Mountain tourism - towards a more sustainable path

This study highlights the important role that tourism can play in valuing the natural and spiritual heritage of mountains, and the cultural diversity and traditional practices of mountain peoples. Particularly when linked to nature and rural tourism, mountain tourism can make a valuable contribution to promoting sustainable food systems and adding value to local products. Developing sustainable tourism in mountains requires reducing its negative environmental and social impacts and addressing the challenges posed by climate change. The COVID-19 pandemic has already brought about major changes in the mountain tourism sector and substantial losses for communities and businesses. However, consumer appetites for destinations that are outdoors and less crowded have increased in the wake of the pandemic, and these changes usher in new opportunities for mountain destinations to rebuild a greener and more sustainable form of tourism and rethink their products and services. For this to happen, the following measures will be critical: innovation and development of year-round tourism experiences;investments in infrastructure, particularly for the digitalization of mountain tourism services;strengthening multi-level-governance, partnerships and active community participation;and ensuring regular assessments of the impact of tourism on mountains, the effective management of waste and resources, and clearer practices for defining and managing the carrying capacity of highland destinations. Nineteen case studies are featured, which highlight solutions being implemented or tested in mountain regions around the world.

Organ Transplantation from Donors with Active SARS-CoV-2 Infection: The Italian Experience

Purpose: In the present study we want to report safety and outcome of organ transplantation from donors with active SARS-CoV-2 infection in Italy. Method(s): In November 2020 the Italian CNT allowed the use of hearts and livers from asymptomatic donors with incidentally discovered active SARS-CoV-2 infection. Organ could be offered to candidates with asymptomatic or resolved COVID-19 or with a full COVID-19 vaccination (3 doses with documented seroconversion) and to Kidney transplant candidates with resolved COVID-19 or with a full course of anti-COVID-19 vaccination. After transplantation all recipients underwent SARS-CoV-2 RNA detection on respiratory secretions on a weekly basis for up to 4 weeks after transplantation. Result(s): From November 21, 2020 to January 23, 2022 we have performed 44 solid organ transplants (33 livers, including 3 split, 5 hearts and 6 kidneys), in 34 males, and 10 females, mean age 49.5 years, range 0-70), from 32 donors (18 males, mean age 47.9, range 14-82) with active SARS-CoV-2 infection and cause of death unrelated to COVID-19. None of the recipients developed a donor derived SARS-CoV-2 infection. Conclusion(s): We believe that the use of non-lung organs from donors with active SARS-CoV-2 infection in selected and consented recipients may contribute to safely increase the donors pool.

Balance between parsimony and abundance in diagnosis at the time of COVID-19 (Ockham “against” Hickam)

Background and Aim: The persistence of the SARS-CoV-2 pandemic requires Internal Medicine units to manage the complexity of patients with acute CoViD-19 disease, overlapping in most cases with relevant comorbidities. Methods: In two months we cared for 211 patients affected from CoViD-19 pneumonia in our 44-beds Internal Medicine unit;among these patients, 9% had no chronic comorbidities (CC), 12% had 1 CC, 27% had 2 CCs, 30% had 3 CCs, 22% had 4 or more CCs. Results: The most frequent symptoms that led to hospitalization were fever (79%) dyspnoea (51%), cough (44%);the most frequent admitting diagnosis was “respiratory failure in CoViD-19 pneumonia” (PaO2 <60 mmHg and typical pulmonary CT-scan): “pluralitas non est ponenda sine necessitate” - William of Ockham. Chronic comorbidities have often been decisive in influencing the clinical outcome and the lenght of hospitalization. The most common diseases were, as expected, heart failure, diabetes, hypertension, neoplasms, anemia, dementia, septic complications: “a patient can have as many diagnosis as he darn well pleased”- J. Hickam. The patient treatment included management of respiratory failure (O2 supplementation or non-invasive ventilation), treatment of concomitant diseases and antiviral and antibiotic therapy, if indicated. Conclusions: Our data support, even in time of Covid-19, the continuing need for integration between the principle of parsimony (Ockham's razor) and abundance (Hickam's dictum) for the purpose of a correct diagnosis and therapy.

