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PubMedDate not supplied

Welcome to the experience economy.

First there was agriculture, then manufactured goods, and eventually services. Each change represented a step up in economic value--a way for producers to distinguish their products from increasingly undifferentiated competitive offerings. Now, as services are in their turn becoming commoditized, companies are looking for the next higher value in an economic offering. Leading-edge companies are finding that it lies in staging experiences. To reach this higher level of competition, companies will have to learn how to design, sell, and deliver experiences that customers will readily pay for. An experience occurs when a company uses services as the stage--and goods as props--for engaging individuals in a way that creates a memorable event. And while experiences have always been at the heart of the entertainment business, any company stages an experience when it engages customers in a personal, memorable way. The lessons of pioneering experience providers, including the Walt Disney Company, can help companies learn how to compete in the experience economy. The authors offer five design principles that drive the creation of memorable experiences. First, create a consistent theme, one that resonates throughout the entire experience. Second, layer the theme with positive cues--for example, easy-to-follow signs. Third, eliminate negative cues, those visual or aural messages that distract or contradict the theme. Fourth, offer memorabilia that commemorate the experience for the user. Finally, engage all five senses--through sights, sounds, and so on--to heighten the experience and thus make it more memorable.

Anniversaries and Special Events↗

PubMed2004

Adolescent and young adult heroin and non heroin users: a quantitative and qualitative study of experiences in a therapeutic community.

Admissions to treatment for heroin abuse have increased in recent years among the adolescent and young adult population, yet few studies have described whether, and to what extent, young heroin users differ from their non heroin-using peers. This exploratory study presents quantitative and qualitative data obtained from lifetime heroin and non heroin-using adolescents and young adults in a long-term, step-down therapeutic community. Self-report data from the Global Appraisal of Individual Needs (GAIN) were obtained from 22 lifetime heroin and 33 non heroin users on admission to residential treatment and 12 months later. Ethnographic interviews (n = 27) were conducted with heroin users at all stages of treatment. Results indicate that lifetime heroin users had greater polysubstance use and lower self-efficacy scores (i.e., confidence to resist relapse) on admission to treatment than non heroin users, and though improved, heroin users' self-efficacy scores remained lower than those of non heroin users at the 12 month follow-up. Ethnographic data suggested that adolescents who had used heroin "hit bottom" before entering treatment and credited treatment with providing the opportunity to change their lives. The overall comparability of treatment outcomes between the heroin and non heroin using groups shows that adolescents and young adult heroin users can achieve similar outcomes in an age-appropriate therapeutic community treatment setting.

Adolescent↗

PubMedDate not supplied

[Computerized tomography guided biopsy in the diagnosis of neoplastic and inflammatory lesions of the pelvis].

