How Sense of Ritual in Tourism Impacts Tourists’Co-Creation of Tourism Experience Values:A Study Based on the Theory of Value Co-Creation

Establishing a sense of ritual within tourism consumption scenarios offers tourists the opportunity for interactive engagement.Drawing upon the value co-creation theory,this study constructed an influence mechanism model to examine tourists'active engagement in the process of co-creating tourism experience values.It employed Partial Least Squares Structural Equation Modeling(PLS-SEM)to empirically test the proposed hypotheses.The findings demonstrate that the model constructed in the present study exhibits robust reliability,validity,and explanatory power.The perception of the sense of ritual in tourism exerts a significant positive influence on tourists’co-creation of tourism experience values,thereby significantly enhancing both the communitas and flow experienced by tourists during their travels.Moreover,such communitas and flow can mediate the influence of the sense of ritual in tourism on tourists’co-creation of tourism experience values.This study contributes to advancing the current research on tourists’co-creation of tourism experience values and the sense of ritual in tourism,thereby providing theoretical foundations for cultivating a sense of ritual within tourism consumption scenarios.

Experiences of Mothers on the Utilization of Elimination of Mother to Child Transmission of HIV Services at Mtendere Clinic, Lusaka

Introduction: Acquired immunodeficiency syndrome is one of the leading causes of mortality among women of reproductive age and Mother to Child Transmission of Human immunodeficiency virus is still a challenge affecting many countries. Globally, an estimation of 180,000 children under 15 years acquire the Human immunodeficiency virus every day, and more than 90% of those infections are due to Mother to Child Transmission. The study sought to explore the experiences of mothers on the Elimination of Mother to Child Transmission-HIV services at Mtendere Clinic, Lusaka. Materials and Methods: Qualitative interpretive phenomenology study design was employed using in-depth interviews to collect data from a sample that was selected using purposive sampling technique. Thirteen participants were recruited, and these were HIV-positive mothers at least between the ages of 15 and 49 years and enrolled in the Elimination of Mother To Child Transmission-HIV program. The in-depth interviews were audiotape recorded and transcribed verbatim. Data was analyzed using thematic method. Findings: Three main themes that emerged are;living with HIV, support system and barriers to utilization of Elimination of Mother To Child Transmission-HIV services. Most of the participants expressed having acquired knowledge from the program, and received counselling and support from spouses, family as well as health personnel at Mtendere health facility which culminated into a positive experience and enhanced their uptake of the Elimination of Mother to Child Transmission-HIV services. However, barriers to service utilization were identified and these included fear of stigma, negative attitudes from health workers, long waiting times, lack of support and lack of transport to the health facility. Conclusion: Interventions such as community awareness campaigns on Elimination of Mother To Child Transmission-HIV, male involvement and implementing mother-to-mother peer support strategies in Elimination of Mother To Child Transmission-HIV service utilization should be prioritized so as to alleviate stigma and enhancing a positive experience for these mothers thus reducing on the Mother to Child HIV Transmission burden and mortality rates.

Qualitative exploration of home life experiences and care needs among elderly patients with temporary intestinal stomas

BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs.Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer.However,the ileostomy is susceptible to peri-stoma skin complications,as well as fluid,electrolyte,and nutritional imbalances,posing challenges to effective management.The successful selfmanagement of patients is intricately linked to their adjustment to temporary colostomy;nonetheless,there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront.AIM To investigate the lived experiences,perceptions,and care requirements of temporary colostomy patients within their home environment,with the ultimate goal of formulating a standardized management protocol.METHODS Over the period of June to August 2023,a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai,China.Employing a phenomenological research approach,a semi-structured interview guide was developed,and qualitative interviews were conducted using in-depth interview techniques.The acquired data underwent coding,analysis,organization,and summarization following Colaizzi’s seven-step method.RESULTS The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes:Firstly,Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression;secondly,patients exhibit limited self-care capabilities and face information deficits,resulting in heightened reliance on healthcare professionals;thirdly,patients demonstrate the potential for internal motivation through proactive self-adjustment;and finally,patients express a significant need for emotional and social support.CONCLUSION Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens,inadequate self-care abilities,informational deficits,and emotional needs.Identifying factors influencing patients’self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.

