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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. Management of severe ischemic cardiomyopathy: left ventricular assist device as destination therapy versus conventional bypass and mitral valve surgery.

    Science.gov (United States)

    Maltais, Simon; Tchantchaleishvili, Vahtang; Schaff, Hartzell V; Daly, Richard C; Suri, Rakesh M; Dearani, Joseph A; Topilsky, Yan; Stulak, John M; Joyce, Lyle D; Park, Soon J

    2014-04-01

    Patients with severe ischemic cardiomyopathy (left ventricular ejection fraction assist device as destination therapy is reserved for patients who are too high risk for conventional surgery. We evaluated our outcomes with conventional surgery within this population and the comparative effectiveness of these 2 therapies. We identified patients who underwent conventional surgery or left ventricular assist device as destination therapy for severe ischemic cardiomyopathy (left ventricular ejection fraction assist device as destination therapy. We compared baseline patient characteristics and outcomes in terms of end-organ function and survival. A total of 88 patients were identified; 55 patients underwent conventional surgery (63%), and 33 patients (37%) received a left ventricular assist device as destination therapy. Patients who received left ventricular assist device as destination therapy had the increased prevalence of renal failure, inotrope dependency, and intra-aortic balloon support. Patients undergoing conventional surgery required longer ventilatory support, and patients receiving a left ventricular assist device required more reoperation for bleeding. Mortality rates were similar between the 2 groups at 30 days (7% in the conventional surgery group vs 3% in the left ventricular assist device as destination therapy group, P = .65) and at 1 year (22% in the conventional surgery group vs 15% in the left ventricular assist device as destination therapy group, P = .58). There was a trend toward improved survival in patients receiving a left ventricular assist device compared with the propensity-matched groups at 1 year (94% vs 71%, P = .171). The operative mortality and early survival after conventional surgery seem to be acceptable. For inoperable or prohibitive-risk patients, left ventricular assist device as destination therapy can be offered with similar outcomes. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby

  3. Frailty and outcomes after implantation of left ventricular assist device as destination therapy.

    Science.gov (United States)

    Dunlay, Shannon M; Park, Soon J; Joyce, Lyle D; Daly, Richard C; Stulak, John M; McNallan, Sheila M; Roger, Véronique L; Kushwaha, Sudhir S

    2014-04-01

    Frailty is recognized as a major prognostic indicator in heart failure. There has been interest in understanding whether pre-operative frailty is associated with worse outcomes after implantation of a left ventricular assist device (LVAD) as destination therapy. Patients undergoing LVAD implantation as destination therapy at the Mayo Clinic, Rochester, Minnesota, from February 2007 to June 2012, were included in this study. Frailty was assessed using the deficit index (31 impairments, disabilities and comorbidities) and defined as the proportion of deficits present. We divided patients based on tertiles of the deficit index (>0.32 = frail, 0.23 to 0.32 = intermediate frail, <0.23 = not frail). Cox proportional hazard regression models were used to examine the association between frailty and death. Patients were censored at death or last follow-up through October 2013. Among 99 patients (mean age 65 years, 18% female, 55% with ischemic heart failure), the deficit index ranged from 0.10 to 0.65 (mean 0.29). After a mean follow-up of 1.9 ± 1.6 years, 79% of the patients had been rehospitalized (range 0 to 17 hospitalizations, median 1 per person) and 45% had died. Compared with those who were not frail, patients who were intermediate frail (adjusted HR 1.70, 95% CI 0.71 to 4.31) and frail (HR 3.08, 95% CI 1.40 to 7.48) were at increased risk for death (p for trend = 0.004). The mean (SD) number of days alive out of hospital the first year after LVAD was 293 (107) for not frail, 266 (134) for intermediate frail and 250 (132) for frail patients. Frailty before destination LVAD implantation is associated with increased risk of death and may represent a significant patient selection consideration. Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  4. Anchoring in Destination-Therapy Left Ventricular Assist Device Decision Making: A Mechanical Turk Survey.

    Science.gov (United States)

    Paine, Arcadia M; Allen, Larry A; Thompson, Jocelyn S; McIlvennan, Colleen K; Jenkins, Amy; Hammes, Andrew; Kroehl, Miranda; Matlock, Daniel D

    2016-11-01

    People with end-stage heart failure may have to decide about destination-therapy left ventricular assist device (DT-LVAD). Individuals facing difficult decisions often rely on heuristics, such as anchoring, which predictably bias decision outcomes. We aimed to investigate whether showing a larger historical Heartmate XVE creates an anchoring effect, making the smaller Heartmate II (HMII) appear more favorable. With the use of Amazon Mechanical Turk, participants watched videos asking them to imagine themselves dying of end-stage heart failure, then were presented the option of LVAD as potentially life-prolonging therapy. Participants were randomized to a control group who were only shown the HMII device, and the intervention group who saw the XVE device before the HMII. Participants then completed surveys. A total of 487 participants completed the survey (control = 252; intervention = 235); 79% were affect likelihood of accepting the LVAD, it did affect device perception. This article highlights an important point with clinical implications: factors such as anchoring have the potential to inappropriately influence perceptions and decisions and should be carefully considered in research and practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Palliative medicine consultation for preparedness planning in patients receiving left ventricular assist devices as destination therapy.

    Science.gov (United States)

    Swetz, Keith M; Freeman, Monica R; AbouEzzeddine, Omar F; Carter, Kari A; Boilson, Barry A; Ottenberg, Abigale L; Park, Soon J; Mueller, Paul S

    2011-06-01

    To assess the benefit of proactive palliative medicine consultation for delineation of goals of care and quality-of-life preferences before implantation of left ventricular assist devices as destination therapy (DT). We retrospectively reviewed the cases of patients who received DT between January 15, 2009, and January 1, 2010. Of 19 patients identified, 13 (68%) received proactive palliative medicine consultation. Median time of palliative medicine consultation was 1 day before DT implantation (range, 5 days before to 16 days after). Thirteen patients (68%) completed advance directives. The DT implantation team and families reported that preimplantation discussions and goals of care planning made postoperative care more clear and that adverse events were handled more effectively. Currently, palliative medicine involvement in patients receiving DT is viewed as routine by cardiac care specialists. Proactive palliative medicine consultation for patients being considered for or being treated with DT improves advance care planning and thus contributes to better overall care of these patients. Our experience highlights focused advance care planning, thorough exploration of goals of care, and expert symptom management and end-of-life care when appropriate.

  6. The successful implantation of continuous-flow left ventricular assist device as a destination therapy in Korea: echocardiographic assessment.

    Science.gov (United States)

    Lee, Ga Yeon; Park, Sung-Ji; Kim, Sujin; Choi, Namgyung; Jeong, Dong Seop; Jeon, Eun-Seok; Lee, Young Tak

    2014-01-01

    Left ventricular assist device (LVAD) is a good treatment option for the patients ineligible for cardiac transplantation. Several studies have demonstrated that a ventricular assist device improves the quality of life and prognosis of the patients with end-stage heart failure. A 75-yr-old man debilitated with New York Heart Association (NYHA) functional class III-IV due to severe left ventricular systolic dysfunction received LVAD implantation as a destination therapy. The patient was discharged with improved functional status (NYHA functional class II) after appropriate cardiac rehabilitation and education about how to manage the device and potential emergency situations. This is the first case of successful continuous-flow LVAD implantation as a destination therapy in Korea.

  7. State-of-the-art implantable cardiac assist device therapy for heart failure: bridge to transplant and destination therapy.

    Science.gov (United States)

    Park, S J; Kushwaha, S S; McGregor, C G A

    2012-01-01

    Congestive heart failure is associated with poor quality of life (QoL) and low survival rates. The development of state-of-the-art cardiac devices holds promise for improved therapy in patients with heart failure. The field of implantable cardiac assist devices is changing rapidly with the emergence of continuous-flow pumps (CFPs). The important developments in this field, including pertinent clinical trials, registry reports, innovative research, and potential future directions are discussed in this paper.

  8. Exploring cognitive bias in destination therapy left ventricular assist device decision making: A retrospective qualitative framework analysis.

    Science.gov (United States)

    Magid, Molly; McIlvennan, Colleen K; Jones, Jaqueline; Nowels, Carolyn T; Allen, Larry A; Thompson, Jocelyn S; Matlock, Dan

    2016-10-01

    Cognitive biases are psychological influences, which cause humans to make decisions, which do not seemingly maximize utility. For people with heart failure, the left ventricular assist device (LVAD) is a surgically implantable device with complex tradeoffs. As such, it represents an excellent model within which to explore cognitive bias in a real-world decision. We conducted a framework analysis to examine for evidence of cognitive bias among people deciding whether or not to get an LVAD. The aim of this study was to explore the influence of cognitive bias on the LVAD decision-making process. We analyzed previously conducted interviews of patients who had either accepted or declined an LVAD using a deductive, predetermined framework of cognitive biases. We coded and analyzed the interviews using an inductive-deductive framework approach, which also allowed for other themes to emerge. We interviewed a total of 22 heart failure patients who had gone through destination therapy LVAD decision making (15 who had accepted the LVAD and 7 who had declined). All patients appeared influenced by state dependence, where both groups described high current state of suffering, but the groups differed in whether they believed LVAD would relieve suffering or not. We found evidence of cognitive bias that appeared to influence decision making in both patient groups, but groups differed in terms of which cognitive biases were present. Among accepters, we found evidence of anchoring bias, availability bias, optimism bias, and affective forecasting. Among decliners, we found evidence of errors in affective forecasting. Medical decision making is often a complicated and multifaceted process that includes cognitive bias as well as other influences. It is important for clinicians to recognize that patients can be affected by cognitive bias, so they can better understand and improve the decision-making process to ensure that patients are fully informed. Published by Elsevier Inc.

  9. Cost-Effectiveness of Ventricular Assist Device Destination Therapy for Advanced Heart Failure in Duchenne Muscular Dystrophy.

    Science.gov (United States)

    Magnetta, Defne A; Kang, JaHyun; Wearden, Peter D; Smith, Kenneth J; Feingold, Brian

    2018-05-17

    Destination ventricular assist device therapy (DT-VAD) is well accepted in select adults with medically refractory heart failure (HF) who are not transplant candidates; however, its use in younger patients with progressive diseases is unclear. We sought to evaluate the cost-effectiveness of DT-VAD in Duchenne muscular dystrophy (DMD) patients with advanced HF. We created a Markov-state transition model (5-year horizon) to compare survival, costs, and quality of life (QOL) between medical management and DT-VAD in DMD with advanced HF. Model input parameters were derived from the literature. We used sensitivity analyses to explore uncertainty around model assumptions. DT-VAD had higher costs ($435,602 vs. $125,696), survival (3.13 vs. 0.60 years), and quality-adjusted survival (1.99 vs. 0.26 years) than medical management. The incremental cost-effectiveness ratio (ICER) for DT-VAD was $179,086 per quality-adjusted life year (QALY). In sensitivity analyses that were widely varied to account for uncertainty in model assumptions, the DT-VAD strategy generally remained more costly and effective than medical management. Only when VAD implantation costs were <$113,142 did the DT-VAD strategy fall below the $100,000/QALY willingness-to-pay threshold commonly considered to be "cost-effective." In this exploratory analysis, DT-VAD for patients with DMD and advanced HF exceeded societal expectations for cost-effectiveness but had an ICER similar to the accepted practice of DT-VAD in adult HF patients. While more experience and research in this population is needed, our analysis suggests that DT-VAD for advanced HF in DMD should not be dismissed solely based on cost.

  10. Left ventricular assist device as destination therapy: application of the payment-by-results approach for the device reimbursement.

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    Messori, Andrea; Trippoli, Sabrina; Bonacchi, Massimo; Sani, Guido

    2009-08-01

    Value-based methods are increasingly used to reimburse therapeutic innovation, and the payment-by-results approach has been proposed for handling interventions with limited therapeutic evidence. Because most left ventricular assist devices are supported by preliminary efficacy data, we examined the effectiveness data of the HeartMate (Thoratec Corp, Pleasanton, CA) device to explore the application of the payment-by-results approach to these devices and to develop a model for handling reimbursements. According to our model, after establishing the societal economic countervalue for each month of life saved, each patient treated with one such device is associated to the payment of this countervalue for every month of survival lived beyond the final date of estimated life expectancy without left ventricular assist devices. Our base-case analysis, which used the published data of 68 patients who received the HeartMate device, was run with a monthly countervalue of euro 5000, no adjustment for quality of life, and a baseline life expectancy of 150 days without left ventricular assist devices. Sensitivity analysis was aimed at testing the effect of quality of life adjustments and changes in life expectancy without device. In our base-case analysis, the mean total reimbursement per patient was euro 82,426 (range, euro 0 to euro 250,000; N = 68) generated as the sum of monthly payments. This average value was close to the current price of the HeartMate device (euro 75,000). Sensitivity testing showed that the base-case reimbursement of euro 82,426 was little influenced by variations in life expectancy, whereas variations in utility had a more pronounced impact. Our report delineates an innovative procedure for appropriately allocating economic resources in this area of invasive cardiology.

  11. LVAD pannus complicating destination therapy

    Directory of Open Access Journals (Sweden)

    Maya Ignaszewski

    2017-11-01

    Full Text Available Despite advances in technology, ventricular assist devices still experience a number of complications limiting their long-term use. We present a 73-year-old woman implanted with a left ventricular assist device (LVAD five years prior due to end-stage dilated cardiomyopathy, who died several weeks after admission to the hospital. Post-mortem examination revealed a large obstructing pannus in the LVAD inflow. As a result of increased LVAD use, complications such as infection, device thrombosis and pannus must be promptly recognized and managed appropriately to ensure the greatest chance of patient survival.

  12. Decision making for destination therapy left ventricular assist devices: "there was no choice" versus "I thought about it an awful lot".

    Science.gov (United States)

    McIlvennan, Colleen K; Allen, Larry A; Nowels, Carolyn; Brieke, Andreas; Cleveland, Joseph C; Matlock, Daniel D

    2014-05-01

    Destination therapy left ventricular assist devices (DT LVADs) are one of the most invasive medical interventions for end-stage illness. How patients decide whether or not to proceed with device implantation is unknown. We aimed to understand the decision-making processes of patients who either accept or decline DT LVADs. Between October 2012 and September 2013, we conducted semistructured, in-depth interviews to understand patients' decision-making experiences. Data were analyzed using a mixed inductive and deductive approach. Twenty-two eligible patients were interviewed, 15 with DT LVADs and 7 who declined. We found a strong dichotomy between decision processes with some patients (11 accepters) being automatic and others (3 accepters, 7 decliners) being reflective in their approach to decision making. The automatic group was characterized by a fear of dying and an over-riding desire to live as long as possible: "[LVAD] was the only option I had…that or push up daisies…so I automatically took this." By contrast, the reflective group went through a reasoned process of weighing risks, benefits, and burdens: "There are worse things than death." Irrespective of approach, most patients experienced the DT LVAD decision as a highly emotional process and many sought support from their families or spiritually. Some patients offered a DT LVAD face the decision by reflecting on a process and reasoning through risks and benefits. For others, the desire to live supersedes such reflective processing. Acknowledging this difference is important when considering how to support patients who are faced with this complex decision. © 2014 American Heart Association, Inc.

  13. Decision Making for Destination Therapy Left Ventricular Assist Devices: “There was no choice” versus “I thought about it an awful lot”

    Science.gov (United States)

    McIlvennan, Colleen K.; Allen, Larry A.; Nowels, Carolyn; Brieke, Andreas; Cleveland, Joseph C.; Matlock, Daniel D.

    2014-01-01

    Background Destination therapy left ventricular assist devices (DT LVAD) are one of the most invasive medical interventions for end-stage illness. How patients decide whether or not to proceed with device implantation is unknown. We aimed to understand the decision-making processes of patients who either accept or decline DT LVADs. Methods and Results Between October 2012–September 2013, we conducted semi-structured, in-depth interviews to understand patients’ decision-making experiences. Data were analyzed using a mixed inductive and deductive approach. Twenty-two eligible patients were interviewed, 15 with DT LVADs and 7 who declined. We found a strong dichotomy between decision processes with some patients (11 accepters) being “automatic” and others (3 accepters, 7 decliners) being “reflective” in their approach to decision making. The automatic group was characterized by a fear of dying and an overriding desire to live as long as possible: “[LVAD] was the only option I had…that or push up daisies…so I automatically took this”. In contrast, the reflective group went through a reasoned process of weighing risks, benefits, and burdens: “There are worse things than death.” Irrespective of approach, most patients experienced the DT LVAD decision as a highly emotional process and many sought support from their families or spiritually. Conclusion Some patients offered a DT LVAD face the decision by reflecting on a process and reasoning through risks and benefits. For others, the desire to live supersedes such reflective processing. Acknowledging this difference is important when considering how to support patients who are faced with this complex decision. PMID:24823949

  14. Proton therapy device

    International Nuclear Information System (INIS)

    Tronc, D.

    1994-01-01

    The invention concerns a proton therapy device using a proton linear accelerator which produces a proton beam with high energies and intensities. The invention lies in actual fact that the proton beam which is produced by the linear accelerator is deflected from 270 deg in its plan by a deflecting magnetic device towards a patient support including a bed the longitudinal axis of which is parallel to the proton beam leaving the linear accelerator. The patient support and the deflecting device turn together around the proton beam axis while the bed stays in an horizontal position. The invention applies to radiotherapy. 6 refs., 5 figs

  15. Tourists’ Risk Perception and the Use of Mobile Devices in Beach Tourism Destinations

    Directory of Open Access Journals (Sweden)

    Francesc González-Reverté

    2018-02-01

    Full Text Available The perceived risk of tourists’ use of smartphones is a key issue in shaping the tourist experience in terms of sustainability, as it can affect the behaviour of tourists and influence their satisfaction with that experience. However, little empirical research exists on the relationship between tourists’ risk perception and the perceived value of mobile device usage. This paper measures the association between tourists’ perceived risk of mobile device usage and several variables that demonstrate the perceived usefulness of mobile devices: utility, hedonic value and future intention of use. A survey on tourists’ use of smartphones was conducted in 2016 and, by means of a cluster analysis, four groups of tourists were identified with significant differences in their perception of the risk and use value of smartphones. Differences between tourists suggest that a single digital tourist profile does not exist and that tourism destinations and smart tourism DMOs (destination marketing organisations should include risk perception in their management agenda. This will allow them to achieve a better understanding of tourist behaviour and to adapt the commercialisation of tourism products and services to a wide range of tourism needs. In addition, four regression models were applied to measure the association between the risk and perceived usefulness of mobile devices. On the one hand, dependence on mobile devices was associated positively with the perceived usefulness of mobile devices. On the other hand, the tourists surveyed saw privacy risk as having a major negative impact on the tourist experience, although it did not affect their perceived utility value and future use of mobile devices. Smart tourism destination managers should bear in mind that privacy risk issues related to the use of mobile devices must be integrated into an ethical perspective when marketing a destination.

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

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    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. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  17. System overview of the fully implantable destination therapy--ReinHeart-total artificial heart.

    Science.gov (United States)

    Pelletier, Benedikt; Spiliopoulos, Sotirios; Finocchiaro, Thomas; Graef, Felix; Kuipers, Kristin; Laumen, Marco; Guersoy, Dilek; Steinseifer, Ulrich; Koerfer, Reiner; Tenderich, Gero

    2015-01-01

    Owing to the lack of suitable allografts, the demand for long-term mechanical circulatory support in patients with biventricular end-stage heart failure is rising. Currently available Total Artificial Heart (TAH) systems consist of pump units with only limited durability, percutaneous tubes and bulky external equipment that limit the quality of life. Therefore we are focusing on the development of a fully implantable, highly durable destination therapy total artificial heart. The ReinHeart-TAH system consists of a passively filling pump unit driven by a low-wear linear drive between two artificial ventricles, an implantable control unit and a compliance chamber. The TAH is powered by a transcutaneous energy transmission system. The flow distribution inside the ventricles was analysed by fluid structure interaction simulation and particle image velocimetry measurements. Along with durability tests, the hydrodynamic performance and flow balance capability were evaluated in a mock circulation loop. Animal trials are ongoing. Based on fluid structure interaction simulation and particle image velocimetry, blood stagnation areas have been significantly reduced. In the mock circulation loop the ReinHeart-TAH generated a cardiac output of 5 l/min at an operating frequency of 120 bpm and an aortic pressure of 120/80 mmHg. The highly effective preload sensitivity of the passively filling ventricles allowed the sensorless integration of the Frank Starling mechanism. The ReinHeart-TAH effectively replaced the native heart's function in animals for up to 2 days. In vitro and in vivo testing showed a safe and effective function of the ReinHeart-TAH system. This has the potential to become an alternative to transplantation. However, before a first-in-man implant, chronic animal trials still have to be completed. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  18. Exercise therapy for an older patient with left ventricular assist device.

    Science.gov (United States)

    Park, Won Hah; Seo, Yong Gon; Sung, Ji Dong

    2014-06-01

    A left ventricular assist device (LVAD) is a mechanical circulation support implanted for patients with end-stage heart failure. It may be used either as a bridge to cardiac transplantation or as a destination therapy. The health of a 75-year-old man with a medical history of systolic heart failure worsened. Therefore, he was recommended to have implanted a LVAD (Thoratec Corp.) as a destination therapy. After the surgery, he was enrolled in patient cardiac rehabilitation for the improvement of dyspnea and exercise capacity. In results, there is an improvement on his exercise capacity and quality of life. For the first time in Korea, we reported a benefit of exercise therapy after being implanted with a LVAD.

  19. A pneumatic muscle hand therapy device.

    Science.gov (United States)

    Koeneman, E J; Schultz, R S; Wolf, S L; Herring, D E; Koeneman, J B

    2004-01-01

    Intensive repetitive therapy improves function and quality of life for stroke patients. Intense therapies to overcome upper extremity impairment are beneficial, however, they are expensive because, in part, they rely on individualized interaction between the patient and rehabilitation specialist. The development of a pneumatic muscle driven hand therapy device, the Mentortrade mark, reinforces the need for volitional activation of joint movement while concurrently offering knowledge of results about range of motion, muscle activity or resistance to movement. The device is well tolerated and has received favorable comments from stroke survivors, their caregivers, and therapists.

  20. 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...

  1. Devices and Endoscopic Bariatric Therapies for Obesity.

    Science.gov (United States)

    Saunders, Katherine H; Igel, Leon I; Saumoy, Monica; Sharaiha, Reem Z; Aronne, Louis J

    2018-04-17

    In this review, we describe the FDA-approved and investigational devices and endoscopic bariatric therapies for the treatment of obesity. We focus on literature published in the past few years and present mechanisms of action as well as efficacy and safety data. Devices and endoscopic procedures are emerging options to fill the significant treatment gap in the management of obesity. Not only are these devices and procedures minimally invasive and reversible, but they are potentially more effective than antiobesity medications, often safer for poor surgical candidates and possibly less expensive than bariatric surgery. As many patients require a variety of management strategies (medications, devices, procedures, and/or surgery) in addition to lifestyle modifications to achieve clinically significant weight loss, the future of obesity treatment involves a multidisciplinary approach. Combinations of advanced treatment strategies can lead to additive or synergistic weight loss. This is an area that requires further investigation.

  2. Advanced Small Animal Conformal Radiation Therapy Device.

    Science.gov (United States)

    Sharma, Sunil; Narayanasamy, Ganesh; Przybyla, Beata; Webber, Jessica; Boerma, Marjan; Clarkson, Richard; Moros, Eduardo G; Corry, Peter M; Griffin, Robert J

    2017-02-01

    We have developed a small animal conformal radiation therapy device that provides a degree of geometrical/anatomical targeting comparable to what is achievable in a commercial animal irradiator. small animal conformal radiation therapy device is capable of producing precise and accurate conformal delivery of radiation to target as well as for imaging small animals. The small animal conformal radiation therapy device uses an X-ray tube, a robotic animal position system, and a digital imager. The system is in a steel enclosure with adequate lead shielding following National Council on Radiation Protection and Measurements 49 guidelines and verified with Geiger-Mueller survey meter. The X-ray source is calibrated following AAPM TG-61 specifications and mounted at 101.6 cm from the floor, which is a primary barrier. The X-ray tube is mounted on a custom-made "gantry" and has a special collimating assembly system that allows field size between 0.5 mm and 20 cm at isocenter. Three-dimensional imaging can be performed to aid target localization using the same X-ray source at custom settings and an in-house reconstruction software. The small animal conformal radiation therapy device thus provides an excellent integrated system to promote translational research in radiation oncology in an academic laboratory. The purpose of this article is to review shielding and dosimetric measurement and highlight a few successful studies that have been performed to date with our system. In addition, an example of new data from an in vivo rat model of breast cancer is presented in which spatially fractionated radiation alone and in combination with thermal ablation was applied and the therapeutic benefit examined.

  3. Protein-anchoring therapy to target extracellular matrix proteins to their physiological destinations.

    Science.gov (United States)

    Ito, Mikako; Ohno, Kinji

    2018-02-20

    Endplate acetylcholinesterase (AChE) deficiency is a form of congenital myasthenic syndrome (CMS) caused by mutations in COLQ, which encodes collagen Q (ColQ). ColQ is an extracellular matrix (ECM) protein that anchors AChE to the synaptic basal lamina. Biglycan, encoded by BGN, is another ECM protein that binds to the dystrophin-associated protein complex (DAPC) on skeletal muscle, which links the actin cytoskeleton and ECM proteins to stabilize the sarcolemma during repeated muscle contractions. Upregulation of biglycan stabilizes the DPAC. Gene therapy can potentially ameliorate any disease that can be recapitulated in cultured cells. However, the difficulty of tissue-specific and developmental stage-specific regulated expression of transgenes, as well as the difficulty of introducing a transgene into all cells in a specific tissue, prevents us from successfully applying gene therapy to many human diseases. In contrast to intracellular proteins, an ECM protein is anchored to the target tissue via its specific binding affinity for protein(s) expressed on the cell surface within the target tissue. Exploiting this unique feature of ECM proteins, we developed protein-anchoring therapy in which a transgene product expressed even in remote tissues can be delivered and anchored to a target tissue using specific binding signals. We demonstrate the application of protein-anchoring therapy to two disease models. First, intravenous administration of adeno-associated virus (AAV) serotype 8-COLQ to Colq-deficient mice, resulting in specific anchoring of ectopically expressed ColQ-AChE at the NMJ, markedly improved motor functions, synaptic transmission, and the ultrastructure of the neuromuscular junction (NMJ). In the second example, Mdx mice, a model for Duchenne muscular dystrophy, were intravenously injected with AAV8-BGN. The treatment ameliorated motor deficits, mitigated muscle histopathologies, decreased plasma creatine kinase activities, and upregulated expression

  4. 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.

  5. 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

  6. 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.

  7. Generating Multi-Destination Maps.

    Science.gov (United States)

    Zhang, Junsong; Fan, Jiepeng; Luo, Zhenshan

    2017-08-01

    Multi-destination maps are a kind of navigation maps aimed to guide visitors to multiple destinations within a region, which can be of great help to urban visitors. However, they have not been developed in the current online map service. To address this issue, we introduce a novel layout model designed especially for generating multi-destination maps, which considers the global and local layout of a multi-destination map. We model the layout problem as a graph drawing that satisfies a set of hard and soft constraints. In the global layout phase, we balance the scale factor between ROIs. In the local layout phase, we make all edges have good visibility and optimize the map layout to preserve the relative length and angle of roads. We also propose a perturbation-based optimization method to find an optimal layout in the complex solution space. The multi-destination maps generated by our system are potential feasible on the modern mobile devices and our result can show an overview and a detail view of the whole map at the same time. In addition, we perform a user study to evaluate the effectiveness of our method, and the results prove that the multi-destination maps achieve our goals well.

  8. 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.

  9. 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...... is often rather atheoretical and lacks operational rigor. These are major shortcomings which undoubtedly hinder the development of academic and managerial insights. In response, this study draws on contemporary psychology to develop the destination content model, comprising three informational components...... held in individuals‘ minds about destinations. The present study further outlines preferable methods and measures for each component, thus aiding researchers to investigate mental destination representations...

  10. The NHLBI REVIVE-IT study: Understanding its discontinuation in the context of current left ventricular assist device therapy.

    Science.gov (United States)

    Pagani, Francis D; Aaronson, Keith D; Kormos, Robert; Mann, Douglas L; Spino, Cathie; Jeffries, Neal; Taddei-Peters, Wendy C; Mancini, Donna M; McNamara, Dennis M; Grady, Kathleen L; Gorcsan, John; Petrucci, Ralph; Anderson, Allen S; Glick, Henry A; Acker, Michael A; Eduardo Rame, J; Goldstein, Daniel J; Pamboukian, Salpy V; Miller, Marissa A; Timothy Baldwin, J

    2016-11-01

    The National Institutes of Health National Heart, Lung, and Blood Institute convened a working group in March 2008 to discuss how therapies for heart failure (HF) might be best advanced using clinical trials involving left ventricular assist devices (LVAD). This group opined that the field was ready for a trial to assess the use of long-term ventricular assist device therapy in patients who are less ill than patients currently eligible for destination therapy, which resulted in the Randomized Evaluation of VAD InterVEntion before Inotropic Therapy (REVIVE-IT) pilot study. The specific objective of REVIVE-IT was to compare LVAD therapy with optimal medical management in patients with less advanced HF than current LVAD indications to determine if wider application of permanent LVAD use to less ill patients would be associated with improved survival, quality of life, or functional capacity. REVIVE-IT represented an extraordinary effort to provide data from a randomized clinical trial to inform clinicians, scientists, industry, and regulatory agencies about the efficacy and safety of LVAD therapy in a population with less advanced HF. Despite significant support from the medical community, industry, and governmental agencies, REVIVE-IT failed to accomplish its goal. The reasons for its failure are instructive, and the lessons learned from the REVIVE-IT experience are likely to be relevant to any future study of LVAD therapy in a population with less advanced HF. Copyright © 2016 International Society for Heart and Lung Transplantation. All rights reserved.

  11. New Innovations in Circulatory Support With Ventricular Assist Device and Extracorporeal Membrane Oxygenation Therapy.

    Science.gov (United States)

    Sladen, Robert N

    2017-04-01

    The past decade has seen an exponential increase in the application and development of durable long-term as well as nondurable short-term mechanical circulatory support for cardiogenic shock and acute or chronic heart failure. Support has evolved from bridge-to-transplant to destination therapy, bridge to rescue, bridge to decision making, and bridge to a bridge. Notable trends include device miniaturization, minimally invasive and/or percutaneous insertion, and efforts to superimpose pulsatility on continuous flow. We can certainly anticipate that innovation will accelerate in the months and years to come. However, despite-or perhaps because of-the enhanced equipment now available, mechanical circulatory support is an expensive, complex, resource-intensive modality. It requires considerable expertise that should preferably be centralized to highly specialized centers. Formidable challenges remain: systemic inflammatory response syndromes and vasoplegia after device insertion; postoperative sepsis; optimal anticoagulation regimens to prevent device-induced thrombosis and cerebral thromboembolism; wound site, intracranial, and gastrointestinal bleeding; multisystem injury and failure; patient dissatisfaction (even when providers consider the procedure a "success"); and ethical decision making in conditions of futility.

  12. 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

  13. 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....... 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...

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

    Science.gov (United States)

    ... Medical Procedures Home Health and Consumer Devices Brochure - Home Healthcare Medical Devices: Infusion Therapy - Getting the Most ... if needed. What is the role of your home healthcare provider and supplier in your infusion therapy? ...

  15. Promoting tourism destination image

    NARCIS (Netherlands)

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

    2007-01-01

    textabstractThis article examines the role of tourism promotion as a component of destination image formation. It reports the findings of a study in which 1,100 respondents from around the globe described their previsit perceived image of seven sample destinations, as well as the information sources

  16. Destination Personality: An Application of Brand Personality to Tourism Destinations

    OpenAIRE

    Ekinci, Yuksel; Hosany, Sameer

    2006-01-01

    In an increasingly competitive tourism market place, destination marketers face the challenge of attracting tourists through destination branding and destination personality building practices. As places become substitutable, destination personality, defined as the set of human characteristics associated with a destination, is seen as a viable metaphor for crafting a destination’s unique identity. At the conceptual level, the importance of destination personality has been widely acknowledged,...

  17. TOURIST DESTINATION MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Karmen Andrea MEZEI

    2009-12-01

    Full Text Available Tourism development has environmental and social consequences upon local and global communities. The impact of tourism must be kept within certain limits which are set up by sustainable tourism. Meanwhile the viability of the investment must be assured. Tourism development matrix is the tourist destination. Destination management must ensure the balance between economic, social, cultural, and environmental activities. Competitive destination management organization means a harmonious combination between planning, lobby, coordination and marketing (promotion. The recommendation of an integrated meta plan for Romanian balneal spa could be the choice for a successful tourism development.

  18. Accessible virtual reality therapy using portable media devices.

    Science.gov (United States)

    Bruck, Susan; Watters, Paul A

    2010-01-01

    Simulated immersive environments displayed on large screens are a valuable therapeutic asset in the treatment of a range of psychological disorders. Permanent environments are expensive to build and maintain, require specialized clinician training and technical support and often have limited accessibility for clients. Ideally, virtual reality exposure therapy (VRET) could be accessible to the broader community if we could use inexpensive hardware with specifically designed software. This study tested whether watching a handheld non-immersive media device causes nausea and other cybersickness responses. Using a repeated measure design we found that nausea, general discomfort, eyestrain, blurred vision and an increase in salivation significantly increased in response to handheld non-immersive media device exposure.

  19. Transformations in destination texture

    DEFF Research Database (Denmark)

    Gyimóthy, Szilvia

    2018-01-01

    This article takes heterogeographical approaches to understand Bollywood-induced destination transformations in Switzerland. Positioned within the theoretical field of mediatized mobility, the study contextualizes Bollywood-induced tourism in Europe the concept of texture. Textural analysis (base...

  20. Tourist destination image

    Directory of Open Access Journals (Sweden)

    Korićanin Maja

    2008-01-01

    Full Text Available In taking an advantages in tourism seems that image of specific tourist destination play an important role. This is very complex process but also a target for a wide list of potential stakeholders - not only organizations in this industry. Paper discuss a few relevant issues in connection to importance as well as development process of creating an image of tourist destination including well known Anhold model.

  1. [Device-aided therapies in advanced Parkinson's disease].

    Science.gov (United States)

    Timofeeva, A A

    Advanced stages of Parkinson's disease (PD) is a consequence of the severe neurodegenerative process and are characterized by the development of motor fluctuations and dyskinesia, aggravation of non-motor symptoms. Treatment with peroral and transdermal drugs can't provide an adequate control of PD symptoms and quality-of-life of the patients at this stage of disease. Currently, three device-aided therapies: deep brain stimulation (DBS), intrajejunal infusion of duodopa, subcutaneous infusion of apomorphine can be used in treatment of patients with advanced stages of PD. Timely administration of device-aided therapies and right choice of the method determine, to a large extent, the efficacy and safety of their use. Despite the high efficacy of all three methods with respect to the fluctuation of separate symptoms, each method has its own peculiarities. The authors reviewed the data on the expediency of using each method according to the severity of motor and non-motor symptoms, patient's age, PD duration, concomitant pathology and social support of the patients.

  2. 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.

  3. Sudden visual loss after cardiac resynchronization therapy device implantation.

    Science.gov (United States)

    De Vitis, Luigi A; Marchese, Alessandro; Giuffrè, Chiara; Carnevali, Adriano; Querques, Lea; Tomasso, Livia; Baldin, Giovanni; Maestranzi, Gisella; Lattanzio, Rosangela; Querques, Giuseppe; Bandello, Francesco

    2017-03-10

    To report a case of sudden decrease in visual acuity possibly due to a cardiogenic embolism in a patient who underwent cardiac resynchronization therapy (CRT) device implantation. A 62-year-old man with severe left ventricular systolic dysfunction and a left bundle branch block was referred to our department because of a sudden decrease in visual acuity. Nine days earlier, he had undergone cardiac transapical implantation of a CRT device, which was followed, 2 days later, by an inflammatory reaction. The patient underwent several general and ophthalmologic examinations, including multimodal imaging. At presentation, right eye (RE) best-corrected visual acuity (BCVA) was counting fingers and RE pupil was hyporeactive. Fundus examination revealed white-centered hemorrhagic dots suggestive of Roth spots. Fluorescein angiography showed delay in vascular perfusion during early stage, late hyperfluorescence of the macula and optic disk, and peripheral perivascular leakage. The first visual field test showed complete loss of vision RE and a normal left eye. Due to suspected giant cell arteritis, temporal artery biopsy was performed. Thirty minutes after the procedure, an ischemic stroke with right hemisyndrome and aphasia occurred. The RE BCVA worsened to hands motion. Four months later, RE BCVA did not improve, despite improvement in fluorescein angiography inflammatory sign. We report a possible cardiogenic embolism secondary to undiagnosed infective endocarditis causing monocular visual loss after CRT device implantation. It remains unclear how the embolus caused severe functional damage without altering the retinal anatomical structure.

  4. Management of antithrombotic therapy during cardiac implantable device surgery.

    Science.gov (United States)

    AlTurki, Ahmed; Proietti, Riccardo; Birnie, David H; Essebag, Vidal

    2016-06-01

    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 thromboembolism, either interrupted or continued warfarin may be used, with no evidence to clearly support either strategy. There is little evidence to support continuing direct acting oral anticoagulants (DOACs) for device implantation. The timing of halting these medications depends largely on renal function. If bleeding occurs, warfarin׳s anticoagulation effect is reversible with vitamin K and activated prothrombin complex concentrate. There are no DOAC reversal agents currently available, but some are under development. Regarding antiplatelet agents, aspirin alone can be safely continued while clopidogrel alone may also be continued, but with a slightly higher bleeding risk. Dual antiplatelet therapy for bare-metal stent/drug-eluting stent implanted within 4 weeks/6 months, respectively, should be continued due to high risk of stent thrombosis; however, if they are implanted after this period, then clopidogrel can be halted 5 days before the procedure and resumed soon after, while aspirin is continued. If the patient is taking both aspirin and warfarin, aspirin should be halted 5 days prior to the procedure, while warfarin is continued.

  5. 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

  6. Device therapy in heart failure with reduced ejection fraction-cardiac resynchronization therapy and more.

    Science.gov (United States)

    Duncker, D; Veltmann, C

    2018-05-09

    In patients with heart failure with reduced ejection fraction (HFrEF), optimal medical treatment includes beta-blockers, ACE inhibitors/angiotensinreceptor-neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists, and ivabradine when indicated. In device therapy of HFrEF, implantable cardioverter-defibrillators and cardiac resynchronization therapy (CRT) have been established for many years. CRT is the therapy of choice (class I indication) in symptomatic patients with HFrEF and a broad QRS complex with a left bundle branch block (LBBB) morphology. However, the vast majority of heart failure patients show a narrow QRS complex or a non-LBBB morphology. These patients are not candidates for CRT and alternative electrical therapies such as baroreflex activation therapy (BAT) and cardiac contractility modulation (CCM) may be considered. BAT modulates vegetative dysregulation in heart failure. CCM improves contractility, functional capacity, and symptoms. Although a broad data set is available for BAT and CCM, mortality data are still lacking for both methods. This article provides an overview of the device-based therapeutic options for patients with HFrEF.

