Search Results (420)

Background and Objectives: Systemic inflammatory markers from an ordinary complete blood count (CBC) may foreshadow where non-small-cell lung cancer (NSCLC) will first spread, but organ-specific signatures remain poorly defined. Materials and Methods: We retrospectively reviewed 302 adults (mean age 60.7 ± 13.4 years; 80.8% men) with stage IV NSCLC managed at OncoHelp Medical Center, Timișoara, between January 2022 and December 2024. Eligibility demanded a single radiologically confirmed distant site at diagnosis and pre-treatment CBC. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-monocyte (LMR) ratios were compared across pleural (n = 52), bone (n = 86), liver (n = 66), and brain (n = 98) metastases using Kruskal–Wallis tests with Bonferroni adjustment; z-standardized logistic models identified independent predictors. Results: Metastases clustered most often in brain (32.5%), followed by bone (28.5%), liver (21.9%), and pleura (17.2%). Median PLR rose selectively in pleural disease (274 vs. 217–253 in other sites; p = 0.006). LMR fell to 2.0 in bone but climbed to 2.8 in brain lesions (p = 0.032 and 0.008, respectively). NLR was globally elevated (6.7–7.6), yet differed significantly only for bone and liver deposits. Logistic modeling showed that each standard-deviation rise in absolute neutrophil count quadrupled the odds of hepatic involvement (Odd Ratio (OR) 4.26; 99% Confidence inerval (CI) 2.20–6.25), monocytosis nearly doubled bone risk (OR 1.83; 1.01–3.33), while higher erythrocytes, eosinophils, and lymphocytes independently protected against pleural seeding (all p < 0.01). Age-stratified analysis revealed that osseous and cerebral metastases predominated in patients ≤ 50 years, whereas inflammatory indices were age-invariant. Conclusions: Routine CBC ratios encode distinct “inflammatory fingerprints” that mirror the first metastatic destination in NSCLC: platelets herald pleural spread, neutrophils favor liver and bone, and divergent lymphocyte–monocyte balances separate bone from brain. Although no substitute for cross-sectional imaging, these low-cost markers could refine clinical suspicion, guide targeted work-up, and illuminate the biology of organ-selective dissemination, particularly in resource-limited settings. Full article

To identify the impact of destination performance on long-term tourist loyalty in the context of sustainable cultural heritage tourism, this study formulated a research model to examine the relationship between destination performance and perceived value, expectation confirmation, satisfaction, and loyalty through extending the expectation–confirmation model (ECM). Using the Pantang Wuyue Historic District in Guangzhou as a case, data were collected from 542 tourists and analyzed using a structural equation model (SEM). The results indicate that destination performance exerts a direct and significant influence on long-term tourist loyalty. Furthermore, destination performance exerts a direct and significant influence on expectation confirmation and perceived value. The empirical analysis not only provides a comprehensive theoretical framework for understanding tourists’ long-term loyalty in the context of sustainable cultural heritage tourism but also offers practical insights for managers aiming to improve the quality and attractiveness of destination performance to foster long-term tourist loyalty. Full article

Social media platforms like Instagram significantly shape destination images and influence tourist behavior. Understanding how different cities are represented and perceived on these platforms is crucial for effective tourism marketing. This study provides a comparative analysis of Instagram content and engagement patterns in Seoul and Tokyo, two major Asian metropolises, to derive actionable marketing insights. We collected and analyzed 59,944 public Instagram posts geotagged or location-tagged within Seoul (n = 29,985) and Tokyo (n = 29,959). We employed a mixed-methods approach involving content categorization using a fine-tuned convolutional neural network (CNN) model, engagement metric analysis (likes, comments), Valence Aware Dictionary and sEntiment Reasoner (VADER) sentiment analysis and thematic classification of comments, geospatial analysis (Kernel Density Estimation [KDE], Moran’s I), and predictive modeling (Gradient Boosting with SHapley Additive exPlanations [SHAP] value analysis). A validation analysis using balanced samples (n = 2000 each) was conducted to address Tokyo’s lower geotagged data proportion. While both cities showed ‘Person’ as the dominant content category, notable differences emerged. Tokyo exhibited higher like-based engagement across categories, particularly for ‘Animal’ and ‘Food’ content, while Seoul generated slightly more comments, often expressing stronger sentiment. Qualitative comment analysis revealed Seoul comments focused more on emotional reactions, whereas Tokyo comments were often shorter, appreciative remarks. Geospatial analysis identified distinct hotspots. The validation analysis confirmed these spatial patterns despite Tokyo’s data limitations. Predictive modeling highlighted hashtag counts as the key engagement driver in Seoul and the presence of people in Tokyo. Seoul and Tokyo project distinct visual narratives and elicit different engagement patterns on Instagram. These findings offer practical implications for destination marketers, suggesting tailored content strategies and location-based campaigns targeting identified hotspots and specific content themes. This study underscores the value of integrating quantitative and qualitative analyses of social media data for nuanced destination marketing insights. Full article

