Role of Travel Motivations, Perceived Risks and Travel Constraints on Destination Image and Visit Intention in Medical Tourism

Travel motivations, perceived risks and travel constraints, along with the attributes and characteristics of medical tourism destinations, are important issues in medical tourism. Although the importance of these factors is already known, a comprehensive theoretical model of the decision-making process of medical tourists has yet to be established, analysing the intricate relationships between the different variables involved. This article examines a large body of literature on both medical and conventional tourism in order to propose a comprehensive theoretical framework of medical tourism decision-making. Many facets of this complex phenomenon require further empirical investigation

Role of Travel Motivations, Perceived Risks and Travel Constraints on Destination Image and Visit Intention in Medical Tourism : Theoretical model

Travel motivations, perceived risks and travel constraints, along with the attributes and characteristics of medical tourism destinations, are important issues in medical tourism. Although the importance of these factors is already known, a comprehensive theoretical model of the decision-making process of medical tourists has yet to be established, analysing the intricate relationships between the different variables involved. This article examines a large body of literature on both medical and conventional tourism in order to propose a comprehensive theoretical framework of medical tourism decision-making. Many facets of this complex phenomenon require further empirical investigation.Keywords:

An Intelligent Advisor for City Traffic Policies

Nowadays, city streets are populated not only by private vehicles but also by public transport, fleets of workers, and deliveries. Since each vehicle class has a maximum cargo capacity, we study in this article how authorities could improve the road traffic by endorsing long term policies to change the different vehicle proportions: sedans, minivans, full size vans, trucks, and motorbikes, without losing the ability of moving cargo throughout the city. We have performed our study in a realistic scenario (map, road traffic characteristics, and number of vehicles) of the city of Malaga and captured the many details into the SUMO microsimulator. After analyzing the relationship between travel times, emissions, and fuel consumption, we have defined a multiobjective optimization problem to be solved, so as to minimize these city metrics. Our results provide a scientific evidence that we can improve the delivery of goods in the city by reducing the number of heavy duty vehicles and fostering the use of vans instead.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. This research has been partially funded by the Spanish MINECO and FEDER projects TIN2014-57341-R, TIN2016-81766-REDT, and TIN2017-88213-R. University of Malaga, Andalucia TECH. Daniel H. Stolfi is supported by a FPU grant (FPU13/00954) from the Spanish MECD. Christian Cintrano is supported by a FPI grant (BES-2015-074805) from Spanish MINECO

Settlement Improvement of Weak Soil of Natural Moisture Content by Using Geogrid Reinforcement Under Different Dynamic Load

مقدمة: تهدف الدراسة الى تحديد تأثير ال (Geogrid reinforcement sheet) على تحسين الخواص الهندسية للتربة الضعيفة والتي تحتوي على محتوى مائي قدره 16% اثناء تعرضها الى احمال ديناميكية بأوزان مختلفة (4,5 و 7,5 و 10) كيلوغرام وبعدد ضربات (5 و 10) لكل حمل ديناميكي وبأماكن مختلفة على سطح التربة الموجودة في الموديل لايجاد قدرة تحمل التربة (bearing capacity) ومقدار التأثير على تقليل تجلس بالتربة عند تعرضها الى الاحمال المتحركة والاهتزازات الطبيعية او الحياتية. بينت نتائج الدراسة بالنسبة للفقرة (أ) ان النسبة المئوية للفرق بين النسبة المئوية للتجلس بدون استخدام (Geogrid sheet) والنسبة المئوية عند استخدام (Geogrid sheet) بالنسبة للتربة ذات الرطوبة الطبيعية (16%) للاوزان 4,5 و 7,5 و 10 كيلوغرام بتسليط عدد ضربات 5 و 10 . عند تحميل وزن ديناميكي (4,5) كان فرق النسبة المئوية (1,2 و 1,8) وفي وزن (7,5) كيلوغرام هي (2,1% و 2.7%) وفي وزن (10) كيلوغرام يكون (1,7% و 2,7%).    وتكون النتائج عن الفرق بين معدل النسبة المئوية لتجلس التربة بدون استخدام (Geogrid sheet) والنسبة المئوية عند استخدام (Geogrid sheet) للتربة النصف مشبعة هي (5,6% و 14,4% و (5,9% و 5,4%) و (4,1% و 6,7%) لنفس الاوزان وعدد الضربات على التوالي. اما بالنسبة للترب المشبعة تكون النتائج كالآتي: (12,8% و 22,9%) و (9,9% و 15,7%) و (16,6% و 5,7%) لنفس الاوزان وعدد الضربات على التوالي.One of new method to improve the bearing capacity of weak soil is  by using  geosynthetic reinforcement materials that has become more common in past 40 years for a number of applications to reduce the cost of maintences by increasing design life. This study concerned with the behavior of weak soil and the amount of settlement that happened when the soil exposed to different weight load with different number of blows . Field and laboratory tests done to calculate soil settlement. For experimental tests a model with dimension (150×75×75cm) has been manufactured, clayey silty sand soil in model exposed to different dynamic weight by using load with ( 4.5kg), load with (7.5kg) and load with (10kg). Each load strick the soil with 9 5 and 10) blows during an experiment for each dynamic load. 12 Laboretory experiments were conductedon 38 test points, 6 experiments done on soil without geogrid and 6 experiments done on soil with geogrid that included 19 test point for each case. The experiments tests show that by increasing the weight load and increasing in number of blows settlement increase in both cases ( without and with geogrid). The experiments show that by using geogrid the settlement decrease comparison with the amount of soil settlement without geogrid. By using geogrid and exposed to weight loads ( 4.5, 7.5 and 10kg.) with No. of blows = 5 the average percent in settlement decrease 1.2, 2.1,1.7%) and with No. of blows =10 for the same loads the average percent of settlement decrease (1.8, 2.7, 2.7%). &nbsp

