A Report of Two Cases of Solid Facial Edema in Acne

Solid facial edema (SFE) is a rare complication of acne vulgaris. To examine the clinical features of acne patients with solid facial edema, and to give an overview on the outcome of previous topical and systemic treatments in the cases so far published.; We report two cases from Switzerland, both young men with initially papulopustular acne resistant to topical retinoids.; Both cases responded to oral isotretinoin, in one case combined with oral steroids. Our cases show a strikingly similar clinical appearance to the cases described by Connelly and Winkelmann in 1985 (Connelly MG, Winkelmann RK. Solid facial edema as a complication of acne vulgaris. Arch Dermatol. 1985;121(1):87), as well as to cases of Morbihan's disease that occurs as a rare complication of rosacea.; Even 30 years after, the cause of the edema remains unknown. In two of the original four cases, a potential triggering factor was identified such as facial trauma or insect bites; however, our two patients did not report such occurrencies. The rare cases of solid facial edema in both acne and rosacea might hold the key to understanding the specific inflammatory pattern that creates both persisting inflammation and disturbed fluid homeostasis which can occur as a slightly different presentation in dermatomyositis, angioedema, Heerfordt's syndrome and other conditions

Réflexions sur les subjectivités occupées et les espaces de résistance dans Kannjawou, roman de l'écrivain haïtien Lyonel Trouillot

The article proposes a reflection on how the intertwined themes of power, subjectivity and agency are articulated in Lyonel Trouillot's 2016 novel Kannjawou. In its narrative space, the hermeneutics of collective reality is produced by an individual memory engaged in questioning the relations of power that affect subjectivity and action of both the occupied Haitians and the foreigners occupiers. A close reading of the novel seeks to unpack its ethnographic thickness, its capacity to built layers of understanding around the stakes of a disadvantaged microcosm in contemporary Port-au-Prince

Clinical assessment of skin phototypes: watch your words!

Fitzpatrick skin phototype classification is widely used to assess risk factors for skin cancers. This skin type evaluation is easy to use in clinical practice but is not always applied as initially described, nor practiced in a standardised way. This can have implications on the results of relevant dermato-epidemiological studies. To demonstrate, in a large multinational setting, that the phrasing of questions on sun sensitivity can have a strong impact on the perception and reporting of skin phototype, as well as the importance of a standardised procedure for phototype assessment. Using data collected from 48,258 screenees of the Euromelanoma campaign in six European countries from 2009 to 2011, we analysed the impact of change in the question phrasing on phototype classification in each country. Changing the wording of a question to assess the phototype of a person also significantly influenced the classification of phototypes in different countries (p<0.001 for each country). The difference essentially corresponded to a shift towards a less sun-sensitive skin type when a shorter question that did not include skin colour description was used. The only exception was Portugal where phototype was not patient-assessed and classification shifted towards a more sun-sensitive phototype. Results were statistically significant and highly consistent, irrespective of gender. The phrasing of questions on skin type is important and substantially influences reporting. A standardized procedure to classify phototypes should be used in order to obtain comparable data between studies

Understanding the role of food sustainability as a strategic value driver in hotel industry: an Italian perspective

The concept of business sustainability has received considerable attention from both practitioners and academicians in recent times and the concerns related to environmental protection have brought changes in consumer demands and behaviors (Mendleson and Polonsky, 1995; Ottman, 1992). In that context the supply-side of the tourism industry is making effort to adopt sustainable practices (Griffin and Delacey, 2003; Zimmer et al., 1994;) and, gradually, going green is believed to be an effective competitive frame in the hospitality industry (Han et al., 2009; Manaktola and Jauhari, 2007; Wolfe and Shanklin, 2001). As a result, a critical challenge for hotels is to gain a better understanding of current and potential customers! desireandintentionforgreenconsumption(Hanetal.,2009).Withinthatscenario,attemptshave been made in investigating tourists! perceptions of environmentally responsible practices implemented by tourism businesses (Andereck, 2009), in examining how responsible purchasing might influence tourism product purchasing (Chafe, 2007) and in exploring relationships between consumers! sustainable purchasing practices and their related attitudes towards purchasing a tourist product (Pereira et al., 2012). Despite some research efforts have been focused in examining different sustainable practices such as recycling programs, architectural design and construction sensitive to both the local culture and environment, alternative energy usage (Griffin and Delacey, 2003; Mehta et al., 2002), the topic of food sustainability remains largely unexplored in hospitality, although the phenomenon seems to be highly relevant considering the experiential nature of the services and the products offered in the industry. This study aims to address this omission. In fact, food can play a vital role in delivering green services to customers (Jang et al., 2011). Generally the term green is alternatively known as eco-friendly, environmentally friendly or sustainable (Han et al, 2009; Pizam, 2009; Laroche et al, 2001) and, especially in the restaurant industry, the term green food has come to mean organic, local and sustainable food (LaVecchia, 2008), even though an accepted and organizational definition is currently missing (Jang et al., 2011)

