When food governance matters to consumer food choice: Consumer perception of and preference for food quality certifications.

Food quality certifications have been widely promoted for sustainable goals and addressing consumers' increasing concern for food safety. However, these mechanisms have achieved varied success in practice. Prior research notes the importance of certification and certifying agencies in making tangible an invisible process to build consumer trust in certified food. What we have yet to understand is if and how perceived trustworthiness of food actors, such as growers and retailers in that process, influences consumers' trust in food certification and their food choices. To extend the literature on food certification in a complex network environment, we examined consumer trust in three food certification schemes which represent two types (community-based versus third-party), two certification origins (international versus domestic), and two certification standards (organic versus Good Agricultural Practice or GAP). Data were collected via in-depth interviews with 27 participants in Vietnam. These participants have similar awareness of, access to and capability to afford organic food but differ in their food choice. This is the first study exploring consumers' perceptions of community-based certification in comparison with other third-party certifications in the same market. Our study shows that the variation in consumer trust in certifications depends on their perceived trustworthiness of the food system and its actors to deliver certified food. Findings reveal that the higher the level of trust in the certification, the lower the need for trust in food actors. Conversely, the lower the level of trust in the system, the higher the need for trust in food actors. Importantly, food chain governance, the mechanisms linking growers to retailers, increase consumers' trust in certified food. The study proposes two food governance frameworks to improve consumer trust in certification schemes in developing countries.

Are trust and consumption values important for buyers of organic food? A comparison of regular buyers, occasional buyers, and non-buyers.

Although many countries have promoted organic farming for its benefits, organic food remains a niche market. This study investigates the drivers of purchasing organic food by examining if and how consumers' consumption values influence the food choices of regular buyers, occasional buyers, and non-buyers of organic food. We use consumption values as a theoretical lens for classifying different motives for purchasing organic food. Data were collected using in-depth interviews with 27 Vietnamese participants who were comparable in terms of their awareness of, their ability to afford, and their access to, organic food. Thematic analysis was used to analyse the qualitative data. The study advances research in organic food consumption by showing that trust and distrust in the food system, a much wider concept than trust in food labelling, is a determinant of consumption values of organic food, and therefore a determinant of organic food choice. It also makes a valuable contribution to the organic consumption values literature by showing a clear difference in the importance of perceived consumption values across regular buyers, occasional buyers, and non-buyers of organic food. Furthermore, the study advances Sheth's (1991) theory of consumption values by providing a more nuanced understanding of how consumption values can be interrelated.

Integrated Scheduling and Capacity Planning with Considerations for Patients' Length-of-Stays.

Motivated by the shortcoming of current hospital scheduling and capacity planning methods which often model different units in isolation, we introduce the first dynamic multi-day scheduling model that integrates information about capacity usage at more than one location in a hospital. In particular, we analyze the first dynamic model that accounts for patients' length-of-stay and downstream census in scheduling decisions. Via a simple and innovative variable transformation, we show that the optimal number of patients to be allowed in the system is increasing in the state of the system and in the downstream capacity. Moreover, the total system cost exhibits decreasing marginal returns as the capacity increases at any location independently of another location. Through numerical experiments on realistic data, we show that there is substantial value in making integrated scheduling decisions. In contrast, localized decision rules that only focus on a single location of a hospital can result in up to 60% higher expenses.

Case Sequencing of Diagnostic Imaging Studies Performed Under General Anesthesia or Monitored Anesthesia Care During Nights and Weekends.

General anesthesia or monitored anesthesia care sometimes is provided in nonoperating room (OR) locations during nights and weekends (e.g., for magnetic resonance imaging [MRI] or computerized tomography [CT]). Rational and consistent scheduling and sequencing decisions for these diagnostic imaging procedures, including coordination with OR cases, cannot be done without knowing how long each case can wait to be started without risking a worsening of the patient's condition. We reviewed the medical records of the 81 patients who underwent diagnostic imaging procedures (78 = MRI, 3 = CT scan) under general anesthesia or monitored anesthesia care either on weekends or between 6 pm and 6 am at the University of Iowa Hospitals between March 2012 and February 2014. For 77.8% of patients, the indications could have changed clinical management within 4 hours (N = 63/81). Among the 63 imaging studies with potential immediate impact, there was documentation of results having been communicated to the treating team within 4 hours of the completion of imaging for 39 of the patients. Among the 39 patients, 15 promptly received medications or underwent procedures based on the imaging results. Thus, 15 of the 81 patients had a change in care (18.5%, 95% lower confidence limit = 11.2%). Our results are important since we showed previously that it is not possible to make rational and consistent decisions in case sequencing without knowing how long each case (including diagnostic imaging procedures) can wait to be started without a change in the patient's risk. The scheduled surgical procedure itself provides sufficient information to assess safe waiting times to start add-on cases (e.g., appendectomy). In contrast, MRI provides no context as to how potential findings will influence treatment. Our results show that the assumption cannot reasonably be made when sequencing cases that all imaging studies can or cannot wait longer than pending surgical procedures. Our results show that, for evidence-based OR management decision-making, information to decide appropriate waiting should be obtained electronically or verbally for each imaging study.

The pediatric vaccine stockpiling problem.

The U.S. has experienced many major interruptions of its pediatric vaccine production in the past decade. The Centers for Disease Control and Prevention (CDC) copes with these shortages by building a national stockpile of pediatric vaccines, which it makes accessible to the public in the event of a shortage. The management of this stockpile is difficult due to limited production capacity and long and unpredictable production interruptions. In this paper, we address policies for managing the stockpile. We provide sufficient conditions for the optimal policy to be a modified state-dependent base-stock policy, with the base-stock level decreasing in the pipeline inventory. Since the optimal policy is in general difficult to evaluate, we derive bounds on the optimal decision in each period. We develop an efficient policy that performs on average within 1% of optimality in simulations. We show that stocking the same supply of vaccine of every type can be over-conservative in some cases, and inadequate in others by large factors. We also quantify the substantial reduction in inventory level that can be achieved when there are multiple suppliers in the market.