Community Caregivers’ Experiences and Programmatic Strategies to Improve Active Case Finding in Community Tuberculosis Care in Botswana 2016-2021

Background: The community tuberculosis care program was started to reduce the impact of TB and increase successful treatment outcomes, thus contributing to meeting WHO targets on TB. According to the Botswana Ministry of Health, community tuberculosis care was introduced with the main goal of reducing tuberculosis-related morbidity and mortality among communities through the expansion of direct observed therapy and community involvement to community settings. The community caregivers were to support tuberculosis patients throughout their treatment period until they were cured or had completed their treatment. Settings: Two major cities of Botswana, Francistown and Gaborone, with more than twenty-two health clinics offering tuberculosis care. Objective: To investigate community caregivers’ experiences and identify programmatic strategies to improve active TB case findings under the community TB care (CTBC) program in Botswana during 2016-2021. Methods: We adopted a descriptive qualitative research design, followed by convenience purposive sampling. We obtained consent and interviewed 40 participants who met the inclusion criteria, 16 out of 73 in Gaborone and 24 out of 38 from Francistown. Results: We interviewed 40 caregivers with a mean age of 43.4 years. Accepting the caregiving role was identified as the main experience by more than two thirds of the caregivers. While at least more than two-fifth felt obligated to care for the patient at home due to personal relations. More than half of the respondents found caregiving difficult or frustrating due to some challenges encountered during the caregiving role. Behavioral modifications were suggested under different subthemes as strategies to improve active case finding. [-rId13-]Conclusion: Acceptance was the major experience in CTBC. Intensification of known programmatic strategies was suggested by caregivers to improve tuberculosis active case finding in CTBC.

The Tenth Anniversary of Free Trade Pilot Zones in China:Fundamental Experiences and Enhancement Strategies

Since the 18th National Congress of the Communist Party of China,the country has established 21 Free Trade Pilot Zones(FTZs),achieving significant pioneering results in reform and opening up and creating a strong demonstrative effect nationwide.The basic experience from a decade of FTZs includes:adhering to the centralized and unified leadership of the CPC Central Committee;combining top-level design with encouragement of grassroots innovation;leveraging the distinct characteristics and strengths of FTZs to form a differentiated development pattern;maintaining the integration of opening up with domestic reforms;using openness to drive reforms;and organically combining openness with national security assurance.Under the current and future new circumstances,China’s FTZs face new challenges and tasks.In accordance with the directives of the 20th National Congress of the Communist Party of China,an enhancement strategy for the FTZs needs to be implemented.This involves the following:First,accurately understanding and responding to the changing situation to create strategic opportunities.Second,shifting paradigms to implement innovation-driven strategies,using the new development pattern concept to guide the reform experiments and construction of the FTZs.Third,granting more autonomy to FTZs for reforms,pursuing progress while maintaining stability,and solidly advancing the reform experiments in the FTZs.Fourth,orderly expanding the opening up of the service sector and cautiously advancing the internationalization of the renminbi.Fifth,promoting innovative development in trade to build a strong trade nation.Sixth,establishing synergy with bilateral FTZs,Belt and Road cooperation,and national diplomatic strategies to enhance the linkage effect.

Transforming Digital Experiences: The Evolution of Digital Experience Platforms (DXPs) from Monoliths to Microservices: A Practical Guide

The research aims to explore the transition from monolithic Digital Experience Platforms (DXPs) to Microservices-based DXPs, addressing scalability challenges. The study systematically decomposes monolithic structures into Microservices, emphasizing business capability and subdomain decomposition. Concrete insights, challenges, and solutions encountered during this transformation process are presented. The research contributes valuable insights into the challenges and benefits of adopting Microservices in DXPs. Results highlight the importance of architectural patterns and strategic scaling dimensions for improved performance and scalability. The case study on Backbase’s Engagement Banking Platform showcases successful implementation, providing flexibility, integration, and efficient development in the evolving DXP landscape.

Mothers’challenges and experiences of children with cerebral palsy:a qualitative meta-synthesis

Objective:To examine what challenges and experiences a mother faces in caring for children with cerebral palsy(CP).As the main caregiver of children with CP,mothers are under multiple pressures.Even though mothers’challenges and experiences of children with CP will affect their quality of life and the rehabilitation of the children,little is known about their challenges and experiences during the whole care.Methods:A qualitative meta-synthesis was conducted to extract and analyze qualitative research from the PubMed,CINAHL,PsycINFO,Web of Science,Ovid and MEDLINE databases.Thirteen articles were selected and analyzed using thematic syntheses.Results:From 2522 screened abstracts,84 texts were reviewed,and 13 studies met the inclusion criteria.Mothers’challenges and experiences of children with CP include 4 themes,both positive and negative.Conclusions:The mothers of children with CP suffer from physical burden,as well as psychological pressure,in the care experience;social and healthcare support are their main challenges.Interventions to help them face the difficulties and adapt to the role of caregivers as soon as possible should target multiple aspects in order to maximize effectiveness,to promote the healthy growth of children with CP.

