Is cannabis use a significant exposition to nicotine?

Purpose: Young cannabis users are at increased risk for cigarette initiation and later progression to nicotine dependence. The present study assesses to which extent cannabis users are exposed to nicotine through mulling, a widespread process consisting of mixing tobacco to cannabis for its consumption. Methods: Data are issued from an ongoing observational study taking place in Switzerland. A total of 267 eligible participants (mean age 19 years, 46.4% males) completed an anonymous self-administered questionnaire on their tobacco and cannabis intake in the previous 5 days. They also provided a urine sample that was blindly analyzed for cotinine (a key metabolite of nicotine) using liquid-chromatography coupled mass-spectrometry. After the exclusion of cannabis users not having smoked at least one joint/blunt in which tobacco had been mixed (n _ 2), and participants reporting other sources of nicotine exposition than cigarettes or mulling (n _37), four groups were created: cannabis and cigarette abstainers (ABS, n_ 69), cannabis only smokers (CAS; n _ 33), cigarette only smokers (CIS; n _ 62); and cannabis and cigarette smokers (CCS, n _ 64). Cotinine measures of CAS were compared to those of ABS, CIS and CCS. All comparisons were performed using ANCOVA, controlling for age, gender, ethnicity, BMI and environmental exposure to cigarette smoke in the past month (at home, in school/at work, in social settings). The number of mixed joints/blunts smoked in the previous 5 days was additionally taken into account when comparing CAS to CCS. Cotinine values (ng/ml) are reported as means with 95% confidence interval (95% CI). Results: In the previous 5 days, CAS had smoked on average 10 mixed joints/blunts, CIS 30 cigarettes, and CCS 8 mixed joints/ blunts and 41 cigarettes. Cotinine levels of participants considerably differed between groups. The lowest measure was found among ABS (3.2 [0.5-5.9]), followed in growing order by CAS (294.6 [157.1-432.0]), CIS (362.8 [258.4-467.3]), and CCS (649.9 [500.7-799.2]). In the multivariate analysis, cotinine levels of CAS were significantly higher than those of ABS (p _.001), lower than those of CCS (p _ .003), but did not differ from levels of CIS (p _ .384). Conclusions: Our study reveals cannabis users to be significantly exposed to nicotine through mulling, even after controlling for several possible confounders such as environmental exposure to cigarette smoke. Utmost, mixing tobacco to Poster cannabis can result in a substantial nicotine exposition as cotinine levels from cannabis only smokers were as high as those of moderate cigarette smokers. Our findings also suggest that mulling is adding up to the already important nicotine exposition of cigarettes smokers. Because of the addictiveness of nicotine, mulling should be part of a comprehensive assessment of substance use among adolescents and young adults, especially when supporting their cannabis and cigarette quitting attempts. Sources of Support: This study was funded by the Public Health Service of the Canton de Vaud. Dr. BÊlanger's contribution was possible through grants from the Royal College of Physicians and Surgeons of Canada, the CHUQ/CMDP Foundation and the Laval University McLaughlin program, QuÊbec, Canada.

Infectious Disease Burden after Solid Organ Transplantation (SOT) in the Swiss Transplant Cohort Study (STCS).

Infectious diseases (ID) are a major cause of morbidity and mortality after SOT. Since May 2008, the STCS has registered 95% of all SOT recipients in Switzerland. The extensive data set includes pre- and post-transplant variables that are prospectively collected at transplantation, 6 months post-transplant, and yearly thereafter. All ID events are recorded using internationally validated defi nitions. We obtained data from 1101 patients (79 heart, 685 kidney, 29 kidney-pancreas, 212 liver, and 96 lung transplants). So far the median observation times were 0.8 (IQR 0.3-1.4; heart); 1.1 (0.6-1.8, kidney); 1.1 (0.6-1.9, kidney-pancreas); 1.0 (0.5-1.7, liver); and 0.9 years (0.5-1.5, lung). The highest rates of proven or probable ID events were seen in lung (76%), followed by liver (64%), heart (62%), kidney-pancreas (62%), kidney (58%). During the observation period, ID was the cause of death in 19 patients (1.7%). Rates of infections per person-years according to pathogen and type of transplantation are shown in Figure 1. The data indicate that virus infections are only second after bacteria whereas fungi occur at relatively low rates. This prospective and standardized long-term collection of all ID events will allow a comprehensive assessment of the burden of ID across all SOT types in Switzerland. Regular analysis will identify new trends, serve as a quality control and help design anti-infectious interventions aiming at increasing safety and improving overall transplantation outcome.

