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Objectives: This scoping review aimed to determine whether the COVID-19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy centres. Method(s): This review was conducted based on the PRISMA methodology and Joanna Briggs Institute scoping review guidelines.1,2 A literature search was performed in Medline, Embase, Web Of Science and Scopus as well as grey literature. Keywords including "COVID-19" and "Proton Therapy" were used. Articles published from 1 January 2020 in English were included. In total, 138 studies were identified of which 14 articles met the inclusion criteria. A scoping review design was chosen to capture the full extent of information published relating to the aim. Result(s): Six of 14 articles included statements regarding treatment of COVID-19 patients. Three publications recommended deferred or alternative treatment, two indicated to treat urgent/emergency patients and one reported continuous treatment for infectious patients. Recurring impacts on PT provision included more frequent use of alternative therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment volume and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended. Discussion/Conclusion: Few publications detailed patient selection or workflow methods used during the pandemic. Further research is needed to obtain more detailed information regarding current global patient selection methods in proton therapy, collecting this data could aid in future planning for proton therapy in Australia.
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Whether or not primates are behaviorally affected by the presence of visitors in a zoo setting is a question of great relevance to zoo animal well-being. The situation imposed by the COVID-19 pandemic provided an unusual opportunity to examine how the absence of visitors impacts behavior. We took advantage of this opportunity to study the behavior of a gorilla troop during periods of no-visitors compared to our long-term database on gorilla behavior during normal zoo operations. While there were notable individual differences in response to visitors, we found no significant relationship between presence of visitors and behavior. These results suggest that the presence of visitors does not have a significant impact on behavior and well-being of zoo-housed gorillas.
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Background: The prevalence of emerging and re-emerging diseases has made the need for basic preparations for all health care organizations more crucial. Strengthening preparedness and formulating crisis strategies will have a great impact on reducing casualties. Given the importance of preparing hospitals to deal with such an outbreak and reduce the resulting mortality, the present study was conducted to assess their readiness against Covid-19. Method(s): The present study is a quantitative and descriptive cross-sectional research conducted from October to March 2019. Data collection used the standard checklists prepared by the European Center for the Prevention and Control of Coronavirus and the Centers for Disease Control and Prevention, consisting of eight domains and 21 components. The minimum score that each hospital could get in this checklist was 143 and the maximum was 429. The sampling method in the present study was a census, and nine reference hospitals for Corona were included in the study. All hospitals' directors, managers, quality officers and crisis secretaries and others related to hospital readiness during Covid-19 were recruited by the census. Result(s): On average, the hospitals scored 391 out of 429, indicating a fairly "high readiness" in dealing with Covid-19. The highest score obtained by the hospitals was 425 and the lowest score was 349. In terms of preparation areas, the hospitals' readiness was higher than 80% in all areas. The highest readiness of hospitals was in the fifth domain, i.e. Hand hygiene, personal protective equipment and hospital waste management. The 7th domain namely, patient placement and relocation, and patient visitor access was of the lowest preparation. Conclusion(s): The hospitals were of fairly appropriate readiness to deal with Covid-19. This level of preparedness, despite being desirable, might not reflect the real capacity of hospitals to deal with this disease. Regular evaluation of the Covid referral hospitals could help make these hospitals more prepared. Also, the experiences of hospitals that were more prepared should be used to improve the condition of other hospitals.Copyright © 2022 Jaafaripooyan et al. Published by Tehran University of Medical Sciences.
