would not market the new intervention. We present a case study in which a phase III trial sample size and trial duration are varied. For each trial design, we sampled 10,000 trial outcomes and estimated VBP using a CE model. The expected commercial net benefit is calculated as the expected profits minus the trial costs. A clinical trial with shorter follow-up, and larger sample size, generated the greatest expected commercial net benefit. Increasing the duration of follow-up had a modest impact on profit forecasts. Expected net benefit of sampling can be adapted to value clinical trials in the pharmaceutical industry to optimise the expected commercial net benefit. However, the analyses can be very time consuming for complex CE models. © 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.

What can the past of pay-for-performance tell us about the future of Value-Based Purchasing in Medicare?

PubMed

Ryan, Andrew M; Damberg, Cheryl L

2013-06-01

The Medicare program has implemented pay-for-performance (P4P), or Value-Based Purchasing, for inpatient care and for Medicare Advantage plans, and plans to implement a program for physicians in 2015. In this paper, we review evidence on the effectiveness of P4P and identify design criteria deemed to be best practice in P4P. We then assess the extent to which Medicare's existing and planned Value-Based Purchasing programs align with these best practices. Of the seven identified best practices in P4P program design, the Hospital Value-Based Purchasing program is strongly aligned with two of the best practices, moderately aligned with three, weakly aligned with one, and has unclear alignment with one best practice. The Physician Value-Based Purchasing Modifier is strongly aligned with two of the best practices, moderately aligned with one, weakly aligned with three, and has unclear alignment with one of the best practices. The Medicare Advantage Quality Bonus Program is strongly aligned with four of the best practices, moderately aligned with two, and weakly aligned with one of the best practices. We identify enduring gaps in P4P literature as it relates to Medicare's plans for Value-Based Purchasing and discuss important issues in the future of these implementations in Medicare. Copyright © 2013 Elsevier Inc. All rights reserved.

California safety-net hospitals likely to be penalized by ACA value, readmission, and meaningful-use programs.

PubMed

Gilman, Matlin; Adams, E Kathleen; Hockenberry, Jason M; Wilson, Ira B; Milstein, Arnold S; Becker, Edmund R

2014-08-01

The Affordable Care Act includes provisions to increase the value obtained from health care spending. A growing concern among health policy experts is that new Medicare policies designed to improve the quality and efficiency of hospital care, such as value-based purchasing (VBP), the Hospital Readmissions Reduction Program (HRRP), and electronic health record (EHR) meaningful-use criteria, will disproportionately affect safety-net hospitals, which are already facing reduced disproportionate-share hospital (DSH) payments under both Medicare and Medicaid. We examined hospitals in California to determine whether safety-net institutions were more likely than others to incur penalties under these programs. To assess quality, we also examined whether mortality outcomes were different at these hospitals. Our study found that compared to non-safety-net hospitals, safety-net institutions had lower thirty-day risk-adjusted mortality rates in the period 2009-11 for acute myocardial infarction, heart failure, and pneumonia and marginally lower adjusted Medicare costs. Nonetheless, safety-net hospitals were more likely than others to be penalized under the VBP program and the HRRP and more likely not to meet EHR meaningful-use criteria. The combined effects of Medicare value-based payment policies on the financial viability of safety-net hospitals need to be considered along with DSH payment cuts as national policy makers further incorporate performance measures into the overall payment system. Project HOPE—The People-to-People Health Foundation, Inc.

A novel dissociative steroid VBP15 reduces MUC5AC gene expression in airway epithelial cells but lacks the GRE mediated transcriptional properties of dexamethasone.

PubMed

Garvin, Lindsay M; Chen, Yajun; Damsker, Jesse M; Rose, Mary C

2016-06-01

Overproduction of secretory mucins contributes to morbidity/mortality in inflammatory lung diseases. Inflammatory mediators directly increase expression of mucin genes, but few drugs have been shown to directly repress mucin gene expression. IL-1β upregulates the MUC5AC mucin gene in part via the transcription factors NFκB while the glucocorticoid Dexamethasone (Dex) transcriptionally represses MUC5AC expression by Dex-activated GR binding to two GRE cis-sites in the MUC5AC promoter in lung epithelial cells. VBP compounds (ReveraGen BioPharma) maintain anti-inflammatory activity through inhibition of NFκB but exhibit reduced GRE-mediated transcriptional properties associated with adverse side-effects and thus have potential to minimize harmful side effects of long-term steroid therapy in inflammatory lung diseases. We investigated VBP15 efficacy as an anti-mucin agent in two types of airway epithelial cells and analyzed the transcription factor activity and promoter binding associated with VBP15-induced MUC5AC repression. VBP15 reduced MUC5AC mRNA abundance in a dose- and time-dependent manner similar to Dex in the presence or absence of IL-1β in A549 and differentiated human bronchial epithelial cells. Repression was abrogated in the presence of RU486, demonstrating a requirement for GR in the VBP15-induced repression of MUC5AC. Inhibition of NFκB activity resulted in reduced baseline expression of MUC5AC indicating that constitutive activity maintains MUC5AC production. Chromatin immunoprecipitation analysis demonstrated lack of GR and of p65 (NFκB) binding to composite GRE domains in the MUC5AC promoter following VBP15 exposure of cells, in contrast to Dex. These data demonstrate that VBP15 is a novel anti-mucin agent that mediates the reduction of MUC5AC gene expression differently than the classical glucocorticoid, Dex. Copyright © 2016 Elsevier Ltd. All rights reserved.

Independent practice associations: Advantages and disadvantages of an alternative form of physician practice organization.

PubMed

Casalino, Lawrence P; Chenven, Norman

2017-03-01

Value-based purchasing (VBP) favors provider organizations large enough to accept financial risk and develop care management infrastructure. Independent Practice Associations (IPAs) are a potential alternative for physicians to becoming employed by a hospital or large medical group. But little is known about IPAs. We selected four IPAs that vary in location, structure, and strategy, and conducted interviews with their president and medical director, as well as with a hospital executive and health plan executive familiar with that IPA. The IPAs studied vary in size and sophistication, but overall are performing well and are highly regarded by hospital and health plan executives. IPAs can grow rapidly without the cost of purchasing and operating physician practices and make it possible for physicians to remain independent in their own practices while providing the scale and care management infrastructure to make it possible to succeed in VBP. However, it can be difficult for IPAs to gain cooperation from hundreds to thousands of independent physicians, and the need for capital for growth and care management infrastructure is increasing as VBP becomes more prevalent and more demanding. Some IPAs are succeeding at VBP. As VBP raises the performance bar, IPAs will have to demonstrate that they can achieve results equal to more highly capitalized and tightly structured large medical groups and hospital-owned practices. Physicians should be aware of IPAs as a potential option for participating in VBP. Payers are aware of IPAs; the Medicare ACO program and health insurer ACO programs include many IPAs. Copyright © 2016 Elsevier Inc. All rights reserved.

Hospital Value-Based Purchasing: The Association Between Patient Experience and Clinical Outcome.

PubMed

Haley, D Rob; Hamadi, Hanadi; Zhao, Mei; Xu, Jing; Wang, Yi

The Affordable Care Act of 2010 introduced a Hospital Value-Based Purchasing Total Performance Score for payment purposes and to evaluate hospital quality of care. In fiscal year 2016, Total Performance Score was composed of (1) Clinical Processes of Care, (2) Patient Experience of Care, (3) Outcome, and (4) Efficiency domains. The objective of this study was to examine the association between the Patient Experience of Care and Outcome domains. The Donabedian model of structure, process, and outcome was used as a conceptual framework for this study. Data from the 2015-2016 Area Health Resource File, the 2016 American Hospital Association database, and the 2016 Hospital Value-Based Purchasing were used. Univariate, bivariate, and multivariate analyses were conducted to examine the impact of patient experience on outcome of care and hospitals. From a sample of 1866 hospitals across the United States, patient experience was significantly and positively associated with patient outcome. In addition, for-profit hospitals, hospitals with more beds, nonteaching hospitals, and hospitals located in less competitive markets were found to have a significant association with better outcomes. The study's findings are important as policy makers consider additional or alternative indicators that may better represent and encourage higher quality of care within acute care hospitals.

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period.

PubMed

2016-11-14

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

Affordability Challenges to Value-Based Pricing: Mass Diseases, Orphan Diseases, and Cures.

PubMed

Danzon, Patricia M

2018-03-01

To analyze how value-based pricing (VBP), which grounds the price paid for pharmaceuticals in their value, can manage "affordability" challenges, defined as drugs that meet cost-effectiveness thresholds but are "unaffordable" within the short-run budget. Three specific contexts are examined, drawing on recent experience. First, an effective new treatment for a chronic, progressive disease, such as hepatitis C, creates a budget spike that is transitory because initial prevalence is high, relative to current incidence. Second, "cures" that potentially provide lifetime benefits may claim abnormally high VBP prices, with high immediate budget impact potentially/partially offset by deferred cost savings. Third, although orphan drugs in principle target rare diseases, in aggregate they pose affordability concerns because of the growing number of orphan indications and increasingly high prices. For mass diseases, the transitory budget impact of treating the accumulated patient stock can be managed by stratified rollout that delays treatment of stable patients and prioritizes patients at high risk of deterioration. Delay spreads the budget impact and permits potential savings from launch of competing treatments. For cures, installment payments contingent on outcomes could align payment flows and appropriately shift risk to producers. This approach, however, entails high administrative and incentive costs, especially if applied across multiple payers in the United States. For orphan drugs, the available evidence on research and development trends and returns argues against the need for a higher VBP threshold to incentivize research and development in orphan drugs, given existing statutory benefits under orphan drug legislation. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Hospital Value-Based Purchasing Performance: Do Organizational and Market Characteristics Matter?

PubMed

Spaulding, Aaron; Edwardson, Nick; Zhao, Mei

The hospital value-based purchasing (HVBP) program of the Centers for Medicare & Medicaid Services challenges hospitals to deliver high-quality care or face a reduction in Medicare payments. How do different organizational structures and market characteristics enable or inhibit successful transition to this new model of value-based care? To address that question, this study employs an institutional theory lens to test whether certain organizational structures and market characteristics mediate hospitals' ability to perform across HVBP domains.Data from the 2014 American Hospital Association Annual Survey Database, Area Health Resource File, the Medicare Hospital Compare Database, and the association between external environment and hospital performance are assessed through multiple regression analysis. Results indicate that hospitals that belong to a system are more likely than independent hospitals to score highly on the domains associated with the HVBP incentive arrangement. However, varying and sometimes counterintuitive market influences bring different dimensions to the HVBP program. A hospital's ability to score well in this new value arrangement may be heavily based on the organization's ability to learn from others, implement change, and apply the appropriate amount of control in various markets.

Adding A Spending Metric To Medicare's Value-Based Purchasing Program Rewarded Low-Quality Hospitals.

PubMed

Das, Anup; Norton, Edward C; Miller, David C; Ryan, Andrew M; Birkmeyer, John D; Chen, Lena M

2016-05-01

In fiscal year 2015 the Centers for Medicare and Medicaid Services expanded its Hospital Value-Based Purchasing program by rewarding or penalizing hospitals for their performance on both spending and quality. This represented a sharp departure from the program's original efforts to incentivize hospitals for quality alone. How this change redistributed hospital bonuses and penalties was unknown. Using data from 2,679 US hospitals that participated in the program in fiscal years 2014 and 2015, we found that the new emphasis on spending rewarded not only low-spending hospitals but some low-quality hospitals as well. Thirty-eight percent of low-spending hospitals received bonuses in fiscal year 2014, compared to 100 percent in fiscal year 2015. However, low-quality hospitals also began to receive bonuses (0 percent in fiscal year 2014 compared to 17 percent in 2015). All high-quality hospitals received bonuses in both years. The Centers for Medicare and Medicaid Services should consider incorporating a minimum quality threshold into the Hospital Value-Based Purchasing program to avoid rewarding low-quality, low-spending hospitals. Project HOPE—The People-to-People Health Foundation, Inc.

Medicare and Medicaid programs: hospital outpatient prospective payment; ambulatory surgical center payment; hospital value-based purchasing program; physician self-referral; and patient notification requirements in provider agreements. Final rule with comment period.

PubMed

2011-11-30

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) for CY 2012 to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we set forth the relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other ratesetting information for the CY 2012 ASC payment system. We are revising the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, adding new requirements for ASC Quality Reporting System, and making additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are allowing eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. Finally, we are making changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

Societal views on NICE, cancer drugs fund and value-based pricing criteria for prioritising medicines: a cross-sectional survey of 4118 adults in Great Britain.

PubMed

Linley, Warren G; Hughes, Dyfrig A

2013-08-01

The criteria used by the National Institute for Health and Clinical Excellence (NICE) for accepting higher incremental cost-effectiveness ratios for some medicines over others, and the recent introduction of the Cancer Drugs Fund (CDF) in England, are assumed to reflect societal preferences for National Health Service resource allocation. Robust empirical evidence to this effect is lacking. To explore societal preferences for these and other criteria, including those proposed for rewarding new medicines under the future value-based pricing (VBP) system, we conducted a choice-based experiment in 4118 UK adults via web-based surveys. Preferences were determined by asking respondents to allocate fixed funds between different patient and disease types reflecting nine specific prioritisation criteria. Respondents supported the criteria proposed under the VBP system (for severe diseases, address unmet needs, are innovative--provided they offered substantial health benefits, and have wider societal benefits) but did not support the end-of-life premium or the prioritisation of children or disadvantaged populations as specified by NICE, nor the special funding status for treatments of rare diseases, nor the CDF. Policies introduced on the basis of perceived--and not actual--societal values may lead to inappropriate resource allocation decisions with the potential for significant population health and economic consequences. Copyright © 2012 John Wiley & Sons, Ltd.

Patient Hospital Experience Improved Modestly, But No Evidence Medicare Incentives Promoted Meaningful Gains.

PubMed

Papanicolas, Irene; Figueroa, José F; Orav, E John; Jha, Ashish K

2017-01-01

The Centers for Medicare and Medicaid Services (CMS) has played a leading role in efforts to improve patients' experiences with hospital care. Yet little is known about how much patient experience has changed over the past decade, and even less is known about the impact of CMS's most recent strategy: tying payments to performance under the Value-Based Purchasing (VBP) program. We examined trends in multiple measures of patient satisfaction in the period 2008-14. We found that patient experience has improved modestly at US hospitals-both those participating in the VBP program and others-with the majority of improvement concentrated in the period before the program was implemented. While certain subsets of hospitals improved more than others, we found no evidence that the program has had a beneficial effect. As policy makers continue to promote value-based payment as a way to improve patient experience, it will be critical to ensure that payment is structured in ways that actually drive improvement. Project HOPE—The People-to-People Health Foundation, Inc.

OFT, VBP: QED?

PubMed

Claxton, Karl

2007-06-01

The report by the Office of Fair Trading (OFT) on the UK pharmaceutical price regulation scheme (PPRS) recommends the reform of the current scheme, which is a combination of profit and price controls, to one where price is based on the health benefits offered by a pharmaceutical. On closer examination some of the more commonly expressed concerns about these proposals do not seem to be well founded. In principle, the OFT's recommendations may contribute to allocative and dynamic efficiency in the NHS. However, there are some dangers and the details of how it will be implemented are crucial. For example, value-based pricing with an inappropriate threshold for cost-effectiveness, or an inappropriate pricing structure, could lead to technologies being adopted at prices where their benefits, in terms of health outcome, do not offset the health displaced elsewhere in the NHS, a situation in which the NHS is damaged rather than improved by innovation. A failure to account for uncertainty and the value of evidence in negotiating prices and coverage could also undermine the evidence base for future NHS practice. Whatever view is taken, the OFT report will inevitably shape the scope of future policy debates about value, guidance, price and innovation.

Quality-based purchasing in health care.

PubMed

Waters, Hugh R; Morlock, Laura L; Hatt, Laurel

2004-01-01

Quality-based purchasing is a growing trend that seeks to improve healthcare quality through the purchaser-provider relationship. This article provides a unifying conceptual framework, presents examples of the purchaser-provider relationship in countries at different income levels, and identifies important supporting mechanisms for quality-based purchasing. As countries become wealthier, a higher proportion of healthcare spending is channeled through pooled arrangements, allowing for greater involvement of purchasers in promoting the quality of service provision. Global and line item budgets are the most common type of provider payment system in low and middle-income countries. In these countries, improving public hospital performance through contracting and incentives is a key issue. In middle and high-income countries, there are several documented examples of governments contracting to private or non-governmental health care providers, resulting in higher perceived quality of care and lower delivery costs. Encouraging quality through employer purchasing arrangements has been promoted in several countries, particularly the United States. Community-based financing schemes are an increasingly common form of health financing in parts of sub-Saharan Africa and Asia, but these schemes still cover less than 10% of national populations in countries in which they are active. To date, there is little evidence of their impact on healthcare quality. The availability of information--concerning healthcare service provision and outcomes--determines the options for establishing and monitoring contract provisions and promoting quality. Regardless of the context, quality-based purchasing depends critically on informa-tion--reporting, monitoring, and providing useful information to healthcare consumers. In many low and middle-income countries, the lack of availability of information is the principal constraint on measuring performance, a critical component of quality-based

Web-based Factors Affecting Online Purchasing Behaviour

NASA Astrophysics Data System (ADS)

Ariff, Mohd Shoki Md; Sze Yan, Ng; Zakuan, Norhayati; Zaidi Bahari, Ahamad; Jusoh, Ahmad

2013-06-01

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.

The effect of proportional v. value pricing on fountain drink purchases: results from a field experiment.

PubMed

Gollust, Sarah E; Tang, Xuyang; Runge, Carlisle Ford; French, Simone A; Rothman, Alexander J

2018-05-15

Reducing sugar-sweetened beverage consumption is a public health priority, yet finding an effective and acceptable policy intervention is challenging. One strategy is to use proportional pricing (a consistent price per fluid ounce) instead of the typical value-priced approach where large beverages offer better value. The purpose of the present study was to evaluate whether proportional pricing affects the purchasing of fountain beverages at a university cinema concession stand. Four price strategies for beverages were evaluated over ten weekends of film screenings. We manipulated two factors: the price structure (value pricing v. proportional pricing) and the provision of information about the price per fluid ounce (labels v. no labels). The key outcomes were the number and size of beverages purchased. We analysed data using regression analyses, with standard errors clustered by film and controlling for the day and time of purchase. A university cinema concession stand in Minnesota, USA, in spring 2015. University students. Over the study period (360 beverages purchased) there were no significant effects of the proportional pricing treatment. Pairing a label with the standard value pricing increased the likelihood of purchasing large drinks but the label did not affect purchasing when paired with proportional pricing. Proportional prices did not significantly affect the size of beverages purchased by students at a university cinema, but adding a price-per-ounce label increased large drink purchases when drinks were value-priced. More work is needed to address whether pricing and labelling strategies might promote healthier beverage purchases.

Disinvestment and Value-Based Purchasing Strategies for Pharmaceuticals: An International Review.

PubMed

Parkinson, Bonny; Sermet, Catherine; Clement, Fiona; Crausaz, Steffan; Godman, Brian; Garner, Sarah; Choudhury, Moni; Pearson, Sallie-Anne; Viney, Rosalie; Lopert, Ruth; Elshaug, Adam G

2015-09-01

Pharmaceutical expenditure has increased rapidly across many Organisation for Economic Cooperation and Development (OECD) countries over the past three decades. This growth is an increasing concern for governments and other third-party payers seeking to provide equitable and comprehensive healthcare within sustainable budgets. In order to create headroom for increasing utilisation, and to fund new high-cost therapies, there is an active push to 'disinvest' from low-value drugs. The aim of this article is to review how reimbursement policy decision makers have sought to partially or completely disinvest from drugs in a range of OECD countries (UK, France, Canada, Australia and New Zealand) where they are publicly funded or subsidised. We employed a systematic literature search strategy and the incorporation of grey literature known to the authorship team. We canvass key policy instruments from each country to outline key approaches to the identification of candidate drugs for disinvestment assessment (passive approaches vs. more active approaches); methods of disinvestment and value-based purchasing (de-listing, restricting treatment, price or reimbursement rate reductions, encouraging generic prescribing); lessons learnt from the various approaches; the potential role of coverage with evidence development; and the need for careful stakeholder management. Dedicated sections are provided with detailed coverage of policy approaches (with drug examples) from each country. Historically, countries have relied on 'passive disinvestment'; however, due to (1) the availability of new cost-effectiveness evidence, or (2) 'leakage' in drug utilisation, or (3) market failure in terms of price competition, there is an increasing focus towards 'active disinvestment'. Isolating low-value drugs that would create headroom for innovative new products to enter the market is also motivating disinvestment efforts by multiple parties, including industry. Historically, disinvestment has

[The price-based certainty of purchase influences consumer behavior for discount].

PubMed

Arihara, Katsuhiko; Ariga, Atsunori; Furuya, Takeshi

2016-04-01

Tversky & Kahneman (1981) reported that most participants decided to drive when they could save money on a low-price good as compared to when they could save on a high-price good, even though the discount prices were same. Although this irrational decision making has been interpreted as a rate-dependent estimation of value (prospect theory), this study newly proposes that it can be explained by the certainty of purchase based on the price of goods. Experiment 1 replicated the previously reported difference in decision making, and additionally demonstrated that participants' certainty of purchase was lower for a high- than a low-price good. When it was emphasized that participants' intention to purchase high- and low-price goods were equally sure, decision making did not significantly differ (Experiment 2). Furthermore, decision making differed based only on the certainty of purchase even,when prices of goods were-same (Experiment 3). Consumers' decision making may be rather rational, depending straightforwardly on the certainty of purchase that is susceptible to price.

The Defense Logistics Agency Properly Awarded Power Purchase Agreements and the Army Obtained Fair Market Value for Leases Supporting Power Purchase Agreements

DTIC Science & Technology

2016-09-28

Fair Market Value for Leases Supporting Power Purchase Agreements I N T E G R I T Y  E F F I C I E N C Y  A C C O U N T A B I L I T Y  E X... Market Value for Leases Supporting Power Purchase Agreements Visit us at www.dodig.mil September 28, 2016 Objective We determined whether the...Department of the Army properly awarded and obtained fair market value for leases supporting energy production projects. We conducted this audit in

Messy but Fair: The ACA's Hospital Value-Based Purchasing Program and the Notice-and-Comment Process.

PubMed

Pan, Janus

2017-01-01

The Centers for Medicare and Medicaid Services (CMS) promulgated a new Medicare program called the Value-Based Purchasing Program (VBPP) as part of the 2010 Affordable Care Act (ACA). Like many other regulatory agencies, CMS used the Notice-and-Comment process to issue proposed rules, solicit public comments, and then publish final rules. Conventional literature suggests that CMS should disproportionately favor business interests during the Notice-and-Comment process, mainly due to the business interests' greater resources and capacity to draft well-reasoned comments. However, this article argues against this presumption and contends instead that CMS listens equally well to both business interest comments and private citizen comments during the formation of the VBPP. With regard to the VBPP and the ACA, CMS appears to be resisting disproportionate sway by business interests and is instead privileging the ACA's goal of improving healthcare quality.

Proposal of a New SI Base Unit for Value. An Hedonic Estimation of the Physical Purchasing Power (PhPP) of Money.

NASA Astrophysics Data System (ADS)

Defilla, Steivan

2006-03-01

Hitherto, the purchasing power of money, i.e. its transaction value, has been measured in terms of inflation index numbers and consumer baskets. Consumer baskets are variable phenomena and their use as measurement units for value confuses the measuring with the measurand. We propose an invariant numeraire, or value unit, based on the market value of a Planck energy (1956 MJ). Planck units form a natural system of units independent of any civilization. The hedonic estimation of the PhPP of a currency differentiates energy by product as well as by thermodynamic quality (exergy). Following SI rules, we propose to name the value unit walras (Wal) in honour of the economist Leon Walras (1834 - 1910). One Wal can also be interpreted as the minimum cost of physiological life of a reference person during one year. The study uses official disaggregated Swiss Producer and Consumer Price Index data and estimates the PhPP of the Swiss franc in 2003.

A General Bayesian Network Approach to Analyzing Online Game Item Values and Its Influence on Consumer Satisfaction and Purchase Intention

NASA Astrophysics Data System (ADS)

Lee, Kun Chang; Park, Bong-Won

Many online game users purchase game items with which to play free-to-play games. Because of a lack of research into which there is no specified framework for categorizing the values of game items, this study proposes four types of online game item values based on an analysis of literature regarding online game characteristics. It then proposes to investigate how online game users perceive satisfaction and purchase intention from the proposed four types of online game item values. Though regression analysis has been used frequently to answer this kind of research question, we propose a new approach, a General Bayesian Network (GBN), which can be performed in an understandable way without sacrificing predictive accuracy. Conventional techniques, such as regression analysis, do not provide significant explanation for this kind of problem because they are fixed to a linear structure and are limited in explaining why customers are likely to purchase game items and if they are satisfied with their purchases. In contrast, the proposed GBN provides a flexible underlying structure based on questionnaire survey data and offers robust decision support on this kind of research question by identifying its causal relationships. To illustrate the validity of GBN in solving the research question in this study, 327 valid questionnaires were analyzed using GBN with what-if and goal-seeking approaches. The experimental results were promising and meaningful in comparison with regression analysis results.

Questionable validity of the catheter-associated urinary tract infection metric used for value-based purchasing.

PubMed

Calderon, Lindsay E; Kavanagh, Kevin T; Rice, Mara K

2015-10-01

Catheter-associated urinary tract infections (CAUTIs) occur in 290,000 US hospital patients annually, with an estimated cost of $290 million. Two different measurement systems are being used to track the US health care system's performance in lowering the rate of CAUTIs. Since 2010, the Agency for Healthcare Research and Quality (AHRQ) metric has shown a 28.2% decrease in CAUTI, whereas the Centers for Disease Control and Prevention metric has shown a 3%-6% increase in CAUTI since 2009. Differences in data acquisition and the definition of the denominator may explain this discrepancy. The AHRQ metric analyzes chart-audited data and reflects both catheter use and care. The Centers for Disease Control and Prevention metric analyzes self-reported data and primarily reflects catheter care. Because analysis of the AHRQ metric showed a progressive change in performance over time and the scientific literature supports the importance of catheter use in the prevention of CAUTI, it is suggested that risk-adjusted catheter-use data be incorporated into metrics that are used for determining facility performance and for value-based purchasing initiatives. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

42 CFR § 484.330 - Process for determining and applying the value-based payment adjustment under the Home Health...

Code of Federal Regulations, 2010 CFR

2016-10-01

...-based payment adjustment under the Home Health Value-Based Purchasing (HHVBP) Model. § 484.330 Section... (HHVBP) Model Components for Competing Home Health Agencies Within State Boundaries § 484.330 Process for determining and applying the value-based payment adjustment under the Home Health Value-Based Purchasing...

42 CFR § 484.330 - Process for determining and applying the value-based payment adjustment under the Home Health...

Code of Federal Regulations, 2010 CFR

2017-10-01

...-based payment adjustment under the Home Health Value-Based Purchasing (HHVBP) Model. § 484.330 Section... (HHVBP) Model Components for Competing Home Health Agencies Within State Boundaries § 484.330 Process for determining and applying the value-based payment adjustment under the Home Health Value-Based Purchasing...

[Is the price of cancer drugs related to the cost of develo-pment and production or to the economic value of their clincal efficacy?].

PubMed

Russi, Alberto; Serena, Marta; Palozzo, Angelo C

2016-04-01

In the past years, the expenditure for cancer drugs has quickly increased, especially for biologic agents. Pharmaceutical companies and national health systems have different approaches in handling the issue of drug reimbursement. Companies support a price based on research and development (R&D) expenditures including those for unsuccessful drug projects while national health systems generally argue that pricing should be based on the incremental benefit generated by the agent under examination (value-based pricing - VBP). Nevertheless, current oncologic drugs prices are too high and not really justified by their incremental benefits or innovation, nor can they demonstrate that higher thresholds in QALYs could bring wider societal benefits. In this article we discuss these two points of view in the light of the most recent national and international literature. In Italy, drug reimbursement is currently managed through a mixed approach between the recognition of R&D expenditures and VBP. Reimbursement is also integrated with post-marketing patient-based national registries, particularly in the field of anti-cancer agents, that provide rebates based on financial risk sharing, cost-sharing, payment by results and success fee methods.

The imperative of culture: a quantitative analysis of the impact of culture on workforce engagement, patient experience, physician engagement, value-based purchasing, and turnover.

PubMed

Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey

2017-01-01

Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach's alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that

The imperative of culture: a quantitative analysis of the impact of culture on workforce engagement, patient experience, physician engagement, value-based purchasing, and turnover

PubMed Central

Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey

2017-01-01

Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach’s alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that

Value-Based Emergency Management.

PubMed

Corrigan, Zachary; Winslow, Walter; Miramonti, Charlie; Stephens, Tim

2016-02-01

This article touches on the complex and decentralized network that is the US health care system and how important it is to include emergency management in this network. By aligning the overarching incentives of opposing health care organizations, emergency management can become resilient to up-and-coming changes in reimbursement, staffing, and network ownership. Coalitions must grasp the opportunity created by changes in value-based purchasing and impending Centers for Medicare and Medicaid Services emergency management rules to engage payers, physicians, and executives. Hope and faith in doing good is no longer enough for preparedness and health care coalitions; understanding how physicians are employed and health care is delivered and paid for is now necessary. Incentivizing preparedness through value-based compensation systems will become the new standard for emergency management.

The value of group purchasing organizations in the United States.

PubMed

Rooney, Curtis

2011-01-01

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.

Purchasing Over-the-counter medicines from Australian pharmacy: What do the pharmacy customers value and expect?

PubMed

Chan, Vincent; Tran, Hung

2016-01-01

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.

Mandatory bundled payment getting into formation for value-based care.

PubMed

Fink, John

2015-10-01

Succeeding under Medicare's enterprise Comprehensive Care for Joint Replacement Model will require collaboration among caregivers and financial arrangements to align incentives Priorities for most organization's transition to becoming a value-based hospitals will be care redesign, supply-purchasing strategy, and post-acute care provider partnering. Pursuing value for your joint replacement program will chart a path for other service lines and lead your organization's transition to becoming a value-based enterprise.

Rolling capital: managing investments in a value-based care world.

PubMed

Jasuta, Lynette

2016-06-01

The importance of capital planning is increasing as the healthcare industry moves toward value-based care. Replacing unwieldy and inflexible traditional capital planning processes with a rolling capital planning approach can result in: Greater standardization, facilitating better strategic planning across the whole system. Reduced labor intensity in the planning and budgeting process. Reduced costs through being able to plan better for replacement purchases and take advantage of group purchasing and bundling opportunities. Increased transparency in the decision-making process.

16 CFR 233.4 - Bargain offers based upon the purchase of other merchandise.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Bargain offers based upon the purchase of... PRACTICE RULES GUIDES AGAINST DECEPTIVE PRICING § 233.4 Bargain offers based upon the purchase of other... given a customer on the condition that he purchase a particular article at the price usually offered by...

Purchasing Over-the-counter medicines from Australian pharmacy: What do the pharmacy customers value and expect?

PubMed Central

2016-01-01

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 existing

Medicare Payment Penalties and Safety Net Hospital Profitability: Minimal Impact on These Vulnerable Hospitals.

PubMed

Bazzoli, Gloria J; Thompson, Michael P; Waters, Teresa M

2018-02-08

To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. Bivariate and multivariate analysis of pooled cross-sectional data. Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins. Safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. While reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time. © Health Research and Educational Trust.

Priority setting and evidence based purchasing.

PubMed

Frith, L

1999-01-01

The purpose of this paper is to consider the role that values play in priority setting through the use of EBP. It is important to be clear about the role of values at all levels of the decision making process. At one level, society as a whole has to make decisions about the kind of health provision that it wants. As is generally accepted, these priority setting questions cannot be answered by medical science alone but involve important judgements of value. However, as I hope to show values come into priority setting questions at another level, one not often explicitly recognised in much of the literature: that of the very definition of the effectiveness of treatments. This has important consequences for patient care. If we do not recognise that the effectiveness of a treatment involve subjective elements--a patient's own assessment of the value of the treatment--then this could lead to the belief that we can purchase one treatment that is the most effective for all patients. This might result in a detrimental reduction in the range of options that a patient is given with some patients not receiving the treatment that is most effective for them.

An approach to value-based simulator selection: The creation and evaluation of the simulator value index tool.

