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Research shows that shopping is a must activity of tourist and resident, and there is intense competition between shopping destinations. However, literature often gives a little attention to how a shopping destination's image impacts customer loyalty. Thus, the current study examines the shopping destination image model that incorporates the affective, cognitive, and overall images in predicting shopping loyalty of both tourist and resident. The results from 408 survey data verify the shopping destination image model's relevance in predicting both tourist and resident loyalty towards shopping destinations. The affective and cognitive image elements are the key drivers of overall image and loyalty towards tourist and resident shopping destinations. Further, this study shows a significant variation between how tourists and residents regard the effect of cognitive image on their loyalty towards a shopping destination.

BACKGROUND This 4-year research project focuses on 6 social community enterprises (SCEs) that operate in 5 neighborhoods in a Dutch city. Residents of these neighborhoods face problems such as poor average levels of physical and mental health, high unemployment rates, and weak social cohesion. SCEs offer residents social, cultural, and work-related activities and are therefore believed to help these persons develop themselves and strengthen the social ties in the community. Because of a lack of empirical evidence; however, it is unclear whether and how SCEs benefit the health and well-being of participants. OBJECTIVE This paper outlines a protocol for an evaluation study on the impact of SCEs, aiming to determine (1) to what extent SCEs affect health and well-being of participating residents, (2) what underlying processes and mechanisms can explain such impact, and (3) what assets are available to SCEs and how they can successfully mobilize these assets. METHODS A mixed methods multiple-case study design including repeated measurements will be conducted. Six SCEs form the cases. An integrated model of SCE health intervention will be used as the theoretical basis. First, the impact of SCEs is measured on the individual and community level, using questionnaires and in-depth interviews conducted with participants. Second, the research focuses on the underlying processes and mechanisms and the organizational and sociopolitical factors that influence the success or failure of these enterprises in affecting the health and well-being of residents. At this organizational level, in-depth interviews are completed with SCE initiators and stakeholders, such as municipal district managers. Finally, structurally documented observations are made on the organizational and sociopolitical context of the SCEs. RESULTS This research project received funding from the Netherlands Organization for Health Research and Development in 2018. Data collection takes place from 2018 until 2022. Data analysis starts after the last round of data collection in 2022 and finalizes in 2024. Expected results will be published in 2023 and 2024. CONCLUSIONS Despite the societal relevance of SCEs, little empirical research has been performed on their functioning and impact. This research applies a variety of methods and includes the perspectives of multiple stakeholders aiming to generate new empirical evidence. The results will enable us to describe how SCE activities influence intermediate and long-term health outcomes and how the organizational and sociopolitical context of SCEs may shape opportunities or barriers for health promotion. As the number of these initiatives in the Netherlands is increasing rapidly, this research can benefit many SCEs attempting to become more effective and increase their impact. The findings of this research will be shared directly with relevant stakeholders through local and national meetings and annual reports and disseminated among other researchers through scientific publications. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/37966

Aims Fecal incontinence (FI) is embarrassing, resulting in poor quality of life. Rectal sensation may be more important than sphincter strength to relieve symptoms. A single-blind, randomized controlled trial among adults with FI compared the effectiveness of rectal balloon training (RBT) and pelvic floor muscle training (PFMT) versus PFMT alone. Methods We randomized 80 patients, recruited from the Maastricht University Medical Centre. Primary outcome was based on the Vaizey score. Secondary outcomes were the Fecal Incontinence Quality of Life Scale (FIQL), 9-point global perceived effect (GPE) score, anorectal manometry, rectal distension volumes, and thresholds of anorectal sensation. Analyses were by intention-to-treat. Results Forty patients were assigned to combined RBT with PFMT and 40 to PFMT alone. Adding RBT did not result in a significant improvement in the Vaizey score [mean difference: −1.19; 95% confidence interval (CI): −3.79 to 1.42; P = 0.37]. Secondary outcomes favoring RBT were: Lifestyle subscale of the FIQL (0.37; 95% CI: 0.02–0.73; P = 0.04), GPE (−1.01; 95% CI: −1.75 to −0.27; P = 0.008), maximum tolerable volume (49.35; 95% CI: 13.26–85.44; P = 0.009), and external anal sphincter fatigue (0.65; 95% CI: 0.26–1.04; P = 0.001). Overall, 50% of patients were considered improved according to the estimated minimally important change (Vaizey change ≥−5). Conclusions RBT with PFMT was equally effective as PFMT alone. Secondary outcomes show beneficial effects of RBT on urgency control, GPE, and lifestyle adaptations. Characteristics of patients who benefit most from RBT remain to be confirmed. Neurourol. Urodynam. 31:132–138, 2012. © 2011 Wiley Periodicals, Inc.

