WorldWideScience

Sample records for device destination therapy

  1. Ethical challenges with the left ventricular assist device as a destination therapy

    Directory of Open Access Journals (Sweden)

    Rady Mohamed Y

    2008-08-01

    Full Text Available Abstract The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1 direct participation of a multidisciplinary care team, including palliative care specialists, (2 a concise plan of care for anticipated device-related complications, (3 careful surveillance and counseling for caregiver burden, (4 advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5 a plan to address the long-term financial burden on patients, families, and caregivers. Short-term mechanical circulatory devices (e

  2. Self-care and communication issues at the end of life of recipients of a left-ventricular assist device as destination therapy.

    Science.gov (United States)

    Ben Gal, Tuvia; Jaarsma, Tiny

    2013-03-01

    The purpose of this review is to provide an overview of self- care and communication issues at the end of life of patients with left-ventricular assist devices (LVADs) for destination therapy, based on recent research on end-of-life communication in other diseases. For many patients with advanced heart failure, LVADs as destination therapy improve survival and quality of life. However, LVADs can be associated with complications, new comorbidities or worsening of previous conditions, resulting in decreased quality of life and limited prognosis, raising the need for planning palliative and end-of-life care. Open communication addressing the consequences of the LVAD implantation for daily life and the future (including advance directives) is advised in different stages of the treatment, involving a multidisciplinary team taking care of these complex patients and their caregivers. Healthcare professionals treating patients before and after LVAD implantation need to take an active role in end-of-life discussions and be able to communicate information regarding expected complications, quality of life and prognosis to the patients and caregivers. Research is needed addressing optimal ways and timing of communication with LVAD patients and families.

  3. Destination therapy: safety and feasibility of national and international travel.

    Science.gov (United States)

    Coyle, Laura A; Martin, Michele M; Kurien, Sudha; Graham, Joel D; Gallagher, Colleen; Silver, Marc A; Slaughter, Mark S

    2008-01-01

    Results for Destination Therapy (DT) continue to improve with advanced technology, better patient selection, and experienced clinical management. Quality of life for these patients is an important component of the overall success of DT, and traveling is becoming more common. We reviewed our experience with long-distance travel in our DT population. All patients implanted with a left ventricular assist device for DT were followed prospectively. Long-distance travel was considered to be >200 miles, one way from their homes. There were 15 patients (14 men) with an average age of 66 years (range, 30-82) who traveled a combined total of 40 long-distance trips. Four trips were international (Spain, Canada (2), and Puerto Rico), 35 within the continental U.S., and one to Hawaii. The average one way distance traveled was 925 miles with a range of 218-4256 miles. The average time away from home was 8.3 days (range, 2-30). Patients traveled by airplane (17), car (23), and one trip included a 5 day cruise. Five complications occurred: driveline trauma, delay of reentry into the United States, missed flight, red heart alarm from bearing wear, and dehydration. All patients returned home safely for routine follow-up. Long-distance travel is possible for DT patients. Anticipating potential problems and careful planning is necessary for safe national and international travel.

  4. A first step beyond traditional boundaries: destination therapy with the SynCardia total artificial heart.

    Science.gov (United States)

    Spiliopoulos, Sotirios; Koerfer, Reiner; Tenderich, Gero

    2014-06-01

    The SynCardia total artificial heart is currently used as a bridge to transplantation therapy in cases of irreversible, acute or chronic, biventricular heart failure. We describe the implementation of this technology in the context of destination therapy in a patient with an end-stage heart failure on grounds of primary amyloidosis.

  5. An implantable aortic valvo-pump for destination therapy.

    Science.gov (United States)

    Qian, Kun-Xi

    2006-03-01

    To investigate the possibility of a long-term applicable left ventricular assist device, a 23 mm outer diameter and 31 g weight implantable aortic valvo-pump was developed. It consists of a rotor and a stator; the rotor has a driven magnets assemble and an impeller, the stator has a motor coil with iron core and a outflow guide vane. The device locates the position of aortic valve, delivers the blood directly from left ventricle to aorta. Neither connecting conduits nor "bypass" circuits are necessary. Therefore, the device has promisingly better antithrombogenicity than other heart pumps. In hemodynamic testing, the pump can produce a blood flow of 7 l/min volume with 50 mmHg pressure increase at 15,000 rpm rotating speed, and at zero flow rate the pump can maintain a diastolic pressure over 80 mmHg at same rotating speed. For further studies the blood compatibility and the durability of the device are of most importance.

  6. Balloon valvuloplasty as destination therapy in elderly with severe aortic stenosis:a cardiac catheterization study

    Institute of Scientific and Technical Information of China (English)

    Vasileios Kamperidis; Georgios K Efthimiadis; Georgios Parcharidis; Haralambos Karvounis; Stavros Hadjimiltiades; Antonios Ziakas; Georgios Sianos; Georgios Kazinakis; George Giannakoulas; Sophia-Anastasia Mouratoglou; Athanasia Sarafidou; Ioannis Ventoulis

    2015-01-01

    Background In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty (BAV) and invasive hemodynamic evaluation of aortic stenosis (AS). The current report aimed to study the invasive hemodynamics of se-vere AS patients treated with BAV as destination therapy and to identify factors associated with better hemodynamic outcome and prognosis. Methods From 2009 to 2012, 63 high risk elderly patients were treated with BAV as destination therapy for symptomatic severe AS and were all prospectively included in the study. Their hemodynamics were invasively evaluated during catheterization, pre-and post-BAV at the same session. All Post-BAV patients were regularly followed-up. Results The patients (82 ± 6 years, 52%male) had post-BAV aortic valve area index (AVAi) significantly increased and mean pressure gradient (MPG) significantly reduced. During the follow-up of 0.9 (maximum 3.3) years, those with post-BAV AVAi<0.6 cm2/m2 compared with the AVAi≥0.6 cm2/m2 group had significantly higher mortality (60%vs. 28%, log-rank P=0.02), even after adjusting for age, gender, atrial fibrillation, chronic kidney disease, diabetes mellitus, coronary artery disease and EuroSCORE [HR:5.58, 95%confidence interval (CI):1.62−19.20, P=0.006]. The only independent predictor of moderate AS post-BAV was the pre-BAV AVAi increase by 0.1cm2/m2 (OR:3.81, 95%CI:1.33−10.89, P=0.01). Pre-BAV AVAi≥0.39 cm2/m2 could predict with sensitivity 84%and specificity 70%the post-BAV hemodynamic outcome. Conclusions BAV as destination therapy for se-vere AS offered immediate and significant hemodynamic improvement. The survival was significantly better when a moderate degree of AS was present.

  7. Can Destination Therapy be implemented in children with heart failure? A study of provider perceptions.

    Science.gov (United States)

    Char, Danton S; Lee, Sandra S-J; Ikoku, Alvan A; Rosenthal, David; Magnus, David

    2016-09-01

    DT is an established final therapeutic choice in adult patients with severe heart failure who do not meet criteria for cardiac transplantation. Patients are given VADs, without the prospect of care escalation to transplantation. VADs are now established therapy for children and are currently used as a bridge until transplantation can be performed or heart failure improves. For children who present in severe heart failure but do not meet transplantation criteria, the question has emerged whether DT can be offered. This qualitative study aimed to elicit the perspectives of early adopters of DT at one of the few institutions where DT has been provided for children. Responses were recorded and coded and themes extracted using grounded theory. Interviewees discussed: envisioning of the DT candidate; approach to evaluation for DT; contraindications to choosing DT; and concerns about choosing DT. Providers articulated two frameworks for conceptualizing DT: as a long bridge through resolution of problems that would initially contraindicate transplantation or, alternatively, as a true destination instead of transplantation. True destination, however, may not be the lasting concept for long-term VAD use in children given improvement in prognosis for current medical contraindications and improving VAD technology.

  8. Cooling Devices in Laser therapy.

    Science.gov (United States)

    Das, Anupam; Sarda, Aarti; De, Abhishek

    2016-01-01

    Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser. On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice.

  9. Cooling devices in laser therapy

    Directory of Open Access Journals (Sweden)

    Anupam Das

    2016-01-01

    Full Text Available Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser. On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician′s personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice.

  10. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used for...

  11. FDI Destination

    Institute of Scientific and Technical Information of China (English)

    LAN XINZHEN

    2010-01-01

    @@ For the past few years,China has topped the list of US.management consulting firm A.T.Kearney's Foreign Direct Investment Confidence Index.On January 25,the consulting firm issued its latest index,which showed China was still the world's most attractive investment destination.

  12. Evidence Considerations for Mobile Devices in the Occupational Therapy Process

    Directory of Open Access Journals (Sweden)

    Kelly Erickson

    2015-04-01

    Full Text Available Mobile app-based device utilization, including smartphones and handheld tablets, suggests a need to evaluate evidence to guide selection and implementation of these devices in the occupational therapy process. The purpose of the research was to explore the current body of evidence in relation to mobile app-based devices and to identify factors in the use of these devices throughout the occupational therapy process. Following review of available occupational therapy profession guidelines, assistive technology literature, and available mobile device research, practitioners using mobile app-based devices in occupational therapy should consider three areas: client needs, practitioner competence, and device factors. The purpose of this guideline is to identify factors in the selection and use of mobile app-based devices throughout the occupational therapy process based on available evidence. Considerations for mobile device implementation during the occupational therapy process is addressed, including evaluating outcomes needs, matching device with the client, and identifying support needs of the client.

  13. Destination: Geology?

    Science.gov (United States)

    Price, Louise

    2016-04-01

    "While we teach, we learn" (Roman philosopher Seneca) One of the most beneficial ways to remember a theory or concept is to explain it to someone else. The offer of fieldwork and visits to exciting destinations is arguably the easiest way to spark a students' interest in any subject. Geology at A-Level (age 16-18) in the United Kingdom incorporates significant elements of field studies into the curriculum with many students choosing the subject on this basis and it being a key factor in consolidating student knowledge and understanding. Geology maintains a healthy annual enrollment with interest in the subject increasing in recent years. However, it is important for educators not to loose sight of the importance of recruitment and retention of students. Recent flexibility in the subject content of the UK curriculum in secondary schools has provided an opportunity to teach the basic principles of the subject to our younger students and fieldwork provides a valuable opportunity to engage with these students in the promotion of the subject. Promotion of the subject is typically devolved to senior students at Hessle High School and Sixth Form College, drawing on their personal experiences to engage younger students. Prospective students are excited to learn from a guest speaker, so why not use our most senior students to engage and promote the subject rather than their normal subject teacher? A-Level geology students embarking on fieldwork abroad, understand their additional responsibility to promote the subject and share their understanding of the field visit. They will typically produce a series of lessons and activities for younger students using their newly acquired knowledge. Senior students also present to whole year groups in seminars, sharing knowledge of the location's geology and raising awareness of the exciting destinations offered by geology. Geology fieldwork is always planned, organised and led by the member of staff to keep costs low, with recent visits

  14. Advancing Destination Image

    DEFF Research Database (Denmark)

    Kock, Florian; Josiassen, Alexander; Assaf, A. George

    2016-01-01

    Knowledge of the mental representations that individuals hold about tourist destinations are important to understand their intentions. These mental destination representations have often been investigated by applying the concept of destination image. This study argues that the extant literature...

  15. Destination Marketing and Management

    OpenAIRE

    KOCKOVÁ, Jitka

    2009-01-01

    Work presents the theoretical aspects of destination management and marketing. It defines the destination management and sustainable development of tourism. The work is applied to destination management and destination marketing in region Sokolovsko. For this destiaci is proposed marketing strategy and marketing mix.

  16. Destination Marketing and Management

    OpenAIRE

    KOCKOVÁ, Jitka

    2009-01-01

    Work presents the theoretical aspects of destination management and marketing. It defines the destination management and sustainable development of tourism. The work is applied to destination management and destination marketing in region Sokolovsko. For this destiaci is proposed marketing strategy and marketing mix.

  17. Rethinking Destination Image

    DEFF Research Database (Denmark)

    Josiassen, Alexander; Kock, Florian; Assaf, Albert G.

    A central research question in tourism management concerns tourist’s choice of specific destinations. The present article reviews the extant literature on destination image. From this review we suggest that individuals have a multitude of destination associations – the total imagery which relates...... to the destination and label this concept destination imagery. Individuals also hold an overall image used as a heuristic or a mental short-cut which is labeled destination image. The concepts of destination imagery and destination image are distinct, yet they have often been conflated within the literature....... The article further provides an extensive review of the literature with regard to the definitions, dimensionality, antecedents, and outcomes of the focal concepts as well as geographical scope of destination imagery and image studies and methodologies. This review has led to a novel understanding...

  18. Cone positioning device for oral radiation therapy.

    Science.gov (United States)

    Mahanna, G K; Ivanhoe, J R; Attanasio, R A

    1994-06-01

    This article describes the fabrication and modification of a peroral cone-positioning device. The modification provides added cone stability and prevents tongue intrusion into the radiation field. This device provides a repeatable accurate cone/lesion relationship and the fabrication technique is simplified, accurate, and minimizes patient discomfort.

  19. Tutorial: Nanomedicine: destination or journey?

    Science.gov (United States)

    Haberzettl, C. A.

    2002-08-01

    Nanomedicine in a broad sense is the application of nano-scale technologies to the practice of medicine. The creation of nanodevices such as nanobots capable of performing therapeutic functions in vivo is a destination within the emerging field of nanomedicine. On the journey to that destination, significant technological advances across multiple scientific disciplines continue to be proposed, validated and commercialized. Advances in delivering therapy, miniaturization of analytical tools, improved computational and memory capabilities and developments in remote communications will be integrated allowing for the development of such nanobots. Nanomedicine is both a destination and a journey. The journey will cross new frontiers, uncover new knowledge and bring new horizons to the understanding and practice of medicine.

  20. Narrowing of the Coronary Sinus: A Device-Based Therapy for Persistent Angina Pectoris.

    Science.gov (United States)

    Konigstein, Maayan; Verheye, Stefan; Jolicœur, E Marc; Banai, Shmuel

    2016-01-01

    Alongside the remarkable advances in medical and invasive therapies for the treatment of ischemic heart disease, an increasing number of patients with advanced coronary artery disease unsuitable for revascularization continue to suffer from angina pectoris despite optimal medical therapy. Patients with chronic angina have poor quality of life and increased levels of anxiety and depression. A considerable number of innovative therapeutic modalities for the treatment of chronic angina have been investigated over the years; however, none of these therapeutic options has become a standard of care, and none are widely utilized. Current treatment options for refractory angina focus on medical therapy and secondary risk factor modification. Interventions to create increased pressure in the coronary sinus may alleviate myocardial ischemia by forcing redistribution of coronary blood flow from the less ischemic subepicardium to the more ischemic subendocardium, thus relieving symptoms of ischemia. Percutaneous, transvenous implantation of a balloon expandable, hourglass-shaped, stainless steel mesh in the coronary sinus to create a fixed focal narrowing and to increase backwards pressure, may serve as a new device-based therapy destined for the treatment of refractory angina pectoris.

  1. The provision of speech-language therapy in services destined to individuals with Autism Spectrum Disorder (ASD).

    Science.gov (United States)

    Defense-Netrval, Danielle Azarias; Fernandes, Fernanda Dreux Miranda

    2016-01-01

    The increased prevalence of autism spectrum disorder (ASD) worldwide has been a major public health concern; therefore, discussion about the services and therapies required has become important. This study aimed to characterize the provision of speech-language therapy services in the metropolitan area of Sao Paulo. To this end, a questionnaire with 23 questions was developed based on the Balanced Scorecard methodology. This questionnaire was applied to 854 individuals assisted in 25 ASD services. The results show that only 64% of the ASD services offer speech-language therapy and that the number of individuals assisted is below the expected. Therefore, there is a necessity for better management in the speech-language therapy services offered to the ASD population.

  2. Novel Silicon Devices for Radiation Therapy Monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Bruzzi, Mara, E-mail: mara.bruzzi@unifi.it

    2016-02-11

    Modern radiotherapy techniques pose specific constraints in radiation-monitoring and dosimetry due to the occurrence of small radiation fields with high dose gradients, variation in space and time of the dose rate, variation in space and time of the beam energy spectrum. Novel devices coping with these strict conditions are needed. This paper reviews the most advanced technologies developed with silicon-based materials for clinical radiotherapy. Novel Si diodes as Pt-doped Si, epitaxial Si as well as thin devices have optimized performance, their response being independent of the accumulated dose, thus ensuring radiation tolerance and no need of recalibration. Monolithic devices based on segmented Si detectors can be easily tailored to optimize spatial resolution in the large active areas required in clinical radiotherapy. In particular, a monolithic device based on epitaxial p-type silicon, characterized by high spatial resolution and ability to directly measure temporal variations in dose modulation proved to be best viable solution for pre-treatment verifications in IMRT fields.

  3. The potential of electrocardiographic markers to tune cardiac device therapy

    NARCIS (Netherlands)

    Wijers, S.C.

    2017-01-01

    In this thesis an effort was made to translate basic research into clinical practice to improve cardiac device therapy. We showed the electrocardiogram (ECG) is everything but obsolete or outdated and is of great value as a simple non-invasive tool in identifying individuals that can benefit from

  4. Patient-reported outcomes in left ventricular assist device therapy

    DEFF Research Database (Denmark)

    Brouwers, Corline; Denollet, Johan; de Jonge, Nicolaas;

    2011-01-01

    Technological advancements of left ventricular assist devices (LVAD) have created today's potential for extending the lives of patients with end-stage heart failure. Few studies have examined the effect of LVAD therapy on patient-reported outcomes (PROs), such as health status, quality of life...

  5. Dream Island Destination

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Chinese residents hail the government’s decision to turn Hainan into an international tourist destination. Officials, potential tourists, tour guides and Hainan locals shared their opinions on the Central Government’s decision with Beijing Review.

  6. Acoustic and Cavitation Fields of Shock Wave Therapy Devices

    Science.gov (United States)

    Chitnis, Parag V.; Cleveland, Robin O.

    2006-05-01

    Extracorporeal shock wave therapy (ESWT) is considered a viable treatment modality for orthopedic ailments. Despite increasing clinical use, the mechanisms by which ESWT devices generate a therapeutic effect are not yet understood. The mechanistic differences in various devices and their efficacies might be dependent on their acoustic and cavitation outputs. We report acoustic and cavitation measurements of a number of different shock wave therapy devices. Two devices were electrohydraulic: one had a large reflector (HMT Ossatron) and the other was a hand-held source (HMT Evotron); the other device was a pneumatically driven device (EMS Swiss DolorClast Vet). Acoustic measurements were made using a fiber-optic probe hydrophone and a PVDF hydrophone. A dual passive cavitation detection system was used to monitor cavitation activity. Qualitative differences between these devices were also highlighted using a high-speed camera. We found that the Ossatron generated focused shock waves with a peak positive pressure around 40 MPa. The Evotron produced peak positive pressure around 20 MPa, however, its acoustic output appeared to be independent of the power setting of the device. The peak positive pressure from the DolorClast was about 5 MPa without a clear shock front. The DolorClast did not generate a focused acoustic field. Shadowgraph images show that the wave propagating from the DolorClast is planar and not focused in the vicinity of the hand-piece. All three devices produced measurable cavitation with a characteristic time (cavitation inception to bubble collapse) that varied between 95 and 209 μs for the Ossatron, between 59 and 283 μs for the Evotron, and between 195 and 431 μs for the DolorClast. The high-speed camera images show that the cavitation activity for the DolorClast is primarily restricted to the contact surface of the hand-piece. These data indicate that the devices studied here vary in acoustic and cavitation output, which may imply that the

  7. TOURIST DESTINATION MARKETING RADAUTI

    OpenAIRE

    Liliana HÎNCU

    2016-01-01

    Tourism is a dynamic phenomenon, which is in continuous change. The tourism market is in constant transformation due to competition and growing. Tourist destinations, is facing many challenges in order to enter and remain on the market. Thus tourist destination is a well-defined service which is an assembly designed to meet tourists. The marketing mix includes the following elements: product, price, distribution, promotion. Tourists come to this area because of monasteries, some of which are ...

  8. Destination image, image at destination. Methodological aspects

    Directory of Open Access Journals (Sweden)

    Pablo Díaz-Rodríguez

    2013-01-01

    Full Text Available Today, the part played by the image in the development of tourism, and, specially, as a diffe- rentiation element of a destination area is widely acknowledged. This is reflected to a great extent in the literature that focuses its interest on identifying the variables that motivate the purchase or stimulate the decision process. However, the reference to feedback processes or image control mechanisms as well as their creation, is surprising. An approach model to these processes will be exposed in this article.

  9. Making Strategies in Destination Branding

    NARCIS (Netherlands)

    da Silva Oliveira, Eduardo

    2013-01-01

    The need for strategic thinking in destination branding has been demanded regarding the challenges tourism destinations are facing nowadays, such as at the digital level. The utilization of Information Communication Technology by tourism destinations, when well-articulated with a destination brandin

  10. TOURIST DESTINATION MARKETING RADAUTI

    Directory of Open Access Journals (Sweden)

    Liliana HÎNCU

    2016-12-01

    Full Text Available Tourism is a dynamic phenomenon, which is in continuous change. The tourism market is in constant transformation due to competition and growing. Tourist destinations, is facing many challenges in order to enter and remain on the market. Thus tourist destination is a well-defined service which is an assembly designed to meet tourists. The marketing mix includes the following elements: product, price, distribution, promotion. Tourists come to this area because of monasteries, some of which are included in UNESCO and are recognized nationally and internationally. Thus Romanian tourists choose this tourist destination just for a weekend. To prolong the stay of both foreigners and Romanians, as well as to attract a large number of tourists is necessary to develop tourism products type tours: 5-6 days for visiting the tourist area of Radauti. These products must contain an offer as varied and diverse, so every day contain different activities and be adjusted, for example by age segments. Linked pricing policy usually access tariffs are differentiated between Romanian and foreign tourists, being lower in the first category. Travel agencies prefer to organize package tours on request only devise some that distribute them internally and externally. There are initiatives to promote tourism area Radauti, due to the high attractiveness among destinations in Romania. Thus, this must be considered a tourist destination tourism brand renowned nationally and internationally.

  11. Destined for disadvantage?

    NARCIS (Netherlands)

    Maurice Guiaux; Annette Roest; Jurjen Iedema

    2011-01-01

    Original title: Voorbestemd tot achterstand? Are children who grow up in poverty destined for disadvantage? Are they still poor 25 years later, when they are adults, and are they also more socially excluded in adulthood?  And if so, why? This publication explores the extent to which

  12. Destined for disadvantage?

    NARCIS (Netherlands)

    Maurice Guiaux; Annette Roest; Jurjen Iedema

    2011-01-01

    Original title: Voorbestemd tot achterstand? Are children who grow up in poverty destined for disadvantage? Are they still poor 25 years later, when they are adults, and are they also more socially excluded in adulthood?  And if so, why? This publication explores the extent to which poverty is

  13. Consumption Values and Destination Evaluation in Destination Decision Making

    Directory of Open Access Journals (Sweden)

    Vasyl Denys

    2014-03-01

    Full Text Available Consumption values have received little attention in the tourism literature, comparing to such determinants of the consumer behavior as motivations, pull and push factors, satisfaction, quality, or destination image, etc. This study attempts to analyze consumption values and their types, and the influence that they have on the destination decision making and, particularly, on the destination choice. Current work brings new insights about the role of consumption values in detrmining preferences toward tourist destinations. Study findings justify the multidimensional nature of the consumption value, and demonstrate that every value dimension has a certain degree of importance for a tourist, which, to a big extent, can determine the destination choice.

  14. Usability evaluation of a locomotor therapy device considering different strategies

    Directory of Open Access Journals (Sweden)

    Langthaler Sonja

    2016-09-01

    Full Text Available Usability of medical devices is one of the main determining factors in preventing use errors in treatment and strongly correlates to patient safety and quality of treatment. This thesis demonstrates the usability testing and evaluation of a prototype for locomotor therapy of infants. Therefore, based on the normative requirements of the EN 62366, a concept combined of evaluation procedures and assessing methods was created to enable extensive testing and analysis of the different aspects of usability. On the basis of gathered information weak points were identified and appropriate measures were presented to increase the usability and operating safety of the locomotor prototype. The overall outcome showed an usability value of 77.4% and an evaluation score of 6.99, which can be interpreted as “satisfactory”.

  15. [Efficacy of new devices for behavior modification therapy for obesity].

    Science.gov (United States)

    Ookuma, K

    2001-03-01

    In the treatment of obesity, the behavior modification therapy has aimed at maintaining weight reduction by reforming wrong daily habitual eating behavior which leads obesity. However, a distorted cognitive pattern or a deviated physical lies behind the problematic eating behavior. In that aspect, we have developed new devices as belows. The ingestive behavioral questionnaire discloses problematic eating behavior and its related cognitive and sensational pattern at an early stage of the treatment. The charting of daily weight pattern is convenient for both therapist and patient himself to visually look out an actual ingestive pattern and reinforces maintenance of weight reduction by long term self-monitoring. The chewing chart recording is useful for the recovery of physical satiety sensation, and prevents over eating.

  16. Detecting cavitation in vivo from shock-wave therapy devices

    Science.gov (United States)

    Matula, Thomas J.; Yu, Jinfei; Bailey, Michael R.

    2005-04-01

    Extracorporeal shock-wave therapy (ESWT) has been used as a treatment for plantar faciitis, lateral epicondylitis, shoulder tendonitis, non-unions, and other indications where conservative treatments have been unsuccessful. However, in many areas, the efficacy of SW treatment has not been well established, and the mechanism of action, particularly the role of cavitation, is not well understood. Research indicates cavitation plays an important role in other ultrasound therapies, such as lithotripsy and focused ultrasound surgery, and in some instances, cavitation has been used as a means to monitor or detect a biological effect. Although ESWT can generate cavitation easily in vitro, it is unknown whether or not cavitation is a significant factor in vivo. The purpose of this investigation is to use diagnostic ultrasound to detect and monitor cavitation generated by ESWT devices in vivo. Diagnostic images are collected at various times during and after treatment. The images are then post-processed with image-processing algorithms to enhance the contrast between bubbles and surrounding tissue. The ultimate goal of this research is to utilize cavitation as a means for optimizing shock wave parameters such as amplitude and pulse repetition frequency. [Work supported by APL internal funds and NIH DK43881 and DK55674.

  17. Design of a Novel Servo-motorized Laser Device for Visual Pathways Diseases Therapy

    Directory of Open Access Journals (Sweden)

    Carlos Ignacio Sarmiento

    2015-12-01

    Full Text Available We discuss a novel servo-motorized laser device and a research protocol for visual pathways diseases therapies. The proposed servo-mechanized laser device can be used for potential rehabilitation of patients with hemianopia, quadrantanopia, scotoma, and some types of cortical damages. The device uses a semi spherical structure where the visual stimulus will be shown inside, according to a previous stimuli therapy designed by an ophthalmologist or neurologist. The device uses a pair of servomotors (with torque=1.5kg, which controls the laser stimuli position for the internal therapy and another pair for external therapy. Using electronic tools such as microcontrollers along with miscellaneous electronic materials, combined with LabVIEW based interface, a control mechanism is developed for the new device. The proposed device is well suited to run various visual stimuli therapies. We outline the major design principles including the physical dimensions, laser device’s kinematical analysis and the corresponding software development.

  18. Design of a Novel Servo-motorized Laser Device for Visual Pathways Diseases Therapy

    Directory of Open Access Journals (Sweden)

    Carlos Ignacio Sarmiento

    2015-12-01

    Full Text Available We discuss a novel servo-motorized laser device and a research protocol for visual pathways diseases therapies. The proposed servo-mechanized laser device can be used for potential rehabilitation of patients with hemianopia, quadrantanopia, scotoma, and some types of cortical damages. The device uses a semi spherical structure where the visual stimulus will be shown inside, according to a previous stimuli therapy designed by an ophthalmologist or neurologist. The device uses a pair of servomotors (with torque=1.5kg, which controls the laser stimuli position for the internal therapy and another pair for external therapy. Using electronic tools such as microcontrollers along with miscellaneous electronic materials, combined with LabVIEW based interface, a control mechanism is developed for the new device. The proposed device is well suited to run various visual stimuli therapies. We outline the major design principles including the physical dimensions, laser device’s kinematical analysis and the corresponding software development.

  19. Ecotourism Destinations in Romania

    Directory of Open Access Journals (Sweden)

    Iuliana Ioana Merce

    2014-05-01

    Full Text Available Romania has about 800 protected areas, which now covers about 5% of the country. Most ecotourism destinations are located within or adjacent to these protected areas such as Danube Delta Biosphere Reserve, northern communities National Park, Yosemite National Park, Apuseni Natural Park. In Romania there are still non-fragmented forest, and over a third of the population of bears, wolves and lynx in Europe, unique paradise of birds in the Danube Delta, more than 12 000 caves and, not least, full of authentic local traditions. Ecotourism allows recovery and conservation of the country's natural capital.

  20. Sami tourism in destination development

    DEFF Research Database (Denmark)

    Olsen, Lise Smed

    2016-01-01

    Indigenous tourism has become an important component of the tourism industry. Previous indigenous tourism research has indicated three conflict areas that can have an impact on destination development - internal conflicts over indigenous identity, the use of indigenous culture in destination...... marketing, and land-use conflicts. To varying degrees these areas of conflict have been found to impact local and regional destination development in northern Europe. This paper draws on case studies to understand how conflicts in Sami tourism in local and regional destination development are addressed...... through stakeholder collaboration in Jokkmokk, Sweden and Kautokeino, Norway. The study indicates that collaboration between destination marketing organisations and Sami stakeholders has been initiated and has improved destination marketing. Conflicts relating to indigenous identity and land use are more...

  1. TOURIST DESTINATION BRANDING

    Directory of Open Access Journals (Sweden)

    Andrijana Mrkaić

    2012-01-01

    Full Text Available The paper shows how the branding,as a process that identifies destinations and allowstourists to make a good choice between differentalternatives, fits into the contemporary marketingconcept. Movement of people and their urge totravel are biological needs which offer relaxationto tourists and result in greater cultural knowledge.Tourism is also reflected as social politics, throughthe benefits for employees. Tourism is ofimportance and branding makes it more expressed,because it is the brand through which numerousmarketing activities are coordinated, in order tobuild value and meet the expectations of tourists.Branding in tourism is a dynamic category that isin constant evolution, which requires better brandmanagement and strengthening and revitalizationof the brand.

  2. First clinical implant of the VentrAssist left ventricular assist system as destination therapy for end-stage heart failure.

    Science.gov (United States)

    Esmore, Donald S; Kaye, David; Salamonsen, Robert; Buckland, Mark; Rowland, Michael; Negri, Justin; Rowley, Yvonne; Woodard, John; Begg, John R; Ayre, Peter; Rosenfeldt, Franklin L

    2005-08-01

    The VentrAssist device left ventricular assist system, designed for permanent implantation, is a novel centrifugal pump with a hydrodynamically suspended rotor. The first human implant was into a 72-year-old man with New York Heart Association (NYHA) class IV heart failure due to idiopathic dilated cardiomyopathy. The implant and recovery were uneventful, and the patient survives at 17 months, is NYHA class II, and lives at home. This device shows promise in end-stage heart failure for permanent implantation and bridge to transplantation.

  3. Home Healthcare Medical Devices: Infusion Therapy - Getting the Most Out of Your Pump

    Science.gov (United States)

    ... Home Healthcare Medical Devices: Infusion Therapy - Getting the Most Out of Your Pump Share Tweet Linkedin Pin ... and accessories schedule routine maintenance What are the most common problems with an infusion pump and how ...

  4. Network Analysis of Cooperation in Tourism Destinations

    Directory of Open Access Journals (Sweden)

    Gajdošík Tomáš

    2015-12-01

    Full Text Available Globalisation on the tourism market causes that the competition is not formed only between stakeholders in a destination, but more and more it is created among destinations. Therefore tourism stakeholders in a destination have to act together and cooperate. The cooperative behaviour of destination stakeholders is seen as a main prerequisite of applying the cooperative destination management, which influences the competitiveness of destination on tourism market.

  5. Management of antithrombotic therapy during cardiac implantable device surgery

    OpenAIRE

    AlTurki, Ahmed; PROIETTI, RICCARDO; Birnie, David H.; Essebag, Vidal

    2016-01-01

    Anticoagulants are commonly used drugs that are frequently encountered during device placement. Deciding when to halt or continue the use of anticoagulants is a balance between the risks of thromboembolism versus bleeding. Patients taking warfarin with a high risk of thromboembolism should continue to take their warfarin without interruption during device placement while ensuring their international normalized ratio remains below 3. For patients who are taking warfarin and have low risk of th...

  6. Reducing mortality with device therapy in heart failure patients without ventricular arrhythmias.

    Science.gov (United States)

    Chapa, Deborah W; Lee, Hyeon-Joo; Kao, Chi-Wen; Friedmann, Erika; Thomas, Sue A; Anderson, Jill; Bardy, Gust H

    2008-09-01

    Use of device therapy to prevent sudden cardiac death in patients with heart failure is expanding on the basis of evidence from recent clinical trials. Three multicenter prospective clinical trials-Sudden Cardiac Death in Heart Failure (SCD-HeFT); Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION); and Cardiac Resynchronization-Heart Failure (CARE-HF)-were conducted to determine the effectiveness of devices in reducing mortality in patients with heart failure who did not have a history of ventricular arrhythmias. The 3 trials varied in the devices used, the population of patients included, and the study designs. In SCD-HeFT, implantable cardioverter defibrillators were more effective than pharmacological therapy in preventing mortality among patients with mild to moderate heart failure. In COMPANION, cardiac resynchronization therapy alone and cardiac resynchronization therapy plus an implantable cardioverter defibrillator were more effective than optimal drug treatment in reducing morbidity and all-cause mortality in patients with moderate to severe heart failure. In CARE-HF, cardiac resynchronization therapy alone was more effective than optimal drug treatment in reducing all-cause mortality in patients with moderate to severe heart failure. No direct comparison of the devices used has been done. These 3 clinical trials provide clear evidence that device therapy is beneficial for some patients with heart failure, even patients who do not have a history of ventricular arrhythmia.

  7. Tourism destination: The networking approach

    Directory of Open Access Journals (Sweden)

    Żemła Michał

    2016-12-01

    Full Text Available Different approaches to the analysis of tourism destinations as the basic units of research in tourism, are reviewed in this paper. Traditional geographical and economic perspectives are presented as the bases for more modern system and networking approaches. Network analysis is discussed as the most useful current approach to understand cooperation and coopetition processes taking place in destinations. This approach, developed in general management theory, however, if implicated directly in tourism, is not free from major problems and may lead to misleading conclusions. Among such problems, spatial embeddedness and the non-voluntary character of membership in a network, the crucial role of free goods in product creation, the predominance of SMEs in a destination network, differences between particular destinations and the difficulty in setting clear borders between networks, are discussed.

  8. Alba County - Rural Tourism Destination?

    Directory of Open Access Journals (Sweden)

    Claudia Olimpia Moisa

    2016-12-01

    Full Text Available The purpose of this paper is to identify the main rural touristic resources available in Alba County and also the preferred tourist destinations, highlighting the role and the importance of the rural tourism and agro-tourism in the economy of Alba County and, not least, identifying the main direction for its development and promotion. In other words, the aim of this paper is to answer the question "Is it or not Alba County a rural tourist destination?"

  9. Easily usable human-device interface for microwave therapy apparatus

    Directory of Open Access Journals (Sweden)

    Vasile Surducan

    2015-01-01

    Full Text Available In this paper we investigate the possibility of using a large dot matrix LCD (Liquid Crystal Display as the essential part of a low cost, user friendly human-device interface which is driving a microwave diathermy medical apparatus. The human-device interface uses only four buttons with multiple functionalities, an analog encoder and the said dot matrix LCD. The interface is a part of the embedded system that drives the entire unit, as a stand alone hardware and complex firmware program. This interface can handle the medical treatment parameters in an ergonomic and simple way. The human-device interface has been designed in agreement with the EN60601-1 and EN60601-1-4 requirements using “the simple to complex” writing and validation algorithm. The interface has been manufactured as prototype and tested on our own proprietary microwave hyperthermia and diathermy device and proves to be intuitive and easy to use. The human-device interface firmware is portable to other scientific apparatus as well; however, a reconfiguration of all displayed information is necessary, depending on the purpose of the served equipment. Compared with a colour graphic LCD equipped with touch screen, the interface presented here is definitely less expensive, can be implemented faster and uses  less hardware resources.

  10. Clinical management of a western lowland gorilla (Gorilla gorilla gorilla) with a cardiac resynchronization therapy device.

    Science.gov (United States)

    Rush, Elizabeth Marie; Ogburn, Anna L; Monroe, Denise

    2011-06-01

    A 24-yr-old, male western lowland gorilla (Gorilla gorilla gorilla) was diagnosed with congestive heart failure using transesophageal and transthoracic echocardiology. New York Heart Association (NYHA) Class III was assigned to the severity of the condition. Over 16 mo, this progressed to NYHA Class IV despite increasing medical therapy. Repeated evaluations suggested that implantation of a cardiac resynchronization therapy device with a defibrillator (CRT-D) could benefit this animal based on clinical signs and underlying evidence of dyssynchrony and suspected fibrotic myocardial disease. Surgical implantation of leads into the right atrium, right ventricle, and left ventricle was accomplished. The CRT-D device was placed under the thoracic pectoral muscles during an initial surgical procedure. Improvement in the gorilla's clinical condition after implantation of the CRT-D device was immediate and dramatic. Subsequent scanning of the device was accomplished through operant conditioning. The data from these device interrogations included stored and real-time cardiac data, which were used to minimize recognized environmental stressors and change device settings. Over 4 yr, case management was critical to successful device use in treatment of the clinical disease. This involved medications, training for device interrogation, exercise to increase activity and improve body condition, and phlebotomy attempts. Dietary management was necessary to manipulate caloric and sodium intake and encourage medication compliance. Cardiac resynchronization therapy device implantation, although requiring specialized equipment and surgical skill, appears to be a viable option for treatment of fibrosing cardiomyopathy with systolic dysfunction in gorillas refractory to medical management. In addition to treatment, this device provides cardiovascular data at rest that could allow for early diagnosis and treatment of gorillas with this and other cardiac conditions in the future. This

  11. Rocket Rendezvous at Preassigned Destinations with Optimum

    Directory of Open Access Journals (Sweden)

    T. N. Srivastava

    1982-10-01

    Full Text Available The problem of rendezvous of an interceptor rocket vehicle through optimal exit path with a destination rocket vehicle at a preassigned location on the destination orbit has been investigated for non-coaxial coplanar elliptic launch and destination orbits in an inverse square gravitational field. The case, when launch and destination orbits are coplanar circular, is also discussed. In the end numerical results for rendezvous have been obtained taking Earth and Mars orbits as launch and destination orbits respectively.

  12. Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation

    OpenAIRE

    Fujiwara, Atsushi; Komasawa, Nobuyasu; Minami, Toshiaki

    2014-01-01

    A 71-year-old man was scheduled to undergo cardiac resynchronization therapy device (CRTD) implantation. He was combined with severe chronic heart failure due to ischemic heart disease. NYHA class was 3 to 4 and electrocardiogram showed non-sustained ventricular. Ejection fraction was about 20% revealed by transthoracic echocardiogram. He was also on several anticoagulation medications. We planned to implant the device under the greater pectoral muscle. As general anesthesia was considered ri...

  13. Hydrogel microfluidic co-culture device for photothermal therapy and cancer migration.

    Science.gov (United States)

    Lee, Jong Min; Seo, Hye In; Bae, Jun Hyuk; Chung, Bong Geun

    2017-02-07

    We developed the photo-crosslinkable hydrogel microfluidic co-culture device to study photothermal therapy and cancer cell migration. To culture MCF7 human breast carcinoma cells and metastatic U87MG human glioblastoma in the microfluidic device, we used 10 w/v% gelatin methacrylate (GelMA) hydrogels as a semi-permeable physical barrier. We demonstrated the effect of gold nanorod on photothermal therapy of cancer cells in the microfluidic co-culture device. Interestingly, we observed that metastatic U87MG human glioblastoma largely migrated toward vascular endothelial growth factor (VEGF)-treated GelMA hydrogel-embedding microchannels. The main advantage of this hydrogel microfluidic co-culture device is to simultaneously analyze the physiological migration behaviors of two cancer cells with different physiochemical motilities and study gold nanorod-mediated photothermal therapy effect. Therefore, this hydrogel microfluidic co-culture device could be a potentially powerful tool for photothermal therapy and cancer cell migration applications. This article is protected by copyright. All rights reserved.

  14. Multifunctional wearable devices for diagnosis and therapy of movement disorders.

    Science.gov (United States)

    Son, Donghee; Lee, Jongha; Qiao, Shutao; Ghaffari, Roozbeh; Kim, Jaemin; Lee, Ji Eun; Song, Changyeong; Kim, Seok Joo; Lee, Dong Jun; Jun, Samuel Woojoo; Yang, Shixuan; Park, Minjoon; Shin, Jiho; Do, Kyungsik; Lee, Mincheol; Kang, Kwanghun; Hwang, Cheol Seong; Lu, Nanshu; Hyeon, Taeghwan; Kim, Dae-Hyeong

    2014-05-01

    Wearable systems that monitor muscle activity, store data and deliver feedback therapy are the next frontier in personalized medicine and healthcare. However, technical challenges, such as the fabrication of high-performance, energy-efficient sensors and memory modules that are in intimate mechanical contact with soft tissues, in conjunction with controlled delivery of therapeutic agents, limit the wide-scale adoption of such systems. Here, we describe materials, mechanics and designs for multifunctional, wearable-on-the-skin systems that address these challenges via monolithic integration of nanomembranes fabricated with a top-down approach, nanoparticles assembled by bottom-up methods, and stretchable electronics on a tissue-like polymeric substrate. Representative examples of such systems include physiological sensors, non-volatile memory and drug-release actuators. Quantitative analyses of the electronics, mechanics, heat-transfer and drug-diffusion characteristics validate the operation of individual components, thereby enabling system-level multifunctionalities.

  15. DESTINATION BRANDING THROUGH BUSINESS TOURISM

    Directory of Open Access Journals (Sweden)

    Doriana, MORAR

    2014-11-01

    Full Text Available Considering the fat that a rate of up to 70% of tourists visiting Romania have a professional motivation, the present papers intends to provide an overview of the advantages held by Romania for offering tourists the proper conditions for spending quality time in this emerging country. Within the present article, the authors provide to readers an overview regarding destination branding, business travel and the critical elements in achieving economic advantages over competing regions/countries; the article emphasizes the fact that -intelligently exploited-, business tourism can be an element of prosperity within the tumultuous period of time through which Romania and other emerging states are crossing nowadays. The results of this paper work are focused on the identifying, analysing and correlating the main factors that can influence a destination' development through its propulsion as a brand destination for business tourism. Generally speaking, the paper approaches aspects regarding business tourism. The methodology used in order to write the present article is limited to the collection and processing empirical data and information. In this regard, the literature in the field has been reviewed, so that the authors could identify and expose the importance of destination branding through business travel for sustainable development in Romania.

  16. A Survey of Insulin-Dependent Diabetes—Part I: Therapies and Devices

    Directory of Open Access Journals (Sweden)

    Daisuke Takahashi

    2008-01-01

    Full Text Available This paper surveys diabetes therapies from telemedicine viewpoint. In type 1 diabetes therapies, the exogenous insulin replacement is generally considered as a primary treatment. However, the complete replacement of exogenous insulin is still a challenging issue because of its complexity of modeling the dynamics, which is typically modeled nonlinearly. On the other hand, thanks to the progress of medical devices, currently the diabetes therapies are being automated. These medical devices include automated insulin pumps and blood glucose sensors. Insulin pumps are designed to create artificial insulin perfusion while they largely rely on the blood glucose profile measurements and these measurements are achieved by one or more blood glucose sensors. The blood glucose measurements are also important for the insulin-dependent diabetes therapies. An insulin pump along with sensors establishes a good feedback system providing the appropriate amount of the exogenous insulin on demand. Controlling the amount of exogenous insulin to suppress the blood glucose levels requires complicated computations. This paper mostly explains both type 1 and 2 diabetes and their mechanisms accompanied by descriptions of diabetes therapy and medical devices currently utilized in the therapy.

  17. Internal Brand Management of Destination Brands

    DEFF Research Database (Denmark)

    Cox, Natasha; Gyrd-Jones, Richard; Gardiner, Sarah

    2014-01-01

    Achieving a consistent brand experience across a destination and all brand-touch points is a major challenge in destination branding efforts. Strategies to manage the complexity of coordination across multiple network stakeholders are therefore critical for destination management organisations....... However, theories to inform these strategies are limited. This paper proposes that internal brand management theory provides a framework to explore strategies that may increase operator buy-in to the destination brand, thus creating a more consistent brand experience for visitors. Semi...... that promote brand citizenship behaviours. This study advances destination brand management theory and provides practical insights into destination brand management practices....

  18. Acoustic regulation of extracorporeal shock wave (ESW) therapy devices in the U.S

    Science.gov (United States)

    Maruvada, Subha; Harris, Gerald R.

    2005-04-01

    The focused, large amplitude pressure fields produced by ESW lithotripsy devices were shown in the early 1980s to provide an efficient means for fragmenting urinary tract calculi. More recently, orthopedic applications of intense pressure pulses for pain relief and fracture healing have been developed. Under the US Medical Device Amendments of 1976, ESW therapy devices were deemed Class III, meaning that a pre-market application typically would be supported by both pre-clinical and clinical studies. This classification still applies, except for ESW lithotripters indicated for fragmenting kidney and ureteral calculi. These devices were reclassified to Class II in 2000, resulting in a simpler path to market in which a demonstration of substantial equivalence to a currently marketed device is sufficient. As part of its regulatory responsibility to address the safety and effectiveness of these devices, particularly with regard to acoustic output, the US Food and Drug Administration has recognized two International Electrotechnical Commission (IEC) standards for ESW lithotripters, one covering field measurements (IEC 61846) and the other dealing with labeling and other safety aspects (IEC 60601-2-36). Although these standards were designed primarily for lithotripsy, the FDA has used them where applicable in the regulatory analysis of other ESW therapy devices.

  19. Evaluation of advanced cooling therapy's esophageal cooling device for core temperature control.

    Science.gov (United States)

    Naiman, Melissa; Shanley, Patrick; Garrett, Frank; Kulstad, Erik

    2016-05-01

    Managing core temperature is critical to patient outcomes in a wide range of clinical scenarios. Previous devices designed to perform temperature management required a trade-off between invasiveness and temperature modulation efficiency. The Esophageal Cooling Device, made by Advanced Cooling Therapy (Chicago, IL), was developed to optimize warming and cooling efficiency through an easy and low risk procedure that leverages heat transfer through convection and conduction. Clinical data from cardiac arrest, fever, and critical burn patients indicate that the Esophageal Cooling Device performs very well both in terms of temperature modulation (cooling rates of approximately 1.3°C/hour, warming of up to 0.5°C/hour) and maintaining temperature stability (variation around goal temperature ± 0.3°C). Physicians have reported that device performance is comparable to the performance of intravascular temperature management techniques and superior to the performance of surface devices, while avoiding the downsides associated with both.

  20. Development of an MRI-compatible device for prostate focal therapy.

    Science.gov (United States)

    Cepek, Jeremy; Chronik, Blaine; Lindner, Uri; Trachtenberg, John; Fenster, Aaron

    2012-01-01

    We present a device that has been developed for delivering prostate focal thermal therapy under magnetic resonance imaging (MRI) guidance. Unlike most existing devices, ours is capable of delivering needles to targets in the prostate without removing the patient from the scanner. This feature greatly reduces procedure time and increases accuracy. The device consists of a mechanical linkage encoded with optical incremental encoders, and is manually actuated. A custom magnetic resonance (MR) compatible alignment interface allows the user to manually align the device to its target with high accuracy in-bore in very short time. The use of manual actuation over motors greatly reduces the complexity and bulk of the system, making it much more compact and portable. This is important when dealing with such tight space constraints. Needle targeting experiments in gel phantoms have demonstrated the device's ability to deliver needles with an accuracy of 2.1 +/- 1.3 mm.

  1. A devices' game of thrones: cardiac resynchronization therapy vs. pacemaker.

    Science.gov (United States)

    Moura-Ferreira, Sara; Gonçalves, Helena; Oliveira, Marco; Primo, João; Fonseca, Paulo; Ribeiro, José; Santos, Elisabeth; Pelicano, Nuno; Martins, Dinis; Gama, Vasco

    2017-04-18

    Oversensing can interfere with biventricular pacing. Cardiac Resynchronization Therapy (CRT) output inhibition due to automatic brady mode change from a sensing to a pacing mode of a previously implanted pacemaker as it reached battery capacity depleted indicator has not been previously published in the medical literature. We report the first case of CRT output inhibition in a pacemaker dependent patient due to electrical stimuli from a previously right-sided implanted pacemaker, after unaware reversion of OVO mode (O = no chambers paced; V = ventricular sensing; O = no response to sensing) to backup VVI (V = ventricular pacing; V = ventricular sensing; I = inhibitory response to sensing) when it reached the elective replacement interval. This paper emphasizes the importance of knowing the distinct pacemaker brady mode behaviours after battery capacity depleted indicator has been reached, according to the pacemakers' manufacturer, including the possibility of automatic brady mode change from sensing to pacing mode. It also highlights the potential for severe bradycardia or asystole of this automatic brady mode change from a previously implanted pacemaker in pacemaker dependent patients submitted to CRT upgrade.

  2. Myocardial recovery in peri-partum cardiomyopathy after continuous flow left ventricular assist device

    Directory of Open Access Journals (Sweden)

    Lund Lars H

    2011-11-01

    Full Text Available Abstract Left ventricular assist devices (LVADs offer effective therapy for severe heart failure (HF as bridge to transplantation or destination therapy. Rarely, the sustained unloading provided by the LVAD has led to cardiac reverse remodelling and recovery, permitting explantation of the device. We describe the clinical course of a patient with severe peri-partum cardiomyopathy (PPCM rescued with a continuous flow LVAD, who experienced recovery and explantation. We discuss assessment of and criteria for recovery.

  3. Left ventricular assist device implantation strategies and outcomes

    OpenAIRE

    Smith, LaVone A.; Yarboro, Leora T; Kennedy, Jamie L. W.

    2015-01-01

    Over the past 15 years, the field of mechanical circulatory support has developed significantly. Currently, there are a multitude of options for both short and long term cardiac support. Choosing the appropriate device for each patient depends on the amount of support needed and the goals of care. This article focuses on long term, implantable devices for both bridge to transplantation and destination therapy indications. Implantation strategies, including the appropriate concomitant surgerie...

  4. Categorization of Destinations and Formation of Mental Destination Representations

    DEFF Research Database (Denmark)

    Kano Glückstad, Fumiko; Kock, Florian; Josiassen, Alexander

    2017-01-01

    , a disruptive biclustering approach advanced by recent developments of Bayesian relational modeling. This new approach, for the first time in tourism research, allows to design and conduct a segmentation analysis by simultaneously biclustering multiple datasets consisting of cases and variables in a parallel...... format. We demonstrate how the new analytical framework can be applied to analyze and compare patterns of associations which individuals have of multiple destinations. Subsequently, this paper elaborates potential contributions the Bayesian relational modeling framework makes to the tourism research...

  5. Practice of Internet Marketing in Destination Branding

    OpenAIRE

    Duong, Linh

    2012-01-01

    This study provides information about destination branding and the effect of Internet marketing on tourism. Tourism branding generates interest in a destination as well as, investments and reputation. Destination branding with the support of Internet marketing is a new way of maximizing profit. The advantages of Internet marketing include speed and efficiency due to sharing and contributing functions. The aims of the research were to figure out the importance of destination branding stra...

  6. Customer-based brand equity: The Effect of Destination Image on Preference for Products Associated with a Destination Brand

    OpenAIRE

    Lim, Yu Mi

    2009-01-01

    Due to highly competitive destination markets, destination branding techniques are becoming popular among destination marketers. The destination marketers tend to leverage their destination brand value to other products associated with the destination brand (referred to as brand extension). This thesis investigated how customer-based brand equity for a tourist destination can be transferred to products associated with a destination brand. Specifically, the effect of destination image on p...

  7. DESTINATION BRANDING THROUGH BUSINESS TOURISM

    OpenAIRE

    Doriana, MORAR; Denisa, COTÎRLEA

    2014-01-01

    Considering the fat that a rate of up to 70% of tourists visiting Romania have a professional motivation, the present papers intends to provide an overview of the advantages held by Romania for offering tourists the proper conditions for spending quality time in this emerging country. Within the present article, the authors provide to readers an overview regarding destination branding, business travel and the critical elements in achieving economic advantages over competing regions/countries;...

  8. TOURIST MOTIVATION FOR RURAL DESTINATIONS

    OpenAIRE

    2014-01-01

    City daily overexertion impels tourists wish to travel. Rural tourism behavior is determined by a set of motivational factors that makes him appreciate favorable tourist destinations. In order to analyze and assess the opinions and attitudes of tourists in rural areas we realized a market survey, the results being presented in the article below. Future trends, the growth rate of market depend largely on the wishes and intentions of goods or services consumers. This study involves the engageme...

  9. MARKETING URBAN DESTINATIONS THROUGH FESTIVALS

    Directory of Open Access Journals (Sweden)

    Lina Georgieva ANASTASSOVA

    2016-07-01

    Full Text Available Within the context of enormous competition on the international tourist market, destination branding is getting an increasing importance as a way to attract more tourists and visitors. There is an overall trend away from product features towards lifestyle or value systems which reveals that the consumer of today makes choices based on whether or not a product fits into her or his lifestyle and whether a destination represents  a desirable tourist experience. After theoretical literature review on brand identity, the results of a festival visitors’ opinion survey about “Include the city” festival’s contribution to the brand identity of Burgas city are discussed. The survey methodology includes descriptive statistics, Z-score method in order to classify in groups visitor’s opinion as well as content analysis of visitors’ opinion. Three research hypotheses are checked and suggestions about the festival’s marketing contribution in three aspects to the brand identity extension of urban destination Burgas are presented.

  10. Space Transportation and Destination Facilities

    Science.gov (United States)

    Smitherman, David; McClure, Wallace

    1999-01-01

    The Space Transportation and Destination Facilities section focused on space transportation vehicles-from use of existing vehicles to development of specialized transports-and on space stations, space business parks, space hotels, and other facilities in space of the kind that eventually would provide services for general public space travel (PST) and tourism. For both transportation and destination facilities, the emphasis was on the identification of various strategies to enable a realistic incremental progression in the development and acquisition of such facilities, and the identification of issues that need resolution to enable formation of viable businesses. The approach was to determine the best: (1) Strategies for general PST and tourism development through the description and analysis of a wide range of possible future scenarios. With these scenarios in mind the section then identified. (2) Key issues to be explored. (3) opportunities to eliminate barriers. (4) Recommendations for future actions. (5) Top-level requirements and characteristics for general PST and tourism systems and services that would guide the development of transportation and destination facilities.

  11. Inexpensive Attachment Device for Cell Therapy Administration into Injured Spinal Cord.

    Science.gov (United States)

    Vaquero, Jesús; Zurita, Mercedes; Fernández, Cecilia; Cotua, Carlos

    2016-12-01

    Cell therapy is configured as a promising strategy for the treatment of spinal cord injury (SCI), but it requires reliable systems to achieve microinjections with different rates and volumes, according to the different characteristics of the injured spinal cord tissue and the targets previously selected. We sought to describe an original and inexpensive device for support of microinjection systems in the course of spinal cord surgery. Our attachment device consists of an arch and a system of bars that can be fixed to the operating table and on which a microinjection pump can be displaced and fixed in the course of surgery. This device has been used for therapy administration into injured spinal cords. It is easy to use and permits reproducible results. We have described an original attachment device for the support of a microinjection pump. It is applicable to spinal cord surgery and should be considered as a cheap solution for intralesional administration of cell therapy after spinal cord injury. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Revisiting tourist behavior via destination brand worldness

    Directory of Open Access Journals (Sweden)

    Murat Kayak

    2016-11-01

    Full Text Available Taking tourists’ perspective rather than destination offerings as its core concept, this study introduces “perceived destination brand worldness” as a variable. Perceived destination brand worldness is defined as the positive perception that a tourist has of a country that is visited by tourists from all over the world. Then, the relationship between perceived destination brand worldness and intention to revisit is analyzed using partial least squares regression. This empirical study selects Taiwanese tourists as its sample, and the results show that perceived destination brand worldness is a direct predictor of intention to revisit. In light of these empirical findings and observations, practical and theoretical implications are discussed.

  13. Water equivalent thickness analysis of immobilization devices for clinical implementation in proton therapy.

    Science.gov (United States)

    Wroe, A J; Ghebremedhin, A; Gordon, I R; Schulte, R W; Slater, J D

    2014-10-01

    Immobilization devices can impact not only the inter- and intra-fraction motion of the patient, but also the range uncertainty of the treatment beam in proton therapy. In order to limit additional range uncertainty, the water equivalent thickness (WET) of the immobilization device needs to be well known and accurately reflected in the calculations by the treatment planning system (TPS). The method presented here focusses on the use of a nozzle-mounted variable range shifter and precision-machined polystyrene blocks of known WET to evaluate commercial immobilization devices prior to clinical implementation. CT studies were also completed to evaluate the internal uniformity of the immobilization devices under study. Mul- tiple inserts of the kVue platform (Qfix Systems, Avondale, PA) were evaluated as part of this study. The results indicate that the inserts are largely interchangeable across a given design type and that the measured WET values agree with those generated by the TPS with a maxi- mum difference less than 1 mm. The WET of the devices, as determined by the TPS, was not impacted by CT beam hardening normally experienced during clinical use. The reproduc- ibility of the WET method was also determined to be better than ±0.02 mm. In conclusion, the testing of immobilization prior to implementation in proton therapy is essential in order to ascertain their impact on the proton treatment and the methodology described here can also be applied to other immobilization systems.

  14. SLOVENIAN SPORT TOURISM DESTINATIONS AND THEIR COMPETITIVENESS

    Directory of Open Access Journals (Sweden)

    Maja Uran Maravić

    2015-12-01

    Full Text Available This paper assesses the competitiveness of Slovenian sport tourism destinations and compares it with other domestic destinations and those abroad. The methodology is based on different destination competitiveness models. An integrated instrument of the sport destination competitiveness was developed and tested for validity of content and used to assess the competitiveness. There are eight main hypotheses tested. The research results confirm the main hypothesis − that Slovenian tourism managers believe Slovenian destinations are more competitive at home than abroad. The contribution of the research lies in the fact that it has applied the generic instrument for measuring destination competitiveness on sport tourism destinations and, for the first time, their competitiveness is measured in Slovenia.

  15. Cardiac resynchronization therapy: Dire need for targeted left ventricular lead placement and optimal device programming

    Institute of Scientific and Technical Information of China (English)

    Sokratis; Pastromas; Antonis; S; Manolis

    2014-01-01

    Cardiac resynchronization therapy(CRT) effected via biventricular pacing has been established as prime therapy for heart failure patients of New York Heart Association functional class Ⅱ, Ⅲ and ambulatory Ⅳ, reduced left ventricular(LV) function, and a widened QRS complex. CRT has been shown to improve symptoms, LV function, hospitalization rates, and survival. In order to maximize the benefit from CRT and reduce the number of non-responders, consideration should be given to target the optimal site for LV lead implantation away from myocardial scar and close to the latest LV site activation; and also to appropriately program the device paying particular attention to optimal atrioventricular and interventricular intervals. We herein review current data related to both optimal LV lead placement and device programming and their effects on CRT clinical outcomes.

  16. Design of a new tracking device for on-line dose monitor in ion therapy

    CERN Document Server

    Traini, Giacomo; Bollella, Angela; Collamati, Francesco; De Lucia, Erika; Faccini, Riccardo; Ferroni, Fernando; Frallicciardi, Paola Maria; Mancini-Terracciano, Carlo; Marafini, Michela; Mattei, Ilaria; Miraglia, Federico; Muraro, Silvia; Paramatti, Riccardo; Piersanti, Luca; Pinci, Davide; Rucinski, Antoni; Russomando, Andrea; Sarti, Alessio; Sciubba, Adalberto; Senzacqua, Martina; Solfaroli-Camillocci, Elena; Toppi, Marco; Voena, Cecilia; Patera, Vincenzo

    2016-01-01

    Charged Particle Therapy is a technique for cancer treatment that exploits hadron beams, mostly protons and carbons. A critical issue is the monitoring of the dose released by the beam to the tumor and to the surrounding tissues. We present the design of a new tracking device for monitoring on-line the dose in ion therapy through the detection of secondary charged particles produced by the beam interactions in the patient tissues. In fact, the charged particle emission shape can be correlated with the spatial dose release and the Bragg peak position. The detector uses the information provided by 12 layers of scintillating fibers followed by a plastic scintillator and a small calorimeter made of a pixelated Lutetium Fine Silicate crystal. Simulations have been performed to evaluate the achievable spatial resolution and a possible application of the device for the monitoring of the dose pro?le in a real treatment is presented.

