Testing an integrated destination image model across residents and tourists

Tourism research has yet to confirm whether an integrated destination image model is applicable in predicting the overall destination image and behavioral intentions of local residents. This study examines whether the cognitive, affective and overall image - hypothesized to be predictors of behavioral intentions - are applicable to residents and tourists in the resort city of Eilat. The proposed model allowed for the distinct effect of each image component on overall image and behavior to be closely examined. The findings support the applicability of the model to local residents and also showed that among tourists, the affective component exerted a greater influence than the cognitive on overall destination image and future behavior. These findings have theoretical and practical implications for research on destination image

Hypocalcémie post-thyroïdectomie

Introduction : L’hypocalcémie est la complication la plus préoccupante de la thyroïdectomie totale. Elle impose un traitement substitutif et un suivi à vie. Objectifs : Le but de cette étude est d’évaluer l’incidence de l’hypocalcémie après chirurgie et d’étudier sa corrélation avec les caractéristiques cliniques, biologiques et le type de chirurgie pratiqué. Matériels et méthodes : Etude rétrospective portant sur 488 cas de thyroïdectomies, opérées entre 1992 et 1996. L’hypocalcémie est définie par une calcémie inférieure à 80 mg/l «2 mmol/l ». Les patients, toujours dépendants d’un traitement substitutif un an après la chirurgie, ont été considérés comme ayant une hypocalcémie définitive. Résultats : Dans notre étude, 368 patients ont eu une thyroïdectomie totale et 120 ont eu une thyroïdectomie subtotale. Le goitre multinodulaire était la pathologie la plus fréquente, noté dans 359 cas, suivie des cancers thyroïdiens noté dans 83 cas. L’hypocalcémie postopératoire a été retrouvée chez 54 patients (11,06%) dont 25 étaient asymptomatique. Cette hypocalcémie s’est révélée définitive chez 14 d’entre eux (2,8%). Nous n’avons pas trouvé de corrélation statistiquement significative entre l’hypoparathyroïdie définitive et les caractéristiques cliniques biologiques et le type de chirurgie.Conclusion : Dans la plupart des cas, l’hypocalcémie est liée à un hypoparathyroïdisme transitoire, secondaire au traumatisme ou à la dévascularisation des parathyroïdes. L’hypoparathyroïdie définitive est rare, elle est toujours secondaire à une lésion irréversible des parathyroïdes. Les caractéristiques cliniques initiales des patients et les examens biologiques précoces ne permettent pas de prédire l’évolution.Mots-clés : Thyroïde, chirurgie, hypocalcémie, parathyroïde

Recidive tardive d'un sarcome a cellule claire

Introduction : The clear cell sarcoma (melanoma of soft tissue) is a rare tumor of young adults. Hi occur most commonly in the extremities. We report the case of a man of 70 years, with previous history of a malignant melanoma of the cervical trachea treated by radiotherapy, who present 18 years after Tracheo-esophageal tumor. The tumor was totally removed.Final pathologic diagnosis is a recurrence of his sarcoma cell clear. Three years later, the patient has no signs of recurrence. The aim of this work is to study the clinical features, the prognosis of these cancers and the modality of her treatments.Keywords: the clear cell sarcoma, melanoma of soft tissue, radiotherapy, surgery

Recurrent cardiac events in patients with idiopathic ventricular fibrillation, excluding patients with the Brugada syndrome

BACKGROUND: The recurrence of cardiac events in patients with idiopathic ventricular fibrillation (VF) excluding patients with the Brugada syndrome is unclear since this entity remains present in previous studies. METHODS: Since 1992, 18 patients (72% male) with idiopathic VF out of 455 ICD implants were treated with an implantable cardioverter defibrillator (ICD). The mean age at first ICD implantation was 42 ± 14 years. Brugada syndrome, as well as other primary electrical diseases (e.g. long QT), were systematically excluded in all patients by the absence of the typical electrocardiogram (ST elevation in the right precordial leads) at rest and/or after pharmacological tests (ajmaline, flecainide, or procainamide). Recurrence of cardiac events was prospectively assessed. RESULTS: During a mean follow-up period of 41 ± 27 months, VF recurrence with appropriate shock occurred in 7 patients (39%) covering a total of 27 shocks. The median time to first appropriate shock was 12 ± 9 months. There were no deaths. In the electrophysiological study, 39% of patients were inducible, but inducibility failed to predict subsequent arrhythmic events. Forty-four percent of patients suffered 21 inappropriate shocks, which were caused by sinus tachycardia, atrial arrhythmias or lead malfunction. CONCLUSION: Idiopathic ventricular fibrillation patients have a high recurrence rate of potentially fatal ventricular arrhythmias, excluding patients with the Brugada syndrome or other known causes. ICD prevents sudden cardiac death but inappropriate shocks remained a major issue in this young and active population