PubMed

Rooney, Deborah M; Hananel, David M; Covington, Benjamin J; Dionise, Patrick L; Nykamp, Michael T; Pederson, Melvin; Sahloul, Jamal M; Vasquez, Rachael; Seagull, F Jacob; Pinsky, Harold M; Sweier, Domenica G; Cooke, James M

2018-04-01

Currently there is no reliable, standardized mechanism to support health care professionals during the evaluation of and procurement processes for simulators. A tool founded on best practices could facilitate simulator purchase processes. In a 3-phase process, we identified top factors considered during the simulator purchase process through expert consensus (n = 127), created the Simulator Value Index (SVI) tool, evaluated targeted validity evidence, and evaluated the practical value of this SVI. A web-based survey was sent to simulation professionals. Participants (n = 79) used the SVI and provided feedback. We evaluated the practical value of 4 tool variations by calculating their sensitivity to predict a preferred simulator. Seventeen top factors were identified and ranked. The top 2 were technical stability/reliability of the simulator and customer service, with no practical differences in rank across institution or stakeholder role. Full SVI variations predicted successfully the preferred simulator with good (87%) sensitivity, whereas the sensitivity of variations in cost and customer service and cost and technical stability decreased (≤54%). The majority (73%) of participants agreed that the SVI was helpful at guiding simulator purchase decisions, and 88% agreed the SVI tool would help facilitate discussion with peers and leadership. Our findings indicate the SVI supports the process of simulator purchase using a standardized framework. Sensitivity of the tool improved when factors extend beyond traditionally targeted factors. We propose the tool will facilitate discussion amongst simulation professionals dealing with simulation, provide essential information for finance and procurement professionals, and improve the long-term value of simulation solutions. Limitations and application of the tool are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

Making Wise Buys: Five Values to Consider when Evaluating a Library Purchase

ERIC Educational Resources Information Center

Durr, Chris

2011-01-01

Library staff members should ultimately base their purchasing choices on the mission statements of their employing institutions. Fortunately, library mission statements have much in common. Undoubtedly, for example, all libraries have a goal that includes "serve the information needs of the community," because on some level, all libraries are…

Evaluating group purchasing organizations.

PubMed

Kaldor, Dennis C; Kowalski, Jamie C; Tankersley, Mark A

2003-01-01

A formal evaluation process can help healthcare organizations assess the current and/or potential value of a group purchasing organization (GPO). Healthcare organizations should approach a GPO evaluation as if they were entering into a new relationship. The evaluation should include purchasing and financial services, value-added services, and corporate relations/business practices. Healthcare organizations should consider the potential economies of scale and other services offered by a GPO. Healthcare organizations should consider using acceptable substitutes for products currently used or seeking products through alternative sources if doing so achieves greater value.

Subprimal purchasing and merchandising decisions for pork: relationship to retail value.

PubMed

Lorenzen, C L; Walter, J P; Dockerty, T R; Griffin, D B; Johnson, H K; Savell, J W

1996-01-01

To assess retail value and profitability, cutting test data were obtained in a simulated retail cutting room for boxed pork subprimals, bone-in loins (n = 180), boneless loins (n = 94), Boston butts (n = 148), fresh hams (n = 28), and boneless hams (n = 23). Processing times (seconds) and retail weights (kilograms) were used to determine relative value. Cutting style affected (P < .05) value differential (US$/subprimal) for bone-in and boneless loins. When cutting styles within subprimals were pooled, value differential was affected (P < .05) by purchasing specification for bone-in loins, boneless loins, Boston butts, and inside fresh hams. Processing bone-in loins to a boneless end point produced a greater (P < .05) value differential and percentage of gross margin than a bone-in retail end point. Bone-in loins fabricated to a boneless retail end point produced a greater (P < .05) value differential and percentage of gross margin than boneless loins fabricated to the same end point. The increase in retail value can be attributed to the increased number and weight of retail cuts produced from bone-in loins. The thick, boneless loin cutting style produced a greater (P < .05) value differential and percentage of gross margin as a result of a lower (P < .05) cost of fabrication and increased value of retail cuts than the thin, boneless cutting style. In general, boneless pork cutting methods were more profitable than bone-in cutting methods regardless of subprimal.

Should general practitioners purchase health care for their patients? The total purchasing experiment in Britain.

PubMed

Wyke, Sally; Mays, Nicholas; Street, Andrew; Bevan, Gwyn; McLeod, Hugh; Goodwin, Nick

2003-09-01

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.

Purchases of ready-to-eat cereals vary across US household sociodemographic categories according to nutritional value and advertising targets.

PubMed

Castetbon, Katia; Harris, Jennifer L; Schwartz, Marlene B

2012-08-01

To describe ready-to-eat (RTE) cereal purchases in 2008 in the USA according to cereal nutritional quality and marketing strategy and household sociodemographic characteristics. Cross-sectional study of purchases in one year. Each type of cereal was assigned to one of four nutrition quality categories (based on Nutrient Profile Index, NPI) and one of four advertising categories based on television exposure and analysis of packaging (child-targeted, family-targeted, adult-targeted and no television advertising). Medians and distributions of purchase indicators were calculated for the cereal categories and the distributions were compared across sociodemographic groups. RTE cereals (n 249) with complete label and nutritional content. RTE cereal purchases according to household sociodemographic characteristics obtained from Nielsen Homescan, a nationally representative panel of households. Purchases of RTE cereals were highest in households with one or more child and lowest in African-American and Asian households, as well as those earning <$US 30 000 per annum. The lowest-quality products were purchased by four times as many households as the highest-quality cereals, but loyalty to these products was lower. Purchases of cereals by households with children and in African-American and Hispanic households increased as cereal nutritional quality declined. Compared with non-advertised products, advertised child-targeted cereals were purchased thirteen times more frequently; family-targeted brand purchases were ten times higher; and adult-targeted cereals were purchased four times more frequently. Our findings suggest that improving the nutritional quality of RTE cereals with advertising targeted to children could also lead to increased consumption of healthier products by young people.

40 CFR 312.29 - The relationship of the purchase price to the value of the property, if the property was not...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 27 2010-07-01 2010-07-01 false The relationship of the purchase price... COMMUNITY RIGHT-TO-KNOW PROGRAMS INNOCENT LANDOWNERS, STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES Standards and Practices § 312.29 The relationship of the purchase price to the value of the property, if the...

U.S. Residential Photovoltaic (PV) System Prices, Q4 2013 Benchmarks: Cash Purchase, Fair Market Value, and Prepaid Lease Transaction Prices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Davidson, C.; James, T. L.; Margolis, R.

The price of photovoltaic (PV) systems in the United States (i.e., the cost to the system owner) has dropped precipitously in recent years, led by substantial reductions in global PV module prices. This report provides a Q4 2013 update for residential PV systems, based on an objective methodology that closely approximates the book value of a PV system. Several cases are benchmarked to represent common variation in business models, labor rates, and module choice. We estimate a weighted-average cash purchase price of $3.29/W for modeled standard-efficiency, polycrystalline-silicon residential PV systems installed in the United States. This is a 46% declinemore » from the 2013-dollar-adjusted price reported in the Q4 2010 benchmark report. In addition, this report frames the cash purchase price in the context of key price metrics relevant to the continually evolving landscape of third-party-owned PV systems by benchmarking the minimum sustainable lease price and the fair market value of residential PV systems.« less

Computer-Based Instruction for Purchasing Skills

ERIC Educational Resources Information Center

Ayres, Kevin M.; Langone, John; Boon, Richard T.; Norman, Audrey

2006-01-01

The purpose of this study was to investigate use of computers and video technologies to teach students to correctly make purchases in a community grocery store using the dollar plus purchasing strategy. Four middle school students diagnosed with intellectual disabilities participated in this study. A multiple probe across participants research…

The influence of ethical values and food choice motivations on intentions to purchase sustainably sourced foods.

PubMed

Dowd, Kylie; Burke, Karena J

2013-10-01

This study examined a three-step adaptation of the Theory of Planned Behaviour (TPB) applied to the intention of consumers to purchase sustainably sourced food. The sample consisted of 137 participants, of which 109 were female, who were recruited through a farmers market and an organic produce outlet in an Australian capital city. Participants completed an online questionnaire containing the TPB scales of attitude, subjective norms, perceived behavioural control and intention; measures of positive moral attitude and ethical self identity; and food choice motives. Hierarchical multiple regression was used to examine the predictive utility of the TPB in isolation (step 1) and the TPB expanded to include the constructs of moral attitude and ethical self-identity (step 2). The results indicated the expansion of the TPB to include these constructs added significantly to the predictive model measuring intention to purchase sustainably sourced food. The third step in the adaptation utilised this expanded TPB model and added a measure of retail channel (where consumers reported buying fresh produce) and 9 food choice motives, in order to assess the predictive utility of the inclusion of choice motivations in this context. Of the 8 food choice motives examined, only health and ethical values significantly predicted intention to purchase sustainably sourced food. However, with the addition of food choice motives, ethical self-identity was no longer a significant predictor of intention to purchase sustainably sourced food. Overall the adapted TPB model explained 76% of the variance in intention to purchase sustainably sourced food. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Impact of Nursing Home Pay-for-Performance on Quality and Medicare Spending: Results from the Nursing Home Value-Based Purchasing Demonstration.

PubMed

Grabowski, David C; Stevenson, David G; Caudry, Daryl J; O'Malley, A James; Green, Lisa H; Doherty, Julia A; Frank, Richard G

2017-08-01

To evaluate the impact of the Nursing Home Value-Based Purchasing demonstration on quality of care and Medicare spending. Administrative and qualitative data from Arizona, New York, and Wisconsin nursing homes over the base-year (2008-2009) and 3-year (2009-2012) demonstration period. Nursing homes were randomized to the intervention in New York, while the comparison facilities were constructed via propensity score matching in Arizona and Wisconsin. We used a difference-in-difference analysis to compare outcomes across the base-year relative to outcomes in each of the three demonstration years. To provide context and assist with interpretation of results, we also interviewed staff members at participating facilities. Medicare savings were observed in Arizona in the first year only and Wisconsin for the first 2 years; no savings were observed in New York. The demonstration did not systematically impact any of the quality measures. Discussions with nursing home administrators suggested that facilities made few, if any, changes in response to the demonstration, leading us to conclude that the observed savings likely reflected regression to the mean rather than true savings. The Federal nursing home pay-for-performance demonstration had little impact on quality or Medicare spending. © Health Research and Educational Trust.

Corner Store Purchases in a Low-Income Urban Community in NYC.

PubMed

Kiszko, Kamila; Cantor, Jonathan; Abrams, Courtney; Ruddock, Charmaine; Moltzen, Kelly; Devia, Carlos; McFarline, Bernice; Singh, Hardeep; Elbel, Brian

2015-12-01

We assessed purchases made, motivations for shopping, and frequency of shopping at four New York City corner stores (bodegas). Surveys and purchase inventories (n = 779) were collected from consumers at four bodegas in Bronx, NY. We use Chi square tests to compare types of consumers, items purchased and characteristics of purchases based on how frequently the consumer shops at the specific store and the time of day the purchase was made. Most consumers shopped at the bodega because it was close to their home (52 %). The majority (68 %) reported shopping at the bodega at least once per day. The five most commonly purchased items were sugary beverages, (29.27 %), sugary snacks (22.34 %), coffee, (13.99 %), sandwiches, (13.09 %) and non-baked potato chips (12.2 %). Nearly 60 % of bodega customers reported their purchase to be healthy. Most of the participants shopped at the bodega frequently, valued its convenient location, and purchased unhealthy items. Work is needed to discover ways to encourage healthier choices at these stores.

Validation of the Consumer Values versus Perceived Product Attributes Model Measuring the Purchase of Athletic Team Merchandise

ERIC Educational Resources Information Center

Lee, Donghun; Byon, Kevin K.; Schoenstedt, Linda; Johns, Gary; Bussell, Leigh Ann; Choi, Hwansuk

2012-01-01

Various consumer values and perceived product attributes trigger consumptive behaviors of athletic team merchandise (Lee, Trail, Kwon, & Anderson, 2011). Likewise, using a principal component analysis technique on a student sample, a measurement scale was proposed that consisted of nine factors affecting the purchase of athletic team…

Orthopedic Implant Value Drivers: A Qualitative Survey Study of Hospital Purchasing Administrators.

PubMed

Li, Chuan Silvia; Vannabouathong, Christopher; Sprague, Sheila; Bhandari, Mohit

2015-01-01

Osteoarthritis (OA) is a chronic, degenerative disease that is highly prevalent in the population, yet the factors that affect purchasing decisions related to this condition are poorly understood. A questionnaire was developed and administered to hospital executives across North America to determine the factors that affect purchasing decisions related to OA. Thirty-four individuals participated in the survey. Clinical evidence and cost effectiveness were deemed to be the most important factors in the process of making purchasing decisions. The most important considerations for adopting new technology were whether there was sufficient evidence in the literature, followed by thoughts of key opinion leaders, and cost of intervention/device. Ongoing research is still needed, but the current study allowed us to identify some trends in the data, providing new insight on how hospital purchasing decisions are made, which could have an immediate impact on those currently involved with making these decisions.

Episode-Based Payment and Direct Employer Purchasing of Healthcare Services: Recent Bundled Payment Innovations and the Geisinger Health System Experience.

PubMed

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

2017-04-01

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.

Consumer peach preferences and purchasing behavior: a mixed methods study.

PubMed

Kelley, Kathleen M; Primrose, Rachel; Crassweller, Robert; Hayes, John E; Marini, Richard

2016-05-01

Peaches (Prunus persica (L.) Stokes) are grown in several regions throughout the USA, are eaten fresh, and used as ingredients in value-added processed products. An Internet survey was conducted to investigate Mid-Atlantic consumers' fresh and processed peach purchasing behaviors, and whether packaging certain numbers of peaches together, providing information about nutritional content, and other factors would increase purchases. Additionally, laboratory-based sensory testing was used to better understand peel color, texture, sweetness, sourness, and flavor preferences for cultivars commonly grown in the Mid-Atlantic region. Irrespective of fresh peach consumption frequency, certain value-added products were of interest. For some products, interest in purchasing was higher than reported purchasing behavior. Preference for certain fresh peach characteristics, such as peel color, differed between less frequent fresh peach consumers and those who consumed fresh peaches more often. Of the four peach cultivars included in the sensory test, most were liked; however, there were some cultivar differences pertaining to color, texture, sweetness, tartness, and flavor liking. Potential marketing strategies can be developed based on frequency of fresh peach consumption and household demographics. Data can be used to select peaches that best appeal to consumers. © 2015 Society of Chemical Industry. © 2015 Society of Chemical Industry.

Buying best value health care: Evolution of purchasing among Australian private health insurers

PubMed Central

Willcox, Sharon

2005-01-01

Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. This paper examines the current status of purchasing through interviews with senior managers representing all Australian private health insurers. Many of the traditional tools used to generate competition and enhance efficiency (such as selective contracting and co-payments) have had limited use due to public and political opposition. Adoption of bundled case payment models using diagnosis related groups (DRGs) has been slow. Insurers cite multiple reasons including poor understanding of private hospital costs, unfamiliarity with DRGs, resistance from the medical profession and concerns about premature discharge. Innovation in payment models has been limited, although some insurers are considering introduction of volume-outcome purchasing and pay for performance incentives. Private health insurers also face a complex web of regulation, some of which appears to impede moves towards more efficient purchasing. PMID:15801982

Procurement Cards Pave the Way to Efficient Purchasing.

ERIC Educational Resources Information Center

Enos, Eileen D.

1999-01-01

As educators battle restricted budgets, inflation, and enrollment changes, strategic sourcing management is replacing traditional transaction-based procurement. Procurement-card programs, allowing organizations to use credit cards for small purchases or low-value items, save time and enhance controls over merchants, credit limits, issuance limits,…

Encouraging use of coupons to stimulate condom purchase.

PubMed Central

Dahl, D W; Gorn, G J; Weinberg, C B

1999-01-01

OBJECTIVES: This study examined the feasibility of using high-value coupons to induce condom purchase and evaluated execution factors that can influence the effectiveness of this form of promotion. METHODS: Two levels of coupon discount value (10% off and 75% off) were used to promote condom purchase among young adults. Coupons were distributed according to a widespread strategy or a more focused in-store disbursement method. RESULTS: Redemption of coupons distributed through the widespread disbursement strategy was negligible. In contrast, coupons from the in-store distribution method, particularly the higher value coupon, resulted in a high redemption rate. CONCLUSIONS: This research provides strong evidence that discount coupons, particularly high-value ones distributed at the purchase location, can be used successfully as a condom promotional incentive. PMID:10589320

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2011 CFR

2011-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2014 CFR

2014-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2012 CFR

2012-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2010 CFR

2010-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2013 CFR

2013-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

Waiting for Merlot: anticipatory consumption of experiential and material purchases.

PubMed

Kumar, Amit; Killingsworth, Matthew A; Gilovich, Thomas

2014-10-01

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.

Reducing uncertainty in value-based pricing using evidence development agreements: the case of continuous intraduodenal infusion of levodopa/carbidopa (Duodopa®) in Sweden.

PubMed

Willis, Michael; Persson, Ulf; Zoellner, York; Gradl, Birgit

2010-01-01

Value-based pricing (VBP), whereby prices are set according to the perceived benefits offered to the consumer at a time when costs and benefits are characterized by considerable uncertainty and are then reviewed ex post, is a much discussed topic in pharmaceutical reimbursement. It is usually combined with coverage with evidence development (CED), a tool in which manufacturers are granted temporary reimbursement but are required to collect and submit additional health economic data at review. Many countries, including the UK, are signalling shifts in this direction. Several countries, including Sweden, have already adopted this approach and offer good insight into the benefits and pitfalls in actual practice. To describe VBP reimbursement decision making using CED in actual practice in Sweden. Decision making by The Dental and Pharmaceutical Benefits Agency (TLV) in Sweden was reviewed using a case study of continuous intraduodenal infusion of levodopa/carbidopa (Duodopa®) in the treatment of advanced Parkinson's disease (PD) with severe motor fluctuations. The manufacturer of Duodopa® applied for reimbursement in late 2003. While the proper economic data were not included in the submission, TLV granted reimbursement until early 2005 to provide time for the manufacturer to submit a formal economic evaluation. The re-submission with economic data was considered inadequate to judge cost effectiveness, so TLV granted an additional extension of reimbursement until August 2007, at which time conclusive data were expected. The manufacturer initiated a 3-year, prospective health economic study and a formal economic model. Data from a pre-planned interim analysis of the data were loaded into the model and the cost-effectiveness ratio was the basis of the next re-submission. TLV concluded that the data were suitable for making a definite decision and that the drug was not cost effective, deciding to discontinue reimbursement for any new patients (current patients were

Demographic and psychographic associations of consumer intentions to purchase healthier food products.

PubMed

Burton, Melissa; Wang, Wei Chun; Worsley, Anthony

2015-01-01

This study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. A national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. Nutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. Communication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods.

Where do people purchase food? A novel approach to investigating food purchasing locations.

PubMed

Thornton, Lukar E; Crawford, David A; Lamb, Karen E; Ball, Kylie

2017-03-07

Studies exploring associations between food environments and food purchasing behaviours have been limited by the absence of data on where food purchases occur. Determining where food purchases occur relative to home and how these locations differ by individual, neighbourhood and trip characteristics is an important step to better understanding the association between food environments and food behaviours. Conducted in Melbourne, Australia, this study recruited participants within sixteen neighbourhoods that were selected based on their socioeconomic characteristics and proximity to supermarkets. The survey material contained a short questionnaire on individual and household characteristics and a food purchasing diary. Participants were asked to record details related to all food purchases made over a 2-week period including food store address. Fifty-six participants recorded a total of 952 food purchases of which 893 were considered valid for analysis. Households and food purchase locations were geocoded and the network distance between these calculated. Linear mixed models were used to determine associations between individual, neighbourhood, and trip characteristics and distance to each food purchase location from home. Additional analysis was conducted limiting the outcome to: (a) purchase made when home was the prior origin (n. 484); and (b) purchases made within supermarkets (n. 317). Food purchases occurred a median distance of 3.6 km (IQR 1.8, 7.2) from participants' homes. This distance was similar when home was reported as the origin (median 3.4 km; IQR 1.6, 6.4) whilst it was shorter for purchases made within supermarkets (median 2.8 km; IQR 1.6, 5.6). For all purchases, the reported food purchase location was further from home amongst the youngest age group (compared to the oldest age group), when workplace was the origin of the food purchase trip (compared to home), and on weekends (compared to weekdays). Differences were also observed by

The attentional drift-diffusion model extends to simple purchasing decisions.

PubMed

Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio

2012-01-01

How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions.

The Attentional Drift-Diffusion Model Extends to Simple Purchasing Decisions

PubMed Central

Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio

2012-01-01

How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions. PMID:22707945

School District Purchasing.

ERIC Educational Resources Information Center

Natale, Joseph L.

This chapter of "Principles of School Business Management" discusses the effective management of purchasing processes in a school district. These processes include obtaining materials, supplies, and equipment of maximum value for the least expense, and receiving, storing, and distributing the items obtained. The chapter opens with an overview of…

From intelligence to evidence-based healthcare: a purchasing odyssey.

PubMed

Booth, A; Hey, S

1995-12-01

Since the appearance of the NHS Executive's guidance document, Purchasing Intelligence (1991), efforts have been concentrated on the development of 'purchasing intelligence facilities' staffed, in the main, by health librarians. However, the concept of 'intelligence' has a wider dimension that impacts upon the whole culture of an organization. The authors examine purchasing organizations against popular theories of organizational development. The characteristics of Handy's Task culture, with Athena as its patron, may be observed in many authorities. Using the results of two surveys, conducted in March 1995, they identify some key information management issues involving structure, tasks, technology and people. Skills in information 'transformation' must be acquired by all staff in purchasing authorities. The intelligence officer must become a modern-day Odysseus if the intelligence facility is to 'survive and thrive'.

Value-based formulas for purchasing. Does managed care offer value to society?

PubMed

Priester, R

1997-01-01

To assess whether managed care is, all things considered, a good investment for our society, we can measure its performance relative to five essential health care goals: promote efficiency; expand access; improve quality; preserve freedom of choice; and protect patient advocacy. These goals, which have shaped and continue to shape health care policy, define what is important to us in our health care system. Concerns about managed care's ability to advance these goals and thus to offer value are heightened if recently observed trends continue.

Demographic and psychographic associations of consumer intentions to purchase healthier food products

PubMed Central

Burton, Melissa; Wang, Wei Chun; Worsley, Anthony

2014-01-01

Objective This study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. Methods A national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. Results Nutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. Conclusion Communication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods. PMID:26844047

The neural bases underlying social risk perception in purchase decisions.

PubMed

Yokoyama, Ryoichi; Nozawa, Takayuki; Sugiura, Motoaki; Yomogida, Yukihito; Takeuchi, Hikaru; Akimoto, Yoritaka; Shibuya, Satoru; Kawashima, Ryuta

2014-05-01

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

21 CFR 820.50 - Purchasing controls.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer... control to be exercised over the product, services, suppliers, contractors, and consultants, based on the...

21 CFR 820.50 - Purchasing controls.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer... control to be exercised over the product, services, suppliers, contractors, and consultants, based on the...

21 CFR 820.50 - Purchasing controls.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer... control to be exercised over the product, services, suppliers, contractors, and consultants, based on the...

21 CFR 820.50 - Purchasing controls.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer... control to be exercised over the product, services, suppliers, contractors, and consultants, based on the...

21 CFR 820.50 - Purchasing controls.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 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... control to be exercised over the product, services, suppliers, contractors, and consultants, based on the...

Evaluation of purchase intention of customers in two wheeler automobile segment: AHP and TOPSIS

NASA Astrophysics Data System (ADS)

Sri Yogi, Kottala

2018-03-01

Winning heart of customers is preeminent main design of any business organization in global business environment. This paper explored customer’s priorities while purchasing a two wheeler automobile segment using Analytical Hierarchy Process (AHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) as a multi criteria decision making tools to accomplish the research objectives. Study has been done to analyze different criteria to be considered during purchasing of two wheeler automobiles among respondents using structured questionnaire based on SAATY scale. Based on our previous work on empirical & fuzzy logic approach to product quality and purchase intention of customers in two wheeler- operational, performance, economic, brand value and maintenance aspects are considered as decision criteria of customers while purchasing a two wheeler. The study suggests high pick up during overtaking, petrol saving, reasonable spare parts price, unique in design and identity and easy to change gear as main criterion in purchasing process. We also found some leading two wheeler automobiles models available in Indian market using some objective function criterion in choosing some important characteristics like price, cylinder capacity, brake horse power and weight during purchasing process of two wheeler automobile in Indian market based on respondents perception.

42 CFR § 484.325 - Payments for home health services under Home Health Value-Based Purchasing (HHVBP) Model.

Code of Federal Regulations, 2010 CFR

2017-10-01

... Purchasing (HHVBP) Model. CMS will determine a payment adjustment up to the maximum applicable percentage... Total Performance Score using a linear exchange function. Payment adjustments made under the HHVBP Model... 42 Public Health 5 2017-10-01 2017-10-01 false Payments for home health services under Home Health...

42 CFR § 484.325 - Payments for home health services under Home Health Value-Based Purchasing (HHVBP) Model.

Code of Federal Regulations, 2010 CFR

2016-10-01

... Purchasing (HHVBP) Model. CMS will determine a payment adjustment up to the maximum applicable percentage... Total Performance Score using a linear exchange function. Payment adjustments made under the HHVBP Model... 42 Public Health 5 2016-10-01 2016-10-01 false Payments for home health services under Home Health...

Differential Regulation of Angiogenesis using Degradable VEGF-Binding Microspheres

PubMed Central

Belair, David G.; Miller, Michael J.; Wang, Shoujian; Darjatmokon, Soesiawati R.; Binder, Bernard Y.K.; Sheibani, Nader; Murphy, William L.

2016-01-01

Vascular endothelial growth factor (VEGF) spatial and temporal activity must be tightly controlled during angiogenesis to form perfusable vasculature in a healing wound. The native extracellular matrix (ECM) regulates growth factor activity locally via sequestering, and researchers have used ECM-mimicking approaches to regulate the activity of VEGF in cell culture and in vivo. However, the impact of dynamic, affinity-mediated growth factor sequestering has not been explored in detail with biomaterials. Here, we sought to modulate VEGF activity dynamically over time using poly(ethylene glycol) microspheres containing VEGF-binding peptides (VBPs) and exhibiting varying degradation rates. The degradation rate of VBP microspheres conferred a differential ability to up- or down-regulate VEGF activity in culture with primary human endothelial cells. VBP microspheres with fast-degrading crosslinks reduced VEGF activity and signaling, while VBP microspheres with no inherent degradability sequestered and promoted VEGF activity in culture with endothelial cells. VBP microspheres with degradable crosslinks significantly reduced neovascularization in vivo, but neither non-degradable VBP microspheres nor bolus delivery of soluble VBP reduced neovascularization. The covalent incorporation of VBP to degradable microspheres was required to reduce neovascularization in a mouse model of choroidal neovascularization in vivo, which demonstrates a potential clinical application of degradable VBP microspheres to reduce pathological angiogenesis. The results herein highlight the ability to modulate the activity of a sequestered growth factor by changing the crosslinker identity within PEG hydrogel microspheres. The insights gained here may instruct the design and translation of affinity-based growth factor sequestering biomaterials for regenerative medicine applications. PMID:27061268

Impact of a Rewards-Based Incentive Program on Promoting Fruit and Vegetable Purchases

PubMed Central

Phipps, Etienne J.; Braitman, Leonard E.; Stites, Shana D.; Singletary, S. Brook; Wallace, Samantha L.; Hunt, Lacy; Axelrod, Saul; Glanz, Karen; Uplinger, Nadine

2015-01-01

Objectives. We assessed the impact of a rewards-based incentive program on fruit and vegetable purchases by low-income families. Methods. We conducted a 4-phase prospective cohort study with randomized intervention and wait-listed control groups in Philadelphia, Pennsylvania, in December 2010 through October 2011. The intervention provided a rebate of 50% of the dollar amount spent on fresh or frozen fruit and vegetables, reduced to 25% during a tapering phase, then eliminated. Primary outcome measures were number of servings of fruit and of vegetables purchased per week. Results. Households assigned to the intervention purchased an average of 8 (95% confidence interval [CI] = 1.5, 16.9) more servings of vegetables and 2.5 (95% CI = 0.3, 9.5) more servings of fruit per week than did control households. In longitudinal price-adjusted analyses, when the incentive was reduced and then discontinued, the amounts purchased were similar to baseline. Conclusions. Investigation of the financial costs and potential benefits of incentive programs to supermarkets, government agencies, and other stakeholders is needed to identify sustainable interventions. PMID:24625144

Women, infants, and children cash value voucher (CVV) use in Arizona: a qualitative exploration of barriers and strategies related to fruit and vegetable purchases.

PubMed

Bertmann, Farryl M W; Barroso, Cristina; Ohri-Vachaspati, Punam; Hampl, Jeffrey S; Sell, Karen; Wharton, Christopher M

2014-01-01

Women, Infants, and Children (WIC) cash value vouchers (CVV) have been inconsistently redeemed in Arizona. The objective of this study was to explore perceived barriers to use of CVV as well as strategies participants use to overcome them. Eight focus groups were conducted to explore attitudes and behaviors related to CVV use. Focus groups were conducted at 2 WIC clinics in metro-Phoenix, AZ. Participants in WIC who were at least 18 years of age and primarily responsible for buying and preparing food for their households. Perceived barriers to CVV use and strategies used to maximize their purchasing value. Transcripts were analyzed using a general inductive approach to identify emergent themes. Among 41 participants, multiple perceived barriers emerged, such as negative interactions in stores or confusion over WIC rules. Among experienced shoppers, WIC strategies also emerged to deal with barriers and maximize CVV value, including strategic choice of times and locations at which to shop and use of price-matching, rewards points, and other ways to increase purchasing power. Arizona WIC participants perceived barriers that limit easy redemption of CVV. Useful strategies were also identified that could be important to explore further to improve WIC CVV purchasing experiences. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Fuzzy Constraint Based Model for Efficient Management of Dynamic Purchasing Environments

NASA Astrophysics Data System (ADS)

Sakas, D. P.; Vlachos, D. S.; Simos, T. E.

2007-12-01

This paper considers the application of a fuzzy constraint based model for handling dynamic environments where only one of possibly many bundles of items must be purchased and quotes for items open and close over time. Simulation results are presented and compared with the optimal solution.

Demographics and beef preferences affect consumer motivation for purchasing fresh beef steaks and roasts.

PubMed

Reicks, A L; Brooks, J C; Garmyn, A J; Thompson, L D; Lyford, C L; Miller, M F

2011-04-01

Surveys completed by 1370 consumers determined the motivational factors affecting consumer purchasing decisions for fresh beef steaks and roasts in three regions in the United States. Females placed greater importance on tenderness, ease of preparation, and nutritional value of steaks and roasts when compared to males. Age influenced tenderness, product consistency, and nutritional value of steaks, but influenced flavor, product consistency, and nutritional value of roasts. Consumers felt juiciness, nutritional value, and natural products were less important in determining their purchasing choices of steaks and roasts as their level of education increased. The preferred degree of doneness of steaks influenced the value placed on six of the nine purchasing motivators. Beef preferences and demographics influenced consumer purchasing decisions for fresh beef steaks and roasts. Results from this study can be used to help identify factors to positively influence purchasing decisions within targeted market segments. © 2010 The American Meat Science Association. Published by Elsevier Ltd. All rights reserved.

Understanding Hospital Value-Based Purchasing.

PubMed

Brooks, Jo Ann

2016-05-01

This column is designed to provide a nursing perspective on new hospital quality measurements. Future articles will cover the various quality indicators hospitals face and the role of the nurse in meeting mandated benchmarks. Reader responses to this column are welcome and will help to make it more useful to nurses in meeting the challenges posed by health care reform and changing Medicare reimbursement programs.

36 CFR 223.62 - Timber purchaser road construction credit.

Code of Federal Regulations, 2010 CFR

2010-07-01

... deposits for slash disposal and road maintenance. As used in this section estimated construction costs... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Timber purchaser road... § 223.62 Timber purchaser road construction credit. Appraisal may also establish stumpage value as if...

How Can Adult Children Influence Parents’ Long-Term Care Insurance Purchase Decisions?

PubMed Central

Voils, Corrine I.; Coe, Norma B.; Konetzka, R. Tamara; Boles, Jillian; Van Houtven, Courtney Harold

2017-01-01

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

48 CFR 313.303-5 - Purchases under blanket purchase agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Purchases under blanket purchase agreements. 313.303-5 Section 313.303-5 Federal Acquisition Regulations System HEALTH AND HUMAN... Methods 313.303-5 Purchases under blanket purchase agreements. (e)(5) HHS personnel that sign delivery...

Convenience-based food purchase patterns: identification and associations with dietary quality, sociodemographic factors and attitudes.

PubMed

Peltner, Jonas; Thiele, Silke

2018-02-01

The present study aimed to derive food purchase patterns considering the convenience level of foods. Associations between identified patterns and dietary quality were analysed, as well as household characteristics associated with the dietary patterns. A Convenience Food Classification Scheme (CFCS) was developed. After classifying basic food groups into the CFCS, the formed groups were used to apply a factor analysis to identify convenience-based food purchase patterns. For these patterns nutrient and energy densities were examined. Using regression analysis, associations between the adherence to the patterns and household characteristic and attitude variables were analysed. The study used representative German food purchase data from 2011. Approximately 12 million purchases of 13 131 households were recorded in these data. Three convenience-based patterns were identified: a low-convenience, a semi-convenience and a ready-to-eat food pattern. Tighter adherence to the semi-convenience pattern was shown to result in the lowest nutrient and highest energy densities. Important factors influencing adherence to the patterns were household size, presence of children and attitudes. Working full-time was negatively associated with adherence to the low-convenience pattern and positively with the ready-to-eat pattern. Convenience foods were an important part of households' food baskets which in some cases led to lower nutritional quality. Therefore, it is important to offer convenience foods higher in nutrient density and lower in energy density. Interventions targeted on enhancing cooking skills could be an effective strategy to increase purchases of unprocessed foods, which, in turn, could also contribute to an improved diet quality.