  7. 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.

  8. 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”.

  9. 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.

  10. Destination: Alumni Relations

    Science.gov (United States)

    Scully, Maura King

    2010-01-01

    Increasingly today, with the growing and sophisticated skill set alumni professionals need to get the job done, alumni relations has become a destination career rather than a stop along the way. Modern alumni relations is "so much more than homecoming and punch-and-cookie receptions." It's marketing, volunteer management, and social networking. To…

  11. 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.

  12. Device therapy in pediatric and congenital heart disease patients

    Directory of Open Access Journals (Sweden)

    Naokata Sumitomo, MD, PhD

    2014-12-01

    Conclusions: Despite the limited experience, limitations of device implantations owing to the size of the devices, and necessity for nonendocardial electrode placement, device implantations are required in more pediatric and CHD patients than expected.

  13. Muscle activity of leg muscles during unipedal stance on therapy devices with different stability properties.

    Science.gov (United States)

    Wolburg, Thomas; Rapp, Walter; Rieger, Jochen; Horstmann, Thomas

    2016-01-01

    To test the hypotheses that less stable therapy devices require greater muscle activity and that lower leg muscles will have greater increases in muscle activity with less stable therapy devices than upper leg muscles. Cross-sectional laboratory study. Laboratory setting. Twenty-five healthy subjects. Electromyographic activity of four lower (gastrocnemius medialis, soleus, tibialis anterior, peroneus longus) and four upper leg muscles (vastus medialis and lateralis, biceps femoris, semitendinosus) during unipedal quiet barefoot stance on the dominant leg on a flat rigid surface and on five therapy devices with varying stability properties. Muscle activity during unipedal stance differed significantly between therapy devices (P < 0.001). The order from lowest to highest relative muscle activity matched the order from most to least stable therapy device. There was no significant interaction between muscle location (lower versus upper leg) and therapy device (P = 0.985). Magnitudes of additional relative muscle activity for the respective therapy devices differed substantially among lower extremity muscles. The therapy devices offer a progressive increase in training intensity, and thus may be useful for incremental training programs in physiotherapeutic practice and sports training programs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. 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.

  15. Is anti-platelet therapy needed in continuous flow left ventricular assist device patients? A single-centre experience.

    Science.gov (United States)

    Litzler, Pierre-Yves; Smail, Hassiba; Barbay, Virginie; Nafeh-Bizet, Catherine; Bouchart, François; Baste, Jean-Marc; Abriou, Caroline; Bessou, Jean-Paul

    2014-01-01

    We report our 5-year experience of continuous flow left ventricular assist device (LVAD) implantation without the use of anti-platelet therapy. Between February 2006 and September 2011, 27 patients (26 men; 1 woman) were implanted with a continuous flow LVAD (HeartMate II, Thoratec Corporation, Pleasanton, CA, USA). The mean age was 55.7 ± 9.9 years. The mean duration of support was 479 ± 436 (1-1555) days with 35.4 patient-years on support. Twenty-one patients were implanted as a bridge to transplantation and 6 for destination therapy. The anticoagulation regimen was fluindione for all patients, with aspirin for only 4 patients. At the beginning of our experience, aspirin was administered to 4 patients for 6, 15, 60 and 460 days. Due to gastrointestinal (GI) bleeding and epistaxis, aspirin was discontinued, and since August 2006, no patients have received anti-platelet therapy. At 3 years, the survival rate during support was 76%. The most common postoperative adverse event was GI bleeding (19%) and epistaxis (30%) (median time: 26 days) for patients receiving fluindione and aspirin. The mean International Normalized Ratio (INR) was 2.58 ± 0.74 during support. Fifteen patients have been tested for acquired Von Willebrand disease. A diminished ratio of collagen-binding capacity and ristocetin cofactor activity to Von Willebrand factor antigen was observed in 7 patients. In the postoperative period, 2 patients presented with ischaemic stroke at 1 and 8 months. One of these 2 patients had a previous history of carotid stenosis with ischaemic stroke. There were no patients with haemorrhagic stroke, transient ischaemic attack or pump thrombosis. The event rate of stroke (ischaemic and haemorrhagic) per patient-year was 0.059 among the patients without aspirin with fluindione regimen only. A fluindione regimen without aspirin in long-duration LVAD support appears to not increase thromboembolic events and could lead to a diminished risk of haemorrhagic stroke.

  16. Integrated model of destination competitiveness

    Directory of Open Access Journals (Sweden)

    Armenski Tanja

    2011-01-01

    Full Text Available The aim of this paper is to determine the weakest point of Serbian destination competitiveness as a tourist destination in comparation with its main competitors. The paper is organized as follows. The short introduction of the previous research on the destination competitiveness is followed by description of the Integrated model of destination competitiveness (Dwyer et al, 2003 that was used as the main reference framework. Section three is devoted to the description of the previous studies on competitiveness of Serbian tourism, while section four outlines the statistical methodology employed in this study and presents and interprets the empirical results. 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 that refer to the image and awareness of the destination itself.

  17. Sami tourism in destination development

    DEFF Research Database (Denmark)

    Olsen, Lise Smed

    2016-01-01

    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......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...

  18. Left ventricular assist device therapy in advanced heart failure

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Rogers, Joseph G

    2017-01-01

    Despite improvements in pharmacological therapy and pacing, prognosis in advanced heart failure (HF) remains poor, with a 1-year mortality of 25-50%. While heart transplantation provides excellent survival and quality of life for eligible patients, only a few can be offered this treatment due...

  19. Destination image and key drivers of perceived destination attractiveness

    Directory of Open Access Journals (Sweden)

    Josip Mikulić

    2008-12-01

    Full Text Available In this exploratory study authors combine several approaches to explore the images of two highly attractive tourist destinations: Hawai’i and Croatia. Two convenience samples were used: the image of Hawai’i was measured among Croatian undergraduate business students, and the image of Croatia was measured among Hawaiian tourism students. Functional and psychological image components were assessed at both a holistic and the attribute level. In addition, an importance-perception analysis was performed to assess the degree to which the destination image at the attribute level coincides with the students’ perception of an optimal destination. Finally, the authors conduct an importance grid analysis to explore the key drivers of the overall perceived destination attractiveness. The results provide a detailed insight into the images of Croatia and Hawaii, and reveal several interesting differences between the two student samples.

  20. Device for magneto-therapy and X-ray studies

    International Nuclear Information System (INIS)

    Amosov, I.; Demidchik, E.; Dikun, V.; Kalikin, V.; Kozel, A.; Korotkov, V.; Makovetskij, G.; Maslennikov, S.; Natradze, Dzh.; Rakhuba, V.; Samojlov, V.; Taturshtikov, A.; Tsyb, A.; Shargaj, V.; Shakhlevich, G.

    1986-01-01

    The device assures an anaesthetizing effect and controls the magnetic contrast media moving. It consists of a pulse generator, connected to a pulse source through a commutating element and a control block for pulse duration. The magnetic field source is a flat bond spiral. The control block consists of an unit specifying the number and frequency of the pulses, pulse duration controller, a timer and a power amplifier. 2 claims, 1 fig

  1. 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.

  2. Smart tourism destination triggers consumer experience: the case of Porto

    Directory of Open Access Journals (Sweden)

    Pedro Liberato

    2018-03-01

    Full Text Available Purpose - The purpose of this paper is to emphasize the increasing importance of information and communication technologies (ICTs in smart tourism destinations, in their integration in the activity of the tourism companies, and in their interaction with visitors/tourists. In summary, it is intended to evaluate in the city of Porto how the use of technology before, during and after the visit influences the tourist experience. Design/methodology/approach - The authors empirically investigate the importance of using ICTs during tourism experience, assess the access/availability of ICT at the destination and its importance in tourist’s decisions. It is analyzed if the applications and/or information available on the internet are important and positively influence the tourism experience in Porto, that is, the degree of tourist satisfaction. The empirical evidence is based on a quantitative analysis, using a data set involving 423 tourists in the city of Porto. Findings - The importance of the internet access at the destination, especially in places like airports and hotels, since most tourists are primarily using their mobile devices and computers during the trip, and the existing information technologies available in the destination (internet, smartphones or other mobile devices and applications are considered very important in explaining tourists’ experience. Originality/value - This study identifies the strengths and weaknesses of the technological strategies, providing useful information for destination management, discussing innovation in tourism, and proposing a framework that empirically evaluates how technological components used in smart tourism destinations can improve tourists’ experiences.

  3. Cyclophosphamide, thalidomide, and dexamethasone as induction therapy for newly diagnosed multiple myeloma patients destined for autologous stem-cell transplantation: MRC Myeloma IX randomized trial results

    Science.gov (United States)

    Morgan, Gareth J.; Davies, Faith E.; Gregory, Walter M.; Bell, Sue E.; Szubert, Alexander J.; Navarro Coy, Nuria; Cook, Gordon; Feyler, Sylvia; Johnson, Peter R.E.; Rudin, Claudius; Drayson, Mark T.; Owen, Roger G.; Ross, Fiona M.; Russell, Nigel H.; Jackson, Graham H.; Child, J. Anthony

    2012-01-01

    Background Thalidomide is active in multiple myeloma and is associated with minimal myelosuppression, making it a good candidate for induction therapy prior to high-dose therapy with autologous stem-cell transplantation. Design and Methods Oral cyclophosphamide, thalidomide, and dexamethasone was compared with infusional cyclophosphamide, vincristine, doxorubicin, and dexamethasone in patients with newly diagnosed multiple myeloma. Results The post-induction overall response rate (≥ partial response) for the intent-to-treat population was significantly higher with cyclophosphamide-thalidomide-dexamethasone (n=555) versus cyclophosphamide-vincristine-doxorubicin-dexamethasone (n=556); 82.5% versus 71.2%; odds ratio 1.91; 95% confidence interval 1.44–2.55; P<0.0001. The complete response rates were 13.0% with cyclophosphamide-thalidomide-dexamethasone and 8.1% with cyclophos-phamide-vincristine-doxorubicin-dexamethasone (P=0.0083), with this differential response being maintained in patients who received autologous stem-cell transplantation (post-transplant complete response 50.0% versus 37.2%, respectively; P=0.00052). Cyclophosphamide-thalidomide-dexamethasone was non-inferior to cyclophosphamide-vincristine-doxorubicin-dexamethasone for progression-free and overall survival, and there was a trend toward a late survival benefit with cyclophosphamide-thalidomide-dexamethasone in responders. A trend toward an overall survival advantage for cyclophosphamide-thalidomide-dexamethasone over cyclophosphamide-vincristine-doxorubicin-dexamethasone was also observed in a subgroup of patients with favorable interphase fluorescence in situ hybridization. Compared with cyclophosphamide-vincristine-doxorubicin-dexamethasone, cyclophosphamide-thalidomide-dexamethasone was associated with more constipation and somnolence, but a lower incidence of cytopenias. Conclusions The cyclophosphamide-thalidomide-dexamethasone regimen showed improved response rates and was not inferior

  4. Dark Tourism and Destination Marketing

    OpenAIRE

    Jahnke, Daniela

    2013-01-01

    This thesis is about the dark tourism and destination marketing. The aim of the thesis is to display how these two terms can be combined. The term dark tourism is a relatively new research area; therefore the thesis will provide an outlook of the current situation of dark tourism. It starts with the beginning of dark tourism and continuous to the managerial aspects of dark tourism sites. The second part of the theoretical background is about destination marketing. It provides an overvie...

  5. Assistive acting movement therapy devices with pneumatic rotary-type soft actuators.

    Science.gov (United States)

    Wilkening, André; Baiden, David; Ivlev, Oleg

    2012-12-01

    Inherent compliance and assistive behavior are assumed to be essential properties for safe human-robot interaction. Rehabilitation robots demand the highest standards in this respect because the machine interacts directly with weak persons who are often sensitive to pain. Using novel soft fluidic actuators with rotary elastic chambers (REC actuators), compact, lightweight, and cost-effective therapeutic devices can be developed. This article describes modular design and control strategies for new assistive acting robotic devices for upper and lower extremities. Due to the inherent compliance and natural back-drivability of pneumatic REC actuators, these movement therapy devices provide gentle treatment, whereby the interaction forces between humans and the therapy device are estimated without the use of expensive force/torque sensors. An active model-based gravity compensation based on separated models of the robot and of the individual patient's extremity provides the basis for effective assistive control. The utilization of pneumatic actuators demands a special safety concept, which is merged with control algorithms to provide a sufficient level of safeness and to catch any possible system errors and/or emergency situations. A self-explanatory user interface allows for easy, intuitive handling. Prototypes are very comfortable for use due to several control routines that work in the background. Assistive devices have been tested extensively with several healthy persons; the knee/hip movement therapy device is now under clinical trials at the Clinic for Orthopaedics and Trauma Surgery at the Klinikum Stuttgart.

  6. 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

    2017-12-01

    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. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  7. Application of head-mounted devices with eye-tracking in virtual reality therapy

    Directory of Open Access Journals (Sweden)

    Lutz Otto Hans-Martin

    2017-03-01

    Full Text Available Using eye-tracking to assess visual attention in head-mounted devices (HMD opens up many possibilities for virtual reality (VR-based therapy. Existing therapy concepts where attention plays a major role can be transferred to VR. Furthermore, they can be expanded to a precise real-time attention assessment, which can serve as a foundation for new therapy approaches. Utilizing HMDs and eye-tracking in a clinical environment is challenging because of hygiene issues and requirements of patients with heterogeneous cognitive and motor impairments. In this paper, we provide an overview of those challenges, discuss possible solutions and present preliminary results of a study with patients.

  8. Design and control of RUPERT: a device for robotic upper extremity repetitive therapy.

    Science.gov (United States)

    Sugar, Thomas G; He, Jiping; Koeneman, Edward J; Koeneman, James B; Herman, Richard; Huang, H; Schultz, Robert S; Herring, D E; Wanberg, J; Balasubramanian, Sivakumar; Swenson, Pete; Ward, Jeffrey A

    2007-09-01

    The structural design, control system, and integrated biofeedback for a wearable exoskeletal robot for upper extremity stroke rehabilitation are presented. Assisted with clinical evaluation, designers, engineers, and scientists have built a device for robotic assisted upper extremity repetitive therapy (RUPERT). Intense, repetitive physical rehabilitation has been shown to be beneficial overcoming upper extremity deficits, but the therapy is labor intensive and expensive and difficult to evaluate quantitatively and objectively. The RUPERT is developed to provide a low cost, safe and easy-to-use, robotic-device to assist the patient and therapist to achieve more systematic therapy at home or in the clinic. The RUPERT has four actuated degrees-of-freedom driven by compliant and safe pneumatic muscles (PMs) on the shoulder, elbow, and wrist. They are programmed to actuate the device to extend the arm and move the arm in 3-D space. It is very important to note that gravity is not compensated and the daily tasks are practiced in a natural setting. Because the device is wearable and lightweight to increase portability, it can be worn standing or sitting providing therapy tasks that better mimic activities of daily living. The sensors feed back position and force information for quantitative evaluation of task performance. The device can also provide real-time, objective assessment of functional improvement. We have tested the device on stroke survivors performing two critical activities of daily living (ADL): reaching out and self feeding. The future improvement of the device involves increased degrees-of-freedom and interactive control to adapt to a user's physical conditions.

  9. 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.

  10. Validation of a Mobile Device for Acoustic Coordinated Reset Neuromodulation Tinnitus Therapy.

    Science.gov (United States)

    Hauptmann, Christian; Wegener, Alexander; Poppe, Hendrik; Williams, Mark; Popelka, Gerald; Tass, Peter A

    2016-10-01

    Sound-based tinnitus intervention stimuli include broad-band noise signals with subjectively adjusted bandwidths used as maskers delivered by commercial devices or hearing aids, environmental sounds broadly described and delivered by both consumer devices and hearing aids, music recordings specifically modified and delivered in a variety of different ways, and other stimuli. Acoustic coordinated reset neuromodulation therapy for tinnitus reduction has unique and more stringent requirements compared to all other sound-based tinnitus interventions. These include precise characterization of tinnitus pitch and loudness, and effective provision of patient-controlled daily therapy signals at defined frequencies, levels, and durations outside of the clinic. The purpose of this study was to evaluate an approach to accommodate these requirements including evaluation of a mobile device, validation of an automated tinnitus pitch-matching algorithm and assessment of a patient's ability to control stimuli and collect repeated outcome measures. The experimental design involved direct laboratory measurements of the sound delivery capabilities of a mobile device, comparison of an automated, adaptive pitch-matching method to a traditional manual method and measures of a patient's ability to understand and manipulate a mobile device graphic user interface to both deliver the therapy signals and collect the outcome measures. This study consisted of 5 samples of a common mobile device for the laboratory measures and a total of 30 adult participants: 15 randomly selected normal-hearing participants with simulated tinnitus for validation of a tinnitus pitch-matching algorithm and 15 sequentially selected patients already undergoing tinnitus therapy for evaluation of patient usability. No tinnitus intervention(s) were specifically studied as a component of this study. Data collection involved laboratory measures of mobile devices, comparison of manual and automated adaptive tinnitus

  11. Is exercise training safe and beneficial in patients receiving left ventricular assist device therapy?

    Science.gov (United States)

    Alsara, Osama; Perez-Terzic, Carmen; Squires, Ray W; Dandamudi, Sanjay; Miranda, William R; Park, Soon J; Thomas, Randal J

    2014-01-01

    Because a limited number of patients receive heart transplantation, alternative therapies, such as left ventricular assist device (LVAD) therapy, have emerged. Published studies have shown that LVAD implantation, by itself, improves exercise tolerance to the point where it is comparable to those with mild heart failure. The improvement in exercise capacity is maximally achieved 12 weeks after LVAD therapy and can continue even after explantation of the device. This effect varies, depending on the type of LVAD and exercise training. The available data in the literature on safety and benefits of exercise training in patients after LVAD implantation are limited, but the data that are available suggest that training trends to be safe and have an impact on exercise capacity in LVAD patients. Although no studies were identified on the role of cardiac rehabilitation programs in the management of LVAD patients, it appears that cardiac rehabilitation programs offer an ideal setting for the provision of supervised exercise training in this patient group.

  12. Comparison of Transplant Waitlist Outcomes for Pediatric Candidates Supported by Ventricular Assist Devices Versus Medical Therapy.

    Science.gov (United States)

    Law, Sabrina P; Oron, Assaf P; Kemna, Mariska S; Albers, Erin L; McMullan, D Michael; Chen, Jonathan M; Law, Yuk M

    2018-05-01

    Ventricular assist devices have gained popularity in the management of refractory heart failure in children listed for heart transplantation. Our primary aim was to compare the composite endpoint of all-cause pretransplant mortality and loss of transplant eligibility in children who were treated with a ventricular assist device versus a medically managed cohort. This was a retrospective cohort analysis. Data were obtained from the Scientific Registry of Transplant Recipients. The at-risk population (n = 1,380) was less than 18 years old, either on a ventricular assist device (605 cases) or an equivalent-severity, intensively medically treated group (referred to as MED, 775 cases). None. The impact of ventricular assist devices was estimated via Cox proportional hazards regression (hazard ratio), dichotomizing 1-year outcomes to "poor" (22%: 193 deaths, 114 too sick) versus all others (940 successful transplants, 41 too healthy, 90 censored), while adjusting for conventional risk factors. Among children 0-12 months old, ventricular assist device was associated with a higher risk of poor outcomes (hazard ratio, 2.1; 95% CI, 1.5-3.0; p comparative study of ventricular assist devices versus medical therapy in children. Age is a significant modulator of waitlist outcomes for children with end-stage heart failure supported by ventricular assist device, with the impact of ventricular assist devices being more beneficial in adolescents.

  13. 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.

  14. Tourism destination development in Thailand

    NARCIS (Netherlands)

    Pongajarn, Chalermpat

    2017-01-01

    Informed by actor-network theory (ANT), this research aims at improving understanding of the nature of tourism destinations in Thailand and their development by investigating through three main notions: ordering, materiality and multiplicity. These notions enabled to study how tourism

  15. Destination Memory in Korsakoff's Syndrome

    NARCIS (Netherlands)

    El Haj, M.; Kessels, R.P.C.; Matton, C.; Bacquet, J.E.; Urso, L.; Cool, G.; Guidez, F.; Potier, S.; Nandrino, J.L.; Antoine, P.

    2016-01-01

    BACKGROUND: Context memory, or the ability to remember the context in which an episodic event has occurred (e.g., where and when an event took place), has been found to be compromised in Korsakoff's syndrome. This study examined whether a similar deficit would be observed for destination memory,

  16. Destination memory in Korsakoff's syndrome

    NARCIS (Netherlands)

    El Haj, M.; Kessels, R.P.C.; Matton, C.; Bacquet, J.E.; Urso, L.; Cool, G.; Guidez, F.; Potier, S.; Nandrino, J.L.; Antoine, P.

    2016-01-01

    Background: Context memory, or the ability to remember the context in which an episodic event has occurred (e.g., where and when an event took place), has been found to be compromised in Korsakoff's syndrome. This study examined whether a similar deficit would be observed for destination memory,

  17. Simulating continuous renal replacement therapy: usefulness of a new simulator device.

    Science.gov (United States)

    Mencía, Santiago; López, Manuel; López-Herce, Jesús; Ferrero, Luis; Rodríguez-Núñez, Antonio

    2014-03-01

    Simulation allows the training of life-support procedures without patient risk. We analyzed the performance and usefulness of a new device that makes feasible the external control of continuous renal replacement therapy (CRRT) machines in order to realistically generate clinical conditions and problems in simulated patients. A simple mechanical device was designed according to training needs and then hand made. This device permits the control of all monitorable pressures and therefore allows simulation of a range of clinical situations and eventual complications that might occur in real patients. We tested its performance in vitro and then during 16 high-fidelity patient-simulation scenarios included in the program of pediatric CRRT courses. Student and teacher satisfaction was assessed through an anonymous survey. Quick, accurate, real-time monitor of pressure changes, concordant with the usual clinical problems to be simulated (catheter complications, filter coagulation, inadequate CRRT device settings), were easily achieved with the new device. Instructors rated the device as user friendly and well adapted to the reality being simulated. During scenarios, students were not aware of the simulator and considered that simulated clinical conditions were realistic. Our device may be very useful for training healthcare professionals in CRRT management, thus avoiding risk to patients.

  18. Photobiomodulation therapy for androgenetic alopecia: A clinician's guide to home-use devices cleared by the Federal Drug Administration.

    Science.gov (United States)

    Dodd, Erin M; Winter, Margo A; Hordinsky, Maria K; Sadick, Neil S; Farah, Ronda S

    2018-06-01

    The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly expanded, and the Food and Drug Administration (FDA) has recently cleared many devices for this purpose. Patients increasingly seek the advice of dermatologists regarding the safety and efficacy of these hair loss treatments. The purpose of this guide was threefold: (1) to identify all home-use photobiomodulation therapy devices with FDA-clearance for treatment of androgenetic alopecia; (2) to review device design, features and existing clinical evidence; and (3) to discuss practical considerations of photobiomodulation therapy, including patient suitability, treatment goals, safety, and device selection. A search of the FDA 510(k) Premarket Notification database was conducted using product code "OAP" to identify all home-use devices that are FDA-cleared to treat androgenetic alopecia. Thirteen commercially available devices were identified and compared. Devices varied in shape, wavelength, light sources, technical features, price, and level of clinical evidence. To date, there are no head-to-head studies comparing the efficacy of these devices. Photobiomodulation therapy devices have an excellent safety profile and mounting evidence supporting their efficacy. However, long-term, high quality studies comparing these devices in diverse populations are lacking. As these devices become increasingly popular, dermatologists should be familiar with this treatment modality to add to their therapeutic armamentarium. AGA, androgenetic alopecia; FDA, Food and Drug Administration; IEC, International Electrotechnical Commission; LED, light-emitting diode; PBMT, photobiomodulation therapy.

  19. 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...

  20. 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

    . In the first half of the study, patients using the device reported 91% compliance versus 85% in the control group. This difference diminished after crossover (88 versus 86%). BP was not affected. Electronic monitoring data on compliance revealed taking, dosing and timing compliance between 45 and 52% in study...... 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...... and were randomized to either electronic compliance monitoring with a reminder and monitoring device or standard therapy for 6 months. Both groups were crossed over after 6 months. Intervention effectiveness was assessed using self-reported compliance and BP. RESULTS: Data from 398 patients were analysed...

  1. Destination brand experience and visitor behavior

    DEFF Research Database (Denmark)

    Mattsson, Jan; Sørensen, Flemming; Barnes, Stuart

    2014-01-01

    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 expe...

  2. 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.

  3. An ontology-based annotation of cardiac implantable electronic devices to detect therapy changes in a national registry.

    Science.gov (United States)

    Rosier, Arnaud; Mabo, Philippe; Chauvin, Michel; Burgun, Anita

    2015-05-01

    The patient population benefitting from cardiac implantable electronic devices (CIEDs) is increasing. This study introduces a device annotation method that supports the consistent description of the functional attributes of cardiac devices and evaluates how this method can detect device changes from a CIED registry. We designed the Cardiac Device Ontology, an ontology of CIEDs and device functions. We annotated 146 cardiac devices with this ontology and used it to detect therapy changes with respect to atrioventricular pacing, cardiac resynchronization therapy, and defibrillation capability in a French national registry of patients with implants (STIDEFIX). We then analyzed a set of 6905 device replacements from the STIDEFIX registry. Ontology-based identification of therapy changes (upgraded, downgraded, or similar) was accurate (6905 cases) and performed better than straightforward analysis of the registry codes (F-measure 1.00 versus 0.75 to 0.97). This study demonstrates the feasibility and effectiveness of ontology-based functional annotation of devices in the cardiac domain. Such annotation allowed a better description and in-depth analysis of STIDEFIX. This method was useful for the automatic detection of therapy changes and may be reused for analyzing data from other device registries.

  4. Clitoral therapy device for treatment of sexual dysfunction in irradiated cervical cancer patients

    International Nuclear Information System (INIS)

    Schroder, MaryAnn; Mell, Loren K.; Hurteau, Jean A.; Collins, Yvonne C.; Rotmensch, Jacob; Waggoner, Steven E.; Yamada, S. Diane; Small, William; Mundt, Arno J.

    2005-01-01

    Purpose: The purpose of this pilot study was to evaluate the efficacy of the clitoral therapy device (Eros Therapy) in alleviating sexual dysfunction in irradiated cervical cancer patients. Methods and materials: Eligible patients had a history of cervical cancer treated with radiotherapy and self-reported sexual dysfunction of sexual arousal and/or orgasmic disorders. Patients used the noninvasive, nonpharmacologic clitoral therapy device using a hand-held, battery-powered vacuum to cause clitoral engorgement four times weekly for 3 months during foreplay and self-stimulation. Study instruments included the Female Sexual Function Index, Derogatis Interview for Sexual Functioning, and Dyadic Adjustment Scale. The outcome evaluation was performed at 3 months. Results: Between 2001 and 2002, 15 women were enrolled and 13 completed the study. The median patient age and radiotherapy-enrollment interval was 43.5 years and 2 years, respectively. At baseline, all patients reported symptoms of sexual arousal and/or orgasmic disorders, and some also had sexual desire and pain disorders. At 3 months, statistically significant improvements were seen in all domains tested, including sexual desire, arousal, lubrication, orgasm, sexual satisfaction, and reduced pain. The median Female Sexual Function Index total score increased from 17 to 29.4 (maximal score, 36; p <0.001). The median Derogatis Interview for Sexual Functioning total raw score increased from 46 to 95 (maximal score, 118; p <0.001). At baseline, the Derogatis Interview for Sexual Functioning total T-score corresponded to the bottom 10th percentile of normal sexual functioning. At 3 months, the total T-score placed the patients at the normalcy cutoff. Gynecologic examinations revealed improved mucosal color and moisture and vaginal elasticity and decreased bleeding and ulceration. Conclusion: Our results from this pilot study suggest that the clitoral therapy device may alleviate sexual dysfunction in irradiated

  5. A novel vacuum assisted closure therapy model for use with percutaneous devices.

    Science.gov (United States)

    Cook, Saranne J; Nichols, Francesca R; Brunker, Lucille B; Bachus, Kent N

    2014-06-01

    Long-term maintenance of a dermal barrier around a percutaneous prosthetic device remains a common clinical problem. A technique known as Negative Pressure Wound Therapy (NPWT) uses negative pressure to facilitate healing of impaired and complex soft tissue wounds. However, the combination of using negative pressure with percutaneous prosthetic devices has not been investigated. The goal of this study was to develop a methodology to apply negative pressure to the tissues surrounding a percutaneous device in an animal model; no tissue healing outcomes are presented. Specifically, four hairless rats received percutaneous porous coated titanium devices implanted on the dorsum and were bandaged with a semi occlusive film dressing. Two of these animals received NPWT; two animals received no NPWT and served as baseline controls. Over a 28-day period, both the number of dressing changes required between the two groups as well as the pressures were monitored. Negative pressures were successfully applied to the periprosthetic tissues in a clinically relevant range with a manageable number of dressing changes. This study provides a method for establishing, maintaining, and quantifying controlled negative pressures to the tissues surrounding percutaneous devices using a small animal model. Published by Elsevier Ltd.

  6. 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.

  7. Smart tourism destinations: ecosystems for tourism destination competitiveness

    OpenAIRE

    Boes, Kim; Buhalis, Dimitrios; Inversini, Alessandro

    2016-01-01

    Purpose\\ud – Grounded in service-dominant (S-D) logic, the purpose of this paper is to explore the core components of smartness to present a framework for the development of the smart tourism destination.\\ud \\ud Design/methodology/approach\\ud – The paper explores the core components of smartness through case study analysis of well-established smart cities.\\ud \\ud Findings\\ud – The paper conceptualises smartness and argues ICT, leadership, innovation and social capital supported by human capit...

  8. Estimation of four-dimensional dose distribution using electronic portal imaging device in radiation therapy

    International Nuclear Information System (INIS)

    Mizoguchi, Asumi; Arimura, Hidetaka; Shioyama, Yoshiyuki

    2013-01-01

    We are developing a method to evaluate four-dimensional radiation dose distribution in a patient body based upon the animated image of EPID (electronic portal imaging device) which is an image of beam-direction at the irradiation. In the first place, we have obtained the image of the dose which is emitted from patient body at therapy planning using therapy planning CT image and dose evaluation algorism. In the second place, we have estimated the emission dose image at the irradiation using EPID animated image which is obtained at the irradiation. In the third place, we have got an affine transformation matrix including respiratory movement in the body by performing linear registration on the emission dose image at therapy planning to get the one at the irradiation. In the fourth place, we have applied the affine transformation matrix on the therapy planning CT image and estimated the CT image 'at irradiation'. Finally we have evaluated four-dimensional dose distribution by calculating dose distribution in the CT image 'at irradiation' which has been estimated for each frame of the EPID animated-image. This scheme may be useful for evaluating therapy results and risk management. (author)

  9. Destination and source memory in Huntington's disease.

    Science.gov (United States)

    El Haj, Mohamad; Caillaud, Marie; Verny, Christophe; Fasotti, Luciano; Allain, Philippe

    2016-03-01

    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 had to put 12 items in a black or a white box (destination task), and to extract another 12 items from a blue or a red box (source task). Afterwards, they had to decide in which box each item had previously been deposited (destination memory), and from which box each item had previously been extracted (source memory). HD participants showed poorer source as well as destination recall performance than healthy adults in the proposed tasks. Correlation analysis showed that destination recall was significantly correlated with episodic recall in HD participants. Destination memory impairment in HD participants seems to be considerably influenced by their episodic memory performance. © 2014 The British Psychological Society.

  10. 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

  11. The Achilles' heel of left ventricular assist device therapy: right ventricle.

    Science.gov (United States)

    Ranganath, Neel K; Smith, Deane E; Moazami, Nader

    2018-06-01

    Many patients suffer from either persistent right ventricular failure (RVF) at the time of left ventricular assist device (LVAD) or have ongoing symptoms consistent with RVF during chronic mechanical circulatory support. The lack of long-term right ventricular assist devices (RVADs) has limited the impact that mechanical circulatory support can provide to patients with biventricular failure. We aim to review the entire spectrum of RVF in patients receiving LVADs and reflect on why this entity remains the Achilles' heel of LVAD therapy. In the early postoperative period, LVAD implantation reduces right ventricle (RV) afterload, but RV dysfunction may be exacerbated secondary to increased venous return. With prolonged therapy, the decreased RV afterload leads to improved RV contractile function. Bayesian statistical models outperform previously published preoperative risk scores by considering inter-relationships and conditional probabilities amongst independent variables. Various echocardiographic parameters and the pulmonary artery pulsatility index have shown promise in predicting post-LVAD RVF. Recent publications have delineated the emergence of 'delayed' RVF. Several devices are currently being investigated for use as RVADs. Post-LVAD RVF depends on the RV's ability to adapt to acute hemodynamic changes imposed by the LVAD. Management options are limited due to the lack of an easily implantable, chronic-use RVAD.

  12. Implant Strategy-Specific Changes in Symptoms in Response to Left Ventricular Assist Devices.

    Science.gov (United States)

    Lee, Christopher S; Gelow, Jill M; Chien, Christopher V; Hiatt, Shirin O; Bidwell, Julie T; Denfeld, Quin E; Grady, Kathleen L; Mudd, James O

    Although we know that the quality of life generally improves after left ventricular assist device (LVAD) implantation, we know little about how symptoms change in response to LVAD. The purpose of this study was to compare the changes in symptoms between bridge and destination therapy patients as part of a prospective cohort study. Physical (dyspnea and wake disturbances) and affective symptoms (depression and anxiety) were measured before LVAD and at 1, 3, and 6 months after LVAD. Multiphase growth modeling was used to capture the 2 major phases of change: initial improvements between preimplant and 1 month after LVAD and subsequent improvements between 1 and 6 months after LVAD. The sample included 64 bridge and 22 destination therapy patients as the preimplant strategy. Destination patients had worse preimplant dyspnea and wake disturbances, and they experienced greater initial improvements in these symptoms compared with bridge patients (all P .05). Destination patients had worse preimplant depression (P = .042) but experienced similar initial and subsequent improvements in depression in response to LVAD compared with bridge patients (both P > .05). Destination patients had similar preimplant anxiety (P = .279) but experienced less initial and greater subsequent improvements in anxiety after LVAD compared with bridge patients (both P < .05). There are many differences in the magnitude and timing of change in symptom responses to LVAD between bridge and destination therapy patients. Detailed information on changes in specific symptoms may better inform shared decision-making regarding LVAD.

  13. 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

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

    Science.gov (United States)

    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 risky, monitored anesthesia care utilizing peripheral nerve block and slight sedation was scheduled. Pectoral nerves (PECS) block and intercostal block was performed under ultrasonography with ropivacaine. For sedation during the procedure, continuous infusion of dexmedetomidine without a loading dose was performed. The procedure lasted about 3 hours, but the patient showed no pain or restlessness. Combination of PECS block and intercostal block may provide effective analgesia for CRTD implantation.

  15. Mastication movements and sleep quality of patients with myofascial pain: occlusal device therapy improvements.

    Science.gov (United States)

    Vilanova, Larissa Soares Reis; Gonçalves, Thais Marques Simek Vega; Pimentel, Marcele Jardim; Bavia, Paula Furlan; Rodrigues Garcia, Renata Cunha Matheus

    2014-12-01

    Patients with myofascial pain experience impaired mastication, which might also interfere with their sleep quality. The purpose of this study was to evaluate the jaw motion and sleep quality of patients with myofascial pain and the impact of a stabilization device therapy on both parameters. Fifty women diagnosed with myofascial pain by the Research Diagnostic Criteria were enrolled. Pain levels (visual analog scale), jaw movements (kinesiography), and sleep quality (Epworth Sleepiness Scale; Pittsburgh Sleep Quality Index) were evaluated before (control) and after stabilization device use. Range of motion (maximum opening, right and left excursions, and protrusion) and masticatory movements during Optosil mastication (opening, closing, and total cycle time; opening and closing angles; and maximum velocity) also were evaluated. Repeated-measures analysis of variance in a generalized linear mixed models procedure was used for statistical analysis (α=.05). At baseline, participants with myofascial pain showed a reduced range of jaw motion and poorer sleep quality. Treatment with a stabilization device reduced pain (Pmastication increased, and improvements in sleep scores for the Pittsburgh Sleep Quality Index (P<.001) and Epworth Sleepiness Scale (P=.04) were found. Myofascial pain impairs jaw motion and quality of sleep; the reduction of pain after the use of a stabilization device improves the range of motion and sleep parameters. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  16. 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.

  17. The Impact of Destination Exposure in Reality Shows on Destination Image, Familiarity, and Travel Intention

    Directory of Open Access Journals (Sweden)

    Stacia Reviany Mege

    2017-12-01

    Full Text Available The increasing popularity of reality shows renders them as potential media for tourism promotion. However, there is limited research regarding the impact of destination exposure in reality shows. This study aimed to investigate the impact of destination exposure in television reality shows on destination image, familiarity, and travel intention. To test the hypotheses, a within subject experiment was conducted. A worldwide popular reality show, The Amazing Race, was used as a stimulus for the participants. The results revealed that, in general, both cognitive and affective destination im- ages were rated higher after watching the reality show. Furthermore, familiarity with the destination and travel intention to the destination increased after watching the destination in the reality show. The result of this study will be useful for destination marketing organization and the government to explore alternative promotional media and aid the promotion of tourism destination.

  18. Diabetic peripheral angiopathy treatment using a multi-laser therapy device

    OpenAIRE

    Zabulonov, Y.; Chukhraiyeva, O.; Vladimirov, A.; Chukhraiyev, M.; Zukow, W.

    2015-01-01

    Zabulonov Y., Chukhraiyeva O., Vladimirov A., Chukhraiyev M., Zukow W. Diabetic peripheral angiopathy treatment using a multi-laser therapy device. Journal of Education, Health and Sport. 2015;5(10):227-233. ISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.32801 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%2810%29%3A227-233 https://pbn.nauka.gov.pl/works/662978 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014 http://journal.rsw....

  19. Diabetic peripheral angiopathy treatment using a multi-laser therapy device

    OpenAIRE

    Y. Zabulonov; O. Chukhraiyeva; A. Vladimirov; M. Chukhraiyev; W. Zukow

    2015-01-01

    Zabulonov Y., Chukhraiyeva O., Vladimirov A., Chukhraiyev M., Zukow W. Diabetic peripheral angiopathy treatment using a multi-laser therapy device. Journal of Education, Health and Sport. 2015;5(10):227-233. ISSN 2391-8306. DOIhttp://dx.doi.org/10.5281/zenodo.32801 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%2810%29%3A227-233 https://pbn.nauka.gov.pl/works/662978 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014http://journal.rsw.ed...

