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Journal of Biology, Agriculture and Healthcare ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol.3, No.17, 2013
Impact of a Designed Nursing Intervention protocol on Myocardial Infarction Patient's Outcome at a selected University Hospital in Egypt 1. 2. 3. 4.
Abdelhameed MahrosAbdelhameed1*, Warda Youssef Mohamed2, Yousria Abd El-salam Seloma3, Hanan El-sayed Zaghla4, Clinical Instructor of Critical Care and Emergency Nursing, Faculty of Nursing, Prof. of Critical care and Emergency Nursing, Faculty of Nursing, Lecturer of Critical Care and Emergency Nursing, Faculty of Nursing, Lecturer of Critical Care medicine Faculty of Medicine, * E-mail of the corresponding author: email@example.com
Abstract Background: Myocardial infarction is a life threatening disease that influences the physical, psychological and social dimensions of the individual. Improper lifestyle is one of the causes of this disease. The designing and implementing of nursing intervention protocol for MI patients could be one of the important and fundamental steps in improving MI patients outcomes. Aim: The aim of this study was to examine the impact of a designed nursing intervention protocol on myocardial infarction patientâ€™s outcomes as indicated by higher post total mean knowledge scores, higher post total mean practices scores and high level of compliance to lifelong instruction. Research hypotheses: H1. Patients who will be exposed to a designed nursing intervention protocol will have a higher post total mean knowledge scores; H2. Patients who will be exposed to a designed nursing intervention protocol will have a higher post total mean practices scores; H3. Patients who will be exposed to a designed nursing intervention protocol will have a high level of compliance to lifelong instruction. Design: A quasi-experimental research design was utilized in this study Sample: A convenience sample of 40 adult male and female MI patients. Setting: The cardiac care units at a selected Cairo University Hospital were recruited to fulfill the aim of this study. Tools: Four tools were formulated& tested to collect data pertinent to the study; Socio-demographic and medical data sheet, Pre/Post knowledge questionnaire sheet, an Observational checklist and Compliance assessment sheet. Structured interview, reviewing medical records and direct observation were utilized for data collection. Results: The study results revealed that the post total mean knowledge scores of the studied subjects is increased significantly with value of t= 20.6 at p=0.000, higher post total practice scores among the studied subjects with t& p values (t=5.6 at p= 0.000 ) also, studied subjects had mild to high compliance level regarding the lifelong instructions. Conclusion: It can be concluded that, enrichment of patients' knowledge and practices in relation to their condition and utilization of the effective nursing intervention protocol as an approach of care could have a positive impact upon improvement of patients' outcome. Recommendations: The study recommended Conduction of further studies in order to assess the effectiveness of the designed protocol on patients' outcome regarding different cardiac disorders with replication of this study on a larger probability sample from different geographical locations at the Arab Republic of Egypt, in addition to establishment of cardiac rehabilitation center in the different heath care organizations. Keywards: Nursing intervention protocol, Myocardial Infarction, Outcomes, Cardiac care units. 1.
Introduction One of the goals of nursing care is health promotion and prevention of disease. Cardiac rehabilitation achieves these goals as it a comprehensive program that prepares the patient to full, vital and productive life in the termination imposed on him by the cardiac disease. It is a process for restoring and maintaining a patient at his optimal physiological, psychological, and social status. Patient moves from complete dependence to independence in his activities of daily living (ADL) (Nair, 2009). The pattern of coronary care has changed, as having treatment philosophies, early hospital discharge is a major force. Supervised programs of exercise, education and lifestyle changes have improved outcome for client who have coronary artery disease, myocardial infarction (MI), and other severe cardiovascular conditions (Hoeman, 2002). Gulanick & Mayers (2011) added, The American Heart Association and American College of cardiology have developed treatment guidelines for patients with unstable angina and Non ST segment elevation Myocardial infarction, as well as for ST segment elevation myocardial infarction. Each guidelines addresses initial and ongoing drug therapy, indication for fibrinolytic and Percutaneous coronary interventions, and discharge consideration. For patient with MI, the therapeutic goals are to establish reperfusion, to reduce infarct size, to prevent and treat complications, and to provide emotional support and education. Recovery from unstable angina is shorter than with myocardial infarction because only ischemic, not infracted, tissue occurs. More than 85% of patients experiencing
Journal of Biology, Agriculture and Healthcare ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol.3, No.17, 2013
myocardial infarction return to full activity level. Ackley, Ladwig, Swan &Tucher (2009) reported that, Cardiac disease self-management are personal actions to manage heart disease and prevent disease progression which are; report symptoms of worsening disease; performs treatment regimen as prescribed; limits sodium intake; follows recommended diet; participates in smoking cessation program; participates in recommended exercise program and uses warming signs to seek health care. Trials have established that several types of intervention can reduce the risk factors for cardiovascular disease; improve psychosocial well-being, and patient knowledge; and reduce morbidity and mortality (Hanestad, Hanssen & Nordrehaug , 2004). Nurses should provide the patient with an exercise instruction such as instructing the patient to record his heart rate before and after each phase of exercise and whenever he feels anything unusual during and after each exercise. Patient may increase speed of walking day by day, and increase the length of walking distance. At the end of 6-8 weeks patient should be able to engage in brisk walking for 5km/hr. patient may be advised to avoid static exercise (lifting, carrying, pushing heavy objects)( Nair 2009). In Egypt, cardiac rehabilitation, usually, is not a part of the routine patient care after acute myocardial infarction, so The designing and implementing of nursing intervention protocol for MI patients could be one of the important and fundamental steps in improving MI patients outcomes. 2.
Significance of the study From clinical observation in the cardiac care and critical care units, it was observed that the number of patients with ACS has increased over the last years and these patients require intensive collaborative care to save their lives and they are at risk for several consequences. These consequences in turn may have negative impact on the patient's physical and psychological condition, and will prolong patient's hospital stay, and increase hospital costs, That is why there is an interest to conduct such type of research which might safeguard this category of patients against these serious consequences, In addition, scattered researches where done in this area especially on the national level. Furthermore, this research could provide health professionals with an in depth understanding related to this category of patients which could be reflected positively on the quality of patients' life, The study as well could support the important role of the nurse in the patients' care through assessing the patient's and providing the required care and teaching regarding the myocardial infarction, Also it is hoped that findings of this study might help in improving quality of patient care and establish evidence based data that can promote nursing practice and research. 3.
Aim of the study The aim of the study is to assess the impact of nursing intervention protocol on myocardial infarction patient's outcomes at the cardiac care units- Cairo University hospitals. 4.
Research hypotheses To fulfill the aim of this study, the following research hypotheses were formulated: H1. Patients who will be exposed to the nursing intervention protocol will have a higher post total mean knowledge scores. H2. Patients who will be exposed to the nursing intervention protocol will have a higher post total mean practices scores. H3. Patients who will be exposed to the nursing intervention protocol plan will have a high level of compliance to medication regimen, diet, exercises, and follows up appointments. 5.
Subjects and Methods: 5.1 Research Design A quasi-experimental research design was utilized in this study 5.2 Setting This study was carried out at the cardiac care units affiliated to Cairo University Hospitals, in Cairo governorate. It is one of the largest educational university hospitals in Egypt in this field. It receives the cardiac patients all over the day. It receives more than 150 MI patients per year. 5.3 Subjects A convenient sample of 40 adult male and female patients admitted to cardiac care units at Cairo university hospitals with acute myocardial infarction for the first time and willing to participate in the study.
Journal of Biology, Agriculture and Healthcare ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol.3, No.17, 2013
5.4 Tools Four tools were developed to collect data pertinent to the study. These tools are: 1-Sociodemographic and medical data sheet (Appendix A):it is a sheet covering two main sections: the first section is related to sociodemographic data which includes age, gender, occupation, marital status, level of education, socioeconomic level, nutritional habits, smoking habits etc. and The second section covers medical data such as date of admission and discharge, diagnosis, vital signs, past medical history& co-morbidities such as diabetes, hypertension), routine medications, family history, and body mass index 2- Pre/Post knowledge questionnaire sheet (Appendix B): This sheet was formulated to assess patients' knowledge about risk factors, manifestations, treatment, complications of acute myocardial infarction, warning signs of recurrent attacks, activities, and life style modificationsâ€Ś.etc. 3- Observational checklist (Appendix C): This sheet was developed to assess patient's practices regarding patients' ability to practice peripheral pulse counting, relaxation technique; deep breathing technique and filling a diet record. 4- Compliance assessment sheet (Appendix D):This sheet was designed to evaluate subjects' adherence to the prescribed regimen. It includes six main areas including a) adherence to the life-long post discharge instructions; b) adherence to prescribed follow up system; c) adherence to prescribed medications regimen; d) adherence to prescribed diet regimen; e) adherence to prescribed exercise regimen and f) adherence to stress management techniques. It is a rating scale which is composed of 4 points (always, sometimes, rarely and never). Ethical consideration An official permission to conduct the study was obtained from the ethical committee of research and Vice Dean for Higher Education and Research- Faculty of Nursing and directors of Critical Care Units. Verbal consents were obtained from head nurses of these units. In addition, patients' agreements to be included in the study were obtained formally after explanation of the nature and purpose of the study. Each patient was free to either participate or not in this study and have the right to withdraw from the study at any time without any rational; also, patients were informed that data will not be included in any further researches without another new consent if they do not mind. Confidentiality and anonymity of each subject were assured through coding of all data. 5.6 Techniques for data collections Structured interview, reviewing medical /nursing records ,direct patients observation and follow up by phone calls were utilized to fill out the study tools. 5.7 Procedure The current study was carried out on two phases, designation and implementation phases which are: 5.7.1 Designing phase: It was concerned with the construction and preparation of the different data collection tools and instructional booklet in addition to obtaining managerial arrangement to carry out the study. 5.7.2 Implementation phase: The researchers visited the cardiac care units on daily bases once they find the patient who met the criteria of selection; socio-demographic and medical data sheet (tool 1) was fulfilled. As well the knowledge assessment sheet (tool 2) and observational checklist sheet (tool 3) were filled out for the whole group as a control group. The whole group was exposed to the routine hospital care. Then the whole group was subjected to the designed nursing intervention protocol on a daily base till discharge as a study group. Then all subjects were supplied with the predetermined instructional booklet. The compliance assessment sheet (tool 4) was filled out for all subjects during the first month after discharge. Mainly follow up was done through the open channel of communication with the investigator through the telephone call to answer their questions, reinforce information, correct misunderstanding and monitor the patient's adherence to the given instructions. 5.8 Statistical data analysis Data obtained from the study tools were categorized, tabulated, analyzed and data entry was performed using the SPSS software (statistical package for social sciences version20.0). Descriptive statistics were applied (e.g. mean, standard deviation, frequency and percentage). Tests of significance were performed to test the study hypotheses (i.e. paired and unpaired t- test, chi square test and ANOVA test). Pearson's correlation coefficient was applied between quantitative variables. A significant level value was considered when p<0.05.The smaller the P- value obtained, the more significant is the result. The P- value is being the probability of error of the conclusion. 6.
Results Findings of the current study are presented in three main sections; section (1) related to sociodemographic data, medical data (table1 and figures1,2,3,4,5,6,7&8), section (2) is concerned with testing the research hypothesis (figure 9,10&11) and section (3) is concerned with the additional findings(table2&3)