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The COVID-19 pandemic has severely impacted the tourism industry in Bali, leading to a decline in tourist visits. To address this issue, efforts have been made to restore tourism by building the intention of tourists to revisit the island. This study aimed to investigate the factors that influence tourists' revisit intentions, with a specific focus on the impact of electronic word-of-mouth (E-WOM) and travel experience, and the mediating role of destination image. The study targeted domestic tourists who had visited Bali, and a sample of 250 respondents was selected through purposive sampling. Data collection was conducted through the distribution of questionnaires, and the analysis was performed using the Structural Equation Modeling (SEM) technique with the SmartPLS tool. The study revealed that E-WOM had no significant influence on the intention to revisit, while travel experience had a positive and significant effect on the intention to revisit. The image of the destination also had a positive and significant impact on tourists' revisit intentions. Additionally, E-WOM and travel experiences positively affected the destination image. The study also found that the destination image partially mediated the influence of E-WOM and tourist experience on the intention to revisit. The findings of this study provide valuable insights into the factors that affect tourists' revisit intentions and can be used to develop effective strategies for restoring the tourism industry in Bali. The study highlights the importance of providing high-quality travel experiences and promoting a positive destination image to encourage tourists to revisit Bali. Additionally, the study emphasizes the need to carefully consider the role of E-WOM in promoting tourism and suggests that it may not always have a significant impact on tourists' revisit intentions. Overall, this study contributes to the body of knowledge on tourism marketing and provides practical recommendations for tourism practitioners and policymakers.
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The COVID-19 pandemic required changes in habits. Tourism was one of the most affected sectors. The objective of the article was to analyze the negative impacts resulting from the pandemic on conservation projects, with emphasis on the Hyacinth Macaw Institute (Instituto Arara Azul - ITA). The research was developed through a literature review and documents from the ITA. In the years 2018 and 2019 the Hyacinth Macaw Institute received an average of 299 tourists per year, in 2020 this average dropped by 60%. With the restrictions imposed by the pandemic, people stopped traveling and visiting the projects, with this, the collection structure was affected. However, ecotourism was one of the first activities to be resumed, after a prolonged period of isolation, people look for activities that provide physical and mental well-being.
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MNLTour is a virtual tour system for selected tourist spots situated within the city of Manila. It utilizes 360-degree images, 2D images, voice recordings, and virtual reality technology to offer an immersive user experience of the virtual environment. The virtual tour system was developed using the Unity3D software and was then integrated into web and mobile applications accessible through web browsers and android smartphones, respectively. MNLTour aims to promote the wonders of Manila city by showcasing some of its historical tourist spots that have been severely affected by the outbreak of the COVID-19 pandemic. The developed web and mobile applications were tested and later evaluated to assess the overall quality of the software in accordance with ISO 9126 standard. The evaluation statements primarily focus on the aspects of functionality, efficiency, usability, effectiveness, and user satisfaction in using the application. Descriptive statistics was used to analyze and summarize the data gathered from the evaluation respondents. The evaluation of the application in both platforms turned out to have admirable evaluation results;hence, it's safe to say that the developed software has an acceptable overall quality. © 2022 IEEE.
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In this paper, we explore the ethics of restricting visitation to hospitals during an infectious disease outbreak. We aim to answer three questions: What are the features of an ethically justified hospital visitor restriction policy? Should policies include scope for case-by-case exemptions? How should decisions about exemptions be made? Based on a critical interpretive review of the existing ethical literature on visitor restrictions, we argue that an ethically justified hospital visitor restriction policy has the following features: proportionality, comprehensiveness, harm mitigation, exemptions for specific patient populations, visitation decisions made separately from a patient's treating clinicians, transparency, and consistency in application. We also argue that an ethical policy ought to include scope for case-by-case exemptions for individual patients. We propose a process for ethical decision-making that provides a shared language and structure to decrease the risks and burdens of decision-making when clinicians or managers are considering requests for exemptions.