Background. Conflicting results are reported about the contribution of maternal, obstetric and fetal characteristics to postpartum fecal incontinence (FI), which is hampering prevention and management of FI. Objective. To perform a systematic review identifying delivery-related etiological factors for postpartum FI. Search strategy. Literature searches of PubMed, EMBASE, CINAHL, DocOnline and reference lists from 1980 up to 2009 were conducted. Selection criteria. Prospective cohort studies evaluating maternal, obstetric or fetal risk factors for postpartum FI, with a follow-up period of at least three months, were assessed. We reviewed full reports in English, German or Dutch, with anal incontinence (AI), FI, flatus incontinence, soiling, urgency and FI severity scores as reported outcomes. Data collection and analysis. Data on study characteristics, methodological quality and outcome were extracted from 31 studies according to a standardized protocol. Clinical and methodological sources of heterogeneity permitted only a qualitative analysis. Main results. A third- or fourth-degree sphincter rupture was the only etiological factor strongly (AI) or moderately (flatus incontinence) associated with postpartum FI. No association with other postulated risk factors was found, for example, birth weight or instrumental delivery. The potential co-existence of different risk factors impedes the interpretation of the influence of a single delivery-related risk factor. Conclusions. This systematic review, including only longitudinal studies and recognizing the importance of separating results for different outcomes, identifies that a third- or fourth-degree sphincter rupture is the only factor that is strongly (AI) or moderately (flatus incontinence) associated with postpartum FI.

BackgroundVarious guidelines for the management of low back pain have been developed to enhance the effectiveness and efficiency of care. Evidence that guideline-adherent care results in better health outcomes, however, is not conclusive.ObjectiveThe main objective of this study was to assess whether a higher percentage of adherence to the Dutch physical and manual therapy guidelines for low back pain is related to improved outcomes. The study further explored whether this relationship differs for the individual steps of the process of care and for distinct subgroups of patients.DesignThis was an observational prospective cohort study (2005–2006) in the Netherlands that included a sample of 61 private practice therapists and 145 patients.MethodsTherapists recorded the process of care and the number of treatment sessions in Web-based patient files. Guideline adherence was assessed using quality indicators. Physical functioning was measured by the Dutch version of the Quebec Back Pain and Disability Scale, and average pain was measured with a visual analog scale. Relationships between the percentage of guideline adherence and outcomes of care were evaluated with regression analyses.ResultsHigher percentages of adherence were associated with fewer functional limitations (β=−0.21, P=.023) and fewer treatment sessions (β=−0.27, P=.005).LimitationsThe relatively small self-selected sample might limit external validity, but it is not expected that the small sample greatly influenced the internal validity of the study. Larger samples are required to enable adequate subgroup analyses.ConclusionsThe results indicate that higher percentages of guideline adherence are related to better improvement of physical functioning and to a lower utilization of care. A proper assessment of the relationship between the process of physical therapy care and outcomes may require a comprehensive set of process indicators to measure guideline adherence.

