Destination Policies Research Articles

HIERARCHICAL REPRESENTATION STUDY ON PERSONAL MOTIVES OF SUMMER HOLIDAY SEEKERS: THE CASE OF ITALY DURING THE COVID-19 PANDEMIC

Using a method that examines goal setting, this study investigates the reasons people take a holiday during the ‘COVID summer’. Participants were 141 Italians that completed a questionnaire during summer 2020. The results revealed 13 reasons for taking a holiday: ‘Family/Friends’, ‘Attachment’, ‘Relax’, ‘Fun’, ‘New experiences’, ‘Increasing knowledge’, ‘Overcoming general stress’, ‘Overcoming lockdown stress’, ‘Present well-being’, ‘Future well-being’, ‘Enrichment’, ‘I like it’, and ‘Socialising’. Revealing connections between reasons, the hierarchical structure revealed that the principal reasons for taking a holiday during the COVID summer are tied to gaining future well-being, maintaining close relationships, and enhancing personal growth. These results are useful for defining tourism destination policies in the post-pandemic phase.

Prediction of the Number of Visitors to Tourism Objects in the Ujung Genteng Coastal Area of Sukabumi Using the Holt-Winter Method

Ujung Genteng Sukabumi Beach is one of the tourism destinations in Sukabumi Regency, West Java. Forecasting tourist arrivals is a very important factor for tourist destination policies and contributes to the regional economy and the surrounding community. The purpose of this study is to predict the number of tourists who come to Ujung Genteng Beach, Sukabumi. The method used is the Holt-Winter approach exponential smoothing. The Holt-Winter method is used for data that is not stationary, has both trend and seasonal elements. The Holt-Winters method has two models, namely the Additive model and the Multiplicative model. The data used is visitor data in January 2017 - February 2020, the results of the analysis show that the prediction of the number of visitors to Ujung Genteng beach in March 2020 from the additive model is 300 people with a MAPE value of 85.48% and an MSE value of 31230672.68 and a prediction of the number of beach visitors. Ujung Genteng in March 2020 from a multiplicative model of 740 people, with MAPE and MSE values obtained were 86.34% and 27754873.34.

Factors associated with destination of pediatric EMS transports.

Pediatric patients comprise 13% of emergency medical services (EMS) transports, and most are transported to general emergency departments (ED). EMS transport destination policies may guide when to transport patients to a children's hospital, especially for medical complaints. Factors that influence EMS providers 'decisions about where to transport children are unknown. Our objective was to evaluate the factors associated with pediatric EMS transports to children's hospitals for medical complaints. We performed a cross-sectional study of a large, urban EMS system over a 12-month period for all transports of patients 0-17years old. We electronically queried the EMS database for demographic data, medical presentation and management, comorbidities, and documented reasons for choosing destination. Distances to the destination hospital and nearest children's and community hospital (if not the transport destination) were calculated. Univariate and multiple logistic regression analyses were conducted to determine the association between independent variables and the transport destination. We identified 10,065 patients, of which 6982 (69%) were for medical complaints. Of these medical complaints, 3518 (50.4%) were transported to a children's hospital ED. Factors associated with transport to a children's hospital include ALS transport, greater transport distance, protocol determination, developmental delay, or altered consciousness. Factors associated with transport to general EDs were older age, unknown insurance status, lower income, greater distance to children's or community hospital, destination determined by closest facility or diversion, abnormal respiratory rate or blood glucose, psychiatric primary impression, or communication barriers present. We found that younger patient age, EMS protocol requirements, and paramedic scene response may influence pediatric patient transport to both children's and community hospitals. Socioeconomic factors, ED proximity, diversion status, respiratory rate, chief complaints, and communication barriers may also be contributing factors. Further studies are needed to determine the generalizability of these findings to other EMS systems.

Sustainable marketing factors

Purpose: This paper discusses tourists’ attitudes towards sustainable marketing factors in the context of cultural tourism. It aims to examine the influence of tourists’ attitudes on satisfaction with the overall cultural experience and perceived ecological, social, and economic effects and their impact on satisfaction. Methodology: The survey was conducted in Croatia in 2020 on a sample of 205 domestic tourists. Based on previous research, two sets of marketing items were defined: items closely related to sustainability (CRS) and items not closely related to sustainability (NCRS). Exploratory factor analysis (EFA) was applied to extract factors, followed by Principal Component Analysis (PCA). Multiple linear regression analysis was used to test the factors’ impact on satisfaction and perceived cultural tourism effects. Results: The results of factor analysis generated two CRS factors (Sustainable destination policies, Propensity for sustainable behaviour) and two NCRS factors (Respect for cultural heritage, Servicescape). The two CRS factors and the factor Respect for cultural heritage have a statistically significant influence on overall satisfaction. Moreover, the results imply that Propensity for sustainable behaviour and Respect for cultural heritage positively contribute to overall satisfaction. Among all the observed factors, only Sustainable destination policy does not significantly influence any perceived cultural tourism effects. In contrast, the perceived socio-cultural and economic effects have a positive influence on tourist satisfaction. Conclusion: The research results underpin the influence of sustainable marketing factors on satisfaction with the overall cultural experience and perceived tourism effects and their impact on satisfaction. The findings provide new insights into marketing theory and guidelines for marketing managers regarding sustainability in cultural tourism.