New Genetic and Linguistic Analyses Show Ancient Human Influence on Baobab Evolution and Distribution in Australia

This study investigates the role of human agency in the gene flow and geographical distribution of the Australian baobab, Adansonia gregorii. The genus Adansonia is a charismatic tree endemic to Africa, Madagascar, and northwest Australia that has long been valued by humans for its multiple uses. The distribution of genetic variation in baobabs in Africa has been partially attributed to human-mediated dispersal over millennia, but this relationship has never been investigated for the Australian species. We combined genetic and linguistic data to analyse geographic patterns of gene flow and movement of word-forms for A. gregorii in the Aboriginal languages of northwest Australia. Comprehensive assessment of genetic diversity showed weak geographic structure and high gene flow. Of potential dispersal vectors, humans were identified as most likely to have enabled gene flow across biogeographic barriers in northwest Australia. Genetic-linguistic analysis demonstrated congruence of gene flow patterns and directional movement of Aboriginal loanwords for A. gregorii. These findings, along with previous archaeobotanical evidence from the Late Pleistocene and Holocene, suggest that ancient humans significantly influenced the geographic distribution of Adansonia in northwest Australia.

First-Line Chemotherapy with Anthracycline and Taxane Combination in Metastatic Breast Cancer. Detection of bone metastases with TRACP 5b

Background: In Finland, breast cancer (BC) is the most common cancer among women, and prostate cancer (PC) that among men. At the metastatic stage both cancers remain essentially incurable. The goals of therapy include palliation of symptoms, improvement or maintenance of quality of life (QoL), delay of disease progression, and prolongation of survival. Balancing between efficacy and toxicity is the major challenge. With increasing costs of new treatments, appropriate use of resources is paramount. When new treatment regimes are introduced into clinical practice a comprehensive assessment of clinical benefit, adverse effects and cost is necessary. Both BC and PC show a predilection to metastasize to bone. Bone metastases cause significant morbidity impairing the patients´ QoL. Diagnosis of bone metastases relies mainly on radiological methods, which however lack optimal sensitivity and specificity. New tools are needed for detection and follow-up of bone metastases. Aims: Anthracyclines and taxanes are effective chemotherapeutic agents in the treatment of metastatic breast cancer (MBC) with different mechanisms of action. Therefore, evaluation of the combination of anthracyclines with taxanes was a justifiable approach in the treatment of MBC patients. We assessed the efficacy, toxicity, cost of treatment and QoL of BC patients treated with first-line chemotherapy for metastatic disease with the combination epirubicin and docetaxel. We also evaluated the diagnostic potential of tartrate-resistant acid phosphatase 5b (TRACP 5b) and carboxyterminal telopeptides of type I collagen (ICTP) in the diagnosis of bone metastases in BC and TRACP 5b in PC patients. Results: The combination of epirubicin and docetaxel was effective in this phase II study, but required individual dose adjustment to avoid neutropenic infections, and the use of growth factors to maintain a feasible dose level. The response rate was 54 % (95 % CI 37-71) and the median overall survival (OS) was 26 months. Of the patients, 87 % were treated for infections. The treatment of adverse events required additional use of health resources mainly due to neutropenic infections, thereby raising direct treatment costs by 20 %. Despite adverse events, the global QoL was not significantly compromised during the treatment. Clinically evident acute cardiac toxicity was not observed. The combination of serum TRACP 5b and ICTP was at least equally sensitive and specific in detection of of bone metastases as commonly used total alkaline phosphatise (tALP) in BC patients. In contrast, TRACP 5b was less specific and sensitive than tALP as a marker of skeletal changes in PC patients. Conclusions: Treatment with epirubicin and docetaxel showed high efficacy in first-line chemotherapy of MBC. The relatively high incidence of neutropenic infections requiring hospitalization increased the treatment costs. Despite adverse events, the global QoL of the patients was not significantly compromised. The combination of TRACP 5b and ICTP showed similar activity as tALP in detecting bone metastases in MBC. In contrast, TRACP 5b was less specific and sensitive than tALP as a marker of skeletal changes in PC.