PURPOSE: To assess the efficacy of percutaneous CT-guided biopsy in the diagnosis and therapeutic planning of neoplastic and flogistic diseases of the pelvis. MATERIAL AND METHODS: From July 1990 to December 1999 193 patients (113 males, 80 females: mean age 49, standard deviation 16) were submitted to CT-guided percutaneous biopsy of the pelvic region; 117 biopsies (61%) were performed at iliac, pubic and ischial segments and 76 (39%) at sacral region; 107 patients were admitted to the hospital and 86 were in clinic. Needles were 8 G (4 mm), 10 to 15 cm long. Approach to pelvic lesions was performed according to the specific site. Lesions of the lateral pelvic region have always been approached through the lateral surgical incision according to Enneking. Lesions of the posterior pelvic region have always been approached by the introduction of the needle along the posterior surgical incision according to Enneking. Lesions of the anterior region have always been approached through the anterior surgical incision according to Enneking. From July 1990 to May 1997 pelvic percutaneous biopsies have been carried out with a CT Sytec 3000. From May 1997 to December 1999 the device was replaced by a High Speed CTi. The introduction of spiral CT allowed reduction of performance mean time from 45 minutes (standard deviation 15) to 30 minutes (standard deviation 10). RESULTS: In 154 patients (80%) we observed a neoplastic, inflammatory or not classified degeneration. In 8 patients (4%) the retrieved material ended to be inadequate for a diagnosis. In 31 patients (16%) no disease was revealed at the histological examination. Such patients with negative histological examination have been kept under clinical and radiological control in the following period in order to verify the manifestation or the presence of an alteration previously not observed. On 31-3-2000 none of them had been submitted to a new percutaneous biopsy of the pelvic region. The overall mean accuracy has been 96% considering the negative patients as really negative. In 5 cases (2.6%) we have had complications represented by pain at the introduction and penetration site of the needle. DISCUSSION AND CONCLUSIONS: The choice of the needle, the approach to the lesion and the position of the patient are conditioned by the site of the tumor, its extension, the distance skin-neoplastic disease and by the respect of the incision lines of Enneking, in order not to complicate the job of the orthopaedic surgeon spreading tumoral cells outside the chosen surgical approach. The mean time of the procedure is 30 minutes (standard deviation 10). There are no absolute contraindications to percutaneous biopsy except the suspect or the presence of an hydatideal cyst. The risks have to be compared with those correlated with alternative methods or with the more concerning risk of a missed diagnosis. Complications in the literature range from 0% to 10%, the incidence varying according to the location; pain is the most frequent complication. Altogether the most negative event, although not a true complication, is the retrieval of an inadequate sample: the only drawback of percutaneous biopsy in comparison with incisional biopsy. The accuracy rate of percutaneous biopsy varies in relation to the involved anatomical region, to the pathological process, to the experience of the user, to the amount of the retrieved tissue and to the cooperation of the patient. Our experience shows that, in selected patients, percutaneous biopsy is a virtually safe and almost painless procedure which saves the patient from a surgical procedure in regional or general anestesia as for an incisional biopsy, and allows immediate planning and scheduling of a correct therapy for primitive or secondary neoplastic lesions.

Biopsy↗

PubMed2003

Daily stereotactic ultrasound prostate targeting: inter-user variability.

We analyzed the inter-user variability of patient setup for prostate radiotherapy using a stereotactic ultrasound-targeting device. Setup variations in 20 prostate cancer patients were analyzed. Users were a radiation oncologist, a medical physicist, four radiation technologists (RTT) and a radiologist. The radiation oncologist, radiologist, physicist and two RTTs were experienced users of the system (>18 months of experience); two RTTs were users new to the system. Gold standard for this analysis was a control CT acquired immediately following ultrasound targeting. For inter-user variability assessments, the radiation oncologist provided a set of axial and sagittal freeze-frames (standard freeze-frames) for virtual targeting by all users. Additionally each user acquired individual freeze-frames for target alignments. We analyzed the range of virtual setups in each patient along the principal room axes based on standard and individual freeze-frames. The magnitude of residual setup error and percentage of setup change for each user was assessed by control CT/planning CT comparison with individual virtual shifts. A total of 184 alignments were analyzed. The range of virtual shifts between users was 2.7+/-1.4, 3.6+/-1.1, and 4.4+/-1.4 mm (mean+/-SD) in x, y and z-direction for setups based on standard freeze-frames and 3.9+/-2.6, 6.0+/-4.7, and 5.4+/-2.7 mm for setups based on individual freeze-frames. When only virtual shifts of experienced users were analyzed, the mean ranges were reduced by up to 2.4 mm. Average magnitude of initial setup error before ultrasound targeting was 14.3 mm. Average improvement of prostate setup was 63.1+/-23.4% in experienced and 35.14+/-37.7% in inexperienced users, respectively (p<0.0001). Only 5 of 184 (2.7%) virtual alignments would have introduced new larger setup errors (mean 3.2 mm, range 0.2 to 9.5 mm) than the magnitude of the initial setup error. We conclude that ultrasound guided treatment setup for patients treated for prostate cancer can be performed with high inter-user consistency and does lead to improved treatment setup in more than 97% of attempted setups. Experienced use is correlated with a reduced range of setups between users and higher degree of setup improvement when compared with users new to the system

Humans↗

PubMed2001

[(13)C,(13)C]- and [(13)C,(1)H]-TROSY in a triple resonance experiment for ribose-base and intrabase correlations in nucleic acids.

