Focus group interviews and a literature review were used to identify an initial comprehensive set of 60 items describing why nonprofit and government entities stage festivals. After pretesting and subsequently testing the items on a sample of 291 festival organizers, a 30-item instrument consisting of eight domains was demonstrated to be reliable and valid. The eight generic reasons for staging festivals were recreation/socialization, culture/ education, tourism, internal revenue generation, natural resources, agriculture, external revenue generation, and community pride/spirit.

An instrument designed to operationalize adoption of the marketing concept was completed by a sample of 291 festival organizers. It consisted of 27 items derived from a literature review and focus group interviews. Factor analyses and a series of decision rules were used to develop a final instrument of 17 items that comprised three dimensions: visitor orientation, pre-experience assessment, and postexperience evaluation. Respondents per ceived most festival organizers to be visitor-oriented, fewer to engage in postexperience evaluation, and still fewer to undertake pre-experience assessment. The level of sophistication at which the marketing concept was implemented by festivals appeared to reflect the level of available resources.

IntroductionIn 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9–12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain.MethodsWe conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU) for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB), and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge.ResultsThere were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103) and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0–5.1%; 95% CI, 0–3.6%).ConclusionApplication of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain.

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