Open-pit mining complex optimization under uncertainty with integrated cut-off grade based destination policies

The aim of a mining complex optimization is to maximize the economic value of the mining project as a whole. To maximize the economic value, it is required to simultaneously optimize the mining extraction sequence and destination of the material into various processing streams. This work presents a global optimization model to simultaneously optimize all aspects of the mining complex under uncertainty. To solve the mining complex problem, the method uses a combination of the maximum flow and a genetic algorithm to define the optimal production sequence, and the flow of extracted material into various destination streams are defined based on the dynamic cut-off grade optimization and block economic values. The dynamic cut-off grade is optimized using Lane's method. An application for a copper-gold mining complex indicates that the optimizer generates results that reduce the risk of not meeting the targets. When compared to commercial deterministic mine planning software, proposed algorithm generates 9.08% higher net present value and the stochastic design generated 13.70% higher expected net present value compared. Two different destination policies are evaluated to study the impact of destination policies on the net present value. Due to change in destination policies, difference of 4.36% is observed in net present value for the stochastic model.

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Statewide Prehospital STEMI Destination Policies Do Little to Improve Timely Reperfusion

Faster reperfusion after ST-segment myocardial infarction (STEMI) improves outcomes. While the chain of survival for these patients has many links, one

Taking the Reins on Systems of Care for ST-Segment-Elevation Myocardial Infarction Patients: A Report From the American Heart Association Mission: Lifeline Program.

Early success with regionalization of ST-segment-elevation myocardial infarction (STEMI) care has led many states to adopt statewide prehospital STEMI hospital destination policies, allowing emergency medical services to bypass non-percutaneous coronary intervention-capable hospitals. The association between adoption of these policies and patterns of care among STEMI patients is unknown. Using data from January 1, 2013, to December 31, 2014, from the National Cardiovascular Data Registry and Acute Coronary Treatment and Intervention Outcomes Network Registry, 6 states with bypass policies (cases included Delaware, Iowa, Maryland, North Carolina, Pennsylvania, and Massachusetts) were matched to 6 states without bypass policies (controls included South Carolina, Minnesota, Virginia, Texas, New York, and Connecticut) a priori on region, hospital density, and percent state participation in the registry. Using the matched sample, logistic regression models were adjusted for patient- and state-level characteristics. Outcomes were receipt of reperfusion and receipt of timely percutaneous coronary intervention. Our study cohort included 19 287 patients at 379 sites across 12 states. Patients from states with hospital destination policies were similar in age, sex, and comorbidities to patients from states without such policies. After adjustment for patient- and state-level characteristics, 57.9% (95% confidence intervals, 53.2%-62.5%) of patients living in states with hospital destination policies when compared with 47.5% (95% confidence intervals, 43.4%-51.7%) living in states without hospital destination policies received primary percutaneous coronary intervention within their relevant guideline-recommended time from first medical contact. Statewide adoption of STEMI hospital destination policies allowing emergency medical services to bypass non-percutaneous coronary intervention-capable facilities is associated with significantly faster treatment times for patients with STEMI.

Geographic Modeling to Quantify the Impact of Primary and Comprehensive Stroke Center Destination Policies.

We evaluated the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and used geographic modeling to evaluate expected changes for a comprehensive stroke center policy. We identified suspected stroke emergency medical services encounters from 1/1/2004 to 12/31/2013 in Philadelphia, PA. Transport times were compared before and after initiation of a PSC destination policy on 10/3/2011. Geographic modeling estimated the impact of bypassing the closest hospital for the closest PSC and for the closest comprehensive stroke center. There were 2 326 943 emergency medical services runs during the study period, of which 15 099 had a provider diagnosis of stroke. Bypassing the closest hospital for a PSC was common before the official policy and increased steadily over time. Geographic modeling suggested that bypassing the closest hospital in favor of the closest PSC adds a median of 3.1 minutes to transport time. Bypassing to the closest comprehensive stroke center would add a median of 8.3 minutes. Within a large metropolitan area, the time cost of routing patients preferentially to PSCs and comprehensive stroke centers is low.

