bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing rural destinations’ loyalty through relationship quality
Authors: Alves Helena , Campón-Cerro Ana María , Hernández-Mogollón José Manuel 
Published: May 2019

PurposeThe literature on the factors generating loyalty towards tourism destinations has seldom focussed its attention on relationship marketing, which has left a gap in the understanding of destination loyalty. This paper aims to examine the influence of relationship quality on rural destination loyalty, approaching this through the variables of trust, attachment and satisfaction.Design/methodology/approachThis study used a quantitative methodology based on an on line survey conducted in Spain. The sample consisted of 464 tourists who participate in rural tourism. The analysis of the proposed model was carried out based on the partial least squares method.FindingsThe results confirm that the model has a substantial to moderate explanatory capacity for overall satisfaction and loyalty, in which overall satisfaction acts as a mediator between the variables that make up relationship quality in reference to loyalty.Research limitations/implicationsThe main limitations of this research arise from the scarcity of works which aim to understand relationship quality in tourism destinations. To broaden results, it should be applied in other tourism destinations, products, services and experiences.Practical implicationsDestination managers should give relationships a special role in their tourism development programmes in rural tourism contexts.Social implicationsRural tourism destinations and companies are generally small-sized organisations that need managerial tools. These can benefit from developing sustainable relationships.Originality/valueThe significant role played by relationship quality regarding destination loyalty is studied in detail in this model.
The paradox of “family”; creating a family environment without children in luxury accommodation in New Zealand
Authors: Harkison Tracy , Hemmington Nigel , Hyde Ken 
Published: May 2019

Purpose
The purpose of the paper is to explore innovative solutions to the challenge of creating a family environment without children in luxury lodges in New Zealand.

Design/methodology/approach
In-depth qualitative interviews were conducted with guests, staff and managers in a luxury lodge that excludes children. An interpretivist analysis of interviewees’ comments was undertaken.

Findings
Guests at the childless lodge talked about the serenity and peace they experienced during their stay, and particularly the meal experiences. They thought that not having children on the premises is an advantage for this experience. Lodge managers said that not admitting children is their point of difference for the market that they are targeting.

Research limitations/implications
This research contributes to the emerging research theme of family tourism and extends the concept of family tourism to include family units without children.

Practical implications
There are significant practical implications in terms of industry approaches to creating a family atmosphere in luxury accommodation without children.

Social implications
That a family atmosphere does not need to include children and enables luxury accommodation to cater to a diverse range of family units. There are also implications for social diversity beyond the traditional assumptions of the nuclear family.

Originality/value
The exclusion of children from luxury lodges is certainly not new, but the concept of maintaining a family environment without children is innovative and worth investigating to consider the wider implications of the paradox of family without children.
How likely is your family to visit you?
Authors: Sedera Darshana , Lokuge Sachithra , Perera W. Jayantha M. 
Published: May 2019

PurposeThis paper aims to investigate whether digital connectedness between family members, attained through social media, increases the intention to travel overseas to visit family or relatives. In the context of the education sector, this paper specifically investigates the likelihood of a family member traveling to see a family member who is currently studying in Australia, despite their regular interactions on digital social platforms.Design/methodology/approachThis paper draws on the perspectives of earlier conceptual papers by Chackoet al.(2012) and Solnet and Hood (2008) in an effort to identify root causes and a possible solution. The context of Singapore and the international literature are also reviewed to establish theoretical and practical gaps that need to be filled.FindingsThe study finds that both “perceived media richness” of social media and communication applications and the “perceived connectedness” gained through social media and communication applications have a positive effect on the “intention to travel to the study destination.” Of the two variables measured in the study, perceived connectedness provides the strongest influence with nearly double the path coefficient as compared to the perceived media richness. Overall, an explanation of 32 per cent in one’s intention to travel provides a substantial discovery of travel intentions.Originality/valueThe role that digital social media like Facebook plays in human connectivity is not a foregone conclusion, when one could argue that digital connectivity especially enhanced by the richness of social media has the potential to replace or minimize physical relationships. Yet, this study demonstrates that such associations between the family members are in fact augmented by social media.
Innovation-centric courses in hospitality management education in Dubai
Authors: Nadkarni Sanjay , Morris Stephanie 
Published: May 2019

Purpose
This paper aims to provide an overview of how a Dubai-based higher education institution in hospitality management has leveraged the enabling macro-environment for building innovation-centric courses in hospitality pedagogy. The policy-level initiatives focusing on innovation adopted by the UAE, and Dubai, in particular, are analyzed along with their impact on the higher education landscape.

Design/methodology/approach
An exploratory research design with an experimental component based on iterative approach has been adopted in this paper.

