The influence of Destination Branding and Authenticity on Tourism: Analysing the tourist experience - Case Study of Lisbon

Destination Branding: a concept that has guided the tourism industry since day one. It strengthens the position of the product in the tourism market and helps it to remain competitive. It has also been an efficient tool to give an image to places and transmit this image to the final consumer. But how much “realness” does this image transmit? Is it genuine, or just a replication of what people actually want to see? How authentic are these images, and how staged are they? The image of a destination influences a lot the experience of the tourist. It creates expectations and develops certain stereotypes that many times create staged experiences. A destination image certainly involves staged characteristics; it implies a front and a back stage, which separate the processes shown to the consumer/ tourist, from the real processes happening behind. This simple segregation causes an enormous outcome on the consumer, who does not get to see the real face of the destination visited, and instead remains with a false and misleading image of the place. Portugal has become famous due to its outstanding landscapes and cultural resources, but mostly for its people and their welcoming character. Since we can remember, it has been a country known for its modesty and humbleness, and exactly this image would accompany it along the years, in order to guarantee its position in the tourism industry. These characteristics can be traced back to the regime of the dictator António de Oliveira Salazar, who helped to establish the image of the “humble” Portugal in the 20th century. Today we can find Portugal booming in terms of tourism; especially the capital Lisbon has noted a remarkable increase in the past time. In line with this, it has been elected the World´s Leading City Break Destination for the last three years. Thus, Lisbon has developed very rapidly; it is seen as a city of diversity and variety, authentic experiences and urban creations; its fast development and strong attraction have led to a strong influx of tourists, which is now breaking the records. Nevertheless, it can be noticed that globalization has taken over the capital and has already made some changes in terms of economy, culture and its social structure. But to what extent did this progress influence the authenticity and the genuineness of the real Lisbon and its people? Demonstrations The Influence of Destination Branding and Authenticity on Tourism: Analysing the tourist experience – Case Study of Lisbon vi and initiatives have marked the life within the city: locals protest against the current touristification and massification of the central areas and are no longer willing to bear the modification of their loved homes. At this point conflicts and barriers are built between the inhabitants, the official authorities, and the tourists. How exactly these conflicts influence the life of the locals, and how they affect the tourists experience in the city of Lisbon will be exposed and analysed in the present dissertation.‘Destination Branding’: um conceito que guiou a indústria do turismo desde o primeiro dia. Um método, que reforça a posição do produto no mercado, e que ajuda a manter a competitividade na indústria. O ‘Destination Branding’ tem sido um instrumento eficiente para comunicar uma imagem concreta do destino e transmitir essa imagem ao consumidor final/turista. Quanto à realidade dos destinos, surge a pergunta: que ‘verdade’ transmite essa imagem? Essa imagem é genuína, ou apenas uma réplica das expetativas dos turistas? Quão autênticas são estas imagens, e quão encenadas são? Uma coisa, porém, é certa: a imagem de um destino influencia a experiência do turista. Essa imagem cria expetativas, e constrói certos estereótipos, que muitas vezes resultam em experiências, que não correspondem á realidade. É por esse motivo que a imagem do destino certamente implica e envolve algumas características ‘encenadas’. No entanto, esse procedimento implica os chamadas ‘front’ e ‘back stages’, que separam os processos apresentados aos consumidores/turistas dos verdadeiros processos que estão a acontecer por trás do cenário. Essa segregação causa um impacte significativo no consumidor, que acaba por não conhecer a verdadeira face do destino, e permanecer com uma imagem enganadora do local. Portugal tornou-se um destino turístico muito procurado, devido às suas paisagens excecionais e aos seus recursos culturais, mas, acima de tudo, graças à sua gente e ao seu carácter acolhedor. Devemos lembrar, que esse mesmo país foi sempre conhecido pela sua humildade e simplicidade; é exatamente essa imagem que tem acompanhado Portugal ao longo dos anos, de modo a garantir a sua posição no setor do turismo. Estas características acompanham a imagem turística deste país desde o regime do ditador António de Oliveira Salazar, que ajudou a construir e criar a imagem de um ‘Portugal modesto’ no século XX. Atualmente, em termos de turismo, Portugal está numa posição cimeira, sobretudo a capital, Lisboa, que registou um aumento notável nos últimos anos, no que toca à chegada de turistas. Lisboa foi também eleita a World´s Leading City Break Destination nos últimos três anos e tem-se desenvolvido muito rapidamente num passado recente; é uma The Influence of Destination Branding and Authenticity on Tourism: Analysing the tourist experience – Case Study of Lisbon viii cidade que representa a diversidade e a variedade, experiências autênticas e criações urbanas. Assim, o desenvolvimento acelerado conduziu a um enorme fluxo de turistas, que está a bater todos os recordes. Contudo, percebe-se que a globalização tem estado a apoderar-se da cidade, e tem até causado mudanças significativas em termos de economia, sociedade, e cultura dos locais. Mas até que ponto é que esse desenvolvimento influencia a autenticidade e a genuinidade de Lisboa e do seu povo? Manifestações e outras iniciativas marcaram os últimos anos da cidade: os habitantes protestam contra a forte turistificação e massificação de locais centrais, e não estão dispostos a aceitar a transformação das suas residências. Sucedem-se, então, conflitos entre os habitantes, as autoridades, e os turistas. O modo como esses conflitos influenciam a vida dos habitantes, e como isso afeta a experiência do turista na cidade de Lisboa, será exposto e analisado na presente dissertação

