Search Results (1,030)

Clinical Rationale and Objectives: Refractory out-of-hospital cardiac arrest (OHCA) is associated with very poor outcomes when treated with conventional cardiopulmonary resuscitation alone, particularly when low-flow time is prolonged. Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) may shorten the interval to extracorporeal perfusion, but its implementation requires a highly standardized operational framework to ensure appropriate patient selection, procedural safety, and efficient use of specialized resources. This manuscript describes the PrehospECPR-GOKVI operational framework, a standardized prehospital ECPR protocol developed by the Gottsegen National Cardiovascular Center in cooperation with the Hungarian National Ambulance Service and the Hungarian Air Ambulance. ECPR Pathway: The programme is based on a dedicated two-person ECPR team, consisting of an experienced physician and a paramedic, deployed with mobile ECPR-specific equipment, including point-of-care ultrasound, a pre-primed VA-ECMO circuit, an ECMO console, and a mobile oxygenator/gas blender. The protocol defines strict inclusion and exclusion criteria, emphasizing witnessed OHCA, age below or apparently below 50 years, initial shockable rhythm or selected pulseless electrical activity with suspected pulmonary embolism, refractory cardiac arrest lasting at least 15 min, no-flow time below 5 min or signs of life, and the feasibility of establishing ECMO flow within 60 min from collapse or emergency call. Two mandatory sonographic STOP criteria are incorporated before cannulation: relevant pericardial effusion or suspected aortic dissection, and inability to safely visualize the femoral artery, femoral vein, and bifurcation. The operational workflow further specifies dispatch activation, ALS continuation, equipment layout, ultrasound-guided femoro-femoral cannulation, failed-access management, air-free circuit connection, post-flow stabilization, receiving-centre notification, and transport to GOKVI. A target interval of no more than 15 min from initiation of ECPR-specific steps to ECMO flow is mandated. Conclusions: The PrehospECPR-GOKVI framework describes a locally developed, standardized operational pathway intended to support early identification, safe procedural preparation, and structured delivery of prehospital ECPR for selected patients with refractory OHCA. The protocol is designed to reduce avoidable delays, standardize ALS–ECPR coordination, and incorporate predefined sonographic safety checkpoints before cannulation. As no patient-level data are reported in this manuscript, feasibility, safety, complication rates, survival, neurological outcomes, resource utilization, and transferability remain to be evaluated prospectively after programme launch. Full article

Integrating Corporate Social Responsibility (CSR) into business strategy requires organizational practices that convert sustainability- and stakeholder-related intentions into measurable and managerially usable information. This study examines whether distinct Business Performance Measurement (BPM) maturity profiles can be identified among hospitality SMEs and how these profiles are associated with sustainability- and stakeholder-oriented measurement practices. BPM maturity is defined as a multidimensional organizational capability reflected in the breadth, integration, monitoring, interpretation, and use of performance information, rather than merely in the possession of a formal measurement system. Using cross-sectional survey data from 600 decision-makers in Hungarian and Romanian accommodation and food service SMEs, the study applies Principal Component Analysis and Two-Step Cluster Analysis. Three profiles emerge: Integrated, Transitional, and Low BPM Maturity. Firms in the Integrated profile report broader use of financial, customer-related, employee-related, sector-specific, and sustainability-oriented performance information, whereas firms in the Low profile report more limited measurement practices. Sustainability- and development-related measurement practices provide the strongest relative contribution to profile differentiation in both national models. The findings demonstrate systematic associations between BPM maturity profiles and sustainability- and stakeholder-oriented measurement practices. They are consistent with the theoretical interpretation that BPM maturity may provide organizational conditions supporting the operationalization of responsible management intentions. However, the cross-sectional design does not establish causal direction, and the study does not directly measure formal CSR implementation or sustainability outcomes. Full article