Role of cardiac energetics in aortic stenosis disease progression: identifying the high-risk metabolic phenotype

Background: Severe aortic stenosis (AS) is associated with left ventricular (LV) hypertrophy and cardiac metabolic alterations with evidence of steatosis and impaired myocardial energetics. Despite this common phenotype, there is an unexplained and wide individual heterogeneity in the degree of hypertrophy and progression to myocardial fibrosis and heart failure. We sought to determine whether the cardiac metabolic state may underpin this variability. Methods: We recruited 74 asymptomatic participants with AS and 13 healthy volunteers. Cardiac energetics were measured using phosphorus spectroscopy to define the myocardial phosphocreatine to adenosine triphosphate ratio. Myocardial lipid content was determined using proton spectroscopy. Cardiac function was assessed by cardiovascular magnetic resonance cine imaging. Results: Phosphocreatine/adenosine triphosphate was reduced early and significantly across the LV wall thickness quartiles (Q2, 1.50 [1.21–1.71] versus Q1, 1.64 [1.53–1.94]) with a progressive decline with increasing disease severity (Q4, 1.48 [1.18–1.70]; P=0.02). Myocardial triglyceride content levels were overall higher in all the quartiles with a significant increase seen across the AV pressure gradient quartiles (Q2, 1.36 [0.86–1.98] versus Q1, 1.03 [0.81–1.56]; P=0.034). While all AS groups had evidence of subclinical LV dysfunction with impaired strain parameters, impaired systolic longitudinal strain was related to the degree of energetic impairment (r=0.219; P=0.03). Phosphocreatine/adenosine triphosphate was not only an independent predictor of LV wall thickness (r=−0.20; P=0.04) but also strongly associated with myocardial fibrosis (r=−0.24; P=0.03), suggesting that metabolic changes play a role in disease progression. The metabolic and functional parameters showed comparable results when graded by clinical severity of AS. Conclusions: A gradient of myocardial energetic deficit and steatosis exists across the spectrum of hypertrophied AS hearts, and these metabolic changes precede irreversible LV remodeling and subclinical dysfunction. As such, cardiac metabolism may play an important and potentially causal role in disease progression

Genetic analysis of resistance to septoria tritici blotch in the French winter wheat cultivars Balance and Apache

The ascomycete Mycosphaerella graminicola is the causal agent of septoria tritici blotch (STB), one of the most destructive foliar diseases of bread and durum wheat globally, particularly in temperate humid areas. A screening of the French bread wheat cultivars Apache and Balance with 30 M. graminicola isolates revealed a pattern of resistant responses that suggested the presence of new genes for STB resistance. Quantitative trait loci (QTL) analysis of a doubled haploid (DH) population with five M. graminicola isolates in the seedling stage identified four QTLs on chromosomes 3AS, 1BS, 6DS and 7DS, and occasionally on 7DL. The QTL on chromosome 6DS flanked by SSR markers Xgpw5176 and Xgpw3087 is a novel QTL that now can be designated as Stb18. The QTLs on chromosomes 3AS and 1BS most likely represent Stb6 and Stb11, respectively, and the QTLs on chromosome 7DS are most probably identical with Stb4 and Stb5. However, the QTL identified on chromosome 7DL is expected to be a new Stb gene that still needs further characterization. Multiple isolates were used and show that not all isolates identify all QTLs, which clearly demonstrates the specificity in the M. graminicola–wheat pathosystem. QTL analyses were performed with various disease parameters. The development of asexual fructifications (pycnidia) in the characteristic necrotic blotches of STB, designated as parameter P, identified the maximum number of QTLs. All other parameters identified fewer but not different QTLs. The segregation of multiple QTLs in the Apache/Balance DH population enabled the identification of DH lines with single QTLs and multiple QTL combinations. Analyses of the marker data of these DH lines clearly demonstrated the positive effect of pyramiding QTLs to broaden resistance spectra as well as epistatic and additive interactions between these QTLs. Phenotyping of the Apache/Balance DH population in the field confirmed the presence of the QTLs that were identified in the seedling stage, but Stb18 was inconsistently expressed and might be particularly effective in young plants. In contrast, an additional QTL for STB resistance was identified on chromosome 2DS that is exclusively and consistently expressed in mature plants over locations and time, but it was also strongly related with earliness, tallness as well as resistance to Fusarium head blight. Although to date no Stb gene has been reported on chromosome 2D, the data provide evidence that this QTL is only indirectly related to STB resistance. This study shows that detailed genetic analysis of contemporary commercial bread wheat cultivars can unveil novel Stb genes that can be readily applied in marker-assisted breeding programs

