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This study investigates how food and beverage services operate as wow factors that enrich the experiential quality of day spas in Phuket, Thailand, addressing the limited empirical research on sensory elements in wellness tourism by utilizing qualitative methods, including in-depth interviews with spa managers and staff (n=10) and a digital ethnography of over 100 customer reviews from Google Reviews. This research identifies key elements contributing to memorable culinary experiences in spas. Findings highlight the importance of sensory engagement, cultural storytelling, personalized offerings, and the incorporation of local ingredients to elevate guest satisfaction and brand identity. The study proposes four strategic guidelines for enhancing food service in spas: leveraging local identity, narrative-driven menus, culturally infused food presentation, and personalized nutrition, aiming to position Phuket as a premier spa destination by integrating innovative food and beverage to create a \"wow\" wellness experience, resulting in a memorable wow factor in Phuket’s spa industry. The new concept is \"A Thai Cultural Journey Through Healing & Cuisine.\" These wow factors offer Thai spa services a unique value that customers cannot find elsewhere. These insights provide practical implications for spa operators and stakeholders in the wellness tourism sector in Phuket, enabling them to enhance the spa customer experience through distinctive Phuket culture, local herbs, and holistic health service standards.

Due to the inadequate literature for fully understanding service quality in the spa industry, this article has the objective to review the related literature to obtain a conceptual understanding of a spa service quality framework. The method is based on a systematic review of related literature by analysing service models/dimensions from past studies and integrating them to obtain a comprehensive framework of spa service quality. Based on the proposed framework, the four themes (dimensions) of spa service quality are identified: (1) spa programmes and products, (2) physical environment, (3) customer-employee interaction, and (4) service outcome. The overview suggests that using a single service model is insufficient to fully understand the spa service quality framework because of its distinct characteristics. The findings can help researchers and spa practitioners to thoroughly understand the overall framework of spa service quality. In particular, the combination of physical environment (technology-based equipment) and better customer-employee interaction can contribute to service innovation for the spa industry. The overview helps to extend the theoretical knowledge (framework) of the traditional SERQVUAL and three-dimensional models (physical, interaction and outcome quality) by adding the product dimension as an additional component of the spa service quality framework.

PurposePoland has a large number of spa enterprises providing spa tourism services, which is closely linked to the largely state-funded spa treatment. Both the period of the COVID-19 pandemic and the period of the following two years after the end of the pandemic involved many changes in the operation of these entities. The purpose of this study is to attempt to identify the determinants of the operation of spa enterprises during both periods, as perceived by managers.Design/methodology/approachData for the study were collected through individual in-depth interviews (IDI) conducted with managers of six Polish spa enterprises, diverse in many respects. This research was exploratory in nature, and inductive thematic analysis was used to analyze the collected data.FindingsThe results of the study indicate that during the pandemic, as a result of the influence of state institutions, macro-level determinants played the greatest role. In the post-Covid period, on the other hand, the surveyed managers paid special attention to personnel and legal conditions. Demand factors manifested by changes in the behavior of spa visitors as well as relations with the environment were also highlighted. The determinants pointed out by the managers were more often perceived as barriers to the operation of enterprises during the analyzed period. The research results show the multidimensional impact of the pandemic on spa enterprises and their subsequent adaptation to post-pandemic realities. The research provides a comprehensive understanding of the operational challenges and development opportunities of spa enterprises.Research limitations/implicationsThe adopted methodology is associated with certain limitations that open up new paths for further analysis and better understanding of the discussed topic. Undoubtedly, the limitation of this research was the small sample size, which resulted from the difficulty of reaching managers of spa enterprises or their unwillingness to participate in this type of research. Perhaps it would be necessary to establish broader cooperation with this environment, e.g. through active participation in conferences associating health resort companies, which would facilitate conducting research in the future. Another limitation was the lack of possibility to record interviews, resulting in the lack of transcription and limiting it only to the researcher’s own notes. This significantly narrowed the possibilities of data analysis. In future research, the theoretical background should be expanded to include literature describing the conditions for the functioning of spa enterprises during and after the COVID-19 pandemic in other countries with a spa operation model similar to Poland. Due to the fact that the research conducted for the purposes of this study was exploratory in nature, its results can be used as source material for further research, enabling a deepening of this topic. Thanks to them, it is possible to create measurement tools that allow the use of more structured qualitative methods (e.g. structured individual in-depth interviews or focused group interviews) or quantitative methods (surveys, questionnaire interviews).Practical implicationsThe results of this study give rise to certain practical implications. Spa enterprises must better prepare for future health crises through flexibility in work organization and sanitary protection. COVID-19 cases, which are still occurring, as well as other serious diseases, cause many negative health effects in patients, and their reduction may become an opportunity to diversify the scope of spa services toward rehabilitation but also prevention. This would allow for a fuller use of the potential of spas. However, in this case, the role of state institutions is also important, as they should include such services in the scope of spa treatment and the financing system. In the case of some spa enterprises, it is necessary to change the marketing strategy, aimed at better matching the offer to younger customers as well as developing promotional activities aimed at attracting new commercial patients. In crisis situations, problems with personnel were noticed, which should be prevented in the future through better management in this area, consisting, for example, of the implementation of motivational programs aimed at encouraging employees to return to work and improve their efficiency. It seems necessary to solve staff shortages, perhaps through education and cooperation with educational institutions as well as through the possibility of employing refugees.Originality/valueThe study fills a certain cognitive gap, as no previous research has been conducted among Polish spa enterprises covering the analyzed period. This research focuses on uncovering the challenges and opportunities for health resort businesses in crisis contexts.