  20. 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.

  1. Impact of an iDevice application on student learning in an occupational therapy kinesiology course.

    Science.gov (United States)

    Hughes, Jason K; Kearney, Pamalyn

    2017-01-01

    As technology continues to evolve, and information is increasingly accessed through smartphones and tablets, it is essential for university faculty to reassess teaching methodologies. This study explored how use of an iDevice application (app) by participants enrolled in an entry-level occupational therapy kinesiology course affected student learning in the course. This iDevice app was developed through a collaboration between the lead author and the Department of Technology Enhanced Learning and Innovation at Augusta University. The iDevice app was released to the public via the Apple ® App Store at the midpoint of the kinesiology course. All students were invited to use the app. Focus groups were conducted with 19 students recruited from the first year cohort of occupational therapy graduate students. These focus groups were conducted at the end of the semester once grades had been submitted. Thematic analysis of focus group transcripts revealed three themes reflecting how participants perceived app use impacting their learning. Participants report the app facilitated learning through provision of visual content, serving as a reliable source of information, and generally supporting the learning process. The Kinesiology Pro Consult App provided on demand learning, allowing students to be more autonomous with their learning and take advantage of opportunities to learn anywhere and anytime. Finally, participants reported the app allowed them to be more efficient in their learning, possibly allowing more time for other courses. Mobile device apps that support student learning in specific content areas may provide positive benefits to student learning both in the specific course related to the app but also in other courses as a result of increased efficiency in learning.

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

    International Nuclear Information System (INIS)

    Gomez, Daniel R.; Poenisch, Falk; Pinnix, Chelsea C.; Sheu, Tommy; Chang, Joe Y.; Memon, Nada; Mohan, Radhe; Rozner, Marc A.; Dougherty, Anne H.

    2013-01-01

    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

  4. 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.

  5. 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......-structured interviews with members of a destination brand network indicate that highly centralised networks hinder operator buy-in to the destination brand. Informal communication via more personalised sub-networks rather than directive leadership appear to facilitate knowledge sharing and create support mechanisms...

  6. Destination memory in traumatic brain injuries.

    Science.gov (United States)

    Wili Wilu, Amina; Coello, Yann; El Haj, Mohamad

    2018-06-01

    Destination memory, which is socially driven, refers to the ability to remember to whom one has sent information. Our study investigated destination memory in patients with traumatic brain injuries (TBIs). Patients and control participants were invited to tell proverbs (e.g., "the pen is mightier than the sword") to pictures of celebrities (e.g., Barack Obama). Then they were asked to indicate to which celebrity they had previously told the proverbs. Besides the assessment of destination memory, participants performed a binding task in which they were required to associate letters with their corresponding location. Analysis demonstrated less destination memory and binding in patients with TBIs than in controls. In both populations, significant correlations were observed between destination memory and performances on the binding task. These findings demonstrate difficulty in the ability to attribute information to its appropriate destination in TBI patients, perhaps owing to difficulties in binding separate information together to form a coherent representation of an event in memory.

  7. 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.

  8. Destination Competitiveness: a Framework for Future Research

    OpenAIRE

    Gruescu, Ramona; Nanu, Roxana; Pirvu, Gheorghe

    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; Nanu, Roxana; Pirvu, Gheorghe

    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. Practical approaches to commencing device-assisted therapies for Parkinson disease in Australia.

    Science.gov (United States)

    Williams, David R; Evans, Andrew H; Fung, Victor S C; Hayes, Michael; Iansek, Robert; Kimber, Thomas; O'Sullivan, John D; Sue, Carolyn M

    2017-10-01

    In Australia 1% of individuals aged over 50 years have Parkinson disease (PD). Guidance for commencing device-assisted therapies (DAT) for PD in Australia was developed based on a review of European recommendations and their relevance to the local clinical setting. An online survey and teleconference discussions were held by a group of eight local movement disorder experts to develop consensus. Referral to a movement disorder specialist and consideration of DAT is appropriate when motor fluctuations cause disability or reduced quality of life, response to treatment is inconsistent or motor fluctuations and dyskinesias require frequent treatment adjustment without apparent benefit and levodopa is required four or more times daily. Three types of DAT are available in Australia for patients with PD: continuous subcutaneous apomorphine; continuous levodopa-carbidopa intestinal gel infusion; and deep brain stimulation. All improve consistency of motor response. The most important aspects when considering which DAT to use are the preferences of the patient and their carers, patient comorbidities, age, cognitive function and neuropsychiatric status. Patients and their families need to be provided with treatment options that are suitable to them, with adequate explanations regarding the recommendations and comparison of potential device-related complications. DAT are best managed, where possible, in a specialist centre with experience in all three types of therapy. Proactive and early management of symptoms during disease progression is essential to maintain optimally motor responses and quality of life in patients with PD. © 2017 Royal Australasian College of Physicians.

  11. Comparison of 4-Layer Bandages and an Adaptive Compression Therapy Device on Intended Pressure Delivery.

    Science.gov (United States)

    Mayrovitz, Harvey N; Partsch, Hugo; Vanscheidt, Wolfgang

    2015-01-01

    To characterize and compare interface pressure profiles of an adaptive compression therapy (ACT) device and a traditional 4-layer bandage (4LB) system. A prospective, randomized, open-label, 1-arm, active controlled study. The sample comprised 12 healthy volunteers. Subjects wore both devices for 8 hours on 3 consecutive days. Treatments were randomized to left and right legs. One clinician performed all applications and was experienced in the clinical use of both devices. Pressures were measured in seated and standing positions at the lower, mid, and upper calf immediately post application and after 1, 4, and 8 hours. Pressures achieved with the ACT were closer to targeted 40/30/20 mmHg graduated pressure values and were significantly less than the 4LB for corresponding sites/postures (P pressures (mean ± SD) for the ACT were 36.9 ± 4.9, 30.5 ± 4.5, and 21.0 ± 3.6 mmHg. Corresponding interface pressures for the 4LB were 52.5 ± 8.4, 57.5 ± 10.3, and 53.5 ± 12.9 mmHg. In the standing position, initial interface pressures for the ACT were 40.7 ± 4.8, 35.6 ± 4.5, and 21.1 ± 4.6 compared to 54.6 ± 12.5, 64.4 ± 10.9, and 53.7 ± 14.3 for the 4LB. At 1, 4, and 8 hours after application, the 4LB showed a significant progressive decline in interface pressure in both seated and standing positions (P pressures than the 4LB and the pressures achieved were consistent with contemporary venous ulcer therapy standards.

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

    International Nuclear Information System (INIS)

    Kim, T; Kang, S; Kim, D; Suh, T; Kim, S

    2014-01-01

    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

  13. The Influence of Destination Image on Medical Tourist’s Intention for Future Destination Choice

    Directory of Open Access Journals (Sweden)

    Norhaslin Abu Hassan

    2016-01-01

    Full Text Available This study proposed to explore how the image of a destination could influence medical tourists in choosing a destination as their future medical and tourism destination choice. Scholars argued that destination image had a significant relationship with behavioral intentions. Destination image influence not only the decision-making process but also conditions after-decision-making behaviors of tourists. In the current study context, the future destination choice behavior referred to the intention to revisit the previous destination and the intention to spread the positive word-of-mouth to others. For this study, inbound medical tourists from private hospitals registered with Malaysia Healthcare Travel Council (MHTC in Penang, Malacca, Kuala Lumpur and Selangor in Malaysia will be approached quantitatively by survey questionnaires. This study will contribute to an understanding of the significant factors influencing medical tourists’ intention for future destination choice.

  14. Heart resynchronization therapy: experience, clinical Follow-up and optimization of the device with echocardiography

    International Nuclear Information System (INIS)

    Munera, Ana G; Restrepo, Gustavo; Duque, Mauricio; Cubides, Carlos; Uribe, William; Medina, Eduardo; Marin, Jorge; Gil, Efrain; Aristizabal, Dagnovar

    2007-01-01

    In patients with advanced heart failure, functional class lll-IV, mortality reaches 50% at one year and 80% at two years. Some remain asymptomatic and have a poor functional state, regardless of the pharmacologic treatment. Heart resynchronization therapy is a therapeutic alternative that improves hemodynamic and symptoms in these patients. The objective is to analyze the experience in the management of heart failure with heart resynchronization therapy devices with or without cardio defibrillator. Methodological design: an intervention study without aleatory patients assignment, with evaluation before and after the intervention. Results: the cohort was constituted by 82 patients. 73% were men. Mean age was 65.4+/- 11.9 years. The etiology was non-ischemic in 50 patients and ischemic in 32. Mean initial ejection fraction was 19.4% +/- 11.7%. Initial functional class was class lll - IV in 85% of cases and all patients received optimal medical treatment. During the follow-up, it was observed improvement of functional class, diastolic function, diastolic diameter of left ventricle, ejection fraction, mitral insufficiency, left atrial area, systolic lung pressure, synchrony parameters and myocardial function index with statistical significant difference in relation to the initial value (p<0.05). Survival at 44 months was 72%. Conclusion: the experience with heart resynchronization therapy and clinical and echocardiographic follow-up of the studied patients is similar to that found in other studies described in the literature

  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. 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.

  17. 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

  18. Energy costs of manual therapy: effects of plinth height and an assistive device.

    Science.gov (United States)

    O'Connell, D G; Holmes, C F; Santos, J L; Jordan, E; Acosta, F

    1994-01-01

    The purpose of this investigation was to examine the metabolic and cardiopulmonary responses of an experienced therapist (8 years experience) performing manual therapy at standard (S) plinth height (31 in), elevated (E) plinth height (38 in), and standard (SMTH) and elevated (EMTH) plinth height wearing a manual therapy harness (MTH). The MTH, developed by one of the investigators (J.L.S.), is a vestlike device worn by the therapist, which, when attached to the patient, can be used to distract articular surfaces. The MTH allows the therapist more freedom of hand movement and use of body weight to help provide joint distraction. Inferior glide (Grade 3-Maitland) was provided to the lift hip of 12 individuals at a rate of 20 oscillations per minute for 4 minutes, continuously, so that steady-rate metabolic conditions could be established. Mean body mass and height for the 12 individuals was 70±10.5 kg and 174.5±13 cm, respectively. The therapist's heart rate returned to resting levels between each of the randomly assigned treatments. One subject was treated daily. The therapist (age 32) was chosen because of his clinical experience, similar height (172 em) and weight (73 kg) to the average adult American male, and excellent intra- and interday (5%≤ METs, 5%≤ HR) reproducibility. Metabolic equivalents (METs), heart rate (HR), and rate of perceived exertion (RPE) were measured and averaged for the last 2 minutes of each treatment condition. The therapist was unaware of day-to-day test results except for RPE. Mean METs were 3. 7,3.2,2.6, and 2.4 for S, E, SMTH, and EMTH, respectively. Mean HRs were .117, 110, 104, and 93 beats/min for S, E, SMTH, and EMTH, respectively. RPE was 11. 0,8.7, 7.9, and 7.3jorS, E, SMTH, and EMTH, respectively. Repeated-measures analysis of variance (Scheffé F-test) revealed that SMTH and EMTH METs were similar, and significantly different (p≤0.05) from Sand E. METs for E were significantly different and lower than for S. HRs were

  19. 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.

  20. 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.

  1. Destination Networks as a Tool for Minimizing the Risk and Improving the Performance of a Destination

    Directory of Open Access Journals (Sweden)

    Holešinská Andrea

    2015-12-01

    Full Text Available The management of a tourist destination in the form of networks is considered to be one of the possible approaches to destination governance structures. The concept of destination governance is based on the cooperation between actors from the public and private sectors. It is known that public–private relationships built on trust, joint risk taking and based on informal structures have a positive impact on the level of growth at a tourist destination. The aim of this paper is to quantify to what extent each of the determinants of the DMO success participate in the total destination performance, and thus point out the factors of a potential risk.

  2. Humidifiers for oxygen therapy: what risk for reusable and disposable devices?

    Science.gov (United States)

    La Fauci, V; Costa, G B; Facciolà, A; Conti, A; Riso, R; Squeri, R

    2017-06-01

    Nosocomial pneumonia accounts for the vast majority of healthcare-associated infections (HAI). Although numerous medical devices have been discussed as potential vehicles for microorganisms, very little is known about the role played by oxygen humidifiers as potential sources of nosocomial pathogens. The purpose of this research was to evaluate the safety of the reuse of humidifiers by analysing the rate of microbial contamination in reusable and disposable oxygen humidifiers used during therapy, and then discuss their potential role in the transmission of respiratory pathogens. Water samples from reusable and disposable oxygen humidifiers were collected from different wards of the University Hospital of Messina, Italy, where nosocomial pneumonia has a higher incidence rate due to the "critical" clinical conditions of inpatients. In particular, we monitored the Internal Medicine and Pulmonology wards for the medical area; the General Surgery and Thoracic and Cardiovascular Surgery wards for the surgical area and the Intensive Care Unit and Neonatal Intensive Care Unit for the emergency area. The samples were always collected after a period of 5 days from initial use for both types of humidifiers. Samples were processed using standard bacteriological techniques and microbial colonies were identified using manual and automated methods. High rates of microbial contamination were observed in samples from reusable oxygen humidifiers employed in medical (83%), surgical (77%) and emergency (50%) areas. The most relevant pathogens were Pseudomonas aeruginosa, amongst the Gram-negative bacteria, and Staphylococcus aureus, amongst the Gram-positive bacteria. Other pathogens were detected in lower percentage. The disposable oxygen humidifier samples showed no contamination. This research presents evidence of the high rate and type of microbial contamination of reusable humidifiers employed for oxygen therapy. These devices may thus be involved in the transmission of potential

  3. Use of mobile device technology to continuously collect patient-reported symptoms during radiation therapy for head and neck cancer: A prospective feasibility study

    Directory of Open Access Journals (Sweden)

    Aaron D. Falchook, MD

    2016-04-01

    Conclusions: A substantial percentage of patients used mobile devices to continuously report symptoms throughout a course of radiation therapy for head and neck cancer. Future studies should evaluate the impact of mobile device symptom reporting on improving patient outcomes.

  4. 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.

  5. 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)

  6. Development of a daily dosimetric control for radiation therapy using an electronic portal imaging device (EPID)

    International Nuclear Information System (INIS)

    Saboori, Mohammadsaeed

    2015-01-01

    Electronic Portal Imaging Devices (EPIDs) can be used to perform dose measurements during radiation therapy treatments if dedicated calibration and correction procedures are applied. The purpose of this study was to provide a new calibration and correction model for an amorphous silicon (a-Si) EPID for use in transit dose verification of step-and-shoot intensity modulated radiation therapy (IMRT). A model was created in a commercial treatment planning system to calculate the nominal two-dimensional (2D) dose map of each radiation field at the EPID level. The EPID system was calibrated and correction factors were determined using a reference set-up, which consisted a patient phantom and an EPID phantom. The advantage of this method is that for the calibration, the actual beam spectrum is used to mimic a patient measurement. As proof-of-principle, the method was tested for the verification of two 7-field IMRT treatment plans with tumor sites in the head-and-neck and pelvic region. Predicted and measured EPID responses were successfully compared to the nominal data from treatment planning using dose difference maps and gamma analyses. Based on our result it can be concluded that this new method of 2D EPID dosimetry is a potential tool for simple patient treatment fraction dose verification.

  7. A NOVEL SUPPORT DEVICE FOR HEAD IMMOBILIZATION DURING RADIATION THERAPY THAT IS APPLICABLE TO BOTH CATS AND DOGS.

    Science.gov (United States)

    Nemoto, Yuki; Maruo, Takuya; Fukuyama, Yasuhiro; Kawarai, Shinpei; Shida, Takuo; Nakayama, Tomohiro

    2015-01-01

    Repeatable head immobilization is important for minimizing positioning error during radiation therapy for veterinary patients with head neoplasms. The purpose of this retrospective cross-sectional study was to describe a novel technique for head immobilization (Device II) and compare this technique with a previously described technique (Device I). Device II provided additional support by incorporating three teeth (vs. two teeth with Device I). Between 2011 and 2013, both devices were applied in clinically affected cats (Device I, n = 17; Device II, n = 11) and dogs (Device I, n = 85; Device II, n = 22) of various breeds and sizes. The following data were recorded for each included patient: variability in the angle of the skull (roll, yaw, and pitch), coordinates of the isocenter, and distance from the reference mark to the tumor. Devices I and II differed for skull angle variability during the treatment of dogs (roll, P = 0.0007; yaw, P = 0.0018; pitch, P = 0.0384) and for yaw of during the treatment of cats (P patients. © 2015 American College of Veterinary Radiology.

  8. Cardiac transplantation after bridged therapy with continuous flow left ventricular assist devices.

    Science.gov (United States)

    Deo, Salil V; Sung, Kiick; Daly, Richard C; Shah, Ishan K; Altarabsheh, Salah E; Stulak, John M; Joyce, Lyle D; Boilson, Barry A; Kushwaha, Sudhir S; Park, Soon J

    2014-03-01

    Cardiac transplantation is an effective surgical therapy for end-stage heart failure. Patients (pts) may need to be bridged with a continuous flow left ventricular assist device (CF-LVAD) while on the transplant list as logistic factors like organ availability are unknown. Cardiac transplantation post-LVAD can be a surgically challenging procedure and outcome in these pts is perceived to be poorer based on experience with earlier generation pulsatile flow pumps. Data from a single institution comparing these pts with those undergoing direct transplantation in the present era of continuous flow device therapy are limited. Evaluate results of cardiac transplantation in pts bridged with a CF-LVAD (BTx) and compare outcomes with pts undergoing direct transplantation (Tx) in a single institution. From June 2007 till January 2012, 106 pts underwent cardiac transplantation. Among these, 37 (35%) pts (51±11 years; 85% male) were bridged with a CF-LVAD (BTx), while 70 (65%) comprised the Tx group (53±12 years; 72% males). The median duration of LVAD support was 227 (153,327) days. During the period of LVAD support, 10/37 (27%) pts were upgraded to status 1A and all were successfully transplanted. Median hospital stay in the BTx (14 days) was slightly longer than the Tx group (12 days) but not statistically significant (p=0.21). In-hospital mortality in the BTx (5%) and Tx (1%) were comparable (p=0.25). Estimated late survival in the BTx cohort was 94±7, 90±10 and 83±16% at the end of one, two and three years, respectively which was comparable to 97±4%, 93±6% and 89±9% for the Tx group (p=0.50). Cardiac transplantation after LVAD implant can be performed with excellent results. Patients can be supported on the left ventricular assist device even for periods close to a year with good outcome after cardiac transplantation. Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand

  9. A modified Glenn shunt reduces right ventricular stroke work during left ventricular assist device therapy.

    Science.gov (United States)

    Schiller, Petter; Vikholm, Per; Hellgren, Laila

    2016-03-01

    Right ventricular (RV) failure is a major cause of morbidity and mortality after left ventricular assist device (LVAD) placement and remains hard to predict. We hypothesized that partial surgical exclusion of the RV with a modified Glenn shunt during LVAD treatment would reduce RV stroke work. An LVAD was implanted in eight pigs and a modified Glenn shunt was constructed. A conductance pressure-volume catheter was placed in the right ventricle through the apex. Haemodynamic data and pressure-volume loops were obtained at the following time periods: (i) baseline, (ii) open shunt, (iii) LVAD with closed shunt and (iii) LVAD and open shunt. During LVAD therapy, the right atrial (RA) pressure increased from 9 mmHg (9-9) to 15 mmHg (12-15), P = 0.01. RV stroke volume increased from 30 ml (29-40) to 51 ml (42-53), P work increased to 708 mmHg ml (654-1193) from 535 mmHg ml (424-717), P = 0.04, compared with baseline. During LVAD therapy in combination with a Glenn shunt, the RA pressure decreased from 15 mmHg (12-15) to 10 mmHg (7-11) when compared with LVAD therapy only, P = 0.01. A decrease in RV stroke work from 708 mmHg ml (654-1193) to 465 mmHg ml (366-711), P = 0.04, was seen when the LVAD was combined with a shunt, not significantly different from the baseline value (535 mmHg ml). The developed pressure in the right ventricle decreased from 29 mmHg (26-32) to 21 mmHg (20-24), P work during the use of the shunt with LVAD treatment. A modified Glenn shunt reduced RV volumes, RV stroke work and RA pressure during LVAD therapy in an experimental model of heart failure in pigs. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  10. A Dual Process Approach to Understand Tourists’ Destination Choice Processes

    DEFF Research Database (Denmark)

    Kock, Florian; Josiassen, Alexander; Assaf, Albert

    2017-01-01

    Most studies that investigate tourists' choices of destinations apply the concept of mental destination representations, also referred to as destination image. The present study investigates tourists’ destination choice processes by conceptualizing how different components of destination image...... are mentally processed in tourists' minds. Specifically, the seminal dual processing approach is applied to the destination image literature. By doing this, we argue that some components of mental destination representations are processed systematically while others serve as inputs for heuristics...... that individuals apply to inform their decision making. Understanding how individuals make use of their mental destination representations and how they color their decision-making is essential in order to better explain tourist behavior....

  11. Tourist destination choice: A bibliometric study

    Directory of Open Access Journals (Sweden)

    Claudio Sunao Saito

    2018-01-01

    Full Text Available This bibliometric study aims to understand the main subjects, approaches, and theoretical references related to travel destination choice. The Scopus database, statistical software, and citation analysis defined the relevance and prestige of the articles, authors, models, and theoretical foundations, based on the number of citations in later articles. The results demonstrate that there are a diversity of perspectives and approaches related to the topic and the articles can be grouped into studies related to decision models or destination choice, motivating factors for tourism, personal characteristics or factors, destination characteristics and attractiveness, scope of the intended trip (holiday, size, distance, duration of the trip, etc., travel experiences (humor, feelings during the trip, post-purchase evaluations, etc., influence of the destination’s image, and influence of information/communication on the travel destination choice. The results also indicate a difference regarding the origin of the articles (countries/institution, authors, and theoretical references used in research related to the topic.

  12. Measuring Tourism Risk Impacts on Destination Image

    Directory of Open Access Journals (Sweden)

    Wen-Qi Ruan

    2017-08-01

    Full Text Available This study develops and tests an integrated model of the moderated mediation of risks (man-made and natural disasters that explains the associations between the benefits of tourism and the destination image. The study also considers how tourists are influenced by natural disasters and provides empirical evidence to predict the hypothesis models. The results of a study of 635 foreign tourists indicate that the tourism risks of man-made disasters positively influence the tourists’ experienced benefits and feeling experience. Foreign tourists’ risk evaluation may have a positive effect on their benefit and feeling experience and, thus, may link to the destination image. Somewhat as expected, the moderating effect of tourist benefit is found to strengthen the relationship between feeling experience and the destination image. Alternatively, foreign tourists’ feeling experiences foster a positive link between tourism risk and destination image. The implications of the moderated mediation results are discussed.

  13. 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.

  14. A new LED device used for photodynamic therapy in treatment of moderate to severe acne vulgaris.

    Science.gov (United States)

    Dong, Yiyun; Zhou, Guoyu; Chen, Jinan; Shen, Lingyue; Jianxin, Zhao; Xu, Qing; Zhu, Yulan

    2016-03-01

    This study investigated the efficacy and safety of a newly designed LED device used in photodiagnosis and photodynamic therapy of moderate to severe acne vulgaris in Chinese patients. Forty-six patients with moderate to severe facial acne showing high degrees of fluorescence by ultraviolet light examination were illuminated during ALA-PDT with two wavelengths of light (543-548 nm, and 630±6 nm, respectively) after 2 h of incubation with ALA. Each patient received treatment once every 30 days for two or three sessions. Two independent investigators assigned an acne severity score at baseline, one week after each treatment, as well as 4, 8, and 12 weeks after the completion of treatment. Adverse effects were recorded during and after each treatment. All patients rated their satisfaction with the results of treatment at a 12-week follow up visit. The ALA-PDL treatment regimen showed an overall effectiveness rate of 89.13% (41/46 patients). Some degree of clinical efficacy was seen in 71.42%, 86.67%, and 95.83% of patients with grades IV, V, and VI acne, respectively, and the rate of clinical effectiveness increased with increasing acne severity. When compared with baseline scores, significant reductions in acne scores were obtained at 8, and 12 weeks after completion of treatment. Maximum efficacy was shown at the 12 week follow up. No severe adverse events were observed. ALA-PDT administered with the newly designed LED device was an effective treatment for moderate to severe acne vulgaris, and side effects were mild and reversible. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Destination Memory Impairment in Older People

    OpenAIRE

    Gopie, Nigel; Craik, Fergus I. M.; Hasher, Lynn

    2010-01-01

    Older adults are assumed to have poor destination memory— knowing to whom they tell particular information—and anecdotes about them repeating stories to the same people are cited as informal evidence for this claim. Experiment 1 assessed young and older adults’ destination memory by having participants tell facts (e.g., “A dime has 118 ridges around its edge”) to pictures of famous people (e.g., Oprah Winfrey). Surprise recognition memory tests, which also assessed confidence, revealed that o...

  16. Destination Information Management System for Tourist

    OpenAIRE

    Abdulhamid, Shafii Muhammad; Usman, Gana

    2014-01-01

    The use of information and communication technology in our day to day activities is now unavoidable. In tourism developments, destination information and management systems are used to guide visitors and provide information to both visitors and management of the tour sites. In this paper, information and navigation system was designed for tourists, taking some Niger state of Nigeria tourism destinations into account. The information management system was designed using Java Applet (NetBeans I...

  17. Marketing of adventure tourism destination in Nepal

    OpenAIRE

    Baral, Nirajan

    2016-01-01

    Adventure tourism is one of the key factors of the Nepalese tourism industry. The main aim of this bachelor’s thesis was to clarify the current situation and challenges for developing adventure tourism in Nepal and to evaluate the importance of appropriate marketing strategies. The thesis also focuses on promoting adventure tourism activities and rural tourism destinations. The objective of the thesis was to explore Dhorpatan Hunting Reserve as an adventure tourism destination at internationa...

  18. The perception of destination competitiveness by tourists

    OpenAIRE

    Amaya-Molinar, Carlos Mario; Sosa-Ferreira, Ana Pricila; Ochoa-Llamas, Ileana; Moncada-Jiménez, Pedro

    2017-01-01

    Based on a review of the academic literature this study identifies some of the most frequently mentioned factors and indicators in the field of a tourist destination competitiveness to design a survey subsequently conducted among tourists in Cancun, México. An exploratory factor analysis was performed with the collected data; the result was the reduction from twelve competitiveness factors most commonly mentioned in academic literature to five: Destination marketing and attractions, Destinati...

  19. Promoting tourism destinations: A strategic marketing approach

    OpenAIRE

    Soteriades, Marios D.; Avgeli, Vasiliki A.

    2007-01-01

    This paper provides an outline of principal marketing strategy issues and their application in promoting tourism destinations. It provides an overview of a report prepared for the Tourism Promotion Committee (T.P.C.) of Heraklion District, Crete. In the context of the tourist industry, the ‘product’ is an experience achieved through the combination of a diverse range of products and services. Nowadays tourism destinations face new and increasing marketing challenges arising from changing tour...

  20. Destination Brand: Membangun Keunggulan Bersaing Daerah

    OpenAIRE

    Situmorang, Syafrizal Helmi

    2010-01-01

    All successful brands have social, emotional and identity value to users: they have personalities and enhance the perceived utility, desirability and quality of a product. Every country, regional or state should build destination brand for competitive advantage. A destination brand can be developed in a variety of ways, most obviously in advertising, through direct marketing, personal selling, on websites and in brochures, but also through public and media relations, and through the co-operat...

  1. Predicting Tourist Loyalty to a Small Emerging Destination – The Importance of Destination Image

    Directory of Open Access Journals (Sweden)

    Bình Nghiêm-Phú

    2017-12-01

    Full Text Available In the Southeast Asia region, Vietnam is a developing country and also a developing tourism destination. The number of international tourists to Vietnam has been increasing in recent years. However, the post-trip issues (e.g., not returning, bad word-of-mouth have become the focal points of many arguments. Based on the existing literature, this study devel- oped and tested a theoretical model to predict international tourists’ loyalty to Vietnam from a combination of destination image, tourist motivation, and overall trip satisfaction. The findings revealed that destination image significantly and positively predicted tourists’ overall satisfaction with the trip and their loyalty to the country in the future. Tourist motiva- tion had some weak but significant effects on both overall trip satisfaction and destination loyalty when tested separately; however, the effect on overall trip satisfaction could not be observed when controlled by destination image. Implications were discussed for Vietnam and other small emerging destinations.

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

    OpenAIRE

    Savaş Artuğer; Burçin Cevdet Çetinsöz

    2014-01-01

    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, frequenc...

  3. Novel Simple Insulin Delivery Device Reduces Barriers to Insulin Therapy in Type 2 Diabetes

    Science.gov (United States)

    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 single-center, open-label, single-arm study comprised three 2-week periods: baseline (MDI), transition from MDI to PaQ, and PaQ treatment. Validated questionnaires were administered during the baseline and PaQ treatment periods: Barriers to Insulin Treatment questionnaire (BIT), Insulin Treatment Appraisal Scale (ITAS), and Problem Areas in Diabetes scale (PAID). Results: Eighteen patients (age 59 ± 5 years, diabetes duration 15 ± 7 years, 21% female, HbA1c 7.7 ± 0.7%) completed the questionnaires. There was a strong, significant effect of PaQ use in mean BIT total scores (difference [D] = −5.4 ± 0.7.7, P = .01, effect size [d] = 0.70). Patients perceived less stigmatization by insulin injection (D = −2.2 ± 6.2, P = .18, d = 0.35), increased positive outcome (D = 1.9 ± 6.6, P = .17, d = 0.29), and less fear of injections (1.3 ± 4.8, P = .55, d = 0.28). Mean change in ITAS scores after PaQ device use showed a nonsignificant improvement of 1.71 ± 5.63 but moderate effect size (d = 0.30, P = .14). No increase in PAID scores was seen. Conclusions: The results and moderate to large effects sizes suggest that PaQ device use has beneficial and clinically relevant effects to overcoming barriers to and negative appraisal of insulin treatment, without increasing other diabetes-related distress. PMID:25670847

  4. 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.

  5. Destination memory in social interaction: better memory for older than for younger destinations in normal aging?

    Science.gov (United States)

    El Haj, Mohamad; Raffard, Stéphane; Fasotti, Luciano; Allain, Philippe

    2018-05-01

    Destination memory, a memory component allowing the attribution of information to its appropriate receiver (e.g., to whom did I lend my pen?), is compromised in normal aging. The present paper investigated whether older adults might show better memory for older destinations than for younger destinations. This hypothesis is based on empirical research showing better memory for older faces than for younger faces in older adults. Forty-one older adults and 44 younger adults were asked to tell proverbs to older and younger destinations (i.e., coloured faces). On a later recognition test, participants had to decide whether they had previously told some proverb to an older/younger destination or not. Prior to this task, participants reported their frequency of contact with other-age groups. The results showed lower destination memory in older adults than in younger adults. Interestingly, older adults displayed better memory for older than for younger destinations. The opposite pattern was seen in younger adults. The low memory for younger destinations, as observed in older adults, was significantly correlated with limited exposure to younger individuals. These findings suggest that for older adults, the social experience can play a crucial role in the destination memory, at least as far as exposure to other-age groups is concerned.

  6. Handcrafted Vacuum-Assisted Device for Skin Ulcers Treatment Versus Traditional Therapy, Randomized Controlled Trial.

    Science.gov (United States)

    Gonzalez, Israel Gonzalez; Angel, Medina Andrade Luis; Baez, Maria Valeria Jimenez; Ruiz Flores, Brenda; de Los Angeles Martinez Ferretiz, Maria; Woolf, Stephanny Vanestty; López, Israel; Sandoval-Jurado, Luis; Pat-Espadas, Fany Guadalupe; Cruz, Alan Alejandro Reyes; Delgado, Arsenio Torres

    2017-02-01

    Chronic lower limb ulcers constitute a public health problem, with important socioeconomic implications and high attention cost. This trial evaluates handcrafted vacuum-assisted therapy versus traditional treatment effectiveness for lower limbs ulcers. It was a prospective randomized clinical trial conducted over 144 patients with lower limbs ulcers. Patients were randomized into two groups of 72 patients: Experimental group were treated with debridement, cure and a handcrafted vacuum-assisted device that was changed every 72 h. Control group was treated with debridement and cure with soap every 24 h. Ulcers were evaluated every 72 h and on 10th day. The presence of systemic inflammatory response, pain, granulation tissue and viability for discharge was registered and analyzed . After exclusion of 18 patients, 126 were included, 65.1% were men with an average of 58 years. Sole region ulcer by diabetic foot was the more frequent in both groups (73%). Leukocytes count, systemic inflammatory response and pain were significantly lower in experimental group (p ulcers. This system would benefit patients favoring earlier infection control, faster granulation tissue appearance and earlier discharge. Clinical trials registered in https://www.clinicaltrials.gov/ Number NCT02512159.

  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. Development and Clinical Application of a Precise Temperature-Control Device as an Alternate for Conventional Moxibustion Therapy

    Directory of Open Access Journals (Sweden)

    Shin Takayama

    2012-01-01

    Full Text Available Moxibustion therapy has been used in East Asian medicine for more than a thousand years. However, there are some problems associated with this therapy in clinical practice. These problems include lack of control over the treatment temperature, emission of smoke, and uneven temperature distribution over the treatment region. In order to resolve these problems, we developed a precise temperature-control device for use as an alternate for conventional moxibustion therapy. In this paper, we describe the treatment of a single patient with paralytic ileus that was treated with moxibustion. We also describe an evaluation of temperature distribution on the skin surface after moxibustion therapy, the development of a heat-transfer control device (HTCD, an evaluation of the HTCD, and the clinical effects of treatment using the HTCD. The HTCD we developed can heat the skin of the treatment region uniformly, and its effect may be equivalent to conventional moxibustion, without the emission of smoke and smell. This device can be used to treat ileus, abdominal pain, and coldness of abdomen in place of conventional moxibustion in modern hospitals.

  9. Oxygen therapy devices and portable ventilators for improved physical activity in daily life in patients with chronic respiratory disease.

    Science.gov (United States)

    Furlanetto, Karina Couto; Pitta, Fabio

    2017-02-01

    Patients with hypoxemia and chronic respiratory failure may need to use oxygen therapy to correct hypoxemia and to use ventilatory support to augment alveolar ventilation, reverse abnormalities in blood gases (in particular hypercapnia) and reduce the work of breathing. Areas covered: This narrative review provides an overview on the use of oxygen therapy devices or portable ventilators for improved physical activity in daily life (PADL) as well as discusses the issue of lower mobility in daily life among stable patients with chronic respiratory disease who present indication for long-term oxygen therapy (LTOT) or home-based noninvasive ventilation (NIV). A literature review of these concepts was performed by using all related search terms. Expert commentary: Technological advances led to the development of light and small oxygen therapy devices and portable ventilators which aim to facilitate patients' mobility and ambulation. However, the day-by-day dependence of a device may reduce mobility and partially impair patients' PADL. Nocturnal NIV implementation in hypercapnic patients seems promising to improve PADL. The magnitude of their equipment-related physical inactivity is underexplored up to this moment and more long-term randomized clinical trials and meta-analysis examining the effects of ambulatory oxygen and NIV on PADL are required.

  10. 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.

  11. Destination memory in social interaction: Better memory for older than for younger destinations in normal aging?

    NARCIS (Netherlands)

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

    2018-01-01

    Destination memory, a memory component allowing the attribution of information to its appropriate receiver (e.g., to whom did I lend my pen?), is compromised in normal aging. The present paper investigated whether older adults might show better memory for older destinations than for younger

  12. Destination memory impairment in older people.

    Science.gov (United States)

    Gopie, Nigel; Craik, Fergus I M; Hasher, Lynn

    2010-12-01

    Older adults are assumed to have poor destination memory-knowing to whom they tell particular information-and anecdotes about them repeating stories to the same people are cited as informal evidence for this claim. Experiment 1 assessed young and older adults' destination memory by having participants tell facts (e.g., "A dime has 118 ridges around its edge") to pictures of famous people (e.g., Oprah Winfrey). Surprise recognition memory tests, which also assessed confidence, revealed that older adults, compared to young adults, were disproportionately impaired on destination memory relative to spared memory for the individual components (i.e., facts, faces) of the episode. Older adults also were more confident that they had not told a fact to a particular person when they actually had (i.e., a miss); this presumably causes them to repeat information more often than young adults. When the direction of information transfer was reversed in Experiment 2, such that the famous people shared information with the participants (i.e., a source memory experiment), age-related memory differences disappeared. In contrast to the destination memory experiment, older adults in the source memory experiment were more confident than young adults that someone had shared a fact with them when a different person actually had shared the fact (i.e., a false alarm). Overall, accuracy and confidence jointly influence age-related changes to destination memory, a fundamental component of successful communication. (c) 2010 APA, all rights reserved).

  13. A Model of Tourism Destination Competitiveness: The case of the Italian Destinations of Excellence

    Directory of Open Access Journals (Sweden)

    Gianluca Goffi

    2013-11-01

    Full Text Available Tourism worldwide is becoming increasingly competitive. Competitiveness has been associated in the tourism literature as a critical element for the success of tourism destinations. Particular emphasis is placed on identifying and analyzing the various factors that influence the competitiveness of tourism destinations. The paper extends the Richie & Crouch (2000 model and develops a set of indicators that considers the different issues concerning tourism competitiveness. The indicators are focused on the various dimensions of sustainability. The paper offers insights into the model, each determinant has been extensively described. The aim of the paper is to test whether and to what extent the current set of indicators integrated into the present model can help explaining the competitiveness of a tourism destination. The model is tested on a unique dataset of 610 Italian Destinations of Excellence. Principal Component Analysis is applied on the responses to the items measuring destination competitiveness.

  14. Evaluation of initial setup errors of two immobilization devices for lung stereotactic body radiation therapy (SBRT).

    Science.gov (United States)

    Ueda, Yoshihiro; Teshima, Teruki; Cárdenes, Higinia; Das, Indra J

    2017-07-01

    The aim of this study was to investigate the accuracy and efficacy of two commonly used commercial immobilization systems for stereotactic body radiation therapy (SBRT) in lung cancer. This retrospective study assessed the efficacy and setup accuracy of two immobilization systems: the Elekta Body Frame (EBF) and the Civco Body Pro-Lok (CBP) in 80 patients evenly divided for each system. A cone beam CT (CBCT) was used before each treatment fraction for setup correction in both devices. Analyzed shifts were applied for setup correction and CBCT was repeated. If a large shift (>5 mm) occurred in any direction, an additional CBCT was employed for verification after localization. The efficacy of patient setup was analyzed for 105 sessions (48 with the EBF, 57 with the CBP). Result indicates that the CBCT was repeated at the 1 st treatment session in 22.5% and 47.5% of the EBF and CBP cases, respectively. The systematic errors {left-right (LR), anterior-posterior (AP), cranio-caudal (CC), and 3D vector shift: (LR 2 + AP 2 + CC 2 ) 1/2 (mm)}, were {0.5 ± 3.7, 2.3 ± 2.5, 0.7 ± 3.5, 7.1 ± 3.1} mm and {0.4 ± 3.6, 0.7 ± 4.0, 0.0 ± 5.5, 9.2 ± 4.2} mm, and the random setup errors were {5.1, 3.0, 3.5, 3.9} mm and {4.6, 4.8, 5.4, 5.3} mm for the EBF and the CBP, respectively. The 3D vector shift was significantly larger for the CBP (P patient comfort could dictate the use of CBP system with slightly reduced accuracy. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  15. 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 ...

