How much for your kidney? The rise of the global transplant tourism industry

The term 'Transplant Tourism' is becoming commonly used to describe any form of travel that serves in the attainment of new organs; this practice is utterly condemned by the medical community and the World Health Organisation. Medical Tourism involves tourists travelling to, 'obtain medical, dental and surgical care while simultaneously being holidaymakers' (Connell, 2006, p. 1094). British Medical Journal (2008) highlights that Medical Tourism is a billion dollar industry, where companies advertise health services and attract patients for a fraction of the price they would have paid at home (Turner, 2008a). However, the typically legitimate Medical Tourism industry's reputation is being tarnished by its association with Transplant Tourism. Human organs used in transplantation can be obtained in two ways: live organ donation or cadaveric organ procurement (Lamb, 1990). In general, recipients prefer having living donor transplants over deceased ones, as the former offer them a better chance of survival (Steinberg, 2004). There is a worldwide struggle to meet the demand for organs; the gap between supply and demand has stimulated global organ trade and transplant tourism. Transplant Tourism has been overlooked within tourism literature and hoping to begin a debate, this note investigates the concept of Transplant Tourism, outlining why it cannot, in general, be considered a legitimate part of the Medical Tourism industry

Commercial hospitality : a vehicle for the sustainable empowerment of Nepali women

To illustrate how commercial hospitality has catalysed sustainable social change in Nepal through empowering women. Utilising a new framework, developed by combining existing theories, empowerment of women Tea House owners/ managers is assessed. Within a critical feminist paradigm, primary research consisting of interviews and participant observation was undertaken in Nepal over a three month period in the central region of Nepal. Involvement in the hospitality industry improved the livelihoods of the women Tea House owners/ managers, it also has the potential to facilitate sustainable empowerment for future generations, providing them with education, choice, control and opportunities. Although steps were taken to limit rhetorical issues, language barriers could have influenced the findings of the interviews. To fully investigate the potential for hospitality to act as a vehicle for the sustainable empowerment of women, it is suggested that this study be replicated again in another region or that a detailed ethnographic study be carried out. Demonstrates how the commercial hospitality industry can be a force for good; women working in the industry are agents of change, actively improving their levels of empowerment in their immediate environment. The commercial hospitality industry has pioneered the empowerment of women and this could lay the foundation for the further emancipation of women. To date, there has been limited research into the relationship between involvement in the commercial hospitality sector and the empowerment of women; this paper begins to fill this gap by investigating a tourist region of Nepal

Love motels : oriental phenomenon or emergent sector?

This study explores the 'Love Motel' concept by examining the changing attitude of consumers in Taiwan. This will increase knowledge of the sector and define love motels. The literature review charts the development of Taiwanese love motels from a duel origin; American Motels and Japanese 'Love Hotels.' This is followed by an empirical qualitative study consisting of a two-stage collection strategy: focus groups of hospitality and tourism professionals to gather a wide range of opinions on the subject area followed by semi-structured interviews with consumers. The findings split into three interrelated areas: growth of Taiwanese love motels due to more liberal attitudes towards sexual practice; a change in the public perception of motels due to increased standards and an increased satisfaction with the personal consumption experience; these hotels are designed for couples. The empirical element of this study is an exploration of consumer experience in Taiwanese love hotels. Due to the sensitive nature of some of the data that was gathered a qualitative approach has been adopted. The sexual associations with this product appear almost coincidental. If the love motel product is considered in its purest form it is simply a hotel product that provides complete anonymity for its guests. Therefore, despite its application in South East Asia, this hospitality concept has potential to be applied in a variety of guises. The phenomenon of 'Love Hotels' is absent from hospitality management literature; this paper begins to fill that gap by beginning a discussion on this possibly controversial sector