Aims To determine the psychometric properties of the (5-item) total PRAFAB-questionnaire score in a group of patients with stress or predominant urgency urinary incontinence (UI) to justify its use in clinical practice and research. Methods Psychometric properties were assessed in a prospective cohort of patients with primary or recurrent UI referred for physiotherapy treatment. Results In total, 99 women enrolled the cohort study, of whom 87 were classified as stable (“about the same” on the global rating scale [GRS]) and included for analyses. Factor analysis resulted in a single underlying factor in both UI groups. The PRAFAB-questionnaire scores demonstrated excellent test–retest reliability (high ICCsagreement [0.93–0.95] and kappa scores for individual items) and excellent internal consistency (Cronbach's alpha's of 0.82). The PRAFAB-questionnaire was able to discriminate among different patient groups indicating good construct validity. Responsiveness to clinical improvement for both groups was shown to be excellent with large effect size statistics and high correlations (0.79–0.89) with patients' perceived benefit on the GRS indicating excellent longitudinal validity. The minimally important change stratified for non-severe and severe classified patients were estimated between −2.5 to −4.6 and −4.5 to −7.0 points, respectively for the stress UI group and −2.5 to −3.4 points and −4.0 to −4.4, respectively for the urgency UI group. Conclusions The brief and simple PRAFAB-questionnaire demonstrated good psychometric properties for use in clinical practice and research to evaluate treatment effects for UI in women. Future research will be necessary to replicate these findings and further explore its psychometric properties. Neurourol. Urodynam. 26:998–1007, 2007. © 2007 Wiley-Liss, Inc.

In the last year LANL has constructed a 1408-node AMD Opteron cluster, a 1024-node Intel P4 Xeon cluster, a 256-node AMD Opteron cluster and two 128-node Intel P4 Xeon clusters. Each of these clusters is controlled by one front-end node, and each cluster needs only one disk in the front-end node for production operations. In this paper we describe the software architecture that boots and manages these clusters. This software architecture represents a clean break from the way that clusters have been set up for the last 14 years. We show the ways that this architecture has been used to greatly improve the operation of the nodes, with particular emphasis on improvements in boot-time performance, scalability, and reliability.

DOE has put forth a considerable effort into light-weight kernels for high performance computing, yet there has been a lack of acceptance and use, perhaps due to the limited support for hardware and software. The arguments for light-weight kernels have been based on the problem of interference , i.e. changes in application performance that occur when the operating system pre-empts the application. Nevertheless, using existing, well supported operating systems for HPC systems has been quite successful. The problems with the standard operating systems remain, however, although their impact on applications is still not quantified. At LANL, we have undertaken a research program to determine whether Linux and/or Plan 9 can be used to realize the benefits of light-weight kernels while maintaining the benefits of a full-featured operating system. Specifically, we are evaluating measures that quantify what is "good" in a Light-Weight Kernel. We are using this knowledge to modify Linux and Plan 9 to make them competitive with custom light weight operating systems, in essence, a Right-Weight Kernel. This paper represents both a summary of early results as well as a description of work in progress.

Aims It is unclear which patients with fecal incontinence (FI) are likely to benefit from physiotherapy treatment, which is relevant for medical decision making and patient counseling. This study aimed to identify patient characteristics predicting a favorable outcome of physiotherapy. Methods Eighty patients with FI, with a mean age of 59.3 (SD ± 11.9), were recruited at the Maastricht University Medical Centre and enrolled in a randomized controlled trial, which assessed the effect of adding rectal balloon training to pelvic floor muscle training. Treatment groups were combined for prediction modeling. Candidate predictors were obtained from demographics, medical history, physical examination, baseline tests, questionnaires, and physiotherapy diagnostics. Favorable outcome was defined as a combination of: (i) Vaizey score reduction ≥5 points, and (ii) “slightly” to “very much improved” on the nine-point global perceived effect score. Predictors were identified by univariable and multivariable logistic regression analysis. Results Thirty-seven patients (46.3%) had a favorable outcome. Multivariable analysis showed that longer time since FI onset appeared to be associated with an unfavorable outcome (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.47–1.00; P = 0.05), whereas the use of constipating medication (OR, 3.79; CI, 0.99–14.51; P = 0.05), any obstetric factor (OR, 2.15; CI, 0.94–4.89; P = 0.07), and experiencing minor embarrassment (OR, 2.12; CI, 1.10–4.09; P = 0.03) predicted a favorable outcome. Conclusions The small subset of identified predictors for a favorable outcome may be relevant in patient counseling and targeting physiotherapy treatment more efficiently, especially as they are available early in the diagnostic process. Neurourol. Urodynam. 31:1156–1160, 2012. © 2011 Wiley Periodicals, Inc.

