bluuebunny/crossref_metadata_2025_split huggingface dataset:
Madeira: developing a new tourism paradigm
Authors: Jesus Eduardo 
Published: December 2016

Purpose
The purpose of this paper is to introduce Madeira’s new tourism strategy and demonstrate how it will lead the region to a new paradigm focused on a culture of service.

Design/methodology/approach
The paper is based on an analysis of Madeira’s strategic tourism and marketing plan and official regional, national and international information sources.

Findings
Madeira’s new tourism strategy is based on the reference tripod “Mountain, Sea and Culture”. The new tourism paradigm, it is focused on quality rather than on quantity and more committed on upgrading the product and its offer; is more aligned with environmental, energy and sustainable development concerns for the destination; and is more active, in a direct association between tourism, health and sports.

Originality/value
This paper presents the perspective and experience of Madeira’s regional government in the management of tourism developmental strategies and shares the solutions implemented in securing and advancing its position as the Best Island Destination in Europe.
World trends and the state of Portuguese tourism – round table on opportunities for businesses development
Authors: Costa Jorge , Carvalho Silva 
Published: December 2016

Purpose
This paper aims to identify the current state of the Portuguese tourism, its opportunities and challenges based on the conclusions of the International Tourism Forum (ITF)/Worldwide Hospitality and Tourism Themes (WHATT) Round Table attended by representatives of the main public and private entities of the tourism sector in Portugal.

Design/methodology/approach
This paper presents and discusses the main conclusions resulting from the ITF/WHATT Round Table. The event was organized by the Institute for Tourism Planning and Development, under the theme “Tourism in 2016: from trends to results”.

Findings
The ITF/WHATT Round Table concluded that the tourism industry worldwide and in Portugal, in particular, is facing major challenges that call for innovative ways of managing the tourism experience. On the other hand, world tourism growth was seen as a reality that will remain, and destinations will have to continue working to achieve better tourists instead of getting more tourists.

Practical implications
This analysis provides knowledge about the current state of the Portuguese tourism, its challenges and opportunities while identifying innovative ways and likely solutions to improve the experience of tourists visiting Portugal.

Originality/value
The profiling of the current state of the Portuguese tourism, its opportunities and challenges contributes to the design of more effective strategies to improve the Portuguese tourist offer and the experience of tourists visiting Portugal.
Profile of female tourists visiting Porto and North of Portugal
Authors: Gomes João , Montenegro Mónica 
Published: December 2016

PurposeThis paper aims to characterize the profile of non-resident female tourists visiting Porto and North of Portugal (PNP) and highlights the importance and evolution of the women travel market and its segmentation.Design/methodology/approachThis paper presents and discusses trends and segmentation in women travel market and the results of a survey on the profile of international female tourists to PNP.FindingsThis study identifies the key differences of male and female travelers to PNP and confirms that segments that have been highlighted as emerging markets in the literature such as businesswomen, solo travelling and girlfriend getaway are all present in this market. It also presents and discusses the profile of female tourists to PNP.Practical implicationsThis study provides knowledge about the women travel market to PNP, thus enabling decision makers to better tailor their marketing strategies to this segment.Originality/valueThis paper seeks to illustrate the importance of the female travel market and characterize the profile of non-resident women tourists visiting PNP.
Adolescents’ role in family decision-making for services in India
Authors: Ashraf Maria , Khan Kaleem Mohammad 
Published: December 2016

Purpose
The purpose of this paper is to understand the involvement of adolescents in family vacation and dining out on the basis of the type of family. Also, the purpose of this paper is to refine the Scanzoni’s sex role orientation scale (SSRS) in the Indian context.

Design/methodology/approach
Data were collected using self-administered questionnaires from adolescents in Delhi and Uttar Pradesh (states in India). The response rate is 44.88 per cent. Sex role orientation was measured using the Scanzoni’s SSRS.

Findings
There is a decline in the involvement of adolescents through the major decision-making stages for both the services, family vacation and dining out. There is no significant difference in the involvement of adolescents in dual-income and single-income families for a vacation and dining out, except that the children from dual-income families are more involved in destination selection for a vacation. Also, the adolescents in modern families are significantly involved in the sub-decision stages, spending and selection of travel agent.

