Objectives: Early tracheotomy, defined as a procedure performed within 10 days from intubation, is associated with more ventilator free days, shorter ICU stay, and lower mortality than late tracheotomy. During the coronavirus disease 2019 pandemic, it was especially important to save operating room resources and to have a shorter ICU stay for patients, when ICUs had insufficient beds. In this context of limited resources, early percutaneous tracheostomy could be an effective way to manage mechanically ventilated patients. Nevertheless, current recommendations suggest delaying or avoiding the tracheotomy in coronavirus disease 2019 patients. Aim of the study was to analyze the hospital mortality of coronavirus disease 2019 patients who had received early percutaneous tracheostomy and factors associated with removal of tracheostomy cannula at ICU discharge. Design: Cohort study. Setting: Coronavirus disease 2019 ICU. Patients: Adult patients with coronavirus disease 2019 3 days after ICU admission. Interventions: None. Measurements and Main Results: Three days after ICU admission, 164 patients were present in ICU and included in the analysis. One-hundred and twenty-one patients (74%) were tracheostomized, whereas the other 43 (26%) were managed with translaryngeal intubation only. In multivariable analysis, early percutaneous tracheostomy was associated with lower hospital mortality. Sixty-six of tracheostomized patients (55%) were discharged alive from the hospital. Age and male sex were the only characteristics that were independently associated with mortality in the tracheostomized patients (45.5% and 62.8% in tracheostomized and nontracheostomized patients, respectively; p = 0.009). Tracheostomy tube was removed in 47 of the tracheostomized patients (71%). The only variable independently associated with weaning from tracheostomy at ICU discharge was a faster start of spontaneous breathing after tracheotomy was performed. Conclusions: Early percutaneous tracheostomy was safe and effective in coronavirus disease 2019 patients, giving a good chance of survival and of weaning from tracheostomy cannula at ICU discharge.
Purpose This is an exploratory study on consumer information and behaviour towards green, health, local, social and environmental credentials on labels. It focusses on many dimensions of sustainability in the food products that affect consumer choices with a dual purpose: to identify and define “sustainable consumption” behaviour in broad sense and to investigate empirically the factors affecting the real consumption behaviours. The purpose of this paper is to shed light on consumers’ understanding, motivation and use of sustainable labelling in order to understand the role sustainability information plays in the food products market. Design/methodology/approach Two focus groups in order to investigate consumer motivation and behaviour in-depth and to prepare the questionnaire. Identification of the outcomes that could summarize sustainable consumption combining: purchase of local products, consume only seasonal fruit, prefer products with recyclable packaging, attention to the fat content in foods, give importance to traceability and purchase products only in the place of origin. Identification of the “at risk” virtuous consumer, using a binary logistic regression approach, taking into account demographic characteristics, the food and nutrition value system, experience, knowledge, institutional factors and marketing. Findings Results from the focus groups are mainly in line with the empirical analysis, highlighting the key role of education in influencing consumer attitude and behaviour. Consumers give little attention to information provided on the label for sustainable food consumption and environmental protection and have little knowledge of environmental problems. The virtuous consumer appears to give importance to a better food nutrition value system, to pay more attention to ingredients and instructions on the label, to be more attentive to environmental and sustainable attributes, to be concerned about product quality and to be slightly influenced by brands and special offers. Research limitations/implications The findings from the empirical analysis confirm the results from focus groups even if it was not possible from the empirical analysis to investigate in-depth the marketing aspects concerning the food choice. This limit probably comes from the low number of observations. Further research will focus on these marketing aspects. Practical implications Products with sustainable attributes can become a strategic variable and allow companies to gain a competitive advantage, especially for small- and medium-sized enterprises. This may encourage the development of new marketing channels based on the direct relationship between producer and the new consumer demand, increasingly sensitive to the food security issues. Social implications There is a potential interest and sensitiveness to having sustainable behaviour in a broad sense, but there is a lack of knowledge about how to behave to be sustainable. In the absence of binding rules, it is necessary that government promote information and campaigns to generate greater awareness on sustainability, aiming at increasing knowledge to drive the consumer’s choices. This may lead to virtuous results in terms of reducing social costs related to an unhealthy diet, food waste and unsustainable consumption. Originality/value The results show that despite the appearance of attention to the environment and to healthy food which is associated with this emerging critical consumer in the literature, there remains the problem of the consumer giving little attention to information provided on the label for sustainable food consumption and environmental protection. This is the problem of “rules of thumb” in purchasing decisions that prevail in the following situations: when consumers have an overload of information that exceeds their processing limits; when they tend to base their decision making on heuristics, focussing their choices on brands as a proxy for high-quality, product-related characteristics.
PurposeThe purpose of this paper is to analyse the structural characteristics, the governance and the performance of two French and Italian groups of wine cooperatives, with two objectives in mind. On one hand, the study will analyse the presence of similarities between the characteristics of the two groups of companies which were founded in the same period within a similar legal framework; on the other, it will study the presence of links between the strategic policy of the companies and their structural, governance and performance characteristics.Design/methodology/approachThe study uses survey data obtained from interviews with 25 wine cooperatives. It covers the topics of their structure, organisation, strategies, management and performance in Italy (specifically in Umbria, a region in the centre of Italy), and in France (in Languedoc‐Roussillon, a region in southern France). Other indicators of performance, calculated from the balance sheets of the companies, were added to this analysis, and a careful analysis was drawn up to check the factors which condition the performance of the companies.FindingsThe main finding underlines some strong differentiating elements between those cooperatives selling the biggest part of their production as bulk wine and those selling it as packaged wine. But the first situation does not lead automatically to inferring a decline or an involution of these cooperatives. On the contrary, the mitigated performances that were found clearly question whether there is a strategic evolution towards more specialisation (intermediate phases of product transformation, leading to business‐to‐business differentiation strategies) which could be more profitable for their growers‐owners than further integration towards packaged wine sales.Originality/valueThe analysis deals with the problem of performance and governance of the transformation cooperative companies in the wine sector, which produce more than 50 percent of the entire wine production both in France and Italy.
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