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.

The Mediating Effect of Social Media on the Relationship Between Travel Preference and Tourist Behavior of Local Tourists in Davao City

This paper aims to determine the mediating effect of social media on the relationship between travel behavior and tourist preference.This paper utilized the mediation analysis design to determine whether social media significantly affects the independent and dependent variables.For the statistical tools,the proponents of the study utilized descriptive statistics,Sobel’s test,mean and standard deviation.Also,the proponents of the study utilized data from questionnaires gathered through an online google form.Most of the respondents are single females,college-level,and use Facebook most of the time.Therefore,this is the social media platform that the majority utilize.It has been revealed in the study the three sets of correlated variables:Travel behavior vs.tourist behavior,travel preference vs.social media,and social media vs.tourist behavior,have a strong positive linear relationship between the two quantitative variables.Thus,the study proponents concluded that there is an indirect effect between the travel preference and tourist behavior of local tourists in Davao City via social media.Lastly,the study’s findings reveal the fundamentals of how visitors make decisions,which are essential for enhancing the competitive advantages of cultural destinations.Significant findings from the study are beneficial to the growth of cultural tourism in Davao City.

Tourists’Willingness to Pay for Recreation Services in Nyerere National Park,Tanzania:Are We Overvaluing or Undervaluing Our Nature Recreation Resources?

This study estimated tourists’Willingness to Pay(WTP)per day for recreation services in Nyerere National Park(NNP)and compared these values with daily travel costs that are incurred by tourists to visit NNP in order to inform whether recreation resources in the park are overvalued or undervalued.The study revealed that tourists’WTP per day for recreation services was estimated at$237.4 and$1521 for resident and non-resident tourists,respectively.The estimated tourists’WTP values exceed the daily travel costs currently incurred by tourists,which are$201.04 and$1517.97 for resident and non-resident tourists,respectively.This indicates that tourists are willing to spend more to enjoy recreation services in NNP,which signifies that recreation resources in NNP are slightly undervalued.In addi­tion,the findings disclosed that the largest share of tourist daily travel expenses is allocated to transportation services,and very little is paid to the park as a conservation fee.It was revealed that out of the daily travel expenses incurred by non-resident and resident tourists,only 4.62%and 2.23%are respectively paid directly to NNP as conservation fees.This study considers that allocation is not very fair;thus,NNP,in collaboration with TANAPA,needs to adjust the current entrance or conservation fee and reduce the transportation costs charged by tourist companies.The travel costs incurred by tourists,age,education,monthly income,site visited,substitute site,and quality of park were identified as significant factors in influencing tourists’WTP for recreation services in NNP.Thus,policies oriented to reduce tour­ists’transportation costs and improve the quality of national parks would attract more tourists to NNP.

Return of Chinese Tourists

South Africa on 29 March received the first group of 13 tourists from China over the past three years.The tourists,taking a flight from Air China,landed at O.R.Tambo International Airport in Johannesburg and were welcomed by people from different walks of life.

A system-integrated approach for the design of tourist areas at the local level under changing conditions:A case study in the Altay Mountains

The existing approaches for the design of tourist areas often lead to limited flexibility in project implementation.To realize a more flexible approach,in this study,we formulated a model for planning and designing tourist areas at the local level.Moreover,specific tools for analyzing tourist areas and ensuring sustainable development under changing conditions were developed.This study was conducted in two tourist regions,Biryuzovaya Katun tourist complex and Belokurikha destination(including Belokurikha City with Belokurikha 2 Gornaya tourist complex and surrounding areas),in the Altay Mountains.We employed the recreation opportunity spectrum and proposed a system-integrated programming approach for the design of tourist areas at the destination and site levels.The key of this approach was the collection and analysis of current spatial data,including the spatial distribution of attractions and visitor flows.We constructed heat maps using video recording and unmanned aerial vehicle(UAV)observation data.Moreover,we analyzed the video stream using an image-analyzing framework You Only Look Once(YOLO)v5 software.The heat map of visitor flows based on video recording data in the Andreevskaya Sloboda museum of Belokurikha 2 Gornaya tourist complex allowed us to highlight the most attractive sites in this area and classify them into one of three types:points of functional concentration,points of transitional concentration,and points of attractions.The heat maps in Biryuzovaya Katun tourist complex,created using UAV observation data,allowed us to determine the spatiotemporal patterns of visitor flows and tourists’preferences throughout the day within four time intervals:09:00-12:00,13:00-14:00,14:00-15:00,and 16:00-18:00(LST).The maximum visitor flow density occurred from 16:00 to 18:00 in the beach area of the artificial lake.A comparison between the visitor-concentrated sites and the current facilities provided insights into the demand for attractions and facilities and the lacking areas.Heat maps are useful in analyzing the land use at the site level,while zoning based on the recreation opportunity spectrum can be used to design tourist areas at the destination level.The proposed methods for analyzing the use of tourist areas contribute to the development of adaptive tourism design.

Assessing the Carrying Capacity of Tourist Resorts: An Application of Tourists’ Spatial Behavior Simulator Based on GIS and Multi-Agent System

Based on the study of visitors' individual spatial behaviors, a tourists'spatial behavior simulator (TSBS) to assess the carrying capacity of tourist resorts was developed,TSBS employs GIS (Geographic Information System) to manage the spatial data,and Multi-Agent systemto simulate the actions of individual visitors. By utilizing TSBS, visitors' travel patterns such aslocation, cost, and state can be analyzed and predicted. Based on this analysis and prediction, themodel of assessing the carrying capacity of resorts is built. Our results show that TSBS will be aneffective tool to accurately assess the carrying capacity of tourist resorts.

A mixed method analysis of patients' complaints: Underpinnings of theory-guided strategies to improve quality of care

Purpose:Patients'complaints can be predictors of patient care quality and safety.Understanding patients'complaints could help healthcare organizations target the areas for improvements.The purpose of this study is to use a mixed method analysis to a)examine the characteristics and categories of patients'complaints,b)explore the relationships of patients'complaints with professions and units,and c)propose theory-based strategies to improve care quality.Methods:This is a descriptive mixed method study.Data examined are patients'complaints filed at a university-affiliated hospital in China from January 2016 to December 2017.A qualitative content analysis was conducted to categorize complaints.A TwoStep cluster analysis was performed to provide an overall profile of patients'complaints.Chi-Square tests were conducted to investigate the relationships among complaints,professions,and units.Results:838 complaints were filed,with 821 valid cases for analysis.Six categories surfaced from the qualitative analysis:uncaring attitudes,unsatisfactory quality of treatment or competence,communication problems,the process of care,fees and billing issues,and other miscellaneous causes.Physicians received most of the complaints(56.6%).The unit receiving the most complaints were outpatient clinics and medical support units(52.7%).The cluster analysis indicated four distinct clusters.Significant relationships existed between complaints and professions(x2(20)=178.82,P<0.01),and between complaints and units(x2(15)=42.72,P<0.01).Conclusions:Patients'complaints are valuable sources for quality improvements.Healthcare providers should be not only scientifically knowledgeable,but also humanistic caring.Caring-based theories may provide guidance in clinical practice.