  16. Destination Characteristics that Drive Hotel Performance

    DEFF Research Database (Denmark)

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

    2017-01-01

    , 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......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...... strategies that take cognisance of the key drivers and barriers to enhancing hotel performance in an ever-changing global tourism sector....

  17. 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.

  18. Bridging knowledge capital with tourism destination stakeholders

    DEFF Research Database (Denmark)

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

    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...

  19. Tourist destination branding on social networks

    Directory of Open Access Journals (Sweden)

    Radenković-Šošić Bojana

    2012-06-01

    Full Text Available Social networks have become the modern means of communication. Intensive electronic word of mouth to mouth (eWOM leads to faster sharing of experiences, and the creation of positive and negative attitudes. On the other hand, branding of tourist destinations has become one of the most powerful resources in the implementation of marketing strategies in tourism. The aim of this study, which is based on primary research, is to examine the concept of electronic word of mouth, as well as the role of social networks in the process of branding tourist destinations.

  20. Destination visual image and expectation of experiences

    DEFF Research Database (Denmark)

    Ye, H.; Tussyadiah, Iis

    2011-01-01

    A unique experience is the essence of tourism sought by tourists. The most effective way to communicate the notion of a tourism experience at a destination is to provide visual cues that stimulate the imagination and connect with potential tourists in a personal way. This study aims...... 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...

  1. Development of a Whole Blood Paper-Based Device for Phenylalanine Detection in the Context of PKU Therapy Monitoring

    Directory of Open Access Journals (Sweden)

    Robert Robinson

    2016-02-01

    Full Text Available Laboratory-based testing does not allow for the sufficiently rapid return of data to enable optimal therapeutic monitoring of patients with metabolic diseases such as phenylketonuria (PKU. The typical turn-around time of several days for current laboratory-based testing is too slow to be practically useful for effective monitoring or optimizing therapy. This report describes the development of a rapid, paper-based, point-of-care device for phenylalanine detection using a small volume (40 μL of whole blood. The quantitative resolution and reproducibility of this device with instrumented readout are described, together with the potential use of this device for point-of-care monitoring by PKU patients.

  2. 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

  3. A NOVEL, REMOVABLE, CERROBEND, BEAM-BLOCKING DEVICE FOR RADIATION THERAPY OF THE CANINE HEAD AND NECK: PILOT STUDY.

    Science.gov (United States)

    Kent, Michael S; Berlato, Davide; Vanhaezebrouck, Isabelle; Gordon, Ira K; Hansen, Katherine S; Theon, Alain P; Holt, Randall W; Trestrail, Earl A

    2017-01-01

    Radiation therapy of the head and neck can result in mucositis and other acute affects in the oral cavity. This prospective pilot study evaluated a novel, intraoral, beam-blocking device for use during imaging and therapeutic procedures. The beam-blocking device was made from a metal alloy inserted into a coated frozen dessert mold (Popsicle® Mold, Cost Plus World Market, Oakland, CA). The device was designed so that it could be inserted into an outer shell, which in turn allowed it to be placed or removed depending on the need due to beam configuration. A Farmer type ionization chamber and virtual water phantom were used to assess effects of field size on transmission. Six large breed cadaver dogs, donated by the owner after death, were recruited for the study. Delivered dose at the dorsal and ventral surfaces of the device, with and without the alloy block in place, were measured using radiochromic film. It was determined that transmission was field size dependent with larger field sizes leading to decreased attenuation of the beam, likely secondary to scatter. The mean and median transmission on the ventral surface without the beam-blocking device was 0.94 [range 0.94-0.96]. The mean and median transmission with the beam-blocking device was 0.52 [range 0.50-0.57]. The mean and median increase in dose due to backscatter on the dorsal surface of the beam-blocking device was 0.04 [range 0.02-0.04]. Findings indicated that this novel device can help attenuate radiation dose ventral to the block in dogs, with minimal backscatter. © 2016 American College of Veterinary Radiology.

  4. Towards a uniform specification of light therapy devices for the treatment of affective disorders and use for non-image forming effects: Radiant flux.

    Science.gov (United States)

    Aarts, M P J; Rosemann, A L P

    2018-08-01

    For treating affective disorders like SAD, light therapy is used although the underlying mechanism explaining this success remains unclear. To accelerate the research on defining the light characteristics responsible for inducing a specific effect a uniform manner for specifying the irradiance at the eye should be defined. This allows a genuine comparison between light-affect studies. An important factor impacting the irradiance at the eye are the radiant characteristics of the used light therapy device. In this study the radiant fluxes of five different light therapy devices were measured. The values were weighted against the spectral sensitivity of the five photopigments present in the human eye. A measurement was taken every five minutes to control for a potential stabilizing effect. The results show that all five devices show large differences in radiant flux. The devices equipped with blue LED lights have a much lower spectral radiant flux than the devices equipped with a fluorescent light source or a white LED. The devices with fluorescent lamps needed 30 min to stabilize to a constant radiant flux. In this study only five devices were measured. Radiant flux is just the first step to identify uniform specifications for light therapy devices. It is recommended to provide all five α-opic radiant fluxes. Preferably, the devices should come with a spectral power distribution of the radiant flux. For the devices equipped with a fluorescent lamp it is recommended to provide information on the stabilization time. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. 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.

  6. Vacation Behaviour: Frequency, Destination Choice and Expenditures

    NARCIS (Netherlands)

    Rouwendal, J.; van Loon, R.R.

    2013-01-01

    The authors study the probability of taking a vacation, foreign or domestic, and the expenditures of Dutch households on vacations. The paper first provides a brief review of Dutch vacation behaviour over the past 30 years. It then presents the results of statistical models for destination choice

  7. 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.

    Science.gov (United States)

    Jensen, Alexandra D; Winter, Marcus; Kuhn, Sabine P; Debus, Jürgen; Nairz, Olaf; Münter, Marc W

    2012-03-29

    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. 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. 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. 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.

  8. Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy: Longitudinal Outcomes for Patients and Family Caregivers.

    Science.gov (United States)

    Bidwell, Julie T; Lyons, Karen S; Mudd, James O; Gelow, Jill M; Chien, Christopher V; Hiatt, Shirin O; Grady, Kathleen L; Lee, Christopher S

    Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device. The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation. This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads). Data on person-oriented outcomes (QOL: EuroQol 5 Dimensions Visual Analog Scale; depression: Patient Health Questionnaire-8; anxiety: Brief Symptom Inventory) were collected at 3 time points (just prior to implantation and at 1 and 3 months post-implantation). Trajectories of change for patients and caregivers on each measure were estimated using latent growth modeling with parallel processes. Patients' QOL improved significantly over time, whereas caregiver QOL worsened. Depression and anxiety also improved significantly among patients but did not change among caregivers. There was substantial variability in change on all outcomes for both patients and their caregivers. This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change in person-oriented outcomes from pre-implantation to post-implantation. This work supports the need for future studies that account for the inherent relationships between patient and caregiver outcomes and examine variability in patient and caregiver responses to VAD therapy.

  9. Setup reproducibility in radiation therapy for lung cancer: a comparison between T-bar and expanded foam immobilization devices

    International Nuclear Information System (INIS)

    Halperin, Ross; Roa, Wilson; Field, Melissa; Hanson, John; Murray, Brad

    1999-01-01

    Purpose: Physiologic and non-physiologic tumor motion complicates the use of tight margins in three-dimensional (3D) conformal radiotherapy. Setup reproducibility is an important non-physiologic cause of tumor motion. The objective of this study is to evaluate and compare patient setup reproducibility using the reusable T-bar and the disposable expanded foam immobilization device (EFID) in radiation therapy for lung cancer. Methods and Materials: Two hundred forty-four portal films were taken from 16 prospectively accrued patients treated for lung cancer. Patients were treated with either a pair of anterior and posterior parallel opposing fields (POF), or a combination of POF and a three-field isocentric technique. Each patient was treated in a supine position using either the T-bar setup or EFID. Six patients were treated in both devices over their treatment courses. Field placement analysis was used to evaluate 3D setup reproducibility, by comparing positions of bony landmarks relative to the radiation field edges in digitized simulator and portal images. Anterior-posterior, lateral, and longitudinal displacements, as well as field rotations along coronal and sagittal planes were measured. Statistical analyses of variance were applied to the deviations among portal films of all patients and the subgroup treated with both immobilization methods. Results: For the T-bar immobilization device, standard deviations of the setup reproducibility were 5.1, 3.7, and 5.1 mm in the anterior-posterior, lateral, and longitudinal dimensions, respectively. Rotations in the coronal plane and the sagittal plane were 0.9 deg. and 1.0 deg. , respectively. For the EFID, corresponding standard deviations of set up reproducibility were 3.6 mm, 5.3 mm, 5.4 mm, 0.7 deg. and 1.4 deg. , respectively. There was no statistically significant difference (p = 0.22) in the 3D setup reproducibility between T-bar and EFID. Subgroup analysis for the patients who were treated with both

  10. Implantation of a cardiac resynchronization therapy-defibrillator device in a patient with persistent left superior vena cava.

    Science.gov (United States)

    Atar, İlyas; Karaçağlar, Emir; Özçalık, Emre; Özin, Bülent; Müderrisoğlu, Haldun

    2015-06-01

    Presence of a persistent left superior vena cava (PLSVC) is generally clinically asymptomatic and discovered incidentally during central venous catheterization. However, PLSVC may cause technical difficulties during cardiac device implantation. An 82-year-old man with heart failure symptoms and an ejection fraction (EF) of 20% was scheduled for resynchronization therapy-defibrillator device (CRT-D) implantation. A PLSVC draining via a dilated coronary sinus into an enlarged right atrium was diagnosed. First, an active-fixation right ventricular lead was inserted into the right atrium through the PLSVC. The stylet was preshaped to facilitate its passage to the right ventricular apex. An atrial lead was positioned on the right atrium free wall, and an over-the-wire coronary sinus lead deployed to a stable position. CRT-D implantation procedure was successfully completed.

  11. Destination Memory in Mild Alzheimer’s Disease

    OpenAIRE

    El Haj, Mohamad; Postal, Virginie; Le Gall, Didier; Allain, Philippe

    2013-01-01

    In order to assess their destination memory, sixteen patients with probable mild Alzheimer Disease (AD), sixteen older adults and 16 young adults were asked to tell facts to pictures. On a subsequent task, they were asked to remember whether they had previously told that fact to that face or not. AD patients showed poorer destination recall than the older adults, and the older adults showed poorer destination recall than the young adults. Our results suggest that destination memory is highly ...

  12. The influence of social media in destination choice

    OpenAIRE

    Tham, Min-En Aaron

    2017-01-01

    The aim of this research is to investigate the influence of social media in destination choice. The evolution of social media within tourism has provided further impetus towards destination information search and image formation. To this end, existing studies have presented the influence of social media at destination micro-levels, such as accommodation and restaurants. At a macro-level, some studies have investigated the influence of social media on a destination. However, current scope is l...

  13. 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.

  14. 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...... the bureaucratic culture of public administration and the marketing culture adopted by private tourism firms (Palmer 1996). This regional coordinating role must be undertaken in spite of limited ownership, budget or power to control how individual firms deliver (D’Angella & Go 2007). Furthermore, various actors...

  15. 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.

  16. 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.

  17. Social Media Strategies and Destination Management

    DEFF Research Database (Denmark)

    Munar, Ana Maria

    2012-01-01

    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...... 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...

  18. 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......; (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...

  19. Hydrophilic MoSe2 Nanosheets as Effective Photothermal Therapy Agents and Their Application in Smart Devices.

    Science.gov (United States)

    Lei, Zhouyue; Zhu, Wencheng; Xu, Shengjie; Ding, Jian; Wan, Jiaxun; Wu, Peiyi

    2016-08-17

    A facile poly(vinylpyrrolidone) (PVP)-assisted exfoliation method is utilized to simultaneously exfoliate and noncovalently modify MoSe2 nanosheets. The resultant hydrophilic nanosheets are shown to be promising candidates for biocompatible photothermal therapy (PTT) agents, and they could also be encapsulated into a hydrogel matrix for some intelligent devices. This work not only provides novel insights into exfoliation and modification of transition metal dichalcogenide (TMD) nanosheets but also might spark more research into engineering multifunctional TMD-related nanocomposites, which is in favor of further exploiting the attractive properties of these emerging layered two-dimensional (2D) nanomaterials.

  20. 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...

  1. Social media storytelling alliances and destination branding.

    OpenAIRE

    Lund, Niels Frederik

    2018-01-01

    The emergence of social media necessitates a fundamental rethink of marketing practises as brands are now co-created with social media users. Destination management organisations (DMOs) therefore need to develop new social media strategies. This thesis suggests that DMOs ought to strengthen their storytelling capabilities as it is an essential tool in increasing social media engagement. A conceptual framework is therefore developed drawing on four particular sociological concepts: storytellin...

  2. 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

  3. Portfolio analysis of a destination's tourism "product line"

    Science.gov (United States)

    Harold Daniel

    2007-01-01

    If we think of a tourist destination as a platform from which a variety of tourist experiences can be delivered, we could conceptualize these experiences as the "product line" offered by or associated with the tourist destination. That conceptualization enables the manager of the destination to employ the logic and discipline associated with product line...

  4. 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

  5. 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.

  6. 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.

  7. Brand Equity of a Tourist Destination

    Directory of Open Access Journals (Sweden)

    Hwa-Kyung Kim

    2018-02-01

    Full Text Available In the current climate of severe competition among tourist destinations, the importance of brand equity in tourism marketing is increasing. This study looks at the impact of branding in relation to the largest group of inbound overseas tourists to South Korea, the Chinese. Data for the current study were obtained from a survey of tourists visiting Seoul from the Greater China region, including Mainland China, Hong Kong, Macao, Taiwan, and the Chinese living in Southeast Asia. The survey was conducted in popular sightseeing spots, four and five-star hotels in the Seoul Metropolitan Area, and the Incheon International Airport. The respondents were selected randomly, with effort expended to avoid any potential bias in the composition of the sample. Out of a total of 385 distributed questionnaires, 350 (China 191, Hong Kong 71, Taiwan 68, others 20 were selected as valid and finally used in the analysis. The results of this study suggest that price and word of mouth have beneficial effects on perceived quality, publicity, and brand awareness, and advertisement has beneficial effects on brand image. We also found that brand awareness and perceived quality have impacts on brand image, and brand image is related to brand loyalty. This is a pioneering study on the relationships between influencing factors, destination brand equity and its elements, and brand loyalty, with respect to Seoul, South Korea, as a tourism destination for tourists from China.

  8. Impact of long term left ventricular assist device therapy on donor allocation in cardiac transplantation.

    Science.gov (United States)

    Uriel, Nir; Jorde, Ulrich P; Woo Pak, Sang; Jiang, Jeff; Clerkin, Kevin; Takayama, Hiroo; Naka, Yoshifumi; Schulze, P Christian; Mancini, Donna M

    2013-02-01

    Left Ventricular Assist Devices (LVAD) are increasingly used as a bridge to transplant (BTT) for patients with advanced congestive heart failure (CHF) and are assigned United Network for Organ Sharing (UNOS) high priority status (1B or 1A). The purpose of our study was asses the effect of organ allocation in the era of continuous flow pumps. A retrospective chart review was performed of all patients transplanted between 1/2001-1/2011 at Columbia University Medical Center. Seven hundred twenty six adult heart transplantations were performed. Two hundred seventy four BTT patients were implanted with LVAD; of which 227 patients were transplanted. Sixty three patients were transplanted as UNOS-1B, while 164 were transplanted as UNOS-1A (72%). Of these 164 patients, 65 were transplanted during their 30-day 1A period (43%) and 96 after upgrading to UNOS-1A for device complication (56%). For 452 non-device patients 139 (31%) were transplanted as UNOS-1A, 233 as UNOS-1B (52%), and 80 as UNOS-2 (17%). The percentage of patients bridged with LVAD increased from 19% in 2001 to 64% in 2010 while the number transplanted during their 30 day 1A grace period declined from 57% in 2005 to 16% in 2011; i.e. 84% of BTT patients in 2011 needed more than 30 days 1A time to be transplanted. Most LVAD patients are now transplanted while suffering device complication. There was no difference in post transplant survival between LVAD patients transplanted as UNOS 1B, 1A grace period or for a device complication As wait time for cardiac transplantation increased the percentage of patients being bridged to transplant with an LVAD has increased with the majority of them transplanted in the setting of device complication. Copyright © 2013 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  9. In vivo determination of tooth mobility after fixed orthodontic appliance therapy with a novel intraoral measurement device.

    Science.gov (United States)

    Konermann, Anna; Al-Malat, R; Skupin, J; Keilig, L; Dirk, C; Karanis, R; Bourauel, C; Jäger, A

    2017-05-01

    Valid measurement systems recording tooth mobility upon displacement within the subtle range of physiological strains are missing. Here, we introduce a novel in vivo measurement device and demonstrate a first clinical application by monitoring tooth mobility changes during retention after fixed multibracket appliance therapy. Tooth mobility was measured in vivo on 21 patients (11 female, 10 male; mean age 16.1 ± 3.1 years) by displacing the upper first incisor 0.2 mm lingually for 0.2, 0.5, 1, 2, 5, and 10 s with the novel intraoral device. Measurements were recorded directly after, as much as 2, 7, and 14 days and up to 6 months after appliance debonding. Device performance was precise and valid in clinical use. Data revealed significant interindividual varying tooth mobility, which was very high during the first 2 days after appliance removal. After 1 week, mobility values decreased, but were generally higher upon short loadings compared to long ones. After 3 months, tooth mobility was significantly lower than directly after debonding. Interestingly, males exhibited significantly less mobility than females. Our work is the first using an in vivo measurement device capable of performing and recording tooth displacements within this delicate range and in such precision. Furthermore, our findings elucidate tooth mobility changes after multibracket treatment, giving important information for retention periods. Establishment of this novel measurement device in clinical use is an important improvement when approaching the complexity of tooth mobility in vivo regarding different issues like orthodontics, periodontal disease, or bruxism.

  10. 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.

  11. Impact on reproducibility of the treatment position by improving immobilization device in image guided radiation therapy

    International Nuclear Information System (INIS)

    Morita, Yuko; Sasaki, Junichi; Shiomi, Hiroya; Oh, Ryoongjin; Inoue, Toshihiko; Tajiri, Shingo

    2012-01-01

    The immobilization device for treatment becomes important to obtain fixation and reproducibility of the treatment position. It was confirmed that reproducibility of the treatment position obtains higher accuracy by the method of using immobilization device. We divided into three terms by the methods of immobilization. An infrared reflective marker performs the setup of a position at the start of treatment, and setup of the patient in a fixed implement is performed by ExacTrac. Difference between coordinates of the immobilization device and the patient position was calculated by the vector in three directions. We estimated the position error index (PE index ) by using the square root of the sum of square of each vectors, and evaluated the amount of differences of patient position at three terms. Mean and standard deviation of index values were 9.53±7.21, 8.50±5.93, and 6.42±3.80 at each three terms. With every passing year, the amount of gap and difference of the patient fixation has decreased. By the improvement of the use of the immobilization device, gap and difference of fixation has decreased. Accordingly, we could obtain better accuracy of fixation. (author)

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

    International Nuclear Information System (INIS)

    Hekkenberg, R T; Richards, A; Beissner, K; Zeqiri, B; Prout, G; Cantrall, Ch; Bezemer, R A; Koch, Ch; Hodnett, M

    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

  13. BUCOVINA AS A TOURIST DESTINATION AND THE IMPACT OF THE RECENT INTERNATIONAL FINANCIAL CRISIS. RECOMMENDATIONS FOR A MODERN DESTINATION MANAGEMENT APPROACH IN INTERNATIONAL DESTINATION MARKETING

    Directory of Open Access Journals (Sweden)

    Heike BÄHRE

    2013-12-01

    Full Text Available Bucovina is a cultural landscape in the triangle bordered between the Ukraine, Romania and Moldova. Based on a theoretical planning approach in destination marketing management, Bucovina is to be regarded as a destination situated at the end of the involvement stage of the Tourism Area Life Cycle (TALC. Literature, internet research, qualitative interviews, and on site-observations depict Bucovina as a travel destination. The authors explore the impact of the financial crisis on Bucovina and forecast the destination trend for the next few years. Finally, they give recommendations for development of the Bucovina region in a sustainable, rapid and regulated manner.

  14. [Use of Intramag devices with Intraterm and LAST-02 attachments in complex therapy of chronic prostatitis].

    Science.gov (United States)

    Shaplygin, L V; Begaev, A I; V'iushina, V V

    2006-01-01

    The examination of the patients exposed to physical factors (magnetotherapy, laser therapy and thermotherapy) has demonstrated that Intramag unit with attachments Intraterm and LAST-02 for local physiotherapy is effective in patients with chronic prostatitis and can be used in urological hospitals and outpatient clinics.

  15. 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.

  16. 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.

  17. Usability testing of an mHealth device for swallowing therapy in head and neck cancer survivors.

    Science.gov (United States)

    Constantinescu, Gabriela; Kuffel, Kristina; King, Ben; Hodgetts, William; Rieger, Jana

    2018-04-01

    The objective of this study was to conduct the first patient usability testing of a mobile health (mHealth) system for in-home swallowing therapy. Five participants with a history of head and neck cancer evaluated the mHealth system. After completing an in-application (app) tutorial with the clinician, participants were asked to independently complete five tasks: pair the device to the smartphone, place the device correctly, exercise, interpret progress displays, and close the system. Quantitative and qualitative methods were used to evaluate the effectiveness, efficiency, and satisfaction with the system. Critical changes to the app were found in three of the tasks, resulting in recommendations for the next iteration. These issues were related to ease of Bluetooth pairing, placement of device, and interpretation of statistics. Usability testing with patients identified issues that were essential to address prior to implementing the mHealth system in subsequent clinical trials. Of the usability methods used, video observation (synced screen capture with videoed gestures) revealed the most information.

  18. The impact of e-WOM on destination image, attitude toward destination and travel intention

    OpenAIRE

    RAMDAN MUHAMAD RIZKY; RAHARDJO KUSDI; ABDILLAH YUSRI

    2017-01-01

    Electronic word of mouth (e-WOM) is a new development of word of mouth by using social media platform to interact in the internet. Current studies only examine the model on its own basis by using theory planned behavior (TPB). Based on this idea, this research is trying to examine the model of e-WOM, Destination Image, Attitude Toward Destination together to reveal which factor that give the greater effects against travel intention both direct effect, indirect effects and total effects. The s...

  19. Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

    Directory of Open Access Journals (Sweden)

    Eleni Ischaki

    2017-09-01

    Full Text Available Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre- and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with “do not intubate” status. In the present review, we differentiate studies that suggest an advantage (benefit from other studies that do not suggest an advantage (no benefit compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.

  20. Automatic analysis of image quality control for Image Guided Radiation Therapy (IGRT) devices in external radiotherapy

    International Nuclear Information System (INIS)

    Torfeh, Tarraf

    2009-01-01

    On-board imagers mounted on a radiotherapy treatment machine are very effective devices that improve the geometric accuracy of radiation delivery. However, a precise and regular quality control program is required in order to achieve this objective. Our purpose consisted of developing software tools dedicated to an automatic image quality control of IGRT devices used in external radiotherapy: 2D-MV mode for measuring patient position during the treatment using high energy images, 2D-kV mode (low energy images) and 3D Cone Beam Computed Tomography (CBCT) MV or kV mode, used for patient positioning before treatment. Automated analysis of the Winston and Lutz test was also proposed. This test is used for the evaluation of the mechanical aspects of treatment machines on which additional constraints are carried out due to the on-board imagers additional weights. Finally, a technique of generating digital phantoms in order to assess the performance of the proposed software tools is described. Software tools dedicated to an automatic quality control of IGRT devices allow reducing by a factor of 100 the time spent by the medical physics team to analyze the results of controls while improving their accuracy by using objective and reproducible analysis and offering traceability through generating automatic monitoring reports and statistical studies. (author) [fr

  1. A case of appropriate inappropriate device therapy: Hyperkalemia-induced ventricular oversensing

    Science.gov (United States)

    Oudit, Gavin Y; Cameron, Doug; Harris, Louise

    2008-01-01

    The present case describes a patient who received inappropriate, but potentially life-saving, therapy from her implantable cardioverter defibrillator (ICD) in the setting of acute hyperkalemia (plasma potassium concentration = 8 mM). Hyperkalemia was associated with the development of a slow sinusoidal ventricular tachycardia, at a rate of 100 beats/min to 125 beats/min (610 ms to 480 ms) in a patient who is pacemaker-dependent. There was associated fractionation of the ICD electrogram and T wave oversensing, leading to ventricular oversensing with resultant detection in the ventricular fibrillation rate zone. This was followed by shock therapy, even though the ventricular tachycardia rate was below the programmed detection rate of the ICD. The subsequent emergency treatment of the hyperkalemia normalized the electrogram, corrected the ventricular oversensing and arrhythmia, and restored rate-adaptive single-chamber ventricular pacing. PMID:18340383

  2. A case of appropriate inappropriate device therapy: Hyperkalemia-induced ventricular oversensing

    OpenAIRE

    Oudit, Gavin Y; Cameron, Doug; Harris, Louise

    2008-01-01

    The present case describes a patient who received inappropriate, but potentially life-saving, therapy from her implantable cardioverter defibrillator (ICD) in the setting of acute hyperkalemia (plasma potassium concentration = 8 mM). Hyperkalemia was associated with the development of a slow sinusoidal ventricular tachycardia, at a rate of 100 beats/min to 125 beats/min (610 ms to 480 ms) in a patient who is pacemaker-dependent. There was associated fractionation of the ICD electrogram and T ...

  3. 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.

  4. Clinical implementation of a low energy x-ray therapy device in the treatment of breast cancer

    International Nuclear Information System (INIS)

    Haworth, A.; University of Western Australia, WA; Joseph, D.; Lanzon, P.; Caswell, N.; Ebert, M.; University of Western Asutralia, WA

    2001-01-01

    Full text: A low energy device producing x-rays of maximum operating potential of 50kV is used to treat primary breast tumours intraoperatively. In pathologically favourable cases, the treatment replaces conventional external beam irradiation. For patients at greater risk of local recurrence, the treatment replaces conventional 'boost' therapy. The dosimetry of the device will be described in a companion paper. QA tests prior to irradiation include: output calibration/verification; isotropy verification and external radiation monitor (the secondary beam termination device) functionality. The internal radiation monitor count (similar to setting monitor units on a linac) for a prescribed dose is calculated from tables of measured depth dose and applicator factors. The spherical applicator which best suits the size of the excised tumour is lightly sutured into position maintaining as much distance between the skin surface as possible to minimise skin erythema. Radiation protection is achieved with the use of portable lead shields and tungsten impregnated silicon drapes. Patients entered into a TROG randomised clinical trial comparing intraoperative with conventional postoperative radiotherapy after conservative breast surgery for women with early stage breast cancer will be studied in collaboration with the CRC/University College London, Cancer Trials Centre (UK) to record the effects of local tumour control, cosmesis, patient satisfaction and health economics. QA tests take approximately 15 minutes to perform and a treatment prescription of 5Gy at 1cm depth with a 5cm applicator would take approximately 30 minutes. A low energy x-ray device may be used intraoperatively in selected cases to replace conventional radiotherapy minimising the inconvenience for patients and reducing waiting lists on treatment machines. Copyright (2001) Australasian College of Physical Scientists and Engineers in Medicine

  5. 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.

  6. Current State and Future Perspectives of Energy Sources for Totally Implantable Cardiac Devices.

    Science.gov (United States)

    Bleszynski, Peter A; Luc, Jessica G Y; Schade, Peter; PhilLips, Steven J; Tchantchaleishvili, Vakhtang

    There is a large population of patients with end-stage congestive heart failure who cannot be treated by means of conventional cardiac surgery, cardiac transplantation, or chronic catecholamine infusions. Implantable cardiac devices, many designated as destination therapy, have revolutionized patient care and outcomes, although infection and complications related to external power sources or routine battery exchange remain a substantial risk. Complications from repeat battery replacement, power failure, and infections ultimately endanger the original objectives of implantable biomedical device therapy - eliminating the intended patient autonomy, affecting patient quality of life and survival. We sought to review the limitations of current cardiac biomedical device energy sources and discuss the current state and trends of future potential energy sources in pursuit of a lifelong fully implantable biomedical device.

  7. Source and destination memory: two sides of the same coin?

    Science.gov (United States)

    Lindner, Isabel; Drouin, Héloïse; Tanguay, Annick F N; Stamenova, Vessela; Davidson, Patrick S R

    2015-01-01

    Whereas source memory involves remembering from whom you have heard something, destination memory involves remembering to whom you have told something. Despite its practical relevance, destination memory has been studied little. Recently, two reports suggested that generally destination memory should be poorer than source memory, and that it should be particularly difficult for older people. We tested these predictions by having young and older participants read sentences to two examiners (destination encoding) and listen to sentences read by two examiners (source encoding), under intentional (Experiment 1) or incidental encoding (Experiments 2 and 3). Only in Experiment 3 (in which cognitive demands during destination encoding were increased) was destination memory significantly poorer than source memory. In none of the experiments were older adults inferior to the young on destination or source memory. Destination- and source-memory scores were significantly correlated. Item memory was consistently superior for sentences that had been read out loud (during destination encoding) versus those that had been heard (during source encoding). Destination memory needs not always be poorer than source memory, appears not to be particularly impaired by normal ageing and may depend on similar processes to those supporting source memory.

  8. 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

  9. 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.

  10. 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.

  11. Destination Motivation, Cultural Orientation, and Adaptation: International Students' Destination-Loyalty Intention

    Science.gov (United States)

    Jamaludin, Nor Lelawati; Sam, David Lackland; Sandal, Gro Mjeldheim

    2018-01-01

    This study aims to understand factors predicting destination-loyalty intention in international education. A sample of 378 long-term (n = 195) and short-term (n = 183) international students participated in the study carried out in 2014 through an on-line survey at the University of Bergen, Norway. Using a series of hierarchical regression…

  12. 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

    2016-03-01

    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.

  13. Biological in situ Dose Painting for Image-Guided Radiation Therapy Using Drug-Loaded Implantable Devices

    International Nuclear Information System (INIS)

    Cormack, Robert A.; Sridhar, Srinivas; Suh, W. Warren; D'Amico, Anthony V.; Makrigiorgos, G. Mike

    2010-01-01

    Purpose: Implantable devices routinely used for increasing spatial accuracy in modern image-guided radiation treatments (IGRT), such as fiducials or brachytherapy spacers, encompass the potential for in situ release of biologically active drugs, providing an opportunity to enhance the therapeutic ratio. We model this new approach for two types of treatment. Methods and Materials: Radiopaque fiducials used in IGRT, or prostate brachytherapy spacers ('eluters'), were assumed to be loaded with radiosensitizer for in situ drug slow release. An analytic function describing the concentration of radiosensitizer versus distance from eluters, depending on diffusion-elimination properties of the drug in tissue, was developed. Tumor coverage by the drug was modeled for tumors typical of lung stereotactic body radiation therapy treatments for various eluter dimensions and drug properties. Six prostate 125 I brachytherapy cases were analyzed by assuming implantation of drug-loaded spacers. Radiosensitizer-induced subvolume boost was simulated from which biologically effective doses for typical radiosensitizers were calculated in one example. Results: Drug distributions from three-dimensional arrangements of drug eluters versus eluter size and drug properties were tabulated. Four radiosensitizer-loaded fiducials provide adequate radiosensitization for ∼4-cm-diameter lung tumors, thus potentially boosting biologically equivalent doses in centrally located stereotactic body treated lesions. Similarly, multiple drug-loaded spacers provide prostate brachytherapy with flexible shaping of 'biologically equivalent doses' to fit requirements difficult to meet by using radiation alone, e.g., boosting a high-risk region juxtaposed to the urethra while respecting normal tissue tolerance of both the urethra and the rectum. Conclusions: Drug loading of implantable devices routinely used in IGRT provides new opportunities for therapy modulation via biological in situ dose painting.

  14. 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

  15. 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.

  16. Cognitive Behavioral Therapy Using a Mobile Application Synchronizable With Wearable Devices for Insomnia Treatment: A Pilot Study.

    Science.gov (United States)

    Kang, Seung-Gul; Kang, Jae Myeong; Cho, Seong-Jin; Ko, Kwang-Pil; Lee, Yu Jin; Lee, Heon-Jeong; Kim, Leen; Winkelman, John W

    2017-04-15

    The use of telemedicine with a mobile application (MA) and a wearable device (WD) for the management of sleep disorders has recently received considerable attention. We designed an MA synchronizable with a WD for insomnia treatment. Our pilot study determined the efficacy of simplified group cognitive behavioral therapy for insomnia (CBT-I) delivered using our MA and assessed participant adherence to and satisfaction with the device. The efficacy of the CBT-I using MA (CBT-I-MA) was assessed by comparing sleep variables (sleep efficiency [SE], Insomnia Severity Index [ISI], and Pittsburgh Sleep Quality Inventory [PSQI] scores) before and after a 4-week treatment protocol in 19 patients with insomnia disorder patients. SE was assessed using a sleep diary, actigraphy, and the PSQI. The intervention significantly improved all three measures of SE ( P treatment was high (94.7%). Total ISI and PSQI scores and sleep latency, as measured by the sleep diary, improved significantly. Participants showed relatively good adherence to our MA, and sleep diary entries were made on 24.3 ± 3.8 of 28 days. Moreover, 94.7% of the participants reported that our MA was effective for treating insomnia. Our pilot study suggested the clinical usefulness of a CBT-I-MA. We expect that our findings will lead to further development and replication studies of CBT-I-MA. © 2017 American Academy of Sleep Medicine

  17. Dosimetric properties of an amorphous silicon electronic portal imaging device for verification of dynamic intensity modulated radiation therapy

    International Nuclear Information System (INIS)

    Greer, Peter B.; Popescu, Carmen C.

    2003-01-01

    Dosimetric properties of an amorphous silicon electronic portal imaging device (EPID) for verification of dynamic intensity modulated radiation therapy (IMRT) delivery were investigated. The EPID was utilized with continuous frame-averaging during the beam delivery. Properties studied included effect of buildup, dose linearity, field size response, sampling of rapid multileaf collimator (MLC) leaf speeds, response to dose-rate fluctuations, memory effect, and reproducibility. The dependence of response on EPID calibration and a dead time in image frame acquisition occurring every 64 frames were measured. EPID measurements were also compared to ion chamber and film for open and wedged static fields and IMRT fields. The EPID was linear with dose and dose rate, and response to MLC leaf speeds up to 2.5 cm s-1 was found to be linear. A field size dependent response of up to 5% relative to d max ion-chamber measurement was found. Reproducibility was within 0.8% (1 standard deviation) for an IMRT delivery recorded at intervals over a period of one month. The dead time in frame acquisition resulted in errors in the EPID that increased with leaf speed and were over 20% for a 1 cm leaf gap moving at 1.0 cm s-1. The EPID measurements were also found to depend on the input beam profile utilized for EPID flood-field calibration. The EPID shows promise as a device for verification of IMRT, the major limitation currently being due to dead-time in frame acquisition

  18. New HOLIDAY Destination Decision Making; a Singapore perspective

    OpenAIRE

    Bhagchandani, Neeraj Vishindas

    2015-01-01

    Singaporeans are known to have high disposable incomes and come from one of the more influential economies in Asia. Singaporeans have a sizeable impact on the world’s tourism industry. Thus, it is not surprising that they are the target of many tourism destination marketing organizations. Influencing this segment bears great international interest. Existing research identifies the many methods new destinations enter the holiday maker’s mind and move along the destination decision making p...

  19. 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.

  20. What marketing strategy for destinations with a negative image?

    OpenAIRE

    Seraphin, Hugues; Gowreesunkar, Vanessa; Hugues Seraphin

    2017-01-01

    Purpose\\ud This concluding article filters out meaningful marketing strategies that aim at re-positioning and re-establishing struggling tourism destinations with negative image. Drawing from a collection of case studies around the world, the article provides evidences from post-colonial, post-conflict and post-disaster destinations to finally anchor the overall conclusion of the theme issue.\\ud \\ud Design\\ud The article summarizes key issues faced by destinations plagued with a negative imag...

  1. 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 destination and if architecture facilitates tourists’ self transformation. Based on narrative structure analysis by deconstruction of travel blog posts, the results suggest that tourists perceive architectural landscape as an important feature that reflects destinations’ identity. Four different interaction...

  2. 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.

  3. 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

  4. Use of mobile device technology to continuously collect patient-reported symptoms during radiation therapy for head and neck cancer: A prospective feasibility study.

    Science.gov (United States)

    Falchook, Aaron D; Tracton, Gregg; Stravers, Lori; Fleming, Mary E; Snavely, Anna C; Noe, Jeanne F; Hayes, David N; Grilley-Olson, Juneko E; Weiss, Jared M; Reeve, Bryce B; Basch, Ethan M; Chera, Bhishamjit S

    2016-01-01

    Accurate assessment of toxicity allows for timely delivery of supportive measures during radiation therapy for head and neck cancer. The current paradigm requires weekly evaluation of patients by a provider. The purpose of this study is to evaluate the feasibility of monitoring patient reported symptoms via mobile devices. We developed a mobile application for patients to report symptoms in 5 domains using validated questions. Patients were asked to report symptoms using a mobile device once daily during treatment or more often as needed. Clinicians reviewed patient-reported symptoms during weekly symptom management visits and patients completed surveys regarding perceptions of the utility of the mobile application. The primary outcome measure was patient compliance with mobile device reporting. Compliance is defined as number of days with a symptom report divided by number of days on study. There were 921 symptom reports collected from 22 patients during treatment. Median reporting compliance was 71% (interquartile range, 45%-80%). Median number of reports submitted per patient was 34 (interquartile range, 21-53). Median number of reports submitted by patients per week was similar throughout radiation therapy and there was significant reporting during nonclinic hours. Patients reported high satisfaction with the use of mobile devices to report symptoms. A substantial percentage of patients used mobile devices to continuously report symptoms throughout a course of radiation therapy for head and neck cancer. Future studies should evaluate the impact of mobile device symptom reporting on improving patient outcomes.

  5. 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......, the narrative reasoning that human beings possess with which they can retrieve information better through a story. Furthermore, it is argued that the increased knowledge of a destination will have a stronger effect on the intention to visit a destination if the audiences can identify themselves with the story...

