The tourism industry is a major economic sector worldwide, significantly contributing to job creation and GDP growth. However, the rapid expansion of this industry, along with rising environmental and social concerns, underscores the critical need for sustainable strategies. This paper presents a novel multi-objective game theory model that simultaneously optimizes profitability and sustainability in the tourism supply chain. The key innovation of this study lies in the integration of game theory with an artificial neural network (ANN) to predict customer demand, effectively capturing nonlinear consumer behaviors and enabling more accurate decision-making. The model analyzes the dynamic interactions between tour operators and local service providers, identifying Nash Equilibrium outcomes where no player can improve profitability through unilateral strategy adjustments. Additionally, the study introduces a comprehensive approach to government subsidies, evaluating their effectiveness in enhancing sustainability incentives and overall profitability. A detailed sensitivity analysis is conducted to examine how variations in pricing, sustainability efforts, and subsidy rates influence profit margins. Another distinctive contribution of this research is its emphasis on human resource management, highlighting how employee training, green organizational culture, and financial incentives can improve productivity and support sustainability initiatives. The results demonstrate that collaborative strategies, such as resource sharing and joint sustainability efforts between tour operators and local providers, significantly increase profitability. The findings further indicate that a combination of optimal pricing, maximum sustainability efforts, and full government subsidies yields the highest total profit of 6,395 units. Overall, this research offers strategic guidelines for pricing, human resource development, and subsidy policies, providing a robust framework for achieving both profitability and sustainability in the tourism supply chain.
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Objective: To investigate the effects of a school-based once-a-week sports program on physical fitness, physical activity, and cardiometabolic health in children and adolescents with a physical disability. Methods: This controlled clinical trial included 71 children and adolescents from four schools for special education [mean age 13.7 (2.9) years, range 8–19, 55% boys]. Participants had various chronic health conditions including cerebral palsy (37%), other neuromuscular (44%), metabolic (8%), musculoskeletal (7%), and cardiovascular (4%) disorders. Before recruitment and based on the presence of school-based sports, schools were assigned as sport or control group. School-based sports were initiated and provided by motivated experienced physical educators. The sport group (n = 31) participated in a once-a-week school-based sports program for 6 months, which included team sports. The control group (n = 40) followed the regular curriculum. Anaerobic performance was assessed by the Muscle Power Sprint Test. Secondary outcome measures included aerobic performance, VO2 peak, strength, physical activity, blood pressure, arterial stiffness, body composition, and the metabolic profile. Results: A significant improvement of 16% in favor of the sport group was found for anaerobic performance (p = 0.003). In addition, the sport group lost 2.8% more fat mass compared to the control group (p = 0.007). No changes were found for aerobic performance, VO2 peak, physical activity, blood pressure, arterial stiffness, and the metabolic profile. Conclusion: Anaerobic performance and fat mass improved following a school-based sports program. These effects are promising for long-term fitness and health promotion, because sports sessions at school eliminate certain barriers for sports participation and adding a once-a-week sports session showed already positive effects for 6 months.
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Low heart rate variability (HRV) is related to health problems that are known reasons for sick-leave or early retirement. A 1-minute-protocol could allow large scale HRV measurement for screening of health problems and, potentially, sustained employability. Our objectives were to explore the association of HRV with measures of health. Cross-sectional design with 877 Dutch employees assessed during a Workers’ Health Assessment. Personal and job characteristics, workability, psychological and mental problems, and lifestyle were measured with questionnaires. Biometry was measured (BMI, waist circumference, blood pressure, glucose, cholesterol). HRV was assessed with a 1-minute paced deep-breathing protocol and expressed as mean heart rate range (MHRR). A low MHRR indicates a higher health risk. Groups were classified age adjusted for HRV and compared. Spearman correlations between raw MHRR and the other measures were calculated. Significant univariable correlations (p < 0.05) were entered in a linear regression model to explore the multivariable association with MHRR. Age, years of employment, BMI and waist circumference differed significantly between HRV groups. Significant correlations were found between MHRR and age, workability, BMI, waist circumference, cholesterol, systolic and diastolic blood-pressure and reported physical activity and alcohol consumption. In the multivariable analyses 21.1% of variance was explained: a low HRV correlates with aging, higher BMI and higher levels of reported physically activity. HRV was significantly associated with age, measures of obesity (BMI, waist circumference), and with reported physical activity, which provides a first glance of the utility of a 1-minute paced deep-breathing HRV protocol as part of a comprehensive preventive Workers’ Health Assessment.Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creat ivecommons .org/licen ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate redit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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At the beginning of May 2020 Inholland students received an invitation to participate in a large international study on the corona crisis impact on student life and studies. Almost 3000 students participated. This factsheet shows data on their lifestyleand their resilience. But also on their worries about corona, their knowledge of it and their opinion on the information supply.