Estimating Destination Carrying Capacity: The Big Data approach

Before the emergence of the COVID-19 crisis, forecasts of the continued tourism growth made overcrowding and related negative consequences for destination image and sustainability, the primary concerns for many destinations (Peeters et al., 2018). Although the emergency caused by the COVID-19 drastically reduced visitation of many renowned destinations, the hopes of back to normal are also associated with fears of large crowds invading touristic spots once the travel will be allowed. Accordingly, a deepening understanding of managing tourist flows and crowds appears essential for policymakers (Butler & Dodds, 2019). The present study aims at assessing social carrying capacity from the demand side (tourists). This research, combining sentiment scoring derived from TripAdvisor online reviews with official statistics about touristic flows, derived and compared two destination carrying capacity thresholds based on positive and negative emotions indices. The managerial and theoretical implications of these findings are discussed

Food Sustainability as a Strategic Value Driver in the Hotel Industry

This paper aims at exploring the impact of green food on consumers’ purchase attitudes toward a hotel stay and on consumers’ behavioral intentions (i.e., intention to visit the hotel, intention to offer positive recommendations to others and willingness to pay a premium price), focusing on an Italian perspective where the food is a worldwide famous cultural element. This research employed a survey sent out by email to a database of contacts provided by an Italian company that operates in tourism. Data collection was completed in four weeks and the initial dataset counted 3586 of target respondents. A total of 302 surveys were completed and the data were analyzed through structural equation modeling (SEM). Firstly, an exploratory factor analysis (EFA) was performed, followed by a confirmatory factor analysis (CFA) that leads to the estimation of the structural model. The results show that personal beliefs toward green food are positively associated with respondents’ purchase attitudes toward green food. Moreover, stronger purchase attitudes toward green food lead to more favorable purchase attitudes toward hotels that offer green food, further substantiating the investigation about whether or not consumers’ attitudes employ similar concerns on sustainability for their daily purchases as well as for vacation products and services. In turn, the latter purchase attitudes are positively associated with individual behavioral intentions toward hotels that offer green food

Il fondamento teorico del diritto inteso come norma e struttura nel pensiero di Alessandro Catelani

Abstract European law is the basis for legal changes. Categories of European law concepts and tools contribute to the creation and dissemination of principles, rules and practices that circulate more quickly into national legislation. The author with comparative method provides examples of such developments in the area of public procurement Key words: Legal chance, Europe, judicial interpretation Riassunto Il diritto europeo è causa di buona parte dei fenomeni di mutazione giuridica che si compiono negli Stati membri. Categorie, concetti e strumenti del diritto europeo concorrono alla creazione e diffusione di principi, regole e prassi che circolano sempre più velocemente negli ordinamenti nazionali. Le mutazioni derivanti da questo processo impattano anche sulla connotazione dei formanti sollecitando la rilettura di impianti dogmatici e ordinatori ritenuti consolidati. Di tale verifica proponiamo alcuni spunti tratti dal settore degli appalti pubblici e svolti con gli strumenti della comparazione giuridica Parole chiave: mutamento giuridico, Europa, interpretazione giurisprudenziale

Radiotherapy for lentigo maligna and lentigo maligna melanoma - a systematic review.

Lentigo maligna (LM) is the most common subtype of in situ melanoma und occurs frequently in the sun-exposed head and neck region in elderly patients. The therapeutic "gold standard" is surgical excision, as there is the risk of progression to invasive (lentigo maligna) melanoma (LMM). However, surgery is not feasible in certain patients due to age, comorbidities or patient preference. Radiotherapy using Grenz rays or superficial X-rays has been established as non-invasive alternative for the treatment of LM and LMM. We performed a systematic literature search of MEDLINE and Embase databases in September 2019 and identified 14 patient series using radiotherapy for LM or LMM. No prospective trials were found. The 14 studies reported a total of 1243 lesions (1075 LM and 168 LMM) treated with radiotherapy. Local recurrence rates ranged from 0 to 31% and were comparable to surgical series in most of the reports on radiotherapy. Superficial radiotherapy was prescribed in 5-23 fractions with a total dose of 35-57 Gy. Grenz ray therapy was prescribed in 42-160 Gy in 3-13 fractions with single doses up to 20 Gy. Cosmetic results were reported as "good" to "excellent" for the majority of patients.In conclusion, the available low-level evidence suggests that radiotherapy may be a safe and effective treatment for LM and LMM. Data from prospective trials such as the phase 3 RADICAL trial are needed to confirm these promising findings and to compare radiotherapy to other non-surgical therapies and to surgery