Older tourists' travel motivations and overall satisfaction at the destination: The case of Sirmione

Purpose: As the number of older tourists is progressively growing due to population ageing, tourism destinations are increasingly striving to attract them. For this purpose, destination marketers need to gain deep knowledge about the relationships between older tourists\u2019 travel motivations and satisfaction at the destination. This paper aims to provide an in-depth examination of such relationships in a specific destination, highlighting the effects of four travel motivations (culture; pleasure-seeking; relaxation; physical). Methodology: A cross-section design was adopted based on a survey among a sample of older tourists visiting Sirmione, a mature destination located on Lake Garda, Italy. Data were analyzed through multiple techniques, including analyses of variance and linear regression. Findings: The results reveal that relaxation was the most important motivation making older tourists decide to visit Sirmione. Moreover, relaxation was the only motivation showing a statistically significant relationship with satisfaction at the destination. Practical implications: The results of this study provide destination managers with valuable inputs to reposition their destination to effectively attract older tourists. Originality/value: This paper contributes to enhance available knowledge \u2013 which is quite scarce \u2013 about the effects of travel motivations on satisfaction at the destination among older tourists

Are sinonasal dissection courses a valid instrument for endoscopic sinus surgeons? A report on 7-years of experience

I corsi di chirurgia endoscopica naso-sinusale sono rivolti sia a giovani specialisti per il training chirurgico, sia a chirurghi più esperti per migliorare le abilità chirurgiche. Ad un totale di centotrenta (130) partecipanti, ad 8 corsi di dissezione in totale, tra il 2013 e il 2019, è stato somministrato un questionario strutturato standardizzato, comprendente domande sulla strumentazione ricevuta e problemi riscontrati durante la pratica di dissezione. L’uncinectomia e l’etmoidectomia anteriore sono state considerate le procedure più semplici del corso, dalla maggior parte dei partecipanti, mentre l’approccio al seno frontale, indipendentemente dall’esperienza e dall’età, è stato ritenuto il passaggio più complicato. Tutti i partecipanti hanno considerato il corso di dissezione come un mezzo utile per migliorare le loro conoscenze anatomiche, ed il grado di confidenza con la strumentazione e con la dissezione. I corsi di chirurgia endoscopica naso-sinusale sono stati ritenuti utili sia dai giovani specialisti, che dai chirurghi più esperti. Il miglioramento delle conoscenze anatomiche può ridurre efficacemente l’insorgenza di complicazioni indesiderate, in particolare per gli approcci endoscopici.Sinonasal dissection courses have been reported to be effective in teaching sinonasal anatomy to trainees, and in improving surgical skills for trained surgeons. Between 2013 and 2019, a standardised structured questionnaire was handed out to 130 participants of 8 sinonasal dissection courses. Each questionnaire included questions about the medical equipment the surgeons were fitted, and the problems encountered during the dissection.The majority of the participants, regardless of their experience and age, considered uncinectomy and anterior ethmoidectomy as the simplest parts of the dissection, whereas the most complicated step was the approach to the frontal sinus. All participants considered the dissection course as a useful way to improve their medical skills while performing an endoscopic surgery procedure, such as their anatomical knowledge, and confidence with instrumentation and the dissection. Sinonasal dissection courses can be considered to be useful for both trainees and trained surgeons. Improving anatomical knowledge can reduce the occurrence of complications, especially in endoscopic surgery

Soluble Immune checkpoints, gut metabolites and performance status as parameters of response to Nivolumab treatment in NSCLC patients

Patients with non-small cell lung cancer (NSCLC) have been shown to benefit from the introduction of anti-PD1 treatment. However, not all patients experience tumor regression and durable response. The identification of a string of markers that are direct or indirect indicators of the immune system fitness is needed to choose optimal therapeutic schedules in the management of NSCLC patients. We analyzed 34 immuno-related molecules (14 soluble immune checkpoints, 17 cytokines/chemokines, 3 adhesion molecules) released in the serum of 22 NSCLC patients under Nivolumab treatment and the gut metabolomic profile at baseline. These parameters were correlated with performance status (PS) and/or response to treatment. Nivolumab affected the release of soluble immune checkpoints (sICs). Patients with a better clinical outcome and with an optimal PS (PS = 0) showed a decreased level of PD1 and maintained low levels of several sICs at first clinical evaluation. Low levels of PDL1, PDL2, Tim3, CD137 and BTLA4 were also correlated with a long response to treatment. Moreover, responding patients showed a high proportion of eubiosis-associated gut metabolites. In this exploratory study, we propose a combination of immunological and clinical parameters (sICs, PS and gut metabolites) for the identification of patients more suitable for Nivolumab treatment. This string of parameters validated in a network analysis on a larger cohort of patients could help oncologists to improve their decision-making in an NSCLC setting