Findings
The synthesis of the exploratory analysis with the outcome of the experiment for developing innovation-centric courses and assessments which integrates elements of sustainability underscores the necessity for a scalable roadmap for developing an innovation-driven ecosystem. Implications for stakeholders in deploying the proposed roadmap are discussed.

Originality/value
The experience curated from the design development and delivery of innovation-focused courses with the mandated framework in a specific geography (in this case Dubai, UAE) attests to the originality. The research adds value by proposing an implementable roadmap for stakeholders to foster an innovation-driven socio-economic ecosystem that encompasses elements of sustainability.
Personal care and practical support at home: a systematic review of older people’s views and experiences
Authors: Kwan Irene , Rutter Deborah , Anderson Beth , Stansfield Claire 
Published: May 2019

Purpose
Considering the views of service users is important to identify their needs as this helps providers to develop appropriate and responsive services. For older people receiving home care, recognising their needs is the first step towards supporting them to maintain independence and promote wellbeing. The paper aims to discuss these issues.

Design/methodology/approach
A systematic review was conducted in 2014 to explore the personal experiences of older people in England about the care and support they received at home. Studies published between 2004 and 2013 were identified from bibliographic databases and websites. A total of 17 studies satisfied the inclusion criteria. Data were extracted using a standardised coding tool and narratively synthesised. Study quality was evaluated.

Findings
Nine themes were identified. Older people valued an approach that was person centred, flexible and proactive to respond to their changing needs and priorities, focusing on what they can or would like to do to maintain their independence. Allowing time to build trust between older people and their care workers helped to realise older peoples’ aspirations and goals. Practical help to promote choice and reduce social isolation was perceived to be as important as personal care.

Practical implications
Evidence from this review contributed to the development of a social care guideline on home care, and informed key practice recommendations for care providers in England.

Originality/value
This review highlighted the value older people place in person-centred care incorporating practical help both inside and outside the realm of personal care.
Fulminant type 1 diabetes: The clinical and continuous glucose monitoring characteristics in Chinese patients
Authors: Ying Lingwen , Ma Xiaojing , Lu Jingyi , Lu Wei , Zhu Wei , Vigersky Robert A. , Jia Weiping , Bao Yuqian , Zhou Jian 
Published: May 2019

AbstractThe purpose of the current study was to investigate the clinical characteristics of fulminant type 1 diabetes mellitus (FT1DM) in Chinese patients and to further determine their glycaemic profiles through continuous glucose monitoring (CGM). Thirty subjects who were diagnosed with FT1DM according to the 2012 JDS criteria were enrolled. Clinical characteristics were compared to those reported in Japanese FT1DM. All subjects received retrospective CGM for 3 days after being converted to subcutaneous insulin injection therapy. Chinese FT1DM patients presented with a shorter duration of symptoms (2.84 ± 2.42 days vs 4.4 ± 3.1 days, P < 0.01), worse islet function (fasting C‐peptide, 0.09 ± 0.11 ng/mL vs 0.30 ± 0.21 ng/mL; 2‐hour C‐peptide, 0.13 ± 0.14 ng/mL vs 0.30 ± 0.30 ng/mL, both P < 0.01), lower prevalence of flu‐like symptoms (46.7% vs 71.4%, P < 0.05), and a significantly higher GADA positive rate (23.3% vs 5.1%, P < 0.01) when compared with Japanese patients. The CGM results showed that the mean time in range (TIR) of FT1DM patients was 49.8 ± 22.1%, while mean amplitude of glycaemic excursion (MAGE) and standard deviations of sensor glucose (SDSG) were 7.58 ± 3.59 mmol/L and 3.19 ± 1.22 mmol/L, respectively, with nearly 1/3 participants coefficient of variation (CV) > 36% (all are male), suggesting a large glucose fluctuation. The female patients were further divided into pregnancy‐related FT1DM (PF) and non‐PF (NPF) subgroups (both n = 5), and we found that PF patients had a significantly higher TIR than NPF patients (77.0 ± 16.1% vs 41.0 ± 22.4%, P < 0.05). There were heterogeneities in the clinical characteristics of FT1DM patients, and the CGM results indicated a very low TIR and large glucose fluctuation which needs careful attention.
Elements of the heterocyst‐specific transcriptome unravelled by co‐expression analysis in Nostoc sp. PCC 7120
Authors: Brenes‐Álvarez Manuel , Mitschke Jan , Olmedo‐Verd Elvira , Georg Jens , Hess Wolfgang R. , Vioque Agustín , Muro‐Pastor Alicia M. 
Published: May 2019

