605 research outputs found

    Development of a Tourism Destination: Exploring the Role of Destination Capabilities

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    This article aims to identify the key elements underlying a destination capability (DC) and to examine what the genesis of these factors is and how they interact to foster the destination development. The article explores a specific development process—the creation of a new product in an alpine destination (Livigno, Italy)—making use of a theoretical framework structured around four major dimensions: DCs, coordination at the destination level, inter-destination bridge ties, and destination development. The results help clarify the genesis of a DC in the context of new product development. First, the dynamics underlying the creation of a DC show that coordination at the destination level constitutes the heart of the process, whereas the integration of scattered resources in the new product plays a more limited role. Second, from a dynamic perspective, the analysis has identified three patterns (scouting, implementation, and involvement)

    Osteoporosis in rheumatoid arthritis: role of the vitamin D/parathyroid hormone system

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    AbstractOsteoporosis is a well-established extra-articular feature of rheumatoid arthritis (RA). Systemic inflammation seems to play a crucial role in causing an alteration of multiple homeostatic systems implied in bone health, such as the RANK/RANKL/Osteoprotegerin and Wnt/β catenin pathways; several other causal factors have been called into question, including the chronic use of corticosteroids. Since vitamin D exerts important immune-regulatory roles, it has been claimed that derangement of the vitamin D/parathyroid hormone (PTH) system, a well-known determinant of bone health, may play a pathogenic role in autoimmunity; animal models and clinical data support this hypothesis. Furthermore, RA patients seem to be relatively refractory to vitamin D-induced PTH suppression. Therefore, the link between RA and osteoporosis might in part be due to alterations in the vitamin D/PTH system. A better understanding of the pathophysiology of this system may be crucial to prevent and cure osteoporosis in patients with inflammatory/autoimmune diseases. A major clinical correlate of the strict cooperation and interdependence between vitamin D and PTH is that correction of the vitamin D deficiency, at least in autoimmune diseases, should be targeted to PTH suppression

    Hotel performance: Rigor and relevant research topics

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    Academic research (rigor) in alignment with practitioners’ challenges (relevancy) has been advocated as a way of overcoming the ivory tower syndrome. Performance measurement is at the heart of strategic management processes, as it provides a mechanism of demonstrating outcomes. Given the importance of this topic for both theory and practice, this article explores the contribution of academic outputs in terms of academic research outputs (rigor) and current practitioners’ needs (relevancy). Using network analysis and cross-citation bibliometric approaches, a sample of 1,155 articles is examined and fourteen clusters are identified. The emergent topics and subtopics from the academic literature are compared to ten insights proposed by Ernst Young to the hotel sector. The findings suggest a good fit between the two approaches together with some gaps. Based from empirical results, nine propositions are articulated

    RevPAR determinants of individual hotels: evidences from Milan

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    Purpose – This paper aims to identify revenue per available room (RevPAR) determinants of individual firms located in a destination. Independent variables are to be sought along “what” and “where” dimensions. Design/methodology/approach – The sample is composed of 72 individual firms, operating in the 3-5 star range and data have been collected from financial statements and questionnaires. Findings – The empirical findings identify four main significant determinants linked to the “what” positioning – number of rooms, number of employees, number of years since the last refurbishment, market orientation – and confirm the relevance of location (“where”), and especially of centrality within the destination. Research limitations/implications – At a theoretical level, the findings suggest the importance of linking the identification of determinants with the local context (destination) and positioning inside the city (location). At an empirical level, the study suggests some interesting implications both for existing hotels and for start-ups. For existing firms, empirical findings show the relevance of a strong advantage (disadvantage) in location (where) that might compensate for a disadvantage (advantage) in the strategic positioning (what). Concerning start-ups, the findings confirm the old rules of the hotel game, significantly summarized in the three success factors of a hotel unit: location, location, and location. Originality/value – The present paper suggests the usefulness of taking into greater account the link between destination and local firms as an important determinant of performance, and explores the key success factors for individual (not affiliated) firms

    The Significance of Impaired Fasting Glucose Versus Impaired Glucose Tolerance: Importance of insulin secretion and resistance

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    OBJECTIVE—The American Diabetes Association recommended substituting 2hBS (glycemia at the second hour of an oral glucose tolerance test [OGTT]) for fasting blood glucose (FBS) in screening for glucose intolerance. It is debated whether these tests measure the same abnormality and relate to defective insulin secretion or resistance. This study examines the diagnostic effectiveness of FBS versus 2hBS and their relationship with insulin secretion and resistance. RESEARCH DESIGN AND METHODS—Based on history or physical findings suggesting glucose intolerance, we enrolled 398 unselected subjects admitted to a general Internal Medicine ward. After 5 days of a weight-maintaining diet, FBS, 2hBS, and insulin were measured during OGTT. The homeostatic model assessment was used to assess β-cell function and insulin resistance. RESULTS—Excluding 19 patients with diabetes (5%), we identified 284 subjects with normal glucose tolerance (NGT), 22 with isolated impaired fasting glucose (IFG), 59 with isolated impaired glucose tolerance (IGT), and 14 with associated IFG/IGT. The sensitivity of FBS in predicting 2hBS was 19%, specificity 93%. Positive and negative predictive values were 39% and 83%, respectively. Insulin resistance was absent in NGT and IFG and markedly elevated in IGT and IFG/IGT, whereas defective insulin release was significant only in isolated IFG. CONCLUSIONS—In unselected patients, elevated FBS depends primarily on defective insulin secretion, and impaired 2hBS on insulin resistance. Because these tests measure different alterations, they are useful in combination

    Hyperglycemic Hyperosmolar State: A Pragmatic Approach to Properly Manage Sodium Derangements

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    Although hypovolemia remains the most relevant problem during acute decompensated diabetes in its clinical manifestations (diabetic ketoacidosis, DKA, and hyperglycemic hyperosmolar state, HHS), the electrolyte derangements caused by the global hydroelectrolytic imbalance usually complicate the clinical picture at presentation and may be worsened by the treatment itself
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