Search

Young employees currently face vast work stress in their careers triggering conflict between work and family. This paper target to examine how work-family conflict affects job satisfaction and turnover intentions through work stress for younger employees. 450 questionnaires were collected from young dealers who work at six casinos in Macau. The findings show that work-family conflict (WFC) and family-work conflict (FWC) positively affect work stress and turnover intention, but do not directly influence job satisfaction. Work stress negatively affected job satisfaction and positively affected turnover intention, fully negatively mediated WFC and FWC towards job satisfaction, and part positive mediated WFC and FWC towards turnover intention. Work stress can directly influence turnover intention, and job satisfaction partially mediated work stress toward turnover intention. Finally, WFC and FWC will affect turnover intention through work stress on job satisfaction. We also proposed suggestions to improve job satisfaction for young dealers in casino management.

Objective To assess the safety, mechanism of action, and preliminary efficacy of rituximab followed by belimumab in the treatment of refractory lupus nephritis (LN). Methods In a multicenter, randomized, open-label clinical trial, 43 patients with recurrent or refractory LN were treated with rituximab, cyclophosphamide (CYC), and glucocorticoids followed by weekly belimumab infusions until week 48 (RCB group), or treated with rituximab and CYC but no belimumab infusions (RC group). Patients were followed up until week 96. Percentages of total and autoreactive B cell subsets in the patients' peripheral blood were analyzed by flow cytometry. Results Treatment with belimumab did not increase the incidence of adverse events in patients with refractory LN. At week 48, a complete or partial renal response occurred in 11 (52%) of 21 patients receiving belimumab, compared to 9 (41%) of 22 patients in the RC group who did not receive belimumab (P = 0.452). Lack of improvement in or worsening of LN was the major reason for treatment failure. B cell depletion occurred in both groups, but the percentage of B cells remained lower in those receiving belimumab (geometric mean number of B cells at week 60, 53 cells/μl in the RCB group versus 11 cells/μl in the RC group; P = 0.0012). Percentages of total and autoreactive transitional B cells increased from baseline to week 48 in both groups. However, percentages of total and autoreactive naive B cells decreased from baseline to week 48 in the belimumab group compared to the no belimumab RC group (P = 0.0349), a finding that is consistent with the observed impaired maturation of naive B cells and enhanced censoring of autoreactive B cells. Conclusion The addition of belimumab to a treatment regimen with rituximab and CYC was safe in patients with refractory LN. This regimen diminished maturation of transitional to naive B cells during B cell reconstitution, and enhanced the negative selection of autoreactive B cells. Clinical efficacy was not improved with rituximab and CYC in combination with belimumab when compared to a therapeutic strategy of B cell depletion alone in patients with LN.

The promotion of tourists’ environmentally responsible behavior (TERB) plays a central role in destination management for sustainability. Based on the stimulus–organism–response framework, this study proposes an integrated model for behavior management by examining the relationship between stimuli (natural environment and availability of infrastructure) and response factors (satisfaction and TERB) through the organism (the emotion of awe). Survey data from 458 tourists visiting Mount Heng in Hunan Province, Southern China, were used to empirically evaluate the proposed framework. The findings demonstrate that the perception of a destination’s natural environment positively impacts tourists’ sense of awe and satisfaction; the perception of availability of infrastructure positively and significantly influences awe, satisfaction, and TERB; and awe positively impacts satisfaction and TERB. Moreover, the emotion of awe plays a significant mediating role in this proposed model. The theoretical significance of this study and the implications for tourism destinations are discussed.

We present multiple modes of visualizing a largescale Monte Carlo simulation. Due to disparity of the data, there is no one best visualization technique to understand the results of the simulation. By connecting the visualization methods directly to the simulation, we are able to visually analyze the simulation as it occurs in real time. This includes viewing the parameters of the model, the relationships among variables, and the 3D environment in which the simulation takes place. Furthermore, these environments may be coordinated for one seamless visual analytic experience.

An audit of the potential for tourism development at heritage sites is a critical step in the planning process. An examination of the current literature on the evaluation of tourism potential reveals two main approaches: descriptive and qualitative. These approaches are not so effective for comparing the tourism potential of heritage sites in a region. Thus, this study aims to develop an operable, quantitative approach to measuring the potential of heritage sites. The mathematics model proposed in this study is characterized by different weights allocated to different indicators for tourism potential, based on resource values and development state. Applying the proposed model allows the assessment results of heritage sites to be compared, as the tourism potential of each site is represented by a value (0-1). A case study of two heritage sites in China demonstrates the effectiveness of the model.