Insights For Coastal Destination Development: The Practices Of Kiteboarders In The Netherlands

Soft adventure is a popular tourism niche that northwest coastal destinations in Europe, such as the province of Zeeland in the Netherlands, are increasingly targeting. Many of these cold-water coastal destinations are struggling with strategies and policies that could maintain or increase their market share, often through the improvement of coastal products and image of the destination. One water sport that has gained enormous popularity in the last decade is kiteboarding. The practices of kiteboarders, which are informed by practice theory and conceptualized by the kiteboarding session, are studied through multiple methods. The research findings led to practical recommendations for deliberate interventions that support coastal destination policies targeting this niche.

Challenges in Emerging Research on Luxury Destinations

Challenges in Emerging Research on Luxury Destinations Since the end of the Cold War, many of the economies in the world have proceeded with market reforms and integrated into the world economy by spurring domestic free enterprise, promoting openness to foreign direct investments and intensifying international trade. All these have resulted in a general uplift of income levels and dynamic changes in many destinations such as Singapore, Dubai, Bangkok, Kuala Lumpur and Ho Chi Minh City to name a few. Over the last two decades, there has been sporadic but steady growth of literature focusing on luxury consumption and destination development. This brief editorial examines challenges of conducting research on luxury destinations while exploring opportunities for research in three key areas: travel consumption patterns, destination policies, and comparative studies.

“I can give you money but there is no use. The best thing I [can] give you is education.” Negotiating Educational Migration and Gender in a Chinese Malaysian family

AbstractOver the past two decades, Singapore has steadily become a popular destination for migrants. While the reasons for migrating to Singapore are many and contextual, labour and education have been the primary driving factors for attracting migrants from around the world to Singapore. Although a popular migrants’ destination, education and migration policies in Singapore are often gendered, and are negotiated along and across other axes of identification and differentiation such as ethnicity and ideas of ‘modernity’. This article analyses gendered educational migration from Malaysia to Singapore focusing particularly on how educational migration leads to female self-transformation. Specifically, I argue that social actors negotiate educational migration within their gendered family constellations. The article first contextualises the empirical material by illustrating socio-historical processes in Singapore and Malaysia. In the next sections, I discuss my ethnographic methods and examine a brief history of the state of research in gender and educational migration. In conclusion, I offer a significant contribution to the growing and important body of scholarship on gender and transnational families by illustrating how gender is negotiated in migration using the case of a single Chinese woman's migration journey to becoming a ‘modern woman’.

Abstract 18115: Are State Policies to Permit Pre-hospital Bypass Associated With Better Treatment Patterns Among Patients With ST-Elevation Myocardial Infarction? A Report From AHA's Mission: Lifeline Program

Introduction: Early success with regionalization of STEMI care has led many states to adopt statewide pre-hospital STEMI destination policies, allowing emergency medical services (EMS) to bypass non-PCI capable hospitals. The association with adoption of these policies and patterns of care among STEMI patients is unknown. Hypothesis: Compared with similar states without STEMI bypass policies, we hypothesized states with bypass policies would have a higher proportion of eligible STEMI patients 1) arrive by direct EMS transport to PCI hospitals (less transfer-in); 2) receive any reperfusion; and 3) receive timely PCI. Methods: Using data from Jan 1, 2013 to Dec 31, 2014 from the NCDR ACTION Registry, six states with bypass policies (cases) were matched to six states without bypass policies (controls) a priori on region, hospital density, and percent state participation in the registry. Using the matched sample, logistic regression models were adjusted for patient- and state-level characteristics. Outcomes were: 1) transfer-in status, 2) receipt of reperfusion, and 3) receipt of timely PCI. Results: Case states: Delaware, Iowa, Maryland, North Carolina, Pennsylvania, and Massachusetts, were matched to the respective control states: South Carolina, Minnesota, Virginia, Texas, New York and Connecticut, with 19,287 patients at 379 sites. Patients from states with bypass policies were similar in age, gender, and comorbidities to patients from states without bypass policies. They were more likely to be white, have private insurance, and reside in rural areas. They were less likely to transfer into a PCI hospital (aOR=0.60, 95% CI 0.26-1.35) and more likely to receive reperfusion therapy (aOR=1.77, 95% CI 0.96-3.24), but these trends were not statistically significant. They were also significantly more likely to receive primary PCI within 90 minutes (aOR=1.59, 95% CI 1.19-2.12) or 120 minutes (aOR=1.44, 95% CI 1.06-1.95) of first medical contact. Conclusions: Statewide adoption of STEMI destination policies allowing EMS to bypass non-PCI capable facilities is associated with shorter time from first medical contact to PCI and non-significant trends toward increased arrival by direct EMS transport and more receipt of reperfusion therapy.