Practical implications
The marketers should advertise the vacation destinations to adolescent children in dual-earning families. Also, the travel agencies should design their promotion strategies so as to appeal to the adolescent children with modern attitudes. While catering to the needs of a family, travel agencies must present their services in a way that appeals to adolescents in modern families. Also, this aspect must be taken care of in all the pricing strategies and promotions for the modern families.

Originality/value
Despite the large number of studies in various Western countries in this area, few studies investigate adolescent influence in family decision-making in India. The present study takes into account the type of family, single income or dual income (on the basis of the employment of parents) and traditional or modern (on the basis of gender role orientation).
Non‐exponential growth of Mycobacterium leprae Thai‐53 strain cultured in vitro
Authors: Amako Kazunobu , Iida Ken‐ichiro , Saito Mitsumasa , Ogura Yoshitoshi , Hayashi Tetsuya , Yoshida Shin‐ichi 
Published: December 2016

ABSTRACTIn this study, attempts were made to culture this bacterium in media supplemented with a variety of biological materials to determine why cultivation of Mycobacterium leprae in vitro has not this far been successful. A slight increase in the number of cells in medium supplemented with human blood plasma and an extract of nude mouse tissue as observed after more than 3 months of cultivation at 30 °C. To ascertain whether this increase was real growth, the growth was analyzed by droplet digital PCR, which showed a slow increase in the copy number of cell‐associated DNA and the release of a large amount of DNA into the culture medium from bacterial cells during cultivation. These results were supported by electron microscopic examination of M. leprae in infected mouse tissues, which showed that most of the replicated bacteria had degenerated and only a few cells survived. Based on these results, it was postulated that many of the replicated cells degenerate during M. leprae growth and that only a few cells remain to participate in the next growth stage. This means that, unlike other cultivable bacteria, the growth of M. leprae is not exponential and the number of cells therefore increase extremely slowly. Thus, accurate judging of the success of M. leprae cultivation requires observation of growth over a long period of time and careful measurement of the increase in number of viable cells.
Genomic sequence and virulence evaluation of MN184A‐like porcine reproductive and respiratory syndrome virus in Japan
Authors: Iseki Hiroshi , Morozumi Takeya , Takagi Michihiro , Kawashima Kenji , Shibahara Tomoyuki , Uenishi Hirohide , Tsunemitsu Hiroshi 
Published: December 2016

ABSTRACTIn this study, a porcine reproductive and respiratory syndrome virus (PRRSV) that was isolated from a 9‐week‐old diseased pig on a farm in Japan with a high mortality rate during 2007–2008 was characterized. This unique isolate, designated as Jpn5‐37, did not have a high nucleotide identity in open reading frame 5 against any Japanese isolates. Among all available type 2 PRRSV complete genome sequences, Jpn5‐37 shared the highest nucleotide identity (93.6%) with virulent strain MN184A. The genomic characteristics of Jpn5‐37 were highly conserved with respect to the virulent MN184A, including a continuous eight amino acid deletion in the nonstructural protein 2 region. Moreover, virus distribution, viremia and the gross and microscopic characteristics of lesions were investigated in pigs 10 days post‐inoculation to elucidate the pathogenicity of the isolate. Intranasal inoculation was found to rapidly result in viremia and dissemination of the Jpn5‐37 isolate to several tissues in a similar manner to EDRD1; however, the amounts of Jpn5‐37 RNA in serum were significantly greater. Similarly, the quantities of Jpn5‐37 viral RNA in all organs tested tended to be higher than with EDRD1 infection. Mean rectal temperatures were significantly higher in the Jpn5‐37‐inoculated than in the control group at 4 and 6 days post infection (dpi) and in the EDRD1‐inoculated group at 6 and 8 dpi. These results suggest that the Jpn5‐37 strain replicates and is more efficiently distributed to the organs than is EDRD1 under the same conditions.
Seroepidemiology of human parechovirus types 1, 3, and 6 in Yamagata, Japan, in 2014
Authors: Tanaka Shizuka , Aoki Yoko , Matoba Yohei , Yahagi Kazue , Itagaki Tsutomu , Matsuzaki Yoko , Mizuta Katsumi 
Published: December 2016

