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Hospitalized cancer patients are at increased risk for Thromboembolic Events (TEs). As untailored thromboprophylaxis is associated with hemorrhagic complications, the definition of a risk-assessment model (RAM) in this population is needed. INDICATE was a prospective observational study enrolling hospitalized cancer patients, with the primary objective of assessing the Negative Predictive Value (NPV) for TEs during hospitalization and within 45 days from discharge of low-grade Khorana Score (KS = 0). Secondary objectives were to assess KS Positive Predictive Value (PPV), the impact of TEs on survival and the development of a new RAM. Assuming 7% of TEs in KS = 0 patients as unsatisfactory percentage and 3% of as satisfactory, 149 patients were needed to detect the favorable NPV with one-sided α = 0.10 and power = 0.80. Stepwise logistic regression was adopted to identify variables included in a new RAM. Among 535 enrolled patients, 153 (28.6%) had a KS = 0. The primary study objective was met: 29 (5.4%) TEs were diagnosed, with 7 (4.6%) cases in the KS = 0 group (NPV = 95.4%, 95% CI 90.8–98.1%; one-sided p = 0.084). However, the PPV was low (5.7%, 95% CI 1.9–12.8%); a new RAM based on albumin (OR 0.34, p = 0.003), log(LDH) (OR 1.89, p = 0.023) and presence of vascular compression (OR 5.32, p < 0.001) was developed and internally validated. Also, TEs were associated with poorer OS (median, 5.7 vs 24.8 months, p < 0.001). INDICATE showed that the KS has a good NPV but poor PPV for TEs in hospitalized cancer patients. A new RAM was developed, and deserves further assessment in external cohorts.

Islands are frequently characterised by an economic structure centred on tourism and the service sector. This specialisation has taken different forms and characterisations concerning the chosen or spontaneously developed model. To understand the development choices and patterns, this article analyses sixteen islands and archipelagos in the European Union over ten years from 2010 to 2019. A panel data analysis was based on critical variables identifying the tourism industry model from those that could represent a proxy of the community-based tourism model. The principal component analysis was adopted to compare the evolutionary trends of these two different ways of choosing the island's tourism model. Findings identified before the COVID-19 pandemic crisis include two island clusters. One group of islands followed a spontaneous tourism model based on the local community and small or micro hospitality systems, with auto-entrepreneurship in tourism. The second group of islands followed a planning and industry-based tourist model with an employment system and a relevant hospitality industry. Both paradigms have limitations and identify two different tourism evolutionary scenarios useful for the EU's future island tourism policies.

Tourism seasonality as a tourist demand concentration in specific seasons is still a big challenge for Mediterranean islands’ tourism policies. Overtourism occurs during high tourist seasons, and undertourism occurs during low tourist seasons, creating undesirable economic, social, and environmental effects on sustainability. However, the imbalance of tourism demand, specifically in fragile territories such as islands, needs specific policies based on scientific evidence. This article examines tourism seasonality dynamics in the Mediterranean islands, thoroughly analysing tourist overnights on island destinations. The adopted methodology uses a set of statistical indicators, such as peak factor intensity, calculated in a time series analysis from 2008 to 2018. The results of this article allow us to understand the importance for the Mediterranean islands to plan a resilient, sustainable, and harmonious tourism policy, using strategies to contain seasonal peaks and creating new tourist demand in the low season months.

