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The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative treatment modalities. In the management of alcohol withdrawal syndrome, symptom-triggered therapy directs nursing staff to regularly assess patients using standardized instruments, such as the Clinical Institute for Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), and administer benzodiazepines at symptom severity thresholds. Symptom-triggered therapy has been shown to lower total benzodiazepine dosage and treatment duration relative to fixed dosage tapers (Daeppen et al., 2002). However, CIWA-Ar has important limitations. Because of its reliance on patient reporting, it is inappropriate for nonverbal patients, non-English speakers (in the absence of readily available translators) and patients in confusional states including delirium and psychosis. Importantly, it also relies on the appropriate selection of patients and considering alternate etiologies for signs and symptoms also associated with alcohol withdrawal.

The authors report a case of a 47-year-old male admitted for cardiac arrest because of benzodiazepine and alcohol overdose who developed worsening delirium on CIWA-Ar protocol.

While symptom-triggered therapy through instruments such as the CIWA-Ar protocol has shown to lower total benzodiazepine dosage and treatment duration in patients in alcohol withdrawal, over-reliance on such tools may also lead providers to overlook other causes of delirium.

This case illustrates the necessity for providers to consider using other available assessment and treatment options including objective alcohol withdrawal scales, fixed benzodiazepine dosage tapers and even antiepileptic medications in select patients.

Few issues in recent times have so provoked debate and dissention within the library field as has the concept of fees for user services. The issue has aroused the passions of our profession precisely because its roots and implications extend far beyond the confines of just one service discipline. Its reflection is mirrored in national debates about the proper spheres of the public and private sectors—in matters of information generation and distribution, certainly, but in a host of other social ramifications as well, amounting virtually to a debate about the most basic values which we have long assumed to constitute the very framework of our democratic and humanistic society.

Communications regarding this column should be addressed to Mrs. Cheney, Peabody Library School, Nashville, Term. 37203. Mrs. Cheney does not sell the books listed here. They are available through normal trade sources. Mrs. Cheney, being a member of the editorial board of Pierian Press, will not review Pierian Press reference books in this column. Descriptions of Pierian Press reference books will be included elsewhere in this publication.

The case of food poisoning which affected some 150 persons at Derby appears to be undoubtedly a genuine case of ptomaine poisoning. During the last few years many isolated deaths have occurred, after the consumption of some particular kind of food, which have been attributed to ptomaine poisoning, but the evidence put forward in support of this view has not unfrequently been open to grave doubt. At Derby, however, the nature of the outbreak and the symptoms presented by the patients were characteristic, and if further proof were needed it would be contributed by the interim report of Dr. SHERIDAN DELEPINE, of Manchester, who made an examination of the suspected pies and their ingredients. Most people are fully acquainted with the history of this out break, which was not confined to Derby but extended to various parts of the country, in every case the persons attacked having consumed portions of the infected pork pies. Dr. DELEPINE has issued an interim report in which he states that he has isolated a bacillus belonging to the colon group which is, in his opinion, undoubtedly responsible for the pathogenic properties of the pies. The evidence as to the relation of the bacillus to the epidemic is, says Dr. DELEPINE, absolutely clear. The bacillus in question has been isolated from a pork pie, from a pork bone pie, from the blood, spleen and intestines of one of the persons who died, and from the blood, spleen, bile and intestines of several animals which have died in two or three days from the effects of feeding on a pork pie. The bacilli obtained from all these sources were identical in appearance. Animals inoculated with this bacillus have died, and in their blood the same bacillus has been again found; and four specimens of blood obtained from patients who had been ill after eating a portion of a pork pie have given, on examination, a clear serum reaction, but the blood of normal persons and also of patients affected with typhoid fever has given no similar clear serum reaction. Dr. DELEPINE has also been able to ascertain the presence of the same bacillus in a pork pie which Dr. ROBERTSON, of Sheffield, had sent him. This statement appears to leave no room for doubt as to the dangerous nature of the pies, and Dr. DELEPINE's complete report will be awaited with considerable interest.

Although none of the new music reference books of the past year totally replaces the old stand‐bys, some significant works did appear, especially in the areas of contemporary music, opera, and classical music discography.

Along with traditional marketing channels, social media outlets are integrated as a part of the marketing mix. Social media has changed the dynamics of interaction between companies and consumers that foster this relationship. Managing brand fan pages on social networking sites is a specific way the companies are using. Customers can become brand fans on these pages and indicate that they like the brand posts, share on their wall or simply comment. The purpose of this paper is to analyse the impact of cultural differences on the effectiveness of social media metrics and scientifically tested brand engagement in terms of commitment, loyalty and brand recommendations.

The authors analysed 1,922 brand posts from five different brands of a single product category in three different countries. Ordinary least square and hierarchical moderation regression was used to test the hypotheses.

Results show that all determinants are not equally suitable for enhancement of number of likes, comments and shares. More specifically, vivid and interactive brand post determinants enhance the number of likes. Furthermore, interactive brand posts enhance the number of comments while vivid brand posts enhance number of shares. Moreover, impact and intensity vary across different cultures.

Brand fan page moderators can obtain guidance from the research in formulating their social media marketing strategies in order to decide which post determinants to place on the fan page.