• Elongated hypocotyl5 (HY5) is a key transcription factor that promotes photomorphogenesis. Constitutive photomorphogenic1 (COP1)–Suppressor of phytochrome A-105 (SPA) E3 ubiquitin ligase complex promotes ubiquitination and degradation of HY5 to repress photomorphogenesis in darkness. HY5 is also regulated by phosphorylation at serine 36 residue. However, the kinase responsible for phosphorylation of HY5 remains unknown. • Here, using extensive in vitro and in vivo biochemical, genetic, and photobiological techniques, we have identified a new kinase that phosphorylates HY5 and demonstrated the significance of phosphorylation of HY5 in Arabidopsis thaliana. • We show that SPA proteins are the missing kinases necessary for HY5 phosphorylation. SPAs can directly phosphorylate HY5 in vitro, and the phosphorylated HY5 is absent in the spaQ background in vivo. We also demonstrate that the unphosphorylated HY5 interacts strongly with both COP1 and SPA1 and is the preferred substrate for degradation, whereas the phosphorylated HY5 is more stable in the dark. In addition, the unphosphorylated HY5 actively binds to the target promoters and is the physiologically more active form. Consistently, the transgenic plants expressing the unphosphorylated form of HY5 display enhanced photomorphogenesis. • Collectively, our study revealed the missing kinase responsible for direct phosphorylation of HY5 that fine-tunes its stability and activity to regulate photomorphogenesis.

The present article includes descriptive research about how water resources in Romanian medical spas could be better promoted to increase their visibility. Romania is one of the European countries with impressive potential in terms of balneology, having a wide diversity of natural factors that allow treating several medical conditions in the same resort. In addition, one-third of the mineral and thermal water springs in Europe are present on the Romanian territory, making Romania one of the most important European destinations in terms of natural spa resources. The present research aims to illustrate how the Romanian medical spas communicate with tourists about the therapeutic water available in five medical spas: Băile Felix-1 Mai, Techirghiol, Băile Tușnad, Sovata and Covasna, having as its main objective to raise the awareness among the spas representatives regarding the necessity of water management implementation. The research is based on primary data obtained from the official websites of the resorts included in the study and in the published scholarly articles that approached the Romanian medical spas.

