Hyper-IgG4 disease: report and characterisation of a new disease

BACKGROUND: We highlight a chronic inflammatory disease we call 'hyper-IgG4 disease', which has many synonyms depending on the organ involved, the country of origin and the year of the report. It is characterized histologically by a lymphoplasmacytic inflammation with IgG4-positive cells and exuberant fibrosis, which leaves dense fibrosis on resolution. A typical example is idiopathic retroperitoneal fibrosis, but the initial report in 2001 was of sclerosing pancreatitis. METHODS: We report an index case with fever and severe systemic disease. We have also reviewed the histology of 11 further patients with idiopathic retroperitoneal fibrosis for evidence of IgG4-expressing plasma cells, and examined a wide range of other inflammatory conditions and fibrotic diseases as organ-specific controls. We have reviewed the published literature for disease associations with idiopathic, systemic fibrosing conditions and the synonyms: pseudotumour, myofibroblastic tumour, plasma cell granuloma, systemic fibrosis, xanthofibrogranulomatosis, and multifocal fibrosclerosis. RESULTS: Histology from all 12 patients showed, to varying degrees, fibrosis, intense inflammatory cell infiltration with lymphocytes, plasma cells, scattered neutrophils, and sometimes eosinophilic aggregates, with venulitis and obliterative arteritis. The majority of lymphocytes were T cells that expressed CD8 and CD4, with scattered B-cell-rich small lymphoid follicles. In all cases, there was a significant increase in IgG4-positive plasma cells compared with controls. In two cases, biopsies before and after steroid treatment were available, and only scattered plasma cells were seen after treatment, none of them expressing IgG4. Review of the literature shows that although pathology commonly appears confined to one organ, patients can have systemic symptoms and fever. In the active period, there is an acute phase response with a high serum concentration of IgG, and during this phase, there is a rapid clinical response to glucocorticoid steroid treatment. CONCLUSION: We believe that hyper-IgG4 disease is an important condition to recognise, as the diagnosis can be readily verified and the outcome with treatment is very good

Social Innovation in Tourism: Unleashing The Time-Money Constraint

This study aims to explore whether the time-money constraint in tourism can be exerted to foster unconventional social innovation in the tourism industry. This study builds its conceptual framework upon the concept of time banking as an alternative currency in spurring social innovation in the tourism economy. To explore the applicability of the concept in tourism, we investigated the intentions and needs of the supplier and consumer sides through interviews and focus groups. To explore the entrepreneurial perspective, three in-depth interviews were conducted respectively with the co-founder of TimeRepublik, an independent social entrepreneur, and a sharing economy specialist. Three focus groups were also conducted to evaluate and elaborate the practical application of the framework from a user’s point of view. We found that using time as a measure of work shows a potential to reconcile the time-money constraint especially for disadvantaged groups. However, this study has exposed discrepancies between the intentions and the needs of the social entrepreneurs and the users, undermining the feasibility of the concept in the tourism context. Namely, the challenges included the value of time, trust and relationship building, and network effects and scaling. As long as the innovation is unable to achieve inclusive and sustainable growth building upon its social values, the lack of user support will only lead to selected and limited application of the concept in tourism and therefore would fail to generate social benefits on a larger scale

The Spiral Economy: a Socially Progressive Circular Economy Model?

The Circular Economy (CE) is a well-established sustainability framework within the industry and business contexts, with strong advocates such as the Ellen MacArthur Foundation. It is designed to be restorative and regenerative, and through a continuous cycle aims to keep products, components, and materials at their highest utility and value at all times. It focuses on preserving and enhancing natural capital, optimising resource yields, and minimising system risks by managing finite stocks and renewable flows. The CE principles align strongly with the Sustainable Development Goal (SDG) framework, which is a relevant lens for further understanding how industry can strategically address environmental and social issues. However, while the CE framework claims to account for the three inter-related and co-evolutionary sustainability dimensions of social, economic and environmental it is challenged for its overt emphasis on the latter two aspects with less done to achieve social value and benefits for those involved in creating and managing the restorative and regenerative cycles. This chapter aims to address this key gap by critically reviewing relevant literature and arguing for a more socially integrated and progressive CE. It develops and presents an original conceptual framework called the Spiral Economy (SE)