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Background: Azithromycin is a commonly prescribed antibiotic included in many first-line regimens for pneumonia. Azithromycin also carries an FDA warning for increased risk for abnormal cardiac electrical activity, including QTc prolongation. Objective: To examine the effect of intravenous azithromycin on the QT interval in a cohort of patients receiving antibiotic therapy for community acquired pneumonia. Methods: A single-center, retrospective chart review of patients admitted to the Intensive Care Unit (ICU). The primary endpoint was change in QTc 48-72 hours after antibiotic initiation. The primary outcome was analyzed using ANOVA matched comparison. Results: Between 6/1/2019 and 3/31/2020, 241 total ICU patients received doses of either antibiotic. After application of exclusion criteria, the total number of patients included in analysis was 93, including 75 azithromycin patient and 18 doxycycline patients. The baseline QTc in the azithromycin group was 449 (95% CI 438-461) and the 72-hour QTc was 442 (95% CI 427-453) with an average change in QTc of -4 ms (P =.14). No statistically significant difference was found in QTc interval change between azithromycin and doxycycline. Conclusion: In this study, azithromycin use was not associated with a statistically significant increase in QTc interval. Based on these results, for the majority of patients receiving azithromycin, QTc prolongation is not likely a major concern. However, caution may still be warranted in patients considered high risk. [ABSTRACT FROM AUTHOR]

Background: Status epilepticus (SE) is a neurologic emergency that can result in serious morbidity and mortality. Recent studies have suggested underdosing of both benzodiazepines (BZDs) and antiseizure medications (ASM) which may result in poorer outcomes. Objectives: This study aims to determine the dose of BZDs and levetiracetam given in our emergency department for episodes of SE and determine the outcomes associated with this dosing. Methods: We conducted a retrospective cohort study of all adult patients with SE admitted to our hospital from 2017 to 2020. We collected demographic data, type of SE, dose of BZD and levetiracetam, and outcomes which included mortality and a calculated Glasgow outcome scale (GOS). We compared outcomes of patients with SE who received adequate dosing (according to practice guidelines) to those who did not. Results: 111 adult patients were included of whom 91% were seen initially in our emergency department. 75% had convulsive SE on presentation. Approximately 55% and 68% of patients did not receive an appropriate dose of BZD or levetiracetam, respectively. Inadequate dosing of BZD was associated with worse clinical outcomes based on GOS (43.6% favorable outcome vs 62.5% with adequate dosing P =.046 (95% CI, 1.01–4.60)) and inadequate dosing of both drugs was also associated with a worse GOS outcome (HR, 2.91 (95% CI, 1.05–9.67, P =.02). No difference was found in length of stay or mortality alone. Conclusion: Our study found inadequate dosing of drugs to treat SE in adults was common in our institution and was associated with worse outcomes. [ABSTRACT FROM AUTHOR]

The reproduction of social relationships in a rural tourism destination is examined through a micro-sociological lens that explores residents' everyday interactions. Interaction ritual theory is adopted as the theoretical foundation. Zhinan, a mountainous village in Hangzhou, China, which initiated tourism in 2014, is the study site. Two rounds of focus groups and interviews were conducted with village residents. Qualitative inquiry shows that, under the influence of tourism, residents' daily interactions consist of three interaction rituals, that is, rural living rituals, tourism operation rituals, and event and festival rituals. Due to the distinct ingredients, these rituals unfold differentially and engage different social actors. They complement each other in the co-construction of rural social relationships that have symbolic, emotional, collective, and normative connotations. This study provides in-depth, contextualized understandings of rural residents' interactions and relationships, and draws practical implications for sustainable development of rural tourism destinations. [ABSTRACT FROM AUTHOR]

