Tourism diagnosis with DTI projection (intelligent tourist destination) of the city of Manta, Ecuador

Los destinos turísticos inteligentes se vislumbran como la respuesta de los territorios a los requerimientos de la actividad turística moderna para gestionar el volumen de información, y que, a su vez, ayuden tanto a los actores públicos como privados a tomar mejores decisiones. La presente investigación tiene como objetivo realizar una evaluación de la ciudad portuaria de Manta, Ecuador, en base a los indicadores relacionados a los Destinos Turísticos Inteligentes (DTI). El tipo de investigación fue de tipo cualitativo teniendo un alcance de carácter exploratorio mediante el uso de la guía de implantación de los DTI de la Comunidad Valenciana, el cual abarca 9 ámbitos de acción tales como (gobernanza, sostenibilidad, accesibilidad, innovación, conectividad, inteligencia turística, información turística, marketing online, demanda turística). Para la obtención de la información se realizó una serie de talleres participativos con actores claves del desarrollo turístico de la ciudad, tales como el buró turístico de Manta, además de representantes estratégicos de cada una de las áreas de estudio de DTI del gobierno local. Como resultado se obtuvo que Manta cumple con un porcentaje de cumplimiento promedio del 49,9% del total de indicadores, siendo el eje de la accesibilidad el punto más bajo con un porcentaje de cumplimiento del 16,6%, por otro lado, la ciudad costera tiene en los ejes de la Innovación y el Marketing Online sus puntos más relevantes (76,6% y 65% respectivamente). Se concluye que Manta tiene autoridades que buscan innovar en sus procesos en pro de mejorar la calidad del servicio turístico.Smart tourist destinations are envisioned as the response of the territories to the requirements of modern tourist activity to manage the volume of information, and that, in turn, helps both public and private actors to make better decisions. The objective of this research is to carry out an evaluation of the port city of Manta, Ecuador, based on the indicators related to Smart Tourist Destinations (STD). The type of research was qualitative, having an exploratory scope using the implementation guide of the STD of the Valencian Community, which covers 9 areas of action such as (governance, sustainability, accessibility, innovation, connectivity, tourist intelligence, tourist information, online marketing, tourist demand). To obtain the information, a series of participatory workshops were held with key stakeholders in the city's tourism development, such as the Manta tourism bureau, as well as strategic representatives from each of the local government's STD study areas. As a result, it was obtained that Manta complies with an average compliance percentage of 49.9% of the total indicators, with the accessibility axis being the lowest point with a compliance percentage of 16.6%, on the other hand, the city Coastal has in the axes of Innovation and Online Marketing its most relevant points (76.6% and 65% respectively). It is concluded that Manta has authorities that seek to innovate in their processes to improve the quality of the tourist service

El cacao, de recurso agrario a potencial turístico cultural. Motivaciones de sus productores en la zona centro norte de Manabí, Ecuador

The situation of the production of cocoa in the province of Manabi (Ecuador) is presented, together with its development possibilities with the introduction of a sustainable cultural revaluation policy. Cocoa producers generally carry out their activities in rural areas and urban peripheries where living conditions are often precarious; each productive unit (farm) has an approximately extension of five hectares, and 90% of their maintenance is carried out by the family. The objective of this research was to identify the different groups of producers, based on their motivations, for the production of cocoa in the north central area of Manabi, Ecuador. The work comprised two stages: (1) exploratory, where data from official bodies was processed on the ARC GIS software; (2) field work, in which a Likert scale questionnaire was used. The sample is made up of 196 cocoa producers. The research design is flexible, with a quantitative and qualitative approach; exploratory in nature. There are two large groups of producers. The first set of producers related to the simple commercialization of cocoa and the second set of producers that shows a significant appropriation of the product as a reflection of the local culture. A positive context is glimpsed for initiatives around agricultural tourism.Se presenta la situación productiva del cacao en la provincia de Manabí (Ecuador), así como sus posibilidades de desarrollo regido por una política de revalorización cultural sostenible. Los productores de cacao, por lo general, desarrollan sus actividades en zonas rurales y periferias urbanas, las condiciones de vida muchas veces son precarias; el 90% de sus unidades productivas, denominadas fincas, con una extensión promedio de cinco hectáreas y su mantenimiento se caracteriza por ser de responsabilidad familiar. El objetivo de la presente investigación es identificar los diferentes grupos de productores, a partir de sus motivaciones, para el cultivo y producción del cacao en la zona centro norte de Manabí, Ecuador. El trabajo se dividió en dos etapas: (1) exploratoria, mediante la utilización de datos provenientes de organismos oficiales, los mismos que fueron procesados con el software ARC GIS; (2) trabajo de campo utilizando un cuestionario con escala de Likert. La muestra está conformada por 196 productores de cacao. El diseño de investigación es flexible, de enfoque cuantitativo y cualitativo; de carácter exploratorio. Existen dos grandes conjuntos de productores. El primer conjunto de productores relacionado con la simple comercialización del cacao y el segundo conjunto de productores que muestra una significante apropiación del producto como reflejo de la cultura local. Se vislumbra un contexto positivo para las iniciativas en torno al turismo agrario

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Estudio de pérdidas y estrategias de reactivación para el sector turístico por crisis sanitaria COVID-19 en el destino Manta (Ecuador).