  17. El Dorado Destination Management Company

    OpenAIRE

    2012-01-01

    El siguiente estudio se basa en la investigación del mercado de negocios y convenciones en la ciudad de Bogotá, en donde se ha identificado como oportunidad de negocios los viajes de Incentivo, el cual es un microsegmento del segmento de negocios, que no se ha aprovechado y en el que se avizora un gran potencial tanto para la ciudad, como para la empresa El Dorado DMC, empresa que nace en el mercado bajo la denominación de una Destination Management Company, conocida técnicamente como una of...

  18. The destinal question of language

    Directory of Open Access Journals (Sweden)

    Saitya Brata Das

    2011-06-01

    Full Text Available How can we think the destinal place of language in the essentially historical condition of our existence if such historicity cannot be understood on the basis of the labor of negativity alone? The attempt is made here to think language in a more originary manner, as non-negative finitude, that affirms what is outside dialectical-speculative closure, what is to come. The notion of 'destinal' itself is thus transformed. No longer being merely a categorical grasp of "entities presently given", language is an originary exposure to the event of arrival in its lightning flash. Destiny appears as that of the messianic arrival of the 'not yet' which is not a telos that the immanent movement of historical reason reaches by an irresistible force of the negative. This essay reads Schelling, Heidegger and Kierkegaard to think language as a "place" of exposure to the non-teleological destiny that may erupt even today, here and now, without any given conditionality.Como nós podemos pensar o lugar destinal da linguagem na condição essencialmente histórica de nossa existência se tal historicidade não pode ser entendida com base apenas no trabalho da negatividade? Faz-se aqui a tentativa de pensar a linguagem de um modo mais originário, como finitude não negativa, que afirma o que se encontra fora do fechamento dialético-especulativo, o que está por vir. A própria noção de 'destinal' é então transformada. Não sendo mais apenas uma apreensão categorial de "entidades presentemente dadas", a linguagem é uma exposição originária ao evento da chegada em seu instante iluminador. O destino aparece como o da chegada messiânica do 'ainda não' que não é um telos que o movimento imanente da razão histórica atinge por meio de uma irresistível força do negativo. Este ensaio lê Schelling, Heidegger e Kierkegaard para pensar a linguagem como um "lugar" de exposição ao destino não teológico que pode irromper mesmo hoje, aqui e agora, sem

  19. Inappropriate implantable cardioverter defibrillator shock from a transcutaneous muscle stimulation device therapy.

    Science.gov (United States)

    Siu, Chung-Wah; Tse, Hung-Fat; Lau, Chu-Pak

    2005-06-01

    Inappropriate shock from implantable cardioverter defibrillator (ICD) may result from external electromagnetic interference (EMI), especially for unipolar ventricle sensing. Previous case reports and small in-vitro safety study suggested that endocardial bipolar lead system may be immune from EMI resulting from transcutaneous electrical neuromuscle stimulation (TENS) therapy. This report presents an unusual case of inappropriate discharge in a patient with ICD of endocardial bipolar lead system, receiving TENS from a commercially available device.

  20. Effect of Mandibular Advancement Device Therapy on the Signs and Symptoms of Temporomandibular Disorders

    Directory of Open Access Journals (Sweden)

    Ritva Näpänkangas

    2012-12-01

    Full Text Available Objectives: Mandibular advancement device therapy is effectively used in the treatment of obstructive sleep apnea, but also several side effects in the masticatory system have been reported. The aim of this study was to evaluate the subjective symptoms and clinical signs of temporomandibular disorders connected to mandibular advancement device therapy. Material and Methods: The material consisted of 15 patients (9 men and 6 women, mean age 51.1 years, range 21 to 70 years diagnosed with obstructive sleep apnea (OSA. Subjective symptoms and clinical temporomandibular disorders (TMD signs were recorded at the beginning of the treatment (baseline and at 1-month, 3-month, 6-month and 24-month follow-ups. The degree of TMD was assessed using the anamnestic (Ai and the clinical dysfunction index (Di of Helkimo. For assessing the effect of TMD the patients were divided in discontinuing and continuing groups. Results: According to Ai and Di, the severity of TMD remained unchanged during the follow-up in most of the patients. Temporomandibular joint (TMJ crepitation was found more frequently in discontinuing patients at all follow-ups. The difference was statistically significant (P < 0.05 at the six-month follow-up. Masticatory muscle pain during palpation was a frequent clinical sign at the baseline and during the follow-up period but the difference between discontinuing and continuing patients was not significant. Conclusions: It seems that signs and symptoms of temporomandibular disorders do not necessarily increase during long-term mandibular advancement device therapy. However, it seems that patients with clinically assessed temporomandibular joint crepitation may discontinue their mandibular advancement device therapy due to temporomandibular disorders.

  1. Destination Branding Identity from the Stakeholders’ Perspectives

    Directory of Open Access Journals (Sweden)

    Mohd Fadil Mohd Yusof

    2015-01-01

    Full Text Available In order to establish a strong destination branding, understanding the process of image in positioning the destination is crucial. Arguably, a brand identity for a tourist destination that makes up a name is often captured from the user point of view. However, little was understood as to how the stakeholders perceived image-making, and later, the branding of destination and their influence. In this context, brand identity through projection of Destination Management Organizations (DMOs, significantly contribute towards existing image. In other words, they are forcing the creation of branding using the vision of how the market and segmentation should perceive a brand. The question that may rise is how this branding process is truly acting as a catalyst of a production towards desirable destination. This paper addresses the following issues; (1 Stakeholders’ involvement particularly local community in tourism development and planning (2 previous studies in destination branding (3 the relationships between destination identity and destination brand. This paper also highlights the existing gaps in understanding destination identity from the stakeholders’ perspectives to the branding strategy. It also suggests the future studies.

  2. Impact of Tourist Perceptions, Destination Image and Tourist Satisfaction on Destination Loyalty: A Conceptual Model

    Directory of Open Access Journals (Sweden)

    R Rajesh

    2013-07-01

    Full Text Available The objective this research paper is develops a destination loyalty theoretical model by using tourist perception, destination image and tourist satisfaction. These study analysis components, attributes, factor influencing the destination image and examine the tourist satisfaction and determinants of destination loyalty. This is a conceptual paper attempts at evaluating recent empirical on destination image, tourist satisfaction and loyalty. The conceptual framework model is developed on the basis of existing theoretical and empirical research in the field of destination marketing. The models include four constructs. Tourist Perception constructs has been influenced by factors like Historical and Cultural Attractions, Destination Affordability, Travel Environment, Natural Attractions, Entertainments and Infrastructure. Destination image construct has been influenced by factors like Infrastructure & Facilities, Heritage Attractions, Natural Made Attractions, Destination Safety & Cleanness, Friendly Local Community & Clam Atmosphere, Rejuvenation and Service Price and Affordability. The satisfaction construct has been influenced by factors like Entertainments, Destination Attractions and Atmosphere, Accommodation, Food, Transportation Services and Shopping. The destination loyalty construct has influenced by intentions to revisit, word of mouth promotion and recommending to others . The earlier study result reveals that tourist perception, destination image and tourist satisfaction directly influence destination loyalty. The outcomes of the study have significant managerial implications for destination marketing managers.

  3. Titanium alloys as fixation device material for cranioplasty and its safety in electroconvulsive therapy.

    Science.gov (United States)

    Kaido, Takanobu; Noda, Takamasa; Otsuki, Taisuke; Kaneko, Yuu; Takahashi, Akio; Nakai, Tetsuji; Nabatame, Maki; Tani, Mariko

    2011-03-01

    Here, we report the case of a patient successfully treated by a series of electroconvulsive therapy (ECT) who had implanted skull fixation devices made of titanium alloy. The patient was a 57-year-old man with bipolar I disorder. He was hospitalized for the treatment of manic symptoms of bipolar I disorder with pharmacotherapy and ECT. He sustained a fall and hit his head hard on the ground. Acute subdural hematoma developed, and emergent surgery to remove the hematoma was carried out. Cranioplasty was performed using fixation devices made of titanium alloy (Ti 6Al-4V). In order to control his manic symptoms, a series of ECT was readministered from 1 week after surgery. No adverse effects occurred. Devices must be investigated and chosen very carefully for permanent implantation, especially in patients during a course of ECT.

  4. Current devices for high-performance whole-body hyperthermia therapy.

    Science.gov (United States)

    Jia, Dewei; Liu, Jing

    2010-05-01

    For late-stage cancer, whole-body hyperthermia (WBH) is highly regarded by physicians as a promising alternative to conventional therapies. Although WBH is still under scrutiny due to potential toxicity, its benefits are incomparable, as diversified devices and very promising treatment protocols in this area are advanced into Phase II and III clinical trials. Following the introduction of the WBH principle, this paper comprehensively reviews the state-of-art high-performance WBH devices based on the heat induction mechanisms - radiation, convection and conduction. Through analyzing each category's physical principle and heat-induction property, the advantages and disadvantages of the devices are evaluated. Technical strategies and critical scientific issues are summarized. For future developments, research directions worth pursuing are presented in this article.

  5. [Complex therapy of occupational respiratory tract diseases using multifunctional massage device: clinical criteria of efficiency].

    Science.gov (United States)

    Artemova, L V; Sorkina, N S; Rumiantseva, O I; Komarova, S G; Rudyĭ, S S; Petrykina, M V

    2011-01-01

    Level of efficiency of CERAGEM MASTER CGM-M3500 treatment device applied for occupational patients suffering from bronchi and lung pathological states has been shown in the paper. Positive effects of treatment have been assessed as reliably high and were proved by improvement of clinical and functional indices, subjunctive self-evaluation of health by patients and positive signs in the clinical course of the diseases. Diagnostic complex has been analyzed, including hematological indicators of the peripheral blood, oxygenation of the capillary blood, immunology. Also dynamics of the clinical course has been studied along with the data on self-assessment of health by patients prior and after the therapy by the device. Prospects on treatment of occupational bronchi and lung pathologies with the help of multifunctional massage device are being discussed in the paper.

  6. The mismatch between patient life expectancy and the service life of implantable devices in current cardioverter-defibrillator therapy: a call for larger device batteries.

    Science.gov (United States)

    Neuzner, Jörg

    2015-06-01

    In 2005, Bob Hauser published a paper in the Journal of the American College of Cardiology entitled "The growing mismatch between patient longevity and the service life of Implantable Cardioverter-Defibrillators". Now, nearly a decade later, I would like to perform a second look on the problem of a mismatching between ICD device service life and the survival of ICD recipients. Since 2005, the demographics of the ICD population has changed significantly. Primary prevention has become the dominant indication in defibrillator therapy and device implantation is indicated more and more in earlier stages of cardiac diseases. In former larger scale ICD trials, the patient average 5-year survival probability was in a range of 68-71%; in newer CRT-D trials in a range of 72-88%. Due to a progressively widened ICD indication and implantation preferentially performed in patients with better life expectancy, the problem of inadequate device service life is of growing importance. The early days of defibrillator therapy started with a generator volume of 145 ccm and a device service life life were similar challenges for the technicians. Today, we have reached a formerly unexpected extent of device miniaturization. However, technologic improvements were often preferentially translated in further device miniaturization and not in prolonging device service life. In his analysis, Bob Hauser reported a prolonged device service life of 2.3 years in ICD models with a larger battery capacity of 0.54 up to 0.69 Ah. Between 2008 and 2014, several studies had been published on the problem of ICD longevity in clinical scenarios. These analyses included "older" and currently used single chamber, dual chamber and CRT devices. The reported average 5-year device service life ranged from 0 to 75%. Assuming today technology, larger battery capacities will only result in minimal increase in device volume. Selected ICD patients may further benefit from device miniaturization-but the vast majority

  7. TOURIST MOTIVATION FOR RURAL DESTINATIONS

    Directory of Open Access Journals (Sweden)

    Angela BOTEZATU

    2014-04-01

    Full Text Available City daily overexertion impels tourists wish to travel. Rural tourism behavior is determined by a set of motivational factors that makes him appreciate favorable tourist destinations. In order to analyze and assess the opinions and attitudes of tourists in rural areas we realized a market survey, the results being presented in the article below. Future trends, the growth rate of market depend largely on the wishes and intentions of goods or services consumers. This study involves the engagement of a number of 658 respondents, which were interviewed to determine the basic motivations in choosing countryside. The working methods used were analysis, synthesis and questionnaire survey as a research method. Results refer to the following: about 59 percent, spend up to 10% of annual income for vacations and travel, for rural tourism this amount is much lower; the association of the term „rural tourism” in the local tourist mind, oscillates among „a villa” in rural areas or „active vacation” (biking, hiking, riding, swimming or hunting; customer loyalty is one of the goals of marketing activities undertaken in hostels or other travel service providers. In conclusion, we mention that the variety of motivational factors in choosing tourist destinations in rural areas drive this type of tourism.

  8. Destination Competitiveness: a Framework for Future Research

    OpenAIRE

    GRUESCU Ramona; Roxana NANU; Gheorghe PIRVU

    2009-01-01

    We identify the competitive advantage of a tourist destination from a double perspective: the critical contribution of the employees and the ICT impact on promoting and selling the destination. Research methodology includes "bottom to top" analysis of the mentioned indicators. Thus, results include the eficientisation of tourist businesses and destinations due to both human element development and ICT. Two essential basis of the competitive advantage are isolated: differentiation and cost adv...

  9. Destination Competitiviness: A Framework for Future Research

    OpenAIRE

    GRUESCU Ramona; Roxana NANU; Gheorghe PIRVU

    2009-01-01

    The paper envisages aspects concerning identification of the competitive advantage of a tourist destination from a double perspective: the critical contribution of the employees and the ICT impact on promoting and selling the destination. Research methodology includes ‘bottom to top’ analysis of the mentioned indicators. Thus, results include the eficientisation of tourist businesses and destinations due to both human element development and ICT technologies. Two essential basis of the compet...

  10. Destination Strategy Marketing Analysis for Seaside Tourism

    Institute of Scientific and Technical Information of China (English)

    HUO Jiaying

    2009-01-01

    Seaside tourism has become one of the popular tourism destinations to the tourists. It is necessary for manager to study the strategy marketing of seaside tourism destination to promote the seaside tourism. This paper examines the characteristics of seaside tourism and uses the SWOT to analyze the strengths, weakness, opportunities and treats of seaside tourism. Then, the challenges of seaside tourism destination are introduced and should be noticed by the marketing managers.

  11. Destination brand experience and visitor behavior

    DEFF Research Database (Denmark)

    Mattsson, Jan; Sørensen, Flemming; Barnes, Stuart

    2014-01-01

    experience (DBE), which provides a more holistic and unified view of the destination brand. It examines the direct and mediated role of DBE components in determining revisit intentions and word-of-mouth recommendations. The findings suggest that DBE is an important determinant of all study outcomes......Destination branding has developed considerably as a topic area in the last decade with numerous conceptualizations focusing on different aspects of the brand. However, a unified view has not yet emerged. This paper examines destination branding via a new conceptualization, destination brand...

  12. 13. Device therapy in secondary hospital (without a cath lab: Feasibility, logistics and outcome

    Directory of Open Access Journals (Sweden)

    A. Jelani

    2016-07-01

    Full Text Available Device therapy for conduction abnormalities, heart failure, primary or secondary SCD preventions is under delivered to requiring patients. Most of these devices are implanted at tertiary care centers in major cities of most countries. This makes the availability of these guideline guided therapies to a very small percentage of needy patients. Implant of such devices at a secondary hospital (without a cardiac cath lab with training of previously novice hospital staff and available resources as well as support of the industry is an alternative and very viable option to have such important therapy delivered to requiring patients. The usage of simple-readily available-C-arm in operating theatre (OR or the interventional radiology suite can be utilized for this purpose. OR nursing staff and radiology technicians can be trained –with help of nursing education department– to help in such procedures over a relatively short period. Technical support utilized from the vendors representatives is an alternative to face the lack of EP technicians in local or international market. The follow up of these patients in OPD can be organized with help of the vendors on regular basis under supervision of trained cardiologist/s. This model can help establish device therapy service at a secondary hospital without huge expenditure on infrastructure or facing the lack of recruitment of specialized technical support that is difficult to find –especially for smaller cities–. We present our experience at a 250 bed secondary hospital, with a relatively small cardiac unit (3 consultants, 5 hospitalists, 10 cardiac ECG/Echo techs and no cath lab of introduction of this service with the help of nursing education department and vendors supplying these devices as well as OR and radiology departments. Training of radiology technicians and OR nursing staff on the basic procedural support with few in-service demonstration helped prepare adequate staff helping during implant

  13. Objective assessment of biomagnetic devices and alternative clinical therapies using infrared thermal imaging

    Science.gov (United States)

    Rockley, Graham J.

    2001-03-01

    The overwhelming introduction of magnetic devices and other alternative therapies into the health care market prompts the need for objective evaluation of these techniques through the use of infrared thermal imaging. Many of these therapies are reported to promote the stimulation of blood flow or the relief of pain conditions. Infrared imaging is an efficient tool to assess such changes in the physiological state. Therefore, a thermal imager can help document and substantiate whether these therapies are in fact providing an effective change to the local circulation. Thermal images may also indicate whether the change is temporary or sustained. As a specific case example, preliminary findings will be presented concerning the use of magnets and the effect they have on peripheral circulation. This will include a discussion of the recommended protocols for this type of infrared testing. This test model can be applied to the evaluation of other devices and therapeutic procedures which are reputed to affect circulation such as electro acupuncture, orthopedic footwear and topical ointments designed to relieve pain or inflammation.

  14. Predictors of Death and Transplant in Patients With a Mechanical Circulatory Support Device : A Multi-institutional Study

    NARCIS (Netherlands)

    Holman, William L.; Kormos, Robert L.; Naftel, David C.; Miller, Marissa A.; Pagani, Frank D.; Blume, Elizabeth; Cleeton, Timothy; Koenig, Steven C.; Edwards, Leah; Kirklin, James K.

    2009-01-01

    Background: INTERMACS is a registry of FDA-approved durable mechanical circulatory support (MCS) devices used for the strategies of destination therapy (DT) and bridge to transplantation (BTT) or recovery. This study identifies predictors for death and transplantation based on initial results from I

  15. Predictors of Death and Transplant in Patients With a Mechanical Circulatory Support Device : A Multi-institutional Study

    NARCIS (Netherlands)

    Holman, William L.; Kormos, Robert L.; Naftel, David C.; Miller, Marissa A.; Pagani, Frank D.; Blume, Elizabeth; Cleeton, Timothy; Koenig, Steven C.; Edwards, Leah; Kirklin, James K.

    Background: INTERMACS is a registry of FDA-approved durable mechanical circulatory support (MCS) devices used for the strategies of destination therapy (DT) and bridge to transplantation (BTT) or recovery. This study identifies predictors for death and transplantation based on initial results from

  16. Comparative study of passive and semi-active energy dissipation devices intended for overhead cranes; Etude comparative de dispositifs de dissipation d`energie passif et semi-actif destines aux ponts roulants

    Energy Technology Data Exchange (ETDEWEB)

    Guihot, P.; Revaud, D.

    1996-04-01

    This paper deals with the results of a bibliographic survey of energy dissipation devices which could be adapted for overhead cranes. The principle of passive devices using friction, yielding steel systems of viscous and viscoelastic systems are remembered. An active control system, which needs a minimum of external control energy is also presented. The application to overhead cranes which have a strong non linear behaviour under strong seismic motion (sliding between rails and wheels, local yielding and damage) is further discussed. The first results of a numerical study in progress are likewise purposed. The criterion of selection of the devices turn on the performance, the robustness and the reliability. The behaviour in the presence of non linearities, the sensitivity to the variations of the vibratory characteristics, and lastly the sensitivity to the response delay of the active controller are taken into account. (authors). 14 refs., 4 figs.

  17. Active exercises utilizing a facilitating device in the treatment of lymphedema resulting from breast cancer therapy

    Directory of Open Access Journals (Sweden)

    de Fátima Guerreiro Godoy, Maria

    2010-01-01

    Full Text Available The aim of this study was to evaluate the reduction in volume of arm lymphedema secondary to breast cancer therapy utilizing an exercise facilitating device. Twenty-one women with arm lymphedema resulting from the surgical and radiotherapeutic treatment of breast cancer were randomly selected. Evaluation was made by water-displacement volumetry before and after each session. The patients were submitted to a series of active exercises using a facilitating device for four 12-minute sessions with intervals of 3 minutes between sessions in the sitting position with alignment of the spinal column. The lymphedematous arm was maintained under compression using a cotton-polyester sleeve. The active exercising device used was a mobile flexion bar fixed on a metal base at a height of 30 cm from the tabletop and at a distance of 10 cm from the patient’s body. The paired t-test was utilized for statistical analysis with an alpha error of 5% (p-value ≤0.05 being considered significant. The initial mean volume of the arms was 2,089.9 and the final volume was 2,023.0 mL with a mean loss of 66.9 mL (p-value <0.001. In conclusion, active exercises utilizing facilitating devices can contribute to a reduction in size of lymphedematous limbs.

  18. Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device

    Directory of Open Access Journals (Sweden)

    Daoud GE

    2016-01-01

    Full Text Available Georges E Daoud,1 Mahmoud Houmsse2 1Department of the Biomedical Research, 2Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA Abstract: Cardiac resynchronization therapy (CRT is an effective and well-established therapy for patients suffering with heart failure, left ventricular (LV systolic dysfunction (ejection fraction ≤35%, and electrical dyssynchrony, demonstrated by a surface QRS duration of ≥120 ms. Patients undergoing treatment with CRT have shown significant improvement in functional class, quality of life, LV ejection fraction, exercise capacity, hemodynamics, and reverse remodeling of LV, and ultimately, morbidity and mortality. However, 30%–40% of patients who receive a CRT device may not show improvement, and they are termed as nonresponders. The nonresponders have a poor prognosis; several methods have been developed to try to enhance response to CRT. Echocardiography-guided optimization of CRT has not resulted in significant clinical benefit, since it is done at rest with the patient in supine position. An ideal optimization strategy would provide continuous monitoring and adjustment of device pacing to provide maximal cardiac resynchronization, under a multitude of physiologic states. Intrinsic activation of the right ventricle (RV with paced activation of the RV, even in the setting of biventricular (BiV pacing, may result in an adverse effect on cardiac performance. With this physiology, the use of LV-only pacing may be preferred and may enhance CRT. Adaptive CRT is a novel device-based algorithm that was designed to achieve patient-specific adjustment in CRT so as to provide appropriate BiV pacing or LV-only pacing. This article will review the goals of CRT optimization, and implementation and outcomes associated with adaptive CRT. Keywords: heart failure, cardiac resynchronization, therapy, adaptive, left and biventricular pacing

  19. Destination bonding: Hybrid cognition using Instagram

    Directory of Open Access Journals (Sweden)

    Arup Kumar Baksi

    2015-01-01

    Full Text Available Empirical research has identified the phenomenon of destination bonding as a result of summated physical and emotional values associated with the destination. Physical values, namely natural landscape & other physical settings and emotional values, namely the enculturation processes, have a significant role to play in portraying visitors’ cognitive framework for destination preference. The physical values seemed to be the stimulator for bonding that embodies action or behavior tendencies in imagery. The emotional values were the conditions that lead to affective bonding and are reflected in attitudes for a place which were evident in text narratives. Social networking on virtual platforms offers the scope for hybrid cognitive expression using imagery and text to the visitors. Instagram has emerged as an application-window to capture these hybrid cognitions of visitors. This study focuses on assessing the relationship between hybrid cognition of visitors expressed via Instagram and their bond with the destination. Further to this, the study attempts to examine the impact of hybrid cognition of visitors on the behavioral pattern of prospective visitors to the destination. The study revealed that sharing of visual imageries and related text by the visitors is an expression of the physico-emotional bonding with the destination. It was further established that hybrid cognition strongly asserts destination bonding and has been also found to have moderating impact on the link between destination bonding and electronic-word-of-mouth.

  20. The Contemporary Roles of Destination Management Organizations

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Aiming at presenting the contemporary topics on roles of destina-tion management organizations (DMOs) and arousing attentions to the shift of their roles to marketing via social media to generate electronic word-of-mouth (eWOM) , this paper reveals a unique picture of the destination management organizations and their emerged roles.

  1. Destination and source memory in Huntington's disease

    NARCIS (Netherlands)

    El Haj, M.; Caillaud, M.; Verny, C.; Fasotti, L.; Allain, P.

    2016-01-01

    Destination memory refers to the recall of the destination of previously relayed information, and source memory refers to the recollection of the origin of received information. We compared both memory systems in Huntington's disease (HD) participants. For this, HD participants and healthy adults

  2. Virtual destination image: a new measurement approach

    NARCIS (Netherlands)

    R. Govers (Robert); F.M. Go (Frank); K. Kumar (Kuldeep)

    2007-01-01

    textabstractThis study utilized enabling internet and computerized content analysis technologies to measure destination image from a phenomenographic post-positivist perspective. In an online survey, respondents were asked to describe their image of one of seven case study destinations that they had

  3. Clinical, Molecular and Genetic Changes in Response to a Left Ventricular Assist Device

    OpenAIRE

    Hall, Jennifer L.; Fermin, David R.; Birks, Emma J.; Barton, Paul J. R.; Slaughter, Mark; Eckman, Peter; Hideo A. Baba; Wohlschlaeger, Jeremias Jeremias; Miller, Leslie W.

    2011-01-01

    The use of left ventricular assist devices (LVADs) in treating patients with end stage heart failure has increased significantly in recent years, both as a bridge to transplant and as destination therapy in those who are ineligible for cardiac transplantation. This increase is based largely on the results of several recently completed clinical trials with the new second generation continuous flow devices that showed significant improvement in survival, functional capacity, and quality of life...

  4. Negative pressure wound therapy and external fixation device: a simple way to seal the dressing.

    Science.gov (United States)

    Bulla, Antonio; Farace, Francesco; Uzel, André-Pierre; Casoli, Vincent

    2014-07-01

    Negative pressure therapy is widely applied to treat lower limb trauma. However, sealing a negative pressure dressing in the presence of an external fixation device may be difficult and time consuming. Therefore, screws, pins, wires, etc, may preclude the vacuum, preventing the plastic drape to perfectly adhere to the foam. To maintain the vacuum, we tried to prevent air leaking around the screws putting bone wax at the junction between the pins and the plastic drape. This solution, in our hands, avoids air leakage and helps maintain vacuum in a fast and inexpensive way.

  5. Renal Replacement Therapy in Congestive Heart Failure Requiring Left Ventricular Assist Device Augmentation

    OpenAIRE

    Thomas, Bernadette A.; Logar, Christine M.; Anderson, Arthur E.

    2012-01-01

    “Cardiorenal syndrome” is a term used to describe a dys-regulation of the heart affecting the kidneys, or vice versa, in an acute or chronic manner (1,2). Renal impairment can range from reversible ischemic damage to renal failure requiring short- or long-term renal replacement therapy (2). Patients who require mechanical circulatory support, such as a left ventricular assist device (LVAD), as definitive treatment for congestive heart failure or as a bridge to cardiac transplantation pose a u...

  6. [The effect of postoperative cold therapy in joint surgery using a new cooling device].

    Science.gov (United States)

    Münst, P; Bonnaire, F; Kuner, E H

    1988-08-01

    The effect of continuous cold therapy with a new cooling device in post-operative treatment after knee surgery has been proved. Ten patients with different operations of the knee joint participated in this study. Eight out of ten patients reported no or poor pain, whereas in the control group especially after arthrotomy considerable or violent pain was reported. After arthroscopic operations we found more an decrease of swelling and effusion, after arthrotomy more pain reduction. The subjective feeling of all patients was very good and they were generally very receptive to it.

  7. Malfunctions of Implantable Cardiac Devices in Patients Receiving Proton Beam Therapy: Incidence and Predictors

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Poenisch, Falk [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Pinnix, Chelsea C. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Sheu, Tommy [Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Joe Y. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Memon, Nada [Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mohan, Radhe [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rozner, Marc A. [Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dougherty, Anne H. [Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-11-01

    Purpose: Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. Methods and Materials: From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIED; 28 pacemakers and 14 cardioverter-defibrillators) underwent 42 courses of PBT for thoracic (23, 55%), prostate (15, 36%), liver (3, 7%), or base of skull (1, 2%) tumors at a single institution. The median prescribed dose was 74 Gy (relative biological effectiveness; range 46.8-87.5 Gy), and the median distance from the treatment field to the CIED was 10 cm (range 0.8-40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Results: Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13-21 Gy) and 346 Sv (range 11-1100 mSv). Six CIED malfunctions occurred in 5 patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and 1 patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9-8 cm), and the mean maximum neutron dose was 655 mSv (range 330-1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the elective replacement indicator message was replaced uneventfully after treatment. Conclusions: The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving

  8. Destination competitivenes: A challenging process for Serbia

    Directory of Open Access Journals (Sweden)

    Tanja Armenski

    2011-05-01

    Full Text Available The degree to which a country can benefit from its tourism industry depends largely on this competitive position on the international tourist market. Therefore, it is very important for one destination to realise its real competitive position on the tourism market as well as to address its weaknesses comparing them to its major competitors. There are different models for measuring the competitiveness. Among all, we follow the framework of authors Dwyer, Livaic and Mellor (2003, so called Integrated model of destination competitiveness. The aim of this paper is to present the model of destination competitiveness and results of the survey, based on indicators associated with the model. The results showed that Serbia is more competitive in its natural, cultural and created resources than in destination management while, according to the Integrated model, Serbia is less competitive in demand conditions, which refer to the image and awareness of the destination itself.

  9. Statistical analysis of tourism destination competitiveness

    Directory of Open Access Journals (Sweden)

    Attilio Gardini

    2013-05-01

    Full Text Available The growing relevance of tourism industry for modern advanced economies has increased the interest among researchers and policy makers in the statistical analysis of destination competitiveness. In this paper we outline a new model of destination competitiveness based on sound theoretical grounds and we develop a statistical test of the model on sample data based on Italian tourist destination decisions and choices. Our model focuses on the tourism decision process which starts from the demand schedule for holidays and ends with the choice of a specific holiday destination. The demand schedule is a function of individual preferences and of destination positioning, while the final decision is a function of the initial demand schedule and the information concerning services for accommodation and recreation in the selected destinations. Moreover, we extend previous studies that focused on image or attributes (such as climate and scenery by paying more attention to the services for accommodation and recreation in the holiday destinations. We test the proposed model using empirical data collected from a sample of 1.200 Italian tourists interviewed in 2007 (October - December. Data analysis shows that the selection probability for the destination included in the consideration set is not proportional to the share of inclusion because the share of inclusion is determined by the brand image, while the selection of the effective holiday destination is influenced by the real supply conditions. The analysis of Italian tourists preferences underline the existence of a latent demand for foreign holidays which points out a risk of market share reduction for Italian tourism system in the global market. We also find a snow ball effect which helps the most popular destinations, mainly in the northern Italian regions.

  10. [Application of modified plaster material and device in acupoint plaster therapy].

    Science.gov (United States)

    Liu, Jing-Xing; Wang, Kui; Wang, De-Li; Yang, Zong-Yun

    2013-02-01

    Through the analysis on the methods of medicinal paste preparation, the irritation of skin to medicine and the plaster materials adopted in acupoint plaster therapy for the prevention of winter-attacked disease in summer, the acupoint plaster materials and devices were improved. According to the differences in age, illness condition, acupoint and medicinal irritation of patients, the high-dosage, moderate-dosage and low-dosage series of medicine were prepared in proportion; 2. 5 mL and 5 mL syringes were manually reconstructed as the pushers for the delivery of the medicine paste of different specifications. The new-type materials such as spun-bonded non-woven fabrics, transparent dressing film and spun-laced non-woven skin-color stick plaster were adopted. In the operation, the medicine was classified and prepared more specifically. The dedicated acupoint plaster was characterized as less in skin irritation, breathable in property, convenient in practice and proper in stickiness. The plastic anti-seepage film in the middle and the medicine storage pool for stabilizing medicinal paste could avoid drug leakage. The medicinal paste pusher could achieve the even size, proper thickness and precise dosage of the paste. The new-type plaster material and the self-prepared innovated plaster device contribute to the development of acupoint plaster therapy in clinical application.

  11. SU-E-J-48: Development of An Abdominal Compression Device for Respiratory Correlated Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, T; Kang, S; Kim, D; Suh, T [Catholic University Medical College, Seoul (Korea, Republic of); Kim, S [Virginia Commonwealth University, Richmond, VA (United States)

    2014-06-01

    Purpose: The aim of this study is to develop the abdominal compression device which could control pressure level according to the abdominal respiratory motion and evaluate its feasibility. Methods: In this study, we focused on developing the abdominal compression device which could control pressure level at any point of time so the developed device is possible to use a variety of purpose (gating technique or respiratory training system) while maintaining the merit of the existing commercial device. The compression device (air pad form) was designed to be able to compress the front and side of abdomen and the pressure level of the abdomen is controlled by air flow. Pressure level of abdomen (air flow) was determined using correlation data between external abdominal motion and respiratory volume signal measured by spirometer. In order to verify the feasibility of the device, it was necessary to confirm the correlation between the abdominal respiratory motion and respiratory volume signal and cooperation with respiratory training system also checked. Results: In the previous study, we could find that the correlation coefficient ratio between diaphragm and respiratory volume signal measured by spirometer was 0.95. In this study, we confirmed the correlation between the respiratory volume signal and the external abdominal motion measured by belt-transducer (correlation coefficient ratio was 0.92) and used the correlated respiratory volume data as an abdominal pressure level. It was possible to control the pressure level with negligible time delay and respiratory volume data based guiding waveforms could be properly inserted into the respiratory training system. Conclusion: Through this feasibility study, we confirmed the correlation between the respiratory volume signal and the external abdominal motion. Also initial assessment of the device and its compatibility with the respiratory training system were verified. Further study on application in respiratory gated

  12. Destiny of Destinations: Can TDM Help?

    Directory of Open Access Journals (Sweden)

    Zsuzsanna Bacsi

    2014-06-01

    Full Text Available Tourism destination management (TDM is a popular catchword of current tourism research. A research, co-financed by the European Union through the Hungary-Croatia IPA Cross-border Co-operation Programme, within the project ’Health &Rural Tourism DM Model’ (project no.: HUHR/1101/2.1.3/0006, was carried out in 2013 to analyse the specialities of TDM in health tourism destinations, the physical and human resources of such destinations, aspects of sustainability and competitiveness, the main factors of success. Primary data were collected by surveys and interviews carried out in six spa towns of Western Hungary. The main findings indicated, that the major natural natural endowment is medicinal water in the research area, tourism infrastructure and superstructure are sufficient, although the range of services, and marketing of health tourism services should be improved. Destination management organisations perform least efficiently in attracting investors. The attitudes of stakeholders of the tourism sector towards the idea of TDM differ, while in less successful destinations they are more inclined to cooperate this way, they are rather reluctant to do so in successful destinations. Assessing the traits of tourism service providers, the natural assets, the local community and the targeted tourist segments a general model of health tourism destinations is outlined by the four componenets of the well-known VICE model.

  13. Invention of the Guide Catheter Irrigation Monitoring Device for Neuroendovascular Therapy.

    Science.gov (United States)

    Ozkul, Ayca; Park, Jong-Hyun; Shin, Dong-Seung; Yilmaz, Ali; Kim, Bum-Tae

    2017-07-01

    The thromboembolic events during neuroendovascular therapy (NET) are the major complications of concern that can be occasionally fatal. The thrombotic occlusion of the guide catheter for NET is thought to be the risk of the thromboembolic events. We have developed an idea for inventing the monitoring system of the continuous irrigation through the guide catheter. We herein present a unique invention of the guide catheter irrigation monitoring device. We have developed ideas for preventing the thrombotic occlusion of the guide catheter. In order to design a convenient device working in the practical use, we have consulted and shared the ideas with the electrical engineers about putting the invention. The guide catheter irrigation monitoring device (GCIMD) consisted of three parts of optical sensor, main body and electric adapter. In brief, the basic principles of working of the GCIMD are as follows. The optical sensor is attached to the dripping chamber of the line to irrigation solution. The main body had the small light and speaker to make an alarm sounds. The sensor monitors the dripping of flush solution. If the dripping stops more than three seconds, a warning alarm has been activated. So, the operating physicians can concentrate and check the guide catheter irrigation. After the use of the GCIMD, there was no major thromboembolic complication in conjunction with the thrombotic occlusion of the guide catheter in our institute. We have developed a brilliant invention of the GCIMD for NET.

  14. Past and present of cardiocirculatory assist devices: a comprehensive critical review

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Francesco Santini; Giuseppe Faggian

    2012-01-01

    During the last 20 years, the management of heart failure has significantly improved by means of new pharmacotherapies, more timely invasive treatments and device assisted therapies. Indeed, advances in mechanical support, namely with the development of more efficient left ventricular assist devices (LVADs), and the total artificial heart have reduced mortality and morbidity in patients awaiting transplantation, so much so, that LVADs are now approved of as a strategy for destination therapy. In this review, the authors describe in detail the current basic indications, functioning modalities, main limitations of surgical LAVDs, total artificial heart development, and percutaneous assist devices, trying to clarify this complex, but fascinating topic.

  15. Using portable negative pressure wound therapy devices in the home care setting

    Directory of Open Access Journals (Sweden)

    Burke JR

    2014-12-01

    Full Text Available Joshua R Burke, Rachael Morley, Mustafa Khanbhai Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK Abstract: Negative pressure wound therapy (NPWT is the continuous or intermittent application of subatmospheric pressure to the surface of a wound that improves the wound environment, accelerates healing, and reduces wound closure time. Since its first documented use, this technology has lent itself to a number of adaptations, most notably, the development of portable devices facilitating treatment in the home care setting. With advancing surgical standards, wound healing is an important rate-limiting factor in early patient discharge and often a major cost of inpatient treatment. The efficacy of NPWT in the home care setting has been investigated through rate of wound closure, time in care, and patient experience. Rate of wound closure is the most appropriate primary end point. Much can be gleaned from patient experience, but the future success of portable NPWT will be measured on time in care and therefore cost effectiveness. However, there is a lack of level 1a evidence demonstrating increased efficacy of portable over inpatient NPWT. The development of portable NPWT is an encouraging innovation in wound care technology, and extending the benefits to the home care setting is both possible and potentially more beneficial. Keywords: portable, negative pressure wound therapy, vacuum-assisted closure, topical negative pressure therapy

  16. International Tourism and Destination Image of China

    Institute of Scientific and Technical Information of China (English)

    黎云莺

    2013-01-01

    The unprecedented growth during the last sixty years has created great challenges in tourism industry. As more and more places have been developing for tourism, the destination choices available to consumers continue to expand. Under such a competitive environment, all segments of the tourist industry have spent large amount of money attempting to build a favorable tourist image. In recent years more attention has been paid by researchers to the role of destination image in the tourist’s holiday choice decision process and to the measurements of destination image.

  17. EUROPEAN NAUTICAL TOURISTS: EXPLORING DESTINATION IMAGE PERCEPTIONS

    National Research Council Canada - National Science Library

    Yen E Lam González; Javier de León Ledesma; Carmelo J León González

    2015-01-01

      The present paper aims at exploring the European nautical tourists' perceptions of image, in relation to the type of nautical sport they carry out and the type of nautical destination they visit...

  18. Will China Still Be the Destination?

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    Though the financial crisis is slowing the growth in foreign direct investment (FDI) this year,China still remains an attractive destination for foreign investors,for its dynamic economy,according to the Ministry of Commerce (MOFCOM).

  19. Destination image: Origins, Developments and Implications

    Directory of Open Access Journals (Sweden)

    Sérgio Dominique Ferreira Lopes

    2011-04-01

    Full Text Available Over the last few decades, tourism has become one of the main sectors of the global economy, not only because of its contribution to the Gross Domestic Product (GDP of different countries, but also because of the employment it generates. Since 2009, however, the results of tourism have been severely affected by the economic and financial crisis and it is now essential to analyze the key elements of tourist consumer behavior. In this context, the image that a destination transmits to the market becomes one of the elements which influence tourists the most when choosing a tourist destination. The authors therefore aim to identify the main elements that characterize the image of a tourist destination, as well as their implications for the management of tourist destinations.

  20. Destination image: Origins, Developments and Implications

    Directory of Open Access Journals (Sweden)

    Sérgio Dominique Ferreira Lopes

    2011-01-01

    Full Text Available Over the last few decades, tourism has become one of the main sectors of the global economy, not only because of its contribution to the Gross Domestic Product (GDP of different countries, but also because of the employment it generates. Since 2009, however, the results of tourism have been severely affected by the economic and financial crisis and it is now essential to analyze the key elements of tourist consumer behavior. In this context, the image that a destination transmits to the market becomes one of the elements which influence tourists the most when choosing a tourist destination. The authors therefore aim to identify the main elements that characterize the image of a tourist destination, as well as their implications for the management of tourist destinations.

  1. SPECIFIC KNOWLEDGE FOR MANAGING ECOTOURISM DESTINATIONS

    OpenAIRE

    Smolčić Jurdana, Dora

    2009-01-01

    Management of ecotourism destinations is very demanding because of the specific and interdisciplinary knowledge that is necessary. Great knowledge, which consists of knowledge from human and natural sciences at the same time, emphasizes the need for permanent education, formal and informal of ecotourism destination managers. In should be generally stated that countries which have a great areas and resources for ecotourism development should create a specific program for education about the...

  2. A graphene-based electrochemical device with thermoresponsive microneedles for diabetes monitoring and therapy

    Science.gov (United States)

    Lee, Hyunjae; Choi, Tae Kyu; Lee, Young Bum; Cho, Hye Rim; Ghaffari, Roozbeh; Wang, Liu; Choi, Hyung Jin; Chung, Taek Dong; Lu, Nanshu; Hyeon, Taeghwan; Choi, Seung Hong; Kim, Dae-Hyeong

    2016-06-01

    Owing to its high carrier mobility, conductivity, flexibility and optical transparency, graphene is a versatile material in micro- and macroelectronics. However, the low density of electrochemically active defects in graphene synthesized by chemical vapour deposition limits its application in biosensing. Here, we show that graphene doped with gold and combined with a gold mesh has improved electrochemical activity over bare graphene, sufficient to form a wearable patch for sweat-based diabetes monitoring and feedback therapy. The stretchable device features a serpentine bilayer of gold mesh and gold-doped graphene that forms an efficient electrochemical interface for the stable transfer of electrical signals. The patch consists of a heater, temperature, humidity, glucose and pH sensors and polymeric microneedles that can be thermally activated to deliver drugs transcutaneously. We show that the patch can be thermally actuated to deliver Metformin and reduce blood glucose levels in diabetic mice.

  3. Iatrogenic oesophageal perforation during placement of an endoscopic vacuum therapy device.

    Science.gov (United States)

    Halliday, Edwin; Patel, Anant; Hindmarsh, Andrew; Sujendran, Vijay

    2016-07-28

    Endoscopic vacuum-assisted closure (VAC) is increasingly being used as a means of managing perforations or anastomotic leaks of the upper gastrointestinal (GI) tract. Published outcomes are favourable, with few mentions of complications or morbidity. We present a case in which the management of a gastric perforation with endoscopic vacuum therapy was complicated by cervical oesophageal perforation. The case highlights the risks of such endoscopic therapeutic procedures and is the first report in the literature to describe significant visceral injury during placement of a VAC device for upper GI perforation. Iatrogenic oesophageal perforation is an inherent risk to upper GI endoscopy and the risk increases in therapeutic endoscopic procedures. Complications may be reduced by management under a multidisciplinary team in a centre with specialist upper GI services. There is no doubt that the endoscopic VAC approach is becoming established practice, and training in its use must reflect its increasingly widespread adoption.

  4. The digital complexity in destination branding: the case of Portugal as tourism destination

    OpenAIRE

    Oliveira, Eduardo de

    2013-01-01

    Tourism destinations are demanding strategic thinking and dynamic methods to address the contemporary digital challenge. The application of information communication technologies (ICTs) by tourism destinations, when correctly articulated with a destination branding strategy, could be a driving force to improve their strategic positioning, competitiveness, image and to optimise the benefits they derive from tourism. The novelty of this paper lies in the strategic approach to the digital comple...

  5. The digital complexity in destination branding: the case of Portugal as tourism destination

    OpenAIRE

    Oliveira,Eduardo

    2013-01-01

    Tourism destinations are demanding strategic thinking and dynamic methods to address the contemporary digital challenge. The application of information communication technologies (ICTs) by tourism destinations, when correctly articulated with a destination branding strategy, could be a driving force to improve their strategic positioning, competitiveness, image and to optimise the benefits they derive from tourism. The novelty of this paper lies in the strategic approach to the digital comple...

  6. Competitiveness of Slovenia as a Tourist Destination

    Directory of Open Access Journals (Sweden)

    Doris Gomezelj Omerzel

    2006-06-01

    Full Text Available In an increasingly saturated market the fundamental task for the destination management, is understanding how tourism destination competitiveness can be enhanced and sustained. Competitiveness of a tourist destination is an important factor that positively influences the growth of the market share. Therefore tourism managers have to identify and explore competitive advantages and analyse the actual competitive position. There exist different approaches that model the competitiveness (Ritchie and Crouch 1993; Evans and Johnson 1995; Hassan 2000; Kozak 2001; De Keyser and Vanhove 1994; Dwyer, Livaic and Mellor 2003. Among all we follow the framework (Dwyer, Livaic and Mellor 2003, which was developed in a collaborative effort by researchers in Korea and Australia and presented in Sydney in 2001, and conduct an empirical analysis on Slovenia as a tourist destination. The aim of this paper is to present the model of destination competitiveness. The paper presents the results of a survey, based on indicators associated with the model, to determine the competitiveness of Slovenia as a tourist destination.

  7. THE ONLINE COMMUNICATION MIX FOR TOURISM DESTINATIONS STUDY CASE ON ROMANIAN TOURISM DESTINATIONS

    Directory of Open Access Journals (Sweden)

    Adina CONSTANTINESCU

    2013-06-01

    Full Text Available The present research aims at contributing to the field of Online Communication for tourism destinations. It provides a study on online communication of Romanian main tourism destinations, focusing on DMOs’ websites completeness in terms of contents and on their capability to respond to users’ needs. The results of the current research show that the Romanian Destination Websites offer a poor online experience for users, in terms of content, functionalities and fail to fully satisfy the needs and wants of potential tourists. This study is important for establishing the strategies for developing the tourism destination management in Romania.

  8. Speech therapy and communication device: impact on quality of life and mood in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Körner, Sonja; Sieniawski, Michael; Siniawski, Michael; Kollewe, Katja; Rath, Klaus Jan; Krampfl, Klaus; Zapf, Antonia; Dengler, Reinhard; Petri, Susanne

    2013-01-01

    Dysarthria has a drastic impact on the quality of life of ALS patients. Most patients suffering from dysarthria are offered speech therapy. Communication devices are prescribed less frequently. In the present study we investigated the impact of these therapeutic arrangements on quality of life in ALS patients. Thirty-eight ALS patients with dysarthria or anarthria, who underwent speech therapy and/or used communication devices answered three standardized questionnaires (Beck Depression Inventory - II (BDI), SF-36 Health Survey questionnaire (SF-36) and ALS Functional Rating Scale-revised (ALSFRS-R)) and were further interviewed about their experience with and benefit of speech therapy and communication devices. Most of the patients described a high impact of the communication device on their quality of life while the influence of speech therapy was rated less. By multiple regression analysis we confirmed an independent positive effect of communication device use on depression and psychological distress. In conclusion, communication systems improve or at least stabilize quality of life and mood in dysarthric ALS patients, and should be provided early in the disease course.

  9. Update on Renal Replacement Therapy: Implantable Artificial Devices and Bioengineered Organs.

    Science.gov (United States)

    Attanasio, Chiara; Latancia, Marcela T; Otterbein, Leo E; Netti, Paolo A

    2016-08-01

    Recent advances in the fields of artificial organs and regenerative medicine are now joining forces in the areas of organ transplantation and bioengineering to solve continued challenges for patients with end-stage renal disease. The waiting lists for those needing a transplant continue to exceed demand. Dialysis, while effective, brings different challenges, including quality of life and susceptibility to infection. Unfortunately, the majority of research outputs are far from delivering satisfactory solutions. Current efforts are focused on providing a self-standing device able to recapitulate kidney function. In this review, we focus on two remarkable innovations that may offer significant clinical impact in the field of renal replacement therapy: the implantable artificial renal assist device (RAD) and the transplantable bioengineered kidney. The artificial RAD strategy utilizes micromachining techniques to fabricate a biohybrid system able to mimic renal morphology and function. The current trend in kidney bioengineering exploits the structure of the native organ to produce a kidney that is ready to be transplanted. Although these two systems stem from different technological approaches, they are both designed to be implantable, long lasting, and free standing to allow patients with kidney failure to be autonomous. However, for both of them, there are relevant issues that must be addressed before translation into clinical use and these are discussed in this review.

  10. A suppressor to prevent direct wave-induced cavitation in shock wave therapy devices

    Science.gov (United States)

    Matula, Thomas J.; Hilmo, Paul R.; Bailey, Michael R.

    2005-07-01

    Cavitation plays a varied but important role in lithotripsy. Cavitation facilitates stone comminution, but can also form an acoustic barrier that may shield stones from subsequent shock waves. In addition, cavitation damages tissue. Spark-gap lithotripters generate cavitation with both a direct and a focused wave. The direct wave propagates as a spherically diverging wave, arriving at the focus ahead of the focused shock wave. It can be modeled with the same waveform (but lower amplitude) as the focused wave. We show with both simulations and experiments that bubbles are forced to grow in response to the direct wave, and that these bubbles can still be large when the focused shock wave arrives. A baffle or ``suppressor'' that blocks the propagation of the direct wave is shown to significantly reduce the direct wave pressure amplitude, as well as direct wave-induced bubble growth. These results are applicable to spark-gap lithotripters and extracorporeal shock wave therapy devices, where cavitation from the direct wave may interfere with treatment. A simple direct-wave suppressor might therefore be used to improve the therapeutic efficacy of these devices.

  11. Evaluation of image quality for various electronic portal imaging devices in radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Son, Soon Yong; Choi, Kwan Woo [Dept. of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Kim, Jung Min [Dept. of College of Health Science, Radiologic Science, Korea University, Seoul (Korea, Republic of); and others

    2015-12-15

    In megavoltage (MV) radiotherapy, delivering the dose to the target volume is important while protecting the surrounding normal tissue. The purpose of this study was to evaluate the modulation transfer function (MTF), the noise power spectrum (NPS), and the detective quantum efficiency (DQE) using an edge block in megavoltage X-ray imaging (MVI). We used an edge block, which consists of tungsten with dimensions of 19 (thickness) × 10 (length) × 1 (width) cm3 and measured the pre-sampling MTF at 6 MV energy. Various radiation therapy (RT) devices such as TrueBeamTM (Varian), BEAMVIEWPLUS (Siemens), iViewGT (Elekta) and Clinac®iX (Varian) were used. As for MTF results, TrueBeamTM(Varian) flattening filter free(FFF) showed the highest values of 0.46 mm-1and1.40mm-1for MTF 0.5 and 0.1. In NPS, iViewGT (Elekta) showed the lowest noise distribution. In DQE, iViewGT (Elekta) showed the best efficiency at a peak DQE and 1 mm-1DQE of 0.0026 and 0.00014, respectively. This study could be used not only for traditional QA imaging but also for quantitative MTF, NPS, and DQE measurement for development of an electronic portal imaging device (EPID)

  12. [Devic syndrome--case report, current principles of diagnosis and therapy].

    Science.gov (United States)

    Iljicsov, Anna; Barsi, Péter; Várallyay, György; Tátrai, Erika; Somfai, Gábor Márk; Bereczki, Dánieli; Rudas, Gábor; Simó, Magdolna

    2010-09-30

    Neuromyelitis optica (NMO, Devic-syndrome) is a rare, relapsing autoimmune disease of the central nervous system, which is distinguished from other demyelinating disorders by a recently identified, specific autoantibody. By demonstrating the anti-aquaporin-4 IgG in the serum, a heterogenous group of syndromes can be defined, called NMO-spectrum. In the future, optical coherence tomography may support this diagnosis besides the clinical features, imaging examinations and presence of serum antibody. Early recognition and treatment can improve clinical outcome even in serious condition. Long-term immunosuppressive therapy is advised to prevent further relapses and to stabilize or improve clinical status. Hereby, we report a case of a 51-year-old woman, under treatment for one and a half years. We summarize the current knowledge about the pathomechanism, diagnostic strategy and therapy of neuromyelitis optica. We review recent findings and the diagnostic value of a new, non-invasive ophtalmological examination, the optical coherence tomography. According to the first results, this method may be helpful in the early differential diagnosis of optic neuritis.

  13. Simple Myofunctional Therapy Using Ready-made 
Mouthpiece Device before and after Orthodontic Treatment.

    Science.gov (United States)

    Fukumoto, Aoi; Otsuka, Takero; Kawata, Toshitsugu

    2016-01-01

    The present report describes myofunctional therapy using a ready-made training device, the T4A, in patients with permanent dentition and its effect on the prevention of relapse. The buccinator mechanism maintains the inner pressure of the tongue muscle equivalent to the outer pressure of the perioral soft tissues, such as the orbicular muscles, including the cephalopharyngeus and buccinator muscles. Training is performed so that patients learn to place their tongue and lips in the appropriate resting positions. The shape of the T4A and tongue guard supports the tongue from the bottom, allowing formation of the correct resting tongue position. However, the use of T4A for a long period of time may cause the teeth movement; therefore, caution is required. Use of the T4A is effective for the correction of oral habits, myofunctional therapy and for teaching the correct resting tongue position during the daytime and for the correction of oral habits, teaching correct resting tongue position during sleep.

  14. Revisiting the destination image construct through a conceptual model

    Directory of Open Access Journals (Sweden)

    Nelson Matos

    2012-05-01

    Full Text Available In a highly complex and dynamic sector like tourism, the current economic crisis brings to destination managers not only challenges but also opportunities. The image destinations promote to the market is a key element in the tourist decision-making process when choosing a tourism destination. This paper’s purpose is, therefore, to review and explore the destination image construct and its implications for the destination, and also to present a model of destination image based on previous studies. Implications for creating, enhancing and implementing the correct marketing programs for tourism destinations are provided.

  15. Current Trends in Implantable Left Ventricular Assist Devices

    Directory of Open Access Journals (Sweden)

    Jens Garbade

    2011-01-01

    Full Text Available The shortage of appropriate donor organs and the expanding pool of patients waiting for heart transplantation have led to growing interest in alternative strategies, particularly in mechanical circulatory support. Improved results and the increased applicability and durability with left ventricular assist devices (LVADs have enhanced this treatment option available for end-stage heart failure patients. Moreover, outcome with newer pumps have evolved to destination therapy for such patients. Currently, results using nonpulsatile continuous flow pumps document the evolution in outcomes following destination therapy achieved subsequent to the landmark Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure Trial (REMATCH, as well as the outcome of pulsatile designed second-generation LVADs. This review describes the currently available types of LVADs, their clinical use and outcomes, and focuses on the patient selection process.

  16. Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics

    NARCIS (Netherlands)

    Leclercq, C.; Padeletti, L.; Cihak, R.; Ritter, P.; Milasinovic, G.; Gras, D.; Paul, V.; Van Gelder, I. C.; Stellbrink, C.; Rieger, G.; Corbucci, G.; Albers, B.; Daubert, J. C.

    2010-01-01

    Little is known about the incidence of paroxysmal atrial tachycardias (PAT) in patients with heart failure (HF). The availability of cardiac resynchronization therapy (CRT) devices with extended diagnostics for AT enables continuous monitoring of PAT episodes. The aim of the study was to assess the

  17. Nepal as a destination for Finnish travelers - Service Design

    OpenAIRE

    Rayamajhi, Subash; Nepali, Manoj

    2016-01-01

    Destination marketing is an important tool to attract travellers to the destination in this fast growing economic sector of tourism industry. The main factor which should be considered during destination marketing is customer environment where the customer experience, product and prices act as the value cluster for the traveller. The second factor includes competitor environment where destination should keep itself most popular among its competitor destinations to attract a significant share ...

  18. Promotion as a Tool in Sustaining the Destination Marketing Activities

    OpenAIRE

    Ivo Mulec

    2010-01-01

    Promoting the tourism destination in the right and best possible way is today one of vital marketing activities of all Destination Management Organizations. Only successful promotion can entice and attract potential travelers to visit the destination. The number of new destinations is increasing every year and some of them are quite similar. Market segmentation is one of the starting points for devising marketing strategy. Only by presenting the destination to the right segment of potential c...

  19. Poetics and politics of destination branding: Rebranding Zimbabwe 2010

    OpenAIRE

    Munjoma, Kenneth

    2012-01-01

    Most destination branding literature ignore the poetics and the actual exercise of destination branding only dwelling much on the promotion of brands. Again many branding and destination branding studies fail to distil some unique challenges between place and product branding and their inspiration comes from general marketing literature. The researcher outlines a conceptual framework for developing a destination brand namely the dialogic perspective to destination branding which accentuates ...

  20. FACTORS INFLUENCING BRAND EQUITY OF BALI AS A TOURISM DESTINATION

    OpenAIRE

    I Ketut Surya Diarta; I Gde Pitana; Nyoman Darma Putra; Agung Suryawan Wiranatha

    2016-01-01

    Globally, competition among tourism destinations is more stringent in getting foreign tourists, including Bali. One effort to win the competition is increasing destination brand equity through maintaining its influencing factors and gaining tourist positive behavior toward destination. This effort, in long run, will increase and stabilize destination revenue and sustainability. This research aims to analyze factors influencing brand equity of Bali as a tourism destination. This research was c...

  1. Single LED-based device to perform widefield fluorescence imaging and photodynamic therapy

    Science.gov (United States)

    Grecco, Clovis; Buzzá, Hilde H.; Stringasci, Mirian D.; Andrade, Cintia T.; Vollet-Filho, Jose D.; Pratavieira, Sebastião.; Zanchin, Anderson L.; Tuboy, Aparecida M.; Bagnato, Vanderlei S.

    2015-06-01

    Photodynamic therapy (PDT) is a treatment modality that can be indicated for several cancer types and pre-cancer lesions. One of the main applications of PDT is the treatment of superficial skin lesions such as basal cell carcinoma, Bowen's disease and actinic keratosis. Three elements are necessary in PDT, a photosensitizer (PS); light at specific wavelength to be absorbed by the PS, and molecular oxygen. A typical PS used for skin lesion is protoporphyrin IX (PpIX), which is an intrinsic PS; its production is stimulated by a pro-drug, such as 5-aminolevulinic acid (ALA). Before starting a treatment, it is very important to follow up the PpIX production (to ensure that enough PS was produced prior to a PDT application) and, during a PDT session, to monitor its photodegradation (as it is evidence of the photodynamic effect taking place). The aim of this paper is to present a unique device, LINCE (MMOptics - São Carlos, Brazil), that brings together two probes that can, respectively, allow for fluorescence imaging and work as a light source for PDT treatment. The fluorescence probe of the system is optically based on 400 nm LED (light emitting diodes) arrays that allow observing the fluorescence emission over 450 nm. The PDT illumination probe options are constituted of 630 nm LED arrays for small areas and, for large areas, of both 630 nm and 450 nm LED arrays. Joining both functions at the same device makes PDT treatment simpler, properly monitorable and, hence, more clinically feasible. LINCE has been used in almost 1000 PDT treatments of superficial skin lesions in Brazil, with 88.4% of clearance of superficial BCC.

  2. Development and assessment of a cutaneous tissue stretch device as a novel scar therapy

    Institute of Scientific and Technical Information of China (English)

    Jonathan Kanevsky; Joshua Vorstenbosch; Julian Diaz-Abele; Tyler Safran; Markus Prinz; Youssef Tahiri; Mirko Gilardino; Satya Prakash

    2016-01-01

    Aim: Scar prevention and reduction is an area of therapeutic opportunity and unmet medical need. With no current effective scar therapy, patients are often disappointed in their appearance post surgery and re-present to surgeons, only to be turned away. The purpose of this study was to develop and test a device that produces intermittent parallel stretch on new scars and to analyze its potential to reduce scarring.Methods: Mice were randomized into 5 scar stretch treatment groups: 1 control, 1 sham, and 3 stretch models (0.5×, 1×, or 2× device strength) and treated for 10 days. Scars were scored using the Vancouver Scar Scale. Scar tissue samples were compared by histology and transforming growth factor beta 1 (TGF-β1) expression between control and treatment groups.Results: Scar scores of 0.5× and 1× groups were signiifcantly lower than the control group (P < 0.05). Scar scores from the 1× treatment group were also signiifcantly lower than the 0.5× group (P < 0.05). Sham, control scar and 2× groups showed more collagen deposition and a thicker dermal scar than the 0.5× and 1× groups. Unstretched scars had fewer ifbroblasts with more collagen deposition than the 0.5× and 2× groups. TGF-β1 levels were signiifcantly lower in the 0.5× (342.1 ± 9.2) and 1× (254.1 ± 3.1) groups than in the control group (P < 0.05). TGF-β1 levels in the 1× treatment group were also signiifcantly lower than the 0.5× treatment group (P < 0.05).Conclusion:Intermittent cutaneous tissue stretch parallel to scars during the proliferative phase of wound healing decreases ifbrosis on a macroscopic, microscopic and biochemical level.