SummaryNitrogen is frequently limiting microbial growth in the environment. As a response, many filamentous cyanobacteria differentiate heterocysts, cells devoted to N2 fixation. Heterocyst differentiation is under the control of the master regulator HetR. Through the characterization of the HetR‐dependent transcriptome in Nostoc sp. PCC 7120, we identified the new candidate genes likely involved in heterocyst differentiation. According to their maximum induction, we defined E‐DIF (early in differentiation) and L‐DIF (late in differentiation) genes. Most of the genes known to be involved in the critical aspects of heterocyst differentiation or function were also classified into these groups, showing the validity of the approach. Using fusions to gfp, we verified the heterocyst‐specific transcription of several of the found genes, antisense transcripts and potentially trans‐acting sRNAs. Through comparative sequence analysis of promoter regions, we noticed the prevalence of the previously described DIF1 motif and identified a second motif, called DIF2, in other promoters of the E‐DIF cluster. Both motifs are widely conserved in heterocystous cyanobacteria. We assigned alr2522 as a third member, besides nifB and nifP, to the CnfR regulon. The elements identified here are of interest for understanding cell differentiation, engineering of biological nitrogen fixation or production of O2‐sensitive molecules in cyanobacteria.
Public Inquiry Methods, Processes and Outputs: an Epistemological Critique
Authors: Walshe Kieran 
Published: May 2019

AbstractPublic inquiries are an important phenomenon in modern British society, often used to address controversial or difficult issues of major concern to policy makers, the media and the public. Although people often comment adversely on how costly inquiries are and how long they take, inquiry methods are rarely discussed, let alone critiqued or challenged. However, from a social sciences perspective, inquiry methods, processes and outputs are often at odds with accepted standards for research methods. This paper discusses this divergence and the implications for how we should regard the inquiry as a way of knowing, or learning.
Maternal near‐miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near‐miss and Maternal Death Survey
Authors: Adanikin AI , Umeora OUJ , Nzeribe E , Agbata AT , Ezeama C , Ezugwu FO , Ugwu GO , Ikechebelu JI , Oladapo OT 
Published: May 2019

ObjectiveTo investigate the prevalence of life‐threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals.DesignSecondary analysis of a nationwide cross‐sectional study.SettingForty‐two tertiary hospitals.PopulationWomen admitted for pregnancy‐related complications.MethodsAll cases of severe maternal outcomes (SMO: maternal near‐miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria.Main outcome measuresPrevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance.ResultsOf 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near‐misses and 78 maternal deaths. Intra‐hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion‐related infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3–7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival.ConclusionsAbortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival.Tweetable abstract78 maternal deaths and 366 near‐misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year.
Development and evaluation of a code frame to identify potential primary care presentations in the hospital emergency department
Authors: Schütze Heike , Rees Rhyannan , Asha Stephen , Eagar Kathy 
Published: May 2019

AbstractObjectiveA major challenge in evaluating the appropriateness of ED presentations is the lack of a universal and workable definition of patients who could have received primary care instead. Our objective was to develop a standardised code frame to identify potential primary care patients in the ED.MethodsA standardised code frame to identify which patients could potentially be treated in a primary care setting was developed and tested on all patient episodes of care who presented to the ED of the St George Hospital, Sydney, between December 2016 and February 2017. Sensitivity and specificity of the code frame were performed. The code frame was then tested on all presentations from 2011 to 2016 in the St George Hospital and The Sutherland Hospital in Sydney.ResultsOf 19 916 ED presentations, 5810 (29%) were potential primary care presentations. The code frame had a sensitivity of 99.9% and a specificity of 49.0%. Results were consistent (28%) when applied to 5 years of presentations (601 168 presentations).ConclusionThis standardised code frame enables accurate retrospective local and national data estimations. The code frame could be used prospectively to evaluate interventions such as diverting patients to primary care settings, and to identify populations for specifically targeted interventions. The conservative nature of the code frame ensures that only those that can safely receive care in a primary care setting are identified as potential primary care.
Hyperkeratotic flexural erythema responding to amoxicillin–clavulanic acid therapy: Report of four cases
Authors: Kumarasinghe Sujith Prasad Wanniarachchi , Chandran Veena , Raby Edward , Wood Benjamin 
Published: May 2019