The Local Complement Activation on Vascular Bed of Patients with Systemic Sclerosis : A Hypothesis-Generating Study

Peer reviewe

The care of older cancer patients in the United Kingdom

The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient’s biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one’s fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer

Real time contrast enhanced ultrasonography in detection of liver metastases from gastrointestinal cancer

Background: Contrast enhanced ultrasound (CEUS) is an imaging technique which appeared on the market around the year 2000 and proposed for the detection of liver metastases in gastrointestinal cancer patients, a setting in which accurate staging plays a significant role in the choice of treatment. Methods: A total of 109 patients with colorectal (n = 92)or gastric cancer prospectively underwent computed tomography (CT) scan and conventional US evaluation followed by real time CEUS. A diagnosis of metastases was made by CT or, for lesions not visibile at CT, the diagnosis was achieved by histopathology or by a malignant behavior during follow-up. Results: Of 109 patients, 65 were found to have metastases at presentation. CEUS improved sensitivity in metastatic livers from 76.9% of patients (US) to 95.4% (p < 0.01), while CT scan reached 90.8% (p = n.s. vs CEUS, p < 0.01 vs US). CEUS and CT were more sensitive than US also for detection of single lesions (87 with US, 122 with CEUS, 113 with CT). In 15 patients (13.8%), CEUS revealed more metastases than CT, while CT revealed more metastases than CEUS in 9 patients (8.2%) (p = n.s.). Conclusion: CEUS is more sensitive than conventional US in the detection of liver metastases and could be usefully employed in the staging of patients with gastrointestinal cancer. Findings at CEUS and CT appear to be complementary in achieving maximum sensitivity. © 2007 Piscaglia et al; licensee BioMed Central Ltd

Rapporto 2007 su consumo e dipendenze da sostanze in Emilia-Romagna.

Report on the state of legal and illegal substances use in the territory of Emilia-Romagna Region.Il report analizza il fenomeno delle dipendenze nel territorio della Regione Emilia-Romagna. La descrizione del fenomeno si sviluppa intorno all\u27analisi degli indicatori individuati dall\u27Osservatorio Europeo delle Dipendenze di Lisbona (OEDT): 1-uso di sostanze nella popolazione generale (questo indicatore va a rilevare i comportamenti nei confronti di alcol e sostanze psicoattive da parte della popolazione generale); 2-prevalenza d\u27uso problematico delle sostanze psicoattive; 3-domanda di trattamento degli utilizzatori di sostanze; 4-mortalit? degli utilizzatori di sostanze; 5-malattie infettive. Altri due importanti indicatori che si stanno sviluppando, e che vengono qui illustrati, sono l\u27analisi delle Schede di Dimissione Ospedaliera (SDO) e gli indicatori relativi alle conseguenza sociali dell\u27uso di droghe (criminalit? droga correlata). Inoltre sono state applicate diverse metodologie standard di stima sia per quantificare la quota parte sconosciuta di utilizzatori di sostanze che non afferiscono ai servizi, sia per identificarne alcune caratteristiche

Buffered high charge spectrally-peaked proton beams in the relativistic-transparency regime

Spectrally-peaked proton beams of high charge (Ep » 8 MeV, DE » 4 MeV, N » 50 nC ) have been observed from the interaction of an intense laser (>1019 W cm−2) with ultrathin CH foils, as measured by spectrally-resolved full beam profiles. These beams are reproducibly generated for foil thicknesses 5–100 nm, and exhibit narrowing divergence with decreasing target thickness down to »8 for 5 nm. Simulations demonstrate that the narrow energy spread feature is a result of buffered acceleration of protons. The radiation pressure at the front of the target results in asymmetric sheath fields which permeate throughout the target, causing preferential forward acceleration. Due to their higher charge- to-mass ratio, the protons outrun a carbon plasma driven in the relativistic transparency regime