  3. Destination Characteristics that Drive Hotel Performance

    DEFF Research Database (Denmark)

    Assaf, A. George; Josiassen, Alexander; Woo, Linda

    2017-01-01

    The increased market saturation and competition in both domestic and international tourism destinations have renewed interest among hotel operators in identifying the key drivers of hotel performance. This paper presents a comprehensive analysis of the determinants of hotel performance...... and their relative importance across multiple tourist destinations. We employ a two-step estimation method to identify key determinants of hotel performance, using a rich sample of international hotels. Our empirical analyses show that the main drivers of hotel performance are the quality of the educational system......, government support, disposable income, and number of international arrivals within a tourism destination. Results indicate that the most important barriers to hotel performance are the competition among accommodation providers, tax rate and fuel price. We argue for the need for hotel providers to develop...

  4. Bridging knowledge capital with tourism destination stakeholders

    DEFF Research Database (Denmark)

    Wejrum, Lone Møller; Madsen, Jan Halberg; d'Ambrosio, Luigi

    2015-01-01

    Backgorund: - The background of this paper is a student initiated study trip to the area of Campi Flegrei (Italy) in April 2014. The authors of this paper participated as lecturers and arranged meetings with a variety of tourism- and hospitality organizations operating in the destination. Through...... with their own research including data collection under the supervision of the lecturers. Methods/data: - The methodology of this study is based on a qualitative investigation of local tourism and hospitality stakeholders that operate in the destination collected by lecturers/researchers and students through...... these meetings it became clear that the destination and its actors would be interested in and benefit from a cooperation with the University College of Northern Denmark (UCN) and the lecturers and students from the International Hospitality Management programme (IHM). Practical implications: - The learning...

  5. Cognitive components of rural tourism destination images

    DEFF Research Database (Denmark)

    Kokkali, Panagiota; Koutsouris, Alex; Chrysochou, Polymeros

    This paper aims at exploring issues related to rural tourism destination image focusing on TDI cognitive components. By means of empirical research addressing tourists visiting the Lake Plastiras area, Central Greece, the cognitive components of the area's TDI were identified along with their eff......This paper aims at exploring issues related to rural tourism destination image focusing on TDI cognitive components. By means of empirical research addressing tourists visiting the Lake Plastiras area, Central Greece, the cognitive components of the area's TDI were identified along...

  6. Clarifications regarding medical tourism destinations marketing

    Directory of Open Access Journals (Sweden)

    STANCIOIU Aurelia-Felicia

    2014-09-01

    Full Text Available The development of new types of tourism (stand-alone, connected or components, from marketing experience, implies a broad spectrum of challenges, which, placed in a planned background, has the purpose the creation and then, the development of tourism products that correspond, at least, to consumers’ expectations. In order to optimize the new type of tourism, it is necessary to be correlated with the relevant resources of the destination, which, harmonized, can lead to the elaboration of destination marketing strategies, in this situation being the medical tourism, component of health tourism.

  7. Multi-Targeted Antithrombotic Therapy for Total Artificial Heart Device Patients.

    Science.gov (United States)

    Ramirez, Angeleah; Riley, Jeffrey B; Joyce, Lyle D

    2016-03-01

    To prevent thrombotic or bleeding events in patients receiving a total artificial heart (TAH), agents have been used to avoid adverse events. The purpose of this article is to outline the adoption and results of a multi-targeted antithrombotic clinical procedure guideline (CPG) for TAH patients. Based on literature review of TAH anticoagulation and multiple case series, a CPG was designed to prescribe the use of multiple pharmacological agents. Total blood loss, Thromboelastograph(®) (TEG), and platelet light-transmission aggregometry (LTA) measurements were conducted on 13 TAH patients during the first 2 weeks of support in our institution. Target values and actual medians for postimplant days 1, 3, 7, and 14 were calculated for kaolinheparinase TEG, kaolin TEG, LTA, and estimated blood loss. Protocol guidelines were followed and anticoagulation management reduced bleeding and prevented thrombus formation as well as thromboembolic events in TAH patients postimplantation. The patients in this study were susceptible to a variety of possible complications such as mechanical device issues, thrombotic events, infection, and bleeding. Among them all it was clear that patients were at most risk for bleeding, particularly on postoperative days 1 through 3. However, bleeding was reduced into postoperative days 3 and 7, indicating that acceptable hemostasis was achieved with the anticoagulation protocol. The multidisciplinary, multi-targeted anticoagulation clinical procedure guideline was successful to maintain adequate antithrombotic therapy for TAH patients.

  8. A Research for Determining the Relationship between Destination Image and Destination Personality

    Directory of Open Access Journals (Sweden)

    Savaş Artuğer

    2014-03-01

    Full Text Available The aim of this study was to determine the relationship between destination image and destination personality. The sample group of the study consisted of tourists visiting Alanya district of Antalya province between June and August 2013. A brand personality scale developed by Aaker (1997 and a survey used for grading the destination image were used as tools for collecting data which were obtained from a total of 395 tourists for the application. Descriptive analyses such percentage, frequency, factor analysis (confirmatory and explanatory as well as statistical tests such as the reliability analysis were used for analyzing the obtained data. In addition the relationship between destination image and destination personality was analyzed with the Structural Equation Modeling (SEMAt the conclusion of the study there appeared to be negative and very weak relationship between affective image and destination personality while the relationship between cognitive image and destination personality appeared to be positive and strong. In addition Aaker’s (1997 5 dimensional brand personality grading turned out to be 4 dimensions. These dimensions were determined as excitement, ruggedness, competence and sincerity

  9. The relationship between destination proximity, destination mix and physical activity behaviors.

    Science.gov (United States)

    McCormack, Gavin R; Giles-Corti, Billie; Bulsara, Max

    2008-01-01

    The presence and mix of destinations is an important aspect of the built environment that may encourage or discourage physical activity. This study examined the association between the proximity and mix of neighbourhood destinations and physical activity. Secondary analysis was undertaken on physical activity data from Western Australian adults (n=1394). These data were linked with geographical information systems (GIS) data including the presence and the mix of destinations located within 400 and 1500 m from respondents' homes. Associations with walking for transport and recreation and vigorous physical activity were examined. Access to post boxes, bus stops, convenience stores, newsagencies, shopping malls, and transit stations within 400 m (OR 1.63-5.00) and schools, transit stations, newsagencies, convenience stores and shopping malls within 1500 m (OR 1.75-2.38) was associated with participation in regular transport-related walking. A dose-response relationship between the mix of destinations and walking for transport was also found. Each additional destination within 400 and 1500 m resulted in an additional 12 and 11 min/fortnight spent walking for transport, respectively. Proximity and mix of destinations appears strongly associated with walking for transport, but not walking for recreation or vigorous activity. Increasing the diversity of destinations may contribute to adults doing more transport-related walking and achieving recommended levels of physical activity.

  10. FACTORS INFLUENCING BRAND EQUITY OF BALI AS A TOURISM DESTINATION

    Directory of Open Access Journals (Sweden)

    I Ketut Surya Diarta

    2016-03-01

    Full Text Available Globally, competition among tourism destinations is more stringent in getting foreign tourists, including Bali. One effort to win the competition is increasing destination brand equity through maintaining its influencing factors and gaining tourist positive behavior toward destination. This effort, in long run, will increase and stabilize destination revenue and sustainability. This research aims to analyze factors influencing brand equity of Bali as a tourism destination. This research was conducted in Bali’s five major tourism objects. The 240 foreign tourists were chosen as respondents through convenience sampling technique. Data were analyzed using factor analysis. The results showed that factors that significantly influenced Bali brand equity were: symbolic and experiential benefit factor, direct and indirect destinations attributes, destination reliability and tangibility, assurance and empathy, brand destinations recognition and recall, destinations common psychological attributes, destination common functional attributes, unique functional attributes, behavioral loyalty, destination awareness, and attitudinal loyalty. Given the fluctuative nature of brand equity, Bali needs a consistent effort to maintain or to enhance brand equity of Bali as a tourism destination. Maintaining the dominant factors that influence the strength of brand equity can be used as a basis to develop destination branding strategy to expand market segment,  choose the right target market, and anchoring destination position in world market competition.

  11. Crew Scheduling for Netherlands Railways: "destination: customer"

    NARCIS (Netherlands)

    L.G. Kroon (Leo); M. Fischetti (Matteo)

    2000-01-01

    textabstract: In this paper we describe the use of a set covering model with additional constraints for scheduling train drivers and conductors for the Dutch railway operator NS Reizigers. The schedules were generated according to new rules originating from the project "Destination: Customer"

  12. Thailand top destination for medical tourists

    National Research Council Canada - National Science Library

    Finch, Steve

    ... is the unofficial leader of medical tourism in Thailand, itself the most popular destination for medical travellers in the world, though accurate data on this fast-growing industry remain elusive. The Ministry of Public Health claimed Thailand received 2.5 million medical tourists last year, but medical tourism directories, like Novasans .com, co...

  13. Destination visual image and expectation of experiences

    DEFF Research Database (Denmark)

    Ye, H.; Tussyadiah, Iis

    2011-01-01

    at understanding how a visual image is relevant to the expectation of experiences by deconstructing images of a destination and interpreting visitors' perceptions of these images and the experiences associated with them. The results suggest that tourists with different understandings of desirable experiences found...

  14. The Destined Death of the Travelling Salesman

    Institute of Scientific and Technical Information of China (English)

    何苗

    2015-01-01

    Death of a Travelling Salesman is a short story with heated discussion and dispute. Death, as the title of the story presents, has always been the center of criticism. This paper aims to dissect this short story, and to discuss the destined death of the travelling salesman.

  15. Standardization of Inter-Destination Media Synchronization

    NARCIS (Netherlands)

    Stokking, H.M.; Brandenburg, R. van; Boronat, F.; Montagud, M.

    2012-01-01

    Inter-Destination Media Synchronization (IDMS) is a process in which various receivers of the same content are synchronized in their playout. Standardization of an IDMS solution helps to enable interoperability between receivers manufactured by different companies. This paper describes the efforts b

  16. Incidence of pocket hematoma after electrophysiological device placement:dual antiplatelet therapy versus low-molecular-weight heparin regimen

    Institute of Scientific and Technical Information of China (English)

    Yan CHEN; Xin-Cun YANG; Kang MENG; Yun-Tao LI; Ming-Dong GAO; Ze-Chun ZENG; Jin-Rong ZHANG; Hong-Liang CONG; Yin LIU; Ru ZHAO; Le-Feng WANG

    2014-01-01

    Background Given the increasing number of patients who require dual antiplatelet (DAP) therapy and electrophysiological device (EPD) placement, perioperative antiplatelet management is a current challenge. In this study, we investigated the incidence of pocket hema-toma formation after EPD placement in patients undergoing DAP therapy or an alternative low-molecular-weight heparin (LMWH) regimen. Methods This clinical observational study was performed from July 2010 to July 2012. In total, 171 patients were enrolled in the analysis after meeting the inclusion criteria. These patients were divided into two groups: 86 patients were treated with DAP therapy at the time of device implantation, and the DAP therapy was discontinued for 5 to 7 days and replaced with enoxaparin before device implantation in the other 85 patients. Adenosine phosphate (ADP)-mediated platelet aggregation and arachidonic acid-induced platelet aggregation were tested preoperatively. We compared the incidence of pocket hematoma between the two groups and the association of pocket hematoma develop-ment with ADP-mediated platelet aggregation and arachidonic acid-induced platelet aggregation.Results The incidence of pocket hema-toma in the patients who continued DAP was lower than that in the patients who replaced the dual antiplatelet regimen with LMWH (3.49%vs. 16.47%, respectively;X2 = 6.66,P < 0.01). Among the patients who continued DAP therapies, the rate of ADP-mediated platelet aggre-gation inhibition in patients with pocket hematomas was higher than that in patients without pocket hematomas. None of the patients under-going DAP or enoxaparin therapy developed pocket infection, thromboembolic events, or other serious complications. Multiple logistic re-gression analysis revealed that LMWH therapy was an independent risk factor for the development of pocket hematoma (RR = 0.054, 95%CI = 0.012-0.251). Furthermore, patients undergoing LMWH therapy were 5.1-fold more likely to develop pocket

  17. Means of assessing a sport tourism destination's competitive advantage sources

    National Research Council Canada - National Science Library

    Nicolae Teodorescu; Aurelia-Felicia Stancioiu; Andreea Botos; Octavian Arsene; Mihail-Cristian Ditoiu

    2012-01-01

    .... The results of the research shall establish a starting point for the Arges County destination marketing audit, as a sport tourism destination with a depth of focus for the mountain-based tourism...

  18. Assessing the effectiveness of consumer narratives for destination marketing

    DEFF Research Database (Denmark)

    Tussyadiah, Iis; Park, S.; Fesenmaier, D.R.

    2011-01-01

    Using tourists' stories to promote destinations is believed to be an innovative approach in destination marketing. This study conceptualizes and investigates the effectiveness of such an approach. This study supports the underlying premise of introducing narrative in marketing, that is...

  19. Destination memory for emotional information in older adults

    NARCIS (Netherlands)

    El Haj, M.; Fasotti, L.; Allain, P.

    2015-01-01

    Background/Study Context: Destination memory, remembering the destination of the information that one tells, shows significant age-related decline. In the present paper, the authors sought to determine whether destination memory can be improved in older adults using emotional stimuli. This aim was

  20. Partners and innovation in American destination marketing organizations

    DEFF Research Database (Denmark)

    Zach, Florian

    2012-01-01

    , this study focuses on destination marketing organizations (DMOs) as they collaborate with destination businesses to assist in the development of new services in marketing the destination. A national survey among American DMOs indicates that partner collaboration is a significant driver of visitor...

  1. City Image – As Tourism Destination

    Directory of Open Access Journals (Sweden)

    Stanciulescu Gabriela Cecilia

    2008-04-01

    Full Text Available Tourism is a competitive industry, even on a global scale. If access to a destination or attraction is too complicated, time consuming, expensive or not providing adequate capacity, even the most spectacular attraction will remain a secret to most tourists, as they will prefer competitive alternatives” (Smiths, 2003. And to continue this, it is considered that „that cultural differences and uniqueness are important if one wants cultural products to become a commercial success” (Lindenberg, 2004. When cultural tourists are looking to experiment or to improve their knowledge, the question is: “Which are the best strategies and practices to market that experience and knowledge for the cultural tourists” (Kantanen, 2005. This paper will be dedicated to presenting city tourist destinations, their marketing and market positioning, also to analyze the way in which potential customers’ perception is built and how the process can be influenced, and to analyze the way the tourist product is assembled.

  2. Tourism experience, destination and event management

    Directory of Open Access Journals (Sweden)

    Vitić Andriela

    2007-01-01

    Full Text Available The paper tend to show some of the challenges of matured and world-known tourism destination, as well some of the modalities in keeping and increasing a level of Honolulu cluster's competitiveness. Accordingly, specific tourism experience as socio-cultural dimension of destination competitiveness was evaluated. A core of the paper is primary research of tourism event "Brunch on the Beach" Honolulu, Hawaii, that was done in 2004. Data for analysis were collected during the internship that author did in the City and Country - Honolulu. Internship was a part of JFDP scholarship received by the American Councils for International Educations (ACIE. George Washington University was the institution where the author completed the most of specialization and which gave a support for the internship organization. Questionnaire method was used for the research, while SPSS software was used for data analyses.

  3. Innovative Governance Strategies in Meetings Destination Networks

    DEFF Research Database (Denmark)

    Gyimóthy, Szilvia; Larson, Mia

    2013-01-01

    Innovative Governance Strategies in Meetings Destination Networks Introduction, problem statement and aims of the study Collaborative regional networks has been long considered as a must in successful tourism development (Dredge & Jenkins 2003) owing to benefits such as scale and scope economics...... on a comparative analysis of Convention Bureaus (CVBs) and the network around them in the two cities, the study sheds light on governance strategies adopted by the convenors in order to mobilize meetings industry stakeholders across cultural, institutional and political borders. Conceptual approach The theoretical......, Ritchie & Hudson 2007) is applied, which defines destination success in terms of how well members of the triad (the DMO and its two most powerful stakeholders (the city administration and the hotels) relate to one another and combine their complementary resources. As each member of the triad possesses...

  4. Tourism destinations as digital business ecosystems

    CERN Document Server

    Baggio, Rodolfo

    2012-01-01

    Tourism has been experiencing very relevant changes since when Information and Communication Technologies (ICTs), in all their forms, have started to pervade the industry and the market. In the last decade, a new concept gained the attention of both researchers and practitioners, that of Digital Business Ecosystem (DBE). It can be considered as a technological infrastructure aimed at creating a digital environment to support and enhance networking between enterprises and stakeholders operating within a sector. Aim of this paper is to assess the extent to which the technological connection has affected the structural configuration of the tourism system and, specifically, of tourism destinations. The present study argues that two components can be considered when assessing the relationships among stakeholders within a tourism destination: a real and a virtual one. Further it shows how these two components are structurally strongly coupled and co-evolve forming a single system.

  5. RESPONSIBILITIES IN MANAGEMENT OF TOURIST DESTINATIONS

    Directory of Open Access Journals (Sweden)

    Mirela MAZILU

    2010-01-01

    Full Text Available Over the past six decades, tourism has experienced continued growth and diversification to become one of the largest and fastest growing economic sectors in the world. Over time, more and more destinations have opened up and invested in tourism development, turning modern tourism into a key driver for socioeconomic progress. Tourism has become one of the major international trade categories. Today, the export income generated by international tourism ranks fourth after fuels, chemicals and automotive products. For many developing countries, it is one of the main income sources and the number one export category, creating much needed employment and opportunities for development. There are many roles and various responsibilities in the management of the tourist destination and marketing. These are lead in different ways, in different countries, but, in general, they are divided among the national, regional and local levels. The national level is normally responsible for more strategic roles, while the local level is responsible for the operational elements.

  6. Trip Generation Model Based on Destination Attractiveness

    Institute of Scientific and Technical Information of China (English)

    YAO Liya; GUAN Hongzhi; YAN Hai

    2008-01-01

    Traditional trip generation forecasting methods use unified average trip generation rates to determine trip generation volumes in various traffic zones without considering the individual characteristics of each traffic zone.Therefore,the results can have significant errors.To reduce the forecasting error produced by uniform trip generation rates for different traffic zones,the behavior of each traveler was studied instead of the characteristics of the traffic zone.This paper gives a method for calculating the trip efficiency and the effect of traffic zones combined with a destination selection model based on disaggregate theory for trip generation.Beijing data is used with the trip generation method to predict trip volumes.The results show that the disaggregate model in this paper is more accurate than the traditional method.An analysis of the factors influencing traveler behavior and destination selection shows that the attractiveness of the traffic zone strongly affects the trip generation volume.

  7. Social Media Strategies and Destination Management

    DEFF Research Database (Denmark)

    Munar, Ana Maria

    2012-01-01

    to the conflicting relationship between corporate culture and social media culture, the challenges innovative communication tools present for traditional management structures, poor levels of formalization and the lack of a knowledge base which results in ad-hoc decision making. Overall, the paper discusses......This study provides insights into social media practices and strategic considerations used by destination management organizations (DMOs). It examines a theoretical model of generic social media strategies for destination management and applies qualitative methods to analyze the social media...... initiatives of DMOs of Denmark, Norway, Finland, Sweden and the Scandinavian Tourist Board Asia/Pacific in the Nordic European Region. The study provides empirical evidence of emerging social media strategies among DMOs and confirms the growing importance of these new media. The findings point...

  8. Innovative Governance Strategies in Meetings Destination Networks

    DEFF Research Database (Denmark)

    Gyimóthy, Szilvia; Larson, Mia

    2013-01-01

    Innovative Governance Strategies in Meetings Destination Networks Introduction, problem statement and aims of the study Collaborative regional networks has been long considered as a must in successful tourism development (Dredge & Jenkins 2003) owing to benefits such as scale and scope economics......, as well as joint planning and coordination of supply facilities. However, the setting up and governance of destination networks is paved with managerial challenges, including, among others: the balancing of conflicting stakeholder interest (Wilkinson & March 2008), and bridging over the gap between...... on a comparative analysis of Convention Bureaus (CVBs) and the network around them in the two cities, the study sheds light on governance strategies adopted by the convenors in order to mobilize meetings industry stakeholders across cultural, institutional and political borders. Conceptual approach The theoretical...

  9. Assessment of Haptic Interaction for Home-Based Physical Tele-Therapy using Wearable Devices and Depth Sensors.

    Science.gov (United States)

    Barmpoutis, Angelos; Alzate, Jose; Beekhuizen, Samantha; Delgado, Horacio; Donaldson, Preston; Hall, Andrew; Lago, Charlie; Vidal, Kevin; Fox, Emily J

    2016-01-01

    In this paper a prototype system is presented for home-based physical tele-therapy using a wearable device for haptic feedback. The haptic feedback is generated as a sequence of vibratory cues from 8 vibrator motors equally spaced along an elastic wearable band. The motors guide the patients' movement as they perform a prescribed exercise routine in a way that replaces the physical therapists' haptic guidance in an unsupervised or remotely supervised home-based therapy session. A pilot study of 25 human subjects was performed that focused on: a) testing the capability of the system to guide the users in arbitrary motion paths in the space and b) comparing the motion of the users during typical physical therapy exercises with and without haptic-based guidance. The results demonstrate the efficacy of the proposed system.

  10. Competitive destination analysis in Southern European countries

    OpenAIRE

    Águas, Paulo; Veiga, Célia; Reis, Helena

    2010-01-01

    Purpose – The purpose of this paper is to analyse the competitiveness of the European Union Member States of Southern Europe (France, Greece, Italy, Portugal and Spain) as tourist destinations for European Union Member States of Central and Northern Europe (Austria, Belgium, Denmark, Finland, Germany, The Netherlands, Ireland, Sweden and the UK). Design/methodology/approach – Application of the market share analysis tool, initially developed by Faulkner, using secondary data from Eurosta...

  11. NON-SKELETON BUILDING OF MULTIPURPOSE DESTINATION

    Directory of Open Access Journals (Sweden)

    В.М. Першаков

    2012-10-01

    Full Text Available  The non-skeleton structure of multipurpose destination is developed from typical reinforce-concrete slabs and intended for building of objects of agroindustrial complex. Fixed building is under the test loadings. After researches was established, that a construction has sufficient bearing capacity. Non-skeleton building is urgent for storage of agricultural production and storage of eguipment, placing of markets and sport complexes.

  12. VARIABLES OF THE IMAGE OF TOURIST DESTINATION

    Directory of Open Access Journals (Sweden)

    Ban Olimpia

    2008-05-01

    Full Text Available The image of a destination is more than a distinguishing element; it is a component of the supply and brings more value to it. The image of a destination can be the decisive component, while the other elements re relatively alike (1. The image of a tourist destination is strongly connected to the image of a country, the image of a nation and the image of a place. The image of a place is formed for a receiver naturally by accumulating experiences with that place, the use of the sources of personal and impersonal information. For the transmitter, the image is the result of some direct and indirect actions. The branding of the place is the conscientious and coordinated process of an image achievement. In the paper there are presented some examples of actions of image research, an essential step having in view the branding or re-branding It is presented a study of the citizens of Oradea regarding their perception of tourist Romania.

  13. Managements and marketing in Korca tourist destination

    Directory of Open Access Journals (Sweden)

    Esmeralda Shkira

    2012-12-01

    Full Text Available Tourism is characterized as being a sector that stands out as one of the business activities with the greatest potential for worldwide expansion and as an engine for economic growth. If at the national level, the appeal of tourism is significant, on the local level this sector presents itself as an essential tool in regional development, as a means to avoid regional desertification and stagnation, stimulating the potential of more undeveloped regions. In such a competitive sector as tourism, companies should develop synergies and achieve competitive advantage. This paper reports on experiences and activities that are taken in destination management and marketing in Korça tourist region. Primarily it is told about importance of management and the role of marketing in the development of tourist destination and how to be combined them to grow up competitive advantages. Then are described all main problems of destination management and marketing in Korça region and all problems that are viewed in tourist villages of this region. In the end is suggested a model that can be used to develop sustainable tourism, to grow up profits and to reduce negative impacts that would come from this industry.

  14. Reduction in stray radiation dose using a body-shielding device during external radiation therapy.

    Science.gov (United States)

    Zhang, Shuxu; Jiang, Shaohui; Zhang, Quanbin; Lin, Shengqu; Wang, Ruihao; Zhou, Xiang; Zhang, Guoqian; Lei, Huaiyu; Yu, Hui

    2017-03-01

    With the purpose of reducing stray radiation dose (SRD) in out-of-field region (OFR) during radiotherapy with 6 MV intensity-modulated radiation therapy (IMRT), a body-shielding device (BSD) was prepared according to the measurements obtained in experimental testing. In experimental testing, optimal shielding conditions, such as 1 mm lead, 2 mm lead, and 1 mm lead plus 10 mm bolus, were investigated along the medial axis of a phantom using thermoluminescent dosimeters (TLDs). The SRDs at distances from field edge were then measured and analyzed for a clinical IMRT treatment plan for nasopharyngeal carcinoma before and after shielding using the BSD. In addition, SRDs in anterior, posterior, left and right directions of phantom were investigated with and without shielding, respectively. Also, the SRD at the bottom of treatment couch was measured. SRD decreased exponentially to a constant value with increasing distance from field edge. The shielding rate was 50%-80%; however, there were no significant differences in SRDs when shielded by 1 mm lead, 2 mm lead, or 1 mm lead plus 10 mm bolus (P>0.05). Importantly, the 10 mm bolus absorbed back-scattering radiation due to the interaction between photons and lead. As a result, 1 mm lead plus 10 mm bolus was selected to prepare the BSD. After shielding with BSD, total SRDs in the OFR decreased to almost 50% of those without shielding when irradiated with IMRT beams. Due to the effects of treatment couch and gantry angle, SRDs at distances were not identical in anterior, posterior, left and right direction of phantom without BSD. As higher dose in anterior and lower dose in posterior, SRDs were substantial similarities after shielding. There was no significant difference in SRDs for left and right directions with or without shielding. Interestingly, SRDs in the four directions were similar after shielding. From these results, the BSD developed in this study may significantly reduce SRD in the OFR during

  15. Postoperative care and complications after ventricular assist device implantation.

    Science.gov (United States)

    Allen, Sara Jane; Sidebotham, David

    2012-06-01

    In this article, the routine postoperative care and complications of patients with ventricular assist devices are reviewed. Routine postoperative care encompasses patients who have undergone emergency ventricular assist device (VAD) implantation for acute cardiogenic shock, as a bridge to decision making, and semi-elective patients who have undergone VAD implantation for end-stage heart failure, either as destination therapy or as a bridge to heart transplantation. Early postoperative management should focus on haemodynamic optimisation, including fluid and inotrope therapy, VAD settings and support of right ventricular function. Echocardiography is an essential tool in optimising haemodynamics and identifying complications. Early postoperative complications include bleeding, arrhythmias, right ventricular failure and infection. Late postoperative problems include bleeding, thrombosis and thrombo-embolism, device failure and psychological problems. In a small percentage of patients, weaning and explantation of the VAD are possible. For patients undergoing VAD implantation for destination therapy, end-of-life care planning should form part of the multidisciplinary care of the patient.

  16. A New Handheld Device for the Detection of Falsified Medicines: Demonstration on Falsified Artemisinin-Based Therapies from the Field.

    Science.gov (United States)

    Wilson, Benjamin K; Kaur, Harparkash; Allan, Elizabeth Louise; Lozama, Anthony; Bell, David

    2017-02-20

    Poor-quality medicines are a major problem for health-care systems in resource-poor settings as identifying falsified medicines requires a complex laboratory infrastructure such as a Medicines Quality Control Laboratory. We report here an evaluation of a low-cost, handheld near-infrared spectrometer (NIRS) device by analyzing a library of artemisinin-based combination therapy (ACT) medicines to determine its usefulness as a drug-screening tool. The "SCiO" research prototype device was used to collect NIR spectra of a library of ACT and artesunate monotherapy medicine samples previously collected in Bioko Island and Equatorial Guinea and Kintampo, Ghana. The quality of these samples had been categorized as falsified, substandard, and quality assured based on the amount of stated active pharmaceutical ingredients detected using high-performance liquid chromatography photodiode array. Numerical analyses were performed on the NIR spectra to assess the usefulness of NIR to identify falsified and substandard medicines. The NIRS device was successful at detecting falsified medicines in all cases where the library contained both quality assured and falsified medicines of the same stated brand of medicines. The NIRS device was successful at identifying substandard amounts of artesunate but not amodiaquine in the ACT samples (N = 15) of artesunate-amodiaquine. This work reveals that this low-cost, portable NIRS device is promising for screening ACTs for falsified samples and could enable widespread drug screening at all points of the health system.

  17. Surgical implantation of a cardiac resynchronization therapy device in a western lowland gorilla (Gorilla gorilla gorilla) with fibrosing cardiomyopathy.

    Science.gov (United States)

    Rush, Elizabeth Marie; Ogburn, Anna L; Hall, Jeffrey; Rush, Dwain; Lau, Yung; Dillon, A R; Garmon, Linda; Tillson, D M; Kay, G Neal

    2010-09-01

    A 24-yr-old, male western lowland gorilla (Gorilla gorilla gorilla) was diagnosed in March of 2003 with congestive heart failure (CHF). Transesophageal and transthoracic echocardiography demonstrated global left and right ventricular hypokinesia with a left ventricular ejection fraction of 0.20. At the time of diagnosis, the animal exhibited symptoms and signs of CHF with minimal exertion (New York Heart Association class III). Over a 16-mo period, the severity of CHF progressed to class IV (resting signs and symptoms) despite angiotensin-converting enzyme inhibition, beta-blockers, and diuretics. Because of intractable CHF and a QRS duration that was markedly prolonged compared with the normal range for this species, a cardiac resynchronization therapy (CRT) device was implanted using implantation techniques based on human surgical procedures. Placement of the right ventricular, right atrial, and left ventricular leads and pulse generator were accomplished in 5.5 hr. Telemetry of the device postoperatively via wand or remote radio frequency has allowed for noninvasive programming and interrogation. The clinical improvement in CHF with this therapy was immediate and dramatic for this animal. Six months after CRT device implantation, the device leads became dislodged during an altercation with another gorilla, with the rapid development of CHF upon cessation of biventricular pacing. A second procedure to replace the leads returned the gorilla to his previous level of activity. In 2007, the pulse generator was electively replaced for battery depletion with a device capable of remote radiofrequency programming and interrogation. CRT implantation, although requiring specialized equipment and surgical skill, appears to be a viable option for treatment of dilated cardiomyopathy in gorillas.

  18. Review of Literature of the Rural Heritage Tourism Destination

    Directory of Open Access Journals (Sweden)

    Kadi Alaa J.

    2014-01-01

    Full Text Available Rural heritage tourism destination management is an essential knowledge area that should be investigated to achieve sustainable destination, especially for an emerging destination. The goal of this process is to ensure that these elements are thoroughly inspected and rigidly organized due to the main concepts, theories, methods and approaches mentioning different perspectives to tackle these certain elements. In order to cope with the complexity of the relation between the destination elements and its characteristics and sequence of the maturity of the selected destination, all that needs in-depth knowledge to assist the researchers in developing and improving different types of approaches and tools, and in structuring and assessing the destination. We develop a neat backbone literature review concerning the all aspects of the sustainable rural heritage tourism destination. We review the existing methods, approaches and theories applied on the relative field, and further study the relevant challenges that have been the target of investigation in the academic literature. The paper is intended to be the newest and the most important existing study on the topic of rural heritage emerging tourism destination. The results are particularly relevant to practitioners seeking a better grasp on managing tourism destination as well as achieving sustainability in tourism destinations. As a major finding of the review, the results strongly suggest the need for more practitioner-oriented and industry-driven empirical studies in the area of flexible managerial framework to cope with special and dynamic characteristics of different tourism destinations.

  19. A controlled trial of the Litebook light-emitting diode (LED) light therapy device for treatment of Seasonal Affective Disorder (SAD)

    National Research Council Canada - National Science Library

    Desan, Paul H; Weinstein, Anea J; Michalak, Erin E; Tam, Edwin M; Meesters, Ybe; Ruiter, Martine J; Horn, Edward; Telner, John; Iskandar, Hani; Boivin, Diane B; Lam, Raymond W

    2007-01-01

    .... Light treatment devices using efficient light-emitting diodes (LEDs) whose output is relatively concentrated in short wavelengths may enable a more convenient effective therapy for Seasonal Affective Disorder (SAD). Methods...

  20. Promotion as a Tool in Sustaining the Destination Marketing Activities

    Directory of Open Access Journals (Sweden)

    Ivo Mulec

    2010-01-01

    Full Text Available Promoting the tourism destination in the right and best possible way is today one of vital marketing activities of all Destination Management Organizations. Only successful promotion can entice and attract potential travelers to visit the destination. The number of new destinations is increasing every year and some of them are quite similar. Market segmentation is one of the starting points for devising marketing strategy. Only by presenting the destination to the right segment of potential clients in the right way will a destination maximize the effectiveness of its marketing and promotion. Tourism destination marketers will continue to face considerable challenges in the future: they will have to take account of the needs, wants and expectations of more mature and knowledgeable customers, and the corresponding need for more up-to-date and reliable information upon which to base decision-making. In the future only marketing which includes collaborative dimensions will meet its objectives fully.

  1. Robotic-based carbon ion therapy and patient positioning in 6 degrees of freedom: setup accuracy of two standard immobilization devices used in carbon ion therapy and IMRT

    Directory of Open Access Journals (Sweden)

    Jensen Alexandra D

    2012-03-01

    Full Text Available Abstract Purpose To investigate repositioning accuracy in particle radiotherapy in 6 degrees of freedom (DOF and intensity-modulated radiotherapy (IMRT, 3 DOF for two immobilization devices (Scotchcast masks vs thermoplastic head masks currently in use at our institution for fractionated radiation therapy in head and neck cancer patients. Methods and materials Position verifications in patients treated with carbon ion therapy and IMRT for head and neck malignancies were evaluated. Most patients received combined treatment regimen (IMRT plus carbon ion boost, immobilization was achieved with either Scotchcast or thermoplastic head masks. Position corrections in robotic-based carbon ion therapy allowing 6 DOF were compared to IMRT allowing corrections in 3 DOF for two standard immobilization devices. In total, 838 set-up controls of 38 patients were analyzed. Results Robotic-based position correction including correction of rotations was well tolerated and without discomfort. Standard deviations of translational components were between 0.5 and 0.8 mm for Scotchcast and 0.7 and 1.3 mm for thermoplastic masks in 6 DOF and 1.2 - 1.4 mm and 1.0 - 1.1 mm in 3 DOF respectively. Mean overall displacement vectors were between 2.1 mm (Scotchcast and 2.9 mm (thermoplastic masks in 6 DOF and 3.9 - 3.0 mm in 3 DOF respectively. Displacement vectors were lower when correction in 6 DOF was allowed as opposed to 3 DOF only, which was maintained at the traditional action level of > 3 mm for position correction in the pre-on-board imaging era. Conclusion Setup accuracy for both systems was within the expected range. Smaller shifts were required when 6 DOF were available for correction as opposed to 3 DOF. Where highest possible positioning accuracy is required, frequent image guidance is mandatory to achieve best possible plan delivery and maintenance of sharp gradients and optimal normal tissue sparing inherent in carbon ion therapy.

  2. Simulation of irradiation exposure of electronic devices due to heavy ion therapy with Monte Carlo Code MCNP6

    Science.gov (United States)

    Lapins, Janis; Guilliard, Nicole; Bernnat, Wolfgang; Buck, Arnulf

    2017-09-01

    During heavy ion irradiation therapy the patient has to be located exactly at the right position to make sure that the Bragg peak occurs in the tumour. The patient has to be moved in the range of millimetres to scan the ill tissue. For that reason a special table was developed which allows exact positioning. The electronic control can be located outside the surgery. But that has some disadvantage for the construction. To keep the system compact it would be much more comfortable to put the electronic control inside the surgery. As a lot of high energetic secondary particles are produced during the therapy causing a high dose in the room it is important to find positions with low dose rates. Therefore, investigations are needed where the electronic devices should be located to obtain a minimum of radiation, help to prevent the failure of sensitive devices. The dose rate was calculated for carbon ions with different initial energy and protons over the entire therapy room with Monte Carlo particle tracking using MCNP6. The types of secondary particles were identified and the dose rate for a thin silicon layer and an electronic mixture material was determined. In addition, the shielding effect of several selected material layers was calculated using MCNP6.

  3. Anaesthesia for patients undergoing ventricular assist-device implantation.

    Science.gov (United States)

    Feussner, Markus; Mukherjee, Chirojit; Garbade, Jens; Ender, Joerg

    2012-06-01

    In the last 10 years, implantation of ventricular-assist devices has become an interesting option as either bridge-to-transplantation or destination procedure for patients with end-stage congestive heart failure. In the future, the number of ventricular assist device implantations is expected to increase furthermore. In general, this patient cohort is associated with significant co-morbidities, for example, pulmonary hypertension, peripheral vascular disease and renal insufficiency. Anaesthetic management for implantation of ventricular assist devices can be challenging for cardiac anaesthesiologists. Even minor changes in their haemodynamics and physiological parameters can cause significant morbidity and mortality. Experience in haemodynamic monitoring including echocardiography and pharmacological management (use of inotropes, phosphodiesterase inhibitors and vasopressors) is a requirement. Particularly, the diagnosis and therapy of right-sided heart failure after implantation of left-ventricular assist devices should be addressed.

  4. Comparison of horizontal and vertical noise power spectrum in measurements by using various electronic portal imaging devices in radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ki Won [Dept. of Radiology, Kyung Hee University Hospital at Gang-dong, Seoul (Korea, Republic of); Choi, Kwan Woo [Dept. of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Jeong, Hoi Woun [Dept. of Radiological Technology, Baekseok Culture University, Cheonan (Korea, Republic of); Jang, Seo Goo [Dept. of Medical Science, Soonchunhyang University, Asan (Korea, Republic of); Kwon, Kyung Tae [Dept. of Radiological Technology, Dongnam Health University, Suwon (Korea, Republic of); Son, Soon Yong [Dept. of Radiological Technology, Wonkwang Health Science University, Iksan (Korea, Republic of); Son, Jin Hyun; Min, Jung Whan [Dept. of Radiological Technology, Shingu University, Sungnam (Korea, Republic of)

    2016-06-15

    The quality assurance (QA) is very important for diagnostic field and radiation therapy field to evaluate the characteristic of devices. The purpose of this study was to compare different NPS methodologies results which are measuring NPS with regard to horizontal and vertical directions by using megavoltage X-ray energies. The NPS evaluation methods were applied to the International Electro-technical Commission standard (IEC 62220-1). The electronic portal imaging devices (EPID) devices such as Siemens BEAMVIEWPLUS, Elekta iViewGT and Varian ClinacR iX aS1000 were used. NPS data were expressed by corresponding each frequency about average of noise value corresponding the each frequency, and NPS were evaluated quantitatively by totaling up the noise values of average frequency which are on horizontal and vertical directions. In NPS results for Elekta iViewGT, NPS of horizontal and vertical by using 4 methods were indicated the difference of 3-5% between horizontal and vertical direction. In the results of Siemens BEAMVIEWPLUS and Varian ClinacR iX aS1000, the NPS of horizontal and vertical direction were indicated the difference of 15% when averaging the whole values. This study were evaluated the NPS of each devices by totaling up the noise values of average frequency which are on horizontal and vertical directions suggesting the quantitative evaluation method using the data.

  5. Cognitive components of rural tourism destination images

    DEFF Research Database (Denmark)

    Kokkali, Panagiota; Koutsouris, Alex; Chrysochou, Polymeros

    ; (3) visitors can be classified in four clusters according the cognitive factors; (4) tourists' clusters differ in terms of age, education and income as well as number of visits and perception of the area's attractiveness. Such findings point towards the need of both a new strategy for the area...... with their effect on destination attractiveness. Furthermore, the influence of tourists' characteristics on their cognitive TDI was explored. The results indicate that: (1) the area's TDI can be delineated in six cognitive factors; (2) the area's attractiveness is significantly influenced by three of these factors...

  6. Pakistani labour emigration: new destinations in Europe

    Directory of Open Access Journals (Sweden)

    Nasra M. Shah

    2005-01-01

    Full Text Available In the first part of this paper a historical overview is made of Pakistani labour emigration to the countries of the Persian Gulf, and to Anglo-Saxon countries in general and to the United Kingdom in particular. In the second part of the paper the new European labourmarkets which Pakistani emigrants have been increasingly discovering is analyzed. In this sense, Spain has become one of the new destinations. The author goes on to point out the specific nature of this new situation and at the same time details some of the future implications for Spain.

  7. Novel Simple Insulin Delivery Device Reduces Barriers to Insulin Therapy in Type 2 Diabetes: Results From a Pilot Study

    OpenAIRE

    Hermanns, Norbert; Lilly, Leslie C.; Mader, Julia K.; Aberer, Felix; Ribitsch, Anja; Kojzar, Harald; Warner, Jay; Pieber, Thomas R.

    2015-01-01

    Background: The PaQ® insulin delivery system is a simple-to-use patch-on device that provides preset basal rates and bolus insulin on demand. In addition to feasibility of use, safety, and efficacy (reported elsewhere), this study analyzed the impact of PaQ on patient-reported outcomes, including barriers to insulin treatment, diabetes-related distress, and attitudes toward insulin therapy in patients with type 2 diabetes on a stable multiple daily injection (MDI) regimen. Methods: This singl...

  8. Reversible Motor Paralysis and Early Cardiac Rehabilitation in Patients With Advanced Heart Failure Receiving Left Ventricular Assist Device Therapy.

    Science.gov (United States)

    Amao, Rie; Imamura, Teruhiko; Nakahara, Yasuo; Noguchi, Satoko; Kinoshita, Osamu; Yamauchi, Haruo; Ono, Minoru; Haga, Nobuhiko

    2016-12-02

    Advanced heart failure (HF) is sometimes complicated with brain impairment because of a microthrombosis caused by decreased left ventricular contraction or reduced brain circulation. Some patients may recover after left ventricular assist device (LVAD) implantation. However, little is known about the perioperative therapeutic strategy in patients suffering from such complications, particularly from a cardiac rehabilitation viewpoint. We report on a 58-year-old male patient with a previous history of poliomyelitis and a light paralysis in the left upper extremity, who suffered left hemiplegia with no evidence of stroke after hemodynamic deterioration. The combination therapy of perioperative cardiac rehabilitation and LVAD therapy improved his left hemiplegia as well as activities of daily living, and the patient was discharged on foot on postoperative day 72 after briefing the family on LVAD home management. Early initiation of cardiac rehabilitation before LVAD implantation may be a key for the smooth discharge and resocialization of patients suffering from brain impairment complicated with advanced HF.

  9. Renal failure in patients with left ventricular assist devices.

    Science.gov (United States)

    Patel, Ami M; Adeseun, Gbemisola A; Ahmed, Irfan; Mitter, Nanhi; Rame, J Eduardo; Rudnick, Michael R

    2013-03-01

    Implantable left ventricular assist devices (LVADs) are increasingly being used as a bridge to transplantation or as destination therapy in patients with end stage heart failure refractory to conventional medical therapy. A significant number of these patients have associated renal dysfunction before LVAD implantation, which may improve after LVAD placement due to enhanced perfusion. Other patients develop AKI after implantation. LVAD recipients who develop AKI requiring renal replacement therapy in the hospital or who ultimately require long-term outpatient hemodialysis therapy present management challenges with respect to hemodynamics, volume, and dialysis access. This review discusses the mechanics of a continuous-flow LVAD (the HeartMate II), the effects of continuous blood flow on the kidney, renal outcomes of patients after LVAD implantation, dialysis modality selection, vascular access, hemodynamic monitoring during the dialytic procedure, and other issues relevant to caring for these patients.

  10. 激光治疗机废气收集装置的研讨%Development of a waste gas-collecting device for laser therapy device

    Institute of Scientific and Technical Information of China (English)

    袁林; 袁强

    2011-01-01

    Objective:During operation, the use of laser therapy device often produce a lot of exhaust gas gasified by human tissue. All of these exhaust gas distributed in surgery rooms. It not only affects the work, but also harms the staff and patients’ health. So we improve the technology in order to solve this problem, by collecting waste gas produced during surgery. Methods:It was set by laser output tube, outsourcing set and waste gas collection and installed in the front of the laser output of laser surgery. The other end of waste gas collection will be connected with attracting device to suck the waste gas produced during the operation in time. Results:Laser surgical waste gas collection device won the practical patents. Conclusion:This device has the advantages of simple structure, low production cost and easy use.%目的;在使用激光治疗机进行手术时,经常产生大量的由人体组织气化后的废气。这些废气全部散发在手术间内,不但影响工作,而且影响工作人员及患者的人身健康。为解决该问题进行技术改进,将手术产生的废气进行收集,并进行排放。方法;由激光输出管外包套废气收集管组成,安装在现使用的激光治疗机激光输出口前,废气收集管的另一端连接吸引装置,将手术过程中产生的废气及时吸走。结果;激光治疗机废气收集装置获实用新型专利。结论;该装置结构简单、制作成本低、使用方便。

  11. DESTINATION MANAGEMENT AND IMAGING KINTAMANI TOWARDS SUSTAINABLE TOURISM

    Directory of Open Access Journals (Sweden)

    Ni Luh Putu Agustini Karta

    2016-03-01

    Full Text Available Kintamani destination has become a forerunner to the development of tourism in Bali. The last few years the brand Kintamani Destinations increasingly unpopular. This study aims to explain the paradigm shift and the role of management Kintamani Destinations in shaping the quality of service, image, satisfaction, and visitor’s loyalty integrated manner affecting the sustainability of tourism. Management acts as a service provider consisting of stakeholders. Research on management aspects (supply side has been implemented in the first phase qualitatively through depth interview. In stage II, conducted quantitative research on aspects of service quality, image, satisfaction and loyalty of visitors to Kintamani using SEM (Structural Equation Modeling. By accidental sampling questionnaire conducted to 250 tourists who visit Kintamani Destinations. Later in the third stage, verify the relationship of service quality, image, satisfaction, and loyalty to the sustainability of tourism in Kintamani through Focus Group Discussion (FGD. The findings of this research is the paradigm and the role of stakeholders in the destination management affects the quality of services provided in Kintamani. Aspects of quality of service, image, satisfaction significantly affect the loyalty of tourists visiting Kintamani. The four aspects are directly determine the sustainability of tourism in Kintamani. The novelty of this research is both, from the aspect of supply and demand, destination management, service quality, imaging, and satisfaction rating affects loyalty, as well as an integrated manner affecting the sustainability of Kintamani tourism Destinations. These research results bring to all stakeholders that the management of destinations and image dominant influence on the sustainability of Kintamani Tourism Destinations. Thus, these aspects will be the focus of stakeholders in maintaining and developing Kintamani Tourism Destinations. Kintamani Destinations

  12. First inappropriate implantable cardioverter defibrillator therapy is often due to inaccurate device programming: analysis of the French OPERA registry.

    Science.gov (United States)

    Leenhardt, Antoine; Defaye, Pascal; Mouton, Elisabeth; Delay, Marc; Delarche, Nicolas; Dupuis, Jean-Marc; Bizeau, Olivier; Mabo, Philippe; Cheggour, Saida; Babuty, Dominique

    2012-10-01

    Inappropriate therapy delivered by implantable cardioverter defibrillators (ICDs) remains a challenge. The OPERA registry measured the times to, and studied the determinants of, first appropriate (FAT) and inappropriate (FIT) therapies delivered by single-, dual- and triple-chamber [cardiac resynchronization therapy defibrillator (CRT-D)] ICD. We entered 636 patients (mean age = 62.0 ± 13.5 years; 88% men) in the registry, of whom 251 received single-, 238 dual-, and 147 triple-chamber ICD, for primary (30.5%) or secondary (69.5%) indications. We measured times to FAT and FIT as a function of multiple clinical characteristics, examined the effects of various algorithm components on the likelihood of FAT and FIT delivery, and searched for predictors of FAT and FIT. Over 22.8 ± 8.8 months of observation, 184 patients (28.9%) received FAT and 70 (11.0%) received FIT. Ventricular tachycardia (VT) was the trigger of 88% of FAT, and supraventricular tachycardia was the trigger of 91% of FIT. The median times to FIT (90 days; range 49-258) and FAT (171 days; 50-363) were similar. The rate of FAT was higher (P <0.001) in patients treated for secondary than primary indications, while that of FIT were similar in both groups. Out of 57 analysable FIT, 27 (47.4%) could have been prevented by fine tuning the device programming like the sustained rate duration or the VT discrimination algorithm. First inappropriate therapy occurred in 11% of 636 ICD recipients followed for ∼2 years. Nearly 50% of FIT could have been prevented by improving device programming.

  13. Efficacy of biofeedback therapy via a mini wireless device on sleep bruxism contrasted with occlusal splint: a pilot study

    Science.gov (United States)

    Gu, WeiPing; Yang, Jie; Zhang, FeiMin; Yin, XinMin; Wei, XiaoLong; Wang, Chen

    2015-01-01

    Abstract The putative causes of bruxism are multifactorial and there are no definite measures for bruxism management. The aim of this study was to evaluate the efficacy of biofeedback therapy on sleep bruxism, compared with occlusal splint. Twenty-four volunteers with sleep bruxism were divided into two groups: the GTB group that were treated with biofeedback therapy (n  = 12) and the GTO group that were treated with occlusal splint (n  = 12). A mini pressure sensor integrated with a monitoring circuit by use of a maxillary biofeedback splint was fabricated. To foster the relaxation of the masticatory muscles and the nervous system, the wireless device received signals from bruxism events and vibrations alerted the bruxer when the threshold was exceeded. Total episodes and average duration of bruxism events during 8 hours of sleep were analyzed with the monitoring program (TRMY1.0). After 6 and 12 weeks, the episodes (P  =  0.001) and duration (P 0.05). Furthermore, the episodes had significant differences between the GTB group and the GTO group after the same period of treatment (P  =  0.000). The results suggest that biofeedback therapy may be an effective and convenient measure for mild bruxers, when compared with occlusal splint therapy. The mini wireless biofeedback method may be of value for the diagnosis and management of bruxism in the future. PMID:25859272

  14. Treatment of a vulvar Paget's disease by photodynamic therapy with a new light emitting fabric based device.

    Science.gov (United States)

    Vicentini, Claire; Carpentier, Olivier; Lecomte, Fabienne; Thecua, Elise; Mortier, Laurent; Mordon, Serge R

    2017-02-01

    The non-invasive vulvar Paget's disease is an intra-epidermal carcinoma with glandular characteristics. It appears like an erythematous plaque. The main symptoms are pruritus and pain. The standard treatment is surgical excision in depth. This treatment is complicated with a severe morbidity and photodynamic therapy can be an alternative choice. However, the pain experienced during the photodynamic treatment of vulvar lesion is intense and leads to a premature interruption of the treatment. The light emitting fabric is a part of a device under clinical evaluation for the treatment of actinic keratosis with photodynamic therapy. We report the observation of a vulvar Paget's disease treated by this device with a satisfactory result and an excellent tolerance. The patient has been diagnosed with non-invasive vulvar Paget's disease for 25 years. The disease recurred constantly despite several imiquimod applications, LASER treatments and conventional photodynamic therapy. These procedures were complicated with intense pain. To improve the tolerance, we performed three PDT sessions a month apart using a 16% methyl-aminolevulinate cream (Metvixia® Galderma, Lausanne, Switzerland) with the light emitting fabric at low irradiance (irradiance = 6 mW/cm(2) -fluence = 37 J/cm(2) ) with a satisfactory result and an excellent tolerance. There are no controlled trials evaluating the efficacy of photodynamic therapy in the treatment of vulvar Paget's disease. The treatment and follow-up protocols in the literature are heterogeneous. Pain is the most common side effect with greater intensity for perineal locations where photodynamic therapy is impractical outside of anesthesia or hypnosis. We report the case of a multirecidivant non-invasive vulvar Paget's disease treated with a satisfactory result and an excellent tolerance by the new light emitting fabric device. A specific study is required but the light emitting fabric could be indicated for the treatment of Paget

  15. The impact of an electronic monitoring and reminder device on patient compliance with antihypertensive therapy

    DEFF Research Database (Denmark)

    Christensen, Arne; Christrup, Lona Louring; Fabricius, Paul Erik;

    2010-01-01

    BACKGROUND: High blood pressure (BP) significantly increases overall cardiovascular risk, the incidence of ischemic heart disease and stroke. One of the most important causes of insufficient BP control is low treatment compliance. Reminders and electronic compliance monitoring have been shown...... to be effective in improving patient compliance to some extent, but the combined effect has not been documented. OBJECTIVE: To assess the impact of an electronic reminder and monitoring device on patient compliance and BP control. METHODS: All patients received medical treatment with telmisartan once daily...... group 1, and between 32 and 38% in study group 2. CONCLUSION: The Helping Hand reminder device was most suitable if used for newly diagnosed hypertensive patients, when it improved compliance by 6%. With the present medical treatment, the device does not have any influence on BP control, but with less...

  16. Chengdu, The Next Destination for International Conferences%Chengdu,The Next Destination for International Conferences

    Institute of Scientific and Technical Information of China (English)

    Yang Wei

    2009-01-01

    @@ This May marks the one-year anniversary of Sichuan's earthquake,and also one year s efforts on their home reconstruction.Chengdu,the capital city of Sichuan province,survived from the earthouake,now focuses its unique strength to build a more modern city,and prepares to join in the list of "favorite international conference holding destination".

  17. QUALITY FROM THE VIEWPOINT OF TOURISM DESTINATION

    Directory of Open Access Journals (Sweden)

    Liliana ELMAZI

    2008-06-01

    Full Text Available Service quality initiatives are high priorities in many tourist destinations, with expenditure seen as long-term investment for future growth and profitability. My study’s goal is to explain the quality dimensions from the viewpoint of tourism destination. When we start to discuss about tourism quality supply, the main problem we have to consider is the structure of tourism supply as a complex of tangible and intangible elements. Analysis of the quality problem, their measuring and monitoring and marketing strategies based on quality, needs to be built on the specificity of tourist offer, regarding the level of goods and services. Because of this, the level of quality and customer satisfaction of quality is very hard to measure and to control. The first major feature of quality programs development is typically, to identify the key components or dimensions of quality from customer and employee research, i.e. their needs and expectations.

  18. CAPITAL FLOWS AND THEIR SECTORAL DESTINATIONS

    Directory of Open Access Journals (Sweden)

    Petris Sorina

    2012-07-01

    Full Text Available Since 2003, New European Union Member States have made large capital inflows, which led to a credit crunch and recession. Whether they are foreign direct investment, or banking flows, capital inflows ultimately affect GDP, depending on how they are invested. In the specialty literature, analysis of capital flows was done especially in terms of their structure, with a lack of analysis in terms of final destination of capital inflows. Therefore, we analyzed the effect of capital inflows on GDP in the New Member States of the European Union (Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania and Slovakia over the last economic cycle. Based on experiences of the new Member States during the recent boom and crisis, the paper studies the impact of capital inflows on GDP growth, inflows channeled to economic sectors, such as real estate and corporate investment sector. The results of this research tries to highlight the extent to which the final destination of capital flows is important for the evolution of GDP.

  19. Patient-specific flexible and stretchable devices for cardiac diagnostics and therapy.

    Science.gov (United States)

    Gutbrod, Sarah R; Sulkin, Matthew S; Rogers, John A; Efimov, Igor R

    2014-08-01

    Advances in material science techniques and pioneering circuit designs have led to the development of electronic membranes that can form intimate contacts with biological tissues. In this review, we present the range of geometries, sensors, and actuators available for custom configurations of electronic membranes in cardiac applications. Additionally, we highlight the desirable mechanics achieved by such devices that allow the circuits and substrates to deform with the beating heart. These devices unlock opportunities to collect continuous data on the electrical, metabolic, and mechanical state of the heart as well as a platform on which to develop high definition therapeutics.

  20. EXPLORING DESTINATION IDENTITY AND DESTINATION IMAGE IN THE NEW AGE OF TOURISM: A CASE STUDY OF BALI BRAND

    Directory of Open Access Journals (Sweden)

    Ni Made - Asti Aksari

    2016-05-01

    Full Text Available Bali's economy has grown rapidly since a decade ago. This is possible because tourism is growing continuously. However, tourism growth is not optimal because of insufficient promotion and tourism destination identity is unclear.  The growth of Web 2.0 as a platform to share travel information has prompted tourism bodies to pay closer attention to how their destinations are perceived by target markets. Set within the context of the emergence of Web 2.0, a platform designed to enable users to generate and share information on the Internet, this paper evaluates the relationship between destination identity and destination image and adopts the view that a successful destination brand relies on the congruence between destination identity and destination image. The elements of destination identity are composed from the supply side and the elements of destination image are composed from the consumer side. The objective of exploring the alignment between these two perspectives is to propose a model to encourage the alignment of these two perspectives and evaluate the effectiveness of a destination branding strategy.

  1. A MANAGEMENT MODEL FOR SUSTAINABLE DEVELOPMENT OF THE TOURIST DESTINATION

    Directory of Open Access Journals (Sweden)

    Krasimir ALEKSANDROV

    2013-01-01

    Full Text Available In recent years, Bulgaria is about to market successfully one of the few competitive advantages that the country has as a tourist destination – the diverse and authentic nature. It is an indisputable fact that tourism in its diversity is closely linked to the choice of destination. Sustainable destination management is critical for tourism development, particularly by having effective spatial planning and land use control and through investment decisions on infrastructure and services. The aim of this paper is to propose a management model of a tourist destination in the context of the ideas and policies for sustainable development. The thesis that is justified is that sustainable tourism destination is the result of a proper use of an appropriate governance model. The development and implementation of specific management model make the destination of an all year-round tourism in its different varieties (recreational, sports, etc., bearing economic, social and environmental benefits to society.

  2. IQM of a tourism destination as a tool of competitiveness

    Directory of Open Access Journals (Sweden)

    Ida Vajčnerová

    2011-01-01

    Full Text Available As the example above shows, the tourists’ satisfaction level from staying at destination depends not only on their experience on specific tourist services, but also or more intangible factors, for example hospitality, safety and security, and cleanliness. The success of a destination is therefore a function of many independent components. It underscores the need for an integrated approach to managing the quality of tourist destination. The objective of the article is to specify the preconditions of a destination for implementing Integrated quality management (IMQ and to demonstrate the possibilities for using the methodological approaches of the Qualitest tool in the tourist destination of Znojemsko and Podyjí. The obtained results show problematic utilization of Qualitest in full extent and the necessity to modify it for its use in the conditions of the Czech Republic destinations.

  3. Radiofrequency ablation therapy of intractable ventricular tachycardia present with a left ventricular assist device

    DEFF Research Database (Denmark)

    Nielsen, Jan Møller; Kristiansen, Steen Buus; Gerdes, Christian;

    2015-01-01

    Ventricular tachycardia (VT) occurs in up to 59% of patients with left ventricular assist devices (LVAD). In some of these patients, the VT cannot be managed medically or by implantable cardioverter-defibrillator. In this case, a 66-year-old male was successfully treated with radiofrequency...