Abstract Background We conducted a longitudinal study to evaluate changes in the clinical presentation and epidemiology of Staphylococcus aureus bacteremia (SAB) in an academic, US medical center. Methods Consecutive patients with monomicrobial SAB were enrolled from January 1995 to December 2015. Each person’s initial bloodstream S. aureus isolate was genotyped using spa typing. Clonal complexes (CCs) were assigned using Ridom StaphType software. Changes over time in both the patient and bacterial characteristics were estimated with linear regression. Associations between genotypes or clinical characteristics and complications were estimated using multivariable regression models. Results Among the 2348 eligible participants, 54.2% had an implantable, foreign body of some type. This proportion increased significantly during the 21-year study period, by 0.96% annually (P = .002), as did comorbid conditions and acquisition outside of the hospital. Rates of any metastatic complication also significantly increased, by 0.94% annually (P = .019). Among the corresponding bloodstream S. aureus isolates, spa-CC012 (multi-locus sequence type [MLST] CC30), -CC004 (MLST CC45), -CC189 (MLST CC1), and -CC084 (MLST CC15) all significantly declined during the study period, while spa-CC008 (MLST CC8) significantly increased. Patients with SAB due to spa-CC008 were significantly more likely to develop metastatic complications in general, and abscesses, septic emboli, and persistent bacteremia in particular. After adjusting for demographic, racial, and clinical variables, the USA300 variant of spa-CC008 was independently associated with metastatic complications (odds ratio 1.42; 95% confidence interval 1.02–1.99). Conclusions Systematic approaches for monitoring complications of SAB and genotyping the corresponding bloodstream isolates will help identify the emergence of hypervirulent clones and likely improve clinical management of this syndrome. During 21 years of continuous enrollment in this prospective, observational cohort study of 2348 patients, bacterial genotypes, patient characteristics, and metastatic complication rates changed significantly. The emergence of the USA300 genotype was independently associated with an increase in metastatic complications.

Background. This single-center study aimed to evaluate the clinical efficacy of upadacitinib (UPA) in patients with axial spondyloarthritis (axSpA) and to assess its long-term treatment persistence. A secondary objective was to identify potential predictors of treatment persistence with UPA.   Materials and Methods. All adult patients diagnosed with axSpA and treated with UPA for at least six months were included. Clinical data were retrospectively collected at baseline and after 3, 6, and 12 months of therapy. Outcome measures included changes in disease activity assessed by ASDAS-CRP and BASDAI, pain intensity evaluated using a visual analogue scale (VAS), and functional limitation measured with the BASFI. The UPA drug retention rate (DRR) at 18 months was estimated using Kaplan–Meier survival analysis, and the influence of potential modifying factors was assessed using the log-rank test.   Results. A total of 49 patients (35 F, 14 M) with a mean ± SD age at baseline of 50.3 ± 12.7 years were included. Median (IQR) baseline values were: ASDAS-CRP = 3.2 (1.2), BASDAI = 6.5 (3.2), BASFI = 4.1 (3.2), and VAS-pain = 7.0 (3.0). From month 3 onward, there was a statistically significant reduction in median ASDAS-CRP (p < 0.01), BASDAI (p < 0.01), BASFI (p = 0.047), ESR (p = 0.02), and VAS-pain (p < 0.01). At month 6, further decreases were observed in ESR (p < 0.01), ASDAS-CRP (p < 0.01), BASDAI (p < 0.01), and BASFI (p = 0.02). A significant improvement in BASFI (p < 0.01) was also recorded between months 6 and 12, while the other parameters reached a plateau (Fig. 1). At the last follow-up, 85.4% of patients remained on UPA therapy; seven patients had discontinued treatment (n = 1 primary inefficacy; n = 5 adverse events). The UPA DRR at 6, 12, and 18 months was 95.5%, 85%, and 81.3%, respectively (Fig. 2). Sex (p = 0.32), BMI (p = 0.07), radiographic SpA (p = 0.88), prior bDMARDs use (p = 0.54), and fibromyalgia (p = 0.08) did not significantly affect treatment persistence.   Conclusions. This study confirms the efficacy of upadacitinib in achieving a rapid reduction in disease activity and pain among patients with axSpA, with significant improvements detectable from month 3 and progressive enhancement of functional capacity up to month 12. The observed DRR indicates sustained long-term effectiveness and a favorable tolerability profile, which appear to be independent of sex, BMI, treatment line, or coexisting fibromyalgia.