A novel TROSY (transverse relaxation-optimized spectroscopy) element is introduced that exploits cross-correlation effects between (13)C-(13)C dipole-dipole (DD) coupling and (13)C chemical shift anisotropy (CSA) of aromatic ring carbons. Although these (13)C-(13)C effects are smaller than the previously described [(13)C,(1)H]-TROSY effects for aromatic (13)C-(1)H moieties, their constructive use resulted in further transverse relaxation-optimization by up to 15% for the resonances in a 17 kDa protein-DNA complex. As a practical application, two- and three-dimensional versions of the HCN triple resonance experiment for obtaining ribose-base and intrabase correlations in the nucleotides of DNA and RNA (Sklenar, V.; Peterson, R. D.; Rejante, M. R.; Feigon, J. J. Biomol. NMR 1993, 3, 721-727) have been implemented with [(13)C,(1)H]- and [(13)C,(13)C]-TROSY elements to reduce the rate of transverse relaxation during the polarization transfers between ribose (13)C1' and base (15)N1/9 spins, and between (13)C6/8 and N1/9 within the bases. The resulting TROSY-HCN experiment is user-friendly, with a straightforward, robust experimental setup. Compared to the best previous implementations of the HCN experiment, 2-fold and 5-fold sensitivity enhancements have been achieved for ribose-base and intrabase connectivities, respectively, for (13)C,(15)N-labeled nucleotides in structures with molecular weights of 10 and 17 kDa. TROSY-HCN experiments should be applicable also with significantly larger molecular weights. By using modified TROSY-HCN schemes, the origins of the sensitivity gains have been analyzed.

Animals↗

PubMed2006

Effects of directional microphone and adaptive multichannel noise reduction algorithm on cochlear implant performance.

Although cochlear implant (CI) users have enjoyed good speech recognition in quiet, they still have difficulties understanding speech in noise. We conducted three experiments to determine whether a directional microphone and an adaptive multichannel noise reduction algorithm could enhance CI performance in noise and whether Speech Transmission Index (STI) can be used to predict CI performance in various acoustic and signal processing conditions. In Experiment I, CI users listened to speech in noise processed by 4 hearing aid settings: omni-directional microphone, omni-directional microphone plus noise reduction, directional microphone, and directional microphone plus noise reduction. The directional microphone significantly improved speech recognition in noise. Both directional microphone and noise reduction algorithm improved overall preference. In Experiment II, normal hearing individuals listened to the recorded speech produced by 4- or 8-channel CI simulations. The 8-channel simulation yielded similar speech recognition results as in Experiment I, whereas the 4-channel simulation produced no significant difference among the 4 settings. In Experiment III, we examined the relationship between STIs and speech recognition. The results suggested that STI could predict actual and simulated CI speech intelligibility with acoustic degradation and the directional microphone, but not the noise reduction algorithm. Implications for intelligibility enhancement are discussed.

Adult↗

PubMed2006

Living in a restricted occupational world: the occupational experiences of stroke survivors who are wheelchair users and their caregivers.

