Boutique festivals and tourism innovation: The case of Sicily

The format of boutique festival is promoted by public and private actors as a model of creative, sustainable and highly interactive event, which favors practices and processes of tourism innovation, especially useful to respond to the challenges related to the emergence of the new urban tourism, as well as to the recovery of tourism in post Covid-19 context. By analyzing the discourses and the imaginaries accompanying the incorporation of the global model in the policies and practices of boutique festivals in Sicily, the aim of the paper is to reflect on their potentials and limits in terms of creative and sustainable tourism innovation and regeneration in the post Covid-19 era. © 2023 Pacini Editore. All rights reserved.

THE CONTRIBUTION OF CRUISE SHIPS TO THE SOUND EMISSION OF A HARBOUR

In recent years, the growth of cruise tourism has often been at the centre of controversy due to the environmental impact, especially for those harbours that, for historical and urban planning reasons, are in close contact with urban areas of particular value or under cultural heritage protection. The deadlock of cruise activities due to the COVID-19 pandemic emergency created the conditions for observing the effects of the substantial disappearance of a specific sound source from the harbours of many cities. This paper presents the evaluation of the contribution of large cruise ships to the overall noise emitted by a specialized cruise harbour and the consequences of their absence on the urban acoustic climate. © International Institute of Acoustics and Vibration (IIAV), 2022.

The impact of influenza viruses and influenza vaccination coverage in Italy in the 2021-2022 season: the InfluNet integrated surveillance system and the introduced news

Introduction: In Italy, the InfluNet integrated influenza surveillance system, during the 2021-2022 season, in the middle of the SARS-CoV-2 pandemic, was adequately modified and strengthened to support the monitoring of the spread of the SARS-CoV-2 virus. The present work aims to describe the impact of the 2021-2022 flu season on the Italian population, also in the light of the changes introduced in the InfluNet surveillance system. For a complete assessment of the impact of influenza viruses, the influenza vaccination coverage achieved during the season was also evaluated. Materials and methods: InfluNet is based on a network of sentinel physicians made up of general practitioners and pediatricians, recruited by the Italian Regions, who report cases of Influenza Like Illness (ILI) observed among their patients. Sentinel physicians (sentinel flow) and other doctors working in hospitals (hospital flow) also collaborate in the collection of biological samples for the identification of circulating viruses. To evaluate the impact of ILI on the Italian population, overall incidence (per 1,000 assisted) was calculated, as well as stratified by age group. Furthermore, vaccination coverage (%) in the total Italian population and by age group were also calculated. Results: The 2021-2022 season was characterized by limited circulation of flu viruses. At the end of December 2021, the incidence of ILI reached an initial peak of 5.16 cases per 1,000 assisted. A second peak was identified, also very contained, at the end of March 2022, equal to 5.25 cases per 1,000 assisted. Virological surveillance made it possible to characterize the two waves: the first was mainly supported by the circulation of respiratory syncytial virus, especially in children under five years of age, while the second wave was characterized by the circulation of influenza viruses. 14.4% of clinical samples analyzed by InfluNet network laboratories were found to be positive for influenza viruses. Among the positive samples, 82.9% belonged to the A(H3N2) virus and 29.3% tested positive for SARS-CoV-2. Vaccination coverage in the 2021-2022 season, which decreased in all age groups, was 20.5% in the general population and 58.1% in the elderly population. Discussion and conclusions: In Italy, the 2021-2022 season marked the return of the circulation of influenza viruses after the start of the COVID-19 pandemic, though in a moderate intensity. The InfluNet surveillance system is turning into a respiratory virus monitoring system and has made it possible, this season, to characterize the trend of ILI and to attribute the increase in cases to the various respiratory viruses. Vaccination coverage decreased compared to the previous season. The adoption of preventive measures in recent seasons has profoundly changed the epidemiology of ILI and respiratory viruses in terms of intensity and seasonality. The accumulation of susceptible population, especially in the pediatric age groups, has partly allowed a greater circulation of respiratory viruses in the 2021-2022 season and will also presumably allow it in future seasons. It is therefore increasingly important to vaccinate against flu to reduce serious complications and deaths, especially in the fragile population.