Background. To evaluate the influence of concomitant psoriasis (PsO) on the clinical and therapeutic pattern of a monocentric cohort of patients affected by Spondyloarthritis (SpA) associated with inflammatory bowel diseases (IBD). Materials and Methods. This study represents a preliminary phase of an ancillary analysis of the DIAMANTE project (Early diagnosis of spondyloarthritis in a cohort of patients affected by inflammatory bowel disease), developed with the general objective of determining the prevalence, predictors, and outcomes of SpA in a cohort of IBD patients, within the context of a close and structured collaboration between gastroenterologists and rheumatologists. Within the DIAMANTE cohort, two subgroups of patients were identified for the study: patients with enteropathic SpA and a concomitant personal diagnosis of PsO (Group 1: IBD+SpA+PsO), and patients with a diagnosis of SpA only (Group 0: IBD+SpA). For both groups, the following demographic, clinical, and therapeutic data were recorded and compared: sex, association with IBD pattern, peripheral joint involvement, axial involvement, history of dactylitis, need for biologic therapy, and multi-resistance to “targeted” drugs (defined as discontinuation due to inefficacy of at least two biologic drugs or small molecules). A p-value <0.05 was considered statistically significant using Fisher’s exact test and the Chi-square test. Results. Data from 665 consecutive patients with IBD recruited between November 2023 and April 2025 were analyzed. Within this cohort, 95 (14%) had a concomitant diagnosis of SpA; among these, 21 (22%) also had a diagnosis of PsO (Group IBD+SpA+PsO), while 74 (78%) had only SpA associated with IBD (Group IBD+SpA). Comparative analysis between the two groups showed notable—though only trending toward statistical significance—differences in terms of female prevalence (71% vs 54%, p=0.15), frequency of peripheral involvement (62% vs 49%, p=0.28), and use of biologic drugs (91% vs 77%, p=0.17). Most notably, a significantly higher frequency of multi-resistance to biologic treatment was observed in patients with concomitant PsO compared to those with IBD and SpA only (29% vs 11%, p=0.04). No significant differences were observed regarding the distribution of different IBD types (ulcerative colitis, Crohn’s disease, indeterminate forms) between the two study groups. Conclusions. In patients with SpA associated with IBD, a frequent concomitant association with PsO—another extra-articular domain typical of the spondyloenthesitis spectrum—was demonstrated. The results of this exploratory analysis suggest the usefulness of further investigating, in larger prospective cohorts, the impact that such a dual combination of extra-articular manifestations may have on disease characteristics and, in particular, on therapeutic management.

This paper proposes a meta heuristic optimization algorithm, called Crayfish Optimization Algorithm (COA), which simulates crayfish’s summer resort behavior, competition behavior and foraging behavior. The three behaviors are divided into three different stages to balance the exploration and exploitation of algorithm. The three stages are summer resort stage, competition stage and foraging stage. The summer resort stage represents the exploration stage of the COA. The competition stage and foraging stage represent the exploitation stage of the COA. Exploration and exploitation of COA are regulated by temperature. When the temperature is too high, crayfish will enter the cave for summer vacation or compete for the same cave. When the temperature is appropriate, crayfish have different foraging behaviors according to the size of food. Among them, the amount of food eaten by crayfish is related to food intake. Through temperature regulate exploration and exploitation process in COA, the COA has higher randomness and global optimization effect. To verify the optimization effect of COA, in the experimental part, 23 standard benchmark functions and CEC2014 benchmark functions are used to test, and 9 algorithms are selected for comparative experiments. The experimental results show that COA can balance the exploration and exploitation, and achieve good optimization effect. Finally, the COA is tested in five engineering problems, and finally achieves better results. The source code website for COA is https://github.com/rao12138/COA-s-code.

The present paper consists of a co-word analysis of the previous research in the medical spa field published in the Web Science Core Collection database. The study’s main purpose is to identify the past trends in the medical spa field from the tourist and medical perspectives and to anticipate the future research focuses in the field. In this regard, the article is based on four objectives that create a descriptive picture of the research in the medical spa area, such as (i) studying the current state of the art, (ii) analysing the most visible articles in the field, (iii) highlighting the leading research interests in medical spa research and (iv) anticipating new possible research trends that link cost-effective medical spa activity to COVID-19 post-recovery treatments. A total of 627 articles, published between 1997 and 2021 (March), were analysed, and the data were interpreted using the VOS Viewer software. The study results indicate that high interest in medical spas started to become observable in 2015, when the funding bodies became interested in this field and began supporting publishing and research regarding medical spas. The main subjects investigated in previous studies were related to the specific issues of the industry and tourism activity. They also considered the medical approach of the spa and the use of natural resources in treating different diseases. Except for these main interests, since 2020, it has started to become evident that another approach in the published studies may lead to a new trend in research. The study results show that researchers have begun to investigate the possibility of using medical spa resorts to aid post-COVID-19 recovery, which is considered a cost-efficient option for completing traditional treatment. This new focus in research proves that the medical spa field can rebrand itself as playing a supportive role in national healthcare systems in countries with a long tradition in balneotherapy, and gives a new developing trajectory to the medical spa industry.