Normalisation de l’évaluation du potentiel musical auprès d’enfants d’âge scolaire

Cette étude introduit un nouvel outil d’évaluation des troubles liés à la perception et la mémoire de la musique pour les enfants âgés entre six et huit ans. La batterie d’évaluation proposée est une adaptation de la batterie de Montréal de l'évaluation de l’amusie (MBEA) afin qu’elle puisse être utilisée chez les enfants, et ce, peu importe leur langue maternelle et leur culture. Dans l'expérience 1, la batterie, qui évalue les composantes musicales suivantes : la tonalité, le contour, l’intervalle, le rythme ainsi que la mémoire incidente, a été administrée auprès de 258 enfants à Montréal et 91 à Pékin. Dans l'expérience 2, une version abrégée de la batterie a été administrée à 86 enfants à Montréal. Les deux versions ont démontré une sensibilité aux différences individuelles et à la formation musicale. Il ne semble pas y avoir une influence de l'apprentissage de la lecture et de l’écriture sur les performances, mais plutôt un effet de la culture. Effectivement, les enfants qui ont comme langue maternelle le Mandarin (une langue tonale) ont obtenu de meilleurs résultats aux tâches de discrimination liées à la composante mélodique en comparaison à leurs homologues canadiens. Pour les deux groupes d’enfants, ceux qui ont été identifiés comme potentiellement amusiques ont principalement, mais pas exclusivement, des difficultés à percevoir de fines variations de hauteurs. Le caractère prédominant du déficit lié au traitement mélodique est moins distinctif avec la version abrégée. Par ailleurs, les résultats suggèrent différentes trajectoires de développement pour le traitement de la mélodie, du rythme et de la mémoire. De ce fait, la version de la MBEA adaptée à l’enfant, renommée la batterie de Montréal d'évaluation du potentiel musical (MBEMP), est un nouvel outil qui permet d’identifier les troubles liés au traitement musical chez les enfants tout en permettant d'examiner le développement typique et atypique des habiletés musicales et leur relation présumée à d'autres fonctions cognitives.

Recommandations des interventions en physiothérapie pour une clientèle âgée souffrant de démence

Travail d'intégration présenté à la Faculté de médecine en vue de l’obtention du grade de maîtrise professionnelle en physiothérapie

Reviewing the EU ETS review? Report of the CEPS TAsk Force on "Does the ETS market produce the 'right' price signal"? CEPS Task Force Report, 12 November 2012

Drawing on discussions within a CEPS Task Force on the revised EU emissions trading system, this report provides a comprehensive assessment of the pros and cons of the various measures put forward by different stakeholders to address the level and stability of the price of carbon in the EU. It argues that the European Commission, the member states, the European Parliament and other stakeholders need to give serious consideration to introducing some kind of ‘dynamic’ adjustment provision to address the relatively inelastic supply. The report also suggests that there is a need to improve communication of market-sensitive information, for example by leaving the management of the ETS to a specialised body.

Modelling monsoons: understanding and predicting current and future behaviour

The global monsoon system is so varied and complex that understanding and predicting its diverse behaviour remains a challenge that will occupy modellers for many years to come. Despite the difficult task ahead, an improved monsoon modelling capability has been realized through the inclusion of more detailed physics of the climate system and higher resolution in our numerical models. Perhaps the most crucial improvement to date has been the development of coupled ocean-atmosphere models. From subseasonal to interdecadal time scales, only through the inclusion of air-sea interaction can the proper phasing and teleconnections of convection be attained with respect to sea surface temperature variations. Even then, the response to slow variations in remote forcings (e.g., El Niño—Southern Oscillation) does not result in a robust solution, as there are a host of competing modes of variability that must be represented, including those that appear to be chaotic. Understanding the links between monsoons and land surface processes is not as mature as that explored regarding air-sea interactions. A land surface forcing signal appears to dominate the onset of wet season rainfall over the North American monsoon region, though the relative role of ocean versus land forcing remains a topic of investigation in all the monsoon systems. Also, improved forecasts have been made during periods in which additional sounding observations are available for data assimilation. Thus, there is untapped predictability that can only be attained through the development of a more comprehensive observing system for all monsoon regions. Additionally, improved parameterizations - for example, of convection, cloud, radiation, and boundary layer schemes as well as land surface processes - are essential to realize the full potential of monsoon predictability. A more comprehensive assessment is needed of the impact of black carbon aerosols, which may modulate that of other anthropogenic greenhouse gases. Dynamical considerations require ever increased horizontal resolution (probably to 0.5 degree or higher) in order to resolve many monsoon features including, but not limited to, the Mei-Yu/Baiu sudden onset and withdrawal, low-level jet orientation and variability, and orographic forced rainfall. Under anthropogenic climate change many competing factors complicate making robust projections of monsoon changes. Absent aerosol effects, increased land-sea temperature contrast suggests strengthened monsoon circulation due to climate change. However, increased aerosol emissions will reflect more solar radiation back to space, which may temper or even reduce the strength of monsoon circulations compared to the present day. Precipitation may behave independently from the circulation under warming conditions in which an increased atmospheric moisture loading, based purely on thermodynamic considerations, could result in increased monsoon rainfall under climate change. The challenge to improve model parameterizations and include more complex processes and feedbacks pushes computing resources to their limit, thus requiring continuous upgrades of computational infrastructure to ensure progress in understanding and predicting current and future behaviour of monsoons.