  4. Development of transfer standard devices for ensuring the accurate calibration of ultrasonic physical therapy machines in clinical use

    Energy Technology Data Exchange (ETDEWEB)

    Hekkenberg, R T [TNO Prevention and Health, Zernikedreef 9, 2333 CK Leiden (Netherlands); Richards, A [National Measurement Laboratory, CSIRO, Bradfield Rd, West Lindfield 2070, Sydney (Australia); Beissner, K [Physikalisch-Technische Bundesanstalt, PTB, Bundesallee 100, D-38116 Braunschweig (Germany); Zeqiri, B [National Physical Laboratory, NPL, Queens Road, Teddington, TW11 0LW (United Kingdom); Prout, G [National Measurement Laboratory, CSIRO, Bradfield Rd, West Lindfield 2070, Sydney (Australia); Cantrall, Ch [National Measurement Laboratory, CSIRO, Bradfield Rd, West Lindfield 2070, Sydney (Australia); Bezemer, R A [TNO Prevention and Health, Zernikedreef 9, 2333 CK Leiden (Netherlands); Koch, Ch [Physikalisch-Technische Bundesanstalt, PTB, Bundesallee 100, D-38116 Braunschweig, (Germany); Hodnett, M [National Physical Laboratory, NPL, Queens Road, Teddington, TW11 0LW (United Kingdom)

    2004-01-01

    Physical therapy ultrasound is widely applied to patients. However, many devices do not comply with the relevant standard stating that the actual power output shall be within {+-}20% of the device indication. Extreme cases have been reported: from delivering effectively no ultrasound or operating at maximum power at all powers indicated. This can potentially lead to patient injury as well as mistreatment. The present European (EC) project is an ongoing attempt to improve the quality of the treatment of patients being treated with ultrasonic physical-therapy. A Portable ultrasound Power Standard (PPS) is being developed and accurately calibrated. The PPS includes: Ultrasound transducers (including one exhibiting an unusual output) and a driver for the ultrasound transducers that has calibration and proficiency test functions. Also included with the PPS is a Cavitation Detector to determine the onset of cavitation occurring within the propagation medium. The PPS will be suitable for conducting in-the-field accreditation (proficiency testing and calibration). In order to be accredited it will be important to be able to show traceability of the calibration, the calibration process and qualification of testing staff. The clinical user will benefit from traceability because treatments will be performed more reliably.

  5. Changes in functional connectivity correlate with behavioral gains in stroke patients after therapy using a brain-computer interface device

    Directory of Open Access Journals (Sweden)

    Brittany Mei Young

    2014-07-01

    Full Text Available Brain-computer interface (BCI technology is being incorporated into new stroke rehabilitation devices, but little is known about brain changes associated with its use. We collected anatomical and functional MRI of 9 stroke patients with persistent upper extremity motor impairment before, during, and after therapy using a BCI system. Subjects were asked to perform finger tapping of the impaired hand during fMRI. Action Research Arm Test (ARAT, 9-Hole Peg Test (9-HPT, and Stroke Impact Scale (SIS domains of Hand Function (HF and Activities of Daily Living (ADL were also assessed. Group-level analyses examined changes in whole-brain task-based functional connectivity (FC to seed regions in the motor network observed during and after BCI therapy. Whole-brain FC analyses seeded in each thalamus showed FC increases from baseline at mid-therapy and post-therapy (p< 0.05. Changes in FC between seeds at both the network and the connection levels were examined for correlations with changes in behavioral measures. Average motor network FC was increased post-therapy, and changes in average network FC correlated (p < 0.05 with changes in performance on ARAT (R2=0.21, 9-HPT (R2=0.41, SIS HF (R2=0.27, and SIS ADL (R2=0.40. Multiple individual connections within the motor network were found to correlate in change from baseline with changes in behavioral measures. Many of these connections involved the thalamus, with change in each of four behavioral measures significantly correlating with change from baseline FC of at least one thalamic connection. These preliminary results show changes in FC that occur with the administration of rehabilitative therapy using a BCI system. The correlations noted between changes in FC measures and changes in behavioral outcomes indicate that both adaptive and maladaptive changes in FC may develop with this therapy and also suggest a brain-behavior relationship that may be stimulated by the neuromodulatory component of BCI therapy.

  6. Creating a working destination brand : Case: Budapest and Helsinki

    OpenAIRE

    Siven, Annika

    2010-01-01

    This bachelor thesis concentrates in researching and analysing the process and aspects of destination branding. Example cities and destination brands are Budapest and Helsinki. The aim of the research is to discover and present diverse information about the subject that can help the Helsinki CityTourist and Convention Bureau. Assignment for the bachelor thesis came from the Helsinki CityTourist and Convention Bureau. As a growing and important part of tourism marketing, destination brandi...

  7. Effects of Films and Television Dramas on Destination Image

    Directory of Open Access Journals (Sweden)

    Pars Şahbaz

    2009-09-01

    Full Text Available The aim of this study is bring up the effects of films and television dramas on destination image. Image is a picture and a imagery which ia about destination and also image affects the purchase decision making. The population of the study contains domestic tourists who visited Mardin. The result of the study suggests that there is a substantive relationship between destination images and films and television dramas.

  8. RESEARCH ON TOURISM DESTINATIONS MARKETING FROM THE PUBLIC RELATIONS’ PERSPECTIVE

    OpenAIRE

    Gabriela ARIONESEI (GAUBE)

    2012-01-01

    Nowadays, tourism destinations are more and more determined to build a unique and competitive identity and image in consumers’ minds. Even though the marketing of tourism destinations has been awarded an intended purpose, in practice there is a lack of steadiness, sometimes an unexplained deficiency of empirical academic research. In some countries, many without "a tradition in tourism", building a marketing strategy for travel destinations is based on artificial and without substance images/...

  9. Tourists' Transformation Experience: From Destination Architecture to Identity Formation

    DEFF Research Database (Denmark)

    Ye, Helen Yi; Tussyadiah, Iis

    2010-01-01

    Today’s tourists seek unique destinations that could associate with their self identity in a profound way. It is meaningful for destinations to design unique physical elements that offer transformational travel experiences. This study aims at identifying how tourists encounter architecture in a d...... modes—gazing, touring, reading and pondering are identified. Conversational architectural design is suggested for destinations to create a unique experience....

  10. DESTINATION LOYALTY MODEL OF ELDERLY FOREIGN TOURISTS VISITING BALI

    Directory of Open Access Journals (Sweden)

    I Gusti Bagus Rai Utama

    2014-03-01

    Full Text Available Research was designed to understand loyalty model of elderly foreign tourists visiitng Bali which was undertaken in the main destinations in Bali i.e., Kuta, Nusa Dua, Sanur, Ubud and Lovina. 400 respondents were determined purposively. The criteria were senior tourists aged 55 or over and tourists vacationing in one of Bali’s tourism destinations. Descriptive statistical analysis and the SEM-AMOS structural model analysis tools were undertaken to analyze statistically. The resuts show that (1 Internal motivation does not have a significant effect on destination image. (2 External motivation has a significant effect on destination image and loyalty, but does not have a significant effect on tourist’s satisfaction. (3 Destination image has a significant effect on tourist’s satisfaction. (4 Tourist’s satisfaction has a significant effect on destination loyalty. Two loyalty models were formed: (1 Destination loyalty is directly influenced by tourist’s satisfaction, and indirectly influenced by destination image and external motivation. (2 Destination loyalty is directly influenced by external motivation, but the influence is not as significant as the influence of tourist’s satisfaction on loyalty. Suggestions of the research are maintaining the joint approach to answer various questions through quantitative approach. Improvement strong image of Bali is crucial, such as: (1 improving uniqueness of culture, (2 welcoming local inhabitants, (3 improving tourism infrastructure, and (4 comfortable tourism atmosphere.

  11. Role of specific geographic landscapes in city break destinations

    Directory of Open Access Journals (Sweden)

    Štetić Snežana

    2009-01-01

    Full Text Available Urban tourist destinations or City Break destinations are representing one of main destination products on tourist market. City Break destinations are big cities, administrative, economic and political centers of states and regions. These cities are 'open' 24 hours per day, seven days in week. Inside these tourist destination we can find different range of products (culture, entertainment, recreation, leisure, history, modern infrastructure. In these destinations season is not present and it lasts trough out the year. Promotional campaigns in City Break destinations are truing to create distinguished images in tourists mind as also as on investors, consumers and future residents. They emphasize advantages that those cities are delivering to their consumers, but often we forget that all these cities are having specific geographic landscapes. In the era of limiting of mass tourism to preserve resources for future generations and emphasizing the importance of sustainable development for tourism perspectives, the importance of specific geographic landscapes inside urban destinations for their further development as tourist destinations an their overall development is slightly neglected.

  12. Influence of security threats on tourism destination development

    Directory of Open Access Journals (Sweden)

    Kurež Bojan

    2015-01-01

    Full Text Available The aim of the paper is to analyze the modern security environment and its impact on tourism destination development. Contemporary security environment is a result of historical events affected by the elements of the contemporary safety and political environment. Ground security concepts, which dominate contemporary security environment, are pointed out and further linked to the development of the modern security threats shaping tourism destination development. We are pointing out how the major security threats influence the tourism destination development. Methodology is based on secondary analysis of literature. Several current case studies are made to support conclusions on relationship between security and tourism destination developments.

  13. Hemodynamic device-based optimization in cardiac resynchronization therapy: concordance with systematic echocardiographic assessment of AV and VV intervals

    Directory of Open Access Journals (Sweden)

    Oliveira MM

    2015-08-01

    Full Text Available Mário M Oliveira, Luisa M Branco, Ana Galrinho, Nogueira da Silva, Pedro S Cunha, Bruno Valente, Joana Feliciano, Ricardo Pimenta, Ana Sofia Delgado, Rui Cruz Ferreira Santa Marta Hospital, Lisbon, Portugal Background: Inappropriate settings of atrioventricular (AV and ventriculo-ventricular (VV intervals can be one of the factors impacting response to cardiac resynchronization therapy (CRT. Optimal concordance of AV and VV intervals between echocardiographic-based assessment and a device-based automatic programming with a hemodynamic sensor was investigated, together with left ventricle (LV reverse remodeling after 6 months of regular automatic device-based optimization.Methods: We evaluated blindly 30 systematic echocardiographic examinations during 6 months in 17 patients (12 men, 64±10 years, in sinus rhythm and New York Heart Association class III; 76% with non-ischemic dilated cardiomyopathy, LV ejection fraction [LVEF] <35%, QRS 130 milliseconds and LV dyssynchrony implanted with the SonRtip lead and a cardioverter-defibrillator device. Dyssynchrony (AV, VV, or intraventricular was evaluated by an experienced operator blinded to the device programming, using conventional echocardiography, tissue synchronization imaging, tissue Doppler imaging, radial strain, and 3D echocardiography.Results: Either no AV or VV dyssynchrony (n=11; 36.7% or a slight septal or lateral delay (n=13; 43.3% was found in most echocardiography examinations (80%. AV or VV dyssynchrony requiring further optimization was identified in one-fifth of the examinations (20%. At 6 months, 76.5% patients were responders with LV reverse remodeling, of which 69% were super-responders (LVEF >40%. A statistically significant increase in LVEF was observed between baseline and 6 months post implant (P<0.01. One patient died from non-cardiac causes.Conclusion: Concordance between echocardiographic methods and device-based hemodynamic sensor optimization was found in most

  14. Predictors of trips to food destinations

    Directory of Open Access Journals (Sweden)

    Kerr Jacqueline

    2012-05-01

    Full Text Available Abstract Background Food environment studies have focused on ethnic and income disparities in food access. Few studies have investigated distance travelled for food and did not aim to inform the geographic scales at which to study the relationship between food environments and obesity. Further, studies have not considered neighborhood design as a predictor of food purchasing behavior. Methods Atlanta residents (N = 4800 who completed a travel diary and reported purchasing or consuming food at one of five food locations were included in the analyses. A total of 11,995 food-related trips were reported. Using mixed modeling to adjust for clustering of trips by participants and households, person-level variables (e.g. demographics, neighborhood-level urban form measures, created in GIS, and trip characteristics (e.g. time of day, origin and destination were investigated as correlates of distance travelled for food and frequency of grocery store and fast food outlet trips. Results Mean travel distance for food ranged from 4.5 miles for coffee shops to 6.3 miles for superstores. Type of store, urban form, type of tour, day of the week and ethnicity were all significantly related to distance travelled for food. Origin and destination environment, type of tour, day of week, age, gender, income, ethnicity, vehicle access and obesity status were all significantly related to visiting a grocery store. Home neighborhood environment, day of week, type of tour, gender, income, education level, age, and obesity status were all significantly related to likelihood of visiting a fastfood outlet. Conclusions The present study demonstrated that people travel sizeable distances for food and this distance is related to urban. Results suggest that researchers need to employ different methods to characterize food environments than have been used to assess urban form in studies of physical activity. Food is most often purchased while traveling from locations other

  15. Implementation study of an analog spiking neural network for assisting cardiac delay prediction in a cardiac resynchronization therapy device.

    Science.gov (United States)

    Sun, Qing; Schwartz, François; Michel, Jacques; Herve, Yannick; Dalmolin, Renzo

    2011-06-01

    In this paper, we aim at developing an analog spiking neural network (SNN) for reinforcing the performance of conventional cardiac resynchronization therapy (CRT) devices (also called biventricular pacemakers). Targeting an alternative analog solution in 0.13- μm CMOS technology, this paper proposes an approach to improve cardiac delay predictions in every cardiac period in order to assist the CRT device to provide real-time optimal heartbeats. The primary analog SNN architecture is proposed and its implementation is studied to fulfill the requirement of very low energy consumption. By using the Hebbian learning and reinforcement learning algorithms, the intended adaptive CRT device works with different functional modes. The simulations of both learning algorithms have been carried out, and they were shown to demonstrate the global functionalities. To improve the realism of the system, we introduce various heart behavior models (with constant/variable heart rates) that allow pathologic simulations with/without noise on the signals of the input sensors. The simulations of the global system (pacemaker models coupled with heart models) have been investigated and used to validate the analog spiking neural network implementation.

  16. Peripartum cardiomyopathy, place of drug therapy, assist devices, and outcome after left ventricular assistance.

    Science.gov (United States)

    Hamdan, Righab; Nassar, Pierre; Zein, Ali; Issa, Mohamad; Mansour, Hassan; Saab, Mohamad

    2017-02-01

    Peripartum cardiomyopathy remains a challenging obstetric and cardiologic emergency. We report 5 interesting cases of peripartum cardiomyopathy with different clinical courses, with 3 patients requiring left ventricular assist device implantation. One patient underwent pump explantation and aortic balloon valvuloplasty postsurgery. Two patients improved with the medical treatment alone without the need of assistance. We will review main important related issues. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Branding the Destination Versus the Place

    DEFF Research Database (Denmark)

    Zenker, Sebastian; Braun, Erik; Petersen, Sibylle

    2017-01-01

    knowledge of the place and could disagree with simplified destination brands. To test the role of brand complexity for residents and tourists, we conducted two empirical studies (N = 765; N = 385), showing that, for residents, positive place attitude (i.e., place satisfaction, identification, and attachment......This article contributes to a broader understanding of how the branding of places affects both residents and tourists. While branding often relies on simplified messages, the effectiveness of such strategies for complex brands remains questionable. Residents in particular possess a confounded......) and place behaviour (i.e., positive word-of-mouth) increase with a higher brand complexity. The second study shows that the positive relationship of brand complexity is stronger for residents than for tourists, supporting the conclusion that brand complexity is relevant for place brands, but that the place...

  18. Bright Prospects for Argyle in Tourist Destinations

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    China's tourist boom has created a huge market for resort hotels.Tourist attractions in second- and third-tier cities have become preferred destinations for hotel investors.Argyle Management Group (Australia) is taking the lead in this trend.Argyle Feiyunhu Resort Zhejiang Argyle Feiyunhu Resort Zhejiang in Wenzhou,currently under construction,is an excellent example.This five-star hotel enjoys transportation convenience both on land and on water.Guests can reach the hotel through a special tourist wharf.Located in the Feiyun Lake scenic area,the hotel will have complete equipment,with a conference center,a business center,a horseracing track and a miniature golf course.

  19. Efficacy of biofeedback therapy via a mini wireless device on sleep bruxism contrasted with occlusal splint: a pilot study

    Institute of Scientific and Technical Information of China (English)

    WeiPing Gu; Jie Yang; FeiMin Zhang; XinMin Yin; XiaoLong Wei; Chen Wang

    2015-01-01

    The putative causes of bruxism are multifactorial and there are no definite measures for bruxism management.The aim of this study was to evaluate the efficacy of biofeedback therapy on sleep bruxism,compared with occlusal splint.Twenty-four volunteers with sleep bruxism were divided into two groups:the GTB group that were treated with biofeedback therapy (n =12) and the GTO group that were treated with occlusal splint (n =12).A mini pressure sensor integrated with a monitoring circuit by use of a maxillary biofeedback splint was fabricated.To foster the relaxation of the masticatory muscles and the nervous system,the wireless device received signals from bruxism events and vibrations alerted the bruxer when the threshold was exceeded.Total episodes and average duration of bruxism events during 8 hours of sleep were analyzed with the monitoring program (TRMY].0).After 6 and 12 weeks,the episodes (P =0.001) and duration (P < 0.05) in the GTB group declined dramatically.In contrast,there were no significant differences in the GTO group after the treatment (P > 0.05).Furthermore,the episodes had significant differences between the GTB group and the GTO group after the same period of treatment (P =0.000).The results suggest that biofeedback therapy may be an effective and convenient measure for mild bruxers,when compared with occlusal splint therapy.The mini wireless biofeedback method may be of value for the diagnosis and management of bruxism in the future.

  20. Clinical trial design and rationale of the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) investigational device exemption clinical study protocol.

    Science.gov (United States)

    Heatley, Gerald; Sood, Poornima; Goldstein, Daniel; Uriel, Nir; Cleveland, Joseph; Middlebrook, Don; Mehra, Mandeep R

    2016-04-01

    The HeartMate 3 left ventricular assist system (LVAS; St. Jude Medical, Inc., formerly Thoratec Corporation, Pleasanton, CA) was recently introduced into clinical trials for durable circulatory support in patients with medically refractory advanced-stage heart failure. This centrifugal, fully magnetically levitated, continuous-flow pump is engineered with the intent to enhance hemocompatibility and reduce shear stress on blood elements, while also possessing intrinsic pulsatility. Although bridge-to-transplant (BTT) and destination therapy (DT) are established dichotomous indications for durable left ventricular assist device (LVAD) support, clinical practice has challenged the appropriateness of these designations. The introduction of novel LVAD technology allows for the development of clinical trial designs to keep pace with current practices. The prospective, randomized Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) clinical trial aims to evaluate the safety and effectiveness of the HeartMate 3 LVAS by demonstrating non-inferiority to the HeartMate II LVAS (also St. Jude Medical, Inc.). The innovative trial design includes patients enrolled under a single inclusion and exclusion criteria , regardless of the intended use of the device, with outcomes ascertained in the short term (ST, at 6 months) and long term (LT, at 2 years). This adaptive trial design includes a pre-specified safety phase (n = 30) analysis. The ST cohort includes the first 294 patients and the LT cohort includes the first 366 patients for evaluation of the composite primary end-point of survival to transplant, recovery or LVAD support free of debilitating stroke (modified Rankin score >3), or re-operation to replace the pump. As part of the adaptive design, an analysis by an independent statistician will determine whether sample size adjustment is required at pre-specified times during the study. A further 662

  1. MotionTherapy@Home - First results of a clinical study with a novel robotic device for automated locomotion therapy at home.

    Science.gov (United States)

    Rupp, Rüdiger; Plewa, Harry; Schuld, Christian; Gerner, Hans Jürgen; Hofer, Eberhard P; Knestel, Markus

    2011-02-01

    In incomplete spinal cord injured subjects, task-oriented training regimes are applied for enhancement of neuroplasticity to improve gait capacity. However, a sufficient training intensity can only be achieved during the inpatient phase, which is getting shorter and shorter due to economic restrictions. In the clinical environment, complex and expensive robotic devices have been introduced to maintain the duration and the intensity of the training, but up to now only a few exist for continuation of automated locomotion training at home. For continuation of the automated locomotion training at home prototypes of the compact, pneumatically driven orthosis MoreGait have been realized, which generate the key afferent stimuli for activation of the spinal gait pattern generator. Artificial pneumatic muscles with excellent weight-to-force ratio and safety characteristics have been integrated as joint actuators. Additionally, a Stimulative Shoe for generation of the appropriate foot loading pattern has been developed without the need for verticalization of the user. The first results of the pilot study in eight chronic incomplete spinal cord injured subjects indicate that the home-based therapy is safe and feasible. The therapy related improvements of the walking capacity are in the range of locomotion robots used in clinical settings.

  2. MARKETING TRENDS AND STRATEGIC MANAGEMENT IN DESTINATION DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    Svetlana Mihić

    2009-11-01

    Full Text Available This paper examines the concept of the destination in strategic tourism develop- ment. It will then look at international best practice and how the SVP/ Hudson Model can be used as a tool to shape the planning, management and marketing of tourism destinations. This analysis will include a review of the critical success factors from lea- ding destinations and in particular, the role of and need for innovation. The concept ofinnovation in tourism will be examined and examples of how innovation has been used in a range of European destinations will be considered in detail. This will include evi- dence from key stakeholders, as well as analysis of the PR and media interest generated by an innovative approach to tourism destination development. The paper will examine key issues such as branding and positioning, along with the importance of clear strate- gic planning, having an effective destination management organisation and delivering benefits to the host community. In an increasingly competitive marketplace the need for destinations to ‘’stand out in a crowd” is essential. International benchmarking is vital to understand how well you are doing compa- red with your competitors whilst innovation ensures that the competitive edge is always maintained. The paper will include detailed case studies, consideration of the concepts of in- novation and benchmarking and focus on the main lessons for destinations in emerging tourism economies

  3. Tourism Competitiveness and Destination Branding - A Theoretical Approach

    OpenAIRE

    Morar Doriana; Cotîrlea Denisa Adriana

    2012-01-01

    The present article was written in order to provide an overview of the theoretical approaches considering competitiveness and differentiation in tourism industry. Also, it emphasizes the importance of competitive advantages in destination branding, their connection and their influence on the size of tourist flows in different destinations.

  4. Destination Memory and Cognitive Theory of Mind in Alzheimer's Disease.

    Science.gov (United States)

    El Haj, Mohamad; Gély-Nargeot, Marie-Christine; Raffard, Stéphane

    2015-01-01

    Destination memory, or the ability to remember the destination to whom a piece of information was addressed, is found to be compromised in Alzheimer's disease (AD). Our paper investigated the relationship between destination memory and theory of mind in AD since both destination memory and theory of mind are social abilities that require processing attributes of interlocutors. Mild AD participants and controls were administered tasks tapping destination memory, affective theory of mind, and 1st and 2nd order cognitive theory of mind. Relative to controls, AD participants showed compromise in destination memory and 2nd order cognitive theory of mind, but preserved performance on affective and 1st order cognitive theory of mind. Significant correlations were observed between destination memory, and 1st and 2nd order cognitive theory of mind in AD participants and controls. By demonstrating a relationship between compromises in 2nd order theory of mind and in destination memory, our work highlights links between social cognition and memory functioning in AD.

  5. Inter-destination Media Synchronization for TV broadcasts

    NARCIS (Netherlands)

    Mekuria, R.N.

    2011-01-01

    This thesis presents a study on the application of inter-destination synchronization for TV-broadcasting. Inter-destination media synchronization implies synchronizing media output at different receivers. This thesis starts by investigating differences in media output between receivers of TV broadca

  6. Validation of a novel device to objectively measure adherence to long-term oxygen therapy

    Directory of Open Access Journals (Sweden)

    Sun-Kai V Lin

    2008-10-01

    Full Text Available Sun-Kai V Lin1, Daniel K Bogen1, Samuel T Kuna2,31Department of Bioengineering; 2Department of Medicine, Pulmonary, Allergy and Critical Care Division, and Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Pennsylvania, USA; 3Department of Medicine, Philadelphia Veterans Affairs Medical Center Philadelphia, Pennsylvania, USARationale: We have developed a novel oxygen adherence monitor that objectively measures patient use of long-term oxygen therapy. The monitor attaches to the oxygen source and detects whether or not the patient is wearing the nasal cannula.Objective: The study’s purpose was to validate the monitor’s performance in patients with chronic obstructive pulmonary disease during wakefulness and sleep.Methods: Ten adult males with stable chronic obstructive pulmonary disease (mean ± SD FEV1 37.7 ± 14.9% of predicted on long-term continuous oxygen therapy were tested in a sleep laboratory over a 12–13 hour period that included an overnight polysomnogram.Measurements: The monitor’s measurements were obtained at 4-minute intervals and compared to actual oxygen use determined by review of time-synchronized video recordings.Main results: The monitor made 1504/1888 (79.7% correct detections (unprocessed data across all participants: 957/1,118 (85.6% correct detections during wakefulness and 546/770 (70.9% during sleep. All errors were false negatives, ie, the monitor failed to detect that the participant was actually wearing the cannula. Application of a majority-vote filter to the raw data improved overall detection accuracy to 84.9%.Conclusions: The results demonstrate the monitor’s ability to objectively measure whether or not men with chronic obstructive pulmonary disease are receiving their oxygen treatment. The ability to objectively measure oxygen delivery, rather than oxygen expended, may help improve the management of patients on long-term oxygen therapy.Keywords: chronic obstructive pulmonary

  7. Exploring Familiarity and Destination Choice in International Tourism

    DEFF Research Database (Denmark)

    Lee, G.; Tussyadiah, Iis

    2012-01-01

    The aim of this study is to identify the characteristics of prospective and experienced tourists to international tourism destinations. More specifically, this study examines how the differences in the level of familiarity with the host country (i.e., informational familiarity and experiential...... familiarity) influence sub-destination choice in terms of its scale and popularity. A survey was conducted with Korean nationals as potential visitors to tourism destinations in Japan. Six one-way ANOVA tests and six chi-square tests were performed to identify the relationships and differences between...... tourists' characteristics and the destination choices. The results indicate that (1) teens and people in their 50s and above were interested in visiting more popular places, (2) tourists who are more familiar with Japan tended to visit less popular destinations, and (3) tourists with more travel...

  8. Sami tourism in destination development: conflict and collaboration

    DEFF Research Database (Denmark)

    Olsen, Lise Smed

    2016-01-01

    Indigenous tourism has become an important component of the tourism industry. Previous indigenous tourism research has indicated three conflict areas that can have an impact on destination development - internal conflicts over indigenous identity, the use of indigenous culture in destination...... marketing, and land-use conflicts. To varying degrees these areas of conflict have been found to impact local and regional destination development in northern Europe. This paper draws on case studies to understand how conflicts in Sami tourism in local and regional destination development are addressed...... challenging to address through collaboration due to the history of colonisation by nation states. Such prevailing conflicts place certain requirements on the facilitator of collaboration processes in tourism destination development....

  9. Moderating Effects of Craftourism on Place Attachment and Destination Loyalty

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    Arup Kumar Baksi

    2015-09-01

    Full Text Available Practice of traditional handicrafts play a significant role in enhancing destination attractiveness. Visitors assign considerable weightage to local craft practices to satisfy their desire to participate in the learning and production process, a case of role-reversal. Promoting this scope of role-reversal has been used by the Destination Marketing Organizations as differentiators. Craftourism has gained considerable momentum. This paper focuses on examining the moderating effects of craftourism on place attachment and destination loyalty. Dimensions of craftourism were identified by applying suitable statistical procedure. The results revealed craftourism, with option for visitors to enact role-reversal, improves the chances of destination loyalty following antecedent effects of place attachment. Keywords: craftourism, place attachment, destination loyalty, visitor, moderating

  10. Online information Impact in the virtual destination image formation

    Directory of Open Access Journals (Sweden)

    Célia Maria Conceição Salmim Rafael

    2014-05-01

    Full Text Available The influence of the destination image in the decision process and choice of destination by tourists is transverse to its intangible nature. Recent studies expand and modify the conventional image constructs specifying information sources transmitted through the internet. The scenario resulting from the literature review allows us to understand the importance of experience for touristic activity and theoretical proposition of virtual tourism as "virtual tourist experience", its determinants and its implications for the overall image destination formation. This study presents a literature review base to the empiric research proposal whose general objective comprises the analysis of the influence of factors, such as interactivity, in online communication and contact with virtual tourism experiences online in image destination formation and image destination.

  11. THE DESTINATION IMAGE OF BUCOVINA AMONG ROMANIAN TOURISTS

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    Ariadna Ioana JURAVLE (GAVRA

    2016-12-01

    Full Text Available The aim of this article is to identify the destination image of Bucovina among Romanian tourists. Bucovina is one of the most important tourist destinations of Romania, it is located in the North Eastern region of Romania and tourism has the potential to provide significant support for economic development of this region. This economic development may occur if the elements of tourism are well-managed. One of the factors influencing the success of a destination is its image. Earlier studies showed the importance of destination image, even though no studies have been conducted for Bucovina to identify the image of this destination. To implement this study, we used survey as the research method and the questionnaire as our research tool. We conducted the content analysis of responses to open questions. The items were included into a broader questionnaire although this article comprises just the qualitative research in which we included emergent coding.

  12. Evolution in VNS therapy for refractory epilepsy, experience with Demipulse devices at Ghent University Hospital.

    Science.gov (United States)

    El Tahry, Riëm; De Herdt, Veerle; Raedt, Robrecht; Van Dycke, Annelies; Meurs, Alfred; Dewaele, Frank; Boon, Paul; Van Roost, Dirk; Vonck, Kristl

    2010-11-01

    Vagus nerve stimulation (VNS) is a frequently used treatment for patients with refractory epilepsy who are unsuitable candidates for epilepsy surgery. There has been a steady evolution in VNS technology, as generators' volumes have become smaller and battery life expectancy longer. This pilot study is an open-label retrospective study that describes our experience with the latest commercially available generator, i.e. the VNS Therapy Demipulse Model 103. Treatment efficacy and side effects, as well as technical and practical enhancements useful for the patient and for the medical staff are discussed in this study. Twenty patients (11F/9M) with a mean age of 40 years (range 8-61), who were considered unsuitable candidates for resective surgery, were implanted with a VNS Therapy Demipulse Model 103. Mean monthly seizure frequency reduction and side effects were evaluated 1 year after implantation. Mean monthly seizure frequency decreased significantly from 54 seizures/month (SEM 30; range 1-555) before treatment to 33 (SEM 24, range 0-445) following 12 months of treatment (psize and improved options for battery life follow-up. Copyright © 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  13. Effect of an oxygen pressure injection (OPI) device on the oxygen saturation of patients during dermatological methyl aminolevulinate photodynamic therapy.

    Science.gov (United States)

    Blake, E; Allen, J; Thorn, C; Shore, A; Curnow, A

    2013-05-01

    Methyl aminolevulinate photodynamic therapy (MAL-PDT) (a topical treatment used for a number of precancerous skin conditions) utilizes the combined interaction of a photosensitizer (protoporphyrin IX (PpIX)), light of the appropriate wavelength, and molecular oxygen to produce singlet oxygen and other reactive oxygen species which induce cell death. During treatment, localized oxygen depletion occurs and is thought to contribute to decreased efficacy. The aim of this study was to investigate whether an oxygen pressure injection (OPI) device had an effect on localized oxygen saturation levels and/or PpIX fluorescence of skin lesions during MAL-PDT. This study employed an OPI device to apply oxygen under pressure to the skin lesions of patients undergoing standard MAL-PDT. Optical reflectance spectrometry and fluorescence imaging were used to noninvasively monitor the localized oxygen saturation and PpIX fluorescence of the treatment area, respectively. No significant changes in oxygen saturation were observed when these data were combined for the group with OPI and compared to the group that received standard MAL-PDT without OPI. Additionally, no significant difference in PpIX photobleaching or clinical outcome at 3 months between the groups of patients was observed, although the group that received standard MAL-PDT demonstrated a significant increase (pMAL-PDT. Further investigation is therefore required to find a more effective method of MAL-PDT enhancement.

  14. Development of low-cost devices for image-guided photodynamic therapy treatment of oral cancer in global health settings

    Science.gov (United States)

    Liu, Hui; Rudd, Grant; Daly, Liam; Hempstead, Joshua; Liu, Yiran; Khan, Amjad P.; Mallidi, Srivalleesha; Thomas, Richard; Rizvi, Imran; Arnason, Stephen; Cuckov, Filip; Hasan, Tayyaba; Celli, Jonathan P.

    2016-03-01

    Photodynamic therapy (PDT) is a light-based modality that shows promise for adaptation and implementation as a cancer treatment technology in resource-limited settings. In this context PDT is particularly well suited for treatment of pre-cancer and early stage malignancy of the oral cavity, that present a major global health challenge, but for which light delivery can be achieved without major infrastructure requirements. In recent reports we demonstrated that a prototype low-cost batterypowered 635nm LED light source for ALA-PpIX PDT achieves tumoricidal efficacy in vitro and vivo, comparable to a commercial turn-key laser source. Here, building on these reports, we describe the further development of a prototype PDT device to enable intraoral light delivery, designed for ALA- PDT treatment of precancerous and cancerous lesions of the oral cavity. We evaluate light delivery via fiber bundles and customized 3D printed light applicators for flexible delivery to lesions of varying size and position within the oral cavity. We also briefly address performance requirements (output power, stability, and light delivery) and present validation of the device for ALA-PDT treatment in monolayer squamous carcinoma cell cultures.

  15. Intraoperative magnetic resonance imaging-conditional robotic devices for therapy and diagnosis.

    Science.gov (United States)

    Fisher, Taylor; Hamed, Abbi; Vartholomeos, Panagiotis; Masamune, Ken; Tang, Guoyi; Ren, Hongliang; Tse, Zion T H

    2014-03-01

    Magnetic resonance imaging presents high-resolution preoperative scans of target tissue and allows for the availability of intraoperative real-time images without the exposure of patients to ionizing radiation. This has motivated scientists and engineers to integrate medical robotics with the magnetic resonance imaging modality to allow robot-assisted, image-guided diagnosis and therapy. This article provides a review of the state-of-the-art medical robotic systems available for use in conjunction with intraoperative magnetic resonance imaging. The robot functionalities and mechanical designs for a wide range of magnetic resonance imaging interventions are presented, including their magnetic resonance imaging compatibility, actuation, kinematics and the mechanical and electrical designs of the robots. Classification and comparative study of various intraoperative magnetic resonance image guided robotic systems are provided. The robotic systems reviewed are summarized in a table in detail. Current technologies for magnetic resonance imaging-conditional robotics are reviewed and their potential future directions are sketched.

  16. Comparison of noise power spectrum methodologies in measurements by using various electronic portal imaging devices in radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Son, Soon Yong [Dept. of Radiological Technology, Wonkwang Health Science University, Iksan (Korea, Republic of); Choi, Kwan Woo [Dept. of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Jeong, Hoi Woun [Dept. of Radiological Technology, Baekseok Culture University College, Cheonan (Korea, Republic of); Kwon, Kyung Tae [Dep. of Radiological Technology, Dongnam Health University, Suwon (Korea, Republic of); Kim, Ki Won [Dept. of Radiology, Kyung Hee University Hospital at Gang-dong, Seoul (Korea, Republic of); Lee, Young Ah; Son, Jin Hyun; Min, Jung Whan [Shingu University College, Sungnam (Korea, Republic of)

    2016-03-15

    The noise power spectrum (NPS) is one of the most general methods for measuring the noise amplitude and the quality of an image acquired from a uniform radiation field. The purpose of this study was to compare different NPS methodologies by using megavoltage X-ray energies. The NPS evaluation methods in diagnostic radiation were applied to therapy using the International Electro-technical Commission standard (IEC 62220-1). Various radiation therapy (RT) devices such as TrueBeamTM(Varian), BEAMVIEWPLUS(Siemens), iViewGT(Elekta) and ClinacR iX (Varian) were used. In order to measure the region of interest (ROI) of the NPS, we used the following four factors: the overlapping impact, the non-overlapping impact, the flatness and penumbra. As for NPS results, iViewGT(Elekta) had the higher amplitude of noise, compared to BEAMVIEWPLUS (Siemens), TrueBeamTM(Varian) flattening filter, ClinacRiXaS1000(Varian) and TrueBeamTM(Varian) flattening filter free. The present study revealed that various factors could be employed to produce megavoltage imaging (MVI) of the NPS and as a baseline standard for NPS methodologies control in MVI.

  17. The Serbian Danube region as tourist destination

    Directory of Open Access Journals (Sweden)

    Lukić Dobrila

    2015-01-01

    Full Text Available The aim of this paper is to show the advantages and disadvantages of the Serbian Danube Region as a tourist destination. Tasks to be completed in order to achieve the set aim include: determining the position of the Serbian Danube Region from the perspective of transportation geography, identifying its natural and anthropogenic tourism assets, its tourism infrastructure, as well as the types of tourism that can develop there based on the above. The methods used in this paper comprise: the cartographic method; a statistical method used for determining monthly and annual mean values of the Danube water level, water temperature and climatic elements for the period 1991-2010, the number of tourists and overnights in the Danube Region in 2012, as well as the number of accommodation facilities and their comparison for the years 2010 and 2012; the analytic and synthetic method; the fieldwork method combined with the photographic method, etc. The only conclusion that can be drawn is that the potentials of the Serbian Danube Region for tourism development have not been sufficiently valorised or realised except in Belgrade and Novi Sad. Therefore, taking action and measures in connection with sustainable development of tourism would favour economic development outside major cities, advance the spatial distribution of population and improve the overall social situation.

  18. Branding Serbia as a Tourist Destination on the Global Market

    Directory of Open Access Journals (Sweden)

    Ivan Paunović

    2014-04-01

    Full Text Available Destination branding has become one of the most popular contemporary topics, both among tourism practitioners and politicians, because there is strong evidence that strong national destination brand supports commercial brands in industries related to tourism. Therefore, factors that influence destination brand loyalty are of crucial importance for understanding and promoting the brand. Building brand loyalty is not just about repeat buying, but also about building customers emotional attachment to the brand. Global growth and diversification of tourist markets has transformed destinations from “vacation industry” concept, to “industry of experience” concept.The study performed statistical tests with a goal to analyze the factors influencing brand loyalty in Serbia: age, length of stay and daily spending. Additionally, sub-brand loyalty levels are presented (by major destinations inside Serbia, markets of origin and by major themes for travel in order to identify groups of tourists that are more loyal, and the ones that are less loyal to the destination brand of Serbia. The study results and recommendations should be used as a contribution towards designing national and regional destination marketing strategies.

  19. A research for visitors’ perceptions towards Pamukkale destination

    Directory of Open Access Journals (Sweden)

    Serkan Bertan

    2013-07-01

    Full Text Available Determining visitor profiles and destination perceptions is useful to enhance competitiveness of Pamukkale as a destination, to contribute sustainable development and to identify strategies for the future. The main purpose of this study is searching the profiles and destination perceptions of visitors towards Pamukkale –as the destination of the thermal tourism city Denizli. For these purposes, German, English, Russian, Turkish and French questionnaires were applied in Pamukkale destination to the visitors who came to the city of Denizli. Out of 902 participants 889 completed the survey and analyzes were carried out of these who finished all of the survey. %42of visitors are domestic and %57 is foreign visitors. T-test and one-way variance analysis were applied to investigate the effect of country, gender, education and income status of visitors towards the attitudes of visitors to Pamukkale destination. Significant differences emerged when the effect of country, gender, education and income status of visitors towards the perceptions of Pamukkale destination is inspected. Scheffe Test was applied due to the significant results of variance analysis.

  20. Church, place, and crime: Latinos and homicide in new destinations.

    Science.gov (United States)

    Shihadeh, Edward S; Winters, Lisa

    2010-01-01

    Latinos are moving beyond traditional areas and settling in new, potentially disorganized destinations. Without an established immigrant community, new destinations appear to rely more on the local religious ecology to regulate community life and to keep crime low. We examine the link between religious ecology and Latino homicide victimization for traditional and new destination counties. We observe four findings. (1) A Catholic presence has no effect on Latino violence in the old and well-organized traditional settlement areas. But in new Latino settlement areas, a Catholic presence substantially lowers violence against Latinos. In contrast, mainline Protestantism is linked to high levels of violence against Latinos in new destinations. (2) Previous claims that Latino communities are safe do not apply to new destinations, where Latinos are murdered at a high rate. (3) Previous claims that areas with high Latino immigration are safe for Latinos are not true for new destinations. (4) New Latino destinations offer little insulation from the effects of economic deprivation on violence. We discuss the implications of the findings.

  1. Migrant pupils’ scientific performance: the influence of educational system features of origin and destination countries

    NARCIS (Netherlands)

    Dronkers, J.; Levels, M.; de Heus, M.

    2014-01-01

    Background Earlier studies using a double perspective (destination & origin) indicate that several macro-characteristics of both destination and origin countries affect the educational performance of migrant children. This paper explores the extent to which educational system features of destination

  2. Possibility for the Conjugated Use of Photodynamic Therapy and Electrosurgical Devices.

    Science.gov (United States)

    Rego Filho, Francisco de Assis Martins Gomes; Caldas, Romualdo Arthur Alencar; Kurachi, Cristina; Bagnato, Vanderlei Salvador; de Araujo, Maria Tereza

    2015-01-01

    Because tissue optics limits the treated volume during anti-tumor Photodynamic Therapy (PDT), its conjugation with prior tissue debulking has been suggested clinically. In this context, the conjugation of radiofrequency ablation and PDT has already been demonstrated. However, the basic principles that enable the success of these protocols have not been discussed. This proof-of-principle study analyzes the possibility of conjugating electrosurgery (ES) and PDT, analyzing different sequences of photosensitizer (PS) administration in an animal model. The animals were distributed over five groups: ES, PS+Light, PS+ES, ES+PS+Light and PS+ES+Light. The PS Photogem was administered systemically. An electrosurgical unit (480 kHz) was used to remove a portion of the liver, leaving a plane surface for PDT illumination (630 nm, 150 J/cm²). Fluorescence was collected during the stages of the experiment to monitor the PS accumulation. After 30 hours, histological processing was performed. The fluorescence spectra revealed strong Photogem emission in both administration sequences (ES+PS; PS+ES), and little PS bleach after ES was observed. The maximum necrosis depth was observed for the PS+ES+Light group-(716 ± 75) μm-higher than its respective control group (160 ± 28) μm, proving successful conjugation. Histological features from ES and PDT on both conjugation sequences were observed. Pre-photosensitized tissue presented decreased ES-related thermal damage. A simple physical hypothesis, based on the Joule effect and the tissue electrical conductivity, was proposed to support these findings. In conclusion, the results successfully demonstrated the possibility of conjugating ES and PDT in a single protocol.

  3. Possibility for the Conjugated Use of Photodynamic Therapy and Electrosurgical Devices.

    Directory of Open Access Journals (Sweden)

    Francisco de Assis Martins Gomes Rego Filho

    Full Text Available Because tissue optics limits the treated volume during anti-tumor Photodynamic Therapy (PDT, its conjugation with prior tissue debulking has been suggested clinically. In this context, the conjugation of radiofrequency ablation and PDT has already been demonstrated. However, the basic principles that enable the success of these protocols have not been discussed. This proof-of-principle study analyzes the possibility of conjugating electrosurgery (ES and PDT, analyzing different sequences of photosensitizer (PS administration in an animal model. The animals were distributed over five groups: ES, PS+Light, PS+ES, ES+PS+Light and PS+ES+Light. The PS Photogem was administered systemically. An electrosurgical unit (480 kHz was used to remove a portion of the liver, leaving a plane surface for PDT illumination (630 nm, 150 J/cm². Fluorescence was collected during the stages of the experiment to monitor the PS accumulation. After 30 hours, histological processing was performed. The fluorescence spectra revealed strong Photogem emission in both administration sequences (ES+PS; PS+ES, and little PS bleach after ES was observed. The maximum necrosis depth was observed for the PS+ES+Light group-(716 ± 75 μm-higher than its respective control group (160 ± 28 μm, proving successful conjugation. Histological features from ES and PDT on both conjugation sequences were observed. Pre-photosensitized tissue presented decreased ES-related thermal damage. A simple physical hypothesis, based on the Joule effect and the tissue electrical conductivity, was proposed to support these findings. In conclusion, the results successfully demonstrated the possibility of conjugating ES and PDT in a single protocol.

  4. Cardiovascular autonomic control in patients undergoing left ventricular assist device (LVAD) support and pharmacologic therapy.

    Science.gov (United States)

    Nunan, David; Sandercock, Gavin R H; George, Robert S; Jakovljevic, Djordje G; Donovan, Gay; Bougard, Robert; Yacoub, Magdi H; Brodie, David A; Birks, Emma J

    2013-10-09

    The objective of the study is to determine cardiac autonomic control in patients undergoing assessment for and/or LVAD therapy. Heart rate variability (HRV) was measured in 17 explanted LVAD, 17 implanted LVAD and 23 NYHA III-IV classified chronic heart failure (CHF) patients and ten healthy matched controls under three conditions: supine free breathing, standing and supine controlled breathing. Five measures of HRV were assessed: mean R-R interval (mR-R), high frequency (HF) and low frequency (LF) spectral power, LF in normalised units (LFnu), and LF to HF (LF:HF) ratio. Repeat measures ANOVA showed significant (p < 0.05) differences in HRV between all three conditions within groups. Lower values were observed in CHF for LF(in log natural units) compared with explanted patients (-1.4 [95% CI -2.6 to -0.7], p = 0.04) and controls (-2.1 [-3.5 to -0.7], p = 0.001) and for LF:HF compared with implanted patients under paced breathing conditions (z = -2.7, p = 0.007) and controls in standing (z = -2.9, p = 0.004) and paced breathing conditions (z = -2.3, p = 0.02). However, no significant differences were seen between explanted, implanted and control groups under any condition. Patients implanted with an LVAD and explanted from a LVAD following myocardial recovery demonstrate a more normal dynamic response to autonomic stimuli and have a lower HRV risk profile compared to CHF patients. © 2013.

  5. RESEARCH ON TOURISM DESTINATIONS MARKETING FROM THE PUBLIC RELATIONS’ PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Gabriela ARIONESEI

    2012-12-01

    Full Text Available Nowadays, tourism destinations are more and more determined to build a unique and competitive identity and image in consumers’ minds. Even though the marketing of tourism destinations has been awarded an intended purpose, in practice there is a lack of steadiness, sometimes an unexplained deficiency of empirical academic research. In some countries, many without "a tradition in tourism", building a marketing strategy for travel destinations is based on artificial and without substance images/perceptions of real and potential tourists. The paper describes the role of marketing in the domain of tourism, emphasizing the importance of public relations in the promotion process of the region of Bucovina.

  6. Research on Psychological Carrying Capacity of Tourism Destination

    Institute of Scientific and Technical Information of China (English)

    Fan Zhiyong; Zhong Sheng

    2009-01-01

    As a part of the carrying capacity system of tourism destination,tourism psychological carrying capacity and its makeup are very important indexes which reflect the harmonious development of tourism destination develops harmoniously,but the academy has not paid enough attention to them.Based on the concept and connotation of psychological carrying capacity,this paper explains the influencing factors which affect the psychological capacity of the tourist and the resident after the acknowledged concept,and then designs a harmonious development model of tourism destination.Finally,it offers some countermeasures against the overloading psychological capacity.

  7. Destination Image And Tourism: A Study On Chandipur Beach Of Odisha

    OpenAIRE

    Parida, Sandeep kumar

    2015-01-01

    In the competitive world Destination marketing gaining priority with its Destination image. The purpose of this study is to highlight destination image and its economic benefits to tourism industry, with special reference of Chandipur beach of Odisha. This paper also explains the promotion,packaging of destination, by public and private marketing planner with its unique product image. The first part of study is the extensive literature review of Destination image, its role in destination mark...

  8. Positive Response to Thermobalancing Therapy Enabled by Therapeutic Device in Men with Non-Malignant Prostate Diseases: BPH and Chronic Prostatitis

    Directory of Open Access Journals (Sweden)

    Ivan Gerasimovich Aghajanyan

    2016-04-01

    Full Text Available Background: The most common types of non-malignant prostate diseases are benign prostatic hyperplasia (BPH and chronic prostatitis (CP. The aim of this study was to find out whether thermobalancing therapy with a physiotherapeutic device is effective for BPH and CP. Methods: During a 2.5-year period, 124 men with BPH over the age of 55 were investigated. Clinical parameters were tested twice: via the International Prostate Symptom Score (IPSS and via ultrasound measurement of prostate volume (PV and uroflowmetry maximum flow rate (Qmax, before and after six months of therapy. In 45 men with CP under the age of 55, the dynamics of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI were studied. Results: The results of the investigated index tests in men with BPH confirmed a decrease in IPSS (p < 0.001, a reduction in PV (p < 0.001, an increase in Qmax (p < 0.001, and an improvement of quality of life (QoL (p < 0.001. NIH-CPSI scores in men with CP indicated positive dynamics. Conclusions: The observed positive changes in IPSS, PV, and Qmax in men with BPH and the improvement in NIH-CPSI-QoL in patients with CP after using a physiotherapeutic device for six months as mono-therapy, support the view that thermobalancing therapy with the device can be recommended for these patients. Furthermore, the therapeutic device is free of side effects.

  9. The effect of device-based cardiac contractility modulation therapy on myocardial efficiency and oxidative metabolism in patients with heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Goliasch, Georg; Khorsand, Aliasghar; Sochor, Heinz; Schmidinger, Herwig; Graf, Senta [Vienna General Hospital/Medical University of Vienna, Department of Cardiology, Vienna (Austria); Schuetz, Matthias; Karanikas, Georgios [Vienna General Hospital/Medical University of Vienna, Department of Nuclear Medicine, Vienna (Austria); Khazen, Cesar [Vienna General Hospital/ Medical University of Vienna, Department of Cardiothoracic Surgery, Vienna (Austria); Wolzt, Michael [Vienna General Hospital/Medical University of Vienna, Department of Cardiology, Vienna (Austria); Vienna General Hospital/ Medical University of Vienna, Department of Clinical Pharmacology, Vienna (Austria)

    2012-03-15

    Cardiac contractility modulation (CCM) is a device-based therapy that involves delivery of nonexcitatory electrical signals resulting in improved ventricular function and a reversal of maladaptive cardiac fetal gene programmes. Our aim was to evaluate whether acute application of CCM leads to an increase in myocardial oxygen consumption (MVO{sub 2}) in patients with chronic heart failure using {sup 11}C-acetate positron emission tomography (PET). We prospectively enrolled 21 patients with severe heart failure. {sup 11}C-acetate PET was performed before and after activation of the CCM device. In 12 patients an additional stress study with dobutamine was performed. Under resting conditions, the values of myocardial blood flow (MBF), MVO{sub 2} and work metabolic index (WMI, reflecting myocardial efficiency) with the CCM device activated did not differ significantly from the values with the device deactivated. MBF was 0.81 {+-} 0.18 ml min{sup -1} g{sup -1} with the device off and 0.80 {+-} 0.15 ml min{sup -1} g{sup -1} with the device on (p = 0.818), MVO{sub 2} was 6.81 {+-} 1.69 ml/min/100 g with the device off and 7.15 {+-} 1.62 ml/min/100 g with the device on (p = 0.241) and WMI was 4.94 {+-} 1.14 mmHg ml/m{sup 2} with the device off and 5.21 {+-} 1.36 mmHg ml/m{sup 2} with the device on (p = 0.344). Under dobutamine stress, the values of MBF, MVO{sub 2} and WMI with the CCM device activated did not differ from the values with the device deactivated, but were significantly increased compared with the values obtained under resting conditions. These results indicate that CCM does not induce increased MVO{sub 2}, even under stress conditions. (orig.)

  10. Defining criteria to choose appropriate destination hospital for trauma patients: Piacenza Local Health Authority’s Piacenza trauma algorithm protocol

    Directory of Open Access Journals (Sweden)

    Fabio Mozzarelli

    2016-04-01

    Full Text Available Ambulance crew’s choosing of appropriate destination hospital for trauma patients can affect survival and morbidity outcomes. Aim of the present study is to devise a decision-making algorithm in order to allow the best choice of destination hospital for trauma patients and to apply it on an electronic device able to facilitate the decision made by ambulance staff. The method used was analysis of literature data, context and workload with a retrospective observational study. A comparison between the destination hospitals actually chosen and those that could have been chosen with the Piacenza trauma algorithm has been applied. The data shows a 9.5% (P>0.10 more advantageous change in appropriateness in the choice of medical facility and a 1.4% increase in admissions to the Emergency Department of the provincial hospital. The creation and use of a medical protocol and its consequent installation on an electronic device (tablet that can be shared over a computer platform could help medical staff make appropriate pre-hospital choices as regards the destination hospital for trauma patients.

  11. SU-E-T-557: Measuring Neutron Activation of Cardiac Devices Irradiated During Proton Therapy Using Indium Foils

    Energy Technology Data Exchange (ETDEWEB)

    Avery, S; Christodouleas, J; Delaney, K; Diffenderfer, E; Brown, K [University of Pennsylvania, Sicklerville, NJ (United States)

    2014-06-01

    Purpose: Measuring Neutron Activation of Cardiac devices Irradiated during Proton Therapy using Indium Foils Methods: The foils had dimensions of 25mm x 25mm x 1mm. After being activated, the foils were placed in a Canberra Industries well chamber utilizing a NaI(Tl) scintillation detector. The resulting gamma spectrum was acquired and analyzed using Genie 2000 spectroscopy software. One activation foil was placed over the upper, left chest of RANDO where a pacemaker would be. The rest of the foils were placed over the midline of the patient at different distances, providing a spatial distribution over the phantom. Using lasers and BBs to align the patient, 200 MU square fields were delivered to various treatment sites: the brain, the pancreas, and the prostate. Each field was shot at least a day apart, giving more than enough time for activity of the foil to decay (t1=2 = 54.12 min). Results: The net counts (minus background) of the three aforementioned peaks were used for our measurements. These counts were adjusted to account for detector efficiency, relative photon yields from decay, and the natural abundance of 115-In. The average neutron flux for the closed multi-leaf collimator irradiation was measured to be 1.62 x 106 - 0.18 x 106 cm2 s-1. An order of magnitude estimate of the flux for neutrons up to 1 keV from Diffenderfer et al. gives 3 x 106 cm2 s-1 which does agree on the order of magnitude. Conclusion: Lower energy neutrons have higher interaction cross-sections and are more likely to damage pacemakers. The thermal/slow neutron component may be enough to estimate the overall risk. The true test of the applicability of activation foils is whether or not measurements are capable of predicting cardiac device malfunction. For that, additional studies are needed to provide clinical evidence one way or the other.

  12. Novel devices for individualized controlled inhalation can optimize aerosol therapy in efficacy, patient care and power of clinical trials

    Directory of Open Access Journals (Sweden)

    Fischer A

    2009-12-01

    Full Text Available Abstract In the treatment of pulmonary diseases the inhalation of aerosols plays a key role - it is the preferred route of drug delivery in asthma, chronic obstructive pulmonary disease (COPD and cystic fibrosis. But, in contrast to oral and intravenous administration drug delivery to the lungs is controlled by additional parameters. Beside its pharmacology the active agent is furthermore determined by its aerosol characteristics as particle diameter, particle density, hygroscopicity and electrical charge. The patient related factors like age and stage of pulmonary disease will be additionally affected by the individual breathing pattern and morphometry of the lower airways. A number of these parameters with essential impact on the pulmonary drug deposition can be influenced by the performance of the inhalation system. Therefore, the optimization of nebulisation technology was a major part of aerosol science in the last decade. At this time the control of inspiration volume and air flow as well as the administration of a defined aerosol bolus was in the main focus. Up to date a more efficient and a more targeted pulmonary drug deposition - e.g., in the alveoli - will be provided by novel devices which also allow shorter treatment times and a better reproducibility of the administered lung doses. By such means of precise dosing and drug targeting the efficacy of inhalation therapy can be upgraded, e.g., the continuous inhalation of budesonide in asthma. From a patients' perspective an optimized inhalation manoeuvre means less side effects, e.g., in cystic fibrosis therapy the reduced oropharyngeal tobramycin exposure causes fewer bronchial irritations. Respecting to shorter treatment times also, this result in an improved quality of life and compliance. For clinical trials the scaling down of dose variability in combination with enhanced pulmonary deposition reduces the number of patients to be included and the requirement of pharmaceutical

  13. PROMOTION: BRANDING TOOL FOR MACEDONIA AS A TOURIST DESTINATION

    National Research Council Canada - National Science Library

    Violeta Milenkovska; Zoran Strezovski; Angela Milenkovska

    2015-01-01

      In times when competition between countries in the world is stronger, in order to attract as many tourists as possible, and strengthening their brand as a tourist destination, Republic of Macedonia...

  14. DIFFERENT PERCEPTIONS ABOUT TOURIST IDENTITY IN THE DANUBE GATE DESTINATION

    Directory of Open Access Journals (Sweden)

    SABINA GHEORGHECI

    2015-12-01

    Full Text Available Thus, uncontrollable elements such as nice weather, nature/scenery, accessibility, transformed into controllable elements such as pleasant environment, relaxing atmosphere, infrastructure, can create a favourable artistic image that would determine the tourist to pick the destination. Uncontrollable elements such as local culture, diversity of sport activities, of restaurant, cafes etc. that can increase the value of a destination, transformed into controllable elements such as historical sites, events (cultural activities, festivals etc. form an environment where “there are plenty of things to do” and can create a favourable psychological image that will make the tourist return to this destination. The transformation of these attributes into advantages for the tourist, so that a destination can be differentiated, takes places within a positioning strategy.

  15. Cross-border shopping and tourism destination marketing

    DEFF Research Database (Denmark)

    Makkonen, Teemu

    2016-01-01

    This article addresses the economic impact that cross-border shopping has on the local tourism industry and the ways that cross-border shopping is taken advantage of in tourism destination marketing. Southern Jutland–situated in Denmark just north of the German border, where border shops situated...... a tourist attraction in itself, which benefits the local economies on both sides of the border. However, this potential is not taken advantage of in tourism destination marketing. The article, thus, concludes with suggestions for the tourism industry to develop its image and brand by integrating cross...... just south of the same border enable Danes to capitalize on the lower value added tax levels in Germany–is utilized as an illustrative case example. The data was collected by analysing the relevant tourism destination marketing material and via interviews with local destination marketing organizations...

  16. Challenges Facing Customer Patronage of Tourism Destinations in ...

    African Journals Online (AJOL)

    Prof

    AN INTERNATIONAL MULTI-DISCIPLINARY JOURNAL, ... the Federal Ministry of Culture and Tourism, revealed a total of thirty-five (35) tourism ... problems that bedevil the marketing of tourism destinations in Nigeria ..... Cross River Calabar.

  17. Management of sustainable tourism destination through stakeholder cooperation

    Directory of Open Access Journals (Sweden)

    Božena Krce Miočić

    2016-12-01

    Full Text Available Destination presents a set of different organizations and individuals who can work towards realising the same objectives or their objectives can be diametrically opposed. Harmonisation of such objectives in a unique strategic development of the entire destination is usually taken over by destination management organization (DMO established to accomplish the mentioned objective. The opposed interests in such a system as complex as tourism result in the degradation of space and society in which tourism takes place. Therefore sustainable development in tourism represents a primary concept of development today. Tourism is a fast growing phenomenon and its sustainable development represents a necessity. Besides the positive economic outputs of tourism, we should also mention its negative impact on the particular destination, the environmental degradation to some extent, as well as socio-economic elements of local community. Accordingly, multi-stakeholder concept in destination management should include all interest and influential groups in tourism development planning. Such integrated destination management connects all stakeholders independent from influence or interest powers to participate directly or indirectly in creating and implementing the quality tourism development. This concept’s basic function is connecting and coordinating stakeholders with different interests within a tourism destination, in order to create quality product and a recognizable destination image, and to achieve a long-term sustainable competitiveness on the market. However, based on the stakeholder approach, the most emphasized issue in sustainable tourism development concept is the government that holds a key role in socio-economic development. In this paper, we analysed current involvement of stakeholders in Zadar County tourism development and examined their interest in future involvement in sustainable destination development. Based on the analysis of focus group

  18. The quality of tourism destination – integrated quality management

    Directory of Open Access Journals (Sweden)

    Ida Vajčnerová

    2009-01-01

    Full Text Available The paper deals with the quality of tourism services. It mentions various ways of approaching quality management, such as the standards of quality, systems based on ISO standards and systems of complex quality management. It describes approaches applied in the Czech Republic and points out the difficulty keeping the quality in tourism. Tourism services are not offered individually, which is why it is necessary to assess the quality of a whole complex of services within the frame of a tourism product or a tourist destination. The level of tourists' satisfaction is not based on the quality of individual tou­rism services or a destination product but it arises from their overall impression which is formed from the hospitality of local inhabitants, the willingness of employees, the cleanness of the environment, security and so on. The presumption of maintaining the quality of a destination is a unified approach of all participants in tourism development that can be reached by various forms of cooperation. Crea­ting a strategic alliance is one of such possibilities. The main objective of the article is to introduce the European system of Integrated Quality Management (IQM and the tool for assessing the qua­li­ty in a destination “Qualitest”. The Integrated Quality Management is an approach based on the cooperation of all areas taking part in tourism development in a destination. The qua­li­ty is assessed in a complex way with respect to tourism development impacts on local inhabitants and the environment. “Qualitest” is made of 16 indexes that are focused on the quality of a destination and the quality of a product. Each index is evaluated by three indicators that asses the quality of conditions (QPCI, the quality of management (QMI and the quality of a destination performance (QPI. These indicators combine qualitative as well as quantitative values. The precondition for using “Qualitest” in our destinations is the existence of a

  19. Drug-induced sleep endoscopy as a selection tool for mandibular advancement therapy by oral device in patients with mild to moderate obstructive sleep apnoea.

