Decomposing Joint vs. Separate Evaluation Modes in Destination Choice Sets

The purpose of this study was to assess the practical values of the choice sets in the stage 2 by decomposing joint (considering multiple destinations for a pleasure trip) vs. separate (considering only one destination) evaluation modes. Throughout the survey questionnaire, tourists who were in joint evaluation (JE) or separate evaluation (SE) were identified, and significant predictors influencing them to engage in each evaluation mode were found. Logistic regression revealed that female, repeated visitors, and high income tourists living out of the State are more likely to take the SE mode in selecting pleasure destinations. On the other hand, tourists who frequently take overnight trips and were in-state residents were more likely to take the JE mode in their decision making process. The results of this study suggest that tourism practitioners should implement customer-centric marketing and develop customized marketing information that best fit each segment, beyond the passive responses to information requester

A Conceptual Framework of Perceived Price Fairness : An Attributional Approach

The purpose of this study was to propose a conceptual framework of perceived price fairness for tourism purchases. The proposed framework is theoretically based on Weiner’s (1980) attribution theory, which has not been largely applied in price literature regardless of its potential theoretical importance. Thus, it is hoped that this framework will contribute to understanding how tourists perceive price increases or extra charges, and help to establish appropriate marketing strategies related to consumers’ perceptions of price (un)fairness. In order to empirically test the propositions formulated by the model, a methodological approach is also suggested. Accordingly, it is anticipated that further empirical research will be able to enhance the theoretical credibility of this conceptual model. It is further believed that understanding how perceived price fairness influences tourists behavior, depending on their inferences, will also provide practical implications. For instance, when suppliers encounter inevitable price increases, they could utilize a marketing strategy based on this theoretical understanding and its empirical results to mitigate consumer’s negative reaction

Clinical Outcomes of Primary Stenting versus Balloon Angioplasty in Patients with Myocardial Infarction: A Meta-analysis of Randomized Controlled Trials

PURPOSE: To examine whether primary stenting as compared with primary balloon angioplasty reduces clinical outcomes in patients with myocardial infarction. METHODS: Major medical databases from 1979 to March 2002 were searched for randomized controlled trials that compared primary stenting with balloon angioplasty in patients with myocardial infarction. Two independent reviewers selected and extracted data from identified trials. The outcomes were mortality at 30 days, 6 months, and 12 months; recurrent events; and bleeding. RESULTS: Nine trials with a total of 4433 patients fulfilled the inclusion criteria. The odds ratios for mortality after stenting as compared with balloon angioplasty were 1.17 (95% confidence interval [CI]: 0.78 to 1.74) at 30 days, 1.07 (95% CI: 0.76 to 1.52) at 6 months, and 1.09 (95% CI: 0.80 to 1.50) at 12 months (P for heterogeneity Ͼ0.1 for each comparison). The odds ratios for reinfarction after stenting as compared with balloon angioplasty were 0.52 (95% CI: 0.31 to 0.87) at 30 days, 0.67 (95% CI: 0.45 to 1.00) at 6 months, and 0.67 (95% CI: 0.45 to 0.99) at 12 months; for target vessel revascularization, they were 0.46 (95% CI: 0.34 to 0.61) at 30 days, 0.42 (95% CI: 0.35 to 0.51) at 6 months, and 0.48 (95% CI: 0.39 to 0.59) at 12 months (P for heterogeneity Ͼ0.1 for all estimates with the exception of reinfarction at 12 months where P ϭ 0.08). The odds ratio for postinterventional bleeding complications after stenting as compared with balloon angioplasty was 1.34 (95% CI: 0.95 to 1.88; P for heterogeneity Ͼ0.1). CONCLUSION: Compared with balloon angioplasty, primary stenting is not associated with lower mortality, but is associated with a lower risk of reinfarction and target vessel revascularization. Am J Med. 2004;116:253-262. ©2004 by Excerpta Medica Inc. I n patients with myocardial infarction, balloon angioplasty reduces short-term death, nonfatal myocardial infarction, and stroke when compared with thrombolytic reperfusion (1). Still, the clinical efficacy of balloon angioplasty is limited by the development of late restenosis in up to 50% of patients, and by recurrent myocardial infarction in 3% to 5% of patients (2-5). Primary stenting may offer additional benefits. However, a recent meta-analysis of clinical trials found no difference in mortality and reinfarction rates among patients undergoing stenting or balloon angioplasty (6). We conducted a meta-analysis based on published and unpublished trial data to investigate whether primary stenting as compared with balloon angioplasty reduces mortality, recurrent events, and the risk of bleeding in patients with myocardial infarction. METHODS Data Search and Trial Selection We searched MEDLINE, EMBASE, Pascal, Index Medicus, the Cochrane Library, and abstracts from cardiology conferences from 1979 to March 2002 to identify all randomized controlled trials that compared primary stenting with balloon angioplasty in patients with myocardial infarction. We used the following search terms: angioplasty transluminal percutaneous coronary, stents, randomized controlled trials, clinical trials, coronary artery dilatation, transluminal coronary angioplasty, and random. We also searched all references of relevant articles for additional trials. If necessary, authors of identified trials were contacted for additional information

Spinal epidural hematoma associated with tissue plasminogen activator treatment of acute myocardial infarction.