A point-of-purchase intervention featuring in-person supermarket education affects healthful food purchases.

PubMed

Milliron, Brandy-Joe; Woolf, Kathleen; Appelhans, Bradley M

2012-01-01

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. The design was a randomized trial comparing the intervention with usual care (no treatment). A supermarket in a socioeconomically diverse region of Phoenix, AZ. One hundred fifty-three adult shoppers were recruited onsite. The intervention consisted of brief shopping education by a nutrition educator and an explanation and promotion of a supermarket point-of-purchase healthful shopping program that included posted shelf signs identifying healthful foods, sample shopping lists, tips, and signage. Outcomes included purchases of total, saturated, and trans fat (grams/1,000 kcal), and fruits, vegetables, and dark-green/yellow vegetables (servings/1,000 kcal) derived through nutritional analysis of participant shopping baskets. Analysis of covariance compared the intervention and control groups on food purchasing patterns while adjusting for household income. The intervention resulted in greater purchasing of fruit and dark-green/yellow vegetables. No other group differences were observed. Long-term evaluations of supermarket interventions should be conducted to improve the evidence base and to determine the potential for influence on food choices associated with decreased chronic disease incidence. Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

How Can Adult Children Influence Parents' Long-Term Care Insurance Purchase Decisions?

PubMed

Sperber, Nina R; Voils, Corrine I; Coe, Norma B; Konetzka, R Tamara; Boles, Jillian; Van Houtven, Courtney Harold

2017-04-01

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: journals.permissions@oup.com.

The Questionable Economic Case for Value-Based Drug Pricing in Market Health Systems.

PubMed

Pauly, Mark V

2017-02-01

This article investigates the economic theory and interpretation of the concept of "value-based pricing" for new breakthrough drugs with no close substitutes in a context (such as the United States) in which a drug firm with market power sells its product to various buyers. The interpretation is different from that in a country that evaluates medicines for a single public health insurance plan or a set of heavily regulated plans. It is shown that there will not ordinarily be a single value-based price but rather a schedule of prices with different volumes of buyers at each price. Hence, it is incorrect to term a particular price the value-based price, or to argue that the profit-maximizing monopoly price is too high relative to some hypothesized value-based price. When effectiveness of treatment or value of health is heterogeneous, the profit-maximizing price can be higher than that associated with assumed values of quality-adjusted life-years. If the firm sets a price higher than the value-based price for a set of potential buyers, the optimal strategy of the buyers is to decline to purchase that drug. The profit-maximizing price will come closer to a unique value-based price if demand is less heterogeneous. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The impact of financial incentives on participants' food purchasing patterns in a supermarket-based randomized controlled trial.

PubMed

Olstad, Dana Lee; Crawford, David A; Abbott, Gavin; McNaughton, Sarah A; Le, Ha Nd; Ni Mhurchu, Cliona; Pollard, Christina; Ball, Kylie

2017-08-25

The impacts of supermarket-based nutrition promotion interventions might be overestimated if participants shift their proportionate food purchasing away from their usual stores. This study quantified whether participants who received price discounts on fruits and vegetables (FV) in the Supermarket Healthy Eating for Life (SHELf) randomized controlled trial (RCT) shifted their FV purchasing into study supermarkets during the intervention period. Participants were 642 females randomly assigned to a 1) skill-building (n = 160), 2) price reduction (n = 161), 3) combined skill-building and price reduction (n = 160), or 4) control (n = 161) group. Participants self-reported the proportion of FV purchased in study supermarkets at baseline, 3- and 6-months post-intervention. Fisher's exact and χ 2 tests assessed differences among groups in the proportion of FV purchased in study supermarkets at each time point. Multinomial logistic regression assessed differences among groups in the change in proportionate FV purchasing over time. Post-intervention, 49% of participants purchased ≥50% of their FV in study supermarkets. Compared to all other groups, the price reduction group was approximately twice as likely (RRR: 1.8-2.2) to have increased proportionate purchasing of FV in study supermarkets from baseline to post-intervention (p< 0.05). Participants who received price reductions on FV were approximately twice as likely to shift their FV purchasing from other stores into study supermarkets during the intervention period. Unless food purchasing data are available for all sources, differential changes in purchasing patterns can make it difficult to discern the true impacts of nutrition interventions. The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901, Registered 30 June 2010, Retrospectively registered ( http://www.isrctn.com/ISRCTN39432901 ).

Hazard map for volcanic ballistic impacts at Popocatépetl volcano (Mexico)

NASA Astrophysics Data System (ADS)

Alatorre-Ibargüengoitia, Miguel A.; Delgado-Granados, Hugo; Dingwell, Donald B.

2012-11-01

During volcanic explosions, volcanic ballistic projectiles (VBP) are frequently ejected. These projectiles represent a threat to people, infrastructure, vegetation, and aircraft due to their high temperatures and impact velocities. In order to protect people adequately, it is necessary to delimit the projectiles' maximum range within well-defined explosion scenarios likely to occur in a particular volcano. In this study, a general methodology to delimit the hazard zones for VBP during volcanic eruptions is applied to Popocatépetl volcano. Three explosion scenarios with different intensities have been defined based on the past activity of the volcano and parameterized by considering the maximum kinetic energy associated with VBP ejected during previous eruptions. A ballistic model is used to reconstruct the "launching" kinetic energy of VBP observed in the field. In the case of Vulcanian eruptions, the most common type of activity at Popocatépetl, the ballistic model was used in concert with an eruptive model to correlate ballistic range with initial pressure and gas content, parameters that can be estimated by monitoring techniques. The results are validated with field data and video observations of different Vulcanian eruptions at Popocatépetl. For each scenario, the ballistic model is used to calculate the maximum range of VBP under optimum "launching" conditions: ballistic diameter, ejection angle, topography, and wind velocity. Our results are presented in the form of a VBP hazard map with topographic profiles that depict the likely maximum ranges of VBP under explosion scenarios defined specifically for Popocatépetl volcano. The hazard zones shown on the map allow the responsible authorities to plan the definition and mitigation of restricted areas during volcanic crises.

Habitual and value-guided purchase behavior.

PubMed

Biel, Anders; Dahlstrand, Ulf; Grankvist, Gunne

2005-06-01

Society increasingly requests that individuals adopt environmentally benign behavior. Information campaigns purported to change people's attitudes are often regarded as prerequisites to installing such changes. While such information may be a necessary step, it is not sufficient by itself. We argue that many everyday behaviors with environmental consequences are habitual, and that little attention is given to information directed toward changing these habitual behaviors. In other instances, behavior is guided by values in a more reflective process. However, other information besides environmental consequences may draw a person's attention and affect behavioral choice. Using surveys and experimental studies targeting consumer behavior, we studied under what conditions different kinds of information is likely to influence people with varying levels of environmental concern. Based on results from these studies, implications for behavioral change are discussed.

Collective purchase behavior toward retail price changes

NASA Astrophysics Data System (ADS)

Ueno, Hiromichi; Watanabe, Tsutomu; Takayasu, Hideki; Takayasu, Misako

2011-02-01

By analyzing a huge amount of point-of-sale data collected from Japanese supermarkets, we find power law relationships between price and sales numbers. The estimated values of the exponents of these power laws depend on the category of products; however, they are independent of the stores, thereby implying the existence of universal human purchase behavior. The rate of sales numbers around these power laws are generally approximated by log-normal distributions implying that there are hidden random parameters, which might proportionally affect the purchase activity.

Food concerns and support for environmental food policies and purchasing.

PubMed

Worsley, Anthony; Wang, Wei C; Burton, Melissa

2015-08-01

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.

A point-of-purchase intervention featuring in-person supermarket education impacts healthy food purchases

PubMed Central

Woolf, Kathleen; Appelhans, Bradley M.

2011-01-01

Objective This study tested the efficacy of a multicomponent supermarket point-of-purchase (POP) intervention featuring in-person nutrition education on the nutrient composition of food purchases. Design The design was a randomized trial comparing the intervention to usual care (no treatment). Setting A supermarket in a socioeconomically diverse region of Phoenix, Arizona. Participants One-hundred fifty-three adult shoppers were recruited on-site. Intervention The intervention consisted of brief shopping education by a nutrition educator and an explanation and promotion of a supermarket POP healthy shopping program that included posted shelf signs identifying healthy foods, sample shopping lists, tips, and signage. Main Outcome Measures Outcomes included purchases of total, saturated, and trans fat (g/1000 kcals), and fruits, vegetables, and dark green and bright yellow vegetables (servings/1000 kcals) derived through nutritional analysis of participant shopping baskets. Analysis Analysis of covariance compared the intervention and control groups on food purchasing patterns while adjusting for household income. Results The intervention resulted in greater purchasing of fruit and green and yellow vegetables. No other group differences were observed. Conclusions and Implications Long-term evaluations of supermarket interventions should be conducted to improve the evidence base, and to determine the potential for impact on food choices associated with decreased chronic disease. PMID:22104016

Who Purchases Low-Cost Alcohol in Australia?

PubMed

Callinan, Sarah; Room, Robin; Livingston, Michael; Jiang, Heng

2015-11-01

Debates surrounding potential price-based polices aimed at reducing alcohol-related harms tend to focus on the debate concerning who would be most affected-harmful or low-income drinkers. This study will investigate the characteristics of people who purchase low-cost alcohol using data from the Australian arm of the International Alcohol Control study. 1681 Australians aged 16 and over who had consumed alcohol and purchased it in off-licence premises were asked detailed questions about both practices. Low-cost alcohol was defined using cut-points of 80¢, $1.00 or $1.25 per Australian standard drink. With a $1.00 cut-off low income (OR = 2.1) and heavy drinkers (OR = 1.7) were more likely to purchase any low-cost alcohol. Harmful drinkers purchased more, and low-income drinkers less, alcohol priced at less than $1.00 per drink than high income and moderate drinkers respectively. The relationship between the proportion of units purchased at low cost and both drinker category and income is less clear, with hazardous, but not harmful, drinkers purchasing a lower proportion of units at low cost than moderate drinkers. The impact of minimum pricing on low income and harmful drinkers will depend on whether the proportion or total quantity of all alcohol purchased at low cost is considered. Based on absolute units of alcohol, minimum unit pricing could be differentially effective for heavier drinkers compared to other drinkers, particularly for young males. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Opinion survey: materials management and purchasing habits.

PubMed

1988-01-01

This opinion survey was undertaken to gauge the current status of materials management and purchasing departments at hospitals throughout the southern and southeastern United States. The survey was based on lengthy telephone interviews (from 30 to 60 minutes) and followup discussions with materials managers, purchasing agents and administrators. Interviews covered a variety of topics, including: cost-containment strategies; group purchasing and consignment purchasing; and current and anticipated trends in materials management. Many questions were left open-ended, so the survey could gauge attitudes, as well as determine contemporary practices and procedures. (In some cases, respondents were also given the opportunity to comment on the statements of their peers, in order to corroborate and substantiate data.)

Does drug price-regulation affect healthcare expenditures?

PubMed

Ben-Aharon, Omer; Shavit, Oren; Magnezi, Racheli

2017-09-01

Increasing health costs in developed countries are a major concern for decision makers. A variety of cost containment tools are used to control this trend, including maximum price regulation and reimbursement methods for health technologies. Information regarding expenditure-related outcomes of these tools is not available. To evaluate the association between different cost-regulating mechanisms and national health expenditures in selected countries. Price-regulating and reimbursement mechanisms for prescription drugs among OECD countries were reviewed. National health expenditure indices for 2008-2012 were extracted from OECD statistical sources. Possible associations between characteristics of different systems for regulation of drug prices and reimbursement and health expenditures were examined. In most countries, reimbursement mechanisms are part of publicly financed plans. Maximum price regulation is composed of reference-pricing, either of the same drug in other countries, or of therapeutic alternatives within the country, as well as value-based pricing (VBP). No association was found between price regulation or reimbursement mechanisms and healthcare costs. However, VBP may present a more effective mechanism, leading to reduced costs in the long term. Maximum price and reimbursement mechanism regulations were not found to be associated with cost containment of national health expenditures. VBP may have the potential to do so over the long term.

Bid purchasing of pharmaceuticals.

PubMed

Swift, R G; Ryan, M R

1978-11-01

The effects of bid purchasing of drug products by hospitals and the factors to consider in bid purchasing of pharmaceuticals are reviewed; further, the prices available with bid purchasing to a specific hospital in 1974 and 1977 are presented. Factors important for a successful bid purchasing system of pharmaceuticals are: (1) use of a formulary policy, (2) an effective procedure for handling bid purchasing and (3) criteria for evaluation of drug products. Significant differences were found between prices available with and without bid purchasing for 50 nonproprietary drug products in 1974 and for 19 products in 1977. Although monetary savings to hospitals do exist with bid purchasing of pharmaceuticals, the degree of savings is dependent upon the drug usage for that hospital.

Purchasing oncology services. Kerr L. White Institute/American Cancer Society Task Force on Purchasing Oncology Services.

PubMed

Cangialose, C B; Blair, A E; Borchardt, J S; Ades, T B; Bennett, C L; Dickersin, K; Gesme, D H; Henderson, I C; McGinnis, L S; Mooney, K; Mortenson, L E; Sperduto, P; Winkenwerder, W; Ballard, D J

2000-06-15

A multidisciplinary panel representing various stakeholders in the health care delivery and oncology services marketplace was convened to develop specific criteria for healthcare purchasers to consider when evaluating the structures and processes of health plans. These rank ordered criteria also can be used by oncologic service providers and health plan designers as a yardstick for the services they offer. A multidisciplinary 31-member Task Force was assembled by the Kerr L. White Institute and the American Cancer Society in March 1997. Task Force members were selected for their ability to offer expert insight as purchasers, suppliers, policymakers, consumers, or stakeholders in the health care marketplace. A preference-weighted majority voting rule was used to identify the three most important recommendations of the 10 that were generated through a modified Delphi technique. To test the practicality of the top three recommendations, leaders of large managed care organizations (MCOs) were surveyed; the results of this survey then were compared with the results of the Task Force survey. The three most important recommendations from the Task Force were that health plans provide access to: 1) comprehensive cancer care, 2) preventive and screening services, and 3) second opinions and treatment options supported by scientific evidence. The difference between the responses of the Task Force and the MCOs was that MCOs placed the highest importance on evidence-based decision-making, with their next three rankings coinciding with those identified by the Task Force. The value of these summary recommendations will be realized through their use by both purchasers and suppliers to influence the structure and content of the delivery of oncologic services.

48 CFR 1553.213 - Small purchases and other simplified purchase procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Small purchases and other simplified purchase procedures. 1553.213 Section 1553.213 Federal Acquisition Regulations System ENVIRONMENTAL PROTECTION AGENCY CLAUSES AND FORMS FORMS Prescription of Forms 1553.213 Small purchases and other...

Achieving Consumer Purchase Payoffs: A Used Car Purchase.

ERIC Educational Resources Information Center

Maynes, E. Scott; Maynes, Blanche R.

1997-01-01

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)

Purchase habits, use of paracetamol, and information sources on a reregulated Swedish pharmacy market: A population-based study.

PubMed

Hedenrud, T; Håkonsen, H

2017-01-01

Considering the general lack of knowledge on how over-the-counter paracetamol is used combined with the reported increase in paracetamol poisonings after the reregulation of the Swedish pharmacy market in 2009, we aimed to analyze purchase habits and use of paracetamol in Sweden. A further aim was to investigate sources of information about paracetamol. Data were collected in October 2015 through the Citizen Panel, a Web-based panel encompassing over 50,000 Swedes. A stratified sample of 6000 (aged 18 years and older) was emailed a survey invitation. Questions concerned paracetamol use, purchase habits and information sources. The participation rate was 58%. A majority (70.5%) reported use of paracetamol during the last three months. Purchasing paracetamol solely over-the-counter was most common (81.1%). Close to two-thirds usually purchased paracetamol at a pharmacy. However, it was more common to purchase OTC paracetamol at non-pharmacy outlets among younger compared to older respondents. The results of this study did not reveal any harmful paracetamol use. The most common information source overall was patient information leaflets, and it was significantly more common among the youngest compared to older subjects. Based on our results combined with previous research, we suggest more studies, both qualitative and quantitative, among young adults, both on the use of paracetamol and on the understanding of information in patient information leaflets and on the Internet. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Theory of Value-Based Payment Incentives and Their Application to Health Care.

PubMed

Conrad, Douglas A

2015-12-01

To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

Shopping for health: purchasing health services through contracts.

PubMed

Howden-Chapman, P; Ashton, T

1994-01-01

The 1993 New Zealand health service reforms were based on the purported efficiencies of the purchaser/provider split. Purchasers are required to contract for services that will maintain, improve and restore the health of the populations they serve. The purchasing role, which requires the development of contracting skills as well as the setting of strategic directions and priorities, is new and as yet poorly developed. This paper describes the role of purchasing agents in setting priorities, the different approaches that are being taken to contracting for services and some of the problems that have arisen in the first year of contracting. It explores the trade-off that is evident between the potential for improving efficiency through contestable contracting and the need to minimise transaction costs associated with the contracting process. The purchasers' accountability to the public and the Minister is analysed in the broader political context of the purchasers' role in shaping a public health service and improving the health of the population.

Sugar and total energy content of household food purchases in Brazil.

PubMed

Levy, Renata Bertazzi; Claro, Rafael Moreira; Monteiro, Carlos Augusto

2009-11-01

To study the role of energy derived from sugar (both table sugar and sugar added to processed foods) in the total energy content of food purchases in Brazil. Food purchase data were collected during a national household budget survey carried out between June 2002 and July 2003 on a probabilistic sample representative of all households in the country. The amount of food purchased in this 12-month period was transformed into energy and energy from sugar using food composition tables. Multiple linear regression models were used to study the association between amount of energy from sugar and total energy content of food purchases, controlling for sociodemographic variables and potential interactions between these variables and sugar purchases. There was a positive and significant association between energy from sugar and total household energy purchases. A 1 kJ increase in sugar purchase corresponded to a 3.637 kJ increase in total energy. In the absence of expenditure on meals outside the home, i.e. when household food purchases tend to approximate actual food consumption by household members, sugar purchase of 1926.35 kJ/d (the 90th percentile of the distribution of sugar purchases in Brazil) was associated, depending on income strata, with total energy purchase over 40-60 % of the recommended daily value for energy intake in Brazil. The present results corroborate the recommendations of the WHO and the Brazilian Ministry of Health regarding limiting the consumption of sugar.

Weight loss strategies: association with consumption of sugary beverages, snacks and values about food purchases.

PubMed

Bleich, Sara N; Wolfson, Julia A

2014-07-01

To examine whether weight loss strategies are associated with consumption of sugar-sweetened beverages (SSBs), snacks or food values. Cross-sectional analysis of 24-h dietary recall data obtained from the National Health and Nutrition Examination Survey 2007-2010 (N=9440). Adults trying to lose weight consumed roughly 2000 total calories, 250 calories from SSBs, 225 calories from salty snacks, and 350 calories from sweet snacks. Adults not trying to lose weight consumed roughly 2300 total calories, 300 calories from SSBs, 250 calories from salty snacks, and 380 calories from sweet snacks. While overweight and obese adults trying to lose weight consumed fewer calories than those who were not, heavier adults trying to lose weight using dietary strategies or a combination of diet and physical activity consumed more calories than healthy weight adults using that same weight loss strategy (p<0.05). Price (>70%) and nutrition (>50%) were most when making food choices (p<0.05) for all groups. Consumption of discretionary calories is high regardless of body weight or weight loss intention. Promoting reduced SSB and snack consumption in the clinical setting may be important for weight loss, particularly among heavier individuals. Clinicians should consider values related to food purchasing to identify concrete behavioral targets. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

43 CFR 30.175 - When does a purchased interest vest in the purchaser?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false When does a purchased interest vest in the purchaser? 30.175 Section 30.175 Public Lands: Interior Office of the Secretary of the Interior INDIAN PROBATE HEARINGS PROCEDURES Purchase at Probate § 30.175 When does a purchased interest vest in the...

43 CFR 30.175 - When does a purchased interest vest in the purchaser?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false When does a purchased interest vest in the purchaser? 30.175 Section 30.175 Public Lands: Interior Office of the Secretary of the Interior INDIAN PROBATE HEARINGS PROCEDURES Purchase at Probate § 30.175 When does a purchased interest vest in the...

43 CFR 30.175 - When does a purchased interest vest in the purchaser?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false When does a purchased interest vest in the purchaser? 30.175 Section 30.175 Public Lands: Interior Office of the Secretary of the Interior INDIAN PROBATE HEARINGS PROCEDURES Purchase at Probate § 30.175 When does a purchased interest vest in the...

43 CFR 30.175 - When does a purchased interest vest in the purchaser?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false When does a purchased interest vest in the purchaser? 30.175 Section 30.175 Public Lands: Interior Office of the Secretary of the Interior INDIAN PROBATE HEARINGS PROCEDURES Purchase at Probate § 30.175 When does a purchased interest vest in the...

43 CFR 30.175 - When does a purchased interest vest in the purchaser?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true When does a purchased interest vest in the purchaser? 30.175 Section 30.175 Public Lands: Interior Office of the Secretary of the Interior INDIAN PROBATE HEARINGS PROCEDURES Purchase at Probate § 30.175 When does a purchased interest vest in the...

Exploring risk profiles and emergency frequency of purchasers and non-purchasers of personal emergency alarms: a prospective cohort study.

PubMed

De San Miguel, Kristen; Lewin, Gill; Burton, Elissa; Toye, Christine; Boldy, Duncan; Howat, Peter

2015-10-27

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

Wise Purchasing.

ERIC Educational Resources Information Center

Bridgman, Anne

1990-01-01

Recent events in Florida, California, and other states suggest that school equipment purchasing is fraught with scandal and risk. This article recommends putting district policies in writing, carefully selecting bidders, timing bids to avoid peak periods, and resisting personalized incentives. Sidebars detail model purchasing guidelines and…

Purchaser strategies to influence quality of care: from rhetoric to global applications.

PubMed

McNamara, P

2006-06-01

The potential of purchasers to influence the quality and safety of care has captured the attention of health sector leaders worldwide. Quality based purchasing explicitly seeks to hold providers accountable for the quality and safety of care. Three strategies are available to purchasers: (1) selective contracting based on quality; (2) payment differentials based on quality; and (3) sponsorship of comparative provider report cards. Examples are given to illustrate each of the three strategies. Governments, employers, social insurance funds, community based insurance organizations, health plans, donors, and other buyers of health services are encouraged to explore and debate these purchaser strategies within the context of an overarching national or local quality framework. Public and private funders of operations research are encouraged to support and disseminate evaluations of purchaser efforts to improve quality. This paper is designed to highlight and frame purchasers' strategies explicitly crafted to enhance the quality and safety of care. The ultimate aim is to encourage thoughtful discussion about whether or not one or more purchaser strategy might support a particular country's goals to improve care. Experiences from both developed and developing countries are included to facilitate the exchange of ideas and provide the broadest of perspectives.

Effects of nutrient profiling and price changes based on NuVal® scores on food purchasing in an online experimental supermarket.

PubMed

Epstein, Leonard H; Finkelstein, Eric A; Katz, David L; Jankowiak, Noelle; Pudlewski, Corrin; Paluch, Rocco A

2016-08-01

The goal of the present study was to apply experimental economic methods in an online supermarket to examine the effects of nutrient profiling, and differential pricing based on the nutrient profile, on the overall diet quality, energy and macronutrients of the foods purchased, and diet cost. Participants were provided nutrient profiling scores or price adjustments based on nutrient profile scores while completing a hypothetical grocery shopping task. Prices of foods in the top 20 % of nutrient profiling scores were reduced (subsidized) by 25 % while those in the bottom 20 % of scores were increased (taxed) by 25 %. We evaluated the independent and interactive effects of nutrient profiling or price adjustments on overall diet quality of foods purchased as assessed by the NuVal® score, energy and macronutrients purchased and diet cost in a 2×2 factorial design. A large (>10 000 food items) online experimental supermarket in the USA. Seven hundred and eighty-one women. Providing nutrient profiling scores improved overall diet quality of foods purchased. Price changes were associated with an increase in protein purchased, an increase in energy cost, and reduced carbohydrate and protein costs. Price changes and nutrient profiling combined were associated with no unique benefits beyond price changes or nutrient profiling alone. Providing nutrient profile score increased overall NuVal® score without a reduction in energy purchased. Combining nutrient profiling and price changes did not show an overall benefit to diet quality and may be less useful than nutrient profiling alone to consumers who want to increase overall diet quality of foods purchased.

Neural predictors of purchases

PubMed Central

Knutson, Brian; Rick, Scott; Wimmer, G. Elliott; Prelec, Drazen; Loewenstein, George

2007-01-01

Microeconomic theory maintains that purchases are driven by a combination of consumer preference and price. Using event-related FMRI, we investigated how people weigh these factors to make purchasing decisions. Consistent with neuroimaging evidence suggesting that distinct circuits anticipate gain and loss, product preference activated the nucleus accumbens (NAcc), while excessive prices activated the insula and deactivated the mesial prefrontal cortex (MPFC) prior to the purchase decision. Activity from each of these regions independently predicted immediately subsequent purchases above and beyond self-report variables. These findings suggest that activation of distinct neural circuits related to anticipatory affect precedes and supports consumers’ purchasing decisions. PMID:17196537

31 CFR 360.10 - Amounts which may be purchased.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Amounts which may be purchased. 360.10 Section 360.10 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL... follows: (a) General annual limitation, $5,000 (par value). (b) Special limitation, $4,000 (par value...

31 CFR 360.10 - Amounts which may be purchased.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Amounts which may be purchased. 360.10 Section 360.10 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL... follows: (a) General annual limitation, $5,000 (par value). (b) Special limitation, $4,000 (par value...

Experiential or Material Purchases? Social Class Determines Purchase Happiness.

PubMed

Lee, Jacob C; Hall, Deborah L; Wood, Wendy

2018-05-01

Which should people buy to make themselves happy: experiences or material goods? The answer depends in part on the level of resources already available in their lives. Across multiple studies using a range of methodologies, we found that individuals of higher social class, whose abundant resources make it possible to focus on self-development and self-expression, were made happier by experiential over material purchases. No such experiential advantage emerged for individuals of lower social class, whose lesser resources engender concern with resource management and wise use of limited finances. Instead, lower-class individuals were made happier from material purchases or were equally happy from experiential and material purchases.

41 CFR 102-73.130 - When may Federal agencies consider acquiring leases with purchase options?

Code of Federal Regulations, 2010 CFR

2010-07-01

... consider leasing with a purchase option at or below fair market value, consistent with the lease-purchase... and other advantages to the Government and is consistent with the Government's goals. (b) The...

Accounting issues: should the merger be treated as purchase or pooling?

PubMed

Finkler, S A

1985-05-01

Under accounting rules, a merger or consolidation can be treated as either a purchase or pooling. A purchase causes an adjustment in the selling hospital's asset basis to fair market value with goodwill often resulting. Such an adjustment is usually favorable for a taxable acquisition but not a tax-free reorganization. A pooling, on the other hand, results in the assets of the two organizations being merged together with no adjustment in asset values or increase in goodwill. The requirements for pooling are strict but the result is the carryover of assets at historical cost, usually favorable for reporting EPS.

Forecasting Glacier Evolution and Hindcasting Paleoclimates In Light of Mass Balance Nonlinearities

NASA Astrophysics Data System (ADS)

Malone, A.; Doughty, A. M.; MacAyeal, D. R.

2016-12-01

Glaciers are commonly used barometers of present and past climate change, with their variations often being linked to shifts in the mean climate. Climate variability within a unchanging mean state, however, can produce short term mass balance and glacier length anomalies, complicating this linkage. Also, the mass balance response to this variability can be nonlinear, possibly impacting the longer term state of the glacier. We propose a conceptual model to understand these nonlinearities and quantify their impacts on the longer term mass balance and glacier length. The relationship between mass balance and elevation, i.e. the vertical balance profile (VBP), illuminates these nonlinearities (Figure A). The VBP, given here for a wet tropical glacier, is piecewise, which can lead to different mass balance responses to climate anomalies of similar magnitude but opposite sign. We simulate the mass balance response to climate variability by vertically (temperature anomalies) and horizontally (precipitation anomalies) transposing the VBP for the mean climate (Figure A). The resulting anomalous VBP is the superposition of the two translations. We drive a 1-D flowline model with 10,000 years of anomalous VBPs. The aggregate VBP for the mean climate including variability differs from the VBP for the mean climate excluding variability, having a higher equilibrium line altitude (ELA) and a negative mass balance (Figure B). Accordingly, the glacier retreats, and the equilibrium glacier length for the aggregate VBP is the same as the mean length from the 10,000 year flowline simulation (Figure C). The magnitude of the VBP shift and glacier retreat increases with greater temperature variability and larger discontinuities in the VBP slope. These results highlight the importance of both the climate mean and variability in determining the longer term state of the glacier. Thus, forecasting glacier evolution or hindcasting past climates should also include representation of climate

Weight loss strategies: Association with consumption of sugary beverages, snacks and values about food purchases

PubMed Central

Bleich, Sara N.; Wolfson, Julia A.

2014-01-01

Objective To examine whether weight loss strategies are associated with consumption of sugar-sweetened beverages (SSBs), snacks or food values. Design and Methods Cross-sectional analysis of 24-hour dietary recall data obtained from the National Health and Nutrition Examination Survey 2007–2010 (N=9,440). Results Adults trying to lose weight consumed roughly 2000 total calories, 250 calories from SSBs, 225 calories from salty snacks, and 350 calories from sweet snacks. Adults not trying to lose weight consumed roughly 2300 total calories, 300 calories from SSBs, 250 calories from salty snacks, and 380 calories from sweet snacks. While overweight and obese adults trying to lose weight consumed fewer calories than those who were not, heavier adults trying to lose weight using dietary strategies or a combination of diet and physical activity consumed more calories than healthy weight adults using that same weight loss strategy (p < 0.05). Price (>70%) and nutrition (>50%) were most when making food choices (p < 0.05) for all groups. Conclusions Consumption of discretionary calories is high regardless of body weight or weight loss intention. Practice Implications Promoting reduced SSB and snack consumption in the clinical setting may be important for weight loss, particularly among heavier individuals. Clinicians should consider values related to food purchasing to identify concrete behavioral targets. PMID:24801411

Further Validation of a Marijuana Purchase Task

PubMed Central

Aston, Elizabeth R.; Metrik, Jane; MacKillop, James

2015-01-01

Background A valid measure of the relative economic value of marijuana is needed to characterize individual variation in the drug’s reinforcing value and inform evolving national marijuana policy. Relative drug value (demand) can be measured via purchase tasks, and demand for alcohol and cigarettes has been associated with craving, dependence, and treatment response. This study examined marijuana demand with a marijuana purchase task (MPT). Methods The 22-item self-report MPT was administered to 99 frequent marijuana users (37.4% female, 71.5% marijuana use days, 15.2% cannabis dependent). Results Pearson correlations indicated a negative relationship between intensity (free consumption) and age of initiation of regular use (r=−0.34, p<0.001), and positive associations with use days (r=0.26, p<0.05) and subjective craving (r=0.43, p<0.001). Omax (maximum expenditure) was positively associated with use days (r=0.29, p<0.01) and subjective craving (r=0.27, p<0.01). Income was not associated with demand. An exponential demand model provided an excellent fit to the data across users (R2=0.99). Group comparisons based on presence or absence of DSM-IV cannabis dependence symptoms revealed that users with any dependence symptoms showed significantly higher intensity of demand and more inelastic demand, reflecting greater insensitivity to price increases. Conclusions These results provide support for construct validity of the MPT, indicating its sensitivity to marijuana demand as a function of increasing cost, and its ability to differentiate between users with and without dependence symptoms. The MPT may denote abuse liability and is a valuable addition to the behavioral economic literature. Potential applications to marijuana pricing and tax policy are discussed. PMID:26002377

12 CFR 167.12 - Purchased credit card relationships, servicing assets, intangible assets (other than purchased...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card relationships and servicing assets), credit... Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card...

12 CFR 167.12 - Purchased credit card relationships, servicing assets, intangible assets (other than purchased...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card relationships and servicing assets), credit... Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card...

12 CFR 167.12 - Purchased credit card relationships, servicing assets, intangible assets (other than purchased...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card relationships and servicing assets), credit... Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card...

A Curriculum for Purchasing.

ERIC Educational Resources Information Center

Pinkerton, Richard LaDoyt

The objective of this research was to identify the necessary educational organization required to form a curriculum plan for the field of purchasing and to investigate the nature of the industrial purchasing function. The dissertation delineates the critical areas of business operation: industrial purchasing, procurement, and material management.…

Seven PC Purchasing Pitfalls.

ERIC Educational Resources Information Center

Wodarz, Nan

1997-01-01

Explores how to avoid common pitfalls when schools purchase computer equipment. Purchasing tips are provided in the areas of choosing multiple platforms, buying the cheapest model available, choosing a proprietary design, falling for untested technology, purchasing systems that are not upgradable, ignoring extended warranties, and failing to plan…

Off-premise alcohol purchasing in Australia: Variations by age group, income level and annual amount purchased.