AbstractHyperkeratotic eruptions in the flexures, especially in the inguinal region, often pose a diagnostic and therapeutic dilemma. Inguinal keratotic eruptions may be caused by various infections, inflammatory dermatoses, vesico‐bullous dermatoses, nutrient deficiencies, medication allergies and other miscellaneous causes such as granular parakeratosis. We hereby report four patients who presented with idiopathic hyperkeratotic erythematous eruptions with a migratory nature involving the inguinal region and occasionally showing the histopathologic features of granular parakeratosis. All four patients showed a dramatic therapeutic response to amoxicillin–clavulanic acid combination. We suggest that ‘granular parakeratosis’ should be considered as a histopathologic feature rather than the diagnosis. We would prefer to label our cases as ‘Hyperkeratotic Flexural Erythema’. We recommend that detailed study of skin microbiome may help identify a possible alteration in skin microbiome contributing to the pathogenesis. We briefly review strategies on characterising the skin microbiome and the latest knowledge surrounding how alterations to the skin microbial populations can contribute to some diseases.
The use of post‐mortem lividity to determine sleep position in sudden unexpected deaths in infancy
Authors: Shipstone Rebecca , Thompson John M.D. , Young Jeanine , Byard Roger W. 
Published: May 2019

AbstractAimTo compare parental reports of position found in sudden unexpected deaths in infancy (SUDI) to autopsy reports of lividity and to more accurately classify infant sleep position.MethodsCases of SUDI in Queensland between 2010 and 2014 were reviewed to determine the position in which infants were reported to have been placed and found. This was compared to the distribution of post‐mortem lividity at autopsy. Evidence of lividity present during early death scene investigation was also recorded.ResultsThere was a discordance between the position an infant was reported to have been found and the position of lividity at autopsy in 22/228 SUDI (9.6%). All infants had anterior lividity despite 13 reportedly found supine, three on their side and six in an unknown position. Using anterior lividity at autopsy to change the position found increased the proportion of prone infants from 37.7% to 47.4%. In 47.8% cases, anterior or lateral lividity reported at the scene was no longer present at autopsy.ConclusionPreviously published odds ratios may have underestimated the risk of sudden infant death associated with prone sleep position. SUDI death scene investigation protocols should require photographic documentation of lividity prior to transporting an infant.
Bayesian generalized structured component analysis
Authors: Choi Ji Yeh , Hwang Heungsun 
Published: May 2019

Generalized structured component analysis (GSCA) is a component‐based approach to structural equation modelling, which adopts components of observed variables as proxies for latent variables and examines directional relationships among latent and observed variables. GSCA has been extended to deal with a wider range of data types, including discrete, multilevel or intensive longitudinal data, as well as to accommodate a greater variety of complex analyses such as latent moderation analysis, the capturing of cluster‐level heterogeneity, and regularized analysis. To date, however, there has been no attempt to generalize the scope of GSCA into the Bayesian framework. In this paper, a novel extension of GSCA, called BGSCA, is proposed that estimates parameters within the Bayesian framework. BGSCA can be more attractive than the original GSCA for various reasons. For example, it can infer the probability distributions of random parameters, account for error variances in the measurement model, provide additional fit measures for model assessment and comparison from the Bayesian perspectives, and incorporate external information on parameters, which may be obtainable from past research, expert opinions, subjective beliefs or knowledge on the parameters. We utilize a Markov chain Monte Carlo method, the Gibbs sampler, to update the posterior distributions for the parameters of BGSCA. We conduct a simulation study to evaluate the performance of BGSCA. We also apply BGSCA to real data to demonstrate its empirical usefulness.
Expression of CD1d by astrocytes corresponds with relative activity in multiple sclerosis lesions
Authors: Muir Fraser G.W. , Samadi‐Bahrami Zahra , Moore George R. Wayne , Quandt Jacqueline A. 
Published: May 2019

AbstractThe CD1 protein family present lipid antigens to the immune system. CD1d has been observed in the CNS of MS patients, yet no studies have quantitatively characterized this expression and related it to inflammatory demyelinative activity in MS plaques. In this study, we set out to localize and quantify the presence of CD1d expression by astrocytes in MS brain tissue lesions. Formalin‐fixed, paraffin‐embedded MS and control brain tissues were examined. Lesions were classified as active, chronic active or chronic silent. Using immunofluorescence, the density of CD1d‐positive cells was determined in active lesions, chronic active lesion edges and chronic active lesion centers. The percentage of CD1d‐positive cells that were GFAP‐positive was also determined in each of these regions. CD1d immunoreactivity was significantly increased in MS compared to control tissue, was significantly more prevalent in areas of active demyelination, and colocalized with GFAP‐positive reactive astrocytes. Increases of CD1d immunoreactivity in the CNS of MS patients being greatest in areas of active demyelination and localized to GFAP‐positive astrocytes lend support to the hypothesis of a lipid‐targeted autoimmune process contributing to the pathogenesis of MS.