Globalization and market saturation have led Portuguese textile companies to seek international markets not only for growth but also to contribute to their country’s international image. This study aims to explore how the internationalization of the Portuguese textile sector into the Chinese market contributes to Portugal’s destination image and identify the critical success factors in this process. The research follows an inductive, qualitative methodology based on semi-structured interviews with two groups of companies: those already operating in China (n = 5) and those preparing to enter the market (n = 5). The interviews were thematically analyzed to extract key patterns and insights. The findings reveal that successful companies operate in the luxury segment, rely on prior international experience, and often use local intermediaries. Firms planning to internationalize highlight quality differentiation, brand authenticity, and innovation as strategic advantages. These insights support the role of niche positioning and cultural adaptation in building both commercial success and a refined international image of Portugal. This study contributes to the literature by linking internationalization and destination branding through industry-specific case evidence and offers practical implications for managers targeting emerging markets like China. Full article

Given that participating in or spectating sports events plays a vital role in enhancing individuals’ mental health, understanding the key factors that promote continued participation and attendance in sports events is of significant theoretical and practical importance within the context of sports tourism. From this perspective, the service quality of sports events and the image of the host destination have been identified as major determinants of sustained engagement among sports tourists. However, a review of the literature reveals that findings on the influence of sports event service quality and host destination image on the behavioral intentions of sports tourists have been inconsistent. Therefore, the purpose of this study is to employ a meta-analytic structural equation modeling (MASEM) approach to synthesize data from 39 independent studies comprising 16,335 participants, which were collected up to 30 September 2024, thereby providing generalizable conclusions. The results indicate that, first, host destination image is the most critical factor in enhancing visitor satisfaction. Additionally, the service quality of sports events significantly influences visitor satisfaction, which in turn impacts their future behavioral intentions. Second, tourist satisfaction fully mediates the relationship between event service quality and behavioral intentions, and it partially mediates the relationship between host destination image and behavioral intentions. Third, under the moderating effect of event scale (small scale vs. mega scale), host destination image and physical environment quality are more important in small-scale sports events than in mega-scale sports events. Furthermore, under the moderating effect of cultural context (Eastern vs. Western), service quality dimensions are more influential in Western cultural settings, whereas host destination image is more important in Eastern cultural settings. The significance of this study lies in its integration of previously disparate findings into a unified model, offering a more comprehensive understanding of the relationships among the variables. The results provide broad implications for future academic research and practical insights for sports tourism practitioners. Full article

Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity worldwide, with the Glasgow Coma Scale (GCS) serving as a tool to measure injury severity. This study aimed to investigate the relationship between GCS admission scores and various socio-demographic, clinical, injury-related, and hospital-related variables in patients with TBI across two tertiary care centers in Eastern Europe, a region that remains underrepresented in the literature. Methods: A retrospective observational study was conducted using data from 119 TBI patients admitted between March 2020 and June 2023 at Cluj County Emergency Hospital (Romania) and Saint Vincent Hospital (Poland). GCS scores were analyzed as both categorical and continuous variables. Statistical analyses included Wilcoxon and Kruskal–Wallis tests for group comparisons and Spearman correlations for continuous variables. Results: Most patients included suffered a mild TBI (GCS score between 13 and 15). There were significant associations between GCS scores and post-traumatic amnesia (p < 0.05), discharge status (p < 0.01), discharge destination (p < 0.01), and education level (p < 0.01). GCS scores at admission were linked to survival, absence of post-traumatic amnesia, higher education levels, and home discharge. No significant differences observed across sex, residence, employment status, injury type, cause, or mechanism of injury. A weak but significant negative correlation was observed between GCS and length of hospital stay (rho = −0.229, p > 0.05), while age showed a non-significant correlation. Conclusions: The GCS score at admission is significantly associated with various clinical and socio-demographic outcomes in TBI patients, supporting the utility of the GCS score as a prognostic tool. The predominance of mild cases and the absence of radiological data, such as cerebral contusions or epidural or subdural hematomas, limit the generalizability of the findings. Further studies with larger samples and comprehensive imaging data are necessary to validate these findings. Full article

As digital technology evolves rapidly, smart tourism has become a significant trend in the modernization of the industry, relying on advanced tools like big data and cloud computing to improve travelers’ experiences. Despite the growing use of human–computer interaction in museums, there remains a lack of in-depth academic investigation into its impact on visitors’ behavioral intentions regarding museum engagement. This paper employs Cognitive Appraisal Theory, considers human–computer interaction experience as the independent variable, and introduces destination image and satisfaction as mediators to examine their impact on destination loyalty. Based on a survey of 537 participants, the research shows that human–computer interaction experience has a significant positive impact on destination image, satisfaction, and loyalty. Destination image and satisfaction play a partial and sequential mediating role in this relationship. This paper explores the influence mechanism of human–computer interaction experience on destination loyalty and proposes practical interactive solutions for museums, aiming to offer insights for smart tourism research and practice. Full article

