Plano de Negócio: Empresa de Animação Turística Stella Tour

A ideia primordial deste projeto conjuga o Turismo e o Lazer. O projeto consiste na elaboração da proposta de criação de uma empresa de serviços focados na exploração de tours exclusivos e diferenciadores com o objetivo de oferecer experiências distintas e diferenciadoras. Este projeto pretende avaliar a viabilidade de mercado, bem como, a viabilidade económica e financeira da criação de uma empresa de animação turística, recorrendo à elaboração de um plano de negócio. Para que a economia nacional possa aproveitar cada unidade de valor acrescentado que o turismo gera e pode gerar, importa reconhecer a imperiosa necessidade de, por um lado, acelerar alterações ao próprio setor, que lhe permita continuar a competir internacionalmente ao mais alto nível, e, por outro lado, de intensificar a interconexão e interseção com os demais setores de atividade económica em todo o território. Numa perspetiva global, existe uma constante mudança nos mercados o que se apresenta como motivo de preocupação por parte das empresas. Estar preparado, antecipar as mudanças e definir os caminhos a seguir, tendo em conta os possíveis cenários, é uma das maiores valias que uma empresa pode obter nos dias de hoje. Após a realização da análise económica e financeira do projeto, chegou-se a conclusão de que o projeto é economicamente viável e que existe um grande interesse tanto do setor privado como no público de investimentos desta natureza, considerando-se pertinente a implementação do Projeto.The main idea of this project combines Tourism and Leisure. The project consists in the elaboration of the proposal to create a services company focused on the exploration of exclusive and differentiating tours with the objective of offering distinct and differentiating experiences. This project aims to evaluate the market viability, as well as the economic and financial viability of creating a tourist entertainment company, using the preparation of a business plan. In order for the national economy to be able to take advantage of every unit of added value that tourism generates and can generate, it is important to recognize the imperative need, on the one hand, to accelerate changes to the sector itself, allowing it to continue to compete internationally at the highest level, and, on the other hand, to intensify the interconnection and intersection with other sectors of economic activity throughout the territory. From a global perspective, there is a constant change in the markets, which presents itself as a reason for concern on the part of companies. Being prepared, anticipating changes and defining the paths to follow, taking into account possible scenarios, is one of the greatest values a company can obtain these days. After carrying out the economic and financial analysis of the project, it was concluded that the project is economically viable and that there is great interest from both the private and public sectors in investments of this nature, considering that the implementation of the Project is relevant

First-time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream

AIM: More than 50% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream. METHODS: We conducted this multicentre randomised controlled trial at three tertiary-level children's hospitals in Italy in 2015. Children aged three to 10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt. RESULTS: The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4%) who received the warm patch and in 142 children (85.0%) who received the cream (p = 0.03). The pain scores were similar in both groups. CONCLUSION: This study showed that the first-time needle procedure success was 7.4% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream

Nosocomial COVID-19 Incidence and Secondary Attack Rates among Patients of Tertiary Care Center, Zurich, Switzerland

Of 1,118 patients with COVID-19 at a university hospital in Switzerland during October 2020-June 2021, we found 83 (7.4%) had probable or definite healthcare-associated COVID-19. After in-hospital exposure, we estimated secondary attack rate at 23.3%. Transmission was associated with longer contact times and with lower cycle threshold values among index patients. Keywords: COVID-19; SARS-COV-2; Switzerland; coronavirus disease; cross-infection; infection control; infectious disease transmission; nosocomial infections; risk factors; severe acute respiratory syndrome coronavirus 2; viruses; zoonoses

Genome-wide identification and phenotypic characterization of seizure-associated copy number variations in 741,075 individuals

Copy number variants (CNV) are established risk factors for neurodevelopmental disorders with seizures or epilepsy. With the hypothesis that seizure disorders share genetic risk factors, we pooled CNV data from 10,590 individuals with seizure disorders, 16,109 individuals with clinically validated epilepsy, and 492,324 population controls and identified 25 genome-wide significant loci, 22 of which are novel for seizure disorders, such as deletions at 1p36.33, 1q44, 2p21-p16.3, 3q29, 8p23.3-p23.2, 9p24.3, 10q26.3, 15q11.2, 15q12-q13.1, 16p12.2, 17q21.31, duplications at 2q13, 9q34.3, 16p13.3, 17q12, 19p13.3, 20q13.33, and reciprocal CNVs at 16p11.2, and 22q11.21. Using genetic data from additional 248,751 individuals with 23 neuropsychiatric phenotypes, we explored the pleiotropy of these 25 loci. Finally, in a subset of individuals with epilepsy and detailed clinical data available, we performed phenome-wide association analyses between individual CNVs and clinical annotations categorized through the Human Phenotype Ontology (HPO). For six CNVs, we identified 19 significant associations with specific HPO terms and generated, for all CNVs, phenotype signatures across 17 clinical categories relevant for epileptologists. This is the most comprehensive investigation of CNVs in epilepsy and related seizure disorders, with potential implications for clinical practice

Dolore da venipuntura: come trattarlo?