The National Surveillance System for legionellosis: results for the year 2021

Introduction: Legionellosis is the common name for infections caused by bacteria belonging to the genus Legionella. The most severe clinical presentation is an interstitial pneumonia, named Legionnaires' disease, caused by Legionella pneumophila. The disease is subject to mandatory reporting and laboratory tests are required to confirm the diagnosis. This article summarises the results of the National Surveillance System (NSS) for legionellosis for the year 2021, coordinated and managed by the Istituto Superiore di Sanita (ISS). This report highlights also the microbiological surveillance data from the national reference laboratory for legionellosis of the ISS. Materials and methods: The surveillance forms, filled in by the doctors who diagnose legionellosis, are analyzed by the NSS for possible sources of infection, clinical picture and etiological assessment. In parallel with the NSS there is a European Surveillance System for Travel associated Legionnaires 'disease, the European Legionnaires' Disease Surveillance Network (ELDSNet).

Differences in the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals using routine data.

OBJECTIVES: This study was to compare the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals. STUDY DESIGN: We retrospectively analysed data from the COVID-19 Italian integrated surveillance system (14 September 2020 to 17 October 2021). METHODS: We used multivariable Cox proportional hazards models to estimate the hazard ratio (HR) of infection and, among cases, the HRs of death, hospitalisation and subsequent admission to intensive care unit in non-Italian nationals relative to Italian nationals. Estimates were adjusted for differences in sociodemographic characteristics and in the week and region of diagnosis. RESULTS: Of 4,111,067 notified cases, 336,265 (8.2%) were non-Italian nationals. Compared with Italian nationals, non-Italians showed a lower incidence of SARS-CoV-2 infection (HR = 0.81, 95% confidence interval [CI]: 0.80-0.81). However, once diagnosed, they were more likely to be hospitalised (HR = 1.90, 95% CI: 1.87-1.92) and then admitted to intensive care unit (HR = 1.08, 95% CI: 1.04-1.13), with differences larger in those coming from countries with a lower human development index. Compared with Italian cases, an increased rate of death was observed in non-Italian cases from low-human development index countries (HR = 1.41, 95% CI: 1.23-1.62). The HRs of SARS-CoV-2 infection and severe outcomes slightly increased after the start of the vaccination campaign. CONCLUSIONS: Underdiagnosis and delayed diagnosis in non-Italian nationals could explain their lower incidence compared with Italians and, among cases, their higher probability to present clinical conditions leading to worse outcomes. Facilitating early access to vaccination, diagnosis and treatment would improve the control of SARS-CoV-2 transmission and health outcomes in this vulnerable group.

Isolated pauci-immune pulmonary capillaritis associated with an extensive bilateral hemothorax and pleuro-pericarditis

Introduction: Isolated pauci-immune pulmonary capillaritis (IPIPC) is a rare disorder characterized by small vessel vasculitis limited to alveolar capillaries in the absence of systemic manifestations. There are very few case reports of this disorder in the medical literature. Case Report: A 37-yo male with no known history of autoimmune pathology who was admitted to the hospital for evaluation and treatment of dyspnea and thoracalgia. Peripheral blood cultures, serum studies to detect Legionella and Pneumococcus antigens, and a nasopharyngeal swab test for covid-19 were all negative. Chest imaging revealed bilateral pleural effusions from the base to the apices with concomitant atelectasis of the adjacent lung parenchyma. Although the results of an 18F-PET-CT scan revealed no pathological uptake, video-assisted thoracoscopy revealed diffusely edematous pleura with crater-like patches with new onset of venous vessel varicosities, intra-alveolar hemorrhages associated with disordered vascularization, suggesting small vessel vasculitis. Histologic findings included widespread intra-alveolar hemorrhage with organizing injury, hemosiderin-laden macrophages, scattered intra-arterial thrombi, and diffuse perivascular neutrophilic infiltrates consistent with a diagnosis of capillaritis. Conclusions: Given the negative immune studies (save for a weakly-positive lupus anticoagulant and no evidence for extra-pulmonary vasculitis, the diagnosis was Isolated pauci-immune pulmonary capillaritis. The patient recovered in response to immunosuppressive/anti-inflammatory therapy.

