Environmental management decision-making in certified hotels

This paper analyses environmental decision-making against two axes, motivations and decision-making processes, to understand the reasons for pro-environmental behaviour by the managements of Spanish Eco-management and Audit Scheme (EMAS)-certified hotels. Mixed methods were used to study perceptions of EMAS and reasons for being certified, with current and lapsed EMAS-certified firms triangulated against expert interviews and documentary evidence. Four groups of hotels were differentiated: Strategic hotels (22%) (with high levels of integrated environmental management), Followers (48%), Greenwashers (11%) and Laggers (19%) (with low levels of integrated environmental management). Most hotels were found to be internally driven in their purpose and ad hoc in their decision-making, with limited understanding of externally driven benefits and motivation for more systematic management systems. This questions the success of EMAS as both a continuous improvement management and as a market-based regulation tool for hotels. Few hotels overall related high environmental standards to the possibilities of gaining market advantage: most wished to avoid legal challenges. The paper also illustrates the ways in which hotels opportunistically switch certification systems to get what they see as a better deal. © 2011 Taylor & Francis

On the LpL^p boundedness of wave operators for two-dimensional Schr\"odinger operators with threshold obstructions

Let $H=-\Delta+V$ be a Schr\"odinger operator on $L^2(\mathbb R^2)$ with real-valued potential $V$, and let $H_0=-\Delta$. If $V$ has sufficient pointwise decay, the wave operators $W_{\pm}=s-\lim_{t\to \pm\infty} e^{itH}e^{-itH_0}$ are known to be bounded on $L^p(\mathbb R^2)$ for all $1< p< \infty$ if zero is not an eigenvalue or resonance. We show that if there is an s-wave resonance or an eigenvalue only at zero, then the wave operators are bounded on $L^p(\mathbb R^2)$ for $1 < p<\infty$. This result stands in contrast to results in higher dimensions, where the presence of zero energy obstructions is known to shrink the range of valid exponents $p$.Comment: Revised according to referee's comments. 22 pages, to appear in J. Funct. Ana

Annotators-in-the-loop: Testing a Novel Annotation Procedure on Italian Case Law

The availability of annotated legal corpora is crucial for a number of tasks, such as legal search, legal information retrieval, and predictive justice. Annotation is mostly assumed to be a straightforward task: as long as the annotation scheme is well defined and the guidelines are clear, annotators are expected to agree on the labels. This is not always the case, especially in legal annotation, which can be extremely difficult even for expert annotators. We propose a legal annotation procedure that takes into account annotator certainty and improves it through negotiation. We also collect annotator feedback and show that our approach contributes to a positive annotation environment. Our work invites reflection on often neglected ethical concerns regarding legal annotation

Burden of acute otitis media in primary care pediatrics in Italy: A secondary data analysis from the Pedianet database

Background: The incidence of acute otitis media (AOM) vary from country to country. Geographical variations together with differences in study designs, reporting and settings play a role. We assessed the incidence of AOM in Italian children seen by primary care paediatricians (PCPs), and described the methods used to diagnose the disease.Methods: This secondary data analysis from the Pedianet database considered children aged 0 - 6 years between 01/2003 and 12/2007. The AOM episodes were identified and validated by means of patient diaries. Incidence rates/100 person-years (PY) were calculated for total AOM and for single or recurrent AOM.Results: The 92,373 children (52.1% males) were followed up for a total of 227,361 PY: 23,039 (24.9%) presented 38,241 episodes of AOM (94.6% single episodes and 5.4% recurrent episodes). The total incidence rate of AOM in the 5-year period was 16.8 episodes per 100 PY (95% CI: 16.7-16.9), including single AOM (15.9 episodes per 100 PY; 95% CI: 15.7-16.1) and recurrent AOM (0.9 episodes per 100 PY; 95% CI: 0.9-0.9). There was a slight and continuously negative trend decrease over time (annual percent change -4.6%; 95%CI: -5.3, -3.9%). The AOM incidence rate varied with age, peaking in children aged 3 to 4 years (22.2 episodes per 100 PY; 95% CI 21.8-22.7). The vast majority of the AOM episodes (36,842/38,241, 96.3%) were diagnosed using a static otoscope; a pneumatic otoscope was used in only 3.7%.Conclusions: Our data fill a gap in our knowledge of the incidence of AOM in Italy, and indicate that AOM represents a considerable burden for the Italian PCP system. Educational programmes concerning the diagnosis of AOM are needed, as are further studies to monitor the incidence in relation to the introduction of wider pneumococcal conjugate vaccines