Lesson plans were developed to present concepts of medical physics and radiation therapy to a middle school audience. These workshop learning units relied on hands‐on participation and collaboration within student groups to acquaint students with computed tomography simulation and treatment planning processes. These lesson plans were delivered at two different educational outreach programs targeted at student groups that have traditionally been underrepresented in science, technology, engineering, and mathematics (STEM) fields. The lesson plans are scheduled to be delivered at a third program in the future. The activities were used to introduce occupations in medical physics and radiation therapy as possible career opportunities for students, and to generate enthusiasm for continuing STEM education. Lesson plans are available upon request for educators interested in exploring medical physics educational outreach activities in their communities.

Background: Costimulatory blockade of T lymphocytes with the CTLA4-Ig fusion protein abatacept could be an effective treatment for the immune-mediated neuroinflammatory disease relapsing-remitting multiple sclerosis (RRMS). Objective: To evaluate efficacy and safety of abatacept in RRMS. Methods: ACCLAIM (A Cooperative Clinical Study of Abatacept in Multiple Sclerosis) was a Phase II, randomized, double-blind, placebo-controlled, multi-center trial. In all, 65 of 123 planned participants with RRMS were randomized to monthly intravenous infusions of abatacept or placebo for 24 weeks in a 2:1 ratio, switched to the opposite treatment at 28 weeks, and received their final dose of study medication at 52 weeks. Enrollment was closed early due to slow accrual. The primary endpoint was the mean number of new gadolinium-enhancing (Gd+) lesions obtained on magnetic resonance imaging (MRI) scans performed every 4 weeks. Results: No statistically significant differences were observed in mean number of new Gd+ MRI lesions between the abatacept and placebo groups. No statistically significant differences were observed in other MRI and clinical parameters of RRMS disease activity. Abatacept was well tolerated. Conclusion: The ACCLAIM study did not demonstrate efficacy of abatacept in reducing the number of new Gd+ MRI lesions, or clinical measures of disease activity in RRMS.

This study examines the relationship between students’ perception of blended learning platform and course satisfaction based on engagement. Partial least-squares analysis is used. The results show that: (1) course satisfaction with blended learning is influenced by emotional engagement and perceived playfulness of blended learning platform; (2) perceived usefulness, ease of use, and interaction indirectly affect course satisfaction through emotional engagement; (3) perceived usefulness has a stronger direct influence on student cognitive and emotional engagement in blended learning. Emotional engagement is a mediator between perception and satisfaction. Implications for teaching practice are discussed, limitations provided, and future research directions suggested.

Objective To assess the efficacy and safety of a 24-week course of abatacept in the treatment of active lupus nephritis. An additional exploratory objective was to assess the potential of abatacept to induce ‘clinical tolerance’, defined as sustained clinical quiescence of lupus nephritis after discontinuation of immunosuppressive therapy.

China's hotel industry has been developed quickly from a small number of 137 only in 1978 to 14,237 in 2009. One of the main drivers of the rapid development of the hotel industry has been the expansion of multinational hotel groups (MHGs) into China. The purposes of this study are to analyze the factors that determine the location strategies of MHGs and to assess what factors determine MHG's investment strategies in regard to choice of location. The study finds that the market demand and market size measured by number of inbound tourists, tourist spending, and actual foreign direct investment, the business environment measured by GDP per capital, and dummy variables measured by policy and mega events are all significant factors in affecting MHG's locational choices for investment. These findings may provide some insights for MHG's future investment strategies in regard to location choice.

This study provides an updated outlook on the future of the investments proposed by multinational hotel corporations in China. Data were collected from secondary sources using keyword research to identify proposed new hotel developments and future trends in China. A grounded theory approach was used to analyze the data. Findings revealed that the decisions of multinational hotel groups with respect to business formats, the direction trends of investments, and the attractiveness of Chinese market are affected by the happening of mega-events, Chinese government policies, the presence of local entrepreneurs, and market potential.

Purpose: Eleven patients with progressive advanced malignancy after administration of a cancer vaccine received a fully human anti-CTLA-4 monoclonal antibody (ipilimumab). The primary end point was to determine drug toxicity. Tumor response, tumor-specific CD8+ T-cell immune responses, and modulation of CD4+ CD25+ FoxP3+ regulatory T-cell (Treg) numbers were secondary end points. Experimental Design: Three patients with colon cancer, four with non–Hodgkin's lymphoma, and four with prostate cancer were treated. The first dose was given at 3 mg/kg and subsequent doses were administered monthly at 1.5 mg/kg for a total of four cycles. Results: Tumor regression was observed in two patients with lymphoma; one of which obtained a partial response of 14-month duration. Ipilimumab was well tolerated with predominantly grade 1/2 toxicities. One drug-related grade 3 toxicity was observed. One patient died within 30 days of treatment due to progressive colon cancer. No increase in vaccine-specific T-cell responses was observed after therapy. Tregs as detected by expression of CD4+CD25 +CD62L + declined at early time points but rebounded to levels at or above baseline values at the time of the next infusion. Conclusions: Ipilimumab treatment depressed Treg numbers at early time points in the treatment cycle but was not accompanied by an increase in vaccine-specific CD8+ T-cell responses in these patients previously treated with a variety of investigational anticancer vaccines. A partial response was observed in one patient with follicular lymphoma. A phase I/II trial evaluating ipilimumab in patients with follicular lymphoma is currently ongoing.

