Unveiling barriers to sustainable public procurement in emerging economies: Evidence from a leading sustainable supply chain initiative in Latin America

In light of the Theory of Ecological Modernisation, this is the first work to explore the organisational barriers affecting one of the most significant sustainable public procurement initiatives in Latin America: the Brazilian Environmental Agenda for Public Operations Management (the ‘A3P Programme’). This article explores the barriers to sustainable procurement in a Brazilian context, inspired by the work of Brammer and Walker (2011). Based on the results of a survey of programme managers, our first recommendation is to group the barriers to sustainable procurement into five categories: organisational culture, motivation, economic uncertainty, market, and operations. Amongst these, it was found that organisational culture stands out as a particular barrier to sustainable public procurement. This work also highlights Ecological Modernisation Theory as a useful tool for understanding why variables related to cost and budget are not barriers to implementing sustainable public procurement initiatives. Consequently, the main implication of this study is that government should consider cultural change management when developing sustainability management initiatives. © 201

Prediction of Breast Cancer Risk Based on Profiling With Common Genetic Variants

Background: Data for multiple common susceptibility alleles for breast cancer may be combined to identify women at different levels of breast cancer risk. Such stratification could guide preventive and screening strategies. However, empirical evidence for genetic risk stratification is lacking. Methods: We investigated the value of using 77 breast cancer-associated single nucleotide polymorphisms (SNPs) for risk stratification, in a study of 33 673 breast cancer cases and 33 381 control women of European origin. We tested all possible pair-wise multiplicative interactions and constructed a 77-SNP polygenic risk score (PRS) for breast cancer overall and by estrogen receptor (ER) status. Absolute risks of breast cancer by PRS were derived from relative risk estimates and UK incidence and mortality rates. Results: There was no strong evidence for departure from a multiplicative model for any SNP pair. Women in the highest 1% of the PRS had a three-fold increased risk of developing breast cancer compared with women in the middle quintile (odds ratio [OR] = 3.36, 95% confidence interval [CI] = 2.95 to 3.83). The ORs for ER-positive and ER-negative disease were 3.73 (95% CI = 3.24 to 4.30) and 2.80 (95% CI = 2.26 to 3.46), respectively. Lifetime risk of breast cancer for women in the lowest and highest quintiles of the PRS were 5.2% and 16.6% for a woman without family history, and 8.6% and 24.4% for a woman with a first-degree family history of breast cancer. Conclusions: The PRS stratifies breast cancer risk in women both with and without a family history of breast cancer. The observed level of risk discrimination could inform targeted screening and prevention strategies. Further discrimination may be achievable through combining the PRS with lifestyle/environmental factors, although these were not considered in this report.Peer reviewe