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` In the Foodscapes research programme Wiskerke is emphasising three themes: the dynamics of urban and rural places and spaces and the way in which those urban and rural dynamics influence one another; the social and economic relations between the urban and rural within city regions; and the possibility to develop more sustainable foodscapes at the city region level through (re)design. Wiskerke connects those themes to spatial design research by masters students of landscape architecture. They are eminently positioned to present spatial proposals for future cultural landscapes and to make important aesthetic contributions to the transformation of areas. The design research project in Dar es Salaam is the first project in a series of three. The essays and designs presented in this book are not the solution for a more sustainable and resilient urban foodscape, but do provide interesting building blocks and food for thought for rethinking and reshaping Dar es Salaam’s foodscape, with a focus on food security and quality of life, especially for the urban poor. With contributions by Gianni Cito, Marc Wegerif, Jerryt Krombeen, Anna Maria Fink, Leonardo Kappel, Meintje Delisse, Roy van Maarseveen and Tim Kort.
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ObjectiveTo determine the effectiveness of the “Plants for Joints” multidisciplinary lifestyle program in patients with metabolic syndrome-associated osteoarthritis (MSOA).DesignPatients with hip or knee MSOA were randomized to the intervention or control group. The intervention group followed a 16-week program in addition to usual care based on a whole food plant-based diet, physical activity, and stress management. The control group received usual care. The patient-reported Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) total score (range 0–96) was the primary outcome. Secondary outcomes included other patient-reported, anthropometric, and metabolic measures. An intention-to-treat analysis with a linear-mixed model adjusted for baseline values was used to analyze between-group differences.ResultsOf the 66 people randomized, 64 completed the study. Participants (84% female) had a mean (SD) age of 63 (6) years and body mass index of 33 (5) kg/m2. After 16 weeks, the intervention group (n = 32) had a mean 11-point larger improvement in WOMAC-score (95% CI 6–16; p = 0.0001) compared to the control group. The intervention group also lost more weight (–5 kg), fat mass (–4 kg), and waist circumference (–6 cm) compared to the control group. Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue, pain interference, C-reactive protein, hemoglobin A1c, fasting glucose, and low-density lipoproteins improved in the intervention versus the control group, while other PROMIS measures, blood pressure, high-density lipoproteins, and triglycerides did not differ significantly between the groups.ConclusionThe “Plants for Joints” lifestyle program reduced stiffness, relieved pain, and improved physical function in people with hip or knee MSOA compared to usual care.
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Third chapter of the English version of the book 'Energieke Arbeid' published by the Centre of Applied Labour Market Research and Innovation (Dutch abbreviation: KCA) to celebrate the 10th anniversary of applied labour market research at Hanze University of Applied Sciences. This chapter discusses the second line of research of KCA: The Labour Market in the EnergyPort Groningen Region.
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In this review, we present the growing scientific evidence showing the importance of protein and amino acid provision in nutritional support and their impact on preservation of muscle mass and patient outcomes.
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Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6–12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.
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SYNOPSIS: Vascular serious adverse events can occur after examining, manipulating, mobilizing, and prescribing exercise for the cervical spine. Patients presenting with neck pain and headache who develop a vascular serious adverse event during or after treatment may have vascular flow limitations that go unrecognized and are aggravated by treatment. Patients with neck pain and headache-the first nonischemic symptoms of arterial dissection-frequently access physical therapists as first-point providers, not all of whom have specialist training in orthopaedic manual physical therapy. All physical therapists, irrespective of their training, who are helping patients manage neck pain, headache, and/or facial symptoms must feel confident to identify potential vascular flow limitations of the neck prior to providing treatment. J Orthop Sports Phys Ther 2021;51(9):418-421. Epub 10 May 2021. doi:10.2519/jospt.2021.10408.
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