Doctor of Philosophy

dissertationMost research predicting future behaviors have used the Theory of Reasoned Action or the Theory of Planned Behavior. A visitor's intention to return has been used as a measure of potential repeat patronage in travel and tourism research. As real estate development companies continue to saturate the tourism market, it is becoming more important for management companies to retain and build their existing client base. According to Petrick, Morais, and Norman, "with a market that appears to be getting more competitive every year, it is becoming more and more important for managers at entertainment destinations to examine the variables related to attracting and retaining entertainment travelers." Research reports that companies find it more cost efficient to focus on retaining clients rather than seeking new ones. Resorts may gain important information for accomplishing this objective by attempting to understand visitors' intentions to return. While intent does not guarantee behavior, past research has linked intentions to actual behavior. Understanding visitors' intentions and their psychosocial antecedents can thus provide useful marketing information. This study focused on vacation rentals (nontraditional whole-ownership condominium resorts) along the Florida/Alabama Gulf Coast. The Theory of Planned Behavior has been used successfully in predicting and explaining visitor intentions in traditional lodging markets such as the hotel/motel market. However, the theory has not been used to understand the vacation rental market. In the downswing of the current economy and with the increase of industry competition for gaining market share, there is a need for better understanding the underlying variables that affect customer retention. Therefore, the purpose of this study was to examine the relation between intention to return to a vacation rental along the Florida/Alabama Gulf Coast and the antecedent variables of attitude, social influence, and perceived behavioral control

Battlegrounds of environmental change

The Thames catchment encompasses one of Europe’s largest cities, the UK’s principal aquifer, an extensive zone of coastal interaction and much else. It presents a unique conjunction of geological, hydrogeological, environmental and socio-economic factors that are intrinsically linked by the effects of environmental change and the pressures of developmen

Referral Policy for Moderate to High-Risk Obstructive Sleep Apnea Patients Identified by the STOP-Bang Questionnaire: A Quality Improvement Project

BACKGROUND: An increase in the prevalence of Obstructive Sleep Apnea is as high as 70% in the surgical population. OSA is associated with a higher incidence of complications in the perioperative setting showing the increased need for proper identification of moderate to high-riskpatients for referral to local sleep clinics. Identifying and treating OSA is an important step to improve managementof chronic diseases, decrease complications both inside and outside the perioperative setting, and reduce healthcare spending. METHODS: The purpose of this project was to create an OSA referral program for patients undergoing general anesthesia at a hospital in Mississippi. The recommended OSA referral policy was a quality improvement project to improve the OSA referral process through policy development. The Modified Prisma 2009 Checklist of systematic review evaluation tool for quality in literature was used to analyze the recommendations in the creation of a recommended OSA referral policy. The referral program aimed to identify patients with a moderate to high-risk for OSA and refer them to local sleep medicine specialists for diagnostic testing. This project utilized a hospital located in Mississippi home to 400 inpatient beds, 18 operating rooms, and is a level II trauma center. The only accredited sleep disorder center in the State of Mississippi is located within the hospital. The sleep disorder center offers both inpatient and outpatient assessments as well as contains certified staff experts in sleep disorder medicine. INTERVENTION: A systematic review of best practices was performed to recommend the creation of a policy for the referral of patients to local sleep clinics based on preoperative STOP-Bang Questionnaire scores. With the creation of a policy, undiagnosed OSA patients are more likely to be identified and properly treated with referral to local sleep clinics. CONCLUSIONS: With the use of the STOP-Bang Questionnaire in place at a hospital in Mississippi, a coinciding referral policy does not currently exist for patients scoring ≥ 3 for referralto an accredited sleep center. The increased perioperative risks associated with undiagnosed and untreated OSA raises concern to support a referral policy. The increase in the referral of patients with moderate to high-risk for OSA can aid in decreasing perioperative risk and increasingthe overall health status of patients

Voting to End Vulnerability: Understanding the Recent Proliferation of State-Level Child Sex Trafficking Legislation

This Article first focuses on the history of CSEC (commercially sexually exploited children) legislation in the United States by contextualizing the history of state anti-trafficking laws within the larger anti-trafficking policy framework of federal U.S. statutes and United Nations’ (U.N.) protocols. The second and third sections address the variables, statistical model, and results of our data analysis. The fourth section discusses the implications of these findings. The Article concludes with practical considerations for future CSEC legislative efforts on the state level

Repeat prescribing of medications: a system-centred risk management model for primary care organisations

Rationale, aims and objectives: Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care. Methods: All 48 general medical practices in National Health Service (NHS) Lambeth Clinical Commissioning Group (an inner city area of south London in England) were recruited. Multiple interventions were implemented, including educational workshops, a web-based risk monitoring system, and external reviews of repeat prescribing system risks by clinicians. Data were collected via documentation reviews and interviews and subject to basic thematic and descriptive statistical analyses. Results: Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions (eg, practices frequently experiencing difficulty interpreting medication changes on hospital discharge summaries), equating to a mean of 8.1 risks per practice (range: 1-33; SD = 7.13). Seven hundred sixty-seven system improvement actions were recommended across 96 categories (eg, alerting hospitals to illegible writing and delays with discharge summaries) with a mean of 15.6 actions per practice (range: 0-34; SD = 8.0). Conclusions: The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System-wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally

Developing a Carbon Management Plan for the Royal Botanic Garden Edinburgh

Royal Botanic Garden Edinburgh joined the Carbon Management-Lite Programme run by the Carbon Trust in November 2009. This paper provides details of the programme and the process of writing a Carbon Management Plan

Resorts, Resilience and Retention Ater the BP Oil Spill Disaster of 2010

This study attempted to quantify intention to return to a vacation rental along the Florida/Alabama Gulf Coast. Compounding this was the 2010 Deepwater Horizon oil spill disaster. We examined the intention to return to a vacation rental (nontraditional whole-ownership condominium resorts), as well as investigated marketing/retention efforts following the oil spill disaster and data on tourists’ trends over the summers of 2010 – 2013 via bed tax data. Data on tourists\u27 trends since the oil spill provided inference on the resilience of resort tourism in the area. Qualitative interviews with key informants of property management companies allowed analysis of customer retention efforts. Bed tax data in the region indicated strong growth from 2010—2013. Customer intention to return was most strongly influenced by proximity and amenities. Retention efforts after the spill focused on targeted messaging that built social capital values of trust and networks, thus improving resilience and moderating the customer perceptions of oil spill impacts in the region

Healthy happy family eating: development and feasibility of an online intervention to improve family eating behaviours

Unhealthy eating in children is a global problem, associated with poor long-term health outcomes and evidence indicates that unhealthy eating habits developed early in life may track into adulthood. Increasingly, description of behaviour change intervention development is encouraged. This paper describes the development and refinement of an online intervention designed to improve family eating behaviours. Part 1 describes three pilot studies designed to collect quantitative and qualitative feedback about the intervention to inform its development. This is followed by Part 2, which describes an additional study covering other formative work involved in developing the intervention, including theoretical approaches, evidence-base review and stakeholder input. The resulting, robustly refined intervention is described, the efficacy of which is being evaluated by a randomised controlled trial