Antimicrobial resistance seriously threatened human health. Combination therapy is generally an effective strategy to fight resistance, while some data on its effects are conflicting. To explore the reasons, the fractional inhibitory concentration indexes (FICIs) of three designed combinations against methicillin-resistant Staphylococcus aureus (MRSA) were determined using checkerboard method, and their minimal concentrations inhibiting colony formation by 99% (MIC99%s) and mutant prevention concentrations (MPCs) alone or in combinations including different proportions were first determined using agar plates. The results indicated that different proportions of a combination had presented different MPCs and mutant selection window (MSWs), and also showed that the smaller the FICIs of two agents in combinations were, the more probable their MSWs were to close each other. As two agents of a combination had different pharmacokinetic characters, the ratios of two agents in blood and infectious sites were likely different even though a specific proportion was administrated, which would lead to different effects preventing resistance. Thereby, these experimental results theoretically indicated that synergistic combination closing each other’s MSWs had a great potency to prevent resistance according to the hypotheses of MSW and MPC, and deduced that in vivo synergistic validity of a combination was likely a key to prevent resistance. Moreover, a synergistic combination of roxithromycin/doxycycline with the FICIs of 0.26–0.50 and 0.28–0.38 respectively against MRSA 01 and 02 was obtained, and the MSWs of these two agents could be simultaneously closed each other in a certain range of proportions, but for others. Meanwhile, its effect preventing resistance needs to be further verified.
A conceptual network between and among tourist engagement, perceived value, tourist satisfaction, and destination loyalty was constructed and validated based on 401 valid samples collected in Phoenix Ancient Town, a famous destination in western Hunan, China. The research results confirm the logic chain in marketing psychology of “engagement-value-evaluation/behavior” in the context of a tourism destination. Specifically, tourist engagement has direct positive effects on destination loyalty, but not on tourist satisfaction. In addition, tourist engagement exerts indirect positive effects on destination loyalty by producing functional value and emotional value for tourists which, in turn, promotes tourist satisfaction towards a destination. However, the indirect influences of tourist engagement on tourist satisfaction and destination loyalty by way of creating tourists’ social value are not significant. This research validates the role of tourist engagement in the formation of destination loyalty from a tourist value perspective and thereby offers a new theoretical clue for tourism marketing.
Tourists are in contact with two types of services at destinations: enterprise services offered by tourism enterprises (e.g., hotels, shops, restaurants, etc.) and public services (public transportation, public information, public safety, etc.) provided by the local government. Following Churchill’s (1979) procedures, a model of destination service encounters (DSEs), including four dimensions (i.e.,enterprise personal interaction encounters (EPIEs), enterprise physical environment encounters (EPEEs), public personal interaction encounters (PPIEs), public physical environment encounters (PPEEs), and 10 subdimensions, was constructed. Then, the effects of DSEs on tourist satisfaction (TS) were tested with data collected in Shaoshan Township, China. The results revealed that EPIEs, PPIEs, and PPEEs had significant positive effects on TS. This model promotes the application of service encounter (SE) theory in destination management, and it offers implications for the synergy management of public and private sectors at destinations to improve tourist experiences.
Background: Improving Quality of Life (QOL) is an essential objective in the management of inflammatory bowel disease. An accumulating body of research has been conducted to explore the association between perceived stigma and QOL among patients with chronic illness. Still, underlying mechanisms behind this pathway have not been thoroughly examined.Objective: To investigate (a) the effect of perceived stigma on QOL among patients with inflammatory bowel disease; and (b) the mediating role of resilience in the association between perceived stigma and QOL.Methods: This cross-sectional study included a convenient sample of patients diagnosed with inflammatory bowel disease from four tertiary hospitals in Jiangsu Province, China. Patients completed the Perceived Stigma Scale in Inflammatory Bowel Disease (PSS-IBD), the Resilience Scale for Patients with Inflammatory Bowel Disease (RS-IBD), and the Inflammatory Bowel Disease Questionnaire (IBDQ). A bootstrapping analysis was implemented using the SPSS macro PROCESS.Results: A total of 311 patients with Cohn's disease and ulcerative colitis participated in this study, and 57.6% were men. The mean disease duration was 3.51 ± 1.04 years. Approximately 40% of the sample exceeded the criterion score for moderate stigma. Patients who perceived moderate or severe stigma reported lower QOL compared with those with mild stigma. After controlling for sociodemographic and clinical variables, we observed that perceived stigma was negatively associated with resilience. Moreover, resilience was found to mediate the relationship between perceived stigma and all aspects of QOL.Conclusions: These findings suggested that QOL of patients with inflammatory bowel disease was associated with perceived stigma and resilience and identified the mediating effects of resilience in the relationship between perceived stigma and QOL. Furthermore, this suggests that integrating intervention techniques to target resilience into the QOL improvement program of individuals with perceived stigma is possible.
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