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Aim: Community health workers (CHWs) and home visitors (HVs) are members of the public health workforce who are uniquely poised to support vulnerable populations during the COVID-19 pandemic. In this study, we assess the experiences of CHWs and HVs in Wisconsin during the early stages of the COVID-19 pandemic to learn about their experiences related to mitigation strategies and vaccination efforts. Subject and methods: Working closely with community partners, we recruited CHWs and HVs via email to complete an online survey between June 24 and August 10, 2021. Participants were eligible if they worked at any time since March 25, 2020, when the Safer at Home Order was put into place. The survey asked CHWs and HVs about their experiences during the COVID-19 pandemic and vaccination efforts. Results: Eligible respondents included 48 HVs and 26 CHWs. Most CHWs (96%) and HVs (85%) reported discussing the COVID-19 vaccine with clients, and 46% of HVs and 85% of CHWs said they planned to encourage their clients to vaccinate themselves against COVID-19. We found that many CHWs and HVs identified the COVID-19 pandemic as a threat to the health of the US population, and many reported that they thought mitigation strategies were effective at keeping people safe from COVID-19. There was inconsistency in regard to respondents plans to encourage their clients to receive vaccination for COVID-19. Conclusion: Future study, training, and support for CHWs and HVs should focus on facilitating vaccination efforts and other emerging public health interventions.
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Purpose: This study aims to construct a scale for measuring the spa hotel experiencescape in wellness tourism, clarify the mechanism through which wellness tourism experiencescape influences revisit intention and investigate the mediation roles of authenticity, memorability and organizational identification. Design/methodology/approach: This study conducted content analysis of interviews, online reviews and relevant articles and used the concept of experiencescape to interpret spa hotels' experiential environment. The stimulus-organism-response (SOR) model was used as the basis for introducing authenticity, memorability, organizational identification and revisit intention to investigate how wellness tourism experiencescape affects tourists' behavior. In total, 488 valid questionnaires were collected at Taiwanese spa hotel clusters. Findings: Four factors of spa hotel experiencescape were identified: health promotion treats, mental learning, unique travel experience and healthy diet. Existential authenticity-memorability and existential authenticity-organizational identification exerted full positive mediation effects in the relationship between wellness tourism experiencescape and revisit intention. Practical implications: This study provides guidance on experience design for spa hotels. It promotes the consideration of existential authenticity in wellness tourism design. Originality/value: The COVID-19 pandemic has raised awareness of wellness, drastically increasing the potential of the wellness tourism market. This study investigated the construction of wellness tourism experiencescape and its influence, and the findings can facilitate post-pandemic restoration of the wellness tourism industry. On the basis of SOR model, a chain mediation model was proposed to reveal the influence of wellness tourism experiencescape on revisit intention. Existential authenticity was discovered to play a crucial role in the relationship between wellness tourism experiencescape and revisit intention, which suggests that existential authenticity should be considered during service design and in marketing strategies for wellness tourism.
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BACKGROUND: Nursing homes were disproportionally affected by the COVID-19 pandemic. Vaccination was considered critical for the normalization of daily live of nursing home residents. The present study investigates the impact of the prolonged COVID-19 pandemic and the effect of vaccinations on the daily lives of residents and staff in Dutch nursing homes. SETTING AND PARTICIPANTS: The sample consisted of 78 nursing homes that participated in the Dutch national pilot on nursing home visits after the COVID-19 pandemic. One contact person per nursing home was approached for participation in this mixed-methods cross-sectional study. METHODS: Data was collected twice through questionnaires in April and December 2021. Quantitative questions focused on recent COVID-19 outbreaks, progress of vaccination, effects of vaccination on daily living in the nursing home and burden experienced by staff. Open-ended questions addressed the prolonged effect of the pandemic on residents, family members and staff. RESULTS: The overall vaccination rate of residents across nursing homes appeared to be high among both residents and staff. However, daily living in the nursing home had not returned to normal concerning personal interactions, visits, the use of facilities and work pressure. Nursing homes continued to report a negative impact of the pandemic on residents, family members and staff. CONCLUSIONS: Restrictions to the daily lives of residents in nursing homes were stricter than restrictions imposed on society as a whole. Returning to a normal daily living and working was found to be complex for nursing homes. With the emergence of new variants of the virus, policies strongly focusing on risk aversion were predominantly present in nursing homes.