Hotel capacity in emerging destinations is often described through room counts or conventional classifications, even when these say little about how accommodation systems operate. This study investigates the accommodation sector in Villavicencio, Colombia, through the Hotel Capacity Index (ICH), a classification tool based on three variables: rooms, beds, and services. Using field data from 84 hotels, the analysis considers capacity structure, room and bed configuration, occupancy patterns, service provision, and selected operational practices. The results show a hotel system concentrated mainly in medium-capacity establishments, with 71% of the sample in the ICH-2 category. Although the sector shows some internal flexibility in the way sleeping capacity is organized, it remains only weakly differentiated in service provision and operational sophistication. Occupancy patterns also show marked seasonality, with stronger performance in the second half of the year and clear peaks in the final quarter. Limited digital integration, low levels of certification, weakly formalized feedback systems, and incomplete accessibility conditions show broader constraints in upgrading the accommodation base. The study shows that the main issue in Villavicencio is not simply the amount of hotel supply, but the composition and functionality of that supply. In emerging destinations, expanding accommodation supply is not enough when the structure of that supply remains concentrated and only weakly differentiated. Full article

Tourism plays an important role in the global economy, contributing massively to the gross domestic product (GDP) and creating numerous jobs. The introduction of emerging technologies can accelerate the sector’s growth through personalization, improved user experience and better operational efficiency. The present work investigates the impact of visible light communications (VLC) in the tourism and hospitality industry based on the analysis of the recent literature published in the last decade, with the scope of improving tourist experience, operational efficiency and sustainability. Additionally, this work aims to critically evaluate the advantages and disadvantages of implementing VLC technology in the tourism and hospitality industry. For these purposes, this study presents a narrative review of the recent academic literature. The findings indicate that VLC technology can be used in a wide range of tourism-related applications, including contactless hotel services, indoor positioning and navigation, secure communications, accessibility solutions for visually impaired individuals and energy-efficient lighting infrastructure. In addition, this review demonstrates VLC’s potential to support the development of smart and sustainable tourism destinations through the integration of user-centered communication and illumination infrastructure. Finally, this work also identifies several challenges that affect large-scale deployment, including implementation costs, line-of-sight dependency and ongoing standardization issues. Full article

Telemedicine in emergency and remote care relays medical images from ambulances and rural clinics to a hospital edge-computing server over a congested wireless uplink. Existing work prices such transmissions per bit or per quality-of-experience; neither metric captures the clinical value of a medical transmission. Diagnostic utility vanishes below a modality-specific acceptability floor rather than degrading gracefully, the deadline is determined by triage acuity rather than by the network, and a missed finding is far costlier than a false alarm. A per-bit clearing price therefore disadvantages the node that has expended local compute to produce a compact, diagnostically sufficient stream. We propose SemAuc, a triage-aware truthful mechanism for medical-image admission over a rate-splitting uplink, in which the shared semantic knowledge base rides the common stream, and case-specific residuals ride private streams. SemAuc filters tiers below the diagnostic floor and beyond the clinical deadline, reserves a regulated-price lane for life-threatening cases, and allocates remaining capacity through a single-parameter contestable auction whose bid-independent pre-selection step satisfies the conditions of Myerson’s lemma. The contestable lane is dominant-strategy truthful, individually rational, near-linear in the number of nodes, and achieves a constant-factor density-greedy welfare guarantee; the clinical lanes follow from triage policy without disturbing these properties. Diagnostic value is grounded by an offline kernel fitted on BraTS and CheXpert. On a Rayleigh-faded uplink at two hundred contending nodes, SemAuc preserves the high-acuity diagnostic service-level objective where bit-centric benchmarks fail, and tracks the offline optimum. Full article