To conduct a nationwide survey to evaluate the current status of resident mentorship in radiation oncology.An anonymous electronic questionnaire was sent to all residents and recent graduates at US Accreditation Council for Graduate Medical Education-accredited radiation oncology residency programs, identified in the member directory of the Association of Residents in Radiation Oncology. Factors predictive of having a mentor and satisfaction with the mentorship experience were identified using univariate and multivariate analyses.The survey response rate was 25%, with 85% of respondents reporting that mentorship plays a critical role in residency training, whereas only 53% had a current mentor. Larger programs (≥ 10 faculty, P=.004; and ≥ 10 residents, P.001) were more likely to offer a formal mentorship program, which makes it more likely for residents to have an active mentor (88% vs 44%). Residents in a formal mentoring program reported being more satisfied with the overall mentorship experience (univariate odds ratio 8.77, P.001; multivariate odds ratio 5, P.001). On multivariate analysis, women were less likely to be satisfied with the mentorship experience.This is the first survey focusing on the status of residency mentorship in radiation oncology. Our survey highlights the unmet need for mentorship in residency programs.

There is a growing interest in the application of incident learning systems (ILS) to radiation oncology. The purpose of the present study is to define statistical metrics that may serve as benchmarks for successful operation of an incident learning system.A departmental safety and quality ILS was developed to monitor errors, near-miss events, and process improvement suggestions. Event reports were reviewed by a multiprofessional quality improvement committee. Events were scored by a near-miss risk index (NMRI) and categorized by event point of origination and discovery. Reporting trends were analyzed over a 2-year period, including total number and rates of events reported, users reporting, NMRI, and event origination and discovery.A total of 1897 reports were evaluated (1.0 reports/patient, 0.9 reports/unique treatment course). Participation in the ILS increased as demonstrated by total events (2.1 additional reports/month) and unique users (0.5 new users/month). Sixteen percent of reports had an NMRI of 0 (none), 42% had an NMRI of 1 (mild), 25% had an NMRI of 2 (moderate), 12% had an NMRI of 3 (severe), and 5% had an NMRI of 4 (critical). Event NMRI showed a significant decrease in the first 6 months (1.68-1.42, P.001). Trends in origination and discovery of reports were broadly distributed between radiation therapy process steps and staff groups. The highest risk events originated in imaging for treatment planning (NMRI = 2.0 ± 1.1; P.0001) and were detected in on-treatment quality management (NMRI = 1.7 ± 1.1; P = .003).Over the initial 2-year period of ILS operation, rates of reporting increased, staff participation increased, and NMRI of reported events declined. These data mirror previously reported findings of improvement in safety culture endpoints. These metrics may be useful for other institutions seeking to create or evaluate their own ILS.

Twelve patients with T cell large granular lymphocyte leukemia and associated hematocytopenia were treated in a phase I dose-escalation trial with the murine monoclonal antibody Mikβ1. Mikβ1 identifies CD122, the β-subunit shared by the IL-2 and IL-15 receptors. At the doses administered in this study the antibody inhibited the actions of IL-15 on both natural killer and T cells and that of IL-2 when the intermediate-affinity IL-2 receptor was expressed. Mikβ1 treatment was not associated with significant toxicity or with the development of an immune response to the infused monoclonal antibody. At these doses of Mikβ1, >95% saturation of the IL-2/IL-15β receptor (CD122) on the surfaces of the leukemic cells was achieved. Furthermore, in seven patients this led to the down-modulation of the receptor from the surfaces of the leukemic cells. Nevertheless, no patients manifested a reduction in peripheral leukemic cell count or an amelioration of their hematocytopenia. This latter observation may reflect the fact that the monoclonal T cell large granular lymphocyte leukemia leukemic cells of the patients did not produce IL-2 or IL-15 or require their actions for cell survival. In light of the lack of toxicity and lack of immunogenicity of the antibody observed in the present study and the role for IL-15 in the pathogenesis of autoimmune diseases, clinical trials should be performed using the humanized version of Mikβ1 in groups of patients with human T cell lymphotropic virus I-associated myelopathy/tropical spastic paraparesis, rheumatoid arthritis, multiple sclerosis and refractory celiac disease.