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COVID-19 , Humans , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Pandemics , Cross-Sectional Studies , Nursing Homes , VaccinationABSTRACT
This paper presents a longitudinal study of domestic travel by residents of Southeast Queensland, Australia. It is framed within the distance decay concept. Two major findings emerged from the study. First, people who were most likely to forsake travel as a result of COVID-19 generally did not value it very highly, while those who continued to travel saw it as an important part of their lifestyles. Second, applying the distance decay concept revealed no change in destination choice in intra-destination movements over time, although the volume of tourists was substantially lower as a result of COVID-19. This findings suggests a degree of habit persistence prevails even in times of crisis.
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INTRODUCTION: In 2020, during the first wave of the COVID-19 pandemic in Melbourne, visitor access to acute hospitals including intensive care units (ICUs) was initially barred, followed by a limit of one person per patient for one hour per day. This study explores the care and communication experienced by family members of ICU patients during this time. METHODS: This qualitative descriptive study was conducted at an Australian quaternary hospital. Semistructured phone interviews were conducted using an aide-memoire designed to understand participants' experiences as family of a patient during this time. Interviews were recorded, transcribed, and thematically analysed. FINDINGS: Twenty family members of patients in the ICU participated. Three major themes were identified: 'impact of restricting visiting procedures', 'family experiences of communication', and 'care and support'. Inflexible visiting restrictions had a momentous impact on families. Participants objected to having to nominate only two people to visit during the admission and the short visiting time limit. Some family members suffered extreme stress and anxiety during their absence from the bedside. Additional challenges were experienced by rural families, visitors with disabilities, and the young children of patients who were excluded. Communication with clinicians varied. Telehealth was valued by some but not universally embraced. The relationship between staff members and families and involvement in decision-making were unaffected. CONCLUSION: Families experienced significant psychological distress from being separated from their critically ill relatives. Patient care and involvement in decision-making appeared to be unchanged, but communication with staff felt to be lacking. Better alternatives to face-to-face communication must be sought to limit the impact of family separation on mental health. Families are a key link between the patient and clinicians and often play a major role in patient support and recovery after discharge. There is an urgent need to support them and facilitate meaningful engagement despite the obstacles.
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Mining data from social media platforms has become increasingly popular to explore aspects of human behaviour, including attitudes towards the natural environment or visiting protected areas. Most studies and analytical algorithms refer to digital content published in English. However, it is also useful to conduct research in other languages to complement existing international studies. Our main aim was to explore Twitter content on national parks, published between 2006 and July 2021, in German. The study also presents a differentiated analysis for tweets published in 2019 and 2020 on national parks and associated with the Covid-19 pandemic. The tweets came from German-speaking countries, but also other countries worldwide. The most frequently mentioned national parks were located mainly in mountain areas, yet terms, hashtags, emojis and topics directly relating to mountains were rare in comparison to other subjects. Tweets most frequently included words such as forest (Wald), holiday (Urlaub) and nature (Natur);messages related not only to the natural heritage and environmental protection but also to natural disasters. The Covid-19 pandemic and national parks were also a subject of discussion on Twitter, often accompanied by photographs or videos. As 85% of all the tweets studied were never retweeted, 92% never received a reply, and 74% were never assigned likes, we conclude that there is potential to improve (social media) communications by users interested in protected areas in mountainous regions.