Iranian hospitality : embodiment, experience and representation

This paper seeks to triangulate methods to locate the essence of Iranian hospitality within heritage settings. It uses caravanserais, hostels for travellers and their trains of animals, and bazaars, covered markets, as its foci. These buildings have always offered multi-sensual experiences and represented aspects of symbolic interaction, as well as facilitating physical exchange, between travellers and locals. Hospitality has been fundamental to their evolution and remains so, particularly for the commercial caravanserais and tea houses which now exist as refurbished heritage accommodation and restaurants. There has always been a strong tradition of hospitality in the Islamic world, and Islamic practice emulates Ibrahim in the Koran. The first method used is to interpret physical structures, and in particular to show how the physical form of caravanserais traditionally embodied dimensions of expectation and behaviour that have characterised hospitality since it was first codified. The second method recognises the importance of personal sensing and reflection as a method, articulating personal experiences between individuals to come to a group experience. Bazaars are the focus of this second method. These were communities within communities, and had commonly caravanserais, tea houses, houses, workshops, baths, mosques and madrasas sited within them. Their architecture is commonly geometrical and enclosed. Personal sensing is used as a means of representing the felt experiences of authenticity and sincerity which these buildings and their communities and users facilitate, and the role of hospitality within this. The third method used is a content analysis of the representations of utilitarian, experiential and symbolic selling points collated from Iranian tourism and hospitality knowledgeables. The third method operationalises the Prentice-O'Gorman Destination Appraisal Matrix methodology, as a means of understanding the experiential and symbolic products offered by contemporary Iranian hospitality. Particular attention is paid to authenticity and sincerity within the hospitality and wider tourism offering of Iran

"Responsible drinkers create all the atmosphere of a mortuary" : policy implementation of responsible drinking in Scotland

The purpose of this paper is to explore the reaction of customer facing staff and their attitude to the introduction of high profile corporate social responsibility (CSR) programmes; in particular their level of awareness and willingness to implement them. Conducted using a series of site visits and interviews with managers working within the licensed trade, this was followed up with structured interviews of "front line" staff. Despite high levels of awareness of both the social problems relating to alcohol consumption and the legislative changes, engagement with operational CSR was limited and often disinterested. Legal and societal expectations regarding drunkenness are of little concern. This paper is concerned with nascent legislation, the full impact and success of which has not yet emerged. Reviewing this study in five years would add to the strength of the results. Limited to Scotland due to its devolved licensing laws, however, it clearly highlights lack of employee engagement with CSR. Despite placing CSR issues at the forefront of day to day operations within the licensed trade there is little empirical evidence around customer facing staff engagement. CSR is a dynamic process that relies on the involvement of employees for its successful implementation. A new CSR implementation matrix is presented which allows hospitality businesses to be positioned according to levels of both management and employee engagement with CSR policies

Hospitality codes and social exchange theory : the Pashtunwali and tourism in Afghanistan

The Afghan people are shrouded in rumor, myth and superstition. Drawing upon insights from military personnel, intelligence operatives, journalists and others, this study uses Social Exchange Theory (SET) to frame our understanding of their underpinning cultural code, the Pashtunwali. The study contributes both theoretically and empirically: The nature of the Pashtunwali highlights that SET cannot adequately frame some cultural exchange practices and a hybrid framework for negotiated and reciprocal exchange is presented. Furthermore, contextually, this is the first study that explores a code of hospitality through a social exchange lens to explore potential tourism development. A framework exists upon which commercial activity can be built without altering beliefs, social dynamics or day to day pursuits. For commercial development to be successful, it must yield similar or greater levels of income to those that currently exist, more importantly, traditions of autonomy and self-dependence will affect employment and training within an emergent tourism industry

Impact of Community Treatment With Ivermectin for the Control of Scabies on the Prevalence of Antibodies to Strongyloides stercoralis in Children.

The prevalence of antibodies to Strongyloides stercoralis was measured in 0-12-year-olds using a bead-based immunoassay before and after ivermectin mass drug administration (MDA) for scabies in the Solomon Islands. Seroprevalence was 9.3% before and 5.1% after MDA (P = .019), demonstrating collateral benefits of ivermectin MDA in this setting

Randomized Trial of Community Treatment With Azithromycin and Ivermectin Mass Drug Administration for Control of Scabies and Impetigo.