    Science.gov (United States)

    De Corso, E; Bastanza, G; Della Marca, G; Grippaudo, C; Rizzotto, G; Marchese, M R; Fiorita, A; Sergi, B; Meucci, D; Di Nardo, W; Paludetti, G; Scarano, E

    2015-12-01

    Nowadays oral appliance therapy is recognised as an effective therapy for many patients with primary snoring and mild to moderate obstructive sleep apnoea (OSA), as well as those with more severe OSA who cannot tolerate positive airway pressure (PAP) therapies. For this reason, it is important to focus on objective criteria to indicate which subjects may benefit from treatment with a mandibular advancement device (MAD). Various anthropometric and polysomnographic predictors have been described in the literature, whereas there are still controversies about the role of drug-induced sleep endoscopy (DISE) and advancement bimanual manoeuvre as predictor factors of treatment outcome by oral device. Herein, we report our experience in treatment of mild moderate OSA by oral appliance selected by DISE. We performed a single institution, longitudinal prospective evaluation of a consecutive group of mild moderate patients with obstructive sleep apnoea syndrome who underwent DISE. During sleep endoscopy, gentle manoeuvre of mandibular advancement less than 5 mm was performed. In 30 of 65 patients (46.2%) we obtained an unsuccessful improvement of airway patency whereas in 35 of 65 patients (53.8%) the improvement was successful and patients were considered suitable for oral device application. Because 7 of 35 patients were excluded due to conditions interfering with oral appliance therapy, we finally treated 28 patients. After 3 months of treatment, we observed a significant improvement in the Epworth medium index [(7.35 ± 2.8 versus 4.1 ± 2.2 (p DISE for MAD therapy. In the current study, mandibular advancement splint therapy was successfully prescribed on the basis not only of severity of disease, as determined by the subject's initial AHI, but also by DISE findings combined with results of gentle mandibular advancement manoeuvre allowing direct view of the effects of mandibular protrusion on breathing spaces in obstruction sites, and showing good optimisation of

  20. The image of Helsinki as a cultural tourism destination

    OpenAIRE

    Matikainen, Petteri

    2015-01-01

    Cultural tourism has been increasing constantly during the last decades and has become one of the most essential sections of tourism industry. Culture influences strongly on decisions to travel and it is often placed on the key role in tourism strategies. Similarly a strong destination image is inevitable in order to success in highly competed tourism industry. The purpose of this study is to examine the image of Helsinki as a cultural tourism destination. The main objective is to examine...

  1. Promoting Tourist Destination Image and Websites in North Sulawesi Indonesia

    OpenAIRE

    Ivonne Angelic Umboh; Vincent Didiek Wiet Aryanto

    2015-01-01

    North Sulawesi's tourist destination image is imperative to be promoted to the rest of the world, it is one of the top ten tourist destination in Indonesia. The tourism objects in North Sulawesi are varying such as culinary, undersea coral diving in Bunaken and Lembe, festivals, rituals both Christian and Muslim, eco-tourism, mountain climbing, jungle explorer, variety of culture's ethnic groups, tropical panorama etc. North Sulawesi is also known to have abundant of spice (nutmeg) and one of...

  2. Study on destination image, satisfaction, trust and behavioral intention

    OpenAIRE

    PUJIASTUTI ENY ENDAH; NIMRAN UMAR; SUHARYONO S.; KUSUMAWATI ANDRIANI

    2017-01-01

    The purpose of the study was to develop understanding about the influence of Destination image, and satisfaction towards pada trust and behavioral intention in the tourist village in Sleman, Yogyakarta. The sampes of the study were the domestic tourists whose ages were between 18 and 35 years old. The method of analysis was Generalized Structured Component Analysis (GSCA) in order to analyze the correlation between Destination image as well as satisfaction and trust as well as behavioral inte...

  3. Students in Action: Engaging Students with Destination Stakeholders

    OpenAIRE

    Craggs, Ruth; Gorman, Catherine; Griffin, Kevin; Mottiar, Ziene; Quinn, Deirdre; Quinn, Bernadette; Ryan, Theresa

    2015-01-01

    The Students in Action Project in the School of Hospitality Management and Tourism was established in 2012 as a way of engaging students and working with stakeholders in a destination. The overall aim of the project was to immerse students in an active collaborative learning environment within the destination to identify ways in which tourism could be enhanced. In the 2014/2015 academic year the project involved over 300 students from a variety of programmes and modules working with local sta...

  4. Linguistic Barriers in the Destination Language Acquisition of Immigrants

    OpenAIRE

    Isphording, Ingo E.; Otten, Sebastian

    2014-01-01

    There are various degrees of similarity between the languages of different immigrants and the language of their destination country. This linguistic distance is an obstacle to the acquisition of a language, which leads to large differences in the attainments of the language skills necessary for economic and social integration in the destination country. This study aims at quantifying the influence of linguistic distance on the language acquisition of immigrants in the US and in Germany. Drawi...

  5. Developing a structural brand equity model for cultural destinations

    OpenAIRE

    Kladou, Stella; Kehagias, John

    2014-01-01

    Purpose\\ud – This paper aims to investigate the structural relationships between the brand equity (BE) dimensions, when the fifth dimension of cultural brand assets is incorporated. The paper seeks to establish and validate a five-dimensional BE measure for cultural urban destination, by comparing findings in two destinations.\\ud \\ud Design/methodology/approach\\ud – The structural model was tested from the perspective of 399 international tourists visiting Athens. Confirmatory factor analysis...

  6. [Risk of bee or wasp stings in various vacation destinations].

    Science.gov (United States)

    Mauss, V

    2014-09-01

    The risk for tourists who are allergic to bee or wasp venom to be stung in various holiday destinations is mainly influenced by the structure of the regional bee or wasp community affected by zoogeographical and ecological factors. Information is presented for important destinations of German holiday-makers concerning distribution of honey bees (Apinae, Apis) and social wasps (Polistinae, Vespinae) as well as places and season of danger.

  7. Destination and route attributes associated with adults' walking: a review.

    Science.gov (United States)

    Sugiyama, Takemi; Neuhaus, Maike; Cole, Rachel; Giles-Corti, Billie; Owen, Neville

    2012-07-01

    Increasing adults' physical activity through environmental initiatives that promote walking as a public health priority. To this end, evidence relevant to the urban planning and transport sectors is required. This review synthesized findings on destination and route attributes associated with utilitarian and recreational walking. A literature search was conducted in April 2011 using Web of Science, PubMed, Transport Research Information Services, GEOBASE, and SPORTDiscus. Environmental attributes were classified into the domains of utilitarian and recreational destinations (presence, proximity, quality) and route (sidewalks, connectivity, aesthetics, traffic, safety). Forty-six studies examining associations of these attributes with utilitarian and/or recreational walking were identified. Specific destination and route attributes associated with each type of walking were summarized. Adults' utilitarian walking was consistently associated with presence and proximity of retail and service destinations (in 80% of the studies reviewed). It was also associated with functional aspects of routes (sidewalks and street connectivity) in 50% of studies. Recreational walking was associated with presence, proximity, and quality of recreational destinations (35% of studies) and route aesthetic (35% of studies). Both types of walking were found unrelated to route safety and traffic in most studies. There is consistent evidence that better access to relevant neighborhood destinations (e.g., local stores, services, transit stops) can be conducive to adults' utilitarian walking. Some evidence also suggests that availability of sidewalks and well-connected streets can facilitate utilitarian walking. To better inform initiatives to promote adults' walking in the planning and transport sectors, future studies need to examine how accessible such destinations should be, as well as the effect of the quality of recreational destinations.

  8. Destination memory and cognitive theory of mind in normal ageing.

    Science.gov (United States)

    El Haj, Mohamad; Raffard, Stéphane; Gély-Nargeot, Marie-Christine

    2016-01-01

    Destination memory is the ability to remember the destination to which a piece of information has been addressed (e.g., "Did I tell you about the promotion?"). This ability is found to be impaired in normal ageing. Our work aimed to link this deterioration to the decline in theory of mind. Forty younger adults (M age = 23.13 years, SD = 4.00) and 36 older adults (M age = 69.53 years, SD = 8.93) performed a destination memory task. They also performed the False-belief test addressing cognitive theory of mind and the Reading the mind in the eyes test addressing affective theory of mind. Results showed significant deterioration in destination memory, cognitive theory of mind and affective theory of mind in the older adults. The older adults' performance on destination memory was significantly correlated with and predicted by their performance on cognitive theory of mind. Difficulties in the ability to interpret and predict others' mental states are related to destination memory decline in older adults.

  9. Are Tourists Really Willing to Pay More for Sustainable Destinations?

    Directory of Open Access Journals (Sweden)

    Juan Ignacio Pulido-Fernández

    2016-11-01

    Full Text Available The understanding of pro-sustainable behavior and its true economic implications is an important subject for tourism destination marketers and policymakers, especially given that limited research has focused on the economic implications of tourist preferences for more sustainable destinations. Following the identification of three different demand segments using the concept of “sustainable intelligence” (level of commitment, attitude, knowledge and/or behavior with regard to sustainability, this study hypothesizes that the tourist segment with high level of “sustainable intelligence” (called “pro-sustainable tourist” is willing to pay more to visit a more sustainable destination. The main aim of this paper is to use the logistic regression model to estimate the premium price that each segment is willing to pay to visit a sustainable destination. This paper reports the result of a willingness to pay study using data from 1118 respondents visiting the Western Costa del Sol (Andalusia, Spain, a mature sun-and-sand destination that is currently facing several developmental challenges supposedly associated with sustainability. The results obtained from this research study indicate that the tourist segment with high levels of “sustainable intelligence” is willing to pay more to visit a more sustainable tourism destination. However, there is little willingness to pay if the destination’s commitment to sustainability increases the price of the tourism product (26.6% of respondents.

  10. Entrepreneurship development in destinations of religious tourism

    Directory of Open Access Journals (Sweden)

    Ivanović Slobodan

    2014-01-01

    Full Text Available After the introduction which summarizes the basic guidelines for the development of entrepreneurship in special interest tourism, the author explores the development and application as well as the management of entrepreneurship in religious tourism as a type of special interest tourism. Religious components and motives for visiting shrines as an integral part of human culture and tradition have a strenuous impact on the tourism industry, both on the offering and demanding side. The most visited shrines such as Fatima or Lourdes attract four to eight million visitors per year. Considering the fact that this type of tourism is economically very useful in a particular local environment, many shrines as sites have become centres of religious, commercial and cultural events in certain regions throughout history. Their development was followed by investment in infrastructure, culture, catering and other facilities. The implementation of entrepreneurship is based on various segments that enable the development of religious tourism in a particular area, such as catering industry, hospitality industry, tourist mediation, transportation companies and other complementary activities (agriculture, fishing, wine production, commerce and other services. The author explores the indicators of entrepreneurship development in the field of religious tourism as a type of special interest tourism indicating the possibilities it has on the destination development. The development of special interest tourism should be based on effective investment in tourism offer through entrepreneurial projects (catering and other tourist facilities in accordance with market trends. The investment in tourism offer in the context of religious tourism would result in the growth of religious passengers' consumption as well as the increase in income from religious tourism, and thus the economic development of the sites with religious content. Examples of such shrines in the world are

  11. Targeted ultrasound-mediated delivery of nanoparticles: on the development of a new HIFU-based therapy and imaging device.

    Science.gov (United States)

    Seip, Ralf; Chin, Chien Ting; Hall, Christopher S; Raju, Balasundar I; Ghanem, Alexander; Tiemann, Klaus

    2010-01-01

    Ultrasound-mediated delivery (USMD) is an active research topic, as researchers develop applications for therapeutic ultrasound in addition to thermal ablation. In USMD, ultrasound is used in conjunction with microbubbles and drugs, nanoparticles, siRNA, pDNA, stem cells, etc., to facilitate their cellular delivery and uptake using pressure and temperature-mediated mechanisms to bring about a desired therapeutic effect. To investigate the potential of targeted USMD of nanoparticles, pDNA, and stem cells for cardiovascular and other applications, a general-purpose preclinical research tool, therapy imaging probe system (TIPS) was designed. It consists of a wideband annular array, a small-animal acoustic coupler, a motorized positioning system, integrated control software for ultrasound image-guided treatment planning and execution, and triggering electronics that allow ECG and respiration-gated ultrasound exposures. TIPS was then used to enhance delivery of nanoparticles into the murine myocardium and heart vessel walls to demonstrate the feasibility of the technology, pave the way for additional basic research in cardiovascular USMD, and begin to explore the requirements that USMD devices will have to meet to be useful in a clinical setting.

  12. Synergic Effect of Compression Therapy and Controlled Active Exercises Using a Facilitating Device in the Treatment of Arm Lymphedema

    Directory of Open Access Journals (Sweden)

    Maria de Fátima Guerreiro Godoy, Maria Regina Pereira, Antonio Helio Oliani, Jose Maria Pereira de Godoy

    2012-01-01

    Full Text Available Trial design: A randomized controlled trial was performed to evaluate the effect of the combination of compression therapy with active exercising using a facilitating apparatus on arm lymphedema. Method: Twenty women with a mean age of 63.3 years were evaluated; all had lymphedema resulting from breast cancer treatment. The inclusion criterion was a difference of 200 mL in size between arms. The apparatus used, called 'pulley system', is a vertical iron wheel fixed on a support at a distance of 10 cm from the patient's body. Participants were submitted to two series of active exercises using this facilitating device, one series using a compression sleeve and the other without. Each series consisted of four 12-minute sessions of exercises separated by 3-minute rest intervals. Volumetry was performed before and after each series of exercises. The paired t-test was utilized for statistical analysis (p-value < 0.05. Results: A significant mean reduction (p-value < 0.007 and non-significant mean increase (p-value < 0.2 in volumes were observed during exercising with and without compression, respectively. Conclusion: Controlled active exercising utilizing a facilitating apparatus while wearing a compression sleeve reduces the size of lymphedematous arms.

  13. New and emerging drugs and device therapies for chronic heart failure in patients with systolic ventricular dysfunction.

    Science.gov (United States)

    Rouleau, Jean L

    2011-01-01

    Chronic heart failure remains a common end product of cardiovascular diseases and, despite significant advances in therapy, continues to be accompanied by significant morbidity and mortality. Attenuation of neurohumoral overactivation with blockers of the renin-angiotensin-aldosterone system and β-blockers has improved outcome and helped reverse or halt disease progression in many patients; however, despite this, morbidity and mortality have remained elevated, and only marginal advances have occurred over the last few years. How best to combine these various agents continue to be tested but, apart from the addition of aldosterone receptor blockers and reduction of heart rate with ivabradine, advances have been few. Implantable defibrillators and cardiac resynchronization devices have proved to be very beneficial, and the limits of their use are presently still being tested. How best to handle atrial fibrillation in patients with heart failure remains unanswered, but for now, rate control appears to be appropriate in many patients. Surgical ventricular restoration of the left ventricle has not proved to generally be useful, and although the role of coronary artery bypass graft surgery (CABG) is well established in some patients, its use in others is being reevaluated. The use of biomarkers in patients with heart failure has stimulated great interest; however, much work remains before its full potential can be realized. As the complexity of the use of pharmacogenomics in clinical practice becomes clearer, research in the area is intensifying, but much work remains to be done before its use can be clearly outlined in patients with heart failure.

  14. Crossing the bends: Support-catheter based left ventricular lead placement in challenging cardiac resynchronization therapy device implantation

    Directory of Open Access Journals (Sweden)

    Amit Kumar Malik, MBBS, MD

    2012-08-01

    Full Text Available The combined use of an Amplatz guiding catheter and support catheter creates a progressively supportive rail to implant the left ventricular (LV lead in difficult cardiac resynchronization therapy device implantation. We describe the case of a 32-year-old male with non-ischaemic cardiomyopathy, left bundle-branch block, and an LV ejection fraction of 30%, who was referred to our centre for a repeat attempt at an LV lead implant. Previously, the implanter had been unable to advance different guide catheters over the wire to the desired tributary of the coronary sinus (CS. At our centre, the CS was cannulated with a 6-Fr AL2 coronary guiding catheter. A 135-cm support catheter (Spectranetics Quick-Cross was advanced via AL2 guiding over the 0.035 in. guide wire to the distal CS. The proximal luer fitting of the support catheter was cut and an inner sheath (Medtronic ATTAIN SELECT II advanced over the support catheter into the CS. A 4-Fr over-the-wire LV lead was advanced through the inner sheath over a 0.014 in. percutaneous transluminal coronary angioplasty wire after removal of the support catheter. The use of a support catheter serves as rail for the placement of the inner sheath deep in the CS and facilitates implantation of the LV pacing lead. This technique is safe and easily applied.

  15. Medical eligibility, contraceptive choice, and intrauterine device acceptance among HIV-infected women receiving antiretroviral therapy in Lilongwe, Malawi.

    Science.gov (United States)

    Haddad, Lisa B; Feldacker, Caryl; Jamieson, Denise J; Tweya, Hannock; Cwiak, Carrie; Bryant, Amy G; Hosseinipour, Mina C; Chaweza, Thomas; Mlundira, Linly; Kachale, Fanny; Stuart, Gretchen S; Hoffman, Irving; Phiri, Sam

    2014-09-01

    To determine medical eligibility for contraceptive use, contraceptive preference, and acceptance of a copper intrauterine device (IUD) among a cohort of HIV-infected women receiving antiretroviral therapy (ART). All HIV-infected women who received ART and sought contraceptive services at the Lighthouse clinic, an integrated HIV/ART clinic in Lilongwe, Malawi, between August and December 2010 were invited to participate in a structured interview. Eligibility and preference for the following contraceptive methods were assessed: combined hormonal contraceptives, progestogen-only pills, copper IUD, injectable depot medroxyprogesterone acetate (DMPA), and contraceptive implants. The final sample included 281 women; five were pregnant. The remaining 276 women were eligible for at least three contraceptive methods, with 242 (87.7%) eligible for all five methods evaluated. After counseling, 163 (58.0%) selected DMPA and 98 (34.9%) selected an IUD as their preferred contraceptive method. Regardless of their method of choice, 222 (79.0%) women agreed to have an IUD placed on the same day. Most methods of contraception are safe for use by HIV-infected women. Approximately 80% of the women were willing to receive an IUD. Efforts must be made to increase education about, and access to, long-acting reversible methods that may be acceptable and appropriate contraceptive options for HIV-infected women. Copyright © 2014 International Federation of Gynecology and Obstetrics. All rights reserved.

  16. Combined sildenafil with vacuum erection device therapy in the management of diabetic men with erectile dysfunction after failure of first-line sildenafil monotherapy.

    Science.gov (United States)

    Sun, Lu; Peng, Fang-Li; Yu, Zhi-Ling; Liu, Cai-Ling; Chen, Jun

    2014-12-01

    To evaluate the efficacy and safety of combination therapy of sildenafil plus vacuum erection devices in men with type 2 diabetes mellitus with moderate to severe erectile dysfunction who are dissatisfied with the results of using sildenafil alone. The study included 66 diabetes mellitus patients presenting erectile dysfunction for at least 6 months and dissatisfied with the use of 100 mg sildenafil monotherapy. The patients were randomized in two groups. Those in group A (n = 33) were instructed to use a vacuum erection device only, whereas those in group B (n = 33) were treated with combination therapy, including sildenafil 100 mg and a vacuum erection device. Erectile function was evaluated subjectively using the International Index of Erectile Function, Sexual Encounter Profile questionnaire questions 2 and 3 at visit 1 (baseline; study entry), visit 2 (4 weeks after baseline), and visit 3 (12 weeks after baseline; study end). There were no significant differences in average patient age, duration of diabetes, duration of erectile dysfunction, baseline International Index of Erectile Function scores, hypertension, blood testosterone, smoking and alcohol consumption between two groups. Mean International Index of Erectile Function scores were significantly higher for group B at the 1-month (14.86 ± 2.17 vs 12.41 ± 2.63; P vacuum erection device therapy significantly enhances erectile function, and it is well tolerated by diabetes mellitus patients not responding to first-line sildenafil alone. © 2014 The Japanese Urological Association.

  17. Sustainable Cultural Tourism in Urban Destinations: Does Space Matter?

    Directory of Open Access Journals (Sweden)

    Ibon Aranburu

    2016-07-01

    Full Text Available Policy makers and tourism developers must understand visitors’ mobility behavior and how they consume space and tourism resources in order to set up sustainable cultural tourism destinations. With this in mind, it should also be pointed out that the mobility patterns of tourists in urban destinations are mainly located in the city center (spatial centrality, the analysis of which enables us to define “how central” the resources (museums, monuments, etc. are and what the interactions between them are. Comprehending which factors influence visitors’ urban mobility behavior is key to understanding tourists’ consumption of space and their connections with the tourism assets of the city. Furthermore, when tourists visit a destination, they make a mental representation of the destination, constructing a mental map of it. Thus, tourists consume not only spaces but also the image of a city/destination. Moreover, the latter influences the former. The quality of surrounding architecture and urbanism plays a crucial role in enhancing the experiential value of a destination and influencing space consumption preferences. Clearly, visitors are more likely to use/consume environments that are easily navigated and mentally legible. In order to explore these patterns, a real experiment was performed based on visitor behavior in the city of Bilbao. In addition, the central places of Bilbao were determined and an analysis of the spatial interaction between cultural sites was performed, making use of a new methodology based on GPS technologies, network analysis, and surveys. This methodology is the main contribution of this work. The results suggest that (1 easy mobility (walkability, accessibility, different transport modes of the visited space facilitates the tourist experience; (2 simple and eligible mental maps of the city that are easily perceived by visitors facilitate the rapid consumption of the tourist destination; and (3 the centrality of the

  18. Retrospective Cohort Study Examining Reduced Intensity and Duration of Anticoagulant and Antiplatelet Therapy Following Left Atrial Appendage Occlusion with the WATCHMAN Device.

    Science.gov (United States)

    Tung, Matthew K; Ramkumar, Satish; Cameron, James D; Pang, Benjamin; Nerlekar, Nitesh; Kotschet, Emily; Alison, Jeffrey

    2017-05-01

    Anticoagulant and antiplatelet therapy are recommended following WATCHMAN implantation (45 days and 6 months) to reduce the risk of embolic events. These patients are often also at high risk of recurrent bleeding complications. We aimed to assess the safety of reduced duration of treatment with anticoagulant and antiplatelet therapy in the early post implant period. This was a retrospective cohort study assessing the duration of antiplatelet and anticoagulant therapy in 47 consecutive patients following WATCHMAN implant. The primary outcome was rate of major bleeding, stroke and systemic embolic complications. The secondary endpoints were rate of device thrombus and peri-device leak >4mm as assessed by transoesophogeal echocardiography. Forty-seven patients were followed up for a mean of 2.4+/-1.7 years (111.4 total patient-years). The rate of stroke was 1.8/100 patient-years (two events) and the rate of major bleeding complication was 8.9/100 patient-years. Three patients had peri-device leak >4mm and no patients had device thrombus visualised. 70.2% of patients had discontinued anticoagulation at 45 days, 89.4% had discontinued dual antiplatelet therapy at 90 days. Seven patients were not on any form of anticoagulant or antiplatelet at five months. Comparison of probability of survival free from stroke by time of cessation of anticoagulant and antiplatelet therapy demonstrated no significant differences (p-value for log rank test 0.238 and 0.820). Following WATCHMAN implant shortened periods of anticoagulants and antiplatelets may be considered, particularly in the context of high bleeding risk. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  19. MO-C-BRB-05: Translating NIH funding to a [potential] clinical device in breast cancer radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Yu, C. [Univ Maryland School of Medicine (United States)

    2015-06-15

    Diagnostic radiology and radiation oncology are arguably two of the most technologically advanced specialties in medicine. The imaging and radiation medicine technologies in clinical use today have been continuously improved through new advances made in the commercial and academic research arenas. This symposium explores the translational path from research through clinical implementation. Dr. Pettigrew will start this discussion by sharing his perspectives as director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The NIBIB has focused on promoting research that is technological in nature and has high clinical impact. We are in the age of precision medicine, and the technological innovations and quantitative tools developed by engineers and physicists working with physicians are providing innovative tools that increase precision and improve outcomes in health care. NIBIB funded grants lead to a very high patenting rate (per grant dollar), and these patents have higher citation rates by other patents, suggesting greater clinical impact, as well. Two examples of clinical translation resulting from NIH-funded research will be presented, in radiation therapy and diagnostic imaging. Dr. Yu will describe a stereotactic radiotherapy device developed in his laboratory that is designed for treating breast cancer with the patient in the prone position. It uses 36 rotating Cobalt-60 sources positioned in an annular geometry to focus the radiation beam at the system’s isocenter. The radiation dose is delivered throughout the target volume in the breast by constantly moving the patient in a planned trajectory relative to the fixed isocenter. With this technique, the focal spot dynamically paints the dose distribution throughout the target volume in three dimensions. Dr. Jackson will conclude this symposium by describing the RSNA Quantitative Imaging Biomarkers Alliance (QIBA), which is funded in part by NIBIB and is a synergistic collaboration

  20. SU-E-T-242: Design of a Novel Afterloader Clearance QA Device for Biliary HDR Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Mullins, JP; Deufel, CL [Mayo Clinic, Rochester, MN (United States)

    2015-06-15

    Purpose: Bile duct cancer affects 2–3 thousand people annually in the United States. Radiation therapy has been shown to double median survival, with combined external beam and intraluminal high dose-rate (HDR) brachytherapy being most effective. Endoscopic retrograde cholangiopancreatography (ERCP) biliary HDR, a less-invasive alternative to trans-hepatic brachytherapy, is delivered through a catheter that travels a tortuous path from nose to bile duct, requiring wire drive force and dexterity beyond typical afterloader performance specifications. Thus, specific afterloader quality assurance(QA) is recommended for this procedure. Our aim was to create a device and process for Varisource afterloader clearance QA with objectives that it be quantitative and can monitor afterloader performance over time, compare performance between two distinct afterloaders and potentially Result in a predictive nomogram for patient-specific clearance. Methods: Based on retrospective reconstruction of 20 ERCP patient anatomies, we designed a phantom to test afterloader ability to drive the source wire along an intended treatment path. The ability of the afterloader to fully extend the intended treatment path is a function of number and diameters of turns. We have determined experimentally that relative position of the turns does not impact performance. Results: Both patient and QA paths involve three common turns/loops: a large turn representing the stomach(10.8cm±2.0cm), an elliptical loop representing the duodenum(7.3cm±1.5cmx4.8cm±0.7cm), and a final turn at the end of the bile duct that may be tight for some patient-specific anatomies and absent in others(3.7cm±0.7cm, where present). Our phantom design uses anatomical average turn diameters for the stomach and duodenum then terminates in a turn of quantitatively selectable diameter. The smallest final turn diameter that an afterloader can pass is recorded as the QA parameter. Conclusion: With this device and QA process, we

  1. Evaluation of usefulness of portal image using Electronic Portal Imaging Device (EPID) in the patients who received pelvic radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Woo Chul; Kim, Heon Jong; Park, Seong Young; Cho, Young Kap; Loh, John J. K. [College of Medicine, Inha Univ., Pusan (Korea, Republic of); Park, Won; Suh, Chang Ok; Kim, Gwi Eon [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of)

    1998-12-01

    To evaluate the usefulness of electronic portal imaging device through objective compare of the images acquired using an EPID and a conventional port film. From Apr. to Oct. 1997, a total of 150 sets of images from 20 patients who received radiation therapy in the pelvis area were evaluated in the Inha University Hospital and Severance Hospital. A dual image recording technique was devised to obtain both electronic portal images and port film images simultaneously with one treatment course. We did not perform double exposure. Five to ten images were acquired from each patient. All images were acquired from posteroanterior (PA) view except images from two patients. A dose rate of 100-300 MU/min and a 10-MV X-ray beam were used and 2-10 MUs were required to produce a verification image during treatment. Kodak diagnostic film with metal/film imaging cassette which was located on the top of the EPID detector was used for the port film. The source to detector distance was 140 cm. Eight anatomical landmarks (pelvic brim, sacrum, acetabulum, iliopectineal line, symphysis, ischium, obturator foramen, sacroiliac joint) were assessed. Four radiation oncologist joined to evaluate each image. The individual landmarks in the port film or in the EPID were rated-very clear (1), clear (2), visible (3), notclear (4), not visible (5). Using an video camera based EPID system, there was no difference of image quality between no enhanced EPID images and port film images. However, when we provided some change with window level for the portal image, the visibility of the sacrum and obturator foramen was improved in the portal images than in the port film images. All anatomical landmarks were more visible in the portal images than in the port film when we applied the CLAHE mode enhancement. The images acquired using an matrix ion chamber type EPID were also improved image quality after window level adjustment. The quality of image acquired using an electronic portal imaging device was

  2. Indications for long-term assist device placement as bridge to transplantation.

    Science.gov (United States)

    Sun, Benjamin C

    2003-02-01

    The current indications for long-term mechanical support as bridge to transplantation first require the patient to be a transplant candidate. Often times a patient presents with limited history and refractory cardiogenic shock, where a full transplant work-up for contraindications cannot be safely performed. The use of short-term mechanical support can be used to help filter out many patients who have easily identifiable contraindications to heart transplant. Nevertheless, patients need to be listed for a heart transplant before the implantation of some of these devices. This paradigm needs to be altered, because there are many instances where mechanical support can be used to support a patient for an intervention to "make" them a transplant candidate where they otherwise would not have been. Long-term mechanical support can overcome the cardiac contraindication to the surgical/interventional therapy to "cure" them of the process that would have prevented them from being a good cardiac transplant candidate in the first place. Noncardiac surgical procedures are well tolerated in these patients [11]. The FDA is currently evaluating the Vented Electric Heartmate system for use as destination therapy for patients who are not transplant candidates. Approval for this indication (with a device that is already approved for bridge to transplantation) will allow this paradigm shift. This system could be used in the group who may be good candidates, but not determined. If they were subsequently determined to not be a good surgical candidate, they would be chronically supported with the LVAD as destination therapy.

  3. The Branding of Kharkov City as a Tourist Destination

    Directory of Open Access Journals (Sweden)

    Danko Nataliya I.

    2016-05-01

    Full Text Available On the basis of analyzing publications and documents of the United Nations World Tourism Organization (UNWTO, the authors clarified the concept of «tourist destination»; considered and clarified the concept of «brand of the tourist destination»; suggested the mechanism for development of the brand of the tourist destination. The existing brand of Kharkiv – «Kharkiv – smart city» – has been analyzed and it was concluded that this brand is promising and successful for educational tourism, for attracting foreign students and scholars – connoisseurs of new technologies and science fiction. The direction of further work on the brand of Kharkiv city as a tourist destination is to enhance the already existing brand «Kharkiv – smart city» by introducing a set of marketing communications, aggressive advertising campaign in Ukrainian and international media and travel exhibitions. Besides, it is considered to be promising to design brands intended for other target segments of consumers – «Kharkiv – historic city», «Kharkiv – sport city», etc., which will lead to a synergistic effect in the tourism industry of Kharkiv. Prospects for further research in this direction are studying new strategic directions of development of Kharkiv city as a tourist destination

  4. A model of destination competitiveness/sustainability: Brazilian perspectives

    Directory of Open Access Journals (Sweden)

    J.R. Brent Ritchie

    2010-10-01

    Full Text Available This paper reviews the understanding I have gained from several years of research, and from several more years of ongoing discussions with industry leaders regarding the nature of competitiveness among tourism destinations. This understanding has been captured, in summary form, in the model of Destination Competitiveness/Sustainability (Ritchie and Crouch, 2003. This model contains seven (7 components which we have found to play a major role, from a policy perspective, in determining the competitiveness/sustainability of a tourism destination. In addition to the valuable understanding which these seven components provide from a policy perspective, the specific elements of each the major components provide a more useful/practical guidance to those who are responsible for the ongoing management of a DMO (Destination Management Organization. With this overview in mind, this paper will provide a detailed review and explanation of the model that I have developed with colleague, Dr. Geoffrey I. Crouch of Latrobe University in Melbourne, Australia. Based on previous presentations throughout the world, it has proven very helpful to both academics and practitioners who seek to understand the complex nature of tourism destination competitiveness/sustainability.

  5. IMPORTANT - PERFORMANCE ANALYSIS AS A TOOL IN DESTINATION MARKETING

    Directory of Open Access Journals (Sweden)

    Eleina QIRICI

    2011-06-01

    Full Text Available The Korça Region is located in the Southeast of Albania and borders Greece and Macedonia to the South and the East. It is a mountainous region with two major lakes, Lake Ohrid, the oldest lake in Europe, which is shared with Macedonia and Lake Prespa which is shared with Greece and Macedonia (100km2 in Albania.If we consider the last years, there is an increasing tendency to improve the tourist facilities and to attract the tourist market which is interested for activities in open nature and relax in fresh and pure air. These demands could be met very well in Korca destination which is characterized by suitable climatic conditions and tourist services. Eventually a combination of development of town tourism and tourist villages helped the sustainability of the development of Korca as tourist destination in general.The main purpose of this paper is to present the using of important - performance analysis in marketing destination for the development of tourism.Highlights: (1 the paper considers multifarious goals of the destination management; (2 a computer booking system is used by hotels and guest houses in the region; (3 the relationship between what a tourists wants to find in a destination and that he finds in fact.

  6. PROMOTION: BRANDING TOOL FOR MACEDONIA AS A TOURIST DESTINATION

    Directory of Open Access Journals (Sweden)

    Violeta Milenkovska

    2015-12-01

    Full Text Available In times when competition between countries in the world is stronger, in order to attract as many tourists as possible, and strengthening their brand as a tourist destination, Republic of Macedonia started to build and strengthen its tourism brand. Due to the enormous competition, traditional destinations maintain and improve their brand through new innovative tourist attractions. On the contrary, the new tourist destinations strongly attack potential tourists with intention of gaining a better position on the tourist market. The subject of this paper is Macedonia as a tourist destination seen through the prism of promotional activities that Agency for promotion and support tourism in Republic of Macedonia realized in period 2009– 2012. This paper presents an action research conducted on a sample of 65 tourist stockholders (travel agencies and hotels in Macedonia in 2012. In this study it will be analyzed what other countries have undertaken regarding the aspect of promotion of their tourist product, concerning promotion of their tourist destination and what Macedonia has undertaken and should undertake regarding that aspect.

  7. Ventricular assist device for failing systemic ventricle in an adult with prior mustard procedure.

    Science.gov (United States)

    Neely, Robert C; Davis, Robert Patrick; Stephens, Elizabeth H; Takayama, Hiroo; Khalpey, Zain; Ginns, Jonathan; Lee, Sun Hi; Chen, Jonathan

    2013-08-01

    The Mustard procedure is a palliative surgical procedure used to repair complete transposition of the great arteries. Cardiac transplantation remains the only definitive therapy for patients who develop heart failure after a Mustard procedure. However, pulmonary hypertension represents a major hemodynamic contraindication. The use of a ventricular assist device as destination therapy has not yet been established after a Mustard procedure. Here, we present the case of a 41-year-old patient who presented with systemic right ventricular failure following Mustard procedure complicated by pulmonary hypertension. The patient received a HeartMate II (Thoratec, Pleasanton, CA) ventricular assist device as a bridge to decision. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Competitiveness of Frontier Regions and Tourism Destination Management

    Directory of Open Access Journals (Sweden)

    Ksenija Vodeb

    2012-03-01

    Full Text Available The competitiveness of border regions is often lower than the competitiveability of a country’s interior regions. Mostly being areas thatmark the end of one entity and the beginning of another, border regionsdemonstrate weaker economic performance. Tourism, as a method ofdevelopment, provides opportunities to develop tourism destinationsin places where tourism attractions and resources, and comparative andcompetitive advantages exist. This paper dealswithmodels for assessingcompetitiveness in the field of tourism and destination managementas a vital element in achieving a higher level of competitiveness for atourism destination. Our research focuses on tourism supply providersin the border regions of Slovenia and Croatia. We assess their attitudeson tourism, regional competitiveness, and potential tourism destinationsas the outcome of cooperation between the two countries. Resultsindicate the possibility of enhancing competitiveness through a strategicapproach in planning and managing cross-border tourism destinations.

  9. Long Journey Travel to Tourist Destination: A Review Paper

    Directory of Open Access Journals (Sweden)

    Shahrin Norkamaliah

    2014-01-01

    Full Text Available Tourists are now more open in selecting tourist destination. The number of holiday trips were growing rapidly. There were various promotions available to attract tourists to travel either within or outside the country. Travel distance is not an obstacle for tourists to travel, regardless of local and foreign destination. This study will be conducted to identify the motivation of long journey travel that involves push and pull factors. The long journey involves distance, cost and the type of transportation used to get to the destination. For this purpose a comprehensive review and discussion on previous sources which involved a variety of secondary data sources will be used to meet every need of the study objectives. The finding showed that the travel distance was dependent on the motivation for tourists to travel and the type of transport they want to use. Mode of transport used has advantages and disadvantages for long journey travel depending on traveller choice.

  10. The Spatial Structure of Rural Recreational Tourism Destinations

    Institute of Scientific and Technical Information of China (English)

    Hongna; LI; Liang; ZHAO

    2013-01-01

    We select 149 rural recreational tourism destinations in Liaoning Province as the samples, and use geographical mathematical method to analyze the travel spatial structure of rural recreational tourism destinations from aggregation degree of spatial distribution, the balance of spatial distribution, spatial connection and spatial accessibility. The results show that the spatial distribution of tourism destinations shows the gathering distribution pattern, and the evenness of the distribution is very low, displaying strong neighboring positive effect; the accessibility of traffic network is high, and basically the dense tourist traffic network is formed; the nodes with the best accessibility are mainly concentrated in the city groups of central Liaoning and the southern regions of Liaoning, while the nodes with poor accessibility are mainly concentrated in the city groups of western Liaoning and the eastern regions of Liaoning.

  11. Modelling the Image Research of a Tourism Destination

    Directory of Open Access Journals (Sweden)

    Nicolae Teodorescu

    2014-11-01

    Full Text Available The problematic area of the tourism destination image has a high expansion in marketing, the efforts of its conceptualization and phenomenalism being remarkable among specialists. In this context, the authors propose a systemic approach, the result of which refers to a model regarding the image research of a tourism destination, whose validation has been attained using Transalpina destination. The model created by the authors envisages morphological features and specific functional relationships, which are consistent with the marketing theory, and, in context, with the consumer behaviour theory. The conceptualmethodological solutions are magnified by applicative-experimental validations, which enhance the theoretical and practical valences of the created model. The main direction of developing the elaborated model consists in efforts of formalization and abstracting, in the perspective offered by several scientific disciplines.

  12. Sochi Market Analysis as a Health Tourism Destination

    Directory of Open Access Journals (Sweden)

    Nadezhda K. Serdyukova

    2013-01-01

    Full Text Available The article considers major characteristics of Sochi market as a health tourism destination, analyses the structure of resort collective accommodation facilities, dynamics of tourist flows and their structure, prevailing kinds of tourism and estimates tourist flows of health tourism in Sochi in 2008-2012. The authors indicate major characteristics and trends of Sochi tourist market development and the prospects of Sochi development as a health tourism destination. The percent of health tourist flow in the general tourist flow of Sochi and the percent of domestic tourist flow in the sector of collective accommodation facilities are estimated. The authors came to the conclusion that to develop tourism in Sochi in post-Games period, it is necessary to promote Sochi as a health tourism destination.

  13. Maintaining persistence and adherence with subcutaneous growth-hormone therapy in children: comparing jet-delivery and needle-based devices

    Directory of Open Access Journals (Sweden)

    Spoudeas HA

    2014-09-01

    Full Text Available Helen A Spoudeas,1 Priti Bajaj,2 Nathan Sommerford3 1London Centre for Paediatric Endocrinology, University College London, London, 2Ferring Pharmaceuticals, London, 3Health Informatics Research, Sciensus Ltd, Brighton, UK Purpose: Persistence and adherence with subcutaneous growth hormone (GH; somatropin therapy in children is widely acknowledged to be suboptimal. This study aimed to investigate how the use of a jet-delivery device, ZomaJet®, impacts on medication-taking behaviors compared to needle-based devices.Materials and methods: A retrospective cohort study of children aged ≤18 years was conducted using a UK-based, nationwide database of GH home-delivery schedules. Data were evaluated for the period between January 2010 and December 2012 for 6,061 children receiving either Zomacton® (somatropin via the ZomaJet jet-delivery device or one of six brands of GH all administered via needle-based devices. Persistence was analyzed for patients with appropriate data, measured as the time interval between first and last home deliveries. An analysis of adherence was conducted only for patients using ZomaJet who had appropriate data, measured by proportion of days covered. Brand switches were identified for all patients.Results: Persistence with GH therapy was significantly longer in patients using ZomaJet compared to needle-based devices (599 days versus 535 days, respectively, n=4,093; P<0.001; this association was observed in both sexes and across age subgroups (≤10 and 11–16 years. The majority (58% of patients using ZomaJet were classed as adherent (n=728. Only 297 patients (5% switched GH brand (n=6,061, and patients tended to use ZomaJet for longer than other devices before switching.Conclusion: It appears important that the choice of a jet-delivery device is offered to children prescribed daily GH therapy. These devices may represent a much-needed effective strategy for maintaining persistence with subcutaneous GH administration in

  14. How to develop sustainable tourism in rural destinations in Serbia

    Directory of Open Access Journals (Sweden)

    Štetić Snežana

    2008-01-01

    Full Text Available The classical distinction between countries of tourist offer and countries of tourist demand has already been surpassed considering that many countries of tourist demand (USA, Germany, Great Britain … earn much more from tourism than the countries of tourist offer (Italy, Greece, Portugal …. The changes in customers' behaviour are reflected through restructuring of tourist movements towards new destinations. What is essential in creating, promoting and marketing tourist destinations for the specific tourism forms development is the identification of all the positive and negative factors that influence the development of these destinations. Converting a potential into a tourist destination depends on many factors both in qualitative and in quantitative sense. Discovering an area of preserved environment that also possesses attractive motifs presents the beginning of the possible tourist destination creating. Further 'destiny' of a tourist destination depends on its planning and development intensity. Rural tourism is a significant component of integral and sustainable development and revitalization of the village, as well as a component that is missing in stimulating the local market development for agricultural and non-agricultural activities in the country, along with a special stimulation to employment. Serbia possesses remarkable natural resources and other potentials for the development of all forms of rural tourism. However, rural tourism in Serbia is an insufficiently organized field that is not being developed adequately to the possibilities available to it. That is why this paper wants to point out the potential opportunities for the development of rural tourism in Serbia through sustainable development and correct performance policy on both national and international tourist market.

  15. Sustainability development and competitiveness of Rome as a tourist destination

    OpenAIRE

    Valeri, Marco

    2015-01-01

    Objectives – The aim of the paper is to study the sustainability level of the city of Rome (Italy) as a tourist destination. The paper’s basic assumption is based on the fact that, compared to other international tourist destinations, Rome is high on the list as far as the number of international visitors is concerned, yet it is not the city at the top of the list. Design/Methodology/Approach – The methodology used is that of case study research (Yin, 2003). The results will be evaluated b...

  16. Solutions for Destination Management on Agri-Tourism Farm

    OpenAIRE

    Ioan Petroman; Cornelia Marin; Constantin Buzatu; Adrian Dumitrescu; Ştefan Coman; Andreea Stan; Daniela Avramescu

    2012-01-01

    Farm tourism can be an alternative to agricultural jobs in rural communities with real agri-tourism potential. To improve destination management, we need to implement a type of management based on knowledge management. A second type of management that is a must in farm tourism is the integrated management of agri-tourism destination quality based on a code of good practices in the integrated management of quality. In order to improve agri-tourism management quality, we need to apply best mana...

  17. The Unique Destination Proposition of Eskisehir: Industrial Heritage

    Directory of Open Access Journals (Sweden)

    Hakan Yılmaz

    2014-12-01

    Full Text Available This paper examines the transformation of Unique Sales Proposition (USP concept which is one of the most important strategies of advertising history, to the Unique Destination Proposition (UDP for the case of Eskisehir. This study aims to propose industrial heritage as the UDP of Eskisehir by a descriptive approach. Industrial heritage helps Eskisehir destination brand to attain a meaningful, sustainable and distinctive dimension from its competitors. The current industrial heritage samples of Eskisehir were initially evaluated in this context. Subsequently, in the focus of the relation between industrial heritage and tourism, an excursion route and a tour program is suggested including the unique industrial heritage values of Eskisehir.

  18. Referring patients for consideration of device treatment of sudden cardiac death and heart failure: incorporating evidence-based therapies within the Canadian health care system.

    Science.gov (United States)

    Gillis, Anne M

    2005-05-01

    The growing use of the implantable cardioverter defibrillator (ICD) in Canada reflects the impact that primary and secondary prevention trials have had in demonstrating the superiority of the ICD over medical therapy in the prevention of sudden cardiac death in high-risk populations. Currently, there are significant regional disparities in ICD implantation in Canada. These disparities may reflect a lack of regional ICD implant and follow-up programs, and capping of funding for ICDs. In addition to increased funding for ICD systems, more resources are required to perform device implantations and follow patients over the long-term. Potentially eligible patients should be referred to an electrophysiologist for consideration of ICD therapy for the prevention of sudden cardiac death or to an electrophysiologist/ heart failure specialist for the consideration of combination cardiac resynchronization and ICD therapy for the management of refractory heart failure.

  19. A Bayesian Model to Predict Right Ventricular Failure Following Left Ventricular Assist Device Therapy.

    Science.gov (United States)

    Loghmanpour, Natasha A; Kormos, Robert L; Kanwar, Manreet K; Teuteberg, Jeffrey J; Murali, Srinivas; Antaki, James F

    2016-09-01

    This study investigates the use of a Bayesian statistical model to address the limited predictive capacity of existing risk scores derived from multivariate analyses. This is based on the hypothesis that it is necessary to consider the interrelationships and conditional probabilities among independent variables to achieve sufficient statistical accuracy. Right ventricular failure (RVF) continues to be a major adverse event following left ventricular assist device (LVAD) implantation. Data used for this study were derived from 10,909 adult patients from the Inter-Agency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who had a primary LVAD implanted between December 2006 and March 2014. An initial set of 176 pre-implantation variables were considered. RVF post-implant was categorized as acute (14 days) in onset. For each of these endpoints, a separate tree-augmented naïve Bayes model was constructed using the most predictive variables employing an open source Bayesian inference engine. The acute RVF model consisted of 33 variables including systolic pulmonary artery pressure (PAP), white blood cell count, left ventricular ejection fraction, cardiac index, sodium levels, and lymphocyte percentage. The early RVF model consisted of 34 variables, including systolic PAP, pre-albumin, lactate dehydrogenase level, INTERMACS profile, right ventricular ejection fraction, pro-B-type natriuretic peptide, age, heart rate, tricuspid regurgitation, and body mass index. The late RVF model included 33 variables and was predicted mostly by peripheral vascular resistance, model for end-stage liver disease score, albumin level, lymphocyte percentage, and mean and diastolic PAP. The accuracy of all Bayesian models was between 91% and 97%, with an area under the receiver operator characteristics curve between 0.83 and 0.90, sensitivity of 90%, and specificity between 98% and 99%, significantly outperforming previously published risk scores. A Bayesian prognostic

  20. EXPLORING DESTINATION IDENTITY AND DESTINATION IMAGE IN THE NEW AGE OF TOURISM: A CASE STUDY OF BALI BRAND

    OpenAIRE

    Ni Made - Asti Aksari; I Komang Gde - Bendesa

    2016-01-01

    Bali's economy has grown rapidly since a decade ago. This is possible because tourism is growing continuously. However, tourism growth is not optimal because of insufficient promotion and tourism destination identity is unclear.  The growth of Web 2.0 as a platform to share travel information has prompted tourism bodies to pay closer attention to how their destinations are perceived by target markets. Set within the context of the emergence of Web 2.0, a platform designed to enable users to g...

  1. Development of Composite Bio-Artificial Liver Therapy Device%混合型生物人工肝治疗设备的研制

    Institute of Scientific and Technical Information of China (English)

    田林怀; 梁晓会; 杨树欣; 辛绍杰; 荣毅辉

    2012-01-01

    目的:结合临床应用需求,研制一种新式混合型生物人工肝治疗应用系统.方法:以2个可编程控制器(PLC)作为控制系统核心,辅以多种安全监测报警装置,具有密闭、洁净和恒温的生物反应治疗环境,为离线混合型生物人工肝治疗提供一体化集成解决方案.结果:该设备能实现对血液流量、流速、质量等参数的精确控制,并提供温度、气泡、漏血等参数的报警监测功能.控制系统操作简便,人机界面友好,并为封闭式生物反应离线治疗过程提供实时影像监控.结论:新型治疗设备实现了混合式生物反应人工肝的离线治疗,有效缩短了生物人工肝治疗时间,同时改善了生物治疗环境.%Objective To develop a composite hio -artificial liver therapy system with particular intellectual properties. Methods Two PLCs were used as the core of the control system, with a closed, clean and thermostatic environment for biological reaction therapy and multi safety monitoring & alarming devices involved, and a offline package for composite bio-artificial liver therapy was also put forward. Results Some parameters, such as blood flow, flow rate and quality, could be controlled precisely, and alarming & monitoring were available for temperature, air bladder, blood leakage and so on. The composite bio-artificial liver therapy device, being easy-to-operate and gifted with a friendly man-machine interface, could realize real -time image monitoring for closed offline biological reaction therapy. Conclusion The composite bio - artificial liver therapy device can accomplish offline therapy, reduce treatment time and improve biotherapy environment. [Chinese Medical Equipment Journal,2012,33(7):4-6,38

  2. Economic Evaluation of Left Ventricular Assist Devices for Patients With End Stage Heart Failure Who Are Ineligible for Cardiac Transplantation.

    Science.gov (United States)

    Chew, Derek S; Manns, Braden; Miller, Robert J H; Sharma, Nakul; Exner, Derek V

    2017-10-01

    Continuous flow (CF) left ventricular assist devices (LVADs) improve survival in end-stage heart failure patients who are ineligible for cardiac transplantation. Their use in this population (referred to as destination therapy) is increasing in many countries, yet they are not routinely funded for this indication in Canada. We assessed the cost-effectiveness of destination therapy CF-LVADs from the perspective of the Canadian health care payer. A Markov model was used to project the outcomes and costs of 2 treatment pathways, CF-LVAD implantation and medical management alone, in an end-stage heart failure patient cohort ineligible for transplantation. Clinical and cost input estimates were informed from the available literature. Model outcomes included costs (in 2015 Canadian dollars), quality-adjusted life-years (QALYs), and the cost per QALY gained. Compared with medical management, CF-LVAD patients had higher costs ($284,287 vs $31,984) and QALYs (1.48 vs 0.39) over a lifetime horizon. The incremental cost per QALY gained was $230,692. The model was most sensitive to device implantation costs, and the clinical effectiveness of CF-LVADs on survival and quality of life. A scenario analysis using contemporary survival data resulted in a cost per QALY gained of $125,936. When applying contemporary LVAD survival trends, the model showed that the cost of initial LVAD implantation needed to be less than $123,000 to be considered cost-effective. The incremental cost per QALY for destination therapy CF-LVADs is predicted to be above usual thresholds for funding in Canada. In some plausible scenarios, its cost-effectiveness is similar to dialysis for kidney failure, a therapy that is also immediately life-saving. Because of this, there will be likely ongoing pressure to fund CF-LVADs for a subset of patients ineligible for transplantation. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  3. The role of brand destination experience in determining revisit intention

    DEFF Research Database (Denmark)

    Mattsson, Jan; Barnes, Stuart; Sørensen, Flemming

    experience, which provides a more holistic and unified view of the brand destination. The research uses a logistic regression model to determine the role of satisfaction and brand experience in determining revisit intentions. The study also examines differences among subgroups and four brand experience sub...

  4. Gornergrat and Jungfraujoch - two exciting destinations for tourism and research

    Science.gov (United States)

    Flückiger, E. O.

    2015-05-01

    After having been made accessible by two of the first cog railways in Europe more than 100 years ago, Gornergrat and Jungfraujoch became two extraordinary places: both are well known worldwide as exciting tourist destinations, and at the same time they are unique research sites. This article illustrates this duality in relation with the International Foundation HFSJG.

  5. Destination Attractiveness of the Silos and Smokestacks National Heritage Area

    Science.gov (United States)

    Choi, Puyong

    2012-01-01

    The purpose of this study was to identify the characteristics of destination attractiveness of the Silos and Smokestacks National Heritage Area (SSNHA) in Iowa using the relative attractiveness and importance of the 15 attributes identified by Gearing, Swart, and Var's (1974) scale and 3 attributes identified by Hu and Ritchie (1993). These…

  6. Tourist Information Search and Destination Choice in a Digital Age

    DEFF Research Database (Denmark)

    Kristian Steen Jacobsen, Jens; Munar, Ana Maria

    2012-01-01

    This study provides empirical evidence of self-reported impacts of selected electronic and other information sources on international tourists' destination choices regarding a popular, mature and mainstream summer holiday location. It is shown that traditional information provisions such as direc......-making, utilitarian information values seem more relevant than socialisation opportunities....

  7. Destination Attractiveness of the Silos and Smokestacks National Heritage Area

    Science.gov (United States)

    Choi, Puyong

    2012-01-01

    The purpose of this study was to identify the characteristics of destination attractiveness of the Silos and Smokestacks National Heritage Area (SSNHA) in Iowa using the relative attractiveness and importance of the 15 attributes identified by Gearing, Swart, and Var's (1974) scale and 3 attributes identified by Hu and Ritchie (1993). These…

  8. YouTube's Role in Destination Image Creation

    Directory of Open Access Journals (Sweden)

    Hrvoje Jakopović

    2015-09-01

    Full Text Available Contemporary promotion of tourist destinations represents a challenge and gives rise to many questions in a regard to numerous ways of communicating and transferring information. With concern to modern communication practices in society and due to fast-paced lifestyle, individuals are looking for information online and are making decisions based on available Internet data. Attracting tourists through traditional promotional techniques such as brochures, leaflets, printed guidebooks, fairs and festivals are unsufficient with a respect to the rising number of online users. Promotion of tourism is based on destination image which is created through direct or mediated experience and projected on the minds of individuals. It is greatly dependent on available information mostly visual. YouTube is a popular video sharing site that counts over one billion users. It gives open access to a great number of videos and therefore could have an important role in promoting tourist destinations. The website was firstly used for non-commercial purposes but today it is very attractive for advertisers. The author examines phenomena of YouTube and its potential for destination image creation. The aim of this article is to give an insight on characteristics of promotional videos used for tourism and to explore how various national and local tourist boards can use them on YouTube. The author identifies the public relations profession’s role in creation of promotional audio-visual material.

  9. Tradition as an initiator of rural tourism destinations development

    Directory of Open Access Journals (Sweden)

    Antić Aleksandar

    2015-01-01

    Full Text Available Rural tourism is a form of tourism that best illustrates the importance of tradition in the development of tourist destinations. Music, dance, clothing, culinary specialties of local cuisine, unique natural beauty and the very mentality and hospitality of people in rural areas, represent some of the factors that influence the tourist's consciousness when choosing this type of holiday. The research is focused on the main hypothesis that the tradition is an initiator of rural tourism destinations development. Furthermore, this would imply positive effects in the field of tourism and economy in general and the economy of the region. The goal of the paper is to show the importance of tradition in the cultural identity of rural areas and potentials of tradition in the role of initiating rural tourism destinations development. The interview with staff members in Pozarevac Tourism Organization has helped in the SWOT analysis of the observed rural destination. An empirical research is conducted on a random sample of 232 participants in order to highlight the benefits of rural tourism development in Pozarevac and its surrounding area. The data were processed in SPSS program (version 17.0.

  10. Destination brands and website evaluation: a research methodology

    Directory of Open Access Journals (Sweden)

    J Fernández-Cavia

    2013-10-01

    Full Text Available Introduction:The World Wide Web has become the primary instrument used by tourists in order to search for information. As a result, tourism websites pertaining to destinations need to be appealing and must convey their brand image in an appropriate, effective manner. However, there is no methodology in place to assess the quality and communicative effectiveness of destination websites that is scientifically sound and universally accepted. The development of such a methodology is one of the tasks we have proposed within the framework of the research project: “New strategies for advertising and promoting Spanish tourism brands online” (CSO2008-02627, funded by the Spanish Ministry of Science and Innovation. Method: The project team have developed an interdisciplinary, all-embracing analysis template combining certain automated analyses with other qualitative and quantitative ones. The template comprises a total of 12 subject areas and 154 indicators prepared on the basis of contributions from prominent experts in each of the fields of work. This article sets out the analysis methodology drawn up and possible applications are given. Results: The primary aim of the project is to provide an assessment methodology that would make it possible to optimise destination brand websites, thus providing a tool to support the work of public tourism destination managers.

  11. Social Trust, Safety and the Choice of Tourist Destination

    DEFF Research Database (Denmark)

    Jensen, Susanne; Svendsen, Gert Tinggaard

    2016-01-01

    Does social trust influence safety and tourists’ destination choice? Our claim is that the roots of safety may take two forms: either formal institutions or informal institutions. Formal institutions concern how society can build up control mechanisms through the legal system, police authority...

  12. Combinatorial Model Involving Stochastic Choices of Destination, Mode and Route

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Traffic assignment models are one of the basic tools for the analysis and design of transportation systems. However, the existing models have some defects. Considering the characteristics of Chinese urban mixed traffic and the randomness of transportation information, the author develops a combinatorial model involving stochastic choices of destination, mode and route. Its uniqueness and equivalance are also proved by the optimization theory.

  13. Popular Destination Brings in Wealth of Revenue for Nevada

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    <正>Las Vegas,in the western state of Nevada,is one of the most popular tourist destinations in America and the world.It attracts millions of visitors each year who spend$34 billion for a good show and a good time.VOA’s Crystal Park takes a look at the city of neon lights.

  14. IPTV inter-destination synchronization: A network-based approach

    NARCIS (Netherlands)

    Stokking, H.M.; Deventer, M.O. van; Niamut, O.A.; Walraven, F.A.; Mekuria, R.N.

    2010-01-01

    This paper introduces a novel network-based approach to inter-destination media synchronization. The approach meets the need for synchronization in advanced TV concepts like social TV and offers high scalability, unlike conventional end-point based approaches. The solution for interdestination media

  15. Inter-destination media synchronization for TV broadcasts

    NARCIS (Netherlands)

    Mekuria, R.N.

    2011-01-01

    This thesis presents an experimental study to derive requirements for the application of inter-destination media synchronization for TV-broadcasts. It presents a novel measurement system, a set of measurements on real TV broadcasts services and the results of two user experiments involving a total o

  16. ROLE OF INTERVENING OPPORTUNITY IN TOURIST DESTINATION DEVELOPMENT

    Institute of Scientific and Technical Information of China (English)

    PAN Li-li; BAO Ji-gang

    2005-01-01

    Intervening opportunity is an important factor in spatial interaction, and has very important impacts on tourist destination development in a region. There are few literatures on this topic in tourist researches, and especially in China fewer tourist researchers pay attention to intervening opportunity theory. This article, taking Lin'an as a case study, aims to introduce intervening opportunity theory in tourist destination development by the comprehensive analysis of some data including literatures, Intemet information, longitudinal data and some tourist surveys. Both quaitative and quantitative methods are all used in this research. Firstly, the authors expatiate upon the definition of intervening opportunity, by reviewing the literatures in detail, take Lin'an of Zhejiang Province as a case study, and then analyze some necessary factors of intervening opportunity, such as regional tourist demands and supplies, tourist attractions, spatial distance and transportation, tourist images and costs, regional competition and cooperation in tourist destinations. Finally the impacts of intervening opportunity on Lin'an tourist development are analyzed in detail. The results show that intervening opportunity do not occur everywhere, and there must be some critical factors, and intervening opportunity surely plays important roles in tourist destination development. The tourist development in Lin'an is attributed to intervening opportunity of the spatial location between Hangzhou and Huangshan that are two famous tourist cities in China, and the occurrence of intervening opportunities in Lin'an is the integration of some external and internal factors.

  17. THE FESTIVALS AS A TOOL ON OHRID TOURISM DESTINATION BRANDING

    Directory of Open Access Journals (Sweden)

    Zoran Strezovski

    2013-12-01

    Full Text Available The main aim of the paper is about festivals in the southern west city in the Republic of Macedonia – Ohrid, empirical research of influence of the Ohrid summer festival on Ohrid tourism destination branding. Its strength to attract foreign tourist and the role of Ohrid municipality and tourism stockholders to use festival as a tool to attract more foreign tourist and branding Ohrid as a tourism destination. Nowadays, many tourist organization develop strategy for creating or support festivals on their destination. The festivals have strong influence of the destination attracting many foreign tourist. Some cities are branding as a festival cities, attract over million visitors per year. Ohrid summer festival as a member of European festival association, is the most important festival in Ohrid city but also in the country. The festival has the role to promote and present culture achievements from the country but also it is attractive factor for foreign tourist to visit Ohrid city and the region in the summer period. It is held from 12 of July until 20 of August each year. Ohrid municipality should incorporate Ohrid summer festival and other festivals in general promotion on Ohrid city. It should support and create new festivals.This paper presents an action research conducted on a sample of 150 foreign visitors on Ohrid summer festival during the festival from 12 July till 20 august 2010.

