Natural Disasters’ Effect on Tourism Employment

Not only do natural disasters cause immediate physical damage to an area, but they often have long-lasting social and economic effects as well. Tourism is a sector of the economy that is relatively fragile and relies heavily on a stable economy. This paper attempts to capture the effect of natural disasters on the tourism industry, specifically tourism employment. This research uses panel data and focuses specifically on 7 metropolitan statistical areas in the United States between 2002-2018. Data collected from the BEA as well as SHELDUS is used in order to quantify this effect. A fixed effects model with a log on the dependent variable finds that for every dollar chance of damage over personal income, tourism employment per capita decreases by about 1.34%. These results are statistically significant at the 5% level

Sustained virological response after ten days of triple anti-hepatitis C virus (HCV) therapy with telaprevir plus pegylated interferon and ribavirin in an HIV/HCV co-infected cirrhotic woman

The introduction of first-generation protease inhibitors for the treatment of chronic hepatitis C in subjects infected with hepatitis C virus (HCV) genotype 1 has significantly improved the sustained virological response (SVR) rate. As liver cirrhosis reduces the probability of achieving SVR, current guidelines discourage response-guided therapy in cirrhotic patients. We report the first case of a cirrhotic woman with chronic HCV and HIV co-infection achieving virological response after an ultra-short course of therapy. A 40-year-old HIV/HCV co-infected woman with compensated liver cirrhosis was treated with anti-HCV triple therapy containing telaprevir plus pegylated interferon and ribavirin. Baseline plasma HCV RNA was 3.6 log IU/ml and transaminases were within the normal range. She harboured IL28B rs12979860 C/C alleles. Ten days after starting therapy, the patient stopped treatment because of mild anorexia and nausea. Virological response was detected at treatment discontinuation and was maintained up to 24 weeks. This case describes an unexpected SVR after a 10-day course of antiviral therapy in a cirrhotic HIV/HCV co-infected woman presenting positive predictive factors for a response (low viral load, IL28B genotype). Nonetheless, there is no evidence to suggest a shorter duration of treatment in this subset of patients

Detection of low-level HCV variants in DAA treated patients: comparison amongst three different NGS data analysis protocols

Background: Notwithstanding the efforts of direct-acting antivirals (DAAs) for the treatment of chronically infected hepatitis C virus (HCV) patients, concerns exist regarding the emergence of resistance-associated substitutions (RAS) related to therapy failure. Sanger sequencing is still the reference technique used for the detection of RAS and it detects viral variants present up to 15%, meaning that minority variants are undetectable, using this technique. To date, many studies are focused on the analysis of the impact of HCV low variants using next-generation sequencing (NGS) techniques, but the importance of these minority variants is still debated, and importantly, a common data analysis method is still not defined. Methods: Serum samples from four patients failing DAAs therapy were collected at baseline and failure, and amplification of NS3, NS5A and NS5B genes was performed on each sample. The genes amplified were sequenced using Sanger and NGS Illumina sequencing and the data generated were analyzed with different approaches. Three different NGS data analysis methods, two homemade in silico pipeline and one commercially available certified user-friendly software, were used to detect low-level variants. Results: The NGS approach allowed to infer also very-low level virus variants. Moreover, data processing allowed to generate high accuracy data which results in reduction in the error rates for each single sequence polymorphism. The results improved the detection of low-level viral variants in the HCV quasispecies of the analyzed patients, and in one patient a low-level RAS related to treatment failure was identified. Importantly, the results obtained from only two out of the three data analysis strategies were in complete agreement in terms of both detection and frequency of RAS. Conclusions: These results highlight the need to find a robust NGS data analysis method to standardize NGS results for a better comprehension of the clinical role of low-level HCV variants. Based on the extreme importance of data analysis approaches for wet-data interpretation, a detailed description of the used pipelines and further standardization of the in silico analysis could allow increasing diagnostic laboratory networking to unleash true potentials of NGS

A fitness index model for Italian adolescents living in Southern Italy. The ASSO project

Strong relations between physical fitness and health in adolescents have been established in the last decades. The main objectives of the present investigation were to assess major physical fitness components in a sample of Italian school adolescents, comparing them with international data, and providing a fitness index model derived from percentile cut-off values of five considered physical fitness components. A total of 644 school pupils (15.9±1.1yrs; M=399; F=245) were tested using the ASSO-Fitness Test Battery (FTB), a tool developed within the Adolescents and Surveillance System for the Obesity prevention project, which included the handgrip, standing broad-jump, sit-up to exhaustion, 4×10m shuttle run and 20m shuttle run tests. Stratified percentile values and related smoothed curves were obtained. The method of principal components analysis (PCA) was applied to the considered five fitness components to derive a continuous fitness level score (the Fit-Score). A Likert-type scale on the Fit-Score values was applied to obtain an intuitive classification of the individual level of fitness: very poor (

CARATTERIZZAZIONE DEL MICROBIOTA ORALE E DI BIOPSIE DI TESSUTO VALVOLARE PATOLOGICO IN UN CAMPIONE DI PAZIENTI PARODONTALI E NON PARODONTALI