Tourism faces one of its greatest crises of all time (COVID-19), this difficult situation of survival that companies and tourist destinations are going through must be solved through tourism diagnostic studies that contribute to decision-making. This research aims to contribute in a practical way with a diagnostic methodology, which allows identifying the problems that affect the business sector. A questionnaire is used for data collection, shared online via Google forms, which establishes as its main objective the need to collect the impressions of the tourist entrepreneurs of the Manta-Ecuador canton, taking into account their projections in various areas such as: economic losses, job stability, search for incentives and possible reactivation strategies. The questionnaire was answered by 272 managers of tourist establishments, which represent 48% of the total tourist plant registered in the cadastre; the information was processed in the statistical program SPSS version 23. The results show loss of income due to non-invoicing and totals, and inability to settle expenses, likewise, the main reactivation strategies are foreseen, the lowering of service fees, promotion in social networks and the migration of companies to models. on line.El turismo enfrenta hoy día una de sus mayores crisis de todos los tiempos tras la extensión de la pandemia del COVID-19). Esta difícil situación de supervivencia que atraviesan las empresas y los destinos turísticos debe ser afrontada mediante estudios de diagnóstico turístico que contribuyan a una correcta toma de decisiones por parte de los organismos turísticos competentes. La presente investigación pretende contribuir de forma práctica con una metodología de diagnóstico que permita identificar las problemáticas que conmueven al sector empresarial en un destino ecuatoriano en plena crisis sanitaria mundial. Se emplea para ello un cuestionario para recoger los resultados de una encuesta instrumentada vía online a través de google forms con el objetivo principal de captar impresiones de los empresarios y gestores turísticos del cantón de Manta (Ecuador) en función de los escenarios y proyecciones de evolución del sector turístico en aspectos tales como pérdidas económicas, estabilidad laboral, búsqueda de incentivos y posibles estrategias de reactivación. Respondieron el cuestionario 272  gerentes de establecimientos turísticos, que representan el 48% de la planta turística total registrada en el catastro turístico y la información fue procesada en el programa estadístico SPSS versión 23. Los resultados muestran pérdidas de ingresos importantes por no facturación e incapacidad para solventar los pagos a proveedores de servicios, previéndose como principales estrategias de reactivación la bajada de precios de los servicios turísticos, la promoción en redes sociales y la migración de empresas a la gestión y comercialización mediante modelos on line más efectivos e innovadores

Diagnóstico turístico con proyeccion DTI (destino turístico inteligente) de la ciudad de Manta, Ecuador

Smart tourist destinations are envisioned as the response of the territories to the requirements of modern tourist activity to manage the volume of information, and that, in turn, helps both public and private actors to make better decisions. The objective of this research is to carry out an evaluation of the port city of Manta, Ecuador, based on the indicators related to Smart Tourist Destinations (STD). The type of research was qualitative, having an exploratory scope using the implementation guide of the STD of the Valencian Community, which covers 9 areas of action such as (governance, sustainability, accessibility, innovation, connectivity, tourist intelligence, tourist information, online marketing, tourist demand). To obtain the information, a series of participatory workshops were held with key stakeholders in the city's tourism development, such as the Manta tourism bureau, as well as strategic representatives from each of the local government's STD study areas. As a result, it was obtained that Manta complies with an average compliance percentage of 49.9% of the total indicators, with the accessibility axis being the lowest point with a compliance percentage of 16.6%, on the other hand, the city Coastal has in the axes of Innovation and Online Marketing its most relevant points (76.6% and 65% respectively). It is concluded that Manta has authorities that seek to innovate in their processes to improve the quality of the tourist service.Los destinos turísticos inteligentes se vislumbran como la respuesta de los territorios a los requerimientos de la actividad turística moderna para gestionar el volumen de información, y que, a su vez, ayuden tanto a los actores públicos como privados a tomar mejores decisiones. La presente investigación tiene como objetivo realizar una evaluación de la ciudad portuaria de Manta, Ecuador, en base a los indicadores relacionados a los Destinos Turísticos Inteligentes (DTI). El tipo de investigación fue de tipo cualitativo teniendo un alcance de carácter exploratorio mediante el uso de la guía de implantación de los DTI de la Comunidad Valenciana, el cual abarca 9 ámbitos de acción tales como (gobernanza, sostenibilidad, accesibilidad, innovación, conectividad, inteligencia turística, información turística, marketing online, demanda turística). Para la obtención de la información se realizó una serie de talleres participativos con actores claves del desarrollo turístico de la ciudad, tales como el buró turístico de Manta, además de representantes estratégicos de cada una de las áreas de estudio de DTI del gobierno local. Como resultado se obtuvo que Manta cumple con un porcentaje de cumplimiento promedio del 49,9% del total de indicadores, siendo el eje de la accesibilidad el punto más bajo con un porcentaje de cumplimiento del 16,6%, por otro lado, la ciudad costera tiene en los ejes de la Innovación y el Marketing Online sus puntos más relevantes (76,6% y 65% respectivamente). Se concluye que Manta tiene autoridades que buscan innovar en sus procesos en pro de mejorar la calidad del servicio turístic

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use