Comparative methods for PET image segmentation in pharyngolaryngeal squamous cell carcinoma

Several methods have been proposed for the segmentation of ¹⁸F-FDG uptake in PET. In this study, we assessed the performance of four categories of ¹⁸F-FDG PET image segmentation techniques in pharyngolaryngeal squamous cell carcinoma using clinical studies where the surgical specimen served as the benchmark

Films and critical pedagogy in management education: A tourism studies context

This article examines and critically assesses the role of films in the practice of critical pedagogy in undergraduate management education, using tourism studies as a context. Utilising online focus groups, it aims to gain an in-depth knowledge and understanding of the role of films as an effective pedagogical medium in enhancing experiential approaches to learning. It argues that films play an important role in facilitating critical analyses of the studied phenomenon, illustrating and problematising abstract concepts and ideas, as well as in facilitating students’ ability to discern multiple and alternative discourses about management. The findings highlight the role of films in context-specific critical engagement with the studied content and in stimulating emotionality in learning development, thereby enhancing deep approaches to learning. Emotional responses, even negative ones, prove to be critical in engaging with intellectual and critical reflection after watching films. The findings yield new and empirical insights into the pedagogic use of films in management education, thereby contributing to some of the goals of critical management studies

Gender Differences in Patients with Brugada Syndrome and Arrhythmic Events: Data from a Survey on Arrhythmic Events in 678 Patients.

BACKGROUND: There is limited information on gender differences in patients with Brugada syndrome (BrS) who experienced arrhythmic events (AEs). OBJECTIVES: To compare clinical, electrocardiographic (ECG), electrophysiologic (EP) and genetic characteristics between males and females in BrS-patients with their first AE. METHODS: The multicenter Survey on AE in BrS (SABRUS) collected data on first AE in 678 BrS-patients including 619 (91.3%) males and 59 (8.7%) females aged 0.27 to 84 (mean 42.5±14.1) years at the time of AE. RESULTS: After excluding pediatric patients, females were older than males (49.5±14.4 vs. 43±12.7 years, respectively, P=0.001). Higher proportions of females were observed in the pediatric and elderly populations. In Asians, male/female ratio of AE was ≈9-fold higher compared to Caucasians. Spontaneous type 1 BrS-ECG was associated with earlier onset of AE in pediatric females. A similar prevalence (≈65%) of spontaneous type 1 BrS-ECG was present in males and females above age of 60 years. Females less frequently showed a spontaneous type-1 BrS-ECG (31% vs. 59%, P<0.001) or arrhythmia-inducibility at EP study (34% vs. 64%, P<0.001). An SCN5A mutation was more frequently found in females (47.6% vs. 27.8% in males, P=0.007). CONCLUSIONS: This study confirms that female BrS-patients are much rarer, display less type 1 Brugada-ECG and exhibit lower inducibility rates than males. It shows for the first time that BrS females with AE have higher SCN5A mutation rates as well as the relationship between gender vs. age at onset of AE and ethnicity

Profile of Brugada Syndrome Patients Presenting with Their First Documented Arrhythmic Event. Data from the Survey on Arrhythmic Events in BRUgada Syndrome (SABRUS).