Background/Objectives: This study aimed to evaluate the incidence and outcomes of emergency medical service (EMS)-treated out-of-hospital cardiac arrest (OHCA) and to determine whether predictors of outcomes differed across the pre-pandemic, pandemic, and post-pandemic periods. Methods: A retrospective observational study was conducted over a six-year period and included 1150 patients with EMS-treated OHCA. Patients were categorized into three groups according to the study period. Results: The incidence of EMS-treated OHCA differed significantly across the three study periods (χ² = 15.184, p = 0.001), with the highest number of cases observed during the pandemic. The rate of return of spontaneous circulation (ROSC) also varied significantly between periods (p = 0.035). Although the highest overall mortality was observed during the pandemic period (97.5%), differences in overall mortality across the study periods did not reach statistical significance (p = 0.079). Variables independently associated with ROSC were EMS response time, initial cardiac rhythm, and the administration of adrenaline and atropine. Age and initial cardiac rhythm were independently associated with mortality. No significant interactions were observed between study period and the identified predictors of ROSC or mortality. Conclusions: The COVID-19 pandemic was associated with a significant increase in EMS-treated OHCA incidence and poorer patient outcomes, including lower ROSC and survival rates. Although outcomes improved in the post-pandemic period, multivariable analysis demonstrated that the pandemic period itself was not independently associated with ROSC or mortality after adjustment for relevant clinical factors. Instead, outcome differences were primarily explained by established clinical predictors, including patient age, initial cardiac rhythm, EMS response time, and resuscitation-related factors. Prospective studies incorporating more detailed data on patient characteristics, the quality of resuscitation, and organizational characteristics of the healthcare system may enable more accurate outcome modeling. Full article

Background and Objectives: Out-of-hospital cardiac arrest (OHCA) is one of the most clinically significant conditions and can lead to rapid death if cardiopulmonary resuscitation (CPR) or defibrillator use is not performed. Despite this, in approximately half of cases of witnessed OHCA, bystanders do not initiate resuscitation maneuvers. The factors underlying this phenomenon are varied but not yet fully understood. The aim of our analysis is to identify predictors that may indicate a higher likelihood of not performing resuscitation maneuvers. Materials and Methods: Data from cardiac arrests managed by the emergency medical system of the Lombardy region between 1 July 2024 and 30 June 2025 were analyzed. All missions involving cardiac arrests assisted only by lay bystanders were included in the analysis. Results: A total of 12,066 events were analyzed, of which only 4233 were assisted by laypeople. According to the logistic regression model, cardiac arrests occurring in urban settings (OR 0.60; 95% CI: 0.51–0.71), non-medical events (OR 0.44; 95% CI: 0.37–0.51), female patients (OR 0.80; 95% CI: 0.70–0.91), patients over 80 years old (OR 0.40; 95% CI: 0.35–0.45), and events occurring at home (OR 0.33; 95% CI: 0.28–0.39) were associated with a lower likelihood of performing chest compressions. Conversely, when the emergency service arrived within 15 min (OR 1.31; 95% CI: 1.14–1.51), the probability of receiving chest compressions increased. Conclusions: The presence of such a significant gap related to age and sex is noteworthy, prompting greater attention to the educational material presented during BLS-D courses. Moreover, these factors should be considered by the dispatch center when providing pre-arrival instructions to laypeople for initiating chest compressions. Specific communication training should be developed, and communication in these critical phases should be the subject of further study. Full article

Background: Patients with cystic fibrosis frequently require repeated courses of intravenous antibiotic therapy, resulting in cumulative vascular injury, progressive depletion of peripheral venous access, and increasing complexity in long-term vascular access management. Integrating structured vascular access planning into multidisciplinary care pathways has become increasingly important for preserving venous capital, optimising vascular access decision-making, and ensuring continuity of care. Objective: To describe the development and implementation of an Advanced Practice Nursing-led multidisciplinary vascular access care pathway for patients with cystic fibrosis requiring prolonged intravenous therapy. Methods: A practice-based descriptive analysis of a multidisciplinary vascular access pathway was conducted, incorporating ultrasound vascular assessment, structured clinical decision-making, and coordinated care across the Emergency Department, Cystic Fibrosis Unit, Vascular Access and Infusion Team, Hospital Pharmacy Service, and Hospital-at-Home Programme. An illustrative patient example was used to demonstrate pathway implementation in routine clinical practice. Results: Pathway implementation illustrated the feasibility of integrating ultrasound-guided vascular assessment, evidence-informed selection of vascular access devices, and coordinated home-based intravenous therapy within a multidisciplinary care model. Ultrasound-guided vascular assessment identified a suitable upper-arm basilic vein despite severe peripheral venous depletion. An Advanced Practice Nurse successfully performed ultrasound-guided midline catheter insertion, achieving first-attempt cannulation and no immediate complications. The illustrative patient completed four weeks of home-based intravenous antibiotic therapy without observed catheter-related infection, thrombosis, occlusion, catheter dysfunction, or unplanned hospital readmissions. The patient reported satisfaction with the treatment experience and the ability to maintain daily activities throughout treatment. Conclusions: This study describes and clinically contextualises an APN-led multidisciplinary vascular access care pathway for patients with cystic fibrosis requiring prolonged intravenous therapy. The illustrative patient demonstrated the feasibility of applying the pathway in routine clinical practice. Further prospective multicentre studies are required to evaluate its effectiveness, safety, reproducibility, and broader applicability. Full article