Section 1: Figure (1) shows that, 52.5 % of study sample's age ranged from>50 to65 years, and 37.5% of them were aged between 35to50 years. Figure (2) shows that, more than three fourths of the studied subjects (78 %) were males. Figure (3) shows that, 85% of studied subjects came from urban areas and figure (4) shows that (40%) of the studied subjects were overweight and 30% were moderate obese. Figures (5)& (6) shows that, (72.5%) of the studied subjects were smokers and (37.9%) of them were smoking 10 to 20 cigarettes per day. In addition that, figure (7) shows that more than half (55% ) of the studied subjects were diagnosed as STEMI while (44% )of them diagnosed NSTEM and figure(8) shows that (37.5%) of them have not any co-morbidity diseases. Table (1) revealed that more than one third (37.5%) of the studied subjects were able to read and write and (80%) of them were having a work. In addition that, (47.5%) of the studied subjects were used to eat foundry and fatty diet and (72.5%) dose not drink coffee.(97.5%) of the studied subjects does not practice any sports. Finally only (15%) of the studied subjects has positive family history for the cardiac disease. Section (2): Figure (9) indicating higher total knowledge scores among the studied subjects, ranked as satisfactory to good levels. However, all of the studied subjects (100%) remained with an unsatisfactory knowledge level before receiving the designed protocol which is supporting the first hypothesis which stated "Patients who will be exposed to a designed nursing intervention protocol will have a higher post total mean knowledge scores". Figure (10) shows that (100%) were having unsatisfactory level of practice before receiving the designed protocol, this percentage decreased to be (45%)after receiving the designed protocol, the other (55%) of the studied subjects were having satisfactory (25%) and good (30%)level of practice and this is supporting the second hypothesis which stated "Patients who will be exposed to a designed nursing intervention protocol will have a higher post total mean practices scores". finally, it appears from figure(11)that, (50%) of the studied subjects has medium total compliance level to the lifelong instructions, while (47.5%) of them has low level of total compliance, and shows also the different subtotal compliance scores ranking from low to high level of compliance which could partially support the third hypothesis which stated "Patients who will be exposed to a designed nursing intervention protocol will have a high level of compliance to lifelong instruction". Section (3) Table (2) revealed that, there is a significant positive statistical correlations between total knowledge scores and total practice scores, total practice scores and total compliance scores and total compliance scores and total knowledge scores (r = 0.569, p =0.000), (r =0.509, p =0.001) and (r=0.338 ,p=0.033) respectively. Table (3) Demonstrates that, there is a highly significant statistical difference was found between educational level and total mean knowledge, practice and compliance scores of the studied subjects. 7. Discussion The present study delineated that more than three fourths of the cases are male and more than half of the study sample's age ranged between >50-65 years old. This agreed with Bare, Cheever, Hinkle & Smeltzer (2010) who mentioned that risk factors for the development of coronary artery diseases â€œCADâ€? increases with age and male gender. In accordance with these results, Bos-Scheap, Hautvast, Heestermans, Wit &Umans (2011) reported in a published study entitled as "Nursing role to improve care to infarct patients and patients undergoing heart surgery" that (75%) were male. This study results is similar to the study of Angerud ,Brulin , Eliasson & Naslund (2013) in an analysis of 4266 MI patient which revealed that about two third of the studied subjects were male with mean age of 61.8 years, and Hawboldt, Pearce & Young (2010) in a study on 346 MI patients found that, their mean age was 65.3 years and 65.5% of them were male. Moreover, Ahrens, Klinpell & Prentice (2010) found that ACS is more prevalent in older persons than in younger persons, the condition develops earlier in men than in women. Holle, Kirchberger, Kuch, Meisinger, Seidl& Wende (2010) also confirmed that aged patients have a high prevalence of MI. The study results also supported by the results of Hawboldt, Pearce& Young (2010) which studied 346 MI patients, showed that the mean age of patients was 65.4 years and almost two-thirds were male. Another study done by Eliasson, Isaksson ,Jansson , Lundblad , Naslund& Zingmark (2011) studied 8630 with a first MI and showed that about three fourths of the studied subjects were male with mean age of 55.5 years. In contrast with our study, the study of Aurigemma, Chiriboga, Fornasini, Goldberg, Gore, Lessard, Spencer& Yarzebski (2009) that studied 6334 MI patients showed that the mean age of the studied subjects was 71 years and 56% were men. The demographic data of present study also delineated that the majority of the studied subjects came from urban areas. As Cairo University hospitals is one of the largest educational university hospitals in Egypt in this field which receives the cardiac patients from all over the country. This may be due to the unhealthy lifestyle which the urban people have comparing to the rural people lifestyle. This study results is similar to the
study of Angerud ,Brulin, Eliasson & Naslund (2013) in an analysis of 4266 MI patient which revealed that about two thirds of the studied subjects came from urban areas. The present study revealed that about three fourths of the study subjects were smokers, that is why, smoking may be the most probable risk factor for the majority of MI events. This is agreed with Gulanick & Mayers (2011) who reported that smoking causes vasoconstriction and reduces myocardial oxygen supply , risk for developing CAD is 2 to 6 times greater in cigarette smokers and risk is proportional to number of cigarettes smoked. However the study carried out by Angerud , Brulin , Eliasson & Naslund (2013) showed that about one third only of the study subjects which was 4266 MI patients were smokers.In accordance to this study, the study of Eliasson, Isaksson , Jansson , Lundblad , Näslund & Zingmark (2011) which studied 8630 with a first MI and showed that 39.6% of the study subjects were smokers.Moreover, Hawboldt, Pearce & Young (2010) found that more than one third of the studied subjects (346 MI patients ) were current smokers. The reviewed medical data sheet of current study subjects showed that more than half of them were diagnosed STEMI. This result is similar to the results of Aurigemma, Chiriboga, Fornasini, Goldberg, Gore, Lessard, Spencer& Yarzebski (2009) study titled “Contemporary trends in evidence-based treatment for acute myocardial infarction” which showed that the majority of the studied subjects were STEMI. In contrast with this study the study of Young, Hawboldt & Pearce (2010) which studied 346 MI patients found that, the majority of the study subjects diagnosed NSTEMI. Regarding BMI the current study showed that more than one third of the studied subjects were overweight and more than one forth of them were obese, That’s why, the obesity may be one of the risk factors for MI. In this regards, Brubaker, Kaminsy& Whaley (2002) reported that obesity is documented in approximately 40% of people with CAD patients. In accordance with these results, Bucholz, Chan, Jone, Rathore, Krumholz, Reid, Rich& Spertus (2012) in a study titled “Body mass index and mortality in acute myocardial infarction patients” done on study sample 6359 MI patients reported that one third of the studied subjects were obese. Regarding the co-morbidities the current study revealed that co-morbidities was absent in one third of the study subjects, while almost one fourths of the studied subjects had hypertension plus diabetes mellitus and one fifth of the studied subjects had diabetes mellitus only. Gulanick & Mayers (2011) also mentioned that eighty percent of diabetic patients have cardiovascular disease. In addition that High blood pressure is major risk factor for CAD as Nair (2009) reported that the stress of constantly elevated blood pressure can increase the rate of atherosclerosis development. In this regard, Aurigemma, Chiriboga, Fornasini, Goldberg, Gore, Lessard, Spencer& Yarzebski (2009) reported that about one third of the study sample haven’t any co-morbidities, while more than one fourth of the study sample had had 1-2 co-morbidities and about one third of them had 3-4 comorbidities. Also Bucholz et al. (2012) reported in a study done on 6359 MI patients that around two- thirds of the sample had hypertension, and more than one third of them had diabetes mellitus. Moreover, Hawboldt, Pearce & Young (2010) found that more than one fourth of their study subjects had had diabetes mellitus, while more than half of them had hypertension. As regards to the Patient's Knowledge, the current study results delineated, a higher statistically significant difference between patient’s knowledge score pre and post exposure to the designed protocol, indicating higher total and subtotal mean post knowledge scores among the studied subjects, ranked as satisfactory to good levels. However, all of the studied subjects were having an unsatisfactory knowledge level before receiving the designed protocol. The rational for knowledge improvement might be related to the provision of educational booklet and / or verbal instructional information. Also, the curiosity of the studied subjects as this is the first heart attack for them and many concerns are present. Results of present study showed that there was a significant difference before and after the intervention in the studied subjects. Therefore, applying discharge plan could have positive effects on the lifestyle of patients with MI. Similar to the results of this research, another study by Jiang, Sit& Wong (2007) indicated that, a nurseled cardiac rehabilitation program can significantly improve the health behaviors and cardiac physiological risk factors in coronary heart disease patients. Based on these findings, it is necessary to consider the role of nurses in a cardiac rehabilitation program. Dalleck, Lueker& Schmidt (2011) reported that, participation in cardiac rehabilitation programs had positive changes in various risk factors like blood pressure, cholesterol, triglyceride, HDL and LDL cholesterol 17,18 energy expenditure, fat, and stress. Following up the client’s behavior at home helped better controlling the heart disease. This reduced the frequency of their re-hospitalization, cost of hospitalization and mortality rate. Franklin, Gordon Leighton& Salmon (2002) also showed a reduction in risk factors of patients with MI, CABG, Percutaneous coronary intervention, or angina after participating in traditional cardiac rehabilitation, cardiac rehabilitation with physician supervision, and a community-based exercise program run by exercise physiologists. In addition, Abedi, Ahmadi, Arefi ,Faghihi-zadeh& Ghofranipour (2005) reported that, continuous care model has positive effects on the quality of life of patients after CABG and heart failure, in all physical,
emotional and general dimensions. This model was effective in the reduction of the hospitalization period and chest pain in patients with coronary vascular diseases. However, the study carried out by Hosseini, Mohammadi, Rahgozar& Taherian (2006) aiming to determine the effect of applying cardiac rehabilitation at home on the quality of life of patients with MI showed that the rehabilitation program consisting of training sessions regarding MI disease and its complications, dietary and medicinal regime, risk factors of the disease, etc. at home had no particular effect on various dimensions of the quality of life of this group of patients and there was no significant difference between groups. Ghahramanian, Golchin& Rostami (2011) showed that, education programs and follow-up by telephone have positive effects on knowledge, self-care behaviors, a disease symptoms of patients with cardiac failure. Patients forget the therapeutic recommendations gradually after discharge from the hospital; therefore, it is necessary to provide such information. On the other hand, the number of healthy undesirable behaviors of patients with MI increases if it is not followed-up at home. Since the patients’ participation in cardiac rehabilitation programs after an acute MI is low, they require education and follow-up regarding the control of symptoms, medicinal information, and improvement of lifestyle. Chris &Charlie (2004) agreed with this findings as they studied the "Influence of written information on patient's knowledge of their diagnosis" on 64 patients in Oxford University found that patients receiving an information sheet were twice as likely to be correct with their main diagnosis (59% vs 31%) compared with the control group. There was a tendency for patients receiving a sheet to have increased knowledge of previous medical problems. Finally, patients receiving a sheet were significantly more satisfied with the information given about their diagnosis in hospital compared with the control group. As regards to the relationship between knowledge and educational level, the current study revealed that there was significant statistical correlation between educational level and mean knowledge scores among studied subjects. In this regard, Alghanim & Alnaif (2009) agreed with our findings in a published research article entitled as "patients’ knowledge and attitudes towards health education: implications for primary health care services" in Saudi Arabia in which they found, respondents with a higher level of education had a significantly higher mean score (3.63) of knowledge about diabetes than those with a lower level of education (3.28) (t-test = 3.665, p<0.001). Contradicting this, Seloma (2010) reported in an unpublished doctorate thesis entitled as” Impact of utilization of a designed nursing clinical pathway guidelines on the patients' outcomes with cardiac pacing at the critical care units, El-Manial University Hospital” that there was no significant statistical correlation between educational level and mean knowledge scores among study and control group subjects throughout the different assessment periods except during assessment period before pacemaker insertion. As regards to patient’s practice, the current study