Background: Recently, pro-gastrin-releasing peptide (pro-GRP) became available as an alternative sensitive, specific and reliable tumor marker for patients with small cell lung cancer (SCLC), both in limited (LD) and diffuse disease (DD). Methods: We retrospectively analyzed pro-GRP, neuron-specific enolase (NSE) and CEA in patients with SCLC and non-small cell lung cancer (NSCLC). Serum pro-GRP level was measured with electrochemiluminescence at our laboratory (cutoff 77.8 pg/mL). Continuous variables were analyzed with the Mann-Whitney test, contingency data with Fisher’s exact test. Receiver operator characteristic (ROC) curve analysis was performed to identify threshold values to set the highest sensitivity (Sn) and specificity (Sp) values. Results: A total of 65 patients were studied (49 men, median age 67 years, range 27-79). Thirty-seven patients had SCLC (29 DD, 8 LD) and 28 advanced NSCLC. Median pro-GRP level was 919 pg/mL (range 22-147,350) in SCLC and 32 pg/mL (range 10-119.2) in NSCLC (p<0.0001). NSE was 4.38-fold higher in SCLC patients (p = 0.0005); CEA did not reveal significant differences between groups. Pro-GRP Sn and Sp were 86.4% and 96.4%, respectively. With ROC curve analysis, a cutoff value of 329.3 pg/mL showed a Sn of 75.8% and Sp of 87.5% in discriminating DD from LD. Pro-GRP was not influenced by either liver metastases or renal impairment. Conclusions: Pro-GRP is sensitive for SCLC diagnosis. Since high marker levels are related to high disease burden, pro-GRP may have a negative prognostic significance. Follow-up studies are required to define its role in clinical practice in monitoring responses to treatment and early relapses.

\"Patient Voices\" is a software developed to promote the systematic collection of electronic patient-reported outcome measures (ePROMs) in routine oncology clinical practice. This study aimed to assess compliance with and feasibility of the Patient Voices ePROM system and analyze patient-related barriers in an Italian comprehensive cancer center. Consecutive patients with cancer attending 3 outpatient clinics and 3 inpatient wards were screened for eligibility (adults, native speakers, and being able to fill in the ePROMs) and enrolled in a quantitative and qualitative multimethod study. Compliance, reasons for not administering the ePROMs, patients' interaction needs, and patient-perceived System Usability Scale (range 0-100) were collected; semistructured interviews were carried out in a subsample of patients. From June 2020 to September 2021, a total of 435 patients were screened, 421 (96.7%) were eligible, and 309 completed the ePROMs (309/421, 73.4%; 95% CI 69.8%-77.5%; mean age 63.3, SD 13.7 years). Organization problems and patient refusal were the main reasons for not administering the ePROMs (outpatients: 40/234, 17.1% and inpatients: 44/201, 21.9%). Help for tablet use was needed by 27.8% (47/169) of outpatients and 10.7% (15/140) of inpatients, while the support received for item interpretation was similar in the 2 groups (outpatients: 36/169, 21.3% and inpatients: 26/140, 18.6%). Average System Usability Scale scores indicated high usability in both groups (outpatients: mean 86.8, SD 15.8 and inpatients: mean 83.9, SD 18.8). Overall, repeated measurement compliance was 76.9% (173/225; outpatients only). Interviewed patients showed positive attitudes toward ePROMs. However, there are barriers to implementation related to the time and cognitive effort required to complete the questionnaires. There is also skepticism about the usefulness of ePROMs in interactions with health care professionals. This study provides useful information for future ePROM implementation strategies, aimed at effectively supporting the routine clinical management and care of patients with cancer. In addition, these findings may be relevant to other organizations willing to systematically collect PROMs or ePROMs in their clinical routines. ClinicalTrials.gov NCT03968718; https://clinicaltrials.gov/study/NCT03968718.

Background Since a long time, Italy has maintained a dual system to administer childhood immunisations, that is a certain number of mandatory vaccinations and a number of recommended vaccinations. The study aimed to explore the issues surrounding parental acceptance or non-acceptance of the recommended vaccinations for children. Methods Parents of children aged 3-5 years of day-care centres in Sicily were asked to fill out an anonymous questionnaire. Determinants of the attitude towards recommended vaccinations and social influence on the decision-making process were assessed using logistic regression analysis. Results Of the 1,500 selected parents, 81.0% participated in the study. Prior to the survey, the majority of children (97.6%) received recommended vaccines. Most parents (74.4%) received information about vaccinations from Family Paediatricians, showed a good knowledge about the side effects of the vaccines (73.1%), did not worry about their potential dangerousness (53.0%) and would have accepted their children to be vaccinated even if it was not required for day care (84.1%). The majority (79.9%) were not disposed to follow the advises of the anti-vaccination movements. Parents' background characteristics, sources of information and social influence were not significantly associated with parental acceptance of recommended vaccines for childhood. Conclusions This study suggests that health information by Family Paediatricians is significantly associated with parental acceptance of recommended vaccinations.