We report a case of tissue plasminogen activator-associated spinal epidural hematoma in a patient who underwent treatment for myocardial infarction. Diagnostic magnetic resonance imaging was used within 24 hr of coronary artery stent implantation. We review the literature on thrombolytic-associated epidural spinal hematoma and discuss its management. Cathet. Cardiovasc. Intervent. 48:390-396, 1999

The subcellular localization of glutamate dehydrogenase (gdh): is gdh a marker for mitochondria in brain? / James C. K. Lai, Kwan-Fu Rex Sheu, Young Tai Kim, Donald D. Clarke, and John P. Blass Department of Neurology, Cornell University Medical College and Altschul Laboratory for Dementia Research Burke Rehabilitation Center White Plains, NY 10605 and Department of Medicine Cornell University Medical College New York, NY 10021

Glutamate dehydrogenase (GDH, EC 1.4.1.2) has long been used as a marker for mitochondria in brain and other tissues, despite reports indicating that GDH is also present in nuclei of liver and dorsal root ganglia. To examine whether GDH can be used as a marker to differentiate between mitochondria and nuclei in the brain, we have measured GDH by enzymatic activity and on immunoblots in rat brain mitochondria and nuclei which were highly enriched by density-gradient centrifugation methods. The activity of GDH was enriched in the nuclear fraction as well as in the mitochondrial fraction, while the activities of other mitochondrial enzymes (fumarase, NAD-isocitrate dehydrogenase and pyruvate dehydrogenase complex) were enriched only in the mitochondrial fraction. lmmunoblots using polyclonal antibodies against bovine liver GDH confmned the presence of GDH in the rat brain nuclear and mitochondrial fractions. The GDH in these two subcellular fractions had a very similar molecular weight of 56,000 daltons. The mitochondrial and nuclear GDH differed, however, in their susceptibility to solubilization by detergents and salts. The mitochondrial GDH could be solubilized by extraction with low concentrations of detergents (0.1% Triton X-100 and 0.1% Lubrol PX), while the nuclear GDH could be solubilized only by elevated concentrations of detergents (0.3% each) plus KCl (\u3e 150 mM). Our results indicate that GDH is present in both nuclei and mitochondria in rat brain. The notion that GDH may serve as a marker for mitochondria needs to be re-evaluate

Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort study

Summary: Background: People with mental illness and substance use disorder are over-represented in prisons. Injury-related mortality is elevated in people released from prison, and both mental illness and substance use disorder are risk factors for injury. Effective care coordination during the transition between criminal justice and community service providers improves health outcomes for people released from prison. However, the health outcomes and support needs of people with dual diagnosis (co-occurring mental illness and substance use disorder) released from prison are poorly understood. Here we aim to examine the association between dual diagnosis and non-fatal injury in adults released from prison. Methods: Pre-release interview data collected between Aug 1, 2008, and July 31, 2010, from a representative sample of sentenced adults (≥18 years) in Queensland, Australia, were linked, retrospectively and prospectively, to person-level, state-wide emergency department and hospital records. We identified dual diagnoses from inpatient, emergency department, and prison medical records. We modelled the association between mental health status and all injury resulting in hospital contact by fitting a multivariate Cox regression, adjusting for sociodemographic, health, and criminogenic covariates, and replacing missing covariate data by multiple imputation. Findings: In 1307 adults released from prison, there were 2056 person-years of follow-up (median 495 days, IQR 163–958). The crude injury rates were 996 (95% CI 893–1112) per 1000 person-years for the dual diagnosis group, 538 (441–657) per 1000 person-years for the mental illness only group, 413 (354–482) per 1000 person-years for the substance use disorder only group, and 275 (247–307) per 1000 person-years for the no mental disorder group. After adjusting for model covariates, the dual diagnosis (adjusted hazard rate ratio 3·27, 95% CI 2·30–4·64; p<0·0001) and mental illness only (1·87, 1·19–2·95; p=0·0071) groups were at increased risk of injury after release from prison compared with the group with no mental health disorders. Interpretation: People released from prison experience high rates of injury compared with the general population. Among people released from prison, dual diagnosis is associated with an increased risk of injury. Contact with the criminal justice system is a key opportunity to prevent subsequent injury morbidity in people with co-occurring mental health disorders. Engagement with integrated psychiatric and addiction treatment delivered without interruption during the transition from prison into the community might prevent the injury-related disparities experienced by this vulnerable group. The development of targeted injury prevention strategies for people with dual diagnosis released from prison is warranted. Funding: National Health and Medical Research Council

Using a SANE Interdisciplinary Approach to Care of Sexual Assault Victims.

BACKGROUND: Many hospitals have recognized the need to develop policies and procedures for female sexual assault victims\u27 prompt access to emergency medical care and for collecting law enforcement evidence. At Lehigh Valley Hospital (Allentown, Penn), care in the emergency department (ED) for sexual assault victims was covered by oncall obstetricians and gynecologists. Although many aspects of rape management were in place, a busy ED with varying levels of physician response and exposure to the process of rape management contributed to a lack of standardized, objective, timely, and compassionate medical management of sexual assault victims. DEVELOPING THE PROGRAM: The Sexual Assault Nurse Examiner (SANE) interdisciplinary approach to care of sexual assault victims was implemented in May 1998. Community education and awareness projects emphasized prevention of sexual assault and domestic violence, as well as minimization of trauma for victims by promoting services that provide a supportive, caring, and healing environment. RESULTS: Comparing a baseline group of 130 sexual assault victims with 39 patients who were evaluated after the SANE approach was implemented indicated increased clinical interaction and significant improvements in quality indicators, such as completeness of evaluation and information gathered relevant to medical-legal issues. DISCUSSION: Law enforcement staff developed a more collaborative relationship with SANE examiners through the interdisciplinary team approach. Collaborative relationships were initiated with several other hospitals in the hospital\u27s integrated delivery system to help offset some of the program\u27s training, continuing education, and on-call costs and to allow for joint outcomes collection. The SANE program became a core ED service in July 1999