PubMed

Jiang, Heng; Callinan, Sarah; Livingston, Michael; Room, Robin

2017-03-01

To delineate what type and how much alcohol is purchased from different types of off-licence premises and how this varies across demographic sub-groups, as a basis for public debate and decisions on pricing and planning policies to reduce alcohol-related harm in Australia. The data on alcohol purchasing from off-licence premises are taken from the Australian Alcohol Consumption and Purchasing survey-a nationally representative landline and mobile telephone survey in 2013 on the experiences with alcohol consumption and purchasing of 2020 Australians aged 16+. The present analysis uses data from 1730 respondents who purchased alcohol from off-licence premises in the previous 6 months. The majority (54%) of alcohol purchased from off-licence premises was sold from liquor barns (large warehouse-style alcohol stores), with bottle shops (31%) the second most common outlet. Cask wine was the cheapest alcohol available at off-licence premises in Australia. Respondents in higher alcohol purchasing quintiles and with those with lower income purchased a higher percentage of cheaper alcohol in their total volume of purchasing than lower purchasing quintiles and those with middle and higher income, and younger respondents purchased more expensive alcohol than older age groups. A minimum unit price or increasing alcohol taxes may effectively reduce alcohol purchasing for lower income heavy alcohol purchasers and older age groups from off-licence premise sources, and may be less effective on younger age groups. [Jiang H, Callinan S, Livingston M, Room R. Off-premise alcohol purchasing in Australia: Variations by age group, income level and annual amount purchased. Drug Alcohol Rev 2017;36:210-219]. © 2016 Australasian Professional Society on Alcohol and other Drugs.

Barriers to Pharmacy-Based Syringe Purchase Among Injection Drug Users in Tijuana, Mexico: A Mixed Methods Study

PubMed Central

Lozada, Remedios; Gallardo, Manuel; Rosen, Perth; Vera, Alicia; Macias, Armando; Palinkas, Lawrence A.; Strathdee, Steffanie A.

2010-01-01

Injection drug users (IDUs) may be denied purchase of sterile syringes even where purchase without a prescription is legal. This study examined barriers to over-the-counter (OTC) syringe purchase among IDUs in Tijuana, Mexico. A quantitative survey and subsequent focus groups were used to quantify barriers to purchase, identify their correlates and provide in-depth exploration of syringe purchase experiences. Of 627 IDUs, 81% purchased a syringe in the past 6 months and 16% were refused or overcharged. Factors independently associated with refusal/overcharging were homelessness, receptive syringe sharing, >5 uses per syringe, and number of lifetime abscesses. Few pharmacies sold syringes to IDUs, who adapted by limiting purchase attempts to pharmacies known to sell syringes consistently. Failed purchases occurred when drug withdrawal required purchase at unusual times or locations, often following release from jail. IDUs reported syringe sharing, syringe reuse, and searching through unsecured medical waste for syringes in response to failed purchase attempts. Interventions to expand OTC syringe sales to IDUs, particularly near detention facilities, will facilitate safer injection practices. PMID:20300820

[Revelation of purchase system of developed nation to large medical equipment group purchase in our country].

PubMed

Tao, Lin; Guan, Bing; Liu, Shan

2011-01-01

There were some features of purchase system in developed nation, such as clear purchase objectives flexible methods, standard programming, emphasis on competition and open process. The measures suggested include playing the role of competition purchasing; establishing the e-business modern purchasing information system; establishing legislation system; and completing business purchasing.

Price and maternal obesity influence purchasing of low- and high-energy-dense foods.

PubMed

Epstein, Leonard H; Dearing, Kelly K; Paluch, Rocco A; Roemmich, James N; Cho, David

2007-10-01

Price can influence food purchases, which can influence consumption. Limited laboratory research has assessed the effect of price changes on food purchases, and no research on individual differences that may interact with price to influence purchases exists. We aimed to assess the influence of price changes of low-energy-density (LED) and high-energy-density (HED) foods on mother's food purchases in a laboratory food-purchasing analogue. Mothers were randomly assigned to price conditions in which the price of either LED or HED foods was manipulated from 75% to 125% of the reference purchase price, whereas the price of the alternative foods was kept at the reference value. Mothers completed purchases for 2 income levels ($15 or $30 per family member). Purchases were reduced when prices of LED (P < 0.01) and HED (P < 0.001) foods were increased. Maternal BMI interacted with price to influence purchases of HED foods when the price of HED foods increased (P = 0.016) and interacted with price to influence purchases of LED foods when the price of HED foods increased (P = 0.008). These results show the relevance of considering price change as a way to influence food purchases of LED compared with HED foods and the possibility that individual differences may influence the own-price elasticity of HED foods and substitution of LED for HED foods.

Surgical lights. Making a purchase decision.

PubMed

Gregory, M M

1987-11-01

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.

22 CFR 132.1 - Purchase.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Purchase. 132.1 Section 132.1 Foreign Relations DEPARTMENT OF STATE MISCELLANEOUS BOOKS, MAPS, NEWSPAPERS, ETC. § 132.1 Purchase. The purchase by the... determination has been made by the Secretary, as permitted by the provisions of the act, that such purchase is...

Predictability in Pathological Gambling? Applying the Duplication of Purchase Law to the Understanding of Cross-Purchases Between Regular and Pathological Gamblers.

PubMed

Lam, Desmond; Mizerski, Richard

2017-06-01

The objective of this study is to explore the gambling participations and game purchase duplication of light regular, heavy regular and pathological gamblers by applying the Duplication of Purchase Law. Current study uses data collected by the Australian Productivity Commission for eight different types of games. Key behavioral statistics on light regular, heavy regular, and pathological gamblers were computed and compared. The key finding is that pathological gambling, just like regular gambling, follows the Duplication of Purchase Law, which states that the dominant factor of purchase duplication between two brands is their market shares. This means that gambling between any two games at pathological level, like any regular consumer purchases, exhibits "law-like" regularity based on the pathological gamblers' participation rate of each game. Additionally, pathological gamblers tend to gamble more frequently across all games except lotteries and instant as well as make greater cross-purchases compared to heavy regular gamblers. A better understanding of the behavioral traits between regular (particularly heavy regular) and pathological gamblers can be useful to public policy makers and social marketers in order to more accurately identify such gamblers and better manage the negative impacts of gambling.

Ethical issues in purchasing: a field study of Midwest hospitals.

PubMed

Tomaszewski, K; Motwani, J

1995-01-01

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.

Emerging lessons from regional and state innovation in value-based payment reform: balancing collaboration and disruptive innovation.

PubMed

Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

2014-09-01

In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers

12 CFR 925.20 - Stock purchase.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Stock purchase. 925.20 Section 925.20 Banks and... BANKS Stock Requirements § 925.20 Stock purchase. (a) Minimum stock purchase. Each member shall purchase... outstanding advances. (b) Timing of minimum stock purchase. (1) Within 60 calendar days after an institution...

Assessment of perception and intention in pesticide purchase in Taiwan.

PubMed

Yeh, Jong Chao; Liao, Chih-Hsiang

2016-05-01

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.

78 FR 40953 - Loan Participations; Purchase, Sale and Pledge of Eligible Obligations; Purchase of Assets and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-09

...; Purchase, Sale and Pledge of Eligible Obligations; Purchase of Assets and Assumption of Liabilities...- day effective date, a final rule titled Loan Participations; Purchase, Sale and Pledge of Eligible Obligations; Purchase of Assets and Assumption of Liabilities, effective July 25, 2013. The Board extends the...

Using rewards-based incentives to increase purchase of fruit and vegetables in lower-income households: design and start-up of a randomized trial.

PubMed

Phipps, Etienne J; Wallace, Samantha L; Stites, Shana D; Uplinger, Nadine; Brook Singletary, S; Hunt, Lacy; Axelrod, Saul; Glanz, Karen; Braitman, Leonard E

2013-05-01

To report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households. A four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week. A large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA. Fifty-eight households, with at least one child living in the home. During the baseline period, households purchased an average of 3·7 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 1·9 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited. At baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations.

The Viability of Lease Purchases as a Means for Funding School Facilities.

ERIC Educational Resources Information Center

Bunch, Beverly S.; Smith, Tina

2002-01-01

Examines the use of the lease purchase of school facilities in Texas; provides background on the use of lease purchases by Texas school districts; describes factors influencing the use of lease purchases and superintendents' experiences based on survey responses from 50 school districts; recommends careful evaluation of advantages and…

Influence of neighbourhood purchasing power on breastfeeding at four months of age: a Swedish population-based cohort study.

PubMed

Almquist-Tangen, Gerd; Strömberg, Ulf; Holmén, Anders; Alm, Bernt; Roswall, Josefine; Bergman, Stefan; Dahlgren, Jovanna

2013-11-15

Parental socioeconomic status (SES) is an important determinant in child health, influencing beneficial factors such as breastfeeding. A better understanding of the influence of neighbourhood-level SES measures, relating to spatial determinants, might lead to targeted actions to promote breastfeeding during infancy. A cross-sectional study analysis the association between breastfeeding at four months of age and neighbourhood purchasing power, taking account of individual-level variables including maternal age, smoking and parental level of education. Data were obtained from a prospective population- based cohort study recruited from birth in 2007-2008 in the Halland region, southwestern Sweden. Questionnaire data on the individual-level variables and the outcome variable of breastfeeding at four months (yes/no) were used (n=2,407). Each mother was geo-coded with respect to her residential parish (there are 61 parishes in the region) and then stratified by parish-level household purchasing power. It emerged that four neighbourhood characteristics were reasonable to use, viz. <10%, 10-19%, 20-29% and ≥ 30% of the resident families with low purchasing power. The proportion of mothers not breastfeeding at four months of age showed a highly significant trend across the neighbourhood strata (p=0.00004): from 16.3% (< 10% with low purchasing power) to 29.4% (≥ 30% with low purchasing power), yielding an OR of 2.24 (95% confidence interval: 1.45-3.16). After adjusting for the individual-level variables, the corresponding OR=1.63 (1.07-2.56) was significant and the trend across the strata was still evident (p=0.05). A multi-level analysis estimated that, in the neighbourhoods with ≥ 30% of the families with low purchasing power, 20% more mothers than expected, taking account of the individual-level factors, reported no breastfeeding at four months of age (≥ 95% posterior probability of an elevated observed-to-expected ratio). The neighbourhood purchasing power

Influence of neighbourhood purchasing power on breastfeeding at four months of age: a Swedish population-based cohort study

PubMed Central

2013-01-01

Background Parental socioeconomic status (SES) is an important determinant in child health, influencing beneficial factors such as breastfeeding. A better understanding of the influence of neighbourhood-level SES measures, relating to spatial determinants, might lead to targeted actions to promote breastfeeding during infancy. Methods A cross-sectional study analysis the association between breastfeeding at four months of age and neighbourhood purchasing power, taking account of individual-level variables including maternal age, smoking and parental level of education. Data were obtained from a prospective population- based cohort study recruited from birth in 2007–2008 in the Halland region, southwestern Sweden. Questionnaire data on the individual-level variables and the outcome variable of breastfeeding at four months (yes/no) were used (n = 2 407). Each mother was geo-coded with respect to her residential parish (there are 61 parishes in the region) and then stratified by parish-level household purchasing power. It emerged that four neighbourhood characteristics were reasonable to use, viz. <10%, 10-19%, 20-29% and ≥ 30% of the resident families with low purchasing power. Results The proportion of mothers not breastfeeding at four months of age showed a highly significant trend across the neighbourhood strata (p = 0.00004): from 16.3% (< 10% with low purchasing power) to 29.4% (≥ 30% with low purchasing power), yielding an OR of 2.24 (95% confidence interval: 1.45-3.16). After adjusting for the individual-level variables, the corresponding OR = 1.63 (1.07-2.56) was significant and the trend across the strata was still evident (p = 0.05). A multi-level analysis estimated that, in the neighbourhoods with ≥ 30% of the families with low purchasing power, 20% more mothers than expected, taking account of the individual-level factors, reported no breastfeeding at four months of age (≥ 95% posterior probability of an elevated observed

Scaling-up strategic purchasing: analysis of health system governance imperatives for strategic purchasing in a free maternal and child healthcare programme in Enugu State, Nigeria.

PubMed

Ogbuabor, Daniel Chukwuemeka; Onwujekwe, Obinna Emmanuel

2018-04-05

Significant knowledge gaps exist in the functioning of institutional designs and organisational practices in purchasing within free healthcare schemes in low resource countries. The study provides evidence of the governance requirements to scale up strategic purchasing in free healthcare policies in Nigeria and other low-resource settings facing similar approaches. The study was conducted at the Ministry of Health and in two health districts in Enugu State, Nigeria, using a qualitative case study design. Semi-structured interviews were conducted with 44 key health system actors (16 policymakers, 16 providers and 12 health facility committee leaders) purposively selected from the Ministry of Health and the two health districts. Data collection and analysis were guided by Siddiqi and colleagues' health system governance framework. Data were analysed using a framework approach. The key findings show that supportive governance practices in purchasing included systems to verify questionable provider claims, pay providers directly for services, compel providers to procure drugs centrally and track transfer of funds to providers. However, strategic vision was undermined by institutional conflicts, absence of purchaser-provider split and lack of selective contracting of providers. Benefit design was not based on stakeholder involvement. Rule of law was limited by delays in provider payment. Benefits and obligations to users were not transparent. The criteria and procedure for resource allocation were unclear. Some target beneficiaries seemed excluded from the scheme. Effectiveness and efficiency was constrained by poor adherence to purchasing rules. Accountability of purchasers and providers to users was weak. Intelligence and information is constrained by paper-based system. Rationing of free services by providers and users' non-adherence to primary gate-keeping role hindered ethics. Weak governance of purchasing function limits potential of FMCHP to contribute towards

Activity space-based measures of the food environment and their relationships to food purchasing behaviours for young urban adults in Canada.

PubMed

Widener, Michael J; Minaker, Leia M; Reid, Jessica L; Patterson, Zachary; Ahmadi, Tara Kamal; Hammond, David

2018-03-16

To examine the potential links between activity spaces, the food retail environment and food shopping behaviours for the population of young, urban adults. Participants took part in the Canada Food Study, which collected information on demographics, food behaviour, diet and health, as well as an additional smartphone study that included a seven-day period of logging GPS (global positioning system) location and food purchases. Using a time-weighted, continuous representation of participant activity spaces generated from GPS trajectory data, the locations of food purchases and a geocoded food retail data set, negative binomial regression models were used to explore what types of food retailers participants were exposed to and where food purchases were made. Toronto, Montreal, Vancouver, Edmonton and Halifax, Canada. Young adults aged 16-30 years (n 496). These participants were a subset of the larger Canada Food Study. Demographics, household food shopper status and city of residence were significantly associated with different levels of exposure to various types of food retailers. Food shopping behaviours were also statistically significantly associated with demographics, the activity space-based food environment, self-reported health and city of residence. The study confirms that food behaviours are related to activity space-based food environment measures, which provide a more comprehensive accounting of food retail exposure than home-based measures. In addition, exposure to food retail and food purchasing behaviours of an understudied population are described.

30 CFR 1206.301 - Value basis for royalty computation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... royalty computation. (a) The gross value for royalty purposes shall be the sale or contract unit price...) That a contract of sale or other business arrangement between the lessee and a purchaser of some or all... because it is based in whole or in part upon considerations other than the value of the commodities, or (2...

Teaching Grocery Store Purchasing Skills to Students with Intellectual Disabilities Using a Computer-Based Instruction Program

ERIC Educational Resources Information Center

Hansen, David L.; Morgan, Robert L.

2008-01-01

This research evaluated effects of a multi-media computer-based instruction (CBI) program designed to teach grocery store purchasing skills to three high-school students with intellectual disabilities. A multiple baseline design across participants used measures of computer performance mastery and grocery store probes to evaluate the CBI. All…

Effects of a price increase on purchases of sugar sweetened beverages. Results from a randomized controlled trial.

PubMed

Waterlander, Wilma Elzeline; Ni Mhurchu, Cliona; Steenhuis, Ingrid H M

2014-07-01

Sugar sweetened beverage (SSB) taxes are receiving increased political interest. However, there have been no experimental studies of the effects of price increases on SSBs or the effects on close substitutes such as diet drinks, alcohol or sugary snacks. Therefore, the aim of this study was to examine the effects of a price increase on SSBs on beverage and snack purchases using a randomized controlled design within a three-dimensional web-based supermarket. The trial contained two conditions: experimental condition with a 19% tax on SSBs (to reflect an increase in Dutch value added tax from 6% to 19%); and a control condition with regular prices. N = 102 participants were randomized and purchased groceries on a single occasion at a three-dimensional Virtual Supermarket. Data were analysed using independent t-tests and regression analysis. Results showed that participants in the price increase condition purchased significantly less SSBs than the control group (B = -.90; 95% CI = -1.70 to -.10 L per household per week). There were no significant effects on purchases in other beverage or snack food categories. This means that the higher VAT rate was effective in reducing SSB purchases and had no negative side-effects. Copyright © 2014. Published by Elsevier Ltd.

The Value of Timber Inventory Information.

Treesearch

B.E. Borders; W.M. Harrison; M.L. Clutter; B.D. Shiver; R.A. Souter

2008-01-01

Timber inventory data is the basis for many monetary transactions related to timber and timberland sale and (or) purchase as well as for development of timber management plans. The value of such data is well known and much appreciated for sale and (or) purchase of standing merchantable timber.  Unfortunatley, the value of timber inventory data for planning...

10 CFR 603.700 - Standards for purchasing systems of for-profit firms.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Purchasing § 603.700 Standards for purchasing systems of for-profit firms. (a) If the TIA is an expenditure... instruments subject to the purchasing standards in 10 CFR 600.331 to use the same requirements for the TIA... documented in the award file). (b) Other for-profit participants under an expenditure-based TIA should be...

12 CFR 567.12 - Purchased credit card relationships, servicing assets, intangible assets (other than purchased...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 6 2013-01-01 2012-01-01 true Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card relationships and servicing assets), credit... credit card relationships, servicing assets, intangible assets (other than purchased credit card...

12 CFR 567.12 - Purchased credit card relationships, servicing assets, intangible assets (other than purchased...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 6 2012-01-01 2012-01-01 false Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card relationships and servicing assets), credit... credit card relationships, servicing assets, intangible assets (other than purchased credit card...

12 CFR 567.12 - Purchased credit card relationships, servicing assets, intangible assets (other than purchased...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 6 2014-01-01 2012-01-01 true Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card relationships and servicing assets), credit... credit card relationships, servicing assets, intangible assets (other than purchased credit card...

Monitoring changes in the nutritional content of ready-to-eat grain-based dessert products manufactured and purchased between 2005 and 2012.

PubMed

Mathias, Kevin C; Ng, Shu Wen; Popkin, Barry

2015-03-01

Monitoring changes in the nutritional content of food/beverage products and shifts in consumer purchasing behaviors is needed to measure the effectiveness of efforts by both food manufacturers and policy makers to improve dietary quality in the United States. To examine changes in the nutritional content (eg, energy, saturated fat, and sugar density) of ready-to-eat (RTE) grain-based dessert (GBD) products manufactured and purchased between 2005 and 2012. Nutrition Facts panel information from commercial databases was linked to RTE GBD products purchased by households (N=134,128) in the Nielsen Homescan longitudinal dataset 2005-2012. Linear regression models were used to examine changes in the energy, saturated fat, and sugar density of RTE GBD products manufactured in each year between 2005 and 2012. Random effects models controlling for demographics, household composition/size, and geographic location were used to examine changes in household purchases of RTE GBD products (in grams) and the average energy, saturated fat, and sugar density of RTE GBD products purchased. The saturated fat density (grams/100 g) of RTE GBD products increased significantly from 6.5±0.2 in 2005 to 7.3±0.2 and 7.9±0.2 for pre-existing and newly introduced products in 2012, respectively. Between 2005 and 2012, the energy density (kilocalories/100 g) of RTE GBD products purchased decreased significantly from 433±0.2 to 422±0.2, the saturated fat density (grams/100 g) of products purchased increased significantly from 6.3±0.01 to 6.6±0.01, the sugar density (grams/100 g) of products purchased decreased significantly from 32.4±0.03 to 31.3±0.02, and household purchases of RTE GBD products (in grams) decreased by 24.1%±0.4%. These results highlight an opportunity for both food manufacturers and public health officials to develop new strategies to shift consumer purchases toward products with lower energy, saturated fat, and sugar densities in addition to decreasing overall

Monitoring Changes in the Nutritional Content of Ready-To-Eat Grain-Based Dessert Products Manufactured and Purchased Between 2005 and 2012

PubMed Central

Mathias, Kevin C.; Wen, Shu; Popkin, Barry; Kenan, W.R.

2014-01-01

Background Monitoring changes in the nutritional content of food/beverage products and shifts in consumer purchasing behaviors is needed to measure the effectiveness of efforts by both food manufacturers and policy makers to improve dietary quality in the United States. Objective Examine changes in the nutritional content (e.g., energy, saturated fat, and sugar density) of Ready-To-Eat (RTE) Grain-Based Dessert (GBD) products manufactured and purchased between 2005 and 2012. Design Nutrition facts panel information from commercial databases was linked to RTE GBD products purchased by households (n=134,128) in the Nielsen Homescan longitudinal dataset 2005–2012. Statistical Analysis Linear regression models were utilized to examine changes in the energy, saturated fat, and sugar density of RTE GBD products manufactured in each year between 2005 and 2012. Random effects models controlling for demographics, household composition/size, and geographic location were utilized to examine changes in household purchases of RTE GBD products (grams) and the average energy, saturated fat, and sugar density of RTE GBD products purchased. Results The saturated fat density (g/100 g) of RTE GBD products increased significantly from 6.5 ± 0.2 in 2005 to 7.3 ± 0.2 and 7.9 ± 0.2 for pre-existing and newly introduced products in 2012, respectively. Between 2005 and 2012, the energy density (kcal/100 g) of RTE GBD products purchased decreased significantly from 433 ± 0.2 to 422 ± 0.2, the saturated fat density (g/100 g) of products purchased increased significantly from 6.3 ± 0.01 to 6.6 ± 0.01, the sugar density (g/100 g) of products purchased decreased significantly from 32.4 ± 0.03 to 31.3 ± 0.02, and household purchases of RTE GBD products (grams) decreased by 24.1 ± 0.4%. Conclusions These results highlight an opportunity for both food manufacturers and public health officials to develop new strategies to shift consumer purchases towards products with lower energy

Price and maternal obesity influence purchasing of low- and high-energy-dense foods2

PubMed Central

Epstein, Leonard H; Dearing, Kelly K; Paluch, Rocco A; Roemmich, James N; Cho, David

2007-01-01

Background Price can influence food purchases, which can influence consumption. Limited laboratory research has assessed the effect of price changes on food purchases, and no research on individual differences that may interact with price to influence purchases exists. Objective We aimed to assess the influence of price changes of low-energy-density (LED) and high-energy-density (HED) foods on mother’s food purchases in a laboratory food-purchasing analogue. Design Mothers were randomly assigned to price conditions in which the price of either LED or HED foods was manipulated from 75% to 125% of the reference purchase price, whereas the price of the alternative foods was kept at the reference value. Mothers completed purchases for 2 income levels ($15 or $30 per family member). Results Purchases were reduced when prices of LED (P < 0.01) and HED (P < 0.001) foods were increased. Maternal BMI interacted with price to influence purchases of HED foods when the price of HED foods increased (P = 0.016) and interacted with price to influence purchases of LED foods when the price of HED foods increased (P = 0.008). Conclusion These results show the relevance of considering price change as a way to influence food purchases of LED compared with HED foods and the possibility that individual differences may influence the own-price elasticity of HED foods and substitution of LED for HED foods. PMID:17921365

Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2016-11-03

This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).

Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2015-11-05

This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.

12 CFR 390.471 - Purchased credit card relationships, servicing assets, intangible assets (other than purchased...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 5 2013-01-01 2013-01-01 false Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card relationships and servicing assets), credit... THE OFFICE OF THRIFT SUPERVISION Capital § 390.471 Purchased credit card relationships, servicing...

12 CFR 390.471 - Purchased credit card relationships, servicing assets, intangible assets (other than purchased...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card relationships and servicing assets), credit... THE OFFICE OF THRIFT SUPERVISION Capital § 390.471 Purchased credit card relationships, servicing...

12 CFR 390.471 - Purchased credit card relationships, servicing assets, intangible assets (other than purchased...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Purchased credit card relationships, servicing assets, intangible assets (other than purchased credit card relationships and servicing assets), credit... THE OFFICE OF THRIFT SUPERVISION Capital § 390.471 Purchased credit card relationships, servicing...

Stakeholder challenges in purchasing medical devices for patient safety.

PubMed

Hinrichs, Saba; Dickerson, Terry; Clarkson, John

2013-03-01

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.

State and Local Government Purchasing.

ERIC Educational Resources Information Center

Council of State Governments, Lexington, KY.

This report concerns public purchasing at all levels of government and brings into focus the role of the purchasing official in government management. Covered in the report are essential elements of the purchasing process, including the assessment of needs; written specifications; advertising, evaluating, and awarding bids; and inspection and…

The Importance of Teaching Management's Role in Capital Equipment Purchases.

ERIC Educational Resources Information Center

Silbergleid, Michael Ian

This essay discusses broadcasting and telecommunication management curricula and makes an argument for including instruction in capital equipment purchases. The argument is based on recent changes in the role of the television station department managers who in economically competitive times are involved in decisions about equipment purchasing. In…

48 CFR 213.7002 - Purchase orders.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Purchase orders. 213.7002... Acquisition Procedures Under the 8(a) Program 213.7002 Purchase orders. The contracting officer need not obtain a contractor's written acceptance of a purchase order or modification of a purchase order for an...

43 CFR 30.271 - How must the tribe pay for the interests it purchases?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false How must the tribe pay for the interests it purchases? 30.271 Section 30.271 Public Lands: Interior Office of the Secretary of the Interior... the tribe pay for the interests it purchases? (a) A tribe must pay the full fair market value of the...

43 CFR 30.271 - How must the tribe pay for the interests it purchases?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false How must the tribe pay for the interests it purchases? 30.271 Section 30.271 Public Lands: Interior Office of the Secretary of the Interior... the tribe pay for the interests it purchases? (a) A tribe must pay the full fair market value of the...

Some "Thing" to Talk About? Differential Story Utility From Experiential and Material Purchases.

PubMed

Kumar, Amit; Gilovich, Thomas

2015-10-01

Psychological research has shown that experiential purchases (a hike in the woods, a trip to Rome) bring more happiness than material purchases (a designer shirt, a flat-screen television). The research presented in this article investigates one cause and consequence of this difference: People talk more about their experiences than their possessions and derive more value from doing so. A series of eight studies demonstrate that taking away the ability to talk about experiences (but not material goods) would diminish the enjoyment they bring; that people believe they derive more happiness from talking about experiential purchases; that when given a choice about which of their purchases to talk about, people are more likely to talk about experiential rather than material consumption; and that people report being more inclined to talk about their experiences than their material purchases and derive more hedonic benefits as a result--both in prospect and in retrospect. © 2015 by the Society for Personality and Social Psychology, Inc.

[Consumer's psychological processes of hoarding and avoidant purchasing after the Tohoku earthquake].

PubMed

Ohtomo, Shoji; Hirose, Yukio

2014-02-01

This study examined psychological processes of consumers that had determined hoarding and avoidant purchasing behaviors after the Tohoku earthquake within a dual-process model. The model hypothesized that both intentional motivation based on reflective decision and reactive motivation based on non-reflective decision predicted the behaviors. This study assumed that attitude, subjective norm and descriptive norm in relation to hoarding and avoidant purchasing were determinants of motivations. Residents in the Tokyo metropolitan area (n = 667) completed internet longitudinal surveys at three times (April, June, and November, 2011). The results indicated that intentional and reactive motivation determined avoidant purchasing behaviors in June; only intentional motivation determined the behaviors in November. Attitude was a main determinant of the motivations each time. Moreover, previous behaviors predicted future behaviors. In conclusion, purchasing behaviors were intentional rather than reactive behaviors. Furthermore, attitude and previous behaviors were important determinants in the dual-process model. Attitude and behaviors formed in April continued to strengthen the subsequent decisions of purchasing behavior.

Analysis of Cigarette Purchase Task Instrument Data with a Left-Censored Mixed Effects Model

PubMed Central

Liao, Wenjie; Luo, Xianghua; Le, Chap; Chu, Haitao; Epstein, Leonard H.; Yu, Jihnhee; Ahluwalia, Jasjit S.; Thomas, Janet L.

2015-01-01

The drug purchase task is a frequently used instrument for measuring the relative reinforcing efficacy (RRE) of a substance, a central concept in psychopharmacological research. While a purchase task instrument, such as the cigarette purchase task (CPT), provides a comprehensive and inexpensive way to assess various aspects of a drug’s RRE, the application of conventional statistical methods to data generated from such an instrument may not be adequate by simply ignoring or replacing the extra zeros or missing values in the data with arbitrary small consumption values, e.g. 0.001. We applied the left-censored mixed effects model to CPT data from a smoking cessation study of college students and demonstrated its superiority over the existing methods with simulation studies. Theoretical implications of the findings, limitations of the proposed method and future directions of research are also discussed. PMID:23356731

Analysis of cigarette purchase task instrument data with a left-censored mixed effects model.

PubMed

Liao, Wenjie; Luo, Xianghua; Le, Chap T; Chu, Haitao; Epstein, Leonard H; Yu, Jihnhee; Ahluwalia, Jasjit S; Thomas, Janet L

2013-04-01

The drug purchase task is a frequently used instrument for measuring the relative reinforcing efficacy (RRE) of a substance, a central concept in psychopharmacological research. Although a purchase task instrument, such as the cigarette purchase task (CPT), provides a comprehensive and inexpensive way to assess various aspects of a drug's RRE, the application of conventional statistical methods to data generated from such an instrument may not be adequate by simply ignoring or replacing the extra zeros or missing values in the data with arbitrary small consumption values, for example, 0.001. We applied the left-censored mixed effects model to CPT data from a smoking cessation study of college students and demonstrated its superiority over the existing methods with simulation studies. Theoretical implications of the findings, limitations of the proposed method, and future directions of research are also discussed.

31 CFR 315.11 - Excess purchases.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Excess purchases. 315.11 Section 315..., D, E, F, G, H, J, AND K, AND U.S. SAVINGS NOTES Limitations on Annual Purchases § 315.11 Excess purchases. The Commissioner of the Public Debt may permit excess purchases to stand in any particular case...

24 CFR 291.515 - Purchaser qualifications.

Code of Federal Regulations, 2010 CFR

2010-04-01

... in § 291.530) at the time he/she submits a bid to purchase a home through the program and at the time of closing on the purchase of the home; (b) The person must certify to his/her good faith intention... Next Door Sales Program § 291.515 Purchaser qualifications. To qualify to purchase a home through the...

Place over traits? Purchasing edibles from medical marijuana dispensaries in Los Angeles, CA.

PubMed

Kepple, Nancy Jo; Freisthler, Bridget

2017-10-01

To examine discrete purchasing behaviors of marijuana-infused edibles from medical marijuana dispensaries with the aim to identify potential venue- and individual-level targets for prevention. Two-stage, venue-based sampling approach was used to randomly select patrons exiting 16 medical marijuana dispensaries in Los Angeles, California during Spring 2013. Hierarchical generalized linear modeling was used to examine the likelihood of purchasing edibles among 524 patrons reporting a discrete purchase regressed on characteristics of the sampled dispensaries and their patrons. At a venue level, patrons were more likely to purchase edibles from dispensaries located within Census tracts with higher median incomes or in close proximity to a higher number of dispensaries. At an individual level, patrons who identified as Black or Hispanic were associated with a lower likelihood of purchasing edibles when compared to patrons who identified as other non-White, non-Hispanic race/ethnicity. Place-based policies focused on regulating edible sales through dispensaries may be fruitful in influencing access to edibles. Additionally, social marketing campaigns may benefit from targeting both locations where edible purchases are more likely and populations who are more likely to purchase edibles. Copyright © 2017 Elsevier Ltd. All rights reserved.

Beyond cost: 'responsible purchasing' of managed care by employers.

PubMed

Lo Sasso, A T; Perloff, L; Schield, J; Murphy, J J; Mortimer, J D; Budetti, P P

1999-01-01

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.

The effects of price and perceived quality on the behavioural economics of alcohol, amphetamine, cannabis, cocaine, and ecstasy purchases.

PubMed

Goudie, Andrew J; Sumnall, Harry R; Field, Matt; Clayton, Hannah; Cole, Jon C

2007-07-10

Behavioural economic models of substance use describe the relationship between changes in unit price and consumption. However, these models rarely take account of the perceived quality (i.e. potency) of controlled drugs. Therefore we investigated the effects of both price and quality on the decision to purchase controlled drugs by polysubstance misusers. Forty current polysubstance misusers (29 males, 11 females; mean age 23.8) were recruited into the study. Participants were asked to hypothetically purchase drugs from a price list of alcohol, amphetamine, cannabis, cocaine and ecstasy at different levels of quality and price (i.e. better quality drugs cost more money). The disposable income available for those purchases was systematically varied in order to determine the impact of income on the decision to purchase drugs. Demand for both normal and strong alcohol was income inelastic. Demand for both poor and average quality cannabis and ecstasy was income inelastic, but demand for good quality cannabis and ecstasy was income elastic. The demand for poor quality cocaine was income inelastic, with the demand for both average and good quality cocaine being income elastic. Participants reported too few purchases of amphetamine, which precluded behavioural economic analysis. These results suggest that, like other goods, controlled drugs are purchased based upon the consumer's interpretations of their relative value. Therefore, it is probable that the purchase and subsequent use of controlled drugs by polysubstance misusers will be heavily influenced by the economic environment.

A framework for understanding grocery purchasing in a low-income urban environment.

PubMed

Zachary, Drew A; Palmer, Anne M; Beckham, Sarah W; Surkan, Pamela J

2013-05-01

Research demonstrates that food desert environments limit low-income shoppers' ability to purchase healthy foods, thereby increasing their likelihood of diet-related illnesses. We sought to understand how individuals in an urban American food desert make grocery-purchasing decisions, and specifically why unhealthy purchases arise. Analysis is based on ethnographic data from participant observation, 37 in-depth interviews, and three focus groups with low-income, primarily African American shoppers with children. We found participants had detailed knowledge of and preference for healthy foods, but the obligation to consistently provide food for their families required them to apply specific decision criteria which, combined with structural qualities of the supermarket environment, increased unhealthy purchases and decreased healthy purchases. Applying situated cognition theory, we constructed an emic model explaining this widely shared grocery-purchasing decision process and its implications. This context-specific understanding of behavior suggests that multifaceted, system-level approaches to intervention are needed to increase healthy purchasing in food deserts.

"Whether something cool is good enough": The role of evidence, sales representatives and nurses' expertise in hospital purchasing decisions.

PubMed

Grundy, Quinn

2016-09-01

The emphasis on "value" within healthcare institutions has achieved unprecedented priority, particularly around the purchase of medical products and equipment. Health systems and institutions are implementing formal decision-making processes involving clinicians and supply chain professionals to rationalize purchasing and promote cost-effective investment. One particular form of this process is the "Value Analysis" process. Drawing from fieldwork (100 h), interviews (n = 51) and focus groups (n = 4) conducted from January 2012 to October 2014 at 4 acute care hospitals in the western United States, I analyze the ways that committee members constructed and evaluated a case for a product's value. Participants (n = 72) were a purposive sample including nurses, administrators, supply chain and industry professionals. Interpretive phenomenology served as the analytic approach to generating iterative themes. While trying to be evidence-based, Value Analysis committees lacked data related to a product's price or efficacy and relied heavily on local knowledge and expertise. Sales representatives were an integral part of the process, creating interest in the product and providing product information. As vehicles for cost-savings and quality improvement, purchasing committees need unique support that emphasizes local contexts and expertise, while maintaining rigor and minimizing bias. Drawing from participants' experiences, and principles of health technology assessment and economic evaluation, a guiding framework is proposed to support this decision-making. Copyright © 2016 Elsevier Ltd. All rights reserved.

Acceptance and purchase intent of US consumers for nonwheat rice butter cakes.

PubMed

Sae-Eaw, A; Chompreeda, P; Prinyawiwatkul, W; Haruthaithanasan, V; Suwonsichon, T; Saidu, J E; Xu, Z

2007-03-01

This study evaluated consumer acceptance and purchase intent of nonwheat butter cake formulations prepared with Thai jasmine rice flour. Three nonwheat rice butter cakes were prepared with varying amounts of powdered emulsifier (propylene glycol ester:diacetyl tartaric acid ester of monoglyceride, 8:2) at 0% (product A), 7.5% (product B), and 15% (product C) of the margarine content (15%) in the cake formulation. A commercial wheat-based butter cake served as the control. Consumers (n= 400) evaluated acceptability of 9 sensory attributes using a 9-point hedonic scale. Overall acceptance and purchase intent were determined with a binomial (yes/no) scale. At least 81% of consumers accepted products B and C, of which 42.1% and 47%, respectively, would purchase the products if commercially available. Product A was neither liked nor disliked with an overall liking score of 5.39. The butter cake products were differentiated by textural acceptability (overall texture, softness, and moistness) with a canonical correlation of 0.71 to 0.79. Overall liking and taste influenced overall acceptance and purchase intent. Odor influenced purchase intent (P= 0.0014), but not overall acceptance. The odds ratio of overall liking was 3.462 for purchase intent, indicating the probability of the product being purchased is 3.462 times higher (than not being purchased, P < 0.0001) with every 1-unit increase of the overall liking score. Based on the logit model, overall acceptance and purchase intent could be predicted with 89.3% and 83.3% accuracy, respectively. The study demonstrated feasibility of completely substituting wheat flour with Thai jasmine rice flour for production of butter cake products acceptable to American consumers.

A Community-Based Social Marketing Campaign at Pacific University Oregon: Recycling, Paper Reduction, and Environmentally Preferable Purchasing

ERIC Educational Resources Information Center

Cole, Elaine J.; Fieselman, Laura

2013-01-01

Purpose: The purpose of this paper is to design a community-based social marketing (CBSM) campaign to foster sustainable behavior change in paper reduction, commingled recycling, and purchasing environmentally preferred products (EPP) with faculty and staff at Pacific University Oregon. Design/methodology/approach: A CBSM campaign was developed…

Are users' most recent drug purchases representative?

PubMed

Bond, Brittany; Caulkins, Jonathan P; Scott, Nick; Kilmer, Beau; Dietze, Paul

2014-09-01

Various surveys now ask respondents to describe their most recent purchase of illicit drugs, as one mechanism through which market size can be estimated. This raises the question of whether issues surrounding the timing of survey administration might make a sample of most recent purchases differ from a random sample of all purchases. We investigate these issues through a series of questions which ask about the three most recent purchases, and about drug use. Data were drawn from 688 respondents in the Melbourne Injecting Drug User Cohort Study across the period 2008-2013 and 2782 respondents to the Washington Cannabis Consumption Study in 2013. Responses to questions about the most recent purchases were compared to larger subsets of all recent purchases. For heroin, methamphetamine and cannabis no differences were found between the amount spent by participants on their most recent purchase and the average amount spent on three or more recent purchases. There were also no differences concerning the locations and types of deals, and the duration between consecutive cannabis purchases was the same for first and second most recent, and second and third most recent. Asking about the most recent purchase appears to be an economical way to learn about purchases more generally, with little evidence of substantial variation between the most recent purchase and other recent purchases reported by participants. In spite of consistent findings across our two surveys, further replication of the work reported in this paper involving other populations of users is warranted. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Food and beverage purchases in corner stores, gas-marts, pharmacies and dollar stores.

PubMed

Caspi, Caitlin E; Lenk, Kathleen; Pelletier, Jennifer E; Barnes, Timothy L; Harnack, Lisa; Erickson, Darin J; Laska, Melissa N

2017-10-01

Little is known about customer purchases of foods and beverages from small and non-traditional food retailers (i.e. corner stores, gas-marts, dollar stores and pharmacies). The present study aimed to: (i) describe customer characteristics, shopping frequency and reasons for shopping at small and non-traditional food retailers; and (ii) describe food/beverage purchases and their nutritional quality, including differences across store type. Data were collected through customer intercept interviews. Nutritional quality of food/beverage purchases was analysed; a Healthy Eating Index-2010 (HEI-2010) score for purchases was created by aggregating participant purchases at each store. Small and non-traditional food stores that were not WIC-authorized in Minneapolis and St. Paul, MN, USA. Customers (n 661) from 105 food retailers. Among participants, 29 % shopped at the store at least once daily; an additional 44 % shopped there at least once weekly. Most participants (74 %) cited convenient location as the primary draw to the store. Customers purchased a median of 2262 kJ (540 kcal), which varied by store type (P=0·04). The amount of added sugar far surpassed national dietary recommendations. At dollar stores, participants purchased a median of 5302 kJ (1266 kcal) for a median value of $US 2·89. Sugar-sweetened beverages were the most common purchase. The mean HEI-2010 score across all stores was 36·4. Small and non-traditional food stores contribute to the urban food environment. Given the poor nutritional quality of purchases, findings support the need for interventions that address customer decision making in these stores.

Parental Characteristics and Reasons Associated With Purchasing Kids' Meals for Their Children.

PubMed

Lee-Kwan, Seung Hee; Park, Sohyun; Maynard, Leah M; Blanck, Heidi M; McGuire, Lisa C; Collins, Janet L

2018-02-01

Characteristics of parents who purchased kids' meals, reasons for the purchase, and desire for healthy options were examined. Quantitative, cross-sectional study. National. The SummerStyles survey data of 1147 parents (≥18 years). Self-reported outcome variables were purchase of kids' meals (yes/no), reasons for the purchase (13 choices), and desire for healthy options (yes/no). We used multivariable logistic regression to estimate odds ratios (ORs) for purchasing kids' meals based on parental sociodemographic and behavioral characteristics. Over half (51%) of parents reported purchasing kids' meals in the past month. The adjusted OR of purchasing kids' meals were significantly higher among younger parents (OR = 3.44 vs ≥50 years) and among parents who consumed sugar-sweetened beverages (SSBs) daily (OR = 2.70 vs none). No differences were found for race/ethnicity, income, and education. Parents who purchased kids' meals reported that the top 3 reasons for purchase were (1) because their children asked for kids' meals, (2) habit, and (3) offering of healthier sides such as fruits or fruit cups. Thirty-seven percent of parents who did not purchase kids' meals expressed willingness to purchase kids' meals if healthy options were available; this willingness was highest among younger parents (47%; P < .05). Kids' meal purchases were somewhat common. Our findings on characteristics of parents who frequently bought kids' meals (ie, younger parents and SSB consumers), common reasons for purchasing kids' meals, and willingness to buy healthier kids' meal can be used to inform intervention efforts to improve quality of kids' meals.

Employers flex their muscles as health care purchasers.

PubMed

Delbanco, Suzanne

2007-08-01

Engaged health care purchasers--both individual and group--can stimulate some good, healthy competition in the health care system, and competition needs to be based on results. To determine results, we need accepted measures of quality and efficiency that make sense. Then, performance on those measures must be disclosed publicly. Only when this information is available to consumers and other purchasers of health care will they be able to make informed choices and reward effective and efficient health care providers.

Direct purchase contracts carry risks, benefits.

PubMed

Fine, A

1991-05-01

To better control their purchasing of healthcare services, some employers are seeking direct managed care contracts with healthcare facilities. Along with evaluating potential markets introduced by a proposed contract, a provider should develop a pricing strategy, a monitoring system, and a process for internal audit before entering into a direct purchase contract. With the proper checks in place, direct purchase contracts can be mutually beneficial to providers and purchasers.

Consortium Purchases: Case Study for a Cost-Benefit Analysis.

ERIC Educational Resources Information Center

Scigliano, Marisa

2002-01-01

Discusses library cooperation and academic library consortia and presents a case study of a Canadian consortia that conducted a cost-benefit analysis for purchasing an electronic resource. Reports on member library subscription costs, external economic factors, value of patron time saved, costs and benefits for patrons, and net savings. (LRW)

Responsible Purchasing Network - Sustainable Purchasing Guidance Profile

EPA Pesticide Factsheets

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.

International Green Purchasing Network - Sustainable Purchasing Profile

EPA Pesticide Factsheets

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.

Social capital, political trust and purchase of illegal liquor: a population-based study in southern Sweden.

PubMed

Lindström, Martin

2008-05-01

To investigate the association between political trust in the Riksdag (the national parliament in Sweden) and having purchased illegal liquor during the past 12 months. The 2004 public health survey in Skåne is a cross-sectional postal questionnaire study answered by 27,757 respondents aged 18-80 with a 59% response rate. A logistic regression model was used to investigate the associations between political trust and having purchased illegal liquor during the past 12 months. Multivariate analyses of political trust and having purchased illegal liquor were performed in order to investigate the importance of possible confounders (including generalized/horizontal trust in other people). A 21.2% fraction of the men and 9.6% of the women had purchased illegal alcohol during the past 12 months. A total of 17.3% and 11.6% of the male and female respondents, respectively, reported that they had no trust at all in the national parliament, and another 38.2% and 36.2%, respectively, reported that their political trust was not particularly high. Respondents in younger age groups, with medium/low education, economic stress, low horizontal trust and not particularly high and no political trust at all and no opinion had significantly higher levels of having purchased illegal liquor. The significant odds ratios of having purchased illegal liquor in the not particularly high political trust and no political trust at all categories were somewhat reduced although still significant after multiple adjustments. The results suggest that political trust may have an independent effect on the propensity to purchase illegal liquor in Sweden.

[Factors related to purchasing over-the-counter medications online].

PubMed

Kishimoto, Keiko; Yoshida, Takeshi; Fukushima, Noriko

2009-09-01

We conducted a Web-based survey of approximately 40,000 Internet users on the purchase of over-the-counter (OTC) medications online in March 2009. The valid response rate was 97.8% and the number of responses was 39,208. The number of people who had purchased OTC medications online was 4,653 (11.9%), prescription medicines 792 (2.0%), and medical contact lenses 1,993 (5.1%). As a result of the multiple logistic regression analysis, independent variables with odds ratios (ORs) >1.5 were experience of purchasing prescription-only medicine online (OR=4.997, 95%CI=4.288-5.824), regular supplement use (OR=2.384, 95%CI=2.233-2.548), experience of purchasing colored contact lenses online (OR=2.206, 95%CI=1.632-2.983), no time to visit drugstores (OR=2.092, 95%CI=1.928-2.270), usage of Web sites of uncertain reliability (OR=1.992, 95%CI=1.857-2.137), and experience of purchasing therapeutic contact lenses online (OR=1.796, 95%CI=1.597-2.020). As some people have purchased prescription-only medicine or medical devices and had problems with drug information sources, the development of awareness of medical and pharmaceutical supplies and health and medical information literacy are key priorities to ensure safe OTC medication sales systems.

von Hippel–Lindau binding protein 1-mediated degradation of integrase affects HIV-1 gene expression at a postintegration step

PubMed Central

Mousnier, Aurélie; Kubat, Nicole; Massias-Simon, Aurélie; Ségéral, Emmanuel; Rain, Jean-Christophe; Benarous, Richard; Emiliani, Stéphane; Dargemont, Catherine

2007-01-01

HIV-1 integrase, the viral enzyme responsible for provirus integration into the host genome, can be actively degraded by the ubiquitin–proteasome pathway. Here, we identify von Hippel–Lindau binding protein 1(VBP1), a subunit of the prefoldin chaperone, as an integrase cellular binding protein that bridges interaction between integrase and the cullin2 (Cul2)-based von Hippel–Lindau (VHL) ubiquitin ligase. We demonstrate that VBP1 and Cul2/VHL are required for proper HIV-1 expression at a step between integrase-dependent proviral integration into the host genome and transcription of viral genes. Using both an siRNA approach and Cul2/VHL mutant cells, we show that VBP1 and the Cul2/VHL ligase cooperate in the efficient polyubiquitylation of integrase and its subsequent proteasome-mediated degradation. Results presented here support a role for integrase degradation by the prefoldin–VHL–proteasome pathway in the integration–transcription transition of the viral replication cycle. PMID:17698809

Factors Influencing the Food Purchases of Early Care and Education Providers.

PubMed

Otten, Jennifer J; Hirsch, Tad; Lim, Catherine

2017-05-01

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

Capturing the spectrum of household food and beverage purchasing behavior: a review.

PubMed

French, Simone A; Shimotsu, Scott T; Wall, Melanie; Gerlach, Anne Faricy

2008-12-01

The household setting may be the most important level at which to understand the food choices of individuals and how healthful food choices can be promoted. However, there are few available measures of the food purchase behaviors of households and little consensus on the best way to measure it. This review explores the currently available measures of household food purchasing behavior. Three main measures are described, evaluated, and compared: home food inventories, food and beverage purchase records and receipts, and Universal Product Code bar code scanning. The development of coding, aggregation, and analytical methods for these measures of household food purchasing behavior is described. Currently, annotated receipts and records are the most comprehensive, detailed measure of household food purchasing behavior, and are feasible for population-based samples. Universal Product Code scanning is not recommended due to its cost and complexity. Research directions to improve household food purchasing behavior measures are discussed.

Explaining Counterfeit Alcohol Purchases in Russia.

PubMed

Kotelnikova, Zoya

2017-04-01

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

Video-Based Grocery Shopping Intervention Effect on Purchasing Behaviors Among Latina Shoppers.

PubMed

Amaro, Hortensia; Cortés, Dharma E; Garcia, Samantha; Duan, Lei; Black, David S

2017-05-01

To compare changes in food-purchasing knowledge, self-efficacy, and behavior after viewing nutrition education videos among Los Angeles, California Latinas responsible for household grocery shopping. From February to May 2015, a convenience sample of 113 Latinas watched 1 video (El Carrito Saludable) featuring MyPlate guidelines applied to grocery shopping (1-video intervention) and another convenience sample of 105 Latinas watched 2 videos (El Carrito Saludable and Ser Consciente), the latter featuring mindfulness to support attention and overcome distractions while grocery shopping (2-video intervention). We administered questionnaires before and after intervention. A preselected sample in each intervention condition (n = 72) completed questionnaires at 2-months after intervention and provided grocery receipts (before and 2-months after intervention). Knowledge improved in both intervention groups (P < .001). The 2-video group improved more in self-efficacy and use of a shopping list (both P < .05) and purchased more healthy foods (d = 0.60; P < .05) at 2 months than did the 1-video group. Culturally tailored videos that model food-purchasing behavior and mindfulness show promise for improving the quality of foods that Latinas bring into the home.

Video-Based Grocery Shopping Intervention Effect on Purchasing Behaviors Among Latina Shoppers

PubMed Central

Cortés, Dharma E.; Garcia, Samantha; Duan, Lei; Black, David S.

2017-01-01

Objectives. To compare changes in food-purchasing knowledge, self-efficacy, and behavior after viewing nutrition education videos among Los Angeles, California Latinas responsible for household grocery shopping. Methods. From February to May 2015, a convenience sample of 113 Latinas watched 1 video (El Carrito Saludable) featuring MyPlate guidelines applied to grocery shopping (1-video intervention) and another convenience sample of 105 Latinas watched 2 videos (El Carrito Saludable and Ser Consciente), the latter featuring mindfulness to support attention and overcome distractions while grocery shopping (2-video intervention). We administered questionnaires before and after intervention. A preselected sample in each intervention condition (n = 72) completed questionnaires at 2-months after intervention and provided grocery receipts (before and 2-months after intervention). Results. Knowledge improved in both intervention groups (P < .001). The 2-video group improved more in self-efficacy and use of a shopping list (both P < .05) and purchased more healthy foods (d = 0.60; P < .05) at 2 months than did the 1-video group. Conclusions. Culturally tailored videos that model food-purchasing behavior and mindfulness show promise for improving the quality of foods that Latinas bring into the home. PMID:28323473

Influences of packaging attributes on consumer purchase decisions for fresh produce.

PubMed

Koutsimanis, Georgios; Getter, Kristin; Behe, Bridget; Harte, Janice; Almenar, Eva

2012-10-01

Packaging attributes are considered to have an influence on consumer purchase decisions for food and, as a consequence, also on its consumption. To improve the current minimal understanding of these influences for fresh produce, a survey instrument in the form of an online questionnaire has been developed and launched in the US. The first part of the questionnaire covers consumers' preferences for packaging convenience features, characteristics, materials, disposal method, and others for fresh produces in general, and the second focuses on attributes like price, container size, produce shelf life for a specific fresh produce, sweet cherries, to allow us to supply specific values for these factors to the participants. Cluster and conjoint analyses of responses from 292 participants reveal that specific packaging and produce attributes affect consumer purchase decisions of fresh produce in general and of sweet cherries in particular (P ≤ 0.05) and that some are population segment dependent (P ≤ 0.05). For produce packaging in general, 'extend the "best by" date' was ranked as the top convenience feature, the type of packaging material was considered to affect the food product quality (92.7%) and containers made from bio-based materials were highly appealing (3.52 out of 5.00). The most important attributes that affect the purchasing decisions of consumers regarding a specific fresh produce like sweet cherries are price (25%), shelf life (19%) and container size (17.2%). Copyright © 2012 Elsevier Ltd. All rights reserved.

Purchasing in a supply chain environment.

PubMed

Schorr, J E

2000-08-01

Why the interest in purchasing? In the typical company, material costs are 40% to 75% of the cost of goods sold, labor is 5% to 15%, and the balance is burden. The typical company has $4-$5 in purchased cost to $1 in labor. Most companies are implementing material requirements planning (MRP II) and enterprise resource planning systems to control the $1 in labor and have little expectation in the area of purchasing savings. Yet a dollar saved in purchasing goes directly to the bottom line. I ran a survey of 100 Class A users of MRP II; in all 100 of the companies, the biggest payback was in the area of purchasing.

48 CFR 813.202 - Purchase guidelines.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 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...

Emerging Lessons From Regional and State Innovation in Value-Based Payment Reform: Balancing Collaboration and Disruptive Innovation

PubMed Central

Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

2014-01-01

structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers’ limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. Conclusions From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected “honest broker” that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a “burning bridge” between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of “reformed” fee-for-service with bundled payments and global payments. PMID:25199900

ATTITUDES OF ORTHOPEDIC SPECIALISTS TOWARD EFFECTS OF MEDICAL DEVICE PURCHASING.

PubMed

Lingg, Myriam; Merida-Herrera, Everth; Wyss, Kaspar; Durán-Arenas, Luis

2017-01-01

The aim of this study was to assess viewpoints of end-users concerning the purchasing process of high-risk medical devices and to discuss the relevance of health technology assessments (HTAs) at the hospital level and other potential areas for improvement of purchasing processes. We used a cross-sectional study and assessed the attitudes and thoughts of orthopedic specialists. The study took place between June and October 2015 in Mexico. We collected data from 187 orthopedic surgeons. Involvement of orthopedic specialists in purchasing was reported by 86 percent. However, clinical practice was perceived as negatively influenced by purchasing outcomes by 92 percent. The problems were described as: material failure; effectiveness of medical devices; obsolete medical device technology; incomplete provision of implant / instrument sets; delayed provision of implants and instruments. To prevent sub-standard outcomes of purchasing decisions, this study and the current literature suggest that technologies should be assessed during the purchasing process, end-users should be adequately involved, and decisions should be based on multiple criteria including clinical impact in the short-term (e.g., primary stability of implant) and long-term (e.g., survival of implant). The focus on Mexico is particularly novel and provides insights into a health system where HTA is mainly present at the macro level and can be used for the listing of medical device technologies in the standard list. This study concludes that Mexican stakeholders of the purchasing process underestimate the contribution of HTAs at the level of purchasing decisions. HTA in Mexico has improved over the past years but still requires more advancement.

Occupational health purchasing behaviour by SMEs--a new theoretical model.

PubMed

Harrison, J; Woods, A; Dickson, K

2013-10-01

Factors influencing corporate decisions to purchase occupational health (OH) are unknown. To assist the marketing of OH services to small- and medium-sized enterprises (SMEs) by characterizing purchasing behaviour. We developed a 2×2 model, based on published studies, to describe OH purchasing behaviour by SMEs. We tested the model by analysis of responses to a cross-sectional market research survey carried out in November 2007. The companies surveyed were SMEs employing 30-250 employees, within the localities of five UK National Health Service OH services: West London, Buckinghamshire, Cambridge, Portsmouth and York. We chose a sample representative of all SMEs for each location. The survey explored knowledge of OH and the perceived importance of a variety of services. We obtained responses from 387 companies (19%); 81% indicated that they knew about OH and 24% had purchased OH services. OH was rated 'very important' by 35%, and 65% rated it as 'quite' or 'very important'. Sickness absence and its business impact were monitored by 89%. Enterprises claiming OH understanding were significantly more likely to purchase OH services (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.6-8.0). Companies employing fewer than 90 employees were significantly less likely to purchase such services than larger ones (OR 0.17, 95% CI 0.09-0.3). OH knowledge and company size are key determinants of SME purchasing behaviour. Our findings support our proposed theoretical model. However, more research could explore claimed knowledge of OH with respect to the proposed purchaser types and business benefits.

The impact of embarrassment on condom purchase behaviour.

PubMed

Dahl, D W; Gorn, G J; Weinberg, C B

1998-01-01

A survey on the impact of embarrassment on condom purchase behavior was conducted among 130 individuals. The survey sample (93 males, 37 females) were recruited at the University of British Columbia. The primary independent variable of interest was the embarrassment of the respondents when purchasing condoms. The background variables were also considered which included the assessments of sexual behavior, gender, age, and residency status. A 4-point scale was used to measure the intensity of embarrassment and a 5-category scale was used to determine the frequency of condom purchase. The results for purchase embarrassment indicate that 41% of females and 34% of males expressed no embarrassment when making a condom purchase. Gender, age, number of sexual partners in the past year, and residency status were not significantly correlated with purchase embarrassment. 62% of males vs. 40% of females purchased at least once every 6 months. In summary, young people feel embarrassed about purchasing condoms, thus affecting their purchase behavior. The people who reported being more embarrassed purchasing condoms did so less often and purchased fewer condoms per visit. Subjects also tended to purchase from vending machines when possible in lieu of from store clerks or pharmacists.

48 CFR 8.603 - Purchase priorities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Purchase priorities. 8.603... REQUIRED SOURCES OF SUPPLIES AND SERVICES Acquisition From Federal Prison Industries, Inc. 8.603 Purchase... shall purchase supplies and services in the following priorities: (a) Supplies. (1) Federal Prison...

48 CFR 8.706 - Purchase exceptions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Purchase exceptions. 8.706... Blind or Severely Disabled 8.706 Purchase exceptions. (a) Ordering offices may acquire supplies or... in a purchase exception granted by the designated central nonprofit agency. (b) The central nonprofit...

48 CFR 808.603 - Purchase priorities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Purchase priorities. 808... Industries, Inc. (FPI) 808.603 Purchase priorities. Contracting officers may purchase supplies and services... small businesses, in accordance with procedures set forth in subpart 819.70, without seeking a waiver...

41 CFR 51-5.4 - Purchase exceptions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Purchase exceptions. 51-5... Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 5-CONTRACTING REQUIREMENTS § 51-5.4 Purchase exceptions. (a) A central nonprofit agency will normally grant a purchase exception...

48 CFR 2913.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2010 CFR

2010-10-01

... purchase card. 2913.301 Section 2913.301 Federal Acquisition Regulations System DEPARTMENT OF LABOR... commercial purchase card. (a) The Government purchase card has far fewer requirements for documentation than other methods of purchasing. However, the same legal restrictions apply to credit card purchases that...

7 CFR 1780.62 - Utility purchase contracts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Utility purchase contracts. 1780.62 Section 1780.62..., Constructing and Inspections § 1780.62 Utility purchase contracts. Applicants proposing to purchase water or... may be requested. Form RD 442-30, “Water Purchase Contract,” may be used when appropriate. If the...

48 CFR 217.7003 - Purchase request.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Purchase request. 217.7003... Property 217.7003 Purchase request. Ensure that the requiring activity provides all of the following in support of the purchase request— (a) A certification that the property is eligible for exchange and...

48 CFR 408.706 - Purchase exemptions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Purchase exemptions. 408... People Who Are Blind or Severely Disabled 408.706 Purchase exemptions. Prior to applying to the Committee for a purchase exemption, the chief of the contracting office should provide advance notice to the...

42 CFR 441.482 - Permissible purchases.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Permissible purchases. 441.482 Section 441.482... Optional Self-Directed Personal Assistance Services Program § 441.482 Permissible purchases. (a... assistance. (b) The services, supports and items that are purchased with a service budget must be linked to...

48 CFR 13.202 - Purchase guidelines.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 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 METHODS AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Actions at or Below the Micro-Purchase Threshold 13.202 Purchase guidelines. (a)...

Value-based assessment of robotic pancreas and liver surgery

PubMed Central

Patti, James C.; Ore, Ana Sofia; Barrows, Courtney; Velanovich, Vic

2017-01-01

Current healthcare economic evaluations are based only on the perspective of a single stakeholder to the healthcare delivery process. A true value-based decision incorporates all of the outcomes that could be impacted by a single episode of surgical care. We define the value proposition for robotic surgery using a stakeholder model incorporating the interests of all groups participating in the provision of healthcare services: patients, surgeons, hospitals and payers. One of the developing and expanding fields that could benefit the most from a complete value-based analysis is robotic hepatopancreaticobiliary (HPB) surgery. While initial robot purchasing costs are high, the benefits over laparoscopic surgery are considerable. Performing a literature search we found a total of 18 economic evaluations for robotic HPB surgery. We found a lack of evaluations that were carried out from a perspective that incorporates all of the impacts of a single episode of surgical care and that included a comprehensive hospital cost assessment. For distal pancreatectomies, the two most thorough examinations came to conflicting results regarding total cost savings compared to laparoscopic approaches. The most thorough pancreaticoduodenectomy evaluation found non-significant savings for total hospital costs. Robotic hepatectomies showed no cost savings over laparoscopic and only modest savings over open techniques. Lastly, robotic cholecystectomies were found to be more expensive than the gold-standard laparoscopic approach. Existing cost accounting data associated with robotic HPB surgery is incomplete and unlikely to reflect the state of this field in the future. Current data combines the learning curves for new surgical procedures being undertaken by HPB surgeons with costs derived from a market dominated by a single supplier of robotic instruments. As a result, the value proposition for stakeholders in this process cannot be defined. In order to solve this problem, future studies

Value-based assessment of robotic pancreas and liver surgery.

PubMed

Patti, James C; Ore, Ana Sofia; Barrows, Courtney; Velanovich, Vic; Moser, A James

2017-08-01

Current healthcare economic evaluations are based only on the perspective of a single stakeholder to the healthcare delivery process. A true value-based decision incorporates all of the outcomes that could be impacted by a single episode of surgical care. We define the value proposition for robotic surgery using a stakeholder model incorporating the interests of all groups participating in the provision of healthcare services: patients, surgeons, hospitals and payers. One of the developing and expanding fields that could benefit the most from a complete value-based analysis is robotic hepatopancreaticobiliary (HPB) surgery. While initial robot purchasing costs are high, the benefits over laparoscopic surgery are considerable. Performing a literature search we found a total of 18 economic evaluations for robotic HPB surgery. We found a lack of evaluations that were carried out from a perspective that incorporates all of the impacts of a single episode of surgical care and that included a comprehensive hospital cost assessment. For distal pancreatectomies, the two most thorough examinations came to conflicting results regarding total cost savings compared to laparoscopic approaches. The most thorough pancreaticoduodenectomy evaluation found non-significant savings for total hospital costs. Robotic hepatectomies showed no cost savings over laparoscopic and only modest savings over open techniques. Lastly, robotic cholecystectomies were found to be more expensive than the gold-standard laparoscopic approach. Existing cost accounting data associated with robotic HPB surgery is incomplete and unlikely to reflect the state of this field in the future. Current data combines the learning curves for new surgical procedures being undertaken by HPB surgeons with costs derived from a market dominated by a single supplier of robotic instruments. As a result, the value proposition for stakeholders in this process cannot be defined. In order to solve this problem, future studies

7 CFR 17.3 - Purchase authorizations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Purchase authorizations. 17.3 Section 17.3 Agriculture... THE AGRICULTURAL TRADE DEVELOPMENT AND ASSISTANCE ACT OF 1954, AS AMENDED § 17.3 Purchase authorizations. (a) Issuance. After an agreement is signed, the GSM will issue a purchase authorization to the...

48 CFR 8.704 - Purchase priorities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Purchase priorities. 8.704... Blind or Severely Disabled 8.704 Purchase priorities. (a) The Javits-Wagner-O'Day Act requires the Government to purchase supplies or services on the Procurement List, at prices established by the Committee...

Country and regional variations in purchase prices for essential cancer medications.

PubMed

Cuomo, Raphael E; Seidman, Robert L; Mackey, Tim K

2017-08-24

Accessibility to essential cancer medications in low- and middle-income countries is threatened by insufficient availability and affordability. The objective of this study is to characterize variation in transactional prices for essential cancer medications across geographies, medication type, and time. Drug purchase prices for 19 national and international buyers (representing 29 total countries) between 2010 and 2014 were obtained from Management Sciences for Health. Median values for drug pricing were computed, to address outliers in the data. For comparing purchase prices across geographic units, medications, and over time; Mann-Whitney U tests were used to compare two groups, Kruskal Wallis H tests were used to compare more than two groups, and linear regression was used to compare across continuous independent variables. During the five-year data period examined, the median price paid for a package of essential cancer medication was $12.63. No significant differences in prices were found based on country-level wealth, country-level disease burden, drug formulation, or year when medication was purchased. Statistical tests found significant differences in prices paid across countries, regions, individual medications, and medication categories. Specifically, countries in the Africa region appeared to pay more for a package of essential cancer medication than countries in the Latin America region, and cancer medications tended to be more expensive than anti-infective medications and cardiovascular medications. Though preliminary, our study found evidence of variation in prices paid by health systems to acquire essential cancer medications. Primarily, variations in pricing based on geographic location and cancer medication type (including when comparing to essential medicines that treat cardiovascular and infectious diseases) indicate that these factors may impact availability, affordability and access to essential cancer drugs. These factors should be taken into

Online Sellers’ Website Quality Influencing Online Buyers’ Purchase Intention

NASA Astrophysics Data System (ADS)

Shea Lee, Tan; Ariff, Mohd Shoki Md; Zakuan, Norhayati; Sulaiman, Zuraidah; Zameri Mat Saman, Muhamad

2016-05-01

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.