Salivary molecular tests for the diagnosis of SARS-CoV-2 infection: an experimental monitoring approach in Italian schools throughout the 2021-2022 school year

Introduction: The widespread of SARS-CoV-2 infection has raised concerns about the potential role of schools in community transmission. In Italy, a national screening test strategy was implemented throughout the 2021-2022 school year to monitor virus circulation in schools. Materials and methods The National Plan for Monitoring the circulation of SARS-CoV-2 virus in primary and secondary schools aims at testing students attending a sample of primary and secondary schools in each Italian Region, by means of molecular salivary testing, every two weeks. We report preliminary data for the period 13/9/2021-13/2/2022 comparing them with the trend of the incidence rate in the Italian population aged 6-13 years. Results A total of 486,206 students from across the country were invited for the screening 273,738 (55.3%) underwent the test and 1086 (0.40%) came back positive. The highest participation rate (> 60%) was recorded on January 2022. Incidence rate was low (< 5 x 10,000 students tested) between September and December 2021, it increased steadily on January 2022 (20.8 x 10,000) and it began to slowly decrease on February 2022. A similar trend was recorded in general population. Of note, a national average of 10% of tests performed on saliva gave indeterminate results. Discussion and conclusions The heterogeneous adherence of Regions to the Plan, the low testing acceptance by students and the high rate of indeterminate results suggest that saliva sampling should be considered carefully when planning a screening campaign in schools. Screening tests in schools emerged as a useful strategy in detecting and contrasting the spread of SARS-CoV-2, but more research is needed on the determinants of student participation and saliva sampling methods.

Epidemiological characteristics of COVID-19 cases in Italy: an analysis from a sex/gender perspective

The current study aims to describe the characteristics of the SARS-CoV-2 infection from the beginning of its spread in Italy, in February 2020, up to April 2021 across the tested positive cases in Italy. Global data strongly suggest that a sex/gender-based disparity exists, with men being at higher risk of SARS-CoV-2 infection, hospitalization, poor clinical outcomes and death due to the coronavirus disease 2019 (COVID-19). With this in mind, we focused on a sex/gender analysis, in order to better understand the role of sex/gender-related determinants in the outcome of COVID-19. We used rou-tinely collected data retrieved from the Italian National Surveillance System of confirmed SARS-CoV-2 infections. Data is collected and entered daily on a secure online platform by the 19 Italian Regions and the two Autonomous Prov-inces, and all the system is coordinated by the Italian National Institute of Health. In total, 4.027.075 cases occurred from February 2020 to April 2021, and were included in the analysis. Our results show that in Italy the numbers of SARS-CoV-2 infections are quite similar in women and men, even if some differences in ex-posure and outcomes between sexes are present. In par-ticular, the case fatality rate over 50 years of age is signifi-cantly higher in men than in women, with the difference increasing with age. These data further confirm the importance of the integration of a sex/gender analysis in future studies, thus enabling effective public health measures and gender-specific solutions. © 2022, Il Pensiero Scientifico Editore s.r.l. All rights reserved.

COVID-19: identifying the main outcome predictors. A retrospective cohort study in Northern Italy.

