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A process that does not include the customer's value may not be effective in providing care. This study aimed to identify value and waste in an emergency department (ED) patient flow process from a patient and clinician perspective.

A qualitative case study was conducted in an ED in Trinidad and Tobago. Observations and informal conversational interviews with clinicians (n = 33) and patients (n = 50) explored patient flow, value and waste. Thematic analysis was used to create a framework on valuable and wasteful aspects in the ED patient flow process.

Valuable aspects led to direct improvements in the patient's health or an exchange of information in the process. Wasteful aspects were those with no patient activity, no direct ED clinical involvement, or resulted in a perceived inappropriate use of ED resources. However, there was a disparity in responses between clinicians and patients with clinicians identifying more features in the process.

The single case study design limits the generalizability of findings to other settings. This study did not specifically explore the influence of age and gender on what mattered to patients in ED services. Future studies would benefit from exploring whether there are any age and gender differences in patient perspectives of value and waste. Further research is needed to validate the usefulness of the framework in a wider range of settings and consider demographic factors such as age and gender.

The study has produced a framework which may be used to improve patient flow in a way that maximized value to its users. A collaborative approach, with active patient involvement, is needed to develop a process that is valuable to all. The single case study design limits the generalizability of findings to other settings.

Qualitative methods were used to explicitly explore both value and waste in emergency department patient flow, incorporating the patient perspective. This paper provides an approach that decision makers may use to refine the ED patient flow process into one that flows well, improves quality and maximizes value to its users.

The paper aims to present a literary itinerary inspired in Julio Dinis’ novel An English Family (Uma Família Inglesa) through a comparative analysis of the places identified in the novel and the touristic attraction proposed by Visit Porto website. This novel is representative of the cultural identity and society of Porto city in the 19th century. Developing an itinerary based on this novel can facilitate the reading and understanding of the historical and cultural development of Porto.

This case study is based on the reading of the Julio Dinis’ novel An English Family (Uma Família Inglesa), whose storyline takes place in Porto city, Portugal in the 19th century. It used QGIS v. 3.12 software, a geographical information system to identify the places, to produce the maps and to create the itinerary.

The comparison between the places identified in the novel and the tourist attraction in Visit Porto website revealed that only 6 points in the novel are referenced on Visit Porto website. These points correspond to the ones in the historical city centre of Porto. However, the creation of an itinerary that brings together all the points mentioned by Julio Dinis in his novel, will allow the development of a new touristic itinerary, alternative to existing itineraries in the city and that can be seen as a distinguish offer that allows a different view of the urban space of Porto.

There are some limitations to this study that can be highlighted. First, it was difficult to find the correct location of some points identified in the novel, due to difficulty of finding historical maps with quality of the data. At the same time, as tourist information is dispersed by several sources, and most of those data is not georeferenced, it was time consuming the integration of all the information in the same geodatabase. The choice of the shortest path can also be considered as a limitation, rather than the route followed by the author in the novel, but geographic information systems operates on spatial and temporal scale, which can present a limitation in tourism analysis. In the case of this project, we have chosen the shortest path, assuming that tourist would prefer that.

This research allowed to address two areas of knowledge that are emerging in the study of urban centres as tourist areas: the use of GIS and literary tourism. Despite the fact that there are already articles on this subject, the originality focuses on the approach made around one of the greatest writers of Portugal in the 19th century, allowing to present a tourist itinerary about one of his literary works, and the comparison made between the places identified in the novel and the tourist points identified on the Visit Porto website.

The purpose of this paper is to identify regional foods and analyze its use on school menus of a Brazilian city, as well as the respect to symbolic and cultural aspects related to it.

The study was conducted in two stages. In the first stage, regional foods were identified through interviews with key school meal and city agents. In the second stage, the inclusion of these foods in school menus from 2009 to 2013 was assessed.

In total, 142 regional foods were identified and classified into four groups. This classification resulted in a decision tree model to identify regional foods. Approximately 45 percent of regional preparations and 82.5 percent of regional foods were offered totaling 455 preparations and 977 foods analyzed. However, 31 percent of the regional foods identified in Stage 1 were not offered in the menus analyzed. Various regional preparations lost their authenticity, possibly not being recognized because of a lack of traditional ingredients or because they contained non-regional foods that changed their character.

The results mainly point to symbolic aspects of the production and consumption of regional foods and preparations that are important to promoting healthy diets. In addition, they can support public policies that promote the use of these foods in the school environment.

This study analyzes the inclusion of regional foods in school meals--a topic rarely explored in the scientific literature – and proposes a decision tree model to identify regional foods with methodological rigor. This model can assist school food managers in including regional foods and developing studies related to this topic.