Practice variability among the EMS systems participating in Cardiac Arrest Registry to Enhance Survival (CARES)

Study objectiveTo describe the demographic, organizational and provider characteristics of the Emergency Medical Services (EMS) agencies participating in the Cardiac Arrest Registry to Enhance Survival (CARES). MethodsA web based survey instrument was developed by the CARES investigators and distributed to the EMS agencies participating in CARES in 2008. Survey questions addressed three domains related to prehospital care: (1) descriptors of the participating EMS agencies, (2) methods of clinical care and clinical protocols used by EMS agencies to deliver out-of-hospital cardiac arrest care and (3) use of resuscitation techniques by EMS agencies. Survey responses were collated and analyzed using descriptive statistics. ResultsSurveys were received from 21/25 (84%) sites. The EMS agency characteristics including the response areas served by the agencies, organizational structure, medical direction status and deployment status are described. All respondents were non-volunteer agencies with a large number of them being fire-based (43%). Significant variability among the communities was observed with respect to their medical direction status and deployment status. We also observed differences in the management of OHCA among the participating agencies which included implementation of ACLS guideline updates, presence of termination of resuscitation protocol and destination policies for OHCA subjects. Similar variations between agencies were also observed in the use of resuscitation techniques. ConclusionsDifferences were observed between the EMS agencies participating in CARES. The clinical impact of these observed differences in agency and provider characteristics on OHCA outcomes deserves study.

A Population-Based Analysis of Injury-Related Deaths and Access to Trauma Care in Rural-Remote Northwest British Columbia

Injury rates and injury mortality rates are generally higher in rural and remote communities compared with urban jurisdictions as has been shown to be the case in the rural-remote area of Northwest (NW) British Columbia (BC). The purpose of study was to identify: (1) the place and timing of death following injury in NW BC, (2) access to and quality of local trauma services, and (3) opportunities to improve trauma outcomes. Quantitative data from demographic and geographic databases, the BC Trauma Registry, Hospital discharge abstract database, and the BC Coroner's Office, along with qualitative data from chart reviews of selected major trauma cases, and interviews with front-line trauma care providers were collated and analyzed for patients sustaining injury in NW BC from April 2001 to March 2006. The majority of trauma deaths (82%) in NW BC occur prehospital. Patients arriving alive to NW hospitals have low hospital mortality (1.0%), and patients transferring from NW BC to tertiary centers have better outcomes than matched patients achieving direct entry into the tertiary center by way of geographic proximity. Access to local trauma services was compromised by: incident discovery, limited phone service (land lines/cell), incomplete 911 emergency medical services system access, geographical and climate challenges compounded by limited transportation options, airport capabilities and paramedic training level, dysfunctional hospital no-refusal policies, lack of a hospital destination policies, and lack of system leadership and coordination. Improving trauma outcomes in this rural-remote jurisdiction requires a systems approach to address root causes of delays in access to care, focusing on improved access to emergency medical services, hospital bypass and destination protocols, improved transportation options, advanced life support transfer capability, and designated, coordinated local trauma services.

Implementing carbon neutral destination policies: issues from the Seychelles

It is now accepted that tourism is a significant contributor to global climate change, especially through air travel's high greenhouse gas emissions. This paper analyses the dilemmas facing tourism planning in many small island developing states and presents a model approach toward overcoming those dilemmas by adapting carbon neutral tourism policies. It researches the implementation issues facing carbon neutral tourism policies on the Seychelles Islands: tourism to the islands is energy-intensive, and current plans to increase tourist numbers will entail growing emissions of greenhouse gases. This paper analyses tourism's current levels of energy use and emissions, and explores ways to reduce them. Based on a survey of tourists and industry representatives in the Seychelles, it discusses options for tourism-dependent small island developing states to implement and finance carbon neutrality, while outlining the complexities and limitations of such an objective.

Development Opportunities for a Tourism Benchmarking Tool-The Case of Tyrol

The aim of this study is to improve an already existing Tourism benchmarking tool designed and implemented by the Austrian Provincial Government of Tyrol in 1987 (Haemmerle and Lehar 1987, Berktold 1992). After a brief introduction which overviews latest benchmarking approaches within tourism (Morey and Dittman 1995, Kozak and Rimmington 1998, Siguaw and Enz 1999, Dubé et al. 1999, Ritchie and Crouch 2000) and emphasizing its strategic significance of continually monitoring and emulating standards of performance, the principal purpose of an already existing benchmarking tool, the Tyrolean Tourism Barometer, is described in form of a case study. Both, the data gathering process as well as the operational sequences leading to a variety of indicators are thoroughly discussed. The paper concludes by analyzing the strengths and weaknesses of this secondary data based benchmarking tool. The final section of the paper critically assesses the neglect of relevant elements within the production process of tourism services. Here, the point will be made that it will not suffice to only describe structural shifts in tourism supply and demand in order to establish a reliable instrument for retrospectively evaluating tourism policy and strategically optimize future destination policies. Thus, the existing approach, initially based on price and capacity data only, is extended by linking it to both quality measures of customer satisfaction as well as resource allocation conditions (Weiermair and Fuchs 1999, Wöber 2000).