The Importance of Liminality and Communitas or Getting Lost in Venice

Venice bears the distinction of being the most touristed city in the world. Way finding in Venice is a substantial challenge to those unfamiliar with the city. Interviews of tourists to Venice indicate that all but two became lost at least once during their visit. Interviewees reported that they were never scared or frightened. Indeed, most indicated that getting lost was “part of the fun.” We argue that research by Urry, Graburn and Esposito are useful in understanding how a normally frightening experience, getting lost in an unfamiliar place, can be understood as enjoyable when on vacation

The fantasy of authenticity: touring with Lacan

Amidst the plethora of research regarding the meaning of authenticity, there remains uncertainty as to the work authenticity performs in tourism. Existential authenticity conceptually shifts focus from the objects of touristic practice to a sense of Being, suggesting that authenticity can be achieved, albeit only in the liminal moments of tourism experiences. Psychoanalysis would contend otherwise – authenticity will always be beyond our reach. In a 2006 publication, Tim Oakes broaches the topic when discussing authenticity as “an abyss”. We revisit that idea, developing it further through the lens of Lacanian psychoanalysis to argue that authenticity is a fantasy. It is not an empty concept, however, but like all fantasies authenticity does important work, particularly in tourism marketing and touristic motivation and experience. To better understand how authenticity as a fantasy fosters tourism desire, it is necessary to develop a conceptual understanding of alienation in relation to tourism motivation. This paper moves alienation from the periphery to the center of tourism theories, demonstrates the dialectical relationship of authenticity/alienation, and posits that as a fantasy authenticity is a malleable concept that has the ability to contextualize the “something” that is missing from our lives. As such, it will remain salient in tourism

Wilderness state of mind: expanding authenticity

This paper challenges the overuse of existential authenticity as a categorical umbrella encapsulating touristic experience and contributes new insights to the way postmodern authenticity is defined in tourism research. To date, studies associated with postmodern authenticity have focused on the inauthentic and themed, with scholars contending that it speaks more to the consumptive, the superficial, and the trivial than to the substantive and meaningful. By working through a case study focused on nature tourists in pursuit of authentic wilderness experiences, this paper illustrates the ways postmodern authenticity encompasses much more than cynical authenticity, for while the American wilderness may be a hyperreal, and even hypernatural, simulacrum, nature tourists nevertheless report deep, meaningful, and " authentic " engagements with wilderness

Touring as a Peircean habit

The Peircean sign contains three parts: object, representamen (image) and interpretant (interpretation). Interpretation in the Peircean system draws heavily upon the accumulated knowledge that an individual has built up over time. Interpretation might be thoughtful, but more often it is an embodied habit. The Peircean notion of habit inherently relates to the performative and is sufficiently general to incorporate emotionality

Comparative economic evaluation of data from the ACRIN national CT colonography trial with three cancer intervention and surveillance modeling network microsimulations

Purpose: To estimate the cost-effectiveness of computed tomographic (CT) colonography for colorectal cancer (CRC) screening in average-risk asymptomatic subjects in the United States aged 50 years. Materials and Methods: Enrollees in the American College of Radiology Imaging Network National CT Colonography Trial provided informed consent, and approval was obtained from the institutional review board at each site. CT colonography performance estimates from the trial were incorporated into three Cancer Intervention and Surveillance Modeling Network CRC microsimulations. Simulated survival and lifetime costs for screening 50-year-old subjects in the United States with CT colonography every 5 or 10 years were compared with those for guideline-concordant screening with colonoscopy, flexible sigmoidoscopy plus either sensitive unrehydrated fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT), and no screening. Perfect and reduced screening adherence scenarios were considered. Incremental cost-effectiveness and net health benefits were estimated from the U.S. health care sector perspective, assuming a 3% discount rate. Results: CT colonography at 5- and 10-year screening intervals was more costly and less effective than FOBT plus flexible sigmoidoscopy in all three models in both 100% and 50% adherence scenarios. Colonoscopy also was more costly and less effective than FOBT plus flexible sigmoidoscopy, except in the CRC-SPIN model assuming 100% adherence (incremental cost-effectiveness ratio: $26 300 per life-year gained). CT colonography at 5- and 10-year screening intervals and colonoscopy were net beneficial compared with no screening in all model scenarios. The 5-year screening interval was net beneficial over the 10-year interval except in the MISCAN model when assuming 100$50 000 per life-year gained. Conclusion: All three models predict CT colonography to be more costly and less effective than non-CT colonographic screening but net beneficial compared with no screening given model assumptions