  18. An empirical survey on perceived value from tourism destination based on brand equity model: A case study of Qeshm Island

    Directory of Open Access Journals (Sweden)

    Vahid Qaemi

    2012-10-01

    Full Text Available Tourism destination brand equity is defined as all assets (or debts of brands provided with name and symbol of tourism destination to make changes in value services of experiences. In many cases, brand equity is more than physical assets. This survey performs an investigation to identify effective factors in tourism destination equity, cause and affects relationships, and proposes a model for perceived value of tourism destination. The proposed study is performed in one of free islands named Gheshm. The preliminary results indicate that there is a positive relationship between tourism destination brand awareness and destination brand equity, tourism destination brand image, destination brand equity and tourism destination brand loyalty.

  19. STARTING POINT FOR BRANDING SLAVONIA AS A TOURIST DESTINATION

    Directory of Open Access Journals (Sweden)

    Berislav Bolfek

    2012-12-01

    Full Text Available Branding in tourism is a process that selects a particular destination by its characteristics, thus creating destination identity. The greatest success in this process is achieved by emphasizing authenticity, where Slavonia has great potential. By creating international recognisability of the region, a brand attracts investments and a skilled labour force, thus indirectly having a positive effect on export growth. Values that should draw the attention of both domestic and foreign tourists, i.e. values that are sufficiently attractive to bring tourists, are embedded in the brand. These values should be realistically based. Although Slavonia is an underdeveloped region in terms of tourism, it has a realistic perspective to become a desirable tourist destination. The paper provides analysis of the results of the conducted primary research about the perception that tourists have about Slavonia as a tourist destination. One of the goals was to determine the key components and areas that would be used in the future as a foundation for the definition of a unique brand identity of Slavonia and creation of a desirable tourist environment in this area. Based on the conducted research, clear indicators reflect the opinion of tourists which makes Slavonia unique and attractive, being at the same time elements of its unique brand identity. The results showed that the possible strong driving force of tourism development in Slavonia may include products such as rural tourism, thematic events, special interests (cycling, hiking, fishing and hunting, religious tourism, health and nautical tourism. Another conclusion that was made during the research is that Slavonia should aim at the target population. Thus, segmentation results in several target groups such as tourists with special interests, tourists preferring cultural heritage and other traditional values, nature lovers, recreational athletes and athletes. The aim was to gather data that could be used in the

  20. Destination Quality Perception in the Context of Different Behavioural Characteristics of Visitors

    Directory of Open Access Journals (Sweden)

    Ryglová Kateřina

    2016-06-01

    Full Text Available Visitors’ perceptions of the quality of a tourism destination are fundamental for effective destination management and marketing. This paper deals with the topic of destination quality from the viewpoint of demand, i.e. from the viewpoint of a destination visitor. The results of perceiving the destination quality partial factors in the context of different behavioural characteristics of a visitor are presented, particularly, the way how spending and organizing a holiday influences the perception of destination quality factors (Kruskal-Wallis test. The research nineteen factors were designed on the basis of contemporary theories and on qualitative research. Some important quality aspects related to tourism were identified and assessed for the Czech population. The primary data were obtained through a questionnaire survey with quota sampling (n = 1097. The dependence of destination quality perception on the way of spending the holiday was revealed in the case of 8 factors (e.g., Availability of transportation to the destination, Availability and quality of information; Additional infrastructure, Sense of security, Destination cleanliness, Uniqueness of destination, Price level in the destination, Cultural monuments. The significant differences identified among various groups of respondents are described in detail in this study. The research findings contribute to better understanding of the behavioural mechanism and can be used by destination managers to design communication strategies for different segments of consumers for individual destinations to improve their competiveness.

  1. The ADMIT series - Issues in inhalation therapy. 4) How to choose inhaler devices for the treatment of COPD.

    NARCIS (Netherlands)

    Vincken, W.; Dekhuijzen, P.N.R.; Barnes, P.

    2010-01-01

    For patients with COPD, inhalation is the preferred route of administration of respiratory drugs for both maintenance and acute treatment. Numerous inhaler types and devices have been developed, each with their own particularities, advantages and disadvantages. Nevertheless, published COPD managemen

  2. Circulatory support devices: fundamental aspects and clinical management of bleeding and thrombosis.

    Science.gov (United States)

    Susen, S; Rauch, A; Van Belle, E; Vincentelli, A; Lenting, P J

    2015-10-01

    Circulatory support devices are increasingly being used to overcome cardiac or respiratory failure. Long-term devices are used either as a 'bridge to transplant' to support patients who are unable to wait any longer for a heart transplant, or, more recently, as 'destination therapy' for older patients suffering from end-stage heart failure and who have contraindications to heart transplantation. Short-term support devices for high-risk percutaneous coronary intervention, or as a 'bridge for decision' for patients suffering from refractory cardiogenic shock, have also been developed. The clinical benefit of such assist devices has been demonstrated in several important studies, but, unfortunately, thrombotic and bleeding complications are two major clinical issues in patients requiring these devices. Overcoming these issues is of major importance to allow the safe and broad use of these devices, and to consider them as true alternatives to heart transplantation. The present review focuses on thrombotic and bleeding complications, and describes how the risk of thrombosis and bleeding may vary according to the clinical indication, but also according to the type of device. We describe the current knowledge of the mechanisms underlying the occurrence of these complications, provide some guidance for choosing the most appropriate anticoagulation regimen to prevent their occurrence for each type of device and indication, and provide some recommendations for the management of patients when the complication occurs.

  3. A non-randomised, controlled clinical trial of an innovative device for negative pressure wound therapy of pressure ulcers in traumatic paraplegia patients.

    Science.gov (United States)

    Srivastava, Rajeshwar N; Dwivedi, Mukesh K; Bhagat, Amit K; Raj, Saloni; Agarwal, Rajiv; Chandra, Abhijit

    2016-06-01

    The conventional methods of treatment of pressure ulcers (PUs) by serial debridement and daily dressings require prolonged hospitalisation, associated with considerable morbidity. There is, however, recent evidence to suggest that negative pressure wound therapy (NPWT) accelerates healing. The commercial devices for NPWT are costly, cumbersome, and electricity dependent. We compared PU wound healing in traumatic paraplegia patients by conventional dressing and by an innovative negative pressure device (NPD). In this prospective, non-randomised trial, 48 traumatic paraplegia patients with PUs of stages 3 and 4 were recruited. Patients were divided into two groups: group A (n = 24) received NPWT with our NPD, and group B (n = 24) received conventional methods of dressing. All patients were followed up for 9 weeks. At week 9, all patients on NPD showed a statistically significant improvement in PU healing in terms of slough clearance, granulation tissue formation, wound discharge and culture. A significant reduction in wound size and ulcer depth was observed in NPD as compared with conventional methods at all follow-up time points (P = 0·0001). NPWT by the innovative device heals PUs at a significantly higher rate than conventional treatment. The device is safe, easy to apply and cost-effective.

  4. Images of safe tourism destinations in the United States held by African Americans

    Directory of Open Access Journals (Sweden)

    Bingjie Liu

    2013-07-01

    Full Text Available Ensuring a safe destination is an essential factor in travelers’ decision-making, as well as a destination’s success. Recent crises have threatened perceptions of safety related to tourism. Under such circumstances, negative destination images might be produced and destination choices might be altered. Thus, understanding the effect of risk perceptions on destination image is a necessary researchstream. This study examined African American travelers’ perceptions of safety related to the top three state tourism destinations in the USA. Factors that influenced perceptions of a safe destination varied among the destinations. Consistently, however, past travel experience and the perception of the likelihood of health-related crisis were significant predictors of perceptions of a safe destination

  5. Manipulator for the therapy of breast cancer in the magnetic-resonance-tomography-device (MRT); Manipulator fuer die Therapie von Mammakarzinomen im Magnetresonanztomographen (MRT)

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, H.; Selig, M.; Vagner, J. [Institut fuer Molekulare Biotechnologie (IMB), Jena (Germany); Kaiser, W.A. [Jena Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie

    2000-07-01

    A significant progress has been achieved in the diagnosis of small sized mamma carcinomas by magnetic resonance mammography. Diagnosis and therapy in one turn using the same machine would enhance precision and reduce cost of the intervention, minimizing the patient's strain and side effects. A manipulator with a biopsy unit will be presented allowing the combination of diagnostic imaging with biopsy and subsequent therapy. Tests have shown that a marked target could be reached reproducibly. It was placed within a pig liver in the isocenter of a MRT running with a magnetic field of 1.5 T. (orig.)

  6. Tourist Profile and Destination Brand Perception: The Case of Cape Town, South Africa

    OpenAIRE

    Ikechukwu O Ezeuduji; Kirsti Lee November; Chelsea Haupt

    2016-01-01

    Tourists pay for destination brands. This study checked for the relationships between tourists’ profile and how they perceived the destination brand of Cape Town. A questionnaire survey of 220 tourists visiting Cape Town was done. This study found that repeat visit, age of tourist, length of stay, and tourist origin, have significant influences on how tourists visiting Cape Town perceived the destination. The top three destination attributes of Cape Town (cognitive images), which ...

  7. 19 CFR 18.23 - Change of destination; change of entry.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Change of destination; change of entry. 18.23... the United States to Foreign Countries § 18.23 Change of destination; change of entry. (a) The foreign destination of such merchandise may be changed by the parties in interest upon notice to the director of...

  8. 14 CFR 135.393 - Large nontransport category airplanes: Landing limitations: Destination airports.

    Science.gov (United States)

    2010-01-01

    ...: Landing limitations: Destination airports. 135.393 Section 135.393 Aeronautics and Space FEDERAL AVIATION... category airplanes: Landing limitations: Destination airports. (a) No person operating a large nontransport... effective length of the most suitable runway at the destination airport; and (2) Is greater than the...

  9. Country Image and the Study Abroad Destination Choice of Students from Mainland China

    Science.gov (United States)

    Ghazarian, Peter G.

    2016-01-01

    In this study, the author focuses on the issue of country image in destination choice. To examine the relationship between these two variables, the study tests whether mainland Chinese who favor a destination as their ideal first choice for study abroad have a significantly more positive view of that destination's country image than their…

  10. The Changing Relationship between Origins, Education and Destinations in the 1990s and 2000s

    Science.gov (United States)

    Devine, Fiona; Li, Yaojun

    2013-01-01

    This paper examines the changing relationship between origins, education and destinations in mobility processes. The meritocracy thesis suggests the relationships between origins and education and between origins and destination will weaken while the relationship between education and destinations will strengthen. Comparing data from the 1991…

  11. Marketing and Brand Design of Destination Experiences: The Role of ICT

    OpenAIRE

    Dora Agapito; António Lacerda

    2014-01-01

    The proliferation of Information and Communication Technologies (ICT) with particular emphasis on internet have been rapidly adapted to tourism, where new opportunities for design and marketing strategies for destinations are being explored in both physical and virtual environments. Furthermore, the process of designing strong brands and facilitating positive and memorable experiences are central activities concerning destinations aiming to become more competitive. Accordingly, Destinations M...

  12. 75 FR 19882 - Safety Zone; Benchmark Destination Corporate Party, Fireworks Display, San Francisco, CA

    Science.gov (United States)

    2010-04-16

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Benchmark Destination Corporate Party... support of the Benchmark Destination Corporate Party Fireworks Display. This safety zone is being... City of San Francisco will sponsor the Benchmark Destinations Corporate Party Fireworks Display on...

  13. Competitiveness as an Indicator of Sustainable Development of Tourism: Applying Destination Competitiveness Indicators to Ethiopia

    NARCIS (Netherlands)

    Wondowossen, T.A.; Nakagoshi, N.; Yukio, Y.; Jongman, R.H.G.; Dawit, A.Z.

    2014-01-01

    Competitiveness can be applied to predict the economic sustainability of tourism in destinations which has been measured in terms of leakages and linkage related to employment and income generation opportunities to the destinations. This article examines destination competitiveness of Ethiopia based

  14. Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion

    Directory of Open Access Journals (Sweden)

    Khayat Andre

    2011-01-01

    Full Text Available Abstract We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies.

  15. PROMOTING TOURIST DESTINATIONS THROUGH SPORT EVENTS. THE CASE OF BRASOV

    OpenAIRE

    Adina Nicoleta CANDREA; Ana ISPAS

    2010-01-01

    Sport event tourism is a huge and growing global industry with important economic implications for both the sport, the event and the impact of travel and tourism related benefits on host destinations. A primary function of a sport event is to provide the host community with an opportunity to secure high prominence in the tourism market place. However, international or regional prominence may be gained with significant social and environmental costs. Hosting sport events has been a focus of de...

  16. Destination brand equity research from 2001 to 2012

    OpenAIRE

    Kladou, Stella; Giannopoulos, Antonios A.; Mavragani, Eleni

    2015-01-01

    The present study delves into a review of the destination brand equity literature published since 2001, aiming to offer tourism researchers a reference guide to the general context, corresponding methods,and focus of previous works. A multisource search resulted in the identification of 64 relevant papers. Content analysis using multiple classifier variables provides further insights into specific geographical, conceptual, and methodological aspects. Conclusions pertain to the multidimensiona...

  17. Immigration and Economic Growth: Do Origin and Destination Matter?

    OpenAIRE

    Kang, Young ho; Kim, Byung Yeon

    2012-01-01

    This paper assesses the heterogeneous effects of immigration on economic growth depending on both the origin and the destination countries. Following the development of a simple growth model augmented by the embodied human capital of immigrants, we estimate the growth equation using both a gravity-style instrument variable approach and the dynamic system-GMM estimator. We find that immigration from developed economies positively affects the economic growth of the host countries. Furthermore, ...

  18. Complex Behaviour for the Origin and Destination Matrix Estimation Problem

    Institute of Scientific and Technical Information of China (English)

    SUN Hui-Jun; WU Jian-Jun

    2006-01-01

    @@ The origin and destination (O-D) matrix estimation is an important problem in traffic networks. We apply the gravitation model to express the preference attachment and to analyse the statistical characteristics of the traffic flow in each O-D pair in theory. It is found that the distribution of the future O-D matrix decays as a power law.Additionally, different exponents are obtained for both the constant and variable link cost.

  19. STRATEGY FOR THE DESTINATIONAL E-MARKETING & SALES

    OpenAIRE

    Zlatko Sehanovic; Giorgio Cadum; Igor Sehanovic

    2010-01-01

    Every tourist destination should make and implement a destination’s marketing and sales strategy. A very important part of destination’s sales and marketing strategy is the e-marketing and sales strategy. The cooperation of specialized regional development agencies, regional tourist board, local (city and county) tourist boards, hoteliers, tourist agencies, conservators, entertainment and cultural program developers, private accommodation owners and others involved in creation of destination’...

  20. Dark destinations – Visitor reflections from a holocaust memorial site

    OpenAIRE

    Liyanage, Sherry; Coca-Stefaniak, Andres; Powell, Raymond

    2015-01-01

    Abstract\\ud \\ud Purpose – Dark tourism and, more specifically, visitor experiences at Nazi concentration camp memorials are emerging fields of research in tourism studies and destination management. This paper builds on this growing body of knowledge and focuses on the World War II Nazi concentration camp at Dachau in Germany to explore the psychological impact of the site on its visitors as well as critical self-reflection processes triggered by this experience.\\ud \\ud Design/methodology/app...

  1. Endocarditis in left ventricular assist device

    Science.gov (United States)

    Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Sikachi, Rutuja R; Agrawal, Abhinav

    2016-01-01

    Summary Heart failure is one of the leading causes of death in developed nations. End stage heart failure often requires cardiac transplantation for survival. The left ventricular assist device (LVAD) has been one of the biggest evolvements in heart failure management often serving as bridge to transplant or destination therapy in advanced heart failure. Like any other medical device, LVAD is associated with complications with infections being reported in many patients. Endocarditis developing secondary to the placement of LVAD is not a frequent, serious and difficult to treat condition with high morbidity and mortality. Currently, there are few retrospective studies and case reports reporting the same. In our review, we found the most common cause of endocarditis in LVAD was due to bacteria. Both bacterial and fungal endocarditis were associated with high morbidity and mortality. In this review we will be discussing the risk factors, organisms involved, diagnostic tests, management strategies, complications, and outcomes in patients who developed endocarditis secondary to LVAD placement. PMID:27672540

  2. Sustainable Coastal Destination Development: Fostering Green Practices of Restaurateurs

    Directory of Open Access Journals (Sweden)

    Timo Derriks

    2015-12-01

    Full Text Available Coastal tourism destinations are reinventing themselves, concentrating on product improvement and image enhancement. Reinventing sustainably is key and restaurants are an important factor. Research upon the processes of change in the industry seems to be fragmented and undefined in its conclusions. Knowledge is lacking on what specifically drives innovation in the hospitality industry. Since restaurants seem to be focusing more than ever on implementing green strategies, incorporating sustainability into restaurant practices is not an unexplored area. However, the how and why it is incorporated or not, can be different per restaurant. The objective of this study is to identify possibilities of change in restaurateur practices, which can lead to interventions that will foster sustainable destination development in Vrouwenpolder; a coastal destination within the Netherlands. For the identification of interventions that could advance the sustainability enacted in restaurateur practices, a qualitative research was conducted. Practices of restaurateurs in Vrouwenpolder are identified and compared to perceived-to-be ideal practices. Analysis of data collection draws on practice theory, and resulted into recommendations for advancing the sustainability enacted in restaurateur practices. It seems to be that primarily the meaning within a practice is decisive in whether sustainability is integrated or not.

  3. BRAND EQUITY OF LAHORE FORT AS A TOURISM DESTINATION BRAND

    Directory of Open Access Journals (Sweden)

    Muhammad Kashif

    2015-06-01

    Full Text Available Studies that measure the brand equity of destination brands by using the Customer-Based Brand Equity (CBBE model in a developing country context are scarce. The present study investigates the destination brand equity of the Lahore Fort by employing the CBBE model in a developing country context of Pakistan. Following the positivist tradition, we adopted a survey-based approach to collect data from 237 tourists visiting the Lahore Fort. Data were collected through a questionnaire developed to explain the relationship of brand awareness, brand image, brand association, and brand loyalty with Lahore Fort’s overall brand equity. We used various robust statistical techniques such as correlation, regression and confirmatory factor analysis (using PLS method to reach meaningful conclusions and found that brand image and brand associations positively contribute to brand loyalty. Furthermore, brand loyalty significantly contributes towards overall brand equity. Pragmatically, this study measures the customer based brand equity of the Lahore Fort, a destination brand. The results are useful as they suggest a few strategies that can help policy makers to enhance Lahore Fort’s brand performance.

  4. FACTORS AFFECTING CITY DESTINATION CHOICE AMONG YOUNG PEOPLE IN SERBIA

    Directory of Open Access Journals (Sweden)

    Nemanja Tomić

    2015-07-01

    Full Text Available The main goal of this study is to explore factors which influence city destination choice among young people in Serbia. In order to achieve this we conducted a survey consisting of 20 different items influencing the choice of city destination. Afterwards the principal component exploratory factor analysis (EFA was carried out in order to extract factors. T-test and ANOVA test were also used to determine if there is a difference between different gender and age groups in terms of which factors influence their choice of a city destination. The results indicate four motivating factors extracted by factor analysis, from which Good hospitality and restaurant service seems to be the major motivating factor. The results also show that respondents belonging to the age group of under 25 give more importance to Information and promotion as well as to Good hospitality and restaurant service than those belonging to older age groups. The same two factors are also more important to females than males.

  5. Posterior Wall Capture and Femoral Artery Stenosis Following Use of StarClose Closing Device: Diagnosis and Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Stefanczyk, Ludomir [Medical University of Lodz, First Department of Radiology and Diagnostic Imaging (Poland); Elgalal, Marcin T., E-mail: telgalal@yahoo.co.uk [Medical University of Lodz, Second Department of Radiology and Diagnostic Imaging (Poland); Szubert, Wojciech; Grzelak, Piotr [Medical University of Lodz, First Department of Radiology and Diagnostic Imaging (Poland); Szopinski, Piotr [Institute of Haematology and Transfusion Medicine, Department of Vascular Surgery (Poland); Majos, Agata [Medical University of Lodz, Second Department of Radiology and Diagnostic Imaging (Poland)

    2013-10-15

    A case of femoral artery obstruction following application of a StarClose type arterial puncture closing device (APCD) is presented. Ultrasonographic and angiographic imaging of this complication was obtained. The posterior wall of the vessel was accidentally caught in the anchoring element of the nitinol clip. This complication was successfully resolved by endovascular treatment and the implantation of a stent.

  6. Development of Diversified Tourism Destination Products – A Case Study of Tourism Destination, Municipality of Sofia, Bulgaria

    Directory of Open Access Journals (Sweden)

    Elena PETKOVA

    2017-03-01

    Full Text Available In this paper, it is argued that there is a variety of products and accordingly a diversity of types of tourism in the municipality of Sofia, Bulgaria: urban and "non-urban", mass and specialized, tourism based on natural and anthropogenic, on tangible and intangible resources. In this regard, diverse tourism products of the destination may be offered to its visitors, which to a greater extent meets their various needs and contributes to the sustainable tourism development. Thus, the aim of the paper is to reveal whether tourism professionals in Sofia are aware of the possibilities for combining various types of tourism and promoting the diversified destination tourism product among local and foreign visitors.

  7. Longevity of implantable cardioverter-defibrillators for cardiac resynchronization therapy in current clinical practice: an analysis according to influencing factors, device generation, and manufacturer.

    Science.gov (United States)

    Landolina, Maurizio; Curnis, Antonio; Morani, Giovanni; Vado, Antonello; Ammendola, Ernesto; D'onofrio, Antonio; Stabile, Giuseppe; Crosato, Martino; Petracci, Barbara; Ceriotti, Carlo; Bontempi, Luca; Morosato, Martina; Ballari, Gian Paolo; Gasparini, Maurizio

    2015-08-01

    Device replacement at the time of battery depletion of implantable cardioverter-defibrillators (ICDs) may carry a considerable risk of complications and engenders costs for healthcare systems. Therefore, ICD device longevity is extremely important both from a clinical and economic standpoint. Cardiac resynchronization therapy defibrillators (CRT-D) battery longevity is shorter than ICDs. We determined the rate of replacements for battery depletion and we identified possible determinants of early depletion in a series of patients who had undergone implantation of CRT-D devices. We retrieved data on 1726 consecutive CRT-D systems implanted from January 2008 to March 2010 in nine centres. Five years after a successful CRT-D implantation procedure, 46% of devices were replaced due to battery depletion. The time to device replacement for battery depletion differed considerably among currently available CRT-D systems from different manufacturers, with rates of batteries still in service at 5 years ranging from 52 to 88% (log-rank test, P < 0.001). Left ventricular lead output and unipolar pacing configuration were independent determinants of early depletion [hazard ratio (HR): 1.96; 95% 95% confidence interval (CI): 1.57-2.46; P < 0.001 and HR: 1.58, 95% CI: 1.25-2.01; P < 0.001, respectively]. The implantation of a recent-generation device (HR: 0.57; 95% CI: 0.45-0.72; P < 0.001), the battery chemistry and the CRT-D manufacturer (HR: 0.64; 95% CI: 0.47-0.89; P = 0.008) were additional factors associated with replacement for battery depletion. The device longevity at 5 years was 54%. High left ventricular lead output and unipolar pacing configuration were associated with early battery depletion, while recent-generation CRT-Ds displayed better longevity. Significant differences emerged among currently available CRT-D systems from different manufacturers. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  8. THE PROMOTION OF CULTURAL TOURISM ON THE LEVEL OF BELGRADE AS A TOURIST DESTINATION

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    Radomir Stojanovic

    2010-12-01

    Full Text Available Cultural contents are among the most important elements of the overall cultural offer of big city destinations.The importance of cultural tourism promotion is especially significant in big cities, in their endeavors to create an image of authentic destination and in a psychological differentiation compared to competitive city destinations. Namely, cultural and natural attractions are the ones by which some city, as a destination, differs from the others, while some other factors of tourist offer (for instance, receptive factors, especially hotels within international hotel chains offer uniform and standardized services in all destinations

  9. Electronic device for measuring the polarization parameter in the {pi}{sup -}p {yields} {pi}{sup 0}n charge exchange reaction on a polarized proton target; Un appareillage electronique destine a la mesure du parametre de polarisation dans la reaction d'echange de charge {pi}{sup -}p {yields} {pi}{sup 0}n sur cible de protons polarises

    Energy Technology Data Exchange (ETDEWEB)

    Brehin, S. [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

    1967-12-15

    An electronic apparatus has been constructed to measure the polarization parameter P{sub 0}(t) in {pi}{sup -}p {yields} {pi}{sup 0}n charge exchange scattering at 5.9 GeV/c and 11,2 GeV/c on polarized proton target. This device insures triggering of a heavy plate spark chamber, allowing visualisation of {gamma} rays from the {pi}{sup 0} decays when the associated neutron offers suitable characteristics in direction and energy. The neutron is detected by an array of 32 counters and his energy is measured by a time of flight method. Electronic circuits of this apparatus are described as test and calibration methods used. (author) [French] Un appareillage electronique a ete realise pour mesurer le parametre de polarisation P{sub 0}(t) dans la reaction d'echange de charge {pi}{sup -}p {yields} {pi}{sup 0}n a 5,9 GeV/c et 11,2 GeV/c sur une cible de protons polarises. Ce dispositif assure le declenchement d'une chambre a etincelles a plaques lourdes, permettant de visualiser les {gamma} de desitegration du {pi}{sup 0}, lorsque le neutron associe presente les caracteristiques convenables en direction et en energie. Le neutron est detecte par un ensemble de 32 compteurs et son energie est mesuree par une methode de temps de vol. Les circuits composant cet appareillage sont decrits ainsi que les methodes d'etalonnage et de verification utilisees. (auteur)

  10. Evolvement of left ventricular assist device: the implications on heart failure management.

    Science.gov (United States)

    Chair, Sek Ying; Yu, Doris Sf; Ng, Michael Timothy; Wang, Qun; Cheng, Ho Yu; Wong, Eliza Ml; Sit, Janet Wh

    2016-07-01

    Heart failure (HF) is a potentially fatal disease that affects increasing number of people worldwide. Although heart transplant is the "gold standard" therapy for HF, due to the limited availability of organs, many patients died when waiting for the transplant. Left ventricular assist device (LVAD), as a mechanical circulatory support, has become a new light for patients with HF. With the technical advancements, LVADs work not only as a bridge to transplant, but also assist heart recovery and even as a destination therapy in long-term treatment. This observation paper reviewed the development of LVAD and its clinical roles. The challenges and possible solutions in nursing care for patients with LVAD at different stage of implantation were discussed. The healthcare professionals could obtain a better understanding about the LVAD treatment for HF patients.

  11. Exploring the Personality Traits of Portugal as a Tourist Destination: Perspective of the Czech Market

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    Manuela Guerreiro

    2015-06-01

    Full Text Available The personality of a destination is vital to build a coherent destination brand and strengthen the place identity. Furthermore, brand personality appears in literature as a strategic axis that can be explored by tourist destinations in order to differentiate themselves from competitors. Since a brand encompasses not only functional but also symbolic elements, its image, as perceived by consumers, can be assessed with respect to both its functional and psychological components. Hence, this exploratory study investigates the brand personality of Portugal as a tourist destination, from the perspective of the Czech market, through a destination image approach. The online survey instrument included open-ended items to depict functional and psychological destination features and additional questions to characterize the profile of a sample of Czech university students. The main findings of this research highlight positive personality traits that are related to the brand of Portugal, which suggest its potential as a vacation destination for the Czech market under study.

  12. The Process of Managing a Destination in Lower and Upper Austria

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    Bobková Markéta

    2015-12-01

    Full Text Available The focus of the submitted article is to introduce the findings of author’s research in the area of destination management process conducted in the developed (Alpine tourist destinations in the year of 2014. The theoretical part based on a literature review summarizes current knowledge dealing with the destination management process in terms of approaches and research findings. Problems influencing either positively or negatively this process, e.g. financing, legislation or cooperation among stakeholders are also defined. The practical application part includes an analysis of model destinations in Lower Austria and Upper Austria and presents the results of qualitative research conducted in these destinations. The collected information can be used to design methods leading to the improvement of the destination management process in tourist less developed destinations.

  13. Failure of antibiotic therapy in Staphylococcus epidermidis infection of implantable venous access devices in patients with AIDS, as documented by molecular typing.

    Science.gov (United States)

    Piketty, Christophe; Hoï, Annie Buu; Gilquin, Jacques; Casetta, Anne; Castiel, Philippe; Vaupre, Sabine; Gutmann, Laurent; Kazatchkine, Michel D.

    1999-04-01

    OBJECTIVE: To study the efficacy and safety of high-concentration antibiotic locks in association with systemic antibiotherapy in Staphylococcus epidermidis infections of totally implantable venous access devices (TIVADs) in patients with AIDS. METHODS: Thirty-one episodes of S. epidermidis TIVAD infection were observed in nine patients. Locks consisted of high concentrations of aminoglycosides or vancomycin according to antibiogram results (susceptibility results obtained with the disk diffusion technique). Genotyping of bacterial strains was performed by pulsed-field gel electrophoresis (PFGE) in 26 of the 31 infectious episodes. RESULTS: The infections occurred within a median period of 62 catheter-days. The median duration of systemic antibiotic therapy was 17.5 days in association with a median of three antibiotic locks. Failure as defined by the occurrence of a novel episode within 2 months was observed in 17 of the 31 infections (58%). According to the PFGE results, relapse with the same strain of S. epidermidis or reinfection with a different strain of S. epidermidis could be assigned to 10 episodes which failed to respond to therapy. Relapse was observed in six of 10 episodes. Four episodes were followed by the occurrence of a novel infection with a different S. epidermidis strain. In one patient, a relapse occurred despite TIVAD removal. CONCLUSION: Our observations further document the poor efficacy of associating antibiotic locks with systemic antibiotic therapy for the treatment of TIVAD infections in patients with AIDS.

  14. Right ventricular stimulation threshold at ICD implant predicts device therapy in primary prevention patients with ischaemic heart disease.

    Science.gov (United States)

    Atary, Jael Z; Borleffs, C Jan Willem; van der Bom, Johanna G; Trines, Serge A I P; Bootsma, Marianne; Zeppenfeld, Katja; van Erven, Lieselot; Schalij, Martin J

    2010-11-01

    Myocardial excitability is known (amongst other reasons) to be related to the degree of ischaemia, contractile dysfunction and heart failure. It was hypothesized that the right ventricular (RV) stimulation threshold has prognostic value with respect to the occurrence of ventricular arrhythmias (VAs) and patient survival in recipients of an implantable cardioverter defibrillator (ICD). Ischaemic heart disease patients receiving an ICD at Leiden University Medical Center as primary prevention for sudden cardiac death were included in this study. Right ventricular thresholds were determined at ICD implant. Data were collected on VAs triggering ICD therapy and on all-cause mortality. A total of 689 consecutive patients were included (87% male, age 63 ± 11 years, left ventricular ejection fraction (LVEF) 29 ± 11%) and followed for a median of 28 months. Post-implant RV-threshold was 0.7 ± 0.5 volt (V) at 0.5 ms pulse duration. Best dichotomous separation was reached at a cut-off of 1 V. During follow-up, 167 (24%) patients received appropriate ICD therapy, 88 (13%) had appropriate shocks and 134 (19%) died. Cumulative appropriate shock incidence for patients with RV threshold ≥ 1 V (n = 166) was 16% at 1 year, 24% at 3 years and 34% at 5 years compared with 4, 11 and 17% for patients with an RV-threshold implant has a strong independent prognostic value for the occurrence of VAs triggering appropriate ICD therapy, appropriate shocks and mortality.

  15. A controlled trial of the Litebook light-emitting diode (LED light therapy device for treatment of Seasonal Affective Disorder (SAD

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    Telner John

    2007-08-01

    Full Text Available Abstract Background Recent research has emphasized that the human circadian rhythm system is differentially sensitive to short wavelength light. Light treatment devices using efficient light-emitting diodes (LEDs whose output is relatively concentrated in short wavelengths may enable a more convenient effective therapy for Seasonal Affective Disorder (SAD. Methods The efficacy of a LED light therapy device in the treatment of SAD was tested in a randomized, double-blind, placebo-controlled, multi-center trial. Participants aged 18 to 65 with SAD (DSM-IV major depression with seasonal pattern were seen at Baseline and Randomization visits separated by 1 week, and after 1, 2, 3 and 4 weeks of treatment. Hamilton Depression Rating Scale scores (SIGH-SAD were obtained at each visit. Participants with SIGH-SAD of 20 or greater at Baseline and Randomization visits were randomized to active or control treatment: exposure to the Litebook LED treatment device (The Litebook Company Ltd., Alberta, Canada which delivers 1,350 lux white light (with spectral emission peaks at 464 nm and 564 nm at a distance of 20 inches or to an inactivated negative ion generator at a distance of 20 inches, for 30 minutes a day upon awakening and prior to 8 A.M. Results Of the 26 participants randomized, 23 completed the trial. Mean group SIGH-SAD scores did not differ significantly at randomization. At trial end, the proportions of participants in remission (SIGH-SAD less than 9 were significantly greater (Fisher's exact test, and SIGH-SAD scores, as percent individual score at randomization, were significantly lower (t-test, with active treatment than with control, both in an intent-to-treat analysis and an observed cases analysis. A longitudinal repeated measures ANOVA analysis of SIGH-SAD scores also indicated a significant interaction of time and treatment, showing superiority of the Litebook over the placebo condition. Conclusion The results of this pilot study support

  16. Selling the favela: thoughts and polemics about a tourist destination

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    Bianca Freire-Medeiros

    2008-01-01

    Full Text Available The article discusses the development of the favela into a tourist attraction, examining how promoters in four different favelas attempted to actually place them in the tourist market. The development of the favela into a tourist destination is seen as part of the so-called reality tours phenomenon and of the global circulation of the favela as a trademark. The methodology included different strategies: long interviews with qualified informants, field observation, and participant observation in different tours. The article concludes with some thoughts on my own research experience on such a polemic field of investigation.

  17. The Role of Destination Attributes in Islamic Tourism

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    Battour Mohamed

    2014-01-01

    Full Text Available The objectives of this study are to test the relationship between tourism motivations and tourist satisfaction, and to test how ‘Religion’ moderates the relationship. The variable ‘Religion’ is represented by the availability of Islamic norms and practices which are relevant to tourism at the destination. The results of the Partial least square (PLS indicated that the tourism motivations are significantly and positively related to tourist satisfaction. The results also showed that Religion significantly moderates the relationship between pull motivation and tourist satisfaction. However, the moderating effect of Religion on the relationship between push motivation and tourist satisfaction was not supported.

  18. NASA Technology Area 07: Human Exploration Destination Systems Roadmap

    Science.gov (United States)

    Kennedy, Kriss J.; Alexander, Leslie; Landis, Rob; Linne, Diane; Mclemore, Carole; Santiago-Maldonado, Edgardo; Brown, David L.

    2011-01-01

    This paper gives an overview of the National Aeronautics and Space Administration (NASA) Office of Chief Technologist (OCT) led Space Technology Roadmap definition efforts. This paper will given an executive summary of the technology area 07 (TA07) Human Exploration Destination Systems (HEDS). These are draft roadmaps being reviewed and updated by the National Research Council. Deep-space human exploration missions will require many game changing technologies to enable safe missions, become more independent, and enable intelligent autonomous operations and take advantage of the local resources to become self-sufficient thereby meeting the goal of sustained human presence in space. Taking advantage of in-situ resources enhances and enables revolutionary robotic and human missions beyond the traditional mission architectures and launch vehicle capabilities. Mobility systems will include in-space flying, surface roving, and Extra-vehicular Activity/Extravehicular Robotics (EVA/EVR) mobility. These push missions will take advantage of sustainability and supportability technologies that will allow mission independence to conduct human mission operations either on or near the Earth, in deep space, in the vicinity of Mars, or on the Martian surface while opening up commercialization opportunities in low Earth orbit (LEO) for research, industrial development, academia, and entertainment space industries. The Human Exploration Destination Systems (HEDS) Technology Area (TA) 7 Team has been chartered by the Office of the Chief Technologist (OCT) to strategically roadmap technology investments that will enable sustained human exploration and support NASA s missions and goals for at least the next 25 years. HEDS technologies will enable a sustained human presence for exploring destinations such as remote sites on Earth and beyond including, but not limited to, LaGrange points, low Earth orbit (LEO), high Earth orbit (HEO), geosynchronous orbit (GEO), the Moon, near

  19. Going Round in Circles: Mobility, Destination and Experience

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    Alan Clarke

    2011-10-01

    Full Text Available This paper addresses the changing approaches to transport in urban tourism as seen through the move from functional sectoral accounts towards a perspective informed by the experience economy. By reviewing the traditional service offers, it is possible to unpack what lies within the service dominant logics that lead to co-creation of value and the realisation of quality tourism experiences. The paper then considers the adoption and adaptation of traditional forms of transport within the value proposition in urban tourism. Mobility in tourism is a strangely new focus of attention, strangely because without it there would be no tourism to speak of. However mobility requires a framework of civil and legal entitlements that allow people to move and a transport infrastructure that allows those rights to be realised in both working and leisure time situations. This article will address the construction of the tourism transport infrastructure by examining the ways in which the transportation elements in mobility have been re-thought within tourism. The first part of the paper will re-construct an account of transport and mobility which deals with it in terms of the functions and logistics of delivery, both between points of origin and destinations, and within destinations. These perspectives can be seen in the texts which shape the basic tourism curriculum (Cooper et al, 2008; Page, 2009 and explain how tourism and transport have developed over the years by integrating the opportunities provided by the new technologies – motorised vehicles (both cars and coaches, trains, ships and aeroplanes – to allow for the development of a range of destinations. Lumsdon and Page (2004 introduced a new approach to transport and tourism by distinguishing between transport for tourism and transport as tourism, which provides a linkage between the first and second parts of this article. The second part will develop an account of mobility in tourism that demonstrates

  20. Tourism Destination Management – New Approaches in Romania

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    Gabriela Tigu

    2013-07-01

    Full Text Available Tourism is an important industry for a long time, even vital in some countries, while being an important employer. Romania has an important tourism potential and a background which can be an important tourist destination. The paper proposes to analise development strategies for three forms of tourism -spa, mountain, coastal- in European context. The hypothesis is that the Romanian tourism, for all forms analised, are in a process of readjustment to the current requirements of international tourist market, in a period of transition and transformations.

  1. Going round in circles: mobility, destination and experience

    Directory of Open Access Journals (Sweden)

    Alan Clarke

    2010-10-01

    Full Text Available This paper addresses the changing approaches to transport in urban tourism as seen through the move from functional sectoral accounts towards a perspective informed by the experience economy. By reviewing the traditional service offers, it is possible to unpack what lies within the service dominant logics that lead to co-creation of value and the realisation of quality tourism experiences. The paper then considers the adoption and adaptation of traditional forms of transport within the value proposition in urban tourism. Mobility in tourism is a strangely new focus of attention, strangely because without it there would be no tourism to speak of. However mobility requires a framework of civil and legal entitlements that allow people to move and a transport infrastructure that allows those rights to be realised in both working and leisure time situations. This article will address the construction of the tourism transport infrastructure by examining the ways in which the transportation elements in mobility have been re-thought within tourism. The first part of the paper will re-construct an account of transport and mobility which deals with it in terms of the functions and logistics of delivery, both between points of origin and destinations, and within destinations. These perspectives can be seen in the texts which shape the basic tourism curriculum and explain how tourism and transport have developed over the years by integrating the opportunities provided by the new technologies – motorised vehicles (both cars and coaches, trains, ships and aeroplanes – to allow for the development of a range of destinations. Lumsdon and Page (2004 introduced a new approach to transport and tourism by distinguishing between transport for tourism and transport as tourism, which provides a linkage between the first and second parts of this article. The second part will develop an account of mobility in tourism that demonstrates how their uniqueness derives

  2. Iconic Destination: a Snapshot of Sustainable Tourism in Pisa

    Directory of Open Access Journals (Sweden)

    Silvia Sarti

    2015-12-01

    Full Text Available Tourism is one of the world's fastest growing industries. According to the World Tourism Organization, Italy is the fifth most visited country in the world, with more than 47.7 million tourists a year (2013. At the same time, the increasing number of studies focused on sustainable tourism demonstrates a growing interest about the topic. In addition, practitioners’ attitude is changing and the most important actors of the market are acting in a more sustainable way and developing reports on their eco-friendly performances. Nowadays, the entire supply chain maybe environmentally sustainable. From the reservation to the post-holiday phase, it is possible to select the more eco-friendly suppliers. The main companies operating in the different stages of the process are demonstrating a concrete interest on sustainable development. This new challenge is generated through the information flow between local authorities, private firms and final customers. We propose to make a reflection based on the latter actors’ attitude. Our research aims to investigate the level of sensitivity of tourists about environmental sustainability from two different perspectives: self-evaluation and real purchasing behavior. We conducted a face-to-face survey among tourists in Pisa, in Piazza dei Miracoli, during May 2015. By using a structured questionnaire, we gathered primary data from a sample of 406 respondents. We selected respondents randomly. Pisa is the perfect location to obtain information from several typologies of tourists, with different levels of awareness of sustainable issues. Itis one of the most important tourist destination in Italy and it is an iconic destination recognized worldwide thanks to the attractiveness of the leading tower. The results of our study is a snapshot of the current level of awareness among tourists. The analysis of the questionnaires revealed tourist profiles, their eco-friendly behaviors, their concerns about sustainability

  3. Neutron production from beam-modifying devices in a modern double scattering proton therapy beam delivery system.

    Science.gov (United States)

    Pérez-Andújar, Angélica; Newhauser, Wayne D; Deluca, Paul M

    2009-02-21

    In this work the neutron production in a passive beam delivery system was investigated. Secondary particles including neutrons are created as the proton beam interacts with beam shaping devices in the treatment head. Stray neutron exposure to the whole body may increase the risk that the patient develops a radiogenic cancer years or decades after radiotherapy. We simulated a passive proton beam delivery system with double scattering technology to determine the neutron production and energy distribution at 200 MeV proton energy. Specifically, we studied the neutron absorbed dose per therapeutic absorbed dose, the neutron absorbed dose per source particle and the neutron energy spectrum at various locations around the nozzle. We also investigated the neutron production along the nozzle's central axis. The absorbed doses and neutron spectra were simulated with the MCNPX Monte Carlo code. The simulations revealed that the range modulation wheel (RMW) is the most intense neutron source of any of the beam spreading devices within the nozzle. This finding suggests that it may be helpful to refine the design of the RMW assembly, e.g., by adding local shielding, to suppress neutron-induced damage to components in the nozzle and to reduce the shielding thickness of the treatment vault. The simulations also revealed that the neutron dose to the patient is predominated by neutrons produced in the field defining collimator assembly, located just upstream of the patient.

  4. Competitiveness of Serbia as a tourist destination: Analysis of selected key indicators

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    Popesku Jovan

    2013-01-01

    Full Text Available To achieve the favourable competitiveness position, tourist destination has to offer quality experiences to tourists that can make the destination more attractive compared to other tourist destinations. The role of destination management is to exploit and develop existing resources by using clear and effective strategies for developing tourism products and creating additional value of tourist experience. The first step of analysis is to define destination competitiveness by using the indicators which will review and give the guidelines for improvement of competitive position. This paper discusses the tourist destinations' competitiveness and indicators for its measurement with a special reference to Serbia. Tourism development of Serbia is a big chance for overall economic development of the country. Current competitive position of Serbian tourism on international market is not satisfactory and this paper is trying to analyze and to point out the reasons of Serbia's tourism low competitiveness. Conclusions about the competitive positioning of Serbia as a tourist destination are drawn out firstly based on the relevant studies as well as on the Serbian Tourism Development Strategy. The results of Travel and Tourism Competitiveness Index (WEF TTCI reports for Serbia are also presented. Based on own research, this paper is also showing the results related to competitiveness of Serbia as a tourist destination in terms of two groups of indicators: natural, cultural and historical resources as well as destination management. According to the results, Serbia is more competitive in its natural, cultural and historical resources comparing to the role of destination management.

  5. The importance of origin and destination country skills for labour market attachment of immigrants from Pakistan, Iran and Turkey

    DEFF Research Database (Denmark)

    Arendt, Jacob; Nielsen, Chantal; Jakobsen, Vibeke

    2016-01-01

    This study explores how qualifications acquired prior to migration affect employment of adult immigrants in the destination country. It explores the direct effect as well as indirect effects arising through destination country investments. The study combines survey information on destination coun...... by domestic language proficiency. Yet, foreign educated do acquire more education in the destination country, that raises their employment....

  6. Influence of time between last myocardial infarction and prophylactic implantable defibrillator implant on device detections and therapies. “Routine Practice” data from the SEARCH MI registry

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    Boriani Giuseppe

    2012-09-01

    Full Text Available Abstract Background A multicenter European Registry, SEARCH-MI, was instituted in the year 2002 in order to assess patients’ outcomes and ICD interventions in patients with a previous MI and depressed LV function, treated with an ICD according to MADIT II results. In this analysis, we evaluate the influence of the time elapsed between last myocardial infarction (MI and prophylactic cardioverter defibrillator (ICD implant on device activations. Methods 643 patients with left ventricular dysfunction (mean LVEF 26 ± 5% and NYHA class I-III were prospectively followed for 1.8 ± 1.2 years in a multicenter registry. The population was divided into 3 groups according to the time between last MI and ICD implant: [1] from 40 days to less than 1.5 years; [2] from 1.5 to less than 7 years and [3] at least 7 years. Results The cumulative incidence of ventricular tachyarrhymias and appropriate device therapy (ATP or shock were higher in patients implanted longer time from last MI (Gray’s Test p = 0.002 and p = 0.013 respectively. No significant differences were seen in all cause mortality (Gray’s Test p = 0.618 or sudden cardiac death across the MI stratification groups (Gray’s Test p = 0.663. Conclusions Patients implanted with an ICD longer after the MI have a higher chance of presenting ventricular tachyarrhythmias and appropriate ICD therapy, while no differences were seen in overall mortality. These observations may be important for improving patient targeting in sudden death prevention.

  7. Identity of the state as a tourist destination

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    Čugurović Jelena

    2011-01-01

    Full Text Available In contemporary market conditions every country has to compete for its part of customers, tourists, investors, students, events. Accordingly, great attention is paid to marketing and communication and branding as its integral parts. In this paper country brand is explored from the tourism aspect as a destination brand or, in other way, from the aspect of the way the countries have formed and designed their brands in order to attract as many tourists they can. One of the fundamental aspects of brand is its identity, visual and verbal concretization created in order to identify and differentiate itself from its competitors. Brand identity elements are logo, slogan, colors and ways of their implementation. In this paper the best country brands from each continent and country brands which are specific or different from other will be presented and discussed according to the Future Brand research for 2010, which ranks the country brands from the whole world. Country brands are analyzed in terms of their design, whether brand design contains formal state symbols like flag, emblem and anthem, or it has elements to which the brand 'wants' to be associated with. The comparative analysis of selected brands is done and should point out the importance of building strong country brand identities for countries as tourist destinations.

  8. TEXT AREA IDENTIFICATION FOR RECOGNIZING DESTINATION PLACES FROM VEHICLES

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    Selvanayaki K.S

    2014-07-01

    Full Text Available Nowadays, automatic detection of text from the vehicles is an important problem in many applications. Text information present in an image can be easily understood by both human and computer. It has wide applications such as license plate reading, sign detection, identification of destination places, mobile text recognition and so on. This problem is challenging due to complex backgrounds, the non-uniform illuminations, variations of text font, size and line orientation. Once the text is identified, it can be analyzed, recognized and interpreted. Hence, there is a need for a better algorithm for detection and localization of text from vehicles. A method is proposed for detecting text from vehicles. The method makes use of features such as Histogram of oriented Gradients (HOG and Local Binary Pattern (LBP. These features are stored which can be further used for feature matching at the time of classification. After the text region is being detected, it can be further subjected to character segmentation and recognition thereby identifying the destination places. The ability to recognize text area from the vehicles, especially buses has obvious applications like traffic management in the bus stands. The obtained results are verified and performance parameters like speed, precision and recall are determined.

  9. Models of entrepreneurship development in rural tourism destinations in Vojvodina

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    Jegdić Vaso

    2017-01-01

    Full Text Available The subject of the research in this paper is the development and the application of entrepreneurship in rural tourism destinations. The aim of the paper is to identify key forms of rural entrepreneurship tourism in Vojvodina. General analytic-synthetic method of research was applied, spanning from the bibliographic-speculative to empirical approach. It has been determined that messuages, villages as tourist products, ethno-houses, and rural households that provide services of accommodation and food, eco-active tourism, tourism offer of food and drinks produced in the system of organic production, as well as traditional rural events, can be the basis of rural tourism product in Vojvodina. The development of rural tourism should be based on effective investment in the tourism offer through entrepreneurial projects that are in accordance with modern trends of demand. Investment into tourism offer in rural tourism destinations would influence the growth of income made from rural tourism, and therefore, the economic development of those areas.

  10. The Convergent Cancer Evolution toward a Single Cellular Destination.

    Science.gov (United States)

    Chen, Han; He, Xionglei

    2016-01-01

    The essence of Darwin's theory is that evolution is driven by purposeless mutations that are subsequently selected by natural environments, so there is often no predefined destination in organismal evolution. Using gene expressions of 107 cell types, we built a functional space of human cells to trace the evolutionary trajectory of 18 types of solid tumor cancers. We detected a dominant evolving trend toward the functional status of embryonic stem cells (ESC) for approximately 3,000 tumors growing in distinct tissue environments. This pattern remained the same after excluding known cancer/ESC signature genes (∼ 3,000 genes) or excluding all oncogenic gene sets (∼ 12,000 genes) annotated in MSigDB, suggesting a convergent evolution of the overall functional status in cancers. In support of this, the functional distance to ESC served as a common prognostic indicator for cancers of various types, with shorter distance corresponding to poor prognosis, which was true even when randomly selected gene sets were considered. Thus, regardless of the external environments, cancer evolution is a directional process toward a defined cellular destination, a finding reconciling development and evolution, the two seemingly incompatible philosophies both adopted by the cancer research community, and also raising new questions to evolutionary biology. © The Author 2015. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Case Studies Approach in Tourism Destination Branding Research

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    Adeyinka-Ojo S.F.

    2014-01-01

    Full Text Available A review of literature indicates that there are different types of qualitative research methods such as action research, content analysis, ethnography, grounded theory, historical analysis, phenomenology and case study. However, which approach is to be used depends on several factors such as the nature and objectives of the research. The aim of this paper is to focus on the research methodology aspects of applying case study as a research approach and its relevance in tourism destination branding research specifically on a single case study (SCS context. There are arguments that the SCS is a weak research strategy. Some of the potentials or shortcomings highlighted in the literature include the primitive nature of SCS, flexibility of sample technique, data collection method and data analysis. Others include lack of rigour, reliability, validity, credibility of findings and generalisation. This paper has adopted content analysis of the literature on tourism destination branding. Findings indicate that the quality of SCS can be verified using specific case study tactics for four design tests such as validity (construct, internal and external; and reliability using the case study protocol. Theoretical implication suggests that SCS is an empirical enquiry use to understand complex phenomena and favoured by practitioners.

  12. SAME-DAY TRIPS: A CHANCE OF URBAN DESTINATION DEVELOPMENT

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    Dario Simicevic

    2011-12-01

    Full Text Available The global economic crisis, the decline of standard and climatic factors influence the allocation of tourism trends at the global level. Certain types of tourist movements start up and develop; they have been present, but not sufficiently studied by authors. They also include a short trip or visit to a particular destination. Considering their characteristics, they do not require a lot of money and they make an increasingly important segment of the tourism market. Therefore, the importance of same-day trips should not be neglected on today's tourism market. Although in practice this part of the tourist offers and demand has not often been attached enough importance, same day trip can achieve a very significant inflow of funds and encourage the development of many potential tourist destinations. For all the reasons mentioned above, and because of its importance, the organization of same day-trips should be the fundamental basis and essential focus for tourism development. Taking into consideration that inbound tourist agencies show special interest for same-day trips, we have tried to give a starting point for further research in this part of the tourism market.

  13. Travel Destinations and Sexual Behavior as Indicators of Antibiotic Resistant Shigella Strains--Victoria, Australia.

    Science.gov (United States)

    Lane, Courtney R; Sutton, Brett; Valcanis, Mary; Kirk, Martyn; Walker, Cathryn; Lalor, Karin; Stephens, Nicola

    2016-03-15

    Knowledge of relationships between antibiotic susceptibility of Shigella isolates and travel destination or other risk factors can assist clinicians in determining appropriate antibiotic therapy prior to susceptibility testing. We describe relationships between resistance patterns and risk factors for acquisition in Shigella isolates using routinely collected data for notified cases of shigellosis between 2008 and 2012 in Victoria, Australia. We included all shigellosis patients notified during the study period, where Shigella isolates were tested for antimicrobial sensitivity using Clinical and Laboratory Standards Institute breakpoints. Cases were interviewed to collect data on risk factors, including recent travel. Data were analyzed using Stata 13.1 to examine associations between risk factors and resistant strains. Of the 500 cases of shigellosis, 249 were associated with overseas travel and 210 were locally acquired. Forty-six of 51 isolates of Indian origin displayed decreased susceptibility or resistance to ciprofloxacin. All isolates of Indonesian origin were susceptible to ciprofloxacin. Twenty-six travel-related isolates were resistant to all tested oral antimicrobials. Male-to-male sexual contact was the primary risk factor for 80% (120/150) of locally acquired infections among adult males, characterized by distinct periodic Shigella sonnei outbreaks. Clinicians should consider travel destination as a marker for resistance to common antimicrobials in returning travelers, where severe disease requires empirical treatment prior to receipt of individual sensitivity testing results. Repeated outbreaks of locally acquired shigellosis among men who have sex with men highlight the importance of prevention and control measures in this high-risk group. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  14. Low-cost photodynamic therapy devices for global health settings: Characterization of battery-powered LED performance and smartphone imaging in 3D tumor models

    Science.gov (United States)

    Hempstead, Joshua; Jones, Dustin P.; Ziouche, Abdelali; Cramer, Gwendolyn M.; Rizvi, Imran; Arnason, Stephen; Hasan, Tayyaba; Celli, Jonathan P.

    2015-05-01

    A lack of access to effective cancer therapeutics in resource-limited settings is implicated in global cancer health disparities between developed and developing countries. Photodynamic therapy (PDT) is a light-based treatment modality that has exhibited safety and efficacy in the clinic using wavelengths and irradiances achievable with light-emitting diodes (LEDs) operated on battery power. Here we assess low-cost enabling technology to extend the clinical benefit of PDT to regions with little or no access to electricity or medical infrastructure. We demonstrate the efficacy of a device based on a 635 nm high-output LED powered by three AA disposable alkaline batteries, to achieve strong cytotoxic response in monolayer and 3D cultures of A431 squamous carcinoma cells following photosensitization by administering aminolevulinic acid (ALA) to induce the accumulation of protoporphyrin IX (PpIX). Here we characterize challenges of battery-operated device performance, including battery drain and voltage stability specifically over relevant PDT dose parameters. Further motivated by the well-established capacity of PDT photosensitizers to serve as tumour-selective fluorescence contrast agents, we demonstrate the capability of a consumer smartphone with low-cost add-ons to measure concentration-dependent PpIX fluorescence. This study lays the groundwork for the on-going development of image-guided ALA-PDT treatment technologies for global health applications.

  15. Miniature Swine for Preclinical Modeling of Complexities of Human Disease for Translational Scientific Discovery and Accelerated Development of Therapies and Medical Devices.

    Science.gov (United States)

    Schomberg, Dominic T; Tellez, Armando; Meudt, Jennifer J; Brady, Dane A; Dillon, Krista N; Arowolo, Folagbayi K; Wicks, Joan; Rousselle, Serge D; Shanmuganayagam, Dhanansayan

    2016-04-01

    Noncommunicable diseases, including cardiovascular disease, diabetes, chronic respiratory disease, and cancer, are the leading cause of death in the world. The cost, both monetary and time, of developing therapies to prevent, treat, or manage these diseases has become unsustainable. A contributing factor is inefficient and ineffective preclinical research, in which the animal models utilized do not replicate the complex physiology that influences disease. An ideal preclinical animal model is one that responds similarly to intrinsic and extrinsic influences, providing high translatability and concordance of preclinical findings to humans. The overwhelming genetic, anatomical, physiological, and pathophysiological similarities to humans make miniature swine an ideal model for preclinical studies of human disease. Additionally, recent development of precision gene-editing tools for creation of novel genetic swine models allows the modeling of highly complex pathophysiology and comorbidities. As such, the utilization of swine models in early research allows for the evaluation of novel drug and technology efficacy while encouraging redesign and refinement before committing to clinical testing. This review highlights the appropriateness of the miniature swine for modeling complex physiologic systems, presenting it as a highly translational preclinical platform to validate efficacy and safety of therapies and devices.

  16. Effects of Device-Facilitated Isometric Progressive Resistance Oropharyngeal Therapy on Swallowing and Health-Related Outcomes in Older Adults with Dysphagia.

    Science.gov (United States)

    Rogus-Pulia, Nicole; Rusche, Nicole; Hind, Jacqueline A; Zielinski, Jill; Gangnon, Ronald; Safdar, Nasia; Robbins, JoAnne

    2016-02-01

    Swallowing disorders (dysphagia) are associated with malnutrition, aspiration pneumonia, and mortality in older adults. Strengthening interventions have shown promising results, but the effectiveness of treating dysphagia in older adults remains to be established. The Swallow STRengthening OropharyNGeal (Swallow STRONG) Program is a multidisciplinary program that employs a specific approach to oropharyngeal strengthening-device-facilitated (D-F) isometric progressive resistance oropharyngeal (I-PRO) therapy-with the goal of reducing health-related sequelae in veterans with dysphagia. Participants completed 8 weeks of D-F I-PRO therapy while receiving nutritional counseling and respiratory status monitoring. Assessments were completed at baseline, 4, and 8 weeks. At each visit, videofluoroscopic swallowing studies were performed. Dietary and swallowing-related quality of life questionnaires were administered. Long-term monitoring for 6-17 months after enrollment allowed for comparison of pneumonia incidence and hospitalizations to the 6-17 months before the program. Veterans with dysphagia confirmed with videofluoroscopy (N = 56; 55 male, 1 female; mean age 70) were enrolled. Lingual pressures increased at anterior (effect estimate = 92.5, P dysphagia.

  17. EVALUATING THE IMAGE OF TOURISM DESTINATIONS. THE CASE OF THE AUTONOMOUS COMMUNITY OF THE CANARY ISLANDS

    Directory of Open Access Journals (Sweden)

    Roxana - Andreea SARAGEA

    2011-12-01

    Full Text Available In the context of increased competition on the international tourism market, the assessment of destination image has become a research subject for both managers aiming to improve destination positioning and academic researchers. In order to obtain a competitive advantage, every tourist destination must identify, maintain and reinforce, through appropriate marketing policies, unique items that form and build over time "the destination' s image". Accordingly, the ultimate target of the tourist destinations' promoters should be to achieve a high level of coincidence between the promoted or projected image and the perceived image of the destination, held by potential and actual tourists. Therefore, the aim of this paper is to illustrate promotional techniques and methods used by the authorities of the Canary Islands over the years (projected image, and to identify, through a survey among the citizens of Braşov, the image that they have of the Canary Islands (perceived image.

  18. [Role of context recall in destination memory decline in normal aging].

    Science.gov (United States)

    El Haj, Mohamad; Allain, Philippe

    2014-12-01

    Until recently, little was known about destination memory, or memory for the destination of outputted information. In the present work, this memory was evaluated in 32 older adults and 36 younger adults, who had to associate proverbs to pictures of famous people and decide, on a subsequent recognition task, whether they had previously told that proverb to that face or not. When deciding about the destination, participants had to provide contextual judgment, that is, whether each picture had been previously exposed in color or in black and white. Participants also performed a neuropsychological battery tapping episodic memory and executive functions. Findings showed poor destination recall in older participants. Destination recall in older adults was reliably predicted by with their context recall. Destination memory seems to be particularly affected by aging, a deterioration that can be related to deficits in processing contextual features during encoding.