ABSTRACTTo clarify the seroepidemiology of human parechovirus type 1 (HPeV1), 3 and 6, neutralizing antibodies (NT Abs) were measured in 214 serum specimens collected in 2014 in Yamagata, Japan. The seroprevalence against HPeV1 was 100% in all age groups, while that against HPeV3 and HPeV6 was 79.4% and 66.8%, respectively, overall. The geometric mean titers of NT Abs against HPeV1, 3 and 6 were 755.2, 255.0 and 55.9, respectively, overall. Our findings indicate that HPeV1 is the most prevalent HPeV circulating in Yamagata, followed by HPeV3 and HPeV6.
Quality Upgrades of EU Agri‐Food Exports
Authors: Bojnec Štefan , Fertő Imre 
Published: December 2016

AbstractWe investigate determinants of quality upgrades in EU agri‐food exports using panel data models for the period 2000–2011. By employing highly disaggregated data we show that the unit value of exports is positively correlated to level of economic development and size of population. Our results highlight the negative impacts of comparative advantage and trade costs on upgrades in export quality. Our analysis partly confirms the role of income distribution in quality specialisation, that greater income inequality increases specialisation in quality upgrades. Findings are robust when applied to alternative subsamples, including vertically specialised and final agri‐food products.
Intensive care unit (ICU) readmission after major lung resection: Prevalence, patterns, and mortality
Authors: Jung Jae Jun , Cho Jong Ho , Hong Tae Hee , Kim Hong Kwan , Choi Yong Soo , Kim Jhingook , Shim Young Mog , Zo Jae Ill 
Published: December 2016

BackgroundThe aim of this study was to identify risk factors associated with mortality in patients re‐admitted to an intensive care unit (ICU) after initial recovery from major lung resection.MethodsWe retrospectively reviewed the case records of all patients who underwent major lung resection between February 2011 and May 2013. A total of 1916 patients underwent major resection surgery for various lung diseases, 63 (3.3%) of which required ICU admission after initial recovery. We analyzed preoperative and perioperative data, including ICU factors and outcomes.ResultsThe patient group included 57 men (90.5%) with a mean age of 65.3 years. Pathologic diagnosis was malignancy in 92.1% of patients, while 7.9% had benign disease. Open thoracotomy was performed in 84.1%, whereas minimally invasive approaches were performed in 15.9%. In‐hospital mortality occurred in 16 (25.4%) patients. Patients were classified as either survivors (n = 47, 74.6%) or non‐survivors (n = 16, 25.4%). The most common reason for ICU readmission was pulmonary complication (n = 50, 79.4%). Thirty‐one patients (49.2%) required mechanical ventilation, seven (11.1%) required extracorporeal membrane oxygenation, and three (4.8%) required renal support. Multivariate analysis showed that acute respiratory distress syndrome (ARDS) and delirium were independent risk factors for in‐hospital mortality. In addition, delirium frequently occurred in patients with ARDS.Conclusion
ARDS and delirium were independent risk factors for in‐hospital mortality in patients who were readmitted to the ICU after major lung resection. Future studies are needed to determine if the prevention of delirium and ARDS can improve postoperative outcomes for patients with lung cancer.
Nationwide access to an internet‐based contingency management intervention to promote smoking cessation: a randomized controlled trial
Authors: Dallery Jesse , Raiff Bethany R. , Kim Sunny Jung , Marsch Lisa A. , Stitzer Maxine , Grabinski Michael J. 
Published: December 2016