BACKGROUND: In order to meet the responsibilities of understanding and enabling occupation, occupational scientists and therapists must conduct research that is framed within an occupational perspective. PURPOSE: This paper reports the results of a qualitative investigation of the occupational experiences of stroke survivors (n = 16) who use wheelchairs and their primary caregivers (n = 15). RESULTS: Inductive analysis of data collected via in-depth interviews resulted in two major themes related to occupation, specifically: living in a restricted occupational world and challenges to participation in occupation. These results highlight the overall experience labeled occupation by default, and the intricate interconnections or spill-over effect between the occupations of stroke survivors and caregivers. PRACTICE IMPLICATIONS: In addition to providing empirical support for the importance of having a sense of control over occupation and the connection between occupation and identity, the results have implications for practice aimed at enabling occupation and directions for future research. As well, the results illustrate that occupational therapy services need to extend beyond wheelchair prescription in order to enable occupation with clients.

Activities of Daily Living↗

PubMed2004

Users' perceptions of the impact of electronic aids to daily living throughout the acquisition process.

This study investigated the experience of seven new users of a particular type of assistive technology through the stages of anticipating, acquiring, and using an electronic aid to daily living. A mixed methods research approach was used to explore each of these stages. The Psychosocial Impact of Assistive Devices Scale was used to measure the perceived impact of the new assistive technology on users' quality of life, and findings were further explored and developed through open-ended questioning of the participants. Results indicated that preacquisition of the device, users predicted that the electronic aid to daily living would have a positive impact on their feelings of competence and confidence and that the device would enable them in a positive way. One month after acquiring the device a reduced, yet still positive, impact was observed. By 3 and 6 months after acquisition, perceived impact returned to the same positive high level as preacquisition. It is suggested that prior to receiving the device, potential users have positive expectations for the device that are not based in experience. At the early acquisition time, users adjust expectations of the role of the assistive technology in their lives and strive to balance expectations with reality. Three to 6 months after acquiring an electronic aid to daily living, the participants have a high positive view of how the device impacts on their lives based in experience and reality. A model illustrating the electronic aids to daily living acquisition process is proposed, and suggestions for future study are provided.

Activities of Daily Living↗

PubMed2007

The need for change in UK mental health services: South Asian service users' views.

OBJECTIVES: UK literature on mental health services for ethnic minority service users relies heavily on perceptions of professionals, carers and community representatives. This research investigates the views of South Asian service users themselves about experiences of mental health services and how they might be improved. DESIGN: Thematic analysis of material from focus groups and individual interviews with Asian mental health service users within one local area. RESULTS: South Asian service users clearly identify the impact of socio-economic exclusion upon their mental health. Cultural and institutional exclusion compound this, leading to continuing insensitivity towards their particular needs within hospital and community-based services. Asian service users feel unsafe to share their particular concerns within many service settings. They see advocacy that recognises their experience of exclusion as a significant resource for mental health improvement. They want sounder financing of culturally appropriate services for recovery; further development of the cultural competence of staff within mainstream services; and educational programmes about mental health directed at minority communities. CONCLUSION: UK mental health services remain unresponsive to the consistently expressed views of South Asian service users. A major cultural change is required if the UK Government initiative Delivering Race Equality is to impact successfully at the local level. It will have a greater chance of success if the rhetoric of user involvement is matched by systematic consultation with South Asian service users.

Adult↗

PubMed2006

Breast implant surveillance reports to the U.S. Food and Drug Administration: maternal-child health problems.

There is continuing concern that women who receive breast implants may be at increased risk for adverse reproductive outcomes or experience problems with breastfeeding. It is unknown whether exposure to biomaterials in breast implants may have teratogenic effects or leach into breast milk causing postnatalproblems. We studied the Food and Drug Administration (FDA) experience by analyzing a case series of adverse event reports received and entered into the FDA's Manufacturer and User Facility Device Experience (MAUDE) database or the Device Experience Network (DEN) database by December 31, 2002 regarding women with breast implants. Reports were critically reviewed for lactation difficulties, reproductive problems (spontaneous abortion, delayed conception) and medical conditions among offspring, including neonatal, infant, and childhood diseases and congenital defects that were attributed to implants. We identified 339 reports that described maternal-child adverse events. Nearly half of these reports (46%) described actual problems with breastfeeding or expressed concern that implants would be unsafe or interfere with breastfeeding. Forty-four percent of reports (n=149) described either nonspecific or specific signs, symptoms, or illnesses in children. An additional 3.5% of reports (n=12) detailed a congenital anomaly believed by the reporter to be caused by breast implants.

