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Cruise Ships (cruise + ship)
Selected AbstractsEmergency Air Evacuation of Critically Ill Patients from Cruise ShipsJOURNAL OF TRAVEL MEDICINE, Issue 6 2002John A. Knowles MD No abstract is available for this article. [source] Evaluation of Emergency Air Evacuation of Critically Ill Patients from Cruise ShipsJOURNAL OF TRAVEL MEDICINE, Issue 6 2001Laurence D. Prina Background: The study objectives were to assess the ship physician's diagnostic accuracy in making the decision to air evacuate critically ill patients from cruise ships, to determine the outcome of these patients, and the overall benefit of air evacuation. Methods: From October 1999 to May 2000, we performed a prospective study of critically ill patients coming from cruise ships in the Caribbean and transported to our institution by air ambulance. Demographics, initial diagnosis, and treatment on board were collected by the triage officer at the time of the cruise physician's first call. In route complications and flight team composition were obtained from the air ambulance monitoring log. Patients were followed-up in the hospital for complications, outcome, and final diagnosis. Results: A consecutive series of 104 patients were considered for analysis. There were 65 men and 39 women (mean age: 68.7 years). Cruise physician's diagnosis was correct in more than 90% of the cases. Internal medicine and surgical conditions represented 80.8% and 19.2% of the cases respectively, falling mainly into three categories: cardiac (34.6%), neurological (20.2%), and digestive (14%). Two cardiac arrests and 1 ventricular fibrillation were successfully resuscitated and 5 of 15 myocardial infarctions received thrombolytic therapy on board. Air transfers were warranted in 96.1% of the cases and physician presence in the flight was considered appropriate in 97.6%. In route complications and mortality rate were 5.8% and 2.9% respectively, related to serious cardiac events. Among the 98 hospitalized patients, 10 patients developed new complications and 5 died. The overall mortality rate was 7.7%. Conclusion: The cruise industry appears off to a good start in the medical treatment of passengers needing air evacuation to a land based medical facility. There is room for improvement and adoption of American College of Emergency Physicians (ACEP) and International Council of Cruise Lines (ICCL) Health Care Guidelines are meaningful first steps. Analysis of Caribbean medical facilities and implementation of active telemedicine conferencing represent alternatives to air evacuation that need to be studied. [source] A Picture of the Floating World: Grounding the Secessionary Affluence of the Residential Cruise LinerANTIPODE, Issue 1 2009Rowland Atkinson Abstract:, A quarter century of financial deregulation, robber-baron corporatism and growing income polarisation has enabled the spatial partitioning of urban space into new and complex arrangements of micro-neighbourhood governance and privatism. These archipelagos of fortress homes and neighbourhoods increasingly lie outside the spaces of conventional state and city government. Yet while residential spaces of urban affluence have been unable to fully remove contact with the social diversity of the public realm, nomadic forms of super-affluence, flowing around a global,national urban system, have generated a form of networked extra-territoriality,a social space decoupled from the perceived risks and general dowdiness of the social world beneath it. This paper examines this space via the curious case of The World, a large residential cruise ship which, as its name suggests, roams the oceans and ports of the globe. Our title is taken from the name given to Japanese paintings of the new affluence and fantasy of life lived by the affluent and artists in late nineteenth century Japanese cities (O Ukiyo E, or pictures of the floating world). We suggest that The World forms a similarly disconnected realm, not only literally afloat, also detached from the reality of a world that has been strategically left behind. [source] Pathological gambling: an increasing public health problemACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2001Article first published online: 7 JUL 200 Gambling has always existed, but only recently has it taken on the endlessly variable and accessible forms we know today. Gambling takes place when something valuable , usually money , is staked on the outcome of an event that is entirely unpredictable. It was only two decades ago that pathological gambling was formally recognized as a mental disorder, when it was included in the DSM-III in 1980. For most people, gambling is a relaxing activity with no negative consequences. For others, however, gambling becomes excessive. Pathological gambling is a disorder that manifests itself through the irrepressible urge to wager money. This disorder ultimately dominates the gambler's life, and has a multitude of negative consequences for both the gambler and the people they interact with, i.e. friends, family members, employers. In many ways, gambling might seem a harmless activity. In fact, it is not the act of gambling itself that is harmful, but the vicious cycle that can begin when a gambler wagers money they cannot afford to lose, and then continues to gamble in order to recuperate their losses. The gambler's ,tragic flaw' of logic lies in their failure to understand that gambling is governed solely by random, chance events. Gamblers fail to recognize this and continue to gamble, attempting to control outcomes by concocting strategies to ,beat the game'. Most, if not all, gamblers try in some way to predict the outcome of a game when they are gambling. A detailed analysis of