Small-Scale Dynamic Aurora

Small-scale dynamic auroras have spatial scales of a few km or less, and temporal scales of a few seconds or less, which visualize the complex interplay among charged particles, Alfvén waves, and plasma instabilities working in the magnetosphere-ionosphere coupled regions. We summarize the observed properties of flickering auroras, vortex motions, and filamentary structures. We also summarize the development of fundamental theories, such as dispersive Alfvén waves (DAWs), plasma instabilities in the auroral acceleration region, ionospheric feedback instabilities (IFI), and the ionospheric Alfvén resonator (IAR)

Racial differences in prostate inflammation: Results from the REDUCE study

Prostate cancer (PC) risk differs between races, and we previously showed prostate inflammation in benign prostate tissue was linked with a lower future PC risk. However, whether prostate tissue inflammation varies by race is unknown. We analyzed baseline acute and chronic prostate inflammation by race in REDUCE, a 4-year, multicenter, placebo-controlled study where all men had a negative prostate biopsy prior to enrollment. We included 7,982 men with standardized central pathology review to determine the presence or absence of chronic or acute inflammation in baseline prostate biopsy tissue. Logistic regression was used to compare prostate inflammation by race, adjusting for confounders. Of 7,982 men, 7,271 were white (91.1%), 180 (2.3%) black, 131 (1.6%) Asian, 319 (4.0%) Hispanic and 81 (1%) unknown. A total of 78% had chronic and 15% had acute inflammation. On multivariable analysis relative to white men, black men were less likely (OR = 0.65, 95%CI: 0.41-1.03

Clinical characteristics of emergency department heart failure patients initially diagnosed as non-heart failure

BACKGROUND: Since previous studies suggest the emergency department (ED) misdiagnosis rate of heart failure is 10–20% we sought to describe the characteristics of ED patients misdiagnosed as non-decompensated heart failure in the ED. METHODS: We analyzed a prospective convenience sample of 439 patients at 4 emergency departments who presented with signs or symptoms of decompensated heart failure. Patients with a cardiology criterion standard diagnosis of decompensated heart failure and an ED diagnosis of decompensated heart failure were compared to patients with a criterion standard of decompensated heart failure but no ED diagnosis of decompensated heart failure. Two senior cardiology fellows retrospectively determined the patient's heart failure status during their acute ED presentation. The Mann-Whitney u-test for two groups, the Kruskall-Wallis test for multiple groups, or Chi-square tests, were used as appropriate. RESULTS: There were 173 (39.4%) patients with a criterion standard diagnosis of decompensated heart failure. Among those with this criterion standard diagnosis of decompensated heart failure, discordant patients without an ED diagnosis of decompensated heart failure (n = 58) were more likely to have a history of COPD (p = 0.017), less likely to have a previous history of heart failure (p = 0.014), and less likely to have an elevated b-type natriuretic peptide (BNP) level (median 518 vs 764 pg/ml; p = 0.038) than those who were given a concordant ED diagnosis of decompensated heart failure. BNP levels were higher in those with a criterion standard diagnosis of decompensated heart failure than in those without a criterion standard diagnosis (median 657 vs 62.7 pg/ml). However, 34.6% of patients with decompensated heart failure had BNP levels in the normal (<100 pg/ml; 6.1%) or indeterminate range (100–500 pg/ml; 28.5%). CONCLUSION: We found the ED diagnoses of decompensated heart failure to be discordant with the criterion standard in 14.3% of patients, the vast majority of which were due to a failure to diagnose heart failure when it was present. Patients with a previous history of COPD, without a previous history of heart failure and with lower BNP levels were more likely to have an ED misdiagnosis of non-decompensated heart failure. Readily available, accurate, objective ED tests are needed to improve the early diagnosis of decompensated heart failure in ED patients