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The COVID -19 pandemic posed serious challenge for securing public health worldwide. Public health preparedness and restrictions put in place impacted many aspects of human life, including recreational activities and access to outdoor recreational destinations. Green spaces have become one of the few sources of resilience during the coronavirus crisis due to their restorative effects on psychophysical health and community well-being. The aim of this study is to analyse the impact of the COVID -19 pandemic on forest visitation. The results are based upon long-term visitor data acquired via pyroelectric sensors (Eco-Counter) in three forest districts located in Poland (Browsk, Gdansk & Kozienice Forest Districts). The analysis covers the period between January 01, 2019 and December 31, 2020 and the results confirm changes in recreational use in the studied forest areas during the pandemic compared to the preceding year. However, observed changes in forest visitation vary by pandemic period and study area. The ban on access to forest areas significantly reduced the number of forest visits in all studied areas. The number of visits to sub-urban forests (Gdansk Forest District) and to remote nature-based tourist destinations (Browsk Forest District) increased in the later pandemic periods, especially in the summer months of 2020, while it remained the same in a popular nearby recreation area: Kozienice Forest District. There were only minor temporal shifts in the distribution of weekly and daily visits. The results are important for public health preparedness planning in crisis situations and for provisioning conditions supporting societal health and well-being. Objective data on forest visits are necessary for successful management of forest areas and surrounding amenities. More cross-sector collaboration and public participation would be desirable to create sustainable, resilient, and liveable spaces for the society. Management Implications: Long-term visitation monitoring is crucial for successful management of outdoor recreation destinations and their catchment areas. Objective numbers concerning forest visitation from the pre-pandemic and COVID-19 pandemic period allow observing trends and making fact-based management decisions during period of crisis. Changes in the investigated three forest study areas in Poland were not homogenous, which implies the necessity of systematic visitor monitoring in multiple destinations, in order to cover different types of forest areas and also local diversity in recreational use. More intersectoral, interdisciplinary and transdisciplinary exchange would be desirable to better integrate existing on-site visitor monitoring data into decision making processes related to forest management, urban planning, transportation, tourism and public health.
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The COVID-19 pandemic has changed the mobility, accessibility, and behaviors of visitors dramatically. Under the impact of COVID-19, the social carrying capacity and emotion dynamics in parks and recreation areas are expected to change due to the uncertainty of health risks associated with visitors' behaviors. This study conducted an on-site visitor survey at Leiqiong Global Geological Park, a national park located in urban-proximate areas in Haikou, China. This study aims to examine factors impacting visitors' perceived crowding and emotions under varying levels of visitor use in urban national parks in the context of COVID-19. Study results suggest that visitors have the highest level of motivation for scenery and culture viewing and are generally satisfied with the environmental quality and design and COVID-19 prevention strategies and implementation efforts within the park. Moreover, this study suggests that the level of crowding and COVID-19 prevention strategies and implementation can affect visitors' emotions in urban natioanl parks significantly. These findings highlight the importance of enforcing the social carrying capacity limits and COVID-19 prevention strategies for urban parks and protected areas to mitigate physical and mental health risks during the COVID-19 pandemic.
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The challenge of simultaneously providing outdoor recreation opportunities while protecting the public from SARS-CoV-2 virus and COVID-19 transmission, as well as future pandemics, remains foremost on managers' minds. Safe spaces and cultures are paramount for managers and visitors alike. Recommended protective measures against COVID-19 included physically distancing 1.8 m (six-feet) between parties and mask-wearing when distancing is not possible. Adoption of these protective measures is relatively unknown but essential to inform recreation management and planning through future health crises. Such adoption is likely influenced by both the pandemic context and site context, particularly related to visitor density. An observational study assessed mask-wearing behaviors among trail walkers on multiple trails in the United States from November 2020 through May 2021. Trained observers identified if walking groups were prepared to mask or had masks correctly worn as well as if encounters were compliant with the 1.8 m recommendations. Data collected across seven U.S. states enabled comparisons of mask-related behaviors across sites as well as considerations to: the influence of the pandemic context in terms of cases and vaccination rates, mask mandates, and trail density. Results from nearly 3000 encounters revealed significant variance in visible masks, low compliance of mask-wearing in encounters less than 1.8 m, significant influence of both COVID-19 cases and vaccination rates on mask wearing at half the sites, and no impact of state-level mask mandates when controlling for cases and vaccinations. Integrating public health data can inform predictions of compliant behaviors, or lack thereof, and needs exist to advance a safety culture.