gamblers' selfverbalizations reveals that most of them behave as though the outcome of the game relied on their personal ,skills'. From the gambler's perspective, skill can influence chance , but in reality, the random nature of chance events is the only determinant of the outcome of the game. The gambler, however, either ignores or simply denies this fundamental rule (1). Experts agree that the social costs of pathological gambling are enormous. Changes in gaming legislation have led to a substantial expansion of gambling opportunities in most industrialized countries around the world, mainly in Europe, America and Australia. Figures for the United States' leisure economy in 1996 show gross gambling revenues of $47.6 billion, which was greater than the combined revenue of $40.8 billion from film box offices, recorded music, cruise ships, spectator sports and live entertainment (2). Several factors appear to be motivating this growth: the desire of governments to identify new sources of revenue without invoking new or higher taxes; tourism entrepreneurs developing new destinations for entertainment and leisure; and the rise of new technologies and forms of gambling (3). As a consequence, prevalence studies have shown increased gambling rates among adults. It is currently estimated that 1,2% of the adult population gambles excessively (4, 5). Given that the prevalence of gambling is related to the accessibility of gambling activities, and that new forms of gambling are constantly being legalized throughout most western countries, this figure is expected to rise. Consequently, physicians and mental health professionals will need to know more about the diagnosis and treatment of pathological gamblers. This disorder may be under-diagnosed because, clinically, pathological gamblers usually seek help for the problems associated with gambling such as depression, anxiety or substance abuse, rather than for the excessive gambling itself. This issue of Acta Psychiatrica Scandinavica includes the first national survey of problem gambling completed in Sweden, conducted by Volberg et al. (6). This paper is based on a large sample (N=9917) with an impressively high response rate (89%). Two instruments were used to assess gambling activities: the South Oaks Gambling Screen-Revised (SOGS-R) and an instrument derived from the DSM-IV criteria for pathological gambling. Current (1 year) and lifetime prevalence rates were collected. Results show that 0.6% of the respondents were classified as probable pathological gamblers, and 1.4% as problem gamblers. These data reveal that the prevalence of pathological gamblers in Sweden is significantly less than what has been observed in many western countries. The authors have pooled the rates of problem (1.4%) and probable pathological gamblers (0.6%), to provide a total of 2.0% for the current prevalence. This 2% should be interpreted with caution, however, as we do not have information on the long-term evolution of these subgroups of gamblers; for example, we do not know how many of each subgroup will become pathological gamblers, and how many will decrease their gambling or stop gambling altogether. Until this information is known, it would be preferable to keep in mind that only 0.6% of the Swedish population has been identified as pathological gamblers. In addition, recent studies show that the SOGS-R may be producing inflated estimates of pathological gambling (7). Thus, future research in this area might benefit from the use of an instrument based on DSM criteria for pathological gambling, rather than the SOGS-R only. Finally, the authors suggest in their discussion that the lower rate of pathological gamblers obtained in Sweden compared to many other jurisdictions may be explained by the greater availability of games based on chance rather than games based on skill or a mix of skill and luck. Before accepting this interpretation, researchers will need to demonstrate that the outcomes of all games are determined by other factor than chance and randomness. Many studies have shown that the notion of randomness is the only determinant of gambling (1). Inferring that skill is an important issue in gambling may be misleading. While these are important issues to consider, the Volberg et al. survey nevertheless provides crucial information about gambling in a Scandinavian country. Gambling will be an important issue over the next few years in Sweden, and the publication of the Volberg et al. study is a landmark for the Swedish community (scientists, industry, policy makers, etc.). This paper should stimulate interesting discussions and inspire new, much-needed scientific investigations of pathological gambling. Acta Psychiatrica Scandinavica Guido Bondolfi and Robert Ladouceur Invited Guest Editors References 1.,LadouceurR & WalkerM. The cognitive approach to understanding and treating pathological gambling. In: BellackAS, HersenM, eds. Comprehensive clinical psychology. New York: Pergamon, 1998:588 , 601. 2.,ChristiansenEM. Gambling and the American economy. In: FreyJH, ed. Gambling: socioeconomic impacts and public policy. Thousand Oaks, CA: Sage, 1998:556:36 , 52. 3.,KornDA & ShafferHJ. Gambling and the health of the public: adopting a public health perspective. J Gambling Stud2000;15:289 , 365. 4.,VolbergRA. Problem gambling in the United States. J Gambling Stud1996;12:111 , 128. 5.,BondolfiG, OsiekC, FerreroF. Prevalence estimates of pathological gambling in Switzerland. Acta Psychiatr Scand2000;101:473 , 475. 6.,VolbergRA, AbbottMW, RönnbergS, MunckIM. Prev-alence and risks of pathological gambling in Sweden. Acta Psychiatr Scand2001;104:250 , 256. 