Background and aimsContingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of internet‐based CM relative to an internet‐based monitoring and goal‐setting control group in a nationwide sample of cigarette smokers.DesignRandomized controlled trial with 3‐ and 6‐month follow‐ups.SettingUnited States.ParticipantsSmokers (n = 94) from 26 states were enrolled (mean age 36, 56% female).Intervention and comparatorParticipants were randomized to earn financial incentives (up to $480 over 7 weeks) based on video‐verified abstinence using breath carbon monoxide (CO) output (n = 48; abstinent contingent group, AC), or based on submitting CO samples (n = 46, submission contingent, SC). Both groups also received the same CO‐based goals. A $50 deposit was required in both groups that could be recouped from initial earnings.MeasuresThe primary outcome was point prevalence at week 4. Secondary outcomes were point prevalence at the 3‐ and 6‐month follow‐ups, percentages of negative CO samples, adherence to the CO sampling protocol, and treatment acceptability ratings on a 0–100‐mm visual analog scale.FindingsAbstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups [odds ratio (OR) = 4.4, 95% confidence interval (CI) = 1.6–12.3], but not at the 3‐ (29.2% AC and 19.6% SC, OR = 1.7, 95% CI = 0.6–4.4) or 6‐ (22.9% AC and 13.0% SC, OR = 2.0, 95% CI = 0.7–5.9) month follow‐ups. During the two main treatment phases, there were significant differences in negative COs (53.9% AC and 24.8% SC, OR = 3.5, 95% CI = 3.1–4.0; 43.4% AC and 24.6% SC, OR = 2.3, 95% CI = 1.6–3.4). Adherence to the CO submission protocol was equivalent (78% AC and 85% SC, difference = 7.0%, 95% CI = −10.3 to 23.8 %, F < 1, P = 0.39). The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money.ConclusionsA contingency management/financial incentive program delivered via the internet improved short‐term abstinence rates compared with an internet program without the incentives.
Mold and dampness exposure and allergic outcomes from birth to adolescence: data from the BAMSE cohort
Authors: Thacher J. D. , Gruzieva O. , Pershagen G. , Melén E. , Lorentzen J. C. , Kull I. , Bergström A. 
Published: December 2016

AbstractBackgroundExposure to moldy or damp indoor environments is associated with allergic disease in young children, but it is unclear whether the effects persist to adolescence. Our objective was to assess whether exposure to mold or dampness during infancy increases the risk of asthma, rhinitis, or IgE sensitization in children followed from birth to 16 years of age.MethodsWe collected questionnaire derived reports of mold or dampness indicators and allergic outcomes from 3798 children in a Swedish birth cohort (BAMSE). Sensitization was assessed from blood samples in 3293 children. Longitudinal associations between prevalent asthma, rhinitis, and IgE sensitization and mold or dampness indicators were assessed using generalized estimating equations.ResultsExposure to any mold or dampness indicator was associated with asthma up to 16 years of age (OR 1.31; 95% CI 1.08–1.59), while exposure to mold odor (OR 1.29; 95% CI 1.03–1.62) and visible mold (OR 1.28; 95% CI 1.04–1.58) were associated with rhinitis. Increased risks were observed for nonallergic asthma (OR 1.80; 95% CI 1.27–2.55) and rhinitis (OR 1.41; 95% CI 1.03–1.93). No association was observed between mold or dampness indicators and IgE sensitization. Exposure to any mold or dampness indicator was associated with persistent asthma (OR 1.73; 95% CI 1.20–2.50), but not with early‐transient or late‐onset asthma.ConclusionExposure to mold or dampness during infancy increased the risk of asthma and rhinitis up to 16 years of age, particularly for nonallergic disease. Early exposure to mold or dampness appeared particularly associated with persistent asthma through adolescence.
A comparison of vaginal ultrasound and digital examination in predicting preterm delivery in women with threatened preterm labor: a cohort study
Authors: Pinton Anne , Severac François , Meyer Nicolas , Akladios Cherif Y. , Gaudineau Adrien , Favre Romain , Langer Bruno , Sananes Nicolas 
Published: December 2016

AbstractIntroductionThe aim of this study is to evaluate the utility of digital examination in addition to ultrasonic measurement of cervical length for predicting spontaneous preterm delivery in women with threatened preterm labor.Material and methodsThis was a prospective cohort study in Strasbourg University Hospital, France, between January 2013 and January 2015. All women with a singleton pregnancy hospitalized with threatened preterm labor between 23 and 34 weeks of gestation were included. Cases of iatrogenic preterm delivery were excluded. A multivariable logistic regression model to estimate the significant predictive parameters of spontaneous preterm delivery was performed. The primary endpoint of our study was a preterm birth before 34 weeks of gestation.ResultsA total of 395 women were included in our study. The rate of preterm delivery before 34 weeks was 13%. In univariate analysis every single cervical parameter assessed by the digital examination and all the ultrasound parameters were significantly associated with preterm delivery. The final model included five variables predicting preterm birth: visualization of the membranes at the speculum examination (OR 15.8, 95% CI 2.43–146), ultrasound cervical length (OR 0.82, 95% CI 0.75–0.89), signs of inflammation (OR 6.23, 95% CI 2.07–22.9), gestational age on admission (OR 0.84, 95% CI 0.71–1.0), and presence of vaginal infection (OR 4.28, 95% CI 1.52–12.7). None of the cervical parameters assessed by the digital examination provided additional predictive value of preterm delivery.ConclusionOur study suggests that digital examination does not add to the information given by vaginal ultrasound evaluation in predicting preterm labor.
New guidelines for screening, diagnosing, and treating gestational diabetes – evaluation of maternal and neonatal outcomes in Finland from 2006 to 2012
Authors: Ellenberg Anni , Sarvilinna Nanna , Gissler Mika , Ulander Veli‐Matti 
Published: December 2016

