U radu se istražuje fenomen mixed use resorts kao savremeni oblik razvoja smještajne industrije. Cilj rada je da se ova vrsta resorta precizno definiše, predstave neki uspješni modelu u svijetu i ...sagledaju izazovi u pogledu razvojne održivosti ove vrste smještajnih objekata. Posebno se analizira prvi internacionalni projekat mixed use resorts u Crnoj Gori, poznat pod imenom Lustica Bay. Održivost na konkretnom primjeru se analizira sa aspekta Strategije održivog razvoja turizma Crne Gore i teorijskih postulata o održivosti razvoja turizma.
Razvoj turizma je praćen problemom insuficijencije finansijskih resursa za razvoj. Kreditno i kapitalsko finansiranje ima svoja stanovita ograničenja u pogledu obima kapitala i obima i cijene kreditnih sredstava. Zbog toga se pribjegava kombinaciji sa modelom prodaje nekretnina, koje bi se, u dobrom dijelu, uključile u operativno poslovanje mixed use resorts. Ta ograničenja su u Crnoj Gori, kao zemlji u tranziciji, još više izražena.
Kada se tome doda i nepostojanje potrebne infrastrukture za podršku inostranim investitorima (sposobna i efikasna administracija, fleksibilni urbanistički planovi, dobro istražene lokacije sa aspekta održivosti, kredibilne domaće razvojne kompanije-lokalni diveloperi koji bi bili pouzdan partner ino investitorima i sl), onda je jasno da se u posljednje 2-3 decenije neuporedivo brže grade vikend stanovi i kuće (second homes) nego hoteli, risorti i slićni objekti koji imaju najveći uticaj na ekonomiju i društvo.
U radu su identifikovani glavni izazovi i prijetnje takvoga razvoja, gdje se često puta, mixed use resorts zloupotrebljavaju kao ulaznica za razvoj novih naselja za prodaju, a ne novih smještajnih objekata za turističko privređivanje. Izazovi koji prate izabrani slučaj za istraživanje, ukazuju na konkretno ispoljavanje generalno identifikovanih problema i razvojnih prijetnji.
This paper examines the phenomenom of mixed use resorts as a contemporary form of development of accommodation industry. The aim is to precisly define this type of resort, to represent some succesful models in the world and to consider the challenges of sustainable development of this type of accommodation facilities. In particular, we analyze the first international project of mixed use resorts in Montenegro, known as Lustica Bay. Sustainability of a concrete example is analyzed in terms of the Stategy of sustainable tourism development of Montenegro and theoretical aspects of the sustainability of tourism development.
Tourism development is accompanied by the problem of insufficiency of financial resources for development. Credit and equity financing have their constant limitations regarding the extent of capital and cost of credit funds. Therefore, it is combined with a model of real estate sales, which, in good part, would be involved in the operational business of mixed use resorts. These restrictions are even more emphasized in Montenegro, as a country in transition.
When we add to that the lack of the necessary infrastructure to support foreign investors (capable and efficient administration, flexible urban plans, well-explored areas in terms of sustainability, credible domestic developed companies-local developers who could be reliable partner for foreign investors and so on), then it is clear that in the last 2-3 decades, weekend flats and houses (second homes) are incomparably more rapidly built than the hotels, resorts and similar objects which have the greatest impact on the economy and society.
This paper identifies the main challenges and threats of such development, where mixed use resorts are often abused as an entry ticket for the development of new resorts for sale instead of new accommodation facilities for tourism economy. The challenges of a selected case for research suggest a concrete manifestation of generally identified problems and development threats.
This paper examines the phenomenom of mixed use resorts as a contemporary form of development of accommodation industry. The aim is to precisly define this type of resort, to represent some succesful ...models in the world and to consider the challenges of sustainable development of this type of accommodation facilities. In particular, we analyze the first international project of mixed use resorts in Montenegro, known as Lustica Bay. Sustainability of a concrete example is analyzed in terms of the Stategy of sustainable tourism development of Montenegro and theoretical aspects of the sustainability of tourism development. Tourism development is accompanied by the problem of insufficiency of financial resources for development. Credit and equity financing have their constant limitations regarding the extent of capital and cost of credit funds. Therefore, it is combined with a model of real estate sales, which, in good part, would be involved in the operational business of mixed use resorts. These restrictions are even more emphasized in Montenegro, as a country in transition. When we add to that the lack of the necessary infrastructure to support foreign investors (capable and efficient administration, flexible urban plans, well-explored areas in terms of sustainability, credible domestic developed companies-local developers who could be reliable partner for foreign investors and so on), then it is clear that in the last 2-3 decades, weekend flats and houses (second homes) are incomparably more rapidly built than the hotels, resorts and similar objects which have the greatest impact on the economy and society. This paper identifies the main challenges and threats of such development, where mixed use resorts are often abused as an entry ticket for the development of new resorts for sale instead of new accommodation facilities for tourism economy. The challenges of a selected case for research suggest a concrete manifestation of generally identified problems and development threats.