BACKGROUND: Detailed information on the profile of Brugada syndrome (BrS) patients presenting their first arrhythmic event (AE) after prophylactic implantation of a cardioverter defibrillator (ICD) is limited. OBJECTIVES: 1) To compare clinical, electrocardiographic, electrophysiologic and genetic profiles of patients who exhibited their first documented AE as aborted cardiac arrest (CA) (group A) with those in whom the AE was documented after prophylactic ICD implantation (group B); 2) To characterize group B patients' profile using the Class II indications for ICD implantation established by HRS/EHRA/APHRS Expert Consensus Statement in 2013. METHODS: A survey of 23 centers from 10 Western and 4 Asian countries enabled data collection of 678 BrS patients with AE (group A, n=426; group B, n=252). RESULTS: First AE occurred in group B patients 6.7 years later than in group A (46.1+ 13.3 vs. 39.4+15.1, P<0.001). Group B patients had a higher incidence of family history of sudden cardiac death (SCD) and SCN5A mutations. Of the 252 group B patients, 189 (75%) complied with the HRS/EHRA/APHRS indications whereas the remaining 63 (25%) did not. CONCLUSION: BrS patients with first AE documented after prophylactic ICD implantation exhibited their AE at a later age with a higher incidence of positive family history of SCD and SCN5A mutations compared to those presenting with an aborted CA. Only 75% of patients who suffered an AE after receiving a prophylactic ICD complied with the 2013 Class II indications, suggesting efforts are still required for improving risk stratification

Age of First Arrhythmic Event in Brugada Syndrome: Data From the SABRUS (Survey on Arrhythmic Events in Brugada Syndrome) in 678 Patients.

BACKGROUND: Data on the age at first arrhythmic event (AE) in Brugada syndrome are from limited patient cohorts. The aim of this study is 2-fold: (1) to define the age at first AE in a large cohort of patients with Brugada syndrome, and (2) to assess the influence of the mode of AE documentation, sex, and ethnicity on the age at first AE. METHODS AND RESULTS: A survey of 23 centers from 10 Western and 4 Asian countries gathered data from 678 patients with Brugada syndrome (91.3% men) with first AE documented at time of aborted cardiac arrest (group A, n=426) or after prophylactic implantable cardioverter-defibrillator implantation (group B, n=252). The vast majority (94.2%) of the patients were 16 to 70 years old at the time of AE, whereas pediatric (70 years) comprised 4.3% and 1.5%, respectively. Peak AE rate occurred between 38 and 48 years (mean, 41.9±14.8; range, 0.27-84 years). Group A patients were younger than in Group B by a mean of 6.7 years (46.1±13.2 versus 39.4±15.0 years; P<0.001). In adult patients (≥16 years), women experienced AE 6.5 years later than men (P=0.003). Whites and Asians exhibited their AE at the same median age (43 years). CONCLUSIONS: SABRUS (Survey on Arrhythmic Events in Brugada Syndrome) presents the first analysis on the age distribution of AE in Brugada syndrome, suggesting 2 age cutoffs (16 and 70 years) that might be important for decision-making. It also allows gaining insights on the influence of mode of arrhythmia documentation, patient sex, and ethnic origin on the age at AE

Fever-related arrhythmic events in the multicenter Survey on Arrhythmic Events in Brugada Syndrome

BACKGROUND: The literature on fever related arrhythmic events (AE) in Brugada syndrome (BrS) is currently limited to few case reports and small series. OBJECTIVE: The current study aims to describe the characteristics of fever-related AE in a large cohort of BrS patients. METHODS: SABRUS is a multicenter study on 678 BrS patients with first AE documented at time of aborted cardiac arrest (ACA) (n=426) or after prophylactic ICD implantation (n=252). RESULTS: In 35(6%) of the 588 patients with available information, the AE occurred during a febrile illness. Most of the 35 patients were male (80%), Caucasian (83%) and proband (70%). Age at time of AE was 29±24 (range 0.3-76) years. Most patients (80%) presented with ACA and 6 (17%) with arrhythmic storm. Family history of sudden death, history of syncope and spontaneous type 1 Brugada-ECG were noted in 17%, 40% and 66% of patients, respectively. VF was induced at EPS in 9/19(47%) patients. An SCN5A mutation was found in 14/28(50%) patients. The highest proportion of fever-related AE was observed in the pediatric population (age <16), with disproportionally higher event rate in the very young (0-5 years old) (65%). Males were involved in all age groups and females only in the pediatric and elderly groups. Fever-related AE affected 17 Caucasians aged<24 years, but no Asians aged <24 years. CONCLUSIONS: The risk of fever-related AE in BrS markedly varies according to age group, gender and ethnicity. Taking these factors into account could help the clinical management of BrS patients with fever