Sex purchasing and associations with HIV/STI among a clinic-based sample of US men.

PubMed

Decker, Michele R; Raj, Anita; Gupta, Jhumka; Silverman, Jay G

2008-07-01

Despite high rates of human immunodeficiency virus/sexually transmitted infection (HIV/STI) among commercial sex workers and international concern that male clients may constitute a critical bridge population for HIV/STI transmission, little empirical data exist within the United States to characterize men who purchase sex or to assess their sexual risk and HIV/STI infection. The study involves the analysis of a community-based survey of men aged 18-35 years attending urban health centers (n=1515) to assess the prevalence of engagement in sex purchasing during the past year and to evaluate relations with self-reported HIV/STI diagnosis and symptoms across this same period. More than 1 in 12 (8.7%) men reported exchanging drugs, money, or a place to stay for sex with a female partner in the past year. Such behavior was associated with additional sexual risk taking and emerged as an independent predictor of self-reported HIV/STI diagnosis [adjusted odds ratio (ORadj)=2.99; 95% confidence interval (CI): 1.51 to 5.94] and STI symptoms (ORadj=2.57; 95% CI: 1.57 to 4.22) in the past year in analyses adjusted for alternate HIV/STI risk sources. Sex purchasing is a common form of HIV/STI risk among the population sampled. Men engaging in such behavior are more likely to be HIV/STI infected and, thus, represent a risk to the sexual health of both commercial and noncommercial sex partners. Further research is needed to inform interventions targeted toward male clients of prostituted women.

A conceptual schema for government purchasing arrangements for Australian alcohol and other drug treatment.

PubMed

Ritter, Alison; Hull, Philip; Berends, Lynda; Chalmers, Jenny; Lancaster, Kari

2016-09-01

The aim of this study was to establish a conceptual schema for government purchasing of alcohol and other drug treatment in Australia which could encompass the diversity and variety in purchasing arrangements, and facilitate better decision-maker by purchasers. There is a limited evidence base on purchasing arrangements in alcohol and drug treatment despite the clear impact of purchasing arrangements on both treatment processes and treatment outcomes. The relevant health and social welfare literature on purchasing arrangements was reviewed; data were collected from Australian purchasers and providers of treatment giving detailed descriptions of the array of purchasing arrangements. Combined analysis of the literature and the Australian purchasing data resulted in a draft schema which was then reviewed by an expert committee and subsequently finalised. The conceptual schema presented here was purpose-built for alcohol and other drug treatment, with its overlap between health and social welfare services. It has three dimensions: 1. The ways in which providers are chosen; 2. The ways in which services are paid for; and 3. How price is managed. Distinguishing between the methods for choosing providers (such as competitive or individually negotiated processes) from the way in which organisations are paid for their provision of treatment (such as via a block grant or payment for activity) provides conceptual clarity and enables closer analysis of each mechanism. Governments can improve health and wellbeing by making informed decisions about the way they purchase and fund alcohol and other drug treatment. Research comparing different purchasing arrangements can provide a vital evidence-base to inform funders; however a first step is to accurately and consistently categorise current approaches against a typology or conceptual schema. Copyright © 2016 Elsevier Ltd. All rights reserved.

39 CFR 601.104 - Postal purchasing authority.

Code of Federal Regulations, 2011 CFR

2011-07-01

...: INTELLECTUAL PROPERTY RIGHTS OTHER THAN PATENTS PURCHASING OF PROPERTY AND SERVICES § 601.104 Postal purchasing..., or terminating any contract regarding the acquisition of property, services, and related purchasing...

A Dynamic Panel Model of the Associations of Sweetened Beverage Purchases With Dietary Quality and Food-Purchasing Patterns

PubMed Central

Piernas, Carmen; Ng, Shu Wen; Mendez, Michelle A.; Gordon-Larsen, Penny; Popkin, Barry M.

2015-01-01

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

31 CFR 342.4 - Purchase-registration.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Purchase—registration. (a) Purchase. Savings notes, in combination with Series E bonds, could be purchased... Service. Payment for the notes could be made in the same manner as payment for Series E savings bonds. Issuing agents delivered the notes at the time of purchase, or by mail at the risk and expense of the...

Value-based medicine: evidence-based medicine and beyond.

PubMed

Brown, Gary C; Brown, Melissa M; Sharma, Sanjay

2003-09-01

Value-based medicine is the practice of medicine emphasizing the value received from an intervention. Value is measured by objectively quantifying: 1) the improvement in quality of life and/or 2) the improvement in length of life conferred by an intervention. Evidence-based medicine often measures the improvement gained in length of life, but generally ignores the importance of quality of life improvement or loss. Value-based medicine incorporates the best features of evidence-based medicine and takes evidence-based data to a higher level by incorporating the quality of life perceptions of patients with a disease in concerning the value of an intervention. Inherent in value-based medicine are the costs associated with an intervention. The resources expended for the value gained in value-based medicine is measured with cost-utility analysis in terms of the US dollars/QALY (money spent per quality-adjusted life-year gained). A review of the current status and the likely future of value-based medicine is addressed herein.

Calories from beverages purchased at 2 major coffee chains in New York City, 2007.

PubMed

Huang, Christina; Dumanovsky, Tamara; Silver, Lynn D; Nonas, Cathy; Bassett, Mary T

2009-10-01

Calorie intake from beverages has increased in the past decades, which most likely contributes to higher obesity rates. Although coffee chains have grown in popularity in recent years, few data examine the calorie contribution of these drinks. We examined afternoon beverage purchases in New York City at 2 major coffee chains and estimated the mean calorie content of these beverages. We collected purchase receipts and brief surveys from adult customers at 42 Starbucks and 73 Dunkin' Donuts stores during the spring of 2007. For each purchase, we obtained the calorie content from the company's Web site; these values were adjusted to account for self-reported customization of the drink. We included 1,127 beverage purchases at Starbucks and 1,830 at Dunkin' Donuts in our analyses. Brewed coffee or tea averaged 63 kcal, and blended coffee beverages averaged 239 kcal. Approximately two-thirds of purchases at Starbucks and one-fourth of purchases at Dunkin' Donuts were blended coffee beverages. Calories in blended coffee beverages are high; on average, customers bought 12% of a 2,000-kcal diet. Policy changes to provide for calorie posting at the point of purchase could increase customer awareness of the calories in these beverages; modifying standard formulations of blended coffee beverages, such as using low-fat milk or smaller serving sizes, would also reduce calorie content.

Purchasing for Food Service: Self-Instruction.

ERIC Educational Resources Information Center

Ross, Lynne Nannen

This book is designed to teach accounting procedures and product specifications that are needed by the competent purchaser in order to make optimum purchasing decisions basic to a successful food service operation. It may be used by any level of food service personnel that is involved with any phase of the purchasing process. Preferably, the book…

31 CFR 342.4 - Purchase-registration.

Code of Federal Regulations, 2013 CFR

2013-07-01

...—registration. (a) Purchase. Savings notes, in combination with Series E bonds, could be purchased from any... notes could be made in the same manner as payment for Series E savings bonds. Issuing agents delivered the notes at the time of purchase, or by mail at the risk and expense of the United States, but only...

31 CFR 342.4 - Purchase-registration.

Code of Federal Regulations, 2010 CFR

2010-07-01

...—registration. (a) Purchase. Savings notes, in combination with Series E bonds, could be purchased from any... notes could be made in the same manner as payment for Series E savings bonds. Issuing agents delivered the notes at the time of purchase, or by mail at the risk and expense of the United States, but only...

31 CFR 342.4 - Purchase-registration.

Code of Federal Regulations, 2011 CFR

2011-07-01

...—registration. (a) Purchase. Savings notes, in combination with Series E bonds, could be purchased from any... notes could be made in the same manner as payment for Series E savings bonds. Issuing agents delivered the notes at the time of purchase, or by mail at the risk and expense of the United States, but only...

31 CFR 342.4 - Purchase-registration.

Code of Federal Regulations, 2012 CFR

2012-07-01

...—registration. (a) Purchase. Savings notes, in combination with Series E bonds, could be purchased from any... notes could be made in the same manner as payment for Series E savings bonds. Issuing agents delivered the notes at the time of purchase, or by mail at the risk and expense of the United States, but only...

48 CFR 970.4402 - Contractor purchasing system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 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. ...

Purchase rates and energy content of nutritionally promoted and traditional fast foods purchased at lunchtime in Australia - a pilot study.

PubMed

Atkinson, Louise F; Palmer, Michelle A

2012-03-01

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.

Influence of information about specific absorption rate (SAR) upon customers' purchase decisions and safety evaluation of mobile phones.

PubMed

Wiedemann, Peter M; Schütz, Holger; Clauberg, Martin

2008-02-01

This study investigated whether the SAR value is a purchase-relevant characteristic of mobile phones for laypersons and what effect the disclosure of a precautionary SAR value has on laypersons' risk perception. The study consisted of two parts: Study part 1 used a conjoint analysis design to explore the relevance of the SAR value and other features of mobile phones for an intended buying decision. Study part 2 used an experimental, repeated measures design to examine the effect of the magnitude of SAR values and the disclosure of a precautionary SAR value on risk perception. In addition, the study included an analysis of prior concerns of the study participants with regard to mobile phone risks. Part 1 indicates that the SAR value has a high relevance for laypersons' purchase intentions. In the experimental purchase setting it ranks even before price and equipment features. The results of study part 2 show that providing information of a precautionary limit value does not influence risk perception. This result suggests that laypersons' underlying subjective "safety model" for mobile phones resembles more a "margin of safety" concept than a threshold concept. The latter observation holds true no matter how concerned the participants are. (c) 2007 Wiley-Liss, Inc.

Life cycle impact assessment weights to support environmentally preferable purchasing in the United States.

PubMed

Gloria, Thomas P; Lippiatt, Barbara C; Cooper, Jennifer

2007-11-01

LCA is a quantitative method for understanding the environmental impacts of a product, yet all product purchasing decisions are ultimately subjective. Weights are the nexus between the quantitative results of LCA and the values-based, subjective choices of decision makers. In May 2007, NIST introduced a new optional weight set in Version 4.0 of the BEES software. Three key points about this new optional weight set are the basis for discussion in this paper: The new weight set was created specifically in the context of BEES. It is intended to support a practical method to assist environmentally preferable purchasing in the United States based on LCIA results. This is in contrast to the weight sets currently in BEES, which are based on generalist perspectives. The new weight set was created by a multi-stakeholder panel via the AHP method, and is a synthesis of panelists' perspectives on the relative importance of each environmental impact category in BEES. The weight set draws on each panelist's personal and professional understanding of, and value attributed to, each impact category. While the synthesized weight set may not equally satisfy each panelist's view of impact importance, it does reflect contemporary values in applying LCAto real world decisions, and represents one approach others can learn from in producing weight sets. The new weight set offers BEES users an additional option for synthesizing and comparing the environmental performance of building products and making purchasing decisions. In so doing, it strengthens the decision-making process, which is important when making product comparisons in the public domain. The Weight Set: Across all panelists and with explicit consideration of all time horizons, anthropogenic contributions to global warming, weighted at 29%, was judged most important, yet not so important that decisions can be made solely on the basis of this impact. A strong tail of other concerns include fossil fuel depletion (10%), criteria

Guide to Purchasing Green Power

EPA Pesticide Factsheets

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

A Point-of-Purchase Intervention Featuring In-Person Supermarket Education Affects Healthful Food Purchases

ERIC Educational Resources Information Center

Milliron, Brandy-Joe; Woolf, Kathleen; Appelhans, Bradley M.

2012-01-01

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…

Heroin purchasing is income and price sensitive.

PubMed

Roddy, Juliette; Steinmiller, Caren L; Greenwald, Mark K

2011-06-01

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 < .005) decrease heroin daily 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).

Strategic Purchasing in Practice: Comparing Ten European Countries.

PubMed

Klasa, Katarzyna; Greer, Scott L; van Ginneken, Ewout

2018-02-05

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.

48 CFR 2913.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2013 CFR

2013-10-01

... other methods of purchasing. However, the same legal restrictions apply to credit card purchases that.../Agency Purchase/Credit Card Program procedures. A number of the more common restrictions which... purchase card. 2913.301 Section 2913.301 Federal Acquisition Regulations System DEPARTMENT OF LABOR...

48 CFR 2913.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2014 CFR

2014-10-01

... other methods of purchasing. However, the same legal restrictions apply to credit card purchases that.../Agency Purchase/Credit Card Program procedures. A number of the more common restrictions which... purchase card. 2913.301 Section 2913.301 Federal Acquisition Regulations System DEPARTMENT OF LABOR...

48 CFR 2913.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2011 CFR

2011-10-01

... other methods of purchasing. However, the same legal restrictions apply to credit card purchases that.../Agency Purchase/Credit Card Program procedures. A number of the more common restrictions which... purchase card. 2913.301 Section 2913.301 Federal Acquisition Regulations System DEPARTMENT OF LABOR...

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... security. (2) The aggregate par value of securities treated as investment securities under paragraph (i)(1... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... security. (2) The aggregate par value of securities treated as investment securities under paragraph (i)(1... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

Increase the Government Purchase Card Limit

DTIC Science & Technology

2014-06-01

Acquisition BPA blanket purchase agreement CCPMD Consolidated Card Program Management Division COTS commercial, off-the-shelf CPI consumer price index...purchase agreements ( BPA ) or indefinite delivery/indefinite quantity (ID/IQ) contracts for repetitive orders. This authority is discussed further in...where they can purchase up to $150,000 in supplies from established mandatory sources and BPAs , for example. (3) Fewer commands have “ordering 2

Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing.

PubMed

Tangcharoensathien, Viroj; Limwattananon, Supon; Patcharanarumol, Walaiporn; Thammatacharee, Jadej; Jongudomsuk, Pongpisut; Sirilak, Supakit

2015-11-01

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser-provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite

A dynamic panel model of the associations of sweetened beverage purchases with dietary quality and food-purchasing patterns.

PubMed

Piernas, Carmen; Ng, Shu Wen; Mendez, Michelle A; Gordon-Larsen, Penny; Popkin, Barry M

2015-05-01

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: journals.permissions@oup.com.

48 CFR 1313.303-5 - Purchases under BPAs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Purchases under BPAs. 1313... Purchases under BPAs. (a) Individual purchases shall not exceed the simplified acquisition threshold, subject to the following: (1) The limitations for individual purchases against BPAs established against...

Reducing uninsurance through the nongroup market: health insurance credits and purchasing groups.

PubMed

McClellan, Mark; Baicker, Katherine

2002-01-01

The president's proposal to introduce tax credits for the purchase of health insurance will enable millions of Americans to purchase private health insurance, improving the functioning of private markets, empowering patients to make informed decisions, and increasing the use of high-value health care. Evidence points to the availability of comprehensive individual insurance for the young and the old, the sick and the healthy. There are a number of policies that would increase access to the nongroup market, none of which would adversely affect group markets. These policies together will ensure that all Americans have good, affordable health insurance choices available to them.

Helping E-Commerce Consumers Make Good Purchase Decisions: A User Reviews-Based Approach

NASA Astrophysics Data System (ADS)

Zhang, Richong; Tran, Thomas T.

Online product reviews provided by the consumers, who have previously purchased and used some particular products, form a rich source of information for other consumers who would like to study about these products in order to make their purchase decisions. Realizing this great need of consumers, several e-commerce web sites such as Amazon.com offer facilities for consumers to review products and exchange their purchase opinions. Unfortunately, reading through the massive amounts of product reviews available online from many e-communities, forums and newsgroups is not only a tedious task but also an impossible one. Indeed, nowadays consumers need an effective and reliable method to search through those huge sources of information and sort out the most appropriate and helpful product reviews. This paper proposes a model to discover the helpfulness of online product reviews. Product reviews can be analyzed and ranked by our scoring system and those reviews that may help consumers better than others will be found. In addition, we compare our model with a number of machine learning techniques. Our experimental results confirm that our approach is effective in ranking and classifying online product reviews.

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the obligor will be able to satisfy its obligations under that security. (2) The aggregate par value... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the obligor will be able to satisfy its obligations under that security. (2) The aggregate par value... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

Using Research Case Studies in eCommerce Marketing Courses: Customer Satisfaction at Point-of-Purchase and Post-Purchase

ERIC Educational Resources Information Center

Nawi, Noorshella Che; Fong, Michelle; Tatnall, Arthur

2014-01-01

This paper describes a research case study of Internet apparel marketing by small businesses in Malaysia which can beneficially be included in postgraduate business courses for understanding the importance of measuring customer satisfaction at point-of-purchase and post-purchase in online purchases. The sample size in this research is 154…

The value prescription: relative value theorem as a call to action.

PubMed

Alston, Greg L; Blizzard, Joseph C

2012-01-01

The Joint Commission of Pharmacy Practitioners Future Vision of Pharmacy Practice 2015 (2005) and Project Destiny (2008) clearly defined a vision for transforming community practice pharmacy from a culture of dispensing drugs to the provision of services. Several viable service offerings were identified. Pharmacy has not yet fully capitalized on these opportunities. Pharmacy must demonstrate value in providing these services to remain viable in the marketplace. Many pharmacists do not understand how value is created and lack sufficient marketing skills to position their practice for long-term success. The relative value theorem (RVT) describes in simple terms the key elements that drive purchase decisions and thus marketing decisions: (P+S)×PV=RV (P, price; S, service; PV, perceived value; RV, relative value). A consumer compares the P, extra S, and PV of the purchase against all potential uses of their scarce resources before deciding what to buy. Evidence suggests that understanding and applying the principles of RVT is a critical skill for pharmacy professionals in all practice settings to master if they plan to remain viable players in the health care marketplace of the future. Copyright © 2012 Elsevier Inc. All rights reserved.

13 CFR 120.641 - Disclosure to purchasers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 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...

7 CFR 1730.64 - Power purchase agreements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Power purchase agreements. 1730.64 Section 1730.64 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF... Power purchase agreements. Nothing in this subpart requires the borrower to enter into purchase power...

Great Balls of Fire: A probabilistic approach to quantify the hazard related to ballistics - A case study at La Fossa volcano, Vulcano Island, Italy

NASA Astrophysics Data System (ADS)

Biass, Sébastien; Falcone, Jean-Luc; Bonadonna, Costanza; Di Traglia, Federico; Pistolesi, Marco; Rosi, Mauro; Lestuzzi, Pierino

2016-10-01

We present a probabilistic approach to quantify the hazard posed by volcanic ballistic projectiles (VBP) and their potential impact on the built environment. A model named Great Balls of Fire (GBF) is introduced to describe ballistic trajectories of VBPs accounting for a variable drag coefficient and topography. It relies on input parameters easily identifiable in the field and is designed to model large numbers of VBPs stochastically. Associated functions come with the GBF code to post-process model outputs into a comprehensive probabilistic hazard assessment for VBP impacts. Outcomes include probability maps to exceed given thresholds of kinetic energies at impact, hazard curves and probabilistic isoenergy maps. Probabilities are calculated either on equally-sized pixels or zones of interest. The approach is calibrated, validated and applied to La Fossa volcano, Vulcano Island (Italy). We constructed a generic eruption scenario based on stratigraphic studies and numerical inversions of the 1888-1890 long-lasting Vulcanian cycle of La Fossa. Results suggest a ~ 10- 2% probability of occurrence of VBP impacts with kinetic energies ≤ 104 J at the touristic locality of Porto. In parallel, the vulnerability to roof perforation was estimated by combining field observations and published literature, allowing for a first estimate of the potential impact of VBPs during future Vulcanian eruptions. Results indicate a high physical vulnerability to the VBP hazard, and, consequently, half of the building stock having a ≥ 2.5 × 10- 3% probability of roof perforation.

Who purchases nonprescription syringes? Characterizing customers of the Expanded Syringe Access Program (ESAP).

PubMed

Battles, Haven B; Rowe, Kirsten A; Ortega-Peluso, Christina; Klein, Susan J; Tesoriero, James M

2009-11-01

This study represents the first attempt in the USA to survey pharmacy nonprescription syringe customers at their point of purchase. We surveyed 62 individuals purchasing nonprescription syringes in seven pharmacies located in NYC and Albany, NY, USA. Three quarters of respondents purchased for illicit use, and 36% purchased for medical use, with differences found by race and gender. Half got their syringes from pharmacies "most of the time." Half had ever been refused a syringe purchase in a NYS pharmacy, with men, Blacks, and Hispanics reporting higher levels of refusals than women or whites. Two thirds reported syringe reuse but very few reported sharing. While approximately one quarter safely obtained and disposed of syringes "most of the time," two thirds used both safe and unsafe methods. Pharmacy-based syringe access programs are essential in areas not served by syringe exchanges.

THE ROLE OF CONSUMER VALUES AND SOCIO-DEMOGRAPHICS IN GREEN PRODUCT SATISFACTION: THE CASE OF HYBRID CARS.

PubMed

Hur, Won-Moo; Woo, Jeong; Kim, Yeonshin

2015-10-01

This study investigated the relationship between consumer value and customer satisfaction, seeking a better understanding of the motivations underlying "green product" purchases. Based on the influence of demographic factors, it further explores the moderation effects of buyers' socio-demographics on the link between value and satisfaction. Data were collected through a mail survey of American hybrid car buyers. Consumer value, satisfaction, and socio-demographic information were measured, and the proposed relationships among them were tested using hierarchical multiple regression analysis. This study's findings reveal that values (i.e., functional and social) significantly impact hybrid satisfaction and that the effects vary by sex and age. This research provides insight into the motivations of green product purchases by incorporating important consumer characteristics.

12 CFR 7.1020 - Purchase of open accounts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Purchase of open accounts. 7.1020 Section 7... OPERATIONS Bank Powers § 7.1020 Purchase of open accounts. (a) General. The purchase of open accounts is a... national bank may purchase open accounts in connection with export transactions; the accounts should be...

12 CFR 7.1020 - Purchase of open accounts.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Purchase of open accounts. 7.1020 Section 7... OPERATIONS Bank Powers § 7.1020 Purchase of open accounts. (a) General. The purchase of open accounts is a... national bank may purchase open accounts in connection with export transactions; the accounts should be...

12 CFR 7.1020 - Purchase of open accounts.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Purchase of open accounts. 7.1020 Section 7... OPERATIONS Bank Powers § 7.1020 Purchase of open accounts. (a) General. The purchase of open accounts is a... national bank may purchase open accounts in connection with export transactions; the accounts should be...

12 CFR 7.1020 - Purchase of open accounts.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Purchase of open accounts. 7.1020 Section 7... OPERATIONS Bank Powers § 7.1020 Purchase of open accounts. (a) General. The purchase of open accounts is a... national bank may purchase open accounts in connection with export transactions; the accounts should be...

12 CFR 7.1020 - Purchase of open accounts.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Purchase of open accounts. 7.1020 Section 7... OPERATIONS Bank Powers § 7.1020 Purchase of open accounts. (a) General. The purchase of open accounts is a... national bank may purchase open accounts in connection with export transactions; the accounts should be...

Portfolio Purchasing Decision for Mobile Power Equipment of B2C E-Commerce Export Retailer Based on CVaR

NASA Astrophysics Data System (ADS)

Yanchun, Wan; Qiucen, Chen

2017-11-01

Purchasing is an important part of export e-commerce of B2C, which plays an important role on risk and cost control in supply management. From the perspective of risk control, the paper construct a CVaR model for portfolio purchase. We select a heavy sales mobile power equipment from a typical B2C e-commerce export retailer as study sample. This study optimizes the purchasing strategy of this type of mobile power equipment. The research has some reference for similar enterprises in purchasing portfolio decision.

Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2017-11-07

This final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year (CY) 2012 and CY 2014; and discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017. In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.

Purchaser-provider: the international dimension.

PubMed

Mason, A; Morgan, K

1995-01-28

Purchaser-provider systems in health care are being implemented in several countries and are under consideration in many more. These new arrangements are described for the United Kingdom, Finland, New Zealand, and Australia, and in each case responsibility for funding, purchasing, providing, and ownership is identified. The four systems, along with managed care organisations in the United States, are also compared with regard to several important features. There is a fundamental similarity between these purchaser-provider arrangements but several key differences are well worth systematic study. This is a major challenge for academic bodies in Britain and other countries, and the opportunity to learn from each other should not be missed.

31 CFR 332.6 - Purchase of bonds.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Purchase of bonds. 332.6 Section 332....6 Purchase of bonds. (a) Issuing agents. Only Federal Reserve Banks and Branches, as fiscal agents.... However, financial institutions were permitted to forward applications for purchase of the bonds to the...

19 CFR 148.112 - Evidence of purchase.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Evidence of purchase. 148.112 Section 148.112 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE... Evidence of purchase. A sales slip, invoice, or other evidence of purchase, shall be presented with the...

Guide to Effective Purchasing. Operational Management Programme.

ERIC Educational Resources Information Center

Frediani, Pam

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,…

31 CFR 346.4 - Proof of purchase.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Proof of purchase. 346.4 Section 346.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... agent will furnish therewith to the purchaser a copy of Form PD 4345 for the purchaser's personal...

31 CFR 346.4 - Proof of purchase.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Proof of purchase. 346.4 Section 346.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... agent will furnish therewith to the purchaser a copy of Form PD 4345 for the purchaser's personal...

31 CFR 346.4 - Proof of purchase.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Proof of purchase. 346.4 Section 346.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... agent will furnish therewith to the purchaser a copy of Form PD 4345 for the purchaser's personal...

31 CFR 346.4 - Proof of purchase.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Proof of purchase. 346.4 Section 346.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... agent will furnish therewith to the purchaser a copy of Form PD 4345 for the purchaser's personal...

The criminal purchase of firearm ammunition.

PubMed

Tita, G E; Braga, A A; Ridgeway, G; Pierce, G L

2006-10-01

Laws that prohibit certain individuals from owning firearms also pertain to ammunition. Whereas retail sales of firearms to criminals are regularly disrupted by instant background checks, sales of ammunition are essentially unchecked and the rate at which criminals acquire ammunition is unknown. This research describes the ammunition market and estimates the rate at which criminals are acquiring ammunition. Criminal background checks conducted on individuals purchasing ammunition in the City of Los Angeles in April and May 2004. Los Angeles, CA, USA. Ammunition purchasers. Criminal activity that prohibits one from owning, purchasing, or possessing ammunition. 2.6% (95% CI 1.9% to 3.2%) of ammunition purchasers had a prior felony conviction or another condition that prohibited them from possessing ammunition. During the study period prohibited possessors purchased 10,050 rounds of ammunition in Los Angeles. These estimates suggest that monitoring ammunition transactions may help reduce the supply of ammunition to criminals and the frequency of injuries from felonious gun assaults. Such a record can also provide information for generating leads on illegal firearm possession.

Value-based genomics.

PubMed

Gong, Jun; Pan, Kathy; Fakih, Marwan; Pal, Sumanta; Salgia, Ravi

2018-03-20

Advancements in next-generation sequencing have greatly enhanced the development of biomarker-driven cancer therapies. The affordability and availability of next-generation sequencers have allowed for the commercialization of next-generation sequencing platforms that have found widespread use for clinical-decision making and research purposes. Despite the greater availability of tumor molecular profiling by next-generation sequencing at our doorsteps, the achievement of value-based care, or improving patient outcomes while reducing overall costs or risks, in the era of precision oncology remains a looming challenge. In this review, we highlight available data through a pre-established and conceptualized framework for evaluating value-based medicine to assess the cost (efficiency), clinical benefit (effectiveness), and toxicity (safety) of genomic profiling in cancer care. We also provide perspectives on future directions of next-generation sequencing from targeted panels to whole-exome or whole-genome sequencing and describe potential strategies needed to attain value-based genomics.

Value-based genomics

PubMed Central

Gong, Jun; Pan, Kathy; Fakih, Marwan; Pal, Sumanta; Salgia, Ravi

2018-01-01

Advancements in next-generation sequencing have greatly enhanced the development of biomarker-driven cancer therapies. The affordability and availability of next-generation sequencers have allowed for the commercialization of next-generation sequencing platforms that have found widespread use for clinical-decision making and research purposes. Despite the greater availability of tumor molecular profiling by next-generation sequencing at our doorsteps, the achievement of value-based care, or improving patient outcomes while reducing overall costs or risks, in the era of precision oncology remains a looming challenge. In this review, we highlight available data through a pre-established and conceptualized framework for evaluating value-based medicine to assess the cost (efficiency), clinical benefit (effectiveness), and toxicity (safety) of genomic profiling in cancer care. We also provide perspectives on future directions of next-generation sequencing from targeted panels to whole-exome or whole-genome sequencing and describe potential strategies needed to attain value-based genomics. PMID:29644010

Informed Purchasing Can Stretch Short Dollars.

ERIC Educational Resources Information Center

Miller, John B.; Miller, Kathryn Madera

1979-01-01

Provides purchasing tips for programs on a tight budget. Topics include writing specifications for the merchandise needed, finding and developing sources (vendors), receiving and analyzing bids, writing purchase orders, and receiving merchandise. (CM)

Purchases Made with a Fruit and Vegetable Voucher in a Rural Mexican-Heritage Community.

PubMed

Hanbury, Meagan M; Gomez-Camacho, Rosa; Kaiser, Lucia; Sadeghi, Banafsheh; de la Torre, Adela

2017-10-01

Recent recommendations for US food assistance programs are intended to ensure foods provided through these programs help households consume a varied, healthful diet. From a policy viewpoint, it is important to examine the impact of economic incentives to purchase healthy foods across subpopulations, particularly low-income Latinos, who comprise 40% of the WIC program nationwide. Our aim was to determine how rural, Mexican-heritage households (N = 227) residing in California's Central Valley distributed fruit and vegetable (F/V) voucher spending among F/V subgroups and specific items over a 1-year period. Households contained at least one child who was between 3 and 8 years old at baseline and had a parent of Mexican-heritage. F/V voucher purchase data were collected via grocery store scanners. Expenditure and frequency shares of subgroups and individual items were analyzed to determine purchasing habits. Fruits were the most commonly purchased subgroup, representing 55% of spending and 45% of frequency. Households allocated low percentages of their voucher to dark green and red/orange vegetables-7 and 9% respectively. Approximately 20% of purchases were good potassium sources and 30% of purchases were good fiber sources. Many of the most frequently purchased items were of cultural significance (tomatillo, chayote, chili/jalapeño pepper, and Mexican squash). This study suggests that economic incentives can contribute important nutrients to participants' diets and targeted vouchers provided by food assistance programs should continue to include culturally important foods and be aware of the cultural values of their participants.

Sodium content of processed foods in the United Kingdom: analysis of 44,000 foods purchased by 21,000 households.

PubMed

Ni Mhurchu, Cliona; Capelin, Cathy; Dunford, Elizabeth K; Webster, Jacqueline L; Neal, Bruce C; Jebb, Susan A

2011-03-01

In the United Kingdom, sodium reduction targets have been set for a large number of processed food categories. Assessment and monitoring are essential to evaluate progress. Our aim was to determine whether household consumer panel food-purchasing data could be used to assess the sodium content of processed foods. Our further objectives were to estimate the mean sodium content of UK foods by category and undertake analyses weighted by food-purchasing volumes. Data were obtained for 21,108 British households between October 2008 and September 2009. Purchasing data (product description, product weight, annual purchases) and sodium values (mg/100 g) were collated for all food categories known to be major contributors to sodium intake. Unweighted and weighted mean sodium values were calculated. Data were available for 44,372 food products. The largest contributors to sodium purchases were table salt (23%), processed meat (18%), bread and bakery products (13%), dairy products (12%), and sauces and spreads (11%). More than one-third of sodium purchased (37%) was accounted for by 5 food categories: bacon, bread, milk, cheese, and sauces. For some food groups (bread and bakery, cereals and cereal products, processed meat), purchase-weighted means were 18-35% higher than unweighted means, suggesting that market leaders have higher sodium contents than the category mean. The targeting of sodium reduction in a small number of food categories and focusing on products sold in the highest volumes could lead to large decreases in sodium available for consumption and therefore to gains in public health.

A Community-Based Marketing Campaign at Farmers Markets to Encourage Fruit and Vegetable Purchases in Rural Counties With High Rates of Obesity, Kentucky, 2015-2016.

PubMed

DeWitt, Emily; McGladrey, Margaret; Liu, Emily; Peritore, Nicole; Webber, Kelly; Butterworth, Brooke; Vail, Ann; Gustafson, Alison

2017-08-31

Availability of farmers markets may increase fruit and vegetable consumption among rural residents of the United States. We conducted a community-based marketing campaign, Plate it Up Kentucky Proud (PIUKP), in 6 rural communities over 2 years to determine the association between exposure to the campaign and fruit and vegetable purchases, adjusted for Supplemental Nutrition Assistance Program recipient status. Logistic regression was used to examine the odds of the PIUKP campaign influencing purchases. Awareness of the PIUKP marketing campaign was significantly associated with a willingness to prepare fruits and vegetables at home. Using marketing strategies at farmers markets may be an effective way to improve fruit and vegetable purchases in rural communities.

24 CFR 982.317 - Lease-purchase agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Lease-purchase agreements. 982.317...-purchase agreements. (a) A family leasing a unit with assistance under the program may enter into an agreement with an owner to purchase the unit. So long as the family is receiving such rental assistance, all...

Purchasing. School Business Management Handbook Number 5.