Venipuncture, although it is relatively simple and fast, is one of the painful procedures which is most frequently performed on paediatric patients. The pain in this context is present in 50% of children, and has been rated as moderate to severe in 36% of children aged 3 to 6 years and 13% of those aged 7 to 17 years. The response to pain is influenced and shaped by past painful experiences. Infants who have not been adequately treated in regard to procedural analgesia undergo a real conditioning. Considering that pain has two basic components, nociception and suffering, the best approach will be multidisciplinary, based on pharmacological and non-pharmacological strategies

Does respiratory co-infection facilitate dispersal of SARS-CoV-2? investigation of a super-spreading event in an open-space office

BACKGROUND Super-spreaders are individuals infecting disproportionately large numbers of contacts. They probably play a crucial role in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe a super-spreading event within a team working in an open-space office and investigate factors potentially having facilitated SARS-CoV-2 transmission. METHODS In this retrospective cohort study, semi-structured telephone interviews with all team members were carried out to identify symptoms, contacts, and adherence to basic hygiene measures. During site visits, we gathered information about workplace and seating arrangements. The secondary attack rate in office and households was calculated. Potential respiratory viral co-infections were assessed by multiplex PCR. SARS-CoV-2 whole-genome sequencing was performed using a tiled-amplicon sequencing approach. RESULTS Of 13 team members, 11 fell ill with Coronavirus disease 2019 (COVID-19). Due to the sequence of events and full genome sequence data, one person was considered the index case for this outbreak, directly infecting 67 to 83% of the teammates. All team members reported repetitive close contacts among themselves during joint computer work, team meetings and a "Happy Birthday" serenade. Two individuals shared nuts and dates. The arrangement of the office and meeting rooms precluded sufficient adherence to physical distancing. The index case and a further individual were diagnosed with an adenovirus serotype 4 co-infection. CONCLUSION We identified several environmental and behavioral factors that probably have facilitated the transmission of SARS-CoV-2. The relevance of the adenovirus co-infection remains unclear and merits further investigation

Does the Application of Heat Gel Pack After Eutectic Mixture of Local Anesthetic Cream Improve Venipuncture or Intravenous Cannulation Success Rate in Children? A Randomized Control Trial

OBJECTIVE: Needle-related procedures are the most common sources of pain for children in the hospital setting. The most used topical anesthetic, eutectic mixture of local anesthetic (EMLA) cream, may cause transient vasoconstriction. It has been postulated that this vasoconstriction may decrease vein visualization. The application of heat gel pack after removal of EMLA cream in the site of venipuncture counteracts the vasoconstriction, improving vein visualization. We assessed using a prospective randomized controlled trial whether the application of heat gel pack increases the needle procedure success rate. The primary study outcome was procedural success rate at the first attempt. METHODS: The study enrolled 400 children, 200 of whom applied heat gel pack after removing EMLA (treatment group) and 200 did not (control group). Procedural success rate at the first attempt, vein perception before procedure, procedural pain, and adverse events were recorded in both groups. RESULTS: Eighty-eight percent of the procedures were successful at the first attempt in the treatment group and 89% in the control group (P = 0.876). Vein perception was not significantly different in the 2 groups (P = 0.081). Pain score after the procedure was similar in the 2 groups. CONCLUSIONS: This study shows that the application of heat gel pack after removal of EMLA cream does not improve venipuncture or intravenous cannulation success rate

Il dolore acuto del bambino: Dalla misurazione al trattamento, farmacologico e non.

Background - Pain is a relevant symptom reported by children who require Emergency Unit evaluation, but it is still underestimated and undertreated. Purpose - This review offers simple information about pharmacological and non-pharmacological approaches in the management of pain in emergency settings and in subcentres. Data sources - Found on PubMed articles, using different key-words: pain, procedural pain, children, emergency unit, epidemiology, measurement, management, and treatment. Results - Pain has to be measured before treatment. It can be controlled with non-pharmacological and pharmacological approaches, which have specific guidelines. Conclusions - Instruments for any kind of pain are available; an insufficient management is attributable to poor knowledge rather than to lack of means

La gestione del bambino con gastroenterite acuta.

Acute gastroenteritis (AG) is a very common disease in children. It causes significant mortality in developing countries and significant economic burden to developed countries. Viruses are responsible for approximately 70% of episodes of acute gastroenteritis in children and rotavirus is one of the best studied of these viruses. Although guidelines exist to assist clinicians, there is evidence that the treatment of paediatric AG varies considerably from place to place, that Oral Rehydration Solution (ORS) is still underused and that children frequently receive intravenous rehydration. In this paper the literature and international guidelines on the epidemiology, diagnosis, management and prevention of AG and its major complication, dehydration are reviewed; in particular a scale to evaluate the level of dehydration and a detailed protocol for oral and intravenous rehydration are provided. The correct approach to diet and the role of antiemetic drugs are also discussed

Nasal irrigation with saline solution significantly improves oxygen saturation in infants with bronchiolitis

Published guidelines do not recommend nasal irrigation in bronchiolitis, but it is common practice in Italy, despite a lack of data on its benefits or adverse effects. This single-blind, multicentre, randomised controlled trial compared nasal irrigation using either isotonic 0.9% sodium chloride or hypertonic 3% sodium chloride with simple supportive care in infants with bronchiolitis. METHODS: We randomly assigned 133 infants up one year of age, who were admitted to the emergency department with bronchiolitis and an oxygen saturation (SpO2) of between 88 and 94%, to the isotonic (n = 47), hypertonic (n = 44) or standard care (n = 42) groups. Variations in SpO2 and the wheeze, air exchange, respiratory rate, muscle use (WARM) respiratory distress score were recorded at zero, five, 15, 20 and 50 minutes. RESULTS: Five minutes after the intervention, the median SpO2 value (95%) in the isotonic group was higher than both the hypertonic (94%) and the standard care (93%) groups. The differences between the isotonic and standard treatment groups were statistically significant at each time point, while the hypertonic group only reached significantly higher values after 50 minutes. However, the WARM score did not improve. CONCLUSION: A single nasal irrigation with saline solution significantly improved oxygen saturation in infants with bronchiolitis