Adolescent↗

PubMed1992

Oral contraception noncompliance: the extent of the problem.

Compliance has been defined as the extent to which a patient's behavior coincides with the clinical prescription. The lowest expected failure rate of oral contraceptive (OC) use has been suggested to be 0.1%; however, in typical users, the failure rate varies by age, race, and marital status. In some populations in the United States (eg, unmarried black adolescents), the failure rate is 18%; rates that factor in the occurrence of abortions suggest an overall failure rate of 6.2% during the first year of use. If the annual failure rate of 6.2% is assumed, long-term failure rates rapidly approach 25% to 50% (ie, the proportion of users who will experience an unintended pregnancy) over 10 years of use. The gap between the lowest expected failure rate and the failure rates seen in typical users is related in large part to problems of compliance. Compliance with OC use includes both correct daily use and continuing use. Factors that contribute to OC discontinuation include the experience of side effects, fears and misinformation about OC side effects fueled by negative media reports, and intermittent use. There are relatively few data regarding the issue of missed pills and correct use, but studies suggest that adolescents may miss an average of 3 pills a month, and at least 20% to 30% of individuals miss a pill every month. Patients may have difficulty in the transition from one packet of pills to the next, and missed pills that extend the hormone-free interval may contribute to the failure rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed2002

Cocaine induction of dopamine transporter trafficking to the plasma membrane.

Several previous human postmortem experiments have detected an increase in striatal [(3)H]WIN 35428 binding to the dopamine transporter (DAT) in chronic cocaine users. However, animal experiments have found considerable variability in DAT radioligand binding levels in brain after cocaine administration, perhaps caused by length and dose of treatment and type of radioligand used. The present experiments tested the hypothesis that [(3)H]WIN 35428 binding and [(3)H]dopamine uptake would be increased by exposure to cocaine through alterations in DAT cellular trafficking, rather than increased protein synthesis. Experiments were conducted in stably hDAT-transfected N2A cells and assessed the dose response and time course of cocaine effects on [(3)H]WIN 35428 binding to the DAT, [(3)H]dopamine uptake, measures of DAT protein and mRNA, as well as DAT subcellular location. Cocaine doses of 10(-6) M caused statistically significant increases in [(3)H]WIN 35428 binding and [(3)H]dopamine uptake after 12 and 3 h, respectively. Despite these increases in DAT function, there was no change in DAT total protein or mRNA. Immunofluorescence and biotinylation experiments indicated that cocaine treatment induced increases in plasma membrane DAT immunoreactivity and intracellular decreases. The present model system may further our understanding of regulatory alterations in DAT radioligand binding and function caused by cocaine exposure.

Animals↗

PubMed2004

Investigating human color preferences in the perception of complex three-dimensional structures.

This article describes preliminary results of a investigation that addresses the problem of human color perception in the visual analysis of complex three-dimensional shapes. We built 3D visualization models of synthetic neural cells, and designed two experiments to identify user preferences for color when observing and executing tasks on these 3D models. Though preliminary, the results obtained from these experiments are consistent and indicate that some trends exist that deserve further investigation.

Color Perception↗

PubMed1999

Private or NHS General Dental Service care in the United Kingdom? A study of public perceptions and experiences.