ERIC Educational Resources Information Center

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.…

Trends in childhood vaccine purchase costs in the US public sector: 1996-2014.

PubMed

Chen, Weiwei; Messonnier, Mark; Zhou, Fangjun

2016-09-07

While vaccination remains as one of the most cost-effective preventive strategies, the cost of fully immunizing a child has grown considerably over the last few decades. This study examines trends in non-influenza childhood vaccine purchase costs in the public sector from 1996 to 2014. Non-influenza vaccine purchase cost per child for children aged 0 through 18years was calculated based on public-sector purchase prices. Purchase cost changes were then decomposed into changes attributable to recommendation updates and changes attributable to price variation. The study analyzed the growth rate of combination vaccine prices separately and compared these prices with the sum of prices of component vaccines. It is found that the average annual growth rate of non-influenza vaccine purchase cost per child during 1996-2014 was 12.6%. The growth rate attributable to price changes was 1.0% on average. Combination vaccine prices showed greater variation. The study concludes that vaccine price variation was one but a minor reason for purchase cost changes. Recommendation updates, particularly the introduction of new vaccines, played a much larger role in raising the purchase costs. If the 12.6% annual growth rate found during 1996-2014 in the study continues to apply, the purchase costs of childhood vaccines may more than double by 2020. Copyright © 2016 Elsevier Ltd. All rights reserved.

Intervention impact on depression product appraisal and purchasing behavior by employers: a randomized trial.

PubMed

Rost, Kathryn M; Marshall, Donna; Xu, Stanley

2014-09-24

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

A critical narrative analysis of shared decision-making in acute inpatient mental health care.

PubMed

Stacey, Gemma; Felton, Anne; Morgan, Alastair; Stickley, Theo; Willis, Martin; Diamond, Bob; Houghton, Philip; Johnson, Beverley; Dumenya, John

2016-01-01

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients' care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

31 CFR 352.4 - Limitation on purchases.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Limitation on purchases. 352.4..., SERIES HH § 352.4 Limitation on purchases. Series HH bonds issued under the terms of this Circular were not subject to a purchase limitation. [54 FR 40249, Sept. 29, 1989, as amended at 69 FR 40318, July 2...

Overstating values: medical facts, diverse values, bioethics and values-based medicine.

PubMed

Parker, Malcolm

2013-02-01

Fulford has argued that (1) the medical concepts illness, disease and dysfunction are inescapably evaluative terms, (2) illness is conceptually prior to disease, and (3) a model conforming to (2) has greater explanatory power and practical utility than the conventional value-free medical model. This 'reverse' model employs Hare's distinction between description and evaluation, and the sliding relationship between descriptive and evaluative meaning. Fulford's derivative 'Values Based Medicine' (VBM) readjusts the imbalance between the predominance of facts over values in medicine. VBM allegedly responds to the increased choices made available by, inter alia, the progress of medical science itself. VBM attributes appropriate status to evaluative meaning, where strong consensus about descriptive meaning is lacking. According to Fulford, quasi-legal bioethics, while it can be retained as a kind of deliberative framework, is outcome-based and pursues 'the right answer', while VBM approximates a democratic, process-oriented method for dealing with diverse values, in partnership with necessary contributions from evidence-based medicine (EBM). I support the non-cognitivist underpinnings of VBM, and its emphasis on the importance of values in medicine. But VBM overstates the complexity and diversity of values, misrepresents EBM and VBM as responses to scientific and evaluative complexity, and mistakenly depicts 'quasi-legal bioethics' as a space of settled descriptive meaning. Bioethical reasoning can expose strategies that attempt to reduce authentic values to scientific facts, illustrating that VBM provides no advantage over bioethics in delineating the connections between facts and values in medicine. © 2011 Blackwell Publishing Ltd.

48 CFR 213.302 - Purchase orders.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Purchase orders. 213.302 Section 213.302 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT... Acquisition Methods 213.302 Purchase orders. ...

Value-based metrics and Internet-based enterprises

NASA Astrophysics Data System (ADS)

Gupta, Krishan M.

2001-10-01

Within the last few years, a host of value-based metrics like EVA, MVA, TBR, CFORI, and TSR have evolved. This paper attempts to analyze the validity and applicability of EVA and Balanced Scorecard for Internet based organizations. Despite the collapse of the dot-com model, the firms engaged in e- commerce continue to struggle to find new ways to account for customer-base, technology, employees, knowledge, etc, as part of the value of the firm. While some metrics, like the Balance Scorecard are geared towards internal use, others like EVA are for external use. Value-based metrics are used for performing internal audits as well as comparing firms against one another; and can also be effectively utilized by individuals outside the firm looking to determine if the firm is creating value for its stakeholders.

48 CFR 13.303-5 - Purchases under BPAs.

Code of Federal Regulations, 2014 CFR

2014-10-01

...-5 Purchases under BPAs. (a) Use a BPA only for purchases that are otherwise authorized by law or... BPA does not justify purchasing from only one source or avoiding small business set-asides. The...

48 CFR 13.303-5 - Purchases under BPAs.

Code of Federal Regulations, 2011 CFR

2011-10-01

...-5 Purchases under BPAs. (a) Use a BPA only for purchases that are otherwise authorized by law or... BPA does not justify purchasing from only one source or avoiding small business set-asides. The...

48 CFR 13.303-5 - Purchases under BPAs.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-5 Purchases under BPAs. (a) Use a BPA only for purchases that are otherwise authorized by law or... BPA does not justify purchasing from only one source or avoiding small business set-asides. The...

48 CFR 13.303-5 - Purchases under BPAs.

Code of Federal Regulations, 2012 CFR

2012-10-01

...-5 Purchases under BPAs. (a) Use a BPA only for purchases that are otherwise authorized by law or... BPA does not justify purchasing from only one source or avoiding small business set-asides. The...

48 CFR 13.303-5 - Purchases under BPAs.

Code of Federal Regulations, 2013 CFR

2013-10-01

...-5 Purchases under BPAs. (a) Use a BPA only for purchases that are otherwise authorized by law or... BPA does not justify purchasing from only one source or avoiding small business set-asides. The...

The role of nurses in health purchasing.

PubMed

Chadderton, H; Cawthorn, H; Whiting, M

This paper considers nurses' responsibilities on giving advice about the purchasing of health care. By outlining the steps in the purchasing cycle, a coherent framework is presented for identifying the specific issues associated with the purchasing of health services by district health authorities (DHAs), and family health service authorities (FHSAs) in England and Wales, and health boards (HBs) in Scotland. Purchasing health is every nurse's business. All registered nurses in the UK have a contribution that they can and should make to ensure that their DHA, HB or FHSA makes the best possible provision for their resident population.

43 CFR 30.160 - What may be purchased at probate?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false What may be purchased at probate? 30.160... PROCEDURES Purchase at Probate § 30.160 What may be purchased at probate? An eligible purchaser may purchase... survives the decedent), may be purchased at probate with the following exceptions: (1) If an interest is...

16 CFR 1406.4 - Requirements to provide performance and technical notice to prospective purchasers and purchasers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS COAL AND WOOD BURNING APPLIANCES... notice to prospective purchasers and purchasers. Manufacturers, including importers, of coal and wood...: Creosote Formation and Need for Removal When wood is burned slowly, it produces tar and other vapors, which...

16 CFR 1406.4 - Requirements to provide performance and technical notice to prospective purchasers and purchasers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS COAL AND WOOD BURNING APPLIANCES... notice to prospective purchasers and purchasers. Manufacturers, including importers, of coal and wood...: Creosote Formation and Need for Removal When wood is burned slowly, it produces tar and other vapors, which...

Analysis on the Intention to Purchase Weather Index Insurance and Development Agenda

NASA Astrophysics Data System (ADS)

Park, K.; Jung, J.; Shin, J.; Kim, B.

2013-12-01

The purpose of this paper is to analyze how to revitalize weather insurance. Current state of weather insurance market is firstly described, and the necessity of insurance products and intention to purchase are analyzed based on the recognition survey regarding weather insurance focusing on the weather index insurance. The result of intention to purchase insurance products were examined with Ordered Logit Analysis (OLA), indicating that the amount of damages, the impacts of weather change, and experience of damage and loss have a positive relationship with the intention to purchase weather insurance. In addition, recognition of the amount of acceptable payment for insurance (i.e. willingness to pay) was analyzed for both the group who wants to purchase insurance (Group 1) and the group who does not want to (Group 2). The results demonstrate that Group 1 shows statistically higher significance than Group 2. Based on the results above with the increase in abnormal weather phenomena, we could predict that the amount of damages and losses will be rapidly increasing. The portion of weather insurance market is also expected to consistently develop and expand. This study could be a cornerstone for drawing a plan to revitalize weather insurance.

Valuing values: A history of wilderness economics

Treesearch

J. M. Bowker; H. K. Cordell; N. C. Poudyal

2014-01-01

Prior to the U.S. Wilderness Act of 1964, economics as a science was hardly considered applicable to the types of human values set forth in this pathbreaking legislation. Economics was largely confined to the purchasing and labor decisions of households and firms as well the functioning of markets and economies. However, around this time, John Krutilla (1967) in his...

31 CFR 341.4 - Proof of purchase.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Proof of purchase. 341.4 Section 341... BONDS § 341.4 Proof of purchase. At the time a Retirement Plan Bond is issued, the issuing agent will... name the bond is inscribed, to the registered owner as well, proof of the purchase on Form PD 3550. The...

The criminal purchase of firearm ammunition

PubMed Central

Tita, G E; Braga, A A; Ridgeway, G; Pierce, G L

2006-01-01

Objective Laws that prohibit certain individuals from owning firearms also pertain to ammunition. Whereas retail sales of firearms to criminals are regularly disrupted by instant background checks, sales of ammunition are essentially unchecked and the rate at which criminals acquire ammunition is unknown. This research describes the ammunition market and estimates the rate at which criminals are acquiring ammunition. Design Criminal background checks conducted on individuals purchasing ammunition in the City of Los Angeles in April and May 2004. Setting Los Angeles, CA, USA. Subjects Ammunition purchasers. Main outcome measures Criminal activity that prohibits one from owning, purchasing, or possessing ammunition. Results 2.6% (95% CI 1.9% to 3.2%) of ammunition purchasers had a prior felony conviction or another condition that prohibited them from possessing ammunition. During the study period prohibited possessors purchased 10 050 rounds of ammunition in Los Angeles. Conclusions These estimates suggest that monitoring ammunition transactions may help reduce the supply of ammunition to criminals and the frequency of injuries from felonious gun assaults. Such a record can also provide information for generating leads on illegal firearm possession. PMID:17018671

Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing

PubMed Central

Tangcharoensathien, Viroj; Limwattananon, Supon; Patcharanarumol, Walaiporn; Thammatacharee, Jadej; Jongudomsuk, Pongpisut; Sirilak, Supakit

2015-01-01

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser–provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite

48 CFR 413.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2010 CFR

2010-10-01

... purchase card. 413.301 Section 413.301 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE....301 Governmentwide commercial purchase card. USDA policy and procedures on use of the Governmentwide commercial purchase card are established in Departmental Regulation Series 5000. ...

Prevalence of Malaria Parasitemia and Purchase of Artemisinin-Based Combination Therapies (ACTs) among Drug Shop Clients in Two Regions in Tanzania with ACT Subsidies

PubMed Central

Briggs, Melissa A.; Kalolella, Admirabilis; Bruxvoort, Katia; Wiegand, Ryan; Lopez, Gerard; Festo, Charles; Lyaruu, Pierre; Kenani, Mitya; Abdulla, Salim; Goodman, Catherine; Kachur, S. Patrick

2014-01-01

Background Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. Method and Findings A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6–18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9–11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2–6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5–7.4). Conclusion Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives

Prevalence of malaria parasitemia and purchase of artemisinin-based combination therapies (ACTs) among drug shop clients in two regions in Tanzania with ACT subsidies.

PubMed

Briggs, Melissa A; Kalolella, Admirabilis; Bruxvoort, Katia; Wiegand, Ryan; Lopez, Gerard; Festo, Charles; Lyaruu, Pierre; Kenani, Mitya; Abdulla, Salim; Goodman, Catherine; Kachur, S Patrick

2014-01-01

Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6-18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9-11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2-6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5-7.4). Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops.

Point-of-Sale Cigarette Marketing, Urge to Buy Cigarettes, and Impulse Purchases of Cigarettes: Results From a Population-Based Survey.

PubMed

Siahpush, Mohammad; Shaikh, Raees A; Hyland, Andrew; Smith, Danielle; Sikora Kessler, Asia; Meza, Jane; Wan, Neng; Wakefield, Melanie

2016-05-01

Our aim was to examine the association of exposure to point-of-sale (POS) cigarette marketing for one's regular brand, as well as any brand of cigarettes, with the urge to buy cigarettes and frequency of impulse purchases of cigarettes. Nine hundred ninety-nine smokers in Omaha, Nebraska were interviewed via telephone. Cigarette marketing was measured by asking respondents questions about noticing pack displays, advertisements, and promotions such as discounts for their regular brand as well as any brand of cigarettes in their neighborhoods stores. We measured urge to buy cigarettes with the question "When you are in a store in your neighborhood that sells tobacco products, how often do you get an urge to buy cigarettes?" We measured frequency of impulse purchases of cigarettes with the question "When you are shopping in a store in your neighborhood for something other than cigarettes, how often do you decide to buy cigarettes?" We estimated ordinary least squares linear regression models to address the study aim. Higher levels of POS marketing for one's regular brand and any brands of cigarettes were associated with more frequent urges to buy (P < .001 and P < .001, respectively) and impulse purchases of cigarettes (P = .01 and P = .013, respectively), after adjusting for covariates. Exposure to POS marketing for one's own brand of cigarette as well as any brand is associated with urges to buy and impulse purchases of cigarettes. Existing studies on the association of POS cigarette marketing with urge to buy and an impulse purchase of cigarettes only focus on cigarette pack displays, not on advertisements and promotions. Also, these studies make no distinction between marketing for the smokers' regular brand and any brand of cigarettes. This study found that Exposure to POS marketing for one's own brand of cigarette as well as any brand is associated with urges to buy and impulse purchases of cigarettes. Our findings can provide part of the evidence-base needed by

Financial incentives and purchase restrictions in a food benefit program affect the types of foods and beverages purchased: results from a randomized trial.

PubMed

French, Simone A; Rydell, Sarah A; Mitchell, Nathan R; Michael Oakes, J; Elbel, Brian; Harnack, Lisa

2017-09-16

This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people. Participants (n=279) were randomized to groups: 1) Incentive- 30% financial incentive for fruits and vegetables purchased with food benefits; 2) Restriction- no purchase of sugar-sweetened beverages, sweet baked goods, or candies with food benefits; 3) Incentive plus Restriction; or 4) Control- no incentive or restrictions. Participants received a study-specific debit card where funds were added monthly for 12-weeks. Food purchase receipts were collected over 16 weeks. Total dollars spent on grocery purchases and by targeted food categories were computed from receipts. Group differences were examined using general linear models. Weekly purchases of fruit significantly increased in the Incentive plus Restriction ($4.8) compared to the Restriction ($1.7) and Control ($2.1) groups (p <.01). Sugar-sweetened beverage purchases significantly decreased in the Incentive plus Restriction (-$0.8 per week) and Restriction ($-1.4 per week) groups compared to the Control group (+$1.5; p< .0001). Sweet baked goods purchases significantly decreased in the Restriction (-$0.70 per week) compared to the Control group (+$0.82 per week; p < .01). Paired financial incentives and restrictions on foods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions. Clinicaltrials.gov Identifier: NCT02643576 .

50 CFR 622.226 - Restrictions on sale/purchase.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Restrictions on sale/purchase. (a) South Atlantic wild live rock. Wild live rock in or from the South Atlantic EEZ may not be sold or purchased. The prohibition on sale or purchase does not apply to wild live rock...

50 CFR 622.226 - Restrictions on sale/purchase.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Restrictions on sale/purchase. (a) South Atlantic wild live rock. Wild live rock in or from the South Atlantic EEZ may not be sold or purchased. The prohibition on sale or purchase does not apply to wild live rock...

Expected value based fuzzy programming approach to solve integrated supplier selection and inventory control problem with fuzzy demand

NASA Astrophysics Data System (ADS)

Sutrisno; Widowati; Sunarsih; Kartono

2018-01-01

In this paper, a mathematical model in quadratic programming with fuzzy parameter is proposed to determine the optimal strategy for integrated inventory control and supplier selection problem with fuzzy demand. To solve the corresponding optimization problem, we use the expected value based fuzzy programming. Numerical examples are performed to evaluate the model. From the results, the optimal amount of each product that have to be purchased from each supplier for each time period and the optimal amount of each product that have to be stored in the inventory for each time period were determined with minimum total cost and the inventory level was sufficiently closed to the reference level.

48 CFR 1313.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2010 CFR

2010-10-01

... purchase card. 1313.301 Section 1313.301 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE....301 Governmentwide commercial purchase card. The Department's procedures for the use and control of the Governmentwide commercial purchase card are set forth in CAM 1313.301. ...

48 CFR 14.212 - Economic purchase quantities (supplies).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Economic purchase... REGULATION CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Solicitation of Bids 14.212 Economic purchase quantities (supplies). Contracting officers shall comply with the economic purchase quantity...

48 CFR 14.212 - Economic purchase quantities (supplies).

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Economic purchase... REGULATION CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Solicitation of Bids 14.212 Economic purchase quantities (supplies). Contracting officers shall comply with the economic purchase quantity...

48 CFR 14.212 - Economic purchase quantities (supplies).

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Economic purchase... REGULATION CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Solicitation of Bids 14.212 Economic purchase quantities (supplies). Contracting officers shall comply with the economic purchase quantity...

48 CFR 14.212 - Economic purchase quantities (supplies).

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Economic purchase... REGULATION CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Solicitation of Bids 14.212 Economic purchase quantities (supplies). Contracting officers shall comply with the economic purchase quantity...

48 CFR 14.212 - Economic purchase quantities (supplies).

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Economic purchase... REGULATION CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Solicitation of Bids 14.212 Economic purchase quantities (supplies). Contracting officers shall comply with the economic purchase quantity...

48 CFR 13.302 - Purchase orders.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Purchase orders. 13.302 Section 13.302 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING METHODS AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Simplified Acquisition Methods 13.302 Purchase...

The role of outputs and outcomes in purchaser accountability: reflecting on New Zealand experiences.

PubMed

Cumming, J; Scott, C D

1998-10-01

Recent reforms in a number of countries' health systems have led to the separation of funder, purchaser and provider roles and the strengthening of funders' and purchasers' positions relative to providers. One of the aims of such reforms is to improve accountability. This paper reports on experiences in New Zealand where, in addition to improving the accountability of providers, purchaser accountability has also been a key policy issue. Attempts have been made in New Zealand to develop a funder-purchaser accountability framework based on a mix of outcomes, outputs and inputs. This paper discusses the roles that each might play in contracts and accountability relationships between funders and purchasers. The paper concludes that holding purchasers accountable for outcomes is likely to prove difficult and controversial, because of problems of attribution and because New Zealand funders in recent years have played an important role in determining the priority outputs and inputs which must be purchased. The paper suggests that accountability is more appropriate at the output and process level, in addition to holding purchasers accountable for the ways in which they make decisions and undertake contracting roles. Holding purchasers accountable for purchasing outputs and processes, however, requires greater commitment on the part of the funder to setting priorities more clearly; specifying the range and level of outputs to be purchased and the terms of access to those services; and funding services to this level. The international attention currently being paid to the development of practice guidelines and priority criteria also suggests that holding purchasers accountable for a form of inputs may become an increasingly common practice in future. From 1 July 1998, New Zealand will introduce a priority criteria system for determining access to elective surgery; accountability is thus becoming focused on inputs in the form of patient characteristics. This approach will

48 CFR 52.207-5 - Option To Purchase Equipment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 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...

41 CFR 101-25.203 - Centralized purchases by GSA.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Centralized purchases by...-Interagency Purchase Assignments § 101-25.203 Centralized purchases by GSA. GSA will exclusively, or with specified limited exceptions, make purchases and contracts on a continuing basis for articles and services...

Supermarket purchase contributes to nutrition-related non-communicable diseases in urban Kenya.

PubMed

Demmler, Kathrin M; Klasen, Stephan; Nzuma, Jonathan M; Qaim, Matin

2017-01-01

While undernutrition and related infectious diseases are still pervasive in many developing countries, the prevalence of non-communicable diseases (NCD), typically associated with high body mass index (BMI), is rapidly rising. The fast spread of supermarkets and related shifts in diets were identified as possible factors contributing to overweight and obesity in developing countries. Potential effects of supermarkets on people's health have not been analyzed up till now. This study investigates the effects of purchasing food in supermarkets on people's BMI, as well as on health indicators such as fasting blood glucose (FBG), blood pressure (BP), and the metabolic syndrome. This study uses cross-section observational data from urban Kenya. Demographic, anthropometric, and bio-medical data were collected from 550 randomly selected adults. Purchasing food in supermarkets is defined as a binary variable that takes a value of one if any food was purchased in supermarkets during the last 30 days. In a robustness check, the share of food purchased in supermarkets is defined as a continuous variable. Instrumental variable regressions are applied to control for confounding factors and establish causality. Purchasing food in supermarkets contributes to higher BMI (+ 1.8 kg/m2) (P<0.01) and an increased probability (+ 20 percentage points) of being overweight or obese (P<0.01). Purchasing food in supermarkets also contributes to higher levels of FBG (+ 0.3 mmol/L) (P<0.01) and a higher likelihood (+ 16 percentage points) of suffering from pre-diabetes (P<0.01) and the metabolic syndrome (+ 7 percentage points) (P<0.01). Effects on BP could not be observed. Supermarkets and their food sales strategies seem to have direct effects on people's health. In addition to increasing overweight and obesity, supermarkets contribute to nutrition-related NCDs. Effects of supermarkets on nutrition and health can mainly be ascribed to changes in the composition of people's food choices.

Purchasing health care in China: experiences, opportunities and challenges.

PubMed

Yip, Winnie; Hanson, Kara

2009-01-01

Purchasing has been promoted as a key policy instrument to improve health system performance. Despite its widespread adoption, there is little empirical evidence on how it works, the challenges surrounding its implementation, its impact, and the preconditions for it to function effectively, particularly in low- and middle-income settings. The objective of this chapter is to analyze critically the extent to which purchasing could be, and has been used strategically in China and to identify modifications that are needed for purchasing to be effective in assuring that the government's new funding for health care will result in efficient and effective health services. We present a conceptual framework for purchasing, which identifies three critical principal-agent relationships in purchasing. We draw on evidence from secondary data, results of other research studies, interviews, and the impact evaluation of a social experiment in rural China that explicitly used purchasing to improve quality and efficiency. This information is used to examine purchasing relationships in urban social health insurance (SHI), the rural medical insurance scheme, and purchasing of public health services. To date, use of strategic purchasing is limited in China. Both the urban and the rural health insurance schemes act as passive third-party payers, failing to take advantage of the opportunities to strengthen incentives to improve quality and efficiency. This may be because as government agencies, the extent to which the Ministries of Health and Labor and Social Security can act independently from provider interests, or act in the best interest of the population, is unclear. Other important challenges include ensuring adequate representation of the population's views and preferences and making better use of the leverage provided by purchasing to create appropriate provider incentives, through better integration of financing and improved coordination among purchasers. In designing purchasing

34 CFR 300.210 - Purchase of instructional materials.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Purchase of instructional materials. 300.210 Section... EDUCATION OF CHILDREN WITH DISABILITIES Local Educational Agency Eligibility § 300.210 Purchase of... the National Instructional Materials Access Center (NIMAC), when purchasing print instructional...

Compliance with minimum price and legal age for cigarette purchase laws: evidence from NYC in advance of raising purchase age to 21.

PubMed

Silver, Diana; Bae, Jin Yung; Jimenez, Geronimo; Macinko, James

2016-05-01

New York City (NYC) raised the minimum purchase age for cigarettes from 18 to 21 on 1 August 2014. The new law is intended to decrease current smoking rates and smoking initiation among the city's youth. Assessment of compliance with existing cigarette sales and tax laws could aid in determining what may be needed for successful implementation of the city's new law. To assess compliance with minimum sales price and purchase age laws in NYC, before change in law. Ten trained field investigators purchased cigarettes from different types of retailers throughout all five NYC boroughs, resulting in 421 purchases. Investigators noted whether they were asked for identification and the price of their purchase. Multivariable logistic and Ordinary Least Squares regression techniques were used to assess predictors of retailer compliance with sales price and minimum purchase age laws. In 29% of purchases, investigators did not have to produce identification (p<0.05) to purchase cigarettes. Only 3.1% of sales were at prices lower than the minimum sales price. City borough was significantly associated with purchase without identification (p<0.001) and mean sales price (p<0.024). Vendor type (independent vs chain) was significantly related to investigators being able to purchase cigarettes without identification (p<0.001). Variation in compliance with existing laws suggests that more active monitoring of compliance with the new minimum legal purchase age will be required in order to realise the new law's public health potential. 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/

Sodium content of processed foods in the United Kingdom: analysis of 44,000 foods purchased by 21,000 households123

PubMed Central

Capelin, Cathy; Dunford, Elizabeth K; Webster, Jacqueline L; Neal, Bruce C; Jebb, Susan A

2011-01-01

Background: In the United Kingdom, sodium reduction targets have been set for a large number of processed food categories. Assessment and monitoring are essential to evaluate progress. Objectives: Our aim was to determine whether household consumer panel food-purchasing data could be used to assess the sodium content of processed foods. Our further objectives were to estimate the mean sodium content of UK foods by category and undertake analyses weighted by food-purchasing volumes. Design: Data were obtained for 21,108 British households between October 2008 and September 2009. Purchasing data (product description, product weight, annual purchases) and sodium values (mg/100 g) were collated for all food categories known to be major contributors to sodium intake. Unweighted and weighted mean sodium values were calculated. Results: Data were available for 44,372 food products. The largest contributors to sodium purchases were table salt (23%), processed meat (18%), bread and bakery products (13%), dairy products (12%), and sauces and spreads (11%). More than one-third of sodium purchased (37%) was accounted for by 5 food categories: bacon, bread, milk, cheese, and sauces. For some food groups (bread and bakery, cereals and cereal products, processed meat), purchase-weighted means were 18–35% higher than unweighted means, suggesting that market leaders have higher sodium contents than the category mean. Conclusion: The targeting of sodium reduction in a small number of food categories and focusing on products sold in the highest volumes could lead to large decreases in sodium available for consumption and therefore to gains in public health. PMID:21191142

32 CFR 37.705 - What standards do I include for purchasing systems of for-profit firms?

Code of Federal Regulations, 2010 CFR

2010-07-01

... include for purchasing systems of for-profit firms? (a) If your TIA is an expenditure-based award, it... the purchasing standards in 32 CFR 34.31 to use the same requirements for TIAs, unless there are...). (b) You should allow other for-profit participants under expenditure-based TIAs to use their existing...

Defining the value of magnetic resonance imaging in prostate brachytherapy using time-driven activity-based costing.

PubMed

Thaker, Nikhil G; Orio, Peter F; Potters, Louis

Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process. Future initiatives will be required to follow the costs of care over longer periods of time to determine if improvements in outcomes and toxicities with an MRI-based approach lead to lower resource utilization and spending over the long-term. Understanding provider costs will become important as healthcare reform transitions to value-based purchasing and other alternative payment models. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

48 CFR 1313.302 - Purchase orders.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Purchase orders. 1313.302 Section 1313.302 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CONTRACTING METHODS AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Simplified Acquisitions Methods 1313.302 Purchase orders. ...

48 CFR 813.302 - Purchase orders.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Purchase orders. 813.302 Section 813.302 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS CONTRACTING METHODS AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Simplified Acquisition Methods 813.302 Purchase...

Food Allergen Labeling and Purchasing Habits in the United States and Canada.

PubMed

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.

Motorcycle helmets in Vietnam: ownership, quality, purchase price, and affordability.

PubMed

Hung, Dang Viet; Stevenson, Mark R; Ivers, Rebecca Q

2008-06-01

This study investigated motorcycle helmet ownership, quality, purchase price, and affordability in Vietnam. A random sample of motorcyclists was interviewed to investigate aspects of helmet ownership, the purchase price, and affordability of a motorcycle helmet. Multivariate modeling conducted to determine factors associated with the purchase price and affordability of motorcycle helmets. Helmet quality was assessed based on current legal requirements in Vietnam. The prevalence of helmet use in Vietnam remains low (23.3%) despite a high level of helmet ownership (94%), indicating that this is an important area for public health intervention. Overall the quality of helmets appeared to be good; however, few helmets displayed legally required information. Motorcyclists with a high income purchase more helmets for their household rather than more expensive helmets. To ensure that helmets are accessible to the community, policy-makers need to consider pricing motorcycle helmets at a price indicated by the results of this study. Prior to universal motorcycle helmet legislation, the government will also need to ensure that standard helmets are available and that enforcement is at a level to ensure that motorcycle helmets are actually used.

Socioeconomic inequalities in expenditures and income committed to the purchase of medicines in Southern Brazil.

PubMed

Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Peres, Karen Glazer

2011-10-01

To describe socioeconomic inequalities regarding the use, expenditures and the income committed to the purchase of medicines. A cross-sectional population-based study was carried out with 1,720 adults living in the urban area of Florianópolis, Southern Brazil, in 2009. Cluster sampling was adopted and census tracts were the primary sampling units. Use of medicines and the expenditures incurred in their purchase in the past 30 days were investigated through interviews. Use, expenditures and the income committed concerning medicines were analyzed according to per capita family income, self-reported skin color, age and sex, adjusting for the complex sample. The prevalence of medicine use was 76.5% (95%CI: 73.8; 79.3), higher among women and in older individuals. The mean expenditure on medicine was R$ 46.70, with higher values among women, whites, older individuals and among richer people. While 3.1% of the richest committed more than 15% of their income to purchasing medicine, that figure reached 9.6% in the poorest group. The proportion of people that had to buy medicines after an unsuccessful attempt to obtain them in the public health system was higher among the poor (11.0%), women (10.2%) and the elderly (11.1%). A large part of the adults bought medicines contained in the National List of Essential Medicines (19.9%) or in the Municipal List of Essential Medicines (28.6%), with significant differences according to gender, age and income. There is socioeconomic, age and gender inequality in the income committed to the purchase of medicines, with worse conditions for the poor, older individuals and women.

Ontology-Based Gap Analysis for Technology Selection: A Knowledge Management Framework for the Support of Equipment Purchasing Processes

NASA Astrophysics Data System (ADS)

Macris, Aristomenis M.; Georgakellos, Dimitrios A.

Technology selection decisions such as equipment purchasing and supplier selection are decisions of strategic importance to companies. The nature of these decisions usually is complex, unstructured and thus, difficult to be captured in a way that will be efficiently reusable. Knowledge reusability is of paramount importance since it enables users participate actively in process design/redesign activities stimulated by the changing technology selection environment. This paper addresses the technology selection problem through an ontology-based approach that captures and makes reusable the equipment purchasing process and assists in identifying (a) the specifications requested by the users' organization, (b) those offered by various candidate vendors' organizations and (c) in performing specifications gap analysis as a prerequisite for effective and efficient technology selection. This approach has practical appeal, operational simplicity, and the potential for both immediate and long-term strategic impact. An example from the iron and steel industry is also presented to illustrate the approach.

48 CFR 970.5244-1 - Contractor purchasing system.

Code of Federal Regulations, 2011 CFR

2011-10-01

... for Management and Operating Contracts 970.5244-1 Contractor purchasing system. As prescribed in 970... management system. The Contractor's approved purchasing system and methods shall include the requirements set... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Contractor purchasing...

48 CFR 970.5244-1 - Contractor purchasing system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 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...

Adolescent Purchasing Behavior at McDonald's and Subway.

PubMed

Lesser, Lenard I; Kayekjian, Karen C; Velasquez, Paz; Tseng, Chi-Hong; Brook, Robert H; Cohen, Deborah A

2013-10-01

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 < .01) and from side dishes (i.e., French fries or potato chips; 201 at McDonald's vs. 35 at Subway, p < .01). In contrast, they purchased fewer cups of vegetables at McDonald's (.15 vs. .57 cups, p < .01). We found that, despite being marketed as "healthy," adolescents purchasing a meal at Subway order just as many calories as at 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.

Pennsylvania roundwood purchases and movements by origin and destination

Treesearch

Jamie A. Murphy; Paul M. Smith; Bruce G. Hansen

2008-01-01

A mail survey of all identified roundwood purchasers in Pennsylvania was conducted in 2004 to quantify the roundwood purchasing industry in terms of roundwood volume, origin, destination, roundwood type, and species of 2003 purchases. An adjusted response rate of 50 percent was obtained from the estimated overall population of 334 Pennsylvania roundwood purchasers....

Serological diagnosis of bovine neosporosis: a Bayesian evaluation of two antibody ELISA tests for in vivo diagnosis in purchased and abortion cattle.