Background: Emergency services in urban areas are overcrowded due to a rise in mild-to-moderate acuity consultations, and physician-led home visits are less common. In response, a home-based urgent care model in an urban setting (Docadom) was developed. Consultation requests via a dedicated mobile application or phone call are triaged by a trained emergency nurse. Physicians travel to the patient via an electric cargo bike that has storage for medical equipment. During home visits, physicians perform testing/diagnosis and advanced procedures (e.g., intravenous medication delivery) and prescribe treatment (if needed). This descriptive analysis reports activities during the first 12 months of Docadom. Methods: Data from all patients seen during the first 12 months of Docadom activity (1 May 2023–30 April 2024) were analysed. Outcomes analysed included: age, sex, diagnosis, and whether the patient was referred to the hospital. Patient satisfaction (from 1 [worst] to 5 [best]) is also reported. Each outcome was analysed in two subgroups based on patient age (<75 or ≥75 years) because the Swiss health insurance system distinguishes between these two age groups, using Wilcoxon or chi-square tests as appropriate. Results: A total of 1736 patients requested a consultation (66% female; median age 70 years [interquartile range 36, 84]; 43% aged ≥75 years). The five most frequent clinical presentations were: ear, nose and throat infection, epistaxis and bronchitis (25.7%); soft tissue trauma (7.8%); acute cervical or lower back pain syndrome (5.6%); gastroenteritis and dehydration (5.0%); and cancer and general decline in the elderly (4.6%). Only 4.7% of the patients were referred to the hospital. The mean satisfaction score was 4.97 (response rate: 207/422 patients [49%] who requested a consultation via the app). Conclusions: These data highlight the feasibility and acceptability of a home-based urgent care model in an urban setting. The service effectively addressed a wide range of acute conditions, especially in elderly patients. The low hospital referral rate and high patient satisfaction are encouraging, but as a single-arm descriptive analysis without post-consultation outcome data or a comparator group, this study cannot establish clinical safety or an effect on emergency department use; these questions require a future comparative study. Full article

Although esports-themed hotels have rapidly emerged as a technology-driven segment of smart hospitality, empirical research on their customer experience and satisfaction formation remains limited. Drawing on schema theory and expectancy violations theory (EVT), this study adopts a mixed-methods approach to examine the thematic attributes of esports-themed hotel experiences and their effects on customer satisfaction. Study 1 applied BERTopic and aspect-based sentiment analysis (ABSA) to 225,318 online reviews of 1601 esports-themed hotels. The results show that customer experience encompasses not only conventional hotel attributes, such as service, environment, and cleanliness, but also esports-specific attributes centered on gaming facilities, technological configurations, and esports-related social activities. ABSA results further reveal generally positive sentiment across most attributes, with service attitude and cleanliness receiving the strongest approval, whereas room facilities and comfort were the main sources of dissatisfaction. Study 2 employed hierarchical linear modeling to further examine the effects of six experience-related sentiments on customer satisfaction. The results indicate that all six sentiment dimensions significantly influence satisfaction and that hotel type moderates these relationships. Compared with professional esports-themed hotels (PETHs), the effects of experience-related sentiments on satisfaction are stronger in non-professional esports-themed hotels (NPETHs). This study extends schema theory and EVT to the esports-themed hotel context and offers practical implications for customer experience design and service management in this emerging hospitality segment. Full article