7.,LadouceurR, BouchardC, RhéaumeNet al. Is the SOGS an accurate measure of pathological gambling among children, adolescents and adults?J Gambling Stud2000;16:1 , 24. [source] Evaluation of Emergency Air Evacuation of Critically Ill Patients from Cruise ShipsJOURNAL OF TRAVEL MEDICINE, Issue 6 2001Laurence D. Prina Background: The study objectives were to assess the ship physician's diagnostic accuracy in making the decision to air evacuate critically ill patients from cruise ships, to determine the outcome of these patients, and the overall benefit of air evacuation. Methods: From October 1999 to May 2000, we performed a prospective study of critically ill patients coming from cruise ships in the Caribbean and transported to our institution by air ambulance. Demographics, initial diagnosis, and treatment on board were collected by the triage officer at the time of the cruise physician's first call. In route complications and flight team composition were obtained from the air ambulance monitoring log. Patients were followed-up in the hospital for complications, outcome, and final diagnosis. Results: A consecutive series of 104 patients were considered for analysis. There were 65 men and 39 women (mean age: 68.7 years). Cruise physician's diagnosis was correct in more than 90% of the cases. Internal medicine and surgical conditions represented 80.8% and 19.2% of the cases respectively, falling mainly into three categories: cardiac (34.6%), neurological (20.2%), and digestive (14%). Two cardiac arrests and 1 ventricular fibrillation were successfully resuscitated and 5 of 15 myocardial infarctions received thrombolytic therapy on board. Air transfers were warranted in 96.1% of the cases and physician presence in the flight was considered appropriate in 97.6%. In route complications and mortality rate were 5.8% and 2.9% respectively, related to serious cardiac events. Among the 98 hospitalized patients, 10 patients developed new complications and 5 died. The overall mortality rate was 7.7%. Conclusion: The cruise industry appears off to a good start in the medical treatment of passengers needing air evacuation to a land based medical facility. There is room for improvement and adoption of American College of Emergency Physicians (ACEP) and International Council of Cruise Lines (ICCL) Health Care Guidelines are meaningful first steps. Analysis of Caribbean medical facilities and implementation of active telemedicine conferencing represent alternatives to air evacuation that need to be studied. [source] Falkland Islands cruise ship tourism: an overview of the 1999,2000 season and the way forwardAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue 1 2002Rebecca J. Ingham Abstract 1.Falkland Islands' tourism is evolving at an increasing pace. A record number of passengers, 23 497, visited the Islands during the 1999,2000 season. This rise was due to an increase in both the frequency of vessel visits and the average passenger capacity of vessels, with the number of luxury cruise ships of >1000 passengers steadily increasing. The Falklands' industry is made up of three types of vessel: the expedition cruise vessels (ca. 100,200 passengers); larger cruise vessels (ca. 400 passengers), and the luxury cruise vessels (ca. 1000 passengers). 2.The cruise ship industry has seen a diversification within the market, with cruises now available to a wider audience thus increasing the need for new experiences and landing sites. A similar diversification is being seen within the Islands themselves as the capacity to take larger vessels at remote sites is being developed. Whilst the expedition cruise vessels visiting the Islands are operating to high environmental standards as members of the International Association of Antarctic Tour Operators (IAATO), vessels with 400+ passengers may not become members of IAATO, due to Article III of the organization's Bylaws which limits the number of passengers. These larger capacity vessels are therefore not subject to the same self-regulating guidelines. The implications of increasing passenger numbers in the islands are discussed with regard to pressures on both the wildlife and vegetation. 3.This study outlines the need for an island-wide approach and a legislative framework to ensure high standards of operation are adhered to within the Islands from all visiting vessels and that accurate information is provided to all visitors along with a suitable code of conduct. The collection, collation and analysis of visitor data to identify trends and implement appropriate management strategies, and further research into the potential impacts of tourism on wildlife in the Falklands are also recommended. Copyright © 2002 John Wiley & Sons, Ltd. [source] Golden goose or Trojan horse?ASIA PACIFIC VIEWPOINT, Issue 2 2008Cruise ship tourism in Pacific development Abstract: Pacific governments seeking to expand national economies are increasingly looking to tourism to provide revenues. At the same time, companies that operate cruise ships are searching for new destinations for increasing numbers of larger, faster ships which they are launching to cater for steadily increasing demand for cruises. The Pacific region appeals to both companies and passengers as a cruise destination. This coincidence would, at first glance, seem to provide an opportunity for a mutually beneficial relationship between companies and governments in the region. But little is presently available to those in the Pacific who must decide what role this form of tourism might play in their future. This paper reviews some of the environmental, economic and societal impacts of cruise ship tourism and concludes that, managed effectively, this form of tourism can yield higher returns with lower risks than some alternatives and could form a part of a sustainable tourism policy. [source] | |||||||||||||