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

    DEFF Research Database (Denmark)

    Mattsson, Jan; Barnes, Stuart; Sørensen, Flemming

    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, brand destination...... 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...

  7. 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.

  8. eWOM, Revisit Intention, Destination Trust and Gender

    OpenAIRE

    Abubakar, Abubakar Mohammed; Ilkan, Mustafa; Al-Tal, Raad Meshall; Eluwole, Kayode

    2017-01-01

    This article investigates the impact of eWOM on intention to revisit and destination trust, and the moderating role of gender in medical tourism industry. Result from structural equation modeling (n=240) suggests the following: (1) that eWOM influences intention to revisit and destination trust; (2) that destination trust influences intention to revisit; (3) that the impact of eWOM on intention to revisit is about 1.3 times higher in men; (4) that the impact of eWOM on destination trust is ab...

  9. Tour guides developing urban ecotourism destinations

    DEFF Research Database (Denmark)

    Meged, Jane Widtfeldt; Lasa-Gonzalez, Anne Cecilie

    is “controlled by other stakeholder and largely beyond the influence of tour guides” (ibid). In fact Weiler and Black (2015) argue that pathways and extend have never been investigated on how interpretative guiding improves the economic viability and competitiveness of business, and social and cultural benefits...... to local communities and destinations. In this paper, we want to propose a research agenda where guides have a central role in cooperation with public and private key stakeholder in development of a scalable participatory model for sustainable urban ecotourism. Wang & Wang (2013) define urban ecotourism...... as an “activity system to satisfy needs of the locals and visitors for using local natural scenery, culture and folk customs, and also to maintain ecological balance of urban environment and establish environment-friendly concepts” (2013:1). Drawing on Iterative Participatory Design, where “the concept is defined...

  10. Branding the Destination Versus the Place

    DEFF Research Database (Denmark)

    Zenker, Sebastian; Braun, Erik; Petersen, Sibylle

    2017-01-01

    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...... 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......) 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...

  11. Focal Electrically Administered Therapy (FEAT): Device parameter effects on stimulus perception in humans

    Science.gov (United States)

    Borckardt, Jeffrey J.; Linder, Katie; Ricci, Raffaella; Li, Xingbao; Anderson, Berry; Arana, Ashley; Nahas, Ziad; Amassian, Vahe; Long, James; George, Mark S.; Sackeim, Harold A.

    2010-01-01

    Background Focal Electrically-Administered Therapy (FEAT) is a new method of transcranial electrical stimulation capable of focal modulation of cerebral activity. Other than invasive studies in animals and examination of motor output in humans, there are limited possibilities for establishing basic principles about how variation in stimulus parameters impact on patterns of intracortical stimulation. This study used a simpler paradigm, and evaluated the effects of different stimulation parameters on subjective perception of the quality and location of scalp pain. Methods In two studies, 19 subjects were randomly stimulated over the left forehead, varying the anode-cathode arrangement, the intensity of stimulation, the electrode size and placement, and whether the current flow was unidirectional or bidirectional. Subjects rated the location of the sensation, and its quality. Results The perceived center of stimulation moved toward the cathode, regardless of placement. This shift in subjective sensation was more prominent when the electricity was unidirectional. Additionally, more intense stimulation, as well as stimulation with a smaller electrode, caused greater perceived pain. Unidirectional stimulation was rated more painful when traveling from a large anode to a small cathode and less painful when traveling from a small anode to a large cathode. Finally, participants were more likely to perceive the electrical stimulation as moving towards a specific direction when the intensity was high than when it was low. Conclusions The intensity and location of sensations can be manipulated by varying the intensity, current direction, or geometry of electrodes. PMID:19092677

  12. Evaluation of manufactured device for radiation therapy in head and neck cancer

    International Nuclear Information System (INIS)

    Kim, Tae Jun; Jin, Sun Sik; Kim, Dong Wook; Chung, Weon Kuu; Kim, Kyoung Tae

    2014-01-01

    We compared the set-up accuracy and right-left shoulder position variation of the manufactured device and other commercial shoulder-retractors in the head and neck radiation treatment. Six patients consist of three groups which were used three different Shoulder retractors. We measured position corrections of left and right Shoulder and the couch after the image guidance by using on board imager (OBI) for six head and neck patients who has the extended target to the neck node lower region. The position variation correction of left (right) Shoulder after image guidance were 1.07±3.99 mm (-4.35±2.09 mm), -0.37±5.91 mm (1.26±5.28 mm), -0.63±2.44 mm (0.25±1.61 mm) for group A, B and C. The vertical, lateral, longitudinal position and angular corrections of the couch after image guidance were -2.06±2.68, -1.11±8.15, 0.34±3.78 mm, and 0.51 ±0.77 degree for group A, -1.18±1.82, 0.94±2.13, -0.67±1.98 mm, and 0.91±1.04 degree for group B and 0.12±2.18, - 0.79±2.64, 0.79±2.64 mm, and 0.00±0.49 degree for group C. In this preliminary study, we found the positioning accuracy of the manufactured Shoulder retractor is comparable to other commercial Shoulder retractors. We expect that the reproducibility and accuracy of the patient set-up could be improved by using the home made Shoulder retractor in the head and neck radiation treatment

  13. Evaluation of manufactured device for radiation therapy in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Jun; Jin, Sun Sik; Kim, Dong Wook; Chung, Weon Kuu; Kim, Kyoung Tae [Dept. of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of)

    2014-06-15

    We compared the set-up accuracy and right-left shoulder position variation of the manufactured device and other commercial shoulder-retractors in the head and neck radiation treatment. Six patients consist of three groups which were used three different Shoulder retractors. We measured position corrections of left and right Shoulder and the couch after the image guidance by using on board imager (OBI) for six head and neck patients who has the extended target to the neck node lower region. The position variation correction of left (right) Shoulder after image guidance were 1.07±3.99 mm (-4.35±2.09 mm), -0.37±5.91 mm (1.26±5.28 mm), -0.63±2.44 mm (0.25±1.61 mm) for group A, B and C. The vertical, lateral, longitudinal position and angular corrections of the couch after image guidance were -2.06±2.68, -1.11±8.15, 0.34±3.78 mm, and 0.51 ±0.77 degree for group A, -1.18±1.82, 0.94±2.13, -0.67±1.98 mm, and 0.91±1.04 degree for group B and 0.12±2.18, - 0.79±2.64, 0.79±2.64 mm, and 0.00±0.49 degree for group C. In this preliminary study, we found the positioning accuracy of the manufactured Shoulder retractor is comparable to other commercial Shoulder retractors. We expect that the reproducibility and accuracy of the patient set-up could be improved by using the home made Shoulder retractor in the head and neck radiation treatment.

  14. The pharmacotherapy of the HeartMate II, a continuous flow left ventricular assist device, in patients with advanced heart failure: integration of disease, device, and drug.

    Science.gov (United States)

    Jennings, Douglas L; Chambers, Rachel M; Schillig, Jessica M

    2010-10-01

    Advanced heart failure continues to be a significant cause of morbidity and mortality in the US. Patients with advanced heart failure have a poor prognosis without cardiac transplantation. The use of left ventricular assist devices (LVADs) as destination therapy for these patients is therefore expected to increase in the coming years as technology advances. The HeartMate II, a continuous flow implantable device, is currently the only LVAD that has been approved by the Food and Drug Administration for destination therapy in patients with advanced heart failure. The pharmacotherapy associated with this device is very complex and, therefore, the need for expertly trained clinical pharmacists to care for this expanding patient population will also likely increase. Unfortunately, most pharmacists are unfamiliar with the effect of LVADs on the physiology and pharmacotherapy of a patient's heart failure. The purpose of this article is to give clinical pharmacists an introduction to the most common pharmacotherapeutic issues for patients with LVADs and present practical solutions for managing common drug therapy problems.

  15. Destination Brand Equity, Satisfaction And Revisit Intention: An Application In TRNC As a Tourism Destination

    OpenAIRE

    Sarvari, Neda Gholizadeh

    2012-01-01

    ABSTRACT: This study revisits the previous studies carried out by several researchers on Customer – Based Brand Equity with an intension to further investigate the applications and testing of the Customer-Based Brand Equity (CBBE) model in relation to destination branding. The study specifically examines the effects of Brand Equity Dimensions (Brand Awareness, Brand Loyalty, Brand Value, Brand Quality and Brand Image) on Tourists Satisfaction and ultimately on Future Behaviours that result i...

  16. 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.

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

    Science.gov (United States)

    Aghajanyan, Ivan Gerasimovich; Allen, Simon

    2016-04-18

    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. 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 (Q max ), 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. The results of the investigated index tests in men with BPH confirmed a decrease in IPSS ( p 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.

  18. Predicting Individual Trip Destinations With Artificial Potential Fields.

    NARCIS (Netherlands)

    Zonta, A.; Smit, S.K.; Haasdijk, Evert

    2017-01-01

    This paper presents a method to model the intended destination of a subject in real time, based on a trace of position information and prior knowledge of possible destinations. In contrast to most work in this field, it does so without the need for prior analysis of habitual travel patterns. The

  19. A visual analysis of a cultural tourism destination | Eringa | Research ...

    African Journals Online (AJOL)

    ... can help to frame the experience in all three stages. For that reason it is advisable for destinations to employ some kind of visual identity system management to package the city image into a clear brand. Keywords: European Capital of Culture, Leeuwarden 2018, Chinese visitors, destination branding, flanking research ...

  20. 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.

  1. 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

  2. Exploring Familiarity and Destination Choice in International Tourism

    DEFF Research Database (Denmark)

    Lee, G.; Tussyadiah, Iis

    2012-01-01

    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...

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

    International Nuclear Information System (INIS)

    Goliasch, Georg; Khorsand, Aliasghar; Sochor, Heinz; Schmidinger, Herwig; Graf, Senta; Schuetz, Matthias; Karanikas, Georgios; Khazen, Cesar; Wolzt, Michael

    2012-01-01

    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 2 ) in patients with chronic heart failure using 11 C-acetate positron emission tomography (PET). We prospectively enrolled 21 patients with severe heart failure. 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 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 -1 g -1 with the device off and 0.80 ± 0.15 ml min -1 g -1 with the device on (p = 0.818), MVO 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 2 with the device off and 5.21 ± 1.36 mmHg ml/m 2 with the device on (p = 0.344). Under dobutamine stress, the values of MBF, MVO 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 2 , even under stress conditions. (orig.)

  4. 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.)

  5. Comparison of two repositioning devices used during radiation therapy for Hodgkin's disease

    International Nuclear Information System (INIS)

    Bentel, Gunilla C.; Marks, Lawrence B.; Krishnamurthy, Rupa; Prosnitz, Leonard R.

    1997-01-01

    (mostly mantle fields) are considered, position adjustments were requested in 13.4% 921 out of 157) of treatment setups with the upper torso cradle and in 5.9% (8 out of 135) of treatment setups with the extended cradle (p = 0.054). When all port films below the diaphragm (mostly paraaortic/spleen and pelvic fields) are considered, position adjustments were requested in 33.8% (27 out of 80) of treatment setups with the upper torso cradle and in 16.7% (13 out of 78) of treatment setups with the extended cradle (p = 0.056). A reduction in the frequency of both translational and rotational adjustments were seen. When both treatment sites are combined, position adjustments were requested in 20.3% (48 out of 237) of treatment setups with the upper torso cradle and in 9.9% (21 out of 213) of treatment setups when the extended cradle was used (p = 0.0086). Conclusions: The extended cradle provides superior repositioning of patients undergoing radiation therapy for Hodgkin's disease. Differences observed in setup accuracy in this study underscore the importance of aggressive immobilization of patients with Hodgkin's disease. Increased accuracy of daily setup may provide an opportunity to improve the therapeutic ratio both by increased likelihood of tumor control and decreased risk of normal tissue complications

  6. Pilot study of a new device to titrate oxygen flow in hypoxic patients on long-term oxygen therapy.

    Science.gov (United States)

    Cirio, Serena; Nava, Stefano

    2011-04-01

    The O(2) Flow Regulator (Dima, Bologna, Italy) is a new automated oxygen regulator that titrates the oxygen flow based on a pulse-oximetry signal to maintain a target S(pO(2)). We tested the device's safety and efficacy. We enrolled 18 subjects with chronic lung disease, exercise-induced desaturation, and on long-term oxygen therapy, in a randomized crossover study with 2 constant-work-load 15-min cycling exercise tests, starting with the patient's previously prescribed usual oxygen flow. In one test the oxygen flow was titrated manually by the respiratory therapist, and in the other test the oxygen flow was titrated by the O(2) Flow Regulator, to maintain an S(pO(2)) of 94%. We measured S(pO(2)) throughout each test, the time spent by the respiratory therapist to set the device or to manually regulate the oxygen flow, and the total number of respiratory-therapist titration interventions during the trial. There were no differences in symptoms or heart rate between the exercise tests. Compared to the respiratory-therapist-controlled tests, during the O(2) Flow Regulator tests S(pO(2)) was significantly higher (95 ± 2% vs 93 ± 3%, P = .04), significantly less time was spent below the target S(pO(2)) (171 ± 187 s vs 340 ± 220 s, P less respiratory therapist time (5.6 ± 3.7 min vs 2.0 ± 0.1 min, P = .005). The O(2) Flow Regulator may be a safe and effective alternative to manual oxygen titration during exercise in hypoxic patients. It provided stable S(pO(2)) and avoided desaturations in our subjects.

  7. 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.

  8. 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.

  9. Innovations and networking fostering tourist destination development in Slovakia

    Directory of Open Access Journals (Sweden)

    Gajdošík Tomáš

    2017-12-01

    Full Text Available The paper focuses on the implementation of innovations and networking in the sector of tourism in two Slovak mountain destinations of international significance. The main objective of the paper is to identify and evaluate how innovations and networking contribute to tourist destination development in Slovakia. The implementation of institutional innovation resulted in the establishment of formal and informal networks. The developed networks consist of representatives of all sectors co-ordinating all relevant stakeholders. Formal and informal networks and the collaboration among stakeholders have launched other types of innovations in the tourism sector. The interactions and intensity of relations among stakeholders are analysed by network analysis. Destinations are compared with the network of the same size and density through quantitative network characteristics. Based on empirical research we investigate the impact of networks and innovations on tourist destination development. Due to the synergy effect of networking and implementation of multiple innovations, tourist destination development is observed.

  10. THE DESTINATION IMAGE OF BUCOVINA AMONG ROMANIAN TOURISTS

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  12. 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......-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...

  13. 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

  14. Automatic Prostate Tracking and Motion Assessment in Volumetric Modulated Arc Therapy With an Electronic Portal Imaging Device

    International Nuclear Information System (INIS)

    Azcona, Juan Diego; Li, Ruijiang; Mok, Edward; Hancock, Steven; Xing, Lei

    2013-01-01

    Purpose: To assess the prostate intrafraction motion in volumetric modulated arc therapy treatments using cine megavoltage (MV) images acquired with an electronic portal imaging device (EPID). Methods and Materials: Ten prostate cancer patients were treated with volumetric modulated arc therapy using a Varian TrueBeam linear accelerator equipped with an EPID for acquiring cine MV images during treatment. Cine MV images acquisition was scheduled for single or multiple treatment fractions (between 1 and 8). A novel automatic fiducial detection algorithm that can handle irregular multileaf collimator apertures, field edges, fast leaf and gantry movement, and MV image noise and artifacts in patient anatomy was used. All sets of images (approximately 25,000 images in total) were analyzed to measure the positioning accuracy of implanted fiducial markers and assess the prostate movement. Results: Prostate motion can vary greatly in magnitude among different patients. Different motion patterns were identified, showing its unpredictability. The mean displacement and standard deviation of the intrafraction motion was generally less than 2.0 ± 2.0 mm in each of the spatial directions. In certain patients, however, the percentage of the treatment time in which the prostate is displaced more than 5 mm from its planned position in at least 1 spatial direction was 10% or more. The maximum prostate displacement observed was 13.3 mm. Conclusion: Prostate tracking and motion assessment was performed with MV imaging and an EPID. The amount of prostate motion observed suggests that patients will benefit from its real-time monitoring. Megavoltage imaging can provide the basis for real-time prostate tracking using conventional linear accelerators

  15. Impact of Spot Size and Beam-Shaping Devices on the Treatment Plan Quality for Pencil Beam Scanning Proton Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Moteabbed, Maryam, E-mail: mmoteabbed@partners.org; Yock, Torunn I.; Depauw, Nicolas; Madden, Thomas M.; Kooy, Hanne M.; Paganetti, Harald

    2016-05-01

    Purpose: This study aimed to assess the clinical impact of spot size and the addition of apertures and range compensators on the treatment quality of pencil beam scanning (PBS) proton therapy and to define when PBS could improve on passive scattering proton therapy (PSPT). Methods and Materials: The patient cohort included 14 pediatric patients treated with PSPT. Six PBS plans were created and optimized for each patient using 3 spot sizes (∼12-, 5.4-, and 2.5-mm median sigma at isocenter for 90- to 230-MeV range) and adding apertures and compensators to plans with the 2 larger spots. Conformity and homogeneity indices, dose-volume histogram parameters, equivalent uniform dose (EUD), normal tissue complication probability (NTCP), and integral dose were quantified and compared with the respective PSPT plans. Results: The results clearly indicated that PBS with the largest spots does not necessarily offer a dosimetric or clinical advantage over PSPT. With comparable target coverage, the mean dose (D{sub mean}) to healthy organs was on average 6.3% larger than PSPT when using this spot size. However, adding apertures to plans with large spots improved the treatment quality by decreasing the average D{sub mean} and EUD by up to 8.6% and 3.2% of the prescribed dose, respectively. Decreasing the spot size further improved all plans, lowering the average D{sub mean} and EUD by up to 11.6% and 10.9% compared with PSPT, respectively, and eliminated the need for beam-shaping devices. The NTCP decreased with spot size and addition of apertures, with maximum reduction of 5.4% relative to PSPT. Conclusions: The added benefit of using PBS strongly depends on the delivery configurations. Facilities limited to large spot sizes (>∼8 mm median sigma at isocenter) are recommended to use apertures to reduce treatment-related toxicities, at least for complex and/or small tumors.

  16. Mechanical endovascular therapy for acute ischemic stroke: An indirect treatment comparison between Solitaire and Penumbra thrombectomy devices.

    Directory of Open Access Journals (Sweden)

    Jonathan T Caranfa

    Full Text Available Randomized controlled trials (RCTs have compared mechanical endovascular therapy (MET in addition to intravenous tissue plasminogen activator (IVtPA to IVtPA alone for the management of acute ischemic stroke (AIS. Direct comparative studies between individual METs are not available. In lieu of head-to-head randomized control trials, we performed an adjusted indirect treatment comparison (ITC meta-analysis to assess the comparative efficacy and safety of different METs, Solitaire+IVtPA and Penumbra+IVtPA in AIS patients.We searched MEDLINE, the Cochrane Central Register of Controlled Trials and Embase from January 1, 2005 through April 1, 2017 for RCTs in AIS patients, comparing a single MET+IVtPA to IVtPA alone and reporting shift in ordinal modified Rankin Scale (mRS score at 90 days. Secondary endpoints included 90 day mortality and symptomatic intracranial hemorrhage (sICH. Endpoints were pooled using traditional random effects meta-analysis methods, producing odds ratios and 95% confidence intervals. Adjusted ITCs using pooled estimates were then performed. Three studies (SWIFT PRIME, EXTEND-IA, THERAPY were included; two evaluating the Solitaire stent retriever and one the Penumbra system. Traditional meta-analysis demonstrated that each MET+IVtPA resulted in increased odds of improving ordinal mRS score vs. IVtPA alone, but did not alter the odds of death or sICH. Adjusted ITC showed no significant difference between the METs for any outcome.No significant difference in efficacy or safety between the Solitaire and Penumbra devices was observed.

  17. An Inaugural Girl Scout Destinations Astronomy Camp

    Science.gov (United States)

    Lebofsky, Larry A.; McCarthy, Donald W.; Wright, Joe; Wright, Rita; Mace, Mikayla; Floyd, Charmayne

    2017-10-01

    The University of Arizona (UA) conducted its first teenage Girl Scout Destinations Astronomy Camp. This program was preceded by 24 Leadership Workshops for Adult Girl Scout Leaders, initially supported by EPO funding from NIRCam for JWST. For five days in late June, 24 girls (ages 13-17 years) attended from 16 states. The Camp was led by UA astronomers and long-term educators. Representing Girl Scouts of the USA (GSUSA) were a husband/wife amateur astronomer team who are SOFIA Airborne Astronomy and NASA Solar System Ambassadors. Other leaders included a Stanford undergraduate engineering student who is a lifelong Girl Scout and Gold Award recipient and a recent UA Master’s degree science journalist. The Camp is a residential, hands-on “immersion” adventure in scientific exploration using telescopes in southern Arizona’s Catalina Mountains near Tucson. Under uniquely dark skies girls become real astronomers, operating telescopes (small and large) and associated technologies, interacting with scientists, obtaining images and quantitative data, investigating their own questions, and most importantly having fun actually doing science and building observing equipment. Girls achieve a basic understanding of celestial objects, how and why they move, and their historical significance, leading to an authentic understanding of science, research, and engineering. Girls can lead these activities back home in their own troops and councils, encouraging others to consider STEM field careers. These programs are supported by a 5-year NASA Collaborative Agreement, Reaching for the Stars: NASA Science for Girl Scouts (www.seti.org/GirlScoutStars), through the SETI Institute in collaboration with the UA, GSUSA, Girl Scouts of Northern California, the Astronomical Society of the Pacific, and Aries Scientific, Inc. The Girl Scout Destinations Astronomy Camp aligns with the GSUSA Journey: It’s Your Planet-Love It! and introduces the girls to some of the activities being

  18. Novel simple insulin delivery device reduces barriers to insulin therapy in type 2 diabetes: results from a pilot study.

    Science.gov (United States)

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

    2015-05-01

    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. This single-center, open-label, single-arm study comprised three 2-week periods: baseline (MDI), transition from MDI to PaQ, and PaQ treatment. Validated questionnaires were administered during the baseline and PaQ treatment periods: Barriers to Insulin Treatment questionnaire (BIT), Insulin Treatment Appraisal Scale (ITAS), and Problem Areas in Diabetes scale (PAID). Eighteen patients (age 59 ± 5 years, diabetes duration 15 ± 7 years, 21% female, HbA1c 7.7 ± 0.7%) completed the questionnaires. There was a strong, significant effect of PaQ use in mean BIT total scores (difference [D] = -5.4 ± 0.7.7, P = .01, effect size [d] = 0.70). Patients perceived less stigmatization by insulin injection (D = -2.2 ± 6.2, P = .18, d = 0.35), increased positive outcome (D = 1.9 ± 6.6, P = .17, d = 0.29), and less fear of injections (1.3 ± 4.8, P = .55, d = 0.28). Mean change in ITAS scores after PaQ device use showed a nonsignificant improvement of 1.71 ± 5.63 but moderate effect size (d = 0.30, P = .14). No increase in PAID scores was seen. The results and moderate to large effects sizes suggest that PaQ device use has beneficial and clinically relevant effects to overcoming barriers to and negative appraisal of insulin treatment, without increasing other diabetes-related distress. © 2015 Diabetes Technology Society.

  19. Prospective randomized evaluation of the watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy: The PREVAIL trial.

    Science.gov (United States)

    Belgaid, Djouhar Roufeida; Khan, Zara; Zaidi, Mariam; Hobbs, Adrian

    2016-09-15

    Assessing the safety and effectiveness of left atrial appendage (LAA) (pouch found in the upper chambers of the heart) occlusion, using the Watchman device compared to long term warfarin therapy (drug that reduces clot formation), in preventing the risk of stroke in patients with atrial fibrillation (most common type of irregular heart beat). 90% of strokes in atrial fibrillation arise from clots forming in this pouch. By mechanically blocking it using the device less clots are suggested to be formed. This is an alternative to taking warfarin especially in patients who cannot take it. 50 sites in the United States enrolled 407 participants. After being randomly allocated, the device group had 269 participants and warfarin group (comparator)had 138 participants. Patients with atrial fibrillation and at high risk of stroke were randomly allocated a group after they were deemed eligible. Patients in the device group had to take warfarin and aspirin for 45days till the complete closure of the LAA. The oral anticoagulant was followed by dual antiplatelet therapy until 6months and then ASA. Patients in the warfarin group have to take it for life and were continually monitored. The study ran for 26months. The trial assessed the rate of adverse events using three endpoints: The PREVAIL trial was not designed to show superiority, but non-inferiority. It met the safety endpoint and one efficacy endpoint for the watchman device compared to long term warfarin for overall efficacy of the device. The results established that LAA occlusion is not worse than warfarin intake for the prevention of stroke more than 1week after randomization. Compared to previous trials, the safety of the device has also improved. LAA occlusion is a reasonable alternative to chronic warfarin therapy in stroke prevention for patients with atrial fibrillation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Linkages at Tourism Destinations: Challenges in Zanzibar

    Directory of Open Access Journals (Sweden)

    Wineaster Anderson

    2011-06-01

    Full Text Available This study explores challenges facing the linkages between the tourism industry and local suppliers at the destinations. During 2010 surveys involving hotel and restaurant operators, local suppliers and tourists were conducted in Zanzibar. Qualitative analysis of the perspectives of the respondents reveals the multitude of constraints. From operators, the main constraints include poor quality of the locally supplied products, business informalities, high transaction costs and violation of agreements by local suppliers. Low production levels, low prices offered by hotels and restaurants coupled with late payments for the products delivered were the most serious problems cited by local suppliers. There is also a certain degree of mistrust between the local suppliers and the operators. However, the source of the tourism products consumed in the hotels or restaurants was not a point of concern, at least from the tourists’ perspective. Strategies to bridge the demandsupply gaps in order to maximize the benefits of tourism, among the tools for fighting the rampant poverty, have been recommended.

  1. NHLBI's program for VAD therapy for moderately advanced heart failure: the REVIVE-IT pilot trial.

    Science.gov (United States)

    Baldwin, J Timothy; Mann, Douglas L

    2010-11-01

    Ventricular assist devices (VADs) are used to bridge heart failure patients to transplantation, to allow their own hearts to recover, or as permanent ("destination") therapy. To date, the use of VADs has been limited to late-stage heart failure patients because of the associated device risks. In 2008, a National Heart, Lung, and Blood Institute (NHLBI) working group met to evaluate the treatment of heart failure using VADs and to advise the institute on how therapy for heart failure may be best advanced by clinical trials involving the devices. Recognizing the improvements in VAD technology and in patient care and selection over the past decade, the working group recommended that a trial be performed to assess the use of chronic VAD therapy in patients who are less ill than those currently eligible for destination therapy. The hypothesis proposed for the trial is that VAD therapy may improve both survival and quality of life in moderately advanced heart failure patients who are neither inotrope-dependent nor exercise-intolerant and have not yet developed serious consequences such as malnourishment, end-organ damage, and immobility. Based on the group's recommendations, NHLBI issued an RFP in 2009 for the REVIVE-IT Pilot Trail, which will serve to test the hypothesis and inform the pivotal trial. Published by Elsevier Inc.

  2. Cultural Centre, Destination Cultural Offer and Visitor Satisfaction

    Directory of Open Access Journals (Sweden)

    Benxiang Zeng

    2017-10-01

    Full Text Available This paper aims to establish the link between tourists’ perceptions on cultural offers and their overall satisfaction, and explore the implication of this link for sustainable tourist destination management. Assessing online customers’ reviews, this study identifies a positive correlation between visitors’ perspectives and experiences at the on-site cultural centre and visitors’ destination satisfaction. It suggests that the on-site cultural centre plays a critical role in building up visitors’ perception on cultural attributes of the destination, and its impact on visitor satisfaction is a double-edged sword. Visitors’ positive perspectives on the cultural centre enhance visitors’ experiences and contribute to their destination satisfaction; however, not only does a negative perspective on their cultural and spiritual experience compromise visitors’ satisfaction, but also subsequent negative online reviews damage the destination image and discourage visitor return/visit. The findings help destination management organisations to better understand visitors’ preference for cultural centres and therefore to improve visitors’ cultural experience. This paper appeals for further study of on-site cultural centres’ role in forming destination cultural attributes, and of social media’s potential in enriching cultural experience.

  3. 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.

  4. 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

  5. Comparative Analysis of Official Tourist Destination Websites

    Directory of Open Access Journals (Sweden)

    Mariela Tapia León

    2017-07-01

    take relevance as communication strategies to improve the promotion of a tourist destination. Among the functions performed by the municipal decentralized autonomous governments (GAD are regulate, control and promote the development of cantonal tourism. Most municipalities have their website where they display tourism information, but very few have an exclusive website to publish tourism information. In addition, as shown in this paper, the tourist information provided is very low. The method that was used in this research was the content analysis through a systematic, objective and quantitative analysis. The study was carried out through a direct observation of the municipal websites in Ecuador and their counterparts in Colombia and Spain. The results showed that the vast majority of municipal GADs own websites but very few are the websites that are making appropriate use of the services that an exclusive web destined to the tourism could offer.  Ecuador should work harder to improve its tourism promotion on the Web if it really wants to become a tourist power as posed by the Ecuadorian government.

  6. 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.

  7. 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.

  8. Study of behavior, preferences and attitudes visitors tourist destinations Tara

    Directory of Open Access Journals (Sweden)

    Rakić Mirjana

    2010-01-01

    Full Text Available One of the strategic development of the Serbian economy is tourism. Tourist destinations Tara has great tourism potential. The starting assumption for the development of tourism and creating a tourist destination brand of Tara is the analysis of image of tourism, and this is exactly the subject of the current paper. The image analysis includes the examination of preferences, attitudes and behavior of visitors to this tourist destination. This research is exploratory, but may be a useful starting point for further, more comprehensive research on which the results would be based upon serious analysis and making relevant decisions.

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

    DEFF Research Database (Denmark)

    Kristian Steen Jacobsen, Jens; Munar, Ana Maria

    2012-01-01

    word-of-mouth, Web 1.0 sources and own experience are highly resilient and influential when tourists to a well-known destination area decide where to spend their summer holiday. Moreover, results indicate a complementary nature of Web 1.0 and Web 2.0. In this context of destination decision......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 direct...

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

    International Nuclear Information System (INIS)

    Yu, C.

    2015-01-01

    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

  11. 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

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

    International Nuclear Information System (INIS)

    Kim, Woo Chul; Kim, Heon Jong; Park, Seong Young; Cho, Young Kap; Loh, John J. K.; Park, Won; Suh, Chang Ok; Kim, Gwi Eon

    1998-01-01

    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

  13. 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

  14. The idea of destination brand licensing and the question of its effectiveness

    OpenAIRE

    Michal Zemla

    2012-01-01

    Purpose – Destination branding is one of the most popular topics among tourism destinations researchers and practitioners however recent research revealed that it doesn’t have a clear concept. The purpose of presented paper is to enhance the destination branding theory by introducing some new elements taken from other popular concepts used in destination management into destination branding theory. The concept of destination brand licensing was undertaken as a response to several critical arg...

  15. Impact of Spot Size and Beam-Shaping Devices on the Treatment Plan Quality for Pencil Beam Scanning Proton Therapy

    International Nuclear Information System (INIS)

    Moteabbed, Maryam; Yock, Torunn I.; Depauw, Nicolas; Madden, Thomas M.; Kooy, Hanne M.; Paganetti, Harald

    2016-01-01

    Purpose: This study aimed to assess the clinical impact of spot size and the addition of apertures and range compensators on the treatment quality of pencil beam scanning (PBS) proton therapy and to define when PBS could improve on passive scattering proton therapy (PSPT). Methods and Materials: The patient cohort included 14 pediatric patients treated with PSPT. Six PBS plans were created and optimized for each patient using 3 spot sizes (∼12-, 5.4-, and 2.5-mm median sigma at isocenter for 90- to 230-MeV range) and adding apertures and compensators to plans with the 2 larger spots. Conformity and homogeneity indices, dose-volume histogram parameters, equivalent uniform dose (EUD), normal tissue complication probability (NTCP), and integral dose were quantified and compared with the respective PSPT plans. Results: The results clearly indicated that PBS with the largest spots does not necessarily offer a dosimetric or clinical advantage over PSPT. With comparable target coverage, the mean dose (D_m_e_a_n) to healthy organs was on average 6.3% larger than PSPT when using this spot size. However, adding apertures to plans with large spots improved the treatment quality by decreasing the average D_m_e_a_n and EUD by up to 8.6% and 3.2% of the prescribed dose, respectively. Decreasing the spot size further improved all plans, lowering the average D_m_e_a_n and EUD by up to 11.6% and 10.9% compared with PSPT, respectively, and eliminated the need for beam-shaping devices. The NTCP decreased with spot size and addition of apertures, with maximum reduction of 5.4% relative to PSPT. Conclusions: The added benefit of using PBS strongly depends on the delivery configurations. Facilities limited to large spot sizes (>∼8 mm median sigma at isocenter) are recommended to use apertures to reduce treatment-related toxicities, at least for complex and/or small tumors.

  16. The Effect of Preoperative Cognitive Behavior and Exercise Therapy for a Patient With an Implanted Left Ventricular Assist Device in Korea.

    Science.gov (United States)

    Seo, Yong Gon; Park, Won Hah; Jeon, Eun Seok; Sung, Ji Dong; Jang, Mi Ja

    2017-10-01

    Left ventricular assist devices (LVADs) are used in patients with progressive heart failure symptoms to provide circulatory support. Patients with LVADs are referred to inpatient cardiac rehabilitation to prevent postoperative complications and improve aerobic capacity and quality of life. Preoperative exercise therapy for cardiac patients is an emerging treatment modality, and several studies have reported that it improves postoperative outcomes, such as length of hospital stay and postoperative complications. This case report describes the benefits of preoperative cognitive behavioral and exercise therapy in a Korean patient undergoing LVAD implantation. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  17. 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.

  18. Three-Dimensional Electroanatomic Mapping System-Enhanced Cardiac Resynchronization Therapy Device Implantation: Results From a Multicenter Registry.

    Science.gov (United States)

    Del Greco, Maurizio; Maines, Massimiliano; Marini, Massimiliano; Colella, Andrea; Zecchin, Massimo; Vitali-Serdoz, Laura; Blandino, Alessandro; Barbonaglia, Lorella; Allocca, Giuseppe; Mureddu, Roberto; Marenna, Biondino; Rossi, Paolo; Vaccari, Diego; Chianca, Roberto; Indiani, Stefano; DI Matteo, Irene; Angheben, Carlo; Zorzi, Alessandro

    2017-01-01

    Cardiac resynchronization therapy (CRT) device implantation guided by an electroanatomic mapping system (EAMS) is an emerging technique that may reduce fluoroscopy and angiography use and provide information on coronary sinus (CS) electrical activation. We evaluated the outcome of the EAMS-guided CRT implantation technique in a multicenter registry. During the period 2011-2014 we enrolled 125 patients (80% males, age 74 [71-77] years) who underwent CRT implantation by using the EnSite system to create geometric models of the patient's cardiac chambers, build activation mapping of the CS, and guide leads positioning. Two hundred and fifty patients undergoing traditional CRT implantation served as controls. Success and complication rates, fluoroscopy and total procedure times in the overall study population and according to center experience were collected. Centers that performed ≥10 were defined as highly experienced. Left ventricular lead implantation was successful in 122 (98%) cases and 242 (97%) controls (P = 0.76). Median fluoroscopy time was 4.1 (0.3-10.4) minutes in cases versus 16 (11-26) minutes in controls (P < 0.001). Coronary sinus angiography was performed in 33 (26%) cases and 208 (83%) controls (P < 0.001). Complications occurred in 5 (4%) cases and 17 (7%) controls (P = 0.28). Median fluoroscopy time (median 11 minutes vs. 3 minutes, P < 0.001) and CS angiography rate (55% vs. 21%, P < 0.001) were significantly higher in low experienced centers, while success rate and complications rate were similar. EAMS-guided CRT implantation proved safe and effective in both high- and low-experienced centers and allowed to reduce fluoroscopy use by ≈75% and angiography rate by ≈70%. © 2016 Wiley Periodicals, Inc.

  19. Identifying factors affecting destination choice of medical tourists: a ...

    African Journals Online (AJOL)

    medical tourism”, has emerged as a new source of competitive advantage all over the world. The present study seeks to identify the factors that affect destination choice of medical tourists. Methods: We systematically searched relevant databases ...

  20. 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.

  1. 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

  2. Management of sustainable tourism destination through stakeholder cooperation

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    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

  3. Consuming post-disaster destinations: The case of Sichuan, China

    OpenAIRE

    Biran, Avital; Liu, W.; Li, G.; Eichhorn, V.

    2014-01-01

    Addressing the call for a better understanding of tourist behavior in relation to post-disaster destinations, this study explores the motivations and intentions of potential domestic tourists (from non-hit areas) to visit Sichuan, China in the aftermath of an earthquake. Drawing on dark tourism theories, this study offers a more comprehensive insight into the consumption of post-disaster destinations, aiming to capture the impact of the changes to the destination’s attributes on tourist behav...

  4. Development Strategies for Tourism Destinations: Tourism Sophistication vs. Resource Investments

    OpenAIRE

    Rainer Andergassen; Guido Candela

    2010-01-01

    This paper investigates the effectiveness of development strategies for tourism destinations. We argue that resource investments unambiguously increase tourism revenues and that increasing the degree of tourism sophistication, that is increasing the variety of tourism related goods and services, increases tourism activity and decreases the perceived quality of the destination's resource endowment, leading to an ambiguous effect on tourism revenues. We disentangle these two effects and charact...

  5. Destination Attributes and Chinese Outbound Tourism to Europe

    OpenAIRE

    Andreu, Rosario; Claver-Cortés, Enrique; Quer, Diego

    2014-01-01

    China is one of the fastest growing outbound tourism markets. Europe is an attractive destination for Chinese tourists. However, Europe still accounts for a small percentage of Chinese outbound tourism. If European countries want to benefit from this market, they should pay attention to Chinese tourists’ preferences. This article contributes to the understanding of Chinese outbound tourism by analyzing those destination attributes that can influence the number of Chinese tourists received. Fr...

  6. 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...

  7. The power of social media storytelling in destination branding.

    OpenAIRE

    Lund, Niels Frederik; Cohen, S.A.; Scarles, C.

    2017-01-01

    A large part of the global population is now connected in online social networks in social media where they share experiences and stories and consequently influence each other’s perceptions and buying behaviour. This poses a distinct challenge for destination management organisations, who must cope with a new reality where destination brands are increasingly the product of people’s shared tourism experiences and storytelling in social networks, rather than marketing strategies. This article s...

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

    OpenAIRE

    KASHIF, MUHAMMAD; SAMSI, SITI ZAKIAH MELATU; SARIFUDDIN, SYAMSULANG

    2015-01-01

    ABSTRACTStudies 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 deve...