results reported that there was a significant statistical difference between patient’s practice mean scores pre and post exposure to the designed protocol, the majority of study subjects had higher post total and subtotal mean practice scores, ranked as satisfactory to good levels. However, all of the studied subjects had an unsatisfactory practice scores before receiving the designed protocol .These findings may be as a result of continuous demonstration, redemonestration, follow up and practical content of the instructional booklet which was given to the studied subjects with the continuous explanations, reinforcement and feedback. In the present study, there was a significant statistical correlation between patients mean practices scores and their level of education in different assessment periods among studied subjects before and after the intervention. In addition to, there was a significant statistical positive correlation between total knowledge and total practices scores among the studied subjects. Contradicting this, Seloma (2010) reported that there was no significant statistical correlation between patients mean practices scores and their level of education in different assessment periods among study and control group subjects. However, there was a significant statistical positive correlation between total knowledge and total practices scores among the study and control group subjects throughout the different assessment periods. In accordance with the study findings, Refaii (2010) in an unpublished doctorate thesis entitled as "the impact of a designed nursing clinical pathway guidelines on acute myocardial infarction patients' outcomes" on 60 patients (30 study and 30 control) at Benha University Hospitals in Egypt found that, an increment of study group post mean practices scores as compared to control group after implementation of a designed nursing clinical pathway with a highly significant statistical differences between the two groups during the two follow up assessment (immediately post and three months later) with the following X2 &p values(X2 =21.72 at p=0.001 & X2 = 4.158 at p =0.001 respectively). As well, El Hadary (2009) in an unpublished doctorate found that there was a higher statistically significant difference between the study and control group subjects in different assessment periods, indicating higher mean values of avoiding cardiac stress activities, climbing stairs as advised and arranging activity/rest time throughout the follow up visits among the study group as compared to the control group ones, with high significant statistical differences between them (F= 25.14 at p=0.0001, F=53.39 at p=0.0001&F=30.70 at p=0.0001).Moreover, Mohamed (2006) in a study entitled as" effect of counseling on
patient's compliance with therapeutic regimen after artificial valvular heart replacement surgery" on 100 patients at the cardiothoracic surgery department at Ain Shams University hospital in Egypt, in an unpublished doctorate thesis found that, none of the patients in the study and control groups were performing radial pulse measuring, neck, shoulder and elbow exercises pre-program implementation. However post program implementation; approximately one third had satisfactory performance, with a highly significant statistical difference between study and control group subjects As regards to patientâ€™s compliance, the current study indicated a statistically significant difference between the studied subjects regarding to total and subtotal compliance scores post discharge and during follow up visits. The studied subjects showed different levels of compliance ranging between being low, medium and high compliance levels. This may be due to continuous contact with the studied subjects through open channel of telephone communication between the researcher and the studied subjects. Wal, Jaarsma, Moser&Veeger (2006) mentioned that in order to improve compliance, an increment of knowledge and a change of patient's beliefs by education and counseling are recommended. Extra attention should be paid to patients with depressive symptoms. In this regard, El Hadary (2009) supported these result when reporting that study group subjects showed a higher mean compliance scores regarding following prescribed medications and following prescribed activity regimen as compared to control group subjects with significant statistical differences between the two studied groups (F=25.60at p=0.0001& F= 69.02 at p= 0.0001).Also, Wal, Jaarsma, Moser&Veeger (2006) in a published research article entitled as "Compliance in heart failure patients: the importance of knowledge and belief" in University of Groningen, data were collected in a cohort of 501 heart failure patients. They found that overall compliance was 72% in this older heart failure population. Compliance with medication and appointment keeping was high (>90%). In contrast, compliance with diet (83%), fluid restriction (73%), exercise (39%), and weighing (35%) was markedly lower. Compliance was related to knowledge (OR=5.67; CI 2.87-11.19), beliefs (OR=1.78; CI 1.18-2.69), and depressive symptoms (OR=0.53; CI 0.35-0.78). Adding to that, Zerwic (2007) stated that, the compliance to the therapeutic regimen was promoted by nursing clarification and explanation. Therefore, the information provided through nursing intervention must be sufficient to increase patient's desire and encourage them to comply with prescribed therapeutic regimen after discharge. The patient who are oriented with every-thing about their disease are more likely to engage in activities that promote changing their behaviors, promote physical well-being and enhancing the compliance with therapeutic regimen than those who are not oriented. 8.
Conclusion Considering the results of the present study and the available evidence, it can be concluded that, patients who were exposed to the designed nursing protocol for the myocardial infarction patients showed a relative improvement in their conditions than those who were exposed to the routine hospital care only. This improvement was manifested in the increment in the post total mean knowledge scores, post total mean practice scores and the mean compliance scores as regards to the immediate, life-long and follow up instructions. Rehabilitation centers also could apply this model to follow the patients after MI.
9. Recommendations Based on the findings of the present study, the following recommendations are suggested: Recommendations related to patients: - Establishment of patients' educational centers in hospitals equipped by suitable related materials, medias and audio-visual aids for teaching all myocardial infarction patients' how to live with their medical condition. - Cardiac rehabilitation centers can be established and encouraged. - Regular follow up for all patients with myocardial infarction to evaluate their health conditions and to detect complications early. Recommendations for furthers researches: - Replication of the study on a larger probability sample selected from different geographical areas in Egypt is recommended to obtain more generalizable data. - Further studies have to be carried out in order to assess the effectiveness of nursing intervention protocol applications on patients' outcomes regarding different cardiac disorders. - Further studies have to be carried out in order to assess nurses' knowledge and practices regarding providing a nursing intervention protocol for myocardial infarction patients. Acknowledgment This research article would not have been possible without the support of many people. The authors wish to express their gratitude to all people who share or help in this research.
References Ackley, B. J., Ladwig, G. B., Swan, B. A. & Tucher, S. J. (2009). Evidence-Based nursing care guidelines. Canada, Elsevier Mosby, p.p. 140-148. Abedi, H.A., Arefi, S.H., Ahmadi, F., Faghihi-zadeh, S. & Ghofranipour, F. (2005). Effect of continuous consultation care model on re hospitalization and chest pain in patients with coronary artery disease. J Qazvin Univ Med Sci; 35(9): 99-103. Ahrens, T. S., Kleinpell, R. M. & Prentice, D., (2010). Critical care nursing certification, Singapore, McGrewHill, p.p 65-75. Alghanim, S.A., Alnaif, M.S. (2009). Patients' knowledge and attitudes towards health education: Implications for primary health care services in Saudi Arabia. Published thesis; Volume : 16, Issue : 1, p.p. : 27-3 Angerud, K.H., Brulin, C., Eliasson M. & Naslund, U. (2013).Longer pre-hospital delay in first myocardial infarction among patients with diabetes: BMC cardiovascular disorders2013,13: 6. Aurigemma, P., Chiriboga, D., Fornasini, M., Goldberg, R.J., Gore, J.M., Lessard,D., Spencer, F.A &Yarzebski, J.(2009). Contemporary trends in evidence- based treatment for acute myocardial infarction. AM J Med.2010;123(2): 166. Brubaker, P. H., Kaminsky, L.A., &Whaley, M.H., (2002). Coronary artery diseases, essentials of prevention and rehabilitation programs. United states of America, by Human kinetics, p.p. 291-326. Bucholz, E.M., Chan, P.S., Jones, P.G., Krumholz, H.M., Rathore, S.S., Rich, M.W.& Spertus, J.A.(2012). Body mass index and mortality in acute myocardial infarction Dalleck, L.C., Lueker, R. & Schmidt, L.K.(2011). Cardiac rehabilitation outcomes in a conventional versus telemedicine-based program ; 17(5): 217-21. El Hadary, S. (2009): Impact of Utilization of a Nursing Clinical Pathway Guidelines on the Heart Failure Patients' Outcomes at the Critical Care Units, El-Manial University Hospital: Doctorate thesis. Elison, M., Isaksson, R.M., Jansson, J.H., Lundbald, D., Naslund, U.& Zingmark, K. (2011). Franklin B.A., Gordon N.F., Leighton, R.F. & Salmon, R..D. (2002). Effectiveness of three models for comprehensive cardiovascular disease risk reduction. Am J Cardiol; 89(11): 1263-8. Ghahramanian, A., Golchin, M. & Rostami, H. (2011)Educational needs of myocardial infarction patients. J Urmia Nurs Midwifery Fac 2011; 9(3): 157-63. Gulanick, M. and Myers, J.L. (2011). Nursing care plans(7th ed.). United states of America,Elsevier Mosby, p.p 209-210. Hawboldt, J.J., Pearce, N.J. & Young, S.W. (2010). Use of evidence based therapy at discharge for patients with AMI.CJPH-VOL 63(3):207-211. Hoeman, S. P. (2002). Rehabilitation nursing (3rd ed.). United states of America, Mosby, p.p. 723-735. Holle, R., Kitchberger, I., Kuch, B., Meisinger, C., Seidi, H. & Wende, R.(2010). Nurse based case management for aged patients with MI: study protocol of a randomized controlled trial. BMC Geriatrics 2010, 10:29. Hosseini, M.A., Mohammadi, F., Rahgozar, M. & Taherian, A.(2006). Effect of home-based cardiac rehabilitation on quality of life in the patients with myocardial infarction. Iran Rehabil J 2006; 7(3): 11-9. Jiang, X., Sit, J.W.& Wong, T.K. (2007). A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. J Clin Nurse 2007; 16(10). Nair, U.R. (2009). Textbook of medical surgical nursing (1st ed.). India, Jaypee Brothers medical Publishers, p.p 45-430. Seloma, Y.E. (2010). Impact of utilization of a designed nursing clinical pathway guidelines on the patients' outcomes with cardiac pacing at the critical care units, El-Manial University Hospital: Doctorate thesis.
Figure (11): Differences in total and subtotal compliance score levels of the studied subjectsâ€™ post receiving the designed protocol (n=40):
Compliance scores low compliance
high compliance 95% 87.5%
Patient's Patient's Patient's compliance to compliance to compliance to life-long regular follow up medication instructions regimen
Patient's â€˘ Patient's compliance to compliance to diet regimen exercise regimen
(B) Tables: Table (1): Distribution of the educational level, Occupation, Diet nature, Coffee intake, practicing sports and family history for cardiac diseases for the studied subjects (n=40).
Coffee intake Practice sports Family history
Items - Illiterate - Can read and write - Secondary education - High education - Doesn't work - Worker/ Employer - Low salt - Low fat - Foundry and fatty - Not specific" usual" - No - Yes - No - Yes - No - Yes
No 7 15 12 6 8 32 2 1 19 19 29 11 39 1 34 6
% 17.5 37.5 30.0 15.0 20.0 80.0 5 2.5 47.5 45 72.5 27.5 97.5 2.5 85.0 15.0
Table (2): Correlation Coefficient Between total knowledge scores, total practice scores, and total compliance scores of the studied subjects (n=40). The Items 1-Total knowledge scores and total practice scores 2- Total practice scores and total compliance scores 3- Total compliance scores and total knowledge scores *Significant at the p < 0.05 probability level
r/value 0.569 0.509 0.338 NS= not statistically significant
P/value 0.000* 0.001* 0.033*
Table (3): One way ANOVA test for comparison of total mean knowledge scores, total mean practice score and total mean compliance scores in relation to educational Level of the Studied Subjects (n=40). Variable â€˘
Educational level 10.1 o Educational level/ total mean knowledge scores 5.3 o Educational level/ total mean practice scores 4.2 o Educational level/ total mean compliance scores *Significant at the p< 0.05 probability level *NS= not statistically significant
p 0.000* 0.005* 0.011*
This academic article was published by The International Institute for Science, Technology and Education (IISTE). The IISTE is a pioneer in the Open Access Publishing service based in the U.S. and Europe. The aim of the institute is Accelerating Global Knowledge Sharing. More information about the publisher can be found in the IISTEâ€™s homepage: http://www.iiste.org CALL FOR JOURNAL PAPERS The IISTE is currently hosting more than 30 peer-reviewed academic journals and collaborating with academic institutions around the world. Thereâ€™s no deadline for submission. Prospective authors of IISTE journals can find the submission instruction on the following page: http://www.iiste.org/journals/ The IISTE editorial team promises to the review and publish all the qualified submissions in a fast manner. All the journals articles are available online to the readers all over the world without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. Printed version of the journals is also available upon request of readers and authors. MORE RESOURCES Book publication information: http://www.iiste.org/book/ Recent conferences: http://www.iiste.org/conference/ IISTE Knowledge Sharing Partners EBSCO, Index Copernicus, Ulrich's Periodicals Directory, JournalTOCS, PKP Open Archives Harvester, Bielefeld Academic Search Engine, Elektronische Zeitschriftenbibliothek EZB, Open J-Gate, OCLC WorldCat, Universe Digtial Library , NewJour, Google Scholar
Published on Dec 14, 2013