O sonho de uma nova família - A Adopção como via para o pleno desenvolvimento da criança

Dissertação de Mestrado apresentada ao ISPA - Instituto UniversitárioAs crianças inseridas no sistema de adopção continuam a apresentar, na sua maioria um historial de vivência em ambientes instáveis, precários, negligentes e/ou abusivos, que restringem as possibilidades de desenvolvimento de vinculações seguras e favorecem problemas de conduta. Assim, a adopção surge como resposta interventiva a este dilema social, de modo a colmatar lacunas nas áreas de desenvolvimento da criança e a garantir um lar acolhedor e afectuoso, promotor de vinculações seguras e estáveis. O presente estudo pretende analisar as diferenças nas representações de vinculação e problemas de comportamento associados em crianças adoptadas comparativamente a crianças residentes desde sempre com as famílias de origem. Numa amostra de 28 crianças portuguesas em idade pré-escolar e escolar, sendo 43% do sexo feminino, com idades compreendidas entre 38 e os 75 meses de idade, podemos encontrar dois grupos: 10 crianças em meio familiar adoptivo e 18 crianças em meio familiar de vida. Para a avaliação das representações de vinculação, recorreu-se à aplicação do Attachment Story Completion Task (ASCT), enquanto para avaliação dos problemas e aspectos comportamentais, usou-se o Child Behaviour Checklist (CBCL) direccionado aos pais. Os resultados indicam que não existem diferenças significativas entre as crianças adoptadas e os pares não-adoptados, ao nível da segurança das representações de vinculação e dos problemas de comportamento associados, do tipo internalizante e do tipo externalizante. Conclui-se que ambos os contextos de proveniência das crianças promovem um desenvolvimento emocional, comportamental e vinculativo favorável e semelhante nas suas dimensões, realçando-se assim a eficácia do processo de adopção.ABSTRACT: Children in adoption system are still showing, in their majority, a history of living in unstable, precarious, negligent and/or abusive environments, which restricts the possibilities of developing safe connections and favors behavior problems. Therefore, the adoption emerge as a way of intervention to this social dilemma, so it can fill the blanks in the areas related with the children’s development and to insure a nurturing and welcoming home, who will promote safe and stable attachments. This study intends to analyze the differences in attachment representations and associated behaviour problems in adopted children in comparison with children who have always lived with their original families. From a sample of 28 children ranging from pre-school to school ages, 43% of female gender, aged 38-75 months, we find 2 groups: 10 children in adoptive families and 18 children in original families. For the assessment of the attachment representations was applied the Attachment Story Completion Task (ASCT) and for the assessment of behavior aspects and problems was used the Child Behavior Checklist (CBCL) for parents. Results show that are no significant differences between adopted children and their non-adopted peers, on security of attachment representations and on related behavior problems, of internalizing type and externalizing type. Hence, it is concluded that both contexts of the children’s origin promote a favorable and similar emotional, behavioral and relational development in assessed dimensions, emphasizing therefore the effectiveness of the adoption process

