Sustainable supply chain management in tourism

Sustainable supply chain management (SSCM) encapsulates the trend to use purchasing policies and practices to facilitate sustainable development at the tourist destination. Most research has focused on environmental aspects of manufacturing, while other aspects of sustainability or the challenges for the service sector are largely ignored. Yet SSCM is particularly important for tour operators, as the product depends on the activities of suppliers, such as accommodation, transport and activities. Therefore, tour operators' contribution to sustainable tourism will be more effective through the definition and implementation of policies that acknowledge responsibility for the impacts of suppliers. Exploratory research of SSCM practices amongst tour operators generated a wide range of examples of good practice across the whole supply chain, and recommendations are made for more widespread engagement. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment

Optical spectroscopy-based imaging techniques for the diagnosis of breast cancer: A novel approach

There have been substantial advancements in optical spectroscopy-based imaging techniques in recent years. These developments can potentially herald a transformational change in the diagnostic pathway for diseases such as cancer. In this paper, we review the clinical and engineering aspects of novel optical spectroscopy-based imaging tools. We provide a comprehensive analysis of optical and non-optical spectroscopy-based breast cancer diagnosis techniques vis-à-vis the current standard techniques such as X-Ray mammography, ultrasonography, and tissue biopsy. The recent advancements in optical spectroscopy-based imaging systems such as Transillumination Imaging (TI) and the various types of Diffuse Optical Imaging (DOI) systems (parallel-plate, bed-based, and handheld) are examined. The engineering aspects, including mechanical, electronics, optics, automatic interpretation using artificial intelligence (AI), and ergonomics are discussed. The abilities of these technologies for measuring several cancer biomarkers such as hemoglobin, water, lipid, collagen, oxygen saturation (SO2), and tissue oxygenation index (TOI) are investigated. This article critically assesses the diagnostic ability and practical deployment of these new technologies to differentiate between the normal and cancerous tissue

Primary care challenges in diagnosing and referring patients with suspected rheumatoid arthritis: a national cross-sectional GP survey

Objective: National guidelines advocate referring patients with persistent synovitis to rheumatology within 3 working days of presentation to primary care. This occurs infrequently. We aimed to identify modifiable barriers to early referral of suspected RA patients among English general practitioners (GPs). Methods: We carried out a national cross-sectional survey of 1388 English GPs (RA Questionnaire for GPs [RA-QUEST] study). Questions addressed GPs’ confidence in diagnosing RA, clinical factors influencing RA diagnosis/referral, timeliness of referrals and secondary care access. Data were captured using 10-point visual analog scales, five-point Likert scales, yes/no questions or free text, and were analysed descriptively. Results: Small joint swelling and pain were most influential in diagnosing RA (91 and 84% rated the importance of these as 4 or 5 on a five-point Likert scale, respectively); investigations including RF (61% rating 4 or 5) and anti-CCP antibody (72% rating 4 or 5) were less influential. Patient history had the greatest impact on the decision to refer (92% rating this 4 or 5 on a 5-point Likert scale), with acute phase markers (74% rating 4 or 5) and serology (76% rating 4 or 5) less impactful. Despite the importance placed on history and examination, only 26% referred suspected RA immediately without investigations; 95% of GPs organizing further tests opted to test for RF. Conclusion: For suspected RA patients to be referred within 3 days of presentation to primary care there needs to be a paradigm shift in GPs’ approaches to making referral decisions, with a focus on clinical history and examination findings, and not the use of investigations such as RF

Group motivational intervention in overweight/obese patients in primary prevention of cardiovascular disease in the primary healthcare area

Background The global mortality caused by cardiovascular disease increases with weight. The Framingham study showed that obesity is a cardiovascular risk factor independent of other risks such as type 2 diabetes mellitus, dyslipidemia and smoking. Moreover, the main problem in the management of weight-loss is its maintenance, if it is achieved. We have designed a study to determine whether a group motivational intervention, together with current clinical practice, is more efficient than the latter alone in the treatment of overweight and obesity, for initial weight loss and essentially to achieve maintenance of the weight achieved; and, secondly, to know if this intervention is more effective for reducing cardiovascular risk factors associated with overweight and obesity. Methods This 26-month follow up multi-centre trial, will include 1200 overweight/obese patients. Random assignment of the intervention by Basic Health Areas (BHA): two geographically separate groups have been created, one of which receives group motivational intervention (group intervention), delivered by a nurse trained by an expert phsychologist, in 32 group sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard program of diet, exercise, and the other (control group), receiving the usual follow up, with regular visits every 3 months. Discussion By addressing currently unanswered questions regarding the maintenance in weight loss in obesity/overweight, upon the expected completion of participant follow-up in 2012, the IMOAP trial should document, for the first time, the benefits of a motivational intervention as a treatment tool of weight loss in a primary care setting

Development of a gastroschisis core outcome set

Objective Outcome reporting heterogeneity impedes identification of gold standard treatments for children born with gastroschisis. Use of core outcome sets (COSs) in research reduces outcome reporting heterogeneity and ensures that studies are relevant to patients. The aim of this study was to develop a gastroschisis COS. Design and setting Systematic reviews and stakeholder nomination were used to identify candidate outcomes that were subsequently prioritised by key stakeholders in a three-phase online Delphi process and face-to-face consensus meeting using a 9-point Likert scale. In phases two and three of the Delphi process, participants were shown graphical and numerical representations of their own, and all panels scores for each outcome respectively and asked to review their previous score in light of this information. Outcomes were carried forward to the consensus meeting if prioritised by two or three stakeholder panels in the third phase of the Delphi process. The COS was formed from outcomes where ≥70% of consensus meeting participants scored the outcome 7–9 and <15% of participants scored it 1–3. Results 71 participants (84%) completed all phases of the Delphi process, during which 87 outcomes were assessed. Eight outcomes, mortality, sepsis, growth, number of operations, severe gastrointestinal complication, time on parenteral nutrition, liver disease and quality of life for the child, met criteria for inclusion in the COS. Conclusions Eight outcomes have been included in the gastroschisis COS as a result of their importance to key stakeholders. Implementing use of the COS will increase the potential for identification of gold standard treatments for the management of children born with gastroschisis

Sustainability reporting practices and their social impact to NGO funding in Italy

This study analyses the growing social trends of sustainability reporting practices in non-governmental organisations (NGOs). Taking a preliminary step toward NGO funding, we consider the current lack of information disclosure in existing reporting practices, which are diverse and unsustainable. We investigate key organisational information in order to discover any potential links between funding sources and disclosure practices. In Italy, today there is an on-going effort to encourage public engagement in civil society. A percentage-tax law allows taxpayers to dedicate ‘cinque per mille’ (one-half percent)of their income to NGOs, which is then deducted from their tax obligation (Hereafter, ‘5 per thousand’). Our primary research objective is to understand if there is a link between the ‘5 per thousand’ donations that NGOs receive for providing social impact, and their reporting practices. Therefore, we critically analyse if and how sustainable reporting practices are achieved within the top 100 most funded NGOs that receive the ‘5 per thousand’ donation. We examine public data from official government records published by the Italian Revenue Agency. The findings suggest that sustainability reporting offers a number of financial and social advantages, including social impact that builds trust towards the idea of civil society and its funders. © 2019 Elsevier Lt