Siplizumab is a humanized IgG1κ class monoclonal antibody that binds to the CD2 receptor on human T- and NK-cells. In an animal model of adult T-cell leukemia/lymphoma (ATL), fifty percent of animals survived tumor challenge with 4 weeks of siplizumab treatment and the life-span of tumor bearing animals treated for six months was equivalent to that of animals not challenged with tumors. A single-center phase I dose escalation trial to assess maximum tolerated dose (MTD) and safety in patients (pts) with CD2-positive adult T-cell leukemia (ATL), cutaneous T-cell lymphoma (CTCL), peripheral T-cell lymphoma (PTCL), and large granular lymphocyte leukemia (LGL) is ongoing. Eligibility includes Karnofsky performance status ≥70%; life expectancy >2 months; appropriate hematological status and normal organ function; prior treatment with chemotherapy and monoclonal antibodies is allowed. Cohorts of 3 pts each receive escalating i.v. doses of siplizumab ranging from 0.4 to 4.8 mg/kg administered over 2–3 days per treatment week every other week for 16 weeks or until unacceptable toxicity or disease progression (PD). 16 pts have been enrolled into 5 cohorts: 0.4 (3 pts), 0.6 (3 pts), 0.8 (3 pts), 1.2 (4 pts) and 2.4 (3 pts) mg/kg per week with planned dose escalation to 3.4 and 4.8 mg/kg. Median number of courses received is 4 (range 1–8). Diagnoses include ATL (9), LGL (4), PTCL (1) and CTCL (2). Grade 1/2 infusional reactions primarily manifested as fever and chills were confined to the first dose of treatment in the majority of patients. Meperidine pretreatment significantly ameliorated infusional reactions. The median (range) percentage decrease in CD4, CD8, NK and malignant cell numbers in peripheral blood from baseline are 98(71–100%), 93(50–100%), 89(55–96%) and 88 (0–100%), respectively. No DLTs have occurred at this time. To date, 3 confirmed PRs have been observed (2 ATL, 1 LGL), 6 pts had stable disease, and 7 pts had PD. 1 pt discontinued therapy due to a siplizumab-related adverse event of polymyalgia rheumatica and 3 pts (2 ATL, 1 LGL) were removed due to CMV antigenemia (which was an off-treatment criterion at the time of study drug discontinuation). 4 patients have died during the one-year follow up period due to PD and 4 patients have completed all 8 courses of treatment. In conclusion-siplizumab has been well tolerated in this trial and the maximum tolerated dose has not been reached. The protocol has been amended to allow for treatment of CMV antigen positive patients provided oral antivirals are effective in preventing CMV disease and rising CMV levels. Anti-tumor activity has been observed in some patients. Enrollment in this study continues.

Background: Despite new therapies lung cancer remains the leading cause of cancer death. In a phase I trial we examined the safety and feasibility of antitumor vaccination with three genetically altered human lung cancer cell lines (HyperAcute|[trade]| Lung Cancer Vaccine) engineered to express xenotransplantation antigens through retroviral transfer of the murine |[alpha]|(1,3)galactosyltrasferase gene in patients (Pts) with advanced NSCLC. Methods: Pts with stage IV, recurrent or refractory NSCLC, ECOG PS |[le]|2, |[le]|2 prior chemotherapies, adequate nutrition, bone marrow and organ function were eligible for the study. Cohorts of 3 Pts were scheduled to receive intrademal injections of 3 |[times]| |[Lgr]|6, 10 |[times]| 10|[Lgr]|6, 30 |[times]| 10|[Lgr]|6, or 100 |[times]| 10|[Lgr]|6 irradiated vaccine cells every 4-weeks |[times]| 4. Toxicity was assessed using standard criteria and response was determined by RECIST criteria. Immunological responses included anti-|[alpha]|Gal antibody titers, whole cell interferon-|[gamma]| ELISPOT and vaccine site skin biopsies. Results: To date, 9 Pts, 6 men and 3 women, median age 54 (range, 34-72 yrs.), median number of prior chemotherapies 1 (range, 1-2) were vaccinated with up to 30 |[times]| 10|[Lgr]|6 cells. Five Pts received 4/4 vaccinations, 1 Pt received 3/4 vaccinations and 1 Pt received 2/4 vaccinations, and 2 Pts. have received 1 vaccination. Adverse events (|[le]|grade 2) attributable to vaccination include injection site pain/discomfort, local skin reaction, fatigue, and hypertension. Other adverse events (|[le]|grade 2) include bradycardia, cough, diarrhea, dyspnea, headache, hyperglycemia, hyponatremia, nausea, pleural effusion, and vomiting. Four patients had stable disease |[ge]|16 weeks (range, 21-36+ weeks), three other Pts progressed and 2 Pts are not evaluable at this time. Skin biopsies 48-hrs after vaccination demonstrated vaccine cells in the dermis with infiltration of lymphocytes and eosinophils. Conclusions: Antitumor vaccination with genetically altered allogeneic human lung cells expressing |[alpha]|(1,3) galactosyltrasferase is safe and feasible.