  19. Marketing and Brand Design of Destination Experiences: The Role of ICT

    Directory of Open Access Journals (Sweden)

    Dora Agapito

    2014-09-01

    Full Text Available The proliferation of Information and Communication Technologies (ICT with particular emphasis on internet have been rapidly adapted to tourism, where new opportunities for design and marketing strategies for destinations are being explored in both physical and virtual environments. Furthermore, the process of designing strong brands and facilitating positive and memorable experiences are central activities concerning destinations aiming to become more competitive. Accordingly, Destinations Marketing Organizations (DMOs are now exploring ICT and new forms of human interactions with a view to offer new opportunities for visitors to engage in the process of co-creating enhanced destination experiences in a technology-based environment. Considering that ICT both contribute to the process of designing innovative destination experiences and support enhanced individuals’ experiences before, during and after the trip, the purpose of this paper is to explore the role of ICT in the marketing and brand design of destination experiences.

  20. Walkable area within which destinations matter: differences between Australian and Japanese cities.

    Science.gov (United States)

    Sugiyama, Takemi; Inoue, Shigeru; Cerin, Ester; Shimomitsu, Teruichi; Owen, Neville

    2015-03-01

    Adults' walking for transport is important for health benefits and can be associated with availability of destinations such as shops and services within a walking distance of 10 to 15 minutes from home. However, relevant evidence is mostly from Western countries. This study examined associations of destinations with walking for transport in Australian and Japanese cities. Data were collected from Adelaide, Australia (n = 2508), and 4 Japanese cities (n = 1285). Logistic regressions examined associations of self-reported walking for transport with the number of destination types within walk-distance categories. Walking was significantly associated with the number of destination types within a 10-minute walk from home for Australia and with the number of destination types within a 6- to 20-minute walk for Japan. Further research is needed on why walking by residents of Japanese cities can be influenced by more distant local destinations than in Australia to inform physical activity-related environmental and policy initiatives. © 2012 APJPH.

  1. APPROACHES IN INVESTIGATING ROMANIA’S IMAGE AS A TOURIST DESTINATION AMONG THE TURKISH STUDENTS

    Directory of Open Access Journals (Sweden)

    Olimpia BAN

    2010-12-01

    Full Text Available The image of the tourist destination plays an essential role in the decision making process regarding the choice of a holiday. Image has a crucial role in the success of the destination because it influences the consumers’ satisfaction and helps in drawing up a promotion strategy for the positioning/repositioning on a certain market, branding/rebranding the tourist destination. Information from different sources contribute to the formation of the image of a certain destination, information which can be distributed into: the promotion performed by the destination; the other’s opinions (direct or indirect; mass-media and the popular culture. We intended to investigate Romania’s image a a tourist destination among the Turkish students. The results showed that the students had very poor knowledge of our country.

  2. DESTINATION IMAGE OF BALI BASED ON THE PUSH MOTIVATIONAL FACTORS, IDENTITY AND DESTINATION CREATIONS IN THE PERSPECTIVE OF FOREIGN SENIOR TOURIST*

    Directory of Open Access Journals (Sweden)

    I Gusti Bagus Rai Utama

    2016-03-01

    Full Text Available The strength of the senior traveler segment is the high purchasing power the length of stay in a destination, making this market segment increasingly important in present and future. Consequently, this research aims to establish a model of motivation and its relationship with the image of Bali as an international tourism destination, especially from the perspective of senior tourists. This research employed survey method and utilized a combination of quantitative and qualitative analytical techniques. Factor analysis condensed various indicators into several key indicators to form a model with goodness of fit. Indicators representing push motivation variable include the improvement of health/fitness and the drive to perform physical exercise. Indicators representing destination identity variable include the culture and nature of Bali. Indicators representing destination creation variable include the service quality of travel agencies and service quality of travel guides. Indicators representing destination image variable include the image of cultural uniqueness and holiday atmosphere of Bali. The survey in this study involved 400 respondents of senior tourists, exclusively only foreign nationals. Goodness of fit is affirmed on the results of the analysis model, which answered the hypothesis that push motivation and destination creation affect destination images.

  3. Marketing of the Balkans as à tourist destination for cultural tourism

    OpenAIRE

    2011-01-01

    The aim of this work is to outline possibilities for the marketing of the Balkans as à tourist destination for cultural tourism. It gives à definition of the Balkan region as à tourist destination. The target cultural tourist segments of the region are indicated. The strategic marketing mix is drawn for the positioning of the Balkans on the market of cultural tourism. The possible organizational platform for the marketing of the Balkans as à tourist destination is shown.

  4. "España Verde": tourism destination image among German Facebook users

    OpenAIRE

    Schuh, Till Maximilian

    2016-01-01

    Dissertação de Mestrado, Economia do Turismo e da Economia Regional, Faculdade de Economia, Universidade do Algarve, 2016 Tourism destinations are competing in an environment where it is vital to be differentiated from competition and to focus on unique selling points that attract specific markets. Hence, the destination image held by the target markets is essential in order to build and manage a strong tourism brand. This study aims to explore a methodology to analyze the destination imag...

  5. Human Resources Development and ICT Contribution to the Tourist Destination Competitiveness

    OpenAIRE

    Ramona Gruescu; Roxana Nanu; Anca Tanasie

    2009-01-01

    The paper envisages aspects concerning identification of the competitive advantage of a tourist destination from a double perspective: the critical contribution of the employees and the ICT impact on promoting and selling the destination. Research methodology includes „bottom to top” analysis of the mentioned indicators. Thus, results include the eficientisation of tourist businesses and destinations due to both human element development and ICT technologies. Two essential basis of the compet...

  6. First Destination Transportation and Packaging Initiative (FDTPI), Task Orders 0025 and 0033

    Science.gov (United States)

    2014-01-31

    FDTPI) is a transformational logistics R&D program to reduce the acquisition cost of goods purchased by DLA by 1) First Destination Transportation...FDT) converting inbound freight for new procurement goods from Free On Board (FOB) Destination (supplier purchased and controlled transportation) to FOB...program will reduce the cost of goods purchased by converting inbound freight for new procurement goods from Free On Board (FOB) Destination

  7. Tourist Satisfaction and Destination Loyalty intention: A Structural and Categorical Analysis

    OpenAIRE

    Guerreiro, M.; Mendes, J; J. A. Silva; Oom do Valle, P.

    2006-01-01

    This study explores the relationship between travel satisfaction and destination loyalty intention. The research was conducted with 486 tourists visiting Arade, a Portuguese tourist destination. Taking as the basis the use of structural equation modelling (SEM), the results substantiate the importance of tourism satisfaction as a determinant of destination loyalty. Also, a categorical principal components analysis (CATPCA) provides a detailed analysis of this cause-effect relationship by esta...

  8. The effect of positioning devices and pressure therapy on outcome after full-thickness burns of the neck.

    Science.gov (United States)

    Sharp, Patricia A; Dougherty, Mary E; Kagan, Richard J

    2007-01-01

    The postoperative management of full-thickness burns of the neck can be a challenge for burn therapists despite the availability of many treatment modalities to minimize scar hypertrophy and contracture. Interventions include pressure appliances, massage, exercise, and positioning devices. The objective of this study was to identify factors associated with the development of neck contractures and optimal treatment strategies for their prevention. We performed a retrospective chart review of all patients admitted to our pediatric burn center between 1989 and 2003 with acute full-thickness neck burns. Rehabilitation protocols used for each patient were examined. The necessity of a reconstructive procedure was analyzed, as well as time from initial grafting to that procedure. We identified 49 eligible subjects. Patients ranged in age from 0.6 to 14.2 years at the time of injury. The number of factors present which inhibited both positioning and application of pressure to the neck was found to be significantly related to the need for neck reconstruction (P Patients who had tracheostomies had a mean time to neck reconstruction of 20.3 months compared with 43.4 months in patients without tracheostomies (P patients who were discharged with reduced range of motion of the neck required reconstruction compared with fewer than 65% of patients with normal neck range. Delayed pressure and positioning of the neck after skin grafting result in an earlier and more frequent need for neck reconstruction.

  9. Splenic abcesses as infectious complication following implantation of left ventricular asssist device - case report.

    Science.gov (United States)

    Gajda, Sławomir; Szczepanik, Anna M; Religa, Grzegorz; Misiak, Andrzej; Szczepanik, Andrzej B

    2017-02-28

    Left ventricular assist device (LVAD) is one of the modern management therapies in patients with advanced heart failure, and it serves as a bridge to heart transplantation or even as destination therapy. However, it is burdened with a high risk of thromboembolic, hemorrhagic, and infectious complications despite prophylactic management. Splenic abscesses, as septic complications following implantation of mechanical ventricular support, have not yet been described in the literature. We report of a patient with severe left ventricular insufficiency (NYHA II/III), pulmonary hypertension, and arrhythmia who underwent implantation of the Heart Ware® pump for left ventricular support with simultaneous tricuspidvalvoplasty, as a bridge therapy to heart transplantation. During two years after LVAD implantation, the patient had three MRSA skin infections, localized at the exit site of the drive-line connecting the artificial ventricle with external unit, that were complicated by sepsis and treated with broad-spectrum antibiotics. A few months later, abdominal CT revealed two abscesses in the spleen, and the patient was qualified for splenectomy. Open splenectomy was performed under full-dose anticoagulant therapy with continuous intravenous infusions of unfractionated heparin (UFH). The intra- and postoperative course was uneventful. UFH therapy was continued for 6 days, and oral anticoagulation was re-administered on day 4 after surgery. The patient was discharged on day 7 after surgery with primary healed wound. Open splenectomy, performed with full-dose anticoagulant therapy, proved to be an effective and definitive method of treatment without any complications.

  10. Holiday Destination Choice Behavior Analysis Based on AFC Data of Urban Rail Transit

    Directory of Open Access Journals (Sweden)

    Chang-jun Cai

    2015-01-01

    Full Text Available For urban rail transit, the spatial distribution of passenger flow in holiday usually differs from weekdays. Holiday destination choice behavior analysis is the key to analyze passengers’ destination choice preference and then obtain the OD (origin-destination distribution of passenger flow. This paper aims to propose a holiday destination choice model based on AFC (automatic fare collection data of urban rail transit system, which is highly expected to provide theoretic support to holiday travel demand analysis for urban rail transit. First, based on Guangzhou Metro AFC data collected on New Year’s day, the characteristics of holiday destination choice behavior for urban rail transit passengers is analyzed. Second, holiday destination choice models based on MNL (Multinomial Logit structure are established for each New Year’s days respectively, which takes into account some novel explanatory variables (such as attractiveness of destination. Then, the proposed models are calibrated with AFC data from Guangzhou Metro using WESML (weighted exogenous sample maximum likelihood estimation and compared with the base models in which attractiveness of destination is not considered. The results show that the ρ2 values are improved by 0.060, 0.045, and 0.040 for January 1, January 2, and January 3, respectively, with the consideration of destination attractiveness.

  11. Komparasi Destination Branding dalam Official Website Negara Singapura-Malaysia-Indonesia

    Directory of Open Access Journals (Sweden)

    Ryan Pratama Sutanto

    2010-01-01

    Full Text Available High profit income has attracted South Asian countries to compete in the fields of tourism marketing. Destination branding as a differentiating factor is an alternative approach in marketing communication. The purpose of this research is to make a comparison study of destination branding application in Singapore's, Malaysia's and Indonesia's tourism official websites. Destination branding in websites as part of promotion campaigns is a strategy used by each country to promote tourism to consumers worldwide. This research uses qualitative method, and involves experts in the fields of Information Technology (IT and Visual Communication Design. Each website's elements contributes in the success of a country's destination branding and influences its brand image.

  12. Use of a portable, single-use negative pressure wound therapy device in home care patients with low to moderately exuding wounds: a case series.

    Science.gov (United States)

    Hurd, Theresa; Trueman, Paul; Rossington, Alan

    2014-03-01

    Negative pressure wound therapy (NPWT) is widely used in the management of acute and chronic wounds. The purpose of this 8-week study was to evaluate outcomes of using a new canisterless, portable, single-use NPWT system in patients with wounds treated in a Canadian community healthcare setting. The device is designed to provide negative pressure at 80±20 mm Hg, 24 hours a day of continuous usage, for a maximum wear time of 7 days. Data on wound outcomes, including exudate levels, wound appearance, and wound area, were collected weekly by a Registered Nurse as part of routine practice. When treatment was discontinued, patients and nurses were asked to rate their satisfaction with the device. Data from patients who had used a conventional NPWT device to manage their wounds were retrospectively abstracted from their medical records. In the prospective study, conducted between October 2011 and July 2012, 326 patients (median age=61 years; range 17-91 years) with wounds of mixed etiology (53 pressure ulcers, 21 venous leg ulcers, 16 diabetic foot ulcers, and 15 traumatic and 221 surgical wounds) were treated for a maximum of 8 weeks with the portable NPWT device. The majority of patients (228 out of 326; 68%) achieved complete wound closure within 8 weeks of treatment. The Kaplan-Meier estimate of median time to healing of all wounds was 9 weeks. The majority of patients (318 patients, 97%) reported they were pleased or satisfied with the dressing performance. Nurses indicated satisfaction with the dressing performance for all but two patients (99%). The majority (89%) of patients managed with conventional NPWT (n=539) had an open surgical wound with moderate or high levels of exudate. Healing rates in the portable and conventional NPWT group were similar (10% to 11% per week). Portable, single-use NPWT has the potential to deliver good wound outcomes in community care settings and simplify the use of negative pressure for nurses and patients. Additional research is

  13. GRANITE CUTTING WASTE: TECHNOLOGICAL INNOVATION FOR THE FINAL DESTINATION

    Directory of Open Access Journals (Sweden)

    Joner Oliveira Alves

    2015-06-01

    Full Text Available The granite processing market is one of the most promising business areas of the mineral sector, with an average growth of the world production of about 6% per year. The granite extraction generates residues in the form of powder rock of 20-25 wt.% of the total benefited. The granite dust must be carefully managed since it can cause siltation of rivers and human health risks. This paper presents two routes for the final destination of this waste: the vitrification process aiming the production of fibers for thermo-acoustic insulation, and the magnetic separation in order to recover the steel grit. Results showed that the forms of treatments presented are economically and ecologically viable since they represent a cost reduction in the waste disposal, and also provide the production of new materials with commercial value.

  14. Virtual Community Based Destination Marketing with YouTube

    DEFF Research Database (Denmark)

    Sambhanthan, Arunasalam; Thelijjagoda, Samantha; Good, Alice

    2016-01-01

    YouTube has now evolved into a powerful medium for social interaction. Utilizing YouTube for enhancing marketing endeavours is a strategy practiced by marketing professionals across several industries. This paper rationalizes on the different strategies of leveraging YouTube-based platforms for e...... are reported under the five broad clusters of virtual communities. More broadly, the typology of virtual communities is adapted to evaluate the YouTube platform for effective destination marketing.......YouTube has now evolved into a powerful medium for social interaction. Utilizing YouTube for enhancing marketing endeavours is a strategy practiced by marketing professionals across several industries. This paper rationalizes on the different strategies of leveraging YouTube-based platforms...

  15. Estimation of Origin-Destination Trip Matrices for Small Cities

    Directory of Open Access Journals (Sweden)

    Luka Novačko

    2014-10-01

    Full Text Available This paper presents a model of data assessment for the requirements of a classical four-step model of traffic demand in individual traffic in small cities. The procedure is carried out by creating an initial origin-destination trip matrix using data from the traffic count and by defining the average rate of trip generation within single households. The research applied fuzzy logic for the correction of the initial trip matrix. The paper also presents the recommendations for defining the borders of traffic zones, as well as the locations of traffic counts. A flowchart has been used to show a summarized presentation of the proposed model. In the last part of the paper the model was tested on an example of a smaller city in the Republic of Croatia.

  16. Surgical therapy in advanced heart failure.

    Science.gov (United States)

    Vitali, Ettore; Colombo, Tiziano; Fratto, Pasquale; Russo, Claudio; Bruschi, Giuseppe; Frigerio, Maria

    2003-05-08

    Congestive heart failure (CHF) affects about 1% of adults in the United States and is a contributing factor in >250,000 deaths per year. In an increasingly elderly population, the surgical treatment of CHF made great progress during the past 3 decades, consuming enormous health care resources. Heart transplantation is still the most effective therapy for end-stage heart disease, with the 10-year survival rate after transplantation approaching 50%. Efforts to increase the supply of donor organs have failed to improve the shortage, underscoring the crucial need for alternatives to cardiac allotransplantation. Alternative surgical options to end-stage heart transplantation are rapidly evolving. Left ventricular assist devices have been used as a bridge to heart transplantation for patients who otherwise might die awaiting a new heart. There is also continued interest in the use of these devices either to bridge patients to full recovery or to destination therapy, without the need for heart replacement. Left ventricular reconstruction, including the Batista and Dor procedures, along with mitral valve repair, cardiomyoplasty, and extreme coronary artery bypass graft surgery, are now being increasingly performed as alternative options. The history, status, and personal experience of surgical treatment of end-stage heart disease are discussed.

  17. Cardiac Health Risk Stratification System (CHRiSS: a Bayesian-based decision support system for left ventricular assist device (LVAD therapy.

    Directory of Open Access Journals (Sweden)

    Natasha A Loghmanpour

    Full Text Available This study investigated the use of Bayesian Networks (BNs for left ventricular assist device (LVAD therapy; a treatment for end-stage heart failure that has been steadily growing in popularity over the past decade. Despite this growth, the number of LVAD implants performed annually remains a small fraction of the estimated population of patients who might benefit from this treatment. We believe that this demonstrates a need for an accurate stratification tool that can help identify LVAD candidates at the most appropriate point in the course of their disease. We derived BNs to predict mortality at five endpoints utilizing the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS database: containing over 12,000 total enrolled patients from 153 hospital sites, collected since 2006 to the present day, and consisting of approximately 230 pre-implant clinical variables. Synthetic minority oversampling technique (SMOTE was employed to address the uneven proportion of patients with negative outcomes and to improve the performance of the models. The resulting accuracy and area under the ROC curve (% for predicted mortality were 30 day: 94.9 and 92.5; 90 day: 84.2 and 73.9; 6 month: 78.2 and 70.6; 1 year: 73.1 and 70.6; and 2 years: 71.4 and 70.8. To foster the translation of these models to clinical practice, they have been incorporated into a web-based application, the Cardiac Health Risk Stratification System (CHRiSS. As clinical experience with LVAD therapy continues to grow, and additional data is collected, we aim to continually update these BN models to improve their accuracy and maintain their relevance. Ongoing work also aims to extend the BN models to predict the risk of adverse events post-LVAD implant as additional factors for consideration in decision making.

  18. Continuous-flow left ventricular assist device therapy in patients with preoperative hepatic failure: are we pushing the limits too far?

    Science.gov (United States)

    Weymann, Alexander; Patil, Nikhil P; Sabashnikov, Anton; Mohite, Phrashant N; Garcia Saez, Diana; Bireta, Christian; Wahlers, Thorsten; Karck, Matthias; Kallenbach, Klaus; Ruhparwar, Arjang; Fatullayev, Javid; Amrani, Mohamed; De Robertis, Fabio; Bahrami, Toufan; Popov, Aron-Frederik; Simon, Andre R

    2015-04-01

    The purpose of this study was to evaluate the effects and outcome of continuous-flow left ventricular assist device (cf-LVAD) therapy in patients with preoperative acute hepatic failure. The study design was a retrospective review of prospectively collected data. Included were 42 patients who underwent cf-LVAD implantation (64.3% HeartMate II, 35.7% HeartWare) between July 2007 and May 2013 with preoperative hepatic failure defined as elevation of greater than or equal to two liver function parameters above twice the upper normal range. Mean patient age was 35 ± 12.5 years, comprising 23.8% females. Dilated cardiomyopathy was present in 92.9% of patients (left ventricular ejection fraction 17.3 ± 5.9%). Mean support duration was 511 ± 512 days (range: 2-1996 days). Mean preoperative laboratory parameters for blood urea nitrogen, serum creatinine, total bilirubin, and alanine aminotransferase were 9.5 ± 5.4 mg/dL, 110.3 ± 42.8 μmol/L, 51.7 ± 38.3 mmol/L, and 242.1 ± 268.6 U/L, respectively. All parameters decreased significantly 1 month postoperatively. The mean preoperative modified Model for Endstage Liver Disease excluding international normalized ratio score was 16.03 ± 5.57, which improved significantly after cf-LVAD implantation to 10.62 ± 5.66 (P failure over the follow-up period. Patients with preexisting acute hepatic failure are reasonable candidates for cf-LVAD implantation, with excellent rates of recovery and survival, suggesting that cf-LVAD therapy should not be denied to patients merely on grounds of "preoperative elevated liver enzymes/hepatopathy."

  19. 14 CFR 121.195 - Airplanes: Turbine engine powered: Landing limitations: Destination airports.

    Science.gov (United States)

    2010-01-01

    ... limitations: Destination airports. 121.195 Section 121.195 Aeronautics and Space FEDERAL AVIATION...: Destination airports. (a) No person operating a turbine engine powered airplane may take off that airplane at... alternate airport) the weight of the airplane on arrival would exceed the landing weight set forth in...

  20. Tourism Destination Management (Case Study in Department of Culture and Tourism Pasuruan Regency

    Directory of Open Access Journals (Sweden)

    Sony Manggala Putra

    2015-02-01

    Full Text Available The tourism sector as one of the leading sectors in Pasuruan still faces many obstacles. The constraints associated with conditions that require improvement on tourist destination related to the presence of infrastructure, zoning, the gap between the tourism destination in the West and the East area, up to the level of visitation which has decreased from year to year. The aims of the studi were to describe and analyze Tourism Destination Management conducted by Department of Culture and Tourism Pasuruan at Banyu Biru and Ranu Grati object to become competitive and sustainable tourism destination. This study used a qualitative approach with a case study method locus in the Department of Culture and Tourism Pasuruan. The results of this study indicate that the tourism destination management of Banyu Biru and Ranu Grati when reviewed in terms of competitiveness, still needs a lot of improvement related to the presence of tourism facilities and the quality of employees as service providers. In terms of sustainability, it shows that the synergy between the regional government and tourism stakeholders need to be improved. The need for the establishment of cooperation with third parties in management of tourism destination in Banyu Biru and Ranu Grati, can be used to optimize the carrying capacity and tourist destination marketing system at Banyu Biru and Ranu Grati in order to compete in a competitive and sustainable way Keywords: tourism destination management, competitiveness, sustainability

  1. PROMOTING TOURIST DESTINATIONS THROUGH SPORT EVENTS. THE CASE OF BRAŞOV

    Directory of Open Access Journals (Sweden)

    Ana ISPAS

    2010-12-01

    Full Text Available Sport event tourism is a huge and growing global industry with important economic implications for both the sport, the event and the impact of travel and tourism related benefits on host destinations. A primary function of a sport event is to provide the host community with an opportunity to secure high prominence in the tourism market place. However, international or regional prominence may be gained with significant social and environmental costs. Hosting sport events has been a focus of destination marketers as a strategy to enhance its destination image and differentiate its tourism products. Communities are attracted to hosting sport events to draw marketing benefits that will contribute to the success of the destination in the long run by creating awareness, improving their image with visitors and attracting tourism business to generate future inbound travel. As such, destination images can be influenced by the hosting of a sport event and the attributes associated with this event. The purpose of this paper is to outline the role of sport event tourism in the promotion of tourist destinations. A case study has been chosen in order to illustrate the interdependence between event and destination marketing: Braşov, hosting the winter edition of The European Youth Olympic Festival in 2013. The paper includes a series of recommendations for destination managers in order to maximise the benefits of this event and take this opportunity to promote Braşov on the international market.

  2. Trip distribution for limited destinations: a case study for grocery shopping trips in the Netherlands

    NARCIS (Netherlands)

    Veenstra, Sander; Thomas, Tom; Tutert, Bas

    2010-01-01

    In this paper, we introduce a new trip distribution model for destinations that are not homogeneously distributed. The model is a gravity model in which the spatial configuration of destinations is incorporated in the modeling process. The performance was tested on a survey with reported grocery sho

  3. Policy, Context and Schooling: The Education of English Learners in Rural New Destinations

    Science.gov (United States)

    Lee, Stacey J.; Hawkins, Margaret R.

    2015-01-01

    The number of immigrant English learners attending schools in new destinations across the US is rapidly increasing. We draw on the sociological scholarship on "contexts of reception" and scholarship on sociocultural approaches to policy to examine the educational contexts faced by immigrant English learners in new destination communities…

  4. PROMOTING TOURIST DESTINATIONS THROUGH SPORT EVENTS. THE CASE OF BRAŞOV

    Directory of Open Access Journals (Sweden)

    Adina Nicoleta CANDREA

    2010-12-01

    Full Text Available Sport event tourism is a huge and growing global industry with important economic implications for both the sport, the event and the impact of travel and tourism related benefits on host destinations. A primary function of a sport event is to provide the host community with an opportunity to secure high prominence in the tourism market place. However, international or regional prominence may be gained with significant social and environmental costs. Hosting sport events has been a focus of destination marketers as a strategy to enhance its destination image and differentiate its tourism products. Communities are attracted to hosting sport events to draw marketing benefits that will contribute to the success of the destination in the long run by creating awareness, improving their image with visitors and attracting tourism business to generate future inbound travel. As such, destination images can be influenced by the hosting of a sport event and the attributes associated with this event. The purpose of this paper is to outline the role of sport event tourism in the promotion of tourist destinations. A case study has been chosen in order to illustrate the interdependence between event and destination marketing: Braşov, hosting the winter edition of The European Youth Olympic Festival in 2013. The paper includes a series of recommendations for destination managers in order to maximise the benefits of this event and take this opportunity to promote Braşov on the international market.

  5. Source and destination memory in face-to-face interaction: A multinomial modeling approach.

    Science.gov (United States)

    Fischer, Nele M; Schult, Janette C; Steffens, Melanie C

    2015-06-01

    Arguing that people are often in doubt concerning to whom they have presented what information, Gopie and MacLeod (2009) introduced a new memory component, destination memory: remembering the destination of output information (i.e., "Who did you tell this to?"). They investigated source (i.e., "Who told you that?") versus destination memory in computer-based imagined interactions. The present study investigated destination memory in real interaction situations. In 2 experiments with mixed-gender (N = 53) versus same-gender (N = 89) groups, source and destination memory were manipulated by creating a setup similar to speed dating. In dyads, participants completed phrase fragments with personal information, taking turns. At recognition, participants decided whether fragments were new or old and, if old, whether they were listened to or spoken and which depicted person was the source or the destination of the information. A multinomial model was used for analyses. Source memory significantly exceeded destination memory, whereas information itself was better remembered in the destination than in the source condition. These findings corroborate the trade-off hypothesis: Context is better remembered in input than in output events, but information itself is better remembered in output than in input events. We discuss the implications of these findings for real-world conversation situations. (c) 2015 APA, all rights reserved).

  6. Promoting Sochi as a Tourist Destination in the Post-Olympic Period

    Directory of Open Access Journals (Sweden)

    Larisa M. Romanova

    2014-03-01

    Full Text Available Sochi tourist destination promotion in the post-Olympic period is an important topic for tourist market participants, local authority and researchers. Tourist destination promotion system is an essential factor to enlarge tourist flow to Sochi. The authors are thinking how to use Olympics image effect and Olympic heritage prospects.

  7. Tourists’ Satisfaction at Trijuginarayan: An Emerging Spiritual and Adventure Tourist Destination in Garhwal Himalaya India

    Directory of Open Access Journals (Sweden)

    S.C. Bagri

    2015-10-01

    Full Text Available Tourists’ satisfaction has been acknowledged as one of the most important elements of competitive advantage and formulating effective destination management strategies because it is a reliable standard to evaluate performance of tangible and intangible elements of tourism products and services. The purpose of this study is to investigate tourists’ satisfaction by examining the relationship between destination attribute importance and performance in a tourist destination. Trijuginarayan, an emerging spiritual and adventure tourist destination located in Garhwal Himalaya in Uttarakhand state of India was selected as the study area for this research. Importance-Performance Analysis was employed to examine the relationship between importance and performance of various destination attributes. Results revealed that attributes related to tourism product of spiritual and cultural nature, atmosphere and climate, a variety of tourist activities, hospitality and safety are significant factors in determining tourist satisfaction, whereas basic facilities such as accommodation, transportation, tourism infrastructure and hygiene and sanitation at destination are of significant importance in satisfaction evaluation. Findings also reveal that tourists were satisfied with the core products, but were dissatisfied with basic tourist facilities offered at the destination. The findings alert concerned tourism stakeholders for outlining effective strategies for holistic development and improving performance of attributes in a given destination.

  8. 78 FR 48046 - Safety Zone; Kuoni Destination Management Fireworks; San Diego, CA

    Science.gov (United States)

    2013-08-07

    ... [Docket No. USCG-2013-0666] RIN 1625-AA00 Safety Zone; Kuoni Destination Management Fireworks; San Diego... safety zone on the navigable waters of the San Diego Bay in support of the Kuoni Destination Management... San Diego, Coast Guard; telephone 619-278-7656, email d11marineeventssandiego@uscg.mil . If you have...

  9. The Role of Marketing Mix Components in Destination Choices of Visitors and the Case of Dalyan

    Directory of Open Access Journals (Sweden)

    Özgür ÖZER

    2012-03-01

    Full Text Available This study investigated the impact of the eight components of the marketing mix, as being product, price, distribution, promotion, person, partnership, program and package, upon choice of a destination.For this research purpose, data was collected by face-to-face interviews and survey from 260 foreign tourists visiting the region of Dalyan. First, the marketing mix components were classified according to their importance determined by the arithmetic averages. Then, multiple regression analysis was performed to determine whether the marketing mix components had an effect on the destination choice. The analysis found that the variables of ‘product’ and ‘person’ had an effect on the Dalyan destination choice. This result shows that the ’product’ is an influencial factor, as expected, on the choice of the Dalyan destination, within the scope of ecotourism, visited by the tourists. In addition, ‘person’ is also important factor on the destination choice for the Dalyan region.

  10. Cross-border shopping and tourism destination marketing: The case of Southern Jutland, Denmark

    DEFF Research Database (Denmark)

    Makkonen, Teemu

    2016-01-01

    This article addresses the economic impact that cross-border shopping has on the local tourism industry and the ways that cross-border shopping is taken advantage of in tourism destination marketing. Southern Jutland–situated in Denmark just north of the German border, where border shops situated......-border shopping into tourism destination marketing strategies. The results have wider relevance for other border regions.......This article addresses the economic impact that cross-border shopping has on the local tourism industry and the ways that cross-border shopping is taken advantage of in tourism destination marketing. Southern Jutland–situated in Denmark just north of the German border, where border shops situated...... just south of the same border enable Danes to capitalize on the lower value added tax levels in Germany–is utilized as an illustrative case example. The data was collected by analysing the relevant tourism destination marketing material and via interviews with local destination marketing organizations...

  11. Tourism destination image of Russia in the perspective of the portuguese market

    Directory of Open Access Journals (Sweden)

    Liliya Arslanova

    2017-06-01

    Full Text Available In recent decades the importance of destination image has been increasingly analyzed and it is generally considered to be vital in the marketing of destinations. It can be noted that the tourism industry in Russia has not been the subject of a great deal of research with regard to its destination image. Therefore the purpose of this work is to assess Russia’s destination image in the perspective of Portuguese people. The research instrument was an online questionnaire, comprised of open-ended and closed questions. A combination of two software programs, NVivo and IBM SPSS Statistics 21, was employed to analyze the data. This exploratory study suggests that Portuguese peoples’ perceptions of Russia are mostly favorable and they have a high awareness about Russia’s destination features.

  12. A Novel Evaluation Approach for Tourist Choice of Destination Based on Grey Relation Analysis

    Directory of Open Access Journals (Sweden)

    Xudong Guo

    2016-01-01

    Full Text Available The decision-making process of choosing an ideal tourism destination is influenced by a number of psychological and nonpsychological variables. Tourists need a method to quickly and easily select a suitable destination. Driven by this practical decision issue, a novel approach of tourist destination evaluation, grey relation analysis (GRA, is developed and applied to the ranking evaluation of Taiwan tourism destinations in China. In the evaluating process, we apply entropy to calculate the weight of each index, which is a more objective method of calculating weights. The results of the study indicate that although the same size is small and the distribution of data is unknown, GRA can still be successfully used in evaluating tourist destinations. In addition, we compare the GRA results with the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS and show that more accurate ranking results can be obtained.

  13. CONSIDERATIONS REGARDING THE DESIGN OF SPECIFIC TOURISM PRODUCTS FOR THE TOURISM DESTINATION ROMANIA

    Directory of Open Access Journals (Sweden)

    MONICA PAULA RAŢIU

    2011-01-01

    Full Text Available Romania, as tourism destination with its component micro-destinations (Muntenia, Oltenia, Banat - Crişana, Transylvania, Bucovina, Maramureş, Moldavia and Dobrogea, possesses many tourism attractions and at the same time has a real tourism potential. The fact that it is not included among the Europe’s „valuable” destinations represents a loss both for its inhabitants and for Europeans in general, too. One of the reasons is the lack of an image consolidated by identity elements or / and simply the lack of image that would represent the starting point for development of appropriate tourism products (developing a strategy. This paper proposes, starting from the image perceived by the inhabitants about their own destination – based on the example of Transylvania – to emphasize the importance and also the role of the destination image in developing the main directions of actions and, especially, in developing the strategy for the specific tourism products.

  14. Tourist Satisfaction and Destination Loyalty intention: A Structural and Categorical Analysis

    Directory of Open Access Journals (Sweden)

    Guerreiro, M.

    2006-01-01

    Full Text Available This study explores the relationship between travel satisfaction and destination loyalty intention. The research was conducted with 486 tourists visiting Arade, a Portuguese tourist destination. Taking as the basis the use of structural equation modelling (SEM, the results substantiate the importance of tourism satisfaction as a determinant of destination loyalty. Also, a categorical principal components analysis (CATPCA provides a detailed analysis of this cause-effect relationship by establishing that greater levels of satisfaction (measured by overall satisfaction in terms of holiday experience, destination ttributes and met expectations result in increased likelihood of future repeat visits and a keen willingness to recommend the destination to others. Clusters of tourists were also identified and characterized in relation to satisfaction levels and loyalty intentions. These analyses provide a useful background in the planning of future tourist marketing strategies.

  15. Determinants of consumer intention to go to a tourist destination. The case of

    Directory of Open Access Journals (Sweden)

    Sonia San Martín Gutiérrez

    2011-05-01

    Full Text Available Each tourist destination has a brand the consumer can choose at the moment of travelling. This work analyzes, through a causal model empirically tested for the case of Mundo Maya-México, the paper that reputation, emotions and trust play in the consumer's intention to go to a tourist destination. A theoretical frame is developed using contributions of the signalling theory, emotions theories and relationship marketing. A face-to-face survey was carried out with consumers in travel agencies. Results confirm most of the proposed hypotheses and show interesting results: a reputation of a good management and high awareness of the tourist destination and consumer pleasure and trust in the destination reveal as antecedents of consumer intention to go to a certain tourist destination.

  16. Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials.

    Science.gov (United States)

    Howlett, Jonathan G; McKelvie, Robert S; Arnold, J Malcolm O; Costigan, Jeannine; Dorian, Paul; Ducharme, Anique; Estrella-Holder, Estrellita; Ezekowitz, Justin A; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Herd, Anthony M; Isaac, Debra; Jong, Philip; Kouz, Simon; Liu, Peter; Mann, Elizabeth; Moe, Gordon W; Tsuyuki, Ross T; Ross, Heather J; White, Michel

    2009-02-01

    The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.

  17. Evaluation of relative transmitted dose for a step and shoot head and neck intensity modulated radiation therapy using a scanning liquid ionization chamber electronic portal imaging device.

    Science.gov (United States)

    Mohammadi, Mohammad; Bezak, Eva

    2012-01-01

    The dose delivery verification for a head and neck static intensity modulated radiation therapy (IMRT) case using a scanning liquid ionization chamber electronic portal imaging device (SLIC-EPID) was investigated. Acquired electronic portal images were firstly converted into transmitted dose maps using an in-house developed method. The dose distributions were then compared with those calculated in a virtual EPID using the Pinnacle(3) treatment planning system (TPS). Using gamma evaluation with the ΔD(max) and DTA criteria of 3%/2.54 mm, an excellent agreement was observed between transmitted dose measured using SLIC-EPID and that calculated by TPS (gamma score approximately 95%) for large MLC fields. In contrast, for several small subfields, due to SLIC-EPID image blurring, significant disagreement was found in the gamma results. Differences between EPID and TPS dose maps were also observed for several parts of the radiation subfields, when the radiation beam passed through air on the outside of tissue. The transmitted dose distributions measured using portal imagers such as SLIC-EPID can be used to verify the dose delivery to a patient. However, several aspects such as accurate calibration procedure and imager response under different conditions should be taken into the consideration. In addition, SLIC-EPID image blurring is another important issue, which should be considered if the SLIC-EPID is used for clinical dosimetry verification.

  18. Evaluation of relative transmitted dose for a step and shoot head and neck intensity modulated radiation therapy using a scanning liquid ionization chamber electronic portal imaging device

    Directory of Open Access Journals (Sweden)

    Mohammad Mohammadi

    2012-01-01

    Full Text Available The dose delivery verification for a head and neck static intensity modulated radiation therapy (IMRT case using a scanning liquid ionization chamber electronic portal imaging device (SLIC-EPID was investigated. Acquired electronic portal images were firstly converted into transmitted dose maps using an in-house developed method. The dose distributions were then compared with those calculated in a virtual EPID using the Pinnacle3 treatment planning system (TPS. Using gamma evaluation with the DDmax and DTA criteria of 3%/2.54 mm, an excellent agreement was observed between transmitted dose measured using SLIC-EPID and that calculated by TPS (gamma score approximately 95% for large MLC fields. In contrast, for several small subfields, due to SLIC-EPID image blurring, significant disagreement was found in the gamma results. Differences between EPID and TPS dose maps were also observed for several parts of the radiation subfields, when the radiation beam passed through air on the outside of tissue. The transmitted dose distributions measured using portal imagers such as SLIC-EPID can be used to verify the dose delivery to a patient. However, several aspects such as accurate calibration procedure and imager response under different conditions should be taken into the consideration. In addition, SLIC-EPID image blurring is another important issue, which should be considered if the SLIC-EPID is used for clinical dosimetry verification.

  19. THE BRAND EQUITY OF TOURISTIC DESTINATIONS - THE MEANING OF THE VALUE

    Directory of Open Access Journals (Sweden)

    Silaghi Simona

    2011-07-01

    Full Text Available In today's global economy, each place competes with other places for economic benefits. Destination has become a product that has to be promoted and sold in the most advantageous terms. The work bellow is an analysis of "brand equity" concept for touristic destinations, as found in the specific literature. Destination brands differ from product brands, major distinction being given by their stability/ instability. Brands of products are stable; this constant is maintained by the use of quality standards. Even in case of services, situation can be controlled, as quality standards could be perpetuated by a franchise system. Destinations are not depending on a single person, who decides, but a variety of them, economic agents, businesses, institutions and local population that can create/print form and structure changes of the destination. The concept de brand equity applied for touristic destinations, is something relatively recent. The dimensions of a brand for touristic destinations are: awareness, image, loyalty, quality and value. All these dimensions build the branding equity of a destination. There is interdependency, between quality, image, loyalty and value. In order to determine the perception in regards to the quality of tourism services in Romania, in 2010 a comprehensive study was done among the inhabitants of Oradea city. Through this study we have pursued several objectives: to assess the importance of service characteristics, performance evaluation of tourism services in Romania, tourism personnel evaluation, in terms of evaluation and performance, perception of the quality-price ratio for Romania, compared with other tourist destinations. We call on the exploratory study conducted, as the value of the dimension- destination of the brand equity is given by the price-quality ratio. Using an explorative study on the market of Oradea city, it was highlighted the connection between perception of touristic services, estimation price

  20. Exploration Space Suit Architecture: Destination Environmental-Based Technology Development

    Science.gov (United States)

    Hill, Terry R.

    2010-01-01

    This paper picks up where EVA Space Suit Architecture: Low Earth Orbit Vs. Moon Vs. Mars (Hill, Johnson, IEEEAC paper #1209) left off in the development of a space suit architecture that is modular in design and interfaces and could be reconfigured to meet the mission or during any given mission depending on the tasks or destination. This paper will walk though the continued development of a space suit system architecture, and how it should evolve to meeting the future exploration EVA needs of the United States space program. In looking forward to future US space exploration and determining how the work performed to date in the CxP and how this would map to a future space suit architecture with maximum re-use of technology and functionality, a series of thought exercises and analysis have provided a strong indication that the CxP space suit architecture is well postured to provide a viable solution for future exploration missions. Through the destination environmental analysis that is presented in this paper, the modular architecture approach provides the lowest mass, lowest mission cost for the protection of the crew given any human mission outside of low Earth orbit. Some of the studies presented here provide a look and validation of the non-environmental design drivers that will become every-increasingly important the further away from Earth humans venture and the longer they are away. Additionally, the analysis demonstrates a logical clustering of design environments that allows a very focused approach to technology prioritization, development and design that will maximize the return on investment independent of any particular program and provide architecture and design solutions for space suit systems in time or ahead of being required for any particular manned flight program in the future. The new approach to space suit design and interface definition the discussion will show how the architecture is very adaptable to programmatic and funding changes with

  1. Mobile Augmented Reality: A Tool for Effective Tourism Interpretation in Enhancing Tourist Experience at Urban Tourism Destination

    Directory of Open Access Journals (Sweden)

    Nur Shuhadah Mohd

    2015-09-01

    Full Text Available The formation of tourism experience frequently subjected to complexity of individual tourist psycho-graphical factor, which leads to vast difference in the end experience formed among the respective tourist. However, the fact that travelling is highly subjected to environmental fuzziness and the issue of geographical consciousness may interfere the emotion of tourist and influence the formation of this experience. The evolution and advancement of mobile technologies had been optimized in improving the way human interact with the surrounding environment. Within this context, mobile augmented reality (AR technology is perceived as capable in narrowing the gap between the formation of pleasant experience and the issue of geographical consciousness, thus transform the way tourist interact with the destination. Pertaining to this situation, this conceptual paper is attempted to understand the effectiveness of mobile augmented reality in enhancing tourist travel experience on the tourism destination. In relation to this aim, this study is directed to clarify the mechanism and usability of mobile augmented reality in relation to its capability in improving tourism interpretation and to discover the influence of utilization of this technology towards tourism experience. Critical review of existing literature that relevant to the research area was done in understanding on the extensiveness of impact of mobile AR on tourist and experience formation. Findings revealed the capability of AR in merging virtual information with the real world environment through the platform of mobile device able to create a more dynamic interaction between tourist and surrounding environment.

  2. Developing Touristic Destination - the Way towards Increasing Innovation Performance

    Directory of Open Access Journals (Sweden)

    Tivadar Mahr

    2017-03-01

    Full Text Available Tourism is one of the most developing branches of service sectors. The paper deals with a key area of a Central-Eastern-European country (Hungary from the European perspective, i.e. tourism. Tourism provides a remarkable ratio of GDP, thus its importance is inevitable. Tourism destination management (TDM in further text organisations are local building stones of this important branch. These organisations received remarkable development funds in the previous budget period. The aim was to turn tourism into a competitive and innovative branch. Quadruple helix model - approach to innovation systems provides the opportunity to include the fourth helix - the media-based civic society - into the innovation performance, thus its performance influences the efficacy of the given innovation system. The paper assumes that these TDM organisations, as media-based civil organisations, appear as enterprises that are responsible for touristic innovation performance. The research objective is to prove, or deny that these institutions are important workshops of innovation. A survey research was conducted. In the meantime, feedback was collected about the structure, comprehensiveness and the logical structure of the questionnaire. Cooperation characteristics, the correlations between the innovation performances, the factors generating innovation and the reason for innovation are presented. The results of the study can be used by the state-governed tourism management, the vocational organisations and the Hungarian Tourism Ltd. in the process of establishing the framework of calls, and operational models in order to make international comparisons (with other countries.

  3. The generation, destination, and astrophysical applications of magnetohydrodynamic turbulence

    Science.gov (United States)

    Xu, Siyao; Lazarian, Alex; Zhang, Bing

    2017-01-01

    The ubiquitous turbulence in the interstellar medium (ISM) participates in astrophysical processes over a huge dynamic range of scales. Understanding the turbulence properties in the multiphase, magnetized, partially ionized, and compressible ISM is the fundamental step prior to the studies of the ISM physics and other fields of astrophysics. I feel that a triad of analytical, numerical and observational efforts provides a winning combination to understand this complex system and solve long-standing puzzles. I have intensively studied the fundamental physics of magnetohydrodynamic (MHD) turbulence, and focused on two primary domains, dynamo and dissipation, which concern the origin of strong magnetic fields and the destination of turbulence, respectively. I further applied my theoretical studies in interpreting numerical results and observational data in various astrophysical contexts. The advanced analyses of MHD turbulence enable me to address a number of challenging astrophysical problems, e.g. the importance of magnetic fields for star formation in the early and present-day universe, new methods of measuring magnetic fields, the density distribution in the Galaxy and the host galaxy of a fast radio burst, the diffusion and acceleration of cosmic rays in partially ionized ISM phases.

  4. Madeira-a tourist destination for asthma sufferers.

    Science.gov (United States)

    Camacho, Irene; Grinn-Gofroń, Agnieszka; Camacho, Roberto; Berenguer, Pedro; Sadyś, Magdalena

    2016-11-01

    Madeira Island is a famous tourist destination due to its natural and climatic values. Taking into account optimal weather conditions, flora richness and access to various substrates facilitating fungal growth, we hypothesised a very high risk of elevated fungal spore and pollen grain concentrations in the air of Funchal, the capital of Madeira. Concentration levels of the most allergenic taxa were measured from 2003 to 2009, using a 7-day volumetric air sampler, followed by microscopy analysis. Dependence of bioaerosols on the weather conditions and land use were assessed using spatial and statistical tools. Obtained results were re-visited by a comparison with hospital admission data recorded at the Dr. Nélio Mendonça Hospital in Funchal. Our results showed that despite propitious climatic conditions, overall pollen grain and fungal spore concentrations in the air were very low and did not exceed any clinically established threshold values. Pollen and spore peak concentrations also did not match with asthma outbreaks in the winter. Identification of places that are "free" from biological air pollution over the summer, such as Madeira Island, is very important from the allergic point of view.

  5. Madeira—a tourist destination for asthma sufferers

    Science.gov (United States)

    Camacho, Irene; Grinn-Gofroń, Agnieszka; Camacho, Roberto; Berenguer, Pedro; Sadyś, Magdalena

    2016-11-01

    Madeira Island is a famous tourist destination due to its natural and climatic values. Taking into account optimal weather conditions, flora richness and access to various substrates facilitating fungal growth, we hypothesised a very high risk of elevated fungal spore and pollen grain concentrations in the air of Funchal, the capital of Madeira. Concentration levels of the most allergenic taxa were measured from 2003 to 2009, using a 7-day volumetric air sampler, followed by microscopy analysis. Dependence of bioaerosols on the weather conditions and land use were assessed using spatial and statistical tools. Obtained results were re-visited by a comparison with hospital admission data recorded at the Dr. Nélio Mendonça Hospital in Funchal. Our results showed that despite propitious climatic conditions, overall pollen grain and fungal spore concentrations in the air were very low and did not exceed any clinically established threshold values. Pollen and spore peak concentrations also did not match with asthma outbreaks in the winter. Identification of places that are "free" from biological air pollution over the summer, such as Madeira Island, is very important from the allergic point of view.

  6. The significance of the tourist destination of Zlatibor spatial planning

    Directory of Open Access Journals (Sweden)

    Jovičić Ana

    2013-01-01

    Full Text Available The territory of Zlatibor is known as a region of exquisite beauty, rich in natural and anthropogenic values, and as such it is a significant tourist destination. The tourism on Zlatibor started developing a long time ago, however, recently there has formed a type of settlement with tourism as its basic function, with no adequate planned development and control, which deviates from the natural and aesthetic environment, disturbing the rare and autochthonous quality of the territory. Zlatibor’s beauty has been disturbed with unplanned construction and the development of tourism which is not sustainable in the long-term. The aim of this paper is to point out to the significance of spatial planning for further development of tourism on this mountain and give suggestions on further development which would neutralise, revitalise and improve the already degraded territory. Only by managing the territory of Zlatibor properly, as a resource for tourism, will its economic, ecologic and aesthetic value increase, which will ensure a long term benefit on a local, regional and national level. [Projekat Ministarstva nauke Republike Srbije, br. 47007

  7. Madeira—a tourist destination for asthma sufferers

    Science.gov (United States)

    Camacho, Irene; Grinn-Gofroń, Agnieszka; Camacho, Roberto; Berenguer, Pedro; Sadyś, Magdalena

    2016-05-01

    Madeira Island is a famous tourist destination due to its natural and climatic values. Taking into account optimal weather conditions, flora richness and access to various substrates facilitating fungal growth, we hypothesised a very high risk of elevated fungal spore and pollen grain concentrations in the air of Funchal, the capital of Madeira. Concentration levels of the most allergenic taxa were measured from 2003 to 2009, using a 7-day volumetric air sampler, followed by microscopy analysis. Dependence of bioaerosols on the weather conditions and land use were assessed using spatial and statistical tools. Obtained results were re-visited by a comparison with hospital admission data recorded at the Dr. Nélio Mendonça Hospital in Funchal. Our results showed that despite propitious climatic conditions, overall pollen grain and fungal spore concentrations in the air were very low and did not exceed any clinically established threshold values. Pollen and spore peak concentrations also did not match with asthma outbreaks in the winter. Identification of places that are "free" from biological air pollution over the summer, such as Madeira Island, is very important from the allergic point of view.

  8. Destinations without regulations: Informal practices in Romanian rural tourism

    Directory of Open Access Journals (Sweden)

    Maria Miruna Rădan-Gorska

    2013-12-01

    Full Text Available This article is an ethnographic account of the informal practices I encountered during my fieldwork in three touristic destinations in the Romanian countryside. In these places, as in other parts of rural Romania, over half of the accommodation units are unregistered, making tourism ‘on the black’ [market] widespread. This research is focused on unregistered businesses, as well as on those that aim to be law-abiding, but sometimes engage in informal practices. A typology of informal practices is outlined, dividing them into intended, unintended, and contextual. These categories are illustrated with evidence from interview data and from mass media accounts. Informality is discussed in relation to the legislative framework and to the actions of those authorities responsible with enforcing regulations. Local sense-making strategies are taken into account in explaining informal practices, as well as the wider national and historical contexts. The positive and negative implications of informality are examined and the article concludes by making a number of suggestions that could help to develop more appropriate norms and policies regarding rural guesthouses.

  9. Wound Healing Devices Brief Vignettes

    OpenAIRE

    Anderson, Caesar A.; Hare, Marc A.; Perdrizet, George A.

    2016-01-01

    Significance: The demand for wound care therapies is increasing. New wound care products and devices are marketed at a dizzying rate. Practitioners must make informed decisions about the use of medical devices for wound healing therapy. This paper provides updated evidence and recommendations based on a review of recent publications.

  10. Ventricular assist devices for heart failure: a focus on patient selection and complications

    Directory of Open Access Journals (Sweden)

    Cipriani M

    2014-09-01

    Full Text Available Manlio Cipriani, Vincenzo De Simone, Luciana D'Angelo, Enrico Perna, Marzia Lilliu, Virginia Bovolo, Fabrizio Oliva, Maria Frigerio Cardiovascular and Thoracic Department, A De Gasperis Niguarda Ca' Granda Hospital, Milan, Italy Abstract: Heart transplantation represents the “gold standard” for the treatment of patients with end-stage heart failure, but remains challenged by inadequate donor supply, finite graft survival, and long-term complications arising from immunosuppressive therapy. In addition, a lot of patients waiting for a heart transplant experience clinical deterioration, and other patients become ineligible to undergo this treatment due to their age or relevant comorbidities. Left ventricular assist devices have emerged as a valid therapeutic option for advanced heart failure. In recent years, we have seen significant advances not only in the technologies available, but also in patient selection, indications for use, and management after implantation. Consequently, there has been an increase in the number of implants and an improvement in the survival rate and quality of life for these patients. At the same time, there are new challenges on the horizon. Patient selection is a difficult process, based on clinical and imaging parameters and risk scores, and more data are needed to refine patient selection criteria and the timing of the implant. Left ventricular assist device-related complications are still a serious problem, causing adverse events and hospital readmissions. Continuous progress in the development of these implantable devices, such as a further reduction in size and hopefully the abolition of the external driveline, will probably make ventricular assist devices an option also for less advanced stages of heart failure. Here, we discuss the current indications for left ventricular assist device implantation, patient selection criteria, and the most frequent complications associated with these devices. Keywords

  11. Cosmopolitanism Influence on Destination Image: An Analysis of São Paulo City

    Directory of Open Access Journals (Sweden)

    Felipe Nasrallah Bedran

    2014-12-01

    Full Text Available This study aimed to find out how cosmopolitanism influences the destination image building. To accomplish this objective we interviewed foreign people, who know São Paulo, a city with national and international importance, due to its structure, economy, size, population and by its intense cultural and business life. This work reviewed cosmopolitanism that is the desire to know other cultures, besides his native one. This leads to an intention to travel through different regions, countries, to deepen in other societies and try to blend into it. Thus, one has particular characteristics, which influence the way one lives and consume products. The destination image can be defined as the sum of beliefs, ideas and impressions that a person has about a destination. To understand how cosmopolitanism influences the destination image, two approaches were used. A qualitative approach used interviews with professionals from SPTuris, as well as personal interviews with foreign tourists at the airport., This data was analyzed using content analysis. The quantitative approach included a survey with 205 foreigners. Data was analyzed using univariate and multivariate statistics, ANOVA and structural equation modeling. The result showed that cosmopolitanism and income influences the affective aspect in the destination image formation. It also showed that the stay purpose influenced the cognitive aspect, and that the length of stay influenced both aspects of the destination image. The research result showed that the cosmopolitanism influences mainly the affective aspect of São Paulo destination image. 

  12. Factors affecting the attractiveness of medical tourism destination: an empirical study on India- review article.

    Science.gov (United States)

    Sultana, Seyama; Haque, Ahasanul; Momen, Abdul; Yasmin, Farzana

    2014-07-01

    In this edge, medical tourism is not a new idea. Medical treatment is one of the essential demands of human beings and it requires high quality and intensive care. Beside western world, few developing countries are playing key roles as medical tourism destinations. India is one of the leading names among these countries. The purpose of the paper is to find the factors influencing the attractiveness of India as a health tourism destination. The study has found the major contributing factors and their relative importance in the attractiveness of the health tourism destination that is India from consumers' perspectives by conducting survey with an application of structural equation modelling approach. In Indian context, medical tourists consider service quality and cost mostly to select any medical destination. In addition they also give value to the destination competitiveness but tourist attitude is less important in comparison with other factors affecting their destination choice. Since the study has used structural equation modelling approach to test the hypothesis and figure out the relative importance of the factors, the fundamental indices such as Normed Chi square(less than 3), RMSEA (less than 0.08) and CFI (more than 0.90) values show the overall model fit of the proposed model. In order to transform a country such as India as an attractive and competitive medical tourist destination in this time of globalization, a step should be taken to control cost ensuring the quality of services.

  13. The Impact of the Hotel Industry on the Competitiveness of Tourism Destinations in Hungary

    Directory of Open Access Journals (Sweden)

    Albert Tóth Attila

    2016-12-01

    Full Text Available This paper focuses on a complex question from the perspective of the hotel industry. It tries to draw attention to the importance of hotels, enhancing it on the basis of the tourism destination competitiveness models and introducing the role and place of the hotel industry in the most important models. The hotel industry research evaluates the most important tourism destinations of Hungary on the micro-regional level that justifies the importance and contribution of the hotels and accommodations to competitiveness and success of tourism destinations with exact results. As a result of the research, the micro-regional destinations can be ranged within three groups in Hungary. In the first group of the most developed and most competitive tourism destinations, the hotel industry plays a very important role. In these regions, the hotel industry has a significant effect not only on competitiveness of tourism but also on general development of the regions. In the second group, which can be still called tourism destination, tourism and the hotel industry both play a significant role, but only the competitiveness of tourism can be considered good, the effects of the tourism on general development of the region can be proved only to a lesser extent. In the third group, the effects of tourism and the hotel industry can only be experienced to a lesser extent. The majority of these regions are not considered to be attractive tourism destinations for tourists any more.

  14. The allure of new immigrant destinations and the Great Recession in the United States.

    Science.gov (United States)

    Ellis, Mark; Wright, Richard; Townley, Matthew

    2014-01-01

    In the 1990s, the immigrant population in the United States dispersed to non-traditional settlement locations (what have become known as "new immigrant destinations"). This paper examines whether the allure of new destinations persisted in the 2000s with a particular focus on the internal migration of the foreign born during the recent deep recessionary period and its aftermath. Three specific questions motivate the analysis. First, are immigrants, much like the US-born population, becoming less migratory within the country over time? Second, is immigrant dispersal from traditional gateways via internal migration continuing despite considerable economic contraction in many new destination metropolitan areas? Third, is immigration from aboard a substitute for what appears to be declining immigrant internal migration to new destinations? The findings reveal a close correlation between the declining internal migration propensity of the US-born and immigrants in the last two decades. We also observe parallels between the geographies of migration of native- and foreign-born populations with both groups moving to similar metropolitan areas in the 1990s. This redistributive association, however, weakened in the subsequent decade as new destination metropolitan areas lost their appeal for both groups, especially immigrants. There is no evidence to suggest that immigration from abroad is substituting for the decline in immigrant redistribution through internal migration to new destinations. Across destination types the relationship between immigration from abroad and the internal migration of the foreign born remained the same before, during, and after the Great Recession.

  15. Percutaneous Ventricular Restoration Therapy Using the Parachute Device in Chinese Patients with Ischemic Heart Failure: Three-Month Primary End-point Results of PARACHUTE China Study

    Institute of Scientific and Technical Information of China (English)

    Yue-Jin Yang; Yong Huo; Ya-Wei Xu; Jian-An Wang; Ya-Ling Han; Jun-Bo Ge; Rui-Yan Zhang

    2016-01-01

    Background:The primary cause of ischemic heart failure (HF) is myocardial infarction (MI) resulting in left ventricle (LV) wall motion abnormality secondary to ventricular remodeling.A prospective,nonrandomized study conducted in China was designed to assess safety and efficacy of the percutaneous ventricular restoration therapy using Parachute device (CardioKinetix,Inc.,CA,USA) in ischemic HF patients as a result of LV remodeling after anterior wall MI.Methods:Thirty-one patients with New York Heart Association (NYHA) Class Ⅱ,Ⅲ ischemic HF,ejection fraction between 15% and 40%,and dilated akinetic or dyskinetic anterior-apical wall without the need to be revascularized were enrolled from seven sites in China from October to December 2014.The Parachute device was implanted through femoral artery.All patients received low-dose aspirin and anticoagulation with warfarin for at least 12 months postdevice implantation.The primary end-point was the assessment of efficacy as measured by the reduction in LV end-systolic volume index (LVESVI) against baseline LVESVI at 3 months postdevice implantation,determined by the echocardiography and measured by echocardiography core laboratory.Quality of life was assessed using EQ-5D and visual analog scale (VAS).For quantitative data comparison,paired t-test (normality data) and signed-rank test (abnormality data) were used;application of signed-rank test was for the ranked data comparison.Results:A change in LVESVI as measured by echocardiography from the preimplant baseline to 3-month postdevice implantation revealed a statistically significant reduction from 77.5 ± 20.0 ml/m2 to 53.1 ± 17.0 ml/m2 (P < 0.0001).The trial met its primary end-point.Of the 31 patients,the procedural success was 96.8%.Overall,NYHA HF class assessment results showed an improvement of more than halfa class at 3 months (P < 0.001).Quality of life assessed by the VAS value increased 11.5 points (P < 0.01),demonstrating improvement at 3

  16. MR guided thermal therapy of pancreatic tumors with endoluminal, intraluminal and interstitial catheter-based ultrasound devices: preliminary theoretical and experimental investigations

    Science.gov (United States)

    Prakash, Punit; Salgaonkar, Vasant A.; Scott, Serena J.; Jones, Peter; Hensley, Daniel; Holbrook, Andrew; Plata, Juan; Sommer, Graham; Diederich, Chris J.

