The economic contribution of protected natural areas: benefits from human use

This paper presents two examples from Australia where economic contributions from human use of protected natural areas have been quantified and a clear argument for increased investment in management resources generated

Assessment of the economic value of cultural heritage tourism in the City of Perth, Western Australia

This study measured the direct annual overnight visitor expenditure attributable to cultural heritage in the City of Perth local government area. Appendix 1 provides the project terms of reference.A visitor expenditure survey was used to estimate the average expenditure per visitor per day in the City of Perth. The annual expenditure of all visitors was then calculated by multiplying this figure by the average number of annual overnight visitors (domestic and international) and then multiplying by the average length of stay. In order to determine the proportion of the total visitor expenditure directly attributable to cultural heritage, an attribution factor was generated using a number of variables derived from the visitor survey. The attribution factor was multiplied by the total annual visitor expenditure to create a best estimate of the economic value of heritage tourism

Wine tourism among Generations X and Y

This paper examines the wine tourism experience from the perspective of young adults, specifically Generation X and Y consumers. Both the wine industry and wine tourism destinations have a particular interest in learning more about these age cohorts, as wine consumption and wine-related travel have been dominated by older adults. Little research has focused on Gen X and Y and how they might become more involved. Accordingly, in this paper their motivation for taking a winery tour, level of ego-involvement with wine, and how they got involved with wine in the first place are all assessed. Data were obtained using a self-completed questionnaire of customers of a wine tour company called Wine for Dudes that operates in Margaret River, Western Australia. These young wine tourists displayed a low level of ego-involvement with wine; they were mostly interested in learning about wine in a social context. The findings reinforces previous research indicating that many wine lovers (especially females and young consumers) are primarily interested in the hedonistic pleasure and social experiences associated with wine. The paper concludes with a theoretical discussion of how young wine consumers become involved with wine and wine tourism, including suggestions for further research

The business of cultural heritage tourism: critical success factors

This paper explores critical success factors (CSFs) required for cultural heritage tourism (CHT) operation and how these relate to commercial focus. The literature indicates tension between conservation of authenticity and commercial focus as it is seen to undermine authenticity, potentially degrading its quality and ultimate success as a tourism product. A list of nine key CHT business success factors was devised based on the published literature. Managers and operators of a range of Australian CHT operations were interviewed regarding achievement of CSFs. The operations were broadly categorised according to the level of commercial focus. The level of commercial focus was cross tabulated with the number of CHT business CSFs achieved. While all places in this study had addressed authenticity, CHT places presenting highly commercialised products tended to meet the criteria for achieving a greater number of CSFs than their less commercialised counter-parts. This has implications for sustainable CHT operation practices

Effect of amiloride, or amiloride plus hydrochlorothiazide, versus hydrochlorothiazide on glucose tolerance and blood pressure (PATHWAY-3):a parallel-group, double-blind randomised phase 4 trial

This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/S2213-8587(15)00377-0Background Potassium depletion by thiazide diuretics is associated with a rise in blood glucose. We assessed whether addition or substitution of a potassium-sparing diuretic, amiloride, can prevent glucose intolerance and improve blood pressure control.\ud \ud Methods We undertook a parallel-group, randomised, double-blind trial in 11 secondary and 2 primary care sites in the UK, with enrolment from 18th November 2009 to 15th December 2014. Patients eligible for enrolment were aged 18-80, had systolic BP on permitted background treatment ? 140 mmHg and home systolic BP ? 130mmHg, and they had at least one component of the metabolic syndrome additional to hypertension. Patients were randomly assigned (1:1:1) to 24 weeks treatment with amiloride 10 mg, hydrochlorothiazide (HCTZ) 25 mg, or the combination of both diuretics at half these doses (5/12.5 mg). Random assignment was through a central computer system. There was forced dose-doubling after 12 weeks. Our hierarchical primary endpoints, assessed on an intention-to-treat basis at 12 and 24 weeks, were the differences from baseline in blood glucose measured two hours after a 75 g oral glucose tolerance test (OGTT), compared first between HCTZ and amiloride and then between HCTZ and combination. Secondary endpoints included differences in home systolic BP, plasma electrolytes and renin. This trial is registered with ClinicalTrials.gov, number NCT00797862, and the MHRA, Eudract number 2009?010068?41.\ud \ud Findings 145 patients were randomly assigned to amiloride, 146 to HCTZ, and 150 to HCTZ plus amiloride. 132, 134 and 133, respectively from these groups were available for analysis. Two-hour glucose on OGTT rose in patients receiving HCTZ but fell in patients receiving amiloride. The average difference, at 12 and 24 weeks, between HCTZ and amiloride was 0?55 mmol/L (95% CI 0?14,0?96) (p=0?0093); between HCTZ and low-dose combination, the difference was 0?42 mmol/L (0?004,0?84) (p=0?048). The reduction in home systolic BP, averaged over 24 weeks, was similar on amiloride (-14?7 mmHg (-16?7,-12?6)) and HCTZ (-14?0 mmHg (-15?9,-12?0)), but the reduction on the half-dose combination (-17?5 mmHg (-19?6,-15?5) was 3?4 (0?9, 5?8) mmHg greater than on HCTZ (p=0?0068). Hyperkalaemia was reported in 0, 3 (2%) and 7 (4?8%) of the HCTZ, combination and amiloride groups, respectively; the highest recorded K+ was 5?8 mmol/L. Serious adverse events occurred in 7 (4.8%), 2 (1.4%) and 4 (2.7%) (p=0.21).\ud \ud Interpretation Combination of amiloride with hydrochlorothiazide, at doses equipotent on BP, prevents glucose intolerance and improves BP control. These findings, and previous morbidity-mortality data for the combination, support its first-line use in patients requiring diuretic therapy for hypertension.The study was funded by a special project grant from the British Heart Foundation (number SP/08/002), and support from National Institute of Health Research Comprehensive Local Research Networks

Leadership Training in Endocrinology Fellowship? A Survey of Program Directors and Recent Graduates

Context: There is growing recognition that more physician leaders are needed to navigate the next era of medicine. Objective: To determine current opinions about leadership training in endocrinology fellowship programs. Design/Participants: Twenty-seven-question survey addressing various aspects of leadership training to current nationwide fellowship program directors (PDs) and fellowship graduates since 2010. Intervention: In partnership with the Endocrine Society, the electronic survey was advertised primarily via direct e-mail. It was open from March through July 2016. Main Outcome Measures: The survey addressed leadership traits, importance of leadership training, preferred timing, and content of leadership training. Results: Forty-six of 138 PDs (33.3%) and 147 of 1769 graduates (8.3%) completed the survey. Among PDs and graduates, there was strong agreement (\u3e95%) about important leadership characteristics, including job knowledge, character traits, team-builder focus, and professional skills. PDs (64.5%) and graduates (60.8%) favored teaching leadership skills during fellowship, with PDs favoring mentoring/coaching (75.0%), direct observation of staff clinicians (72.5%), and seminars (72.5%). Graduates favored a variety of approaches. Regarding topics to include in a leadership curriculum, PDs responded that communication skills (97.5%), team building (95.0%), professional skills (90.0%), clinic management (87.5%), strategies to impact the delivery of endocrinology care (85.0%), and personality skills (82.5%) were most important. Graduates responded similarly, with \u3e80% agreement for each topic. Finally, most PDs (89%) expressed a desire to incorporate more leadership training into their programs. Conclusions: Our survey suggests a need for leadership training in endocrinology fellowships. More work is needed to determine how best to meet this need

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]