  9. Tourism Tax: Public Spending and Taxation in Tourism Destinations

    OpenAIRE

    Candela Guido; Castellani Massimiliano; Mussoni Maurizio

    2013-01-01

    In this paper we investigate the effects of a Keynesian policy in tourists destinations where tourism products are mainly sold through «direct sales» (decentralized solution) and the tourism market equilibrium is characterized by sticky prices and unemployment (coordination failure). A Keynesian demand policy is a Pareto improving solution with respect to the organization of sales by Tour operators or Destination managers (centralized solution), since tourism firms are not worse-off in terms ...

  10. Entrepreneurship development in destinations of religious tourism

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    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. Evaluating Tourist Destination Performance: Expanding the Sustainability Concept

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    Wenbin Luo

    2018-02-01

    Full Text Available Performance evaluations are a critical tool in promoting the sustainability of tourist destinations. The literature shows a lack of consensus on basic terminology and definitions of destination performance. While research focuses on business efficiency, areas such as development effectiveness, social equality, and environmental integrity are still not well understood, even though these are salient elements of sustainable development. This paper provides a framework for evaluating destination performance under the 4E rubric of economy, efficiency, effectiveness, and environmental quality, which reflects a more holistic and effective destination performance. The information entropy weight method and a multi-factor comprehensive evaluation model are developed and applied to an international destination, Zhangjiajie, China, which was selected as a case study to test the framework developed. Results show that the economy, efficiency, effectiveness, and environmental quality aspects should be considered when evaluating tourism development performance. The empirical analysis shows that based on these criteria, Zhangjiajie’s destination performance improved measurably during the test period from 2005 to 2009. The results indicate that significant events, natural disasters, and financial crises influence performance most.

  12. 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.

  13. Rural Tourism – Evaluating the Quality of Destination

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    Ryglová Kateřina

    2017-12-01

    Full Text Available This paper concerns the topic of rural destination quality from the viewpoint of tourism development. The research exploring crucial quality factors from the viewpoint of demand is presented. Rural tourism participants attribute the highest significance to Destination cleanliness and Sense of security. The evaluation of the importance of most research quality factors is not dependent on gender and on the contrary, the importance of 16 quality factors depends on the visitor´s age. In the case of the factor of “Friendly acceptance by the locals”, the most significant influence on the visitor´s return to the destination was confirmed. On the contrary, this impact was not proven for the factor of “Level of prices of services and goods in the destination”. The research and the successive factor analysis revealed 6 dimensions representing the rural destination quality: Services, Image, Transportation, Well-being, Information/Communication and Attractions/ Experiences; Well-being was identified as the most important. This was consecutively confirmed by the analysis of the quality factors’ impact on the visitor´s overall satisfaction and loyalty to the destination. The research findings provide the theory with topical destination quality dimensions as well as contribute to better understanding of visitor´s behavioural mechanisms in rural areas.

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

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    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

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

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    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

  16. Dosimetric verification of radiation therapy including intensity modulated treatments, using an amorphous-silicon electronic portal imaging device

    Science.gov (United States)

    Chytyk-Praznik, Krista Joy

    Radiation therapy is continuously increasing in complexity due to technological innovation in delivery techniques, necessitating thorough dosimetric verification. Comparing accurately predicted portal dose images to measured images obtained during patient treatment can determine if a particular treatment was delivered correctly. The goal of this thesis was to create a method to predict portal dose images that was versatile and accurate enough to use in a clinical setting. All measured images in this work were obtained with an amorphous silicon electronic portal imaging device (a-Si EPID), but the technique is applicable to any planar imager. A detailed, physics-motivated fluence model was developed to characterize fluence exiting the linear accelerator head. The model was further refined using results from Monte Carlo simulations and schematics of the linear accelerator. The fluence incident on the EPID was converted to a portal dose image through a superposition of Monte Carlo-generated, monoenergetic dose kernels specific to the a-Si EPID. Predictions of clinical IMRT fields with no patient present agreed with measured portal dose images within 3% and 3 mm. The dose kernels were applied ignoring the geometrically divergent nature of incident fluence on the EPID. A computational investigation into this parallel dose kernel assumption determined its validity under clinically relevant situations. Introducing a patient or phantom into the beam required the portal image prediction algorithm to account for patient scatter and attenuation. Primary fluence was calculated by attenuating raylines cast through the patient CT dataset, while scatter fluence was determined through the superposition of pre-calculated scatter fluence kernels. Total dose in the EPID was calculated by convolving the total predicted incident fluence with the EPID-specific dose kernels. The algorithm was tested on water slabs with square fields, agreeing with measurement within 3% and 3 mm. The

  17. Dynamics of device innovation: implications for assessing value.

    Science.gov (United States)

    Gelijns, Annetine C; Russo, Mark J; Hong, Kimberly N; Brown, Lawrence D; Ascheim, Deborah D; Moskowitz, Alan J

    2013-10-01

    In recent years, there has been growing interest in evaluating the health and economic impact of medical devices. Payers increasingly rely on cost-effectiveness analyses in making their coverage decisions, and are adopting value-based purchasing initiatives. These analytic approaches, however, have been shaped heavily by their use in the pharmaceutical realm, and are ill-adapted to the medical device context. This study focuses on the development and evaluation of left ventricular assist devices (LVADs) to highlight the unique challenges involved in the design and conduct of device trials compared with pharmaceuticals. Devices are moving targets characterized by a much higher degree of post-introduction innovation and "learning by using" than pharmaceuticals. The cost effectiveness ratio of left ventricular assist devices for destination therapy, for example, decreased from around $600,000 per life year saved based on results from the pivotal trial to around $100,000 within a relatively short time period. These dynamics pose fundamental challenges to the evaluation enterprise as well as the policy-making world, which this paper addresses.

  18. The Branding of Kharkov City as a Tourist Destination

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    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

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

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    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.

  20. Interactive visual exploration and analysis of origin-destination data

    Science.gov (United States)

    Ding, Linfang; Meng, Liqiu; Yang, Jian; Krisp, Jukka M.

    2018-05-01

    In this paper, we propose a visual analytics approach for the exploration of spatiotemporal interaction patterns of massive origin-destination data. Firstly, we visually query the movement database for data at certain time windows. Secondly, we conduct interactive clustering to allow the users to select input variables/features (e.g., origins, destinations, distance, and duration) and to adjust clustering parameters (e.g. distance threshold). The agglomerative hierarchical clustering method is applied for the multivariate clustering of the origin-destination data. Thirdly, we design a parallel coordinates plot for visualizing the precomputed clusters and for further exploration of interesting clusters. Finally, we propose a gradient line rendering technique to show the spatial and directional distribution of origin-destination clusters on a map view. We implement the visual analytics approach in a web-based interactive environment and apply it to real-world floating car data from Shanghai. The experiment results show the origin/destination hotspots and their spatial interaction patterns. They also demonstrate the effectiveness of our proposed approach.

  1. Re-motivation in tourist destinations, redistribution and power

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    Carmen Díaz Domínguez

    2016-09-01

    Full Text Available Tourist destinations are constantly required to renew their products, services and projected image. This is possible, among other processes, through business innovation and co-management between tour operators and administrations in order to reach markets. This paper focusses on case studies of two specialised agrotourism businesses located in Fuerteventura (Canary Islands, and shows how innovation in products is limited when tour operators also come to control the supply of small and medium-sized companies, at least in destinations where mass tourism predominate. Here remotivation is presented as a means of providing the tourist with local supply in the destination in a way that allows it to stand out, aid the creation of local businesses and products, enrich the tourist experience and redistribute the profits of tourism across the area.

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

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    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.

  3. Sochi Market Analysis as a Health Tourism Destination

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    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.

  4. Diversity, Flexibility And Identity Mechanisms For Recycling Mature Tourist Destinations

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    Biel Horrach Estarellas

    2012-12-01

    Full Text Available Globalizing dynamic sources are making of tourist destinations, spaces each time more homogeneous, unable to respond to the tourist’s new motivation and to the specific characteristics of the territory and the local landscape. Tourist space has gone through changes, resulting in conurbations without urban structure that require new planning patterns. Despite predictions, which determine a declining process or a post-stagnation, there is a high potential of reconversion of obsolete tourist destinations based on its typological characteristics and its interaction with the territory. The new challenges faced by tourist activity: diversity of tourist resources, travel flexibility and the differentiation of the destination from the rest by enhancing its identity, are methodologically tackled by testing regional tourist dynamics experimented in one of the most paradigmatic cases of tourist coastline development, Majorca Island.

  5. 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 effective destination marketing by the hospitality industry (hotels) and provides insights on the critical drivers and challenges embedded within YouTube-based community interactions for destination marketing. The comments made by YouTube users have been subjected to a content analysis and the results...... 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....

  6. Modelling the Image Research of a Tourism Destination

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    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.

  7. Carotid Doppler ultrasound findings in patients with left ventricular assist devices.

    Science.gov (United States)

    Cervini, Patrick; Park, Soon J; Shah, Dipesh K; Penev, Irina E; Lewis, Bradley D

    2010-12-01

    Left ventricular assist devices (LVADs) have been used to treat advanced heart failure refractory to medical management, as bridge therapy to myocardial recovery, as bridge therapy to cardiac transplantation, or as destination therapy for patients with unfavorable transplant candidacy. Neurologic complications are some of the most common and devastating complications in these patients. Preoperative carotid ultrasound is, therefore, a standard evaluation in patients at risk for cerebrovascular disease. Postoperative carotid artery Doppler sonography is performed in those patients with neurologic symptoms. It is likely, therefore, that sonographers, radiologists, and other physicians working in a center where LVADs are implanted will likely encounter a carotid artery Doppler study in this patient group. To our knowledge, the carotid Doppler findings in these patients have never been published. We review the Doppler ultrasound findings in 6 patients after LVAD insertion.

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

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    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.

  9. Assessing the Level of Popularity of European Stag Tourism Destinations

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    Iwanicki Grzegorz

    2016-09-01

    Full Text Available The primary objective of this article is to determine the degree of popularity of stag tourism destinations in Europe. Research was based on the search engine method, involving an analysis of the highest positioned offers of travel agencies in the most commonly used search engines in Europe (Google, Bing, Yahoo. The analysis divided the studied cities into four categories in terms of popularity. Conducting the said analysis is strongly justified, because academic publications have so far not provided studies which have determined the degree of popularity of stag destinations on a continental scale.

  10. Efficacy in Deep Vein Thrombosis Prevention With Extended Mechanical Compression Device Therapy and Prophylactic Aspirin Following Total Knee Arthroplasty: A Randomized Control Trial.

    Science.gov (United States)

    Snyder, Mark A; Sympson, Alexandra N; Scheuerman, Christina M; Gregg, Justin L; Hussain, Lala R

    2017-05-01

    Aspirin at 325 mg twice daily is now included as a nationally approved venous thromboembolism (VTE) prophylaxis protocol for low-risk total knee arthroplasty (TKA) patients. The purpose of this study is to examine whether there is a difference in deep vein thrombosis (DVT) occurrence after a limited tourniquet TKA using aspirin-based prophylaxis with or without extended use of mechanical compression device (MCD) therapy. One hundred limited tourniquet TKA patients, whose DVT risk was managed with aspirin 325 mg twice daily for 3 weeks, were randomized to either using an MCD during hospitalization only or extended use at home up to 6 weeks postoperatively. Lower extremity duplex venous ultrasonography (LEDVU) was completed on the second postoperative day, 14 days postoperatively, and at 3 months postoperatively to confirm the absence of DVT after treatment. The DVT rate for the postdischarge MCD therapy group was 0% and 23.1% for the inpatient MCD group (P aspirin for 3 weeks postoperatively, and on MCD therapy for up to 6 weeks postoperatively experienced superior DVT prophylaxis than patients receiving MCD therapy only as an inpatient (P aspirin and extended-use MCD further validates this type of prophylaxis in low DVT risk TKA patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Amenity migration: the migratory phenomenon in mountain tourism destinations

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    Lía Domínguez de Nakayama

    2007-12-01

    Full Text Available Since long time ago population dynamics in Argentina has been linked to migration. Nevertheless, scientists have concluded that no research has found migration to be due to positive attractors. Almost every research presents migration as the unavoidable outcome of constraining environmental conditions. Recently a new type of migration has come to be, linked with tourism, which has received the denomination of amenity migration, and has as its subjects people who, after being tourist in a certain destination, decide to come back to it as dwellers. They can stay either for the season or the whole year. This movement produces important effects in the collective profile of tourism destinations. This article intends to study demographic and social processes quickened in mountain tourism destinations by this peculiar kind of migration, with a case study in two Argentinean cities San Martín de los Andes (Neuquén y Villa General Belgrano (Córdoba. Documental research and in-depth interviews with migrants as well as natives enables an preliminary understanding of the way this kind of migration affects socio cultural configuration in destination places as well as relationship amongst residents and newcomers and sustainability policies for local development.

  12. Language, Colonial Attitude and War in Emecheta's Destination Biafra

    African Journals Online (AJOL)

    This study aims at examining the relevance of Sociolinguistic Functional Stylistics (SFS) in supplying a methodical structure upon which Emecheta's Destination Biafra can be appreciated. Much of the critical attention on Emecheta has been centred on issues of gender and sexuality to the extent that ideological implications ...

  13. 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.

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

    African Journals Online (AJOL)

    Prof

    Although there are two categories of tourism destination - recreation/attractions and hospitality, this study ... The first Property Management Systems (Fidelio and Hogatex) appear in the tourism market. ..... In most cases, foreigners are hired to manage and offer consultancy ..... Marketing concepts and strategies in tourism.

  16. Medical Tourist's Perception in Selecting their Destination: A Global Perspective.

    Science.gov (United States)

    Sarwar, Abdullah Am; Manaf, Noorhazilah A; Omar, Azura

    2012-01-01

    The need for better healthcare has grown significantly in recent years. In addition, the rising healthcare costs in the U.S. and in many European countries have forced many patients to seek medical treatment abroad, which has created the demand for medical tourism. With little yet known as to the perception of a medical tourist's destination selection, this study aims to explore medical tourist's perception in selecting their destination while going for medical treatment. Realizing the current need to examine closely the perception of medical tourists, this study had conducted a secondary study to collect data for assessing and identification of the key factors on patient's perception and destination selection criteria. The result confirms the existence of a very strong relationship between cost, service quality, treatment types and availability and marketing impact on the perception of the medical tourists' in selecting their medical tourism destination. This study offers support for the proposed conceptual model and an empirical basis for comparison in future research.

  17. Destination discount : A sensible road for national brands?

    NARCIS (Netherlands)

    Deleersnyder, B.; Koll, O.

    2012-01-01

    Purpose – This paper aims to study the consequences of listing national brands in discounters. Is the discount channel a promising outlet for manufacturer brands? Is it an effective means to attract new buyers? Which combination of brand and discount destination at which price is best suited for

  18. 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.

  19. 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.

  20. 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.

  1. marketing destination information in a tourism driven economy

    African Journals Online (AJOL)

    PROF. BARTH EKWEME

    This paper studies the destination information marketing as an aid to the Cross River Tourism bid. A questionnaire was designed to elicit responses from the stakeholders in the tourism industry. Out of 69 ... State were tourist guide books, internet and the Tourism Bureau. ... beauty are appreciated by all normal human.

  2. Inter-Destination Media Synchronization, now standardized by ETSI TISPAN

    NARCIS (Netherlands)

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

    2010-01-01

    nter-Destination Media Synchronization (IDMS) is een reeks van technologieën voor de synchronisatie van mediacontent op meerdere televisies. Sociale televisie is een belangrijke toepassing van IDMS. Sociale televisie stelt vrienden in staat om een televisieprogramma samen te bekijken vanaf

  3. Moldovan Perception of Greece as a Tourism Destination

    Directory of Open Access Journals (Sweden)

    Stela Cazacu

    2017-06-01

    Full Text Available Purpose: This research study analyzes Moldovans' intentions to visit Greece, and their perceptions of Greece's image as a tourism destination, according to the following dimensions: (1 environmental beauty and convenience, (2 country's citizens, (3 place and architectural structure, (4 shopping and tourist accommodation and (5 similarity of the local culture and cuisine with the Moldovan one. The goal is split into four objectives. Design/methodology/approach: For attaining the goal, a self-administered questionnaire was delivered. The empirical study was conducted in the capital of Moldova. The findings are based upon a sample of 139 respondents. Findings: The findings reveal that, overall, Greece's image as a tourist destination among Moldovan consumers is partially positive. The perceptions of the tourism dimensions were evaluated in the descending order as follows: place and architectural structure, shopping and tourist accommodation, environmental beauty and convenience, country's citizens and similarity of the local culture and cuisine with the Moldovan one. Research limitations/implications: As it was undertaken only in the capital of Republic of Moldova and because most respondents are young people and females, the findings of this investigation do not absolutely reflect the perceptions of all Moldovans. Also, because the number of respondents is small, it is not representative of the whole Moldovan population. Hence, the results might not be very realistic and accurate. Originality/value: This study provides insightful theoretical implications and practical recommendations in creating marketing strategies that would help in managing and improving Greece's image as a destination among Moldovan tourists. Also, no study, at least to the researcher's knowledge, has evaluated Greece's image as a destination among Moldovan consumers. Finally, due to the increasing number of Moldovan tourists in Greece, it is important that Greece grasps this

  4. 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

  5. The evolution of destination branding: A review of branding literature in tourism

    Directory of Open Access Journals (Sweden)

    Marta Almeyda-Ibáñez

    2017-03-01

    Full Text Available Tourism is a promise and destinations communicate the credibility of that promise by means of destination brands. Branding has become a key tool for tourism destinations to make explicit the complexity of experiences to be expected by tourists visiting a destination. This paper provides a comprehensive literature review of various issues associated with tourism destination branding. It brings together a wide range of debates in the generic marketing literature, places them alongside the nuances of tourism, and thereby identifies unique challenges of branding in tourism destination contexts. Finally, a case study of USP based national tourism branding campaigns in the Caribbean is presented.

  6. Monitoring System of Sustainable Development in Cultural and Mountain Tourism Destinations

    Directory of Open Access Journals (Sweden)

    Jurigova Zuzana

    2015-03-01

    Full Text Available Tourism destinations are vulnerable to negative impacts of tourism development and thus require a sustainable approach. It is significant mainly in destinations with fragile environments such as cultural destinations with their historical value and mountain destinations with specific natural conditions. The aim of this paper is to propose the monitoring system for sustainable development of cultural and mountain destinations based on the critical scientific literature review. The added value of this work resides in defining specific indicators (creating monitoring system for measurement of sustainability in cultural routes and mountain destinations.

  7. Esophageal stent fixation with endoscopic suturing device improves clinical outcomes and reduces complications in patients with locally advanced esophageal cancer prior to neoadjuvant therapy: a large multicenter experience.

    Science.gov (United States)

    Yang, Juliana; Siddiqui, Ali A; Kowalski, Thomas E; Loren, David E; Khalid, Ammara; Soomro, Ayesha; Mazhar, Syed M; Rosé, Julian; Isby, Laura; Kahaleh, Michel; Kalra, Ankush; Sarkisian, Alex M; Kumta, Nikhil A; Nieto, Jose; Sharaiha, Reem Z

    2017-03-01

    Endoscopic placement of fully covered self-expanding metal stents (FCSEMS) to treat malignant dysphagia in patients with esophageal cancer significantly improves dysphagia; however, these stents have a high migration rate. To determine whether FCSEMS fixation using an endoscopic suturing device treated malignant dysphagia and prevented stent migration in patients with locally advanced esophageal cancer receiving neoadjuvant therapy when compared to patients with FCSEMS placement alone. A review of patients with locally advanced esophageal cancer who underwent FCSEMS placement at 3 centers was performed. Patients were divided into two groups: Group A (n = 26) was composed of patients who underwent FCSEMS placement with suture placement, and Group B (n = 67) was composed of patients with FCSEMS placement alone. There were no significant differences between Groups A and B in demographics, and tumor characteristics. The technical success rate for stent placement was 100 %. There was no difference between Groups A and B in the median stent diameter and stent lengths. Mean dysphagia score obtained at 1 week after stent placement had improved significantly from baseline (2.4 and 1, respectively, p esophageal FCSEMSs by using an endoscopic suturing device in patients receiving neoadjuvant therapy was shown to be feasible, safe, and relatively effective at preventing stent migration compared to those who had stent placed alone.

  8. Statistical Study on Respiratory Stability Through RPM Signal Analysis according to Patient Position Under Radiation Therapy and Device

    International Nuclear Information System (INIS)

    Park, Myung Hwan; Seo, Jeong Min; Choi, Byeong Gi; Shin, Eun Hyeok; Song, Gi Won

    2011-01-01

    This study statistically analyzed the difference of the stability of maintaining a respiratory period shown according to position and use of a device to search the tendency and usefulness of a device. The study obtained respiratory signals which maintained a respiratory period for 20 minutes each supine and prone position for 11 subjects. The study obtained respiratory signals in a state of using a belly board for 7 patients in a bad condition of a respiratory period in a prone position to analyze a change in respiration and the stability before and after the use of a device. The supine part showed 54.5%, better than the prone part of 36.4% in a case that the stability for maintaining a respiratory period was in a good condition as a fixed respiratory period was well maintained according to the position. 6 patients (85%) showed a maintenance pattern of a respiratory period significantly different before the use and 4 patients showed a significantly good change in the stability for maintaining a respiratory period as a result that belly boards were used for 7 patients that the maintenance of a respiratory period was not in a good condition on a prone position. It seemed that this study could contribute to the maintenance of respiratory period and of respiratory stability as the optimal position for maintenance of respiration and the use of a device such as a belly board were decided through statistic analysis of respiratory signals and its application even if patient position and use of device were decided by the beam arrangement a treatment part of a patient, location of a target, and an expected plan.

  9. 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.

  10. [Assessment of rehabilitation progress in patients with cervical radicular pain syndrome after application of high intensity laser therapy - HILT and Saunders traction device].

    Science.gov (United States)

    Haładaj, Robert; Pingot, Julia; Pingot, Mariusz

    2015-07-01

    Osteoarthritis of the spine is a major global health problem, it is an epidemic of our times. It affects all parts of the spine, but the hardest to treat is its cervical region. The cervical spine is most mobile, delicate and sensitive to any load. It requires special care in conservative treatment. To date the selection of effective therapeutic approaches has been controversial. The aim of the study was to assess the progress of rehabilitation in patients with cervical radicular pain syndrome after using two different methods of treatment: HILT and spinal axial traction with the use of Saunders device. The randomized study included 150 patients (81 women and 69 men, aged 24-67 years, mean age 45.5) divided into two groups of 75 patients each with characteristic symptoms of radicular pain. The measurement of the range of cervical spine movement of the cervical spine, visual analog scale for pain - VAS and a NDI questionnaire (Neck Disability Index - Polish version) - an indicator of functional disorders - were used to evaluate the effectiveness of the two different therapies. The results obtained by Saunders method remained significantly higher than those obtained when HILT laser therapy was used for most of the examined parameters. A thorough analysis of the results showed greater analgesic efficacy, improved global mobility and reduced functional impairment in patients treated with Saunders method. Both therapeutic methods manifest analgesic effect and a positive impact on the improvement of range of cervical spine movement in patients with radicular pain in this spine region. HILT laser therapy and Saunders traction device reduce neck disability index in the treated patients. © 2015 MEDPRESS.

  11. Negative pressure wound therapy using a portable single-use device for free skin grafts on the distal extremity in seven dogs.

    Science.gov (United States)

    Miller, A J; Cashmore, R G; Marchevsky, A M; Havlicek, M; Brown, P M; Fearnside, S M

    2016-09-01

    Retrospective study to describe clinical experience with a portable single-use negative pressure wound therapy device after application of full-thickness meshed skin grafts to wounds on the distal extremities of seven dogs. Seven dogs were treated with portable NPWT after receiving skin grafts; six as the result of tumour resection and one for traumatic injury. Medical records were reviewed and data recorded on patient signalment, cause and location of wound, surgical technique, application and maintenance of portable NPWT, graft survival and outcome, and complications encountered with the system. NPWT was provided for between 4 and 7 days. Five patients were discharged from hospital during the treatment period. Application and maintenance of the portable device was technically easy and no major complications were encountered. Minor complications consisted of fluid accumulation in the evacuation tubing. All dogs achieved 100% graft survival. Application and maintenance of the portable device was technically straightforward. All dogs receiving portable NPWT after transfer of a free skin graft to the distal extremity had a successful outcome. © 2016 Australian Veterinary Association.

  12. 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.

  13. Tourist destination image and consumer behaviour: The case of the Azores

    Directory of Open Access Journals (Sweden)

    Helena Maria Pascoal Melo

    2017-06-01

    Full Text Available Destinations are currently seeking to become more distinctive in an increasingly competitive market in which image is a decisive element in tourists’ destination selection. This study sought to understand the Azores’ overall image as a tourist destination in major source markets and to ascertain these markets’ level of satisfaction and behavioural intentions concerning the archipelago. The literature review in this paper addresses the definition of tourist destination image and the issue of satisfaction, since these influence intention to return and/or intention to recommend tourist destinations. The results indicate that (1 overall image influences satisfaction and intention to recommend and/or return to tourist destinations and (2 satisfaction influences intention to recommend and/or return to tourist destinations. This study also verified that most tourists are very satisfied with the Azores, as well as having a quite positive overall image of this destination.

  14. 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

  15. 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.

  16. Critical success factors of a business tourism destination: Supply side analysis

    OpenAIRE

    Milandrie Marais; Engelina du Plessis; Melville Saayman

    2017-01-01

    Orientation: Globally, destinations offer various products and services to visitors featuring different attributes and characteristics, making each destination unique. The critical success factors (CSFs) of each of these destinations may differ, making the management process more complex. Research purpose: The purpose of this research was to identify the CSFs for business tourism destinations in South Africa from a supply viewpoint. Motivation for the study: Because of the importance of...

  17. Competitiveness Benchmarking of Tourist Destinations in the Czech Republic and Slovenia

    OpenAIRE

    Ricková, Karla

    2011-01-01

    This diploma thesis deals with the benchmarking method and its practical use in continuous process of destinations' competitiveness enhancement. It describes the importance of tourism for destination's development and increasing need of its management, in order to become more competitive. Revealing the key factors of success that are created by destinations' competitive advantages enables destinations to keep or even to strengthen their position on the international tourism market. The main g...

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

    Directory of Open Access Journals (Sweden)

    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

  19. COMPETITIVENESS THROUGH SUSTAINABILITY AND FINANCIAL EFFICIENCY OF SPA TOURIST DESTINATIONS

    Directory of Open Access Journals (Sweden)

    Anis Cecilia

    2010-12-01

    Full Text Available In the specific literature, success may be achieved by two important attributes: competitiveness and sustainability. Competitive advantage represents an essential criterion for surviving on the tourist market and defines the ability of one destination to use these resources effectively and in the long term. The paper work continue a study begun last year by the same authors about tourist perception of attractiveness of the two tourist SPA destinations (Buziaş and Băile Felix on a different market segment (18-35 years old people. This time, we undertake an analysis on SC Turism Felix SA in order to determine and underline the tourist competitiveness through sustainability and financial efficiency (tourism performance indicators evolution, market share, turnover, investment volume, financial returns and costs.

  20. ROMANIA AS TOURISM DESTINATION – AN EXTERNAL PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Carmen Emilia CHASOVSCHI

    2008-06-01

    Full Text Available Only few steps have already been pointed towards bringing Romania at its proper place on the European tourism market. And big challenges are still there, outside, waiting to be settled. Tourism is indeed a very nice sector, but, if we all consider ourselves tourists, it doesn’t, necessary, mean that we all know tourism is done. The present paper offers an outside perspective of Romanian tourism; a perspective based on a research done among the German tour operators and reveals some strengths and weaknesses of Romania, as a tourism destination. These points are delivering an original view, through the eyes of foreign tour operators or tourists that visited the country or the destinations within.

  1. 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...... and military. The problem is that high visibility of police and military in public spaces may give the tourist the impression of an unsafe and insecure destination. Instead, social trust through self-enforcements of social norms for behaviour may be important because the informal institutions guarantee...... the safety of tourists (and locals) without signalling a problem with safety. Building social trust may further enhance the feeling of safety and thereby attract even more tourists. Thus, our trust-safety theory may guide the active use of social trust by tourist officials and policy makers....

  2. Research of consumer motives and attitudes about tourist destinations

    Directory of Open Access Journals (Sweden)

    Stanković Ljiljana

    2012-01-01

    Full Text Available The research on consumer behavior and the consumption system is one of the crucial tasks for destination marketing. The information on consumers' needs, priorities in satisfying them, motives, their solvency and the degree of realized satisfaction represent the basis for the development of marketing strategies and value creation. It is of special importance to identify and clarify the factors that determine consumers' preferences in the process of different options evaluation and the choice of a tourist destination. Consumer behavior and the consumption system are determined by the influence of a large number of factors: geographical, economic, demographic, social, psychological, etc. Only through simultaneous interaction of these factors, the complex processes of translating stimuli in the minds of consumers into their certain reactions in the process of purchasing and using the products could be understood.

  3. Titan: a distant but enticing destination for human visitors.

    Science.gov (United States)

    Nott, Julian

    2009-10-01

    Until recently, very little was known about Saturn's largest satellite, Titan. But that has changed dramatically since the Cassini spacecraft started orbiting in the Saturn system in 2004. Larger than Mercury and with a dense atmosphere, Titan has many of the characteristics of a planet. Indeed, many scientists now see it as the most interesting place in the Solar System for robotic exploration, with many unique features and even the possibility of exotic forms of life. This paper points out that Titan is also a potential destination for humans. With its predominantly nitrogen atmosphere, moderate gravity, and available water and oxygen, it also appears that, once it becomes possible to travel there, it will prove to be much more hospitable for human visitors than any other destination in the Solar System.

  4. 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)

  5. 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...

  6. Marketing a destination: Case of CreateTrips and Mexico

    OpenAIRE

    Tiainen, Johanna; Korvenpää, Emmi

    2015-01-01

    This thesis concentrates on Finnish people travelling to Mexico. Firstly, the writers conduct a quantitative research, a questionnaire, that studies Finnish people’s thoughts and presumptions about Mexico. Secondly, they create mobile travel guides of four different destinations. The questionnaire concentrates on the people’s point of view, asking what people think about Mexico, on what kind of trip would they go it they travel there, how long it would last and so on. The questionnaire also h...

  7. WHY CHINESE TOURISTS CHOOSE FINLAND AS TRAVEL DESTINATION

    OpenAIRE

    Zheng, Qiaoyin

    2016-01-01

    The purpose of this thesis is to find out the reasons why Chinese tourists choose Finland as travel destination. In this study, the author gives general view of Chinese outbound tourism and comes up with some reasonable recommendations for attracting more Chinese tourists to travel to Finland. Also the aim is to help readers to make improvements for increasing the competitiveness of Finland in the Chinese tourism market. The theoretical framework consist of the theory based on consumer b...

  8. Moldovan Perception of Greece as a Tourism Destination

    OpenAIRE

    Stela Cazacu

    2017-01-01

    Purpose: This research study analyzes Moldovans' intentions to visit Greece, and their perceptions of Greece's image as a tourism destination, according to the following dimensions: (1) environmental beauty and convenience, (2) country's citizens, (3) place and architectural structure, (4) shopping and tourist accommodation and (5) similarity of the local culture and cuisine with the Moldovan one. The goal is split into four objectives. Design/methodology/approach: For attaining the goal,...

  9. Split, Croatia - Educational, Adventurous and Sustainable Tourism Destination

    OpenAIRE

    Chabik, Szymon; Imran, Md. Azim

    2015-01-01

    The purpose of this Bachelor’s thesis is to create an audio-visual documentation about an educational trip to Split, Croatia. The trip took place in April, 2014. The educational tour was organized by Laurea University of Applied Sciences. The destination, Split, were chosen by participants’ vote. The tour was arranged and planned by a group of students and the theme of the tour was Educational Tourism. The entire trip was taken into consideration from sustainable, Adventure and educational po...

  10. Gastronomy, Tourism and Destination Differentiation: A Case Study in Spain

    OpenAIRE

    Tom¨¢s L¨®pez-Guzm¨¢n; Sandra S¨¢nchez-Ca?izares

    2012-01-01

    Gastronomy is becoming a key factor in the competitiveness of tourist destinations. The aim of this paper is to present an analysis of food tourism in the city of Cordoba (Spain) and its relation with the motivation. Similarly, the paper shows the connection between local cuisine and the satisfaction of tourists. The main results of this study reflect the high level of education of this kind of travelers, the importance of gastronomy for visiting this city and the satisfaction with both the l...

  11. Intelligent transportation systems in improving traffic flow in tourism destinations

    OpenAIRE

    Mrnjavac, Edna; Marsanic, Robert

    2007-01-01

    The rapid growth and development of motorisation combined with relatively small investments made to improving transportation infrastructure in cities, as well as in tourism destinations, has led to serious problems in the unobstructed movement of vehicles in public traffic areas. Traffic congestion on roadways, in ferryboat ports and at state borders during the summer months and year-round lines of cars going to or returning from work are a regular presence in traffic in most urban and touris...

  12. Case Studies Approach in Tourism Destination Branding Research

    OpenAIRE

    Adeyinka-Ojo S.F.; Nair V.; Khoo-Lattimore C.

    2014-01-01

    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 bran...

  13. Marketing Cameroon as a Cultural Tourism Destination to Finnish Tourists

    OpenAIRE

    Akuri, Lucien; Landa Celestin, Ndingi

    2013-01-01

    Cultural tourism is already a global phenomenon and has been increasingly promoted in the forms such as heritage, arts, creative, rural and urban cultural tourism, amongst others, and their sub-sections. The marketing of these cultural tourism forms and their attractions by various tourism destinations to target markets is still complex and thus, a major challenge. The study investigates the ways in which Cameroon with very rich and diverse cultural products and attractions can be markete...

  14. THE SUSTAINABILITY OF SURFING TOURISM AT REMOTE DESTINATIONS

    OpenAIRE

    Hugues Dit Ciles, Emily Kate

    2009-01-01

    Surfing is an increasing component of the adventure tourism sector. Growth in surfing as a lifestyle, sporting activity and industry has generated a surge of exploration and intrusion by surfing tourism into remote and vulnerable destinations worldwide in the "search" for uncrowded waves at uncharted locations. Consequendy, there have been concerns at the impacts of surfing tourism on coastal, island and marine areas, often characterised by fragile environments and host communi...

  15. 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...

  16. 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’...

  17. Macedonian tourist destinations with a built identity and image

    OpenAIRE

    Dimitrov, Nikola; Angelkova, Tanja

    2013-01-01

    In the last few years Republic of Macedonia is significantly investing in the tourism development. Main arguments for this are diverse natural and cultural heritage which testify for the increased visits of foreign and domestic tourists. Today, on the international tourist market Republic of Macedonia is becoming attractive tourist destination, with a built international tourist identity and image and in the area of lake, mountain, spa, rural, event, religious, and gastronomy tourism. Our ass...

  18. The Sustainable Management of a Tourism Destination in Ireland: A Focus on County Clare

    OpenAIRE

    CONAGHAN, Aíne; HANRAHAN, James; McLOUGHLIN, Emmet

    2015-01-01

    Tourism destination management has significant importance in controlling many impacts of tourism, thus insuring its sustainability. Destination management requires the integration of different planning tools, approaches and concepts that help shape the management and daily operation of tourism related activities. This study examines the sustainable management of a tourism destination, focusing on County Clare, Ireland. Qualitative interviews were conducted with tourism stake...

  19. 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

  20. "Forget to whom you have told this proverb'': Directed forgetting of destination memory in Alzheimer's disease

    NARCIS (Netherlands)

    El Haj, M.; Gandolphe, M.C.; Allain, P.; Fasotti, L.; Antoine, P.

    2015-01-01

    Destination memory is the ability to remember the receiver of transmitted information. By means of a destination memory directed forgetting task, we investigated whether participants with Alzheimer's Disease (AD) were able to suppress irrelevant information in destination memory. Twenty-six AD

  1. 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.

  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. 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.

  4. Tourism Destination Benchmarking: Evaluation and Selection of the Benchmarking Partners

    Directory of Open Access Journals (Sweden)

    Luštický Martin

    2012-03-01

    Full Text Available Tourism development has an irreplaceable role in regional policy of almost all countries. This is due to its undeniable benefits for the local population with regards to the economic, social and environmental sphere. Tourist destinations compete for visitors at tourism market and subsequently get into a relatively sharp competitive struggle. The main goal of regional governments and destination management institutions is to succeed in this struggle by increasing the competitiveness of their destination. The quality of strategic planning and final strategies is a key factor of competitiveness. Even though the tourism sector is not the typical field where the benchmarking methods are widely used, such approaches could be successfully applied. The paper focuses on key phases of the benchmarking process which lies in the search for suitable referencing partners. The partners are consequently selected to meet general requirements to ensure the quality if strategies. Following from this, some specific characteristics are developed according to the SMART approach. The paper tests this procedure with an expert evaluation of eight selected regional tourism strategies of regions in the Czech Republic, Slovakia and Great Britain. In this way it validates the selected criteria in the frame of the international environment. Hence, it makes it possible to find strengths and weaknesses of selected strategies and at the same time facilitates the discovery of suitable benchmarking partners.

  5. Partners and innovation in American destination marketing organizations

    DEFF Research Database (Denmark)

    Zach, Florian

    2012-01-01

    Innovation and interorganizational collaboration have been identified as important elements of competitive tourism strategies. This study proposes a model that relates aspects of organizational settings and collaboration to the success of innovation within the organization. In particular, this st......Innovation and interorganizational collaboration have been identified as important elements of competitive tourism strategies. This study proposes a model that relates aspects of organizational settings and collaboration to the success of innovation within the organization. In particular......, 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......-orientated innovation. Specifically, innovation success was found to be driven solely by the development of market-oriented rather than strategyoriented new services, indicating that many of the American DMOs respond to visitor changes at the expense of providing new services that somehow do not fit within current...

  6. 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)

  7. 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.

  8. A Common Probe Design for Multiple Planetary Destinations

    Science.gov (United States)

    Hwang, H. H.; Allen, G. A., Jr.; Alunni, A. I.; Amato, M. J.; Atkinson, D. H.; Bienstock, B. J.; Cruz, J. R.; Dillman, R. A.; Cianciolo, A. D.; Elliott, J. O.; hide

    2018-01-01

    Atmospheric probes have been successfully flown to planets and moons in the solar system to conduct in situ measurements. They include the Pioneer Venus multi-probes, the Galileo Jupiter probe, and Huygens probe. Probe mission concepts to five destinations, including Venus, Jupiter, Saturn, Uranus, and Neptune, have all utilized similar-shaped aeroshells and concept of operations, namely a 45-degree sphere cone shape with high density heatshield material and parachute system for extracting the descent vehicle from the aeroshell. Each concept designed its probe to meet specific mission requirements and to optimize mass, volume, and cost. At the 2017 International Planetary Probe Workshop (IPPW), NASA Headquarters postulated that a common aeroshell design could be used successfully for multiple destinations and missions. This "common probe"� design could even be assembled with multiple copies, properly stored, and made available for future NASA missions, potentially realizing savings in cost and schedule and reducing the risk of losing technologies and skills difficult to sustain over decades. Thus the NASA Planetary Science Division funded a study to investigate whether a common probe design could meet most, if not all, mission needs to the five planetary destinations with extreme entry environments. The Common Probe study involved four NASA Centers and addressed these issues, including constraints and inefficiencies that occur in specifying a common design. Study methodology: First, a notional payload of instruments for each destination was defined based on priority measurements from the Planetary Science Decadal Survey. Steep and shallow entry flight path angles (EFPA) were defined for each planet based on qualification and operational g-load limits for current, state-of-the-art instruments. Interplanetary trajectories were then identified for a bounding range of EFPA. Next, 3-degrees-of-freedom simulations for entry trajectories were run using the entry state

  9. Discontinuation of antithrombotic therapy for a year or more in patients with continuous-flow left ventricular assist devices.