PubMed

Roelandt, S; Van der Stede, Y; Czaplicki, G; Van Loo, H; Van Driessche, E; Dewulf, J; Hooyberghs, J; Faes, C

2015-06-06

Currently, there are no perfect reference tests for the in vivo detection of Neospora caninum infection. Two commercial N caninum ELISA tests are currently used in Belgium for bovine sera (TEST A and TEST B). The goal of this study is to evaluate these tests used at their current cut-offs, with a no gold standard approach, for the test purpose of (1) demonstration of freedom of infection at purchase and (2) diagnosis in aborting cattle. Sera of two study populations, Abortion population (n=196) and Purchase population (n=514), were selected and tested with both ELISA's. Test results were entered in a Bayesian model with informative priors on population prevalences only (Scenario 1). As sensitivity analysis, two more models were used: one with informative priors on test diagnostic accuracy (Scenario 2) and one with all priors uninformative (Scenario 3). The accuracy parameters were estimated from the first model: diagnostic sensitivity (Test A: 93.54 per cent-Test B: 86.99 per cent) and specificity (Test A: 90.22 per cent-Test B: 90.15 per cent) were high and comparable (Bayesian P values >0.05). Based on predictive values in the two study populations, both tests were fit for purpose, despite an expected false negative fraction of ±0.5 per cent in the Purchase population and ±5 per cent in the Abortion population. In addition, a false positive fraction of ±3 per cent in the overall Purchase population and ±4 per cent in the overall Abortion population was found. British Veterinary Association.

Exploring Consumer and Patient Knowledge, Behavior, and Attitude Toward Medicinal and Lifestyle Products Purchased From the Internet: A Web-Based Survey.

PubMed

Assi, Sulaf; Thomas, Jordan; Haffar, Mohamed; Osselton, David

2016-07-18

In recent years, lifestyle products have emerged to help improve people's physical and mental performance. The Internet plays a major role in the spread of these products. However, the literature has reported issues regarding the authenticity of medicines purchased from the Internet and the impact of counterfeit medicines on public health. Little or no data are available on the authenticity of lifestyle products and actual toxicity associated with their use and misuse. Our aim was to investigate consumer and patient attitudes toward the purchase of lifestyle products from the Internet, their knowledge of product authenticity and toxicity, and their experiences with counterfeit lifestyle products. A Web-based study was performed between May 2014 and May 2015. Uniform collection of data was performed through an anonymous online questionnaire. Participants were invited worldwide via email, social media, or personal communication to complete the online questionnaire. A total of 320 participants completed the questionnaire. The results of the questionnaire showed that 208 (65.0%) participants purchased lifestyle products from the Internet mainly due to convenience and reduced cost. More than half (55.6%, 178/320) of participants purchased cosmetic products, whereas only a minority purchased medicinal products. Yet, 62.8% (201/320) of participants were aware of the presence of counterfeit lifestyle products from the Internet, and 11.9% (38/320) experienced counterfeit products. In only 0.9% (3/320) of those cases were counterfeit lifestyle products reported to authorities. Moreover, 7.2% (23/320) of the participants experienced adverse effects due to counterfeit lifestyle products. In summary, patients experienced counterfeit lifestyle products that resulted in adverse effects on their health. Although certain adverse effects were reported in this study, counterfeit products were underreported to authorities. Further public awareness campaigns and patient education are

Exploring Consumer and Patient Knowledge, Behavior, and Attitude Toward Medicinal and Lifestyle Products Purchased From the Internet: A Web-Based Survey

PubMed Central

Thomas, Jordan

2016-01-01

Background In recent years, lifestyle products have emerged to help improve people’s physical and mental performance. The Internet plays a major role in the spread of these products. However, the literature has reported issues regarding the authenticity of medicines purchased from the Internet and the impact of counterfeit medicines on public health. Little or no data are available on the authenticity of lifestyle products and actual toxicity associated with their use and misuse. Objective Our aim was to investigate consumer and patient attitudes toward the purchase of lifestyle products from the Internet, their knowledge of product authenticity and toxicity, and their experiences with counterfeit lifestyle products. Methods A Web-based study was performed between May 2014 and May 2015. Uniform collection of data was performed through an anonymous online questionnaire. Participants were invited worldwide via email, social media, or personal communication to complete the online questionnaire. A total of 320 participants completed the questionnaire. Results The results of the questionnaire showed that 208 (65.0%) participants purchased lifestyle products from the Internet mainly due to convenience and reduced cost. More than half (55.6%, 178/320) of participants purchased cosmetic products, whereas only a minority purchased medicinal products. Yet, 62.8% (201/320) of participants were aware of the presence of counterfeit lifestyle products from the Internet, and 11.9% (38/320) experienced counterfeit products. In only 0.9% (3/320) of those cases were counterfeit lifestyle products reported to authorities. Moreover, 7.2% (23/320) of the participants experienced adverse effects due to counterfeit lifestyle products. Conclusions In summary, patients experienced counterfeit lifestyle products that resulted in adverse effects on their health. Although certain adverse effects were reported in this study, counterfeit products were underreported to authorities. Further

7 CFR 1280.217 - Lamb purchases.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 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...

The nutrient content of US household food purchases by store types

PubMed Central

Stern, Dalia; Ng, Shu Wen; Popkin, Barry M

2015-01-01

Introduction Little is known about where households shop for packaged foods, what foods and beverages they purchase, and the nutrient content of these purchases. The objectives are to describe volume trends and nutrient content (food groups and nutrient profiles) of household packaged foods purchases (PFP) by store-type. Methods Cross-sectional analysis of US households’ food purchases (Nielsen Homescan) from 2000 to 2012 (n=652,023 household-year observations) with survey weights used for national representativeness. Household PFP trends (% volume) by store-type, household purchases of key food and beverage groups based on caloric contribution by store-type, and mean caloric and nutrient densities (sugars, saturated fat and sodium) of household PFP by store-type are analyzed. Data were collected from 2000–2012. Analyses were conducted in 2014–2015. Results The proportion of total volume of household PFP significantly increased from 2000 to 2012 for mass-merchandisers (13.1 to 23.9%), convenience-stores (3.6 to 5.9%) and warehouse-club (6.2 to 9.8%), and significantly decreased for grocery-chains (58.5 to 46.3%) and non-chain grocerys (10.3 to 5.2%). Top common sources of calories (%) from household PFP by food/beverage group include: savory snacks, grain-based desserts and regular soft-drinks. The energy, total sugar, sodium and saturated fat densities of household PFP from mass-merchandisers, warehouse-club and convenience-stores were higher, compared to grocery-stores. Conclusions PFP from stores with poorer nutrient density (more energy, total sugar, sodium and saturated fat-dense), such as warehouse-club, mass-merchandisers and convenience-stores are growing, representing a potential US public health concern. PMID:26437868

36 CFR 223.101 - Determination of purchaser responsibility.

Code of Federal Regulations, 2011 CFR

2011-07-01

... purchaser has a satisfactory performance record on timber sale contracts. A prospective purchaser that is or... AGRICULTURE SALE AND DISPOSAL OF NATIONAL FOREST SYSTEM TIMBER, SPECIAL FOREST PRODUCTS, AND FOREST BOTANICAL PRODUCTS Timber Sale Contracts Award of Contracts § 223.101 Determination of purchaser responsibility. (a...

48 CFR 813.106-70 - Oral purchase orders.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Oral purchase orders. 813... CONTRACTING METHODS AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Procedures 813.106-70 Oral purchase orders. When advantageous to VA, the contracting officer may use an oral purchase order for transactions...

48 CFR 613.303-5 - Purchases under BPAs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Purchases under BPAs. 613.303-5 Section 613.303-5 Federal Acquisition Regulations System DEPARTMENT OF STATE CONTRACTING METHODS... Purchases under BPAs. (b) Individual purchases under BPAs for commercial items may exceed the simplified...

Lease/Purchase: A Viable Alternative for Financing Schools.

ERIC Educational Resources Information Center

Demers, Denise

1989-01-01

Lease-purchase finance is a viable alternative for school districts that cannot or do not want to employ traditional financing techniques. Outlines the advantages and disadvantages of lease-purchase financing compared to outright purchase; operating leasing, which is taxable; and traditional tax-exempt bond financing. (MLF)

Developing a pharmaceutical purchasing strategy.

PubMed

Hynniman, C E

1992-09-01

The process commonly used by group purchasing organizations to contract for multisource pharmaceuticals and a strategic approach for the director of pharmacy in working with the purchasing group and the P & T Committee is described. The pharmacist should be knowledgeable concerning the group's contract commitment requirements, product specifications, terms and conditions and procedures for vendor selection, product award, contract implementation, and performance monitoring. To ensure results that meet the needs of the medical staff, it is important that the P & T Committee actively participate. The P & T Committee should understand the reasons for selecting a particular purchasing group, understand the necessary steps in obtaining the most favorable economic advantage, review products with potential brand interchange concerns, recommend product specifications, and reaffirm formulary procedures regarding the principle of current consent.

24 CFR 291.545 - Financing purchase of the home.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Financing purchase of the home. 291... Neighbor Next Door Sales Program § 291.545 Financing purchase of the home. (a) Purchase using conventional... conventional financing to purchase a home under the GNND Sales Program, the amount of the mortgage may not...

24 CFR 291.545 - Financing purchase of the home.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Financing purchase of the home. 291... Neighbor Next Door Sales Program § 291.545 Financing purchase of the home. (a) Purchase using conventional... conventional financing to purchase a home under the GNND Sales Program, the amount of the mortgage may not...

24 CFR 291.545 - Financing purchase of the home.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Financing purchase of the home. 291... Neighbor Next Door Sales Program § 291.545 Financing purchase of the home. (a) Purchase using conventional... conventional financing to purchase a home under the GNND Sales Program, the amount of the mortgage may not...

24 CFR 291.545 - Financing purchase of the home.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Financing purchase of the home. 291... Neighbor Next Door Sales Program § 291.545 Financing purchase of the home. (a) Purchase using conventional... conventional financing to purchase a home under the GNND Sales Program, the amount of the mortgage may not...

24 CFR 291.545 - Financing purchase of the home.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Financing purchase of the home. 291... Neighbor Next Door Sales Program § 291.545 Financing purchase of the home. (a) Purchase using conventional... conventional financing to purchase a home under the GNND Sales Program, the amount of the mortgage may not...

Purchase decision-making is modulated by vestibular stimulation.

PubMed

Preuss, Nora; Mast, Fred W; Hasler, Gregor

2014-01-01

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.

Purchase decision-making is modulated by vestibular stimulation

PubMed Central

Preuss, Nora; Mast, Fred W.; Hasler, Gregor

2014-01-01

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. PMID:24600365

Analyzing The Impacts of the Biogas-to-Electricity Purchase Incentives on Electric Vehicle Deployment with the MA3T Vehicle Choice Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Podkaminer, Kara; Xie, Fei; Lin, Zhenhong

This analysis represents the biogas-to-electricity pathway under the Renewable Fuel Standard (RFS) as a point of purchase incentive and tests the impact of this incentive on EV deployment using a vehicle consumer choice model. The credit value generated under this policy was calculated in a number of scenarios based on electricity use of each power train choice on a yearly basis over the 15 year vehicle lifetime, accounting for the average electric vehicle miles travelled and vehicle efficiency, competition for biogas-derived electricity among electric vehicles (EVs), the RIN equivalence value and the time value of money. The credit value calculationmore » in each of these scenarios is offered upfront as a point of purchase incentive for EVs using the Market Acceptance of Advanced Automotive Technologies (MA3T) vehicle choice model, which tracks sales, fleet size and energy use over time. The majority of the scenarios use a proposed RIN equivalence value, which increases the credit value as a way to explore the analysis space. Additional model runs show the relative impact of the equivalence value on EV deployment. The MA3T model output shows that a consumer incentive accelerates the deployment of EVs for all scenarios relative to the baseline (no policy) case. In the scenario modeled to represent the current biogas-to-electricity generation capacity (15 TWh/year) with a 5.24kWh/RIN equivalence value, the policy leads to an additional 1.4 million plug-in hybrid electric vehicles (PHEVs) and 3.5 million battery electric vehicles (BEVs) in 2025 beyond the no-policy case of 1.3 million PHEVs and 2.1 million BEVs when the full value of the credit is passed on to the consumer. In 2030, this increases to 2.4 million PHEVs and 7.3 million BEVs beyond the baseline. This larger impact on BEVs relative to PHEVs is due in part to the larger credit that BEVs receive in the model based on the greater percentage of electric vehicle miles traveled by BEVs relative to PHEVs. In

Influences on the Intent To Make Internet Purchases.

ERIC Educational Resources Information Center

George, Joey F.

2002-01-01

Using the theory of planned behavior as the theoretical base, data collected through a semi-annual survey of Web users were used to determine if beliefs about privacy and Internet trustworthiness helped determine attitudes toward the Internet, which were thought to affect intent to make Internet purchases. (Author/LRW)

Factors affecting flood insurance purchase in residential properties in Johor, Malaysia

NASA Astrophysics Data System (ADS)

Aliagha, U. G.; Jin, T. E.; Choong, W. W.; Nadzri Jaafar, M.; Ali, H. M.

2014-12-01

High-impact floods have become a virtually annual experience in Malaysia, yet flood insurance has remained a grossly neglected part of comprehensive integrated flood risk management. Using discriminant analysis, this study seeks to identify the demand-side variables that best predict flood insurance purchase and risk aversion between two groups of residential homeowners in three districts of Johor State, Malaysia: those who purchased flood insurance and those who did not. Our results revealed an overall 34% purchase rate, with Kota Tinggi district having the highest (44%) and thus the highest degree of flood risk aversion. The Wilks' lambda F test for equality of group means, standardised discriminant function coefficients, structure correlation, and canonical correlation has clearly shown that there are strong significant attribute differences between the two groups of homeowners, based on the measures of objective flood risk exposure, subjective risk perception, and socio-economic cum demographic variables. However, the measures of subjective risk perception were found to be more predictive of flood insurance purchase and flood risk aversion.

Effects of yearling sale purchase price, exercise history, lameness, and athletic performance on purchase price of Thoroughbreds at 2-year-old in-training sales.

PubMed

Preston, Stephanie A; Brown, Murray P; Chmielewski, Terese L; Trumble, Troy N; Zimmel, Dana N; Hernandez, Jorge A

2012-12-01

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.

39 CFR 601.100 - Purchasing policy.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 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 Service acquires property and services pursuant to the authority of 39 U.S.C. 410. ...

39 CFR 601.100 - Purchasing policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 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 Service acquires property and services pursuant to the authority of 39 U.S.C. 410. ...

36 CFR 262.5 - Disposal of purchased property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Disposal of purchased... LAW ENFORCEMENT SUPPORT ACTIVITIES Rewards and Payments § 262.5 Disposal of purchased property. All evidence purchased under the authority of this subpart shall be maintained in accordance with all laws...

48 CFR 213.303-5 - Purchases under BPAs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Purchases under BPAs. 213.303-5 Section 213.303-5 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM... Acquisition Methods 213.303-5 Purchases under BPAs. (b) Individual purchases for subsistence may be made at...

48 CFR 852.270-3 - Purchase of shellfish.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Purchase of shellfish. 852.270-3 Section 852.270-3 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS CLAUSES... Purchase of shellfish. As prescribed in 870.111-3, insert the following clause: Purchase of Shellfish (APR...

24 CFR 291.565 - Continuing obligations after purchase.

Code of Federal Regulations, 2010 CFR

2010-04-01

... purchase. 291.565 Section 291.565 Housing and Urban Development Regulations Relating to Housing and Urban... Neighbor Next Door Sales Program § 291.565 Continuing obligations after purchase. To remain in compliance.../her sole residence, the home purchased through the GNND Sales Program; and (b) Certify initially and...

12 CFR 612.2270 - Purchase of System obligations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Purchase of System obligations. 612.2270... REFERRAL OF KNOWN OR SUSPECTED CRIMINAL VIOLATIONS Standards of Conduct § 612.2270 Purchase of System... Funding Corporation, may only purchase joint, consolidated, or Systemwide obligations that are: (1) Part...

University of Maryland MRSEC - For Members: Purchasing

Science.gov Websites

Educational Education Pre-College Programs Homeschool Programs Undergraduate & Graduate Programs Teacher next to each file. Purchasing Policies & Procedures Purchases of products and services require pre

Dissolved oxygen, stream temperature, and fish habitat response to environmental water purchases.

PubMed

Null, Sarah E; Mouzon, Nathaniel R; Elmore, Logan R

2017-07-15

Environmental water purchases are increasingly used for ecological protection. In Nevada's Walker Basin (western USA), environmental water purchases augment streamflow in the Walker River and increase lake elevation of terminal Walker Lake. However, water quality impairments like elevated stream temperatures and low dissolved oxygen concentrations also limit ecosystems and species, including federally-threatened Lahontan cutthroat trout. In this paper, we prioritize water volumes and locations that most enhance water quality for riverine habitat from potential environmental water rights purchases. We monitored and modeled streamflows, stream temperatures, and dissolved oxygen concentrations using River Modeling System, an hourly, physically-based hydrodynamic and water quality model. Modeled environmental water purchases ranged from average daily increases of 0.11-1.41 cubic meters per second (m 3 /s) during 2014 and 2015, two critically dry years. Results suggest that water purchases consistently cooled maximum daily stream temperatures and warmed nightly minimum temperatures. This prevented extremely low dissolved oxygen concentrations below 5.0 mg/L, but increased the duration of moderate conditions between 5.5 and 6.0 mg/L. Small water purchases less than approximately 0.71 m 3 /s per day had little benefit for Walker River habitat. Dissolved oxygen concentrations were affected by upstream environmental conditions, where suitable upstream water quality improved downstream conditions and vice versa. Overall, this study showed that critically dry water years degrade environmental water quality and habitat, but environmental water purchases of at least 0.71 m 3 /s were promising for river restoration. Published by Elsevier Ltd.

Prevalence and correlates of internet cigarette purchasing among adult smokers in New Jersey.

PubMed

Hrywna, M; Delnevo, C D; Staniewska, D

2004-09-01

To examine the prevalence and correlates of internet cigarette purchasing among adult smokers. Analysis of internet purchasing in data from a population based telephone survey of New Jersey households. Logistic regression was used to determine factors associated with internet cigarette purchasing, adjusting for year, demographic, and smoking behaviour variables. 3447 current cigarette smokers pooled from three cross sectional surveys conducted in 2000, 2001, and 2002. Ever purchasing tobacco and usually buying cigarettes via the internet. Among all current cigarette smokers, ever having purchased tobacco via the internet increased from 1.1% in 2000 to 6.7% in 2002 and usually buying cigarettes via the internet increased from 0.8% in 2000 to 3.1% in 2002. Among current cigarette smokers with internet access, ever having purchased tobacco via the internet was higher among those who reported smoking 31 or more cigarettes per day (adjusted odds ratio (OR) 3.9, 95% confidence interval (CI) 1.5 to 10.2) and those without a past year quit attempt (adjusted OR 1.8, 95% CI 1.1 to 3.0). Usually purchasing cigarettes via the internet was higher among those aged 45-64 years (adjusted OR 4.4, 95% CI 1.1 to 17.1) and who reported having their first cigarette < or = 30 minutes after waking (adjusted OR 3.3, 95% CI 1.2 to 9.2). Although higher prices are known to reduce the demand for cigarettes, internet cigarette purchasing is likely to weaken this effect, particularly among heavy, more dependent smokers who are less interested in quitting.

Medicare and Medicaid programs; CY 2015 Home Health Prospective Payment System rate update; Home Health Quality Reporting Requirements; and survey and enforcement requirements for home health agencies. Final rule.

PubMed

2014-11-06

This final rule updates Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2015. As required by the Affordable Care Act, this rule implements the second year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule provides information on our efforts to monitor the potential impacts of the rebasing adjustments and the Affordable Care Act mandated face-to-face encounter requirement. This rule also implements: Changes to simplify the face-to-face encounter regulatory requirements; changes to the HH PPS case-mix weights; changes to the home health quality reporting program requirements; changes to simplify the therapy reassessment timeframes; a revision to the Speech-Language Pathology (SLP) personnel qualifications; minor technical regulations text changes; and limitations on the reviewability of the civil monetary penalty provisions. Finally, this rule also discusses Medicare coverage of insulin injections under the HH PPS, the delay in the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and a HH value-based purchasing (HH VBP) model.

Effects of Computer-Based Video Instruction on the Acquisition and Generalization of Grocery Purchasing Skills for Students with Intellectual Disability

ERIC Educational Resources Information Center

Goo, Minkowan; Therrien, William J.; Hua, Youjia

2016-01-01

The purpose of this study was to evaluate the effects of computer-based video instruction (CBVI) on teaching grocery purchasing skills to students with moderate intellectual disability (ID). Four high school students with mild to moderate ID participated in the study. A multiple-probe design across students was used to examine the effects. Results…

Producer or purchaser: different expectations may lead to equine wastage and welfare concerns.

PubMed

Hennessy, Karen D; Quinn, Katherine M; Murphy, Jack

2008-01-01

Horses are individual, each having differential characteristics such as height, color, breeding, conformation, and temperament. These bio-characteristics often influence potential purchasers when buying horses. This study sought to investigate if producers and potential purchasers placed similar emphasis on equine bio-characteristics. Sport-horse stakeholders--n = 1377 (792 producers and 585 potential purchasers)--rated various equine bio-characteristics on a Likert psychometric response scale during a questionnaire-based survey. The study analyzed responses, using the Wilcoxan test for statistical significance. The findings indicated consensus between producers and potential purchasers for equine soundness, conformation, and movement. Producers attached significantly greater importance to gender, color, pedigree details, and performance records of the horse and the horse's siblings. In contrast, potential purchasers rated equine temperament and presence (aesthetic appeal) as significantly more important attributes. Shortcomings in suitability for purpose of the horse (such as temperament) could lead to unnecessary wastage and welfare concerns. Producers need to understand consumer expectations/demands to maximize profitability and to avoid wastage and the production of unsuitable horses.

42 CFR 457.1010 - Purchase of family coverage.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Purchase of family coverage. 457.1010 Section 457... Waivers: General Provisions § 457.1010 Purchase of family coverage. A State may purchase family coverage... family coverage is cost-effective under the standards described in § 457.1015; (b) The State does not...

25 CFR 117.10 - Purchase of automotive equipment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Purchase of automotive equipment. 117.10 Section 117.10... COMPETENCY § 117.10 Purchase of automotive equipment. The superintendent may disburse from the surplus funds of an adult Indian not to exceed $2,000 for the purchase of automotive equipment when the Indian...

25 CFR 117.10 - Purchase of automotive equipment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Purchase of automotive equipment. 117.10 Section 117.10... COMPETENCY § 117.10 Purchase of automotive equipment. The superintendent may disburse from the surplus funds of an adult Indian not to exceed $2,000 for the purchase of automotive equipment when the Indian...

25 CFR 117.10 - Purchase of automotive equipment.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Purchase of automotive equipment. 117.10 Section 117.10... COMPETENCY § 117.10 Purchase of automotive equipment. The superintendent may disburse from the surplus funds of an adult Indian not to exceed $2,000 for the purchase of automotive equipment when the Indian...

25 CFR 117.10 - Purchase of automotive equipment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Purchase of automotive equipment. 117.10 Section 117.10... COMPETENCY § 117.10 Purchase of automotive equipment. The superintendent may disburse from the surplus funds of an adult Indian not to exceed $2,000 for the purchase of automotive equipment when the Indian...

25 CFR 117.10 - Purchase of automotive equipment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Purchase of automotive equipment. 117.10 Section 117.10... COMPETENCY § 117.10 Purchase of automotive equipment. The superintendent may disburse from the surplus funds of an adult Indian not to exceed $2,000 for the purchase of automotive equipment when the Indian...

42 CFR 457.1010 - Purchase of family coverage.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Purchase of family coverage. 457.1010 Section 457... Waivers: General Provisions § 457.1010 Purchase of family coverage. A State may purchase family coverage... family coverage is cost-effective under the standards described in § 457.1015; (b) The State does not...

7 CFR 782.18 - Wheat purchased for export.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 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...

Update on value-based medicine.

PubMed

Brown, Melissa M; Brown, Gary C

2013-05-01

To update concepts in Value-Based Medicine, especially in view of the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act assures that some variant of Value-Based Medicine cost-utility analysis will play a key role in the healthcare system. It identifies the highest quality care, thereby maximizing the most efficacious use of healthcare resources and empowering patients and physicians.Standardization is critical for the creation and acceptance of a Value-Based Medicine, cost-utility analysis, information system, since 27 million different input variants can go into a cost-utility analysis. Key among such standards is the use of patient preferences (utilities), as patients best understand the quality of life associated with their health states. The inclusion of societal costs, versus direct medical costs alone, demonstrates that medical interventions are more cost effective and, in many instances, provide a net financial return-on-investment to society referent to the direct medical costs expended. Value-Based Medicine provides a standardized methodology, integrating critical, patient, quality-of-life preferences, and societal costs, to allow the highest quality, most cost-effective care. Central to Value-Based Medicine is the concept that all patients deserve the interventions that provide the greatest patient value (improvement in quality of life and/or length of life).

Value of oak woodlands and open space on private property values in southern California

Treesearch

Richard B. Standiford; Thomas Scott

2002-01-01

Rapid urbanization of California's oak woodlands is having a pronounced effect on its ecological values. These areas are sought out for new residential sites to a large degree because of their amenity values. In response to this rapid exurban migration, there has been an increase in use of conservation easements and purchase of development rights by land trusts...

Extrinsic attributes that influence parents' purchase of chocolate milk for their children.

PubMed

Li, Xiaomeng E; Lopetcharat, Kannapon; Drake, MaryAnne

2014-07-01

The consumption of milk is essential for children's heath; and flavored milk, especially chocolate milk, is often purchased to increase children's milk consumption. However, the sugar content of chocolate milk has raised health concerns. As such, it is important to understand chocolate milk extrinsic attributes that influence parents' purchase decisions when they are purchasing chocolate milk for their children. The objective of this study was to determine the key extrinsic attributes for parents when they purchase chocolate milk for their children. An online survey with a conjoint analysis design, emotions questions, and Kano questionnaire that focused on chocolate milk was conducted targeting parents. Three hundred and twelve parents participated in the survey. Parents reported positive emotions including good, good natured, happy, loving, and satisfied when purchasing chocolate milk for their kids. Three segments of parents were identified with subtle but distinct differences in their key preferences for chocolate milk attributes for their children. Type of sweetener was the primary driver of choice for purchasing chocolate milk for children followed by fat content. Among sweetener types, natural noncaloric/nonnutritive sweeteners or sucrose were preferred over artificial sweeteners, and reduced fat was preferred over full fat or skim milk. Kano results revealed that reduced fat and sugar with an all natural label and added vitamins, minerals, and protein were attractive to the majority of parents when purchasing chocolate milk for their kids. Understanding the driving extrinsic attributes for parents when they purchase chocolate milk for their children will assist manufacturers to target extrinsic attributes that are attractive to parents for chocolate milk. This study established that sweetener type and fat content are the primary extrinsic attributes affecting parents purchase decisions when choosing chocolate milk for their children. Different segments of

Influence of Price and Labeling on Energy Drink Purchasing in an Experimental Convenience Store.

PubMed

Temple, Jennifer L; Ziegler, Amanda M; Epstein, Leonard H

2016-01-01

To examine the impact of energy drink (ED) pricing and labeling on the purchase of EDs. Participants visited a laboratory-based convenience store 3 times and purchased a beverage under different ED labeling (none, caffeine content, and warning labels) and pricing conditions. The 36 participants (aged 15-30 years) were classified as energy drink consumers (≥ 2 energy drinks/wk) and nonconsumers (< 1 energy drink/mo). Data were log transformed to generate elasticity coefficients. The authors analyzed changes in elasticity as a function of price and labeling using mixed-effects regression models. Increasing the price of EDs reduced ED purchases and increased purchasing of other caffeinated beverages among ED consumers. Energy drink labels affected ED sales in adolescents. These data suggest that ED pricing and labeling may influence the purchasing of ED, especially in adolescent consumers. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Establishing values-based leadership and value systems in healthcare organizations.

PubMed

Graber, David R; Kilpatrick, Anne Osborne

2008-01-01

The importance of values in organizations is often discussed in management literature. Possessing strong or inspiring values is increasingly considered to be a key quality of successful leaders. Another common theme is that organizational values contribute to the culture and ultimate success of organizations. These conceptions or expectations are clearly applicable to healthcare organizations in the United States. However, healthcare organizations have unique structures and are subject to societal expectations that must be accommodated within an organizational values system. This article describes theoretical literature on organizational values. Cultural and religious influences on Americans and how they may influence expectations from healthcare providers are discussed. Organizational cultures and the training and socialization of the numerous professional groups in healthcare also add to the considerable heterogeneity of value systems within healthcare organizations. These contribute to another challenge confronting healthcare managers--competing or conflicting values within a unit or the entire organization. Organizations often fail to reward members who uphold or enact the organization's values, which can lead to lack of motivation and commitment to the organization. Four key elements of values-based leadership are presented for healthcare managers who seek to develop as values-based leaders. 1) Recognize your personal and professional values, 2) Determine what you expect from the larger organization and what you can implement within your sphere of influence, 3) Understand and incorporate the values of internal stakeholders, and 4) Commit to values-based leadership.

Power Purchase Agreements | Climate Neutral Research Campuses | NREL

Science.gov Websites

. Examples of how some research campuses have used PPAs are provided below. Power Purchase Agreements , primarily to implement on-site energy installations. The owner, in this case a research campus, is typically Power Purchase Agreements Research campuses can use power purchase agreements (PPAs), such as

7 CFR 782.17 - Wheat purchased for resale.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Wheat purchased for resale. 782.17 Section 782.17... § 782.17 Wheat purchased for resale. (a) This section applies to an importer or subsequent buyer who imports or purchases Canadian-produced wheat for the purpose of reselling the wheat. (b) The importer or...

Behavioural aspects surrounding medicine purchases from pharmacies in Australia

PubMed Central

Emmerton, Lynne

2008-01-01

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 dynamics of

Purchasing health services abroad: practices of cross-border contracting and patient mobility in six European countries.

PubMed

Glinos, Irene A; Baeten, Rita; Maarse, Hans

2010-05-01

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.

Exploring Online Purchasing.

ERIC Educational Resources Information Center

Fickes, Michael

2001-01-01

Examines the setup of American University's electronic procurement system and explains how it works and the benefits it brings to the school. Cautionary advice on setting up an online purchasing system is also offered. (GR)

48 CFR 313.303 - Blanket purchase agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Blanket purchase agreements. 313.303 Section 313.303 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES....303 Blanket purchase agreements. ...

Parent outcome expectancies for purchasing fruit and vegetables: a validation.

PubMed

Baranowski, Tom; Watson, Kathy; Missaghian, Mariam; Broadfoot, Alison; Baranowski, Janice; Cullen, Karen; Nicklas, Theresa; Fisher, Jennifer; O'Donnell, Sharon

2007-03-01

To validate four scales -- outcome expectancies for purchasing fruit and for purchasing vegetables, and comparative outcome expectancies for purchasing fresh fruit and for purchasing fresh vegetables versus other forms of fruit and vegetables (F&V). Survey instruments were administered twice, separated by 6 weeks. Recruited in front of supermarkets and grocery stores; interviews conducted by telephone. One hundred and sixty-one food shoppers with children (18 years or younger). Single dimension scales were specified for fruit and for vegetable purchasing outcome expectancies, and for comparative (fresh vs. other) fruit and vegetable purchasing outcome expectancies. Item Response Theory parameter estimates revealed easily interpreted patterns in the sequence of items by difficulty of response. Fruit and vegetable purchasing and fresh fruit comparative purchasing outcome expectancy scales were significantly correlated with home F&V availability, after controlling for social desirability of response. Comparative fresh vegetable outcome expectancy scale was significantly bivariately correlated with home vegetable availability, but not after controlling for social desirability. These scales are available to help better understand family F&V purchasing decisions.

Monitoring And Modeling Environmental Water Quality To Support Environmental Water Purchase Decision-making

NASA Astrophysics Data System (ADS)

Null, S. E.; Elmore, L.; Mouzon, N. R.; Wood, J. R.

2016-12-01

More than 25 million cubic meters (20,000 acre feet) of water has been purchased from willing agricultural sellers for environmental flows in Nevada's Walker River to improve riverine habitat and connectivity with downstream Walker Lake. Reduced instream flows limit native fish populations, like Lahontan cutthroat trout, through warm daily stream temperatures and low dissolved oxygen concentrations. Environmental water purchases maintain instream flows, although effects on water quality are more varied. We use multi-year water quality monitoring and physically-based hydrodynamic and water quality modeling to estimate streamflow, water temperature, and dissolved oxygen concentrations with alternative environmental water purchases. We simulate water temperature and dissolved oxygen changes from increased streamflow to prioritize the time periods and locations that environmental water purchases most enhance trout habitat as a function of water quality. Monitoring results indicate stream temperature and dissolved oxygen limitations generally exist in the 115 kilometers upstream of Walker Lake (about 37% of the study area) from approximately May through September, and this reach acts as a water quality barrier for fish passage. Model results indicate that low streamflows generally coincide with critically warm stream temperatures, water quality refugia exist on a tributary of the Walker River, and environmental water purchases may improve stream temperature and dissolved oxygen conditions for some reaches and seasons, especially in dry years and prolonged droughts. This research supports environmental water purchase decision-making and allows water purchase decisions to be prioritized with other river restoration alternatives.

Incentivizing fruit and vegetable purchases among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children.

PubMed

Andreyeva, Tatiana; Luedicke, Joerg