Monitoring System of tourist traffic(MSTT) for tourists monitoring in mid-mountain national park,SW Poland

National parks are highly valuable natural areas and have the potential to attract a large number of visitors.The number of visitors at national parks is systematically increasing,often exceeding Tourism Carrying Capacity(TCC)of trails.This situation requires adjusting the number of park visitors to adapt to sustainable management systems of visitor flow,thus preventing or counteracting overtourism.The aim of the study is to propose a comprehensive method for tourists monitoring in mid-mountain national park presented on the example of the Sto?owe Mountains National Park(SMNP)in Poland,called as Monitoring System of tourist traffic(MSTT).The study describes six stages procedure of tourists Monitoring System creation and application as an optimal measurement technique.The MSTT enabled a multidimensional analysis of tourist traffic in SMNP.With the help of 39 pyroelectric sensors and surveys data spatio-temporal characteristic of visitor flow was obtained.The data generated in MSTT included hourly,daily,weekly,monthly,and annual reports,taking into account the direction of traffic measuring both directions:entries(IN),exits(OUT)and passages(IN+OUT).The results from pyroelectric sensors were supplemented with field surveys,where visitor’s motivations,preferences,and behaviours were determined.In 2017 a total of 871,344 visitors were recorded in SMNP what causes one of the most popular national parks in Poland.The SMNP is a suitable destination for short breaks leisure visits in wilderness.In order to sustain MSTT methodology in the long-run the set of guidelines together with the workload estimates were presented.In the future,the MSTT can be further developed,including monitoring of climbing,cycling,cross-country skiing,car traffic and illegal tourism assessment.The MSTT can be considered as a useful tool for tourism management in mid-mountain national parks throughout the entire calendar year.

Identification of contamination source in water distribution network based on consumer complaints

A new methodology was proposed for contamination source identification using information provided by consumer complaints from a probabilistic view.Due to the high uncertainties of information derived from users,the objective of the proposed methodology doesn't aim to capture a unique solution,but to minimize the number of possible contamination sources.In the proposed methodology,all the possible pollution nodes are identified through the CSA methodology firstly.And then based on the principle of total probability formula,the probability of each possible contamination node is obtained through a series of calculation.According to magnitude of the probability,the number of possible pollution nodes is minimized.The effectiveness and feasibility of the methodology is demonstrated through an application to a real case of ZJ City.Four scenarios were designed to investigate the influence of different uncertainties on the results in this case.The results show that pollutant concentration,injection duration,the number of consumer complaints nodes used for calculation and the prior probability with which consumers would complaint have no particular effect on the identification of contamination source.Three nodes were selected as the most possible pollution sources in water pipe network of ZJ City which includes more than 3 000 nodes.The results show the potential of the proposed method to identify contamination source through consumer complaints.

Blockchain Implications in the Management of Patient Complaints in Healthcare

Blockchain is an emerging technology that has recently been the focus for many researchers who have highlighted its diverse applications including healthcare. Transparency in managing unsolicited patient complaints is important in healthcare for both patients and healthcare providers;in addition, patient complaints analysis is significant to the continued quality improvement. Accordingly, the purpose of this study is to understand the nature of patient complaints management in the healthcare settings, explore the implications of blockchain on the management of patient complaints, and identify limitations in the usage of blockchain. Structured qualitative review and content analysis of the literature methods were used through multiple inclusion and exclusion phases for the scope of this research. Blockchain technology characteristics have been analyzed and approximated with desired features in the patients’ complaint management. Patient complaints provide valuable information to drive continuous improvements in healthcare. Blockchain is described as transparent, decentralized, immutable and anonymous. Results of this research found that a complaint Management system that is built on blockchain technology might have desired features that involve data integrity, security and transparency. Blockchain does have certain limitations that involve cybersecurity, scalability, confidentiality, readiness to adopt it, and is uncertainty about its impact. As a conclusion, implementing a system to manage patient complaints that is based on blockchain technology is promising, due to its desired possible features.

