This paper seeks to identify the variables that are related to customer satisfaction during a guided package tour service encounter, including the role of the tour leader and the service performance by suppliers – itinerary arrangements, auxiliary support and service delivery. Data were gathered through participant observation during a mixed-nationality tour of Scandinavian destinations. Expectations, customer on-tour attitude and behaviour and equity were identified as affecting customer satisfaction during the service encounter. Additionally, the consumption experience of hedonism and enjoyment (excitement factors) on the tour had a significant effect on customer satisfaction. Two primary sources of complaints were identified: first, the tour operator's itinerary planning and hotel selection (basic factors), and second, the tour leader's competence (performance factor). The findings indicate that the tour leader is a significant determinant psychologically, spiritually and practically in influencing the success of the tour product. The result contributes to a better knowledge for the tour operator of tourism satisfaction in the international market for guided package tours.

This study aims to investigate the elements that affect customer satisfaction/dissatisfaction through the service offered by the tour leader in on-tour service encounters. It also analyzed the role of the tour leader within a long-haul escorted group. The relationship between overall satisfaction with a travel agency and the generation of repeat business was also investigated. The primary data were collected using three methods: semi-structured face-to-face interviews with managers from randomly selected Taiwanese travel agencies; participant observation of a Taiwanese guided package tour; and semi-structured international telephone interviews with tour group participants. The results revealed that the service attitude of the tour leader is sufficient to satisfy tour participants but interpretation skills will enhance the customers' level of satisfaction. However, Taiwan's tour leaders are tip-sensitive and the issue of tipping plays a crucial factor in influencing the tour leaders' job performance as well as customer satisfaction. Findings also revealed that tour leaders have a good opportunity to develop personal relationships with tour members and that the tour leader is only a partial factor influencing the future return of customers. A reasonable price of the tour is also essential. The results suggested that travel agencies should be aware of the importance of the tour leaders' welfare and should help them to improve their presentation and communication (social) skills -to explain to customers the reason why "negative incidents of low significance" occur and consequently to help reduce customer dissatisfaction when problems occur on the tour.

We aimed to analyse the outcomes of the deployment of extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (E-CPR) 11 times for acute myocardial infarction (AMI) in 10 adult patients at a very low-volume (VLV) centre, where perfusionists or surgeons are not always available. We conducted a three-year retrospective chart review. E-CPR was performed 13 times in 12 adult patients who had cardiac arrest events and who underwent conventional CPR for longer than 10 min. We excluded other aetiologies that led to E-CPR. All 11 selected episodes of E-CPR were diagnosed as AMI. Seven patients (63.6%) were successfully weaned off extracorporeal membrane oxygenation (ECMO). Four patients survived to discharge without neurological deficits or other postE-CPR complications (36.3%). Seven patients died after E-CPR, and with one patient, there was no return of spontaneous beating during E-CPR (0.9%). Three patients died of unstable haemodynamics despite revascularisation of the coronary circulation. Three patients were successfully weaned off ECMO; however, they died subsequently of multiple organ dysfunction, unstable haemodynamic changes and septic shock from nosocomial infections, respectively. The outcome of E-CPR in adults with AMI was compared with previous studies at high-volume centres. Mortality or morbidity rates are not higher at a VLV centre.

This study investigates the relationships between aspects of consumption behavioremotion, equity, and attribution-and the consequences of tourists' satisfaction. It also examines their different degrees of satisfaction in line with these three determinants. The component of equity, which is affected by cultural background, is found to have a greater effect on tourist satisfaction than people had thought, even though it was kept hidden by tourists when on the tour. This study proposes that the channel of communication could be used as a moderator to facilitate tourist satisfaction response. The results might help the travel industry refine its service quality and contribute to the literature of customer satisfaction attributes in the tourism industry.