    Science.gov (United States)

    Pereira, Naveen L; Chen, Dong; Kushwaha, Sudhir S; Park, Soon J

    2010-10-01

    The recommended anticoagulation regimen during continuous-flow axial left ventricular assist device (LVAD) support is aspirin and warfarin with a targeted international normalized ratio of 2.0-3.0. We report two patients in whom recurrent gastrointestinal bleeding during LVAD support necessitated discontinuation of this anti-thrombotic regimen for a year or more. Despite this, neither patients developed thrombotic complications during 29 patient-months of follow-up. An acquired von Willebrand factor (VWF) abnormality reflected by the absence or decreased abundance of the highest molecular weight multimers was demonstrated in both patients. The gold standard test for platelet function, light transmission platelet aggregometry was measured in one patient and was normal, indicative that the predominant abnormality in the coagulation profile of these patients is an acquired VWF syndrome. Clinical trials are required to address the question whether it is safe to discontinue anticoagulation in LVAD patients with acquired VWF abnormalities.

  10. 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.

  11. Human beta-cell precursors mature into functional insulin-producing cells in an immunoisolation device: implications for diabetes cell therapies.

    Science.gov (United States)

    Lee, Seung-Hee; Hao, Ergeng; Savinov, Alexei Y; Geron, Ifat; Strongin, Alex Y; Itkin-Ansari, Pamela

    2009-04-15

    Islet transplantation is limited by the need for chronic immunosuppression and the paucity of donor tissue. As new sources of human beta-cells are developed (e.g., stem cell-derived tissue), transplanting them in a durable device could obviate the need for immunosuppression, while also protecting the patient from any risk of tumorigenicity. Here, we studied (1) the survival and function of encapsulated human beta-cells and their progenitors and (2) the engraftment of encapsulated murine beta-cells in allo- and autoimmune settings. Human islets and human fetal pancreatic islet-like cell clusters were encapsulated in polytetrafluorethylene devices (TheraCyte) and transplanted into immunodeficient mice. Graft survival and function was measured by immunohistochemistry, circulating human C-peptide levels, and blood glucose levels. Bioluminescent imaging was used to monitor encapsulated neonatal murine islets. Encapsulated human islet-like cell clusters survived, replicated, and acquired a level of glucose responsive insulin secretion sufficient to ameliorate hyperglycemia in diabetic mice. Bioluminescent imaging of encapsulated murine neonatal islets revealed a dynamic process of cell death followed by regrowth, resulting in robust long-term allograft survival. Further, in the non-obese diabetic (NOD) mouse model of type I diabetes, encapsulated primary beta-cells ameliorated diabetes without stimulating a detectable T-cell response. We demonstrate for the first time that human beta-cells function is compatible with encapsulation in a durable, immunoprotective device. Moreover, our study suggests that encapsulation of beta-cells before terminal differentiation will be a successful approach for new cell-based therapies for diabetes, such as those derived from stem cells.

  12. Human β-cell Precursors Mature Into Functional Insulin-producing Cells in an Immunoisolation Device: Implications for Diabetes Cell Therapies

    Science.gov (United States)

    Lee, Seung-Hee; Hao, Ergeng; Savinov, Alexei Y.; Geron, Ifat; Strongin, Alex Y.; Itkin-Ansari, Pamela

    2009-01-01

    Background Islet transplantation is limited by the need for chronic immunosuppression and the paucity of donor tissue. As new sources of human β-cells are developed (e.g., stem cell-derived tissue), transplanting them in a durable device could obviate the need for immunosuppression, while also protecting the patient from any risk of tumorigenicity. Here, we studied (1) the survival and function of encapsulated human β-cells and their progenitors and (2) the engraftment of encapsulated murine β-cells in allo- and autoimmune settings. Methods Human islets and human fetal pancreatic islet-like cell clusters were encapsulated in polytetrafluorethylene devices (TheraCyte) and transplanted into immunodeficient mice. Graft survival and function was measured by immunohistochemistry, circulating human C-peptide levels, and blood glucose levels. Bioluminescent imaging was used to monitor encapsulated neonatal murine islets. Results Encapsulated human islet-like cell clusters survived, replicated, and acquired a level of glucose responsive insulin secretion sufficient to ameliorate hyperglycemia in diabetic mice. Bioluminescent imaging of encapsulated murine neonatal islets revealed a dynamic process of cell death followed by regrowth, resulting in robust long-term allograft survival. Further, in the non-obese diabetic (NOD) mouse model of type I diabetes, encapsulated primary β-cells ameliorated diabetes without stimulating a detectable T-cell response. Conclusions We demonstrate for the first time that human β-cells function is compatible with encapsulation in a durable, immunoprotective device. Moreover, our study suggests that encapsulation of β-cells before terminal differentiation will be a successful approach for new cell-based therapies for diabetes, such as those derived from stem cells. PMID:19352116

  13. Destination memory in Alzheimer's Disease: when I imagine telling Ronald Reagan about Paris.

    Science.gov (United States)

    El Haj, Mohamad; Postal, Virginie; Allain, Philippe

    2013-01-01

    Destination memory refers to remembering the destination of information that people output. This present paper establishes a new distinction between external and internal processes within this memory system for both normal aging and Alzheimer's Disease (AD). Young adults, older adults, and mild AD patients were asked either to tell facts (i.e., external destination memory condition) or to imagine telling facts (i.e., internal destination memory condition) to pictures of famous people. The experiment established three major findings. First, the destination memory performance of the AD patients was significantly poorer than that of older adults, which in turn was poorer than that of the young adults. Furthermore, internal destination processes were more prone to being forgotten than external destination memory processes. In other words, participants had more difficulty in remembering whether they had previously imagined telling the facts to the pictures or not (i.e., imagined condition) than in remembering whether they had previously told the facts to the pictures or not (i.e., enacted condition). Second, significant correlations were detected between performances on destination memory and several executive measures such as the Stroop, the Plus-Minus and the Binding tasks. Third, among the executive measures, regression analyses showed that performance on the Stroop task was a main factor in explaining variance in destination memory performance. Our findings reflect the difficulty in remembering the destination of internally generated information. They also demonstrate the involvement of inhibitory processes in destination memory. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. A safe procedure for connecting a continuous renal replacement therapy device into an extracorporeal membrane oxygenation circuit.

    Science.gov (United States)

    Suga, Natsumi; Matsumura, Yosuke; Abe, Ryuzo; Hattori, Noriyuki; Nakada, Taka-Aki; Oda, Shigeto

    2017-06-01

    Patients receiving extracorporeal membrane oxygenation (ECMO) often require continuous renal replacement therapy (CRRT). The intra-circuit pressure of adult ECMO usually deviates from the physiological range. We investigated the use of CRRT connected to an ECMO circuit with physiological intra-circuit pressures (0-150 mmHg, defined as the "safety range") using an in vitro experiment involving a water-filled ECMO circuit. The intra-circuit pressure pre-pump, post-pump, and post-oxygenator were measured while varying the height of the pump or ECMO flow. The bypass conduit pressure and distance from the post-oxygenator port were measured to find the "safety point", where the bypass pressure remained within the safety range. Both drainage and return limbs of the CRRT machine were connected to the safety point and the inlet and outlet pressures of the hemofilter were recorded while varying the ECMO and CRRT flow. The pre-pump pressure only remained within the safety range for heights >75 cm (ECMO flow = 4 L/min) or ECMO flow machine safely under physiological pressures in adult patients receiving ECMO.

  17. A new low-cost negative-pressure wound therapy versus a commercially available therapy device widely used to treat complex traumatic injuries: a prospective, randomized, non-inferiority trial

    Directory of Open Access Journals (Sweden)

    Fabio Kamamoto

    Full Text Available OBJECTIVES: Negative-pressure wound therapy has been widely adopted to reduce the complexity of treating a broad range of acute and chronic wounds. However, its cost is high. The objective of this study was to evaluate the following two different methods of negative-pressure wound therapy in terms of healing time: a low-cost method of negative-pressure wound therapy (a pressure stabilizer device connected to a hospital wall-vacuum system with a gauze-sealed dressing, USP and the standard of care (vacuum-assisted closure, VAC. METHODS: This is a randomized, controlled, non-inferiority, unblinded trial. Patients admitted with complex injuries to a trauma center in a public referral hospital who were indicated for orthopedic surgery were randomized to a USP or VAC group. The primary outcome was the time required to achieve a “ready for surgery condition”, which was defined as a wound bed with healthy granulation tissue and without necrosis or purulent secretion. Wound bed area contraction, granulation tissue growth and the direct costs of the dressings were secondary outcomes. RESULTS: Variation in area and granulation tissue growth were essentially the same between the systems, and healing time was equal between the groups (p=0.379. In both systems, serial debridement increased wound area (p=0.934, and granulation tissue was also increased (p=0.408. The mean treatment cost was US$ 15.15 in the USP group and US$ 872.59 in the VAC group. CONCLUSIONS: For treating complex traumatic injuries, USP was non-inferior to and less expensive than VAC.

  18. A new low-cost negative-pressure wound therapy versus a commercially available therapy device widely used to treat complex traumatic injuries: a prospective, randomized, non-inferiority trial.

    Science.gov (United States)

    Kamamoto, Fabio; Lima, Ana Lucia Munhoz; Rezende, Marcelo Rosa de; Mattar-Junior, Rames; Leonhardt, Marcos de Camargo; Kojima, Kodi Edson; Santos, Carla Chineze Dos

    2017-12-01

    Negative-pressure wound therapy has been widely adopted to reduce the complexity of treating a broad range of acute and chronic wounds. However, its cost is high. The objective of this study was to evaluate the following two different methods of negative-pressure wound therapy in terms of healing time: a low-cost method of negative-pressure wound therapy (a pressure stabilizer device connected to a hospital wall-vacuum system with a gauze-sealed dressing, USP) and the standard of care (vacuum-assisted closure, VAC). This is a randomized, controlled, non-inferiority, unblinded trial. Patients admitted with complex injuries to a trauma center in a public referral hospital who were indicated for orthopedic surgery were randomized to a USP or VAC group. The primary outcome was the time required to achieve a "ready for surgery condition", which was defined as a wound bed with healthy granulation tissue and without necrosis or purulent secretion. Wound bed area contraction, granulation tissue growth and the direct costs of the dressings were secondary outcomes. Variation in area and granulation tissue growth were essentially the same between the systems, and healing time was equal between the groups (p=0.379). In both systems, serial debridement increased wound area (p=0.934), and granulation tissue was also increased (p=0.408). The mean treatment cost was US$ 15.15 in the USP group and US$ 872.59 in the VAC group. For treating complex traumatic injuries, USP was non-inferior to and less expensive than VAC.

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

    Directory of Open Access Journals (Sweden)

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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

  2. MAURITIUS: A SUNNY HOLIDAY DESTINATION FOR FINNISH PEOPLE

    OpenAIRE

    Goburdhun Bhurtun, Ishina

    2016-01-01

    The tourism market of Mauritius is booming as tourists are nowadays coming from many countries, thus improving the economy of the island. However, few Finnish tourists travel to Mauritius as it is still not well-known among Finns. The aim of this study is to find out how Mauritius can be promoted as a holiday destination in Finland. This study was conducted via an analysis of the tourism business environment and interviews. The analytical tools used were a SWOT analysis and Porter’s five ...

  3. 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

  4. The Impact of Climate on Holiday Destination Choice

    Energy Technology Data Exchange (ETDEWEB)

    Bigano, A. [Fondazione Eni Enrico Mattei, Milan (Italy); Hamilton, J.M. [Research unit Sustainability and Global Change, Hamburg University and Centre for Marine and Atmospheric Science, Hamburg (Germany); Tol, R.S.J. [Institute for Environmental Studies, Vrije Universiteit, Amsterdam (Netherlands)

    2006-06-15

    The holiday destination choice is analysed for tourists from 45 countries, representing all continents and all climates. Tourists are deterred by distance, political instability and poverty, and attracted to coasts. Tourists prefer countries with a sunny yet mild climate, shun climates that are too hot or too cold. A country's tourists' aversion for poverty and distance can be predicted by that country's average per capita income. The preferred holiday climate is the same for all tourists, independent of the home climate. However, tourists from hotter climates have more pronounced preferences.

  5. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Identity of the state as a tourist destination

    Directory of Open Access Journals (Sweden)

    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. Predicting discharge destination after stroke: A systematic review.

    Science.gov (United States)

    Mees, Margot; Klein, Jelle; Yperzeele, Laetitia; Vanacker, Peter; Cras, Patrick

    2016-03-01

    Different factors have been studied and proven to significantly influence discharge destination of acute stroke patients after hospitalization. Few reviews have been published combining the results of these studies. Therefore we aim to present an overview of the studies conducted regarding these predicting factors. Through conducting a systematic review we aimed to study the different predictive factors influencing discharge destination of acute stroke patients after hospitalization. Nineteen articles were selected in accordance with the research question and inclusion criteria. The factors found were, according to their significance in the articles, subcategorized in age, gender, functional status, cognitive status, race and ethnicity, co morbidities, education, stroke characteristics, social and living situation. The main factors significantly associated with other than home discharge were functional dependence/comorbidities, neurocognitive dysfunction and previous living circumstances/marital status. A medium or large infarct is associated with institutionalization. The stroke volume is not associated with home discharge. The effect of other factors remain controversial and results differ between studies. These include: age, gender, race, affected hemisphere and availability of a caregiver not living at home. Factors such as education, hospital complications, geographic location and FIM progression during hospitalization have not been studied sufficiently. Copyright © 2016 Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Case Studies Approach in Tourism Destination Branding Research

    Directory of Open Access Journals (Sweden)

    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.

  11. 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.

  12. Sci-Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques - 04: Assessment of intra-fraction motion during lung SABR VMAT using a custom abdominal compression device

    Energy Technology Data Exchange (ETDEWEB)

    Hyde, Derek; Robinson, Mark; Araujo, Cynthia; Teke, Tony; Halperin, Ross; Petrik, David; Mou, Benjamin; Mohamed, Islam [BCCA - Centre for the Southern Interior (Canada)

    2016-08-15

    Purpose: Lung SABR patients are treated using Volumetrically Modulated Arc Therapy (VMAT), utilizing 2 arcs with Conebeam CT (CBCT) image-guidance prior to each arc. Intra-fraction imaging can prolong treatment time (up to 20%), and the aim of this study is to determine if it is necessary. Methods: We utilize an in-house abdominal compression device to minimize respiratory motion, 4DCT to define the ITV, a 5 mm PTV margin and a 2–3 mm PRV margin. We treated 23 patients with VMAT, fifteen were treated to 48 Gy in 4 fractions, while eight were treated with up to 60 Gy in 8 fractions. Intrafraction motion was assessed by the translational errors recorded for the second CBCT. Results: There was no significant difference (t-test, p=0.93) in the intra-fraction motion between the patients treated with 4 and 8 fractions, or between the absolute translations in each direction (ANOVA, p=0.17). All 124 intra-fraction CBCT images were analysed and 95% remained localized within the 5 mm PTV margin The mean magnitude of the vector displacement was 1.8 mm. Conclusions: For patients localized with an abdominal compression device, the intrafraction CBCT image may not be necessary, if it is only the tumor coverage that is of concern, as the patients are typically well within the 5 mm PTV margin. On the other hand, if there is a structure with a smaller PRV margin, an intrafraction CBCT is recommended to ensure that the dose limit for the organ at risk is not exceeded.

  13. 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.

  14. [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.

  15. 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.

  16. 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.

  17. WE-DE-207A-01: Parallels in the Evolution of X-Ray Angiographic Systems and Devices Used for Minimally Invasive Endovascular Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Strother, C. [University of Wisconsin (United States)

    2016-06-15

    1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures. Along with development of catheters, embolic materials, pushable coils and the GDC coils there was simultaneous development and improvement of 2D DSA image quality and the introduction of 3D DSA. Together, these advances resulted in an enormous expansion in the scope and numbers of minimally invasive endovascular procedures. The introduction of flat detectors for c-arm angiographic systems in 2002 provided the possibility of the angiographic suite becoming not just a location for vascular imaging where physiological assessments might also be performed. Over the last decade algorithmic and hardware advances have been sufficient to now realize this potential in clinical practice. The selection of patients for endovascular treatments is enhanced by this dual capability. Along with these advances has been a steady reduction in the radiation exposure required so that today, vascular and soft tissue images may be obtained with equal or in many cases less radiation exposure than is the case for comparable images obtained with multi-detector CT. Learning Objectives: To understand the full capabilities of today’s angiographic suite To understand how c-arm cone beam CT soft tissue imaging can be used for assessments of devices, blood flow and perfusion. Advances in real-time x-ray neuro-endovascular image guidance Stephen Rudin - Reacting to the demands on real-time image guidance for ever finer neurovascular interventions, great improvements in imaging chains are being

  18. WE-DE-207A-01: Parallels in the Evolution of X-Ray Angiographic Systems and Devices Used for Minimally Invasive Endovascular Therapy

    International Nuclear Information System (INIS)

    Strother, C.

    2016-01-01

    1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures. Along with development of catheters, embolic materials, pushable coils and the GDC coils there was simultaneous development and improvement of 2D DSA image quality and the introduction of 3D DSA. Together, these advances resulted in an enormous expansion in the scope and numbers of minimally invasive endovascular procedures. The introduction of flat detectors for c-arm angiographic systems in 2002 provided the possibility of the angiographic suite becoming not just a location for vascular imaging where physiological assessments might also be performed. Over the last decade algorithmic and hardware advances have been sufficient to now realize this potential in clinical practice. The selection of patients for endovascular treatments is enhanced by this dual capability. Along with these advances has been a steady reduction in the radiation exposure required so that today, vascular and soft tissue images may be obtained with equal or in many cases less radiation exposure than is the case for comparable images obtained with multi-detector CT. Learning Objectives: To understand the full capabilities of today’s angiographic suite To understand how c-arm cone beam CT soft tissue imaging can be used for assessments of devices, blood flow and perfusion. Advances in real-time x-ray neuro-endovascular image guidance Stephen Rudin - Reacting to the demands on real-time image guidance for ever finer neurovascular interventions, great improvements in imaging chains are being

  19. The SNaP™ Wound Care System: A Case Series Using a Novel Ultraportable Negative Pressure Wound Therapy Device for the Treatment of Diabetic Lower Extremity Wounds

    Science.gov (United States)

    Lerman, Bruce; Oldenbrook, Leslie; Ryu, Justin; Fong, Kenton D.; Schubart, Peter J.

    2010-01-01

    Although there is significant evidence supporting the use of negative pressure wound therapy (NPWT) for the treatment of lower extremity diabetic ulcers, currently available electrically powered NPWT systems are not ideally suited for treating smaller diabetic foot ulcers. The Smart Negative Pressure (SNaP™) Wound Care System is a novel, ultraportable device that delivers NPWT without the use of an electrically powered pump. It was specifically designed to meet the wound care needs of patients with diabetes. The SNaP System is compact, silent, mobile, easy-to-use, and available off-the-shelf. It is fully disposable and may offer other important benefits over electrically powered systems to both the clinician and patient. We review the evidence for use of NPWT for the treatment of diabetic wounds and discuss the potential benefits of this new NPWT technology for patients with diabetes. We also present a case series of four difficult lower extremity diabetic ulcers that were successfully treated with the SNaP System. This study suggests that the SNaP System may be a useful addition to the armamentarium of the diabetic wound care clinician. PMID:20663444

  20. Combing a novel device and negative pressure wound therapy for managing the wound around a colostomy in the open abdomen: A case report.

    Science.gov (United States)

    Sun, Xiaofang; Wu, Shaohan; Xie, Ting; Zhang, Jianping

    2017-12-01

    An open abdomen complicated with small-bowel fistulae becomes a complex wound for local infection, systemic sepsis and persistent soiling irritation by intestinal content. While controlling the fistulae drainage, protecting surrounding skin, healing the wound maybe a challenge. In this paper we described a 68-year-old female was admitted to emergency surgery in general surgery department with severe abdomen pain. Resection part of the injured small bowel, drainage of the intra-abdominal abscess, and fashioning of a colostomy were performed. She failed to improve and ultimately there was tenderness and lot of pus under the skin around the fistulae. The wound started as a 3-cm lesion and progressed to a 6 ×13  (78 cm) around the stoma. In our case we present a novel device for managing colostomy wound combination with negative pressure wound therapy. This tube allows for an effective drainage of small-bowel secretion and a safe build-up of granulation tissue. Also it could be a barrier between the bowel suction point and foam. Management of open abdomen wound involves initial dressing changes, antibiotic use and cutaneous closure. When compared with traditional dressing changes, the NPWT offers several advantages including increased granulation tissue formation, reduction in bacterial colonization, decreased of bowel edema and wound size, and enhanced neovascularization. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  1. Effect of Smaller Left Ventricular Capture Threshold Safety Margins to Improve Device Longevity in Recipients of Cardiac Resynchronization-Defibrillation Therapy.

    Science.gov (United States)

    Steinhaus, Daniel A; Waks, Jonathan W; Collins, Robert; Kleckner, Karen; Kramer, Daniel B; Zimetbaum, Peter J

    2015-07-01

    Device longevity in cardiac resynchronization therapy (CRT) is affected by the pacing capture threshold (PCT) and programmed pacing amplitude of the left ventricular (LV) pacing lead. The aims of this study were to evaluate the stability of LV pacing thresholds in a nationwide sample of CRT defibrillator recipients and to determine potential longevity improvements associated with a decrease in the LV safety margin while maintaining effective delivery of CRT. CRT defibrillator patients in the Medtronic CareLink database were eligible for inclusion. LV PCT stability was evaluated using ≥2 measurements over a 14-day period. Separately, a random sample of 7,250 patients with programmed right atrial and right ventricular amplitudes ≤2.5 V, LV thresholds ≤ 2.5 V, and LV pacing ≥90% were evaluated to estimate theoretical battery longevity improvement using LV safety margins of 0.5 and 1.5 V. Threshold stability analysis in 43,256 patients demonstrated LV PCT stability of 1 V had the greatest increases in battery life (mean increase 0.86 years, 95% confidence interval 0.85 to 0.87). In conclusion, nearly all CRT defibrillator patients had LV PCT stability <1.0 V. Decreasing the LV safety margin from 1.5 to 0.5 V provided consistent delivery of CRT for most patients and significantly improved battery longevity. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Destination Personality, Satisfaction, And Tourist Future Behavior: The Case Of North Cyprus

    OpenAIRE

    Rostampour, Mehrnoush

    2013-01-01

    ABSTRACT: Going through application of destination personality in North Cyprus and finding about the essence of its relation to tourist satisfaction, and tourist behavior, considering the moderating effect of tourist motivation on relation between destination personality and tourist satisfaction as the main aim of this study. This study focused on two aims: 1) the relationship between destination personality adopted from Aaker (1997) personality scale in tourism realm _ North Cyprus_ due ...

  3. The role of the film as a media communications instrument for the tourist destination promotion strategy

    OpenAIRE

    Pavković Vladimir; Filipović Vinka; Vlastelica-Bakić Tamara

    2015-01-01

    This paper analyses different film genres and their role as a media communications instrument for the tourist destination promotion strategy. The general objective of the paper is to point to the significance of film for the tourist destination recognisability as well as its perception in the public eye. The specific objectives of the paper are directed at the analysis of individual roles that different film genres have in the tourist destination promotion strategy. The research methods emplo...

  4. Implementing existing theories in developing a gastronomic tourism destination : case Kyrö Distillery Company

    OpenAIRE

    Ala-Lahti, Erkka

    2016-01-01

    The aim of this bachelor's thesis was to provide points of development for the subject company Kyrö Distillery Company in the developing of a gastronomic tourism destination. The subject company mainly operates as a distillery, but it has promising tourism potential in the field of gastronomic tourism. The company and the restaurant located in the destination, Kyrönmaan matkailunedistämiskeskus, also operate as a tourism destination providing tours and tastings of the company. The objecti...

  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. Branding Prince Edward County as a Gastronomic Niche Tourism Destination: A Case Study

    OpenAIRE

    Geneviève Brisson; Rocci Luppicini

    2015-01-01

    Increasingly, gastronomy is playing a role in people's motivation for travel, and destinations are making food and beverages their main attraction. This study explored the growing field of gastronomic tourism, a type of niche tourism, through the theoretical framework of destination branding theory. Using a qualitative case study research design, this research examined the branding of the emergent region of Prince Edward County, Ontario, Canada as a gastronomic niche tourism destination from ...

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

    OpenAIRE

    Ryan Pratama Sutanto; Listia Natadjaja; Erandaru .

    2010-01-01

    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 consu...

  8. "The Social Destination": How Social Media Influences the Organisational Structure and Leadership of DMOs

    OpenAIRE

    Mihaela Jucan; Cornel Jucan; Ilie Rotariu

    2013-01-01

    The paper deals with the most important changes that have occurred in business because of social media and its impact on organisations and leadership in recent years. It seeks to synthesize existing research, theories and concepts, in order to understand "social destinations", and to provide a bridge from past research to future success. Becoming a "social destination" is a strategic and tactical leadership and management issue and the paper will present the importance of destination leadersh...

  9. Sustainability as an Identity Factor of Tourist Destinations at Websites:Does the Consumer Care?

    OpenAIRE

    Francisco Vicente Sales Melo; Salomão Alencar de Farias

    2014-01-01

    When choosing a vacation destination, consumers consider various factors, such as culture, natural attractions, history and points of interest, among others. In this article we analyze whether the question of sustainability is a determining factor in the choice of tourist destinations. Therefore, the article investigates the relationship of the identity of tourist destinations, as presented at their official websites, according to sustainability characteristics, the evaluation of the destinat...

  10. A personal tourism navigation system to support traveling multiple destinations with time restrictions

    OpenAIRE

    Maruyama, Atsushi; Shibata, Naoki; Murata, Yoshihiro; Yasumoto, Keiichi; Ito, Minoru

    2004-01-01

    We propose a personal navigation system (called PNS) which navigates a tourist through multiple destinations efficiently. In our PNS, a tourist can specify multiple destinations with desired arrival/stay time and preference degree. The system calculates the route including part of the destinations satisfying tourist's requirements and navigates him/her. For the above route search problem, we have developed an efficient route search algorithm using a genetic algorithm. We have designed and imp...

  11. 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.

  12. 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.

  13. Designs for mechanical circulatory support device studies.

    Science.gov (United States)

    Neaton, James D; Normand, Sharon-Lise; Gelijns, Annetine; Starling, Randall C; Mann, Douglas L; Konstam, Marvin A

    2007-02-01

    There is increased interest in mechanical circulatory support devices (MCSDs), such as implantable left ventricular assist devices (LVADs), as "destination" therapy for patients with advanced heart failure. Because patient availability to evaluate these devices is limited and randomized trials have been slow in enrolling patients, a workshop was convened to consider designs for MCSD development including alternatives to randomized trials. A workshop was jointly planned by the Heart Failure Society of America and the US Food and Drug Administration and was convened in March 2006. One of the panels was asked to review different designs for evaluating new MCSDs. Randomized trials have many advantages over studies with no controls or with nonrandomized concurrent or historical controls. These advantages include the elimination of bias in the assignment of treatments and the balancing, on average, of known and unknown baseline covariates that influence response. These advantages of randomization are particularly important for studies in which the treatments may not differ from one another by a large amount (eg, a head-to-head study of an approved LVAD with a new LVAD). However, researchers have found it difficult to recruit patients to randomized studies because the number of clinical sites that can carry out the studies is not large. Also, there is a reluctance to randomize patients when the control device is considered technologically inferior. Thus ways of improving the design of randomized trials were discussed, and the advantages and disadvantages of alternative designs were considered. The panel concluded that designs should include a randomized component. Randomized designs might be improved by allowing the control device to be chosen before randomization, by first conducting smaller vanguard studies, and by allowing crossovers in trials with optimal medical management controls. With use of data from completed trials, other databases, and registries, alternative

  14. Near-Earth Asteroids: Destinations for Human Exploration

    Science.gov (United States)

    Barbee, Brent W.

    2014-01-01

    The Near-Earth Object Human Space Flight Accessible Targets Study (NHATS) is a system that monitors the near-Earth asteroid (NEA) population to identify NEAs whose orbital characteristics may make them potential destinations for future round-trip human space flight missions. To accomplish this monitoring, Brent Barbee (GSFC) developed and automated a system that applies specialized trajectory processing to the orbits of newly discovered NEAs, and those for which we have updated orbit knowledge, obtained from the JPL Small Bodies Database (SBDB). This automated process executes daily and the results are distributed to the general public and the astronomy community. This aids in prioritizing telescope radar time allocations for obtaining crucial follow-up observations of highly accessible NEAs during the critical, because it is often fleeting, time period surrounding the time at which the NEAs are initially discovered.

  15. Performance of brazilian state capitals as tourism destinations

    Directory of Open Access Journals (Sweden)

    Erick da Silva Santos

    2015-04-01

    Full Text Available This article introduces the application of Data Envelopment Analysis (DEA associated with factor analysis to evaluate the relative efficiency of tourism demand of 18 Brazilian capital cities within a three-year period. Such assessment includes data on factors that affect tourism demand as cities’ budgets allocated on health, transportation, security, infrastructure, tourism as well as the result of this investment on number of tourist arrivals and creation of employments in each destination. The results show the capitals that reached 100% efficiency and also the only three capitals that touched the maximum efficiency over the three years. Findings also revealed that factor analysis associated with DEA offers a potential tool for managers to provide themselves with a set of practical indicators that better assist in decision-making regarding investment on sectors that positively interfere the demand in tourism locations.

  16. Building on the Cornerstone: Destinations for Nearside Sample Return

    Science.gov (United States)

    Lawrence, S. J.; Jolliff, B. L.; Draper, D.; Stopar, J. D.; Petro, N. E.; Cohen, B. A.; Speyerer, E. J.; Gruener, J. E.

    2016-01-01

    Discoveries from LRO (Lunar Reconnaissance Orbiter) have transformed our knowledge of the Moon, but LRO's instruments were originally designed to collect the measurements required to enable future lunar surface exploration. Compelling science questions and critical resources make the Moon a key destination for future human and robotic exploration. Lunar surface exploration, including rovers and other landed missions, must be part of a balanced planetary science and exploration portfolio. Among the highest planetary exploration priorities is the collection of new samples and their return to Earth for more comprehensive analysis than can be done in-situ. The Moon is the closest and most accessible location to address key science questions through targeted sample return. The Moon is the only other planet from which we have contextualized samples, yet critical issues need to be addressed: we lack important details of the Moon's early and recent geologic history, the full compositional and age ranges of its crust, and its bulk composition.

  17. A Comparative Study of Aerocapture Missions with a Mars Destination

    Science.gov (United States)

    Vaughan, Diane; Miller, Heather C.; Griffin, Brand; James, Bonnie F.; Munk, Michelle M.

    2005-01-01

    Conventional interplanetary spacecraft use propulsive systems to decelerate into orbit. Aerocapture is an alternative approach for orbit capture, in which the spacecraft makes a single pass through a target destination's atmosphere. Although this technique has never been performed, studies show there are substantial benefits of using aerocapture for reduction of propellant mass, spacecraft size, and mission cost. The In-Space Propulsion (ISP) Program, part of NASA's Science Mission Directorate, has invested in aerocapture technology development since 2002. Aerocapture investments within ISP are largely driven by mission systems analysis studies, The purpose of this NASA-funded report is to identify and document the fundamental parameters of aerocapture within previous human and robotic Mars mission studies which will assist the community in identifying technology research gaps in human and robotic missions, and provide insight for future technology investments. Upon examination of the final data set, some key attributes within the aerocapture disciplines are identified.

  18. Is Montenegro Considered as a Sports-Recreational Destination?

    Directory of Open Access Journals (Sweden)

    Sanja Pekovic

    2018-06-01

    Full Text Available The paper aims to examine if, according to the tourists coming to the country, Montenegro is considered as a sport-recreational destination. The data used in the study is extracted from the Montenegrin survey called Guest Survey 2014, comprising of 35 questions related to the tourist travel behavior and satisfaction during their stay in Montenegro. The paper uses the results of the study to provide descriptive statistics concerning the motives of tourist to visit Montenegro (one of the question is related to sport-recreational activities. Furthermore, it verifi es link between tourists’ motivation related to sport -recreational activities to come to Montenegro and their overall satisfaction with sport -recreational activities. The results indicated that only around 1% of tourists in our sample who visited Montenegro indicated sport- recreational activities as the main motive for the visit, around 3% of tourists indicated sport- recreational activities as a second motive while around 5% of tourists indicated sport and recreational activities as the third motive. However, around 60% of tourists reported that they were satisfi ed with overall sport -recreational activities during their stay in Montenegro. This study shows that even that Montenegrin sport-recreational off er is on the satisfactory level, managers and policy-makers should provide additional eff ort to present Montenegro as a sport-recreational destination since very low percentage of tourists are motivated to visit Montenegro related to these activities. The paper thus concludes by setting recommendations related to diversifi cation of Montenegrin tourism off er by pursuing sports-recreational tourism forms.

  19. Use of thromboelastography to tailor dual-antiplatelet therapy in patients undergoing treatment of intracranial aneurysms with the Pipeline embolization device.

    Science.gov (United States)

    McTaggart, Ryan A; Choudhri, Omar A; Marcellus, Mary L; Brennan, Tom; Steinberg, Gary K; Dodd, Robert L; Do, Huy M; Marks, Michael P

    2015-06-01

    Platelet function testing is controversial and not well studied in patients with neurovascular disease. To evaluate the performance of thromboelastography (TEG) as a platelet function test in neurovascular patients treated with the Pipeline embolization device (PED). A prospective protocol was instituted for platelet function testing in patients undergoing repair of intracranial aneurysms with the PED. All patients received dual antiplatelet therapy (DAT) and their response to both P2Y12 inhibitors and aspirin was quantified with TEG. Each patient's DAT induction strategy was tailored based on the percentage ADP-induced and percentage arachidonic acid-induced platelet inhibition reported by TEG. Data collected included clinical presentation, aneurysm characteristics, treatment details, and periprocedural events. Patients were followed up clinically and/or angiographically at 30 days, 6 months, and 1 year. Thirty-four PED procedures were performed on 31 patients. TEG results altered the DAT strategy in 35% of patients. Technical success with the Pipeline placement was 100%. Two patients had minor strokes and five had transient ischemic attacks (TIAs). There have been no hemorrhagic complications. No patient had permanent neurologic deficits. Six of eight (75%) of patients with thromboembolic/TIA events were ADP-induced hyporesponders by TEG. Our 6- and 12-month angiographic occlusion rates were 78.9% and 89.5%, respectively. The 19 major branches covered by the PED that were assessed by follow-up imaging have all remained patent. Platelet function testing with TEG altered our DAT induction strategy in a significant number of cases. No hemorrhagic or disabling thromboembolic complications were seen in this series. Future studies should compare methods of platelet function testing and, possibly, no platelet function testing in neurovascular patients undergoing flow diversion and/or stent-assisted treatment of intracranial aneurysms. Published by the BMJ

  20. The Ventricular Assist Device in the Life of the Child: A Phenomenological Pediatric Study

    Science.gov (United States)

    van Manen, Michael A.

    2017-01-01

    What is it like for a child to live with an artificial heart? The use of some medical therapies in children requires developmental considerations, is associated with psychosocial consequences, and calls for ethical sensitivities. A critical case is the ventricular assist device (VAD), a mechanical pump used to support the functioning of a failing heart. As a pediatric therapy, the device can be used as a temporary solution for poor heart function, a bridge to transplantation or recovery, or as a destination therapy. While the mechanical-technical operation of the VAD is well understood, the clinical-technical aspects of young people living with this device are largely unexplored. Drawing on interviews of school-aged children, the aim of this phenomenological study is to explore how a VAD may structure or condition a child’s meaningful experience of their world outside the hospital. The driveline of an implanted VAD is the peripheral attachment, extruding through the skin to connect the controller-power supply. The materiality of the device may be interruptive, restrictive, and disturbing to the psycho-physical being and sense of self-identity of the child as a child. And while a child equipped with a VAD is not necessarily conspicuous among other children, the child may experience the device as an exposing presence, while living with the worry of a caregiver who takes on the role not simply of parent but of watchful health professional. A phenomenological understanding of the VAD should assist parents and caregiving health professionals knowing how to deal with specific issues arising in the life of the VAD child. PMID:28682718

  1. The Ventricular Assist Device in the Life of the Child: A Phenomenological Pediatric Study.

    Science.gov (United States)

    van Manen, Michael A

    2017-05-01

    What is it like for a child to live with an artificial heart? The use of some medical therapies in children requires developmental considerations, is associated with psychosocial consequences, and calls for ethical sensitivities. A critical case is the ventricular assist device (VAD), a mechanical pump used to support the functioning of a failing heart. As a pediatric therapy, the device can be used as a temporary solution for poor heart function, a bridge to transplantation or recovery, or as a destination therapy. While the mechanical-technical operation of the VAD is well understood, the clinical-technical aspects of young people living with this device are largely unexplored. Drawing on interviews of school-aged children, the aim of this phenomenological study is to explore how a VAD may structure or condition a child's meaningful experience of their world outside the hospital. The driveline of an implanted VAD is the peripheral attachment, extruding through the skin to connect the controller-power supply. The materiality of the device may be interruptive, restrictive, and disturbing to the psycho-physical being and sense of self-identity of the child as a child. And while a child equipped with a VAD is not necessarily conspicuous among other children, the child may experience the device as an exposing presence, while living with the worry of a caregiver who takes on the role not simply of parent but of watchful health professional. A phenomenological understanding of the VAD should assist parents and caregiving health professionals knowing how to deal with specific issues arising in the life of the VAD child.

  2. Car drivers’ characteristics and the maximum walking distance between parking facilities and final destination

    NARCIS (Netherlands)

    van der Waerden, P.J.H.J.; Timmermans, H.J.P.; de Bruin - Verhoeven, M.