BACKGROUND: Scabies is a public health problem in many countries, with impetigo and its complications important consequences. Ivermectin based mass drug administration (MDA) reduces the prevalence of scabies and, to a lesser extent, impetigo. We studied the impact of co-administering azithromycin on the prevalence of impetigo and antimicrobial resistance. METHODS: Six communities were randomized to receive either ivermectin-based MDA or ivermectin-based MDA co-administered with azithromycin. We measured scabies and impetigo prevalence at baseline and 12 months. We collected impetigo lesions swabs at baseline, 3 and 12 months to detect antimicrobial resistance. RESULTS: At baseline, scabies and impetigo prevalences were 11.8% and 10.1% in the ivermectin-only arm and 9.2% and 12.1% in the combined treatment arm. At 12 months, the prevalences had fallen to 1.0% and 2.5% in the ivermectin-only arm and 0.7% and 3.3% in the combined treatment arm. The proportion of impetigo lesions containing Staphylococcus aureus detected did not change (80% at baseline vs 86% at 12 months; no significant difference between arms) but the proportion containing pyogenic streptococci fell significantly (63% vs 23%, P < .01). At 3 months, 53% (8/15) of S. aureus isolates were macrolide-resistant in the combined treatment arm, but no resistant strains (0/13) were detected at 12 months. CONCLUSIONS: Co-administration of azithromycin with ivermectin led to similar decreases in scabies and impetigo prevalence compared to ivermectin alone. The proportion of impetigo lesions containing pyogenic streptococci declined following MDA. There was a transient increase in the proportion of macrolide-resistant S. aureus strains following azithromycin MDA. CLINICAL TRIALS REGISTRATION: clinicaltrials.gov (NCT02775617)

The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials.

BACKGROUND: Intolerance to enteral nutrition is common in critically ill adults, and may result in significant morbidity including ileus, abdominal distension, vomiting and potential aspiration events. Prokinetic agents are prescribed to improve gastric emptying. However, the efficacy and safety of these agents in critically ill patients is not well-defined. Therefore, we conducted a systematic review and meta-analysis to determine the efficacy and safety of prokinetic agents in critically ill patients. METHODS: We searched MEDLINE, EMBASE, and Cochrane Library from inception up to January 2016. Eligible studies included randomized controlled trials (RCTs) of critically ill adults assigned to receive a prokinetic agent or placebo, and that reported relevant clinical outcomes. Two independent reviewers screened potentially eligible articles, selected eligible studies, and abstracted pertinent data. We calculated pooled relative risk (RR) for dichotomous outcomes and mean difference for continuous outcomes, with the corresponding 95 % confidence interval (CI). We assessed risk of bias using Cochrane risk of bias tool, and the quality of evidence using grading of recommendations assessment, development, and evaluation (GRADE) methodology. RESULTS: Thirteen RCTs (enrolling 1341 patients) met our inclusion criteria. Prokinetic agents significantly reduced feeding intolerance (RR 0.73, 95 % CI 0.55, 0.97; P = 0.03; moderate certainty), which translated to 17.3 % (95 % CI 5, 26.8 %) absolute reduction in feeding intolerance. Prokinetics also reduced the risk of developing high gastric residual volumes (RR 0.69; 95 % CI 0.52, 0.91; P = 0.009; moderate quality) and increased the success of post-pyloric feeding tube placement (RR 1.60, 95 % CI 1.17, 2.21; P = 0.004; moderate quality). There was no significant improvement in the risk of vomiting, diarrhea, intensive care unit (ICU) length of stay or mortality. Prokinetic agents also did not significantly increase the rate of diarrhea. CONCLUSION: There is moderate-quality evidence that prokinetic agents reduce feeding intolerance in critically ill patients compared to placebo or no intervention. However, the impact on other clinical outcomes such as pneumonia, mortality, and ICU length of stay is unclear