In the last few years, the contribution of the agricultural sector to tourism has been increasingly evident. Agritourism provides the possibility to have a green holiday experience and allows farmers to diversify their income. In the tourist sector, communication is decisive in determining consumption choices, and the Web plays an important role. Considering that the Internet can bring potential benefits and reach new customers, it is important that websites are complete and attractive. This paper evaluates agritourism websites in an Italian region (Sicily) to analyse the strategic choices made by farmers. This study uses the eMICA methodological approach to analyse the quality of the websites and a cluster analysis to find homogeneous groups of farms. The results indicate that there is a large group of Sicilian agritourism providers that have been slow in taking advantage of the new opportunities offered by the Web, whereas another group, which is less numerous, makes use of social networking tools, demonstrating web 2.0 communication.

Tourism as an industry has many kinds of impacts on destinations and their communities. The presence of tourism could create the conditions for an economic development but in the same way produce negative effect (crowding out) and externalities (the Janus-face character). Between the different actors inside the tourist destination, there are the local community which could endure the pressure of tourism. In some cases, this pressure reduces the wellbeing of the residents. The present research paper focuses on how activities like events and tourism impact on community well-being. Winchester (England), a Special Interest Tourism and Event (SITE), is used as a case study. The data are collected using an on-line interview and they are elaborated using multivariate techniques and ordinal regression analysis. The results of the study reveal a close relation between the level of happiness of the local residents and their perception of the tourism industry and event development. Local residents in Winchester are perceiving the tourism industry and events rather positively as they believe it supports their culture and the local economy and job in particular. Our first overall conclusion is that there is a relationship between the residents’ happiness and tourism/event perception. Moreover, our findings support what claimed by several scholars that tourism specialisation improves the residents quality of life (QOL). The present study has not shown the direction of the influence but according to previous research it is the level of happiness of the local residents that determines their perception of the tourism industry and event development and not the other way around. The second finding of the study reveals that SITE destinations have a high potential in terms of contributing to the local residents’ happiness and subsequently visitors. Our third and final conclusion is that, when the benefits of tourism and events are higher than the cost, local residents and are likely to be supportive of the activity.

The attractiveness of regions for firms, investments, tourists, students, workers, talented people, and other categories is a relevant issue for regional economic development in the age of globalization. Tourist attractiveness is one of the most important dimensions, as the economic relevance of tourism is continually on the rise. This is true for peripheral areas like islands, where attracting people and investments is even more difficult due to the geographical characteristics. This paper presents the case study of the tourist attractiveness of Sicily, the largest island in the Mediterranean, based on the qualitative findings of research on stakeholders’ perception and point of view conducted through in-depth semi-structured interviews. Qualitative analyses of the interviews are twofold: On the one hand, we conducted a thematic analysis, identifying and analyzing themes and sub-themes that capture something important in relation to the overall research question. On the other hand, we analyzed document content as a lexical tool using Leximancer software, which analyzes meanings within texts by extracting key concepts and ideas. These analyses highlighted the key aspects and the key drivers that so far have not emerged clearly from studies on Sicilian tourism. The tourist attractiveness of Sicily, for better or worse, cannot be disentangled from its physical nature and its unique and rich history. Thanks to its island status, and thanks to its valuable assets in terms of landscape, climate, art, and culture, it has great potential in terms of tourist attractiveness. However, it also suffers from the disadvantages associated with being an island, such as a low level of accessibility and high seasonality. Moreover, the tourism industry is poorly organized and not competitive compared to other Mediterranean islands, and the governance of the tourism sector is deficient. Ultimately, in an extremely peripheral region like Sicily where private entrepreneurs suffer from absolute competitive disadvantages, the role of public institutions is fundamental in order to exploit successfully its local and unique assets and to increase the level of attractiveness.