Fecal incontinence (FI) is embarrassing, resulting in poor quality of life. Rectal sensation may be more important than sphincter strength to relieve symptoms. A single-blind, randomized controlled trial among adults with FI compared the effectiveness of rectal balloon training (RBT) and pelvic floor muscle training (PFMT) versus PFMT alone.We randomized 80 patients, recruited from the Maastricht University Medical Centre. Primary outcome was based on the Vaizey score. Secondary outcomes were the Fecal Incontinence Quality of Life Scale (FIQL), 9-point global perceived effect (GPE) score, anorectal manometry, rectal distension volumes, and thresholds of anorectal sensation. Analyses were by intention-to-treat.Forty patients were assigned to combined RBT with PFMT and 40 to PFMT alone. Adding RBT did not result in a significant improvement in the Vaizey score [mean difference: -1.19; 95% confidence interval (CI): -3.79 to 1.42; P = 0.37]. Secondary outcomes favoring RBT were: Lifestyle subscale of the FIQL (0.37; 95% CI: 0.02-0.73; P = 0.04), GPE (-1.01; 95% CI: -1.75 to -0.27; P = 0.008), maximum tolerable volume (49.35; 95% CI: 13.26-85.44; P = 0.009), and external anal sphincter fatigue (0.65; 95% CI: 0.26-1.04; P = 0.001). Overall, 50% of patients were considered improved according to the estimated minimally important change (Vaizey change ≥-5).RBT with PFMT was equally effective as PFMT alone. Secondary outcomes show beneficial effects of RBT on urgency control, GPE, and lifestyle adaptations. Characteristics of patients who benefit most from RBT remain to be confirmed.

Aim To determine the psychometric properties of the total Vaizey score and its individual items. Methods The study was conducted as part of a prospective cohort study assessing the outcome of pelvic floor rehabilitation in patients with fecal incontinence. Results One hundred ninety-four patients were analyzed, 53 of whom provided data on the global perceived effect (GPE) score. Pelvic floor rehabilitation resulted in a significant reduction of the total Vaizey score and most individual items. The total Vaizey scores changed in agreement with the GPE scores. The total Vaizey score was responsive, but some individual items yielded inconsistent results for three different measures. The test–retest reliability was adequate or excellent for six individual items and the total Vaizey score. The internal consistency was low for the total Vaizey score at baseline, in contrast to the follow-up and change scores. The estimates for the minimally important change (MIC) and smallest detectable change yielded moderately consistent results. An MIC of −5 points seemed preferable and yielded the lowest misclassification rate. Conclusions More research is required to confirm conclusions on the psychometric properties of the total Vaizey score and its individual items, and to justify its use in research and routine clinical practice. Neurourol. Urodynam. 29:370–377, 2010. © 2009 Wiley-Liss, Inc.

The Beowulf Distributed Process Space (BProc) is a set of Linux kernel modifications which provides a single system image and process migration facilities for processes running in a Beowulf style cluster. With BProc, all the processes running in a cluster are visible on the cluster front end machine and are controllable via existing UNIX process control mechanisms. Process creation is done on the front end machine and the processes are placed on the nodes where they will run with BProc's process migration mechanism.These two features combined greatly simplify creating and cleaning up parallel jobs as well as removing the necessity of a user login to remote nodes in the cluster. Removing the need for user logins drastically reduces the mount of software required on cluster nodes.Job startup with BProc's process migration mechanism is faster than the traditional method of logging into a node and starting the process with rsh. BProc does not affect file or network I/O of processes running on remote nodes so the vast majority of MPI applications will experience no performance loss as a result of being managed by BProc.