Exploring the meaning of care among lived experiences of patients with blindness:an interpretive phenomenological study

Objective:To explore the meaning of care experienced by people with blindness in hospitals.Methods:Interpretive phenomenology along with the 6-step method of van Manen was used to conduct the study.Using purposeful sampling,15 people with legal blindness were interviewed.Thematic analysis was used to isolate the meaning of care.Results:Five themes emerged:(a)nurses in the eyes of patients with blindness;(b)negligence in the caring moments;(c)being cared for in ambiguity;(d)Uncoordinated care;and(e)Psychological discomfor t.These sub-themes were condensed into an overarching theme titled as“marginalized patients inside the stereotypical healthcare system.”Conclusions:Lived experiences of patients with blindness revealed that hospitals provide stereotypic or inappropriate care for this minority group in society.Health professionals par ticularly nurses should be skilled to provide person-centered and coordinated care for patients with blindness.

Nurses’experiences in providing antenatal care during COVID-19 lockdown in Ghana

Background:The coronavirus disease 2019(COVID-19)pandemic posed a major global health threat,leading to the disruption and strain of numerous health systems globally.The situation deprived essential routine healthcare services,including antenatal care,of the needed attention,significantly affecting facility workers.This study therefore aimed to explore the lived experiences and challenges faced by nurses providing antenatal care during the COVID-19 pandemic.Methods:Data were collected through in-depth interviews with seven antenatal care nurses.The interviews were transcribed and analyzed using thematic analysis to identify recurring themes.Four main themes emerged:(1)Knowledge capital,which refers to the essential knowledge and skills required;(2)Interventions,highlighting the measures taken to adapt care;(3)Antenatal care challenges,detailing the specific obstacles faced;and(4)Coping strategies,outlining the methods used by nurses to manage stress and maintain care quality.Results:The results highlight the emotional and economic toll of the pandemic on antenatal care nurses and the importance of effective collaboration and coping strategies.The findings also underscore the crucial role of teamwork,dedication,quick adjustment,and the role of information communication technology in maneuvering through pandemics to provide continuous essential care.Conclusion:These insights are crucial for health agencies and organizations to develop supportive strategies that ensure the continuity of healthcare delivery and safeguard the well-being of healthcare workers during crises.

Value co-creation model based on IS application capabilities

To illustrate how firms and customers co-create value in business to business （B2B） e-commerce, an integrated value co-creation model is proposed based on information systems （IS） application capabilities from the relational view. IS application capabilities, relational assets, customer agility and relational value are constructed and tested by empirical analysis. The empirical research tests and verifies the mediating effect of customer agility, and the interactions of IS application capabilities and relational assets, as well as their effect on relational value. This model expands the research framework of value co-creation in service dominant logic, and reveals the mechanism of how f＇n＇ms and customers co-create value in B2B e-commerce based on IS application capabilities, which provides the basis for further theory development and a practice guide.

以“Co-Creation”为基础的设计融合教育课程教学模式研究

“Co-Creation”可以解释为“Compromise”与“Collaboration”的实践方式。融合教育的特征是融合性、统合性学问的教育,是关于无界限的知识产生过程和方法的研究,它包含了团队整体和学习者个体的教育结合。论文从设计融合教育的历史背景、发展现状探讨设计融合教育改革的必要性,考察IT&设计融合教育方案事例和设计产业融合、顶点设计。设计融合教育的建议注重共同创造的基础与前沿学科理论结合,以协同效应为目标的战略合作。通过教学课程统合类型、统合教学课程示例、融合设计方案流程、每周讲课设计(举例)四个方面进行说明,给出设计融合教育发展与案例实施的建议。

Worldwide experiences of endoscopic submucosal dissection:Not just Eastern acrobatics

The high incidence of gastric cancer has led to the initiation of cancer screening programs.As a result,the number of early gastric cancer cases has increased and consequentially,the cancer mortality rate has decreased.Moreover,the development of minimally invasive endoscopic treatment has been introduced for these early lesions.Endoscopic submucosal dissection(ESD) is now recognized as one of the preferred treatment modalities for premalignant gastrointestinal epithelial lesions and early gastric cancer without lymph node metastasis.We review the results of ESD including experiences in Japan and Korea,as well as western countries.