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The Hanauma Bay Nature Preserve (HBNP) was designated the first Marine Life Conservation District in Hawai'i in 1967. It is the most popular visitor snorkelling experience on the island of O'ahu. A social carrying capacity study was conducted upon reopening, following a nine-month COVID-19 closure due to travel restrictions. Surveys were compared to three prior surveys conducted between 1990 and 2002 to provide a larger historical context of social dynamics and perceived human impacts over time. Demographics, recreational activities, crowding perceptions, and educational availability were assessed. Visitor activity photos and counts were evaluated in context with survey responses. Perceived visitor contact on the reef was compared to in situ snorkelling impact. These quantitative observations reported an average of one reef disturbance for every two individuals. Photographic analysis of breakage of selected baseline corals prior to closure were compared to corals following reopening of the preserve in 2021. Partial mortality occurred in 60% of coral colonies. Successful management policies that include social carrying capacities should align with biological carrying capacities to balance the health of the ecosystem with a positive experience for visitors. These management strategies provide a holistic approach to advance conservation and meet visitor satisfaction goals. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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This paper presents research focused on the post-pandemic opportunities of special interest tourism development, through the elaboration of the stakeholders' perspectives on the sustainable valorisation of local natural and cultural heritage in the changing global context. The main goal of the research was to analyse the impact of the coronavirus pandemic on key stakeholders' activities and their attitudes towards future sustainable tourism development. The empirical research has been realised in the Municipality of Vrsar, a typical Mediterranean tourist destination characterised by mass tourism and high seasonality. The research was based on a combination of qualitative and quantitative methods, including a literature review, semi-structured interviews with key stakeholders' representatives and a tourists' attitudes survey. The conducted research indicated that the current pandemic could be seen also as an opportunity for all key stakeholders to reflect on the sustainability of the existing tourism practices and develop products which will be more nature-friendly and respond to new needs and expectations of changing tourist demand. The new, more sustainable, post-pandemic model of participatory governance in cultural and tourism development should involve all interested stakeholders, by developing a distinctive offer for special interest tourist segments which could disperse demand in time and space and prolong the tourism season.
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Despite its potential utility for the outdoor recreation sector, there is no centralised surveillance system for recreational walking trails in Ireland and thus trail usage in Ireland during the COVID-19 pandemic is unknown. This paper aims to report trends in football count data on Irish trails during the COVID-19 period and to triangulate findings with openly available mobility data. This descriptive study analysed changes in footfall counts gathered from passive infrared sensors on 33 of Ireland's recreational walking trails between January 2019 and December 2020. The relationship between Google Community Mobility Report (GCMR) data and footfall counts was analysed to corroborate trends in footfall data. Total footfall increased by 6% between 2019 and 2020 on trails included in this analysis. Notably, mean trail usage was between 26% and 47% higher in October-December 2020 than during the same period in 2019. A strong correlation between GCMR data from 'parks' and footfall count data was found. The conclusions of this study are twofold. Firstly, the COVID-19 pandemic increased trail usage in Ireland, especially on trails closer to urban areas and there is potential for this to be a lasting legacy. Secondly, combining multiple data sources can provide trail managers with more detailed representations of trail usage and currently these are not harmonised. Future research should examine ways to encourage sustained recreational walking trail use in new users and implement novel ways to coordinate datasets across systems to monitor visitors on Irish recreational walking trails.
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Amid the Covid-19 pandemic, how to attract back visitors has been a major problem for museums across the world. Among diverse museum activities, human-guided tours remain under-studied to date. A post-hoc case analysis on Xuhui Art Museum provided empirical evidence demonstrating the potential power of guided tours. Quantitative methods in content analysis and semantic network analysis were employed to identify general features of visitor comments from both visitor books and social media. An in-depth interview was also conducted with the Chief Curator. Results reveal that the work of ‘jiangjie', or tour guiding, is greatly appreciated and plays a vital role in improving visitor experience and satisfaction. This study calls for re-evaluation of the functions, potential and effects of tour guiding, and a renewal of live tours for better on-site experience in a post COVID-19 period.