Introduction: perspectives for economically important wild species and neglected crops in the Mediterranean

The Mediterranean region is one of the major centres of origin and diversification of cultivated plants and many crop wild relatives are found there. In addition, many native species are still widely harvested from the wild for food, medicine and other uses and some of these have potential for development as alternative crop especially in marginal zones. While there have been several recent initiatives that address the cataloguing and conservation of these species, such as the Network on Identification, Conservation and Use of Wild Plants in the Mediterranean Region (MEDUSA and the Bioversity International (IPGRI) studies on Underutilized Mediterranean Species (VMS), no comprehensive assessment has yet been made and little work undertaken on their agricultural potential. It has been confidently predicted that consequences of global change in the Mediterranean region - population movements and migrations, changes in disturbance regimes, and climate change - will be serious. One the one hand, this will affect the survival prospects of many of these underutilized species and on the other hand it will enhance their importance as the source of potential new crop germplasm. The conservation and availability of genetic diversity of both crops and underutilized species is essential if we are to be able to meet the increasing demand for food and other crops that will be adapted to the new ecoclimatic envelopes that will develop in the region as a consequence of global change. The rapid rate of climatic and other change that is expected adds urgency to the task of assessing, conserving and sustainably using this rich diversity of wild species of economic value in the region but new strategies will be need to be developed to achieve this. The Mediterranean region has the potential of becoming a major source of new crop development in the coming decades.

The effect of cleft lip on socio-emotional functioning in school-aged children

Background: Children with cleft lip are known to be at raised risk for socio-emotional difficulties, but the nature of these problems and their causes are incompletely understood; longitudinal studies are required that include comprehensive assessment of child functioning, and consideration of developmental mechanisms. Method: Children with cleft lip (with and without cleft palate) (N = 93) and controls (N = 77), previously studied through infancy, were followed up at 7 years, and their socio-emotional functioning assessed using teacher and maternal reports, observations of social interactions, and child social representations (doll play). Direct and moderating effects of infant attachment and current parenting were investigated, as was the role of child communication difficulties and attractiveness. Results: Children with clefts had raised rates of teacher-reported social problems, and anxious and withdrawn-depressed behaviour; direct observations and child representations also revealed difficulties in social relationships. Child communication problems largely accounted for these effects, especially in children with cleft palate as well as cleft lip. Insecure attachment contributed to risk in both index and control groups, and a poorer current parenting environment exacerbated the difficulties of those with clefts. Conclusions: Children with clefts are at raised risk for socio-emotional difficulties in the school years; clinical interventions should focus on communication problems and supporting parenting; specific interventions around the transition to school may be required. More generally, the findings reflect the importance of communication skills for children’s peer relations.