Registered Nurses’ Experiences with Clinical Teaching Environment in Malawi

Clinical practice remains an integral part of nursing curriculum because clinical practice provides students with an opportunity to achieve professional competence. Creating a conducive learning environment for students is responsibility of academic staff, clinical nurses and students alike. However, studies in Malawi have reported poor clinical learning environment for students. This study therefore aimed at exploring nurses’ experiences of clinical teaching environment in Malawi. The study used a qualitative research design utilizing a descriptive phenomenological approach. Participants were randomly identified from teaching hospitals across Malawi by nursing managers to attend a six week clinical preceptorship training at one University nursing college. Immediately before commencement of the training, participants were invited to voluntarily participate in a focus group discussion pertaining to their experiences with clinical environment. We conducted focus group discussions with 9 trainees in 2013 and 12 trainees in 2014 training cohorts. Findings reveal that nurses meet a number of challenges in teaching students in the clinical area. Four themes emerged from the study, namely, inadequate faculty support, poor clinical teaching environment, poor competence among nurses and unsupportive working conditions. Nurses require support from academic staff and their managers to ensure a conducive clinical teaching environment.

A Probe into Ernest Hemingway's Suicide Enigma Through His Works and Life Experiences

Ernest Hemingway, one of the brightest stars on the literary stage of both American and the whole world literature in the twentieth century, had gained an everlasting reputation by the image of"the tough man"he created in lots of his works.Hence, to readers, Hemingway must be a strong man both physically and mentally. Though Hemingway had passed away, he left us an inestimable literary treasure, and we can draw some lessons from his suicide tragedy. To modern people who are

Experiences with the Use of Vaginal Dilator by Cervical Cancer Women Who Received Pelvic Radiotherapy at Cancer Diseases Hospital, Lusaka Zambia

Background: Cancer of the cervix is the commonest cancer in women seen at Cancer Diseases Hospital in Zambia and Pelvic Radiotherapy is the main treatment modality used on cervical cancer patients. Radiotherapy to the pelvis has a potential to causes vaginal stenosis but the stenosis can be prevented by regular sexual intercourse or use of vaginal dilators as recommended by cancer organizations. Despite the well-established benefits of vaginal dilators, there was reluctance by women to adopt this practice as seen by the number of survivors with vaginal stenosis at Cancer Diseases Hospital. The objective of this study was to explore experiences with the use of vaginal dilators by cervical cancer women who received Pelvic Radiotherapy. Methodology: A descriptive phenomenological design was used to explore experiences with the use of vaginal dilators by cervical cancer women. The study was conducted at Cancer Diseases Hospital in Lusaka District of Zambia. Participants were identified and purposefully sampled during the follow up clinics, they were then followed for interviews into their homes in Lusaka and data saturation was attained after interviewing 22 participants. Data were analyzed using thematic analysis. Results: Five themes from the study emerged on how women with cervical cancer experienced the use of vaginal dilator;such as uncomfortable dilators, pity for the husband, changed lifestyle, embarrassment and fear. Conclusion: It was acknowledged that the use of vaginal dilator was associated with negative experiences such as uncomfortable dilators, pity for the husband, changed lifestyle, fear and embarrassment. Therefore, this study recommends that Health care providers from CDH and other health institutions should give appropriate information to patients concerning the use of vaginal dilators and the Ministry of Health to provide vaginal dilators instead of 50 milliliter syringes currently in use.

Experiences of Low Gestational Weight Gain: A Phenomenological Study with Pregnant Women

Low maternal, gestational weight gain is associated with preterm birth, intrauterine growth restriction, low birthweight, small-for-gestational-age infants, neural tube defects, infant death, failure to initiate breastfeeding, and childhood asthma. The advantage of qualitative research is it can provide valuable insights for health care professionals into the experience and perceptions of low gestational weight gain from the vantage point of women with first-hand lived experience. In this Heideggarian interpretive phenomenological study, the meaning and experiences of weight gain for pregnant women with low gestational weight gain were explored. Data were collected through interviews with 10 pregnant women from Atlantic Canada. Conroy’s pathway for interpretive phenomenology was utilized. A hermeneutical spiral of interpretation identified six patterns or major themes: confronting one’s mortality;defending oneself against a permanent metamorphosis into a stranger;playing with fire and brimstone;slipping under the radar;trying to find peace;and riding an emotional roller coaster. The findings point to a war that is being waged over pregnant bodies with respect to weight that leaves pregnant women fending for themselves, apparently with little help from their health care providers. Implications of the findings for health practice, education, and research are discussed.