Adult interstitial pneumonia due to respiratory syncytial virus: look and you shall find

Introduction: Once considered a pediatric concern, respiratory syncytial virus (RSV) infection is gaining importance as a cause of significant hospitalisation, need for ICU care and mortality in adults of all ages with chronic comorbidities. Description of the case: A 66-years old woman with an history of smoking, diabetes, obesity, hypertension, chronic renal failure and COPD was admitted to our hospital because of sudden onset of respiratory failure preceded by fever and dry cough since 1 week. At the admission we obtain two negative nasopharyngeal swab test for SARS-CoV-2 RT-PCR assays and, subsequently a positive test for RSV on Respiratory Multiplex PCR assay. A bilateral interstitial pneumonia was detected by a pulmonary CT-scan;blood tests showed WBC 14.400/mm3 Hb 10,5 g/dL PLT 121.000/mm3, CRP 16,3 mg/dL, creatinine 2,81 mg/dL. The patient was treated with intravenous broad-spectrum antibiotic therapy, supplemental 02 with face mask, corticosteroids and loop diuretics, with progressive improvement of clinical status, blood tests and arterial ABG values. A successive control with CT-scan showed a reduction of pneumonia extension and the patient started a respiratory rehabilitation. Conclusions: The COVID-19 pandemic has pointed-out the need for greater diagnostic accuracy of acute respiratory diseases. RSV infection is an often underdiagnosed cause of hospitalisation and mortality even in non-immunocompromised adults affected from chronic comorbidities.

Covid, document production and administrative efficiency: a case study

The article outlines the document production process in some Italian research institutions and compares it to the same pre-pan-demic time span by analyzing whether or not the work organization models that have been adopted have had an impact on the completion time of administrative procedures. The aim was to verify the trend of the performance indicators after the pandemic impact and how the absence of employees at work may have influenced the organizational models. Within specific administrative realities, human relationship is often a pillar to carry out activities correctly. The transition to the management of remote procedures carried out totally in digital form caused inevitably important consequences on the expected results. © 2022, The Author(s).

Shifting Drivers for US House Prices

Historically, US house prices track key housing and economic factors such as housing starts, housing inventory, employment, interest rates, and consumer price indices, to name a few. During the past two years, the US economy has gyrated through myriad distortions resulting from the government's various attempts to control the pandemic. Most recently, the administration has adopted policies that have further disrupted the economy, leading to increases in consumer prices and shortages of goods. We study the potential change in the connection between US house prices and key drivers before and after the onset of the pandemic. We take several approaches to this question, including studying cross-correlations of the multivariate time series, estimating a seasonal ARIMA model, and fitting seemingly unrelated regressions. Finally, we model house prices as a univariate time series. We find some evidence of a change in the association between house prices and other economic measures from before to after the covid response.

But This Time IS Different-COVID Recession

Earlier this year, the US economy dropped from historical highs to a severe downturn almost overnight due to the government's response to the coronavirus outbreak. The pandemic affected all sectors of the economy, including the MBS market. Historically, there has been a direct link between an economic downturn and the fundamentals of the financial markets leading up to the downturn. As we saw in the Great Recession, the exuberance in the mortgage market, poor mortgage loan underwriting quality, and the exponential leverage resulting from the derivative markets contributed to financial disaster. The recent economic downturn resulted not from overleverage and the kind of " wild west" behavior observed in the early to mid-2000s, but from the deliberate shut down of the US economy in an effort to mitigate the spread of the coronavirus. Unlike the Great Recession and the Great Depression, the events leading to the current economic downturn were exogenous to the market. As a result, the economy and the MBS market rebounded quickly.

Clinical findings and disease severity in hospitalized pregnant women with coronavirus disease 2019 (COVID-19)

OBJECTIVE: To investigate the clinical evolution of coronavirus disease 2019 (COVID-19) in hospitalized pregnant women and potential factors associated with severe maternal outcomes. METHODS: We designed a prospective multicenter cohort study of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to 12 Italian maternity hospitals between February 23 and March 28, 2020. Clinical records, laboratory and radiologic examinations, and pregnancy outcomes were collected. A subgroup of patients with severe disease was identified based on intensive care unit (ICU) admission, delivery for respiratory compromise, or both. RESULTS: Seventy-seven patients were included, 14 of whom had severe disease (18%). Two thirds of the patients in the cohort were admitted during the third trimester, and 84% were symptomatic on admission. Eleven patients underwent urgent delivery for respiratory compromise (16%), and six were admitted to the ICU (8%). One woman received extracorporeal membrane oxygenation;no deaths occurred. Preterm delivery occurred in 12% of patients, and nine newborns were admitted to the neonatal intensive care unit. Patients in the severe subgroup had significantly higher pregestational body mass indexes (BMIs) and heart and respiratory rates and a greater frequency of fever or dyspnea on admission compared with women with a nonsevere disease evolution. CONCLUSION: In our cohort, one in five women hospitalized with COVID-19 infection delivered urgently for respiratory compromise or were admitted to the ICU. None, however, died. Increased pregestational BMI and abnormal heart and respiratory rates on admission were associated with severe disease.