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The time we have waited for the release of Cyberpunk 2077 was immense but the result was not as satisfactory as expected. Now the people into gaming want developers to take time but give their best for the result. There has been the name for years of a bizarre kung-fu Role Playing Game (RPG) – Biomutant now but it was delayed for next year. But this year things seem different as the firm release date is being set for Biomutant on May 25, 2021, for platforms – PS$, PC, and Xbox One.
Story Line of Game
Biomutant is described by creators as a “post-apocalyptic kung-fu fable” which places the player in the role of a hypothetical animalistic mutant protagonist. In the game lies a vast world to explore which has gliders, mounts, and other, more bizarre methods of transportation with a mission to doom or save the world and something known as the “Tree-of-Life.”
However, nothing else has been shared by the creators as they have remained mostly tight-lipped about it. But from the story line observed, it seems that Biomutant is a complex, weird, and wholly original game.
Create Own Weapons
But this thing for sure is present in the game that total freedom will be given to craft your weaponry (which will involve mixing various parts from 1 and 2-handers i.e. rifles or revolvers) and punch, kick, leap, or shoot in chaotic third-person battles. The person will be free to unlock power equipment throughout the gameplay of Biomutant with the help of a Non-Playing-Character such as bionic wings, jump-pack, or a “scrap-toy sidekick” known as The Automaton.
And of course, the name suggests that the player could mutate in Biomutant. You can unlock powerful abilities by re-coding your character’s genetic structure, like Mucus Bubble or Turtleform (the former lets you generate a ball around yourself and comically bowl over enemies), and even the likes of levitation and telekinesis.
Few things of Biomutant can’t be expressed in simple words as the game is simply too strange and ambitious for that. But one can watch the gameplay trailer released last June below to get your imagination to work to the best.
But after the disastrous launch of Cyberpunk 2077, these ambitious projects are highly skeptical to settle. But within 3 months we will have a title release which helps us give more sights about the gameplay of Biomutant.