What are the self-management experiences of the elderly with diabetes?A systematic review of qualitative research

BACKGROUND The number of elderly individuals with diabetes is dramatically increasing.Diabetes is a long-term condition and a noncommunicable disease and requires intensive daily self-management.Understanding of self-management from the patients’perspectives is important to nurses,healthcare providers,and researchers and benefits people by improving their self-management skills.AIM To examine and synthesize qualitative studies that explore the experiences of elderly people in self-managing diabetes.METHODS Electronic databases were searched,including MEDLINE,CINAH,PsycINFO,PubMed,CNKI,and WANFADATA.Relevant research was identified by manually searching reference lists and gray literature.Only English and Chinese publications were included.The Critical Appraisal Skills Program was used to assess the quality of the research.The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence of the findings.RESULTS A total of 10 qualitative studies were included,and content analysis was performed.Five themes were identified:The need for knowledge about diabetes care,support systems,functional decline,attitudes toward diabetes,and healthy lifestyle challenges.CONCLUSION This present review provides a deep and broad understanding of the experiences in the self-management of diabetes and can be valuable to nursing practice and provide recommendations for future research.

Functional and Neural Mechanisms of Out-of-Body Experiences: Importance of Retinogeniculo-Cortical Oscillations

Current research on the various forms of autoscopic phenomena addresses the clinical and neurological correlates of out-of-body experiences, autoscopic hallucinations, and heautoscopy. Yet most of this research is based on functional magnetic resonance imaging results and focuses predominantly on abnormal cortical activity. Previously we proposed that visual consciousness resulted from the dynamic retinogeniculo-cortical oscillations, such that the photoreceptors dynamically integrated with visual and other vision-associated cortices, and was theorized to be mapped out by photoreceptor discs and rich retinal networks which synchronized with the retinotopic mapping and the associated cortex. The feedback from neural input that is received from the thalamus and cortex via retinogeniculo-cortical oscillations and sent to the retina is multifold higher than feed-forward input to the cortex. This can effectively translate into out-of-body experiences projected onto the screen formed by the retina as it is perceived via feedback and feed-forward oscillations from the reticular thalamic nucleus, or “internal searchlight”. This article explores the role of the reticular thalamic nucleus and the retinogeniculo-cortical oscillations as pivotal internal components in vision and various autoscopic phenomena.

Single Neuron PID Control Based on Expert Experiences for Temperature Difference Control System of a Digester

Considering the temperature difference of displacement cooking characterized by severe non-linearity, large time delay, and real-time control, a cascade PID adaptive control strategy composed of a single neuron is proposed to ensure cooking temperature uniformity. The control strategy introduces expert experiences to adjust the single neuron gain K, while a single neuron PID self-learning and adaptive ability, as well as cascade advantage can be combined to realize the real-time and fast temperature difference control. In the Simulink, the s-function of this control strategy is used to carry out a dynamic simulation experiment with temperature difference characteristics and verify the robustness and response to model mismatch. Compared to conventional temperature difference-flow PID cascade control and single neuron PID cascade control, this control strategy has better robustness and stronger adaptability. The results of real-time control on the THJSK-1 experiment platform indicate this control strategy is feasible.

Experiences of women with the support they received from their birth companions during labour and delivery in Malawi

A study was conducted to describe the experiences of primiparous women with the support they received from their birth companions during labour and delivery in Malawi. The study design was descriptive and utilized qualitative data collection and analysis method on a sample of 20 primiparous women. The women were recruited from the postnatal ward of Bwaila hospital and were interviewed regarding their experiences on the support they received from their birth companions during labour and delivery using an open ended interview guide. Data was manually analyzed using content analysis. Primiparous women described the support they received from their birth companions as useful and beneficial. Birth companions provided advice, physical, emotional and spiritual support to the women during their labour and delivery. In addition, the birth companions were viewed as guardians of the women during labour and delivery. Results however, show that some women were not properly assisted by their companions because both the mothers and companions lacked knowledge on birth companionship. The results further show that birth companions play important roles during the birth and delivery of primiparous women and thereby improving birth outcomes. Therefore, there is a need to train the companions regarding support to a woman during labour and delivery. Primiparous women also need to be trained during antenatal care education so that they properly understand the roles of a birth companion as opposed to those of the midwives.