The analysis of the spatial location of tourists is essential for effective tourism management. This study explores the potential effects of large language models (LLMs) on urban travel planning. Despite growing academic interest in LLMs, empirical research on their specific impact on urban tourist locations remains limited, even though these models may significantly affect tourist behavior and spatial dynamics. This article compares the location of heritage sites in the city of Barcelona that are traditionally visited by tourists (as identified through Instagram) with those recommended by ChatGPT. The results show that ChatGPT tends to recommend a much smaller and more spatially concentrated number of tourist attractions than those shared on Instagram. The findings indicate that ChatGPT reinforces mainstream representations of cities by prioritizing well-known landmarks, potentially overlooking emerging or local attractions. This simplification can lead to tourist overcrowding and the marginalization of less-visited areas. Likewise, it may entail new needs for the management of urban spaces. Urban planners and tourism managers may need to intervene to redistribute tourist flows in a context where various models of tourist behavior will coexist. Full article

Nowadays, a pedestrian navigation system using a smartphone has become popular as a useful tool to reach an unknown destination. When the destination is the office of a person, a detailed map information is necessary on the target area such as the room number and location inside the building. The information can be collected from various sources including Google maps, websites for the building, and images of signs. In this paper, we propose a map information collection tool for a pedestrian navigation system. To improve the accuracy and completeness of information, it works with the four steps: (1) a user captures building and room images manually, (2) an OCR software using Google ML Kit v2 processes them to extract the sign information from images, (3) web scraping using Scrapy (v2.11.0) and crawling with Apache Nutch (v1.19) software collects additional details such as room numbers, facilities, and occupants from relevant websites, and (4) the collected data is stored in the database to be integrated with a pedestrian navigation system. For evaluations of the proposed tool, the map information was collected for 10 buildings at Okayama University, Japan, a representative environment combining complex indoor layouts (e.g., interconnected corridors, multi-floor facilities) and high pedestrian traffic, which are critical for testing real-world navigation challenges. The collected data is assessed in completeness and effectiveness. A university campus was selected as it presents a complex indoor and outdoor environment that can be ideal for testing pedestrian navigations in real-world scenarios. With the obtained map information, 10 users used the navigation system to successfully reach destinations. The System Usability Scale (SUS) results through a questionnaire confirms the high usability. Full article

As contemporary role models in the digital space, influencers are seen as one of the actors able to engage users with their posts, which also affects the image of a destination, and thus contributes to the co-creation process. At the same time, less information seems to be available on what elements influencers use and to what extent they influence the engagement of their followers. Through content analysis, the contributions to this image have been analysed by comparing different types of destinations and influencers. The results show that natural resources and undiscovered destinations generate a high level of engagement, a key element for co-creation. In addition, influencers, as the ambassadors of destinations, can have a positive impact on their sustainable development. Full article

Determining the technological quality of fresh meat pieces is essential in the meat industry to ensure the production of high-quality products. For this purpose, nuclear magnetic resonance (NMR) is a non-destructive and non-invasive technique that appears as an alternative to traditional methodologies. The objective of this work is to determine the potential of magnetic resonance imaging (MRI) and time-domain (TD-NMR) relaxometry for determining the physicochemical characterization of fresh hams with different industrial destinations (both fresh and cured products, such as dry-cured ham). For this study, the biceps femoris, semimembranosus, and semitendinosus muscles of 20 fresh hind legs from white pigs, classified into four categories according to their fat content, were analyzed. The semitendinosus muscle was selected as a model, and positive and negative correlations were obtained between different physicochemical parameters and the longitudinal (T1) and transverse (T2) relaxation times obtained by MRI and TD-NMR. Regression models using T1 and T2 were also developed to predict the muscle water-holding capacity (WHC) and drip loss, using high, medium, and low magnetic field NMR (R² > 0.80). Therefore, MRI and TD-NMR could be considered as highly suitable and accurate non-destructive techniques for the WHC determination in the meat industry. Full article