domain: game


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MySims heading to the PS3
In MySims SkyHeroes, you will take to the sky to lead the resistance against Morcubus and his drone army in an attempt to stop his plans to take over the skyways.
Starting as an unknown pilot, you fight to become a celebrated hero as you defeat dangerous enemies in aerial combat, test your reflexes in fast-paced speed challenges, and take on massive enemy bosses that demand all your skills as a pilot to survive.
As you progress, you will get the chance to build, customize and tune your aircraft to give them an edge in combat – upgrade wings for swifter manoeuvres, switch out the engine for a speed boost, or change the paint job to camouflage the plane and avoid enemy fire.
The game will feature a full solo campaign, as well as local split-screen and online multiplayer where you will be able to fly with or against up to 10 friends in cooperative or competitive modes.
Whilst graphically you can clearly see the games Wii heritage, we think it is definitely worth keeping an eye on – it might just surprise us all.

domain: entertainment


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Over the past five centuries, the dazzling works of artist and scientist Leonardo da Vinci have continued to fascinate the masses, drawing the attention of both fans and critics. Born in 1452 in Italy, Leonardo managed to transcend his time and place, exemplifying the Italian renaissance and inventing things like helicopters, tanks, calculators and solar panels, centuries before the technology to build them would be realized.
While Leonardo anticipated many later mechanical discoveries, he is most famous for his paintings. At one time, the king of France even stated: “No man knows more than da Vinci” (Saari, Saari and Carnagie 22). His cumulative abilities are most appreciated because he lived during the Renaissance, “an age that was identified with genius, new ideas, exploration, and new ways of thinking” (Saari, Saari and Carnagie 22). This paper examines Leonardo’s style and perspective, as portrayed in several of his most famous paintings.
Leonardo’s General Style
Leonardo believed that the most important element in a successful painting is the comprehension of the structure. He was able to examine people and objects and identify how they are formed. This enabled him to conceptualize the flight of birds, which was captured a few hundred years later using slow-motion cameras. Da Vinci was very inquisitive and perceived that it was possible to relay emotions through paintings. He was able to achieve this using ‘sfumato’ style, whereby he painted a lighter shade of color, and gradually incorporated darker tones to produce a murky blush. His art work sought to show emotion, which is probably what led him to paint his most notable masterpiece, the Mona Lisa (Saari, Saari, and Carnagie 45).
Leonardo used oil paint on poplar to create this famous painting in the period between 1503 and 1507. The painting measures 76.8 by 53 cm, and can currently be found in Musee du Louvre, Paris. Langley claims that the Mona Lisa is the most famous painting in the world, and while there may have been other painters that were as talented or possibly more skilled than da Vinci, Leonardo was certainly the best portrait painter.
The Mona Lisa is one of the paintings that reveal Leonardo’s style of painting, sfumato, combining portrait and landscape to establish a 3D effect or depth. Also, da Vinci was able to capture a variety of emotions and traits in the one painting, allowing viewers to appreciate something new about it every time they looked at it from a different direction. This gave the portrait a sense of mystery since a viewer could not possibly identify all the portrayed emotions and traits of Mona Lisa’s personality from a single glance. For instance, a viewer cannot identify the source of her glow between her mouth and eyes (Langley 16).
Lady with an Ermine
This 53.4 by 39.3 cm, oil on wood panel painting was created between 1483 and 1490 and is believed to have been modeled by the mistress of Duke Sforza, a powerful prince in Renaissance Italy. This painting is currently on display at Czartoryski Museum in Krakow, Poland. Chou claims that the ability of Leonardo to express precise facial subtleties has been unmatched for centuries, and in this particular painting, he was able to reveal the beauty and virtues of Cecilia Gallerani.
Despite her high level of influence in Milan and admiration by all, Leonardo was able to portray Cecilia realistically, showing her relaxed elegance when holding a fierce cannibal, the ermine. The painting shows her as a saint and classy person with a moderate level of insecurity and conceit. Chou argues that this painting reveals the high level of da Vinci’s discerning eye, allowing him to capture aspects of the human character that are not easily detectable (Chou).
Ginevra de’ Benci
This oil on wood, 42.7 by 37 cm painting was made by Leonardo in 1474, during his eighth year as Verrocchio’s apprentice. In this painting, Leonardo brings together a portrait and landscape painting but chooses to make the model sulky, unlike Mona Lisa and Cecilia. His attention to detail is, however, as remarkable as in other paintings, given his ability to express a withdrawn, haughty and unforgiving look by squinting one of her eyes.
This was probably aimed at showing the model’s dissatisfaction with her forthcoming marriage to Niccolini. The background employs the sfumato style of cloudy sky, which was achieved using an overlay of oil finish to establish a thin layer of mist. This was among his first paintings, which showed that he had already mastered the ability to create depth and distance and render light and texture. This portrait was purchased by an American gallery in 1967 and can be viewed at the National Gallery of Art, Washington D.C (Langley 7).
The Adoration of the Magi
This 246 by 243 cm painting was created in Uffizi, Florence in 1481-1482, where it is still found, though Leonardo moved to Milan before completing it. The yellow ochre and brown ink on panel painting was a dramatic portrayal of the collapse of the pagan world and the appearance of the Messiah. It is believed to be da Vinci’s declaration of sovereignty from Verrocchio, seeking to begin with a new and personal style. This is one of his most creative works, whereby he employs his style of light to dark shades, sfumato, at the base to isolate the Virgin and Child group (Virgin Mary and Magi) from the minor treatment of surrounding groups (faithful followers), without compromising on the sense of harmony and interconnection.
The adoration of the Magi painting is thought of as very progressive compared to other art works in Florentine, especially owing to the distinct differences between multiple groups like the praying shepherds, the dignified kings, and other participants. All figures are meant to direct their attention to Mary, acknowledging with a certain level of emotion, the divinity of the Christ Child (Marchetti and Panconesi 104). Compared to other paintings created in Florence that have a sense of expressing adoration, da Vinci chooses to create a mysterious background with an unfinished staircase and equestrian battles, which links the painting to the Augustinian convent of San Donato in Scopeto, which may have wanted to use the composition to relay its own scriptural understanding of the Adoration theme (Marchetti and Panconesi 105).
Leonardo da Vinci is considered a genius who transcended at a time of great discoveries. He died in 1519, though a few pieces of his works are still available for viewers who would like to experience his mastery of diverse disciplines including anatomy, music, engineering, and paintings. It is unlikely that his works can be fully and satisfactorily interpreted, especially his paintings, which are full of symbols, cryptograms, and references to mysteries about his life and home.
Some authors, for instance, claim that the Adoration of the Magi painting was finished, and was intended to relay that exact message. The renaissance was a time of beauty, but it was also associated with much violence, misery, and human suffering, which Leonardo managed to adequately, capture in his paintings and other art works (Marchetti and Panconesi 108).
Chou, Peter. Lady with an Ermine. 2003. Web.
Langley, Andrew. Leonardo da Vinci and the Renaissance. Philadelphia, Pa: Running Press, 2001. Print.
Marchetti, C and E. Panconesi. “Leonardo da Vinci: beauty or human suffering in the world. Notes on pathological cutaneous alterations in the ‘Adoration of the Magi’.” Joumal of the European Academy of DemlaloL VeMreol 8 (1997): 101-111. Print.
Saari, Peggy, Aaron Saari and Julie Carnagie. Renaissance & Reformation. Detroit: UXL, 2002. Print.

domain: artistic


The US Navy is working on four separate laser-based weapons systems and has requested the government for a budget of about $300m (£216m) to develop them under the Navy Laser Family of Systems.
Navy wants these weapons developed in the near term and installed on ships to defend against smaller threats like drones, unmanned ships, speed boats called fast inshore attack craft, reports Popular Mechanics. These threats although unlikely to sink a destroyer can harass, damage, spy and be pesky.
The Navy Laser Family could also include 150kilowatt weapons that can disable incoming missiles or even deter enemy aircraft, adds the report.
Project 3402 is the first of the four weapons the Navy is working on. It is also called the Surface Navy Laser Weapon System — part of the 60-kilowatt-or-higher class. As of now, it is an advanced prototype that is slated to be installed on the USS Arleigh Burke. It could reach three destroyers in the coming days. It is expected to be used for Anti-Surface Warfare, Integrated Air and Missile Defense and Counter-Intelligence, Surveillance and Reconnaissance.
Developed as a solid state laser, the Navy wants to use 3402 to dazzle and destroy drones and fast inshore attack craft. This weapon gets $190m from the 2019 budget and the Navy expects to field them in 2020.
Optical Dazzling Interdictor is a low power module that is designed to primarily blind drones and other unmanned systems that are currently used to spy on ships at sea. The report mentions that two interdictors have already received their funding and that the 2019 budget covers the development of three more. This weapon gets $44m from the 2019 Navy budget.
Another solid state weapon is also being built for a San Antonio-class ship in 2019. It will be a heavy 150 kilowatt laser, notes the report.
The fourth laser weapon that the Navy is working on is the Ruggedized High Energy Laser — a 150kilowatt laser, but will be built using a different architecture than the other big laser guns. The report suggests a modular weapon that can be upgraded to a higher capacity laser in the future.
What did not get any funding this year was the railgun. After reports emerged that the project was dropped in favour of Hyper Velocity Projectiles instead, this omission from the budget proposal seems to have officially killed it.


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Update (Tue 27th Oct, 2020 21:00 GMT): Frontier Developments has now confirmed that the Elite Dangerous expansion and all its content has joined the base game as a free update on Xbox. Existing Horizon owners also now have access to the exclusive Azure paint job for all ships in the game. Enjoy!
Original story (Wed 30th Sep, 2020 15:40 BST): Good news, Elite Dangerous owners! Frontier Developments has announced that it's making the Horizons expansion entirely free on October 27th, bringing a wide range of features to the base game.
Until now, Elite Dangerous: Horizons has been available on the Microsoft Store for £19.99 / $29.99, serving as a season of major gameplay expansions for the game that first debuted back in 2016, featuring Planetary Landings, weapon crafting, ship-launched fighters, multicrew co-op action and much more.
If you've already purchased Horizons in the past, you'll be getting an exclusive Azure ship paint job compatible with all ships currently in the game, which you can check out over at the official website.
Happy about this? Will you be trying Elite Dangerous: Horizons for the first time? Let us know in the comments.

domain: news


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Despite public concerns, the Indio City Council on Wednesday approved a two-year contract with the organizers of the Coachella and Stagecoach music festivals.
The action occurred one day after leaders in neighboring La Quinta withdrew a request that asked Indio to delay signing the agreement.
Some people in La Quinta worry about the possible long-term effects that the multi-day festivals have on their town. The Coachella and Stagecoach events take place on consecutive weekends every spring. They attract tens of thousands of people to Indio’s Empire Polo Club on the border of La Quinta.
There’s mounting concern over the noise, traffic congestion, trespassers and other headaches associated with the world famous rock and country music festivals. La Quinta leaders withdrew their request for an immediate environmental review after concert producer Goldenvoice assured them it’s addressing their concerns.
The promoters’ new two-year agreement with Indio includes a provision for an independent third party to monitor air quality and other impacts of next year’s festivals. Goldenvoice also promised to stop conducting early morning sound checks, contribute money toward street improvements and direct a percentage of every weekend pass it sells to Indio's general fund.
Goldenvoice has also unveiled the lineup for next year’s Stagecoach country music festival.
Stagecoach expands to three full days for the first time in its four-year history. The “twangier” sister to the Indie rock Coachella, Stagecoach offers kind of a living history of American country music. April’s festival includes big selling country-pop acts like Brad Paisley sidled up against rugged bluegrass pioneers like Ralph Stanley and JD Crowe.
Plenty of renegade acts riding the Stagecoach include the tattooed cow-punks of Split Lip Rayfield and country rockers like the Jayhawks, and singer-songwriter Dave Alvin.