Prevenção da violência no namoro o teatro fórum como estratégia de sensibilização em adolescentes

Este estudio tiene como objetivo comprender la importancia atribuida por los adolescentes al Teatro Fórum como estrategia de sensibilización hacia la violencia durante el noviazgo. Esta sensibilización fue desarrollada por educadores entre iguales y es parte del proyecto (O)Usar & Usar & Ser Laço Branco (Proyecto de la cinta blanca) de la escuela de enfermería de Coimbra, Portugal. Este estudio descriptivo se realizó utilizando metodología cuantitativa y cualitativa. Los datos fueron recogidos mediante un cuestionario que fue presentado al final de actividades de sensibilización en la Escuela Secundaria donde se utilizó el Teatro Forum. La muestra constó de 314 adolescentes de ambos sexos entre 13 y 19 años de edad. Teatro Forum fue visto como una estrategia motivadora, atractiva e innovadora. La lógica interactiva/participativa permitió a los jóvenes ser protagonistas que contribuyeron a comprender el fenómeno, tratando de transformar las situaciones presentadas en el teatro. La proximidad de la edad de los educadores crea un ambiente propicio para la comunicación y el aprendizaje. Los resultados coinciden con otros estudios, tanto en lo relativo a la transformación de los espectadores, en transformadores sociales o los beneficios relacionados con la educación de iguales. Las dos estrategias - enseñanza de teatro y compañeros de foro - parecen empoderarse y parecen ser eficaces en la sensibilización sobre violencia durante el noviazgo.This study aims to understand the importance attributed by adolescents to the Forum Theatre as a strategy to raise awareness of dating violence. It is developed by peer education and it is part of the project (O)Usar & Ser Laço Branco (White Ribbon Project) of the School of Nursing of Coimbra, Portugal. This descriptive study was conducted using quantitative and qualitative methodology. Data were collected through a questionnaire which was submitted at the end of awareness activities in Secondary Schools where was used the Forum Theatre developed by peer education. The sample consisted of 314 adolescents of both sexes aged between 13 and 19 years. Forum Theatre was seen as a motivating, engaging and innovative strategy. The participatory/interactive logic enabled the teenagers to be protagonists which contributed to understand the phenomenon, seeking to transform the situations presented in the theatre. The proximity of the age of the educators created a conducive atmosphere for communication and learning. The results coincide with other studies, both as regards the transformation of spectators in social transformers or the benefits related to peer education. The two strategies - forum theatre and peer education - seem to empower themselves and appear to be effective in raising awareness on dating violence.Este estudo tem como objectivo conhecer a importância atribuída pelos adolescentes ao Teatro Fórum como estratégia de sensibilização para a violência no namoro. Esta sensibilização foi desenvolvida por pares educadores e integra-se no projecto (O)Usar & Ser Laço Branco da Escola Superior de Enfermagem de Coimbra, Portugal. Foi realizado um estudo descritivo com utilização de metodologia quantitativa e qualitativa. Os dados foram colhidos através de questionário no final da sensibilização em Escolas Secundárias. Participaram neste estudo 314 adolescentes de ambos os sexos com idades entre os 13 e 19 anos. O Teatro Fórum assumiu-se como uma estratégia motivadora, envolvente e inovadora. A lógica participativa/interactiva permitiu aos adolescentes serem protagonistas, o que contribuiu para melhor compreenderem o como e o porquê do fenómeno, procurando transformar as situações apresentadas no teatro. A proximidade da idade dos educadores criou um ambiente facilitador à comunicação e à aprendizagem. Os resultados são convergentes com outros estudos, quer no que se refere à transformação de espectadores em transformadores sociais, quer nas vantagens relacionadas com a educação pelos pares. As duas estratégias – teatro fórum e educação pelos pares – parecem potencializar-se e serem eficazes na sensibilização para a violência no namoro.peerReviewe

