Background Inappropriate C. difficile testing has adverse consequences for the patient, hospital, and public health. Computerized Clinical Decision Supports (CCDS) in the Electronic Health Record (EHR) may reduce C. difficile test ordering; however, effectiveness of different approaches, ease of use, and best fit into the healthcare providers’ (HCP) workflow, are not well understood. Methods Nine academic and 6 community U.S. hospitals participated in this 2-year cohort study. CCDS (hard- or soft-stop) triggered when duplicate C. difficile test order attempted, or if laxatives were recently received. The primary outcome was the difference in testing rates pre- and post-CCDS interventions, using incident rate ratios (IRR) and mixed effect Poisson regression models. We performed qualitative evaluation (contextual inquiry, interviews, focus groups) based on a human factors model. We identified themes using a codebook with primary- and sub-nodes. Results In 9 hospitals implementing hard-stop CCDS and 4 hospitals implementing soft-stop CCDS, C. difficile testing IRR reduction was 33% (95% CI, 30-36%), and 23% (95% CI 21-25%), respectively. Two hospitals implemented a non-EMR based human intervention with IRR reduction of 21% (95% CI 15-28%). HCPs reported generally favorable experiences, and highlighted time efficiencies such as inclusion of the patients most recent laxative administration on the CCDS. Organizational factors including hierarchical cultures, and communication between HCPs caring for the same patient, impact CCDS acceptance and integration. Conclusions CCDS reduced unnecessary C. difficile testing and were perceived positively by HCPs when integrated into their workflow, and when displayed relevant patient specific information needed for decision-making.

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TV series and cinema productions are considered one of the most recent and promising instruments to promote tourist destinations and to increase tourist flows. However, a few papers analyze empirically their impact on tourist choices. We contribute to the scarce literature by investigating the impact of one of the most successful TV series of all times: Game of Thrones (GoT). The series was internationally broadcasted and filmed around the world. We focus on fourteen filming locations in three different countries: Spain, Croatia and Malta. To estimate how much of their recent tourism performance is due to the visibility obtained through GoT, we use county-level panel data in the years 2007–2019 and apply an event study design as methodology. We deal with the issue of treatment effect heterogeneity over time and across counties by adopting an interaction-weighted estimator which focuses on season-specific treatment effect. The results show a positive and persistent impact of GoT on tourism performance, on both new tourist arrivals and overnight stays, and are not driven by spillover effects. Overall, findings confirm the ability of TV productions to boost the tourist flows in the filming locations.

PurposeThis study aims to explore how closed factories could be transformed and provide a path for sustainable development for a territory. The authors focus on the case of the Great Mine Serbariu, located in Carbonia (Sardinia), which used to be the largest coal mine in Italy between 1939 and 1964.Design/methodology/approachThe authors adopt a qualitative research design based on an exploratory single-case study, drawing on interviews with the main stakeholders, on a survey conducted among 5,158 visitors, and on administrative documentation of the City Council.FindingsThe analysis of the Great Mine Serbariu case showed that the regeneration of an exhausted mine serves a model of sustainable development, especially for the redevelopment of other urban and industrial degraded areas. The Great mine Serbariu was restored and turned into a place of culture, tourism, research and higher education, with the Italian Cultural Centre of Coal Mining (ICCCM) establishing its headquarters in the heart of the former mine. It attracted almost 220,000 visitors, generating both domestic and international tourist flows and making an industrial heritage a real resource for the area.Originality/valueThis article advances the authors’ understanding of how closed industries could become an instrument for sustainable development on the social, economic, touristic and cultural levels. This study would help local governments with examples to enhance the historical resources to create a new identity that led to a sustainable development of an urban landscape, and to create networks with other comparable museums all over Europe to better exploit the touristic and cultural potential.