Chinese visiting Rovaniemi, Finland: profile and perceptions of Arctic tourists

The profile of the Chinese tourist is changing. Outbound tourism destinations for Chinese tourists are no longer limited to the Asia-Pacific region. Chinese tourists visit many different destinations, and the areas around the Arctic Circle are growing in attraction. This paper is based on a 2016 online survey about Chinese tourists visiting Rovaniemi, Finland. The questions were based on a previous study of the Finnish Tourist Board conducted in 2003. The results were analyzed and the two studies were compared. The resultant profile of the Chinese tourist visiting the Rovaniemi area showed natural landscapes to be the most important attraction. All respondents had a ＂must-do＂ activity, and more than half participated in sport and leisure activities. The state of the environment, natural landscape, and safety conditions were rated most important among tourists. Increasingly, tourists prefer to organize individual trips, using multiple information channels. Currently, Chinese tourists demand deeper tourism experiences. They want to enjoy winter activities in a pure environment, and unique experiences, such as sleeping in an ice or glass hotel. Chinese tourists appreciate the uniqueness that cannot be found in other places. They wish to benefit from travel information from various media, which will allow Chinese tourists to make a complete plan before their journey.

Analysis on inbound tourists' satisfaction in China: an empirical study based on the investigation of 5 cities

In China, the tourism industry is regarded as one means of fostering local economic development. This paper tries to examine inbound tourism development in China in the last decade and analyze inbound tourism's satisfaction of their travel experience with tourist attractions, facilities, services and price by an empirical study based on the investigation of Lanzhou, Wuhan, Guangzhou, Shanghai and Beijing. This paper discusses the demographic characteristics of visitors from Hong Kong, Macao and Taiwan, US, Korea and Japan by surveying a sample of 528 visitors in fi ve different cities. The survey showed that four provinces/autonomous region in western China ranked the top 10 popular destinations. Chinese natural landscape, culture and food were highly regarded by the tourists. At the same time, tourists expressed less satisfaction with tourist language convenience, tourist facility and nightlife in China. It was also found that only 7.4% of the tourists thought travel in China was far more than what they had paid, that 6.5% regarded they got what they paid for, and that 34.9% thought the travel cost was reasonable. Most tourists were satisfi ed with their travel experience in China; many of them would like to return to China and would like to recommend China. For the sustainable development of tourism, Chinese tourism authorities should strengthen the construction, propaganda and management of scenic spots, improve tourist facility and tourist education, especially language convenience, and strengthen the supervision of tickets, souvenir and hotel price.

Driving Effect of Theme Cultural Tourist Destination Attributes on Tourists' Place Attachment: A Case Study of Yancheng City in Changzhou

From the perspective of man–land relationship, Yancheng City(ruins of Yancheng in the Spring and Autumn Period) as a typical theme tourist destination is selected to construct the structural model of driving effect of tourist destination attributes on tourists' place attachment, and carry out the empirical research. The results show that attributes of Yancheng City contain 4 dimensions, and tourists' perception of the attributes declines in the sequence "recreational and entertainment attribute→ attribute of culture of the Spring and Autumn Period→ attribute of landscapes and ruins→ attribute of humanistic concern"; the four-dimension attributes vary greatly in driving tourists' place attachment, recreational and entertainment attribute and attribute of culture of the Spring and Autumn Period have obvious positive driving effect, attribute of landscapes and ruins and attribute of humanistic concern have poorer driving effect; generally speaking, driving effect of tourist destination attributes on tourists' place attachment is demonstrated as "highlighted value functions of tourist destination attributes→‘predominant area' of tourists' perceptual experience→ obvious driving effect on tourists' place attachment" and "hysteretic value functions of tourist destination attributes→‘vulnerable area' of tourists' perceptual experience→ weakened driving effect on tourists' place attachment"; driving effect of the overall attributes of tourist destination on tourists' place attachment is to be further improved and optimized.

Analysis on Behavior Characteristics of Tourists under Perspective of Sustainable Development of Tourism Destinations: A Case Study of Mugecuo Scenic Area in Kangding City of Sichuan Province

Tourists are the subject of tourism activity,and it is conducive to promoting sustainable development of tourism destination by studying their behavior characteristics and tourism perception.Mugecuo Scenic Area in Kangding City,Ganzi Tibetan Autonomous Prefecture,Sichuan Province is taken as research case,and visitors and managers in the scenic area are surveyed by using semi-structured interview method.Based on survey data,the research aims to put forward corresponding policy suggestions for sustainable development of Mugecuo Scenic Area by deeply analyzing tourists’ access to information of scenic area,tourists’ travel purpose,tourists’ satisfaction with services of scenic area and willingness to revisit.