OBJECTIVE: The need for efficient drugs and early treatment of patients with SARS-CoV-2 infection developing COVID-19 symptoms is of primary importance in daily clinical practice and it is certainly among the most difficult medical challenges in the current century. Recognizing those patients who will need stronger clinical efforts could effectively help doctors anticipate the eventual need for intensification of care (IoC) and choose the best treatment in order to avoid worse outcomes. PATIENTS AND METHODS: We enrolled 501 patients, consecutively admitted to our two COVID hospitals, and collected their clinical, anamnestic and laboratory data on admission. The aim of this retrospective study was to identify those data that are strictly associated with COVID-19 outcomes (IoC and in-hospital death) and that could somehow be intended as predictors of these outcomes. This allowed us to provide a "sketch" of the patient who undergoes, more often than others, an intensification of care and/or in-hospital death. RESULTS: Males were found to have a double risk of needing an IoC (OR=2.11) and a significant role was played by both the PaO2/FiO2 ratio on admission (OR=0.99) and serum LDH (OR=1.01). The main predictors of in-hospital death were age (OR=1.08) and the PaO2/FiO2 ratio on admission (OR=0.99). CONCLUSIONS: Male patients with high serum LDH on admission are those who undergo more often an intensification of care among COVID-19 inpatients. Both age and respiratory performances on admission modify the prognosis within the hospitalization period.

Legionellosis in Italy and COVID-19 pandemic: results of the Italian National Surveillance System for legionellosis for the year 2020

Introduction: 2020 will be remembered as the year of the COVID-19 pandemic, which caused 2,107,166 cases and 74,159 deaths in Italy as of December 31st. At the same time, protective measures against COVID-19 have proved to be effective for other infectious pathogens, since we noticed the absence or reduction of some infectious diseases, such as measles and seasonal flu. Legionellosis may also have been affected by these measures. Legionellosis is a form of interstitial pneumonia subject to mandatory reporting and laboratory tests are required to confirm the diagnosis. This article summarises the results of the Italian National Surveillance System (INSS) for legionellosis, coordinated and managed by the Istituto Superiore di Sanita (ISS), for the year 2020. Furthermore, this report shows the microbiological surveillance data from the National Reference Laboratory for Legionellosis of the ISS. Materials and methods: The surveillance forms, filled in by the doctors who diagnose legionellosis, are analyzed by the NSS for possible sources of infection, clinical picture and etiological assessment. In parallel with the INSS there is a European Surveillance System for travel-associated Legionnaires' disease, the European Legionnaires' Disease Surveillance Network (ELDSNet).

Impact of 2020-21 seasonal influenza in Italy during the COVID-19 pandemic

Introduction: Influenza and COVID-19 are high transmission pathologies which have a different median incubation period. Although the symptoms are similar, people are more likely to be affected by severe and/or critical COVID-19 infection than severe and/or critical influenza infection. It is well proven that school closure and personal protection measures (mask-wearing and social distancing) are effective in reducing the spread of infection. This study aims to highlight the impact of 2020-21 seasonal influenza on the Italian population during the COVID-19 pandemic and to identify possible reasons for that. Materials and methods: To describe the impact of influenza on the population, data from the Integrated Influence Surveillance InfluNet and vaccination coverage in Italy in the 2020-21 season were used. Influenza Like Illness (ILI) incidence rates per thousand patients and influenza vaccination coverage (%) were calculated on the total population and by age group.

Review and evaluation of heart rate monitoring based vital signs, a case Study: Covid-19 Pandemic

The monitoring of vital signs is essential in the clinical setting, including temperature, respiratory, and heart rates. Remote monitoring devices, systems, and services are emerging as vital signs monitoring must be performed daily. Different types of sensors can be used to monitor breathing patterns and frequency. However, the respiratory rate remains the least measured vital sign in many scenarios due to the intrusiveness of most of the sensors adopted. This is not the case with Covid-19, which directly infects the respiratory system. In this paper, we present a state of the art on the different applications that monitor temperature, heart rate, and restorative rate, as well as the evaluation of an algorithm that extracts the heart rate from an RGB camera. © 2021 IEEE.

SARS-CoV-2 infection and H1N1 vaccination: does a relationship between the two factors really exist? A retrospective analysis of a territorial cohort in Ferrara, Italy.

