Dark London: Dimensions and characteristics of dark tourism supply in the UK capital

This paper will investigate the characteristics of the supply of dark tourism in London, UK through an examination of the identified main dark sites in London, UK. Our methodology is based on web analysis of the presence of marketed and non-marketed dark tourist sites in London, their web visitation, the level of their commercialisation and the characteristics which place them in the various scales as categorised in current literature, notably Stone (2006). We identified that London offers a much more entertainment focussed tourism experience rather than accurate historical and authentic sites which utilised major aspects of dark tourism for purposes such as commemoration or remembrance. The authors found this surprising given London’s long and often dark history

Pomalidomide and dexamethasone grant rapid haematologic responses in patients with relapsed and refractory AL amyloidosis: a European retrospective series of 153 patients

Pomalidomide demonstrated activity in the treatment of AL amyloidosis in three phase II clinical trials. We evaluated the safety and efficacy of 28-day cycles of pomalidomide and dexamethasone in 153 previously treated patients with systemic AL amyloidosis. Ninety-nine (65%) were refractory to the last line of therapy and 54 (35%) had relapsed. The median number of previous lines of therapy was 3 (range: 2–7): 143 patients (93%) previously received bortezomib, 124 (81%) lenalidomide, 114 (75%) oral melphalan, and 37 (24%) underwent autologous stem cell transplant. At the completion of cycle 6, 68 (44%) patients obtained at least partial haematologic response, with 5 complete responses (CR, 3%), 35 very good partial responses (VGPR, 23%). Haematologic response resulted in improved overall survival (median survival 50 vs. 27 months, p = .033) in a 6 months landmark analysis. Obtaining at least partial response was also associated with a significant improvement of the progression-free survival (median PFS 37 vs. 18 months, p < .001). Pomalidomide is an effective treatment for heavily pre-treated patients with AL amyloidosis. Haematologic responses are associated with an overall survival advantage

More than sense of place? Exploring the emotional dimension of rural tourism experiences

It is widely suggested that participation in rural tourism is underpinned by a sense of rural place or “rurality”. However, although nature and the countryside have long been recognised as a source of spiritual or emotional fulfilment, few have explored the extent to which tourism, itself often claimed to be a sacred experience, offers an emotional/spiritual dimension in the rural context. This paper addresses that literature gap. Using in-depth interviews with rural tourists in the English Lake District, it explores the extent to which, within respondents’ individual understanding of spirituality, a relationship exists between sense of place and deeper, emotional experiences and, especially, whether participation in rural tourism may induce spiritual or emotional responses. The research revealed that all respondents felt a strong attachment to the Lake District; similarly, and irrespective of their openness to spirituality, engaging in rural tourism activities resulted in highly emotive experiences for all respondents, the description/interpretation of such experiences being determined by individual “beliefs”. However, sense of place was not a prerequisite to emotional or spiritual experiences. Being in and engaging with the landscape � effectively becoming part of it � especially through physical activity is fundamental to emotional responses

Modeling sediment mobilization using a distributed hydrological model coupled with a bank stability model

In addition to surface erosion, stream bank erosion and failure contributes significant sediment and sediment-bound nutrients to receiving waters during high flow events. However, distributed and mechanistic simulation of stream bank sediment contribution to sediment loads in a watershed has not been achieved. Here we present a full coupling of existing distributed watershed and bank stability models and apply the resulting model to the Mad River in central Vermont. We fully coupled the Bank Stability and Toe Erosion Model (BSTEM) with the Distributed Hydrology Soil Vegetation Model (DHSVM) to allow the simulation of stream bank erosion and potential failure in a spatially explicit environment. We demonstrate the model\u27s ability to simulate the impacts of unstable streams on sediment mobilization and transport within a watershed and discuss the model\u27s capability to simulate watershed sediment loading under climate change. The calibrated model simulates total suspended sediment loads and reproduces variability in suspended sediment concentrations at watershed and subbasin outlets. In addition, characteristics such as land use and road-to-stream ratio of subbasins are shown to impact the relative proportions of sediment mobilized by overland erosion, erosion of roads, and stream bank erosion and failure in the subbasins and watershed. This coupled model will advance mechanistic simulation of suspended sediment mobilization and transport from watersheds, which will be particularly valuable for investigating the potential impacts of climate and land use changes, as well as extreme events

A 24-year experience of autologous stem cell transplantation for light chain amyloidosis patients in the United Kingdom