Announcing our new fostering model
ST FRANCIS DOGS HOME LAUNCHES NEW FOSTERING MODEL TO MAXIMISE CARE FOR DOGS IN THE LOCAL AREA
St Francis Dogs Home, a well-known and loved dog rehoming Charity located in Porth, Newquay, is launching its new fostering model, having already commissioned expert behaviourist and trainer support, as it continues to ensure the care and safety of dogs.
The fostering model, which is supported by recognised charities such as Battersea Dogs & Cats Home, Blue Cross and The Association of Dogs and Cats Homes (ADCH), will see the Charity work with trained and experienced fosterers to look after, and rehabilitate, its rescue dogs in their home until they are ready for rehoming, through using dedicated experts and behaviourists. St Francis Dogs Home has sought help and advice from these leading charities as part of the research and due diligence when exploring all options for fostering.
The rescue sector has changed massively within the past two years due to the Coronavirus pandemic, creating a huge impact on dogs whether it’s through the lack of socialisation from the many lockdowns or behavioural issues, including separation anxiety, from having become used to owners working from home. The ADCH has recently reported that the number of dogs being abandoned is higher in 2022 than 2021 and 2020 with 70% of ADCH member rescues surveyed, reporting an influx of dogs with behavioural issues.
Fostering is a model that can ensure rehabilitation and support for dogs quickly and efficiently.
Michelle Barley, member of the Board of Trustees, comments: “After the pandemic, we are seeing more and more poorly socialised dogs coming to rescues. Housing them in homes offers so many advantages over kennels for dogs not yet well accustomed to domestic life. For example, it provides them with regular companionship which is an essential part of rehabilitation for emotionally traumatised dogs.
“The fostering route allows us to support each dog’s individual needs as we will be able to assess their true behaviour when placed in a domestic environment and in turn be able to find them the correct and best forever home.”
Michelle, who is a qualified Veterinary Nurse, will be leading the fostering strategy at St Francis Dogs Home which includes recruiting new fosterers, overseeing the support for the dogs including access to expert trainers, behaviourists and more.
Each fosterer will benefit from extensive training, Battersea Dogs & Cats Home approved documents and ongoing support including funding for all veterinary costs, quality dog food and on-site facilities.
Anthony Kinder, Chair of the Board of Trustees, comments: “This is an incredibly exciting time for the Charity as we look towards the future and ensure the best care for dogs in the local area.
“We will continue to recruit Trustees with expertise that will help shape our new fostering route and plans for the site moving forward.”


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It’s easier for men to look creepy than for women. It might not be fair, but it makes sense. Since men are more physically dangerous, being suspicious is a reaction to a potential threat.
Psychologists who studied this problem discovered that for women, a creep is somebody who expresses sexual interest that is not harmless or flattering.
MORE: Loud People Are The Most Insecure Ones, Psychology Says
For men, this is frustrating since being nervous about meeting a woman can come across as being creepy. It’s a delicate balance between noticing a woman and approaching her and having a creepy behavior.
Some men are better than others at knowing the difference. Physical appearance, social intelligence and age gap can tip the scale either way. Either towards being smooth and successful in the mating game or towards being that guy that makes women reach for the mace.
MORE: Psychologists Have Finally Found What Makes People Attractive
And of course, it’s a matter of experience, of trial and error for men who learn to seduce without scarring women.
If you think that this is unfair, remember that for women the risk of interacting with a man is that he could hurt her. For men the risk is that he will face humiliation because he was rejected in a bar.
So the simple idea behind approaching a woman is that you should seduce her while making her feel safe and protected.
MORE: Yes, I’m A Feminist. No, I Don’t Hate Men
Easier said than done, so here are some specific guidelines:
- If a woman catches you looking at her, smile, don’t look away, since this will signal predatory behavior
- Make sure that your compliments are showing appreciation, not objectification
- Try to maintain your calm, nervous tics and twitches will make her uncomfortable and less willing to interact with you
- Perseverance is not always a virtue, don’t insist if the woman doesn’t want to meet you
- Give her physical and psychological space when interacting, don’t touch her or insinuate sex too soon or too coarsely
Come on, guys, you can do it! Share this!

domain: sociology


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Tap into your inner superhero with these ‘smashing’ new pins! Pick up these Limited Edition pins from the Disney Studio Store Hollywood coming May 2015. Click on the image below to take a closer look at the new pins. Which pins will make your list?
On May 1st 2015 at 6:00 am at the Disney Studio Store in Hollywood, California the Avengers: Age of Ultron pins will be release. On May 22, 2015 at 6:00 am the Princess and the Tomorrowland El Capitan Marquee pins will be released.


By Tracy SherlockB.C. teachers have started making a tentative plan for escalating job action, in case mediation fails.
A leaked, confidential memo outlining a possible strike plan by B.C. Teachers’ Federation president Teri Mooring was obtained by Global BC’s legislative bureau chief Keith Baldrey.
Teachers and their employer have been bargaining for a year and have been in mediation for months. Mediator David Schaub released a report in November, after 58 days of bargaining and 16 days of mediation, which said only three issues had been resolved.
The leaked plan calls for a four-stage job action, Baldrey reported. The first stage would see teachers continue to put pressure on the government through communications. The second stage would see a withdrawal of extracurricular activities, like attending parent-teacher meetings, coaching sports teams or preparing anecdotal report cards. The third stage would see 20 per cent of teachers strike on a rotating, school-by-school basis. The fourth stage would see a province-wide strike.
In 2014, B.C. teachers were on strike for five weeks, over a period that stretched through the summer. That strike came after 16 months of failed bargaining and included a partial lockout and a 10-per-cent wage reduction. In the ramp-up period there were a couple of weeks of rotating strikes where several districts at a time would be closed for one day per week. As the strike wore on, the government paid parents $40 a day to cover the cost of childcare for kids under the age of 12.Eventually, with the help of a mediator, a negotiated six-year deal was reached, bringing labour peace. The BCTF put a response to the leaked memo on Twitter, saying they remain fully committed to the mediation process, which is still in place.
Important piece of information for those in #bcpoli and #bced speculating about contract talks. The BCTF remains fully committed to the Labour Relations Board mediation process. There can be no strike vote, job action, or lockout by the employer while that process continues.— BCTF (@bctf) January 23, 2020
“There can be no strike vote, job action, or lockout by the employer while that process continues,” the BCTF said on twitter. “It has been a year of bargaining and of course we are talking to members about contingency plans IF mediation concludes without a good deal.
“We hope the employer will agree to meeting dates soon. The mediator is still engaged. We don’t expect any imminent changes.”
The plan would go first to the BCTF Representative Assembly, which is meeting Jan. 31 and Feb. 1. The Representative Assembly is a group of teacher leaders who meet three times each year and make policy decisions for the BCTF. That group could decide to approve the plan in principle, or toss it out and come up with another plan.
The confidential memo includes two strike votes – one that would take place no earlier than Feb. 15 and a second one that would take place before the escalation to a full strike, Baldrey reported.
The BCTF has a meeting with the mediator planned for next week and setting dates to continue mediation will be part of that, BCTF said. In November, teachers rejected the mediator’s recommendation of a two-per-cent wage increase in each of the next three years with a rollover of the rest of the contract, including class size, class composition and specialist teacher ratios, where they exist. Those rules were restored in 2016 by the Supreme Court of Canada, but they are not universal across B.C.
Earlier last year, the two sides were far apart on negotiating those rules, with teachers wanting the entire province to level up and the employer wanting districts with strong language to concede so that others could gain. In November, Mooring said teachers rejected the offer because of low starting salaries, low wages overall and a provincial teacher shortage. She said teachers were willing to accept three years of two-per-cent increases, but only with some modifications to salary grids, which she said do not trigger “me too” clauses for other unions.At that time, Mooring urged the province to offer new funding, but Finance Minister Carole James told the Globe and Mailthis week that this year’s provincial budget won’t offer any new money.
The province will spend $6.6 billion on education this year, including about $400 million to pay for nearly 4,000 new teachers who were hired as a result of the Supreme Court ruling.
In his November report, the mediator said there was a “disconnect” preventing a collective agreement.
A failure to do so would be a missed opportunity to address the issues such as class size, class composition, teacher salary grids and attraction and retention or teachers.”Let’s hope both sides are ready to find a way forward now, so students and their parents can relax and focus on learning.
Read more from the Vancouver Courier


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Let’s Get Green
Graham Hunter, the coordinator for the United Nations climate change program for Australia, joined us on the first half of Monday Drive to talk about the efforts and awards being given out to promote environment-conscious living and working. Click the link below to hear his comments, and to find out more information, visit the United Nations Association of Australia here.
Professor David Ellsworth of the University of Western Sydney also shared on this week’s show to talk about his research on carbon emissions and how Australia’s trees are not combating the effects as well as formerly thought. Click the link below to listen:


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In recent weeks, the Project Maverick video game from the Star Wars franchise has been making the rounds in social media. There have been numerous details that have been shared in the past few months but nothing official has been confirmed. From the game being a "combat flight simulator" experience to leaked concept art, hardcore Star Wars gamers have been clamoring for more details about the new video game.
While there have been a series of delays about the official reveal of the game, it seems that a crucial detail about the rumored Project Maverick game has been leaked.
In an Instagram post, Bespin Bulletin has shared the official title of the Project Maverick game through a leak from the Xbox Store: Star Wars: Squadrons.
Meanwhile, Venture Beat has also learned from their sources that Squadrons is indeed an "aerial/space combat game about piloting ships in head-to-head battles." The outlet also revealed that the game will feature "a single-player campaign, but the main focus for Squadrons is on the multiplayer" with players going against each other in "team battles featuring iconic Star Wars vessels."
Venture Beat also mentioned that Electronic Arts (EA) plans to release the game for PC and consoles this Fall.
UPDATE: EA has confirmed that the reveal trailer of Star Wars: Squadrons will be released on Monday, June 15th at 8:00 AM PDT.
WHAT THIS MEANS
Gamers worldwide have been receiving a bunch of good news lately. Yesterday, Sony unveiled the official look for the PlayStation 5 while also revealing a slew of new games along the way. And now, this new revelation about the long time rumored Project Maverick project under the Star Wars video game umbrella comes at a perfect time.
The Star Wars: Squadrons title seems to go hand-in-hand with earlier leaks about the game being a "combat flight simulator" type of experience, which further solidifies the idea that this will shy away from the lightsaber heavy action of popular Star Wars games such as Battlefront and Jedi: Fallen Order. By diving into the realm of aerial combat, it's not hard to imagine that EA is making efforts to come up with more ways on how to provide a fresh gaming experience for Star Wars fans.
Recently, Jedi: Fallen Order proved to be a massive achievement for EA, which suggests that fans should get excited about the upcoming Squadrons game. However, Venture Beat did mention in their report that Squadrons is the "direct result" of EA wanting to release a new game ahead of schedule, potentially hinting that the rushed aspect of its development could be troublesome when the game is released.
Whatever the case, the upcoming release of Star Wars: Squadrons should be a welcome development for Star Wars gamers.