Predictability of the western North Pacific summer climate demonstrated by the coupled models of ENSEMBLES

The Asian monsoon system, including the western North Pacific (WNP), East Asian, and Indian monsoons, dominates the climate of the Asia-Indian Ocean-Pacific region, and plays a significant role in the global hydrological and energy cycles. The prediction of monsoons and associated climate features is a major challenge in seasonal time scale climate forecast. In this study, a comprehensive assessment of the interannual predictability of the WNP summer climate has been performed using the 1-month lead retrospective forecasts (hindcasts) of five state-of-the-art coupled models from ENSEMBLES for the period of 1960–2005. Spatial distribution of the temporal correlation coefficients shows that the interannual variation of precipitation is well predicted around the Maritime Continent and east of the Philippines. The high skills for the lower-tropospheric circulation and sea surface temperature (SST) spread over almost the whole WNP. These results indicate that the models in general successfully predict the interannual variation of the WNP summer climate. Two typical indices, the WNP summer precipitation index and the WNP lower-tropospheric circulation index (WNPMI), have been used to quantify the forecast skill. The correlation coefficient between five models’ multi-model ensemble (MME) mean prediction and observations for the WNP summer precipitation index reaches 0.66 during 1979–2005 while it is 0.68 for the WNPMI during 1960–2005. The WNPMI-regressed anomalies of lower-tropospheric winds, SSTs and precipitation are similar between observations and MME. Further analysis suggests that prediction reliability of the WNP summer climate mainly arises from the atmosphere–ocean interaction over the tropical Indian and the tropical Pacific Ocean, implying that continuing improvement in the representation of the air–sea interaction over these regions in CGCMs is a key for long-lead seasonal forecast over the WNP and East Asia. On the other hand, the prediction of the WNP summer climate anomalies exhibits a remarkable spread resulted from uncertainty in initial conditions. The summer anomalies related to the prediction spread, including the lower-tropospheric circulation, SST and precipitation anomalies, show a Pacific-Japan or East Asia-Pacific pattern in the meridional direction over the WNP. Our further investigations suggest that the WNPMI prediction spread arises mainly from the internal dynamics in air–sea interaction over the WNP and Indian Ocean, since the local relationships among the anomalous SST, circulation, and precipitation associated with the spread are similar to those associated with the interannual variation of the WNPMI in both observations and MME. However, the magnitudes of these anomalies related to the spread are weaker, ranging from one third to a half of those anomalies associated with the interannual variation of the WNPMI in MME over the tropical Indian Ocean and subtropical WNP. These results further support that the improvement in the representation of the air–sea interaction over the tropical Indian Ocean and subtropical WNP in CGCMs is a key for reducing the prediction spread and for improving the long-lead seasonal forecast over the WNP and East Asia.

Cloud bands over southern Africa: seasonality, contribution to rainfall variability, and modulation by the MJO

Tropical-extratropical cloud band systems over southern Africa, known as tropical temperate troughs (TTTs), are known to contribute substantially to South African summer rainfall. This study performs a comprehensive assessment of the seasonal cycle and rainfall contribution of TTTs by using a novel object-based strategy that explicitly tracks these systems for their full life cycle. The methodology incorporates a simple assignment of station rainfall data to each event, thereby creating a database containing detailed rainfall characteristics for each TTT. This is used to explore the importance of TTTs for rain days and climatological rainfall totals in October–March. Average contributions range from 30 to 60 % with substantial spatial heterogeneity observed. TTT rainfall contributions over the Highveld and eastern escarpment are lower than expected. A short analysis of TTT rainfall variability indicates TTTs provide substantial, but not dominant, intraseasonal and interannual variability in station rainfall totals. TTTs are however responsible for a high proportion of heavy rainfall days. Of 52 extreme rainfall events in the 1979–1999 period, 30 are associated with these tropical-extratropical interactions. Cut-off lows were included in the evolution of 6 of these TTTs. The study concludes with an analysis of the question: does the Madden-Julian Oscillation influence the intensity of TTT rainfall over South Africa? Results suggest a weak but significant suppression (enhancement) of intensity during phase 1(6).