Economic Valuation of River Conservation towards International Tourists’ Preferences and Willingness to Pay for Ecofriendly Services of Hotel Industry: A Case Study of Namxong River in Vangvieng District, Laos

Using choice experiment, the objective of this study is to estimate international tourists’ preferences and willingness to pay for ecofriendly services which related to river and natural environment conservation of hotel industry in Vangvieng, a popular tourist town in Lao PDR. We used the mixed logit to take into account of preference heterogeneity by allowing coefficients to be normally distributed and assumed to vary among individuals. The result shows that all ecofriendly practices offered in this study are significantly preferred by tourists. Income, age, and education did not have significant effect on the probability of choosing ecologically friendly practices of hotel and attributes to support the ecotourism of the area;however, this study provides important information that female tourists are more receptive to a new alternative. These findings do not only support the provision of good and green services in Vangvieng Town, but will also be useful for policy maker to enhance the sustainability of ecotourism in Laos.

Relationship between Stress and Psychosomatic Complaints among Nurses in Tabarjal Hospital

This research was conducted to examine the relationship between stress and psychosomatic complaints among nurses in Tabarjal hospital. To achieve this aim, the researcher used the descriptive method and selected a sample consisting of (56) nurses working in hospital through the simple random sampling technique. The respondents were requested to complete a questionnaire for rating of stress and the most common psychosomatic diseases. The collected data were analyzed statistically by using SPSS. The results revealed that the stress was dominant among nurses in Tabarjal hospital, the prevalence of psychosomatic complaints was significantly higher in nurses, and there was significant correlation between stress and psychosomatic complaints among nurses. Conclusion: This research confirmed the effect of strains on the prevalence of psychosomatic symptoms among nurses in Tabarjal hospital. Further, implications of the results were discussed on the light of some related researches.

Statistical Models for Forecasting Tourists’ Arrival in Kenya

In this paper, an attempt has been made to forecast tourists’ arrival using statistical time series modeling techniques—Double Exponential Smoothing and the Auto-Regressive Integrated Moving Average (ARIMA). It is common knowledge that forecasting is very important in making future decisions such as ordering replenishment for an inventory system or increasing the capacity of the available staff in order to meet expected future service delivery. The methodology used is given in Section 2 and the results, discussion and conclusion are given in Section 3. When the forecasts from these models were validated, Double Exponential Smoothing model performed better than the ARIMA model.

Influence of Tourists′ Environmental Tropisms on Their Attitudes to Tourism and Nature Conservation in Natural Tourist Destinations: A Case Study of Jiuzhaigou National Park in China

People′s environmental tropism has an effect on their understanding of tourism-nature relationship,and also influences their attitudes to natural resources utilization and environmental protection.Taking Jiuzhaigou National Park of China as a study case,the authors conducted some quantitative analyses with the tools of SPSS 16.0 and LISREL 8.7,to explore the influence of tourists′ environmental tropism on their attitudes to tourism and nature conservation in the natural tourist destination.Three hypotheses and the theoretic model of influences of tourists′ environmental tropism on their attitudes to tourism and nature conservation have been tested and accepted based on the Structural Equation Model analysis on survey data collected in Jiuzhaigou National Park of China.Some conclusions were drawn as follows: 1) tourists′ human-prioritized concept influences their cognition to tourism-nature relationship.This concept has a positive influence on their supportive attitudes to tourism,but a negative influence on their attitudes to nature conservation;2) tourists′ human-nature coordination concept has a positive influence on their supportive attitudes to both tourism and nature conservation,especially to the latter.This paper generally proves that human′s environmental tropism does have an influence on their attitudes to tourism and nature conservation in natural tourist destinations.