Effect of heat treatment on surface morphology of titanium

Alkali and heat treatments were first introduced by Kim et al. to prepare a bioactive surface on titanium. This method has been proven very effective and widely used in biomaterial researches to promote titanium osteointegration. This study aims to investigate further the effect of heat treatment on surface morphology of high purity titanium. High purity titanium foils were immersed in 5 M NaOH at 60oC for 24 hours followed by heat treatment at 400oC, 500oC, 600oC, 700oC and 800oC for 1 hour in air atmosphere. The surface morphology was examined using Field Emission Scanning Electron Microscope (FESEM). The surface topography and surface roughness were obtained using Atomic Force Microscopy (AFM). A structure transformation accompanied by significant grain growth were observed as temperature increased from 400oC to 800oC.As temperature increased, the grain coarsened and became larger in size which is in good agreement with the increasing surface roughness. A sudden decrease in surface roughness of titanium at 800oC might be due to the spallation of oxide laye

Characteristics of calcined palm oil pastes for biosilica extraction as a function of calcination temperatures

Palm oil production in Malaysia has increased over the years. As the consequence of high production of palm oil, surplus quantities of palm oil biomass wastes such as empty fruit bunches (EFB), palm kernel shell (PKS), and oil palm decanter cake (DC) are generated. Generally, these wastes are used as fuel to generate steam for boilers, which end up as ash. As several agricultural wastes are well-known to be rich in silica content, this study aims to investigate the bio-silica content of EFB, PKS and DC and their characteristics when calcined at various calcination temperatures from 400°C to 800°C. Several analyses were conducted such as weight loss, color, BET, SEM and FTIR. The results have shown that all samples favorably exhibited silica at higher temperatures, i.e., 800°C. Color analysis depicted that combustible elements were mostly removed at 800°C, leaving non-combusted silica in the waste ash. Weight loss analysis presented that EFB achieved the highest weight loss at 99.05%, followed by PKS at 95.65% and DC at 83.95%. This led to a relatively high amount or purity of silica in the sample. BET analysis showed highest surface area, 20.087m2/g (PKS) and the lowest is 9.492m2/g (DC) at 800°C which verified the high porosity of samples for further absorption applications. The presence of silica was also significantly observed in 800°C FTIR spectra for all waste samples. Overall, it is concluded that EFB, PKS, and DC are highly potential wastes to contribute to the production of bio-silica, which thus can be an option to overcome waste disposal issues in palm oil industries

Assessment of Cardiac Energy Metabolism, Function, and Physiology in Patients With Heart Failure Taking Empagliflozin : The Randomized, Controlled EMPA-VISION Trial

Acknowledgments The authors express their gratitude toward the Oxford cardiovascular magnetic resonance nursing team, specifically Judith DeLos Santos, Catherine Krasopoulos, Marion Galley, and Claudia Nunes; and the diabetes trials unit team, particularly Irene Kennedy, for her organization skills. The authors also thank the team of the computed tomography suite at the Manor Hospital Oxford as well as all patients who participated in this trial. Drs Holman and Neubauer are Emeritus National Institute for Health Research senior investigators. The views expressed are those of the author(s) and not necessarily those of the National Health Service, National Institute for Health and Care Research, or Department of Health. Sources of Funding Boehringer Ingelheim is the sponsor of the EMPA-VISION study and was involved in early stages of its study design. Boehringer Ingelheim employees (Drs Lee and Massey) also supported preparation of this manuscript. Dr Neubauer acknowledges support from the Oxford British Heart Foundation Centre of Research Excellence. Drs Holman and Neubauer were supported by the Oxford National Institute for Health Research Biomedical Research Centre. Drs Rodgers and Valkovič are funded by Sir Henry Dale Fellowships from the Wellcome Trust and the Royal Society [098436/Z/12/B and 221805/Z/20/Z, respectively]. Dr Valkovič also gratefully acknowledges support of the Slovak Grant Agencies VEGA (Vedecká grantová agentúra) [2/0003/20] and APVV (Slovak Research and Development Agency) [No. 19–0032]. Dr Miller acknowledges support from the Novo Foundation (NNF21OC0068683).Peer reviewedPublisher PD