AbstractIntroductionIn this study, we have assessed the changes in pregnancy outcomes following the implementation of national guidelines for gestational diabetes mellitus (GDM). These national guidelines changed the screening policy from risk‐based to comprehensive screening.Material and methodsWe designed a retrospective register‐based cohort study based on the data from the Finnish Medical Birth Register and Hospital Discharge Register including 34 794 singleton births in 2006–2008 and 36 488 in 2010–2012. Maternal characteristics and pregnancy outcomes were analyzed.ResultsOverall, 29.6% of mothers underwent an oral glucose tolerance test in 2006–2008 compared with 59.7% in 2010–2012. The prevalence of GDM increased from 7.2 to 11.3% and was highest among obese women (body mass index ≥30 kg/m2) (from 30.0 to 34.7%; p < 0.001). The proportion of insulin‐treated women remained unchanged (12.5/12.3%; p = 0.70). The main pregnancy outcomes for the women with GDM were the increased usage of oxytocin (19.5/40.0%, p < 0.001), increased number of inductions (27.2/33.0%; p < 0.001) and reduced birthweight (mean ± SD: 3647 ± 575 g/3567 ± 575 g). Healthy and unscreened women displayed similar results. Children of both women with GDM and healthy screened women had fewer admissions to the neonatal intensive care unit (16.3%/12.1%; p < 0.001) and less asphyxia (11.3%/6.3%; p < 0.001). However, the rates of cesarean delivery (26.5%/25.4%, p = 0.31), resuscitation (2.6%/2.0%; p = 0.12), and perinatal mortality (1.2‰/3.1‰, p = 0.11) among women with GDM did not change, whereas the number of hypoglycemia cases increased (2.3%/5.2%; p < 0.001).ConclusionsIn conclusion, glucose tolerance tests were performed twice as often as a result of the implementation of the national GDM guidelines, but this comprehensive screening practice did not improve pregnancy and neonatal outcomes.
Preclinical Study of Anticoagulation Regimens in Sheep After Implantation of CH‐VAD Blood Pump
Authors: Xu Chuangye , Wu Guanghui , Liu Xiujian , He Yuna , Hou Xiaotong , Li Haiyang , Chen Chen , Yang Peng , Lin Changyan 
Published: December 2016

AbstractEffective anticoagulation regimens are needed to reduce risks of thrombosis and bleeding in animal models of ventricular assist device to verify its hemocompatibility, biologic safety and reliability. This study is to develop a validated anticoagulation procedure for a sheep model to test the newly developed CH‐VAD. CH‐VAD models were established in six healthy sheep by constructing blood bypass of left ventricle → ventricular assist device → descending aorta. Heparin infusion was used during operation and in the prior 4 days to maintain activated clotting time 1.5–2.0 times the baseline. From the third day, proper dosage of warfarin was used orally to maintain international normalized ratio values within the range of 1.2–2.0. After termination, we examined whether there was thrombosis in the blood pump, grafts, and anastomotic stoma. Macroscopic and histopathologic examinations were performed in major organs to check for congestion and infarction. Bleeding complications were not found in any animals throughout the experiments. Activated clotting time values were 326 ± 33 s intraoperatively and 157 ± 28 s in the prior 4 days postoperatively. Activated partial thromboplastin time values increased slowly and reached the lower limit of the target range on the fourth day. Only in one of six cases was thrombus or fibrosis tissue found in the blood flow channel of the pump. Pathologic analysis showed no thrombosis, necrosis and microembolus in end‐stage organs. Under the anticoagulation regimens, coagulation system could be well controlled to avoid thrombosis and bleeding complications in sheep models for CH‐VAD.