As small and medium enterprise organisations (SMEs) grapple with competing demands, decision-making is affected when faced with cost and regulatory uncertainties in response to sustainability obligations. Organisations adapt differently, focusing their resources to the most efficient use to optimise resources and enhance productivity. Qualitative interviews were carried out with 22 SME leaders spanning multiple sectors, including manufacturing, retail, services, construction, logistics, and hospitality, enabling examination of cross-sector variation while maintaining a shared regional context. The interviews lasted 45–65 min and captured managerial cognition, tacit knowledge, and informal strategic processes. The analysis reveals that SMEs do not respond uniformly to sustainability pressures. Instead, their responses are shaped by the interaction between cost pressures and regulatory uncertainty, producing distinct but overlapping strategic patterns. Three dominant mechanisms emerged across cases: cost filtering, temporal disruption under regulatory uncertainty, and strategic response variation. These mechanisms collectively explain how SMEs balance economic viability with environmental performance under constraint. The paper contributes to debates on sustainability transitions, resilience, and SME sustainability transitioning and growth strategies by identifying pathways that balance economic viability with environmental performance. Full article

Objectives: The aging population problem caused by low fertility intentions has already emerged worldwide and is expected to become more severe in the future. Despite the gradual implementation of welfare policies, there has been no substantial improvement in individuals’ intentions to have more children. It has therefore become increasingly important to examine the factors that correlate with individuals’ intentions in relation to fertility policy. Methods: The data used in this study were drawn from the 2023 Health Life Satisfaction Survey of the Yangtze River Delta Phase II conducted by Shanghai Jiao Tong University. The primary analysis employed binary logistic regression to examine the association between medical insurance type and fertility intentions, with healthcare accessibility operationalized as a moderating variable. Gender and parity-stratified analyses were conducted as pre-specified exploratory secondary analyses to examine potential heterogeneity in these associations. Results: A total of 8789 citizens were included in the analysis, of whom 18.42 percent reported fertility intentions. Individuals enrolled in the Basic Medical Insurance System for Urban Employees exhibited significantly higher odds of having fertility intentions compared with those enrolled in the Basic Medical Insurance System for Urban and Rural Residents (OR = 1.2154, 95% CI = 1.0626–1.3901, p < 0.001). Moreover, individuals covered by the Basic Medical Insurance System for Urban Employees and residing near secondary hospitals showed significantly higher odds of fertility intentions (OR = 1.6727, 95% CI = 1.1273–2.4821, p < 0.05) than those covered by the Basic Medical Insurance System for Urban and Rural Residents and living near primary hospitals. Conclusions: Medical insurance benefit levels, as well as the quality and accessibility of healthcare resources, are positively associated with individuals’ fertility intentions, suggesting that welfare design and service delivery may jointly shape the institutional context for reproductive decision-making. Full article

Objective: Extracorporeal Membrane Oxygenation (ECMO) has long been used in the treatment of acute respiratory and circulatory failure by providing time for damaged organs to recover. The aim of this study was to evaluate the safety and feasibility of interhospital transport of pediatric patients with acute respiratory failure who had undergone venovenous extracorporeal membrane oxygenation (VV ECMO) initiated at the referring facilities. Subjects and methods: Because of the critical condition of these patients, the high risk associated with transport, and the failure of conventional therapies, ECMO was initiated at the referring center. After cannulation, the patients were transported by ground ambulance to the Pediatric Intensive Care Unit in Poznań for further treatment. Results: Fourteen patients aged 2 months to 11 years with acute respiratory failure were transferred to our ECMO center. The mean time from decision to departure was 7.62 h, and the mean ICU stay before transfer was 4.14 days. The mean transport distance was 157.5 km. No mortality occurred during transport, and no serious adverse events were reported. Two technical complications were noted. Conclusions: Interhospital transport of pediatric patients on VV ECMO initiated at referring centers was feasible and safe, with favorable outcomes in patients who have exhausted conventional intensive care options. Effective collaboration between referring hospitals, ECMO centers, and emergency medical services was essential for optimal results. Full article