Small tourism firms (STFs) established and operated by local families can be an engine of sustainable rural tourism. This paper stresses the intimate intertwining of family and business in rural STFs and conceptualizes their entrepreneurial success as a combination of business performance and family well-being. Integrating the resource-based view and network embeddedness theory, relationships among the STF owners' dual social networks (family and industry networks), entrepreneurial resource acquisition, and entrepreneurial success are proposed and tested with a sample of 276 STFs in rural China. The empirical analyses reveal that (1) compared with tangible and knowledge-based resources, the owners' acquisition of psychic resources has the strongest effect on entrepreneurial success; and (2) although industry networks provide more diverse access to entrepreneurial resources, family networks are superior in facilitating psychic resource acquisition, thus are especially important to the entrepreneurial success of rural STFs. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Intravenous (IV) iron sucrose can be used for iron deficiency anemia (IDA), but little information exists on total dose infusion (TDI) of this drug. At a tertiary hospital, an iron sucrose TDI protocol was implemented with staff pharmacists aiding physicians in appropriate dosing. Objectives: We sought to define the safety and efficacy of this protocol in adults ≥18 years old with IDA. Methods: We conducted a retrospective chart review of patients who received iron sucrose TDI. Inclusion criteria included patients ≥18 years old who were hospitalized and received iron sucrose in doses ≥300 mg. We reviewed the medical record for adverse reactions to any TDI of iron sucrose as well as pre-TDI and post-TDI hemoglobin (Hgb) levels to assess efficacy. Results: A total of 238 patients received iron sucrose TDI for IDA during the study period. One hundred ninety-three (81%) patients were female, and the mean age in our cohort was 60.6 years. Mean pre-TDI Hgb was 8.76 g/dL. The mean total dose of iron sucrose in the total cohort was 680 mg (range: 300-2500 mg). Adverse effects attributable to iron sucrose were reported in 15 patients, with nausea being the most common effect (7/238, 2.9%). When matching patients' preadmission and postadmission records, a Hgb increase of 2.1 g/L was found (P <.001). No increase in liver function tests was found in any patient. Conclusions: A pharmacist-assisted iron sucrose TDI protocol for patients with IDA successfully increased serum Hgb and was well tolerated. Anaphylaxis was not reported. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examines the statistical and clinical effectiveness of nitroglycerin ointment as a treatment option for acute hypertension based on a 20 mm Hg or greater reduction in systolic blood pressure. Topics discussed include the concomitant blood pressure medications used by the patients in the study which include clonidine, amlodipine and hydralazine, the results which revealed a mean decrease in systolic blood pressure of 16 mm Hg and the study's limitations.

Image promotion has been a primary focus of destination marketing. Marketers are eager to learn whether their projected images have been transmitted to potential consumers and are incorporated into their images of the destination. This research compares the images projected by Qingdao (China) government agencies and those perceived by current visitors. The projected and perceived images of Qingdao were investigated by analyzing publicity materials and a questionnaire survey of visitors, respectively. Their relationships were explored using both a qualitative evaluation and statistical tests. The results show that the two types of images incorporated certain common image themes. However, the emphasis of the projected images did not relate significantly to what visitors considered to affect the quality of their experience. Therefore, Qingdao’s projected image was only partially delivered to and embraced by current visitors. [ABSTRACT FROM AUTHOR]

Gout is the most common inflammatory arthritis in western countries and the incidence is increasing. Additionally, evidence now exists that cases of severe, refractory gout seem to be increasing. The management of gout and hyperuricemia has remained largely unchanged for decades and includes antiinflammatories used initially for acute attacks and primarily allopurinol to prevent future attacks. Evidence-based guidance for the management of gout and hyperuricemia has been plagued by a lack of randomized, controlled studies and the lack of new medications. Recently evidence-based guidelines by the European League Against Rheumatism were published; one of the first attempts by a major medical body to assess the state of gout and hyperuricemia treatment. Additionally, several new compounds seem poised to be released for hyperuricemia treatment. This review details the important aspects of the gout guidelines relating to pharmacotherapy and critically examines the data surrounding new modalities to decrease serum uric acid. [ABSTRACT FROM AUTHOR]

This paper employs input-output analysis to evaluate the economic aspects of tourism in China. It concludes that, 5riven the size and diversity of the Chinese economy, tourism has provided only a limited stimulus to economic development at the national level. Tourism development depends markedly on input flora secondary industry. Tourism contributes to direct value added for tourism commodities and generates substantial indirect and induced employment to non-tourism commodities, especially in agriculture. Leakage is rather low. Only 40 per cent of the tourism leakage comes directly from tourism-related commodities and more than half is indirect leakage flora non-tourism commodities, especially secondary industry. This suggests that the availability of secondary commodities may be a constraint on tourism development in China. [ABSTRACT FROM AUTHOR]

A methodology for determining activity packages and the socioeconomic status of their patrons is described in this article. This methodology is applied in an analy sis of United States visitors to Canada. Using factor analysis, four market segments are developed: sightseeing, commercial recreation, water-oriented activities, and outdoor living. The socioeconomic attributes of participants in each segment are then determined. The potential of using these activity packages for marketing rec reational opportunities and designing new vacation packages is suggested. [ABSTRACT FROM PUBLISHER]

The article discusses various reports published within the issue, including one regarding the common rheumatic diseases, another on pharmacotherapy, and on therapeutic advances for these diseases.