    2017-01-01

    In this paper the relationship between car drivers’ personal and trip characteristics and the maximum distance car drivers are willing to walk between a parking facility and the final destination(s) will be discussed. The willingness to walk is investigated in the context of four different trip

  3. An investigation of dematerialization planning options at tourism destinations: Technical and behavioural dimensions

    OpenAIRE

    Kelly, Joseph

    2006-01-01

    The goal of this dissertation is to develop a conceptual framework and associated methods for evaluating alternative tourism planning strategies in terms of dematerialization and acceptability amongst tourists. Its objectives are to (1) examine the technical potential of dematerialization planning options in tourism destinations, (2) investigate tourist perspectives concerning destination planning alternatives that promote dematerialization, (3) assess the travel market responses and demateri...

  4. Building Customer Loyalty in Rural Destinations as a Pre-Condition of Sustainable Competitiveness

    Directory of Open Access Journals (Sweden)

    Kateřina Ryglová

    2018-03-01

    Full Text Available The paper is dedicated to the issues of rural tourism with regard to the visitor’s loyalty towards the destination in a sustainable development context. Particularly, the findings of the research focused on exploring mutual relations among quality dimensions of the rural destination, overall satisfaction of the visitor, and his or her loyalty towards the destination are presented. A structural model was used to explore the relations among quality dimensions, overall satisfaction, and loyalty in the specific environment of the Czech Republic (inland European country, EU member, until 1989 a socialist country, nearly 93% municipalities with fewer than 3000 inhabitants. The research results allow deeper understanding of the visitor’s behavior and the factors influencing the loyalty towards the destination. The significance order of the dimensions according to their direct influence on the required loyalty towards the destination, i.e., coming back to the destination and spreading positive references to the destination, is as follows: 1. well-being, 2. image, 3. services. We conclude that overall satisfaction directly influences loyalty towards the destination.

  5. Describing the Relationship between Tourist Satisfaction and Destination Loyalty in a Segmented and Digitalized Market

    NARCIS (Netherlands)

    Neuts, B.; Romao, J.; van Leeuwen, E.S.; Nijkamp, P.

    2013-01-01

    As a result of advances in ICT services, transportation and local development, among others, more destinations are competing to attract both national and international visitors. Globalization requires destinations to increase their competitiveness or risk losing out on tourist revenues. While the

  6. Emerging Australian Education Markets: A Discrete Choice Model of Taiwanese and Indonesian Student Intended Study Destination.

    Science.gov (United States)

    Kemp, Steven; Madden, Gary; Simpson, Michael

    1998-01-01

    Isolates factors influencing choice of Australia as a preferred destination for international students in emerging regional markets. Uses data obtained from a survey of students in Indonesia and Taiwan to estimate a U.S./Australia and rest-of-world/Australia discrete destination-choice model. This model identifies key factors determining country…

  7. 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

  8. Complexity in built environment, health, and destination walking: a neighborhood-scale analysis.

    Science.gov (United States)

    Carlson, Cynthia; Aytur, Semra; Gardner, Kevin; Rogers, Shannon

    2012-04-01

    This study investigates the relationships between the built environment, the physical attributes of the neighborhood, and the residents' perceptions of those attributes. It focuses on destination walking and self-reported health, and does so at the neighborhood scale. The built environment, in particular sidewalks, road connectivity, and proximity of local destinations, correlates with destination walking, and similarly destination walking correlates with physical health. It was found, however, that the built environment and health metrics may not be simply, directly correlated but rather may be correlated through a series of feedback loops that may regulate risk in different ways in different contexts. In particular, evidence for a feedback loop between physical health and destination walking is observed, as well as separate feedback loops between destination walking and objective metrics of the built environment, and destination walking and perception of the built environment. These feedback loops affect the ability to observe how the built environment correlates with residents' physical health. Previous studies have investigated pieces of these associations, but are potentially missing the more complex relationships present. This study proposes a conceptual model describing complex feedback relationships between destination walking and public health, with the built environment expected to increase or decrease the strength of the feedback loop. Evidence supporting these feedback relationships is presented.

  9. Diverging fortunes? Economic well-being of Latinos and African Americans in new rural destinations.

    Science.gov (United States)

    Crowley, Martha; Lichter, Daniel T; Turner, Richard N

    2015-05-01

    The geographic diffusion of Latinos from immigrant gateways to newly-emerging rural destinations is one of the most significant recent trends in U.S. population redistribution. Yet, few studies have explored how Latinos have fared in new destinations, and even fewer have examined economic implications for other minority workers and their families. We use county-level data from the 1990 and 2000 U.S. Census and the 2006-2010 American Community Survey to compare the changing economic circumstances (e.g., employment and unemployment, poverty, income, and homeownership) of Latinos and African Americans in new Latino boomtowns. We also evaluate the comparative economic trajectories of Latinos in new destinations and established gateways. During the 1990s, new rural destinations provided clear economic benefits to Latinos, even surpassing African Americans on some economic indicators. The 2000s, however, ushered in higher rates of Latino poverty; the economic circumstances of Latinos also deteriorated more rapidly in new vis-à-vis traditional destinations. By 2010, individual and family poverty rates in new destinations were significantly higher among Latinos than African Americans, despite higher labor force participation and lower levels of unemployment. Difference-in-difference models demonstrate that in both the 1990s and 2000s, economic trajectories of African Americans in new Latino destinations largely mirrored those observed in places without large Latino influxes. Any economic benefits for Latinos in new rural destinations thus have not come at the expense of African Americans. Published by Elsevier Inc.

  10. 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.

  11. 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.

  12. A model of destination image promotion with a case study of Nanjing, P. R. China

    Science.gov (United States)

    Xiang Li; Hans Vogelsong

    2003-01-01

    Destination image has long been a popular research topic in tourism studies. However, methods used to integrate image in real marketing practice and evaluating the market performance in a systematic way are still puzzling to practitioners. A destination image promotion model is proposed in this paper as an effort to solve the problem. The roles of some major factors...

  13. 78 FR 48046 - Safety Zone; Kuoni Destination Management Fireworks; San Diego, CA

    Science.gov (United States)

    2013-08-07

    ...-AA00 Safety Zone; Kuoni Destination Management Fireworks; San Diego, CA AGENCY: Coast Guard, DHS... waters of the San Diego Bay in support of the Kuoni Destination Management Fireworks Display on August 6... Guard's ability to protect the public from the potential hazards associated with fireworks displays...

  14. "Forget to whom you have told this proverb": directed forgetting of destination memory in Alzheimer's disease.

    Science.gov (United States)

    El Haj, Mohamad; Gandolphe, Marie-Charlotte; Allain, Philippe; Fasotti, Luciano; Antoine, Pascal

    2015-01-01

    Destination memory is the ability to remember the receiver of transmitted information. By means of a destination memory directed forgetting task, we investigated whether participants with Alzheimer's Disease (AD) were able to suppress irrelevant information in destination memory. Twenty-six AD participants and 30 healthy elderly subjects were asked to tell 10 different proverbs to 10 different celebrities (List 1). Afterwards, half of the participants were instructed to forget the destinations (i.e., the celebrities) whereas the other half were asked to keep them in mind. After telling 10 other proverbs to 10 other celebrities (List 2), participants were asked to read numbers aloud. Subsequently, all the participants were asked to remember the destinations of List 1 and List 2, regardless of the forget or remember instructions. The results show similar destination memory in AD participants who were asked to forget the destinations of List 1 and those who were asked to retain them. These findings are attributed to inhibitory deficits, by which AD participants have difficulties to suppress irrelevant information in destination memory.

  15. Radiation emitting devices regulations

    International Nuclear Information System (INIS)

    1970-01-01

    The Radiation Emitting Devices Regulations are the regulations referred to in the Radiation Emitting Devices Act and relate to the operation of devices. They include standards of design and construction, standards of functioning, warning symbol specifications in addition to information relating to the seizure and detention of machines failing to comply with the regulations. The radiation emitting devices consist of the following: television receivers, extra-oral dental x-ray equipment, microwave ovens, baggage inspection x-ray devices, demonstration--type gas discharge devices, photofluorographic x-ray equipment, laser scanners, demonstration lasers, low energy electron microscopes, high intensity mercury vapour discharge lamps, sunlamps, diagnostic x-ray equipment, ultrasound therapy devices, x-ray diffraction equipment, cabinet x-ray equipment and therapeutic x-ray equipment

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

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    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.

  17. The Sustainable Management of a Tourism Destination in Ireland: A Focus on County Clare

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    Aine CONAGHAN

    2015-06-01

    Full Text Available Tourism destination management has significant importance in controlling many impacts of tourism, thus insuring its sustainability. Destination management requires the integration of different planning tools, approaches and concepts that help shape the management and daily operation of tourism related activities. This study examines the sustainable management of a tourism destination, focusing on County Clare, Ireland. Qualitative interviews were conducted with tourism stakeholders. Additionally a theoretical framework incorporating the various elements that emerged from the theory was also utilised to examine existing tourism strategies and plans. Stakeholders all agreed it would be an advantage to have a Destination Management Office (DMO lead that would coordinate destination management. However, it was found many tourism visions lack consistency and a timeframe with only a few addressing sustainability itself. Also the multiple regulations and guidelines identified by the framework were not communicated effectively to both stakeholders and policy makers when managing tourism in County Clare.

  18. Stakeholder cooperation in implementation of the sustainable development concept: Montenegrin tourist destinations

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    Ljiljana Pjerotic

    2017-06-01

    Full Text Available The importance of involving diverse stakeholders in tourism planning is receiving growing recognition. 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 high level of stakeholder cooperation. The paper examines the level of stakeholder cooperation on the specific example of the sustainable development concept implementation in Montenegrin tourism. It starts with two hypotheses: first, the development level of instruments for managing tourist destination depends on stakeholder cooperation level in a particular destination, and second, implementation of the sustainable development concept is positively correlated with the development of instruments for managing tourist destination. The results have indicated poor implementation of tourism development plans and low level of stakeholder cooperation.

  19. A Novel Evaluation Approach for Tourist Choice of Destination Based on Grey Relation Analysis

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    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.

  20. CONSIDERATIONS REGARDING THE DESIGN OF SPECIFIC TOURISM PRODUCTS FOR THE TOURISM DESTINATION ROMANIA

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    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.

  1. The Role of Marketing Mix Components in Destination Choices of Visitors and the Case of Dalyan

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    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.

  2. Improving the profile of the European tourist destinations through the European tourism indicators system

    Directory of Open Access Journals (Sweden)

    Laura CISMARU

    2015-06-01

    Full Text Available Within the most recent European Policy for Tourism, the competitiveness of the European tourism industry is directly linked to the image of Europe and to its perception, as a collection of sustainable and high-quality tourist destinations. In such context, improving the profile of the European tourist destinations has become a main target. During the last years, the European Commission focused on the sustainable development of tourist destinations. Several projects were developed, the most recent one introducing a practical tool - the European Tourism Indicators System (ETIS for the sustainable development of destinations. The present paper advances the idea that such tool can be successfully used in order to achieve the goal of improving the profile of the European tourist destinations.

  3. The Effect of the Social and Physical Environment on Children's Independent Mobility to Neighborhood Destinations.

    Science.gov (United States)

    Christian, Hayley E; Klinker, Charlotte D; Villanueva, Karen; Knuiman, Matthew W; Foster, Sarah A; Zubrick, Stephan R; Divitini, Mark; Wood, Lisa; Giles-Corti, Billie

    2015-06-16

    Relationships between context-specific measures of the physical and social environment and children's independent mobility to neighborhood destination types were examined. Parents in RESIDE's fourth survey reported whether their child (8-15 years; n = 181) was allowed to travel without an adult to school, friend's house, park and local shop. Objective physical environment measures were matched to each of these destinations. Social environment measures included neighborhood perceptions and items specific to local independent mobility. Independent mobility to local destinations ranged from 30% to 48%. Independent mobility to a local park was less likely as the distance to the closest park (small and large size) increased and less likely with additional school grounds (P dependent upon the specific destination being visited and the impact of neighborhood features varies according to the destination examined. Findings highlight the importance of access to different types and sizes of urban green space for children's independent mobility to parks.

  4. Evaluating Bloemfontein’s image as a tourist destination: A tour operator’s perspective

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    AJ Strydom

    2014-07-01

    Full Text Available Tour operators have been identified as vital information sources influencing the images and decision-making processes of tourists. Bloemfontein is situated in Central South Africa.  Tourism marketers believe that the city is an ideal stopover destination for national tour operators  en route to other destinations.  Research was conducted among national tour operators in Johannesburg, Durban and Cape Town to determine their perceptions of Bloemfontein and whether they regard the city as a tourist or stopover destination.  The research indicates that the city is not regarded as a tourist destination, but is seen as an ideal stopover destination which could be included in future tour itineraries.  It is currently excluded because operators are unfamiliar with the tourism offering(s of Bloemfontein due to insufficient marketing by the tourism officials of the city.

  5. Tourism destination image of Russia in the perspective of the portuguese market

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    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.

  6. 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

  7. 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

  8. [Mechanical circulatory support saves lives -- three years' experience of the newly established assist device program at Semmelweis University, Budapest, Hungary].

    Science.gov (United States)

    Fazekas, Levente; Sax, Balázs; Hartyánszky, István; Pólos, Miklós; Horkay, Ferenc; Varga, Tamás; Rácz, Kristóf; Németh, Endre; Székely, Andrea; Paulovich, Erzsébet; Heltai, Krisztina; Zima, Endre; Szabolcs, Zoltán; Merkely, Béla

    2015-03-29

    Since the celebration of the 20th anniversary of the first heart transplantation in Hungary in 2012 the emerging need for modern heart failure management via mechanical circulatory support has evolved. In May 2012 the opening of a new heart failure and transplant unit with 9 beds together with the procurement of necessary devices at Semmelweis University accomplished this need. The aim of the authors was to report their initial experience obtained in this new cardiac assist device program. Since May, 2012, mechanical circulatory support system was applied in 89 cases in 72 patients. Indication for support were end stage heart failure refractory to medical treatment and acute left or right heart failure. Treatment was initiated for acute graft failure after heart transplantation in 27 cases, for end stage heart failure in 24 cases, for acute myocardial infarction in 21 cases, for acute postcardiotomy heart failure in 14 cases, for severe respiratory insufficiency in 2 cases and for drug intoxication in one case. Among the 30 survivor of the whole program 13 patients were successfully transplanted. The available devices can cover all modalities of current bridge therapy from short term support through medium support to heart transplantation or long term support and destination therapy. These conditions made possible the successful start of a new cardiac assist device program.

  9. 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.

  10. Durability of central aortic valve closure in patients with continuous flow left ventricular assist devices.

    Science.gov (United States)

    McKellar, Stephen H; Deo, Salil; Daly, Richard C; Durham, Lucian A; Joyce, Lyle D; Stulak, John M; Park, Soon J

    2014-01-01

    A competent aortic valve is essential to providing effective left ventricular assist device support. We have adopted a practice of central aortic valve closure by placing a simple coaptation stitch at left ventricular assist device implantation in patients with significant aortic insufficiency. We conducted a follow-up study to evaluate the efficacy and durability of this procedure. The study included patients who had undergone continuous flow left ventricular assist device implantation. The patients were divided into 2 groups, those who did not require any aortic procedure because the valve was competent and those who underwent central aortic valve closure for mild or greater aortic regurgitation. The clinical endpoints were mortality, progression or recurrence of aortic insufficiency, and reoperation for aortic valve pathologic features. Aortic insufficiency was measured qualitatively from mild to severe on a scale of 0 to 5. A total of 123 patients received continuous flow left ventricular assist devices from February 2007 to August 2011. Of those, 18 (15%) underwent central aortic valve closure at left ventricular assist device implantation because of significant aortic insufficiency (1.8 ± 1.4) and 105 who did not (competent aortic valve, 0.15 ± 0.43; P assist device-supported patients, with follow-up extending into 2 years. Although aortic insufficiency progressed over time in those with minimal native valve regurgitation initially, no such progression was noted in those with central aortic valve closure. Additional investigation is needed to evaluate whether prophylactic central aortic valve closure should be performed at left ventricular assist device implantation to avoid problematic aortic regurgitation developing over time, in particular in patients undergoing left ventricular assist device implantation for life-long (destination therapy) support. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights

  11. Singosaren As Interactive Space In Kotagede Tourism Destination

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    Panjaitan Irwin

    2018-01-01

    Full Text Available The development of the area for tourism purposes should have good sensitivity related to the product to consumption aspects, where the interaction between the local community is seen as the supply (insider produce the products, which can then be consumed by the visitor as demand (outsider. Such sensitivity can be seen in the space between the private realm and the public sphere called the interface space. Development of the area for tourism, will enhance the touristsaccessibility in exploring its uniqueness as a tourist attraction. Accessible tourist attractions can improve the degree of permeability, which can also affect the degree of privacy of local communities. Singosaren as an area that will be designed as part of the united Kotagede tourist destinations, Yogyakarta, should consider the influence of tourism activities on a daily basis of the community. Permeability study in the area with mapping method, is expected to connect local potency to the circulation pattern in the interface, by finding the street corridor that needs to be anticipated, to maintain the sustainability of tourism activities in Singosaren area.

  12. 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.

  13. 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.

  14. Market Segmentation: An Application to the Schist Village Tourism Destinations

    Directory of Open Access Journals (Sweden)

    Manuel Martinho

    2017-01-01

    Full Text Available Purpose – The Schist Village network is a sustainable development project in Portugal’s Pinhal Interior region that includes 27 villages located in the central inland area of the country. Overall, this study sets out evidence about the motivations, interests, behaviors, and images of visitors/tourists (tourism consumers regarding the Schist Villages in the area. Design/Methodology/Approach – The sample of individuals interviewed includes a total of 223 individuals (59 international and 164 national tourists, all of whom personally answered the questionnaire. Findings and implications – Through analysis of the survey results obtained, it is possible to chart a profile of Schist Village visitors/tourists, ascertain their preferences and the key attributes associated with the image of this tourist destination and, based on these, put forward strongly focused orientations and guidelines to help develop future marketing plans for this territory. Limitations – One limitation stems from how the data was gathered and analyzed constitutes but a mere “moment” in a fairly vast and dynamic universe given that the questionnaires were completed across a defined and fairly brief period of time. The fact that the questionnaires were handed out by network partners effectively excluded from the study all those tourism consumers who travel and visit the territory without any direct recourse to the services of the aforementioned partners. Originality – This study presents an easy and clear way to segment the market that could be used by several stakeholders in order to improve their targeting activities.

  15. The significance of the tourist destination of Zlatibor spatial planning

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    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

  16. Study on Foreigners' Perception on Romania's Image as Tourism Destination

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    Ruxandra Irina POPESCU

    2013-06-01

    Full Text Available Romania’s image worldwide is a major priority for our public authorities. The aim of this study is to identify foreigners’ perception on Romania’s image as tourism destination departing from three research hypothesis: foreigners’ perception on Romania’s image as a result of Romanians behavior inside and outside the country’s borders, foreign visitors’ perception on tourism services and level of knowledge of Romania’s tourism brand across the borders. The research gathered the opinions of 1.150 foreigners from 10 countries using a questionnaire that integrated variables corresponding to the research questions. The survey was carried out in 11 representative places for foreign tourists’ visits, as well as on the internet, using the Wayn.com website, which allowed the selection of foreign citizens that have visited Romania at least once. The research is relevant not only from the perspective of its direct results regarding foreigners’ perception on Romania’s tourism brand, but might as well be seen as an instrument for analyzing the preliminary results of the campaign ‘Romania, explore the Carpathian garden’, that started in 2010 and is still in progress.

  17. Destinations without regulations: Informal practices in Romanian rural tourism

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    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.

  18. Buzias as a cultural and therapeutic tourism destination

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    Teodora Mot

    2014-10-01

    Full Text Available Tourism makes an important contribution to culture andthe historic heritage by providing means for keeping the traditions alive andfinancing its protection as well as increasing visitor appreciation. Culturaltourism helps preserve the cultural and historic heritage. Therapeutictourism doesn’t just depend on mineral water baths and natural therapeuticsites, it also depends on hospital and healthcare development in the countryproviding a modern medical care service. At Buziaş the emphasis falls on the unique procedureswith natural therapeutic factors. The healing qualities of carbonated water,mofettes and sedative bioclimate are well-known and highlighted by the studiesand researches carried out until now, as well as by the high number of patientswith significant improvement in symptomoatology. Moreover, Buziaş has also arich cultural heritage, including historical monuments which, once restored,will be able to compete other famous international destinations. That's why an urgentmanagerial strategy is necessary to be elaborated in order that Buziaş be ableto regain its prestige and attract a large number of visitors, eager tocontemplate the natural and cultural beauties of this resort.

  19. Developing Touristic Destination - the Way towards Increasing Innovation Performance

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    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.

  20. Prologue: ventricular assist devices and total artificial hearts. A historical perspective.

    Science.gov (United States)

    Frazier, O H

    2003-02-01

    In the 1960s, when LVADs and TAHs were introduced into clinical use, researchers estimated that, with this technology, the problem of heart failure could be solved within 20 years. Unfortunately, the evolution of these devices has taken much longer than anticipated. Nevertheless, significant advances have been achieved in both cardiac assistance and replacement, and today's cardiac surgeons have a wide range of devices from which to choose (Table 4). This progress has largely been due to the support of the NHLBI, especially the Devices and Technology Division headed by John Watson, and of the devoted commitment of the investigators. Because of the long-term commitment required for both basic and clinical research, commercial medical technology companies are unable to assume this burden. Advances in mechanical circulatory support and replacement have benefited numerous patients worldwide who would otherwise have died of heart failure, and devices now exist for use as bridges to recovery, bridges to transplant, and destination therapy. The current challenge is to refine what we have and to apply these technologies to broader patient populations with maximal safety and at a reasonable cost.

  1. Socio-Economic Status: A Barrier to Access to Mandibular Advancement Device Therapy for Patients with Obstructive Sleep Apnea Syndrome in France.

    Directory of Open Access Journals (Sweden)

    Marion Fleury

    Full Text Available Obstructive sleep apnea syndrome (OSAS is a major public health problem which affects between 5 to 10% of the general population. OSAS is known to be associated with high rates of morbidity and mortality mainly due to cardiovascular diseases and traffic accidents. The burden of illness is high for the individual and society. There are 2 treatment options for OSAS, Continuous Positive Airway Pressure (CPAP and Mandibular Advancement Device therapy (MAD. CPAP is known to be an effective but very constraining treatment. Patients are usually poorly adherent. MAD is a more recent treatment easier to use and consequently better tolerated, but MAD can only be prescribed to patients with satisfactory oral hygiene. Oral health constitutes a real issue particularly among underprivileged groups in France. Through this link, the question of whether low socio-economic status constitutes a barrier to access to care for patients with OSAS is raised.In a multicenter prospective cohort of 2822 consecutive OSAS patients in whom MAD has been proposed as an alternative to CPAP between May 15, 2007 and December 1st, 2014, we identified the factors that lead to a patient diagnosed with OSAS to be treated by MAD instead of CPAP. A logistic regression was performed using a stepwise forward procedure. The main outcome of the study was that treatment by MAD was significantly associated with both educational attainment, as determined by the age at which the patient left full-time education, ≥18 years compared with <18 (adjusted odds ratio (aOR: 1.64, 95% CI 1.23 to 2.20, and the patient's occupational category. Executives and higher intellectual professions, intermediate professions, technicians, foremen and employees were significantly more likely to be treated by MAD than workers (aOR: 2.21, 95% CI 1.88 to 2.58; aOR: 1.74, 95% CI 1.15 to 2.63; aOR: 1.96, 95% CI 1.11 to 3.47, respectively.Overall, these results suggest that low socio-economic status constitutes a

  2. 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

    2014-01-01

    Abstract Background 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. Methods 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. Results 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. Conclusion 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. PMID:25909055

  3. Grief Tourism on Destination Image Formation: Afyonkarahisar and Başkomutan National Historical Park

    Directory of Open Access Journals (Sweden)

    Burhan KILIÇ

    2011-06-01

    Full Text Available The diversification of supply sources owned causes differences between destinations and special interest which is shaped for demand leads to become tourism widespread. In Turkey, there are many destinations where different features exist together. By means of alternative tourism types, various destinations and tourism types emerge. When all the events happened during the Independence War are considered in terms of national heritage, Afyonkarahisar is an important centre among grief tourism destinations. In research related to image components of Afyonkarahisar, confectionery, food products, and thermal tourism are the values of this destination that come to mind first. When the city is considered in terms of tourism, by highlighting the thermal tourism, the slogan “The Capital of Thermal Tourism” has been used. However it is hard to say that thermal tourism has a success taking the research into consideration. Therefore either other tourism values will be used to support the slogan available or with the work of a new image, a new image destination image will be created. The aim of this study is to eliminate the current negativity of Afyonkarahisar province’s destination image, strengthen the image and examine the availability of grief tourism which is one of the heritage tourism types so as to increase its market share

  4. 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.

  5. 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.

  6. 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.

  7. Destination Information System for Bandung City Using Location-Based Services (LBS) on Android

    Science.gov (United States)

    Kurniawan, B.; Pranoto, H.

    2018-02-01

    Bandung is a city in West Java, Indonesia with many interesting locations to visit. For most favourite destinations, we can easily look for it on Google and we will find some blogs there discussing about related content. The problem is we can not guarantee that the destination is frequented by visitor. In this research, we utilizes an application to help everyone choosing destination frequented by visitor. The use of information technology in the form of picture, maps, and textual on Android application makes it possible for user to have information about destination with its visitor in a period of time. If destination has visit history, selection of proper destination will be given with fresh informations. This application can run well on Android Lollipop (API Level 21) or above with a minimum RAM of 2 GB since it will compare two coordinates for every data. The use of this app make it possible to access information about location with its visitor history and could help choosing proper destinations for the users.

  8. 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. 

  9. The role of the film as a media communications instrument for the tourist destination promotion strategy

    Directory of Open Access Journals (Sweden)

    Pavković Vladimir

    2015-01-01

    Full Text Available This paper analyses different film genres and their role as a media communications instrument for the tourist destination promotion strategy. The general objective of the paper is to point to the significance of film for the tourist destination recognisability as well as its perception in the public eye. The specific objectives of the paper are directed at the analysis of individual roles that different film genres have in the tourist destination promotion strategy. The research methods employed in the paper entail film identification and its role in media communications, the identification both of different film genres and their specific features, then, the observation of their application in the tourist destination promotion strategy, and eventually, the identification of their significance in the process of raising the public's awareness of the destination itself as well as the creation of positive perception of the destination with the targeted audience. In this regard, the paper focuses on the following: feature films, documentary films, tourist-related report, promotional tourist films, messages conveyed through films to the targeted audience as well as the strategies and methods employed in the film as a promotional tool. One of the key findings of the paper is to highlight the significance of each film genre in the process of tourist destination promotion, whereas their combination represents an important segment of media strategies in the field of tourism, and is a prerequisite for the desired positioning in the contemporary tourism market.

  10. Baking Dalarna's biking cake : Collaboration as a means for destination competitiveness, a case study of “Biking Dalarna"

    OpenAIRE

    Yachin, Jonathan Moshe

    2013-01-01

    In the contemporary tourism industry, the competitive game is between destinations. Tourism operations struggle to remain competitive on the international market and their success depends to a large extent on other complementary and competing tourism organizations at the destination. It is the sum of the total tourism offerings at the destination which determines its attractiveness. This research explores tourism collaboration process as a means of generating destination competitiveness. The ...

  11. 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.

  12. Branding Sicily as Gastronomically Attractive Destination, viewed by Kempinski Hotel Giardino di Costanza

    OpenAIRE

    Kalinina, Anastasia

    2013-01-01

    The object of the study was to investigate the opportunity of destination brand-ing through the tool of its gastronomy. In order to render concrete to the topic I chose a popular destination – Sicily and Sicilian gastronomy. It is a fact that the theme of gastronomic direction in tourism and the role of gastronomy in des-tination branding is not developed at all. Besides, personally I have been always attracted by gastronomic experiences in tourism. So it was a challenge for my-self to explor...

  13. 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.

  14. Characterisation of a CMOS charge transfer device for TDI imaging

    International Nuclear Information System (INIS)

    Rushton, J.; Holland, A.; Stefanov, K.; Mayer, F.

    2015-01-01

    The performance of a prototype true charge transfer imaging sensor in CMOS is investigated. The finished device is destined for use in TDI applications, especially Earth-observation, and to this end radiation tolerance must be investigated. Before this, complete characterisation is required. This work starts by looking at charge transfer inefficiency and then investigates responsivity using mean-variance techniques

  15. NHLBI’s Program for VAD Therapy for Moderately Advanced Heart Failure: The REVIVE-IT Pilot Trial

    Science.gov (United States)

    Baldwin, J. Timothy; Mann, Douglas L.

    2010-01-01

    Background VADs are used to bridge heart failure patients to transplantation, to allow their own hearts to recover, or as permanent (“destination”) therapy. To date, the use of VADs has been limited to late-stage heart failure patients because of the associated device risks. In 2008, an NHLBI working group met to evaluate the treatment of heart failure using VADs and to advise the institute on how therapy for heart failure may be best advanced by clinical trials involving the devices. Discussion and Recommendations Recognizing the improvements in VAD technology and in patient care and selection over the past decade, the working group recommended that a trial be performed to assess the use of chronic VAD therapy in patients who are less ill than those currently eligible for destination therapy. The hypothesis proposed for the trial is that VAD therapy may improve both survival and quality of life in moderately advanced heart failure patients who are neither inotrope-dependent nor exercise-intolerant and have not yet developed serious consequences such as malnourishment, end-organ damage, and immobility. Based on the group’s recommendations, NHLBI issued an RFP in 2009 for the REVIVE-IT Pilot Trail which will serve to test the hypothesis and inform the pivotal trial. PMID:21055648

  16. Multi-Destination Cognitive Radio Relay Network with SWIPT and Multiple Primary Receivers

    KAUST Repository

    Al-Habob, Ahmed A.; Salhab, Anas M.; Zummo, Salam A.; Alouini, Mohamed-Slim

    2017-01-01

    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

  17. 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”.

  18. 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.

  19. 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.

  20. 14 CFR 121.185 - Airplanes: Reciprocating engine-powered: Landing limitations: Destination airport.

    Science.gov (United States)

    2010-01-01

    ... normal consumption of fuel and oil in flight, would allow a full stop landing at the intended destination... above the intersection of the obstruction clearance plane and the runway. For the purposes of...

  1. Complementary Flyover and Surface Exploration of Planetary Destinations Where 3D Detail Matters

    Data.gov (United States)

    National Aeronautics and Space Administration — Points of persistent light exist on the rim of Shackleton crater and at other polar locations on the Moon, and perhaps Mercury. These destinations could serve as...

  2. Google it! Using the Google Trends tool to understand the Algarve Tourist destination public interest

    Directory of Open Access Journals (Sweden)

    G. Dinis

    2015-11-01

    Full Text Available In a sector strongly dependent on information as is the case of tourism, the timely knowledge of consumer behaviour enables making well-considered decisions and less uncertainty. Nowadays, the act of searching on the Internet about a particular subject before decision-making is part of the individuals’ daily lives. The Google Trends tool provides real time aggregated data on the online individuals’ interest based on the carried out search queries on Google. The objective of this paper is to show that Google Trends can provide comparative information about the individuals’ interest in relation to Portugal tourism regional areas and in particular, on the tourist destination "Algarve", and also between its competing tourist destinations. The results show that the tool can contribute to the knowledge of the individuals’ interests in relation to regional tourist destinations, information considered of great interest for Destination Management Organizations.

  3. 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.

  4. A Model of Market Positioning of Destinations Based on Online Customer Reviews of Lodgings

    Directory of Open Access Journals (Sweden)

    Manuel Rodríguez-Díaz

    2017-12-01

    Full Text Available The aim of this study is to develop a methodology to determine the competitive online positioning of lodging companies in different tourist destinations. The rise of the digital age has allowed many customers to share their opinions through specialized websites, providing a dynamic and constantly updated evaluation of the market. In this context, competitiveness is an essential factor in the economic sustainability of destinations. The competitive positioning of destinations is determined by the scale of variables used by Booking.com. The price and lodging category variables are also used, as well as three new variables derived from the initial scale: the quality average, value and added value. This methodology provides a tool to determine the level of competitiveness of the lodging offered in tourist destinations, based on which, actions can be taken to improve destinations’ positioning.

  5. The Scale of Exploration: Planetary Missions Set in the Context of Tourist Destinations on Earth

    Science.gov (United States)

    Garry, W. B.; Bleacher, L. V.; Bleacher, J. E.; Petro, N. E.; Mest, S. C.; Williams, S. H.

    2012-03-01

    What if the Apollo astronauts explored Washington, DC, or the Mars Exploration Rovers explored Disney World? We present educational versions of the traverse maps for Apollo and MER missions set in the context of popular tourist destinations on Earth.

  6. Access to destinations : annual accessibility measure for the Twin Cities Metropolitan Region.

    Science.gov (United States)

    2012-11-01

    This report summarizes previous phases of the Access to Destinations project and applies the techniques developed : over the course of the project to conduct an evaluation of accessibility in the Twin Cities metropolitan region for : 2010. It describ...

  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. Community crosstalk: An exploratory analysis of destination and festival eWOM on Twitter

    OpenAIRE

    Williams, Nigel; Inversini, Alessandro; Buhalis, Dimitrios; Ferdinand, Nicole

    2015-01-01

    Research suggests that festivals can promote a destination via online word-of-mouth (eWOM) on socialmedia, even though the nature of this effect is not yet fully understood. Using a combination of Social Network Analysis and text analysis (qualitative and quantitative), this article examines eWOM at a tourism destination (Bournemouth) when a festival (Bournemouth Air Show 2013) is staged. The Communities of Interest of eWOM interactions on Twitter were captured and analysed to understand the ...

  9. 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...

  10. DIFFERENCES BETWEEN PLACE BRANDING AND DESTINATION BRANDING FOR LOCAL BRAND STRATEGY DEVELOPMENT

    OpenAIRE

    Victor-Alexandru BRICIU

    2013-01-01

    To highlight the principles used in the design and development of a regional brand strategy we need to identify the disciplinary and the theoretical referential that would best fit the branding approach. This paper will address the main forms of branding: place branding, location branding and destination branding, as a specialized form of destination marketing. From the theoretical point of view, by identifying the fundamental and the management brand model, the regional tourism brand conc...

  11. The Role of Entrepreneurship and Longlife Learning in Branding of Tourism Destination

    OpenAIRE

    Gregorić, Marina; Skendrović, Ljiljana

    2012-01-01

    Branding of tourism destination can’t be seen without cooperation between private and public sector, entrepreneurship and government. Lifelong learning is an important element of increased awareness about the market and advantages of tourism destination as well as its market value. Definition of brand which starts from the needs of consumers is one that should lead in contemporary market environment where customers and market determine the value of the product or services. To achieve successf...

  12. Man-Made Wildlife Tourism Destination: The Visitors Perspective on Lok Kawi Wildlife Park, Sabah, Malaysia

    OpenAIRE

    Boyd Sun Fatt; Johnny Cindy; Bakansing Shirley M.

    2014-01-01

    Sabah is blessed with natural forest habitats and rich with floras and faunas. Amongst its’ attraction is wildlife endemism. Lok Kawi Wildlife Park was established to provide an alternative wildlife tourism destination with its inhabitants from the wildlife species of Borneo. Since its opening in 2007, multitudes of tourists have visited the park. However, there has been no study to identify the visitor’s perspective on Lok Kawi Wildlife Park as man-made wildlife tourism destination. The stud...

  13. Development of a Structural Model for Tourism Destination Competitiveness from Stakeholders' Perspectives

    OpenAIRE

    Yoon, Yooshik

    2002-01-01

    This study was conducted to theoretically develop and empirically test a structural equation model of tourism destination competitiveness from the tourism stakeholders'perspective. The proposed hypotheses that attempted to identify the structural relationships among the five constructs in the model were examined through a series of analyses in LISREL: 1) perceived tourism development impacts, 2) environmental attitudes, 3) place attachment, 4) development preferences about destination attract...

  14. 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...

  15. Personal values, subjective well-being and destination-loyalty intention of international students

    OpenAIRE

    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 ...

  16. 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...

  17. Destination website quality, users’ attitudes and the willingness to participate in online co-creation experiences

    Directory of Open Access Journals (Sweden)

    Jano Jiménez-Barreto

    2018-03-01

    Full Text Available Purpose - An official destination website (ODW is a key component for tourist’s decision-making processes. ODW acts as a direct channel where users may share experiences and opinions about previous or future travels. At the same time, it drives user participation in destination branding activities. In this context, it is crucial to identify how the destination website, using Web 2.0 technologies, could motivate user’s participation with the brand. The purpose of this paper is to propose and evaluate a model that posits the destination website quality as a determinant factor to predict users’ attitudes toward the website and their willingness to participate in co-creation experiences. Design/methodology/approach - Using a combined qualitative and quantitative method, this paper provides an exploratory research that examines the role of destination website quality on attitudes toward the website and the willingness to participate in online co-creation experiences. Findings - Findings confirm that there is a direct and significant relationship between website quality, attitudes toward the website and willingness to participate in online co-creation experiences. Moreover, attitudes toward the website partially mediate relationships between destination website quality and willingness to participate in online co-creation experiences. Originality/value - The literature of value co-creation is trying to identify which factors drive consumer’s participation with brands across different consumption contexts. This study provides evidence that confirms, from a tourism destination website point of view, that website quality is one of these key factors that motives user’s co-creation with a destination.

  18. Community crosstalk: an exploratory analysis of destination and festival eWOM on Twitter

    OpenAIRE

    Williams, Nigel L.; Inversini, Alessandro; Buhalis, Dimitrios; Ferdinand, Nicole

    2015-01-01

    Research suggests that festivals can promote a destination via online word-of-mouth (eWOM) on social media, even though the nature of this effect is not yet fully understood. Using a combination of Social Network Analysis and text analysis (qualitative and quantitative), this article examines eWOM at a tourism destination (Bournemouth) when a festival (Bournemouth Air Show 2013) is staged. The Communities of Interest of eWOM interactions on Twitter were captured and analysed to understand the...

  19. Destination India: Investigating the impact of Goa's attributes on families' leisure travel experience

    OpenAIRE

    Ekiz, Erdogan H.; Khoo-Lattimore, Catheryn

    2014-01-01

    The recent discourse of tourism development among officials within the Government of India has included the state of Goa, mainly because it has consistently witnessed positive economic impacts from tourism. However, in view of competition from other destinations, Goan tourism planners will need to identify important attributes of Goa that will positively affect tourists' destination loyalty. This study examines the correlation between five attributes of Goa and tourists' loyalty to Goa. Famil...

  20. The relation between personality traits and psychographic positions of travel destinations

    OpenAIRE

    Ismailov, Amet

    2017-01-01

    Master's thesis in International hotel and tourism management Understanding potential visitors is one of the fundamental tasks for researchers and businesses, destination marketing organizations as well as many other stakeholders in tourism domain. Despite the fact that Internet has become one of the major marketing channels for hospitality and tourism, researchers indicate that there is a notable gap in understanding how to effectively use social media in travel destination marketing. The...