Autologous stem cell transplantation (ASCT) is considered to be the best method to achieve deep haematological/organ responses and improve survival in selected patients with AL amyloidosis. This field has been led by US centres and is less utilised in Europe. The introduction of effective chemotherapy agents for AL prompted us to re‐evaluate UK outcomes of ASCT in affected patients. A total of 264 AL amyloidosis patients treated with an ASCT between 1994 and 2018 were identified. Patient baseline characteristics, transplant‐related mortality (TRM) and overall survival (OS) were analysed. The median OS post‐ASCT was 87 months [95% confidence interval (CI): 77–106 months]. The median time from ASCT to next treatment was 48 months (95% CI: 29–55 months). A haematological response was achieved in 94·8% of patients and was a strong predictor of time to next treatment [P < 0·0001, hazard ratio (HR) = 1·75, 95% CI = 1·35–2·28] and OS (P = 0·007, HR = 1·91, 95% CI = 1·19–3·07). Organ response was: cardiac (n = 28, 60·9%), renal (n = 101, 76%) and liver (n = 7, 13·5%). Overall TRM was 8·7%, with a significant reduction over time (1994–2000: 18·8%; 2001–2006: 13·6%; 2007–2012: 6·2%; 2013–2018: 1·1%). In conclusion, ASCT is significantly safer and remains a highly effective treatment with excellent long‐term survival; it should be more widely considered as a treatment option for systemic AL amyloidosis

Tourism policy and destination marketing in developing countries: the chain of influence

Tourism marketers including destination marketing organisations (DMOs) and international tour operators play a pivotal role in destination marketing, especially in creating destination images. These images, apparent in tourist brochures, are designed to influence tourist decision-making and behaviour. This paper proposes the concept of a “chain of influence” in destination marketing and image-making, suggesting that the content of marketing materials is influenced by the priorities of those who design these materials, e.g. tour operators and DMOs. A content analysis of 2,000 pictures from DMO and tour operator brochures revealed synergies and divergence between these marketers. The brochure content was then compared to the South African tourism policy, concluding that the dominant factor in the chain of influence in the South African context is in fact its organic image

Cyprus' image—a sun and sea destination—as a detrimental factor to seasonal fluctuations. Exploration into motivational factors for holidaying in Cyprus

Cyprus is established as a summer destination. To aid the destination in developing its winter season as well, this research uses a qualitative inductive approach to explore the tourists’ current image of the island and their motivations of visiting it. The research indicates that the current image, which essentially portrays Cyprus as a sun-and-sea destination is thought to dissuade tourists from perceiving the island as a year-round destination. Nonetheless, increasing the pull factors of the destination through the development of unique special interest products can help in extending the tourism season as well as broaden its narrow image

Drivers of success in implementing sustainable tourism policies in urban areas

The existing literature in the field of sustainable tourism highlights a number of barriers that impede the implementation of policies in this area. Yet, not many studies have so far considered the factors that would contribute to putting this concept into practice, and few address the case of urban areas. The concept of sustainability has only received limited attention in urban tourism research, even though large cities are recognised as one of the most important tourist destinations that attract vast numbers of visitors. Adopting a case study approach, this paper discusses a number of drivers of success identified by policy-makers in London to contribute to the implementation of sustainable tourisms policies at the local level, and briefly looks at the relationship between these drivers and the constraints perceived by the respondents to hinder the implementation of such policies in practice. These findings may help policy-makers in other large cities to successfully develop and implement policies towards sustainable development of tourism in their area

Autologous stem cell transplantation vs bortezomib based chemotheraphy for the first‐line treatment of systemic light chain amyloidosis in the UK

OBJECTIVES: The benefit of autologous stem cell transplantation (ASCT) in the treatment of light chain (AL) amyloidosis requires re-evaluation in the modern era. This retrospective case-matched study compares ASCT to bortezomib for the treatment of patients with AL amyloidosis. METHODS: Newly diagnosed patients with AL amyloidosis treated with ASCT or bortezomib between 2001-2018 were identified. Patients were excluded if the time from diagnosis to treatment exceeded 12 months. Patients were matched on a 1:1 basis, using a propensity matched scoring approach. RESULTS: A total of 136 propensity-score matched patients were included (ASCT n= 68, bortezomib n=68). There was no significant difference in overall survival at two years (p=0.908, HR: 0.95, CI:0.41-2.20). For ASCT vs. bortezomib: overall haematological response rate at six months was 90.6% vs. 92.5%; organ response at 12 months: cardiac (70.0% vs. 54%, p>0.999), renal (74% vs.24%, p=0.463)) liver (21% vs. 22%, p=0.048); median progression free survival (50 vs. 42 months p=0.058, HR:0.61, CI:0.37-1.02) and time to next treatment (68 vs. 45 months, p=0.145, HR:0.61, CI:0.31-1.19). More patients required treatment in the bortezomib group compared to ASCT group at 24 months (41 vs. 23, Chi squared p=0.004) and 48 months (57 vs 41, Chi squared p= 0.004). CONCLUSIONS: This small retrospective study suggests that there is no clear survival advantage of ASCT over bortezomib therapy. A prospective randomised controlled trial evaluating ASCT in AL amyloidosis is critically needed