Meddelelser fra Nationaløkonomisk Forening 1992

OBJECTIVES: Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis is currently associated with great operative difficulty and surgical complications. Herein, we report on our single-center experience and describe predictive factors for successfully accomplishing this procedure. METHOD: Between March 1998 and April 2010, 66 patients (27 men and 39 women) underwent laparoscopic nephrectomy for the treatment of a unilateral nonfunctioning kidney. These patients had previous diagnoses of renal chronic inflammation associated with calculi and previous pyonephrosis. All of the nephrectomies were performed using the transperitoneal approach, and a similar technique was used for radical nephrectomy. RESULTS: Laparoscopic nephrectomy for the treatment of renal chronic inflammation was successful in 58/66 cases (87.9%). Eight cases were converted to the open technique because of difficulty in progression, which was related to the discovery of dense adhesions in the hilar or perirenal region. One major (colonic lesion) and two minor (wound infection) complications occurred in the conversion group. A diagnosis of xanthogranulomatous pyelonephritis was confirmed pathologically for all of the specimens. Of the factors examined, a longitudinal renal length greater than 12 cm (laparoscopy group - 7.2 +/- 1.8 cm, versus open group - 13.6 +/- 1.5 cm; p<0.05) and time to access the renal vessels (laparoscopy group - 32 +/- 18 min, versus open group - 91 +/- 11 min; p<0.05) were associated with a higher conversion rate. Although the number of patients in the conversion group was small, the majority of these patients received right-sided nephrectomy. CONCLUSIONS: Laparoscopic nephrectomy for the treatment of xanthogranulomatous pyelonephritis is feasible and associated with low levels of morbidity. Factors including the time required to control the renal vessels, renal length and right-sided nephrectomy were associated with higher chances of conversion into an open procedure

A Novel Intraurethral Device Diagnostic Index to Classify Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

Objectives. Using a urethral device at the fossa navicularis, bladder pressure during voiding can be estimated by a minimal invasive technique. This study purposes a new diagnostic index for patients with lower urinary tract symptoms (LUTSs). Methods. Fifty one patients presenting with LUTSs were submitted to a conventional urodynamic and a minimal invasive study. The results obtained through the urethral device and invasive classic urodynamics were compared. The existing bladder outlet obstruction index (BOOI) equation that classifies men with LUTSs was modified to allow minimal invasive measurement of isovolumetric bladder pressure in place of detrusor pressure at maximum urine flow. Accuracy of the new equation for classifying obstruction was then tested in this group of men. Results. The modified equation identified men with obstruction with a positive predictive value of 68% and a negative predictive value of 70%, with an overall accuracy of 70%. Conclusions. The proposed equation can accurately classify over 70% of men without resorting to invasive pressure flow studies. We must now evaluate the usefulness of this classification for the surgical treatment of men with LUTSs

The intertwining of healthcare-associated infections and COVID-19 in Italian intensive care units: an analysis of the SPIN-UTI project from 2006 to 2021

Background: Although healthcare-associated infections (HAIs) pose an extraordinary burden on public health, the impact of coronavirus disease 2019 (COVID-19) is still a matter of debate. Aim: To describe trends of HAIs in Italian intensive care units (ICUs) from 2006 to 2021, and to compare characteristics and outcomes of patients with or without COVID-19. Methods: We evaluated patients participating in the 'Italian Nosocomial Infections Surveillance in Intensive Care Units' (SPIN-UTI) project, who were admitted to ICUs for more than 48 h. Data regarding diagnosis, clinical conditions, therapies, treatments and outcomes of COVID-19 patients were also collected. Findings: From a total of 21,523 patients from 2006 to 2021, 3485 (16.2%) presented at least one HAI. We observed an increasing trend for both the incidence of patients with HAI and the incidence density of HAIs (P-trend <0.001). Compared with the pre-pandemic period, the incidence density of HAIs increased by about 15% in 2020-2021, with pneumoniae being the greatest contributors to this increase (P-trend <0.001). Moreover, incidence of HAIs was higher in ICUs dedicated to COVID-19 patients (P<0.001), who showed a greater risk of HAIs and death than patients without COVID-19 (P-values <0.001). Accordingly, the mortality in ICUs increased over the years and doubled during the pandemic (P-trend <0.001). Notably, co-infected patients had higher mortality (75.2%) than those with COVID-19 (66.2%) or HAI (39.9%) alone, and those without any infection (23.2%). Conclusions: Our analysis provides useful insight into whether and how the COVID-19 pandemic influenced HAI incidence and death in Italian ICUs, highlighting the need for evaluation of the long-term effects of the pandemic. (c) 2023 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Vesicostomy as a Protector of Upper Urinary Tract in Long-Term Follow-Up

Introduction: The aim of this study was to analyze the results of vesicostomy in children as a protector of the upper urinary tract and assess the adjustments taken by the caregivers. Materials and Methods: Twenty-one children who had undergone vesicostomy with the Blocksom technique were evaluated. Their mean age was 3.7 years (range, < 1 to 10 years). The evaluation consisted of kidney function tests, cystography, and analysis of complications. Twenty parents or caregivers were interviewed about their attitudes towards vesicostomy and its outcomes. Results: The main causes of the vesical dysfunction were posterior urethral valve in 7 (33.3%) and myelomeningocele in 5 patients (23.8%). Ten children (58.8%) showed improvement and 7 (41,2%) showed cure. Hydronephrosis observed in 17 children was alleviated or cured following the procedure. Kidney function, tested by creatinine clearance calculation, remained stable or improved in 20 patients (95.2%). Episodes of urinary tract infection and 1 (71.4%), vesicoureteral reflux lowered in 8 of 21 (38.1%) and 10 of 14 patients respectively. Subjective evaluation of 20 cases showed that 18 children (90.0%) remained dry during the day and 14 caregivers/parents (70.0%) felt they had acquired the skills necessary to handle a patient with vesicostomy. The mean global rate of satisfaction of the results of the surgery ranging from 0 (worst result) to 10 (best result) was 8.7. Conclusion: Vesicostomy is a simple surgery that protects the upper urinary tract, decreases hydronephrosis, and improves kidney function. There was adequate adjustment to vesicostomy and a positive global evaluation as reported by the parents and caregivers.629610