BACKGROUND: Recent changes in the NHS General Dental Service have led to a reduction in the availability of NHS dental care and increased charges. This study explores public and user views and experiences of NHS and private dental care in the light of these changes. METHODS: The study employed a combination of quantitative and qualitative methods. The first phase involved a postal survey of a random sample of adults on the electoral registers in a county in Southern England, which yielded a response rate of 55 per cent (n = 1506). Follow-up face-to-face interviews were carried out with sub-samples (n = 50) selected from survey respondents. RESULTS: The evidence shows greater satisfaction with certain aspects of private care than with NHS dental care and suggests that the decline in perceived quality of NHS care is less to do with the quality of dental technical skills and more to do with perceived access and availability. However, there was general support for the egalitarian principles associated with NHS dentistry, although payment for dental care by users was acceptable even though dentistry on the NHS was preferred. CONCLUSION: The shift in the balance of NHS and private dental care reflects the interests and preferences of dentists rather than of the public. It suggests, however, that a continued shift towards private practice is a trend that the public will not find acceptable, which might limit the extent of expansion of private practice.

Adult↗

PubMed2003

People with dementia and their relatives: personal experiences of Alzheimer's and of the provision of care.

Little is known about the experiences of people with dementia, as there has been relatively little research carried out that includes their perspectives. In the past, user perspectives on experiences of dementia and on services have mostly been solicited from family carers, rather than from people with dementia themselves. It has been suggested that these studies may lack information and insight into the experiences of people with dementia. This study aimed at eliciting the views and feelings of people in all stages of dementia, as well as those of their relatives, on care services and on experiences of dementia. Twenty-seven people with dementia from residential and day care settings were interviewed and their daily lives videotaped. Interviews were also conducted with next of kin. This article reports on findings and issues arising from the study.

Adaptation, Psychological↗

PubMed2003

Application of loudness models to sound processing for cochlear implants.

A new paradigm for processing sound signals for multiple-electrode cochlear implants is introduced, and results are presented from an initial psychophysical evaluation of its effect on the perceived loudness of complex sounds. A real-time processing scheme based on this paradigm, called SpeL, has been developed primarily to improve control of loudness for implant users. SpeL differs from previous schemes in several ways. Most importantly, it incorporates a published numerical model which predicts the loudness perceived by implant users for complex patterns of pulsatile electric stimulation as a function of the pulses' physical parameters. This model is controlled by the output of a corresponding model that estimates the loudness perceived by normally hearing listeners for complex sounds. The latter model produces an estimate of the specific loudness arising from an acoustic signal. In SpeL, the specific loudness function, which describes the contribution to total loudness of each of a number of frequency bands (or cochlear positions), is converted to a pattern of electric stimulation on an appropriate set of electrodes. By application of the loudness model for electric stimulation, this pattern is designed to produce a specific loudness function for the implant user which approximates that produced by the normal-hearing model for the same input signal. The results of loudness magnitude estimation experiments with five users of the SpeL scheme confirmed that the psychophysical functions relating overall loudness perceived to input sound level for five complex acoustic signals were, on average, very similar to those for normal hearing.

Aged↗

PubMed1990

Hospitalizations because of hypoglycemia in users of animal and human insulins. 2. Experience in the United States.

In a 10-year (1979-1988) follow-up study of young insulin-dependent diabetics carried out at Group Health Cooperative of Puget Sound, the frequency of hospitalization for hypoglycemia remained constant. During the early years only animal insulins were available; during the latter years, human insulins were used in a majority of patients. The adjusted relative risk estimate for hospitalizations for hypoglycemia comparing users of human with users of animal insulins was 0.6 (95% confidence interval 0.2, 2.3). We conclude that the use of human insulins is not associated with an increased risk of hospitalization for hypoglycemia as compared with animal insulins in this population.

Animals↗

PubMed1990

A comparison of the risk of hypoglycemia between users of human and animal insulins. 1. Experience in the United Kingdom.

In a case-control study of 121 young insulin-dependent diabetics diagnosed as having an episode of hypoglycemia, the relative risk estimate comparing human with animal insulins was 0.8 (95% confidence interval 0.4, 1.6) controlling for age, general practice, and calendar time. We conclude that in this study population derived from general practices in the United Kingdom, the risk of hypoglycemia was no higher in users of human insulin than it was in users of animal insulins.

Adolescent↗