Transport impacts on atmosphere and climate: shipping

Emissions of exhaust gases and particles from oceangoing ships are a significant and growing contributor to the total emissions from the transportation sector. We present an assessment of the contribution of gaseous and particulate emissions from oceangoing shipping to anthropogenic emissions and air quality. We also assess the degradation in human health and climate change created by these emissions. Regulating ship emissions requires comprehensive knowledge of current fuel consumption and emissions, understanding of their impact on atmospheric composition and climate, and projections of potential future evolutions and mitigation options. Nearly 70% of ship emissions occur within 400 km of coastlines, causing air quality problems through the formation of ground-level ozone, sulphur emissions and particulate matter in coastal areas and harbours with heavy traffic. Furthermore, ozone and aerosol precursor emissions as well as their derivative species from ships may be transported in the atmosphere over several hundreds of kilometres, and thus contribute to air quality problems further inland, even though they are emitted at sea. In addition, ship emissions impact climate. Recent studies indicate that the cooling due to altered clouds far outweighs the warming effects from greenhouse gases such as carbon dioxide (CO2) or ozone from shipping, overall causing a negative present-day radiative forcing (RF). Current efforts to reduce sulphur and other pollutants from shipping may modify this. However, given the short residence time of sulphate compared to CO2, the climate response from sulphate is of the order decades while that of CO2 is centuries. The climatic trade-off between positive and negative radiative forcing is still a topic of scientific research, but from what is currently known, a simple cancellation of global mean forcing components is potentially inappropriate and a more comprehensive assessment metric is required. The CO2 equivalent emissions using the global temperature change potential (GTP) metric indicate that after 50 years the net global mean effect of current emissions is close to zero through cancellation of warming by CO2 and cooling by sulphate and nitrogen oxides.

SPARC Data Initiative: Comparison of water vapor climatologies from international satellite limb sounders

Within the SPARC Data Initiative, the first comprehensive assessment of the quality of 13 water vapor products from 11 limb-viewing satellite instruments (LIMS, SAGE II, UARS-MLS, HALOE, POAM III, SMR, SAGE III, MIPAS, SCIAMACHY, ACE-FTS, and Aura-MLS) obtained within the time period 1978-2010 has been performed. Each instrument's water vapor profile measurements were compiled into monthly zonal mean time series on a common latitude-pressure grid. These time series serve as basis for the "climatological" validation approach used within the project. The evaluations include comparisons of monthly or annual zonal mean cross sections and seasonal cycles in the tropical and extratropical upper troposphere and lower stratosphere averaged over one or more years, comparisons of interannual variability, and a study of the time evolution of physical features in water vapor such as the tropical tape recorder and polar vortex dehydration. Our knowledge of the atmospheric mean state in water vapor is best in the lower and middle stratosphere of the tropics and midlatitudes, with a relative uncertainty of. 2-6% (as quantified by the standard deviation of the instruments' multiannual means). The uncertainty increases toward the polar regions (+/- 10-15%), the mesosphere (+/- 15%), and the upper troposphere/lower stratosphere below 100 hPa (+/- 30-50%), where sampling issues add uncertainty due to large gradients and high natural variability in water vapor. The minimum found in multiannual (1998-2008) mean water vapor in the tropical lower stratosphere is 3.5 ppmv (+/- 14%), with slightly larger uncertainties for monthly mean values. The frequently used HALOE water vapor data set shows consistently lower values than most other data sets throughout the atmosphere, with increasing deviations from the multi-instrument mean below 100 hPa in both the tropics and extratropics. The knowledge gained from these comparisons and regarding the quality of the individual data sets in different regions of the atmosphere will help to improve model-measurement comparisons (e.g., for diagnostics such as the tropical tape recorder or seasonal cycles), data merging activities, and studies of climate variability.

The CURE scale: a multidimensional measure of service recovery strategy

Purpose – This paper aims to address the gaps in service recovery strategy assessment. An effective service recovery strategy that prevents customer defection after a service failure is a powerful managerial instrument. The literature to date does not present a comprehensive assessment of service recovery strategy. It also lacks a clear picture of the service recovery actions at managers’ disposal in case of failure and the effectiveness of individual strategies on customer outcomes. Design/methodology/approach – Based on service recovery theory, this paper proposes a formative index of service recovery strategy and empirically validates this measure using partial least-squares path modelling with survey data from 437 complainants in the telecommunications industry in Egypt. Findings – The CURE scale (CUstomer REcovery scale) presents evidence of reliability as well as convergent, discriminant and nomological validity. Findings also reveal that problem-solving, speed of response, effort, facilitation and apology are the actions that have an impact on the customer’s satisfaction with service recovery. Practical implications – This new formative index is of potential value in investigating links between strategy and customer evaluations of service by helping managers identify which actions contribute most to changes in the overall service recovery strategy as well as satisfaction with service recovery. Ultimately, the CURE scale facilitates the long-term planning of effective complaint management. Originality/value – This is the first study in the service marketing literature to propose a comprehensive assessment of service recovery strategy and clearly identify the service recovery actions that contribute most to changes in the overall service recovery strategy.