domain: hobby


Presentation on theme: "City of Manassas Park PPEA Project Proposal Recreation Center Manassas Park Community Center Department of Parks and Recreation."— Presentation transcript:
City of Manassas Park PPEA Project Proposal Recreation Center Manassas Park Community Center Department of Parks and Recreation
Background 2004 Needs Assessment Q1. As the renovation of the recreation center is in the planning stages, what would you identify as your top five program priorities? After school Programs, Youth Sports, Community Events, Teen Programs, Preschool Programs/Health and Wellness (tie) Q2. If we could add additional space to the recreation center, how would you like to see that space allocated? Indoor Pool, Teen Center, Gymnasium/Art Studios (tie) Q3. A Master Plan for Costello Park will set priorities for future facilities and amenities for the next 25 years. What would you identify as your top five facilities you would like to see in Costello Park? Playgrounds, Indoor Aquatic Facility, Walking/Jogging Paths, Outdoor Aquatic Facility, Lighted Sports Fields
Early Master Plan process: Markham and Associates (2003) VMDO (8/2004 - 5/2006) PPEA unsolicited process (8/2006) 9 responses/3 re-submittals to program HDR services (11/2006) Design submitted by OWPR; 45 day review period commenced (5/2007) Interim Agreement with Howard Shockey and Sons (11/2007) Comprehensive Agreement (5/2008)* Background
50 year construction standard Emergency Preparedness - Triple redundant IT infrastructure Auxiliary Governing Body chambers (live streaming) Emergency shelter for up to 250 people, generator to support the entire facility for 5 days Office space for IT, Community Resource Officer and Social Services. Flexible and diverse programming space Multi-generational programming opportunities Energy Efficient Re-incorporate natural species, reforest Program Requirements
Senior friendly facility Therapeutic recreation opportunities Community partnering Human service support Training and conference spaces Rental Opportunities Emergency Shelter Technologically supported to meet current and future IT demands Year round aquatics opportunities Nature/Outdoor/Interpretive environmental opportunities Facility Benefits
Project Partners Citizens of Manassas Park PPEA Consultants Development/Construction Group Project Architects
Concept Master Plan Concept Facility Plan Needs Assessment (2004) Capital Improvement Plan (since 2002) Technical reports –Geotechnical Survey, Land survey, Boundary survey, Phase I Environmental Survey, Utility Survey –Basis of Site and Landscape Architecture Design –Program Criteria –Division 1 Specifications –Performance Criteria Work Completed
Department of Parks and Recreation Community Center PPEA Project $ 22,435,287.00
Facility Demolition of Existing Elementary School Demolition of Existing Pool and Building Indoor Pool Ornamental Interpretive Garden Outdoor Plaza Miracle League Baseball Field Expansion of Parking Facilities Phase One Inclusions
Proposed Community Center Floor Plan 79,110 sq. ft.
Public Comment Period The public comment period runs from April 4, 2008 through May 6, 2008. Copies of the comprehensive agreement can be reviewed at the Manassas Park City Hall, located at 1 Park Center Court, at the Costello Park Recreation Center, located at 99 Adams Street, or viewed online at www.cityofmanassaspark.us. Please direct all correspondence to Catherine Morretta, Parks and Recreation Director, at email@example.com or via direct mail at 99 Adams Street, Manassas Park, Virginia, 20111. For project specific information please contact the Director at 703.335.8871.


Health workers are providing relentless labor all around the globe against coronavirus. He’s given a movie of his mind bowing on Instagram. At exactly the exact same time, Steven Smith and Indian captain Virat Kohli are called upon to perform the same.
Posting a movie on Instagram on Tuesday,” Warner wrote, “I had been nominated to boost my mind to encourage individuals that are fighting COVID-19. I think it had been the last time I left it during my introduction.’
Article a movie in Addition to a picture.
On social networking, the custom of picking one work over another.
Back in Australia, about 4,000 individuals are infected with the coronavirus. Twenty-one has died up to now. The movement of people throughout the country was limited as a result of the rapid spread of this.


The TV largest-selling brand across E-commerce in India, Vu technology, has launched a Vu Cinema TV – Action Series 4K UHD. To compete with giant companies like Samsung, Sony, LG, and Panasonic, the company has come up with a new television series to grab the market share in premium television.
Vu recently launched the smart TV with 4K ultra HD display in two sizes. You can get this television in 55 and 65 inches respectively. Smart TV has already started gaining popularity in the Indian television market.
The newly launched products by Vu are smart televisions. The television contains official Android Pie 9.0, Google Play Store, Google Ecosystem that includes music, movies, TV and games, built-in Chromecast, parental control, and so on. Vu Cinema TV – Action Series has 2 GB RAM and 16 GB storage that offers you a seamless experience. It supports Bluetooth 5.0 to connect your smartphone or laptop easily and watch movies or shows. Moreover, the facility of Wifi is also given so you can connect the television to the internet.
Smart TV Features
Vu Technologies has not ignored the licensed apps as these are the most demanded. Vu Cinema TV – Action Series 4K support Youtube, Netflix, Amazon Prime Video, Hotstar, and Google Play Hotkeys on remote control. So, now you can watch all your favorite movies and web series on fantastic display. If you often watch Youtube videos, you can watch Youtube videos of your favourite Youtubers on your Vu television.
Vu Cinema TV – Action Series 4K UHD offers a cinematic soundbar and 100 Watt supersonic sound that amaze you with cinematic sound effects. DTX Virtual X Surround and Advanced Dolby Audio MS12 are key features that produce realistic sound. Also, there are 4 master and 2 tweeter speakers for directional sound. Even after having the best sound features, you also get sports sound mode! What else can we expect!
Design and Display
When it comes to design, the bazzle less design looks premium and elegant in your home or office. The Pixelium Glass Technology gives the stunning output. The technology offers 4K visuals and motion smoothing. The premium design of the television can completely change the look of your drawing room. Moreover, it is equipped with Dolby Vision and HDR10. The display comes with PC and Gaming mode. Vu Cinema TV Action Series also has a powerful processor. The 1.4GHz quad-core processor and a powerful GPU allow you to get smooth surfing and viewing experience.
There are three HDMI ports for connectivity to connect set up box, Blu Ray players, gaming consoles, and so on. Also, the two USB ports are also given to connect hard drives and other USB services.
Warranty and Others
With this Vu Action Series television, you get a 3-years of warranty provided by the company. Along with the product, Vu gives you two table-top stands, a power cord, remote with an option of Google Assitance, 2 AAA batteries, a user manual, and a wall mount.
The product has tons of features, outstanding build quality, and fantastic sound and display. And the most important, Vu Cinema TV – Action Series 4K UHD is available at attractive rates!
So, what are you waiting for!
Check the best buy link:
Buy 55 inches TV
Buy 65 inches TV


Vivo Philippines has officially revealed the price for the new Vivo S1.
Basically, the Vivo S1 is just like a toned-down version of the Vivo V15 but instead of having a pop-up selfie camera, the front camera of the S1 remained inside a water-drop notch.
Just a quick recap, the Vivo S1 features a 6.38-inch AMOLED display with an in-screen fingerprint scanner, it has a triple rear camera setup and a 32MP selfie camera.
Powering the device is a Mediatek P65 processor and it has a 4,500 mAh battery. It comes with a 128GB internal storage and the latest Android 9 Pie.
The Vivo S1 was priced at PHP 14,999 and it is now available for pre-order. Customers who pre-ordered will get a free JBL Go speaker.
Vivo S1 Specs:
- 6.38-inch Super AMOLED display, 1080 x 2340 pixels, 19.5:9 ratio
- Mediatek Helio P65 (12nm) Octa-core processor
- Mali-G52 MC2 GPU
- Android 9 Pie with Funtouch 9
- 128GB ROM, expandable up to 256GB
- 6GB RAM
- Triple rear cameras:
- 16MP f/1.8 with PDAF
- 8MP f/2.2 ultrawide
- 2MP f/2.4 depth sensor
- 32MP front camera
- In-display fingerprint scanner
- Dual SIM, 4G/LTE
- Wi-Fi 802.11 a/b/g/n/ac
- Bluetooth v5.0
- GPS with A-GPS, GLONASS, GALILEO, BDS
- Fast battery charging 18W
- 4,500 mAh battery
Stay tuned! For more info and latest tech news, kindly follow us on our social media sites:


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Spain – Over the last decades, urban areas have been rapidly transforming and their populations have grown remarkably. According to the United Nations, in 1990, 43% of the world’s population lived in urban areas; by 2015, this share had grown to 54% and is expected to reach 60% by 2030.
Alongside rapid urbanization, the growth of the tourism sector led by economic development, lower transport costs, travel facilitation and a growing middle class in advanced and emerging economies, made cities increasingly popular destinations for business and leisure tourists. Over the past decades, international tourists have gone from 25 million international arrivals in 1950, to over 1.3 billion in 2017. UNWTO forecasts that the sector is expected to continue growing 3.3% annually until 2030 a year in which 1.8 billion tourists will cross borders.
Today, the income generated from both domestic and international tourism contributes significantly to the socio-economic and cultural development of many cities and their surroundings. Yet, the growth of urban tourism also creates important challenges to ensure sustainable growth and practices that minimize any adverse effects that the development of tourism may have in terms of the use of natural resources, socio-cultural impact, pressure on infrastructure, mobility and congestion management. In recent years, these challenges have been coupled with the growth of supply of tourism accommodation through new platform tourism services in cities.
As a consequence, we have witnessed a rise in negative attitudes among local populations towards visitors due to issues of perceived overcrowding, noise and other nuisances attributed to tourists, the emergence of protests in some cities and the spread of terms such as ‘overtourism’ and ‘tourism phobia’ in the media. To better understand the challenges arising from visitors’ management in urban contexts, particularly the relationship between residents and visitors, this report includes besides a set of recommendations also an analysis of residents’ perceptions towards tourism in eight European cities – Amsterdam, Barcelona, Berlin, Copenhagen, Lisbon, Munich, Salzburg, and Tallinn.
What do we mean when we talk about ‘overtourism’?
In 2016, Skift is said to have created (and later trademarked) the word ‘overtourism. Several definitions of ‘overtourism’ have emerged since. According to the universities collaborating on this project, ‘overtourism’ can be defined as “the impact of tourism on a destination, or parts thereof, that excessively influences perceived quality of life of citizens and/or quality of visitors experiences in a negative way”. The Responsible Tourism Partnership refers to ‘overtourism’ as “destinations where hosts or guests, locals or visitors, feel that there are too many visitors and that the quality of life in the area or the quality of the experience has deteriorated unacceptably. It is the opposite of Responsible Tourism which is about using tourism to make better places to live in and better places to visit. Often both visitors and guests experience the deterioration concurrently. In essence, we are talking about the absence of good management and uncontrolled development. With increasing tourist numbers, tourism must be developed and managed in a sustainable manner for both visitors and local communities. This is key when it comes to what is being labeled as ‘overtourism’.
Tourism is an opportunity for communities and their people to share the benefits of tourism, which is why the relations between the sector and the communities need to be strengthened. This can be achieved through community engagement, congestion management, and reduction of seasonality, careful planning which respects the limits of capacity and the specificities of the destination, as well as product diversification. Therefore, the tourism carrying capacity of a destination, defined by UNWTO as “the maximum number of people that may visit a tourist destination at the same time, without causing destruction of the physical, economic, and socio-cultural environment and an unacceptable decrease in the quality of visitors’ satisfaction”4 is a key challenge for tourism developers and managers alike.
Furthermore, when defining and setting mechanisms to monitor and manage tourism congestion, carrying capacity and ‘the limits of acceptable change’ it is essential to consider quantitative as well as qualitative indicators to ensure a comprehensive vision of tourism’s impact.
At the outset of this discussion, it is central to rebuff four myths associated with tourism congestion.
1. Tourism congestion is not only about the number of visitors but about the capacity to manage them. There are cities that are able to handle a high number of visitors, while others struggle with far fewer visitors. To have a better understanding of the causes of tourism congestion, it is useful to clearly delineate the three main factors that contribute to ‘overtourism’.6
I. Too many visitors, possibly aggravated by seasonality: in this case, it is the absolute numbers of visitors that are seen as disturbing. This can be a perception of overcrowding in parts of the city or the feeling that there are no pleasant spaces in the city anymore where residents can shy away from visitors.
II. Too much adverse visitor impact: here the impact of visitors is perceived negatively. This can be congestion on the roads due to tour buses stopping near attractions or on the streets when large crowds of tourists inadvertently block main streets. It also entails issues like noise disturbance, rowdiness and other disturbances visitors are perceived to cause (even when it may be local people causing the disturbance).
III. Too much physical impact of the visitor economy: the physical impact of services aimed at visitors can also cause agitation. This includes, for example, the over-proliferation of hotels, facilities or retail aimed at visitors.
2. Tourism congestion is commonly a localized rather than a citywide issue. Tourism pressure is predominantly linked to popular areas of the city or main attractions. Nevertheless, even in the most visited cities, it is possible to find areas where only a few or even no tourists can be seen. Such areas can often be found near main tourist attractions or central areas. In looking for solutions it is therefore particularly important to closely examine the specific nature of and locations where tourism congestion is an issue.
3. Tourism congestion is not a tourism-only problem. Tourism congestion can be perceived when the resources and infrastructure of a city are excessively under pressure, or parts thereof. However, it is not only tourists or other visitors that make use of these services and infrastructure. Residents and commuters also compete for the use of the space and services with those temporarily visiting the city. In addition, issues often associated with tourism congestion such as the expansion of short-term rentals via new platform tourism services, concern not only the tourism sector but also the real-estate market. Addressing tourism congestion is a much more complex issue than is commonly recognized, therefore should be treated in a comprehensive manner within the overall city agenda.
4. Technological or smart solutions alone are important but will not solve the issue of tourism congestion. Smart technologies are considered the most effective solution to tackle congestion management. Yet notwithstanding the immense potential benefits of such tools, they alone are not enough. Addressing the challenges facing urban tourism requires intense cooperation between multiple stakeholders, which is a long-term effort, particularly if stakeholders have conflicting interests.
– Rapid urbanization and the recent growth of tourism in urban areas has led to a significantly increased demand for urban tourism;
– Global tourism trends such as increased mobility, growing middle class, more affordable transport, and accommodation option, will continue to stimulate increased demand for urban tourism;
– Well managed tourism can contribute to advance the New Urban Agenda and the 17 Sustainable Development Goals, namely Goal 11 on “Make cities and human settlements inclusive, safe, resilient and sustainable”;
– ‘Overtourism’ is a new buzzword for existing concepts of tourism congestion management and tourism carrying capacity;
– When defining and setting mechanisms to monitor and manage tourism congestion, carrying capacity and ‘the limits of acceptable change’ it is essential to consider quantitative as well as qualitative indicators to ensure a comprehensive vision of tourism’s impact on the destination and its residents;
– Tourism development and management in cities need to be part of the wider urban agenda. The scope of action of tourism policy makers and Destination Management Organizations (DMOs) is limited and these cannot alone address the challenges of tourism congestion and tourism impact on cities;
– Tourism congestion in the urban destination can only be addressed through close cooperation among tourism and non-tourism administrations at the different levels, the private sector, local communities and tourists themselves;
– The complexity of the economic, social and environmental issues faced by cities today requires stakeholders to rethink their current practices and look for innovative solutions;
– Measures cannot focus only on altering tourist visitor numbers and tourist behavior – they should also focus on local stakeholders. To ensure the positive aspects of tourism remain visible to and understood by residents, it is necessary to understand residents’ concerns and grievances and include them in the tourism agenda;
– Understanding residents’ attitude towards tourism and engaging local communities is central. According to the research carried out for this report among residents of eight European cities – Amsterdam, Barcelona, Berlin, Copenhagen, Lisbon, Munich, Salzburg and Tallinn – the majority thinks that “there should be no limitations to the growth of visitor numbers” and only a very small percentage considers tourism development and marketing should be stopped;
– The research also shows that the most relevant positive impacts from tourism as perceived by residents are: greater international atmosphere (different cultures in the city); more events; a more positive image; protection of historical parts of the city; and restorations of traditional architecture. Whereas, the most negative impacts are: increase in house prices; increase in taxi prices; increase in shop prices; increase in the restaurants and cafe prices; and an increase in the public transport cost;
– Eleven strategies and 68 measures have been identified in this report to help understand and manage visitors’ growth in cities. Nevertheless, the effectiveness of measures is highly dependent on their specific context. There is no one-size-to-fit-all solution. Even within cities, management measures can differ between neighborhoods;
– Among the proposed strategies, residents surveyed for this research tend to favor the following measures:
– Improve infrastructure and facilities in the city;
– Communicate with and involve local residents and local businesses in tourism planning;
– Communicate better with visitors on how to behave in the city;
– Distribute visitors better over the year; and
– Create city experiences where residents and visitors can meet and integrate.
– A comprehensive evaluation and planning are essential to determine which strategies can be successfully applied to a destination. Destinations that currently do not have any problems with tourism congestion need to be aware of the potential impact of increased visitor numbers and plan accordingly; and
– Urban tourism makes an important contribution to the socio-economic development of cities and the well-being of their residents and should contribute to creating better cities for all: citizens, investors, and visitors.


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It’s easy to hear the word “cosplay” and to picture elaborate costumes meticulously tailored and sculpted. In that case, let Anucha Saengchart (aka Lonelyman) change your mind. For years, he’s been creating Low Cost Cosplay. The hilarious—and extremely popular—project has him transforming into characters from popular culture all with some basic materials and creative camera angles. If you don’t believe how simple (and low budget)
From cat-shaped bread to corgi butt buns, bakeries around the world are using carbs to not only fill customers’ bellies,...
A giant cat invading a town sounds like something out of a monster film.
Sometimes it’s startling just how like us our primate cousins can be. And recently, one TikTok user found that out in a most amusing way. While visiting a zoo in Indonesia, Lola Testu—known as @minorcrimes on TikTok—accidentally dropped her sunglasses into the orangutan enclosure. Naturally, she captured the entire mishap on video, which is fortunate because what happened next is absolutely priceless.
The depths of the ocean can be an extremely fascinating place, ripe for exploration and new discoveries.
There’s a notorious cat burglar in Beaverton, Oregon, and her name is Esme.
In 2017, a then-21-year-old Campbell Jones and his girlfriend embarked on a bike ride on Rottnest Island. Located off the coast of Western Australia, Rottnest is renowned for its scenic, seaside landscape, warm weather, and ample wildlife—namely, its indigenous quokka population. With its adorable smile and inquisitive personality, the quokka is known as “the happiest animal on Earth.” After meeting one on the bike trail, Jones now knows why.
Kenny Deuss and his two kids love to go on adventures. But these aren’t just any escapades.
From helmet hair to looking uncool, there are a million silly reasons why you might not want to wear a...
Photoshop experts are able to rework images into all kinds of fabricated realities. From color correction and filters to cropping and resizing, the powerful digital tool offers countless editing options. And while most Photoshop experts use the software for professional graphic design, British digital artist James Fridman uses it to troll the Internet. He’s known for taking requests to “fix” the images of people from all over the world.
Ever wonder what a fine art-themed episode of The Simpsons would be like?
Over or under? This is the question that has plagued the Western world since the invention of modern toilet paper.


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Retirement income sources, including annuities, reverse mortgages, Social Security and LTCI, were topics of this two-hour seminar from the Retirement Income Certified Professional program at The American College. (Above: Curtis Cloke, Richard Weber and David Littell.)
'We have all these insurance agents selling billions of dollars of fixed indexed annuities. But they have few clues about how the crediting rates have performed,'' says Kent Jacquay. With his Indexalyzer software, he proposes a solution.
Achaean Financial and Ash Brokerage, a large Fort Wayne, Ind., BGA, are partnering on a potential retirement game-changer: Achaean's immediate indexed income annuity, couched in Ash's JourneyGuide planning software. The underwriter has yet to be named.
Listen to an actuary who put $50k into a five-year indexed variable annuity four years ago as an alternative to CDs. We explain how IVAs are priced, and we tell you how his investment has fared so far.
Whether MetLife can or will avoid designation as a Systemically Important Financial Institution is uncertain, but it is clear "that MetLife will no longer write new U.S. retail life and annuity business—a significant strategic shift for the firm," said Fitch Ratings.
The latest evidence of the opinions of plan sponsors and plan providers on this topic comes to us via the “2015 Survey of Defined Contribution Viewpoints,” produced by Rocaton Investment Advisors. The article contains a link to the survey results.

domain: economics