Accuracy of faecal calprotectin and neutrophil Gelatinase B-associated Lipocalin in evaluating subclinical inflammation in UlceRaTIVE colitis-the ACERTIVE study

Background and Aims: Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B-associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients. Methods: This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers. Results: Macroscopic lesions [i.e. endoscopic Mayo score >= 1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of Severity. Moreover, 21% presented with histological inflammation according to the Geboes index, whereas 15% and 5% presented with focal and diffuse basal plasmacytosis, respectively. The faecal levels of calprotectin and neutrophil gelatinase B-associated lipocalin were statistically higher for patients with endoscopic lesions and histological activity. A receiver operating characteristic-based analysis revealed that both biomarkers were able to indicate mucosal healing and histological remission with an acceptable probability, and cut-off levels of 150-250 mu g/g for faecal calprotectin and 12 mu g/g for neutrophil gelatinase B-associated lipocalin were proposed. Conclusions: Faecal calprotectin and neutrophil gelatinase B-associated lipocalin levels are a valuable addition for assessment of disease activity in asymptomatic ulcerative colitis patients. Biological levels of the analysed biomarkers below the proposed thresholds can rule out the presence of macroscopic and microscopic lesions with a probability of 75-93%. However, caution should be applied whenever interpreting positive results, as these biomarkers present consistently low positive predictive values.Portuguese IBD Group [GEDII - Grupo de Estudo da Doenca Inflamatcria Intestinal]info:eu-repo/semantics/publishedVersio

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis

Background: The early postoperative period is critical for surgical patients. SOFA, SAPS 3 and APACHE II are prognostic scores widely used to predict mortality in ICU patients. This study aimed to evaluate these index tests for their prognostic accuracy for intra-ICU and in-hospital mortalities as target conditions in patients admitted to ICU after urgent or elective surgeries and to test whether they aid in decision-making. The process comprised the assessment of discrimination through analysis of the areas under the receiver operating characteristic curves and calibration of the prognostic models for the target conditions. After, the clinical relevance of applying them was evaluated through the measurement of the net benefit of their use in the clinical decision. Results: Index tests were found to discriminate regular for both target conditions with a poor calibration (C statisticsintra-ICU mortality AUROCs: APACHE II 0.808, SAPS 3 0.821 and SOFA 0.797/in-hospital mortality AUROCs: APACHE II 0.772, SAPS 3 0.790 and SOFA 0.742). Calibration assessment revealed a weak correlation between the observed and expected number of cases in several thresholds of risk, calculated by each model, for both tested outcomes. The net benefit analysis showed that all score's aggregate value in the clinical decision when the calculated probabilities of death ranged between 10 and 40%. Conclusions: In this study, we observed that the tested ICU prognostic scores are fair tools for intra-ICU and in-hospital mortality prediction in a cohort of postoperative surgical patients. Also, they may have some potential to be used as ancillary data to support decision-making by physicians and families regarding the level of therapeutic investment and palliative care.

Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels

Objective Histological remission is being increasingly acknowledged as a therapeutic endpoint in patients with UC. The work hereafter described aimed to evaluate the concordance between three histological classification systems-Geboes Score (GS), Nancy Index (NI) and RobartsHistopathologyIndex (RHI), as well as to evaluate their association with the endoscopic outcomes and the faecal calprotectin (FC) levels. Design Biopsy samples from 377 patients with UC were blindly evaluated using GS, NI and RHI. The results were compared with the patients' Mayo Endoscopic Score and FC levels. Result GS, NI and RHI have a good concordance concerning the distinction between patients in histological remission or activity. RHI was particularly close to NI, with 100% of all patients classified as being in remission with NI being identified as such with RHI and 100% of all patients classified as having activity with RHI being identified as such with NI. These scores could also predict the Mayo Endoscopic Score and the FC levels, with their sensitivity and specificity levels depending on the chosen cut-offs. Moreover, higher FC levels were statistically associated with the presence of neutrophils in the epithelium, as well as with ulceration or erosion of the intestinal mucosa. Conclusions GS, NI and RHI histopathological scoring systems are comparable in what concerns patients' stratification into histological remission/activity. Additionally, FC levels are increased when neutrophils are present in the epithelium and the intestinal mucosa has erosions or ulcers. The presence of neutrophils in the epithelium is, indeed, the main marker of histological activity.Portuguese IBD Group (GEDII-Grupo de Estudo da Doenca Inflamatoria Intestinal)info:eu-repo/semantics/publishedVersio

Comparing the continuous geboes score with the Robarts Histopathology Index: definitions of histological remission and response and their relation to faecal calprotectin levels

Background and Aims: The histological status of ulcerative colitis [UC] patients in clinical and endoscopic remission has gained space as an important prognostic marker and a key component of disease monitoring. Our main aims were to compare two histological indexes-the continuous Geboes score [GS] and the Robarts Histopathology index [RHI]-regarding their definitions of histological remission and response, and the ability of faecal calprotectin [FC] levels to discriminate between these statuses. Methods: This was an analysis of three prospective cohorts including 422 patients previously enrolled in other studies. Results: The two continuous scores [GS and RHI] were shown to be significantly correlated [correlation coefficient of 0.806, p < 0.001] and particularly close regarding their definition of histological response: 95% and 88% of all patients classified as having/not having [respectively] histological response according to RHI also did so according to GS. Moreover, median FC levels in patients with histological response were lower than those in patients without histological response [GS: 73.00 vs 525.00, p < 0.001; RHI: 73.50 vs 510.00, p < 0.001]; a similar trend was observed when FC levels of patients in histological remission were compared to those of patients with histological activity [GS: 76.00 vs 228.00, p < 0.001; RHI: 73.50 vs 467.00, p < 0.001]. FC levels allowed us to exclude the absence of histological remission [according to RHI] and absence of histological response [according to RHI and GS], with negative predictive values varying from 82% to 96%. However, optimization of the FC cut-off to exclude the absence of histological remission, as for the continuous GS, falls within values that resemble those of the healthy population. Conclusion: The continuous GS and RHI histological scores are strongly correlated in their definitions of histological response. An absence of histological remission could only be excluded at physiological levels of FC.Portuguese IBD group [GEDII- Grupo de Estudo da Doenca Inflamatoria Intestinal]info:eu-repo/semantics/publishedVersio

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

A multi-country analysis of COVID-19 hospitalizations by vaccination status

Background: Individuals vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), when infected, can still develop disease&nbsp;that requires hospitalization. It remains unclear whether these patients differ from hospitalized unvaccinated patients with regard to presentation, coexisting comorbidities, and outcomes. Methods: Here, we use data from an international consortium to study this&nbsp;question and assess whether differences between these groups are&nbsp;context specific. Data from 83,163 hospitalized COVID-19 patients (34,843 vaccinated, 48,320 unvaccinated) from 38 countries were analyzed. Findings: While typical symptoms were more often reported in unvaccinated patients, comorbidities, including some associated with worse prognosis in previous studies, were more common in vaccinated patients. Considerable between-country variation in both in-hospital fatality risk and vaccinated-versus-unvaccinated difference in this outcome was observed. Conclusions: These findings will inform allocation of healthcare resources in future surges as well as design of longer-term international studies to characterize changes in clinical profile of hospitalized COVID-19 patients related to vaccination history. Funding: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z, and 220757/Z/20/Z); the Bill&nbsp;&amp; Melinda Gates&nbsp;Foundation (OPP1209135); and the philanthropic support of the donors&nbsp;to the University of Oxford's COVID-19 Research Response Fund (0009109). Additional funders are listed in the "acknowledgments" section