This study examines how social media platforms influence tourism marketing strategies, consumer perceptions, and travel behaviors, addressing their sustainability implications. It aims to evaluate the current state of research on social media in tourism marketing, identify dominant trends, assess empirical evidence of impact, and critically highlight research gaps. The analysis focuses on three core marketing outcomes: destination image, travel intention, and user engagement—and includes a section examining sustainability considerations across environmental, sociocultural, and economic dimensions. The study uses a systematic critical review of 147 peer-reviewed academic articles published between 2015 and 2025, combined with a meta-analysis of 38 quantitative studies that report statistical effect sizes. The meta-analysis uses a random-effects model to compare the influence of different platforms and study contexts. Moderator variables include geographic region, platform type, and methodological design. Findings show that social media marketing has a statistically significant positive effect on destination image (Cohen’s d = 0.61), travel intention (d = 0.54), and user engagement (d = 0.43). The analysis also reveals geographic bias, limited research on emerging platforms, and a lack of longitudinal and ethical inquiry. Findings suggest that tourism researchers and marketers may have to adopt more context-sensitive, interdisciplinary, and ethical approaches. Critical sustainability concerns emerge, including “overtourism”, cultural commodification, digital inequities, and algorithmic biases. Further studies may focus on specific platform-related behaviors, long-term impacts, and integrated online strategies appropriate for global tourism diversity. Lastly, this paper advocates for context-sensitive, interdisciplinary, and ethically grounded approaches to ensure sustainable digital tourism marketing strategies. Full article

Exploring the cognitive and affective image dimensions involved in the formation of attractive sports destinations is essential to understand how sports activities influence participants’ experiences. This study explores how municipal sports programs and small-scale events shape both the cognitive and affective image of a destination. The research was conducted among 456 adult participants engaged in public sports events and recreation programs in various municipalities across Attica, Greece. Participation was voluntary and based on an open public call. The questionnaire was adapted from (a) scale, which examines the influence of a sports event image on a destination image—it included 17 items measuring the cognitive image destination grouped into four factors: (1) environment, (2) experiences, (3) attractions, and (4) entertainment–infrastructure, as well as 5 items assessing one factor of affective image destination—and (b) a scale for the intention to participate in sports events and exercise programs. The findings provide insights into how community-level sports initiatives contribute to form a favorable destination image, not only through tangible elements like facilities and environment but also through emotional engagement and social connectivity. These results can inform the development of more targeted and impactful local sports programs that enhance participant’s satisfaction and foster long-term community involvement. Full article

Traditional Jiangnan water towns in China serve as important cultural heritage sites and tourist destinations. Existing studies have revealed a potential connection between environmental elements and spatial perception in these towns. However, there remains a lack of research systematically investigating whether and how these environmental elements influence subjective evaluation indicators, such as spatial attractiveness, and the mechanisms underlying the interactions between these elements. To further understand these mechanisms, we used Nanxun Old Town as our study site, employed computer vision techniques to perform semantic segmentation on street-view images, extracted the visual proportions of environmental elements, and conducted quantitative correlation analysis with subjective attractiveness evaluations. The findings indicate that different environmental elements in water towns shape spatial imagery in diverse ways, thereby influencing perceived attractiveness. Firstly, though space-defining elements such as buildings and water generally contribute positively to perceived attractiveness, their proportions should be controlled within a reasonable range to maintain a spatial scale that aligns with the traditional imagery of water towns. Secondly, foreground elements like boats and lanterns, although occupying a smaller proportion, can effectively enhance the space when properly combined. Finally, the influence of elements such as bridges and buildings depends on the specific viewing distance and angle. These findings, based on an interpretable analytical framework, reveal that the effects of environmental elements on spatial attractiveness are context-dependent and nonlinear, varying with their proportions, combinations, and perspectives. This approach offers a more comprehensive understanding of the mechanisms by which environmental elements shape spatial attractiveness, providing a scientific foundation for regulating key visual components and optimizing spatial composition for sustainable traditional water town environment management. Full article

In the face of an unprecedented public health crisis (COVID-19), despite tourist perceptions toward cultural heritage tourism having undergone significant transformation, such transitions are increasingly viewed as opportunities to enhance sustainability practices in cultural heritage tourism worldwide. This study traces the evolution of tourist perceptions at Lijiang Old Town, a UNESCO World Heritage Site, across three stages from 2017 to 2024—before the pandemic, during the pandemic, and after the pandemic. Data were collected from major tourism platforms, yielding a comprehensive dataset of 50,022 user-generated reviews. We adopt a mixed-method framework integrating TF-IDF, Social Network Analysis (SNA), and Latent Dirichlet Allocation (LDA) to identify salient terms, semantic structures, and latent themes from large-scale unstructured textual data across time. The findings indicate that cultural heritage tourism demonstrates adaptability and resilience through significant perceptual transitions. After the pandemic, visitors increasingly prioritized cultural depth and high-quality service experiences, whereas before the pandemic, tourists focused more on cultural heritage attractions and commercial experiences. Moreover, during the pandemic period, visitor narratives reflected adaptations toward quieter, safer, and more personalized experiences, highlighting the impact of safety measures on tourism patterns. These findings demonstrate the methodological potential for dynamically monitoring perception shifts and offer empirical grounding for future perception-oriented research and sustainable cultural heritage destination management practices in cultural heritage tourism toward sustainable tourism. Full article