OBJECTIVE: SARS-CoV-2 has been compared with other strains of coronaviruses, SARS-CoV and MERS-CoV, and with the flu viruses: all of them manifest themselves with respiratory symptoms and, although their genetic patterns are similar, the spread of SARS-CoV-2 infection has quickly reached global dimensions, demonstrating that SARS-CoV-2 is a virus with greater spreading capacity, albeit less lethal. Compared with influenza viruses, coronaviruses have a longer incubation period and the patients with coronaviruses' syndromes develop more severe diseases requiring frequent hospitalizations and intensive care admissions. The aim was to explore the relationships between seasonal influenza vaccination and coronavirus infection and to understand whether this hypothetic role by the flu vaccines modifies SARS-CoV-2 infection's outcomes. PATIENTS AND METHODS: In this retrospective, multicenter study, we enrolled 952 patients diagnosed with SARS-CoV-2 infection; 448 were admitted to our two main hospitals in Ferrara territory, while the remaining 504 were isolated at home. We compared the group of patients who had been vaccinated for influenza in the previous 12 months to that of unvaccinated patients. RESULTS: Significant differences were found for both the need for hospitalization and 30-day mortality between vaccinated and unvaccinated patients. We found age to be the only independent risk factor for a worse 30-day prognosis, while gender, influenza vaccinations and age itself were independent risk factors for undergoing hospitalization. CONCLUSIONS: In our groups of patients, we found a relationship between seasonal influenza vaccinations and SARS-CoV-2 infection. Age seems to be the main risk factor for short-term mortality in COVID-19 inpatients, while the influenza vaccination is, together with gender and age itself, a determining factor in predicting the need for hospitalization.

SARS-CoV-2 and finding of vein thrombosis: can IMPROVE and IMPROVEDD scores predict COVID-19 outcomes?

OBJECTIVE: Diffuse thrombosis represents one of the most predominant causes of death by COVID-19 and SARS-CoV-2 infection seems to increase the risk of developing venous thromboembolic diseases (VTE). Aim of this study is to analyze the relationship between validated predictive scores for VTE such as IMPROVE and IMPROVEDD and: (1) Intensification of Care (IoC, admission to Pulmonology Department or Intensive Care Unit) (2) in-hospital mortality rate 3) 30-days mortality rate. PATIENTS AND METHODS: We retrospectively evaluated 51 adult patients with laboratory diagnosis of SARS-CoV-2 infection and calculated IMPROVE and IMPROVEDD scores. All patients underwent venous color-Doppler ultrasound of the lower limbs to assess the presence of superficial vein thrombosis (SVT) and/or deep vein thrombosis (DVT). Patients with normal values of D-dimer did not receive heparin therapy (LMWH); patients with ≥ 4 ULN values of D-dimer or with a diagnosis of DVT were treated with therapeutic LMWH dosage, while the remaining patients were treated with prophylactic LMWH dosages. RESULTS: We found strong relations between IMPROVE score and the need for IoC and with the in-hospital mortality rate and between the IMPROVEDD score and the need for IoC. We defined that an IMPROVE score greater than 4 points was significantly associated to in-hospital mortality rate (p = 0.05), while an IMPROVEDD score greater than 3 points was associated with the need for IoC (p = 0.04). Multivariate logistic analysis showed how IMPROVE score was significantly associated to in-hospital and 30-days mortality rates. CONCLUSIONS: IMPROVE score can be considered an independent predictor of in-hospital and 30-days mortality.

Monitoring of physiological signs and their impact on the Covid-19 pandemic: Review

Recently, monitoring of physiological signs such as heart rate and respiratory rate is very important, especially when we are talking about pandemics like Covid-19. In this paper we present a state of the art on the different techniques used for heart rate and respiratory rate extraction. These techniques presented will be based on image processing, were traditional sensor-based techniques creating a lot of problem at the contact level between patient and doctor. For this reason, we focus on non-contact techniques to avoid these problems. Generally, the literature review shows that non-contact monitoring techniques are based on RGB, thermal and multispectral cameras, the choice between these different cameras depends on the application that will be used. For example, thermal cameras are dedicated to the prediction of respiratory rate and temperature, while RGB and multispectral cameras are used for heart rate. © The Authors, published by EDP Sciences, 2021.