    2013-02-01

    Image-guided thermal interventions have been proposed for potential palliative and curative treatments of pancreatic tumors. Catheter-based ultrasound devices offer the potential for temporal and 3D spatial control of the energy deposition profile. The objective of this study was to apply theoretical and experimental techniques to investigate the feasibility of endogastric, intraluminal and transgastric catheter-based ultrasound for MR guided thermal therapy of pancreatic tumors. The transgastric approach involves insertion of a catheter-based ultrasound applicator (array of 1.5 mm OD x 10 mm transducers, 360° or sectored 180°, ~7 MHz frequency, 13-14G cooling catheter) directly into the pancreas, either endoscopically or via image-guided percutaneous placement. An intraluminal applicator, of a more flexible but similar construct, was considered for endoscopic insertion directly into the pancreatic or biliary duct. An endoluminal approach was devised based on an ultrasound transducer assembly (tubular, planar, curvilinear) enclosed in a cooling balloon which is endoscopically positioned within the stomach or duodenum, adjacent to pancreatic targets from within the GI tract. A 3D acoustic bio-thermal model was implemented to calculate acoustic energy distributions and used a FEM solver to determine the transient temperature and thermal dose profiles in tissue during heating. These models were used to determine transducer parameters and delivery strategies and to study the feasibility of ablating 1-3 cm diameter tumors located 2-10 mm deep in the pancreas, while thermally sparing the stomach wall. Heterogeneous acoustic and thermal properties were incorporated, including approximations for tumor desmoplasia and dynamic changes during heating. A series of anatomic models based on imaging scans of representative patients were used to investigate the three approaches. Proof of concept (POC) endogastric and transgastric applicators were fabricated and experimentally

  17. Preliminary experience with the MicroMed DeBakey pediatric ventricular assist device.

    Science.gov (United States)

    Fraser, Charles D; Carberry, Kathleen E; Owens, W Richard; Arrington, Karol A; Morales, David L S; Heinle, Jeffery S; McKenzie, E Dean

    2006-01-01

    Mechanical circulatory support for both acute and chronic heart failure is a widely applied therapeutic option in the adult population with a variety of devices clinically available. Technology in this field has advanced sufficiently such that long-term support or "destination therapy" has become a generally accepted reality. Similar progress has not occurred in the field of device support for heart failure in children. While the number of potential patients is significantly lower in the pediatric population, the clinical relevance and poignancy of individual need are nonetheless real. Until recently, children with heart failure have been largely disadvantaged in comparison to their adult counterparts. The DeBakey VAD Child (MicroMed Technology, Inc, Houston, TX) represents a hopeful initial step in the direction of reducing the technological gap between adults and children. While the clinical experience with this device is limited at present, preliminary results are encouraging. This report will provide an overview of the DeBakey VAD Child, including device specifications, indications for clinical use, surgical and postoperative considerations, and updated clinical experience.

  18. SEGMENTING AND PROFILING THE CULTURAL TOURISM MARKET FOR AN ISLAND DESTINATION

    OpenAIRE

    Sean M. Hennessey; Dongkoo Yun; Roberta MacDonald

    2014-01-01

    Culture is an important part of the tourism product and is one of the variables that can increase the attractiveness and the competitiveness of a tourism destination. Cultural tourism covers all aspects of travel and provides an opportunity for visitors to learn about a destination’s history and way of life. However, the size and importance of cultural tourism for specific destinations is still a matter of some debate. Some suggest that it is difficult to truly document the size of the cult...

  19. The Influence of Previous Visitation on Customer's Evaluation of a Tourism Destination

    Directory of Open Access Journals (Sweden)

    Maja Konecnik

    2006-06-01

    Full Text Available The paper investigates the customer's perspective on a tourism destination brand through four proposed dimensions: awareness, image, quality and loyalty dimension. In addition to the brand's dimensions evaluation, the influence of previous visitation on each proposed dimension is presented. The evaluation of tourism destination brand Slovenia in the minds of German respondents serves as an investigated example. In addition to an evaluation for each investigated dimensions' variables for destination Slovenia as perceived by German respondents, the study confirms also the influence of previous visitation on brand evaluation. In the investigated example, previous visitation is recognized as the improvement factor in Slovenia's evaluation in the minds of German respondents.

  20. Stakeholder Colaboration in Tourism Destination Planning – The Case of Montenegro

    Directory of Open Access Journals (Sweden)

    Pjerotić Ljiljana

    2016-06-01

    Full Text Available The importance of involving diverse stakeholders in tourism planning is receiving growing recognition. Effective tourism destination planning is a complex process, due to the existence of a wide variety of stakeholders with a wide range of opinions, multiple problem visions and different interests. Despite the complexity of the planning process one feature acknowledged for successful destination management planning is a high level of stakeholder engagement and cooperation. The implementation and success of a tourism plan often relies on the support of destination stakeholders.

  1. Destination Prediction by Identifying and Clustering Prominent Features from Public Trajectory Datasets

    Directory of Open Access Journals (Sweden)

    Li Yang

    2015-07-01

    Full Text Available Destination prediction is an essential task in many location-based services (LBS such as providing targeted advertisements and route recommendations. Most existing solutions were generative methods that model the problem as a series of probabilistic events that are then used to compute the destination probability using Bayes’ rule. In contrast, we propose a discriminative method that chooses the most prominent features found in a public trajectory dataset, clusters the trajectories into groups based on these features, and performs destination prediction queries accordingly. Our method is more concise and simple than existing methods while achieving better runtime efficiency and prediction accuracy as verified by experimental studies.

  2. Preoperative Proteinuria and Reduced Glomerular Filtration Rate Predicts Renal Replacement Therapy in Patients Supported With Continuous-Flow Left Ventricular Assist Devices.

    Science.gov (United States)

    Topkara, Veli K; Coromilas, Ellie J; Garan, Arthur Reshad; Li, Randall C; Castagna, Francesco; Jennings, Douglas L; Yuzefpolskaya, Melana; Takeda, Koji; Takayama, Hiroo; Sladen, Robert N; Mancini, Donna M; Naka, Yoshifumi; Radhakrishnan, Jai; Colombo, Paolo C

    2016-12-01

    Renal failure requiring renal replacement therapy (RRT) has detrimental effects on quality of life and survival of patients with continuous-flow left ventricular assist devices (CF-LVADs). Current guidelines do not offer a decision-making algorithm for CF-LVAD candidates with poor baseline renal function. Objective of this study was to identify risk factors associated with RRT after CF-LVAD implantation. Three hundred and eighty-nine consecutive patients underwent contemporary CF-LVAD implantation at the Columbia University Medical Center between January 2004 and August 2015. Baseline demographics, comorbid conditions, clinical risk scores, and renal function were analyzed in patients with or without RRT after CF-LVAD implantation. Time-dependent receiver-operating characteristic curve analysis was performed to define optimal cutoffs for continuous risk factors. Forty-four patients (11.6%) required RRT during a median follow-up of 9.9 months. Patients requiring RRT had significantly worse renal function, lower hemoglobin, and increased proteinuria at baseline. Low estimated glomerular filtration rate (proteinuria (urine protein to creatinine ratio ≥0.55 mg/mg) were significant predictors of RRT after CF-LVAD support. Dipstick proteinuria was also a significant predictor of RRT after CF-LVAD implantation. Patients with both low estimated glomerular filtration rate and proteinuria had highest risk of RRT (63.6%) compared with those with either low estimated glomerular filtration rate or proteinuria (18.7%) and those with neither of these risk factors (2.7%) at 1-year follow-up (log-rank Pproteinuria are predictors RRT after CF-LVAD implantation and should be routinely assessed in CF-LVAD candidates to guide decision making. © 2016 American Heart Association, Inc.

  3. Analysis of tourism destination image influence on satisfaction e loyalty to sun and sea tourism destinations: A study in Natal/RN

    Directory of Open Access Journals (Sweden)

    Márcio Marreiro das Chagas

    2013-08-01

    Full Text Available This paper analysis tourism destination image influences on satisfaction and loyalty to Sun and Sea tourism destinations, investigating Natal/RN as a case. Quality dimensions were control variables. Therefore, it was conducted an exploratory and descriptive research with quantitative analytical approach. Data collection was performed by a questionnaire addressed to International tourists at the Augusto Severo International Airport. The composition was a simple random sampling by reaching the final number of 300 international tourists interviewed. Among the main results, it was noted that nine are the dimensions of perceived Quality of Sun and Sea segment, it means, Beaches, Public Equipment, Restaurants, Transportation, Information and Finance Services, Hotel Equipment, Diversity of Restaurants and Food, Complementary Services and Access to the hotel and Tourism Attractions, Urban and Natural Scenery. From the results, it was concluded that tourism destination image influences satisfaction and loyalty. Moreover, quality seems to be other important dimension for the satisfaction and loyalty process.

  4. CONCEPTUALISING TOURIST BASED BRAND-EQUITY PYRAMID: AN APPLICATION OF KELLER BRAND PYRAMID MODEL TO DESTINATIONS

    National Research Council Canada - National Science Library

    Anish Yousaf; Insha Amin; Anil Gupta

    2017-01-01

    Different scales available for measuring the brand-equity of destinations are found to be much tourist centric and did not present a holistic view regarding building sustainable customer based brand...

  5. Personal values, subjective well-being and destination-loyalty intention of international students.

    Science.gov (United States)

    Jamaludin, N L; Sam, D L; Sandal, G M; Adam, A A

    2016-01-01

    What are the factors that predict international students' destination-loyalty intention? This is the main question this paper addresses, using an online survey among 396 (short-term, N = 182) and (long-term, N = 214) international students at a Norwegian university. Structural equation model-AMOS was conducted to examine relationships among personal values, subjective well-being and destination-loyalty intentions. The results showed that: (1) universalism was positively related to subjective well-being for short-term students; and (2) subjective well-being was positively related to destination-loyalty intention for all groups. We found that relatively stable and happy individuals might be important for ensuring destination-loyalty intentions. Results also indicated that personal values that emphasize justice and equity are also important for short-term international students' well-being.

  6. Developing marketing strategies for tourism destinations in peripheral areas of Europe: the case of Bornholm

    DEFF Research Database (Denmark)

    Hartl, Ann

    of the components of the marketing mix, but they can cooperate with the providers of the destination mix and incite coopetition for the benefit of visitors. The case study portrays the DMO at a mature cold-water resort in a European peripheral area; it also illustrates the general development of tourism......This thesis concentrates on the subject of destination marketing with a specific focus on the process of developing strategies through a Destination Marketing Organisation (DMO) for a peripheral area, illustrated by a case study from the Danish island of Bornholm. It investigates the theoretical...... foundations for destination marketing, concluding that there should be a shift in focus from general marketing theory to a broader application of organisational theories and associated fields, enabling the DMO to improve performance. The specific conditions for and structures of peripheral areas indicate...

  7. Medical Tourism Destination SWOT Analysis: A Case Study of Malaysia, Thailand, Singapore and India

    Directory of Open Access Journals (Sweden)

    Wong Kee Mun

    2014-01-01

    Full Text Available The growth of global medical tourism in the recent years had spurred the interest of many governments to join in the bandwagon, particularly from Asia. Using the SWOT analytical model, this paper provides pertinent comparative analysis of the medical tourism destinations here being Malaysia, Thailand, Singapore and India. Each destination possesses its own value propositions to convince the demands of medical tourists. Malaysia and Thailand have a good mixture of elements (medical, tourism and wellness to be an excellent medical tourism destination while Singapore and India need further development in some of these elements. Meeting or exceeding the medical tourists’ expectations and requirements are the priority of medical tourism destination marketers in ensuring a successful medical tourism industry development.

  8. Detection of Botnet Command and Control Traffic by the Multistage Trust Evaluation of Destination Identifiers

    Directory of Open Access Journals (Sweden)

    Pieter Burghouwt

    2015-10-01

    Full Text Available Network-based detection of botnet Command and Control communication is a difficult task if the traffic has a relatively low volume and if popular protocols, such as HTTP, are used to resemble normal traffic. We present a new network-based detection approach that is capable of detecting this type of Command and Control traffic in an enterprise network by estimating the trustworthiness of the traffic destinations. If the destination identifier of a traffic flow origins directly from: human input, prior traffic from a trusted destination, or a defined set of legitimate applications, the destination is trusted and its associated traffic is classified as normal. Advantages of this approach are: the ability of zero day malicious traffic detection, low exposure to malware by passive host-external traffic monitoring, and the applicability for real-time filtering. Experimental evaluation demonstrates successful detection of diverse types of Command and Control Traffic.

  9. THE FEATURES AND POSSIBILITIES OF THE RUSSIAN WELLNESS TOURISTIC DESTINATIONS POTENTIAL EVALUATION

    Directory of Open Access Journals (Sweden)

    Olga E. Bashina

    2014-01-01

    Full Text Available The article describes the main problems of the Russian regional tourism. The article includes concepts touristic destination and cartographic taxonomy. In the article suggestions were made for the formation of “the Health Cluster”.

  10. A spatial interaction model with spatially structured origin and destination effects

    Science.gov (United States)

    LeSage, James P.; Llano, Carlos

    2013-07-01

    We introduce a Bayesian hierarchical regression model that extends the traditional least-squares regression model used to estimate gravity or spatial interaction relations involving origin-destination flows. Spatial interaction models attempt to explain variation in flows from n origin regions to n destination regions resulting in a sample of N = n 2 observations that reflect an n by n flow matrix converted to a vector. Explanatory variables typically include origin and destination characteristics as well as distance between each region and all other regions. Our extension introduces latent spatial effects parameters structured to follow a spatial autoregressive process. Individual effects parameters are included in the model to reflect latent or unobservable influences at work that are unique to each region treated as an origin and destination. That is, we estimate 2 n individual effects parameters using the sample of N = n 2 observations. We illustrate the method using a sample of commodity flows between 18 Spanish regions during the 2002 period.

  11. WEBSITES AS A PROMOTING TOOL FOR THE IDENTITY OF TOURISTIC DESTINATIONS

    Directory of Open Access Journals (Sweden)

    Francisco Vicente Sales Melo

    2013-06-01

    Full Text Available Since its advent, the Internet has become an important tool for tourism. Furthermore, some studies tend to indicate that this may contribute directly to the process of identity formation of a tourism destination. Thus, this paper investigates how websites can help in promoting the identity of tourist destinations on the Internet. The study is characterized as exploratory qualitative in nature, which is constituted from a desk research. It was possible to verify that the website is a key means for managing the identity of a tourist destination, as this can help visitors to form a positive image of the place being visited from the information that makes up the identity of the destination.

  12. Solving a four-destination traveling salesman problem using Escherichia coli cells as biocomputers.

    Science.gov (United States)

    Esau, Michael; Rozema, Mark; Zhang, Tuo Huang; Zeng, Dawson; Chiu, Stephanie; Kwan, Rachel; Moorhouse, Cadence; Murray, Cameron; Tseng, Nien-Tsu; Ridgway, Doug; Sauvageau, Dominic; Ellison, Michael

    2014-12-19

    The Traveling Salesman Problem involves finding the shortest possible route visiting all destinations on a map only once before returning to the point of origin. The present study demonstrates a strategy for solving Traveling Salesman Problems using modified E. coli cells as processors for massively parallel computing. Sequential, combinatorial DNA assembly was used to generate routes, in the form of plasmids made up of marker genes, each representing a path between destinations, and short connecting linkers, each representing a given destination. Upon growth of the population of modified E. coli, phenotypic selection was used to eliminate invalid routes, and statistical analysis was performed to successfully identify the optimal solution. The strategy was successfully employed to solve a four-destination test problem.

  13. The effect of destination linked feature selection in real-time network intrusion detection

    CSIR Research Space (South Africa)

    Mzila, P

    2013-07-01

    Full Text Available . Elimination of the insignificant features leads to a simplified problem and may enhance detection rate, which is itself a problem in network intrusion detection system. Furthermore, removal of specifically the destination linked features will allow the trained...

  14. Conference communication. Managing change in tourism destinations: Key issues and current trends.

    OpenAIRE

    Mariani, M.M.; Buhalis, Dimitrios; Longhi, C.; Vitouladiti, O.

    2013-01-01

    This conference communication illustrates the major outcomes emerging from the EIASM Conference on Tourism Management and Tourism Related Issues held in Nice (France), September 20-21, 2012. While a number of managerial issues pertaining to the tourism field were dealt with, this communication covers three specific areas of interest for destination management and marketing: (1) the increasing competition among tourism destinations and the rise and consolidation of BRIC countries as outbound t...

  15. EVALUASI ATRIBUT WISATA TERHADAP KEPUASAN, KEPERCAYAAN DAN DESTINATION LOYALTY (Studi pada Candi Prambanan)

    OpenAIRE

    PUTRI MUNGGAR, PINKAN NIDYA

    2014-01-01

    This research is purposed to understanding the significance of three tourism attributes influence consist of perceived differences culture, perceived safety, perceived convenient transportation toward the tourist’s satisfaction and confidence, and the influence of tourist’s satisfaction and confidence toward destination loyalty. Prambanan temple is being a tourism destination that researched with the number of respondents as much as 200 persons from domestic tourists who has...

  16. DESTINATION MARKETING STRATEGY IN BALI THROUGH OPTIMIZING THE POTENTIAL OF LOCAL PRODUCTS

    OpenAIRE

    I Gusti Ayu Oka Suryawardani; Agung Suryawan Wiranatha; Petr, Christine

    2014-01-01

    This study was designed to study destination marketing strategy in Bali through optimizing the potential of local products. Seventy nine of hotel managers were interviewed based on cluster sampling method to gain their point of view. The results show that destination must build their images around unique attributes that provide them sustainable competitive advantage including its attraction which should be designed to meet the needs of the target market and should be served by local produc...

  17. Conference communication. Managing change in tourism destinations: Key issues and current trends.

    OpenAIRE

    2013-01-01

    This conference communication illustrates the major outcomes emerging from the EIASM Conference on Tourism Management and Tourism Related Issues held in Nice (France), September 20-21, 2012. While a number of managerial issues pertaining to the tourism field were dealt with, this communication covers three specific areas of interest for destination management and marketing: (1) the increasing competition among tourism destinations and the rise and consolidation of BRIC countries as outbound t...

  18. Official tourist destination websites: hierarchical analysis and assessment with ELECTRE-III-H

    OpenAIRE

    Vasto Terrientes, Luis del; Fernández Cavia, Josep; Huertas Roig, Asunción; Moreno, Antonio; Valls, Aida

    2015-01-01

    Official websites are important communication tools for tourist destinations. However, it is difficult to make a systematic and complete evaluation of their quality due to their diversity of functionalities, which makes them complex to analyse. This paper proposes the complementation of the WQI assessment system for Destination Marketing Organizations with the Multi-criteria Decision Aiding (MCDA) method ELECTRE. WQI assessment system contains several indicators (123) that can be organised in...

  19. Does tourism destination competitiveness lead to performance? A case of ASEAN region

    OpenAIRE

    Hafiz Hanafiah, Mohd; Hemdi, Mohamad Abdullah; Ahmad, Ismail

    2016-01-01

    The main purpose of this paper is to identify the causes of ASEAN tourism performance. This paper empirically examines the role of tourism destination competitiveness on tourism performance among the ASEAN countries. This study employed the Travel and Tourism Competitiveness Index (TTCI) to assess tourism performance of the ASEAN countries. More specifically, this paper explores whether tourism's core resources, complementary resources, destination management, tourism prices and globalisation...

  20. A STRUCTURAL EQUATION MODEL: GREECE’S TOURISM DEMAND FOR TOURIST DESTINATION

    OpenAIRE

    Chaitip, Prasert; Chaiboonsri, Chukiat; Kovacs, Sandor; Balogh, Peter

    2010-01-01

    Structural equation model (LISREL 8) was applied to test the causal relationships between tourist travel motivations and tourist destination. A survey containing Likert scale questions was conducted to collect data from 100 tourists who had travelled to Greece’s tourist destination. With the help of factor analysis, four dimensions were identified for scales used in the study: travel cost satisfaction, tourism product, tourism product attributes, and tourism product management. Results indi...

  1. Moderating impact of tourism relationship management dimensions on tourism service quality, tourist satisfaction and destination loyalty

    Directory of Open Access Journals (Sweden)

    Arup Kumar Baksi

    2014-04-01

    Full Text Available This study attempts to assess the moderating impact of recently introduced tourist relationship management (TRM framework on service quality perception-tourist satisfaction-destination loyalty link. Tourist relationship management framework draws inspiration from customer relationship management (CRM model with validated addition of dimensions compatible to tourism dynamics. The study, carried out in Santiniketan, India, confirmed moderating impact of dimensional performance of tourist relationship management on perceived tourism service quality-tourist satisfaction-destination loyalty link.

  2. The internal structure of destination visitation model and implications for image management

    Directory of Open Access Journals (Sweden)

    Babu P George

    2013-07-01

    Full Text Available In the present research, Stanley Plog’s (1967 Psychocentrism – Allocentrism Visitation Model is reimagined. The researcher decomposes Plog’s original model and identifies five smaller bell shaped curves constituting five tourist personas within the normal distribution of tourist flow that depicts Plog’s model. The study also finds that, while allocentric tourists largely prefer nascent destinations, destinations that are close to the end of their life cycles become attractive to them once again.

  3. Events as a Framework for Tourist Destination Branding – Case Studies of Two Cultural Events in Croatia

    Directory of Open Access Journals (Sweden)

    Klara Trošt

    2012-04-01

    Full Text Available Events have become an increasingly significant component of destination branding. Many destinations throughout the world have developed events portfolios as a strategic initiative to attract tourists and to reinforce their brand. In this paper, the focus of research will be on tourist destination branding by means of events. The relationship between events and destination branding is examined through six phases of the process of building a destination brand identity with the use of events. When it comes to destination branding, a need for an analysis of strategic documents of destination development imposes because event tourism strategies help destinations plan how to use events in a tourism role. The purpose of this study is to examine which factors are of the top priorities when using events as a marketing approach. The method of case study will be used, by which two cultural events which take place in the Republic of Croatia will be analyzed, namely, “Špancirfest” in Varaždin and “Trka na prstenac” in Barban. Varaždin and Barban are on different levels in their branding work. The different sizes and locations of the destinations naturally affect the operating procedures. This article may be of interest to destination marketers and event organizers, especially in developing destinations which intend to differentiate themselves from the competitive market.

  4. Exploration Space Suit Architecture and Destination Environmental-Based Technology Development

    Science.gov (United States)

    Hill, Terry R.; McFarland, Shane M.; Korona, F. Adam

    2013-01-01

    This paper continues forward where EVA Space Suit Architecture: Low Earth Orbit Vs. Moon Vs. Mars left off in the development of a space suit architecture that is modular in design and could be reconfigured prior to launch or during any given mission depending on the tasks or destination. This space suit system architecture and technologies required based on human exploration (EVA) destinations will be discussed, and how these systems should evolve to meet the future exploration EVA needs of the US human space flight program. A series of exercises and analyses provided a strong indication that the Constellation Program space suit architecture, with its maximum reuse of technology and functionality across a range of mission profiles and destinations, is postured to provide a viable solution for future space exploration missions. The destination environmental analysis demonstrates that the modular architecture approach could provide the lowest mass and mission cost for the protection of the crew, given any human mission outside of low-Earth orbit. Additionally, some of the high-level trades presented here provide a review of the environmental and nonenvironmental design drivers that will become increasingly important as humans venture farther from Earth. The presentation of destination environmental data demonstrates a logical clustering of destination design environments that allows a focused approach to technology prioritization, development, and design that will maximize the return on investment, largely independent of any particular design reference mission.

  5. 旅游目的地品牌研究%Destination Brand Research

    Institute of Scientific and Technical Information of China (English)

    任宁宁

    2011-01-01

    旅游目的地营销经历了旅游地形象、旅游宣传口号之后,迎来了旅游目的地品牌竞争时代,构建旅游目的地品牌已经成为一种必然趋势。通过在前人研究基础上对旅游目的地品牌做进一步研究,探究了旅游目的地品牌内涵及自身发展规律,对旅游地品牌有进一步的认识,更好的促进旅游地可持续发展。%Tourism destination marketing through the tourist image,tourism promotion slogan,ushered in the era of tourism destination brand competition.Tourism destination brand building has become an inevitable trend.In this paper,based on the previous research on tourism destination brand to do further research,the author explore the meaning of tourism destination brand and its own law of development.Then on a more in-depth understanding of the destination Brand,better promotion of tourism to sustainable development.

  6. Foreign-born out-migration from new destinations: Onward or back to the enclave?

    Science.gov (United States)

    Kritz, Mary M; Gurak, Douglas T; Lee, Min-Ah

    2013-03-01

    Immigrants have a markedly higher likelihood of internal mignation if they live in new destinations. This paper looks at why that pattern occurs and at how immigrants' out-migration to new versus traditional destinations responds to their labor market economic and industrial structure, nativity origins and concentration, geographic region, and labor market type. Confidential data from the 2000 and 1990 decennial censuses are used for the analysis. Metropolitan and non-metropolitan areas are categorized into 741 local labor markets and classified as new or traditional based on the nativity concentrations of immigrants from the 24 largest Asian, Caribbean and Latin American origins. The analysis shows that immigrants are less likely to migrate to new destinations if they live in areas of higher nativity concentration, foreign-born population growth, and wages but more likely to make that move if they are professionals, agricultural or blue collar workers, highly educated, fluent in English, and live in new destinations. While immigrants are more likely to migrate to new rather than traditional destinations that outcome differs sharply for immigrants from different origins and for some immigrants, particularly those from the Caribbean, the dispersal process to new destinations has barely started. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. THE QUALITY OF THE TOURIST DESTINATIONS A KEY FACTOR FOR INCREASING THEIR ATTRACTIVENESS

    Directory of Open Access Journals (Sweden)

    Daliborka Blazeska

    2015-12-01

    Full Text Available Taking into consideration that the tourism is extremely important for any country including Republic of Macedonia, it is necessary to pay attention to the quality of the tourist destinations and increasing of their attractiveness. So winners in the field of tourism will be those countries that have attractive tourist destination that will attract a lot of visitors. In this paper is defined the relationship between the factors of attractiveness of the destination and the achieving of competitiveness. In order to become competitive in the global market, the tourist destination has to be innovative and to continually search for new competitive advantages. Those kind of competitive advantages enable stable and long-term sustainable development of the tourist destination. In this paper special emphasis is put to the monitoring of the quality of the tourist destination with constant inquiries of the tourists (domestic and foreign regarding the most important segments of the quality of the tourist product which they are using, in order to perceive the satisfaction or the eventual dissatisfaction in order to be taken concrete strategies for the following period. The obtained results clearly confirm the dissatisfaction with the road infrastructure and signalization, the price of the services and the conditions for the stay, as well as the additional attractions that were expected to get.

  8. Comparing Destination Image and Loyalty between First-time and Repeat-visit Tourists

    Directory of Open Access Journals (Sweden)

    Mohamad M.

    2014-01-01

    Full Text Available The objective of this study was to investigate the difference between destination image and loyalty among first-time and repeat-visit tourists. The study was undertaken to examine aspects of underlying factors of destination image that influenced tourists’ willingness to recommend Malaysia to their friends and relatives as well as spread positive word-of-mouth to others. In addition, it was to ascertain the relationship between destination image and loyalty among first-time and repeat-visit tourists. The data was collected at Kuala Lumpur International Airport at the departure hall using self-administered questionnaires. 248 usable questionnaires were returned and analysed. The findings of the study revealed that both groups of tourists perceived Malaysia as providing a nature-based destination. The study also empirically proved that both first-time and repeat-visit tourists were willing to disseminate positive word-of-mouth and recommend Malaysia to their friends and relatives as a vacation destination to visit. However, there was a significant difference in destination loyalty between first-visit and repeat-visit tourists.

  9. Tourists and Local Stakeholders Attitudes Towards Offer and Market Position of Tourist Destination Budva

    Directory of Open Access Journals (Sweden)

    Marković Ana Tripković

    2016-12-01

    Full Text Available There are various definitions of tourist destination. All of them define tourist destination as an area with specific tourist facilities and attractions, (primary and secondary elements which tourists choose as their journey goal. Budva individually represents the largest tourist destination due to number of arrivals and overnight stays. During its life cycle Budva has gone through different phases as a tourist destination. This thesis implies that it is not enough to use only common quantitative indicator of visitor number to define proper the position of tourist destination and predict further development. This text is based on a comparative analysis of the attitudes of tourists and local stakeholders in the three field researches, conducted in the period between 2015 and 2016. The thesis comes to the conclusion that the actual growth is based on meeting the needs of existing markets and tourists. On the other side, aspect of desired market position disagrees with scores of tourist offer elements- which should be input for improvement and preparation for the next stage in the destination development.

  10. DESTINATION BRANDING AIMED AT INTERNATIONAL AFFIRMATION OF TOURISTIC POTENTIALS OF BiH

    Directory of Open Access Journals (Sweden)

    Branko Rakita

    2014-12-01

    Full Text Available The aim of the paper is to explain how application of marketing and branding principles contributes to effective management of destinations under conditions of globalization. The paper emphasizes the importance of understanding of tourists’ behavior model, with special focus on importance of destination image in process of decision making on destination choice. Case of the city of Rovinj was presented as good practice example in development of destination brand. In order to get the answer to the question where BiH is located in comparison to other countries of the Western Balkans in regard to the most important tourism indicators, findings of relevant research of the World Tourism Organization and the World Economic Forum were presented. In the last part of the paper, some of the shortcomings that usually arise in the process of destination management in BiH were presented, with recommendations how they can be overcome in accordance with the principles of destination marketing and branding, in order to better utilize tourism potentials in BiH.

  11. Comparison of geometric uncertainties using electronic portal imaging device in focal three-dimensional conformal radiation therapy using different head supports

    Directory of Open Access Journals (Sweden)

    Budrukkar Ashwini

    2008-01-01

    Full Text Available Aims and Objectives: To study the geometric uncertainties in the treatment and evaluate the adequacy of the margins employed for planning target volume (PTV generation in the treatment of focal conformal radiotherapy (CRT for patients with brain tumors treated with different head support systems. Materials and Methods: The study population included 11 patients with brain tumors who were to be treated with CRT. Contrast-enhanced planning CT scan (5-mm spacing and reconstructed to 2 mm of brain were performed. Five patients were immobilized using neck support only (NR-only and six patients had neck support with flexion (NRF, the form of immobilization being decided by the likely beam arrangements to be employed for that particular patient. The data was transferred to the planning system (CadPlan where three-dimensional conformal radiation therapy was planned. Digitally reconstructed radiographs (DRRs were created for the orthogonal portals with the fixed field sizes of 10 x 10 taken at the isocenter. Treatment verification was done using an amorphous silicon detector portal imaging device for using orthogonal portals and the DRR was used as a reference image. An image matching software was used to match the anatomical landmarks in the DRR and the portal imaging and the displacement of the portals in x, y axis and rotation were noted in the anteroposterior (AP and lateral images. Electronic portal imaging was repeated twice weekly and an average of 8-14 images per patient was recorded. The mean deviation in all the directions was calculated for the each patient. Comparison of setup errors between the two head support systems was done. Results: A total 224 images were studied in anterior and lateral portals. The patient group with NR-only had 100 images, while the NRF group had 124 images. The mean total error in all patients, NR-only group, and NRF group was 0.33 mm, 0.24 mm, and 0.79 mm in the mediolateral (ML direction; 1.16 mm, 0.14 mm, and 2

  12. Impact of an electronic monitoring device and behavioral feedback on adherence to multiple sclerosis therapies in youth: results of a randomized trial.

    Science.gov (United States)

    Yeh, E Ann; Grover, Stephanie A; Powell, Victoria E; Alper, Gulay; Banwell, Brenda L; Edwards, Kim; Gorman, Mark; Graves, Jennifer; Lotze, Timothy E; Mah, Jean K; Mednick, Lauren; Ness, Jayne; Obadia, Maya; Slater, Ruth; Waldman, Amy; Waubant, Emmanuelle; Schwartz, Carolyn E

    2017-04-09

    To report the results of a randomized controlled trial using an electronic monitoring device (EM) plus a motivational interviewing (MI) intervention to enhance adherence to disease-modifying therapies (DMT) in pediatric MS. Fifty-two youth with MS (16.03 ± 2.2 years) were randomized to receive either MI (n = 25) (target intervention) or a MS medication video (n = 27) (attention control). Primary endpoint was change in adherence. Secondary outcomes included changes in quality of life, well-being and self-efficacy. Random effects modeling and Cohen's effect size computation evaluated intervention impact. Longitudinal random effect models revealed that the MI group decreased their EM adherence (GroupxTime interaction = -0.19), while increasing frequency of parental DMT reminder (26.01)/administration (11.69). We found decreased EM use in the MI group at 6 months (Cohen's d = -0.61), but increased pharmacy refill adherence (d = 0.23). Parental reminders about medication increased in MI subjects vs controls (d = 0.59 at 3 months; d = 0.70 at 6 months). We found increases in self-reported adherence (d = 0.21) at 3 but not 6 months, fewer barriers to adherence at three (d = -0.58) and six months (d = -0.31), better physical (d = 0.23 at 3 months; d = 0.45 at 6 months), emotional (d = 0.25 at 3 months) and self-efficacy function (d = 0.55 at 3 months; 0.48 at 6 months), but worse well-being, including self-acceptance (d = -0.53 at 6 months) and environmental mastery (d = -0.42 at 3 and 6 months) in intervention as compared to control patients. Participants receiving MI + EM experienced worsening on objective measures of adherence and increased parental involvement, but improved on some self- and parent-reported measures. MI participants reported improvements in quality of life and self-efficacy, but worsened well-being.

  13. [First successful bridge to cardiac transplantation in Chile using the Heart Mate II device. Report of one case].

    Science.gov (United States)

    Bunster, Nicolás; Villavicencio, Mauricio; Lim, Jongsung; Donoso, Erika; Gajardo, Francesca; Rossel, Víctor

    2014-04-01

    Implantable ventricular assist devices are an effective treatment option for end-stage heart failure patients as a bridge to cardiac transplantation, to improve the clinical condition and organ function allowing discharge from the hospital to await for transplantation. The second alternative is to use the device as destination therapy for patients with contraindications for cardiac transplantation, in whom it is maintained indefinitely. We report a 43-year-old patient, with a dilated cardiomyopathy, severe left ventricular dysfunction and advanced heart failure. A ventricular assist device Heart Mate II©, as a bridge to transplantation, was implanted to the patient in the United States. It was explanted for the first time in Chile at the National Thorax Institute. Heart transplantation was performed using the bicaval technique. Induction of immunosuppression was done with basiliximab. Generic immunosuppression was carried out with cyclosporine, mycophenolate mofetil and prednisone. Postoperatively the patient evolved with right femoral vein thrombosis in the femoral cannulation site, phlegmasia alba dolens, rhabdomyolysis, oliguric acute renal failure, which required renal replacement therapy, severe shock, with high requirements of vasoactive drugs and need for mechanical ventilation. He required a reoperation for hemothorax and had an Enterobacter pneumonia. After a period of serious illness, he began a gradual recovery and was discharged from the hospital after 58 days. After two years, he remains in functional class I, with a normal graft function.

  14. Indoor Navigation Design Integrated with Smart Phones and Rfid Devices

    Science.gov (United States)

    Ortakci, Y.; Demiral, E.; Atila, U.; Karas, I. R.

    2015-10-01

    High rise, complex and huge buildings in the cities are almost like a small city with their tens of floors, hundreds of corridors and rooms and passages. Due to size and complexity of these buildings, people need guidance to find their way to the destination in these buildings. In this study, a mobile application is developed to visualize pedestrian's indoor position as 3D in their smartphone and RFID Technology is used to detect the position of pedestrian. While the pedestrian is walking on his/her way on the route, smartphone will guide the pedestrian by displaying the photos of indoor environment on the route. Along the tour, an RFID (Radio-Frequency Identification) device is integrated to the system. The pedestrian will carry the RFID device during his/her tour in the building. The RFID device will send the position data to the server directly in every two seconds periodically. On the other side, the pedestrian will just select the destination point in the mobile application on smartphone and sent the destination point to the server. The shortest path from the pedestrian position to the destination point is found out by the script on the server. This script also sends the environment photo of the first node on the acquired shortest path to the client as an indoor navigation module.

  15. INDOOR NAVIGATION DESIGN INTEGRATED WITH SMART PHONES AND RFID DEVICES

    Directory of Open Access Journals (Sweden)

    Y. Ortakci

    2015-10-01

    Full Text Available High rise, complex and huge buildings in the cities are almost like a small city with their tens of floors, hundreds of corridors and rooms and passages. Due to size and complexity of these buildings, people need guidance to find their way to the destination in these buildings. In this study, a mobile application is developed to visualize pedestrian's indoor position as 3D in their smartphone and RFID Technology is used to detect the position of pedestrian. While the pedestrian is walking on his/her way on the route, smartphone will guide the pedestrian by displaying the photos of indoor environment on the route. Along the tour, an RFID (Radio-Frequency Identification device is integrated to the system. The pedestrian will carry the RFID device during his/her tour in the building. The RFID device will send the position data to the server directly in every two seconds periodically. On the other side, the pedestrian will just select the destination point in the mobile application on smartphone and sent the destination point to the server. The shortest path from the pedestrian position to the destination point is found out by the script on the server. This script also sends the environment photo of the first node on the acquired shortest path to the client as an indoor navigation module.

  16. [Rise of the machines? Left ventricular assist devices for treatment of severe heart failure].

    Science.gov (United States)

    Ujeyl, A; Krüger, M

    2015-11-01

    The use of left ventricular assist devices (LVAD) as a treatment for severe heart failure has gained momentum in recent years. Even at this stage the number of worldwide LVAD implantations far exceeds the volume of heart transplantations in view of the chronic shortage of donor organs. Third generation continuous flow assist devices have helped to improve survival, quality of life and symptom burden of heart failure patients in comparison to a regimen of optimal medication management. Alongside bridging to transplantation, destination therapy has become an established strategy of LVAD implantation. A careful patient selection process is crucial for a good clinical outcome after device implantation and risk assessment for postoperative right ventricular failure is of particular importance in this context. The rate of hospitalization during LVAD support is still high, despite the step-wise attempts to widen the indications to less severely ill heart failure patients. An effective perioperative and postoperative management will help to lower the incidence of complications (e.g. bleeding, infections, thromboembolic events and right ventricular failure) and to improve the encouraging results of mechanical circulatory support.

  17. Radiation Hardened Electronics Destined For Severe Nuclear Reactor Environments

    Energy Technology Data Exchange (ETDEWEB)

    Holbert, Keith E. [Arizona State Univ., Tempe, AZ (United States); Clark, Lawrence T. [Arizona State Univ., Tempe, AZ (United States)

    2016-02-19

    Post nuclear accident conditions represent a harsh environment for electronics. The full station blackout experience at Fukushima shows the necessity for emergency sensing capabilities in a radiation-enhanced environment. This NEET (Nuclear Energy Enabling Technologies) research project developed radiation hardened by design (RHBD) electronics using commercially available technology that employs commercial off-the-shelf (COTS) devices and present generation circuit fabrication techniques to improve the total ionizing dose (TID) hardness of electronics. Such technology not only has applicability to severe accident conditions but also to facilities throughout the nuclear fuel cycle in which radiation tolerance is required. For example, with TID tolerance to megarads of dose, electronics could be deployed for long-term monitoring, inspection and decontamination missions. The present work has taken a two-pronged approach, specifically, development of both board and application-specific integrated circuit (ASIC) level RHBD techniques. The former path has focused on TID testing of representative microcontroller ICs with embedded flash (eFlash) memory, as well as standalone flash devices that utilize the same fabrication technologies. The standalone flash devices are less complicated, allowing better understanding of the TID response of the crucial circuits. Our TID experiments utilize biased components that are in-situ tested, and in full operation during irradiation. A potential pitfall in the qualification of memory circuits is the lack of rigorous testing of the possible memory states. For this reason, we employ test patterns that include all ones, all zeros, a checkerboard of zeros and ones, an inverse checkerboard, and random data. With experimental evidence of improved radiation response for unbiased versus biased conditions, a demonstration-level board using the COTS devices was constructed. Through a combination of redundancy and power gating, the demonstration

  18. Insertion devices

    CERN Document Server

    Bahrdt, J

    2006-01-01

    The interaction of an insertion device with the electron beam in a storage ring is discussed. The radiation property including brightness, ux and polarization of an ideal and real planar and helical / elliptical device is described. The magnet design of planar, helical, quasiperiodic devices and of devices with a reduced on axis power density are resumed.

  19. ANALISIS DAYA SAING DENGAN MENGGUNAKAN DESTINATION COMPETITIVENESS MODEL (Studi pada Heritage Tourism di Jawa

    Directory of Open Access Journals (Sweden)

    Edriana Pangestuti

    2017-06-01

    Full Text Available This study sought to understand the relationship between destination competitiveness factors (such as the tourist’s image, service quality, satisfaction and behavioral intention. Little empirical research has explored these relationships from the heritage tourist’s perspective. A mixed method was used to achieve the study’s objectives and test the conceptual model. Twelve in-depth interviews and 400 questionnaire surveys (international and domestic were conducted using purposive technique sampling. A structural equation modeling (SEM technique was applied to identify, evaluate and develop the dimensions and test the relationship between these dimensions simultaneously. The final model showed that service quality has a significant relationship with satisfaction but an insignificant relationship with behavioral intention. In addition, this study provided new insights, determining that destination image and service quality factors influence destination competitiveness via the mediating of tourists’ satisfaction in a heritage tourism context. This shows the importance of destination image and service quality for measuring competitiveness. This present model will be useful as a guide for future research for measuring destination competitiveness in the heritage tourism context. Understanding destination competitiveness factors will help marketers predict future travel behavior and develop effective strategies in order to compete with other destinations. Keywords: destination image, satisfaction, service quality, behavioral intention and destination competitiveness ABSTRAK Penelitian ini berusaha memahami hubungan antara faktor daya saing destinasi (seperti citra destinasi, kualitas layanan, kepuasan dan niat perilaku. Beberapa penelitian serupa telah dilakukan dengan melihat dari perspektif wisatawan. Metode kualitatif dan kuantitatif (Mix method digunakan untuk menguji model konseptual. Dua belas narasumber dan 400 kuesioner (wisatawan

  20. Complications after cardiac implantable electronic device implantations

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard;

    2014-01-01

    Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient...

  1. Differences of perceived image generated through the Web site: Empirical Evidence Obtained in Spanish Destinations

    Directory of Open Access Journals (Sweden)

    Juan Jose Blazquez-Resino

    2016-11-01

    Full Text Available In this paper, a study of the perceived destination image created by promotional Web Pages is expounded in an attempt to identify their differences as generators of destination image in the consumers’ mind. Specifically, it seeks to analyse whether the web sites of different Spanish regions improve the image that consumers have of the destination, identifying their main dimensions and analysing its effect on satisfaction and intentions of the future behaviour of potential visitors. To achieve these objectives and verify the hypotheses, a laboratory experiment was performed, where it was determined what changes are produced in the tourist´s previous image after browsing the tourist webs of three different regions. Moreover, it analyses the differences in the effect of the perceived image on satisfaction and potential visitors´ future behavioural intentions. The results obtained enable us to identify differences in the composition of the perceived image according to the destination, while confirming the significant effect of different perceived image dimensions regarding satisfaction. The results allow managers to gain a better understanding of the effectiveness of their sites from a consumer perspective as well as suggestions to follow in order to achieve greater efficiency in their communication actions in order to improve the motivation of visitors to go to the destination.

  2. AN EXAMINATION OF COMPETITIVENESS OF RURAL DESTINATIONS FROM THE SUPPLY SIDE PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Dunja Demirović

    2016-12-01

    Full Text Available Tourist destinations are now faced with increased competition at the market and holders of tourist policy and offers have realized that understanding the factors that contribute to a better positioning in the market place, and therefore the competitiveness, is of crucial importance for further development. The aim of this paper is to determine how much Vojvodina is competitive as a rural tourism destination, and to assess the current state of all the factors that affect/could affect the competitiveness of rural tourism destinations in Vojvodina Province (Northern Serbia. The total of 136 tourism experts were interviewed, and we concluded that the key resources and attraction of rural areas in Vojvodina are rated better than the macro and industry-related factors. This suggests that a rural development strategy should have a special bond with resources and attractions of the destination, that priority should be given to maintaining all aspects of safety and security, continuous improvement of services, diversity of culinary products, as well as the application of the principles of sustainability in environmental management. The work of national and provincial institutions should have the aim to ensure that the destination has a clear idea of where it is going and what it takes to become successful in the long term.

  3. Tourist Profile and Destination Brand Perception: The Case of Cape Town, South Africa

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    Ikechukwu O. Ezeuduji

    2016-08-01

    Full Text Available Tourists pay for destination brands. This study checked for the relationships between tourists’ profile and how they perceived the destination brand of Cape Town. A questionnaire survey of 220 tourists visiting Cape Town was done. This study found that repeat visit, age of tourist, length of stay, and tourist origin, have significant influences on how tourists visiting Cape Town perceived the destination. The top three destination attributes of Cape Town (cognitive images, which enhance visitor experience satisfaction are (1 the overall level of service quality at facilities in Cape Town, (2 the city being one of the best places the tourists have visited, and (3 the destination’s good value for money. The top three emotional valuations of destination attributes (affective images which enhance visitor experience satisfaction in Cape Town include (1 memorable visit, (2 valuable visit, and (3 friendly and hospitable population. It is therefore recommended that tourism businesses in Cape Town develop relationship marketing tools to attract and retain its tourists segments of loyal, advanced in age, long-staying and domestic tourists. Results from this research could be compared with related findings in the international arena and have related implications, especially for developing economies

  4. Destination memory and deception: when I lie to Barack Obama about the moon.

    Science.gov (United States)

    Haj, Mohamad El; Saloppé, Xavier; Nandrino, Jean Louis

    2017-01-20

    This study investigates whether deceivers demonstrate high memory of the person to whom lies have been told (i.e., high destination memory). Participants were asked to tell true information (e.g., the heart is a vital organ) and false information (e.g., the moon is bigger than the sun) to pictures of famous people (e.g., Barack Obama) and, in a subsequent recognition test, they had to remember to whom each type of information had previously been told. Participants were also assessed on a deception scale to divide them into two populations (i.e., those with high vs. those with low deception). Participants with high tendency to deceive demonstrated similar destination memory for both false and true information, whereas those with low deception demonstrated higher destination memory for lies than for true information. Individuals with a high tendency to deceive seem to keep track of the destination of both true information and lies to be consistent in their future social interactions, and thus to avoid discovery of their deception. However, the inconsistency between deceiving and the moral standard of individuals with a low tendency to deceive may result in high destination memory in these individuals.

  5. Destination-based seed dispersal homogenizes genetic structure of a tropical palm.

    Science.gov (United States)

    Karubian, Jordan; Sork, Victoria L; Roorda, Tessa; Durães, Renata; Smith, Thomas B

    2010-04-01

    As the dominant seed dispersal agents in many ecosystems, frugivorous animals profoundly impact gene movement and fine-scale genetic structure of plants. Most frugivores engage in some form of destination-based dispersal, in that they move seeds towards specific destinations, resulting in clumped distributions of seeds away from the source tree. Molecular analyses of dispersed seeds and seedlings suggest that destination-based dispersal may often yield clusters of maternal genotypes and lead to pronounced local genetic structure. The long-wattled umbrellabird Cephalopterus penduliger is a frugivorous bird whose lek mating system creates a species-specific pattern of seed dispersal that can potentially be distinguished from background dispersal processes. We used this system to test how destination-based dispersal by umbrellabirds into the lek affects gene movement and genetic structure of one of their preferred food sources Oenocarpus bataua, a canopy palm tree. Relative to background dispersal processes, umbrellabird mating behaviour yielded more diverse seed pools in leks that included on average five times more seed sources and a higher incidence of long-distance dispersal events. This resulted in markedly lower fine-scale spatial genetic structure among established seedlings in leks than background areas. These species-specific impacts of destination-based dispersal illustrate how detailed knowledge of disperser behaviour can elucidate the mechanistic link driving observed patterns of seed movement and genetic structure.

  6. The Determinants of Tourist Use of Public Transport at the Destination

    Directory of Open Access Journals (Sweden)

    Aaron Gutiérrez

    2016-09-01

    Full Text Available Of all the activities associated with tourism, transport is the one that creates most pollution. However, the mobility of tourists at their destination is an activity that has so far received very little attention from researchers in comparison with that afforded to the transport mode used to travel from their point of origin to their destination. This paper provides new evidence about the use of public transport by tourists at their final destination. The study is based on data obtained from a survey conducted with tourists (N = 4336 on the Costa Daurada (Catalonia, a Mediterranean sun and beach resort. The empirical analysis is based on estimations made using a multinomial model of the transport mode chosen by tourists to travel to the Costa Daurada combined with another model that estimated the probability of them using public transport during their stay. The results show that the tourists who arrived by private car were the ones who least used public transport at the destination. This was despite the fact that these tourists had the profile that made them most likely to use this type of transportation. On the other hand, although the tourists who arrived by plane had the profile that made them least likely to use public transport, they were the ones who used it most. It is, therefore, possible to conclude that, in addition to tourist profile, another key factor in deciding whether tourists will use public transport at their destination is whether they will take their own car.

  7. Marketing everything and theming sameness: Urban destination marketing in contemporary Europe

    Directory of Open Access Journals (Sweden)

    Heeley John

    2014-01-01

    Full Text Available This paper reviews the academic and practitioner literature on urban destination marketing, suggesting that it contains within it a dominant paradigm which the author characterises as 'the theory of marketing competitive advantage'. As such, this theory requires towns and cities to differentiate themselves through the provision of unique products, based on which they subsequently undertake branding, market positioning, distribution and other activities through bespoke destination marketing organisations (DMOs. Practice is then contrasted with theory by reference to a discordant strad of the literature as well as the actual destination marketing currently being undertaken in 60 European towns and cities. The theory of marketing competitive advantage is shown to be an ideal which rarely translates into practice. Irrespective of whether or not a town or city possesses competitive advantage, DMO destination marketing gravitates almost inexorably towards a 'marketing of everything'. Such an approach, in turn, reduces to a bland and monolithic 'theming of urban sameness', all of which is diametrically opposite to what one would expect to be the case as per the theory of marketing competitive advantage. The author contends that this gap between theory and practice matters, necessitating a rethinking of how academics and practitioners should in future seek to explain or otherwise account for urban destination marketing.

  8. Bucharest: Analysis of an ‘old’ destination with a new tourism identity

    Directory of Open Access Journals (Sweden)

    Aurelia-Felicia Stăncioiu

    2011-11-01

    Full Text Available To be able to promote itself efficiently on the market, a destination, given the marketing perspective – has to be aware about the authentic and crucial elements of its own identity as being the only way to transfer, virtually and materially, of what it has best – the social-cultural and artistic identity (which, from a tourist perspective, represents its perceived image, along with psychological and artistic image of the destination. Hence without a detailed knowledge of this aspect, the promotion leads to a presentation of a distorted image of the destination which, in time, can distort the socio-cultural identity of the inhabitants of that region. To build the image of a destination (a notoriously long and complex process, begins with the need to profoundly understand tourists’ complexity of expectations (both functional and psychological and, on their basis, to use these as attributes of the destination in order to improve attractiveness. In Romania’s case such an aspect gains more importance due to the fact that, after the 1989, young generation, an important population segment, seem to register a continuous and dangerous process of “identity erosion”, which over time could result into disconnecting from the essence of the Romanian spirit, not being able to understand or even ignoring sense of belonging, sense of identity, heritage and “tourism heritage”.

  9. Multi-Destination Cognitive Radio Relay Network with SWIPT and Multiple Primary Receivers

    KAUST Repository

    Al-Habob, Ahmed A.

    2017-05-12

    In this paper, we study the performance of simultaneous wireless information and power transfer (SWIPT) technique in a multi-destination dual-hop underlay cognitive relay network with multiple primary receivers. Information transmission from the secondary source to destinations is performed entirely via a decode- and-forward (DF) relay. The relay is assumed to have no embedded power source and to harvest energy from the source signal using a power splitting (PS) protocol and employing opportunistic scheduling to forward the information to the selected destination. We derive analytical expressions for the outage probability assuming Rayleigh fading channels and considering the energy harvesting efficiency at relay, the source maximum transmit power and primary receivers interference constraints. The system performance is also studied at high signal-to-noise ratio (SNR) values where approximate expressions for the outage probability are provided and analyzed in terms of diversity order and coding gain. Monte-Carlo simulations and some numerical examples are provided to validate the derived expressions and to illustrate the effect of various system parameters on the system performance. In contrast to their conventional counterparts where a multi- destination diversity is usually achieved, the results show that the multi-destination cognitive radio relay networks with the SWIPT technique achieve a constant diversity order of one.

  10. Comparison of munupal recreation services considering the criterion of being in tourism destination

    Directory of Open Access Journals (Sweden)

    Ali Tekin

    2009-05-01

    Full Text Available Whether they are in tourism destination or not, municipalities effort to meet the various social service requirements of people. Recreation has a special place in social services. This research aimed to compare the recreation services of county municipalities of Muğla considering the criterion of being in tourism destination.For the aim mentioned, a survey questionnaire was developed based on the previous researches to collect data about the recreation services of municipalities. A 16 item survey questionnaire was applied to the people who are in administrator position in 10 municipalities. Before all the researchers tried to reach the major or the person on the level of second top administrator. Frequency and percentages were used to analyse the data collect from the data gathering material. The results of the research exposed that the recreation services of the municipalities in tourism destinations are more various than those are not in tourism destinations. While municipalities in tourism destinations supply these services all year long (not seasonal, the others  give seasonal services (in summer  or traditional days. Most of them have no recreation department and/or recreation programmer. Instead, public relations or any related person get the responsibility of carrying on these services.

  11. Comparison of munupal recreation services considering the criterion of being in tourism destination

    Directory of Open Access Journals (Sweden)

    Fahri Akçakoyun

    2009-05-01

    Full Text Available Whether they are in tourism destination or not, municipalities effort to meet the various social service requirements of people. Recreation has a special place in social services. This research aimed to compare the recreation services of county municipalities of Muğla considering the criterion of being in tourism destination.For the aim mentioned, a survey questionnaire was developed based on the previous researches to collect data about the recreation services of municipalities. A 16 item survey questionnaire was applied to the people who are in administrator position in 10 municipalities. Before all the researchers tried to reach the major or the person on the level of second top administrator. Frequency and percentages were used to analyse the data collect from the data gathering material. The results of the research exposed that the recreation services of the municipalities in tourism destinations are more various than those are not in tourism destinations. While municipalities in tourism destinations supply these services all year long (not seasonal, the others give seasonal services (in summer or traditional days. Most of them have no recreation department and/or recreation programmer. Instead, public relations or any related person get the responsibility of carrying on these services.

  12. An Entropy-Perspective Study on the Sustainable Development Potential of Tourism Destination Ecosystem in Dunhuang, China

    Directory of Open Access Journals (Sweden)

    Huihui Feng

    2014-12-01

    Full Text Available This paper analyzed the characteristic of the tourism destination ecosystem from perspective of entropy in Dunhuang City. Given these circumstances, an evaluation index system that considers the potential of sustainable development was formed based on dissipative structure and entropy change for the tourism destination ecosystem. The sustainable development potential evaluation model for tourism destination ecosystem was built up based on information entropy. Then, we analyzed each indicator impact for the sustainable development potential and proposed some measures for the tourism destination ecosystem. The conclusions include: (a the requirements of Dunhuang tourism destination ecosystem on the natural ecosystem continuously grew between 2000 and 2012; (b The sustainable development potential of the Dunhuang tourism destination ecosystem was on an oscillation upward trend during the study period, which is dependent on government attention, and pollution problems were improved.

  13. Compassionate deactivation of ventricular assist devices in pediatric patients.

    Science.gov (United States)

    Hollander, Seth A; Axelrod, David M; Bernstein, Daniel; Cohen, Harvey J; Sourkes, Barbara; Reddy, Sushma; Magnus, David; Rosenthal, David N; Kaufman, Beth D

    2016-05-01

    Despite greatly improved survival in pediatric patients with end-stage heart failure through the use of ventricular assist devices (VADs), heart failure ultimately remains a life-threatening disease with a significant symptom burden. With increased demand for donor organs, liberalizing the boundaries of case complexity, and the introduction of destination therapy in children, more children can be expected to die while on mechanical support. Despite this trend, guidelines on the ethical and pragmatic issues of compassionate deactivation of VAD support in children are strikingly absent. As VAD support for pediatric patients increases in frequency, the pediatric heart failure and palliative care communities must work toward establishing guidelines to clarify the complex issues surrounding compassionate deactivation. Patient, family and clinician attitudes must be ascertained and education regarding the psychological, legal and ethical issues should be provided. Furthermore, pediatric-specific planning documents for use before VAD implantation as well as deactivation checklists should be developed to assist with decision-making at critical points during the illness trajectory. Herein we review the relevant literature regarding compassionate deactivation with a specific focus on issues related to children.

  14. How did Malaysia Manage its Position as Top 10 World Tourist Destinations in UNWTO Ranking in 2012?

    OpenAIRE

    Nor’Ain Othman; Hassnah Wee; Razip Hassan

    2014-01-01

    There are many reasons contributing to the achievement of Malaysia for being rank as top 10 most visited destinations in the world for the last four years. Among the factors are structures, resources, strategy, policy and leadership. In order to identify how Malaysia manage to be at this rank, a study was carried out on destination branding of Malaysian tourism from destination marketers’ perspectives. The objectives are to identify tourism marketing messages that influence international t...

  15. A NEW APPROACH TO THE ANALYSIS OF VISITOR PERCEPTIONS TOWARDS A TOURISM DESTINATION: THE ROLE OF FOOD AND WINE EXPERIENCES

    OpenAIRE

    Capitello, Roberta; Agnoli, Lara; Diego BEGALLI

    2013-01-01

    The study aims to propose a new approach to analyse visitor perceptions and experiences in a tourism destination. The purpose is to discuss how the discrete choice models can contribute to the analysis of the tourism destination in the visitor experience perspective. The study pays particular attention to the role of food and wine supply in thetourism experience and the destination perception. This research deepens the theoretical approach to the analysis of visitor perceptions for a tourist ...

  16. Competitive branding policies for medium mountain tourism destinations: a case study from the Val di Sole (Trento)

    OpenAIRE

    Elisa Tizzoni

    2015-01-01

    The aim of this essay is to address the issue of medium mountain destination branding from a multidisciplinary perspective, focusing on the Italian tourism area of the Val di Sole as a case study.After having summarized the main potentialities and constraints in medium mountain tourism management, the research applies the many-sided concept of in-between place to the destination branding aspects. Finally, the analysis of destination branding policies carried out in the Val di Sole, a medium m...

  17. Modelo Conceptual integrativo de Destination Branding: teste empírico no Porto e Norte de Portugal

    Directory of Open Access Journals (Sweden)

    Pedro Costa Carvalho

    2015-01-01

    Full Text Available The current study aims to develop and test a new conceptual model for destination branding, including and integrating the concepts of brand identity (brand associations, brand image, perceived quality, satisfation and loyalty. This study hypothesizes relationships among this constructs. This article aims to contribute to the conceptualization of destination branding that is identified as critical concept to the competitiveness of tourist destinations.

  18. An Entropy-Perspective Study on the Sustainable Development Potential of Tourism Destination Ecosystem in Dunhuang, China

    OpenAIRE

    Huihui Feng; Xingpeng Chen; Peter Heck; Hong Miao

    2014-01-01

    This paper analyzed the characteristic of the tourism destination ecosystem from perspective of entropy in Dunhuang City. Given these circumstances, an evaluation index system that considers the potential of sustainable development was formed based on dissipative structure and entropy change for the tourism destination ecosystem. The sustainable development potential evaluation model for tourism destination ecosystem was built up based on information entropy. Then, we analyzed each indicator ...

  19. Destination image and crime in Mexico: An analysis of foreign government travel advice

    Directory of Open Access Journals (Sweden)

    J. Carlos Monterrubio

    2013-07-01

    Full Text Available Destination image has been recognised as an influential component of travel decision processes. Although organic sources of information play an important role in shaping destination image, researchers have often ignored the types of sources and the information they deliver. In particular, official websites where government travel advice is given, especially in relation to crime, have been widely excluded from scholarly research. This paper analyses the relationship between crime-related travel advice given by foreign governments and Mexico’s destination image. Qualitative content analysis of official websites from the US, Canada, the UK and Spain reveals that the travel advice given relates largely to the violence and insecurity that Mexico is currently experiencing. “No advisory in effect”, “Exercise caution” and “Defer non-essential travel” are messages commonly found in the governments’ travel advice about Mexico.

  20. Urban tourism destinations in South Africa: Divergent trajectories 2001–2012

    Directory of Open Access Journals (Sweden)

    Christian M. Rogerson

    2014-07-01

    Full Text Available Cities are growing tourism destinations in both developed and developing countries. For policymakers in many cities the promotion of tourism is a vital issue. The phenomenon of urban tourism has emerged as a significant research topic in tourism and urban studies. The South African experience has been one of the most well documented cases in urban tourism in the developing world. Most existing research is focussed on supply-side issues of the establishment of new tourism products in cities or of the impacts of growing urban tourism. This article examines urban tourism from a demand-side perspective and interrogates the performance of South Africa’s eight metropolitan areas as tourism destinations over the period 2001-2012.The analysis reveals that the metropolitan areas as a group are expanding in significance as tourism destinations. Divergent pathways or trajectories of development are apparent in terms of unpacking the performance of the eight different areas.