The purpose of this paper is to provide novel theoretical insight into service delivery system (SDS) design. To do so, this paper adopts a customer journey perspective, using it as a frame to explore dimensions of experience quality that inform design requirements.

This study utilises UK Patient Opinion data to analyse the stories of 200 cancer patients. Using a critical incident technique, 1,207 attributes of experience quality are generated and classified into 17 quality dimensions across five stages of the customer (patient) journey.

Analysis reveals both similarity and difference in dimensions of experience quality across the patient journey: seven dimensions are common to all five journey stages, from receiving diagnosis to end of life care; ten dimensions were found to vary, present in one or several of the stages but not in all.

Limitations include a lack of representativity of the story sample and the impossibility to verify the factual occurrence of the stories.

Adopting a patient journey perspective can improve the practitioner understanding of the design requirements of SDS in healthcare. The results of the study can be applied by managers to configure SDS that achieve a higher quality of patient care throughout the patient journey.

This paper extends existing literature on SDS design by adopting a customer journey perspective, revealing heterogeneity in experience quality across the customer journey currently unaccounted for in SDS design frameworks. Specifically, the findings challenge homogeneity in extant SDS design frameworks, evidencing the need for multiple, stage-specific SDS design requirements.

The purpose of this paper is to investigate how international tourists’ cosmopolitan values change due to the restraining fear of terrorism, and how this change affects their worldview, destination perception and travel preferences.

In-depth interviews were conducted with international travellers from all five continents to pinpoint the universal shifts in cosmopolitan values, specifically regarding risk perception in the face of terrorism.

Tourists’ personal values are changing due to the increased risk of terrorism (or the perception of it), which prompts international travellers to act less on their desire for stimulation and more for their need for security when travelling. Just as any change in values tends to be relatively permanent, this value shift might have long-term consequences for the entire tourism industry.

Terrorism risk perception and its retraining effect regarding willingness to travel were established to be significant and universal. However, this study suggests that the strength of the travellers’ cosmopolitan orientation influences the extent terrorism risk is acted upon. Results indicate that the higher the travellers’ cosmopolitan conviction is, the less significantly they seem to be affected by the fear of terrorism.

The study offers cues on how managers and policy makers can enhance destination image that keeps up with the current realities of global tourism in the face of terrorism, and highlights a promising market segment, strongly cosmopolitan travellers who are less concerned with potential travel risks and react less negatively in troubled times.

Most of the previous studies considered tourists’ cosmopolitanism as a stable orientation rather than a context-specific state. This study addresses this gap by exploring how resilient the tourists’ cosmopolitan desire for openness and freedom is under the risk perception of terrorism, and what effect the fear of terrorism has on their travel habits.

The purpose of this paper is to examine both the Latino/Hispanic entrepreneurs’ social media adoption (SMA) for business purposes and the influence of culture on personal versus business social network platform (SNP) selection.

The Technology Acceptance Model’s (TAM) factors of perceived usefulness (PU) and perceived ease of use (PEU) as drivers of Latino/Hispanic entrepreneurs’ social network platform selection are examined as well as the effect of SMA on revenue. Data was collected from 633 small business owners across the United States via an online survey administered in English and Spanish.

Results indicate that Latino/Hispanic business owners use personal SNP more than business SNP for business purposes. PU and PEU were not found to predict personal SNP for Latino/Hispanic entrepreneurs. However, for Non-Latino/Hispanics, PU was significant while PEU was marginally significant. Findings for PU and PEU as predictors of business SNP indicate similar results for both Latino/Hispanic and non-Latino/Hispanic entrepreneurs, where only PEU was significant. Finally, there was no relationship between either business or personal SNP and revenue for either Latino/Hispanic or non-Latino/Hispanic entrepreneurs.

This research provides more insight into Latino/Hispanic entrepreneurs’ self-directed engagement in personal SNP (Facebook) and business SNP (LinkedIn) for business purposes and invites future research in this population to further examine cultural influence and business performance. The findings support the need for Latino/Hispanic entrepreneurs’ strengthening their competency in social media usage to remain competitive, as doing so will enhance their capability for building customer relationships, brand development, and equity financing.

This investigation 1) examines SMA’s role in Latino/Hispanic small and medium enterprises (SMEs); 2) distinguishes between personal and business social network platforms; 3) investigates TAM’s relevance for Latino/Hispanic entrepreneurs’ use of social media for business; and 4) explores SME social media usage as a predictor of revenue. We seek to provide practitioners with a greater understanding of how they may influence business success and sustainability through better competency development and usage of social media platforms.

Presents the results of an empirical analysis of the cultural differences between Australian and Japanese populations in a tourism context. Argues that the challenge for tourism marketers lies in understanding the cultural make‐up of the Japanese market, and developing culture‐oriented marketing strategies. Identifies the major reasons for the decline in Japanese tourist arrivals to Australia. Compares the Japanese and Western cultural orientation. Describes and interprets the cultural dimensions identified by a principal components analysis. Determines the most critical cultural dimensions and their indicators by a LISREL analysis. The findings show that the key cultural factors influencing Japanese holiday experiences in Australia are culturally determined perceptions of service and interpersonal relations with hosts. Presents the impact of cultural traits on Japanese tourist perceptions of Australian service and interpersonal contact with hosts. Discusses the implications of these findings for tourism marketers.