Smart cities (SCs) use the Internet of Things (IoT) to collect and process data to communicate with their infrastructure and assets in real time. A great deal of techniques, such as encryption protocols, Random Forest-based AI-driven threat detection, and blockchain architectures, have been developed to address cybersecurity challenges in smart cities (SCs). These techniques, however, have limitations such as their scalability, high computational expenses, and energy inefficiency. Therefore, in this study, to overcome these challenges, we propose a blockchain-based infrastructure called BlockSafeNet. This uses artificial intelligence, big data, and blockchain to enhance cybersecurity in SCs. The effectiveness of the proposed BlockSafeNet framework was evaluated using responsiveness, computational time, encryption quality score, detection rate, false positive rate, latency, throughput, and energy consumption as the primary cybersecurity performance metrics. These metrics were selected to assess communication efficiency, threat detection capability, privacy preservation, scalability, and overall security performance within smart-city IoT environments. To ensure secure data transactions, robust threat detection, and efficient communication. The system’s high calculation speed and detection rate show potential for managing sensitive maternal health data collected by IoT devices. The platform also shows how IoT may be used by healthcare services to monitor public health in real time, allowing hospitals, emergency services, and public health agencies to securely share data. This aids in resource optimization, improving service delivery, and preserving data privacy and trust in SCs. Data was obtained from the UCI Machine Learning Repository on Kaggle to validate the developed framework. By evaluating the effectiveness of BlockSafeNet in tackling cybersecurity challenges, we establish its practical relevance and usability in SCs. The proposed BlockSafeNet framework achieved a responsiveness of 24 s, an encryption quality score of 0.89, computational time of 85 s, and a detection rate of 91%, demonstrating significant improvements in secure IoT communication, privacy preservation, and AI-driven cyber threat detection within smart city infrastructures. shows that SC IoT security has significantly improved through the adoption of new data protection methods and better measures of security, providing a positive impact on the SC ecosystem. Full article

This empirical study positions hotel-based sport wellness programs as structured physical activity offerings embedded in co-created guest experiences in luxury hotels in Saudi Arabia. It examines how the quality of wellness sports programs relates to guests’ satisfaction with the program, loyalty intentions toward the hotel, and self-reported physical activity orientation and intention. The construct is operationalized as guests’ perceived increase in activity during the stay and their stated intention to maintain or increase activity afterward. The study also tests the mediating roles of perceived health benefits and enjoyment, as well as the moderating role of staff health communication. Drawing on service quality and expectancy disconfirmation perspectives, together with health belief and motor learning insights, a cross-sectional survey was conducted with 412 guests who had participated in structured sport-based wellness sessions during their stay in Saudi Arabian luxury hotels. Data were analyzed using partial least squares structural equation modeling (PLS SEM). Wellness sport program quality was positively associated with perceived health benefits, enjoyment, and program satisfaction, and both perceived health benefits and enjoyment partially mediated the quality satisfaction relationship, indicating parallel cognitive and affective pathways in the guest experience. Program satisfaction, in turn, was positively associated with guests’ loyalty intentions and their self-reported orientation toward maintaining healthier physical activity routines after their stay, while staff health communication significantly strengthened the association between program quality and perceived health benefits. These results contribute to wellness tourism and hospitality research by integrating sport pedagogy and health communication into an experience-centric framework and by clarifying how hotel-based sport wellness offerings can support satisfaction, loyalty, and self-reported physical activity orientation in an emerging tourism destination. Practical implications are offered for hotel managers seeking to design human-centered, health-oriented wellness services aligned with Vision 2030 and global physical activity promotion agendas, recognizing that the findings represent perception-based associations that are a promising foundation for future longitudinal and behavioral research. Full article