Aim. To assess the prevalence of periodontal disease among patients presenting severe heart valve impairment and requiring coronary by-pass surgery. To investigate the presence of periodontal pathogens in cardiovascular specimens and to analyse the relationship between oral and cardiovascular patterns of the microorganisms detected. Materials and Methods. An observational study was conducted at the Cardiovascular Surgery Division, University Hospital of Verona, Verona, Italy. The Ethical approval was previously obtained in order to enroll subjects referring to the Hospital for heart valves replacement and coronary bypass surgery. Patients were scheduled to be visited by a dentist, together with a dental hygienist, the day before the surgery: periodontal conditions were accurately registered through clinical and radiographic examinations and dental plaque or salivary samples were collected. Cardiovascular specimens were collected during surgical heart valve replacement for the scheduled microbiological 16 rRNA gene sequencing. Plaque samples and cardiovascular specimens were analyzed according to periodontal status. A qualitative comparison between oral and cardiovascular profiles of the microorganisms detected was also performed. Results. 26 patients (15 men and 11 women) attended the study. The overall number of patients examined for the conditions of soft tissues were 19, as 7 patients were edentulous and reported to had lost dentition for history of periodontal disease. 46.15% and 11.54% individuals respectively presented moderate periodontitis and severe periodontitis. A statistically significant difference (p=0.04) was found for PPD between healthy patients, patients with moderate periodontitis and patients with severe periodontitis. Regarding plaque samples and cardiovascular specimens, no statistically significant differences were found in both cases between healthy patients, patients with moderate periodontitis, patients with severe periodontitis and edentulous patients. Nine valves were found to be positive at the presence of oral and periodontophatic bacterial DNA. The principal species detected were Streptococcus periodonticum, Streptococcus mutans, Fusobacterium nucleatum-periodonticum, Aggregatibacter segnis and Porphyromonas pasteri. Conclusions. The significant number of oral and periodontopathic bacterial DNA species found in valve tissue samples, in patients with periodontitis, suggests that the presence of these microrganisms in valve tissue seems to be not coincidental, and that they may have a role in the development of vascular diseases

Long term nucleotide and nucleoside analogs treatment in chronic hepatitis B HBeAg negative genotype D patients and risk for hepatocellular carcinoma

Background and rationale of the study. Effect of Long-term nucleoside/nucleotide (NUC) on hepatocellular carcinoma (HCC) incidence in a population of HBeAg-negative genotype D patients has not been adequately studied in real-life cohorts. Our aim was to evaluate the impact of liver fibrosis and other variables on HCC incidence in this population of patients. Of 745 patients with chronic hepatitis B (CHB), 306 HBeAg-negative genotype D were selected and included in this study. All patients received treatment with NUC for at least 18 months. Patients with CHB or compensated cirrhosis were included. Patients with HCC diagnosed before or during the first 18 months of NUC therapy were excluded. Results. HCC was diagnosed in 2 CHB patients (1.0%) and 23 cirrhosis patients (20%) (OR = 24.41, 95% CI 5.40 < OR < 153.2; p < 0.0001). Multivariate analysis revealed that HCC risk was independently associated with age ≥ 60 years (OR = 6.45, 95% CI 1.22 to 34.0; p = 0.02) and liver cirrhosis (OR = 12.1, 95% CI 1.39 to 106.2; p = 0.02), but not with virological response (VR), and previous resistance to NUC, or rescue therapy. Multivariate analysis in cirrhosis patients revealed that only age ≥ 60 years was an independent risk factor associated with HCC (p = 0.003). Conclusions. Liver cirrhosis and age ≥ 60 years are the stronger risk factors for HCC in genotype D HBeAgnegative patients. Previous resistance to NUC in patients that achieved a VR after rescue therapy was not a predictive factor regarding HCC. VR does not appear to significantly reduce the overall incidence of HCC when a patient has already progressed to liver cirrhosis

Predictors of long-term response to abiraterone in patients with metastastic castration-resistant prostate cancer: a retrospective cohort study

We aimed to identify clinical predictors of long-term response to abiraterone (defined as &gt;12 months drug exposure) in a retrospective cohort of metastatic castration-resistant prostate cancer patients treated in post-docetaxel setting at 24 Italian centers. The Cox proportional hazards model was used to analyze the association between clinical features and the duration of drug exposure. Results were expressed as hazard ratios (HR) with associated 95% confidence intervals (CI). A total of 143 patients met the inclusion criteria. Their median age was 73 years, median Gleason score 8 and median abiraterone exposure 20 months. At the univariate analysis, a significant correlation with the duration of abiraterone exposure was found for Gleason score (HR 0.82, 95% CI 0.71-0.96; p=0.012), PSA (HR 1.10, 95% CI 1.03-1.18; p=0.08) and lactic dehydrogenase levels (HR 1.22, 95% CI 1.02-1.46; p=0.027), while the association between lower alkaline phosphatase levels and treatment duration was marginally significant (HR 1.07, 95% CI 0.99-1.16; p=0.074). Only PSA and Gleason score were predictive of long-term treatment duration in the multivariate analysis. No other clinical factors resulted to be predictive of sustained response to abiraterone, including metastatic disease at diagnosis and visceral disease, suggesting that all subgroups of patients may derive a substantial clinical benefit from abiraterone treatment. These findings need to be validated in prospective, larger studies

Serous cystic neoplasm of the pancreas: A multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas)

OBJECTIVES: Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. DESIGN: Retrospective multinational study including SCN diagnosed between 1990 and 2014. RESULTS: 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58\u2005years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40\u2005mm (2-200)), 9% had resection beyond 1\u2005year of follow-up (3\u2005years (1-20), size at diagnosis: 25\u2005mm (4-140)) and 39% had no surgery (3.6\u2005years (1-23), 25.5\u2005mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1\u2005year (n=1271), size increased in 37% (growth rate: 4\u2005mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1). CONCLUSIONS: After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN