Clustering local tourism systems by threshold acceptance

Despite the importance of tourism as a leading industry in the development of a country's economy, there is a lack of criteria and methodologies for the detection, promotion and governance of local tourism systems. We propose a quantitative approach for the detection of local tourism systems that are optimal with respect to geographical, economic, and demographical criteria. To this end, we formulate the issue as an optimization problem, and we solve it by means of Threshold Acceptance, a meta-heuristic algorithm which does not require us to predefine the number of clusters and also does not require all geographic areas to belong to a cluster

Early and empirical high-dose cryoprecipitate for hemorrhage after traumatic injury: The CRYOSTAT-2 randomized clinical trial

Critical bleeding is associated with a high mortality rate in patients with trauma. Hemorrhage is exacerbated by a complex derangement of coagulation, including an acute fibrinogen deficiency. Management is fibrinogen replacement with cryoprecipitate transfusions or fibrinogen concentrate, usually administered relatively late during hemorrhage. To assess whether survival could be improved by administering an early and empirical high dose of cryoprecipitate to all patients with trauma and bleeding that required activation of a major hemorrhage protocol. CRYOSTAT-2 was an interventional, randomized, open-label, parallel-group controlled, international, multicenter study. Patients were enrolled at 26 UK and US major trauma centers from August 2017 to November 2021. Eligible patients were injured adults requiring activation of the hospital's major hemorrhage protocol with evidence of active hemorrhage, systolic blood pressure less than 90 mm Hg at any time, and receiving at least 1 U of a blood component transfusion. Patients were randomly assigned (in a 1:1 ratio) to receive standard care, which was the local major hemorrhage protocol (reviewed for guideline adherence), or cryoprecipitate, in which 3 pools of cryoprecipitate (6-g fibrinogen equivalent) were to be administered in addition to standard care within 90 minutes of randomization and 3 hours of injury. The primary outcome was all-cause mortality at 28 days in the intention-to-treat population. Among 1604 eligible patients, 799 were randomized to the cryoprecipitate group and 805 to the standard care group. Missing primary outcome data occurred in 73 patients (principally due to withdrawal of consent) and 1531 (95%) were included in the primary analysis population. The median (IQR) age of participants was 39 (26-55) years, 1251 (79%) were men, median (IQR) Injury Severity Score was 29 (18-43), 36% had penetrating injury, and 33% had systolic blood pressure less than 90 mm Hg at hospital arrival. All-cause 28-day mortality in the intention-to-treat population was 26.1% in the standard care group vs 25.3% in the cryoprecipitate group (odds ratio, 0.96 [95% CI, 0.75-1.23]; P = .74). There was no difference in safety outcomes or incidence of thrombotic events in the standard care vs cryoprecipitate group (12.9% vs 12.7%). Among patients with trauma and bleeding who required activation of a major hemorrhage protocol, the addition of early and empirical high-dose cryoprecipitate to standard care did not improve all cause 28-day mortality. ClinicalTrials.gov Identifier: NCT04704869; ISRCTN Identifier: ISRCTN14998314

Impact of Urban Conditions of Firm Performance of Migrant Entrepreneurs: A Comparative Dutch - US Study

Recent studies on ethnic entrepreneurship have pointed at an increasing share of migrants in urban small- and medium-sized entrepreneurial businesses. These migrant activities are crucial to the urban economy in many countries, as they employ a significant part of the workforce. The main objective of our study is to identify success conditions of ethnic entrepreneurship by using concepts from social capital and human capital from the literature on empirical factors that are responsible for successful ethnic entrepreneurship. The empirical part of the paper is based on a survey questionnaire among migrant entrepreneurs in the city of Amsterdam in the Netherlands and in Fairfax, County in the state of Virginia in the US. We present an overview of cultural, ethno-psychological and motivational aspects that contribute to the understanding of similarities and differences between ethnic entrepreneurs in both locations. The analysis is structured around several dimensions of social and human capital including personal and business characteristics, and network participation for improving business performance. The findings of the two studies are compared to explore a possible correspondence in business performance patterns. The research tool used to assess performance is Data Envelopment Analysis (DEA), a technique for comparative efficiency analysis in various types of corporate organizations. Finally, concluding remarks are presented and possible extensions of the analysis are suggested. © Springer-Verlag 2009

Roma y la renovácion de la imagen y el espacio sacro en Chile durante el siglo XIX

A partir de la cuarta década del siglo XIX la élite intelectual chilena comenzó a referirse a la necesidad de renovar el espacio y la imagen sagrada. La construcción de la nueva nación requería una iglesia moderna que cultivara en los fieles una piedad ilustrada, propósito que requería la supresión del espacio y la imagen barroca, cuyas formas promovían una religiosidad que se consideraba inapropiada. Esta misma élite instaló el prestigio de Roma, de sus iglesias, altares e imágenes, como un faro al cual debían remitirse los arquitectos, escultores y pintores que colaborarían en esta regeneración del espacio y la imagen sagrada. La actividad en Chile de arquitectos y escultores formados en Roma, así como la llegada de obras ejecutadas en los talleres de la Ciudad Eterna, fueron factores decisivos para hacer realidad este proyecto de renovación. Sin embargo, la documentación local registra una resistencia pasiva de la población a estos cambios concebidos por la élite. Los casos de las iglesias de la Recoleta Dominica, del archipiélago de Chiloé, de San Ignacio, de Andacollo y de la capilla del Seminario de Santiago, que se revisarán en el presente texto, permiten conocer las diversas formas de transferencia y apropiación de estos nuevos modelos

A critical review of non invasive procedures for the evaluation of body iron burden in thalassemia major patients

It is evident that different non invasive methodologies have been implemented for the detection of organ specific iron burden in patients with thalassemia major. Among these MR relaxometry has the potential to become the method of choice for non-invasive, safe and accurate assessment of organ-specific iron load, although further theoretical research, along with studies monitoring wider age groups of patients, is needed. Moreover, the possibility of detecting organ-specific iron burden is relevant for tailoring specific chelation treatment in different patients or in the same patient during different periods of life. In fact, while heart organ-specific effect has been suggested by MR relaxometry for some chelation treatments, it is possible to suppose that another single chelator or association of other chelators may show different organ-specific effects. For these reasons, the future of our clinical research will be to understand, mainly by MR relaxometry, whether it would be possible to set up a tailored organ-specific chelation treatment, according to this supposed difference in organ efficacy of the current chelation therapies