Corporate Social Responsibility in the U.S. Travel Industry

As the travel industry consists of various sectors, which often depend on environmental and cultural resources, socially responsible business policies, programs and practices are essential to achieve sustainable tourism at the local as well as the global level. nonetheless, it has yet to be known how the industry perceives and practices corporate social responsibility (CSR) activities. Thus, this study aims to better understand the opinions about and engagementin (CSR) by the the U.S. travel industry. Results of a survey conducted to the members of Travel Industry Association of America can provide travel companies with an important reference point about the concept of and practices of CSR by the industry members. Moreover, results of this study will reveal areas for further research

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Functional and quality of life outcomes of localised prostate cancer treatments (prostate testing for cancer and treatment [ProtecT] study)

Objective To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision-making. Patients and Methods Men aged 50–69 years diagnosed with localised prostate cancer by prostate-specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external-beam radiotherapy (EBRT) with concurrent androgen-deprivation therapy (ADT) and 77 low-dose-rate brachytherapy (BT, not a randomised treatment). Patient-reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores. Results Treatment-received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P < 0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1 pad/day, persisting for 20% at 6 years, compared with no change in men receiving EBRT or AM (P < 0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6 years and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (P < 0.001) with lesser effects after BT. No treatment affected mental or physical QoL. Conclusion Treatment decision-making for localised prostate cancer can be informed by these 6-year functional and QoL outcomes

Economics of tour packaging

Typescript.Thesis (Ph. D.)--University of Hawaii at Manoa, 1984.Bibliography: leaves 182-185.Microfiche.lMaster negative: Microfiche MS33168.ix, 185 leaves, bound ill. 29 cmThis dissertation analyzes the phenomenon of tour packaging from an economic viewpoint. There are many instances in the market-place of goods being sold as packages. Tourism products are just one example. The literature on packaging in general is reviewed with the conclusion that most economic explanations for this phenomenon (except for Barzel) conclude that monopoly power is a prerequisite. Tour packaging under competition and under monopoly conditions are analyzed. The types of tours and the price structures are different in each category. In monopoly conditions only one type of tour is offered (usually all-inclusive), whereas in competitive situations companies offer basic, intermediate and inclusive tours. Data on tours to the Hawaiian Islands were analyzed. Basic tours were found to offer an average of 14% discount over the equivalent retail costs. Intermediate tours and inclusive tours were found to charge a small premium. Progressively more tourists travel independently than on a basic tour; more travel on a basic tour than on an intermediate tour and more travel on an intermediate tour than on an inclusive tour. The addition of components to a tour requires an additional degree of taste similarity among participants. It was found that the more inclusive the tour, the less variance in socio-economic characteristics of the tourists. The consumer's vacation mode decision is modeled as a two-stage decision. The first stage is the consumer's decision of whether to travel independently or to purchase a tour. The second stage is, given that a tour is chosen, the type of package tour that will be purchased. Logit analysis is used to predict the consumer's choice. It is found that there are three factors affecting the first stage of the consumer's vacation mode decision. They are the information and transaction costs associated with each option, the price difference (or ratio), and the additional utility perceived by traveling with a group. The second stage of the decision model was found to be affected only by the number of destinations visited (a proxy for information and transaction costs). Price difference (or ratio) and socio-economic factors were not found to be significant factors in the vacation mode choice

Les réseaux de distribution des voyages aux États-Unis

The U.S. Travel distribution network is changing as less traditional intermediaries and more advanced technologies are developed to match suppliers with consumers. Computer networks are likely to become more global, more comprehensive and more accessible to all travel planners making their jobs easier. All travel planners will be presented with new challenges and demands as the travel market diversifies. The nature of the travel product will ensure the existence of travel intermediaries, however, their future success will be dependent on their ability to adapt to change