Empirical Research on Tourists' After-trip Perception of Landscape Preference in the Confucius Temple in Nanjing City

Thurstone’s Comparative Judgment Model was applied to measure characteristics of tourists’after-trip perception of landscape preference in the Confucius Temple,a famous historical block in Nanjing City.The results show that(a)as time goes by,the tourists’time perception differentiation has continuously sublimated from the general experience into the peak experience,and gradually evolved into the core experience element in the overall perception.In terms of content,perceptional contents of tourists decrease in sequence of the Confucian culture,the commercial culture and the culture of refined scholars.As a whole,tourists’after-trip perception differentiation has 3 sections:halo zone,sub-halo zone,and gray zone.(b)Because of tourism development,the Confucian culture is influenced by other cultures,and the commercial culture shows the trend of"over-generalization",and the culture of refined scholars has weakening carriers and modes of inheritance.Inheritance of its unique cultural connotations deserves increasing attention.

Frequency of Hemorrhoidal Complaints in a Real-Life Population and Possible Concomitance between Hemorrhoidal Disease and Chronic Venous Disease: Going Further in Our Understanding of Hemorrhoidal Disease

Introduction: Hemorrhoids, more commonly known as piles, are swollen veins, similar to varicose veins in the lower rectum. Hemorrhoids can develop both inside and outside the rectum, and oftentimes, the cause of hemorrhoids remains unknown. This is an extremely common ailment faced by three out of four adults in their lifetime. Hemorrhoids can cause various kinds of complications, but the most common and serious ones are perianal thrombosis and incarcerated prolapsed internal hemorrhoids with subsequent thrombosis. They are accompanied by severe pain in the perianal region, and possible bleeding. Data on the coexistence of hemorrhoids with other conditions are sparse. Some data are consistent with a common pathophysiological link between straining at stool, constipation, and obstetrical events such as pregnancy and delivery. These events are also involved in the development of Chronic Vein Disease (CVD) or Chronic Vein Insufficiency (CVI). CVI is a condition that occurs when the venous walls or valves in the leg veins stop working properly, causing difficulty in blood returning to the heart from the legs. The present study was conducted with an aim to determine the frequency of complaints in hemorrhoidal patients and to assess the possible concomitance between hemorrhoidal disease and chronic venous disease. Methods: This was a multicenter, cross-sectional, observational study that enrolled patients spontaneously consulting for hemorrhoids in 17 different hospitals of different regions of Bangladesh from 1st June 2018 to 31st July 2018. Patients’ demographic and lifestyle characteristics were recorded, information on hemorrhoidal grade and signs of chronic venous disease was collected. Types of prescribed treatments were also recorded by the physicians. Results: A total of 499 patients were enrolled and analyzed. Reported frequencies of hemorrhoidal symptoms were: bleeding (80.8%), pain (66.3%), swelling (51.7%), prolapse (28.9%), itching (37.7%), soiling (12%), fecal incontinence (13.4%). 13.8% of the hemorrhoidal patients presented concomitant chronic venous disease. The Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification was used to classify the clinical signs and symptoms of the patients as C0—no visible or palpable signs of venous disease (6.2%), C1—telangiectasias or reticular veins (4.4%), C2—varicose veins (1.4%), C3—edema (2.6%), C4a—pigmentation or eczema (2%), C4b—lipodermatosclerosis or Atrophie Blanche (0.2%), C5 & C6—venous ulcer (0.6%). Commonly prescribed treatments were dietary fiber (89.8%), veno-active drugs (74.7%), topical treatments (63.7%), painkillers (11.2%), and surgical procedures (30.3%). Conclusion: The study provides small-scale data on patient profiles, risk factors, and commonly prescribed treatments in hemorrhoidal patients. The concomitance of chronic venous disease in 13.8% of the hemorrhoidal patients highlights the importance