This paper examines the phenomenon of creative tourism in general and evaluates the cultural capital of Cetinje city and its surroundings. Research has shown that Cetinje has extraordinary cultural ...and natural resources for the development of cultural tourism in the city and the entire municipality. For the purposes of this study secondary ("on desk") researches of the phenomenon of cultural tourism and creative tourism were conducted as its special part. In this context benchmark analysis were applies, respectively identification of international benchmarks in the field of cultural tourism. In the primary part the inventory of attractions was carried out on which creative tourism of Cetinje would be built and survey was executed regarding awareness of the main internal stakeholders with regard to creative tourism, and its development in the town and municipality of Cetinje. Creative tourism is viewed as a derivative of cultural heritage, and only few know the character of active cultural tourism in fact cultural preferences of tourists towards experience of local culture and nature. Managing of development of creative tourism requires proper institutional organization, in order to ensure coordination of all participants and ensure synergy effects of organized joint action. The paper identifies the main challenges and threats to the development of creative tourism in the municipality of Cetinje and the city of Cetinje..
"Translational medicine" has been a buzzword for over two decades. The concept was intended to be lofty, to reflect a new "bench-to-bedside" approach to basic and clinical research that would bridge ...fields, close gaps, accelerate innovation, and shorten the time and effort it takes to bring novel technologies from basic discovery to clinical application. Has this approach been successful and lived up to its promise? Despite incredible scientific advances and innovations developed within academia, successful clinical translation into real-world solutions has been difficult. This has been particularly challenging within the pulmonary field, because there have been fewer U.S. Food and Drug Administration-approved drugs and higher failure rates for pulmonary therapies than with other common disease areas. The American Thoracic Society convened a working group with the goal of identifying major challenges related to the commercialization of technologies within the pulmonary space and opportunities to enhance this process. A survey was developed and administered to 164 participants within the pulmonary arena. This report provides a summary of these survey results. Importantly, this report identifies a number of poorly recognized challenges that exist in pulmonary academic settings, which likely contribute to diminished efficiency of commercialization efforts, ultimately hindering the rate of successful clinical translation. Because many innovations are initially developed in academic settings, this is a global public health issue that impacts the entire American Thoracic Society community. This report also summarizes key resources and opportunities and provides recommendations to enhance successful commercialization of pulmonary technologies.
The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on ...stress-induced regional wall motion abnormalities (RWMA).
The purpose of this study was to assess the feasibility and functional correlates of CFVR.
This prospective, observational, multicenter study initially screened 3,410 patients (2,061 60% male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up.
The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio OR: 6.5; 95% confidence interval CI: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome.
CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.
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Various lung ultrasound (LUS) scanning modalities have been proposed for the detection of B-lines, also referred to as ultrasound lung comets, which are an important indication of extravascular lung ...water at rest and after exercise stress echo (ESE). The aim of our study was to assess the lung water spatial distribution (comet map) at rest and after ESE. We performed LUS at rest and immediately after semi-supine ESE in 135 patients (45 women, 90 men; age 62 ± 12 y, resting left ventricular ejection fraction = 41 ± 13%) with known or suspected heart failure or coronary artery disease. B-lines were measured by scanning 28 intercostal spaces (ISs) on the antero-lateral chest, 2nd-5th IS, along with the midaxillary (MA), anterior axillary (AA), mid-clavicular (MC) and parasternal (PS) lines. Complete 28-region, 16-region (3rd and 4th IS), 8-region (3rd IS), 4-region (3rd IS, only AA and MA) and 1-region (left 3rd IS, MA) scans were analyzed. In each space, the B-lines were counted from 0 = black lung to 10 = white lung. Interpretable images were obtained in all spaces (feasibility = 100 %). B-lines (>0 in at least 1 space) were present at ESE in 93 patients (69%) and absent in 42. More B-lines were found in the 3rd IS and along AA and MA lines. The B-line cumulative distribution was symmetric at rest (right/left = 1.10) and asymmetric with left lung predominance during stress (right/left = 0.67). The correlation of per-patient B-line number between 28-S and 16-S (R
= 0.9478), 8-S (R
= 0.9478) and 4-S scan (R
= 0.9146) was excellent, but only good with 1-S (R
= 0.8101). The average imaging and online analysis time were 5 s per space. In conclusion, during ESE, the comet map of lung water accumulation follows a predictable spatial pattern with wet spots preferentially aligned with the third IS and along the AA and MA lines. The time-saving 4-region scan is especially convenient during stress, simply dismissing dry regions and focusing on wet regions alone.
The trial “Stress Echo (SE) 2020” evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria.
One reader from 78 ...centers of the SE 2020 network asked for credentials to read a set of 20 SE video-clips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31years (mean value 18years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (≥90%).
Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7±13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r=−0.161, p=0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based session and their accuracy improved (74% vs. 96%, p<0.001). The kappa inter-observer agreement before and after web-based training was 0.59 on first attempt and rose to 0.91 on the last attempt.
In SE reading, the volume of activity or years of experience is not synonymous with diagnostic quality. Qualitative analysis and operator-dependence can become a limiting weakness in clinical practice, in the absence of strict pathways of learning, credentialing and audit.
With stress echo (SE) 2020 study, a new standard of practice in stress imaging was developed and disseminated: the ABCDE protocol for functional testing within and beyond CAD. ABCDE protocol was the ...fruit of SE 2020, and is the seed of SE 2030, which is articulated in 12 projects: 1-SE in coronary artery disease (SECAD); 2-SE in diastolic heart failure (SEDIA); 3-SE in hypertrophic cardiomyopathy (SEHCA); 4-SE post-chest radiotherapy and chemotherapy (SERA); 5-Artificial intelligence SE evaluation (AI-SEE); 6-Environmental stress echocardiography and air pollution (ESTER); 7-SE in repaired Tetralogy of Fallot (SETOF); 8-SE in post-COVID-19 (SECOV); 9: Recovery by stress echo of conventionally unfit donor good hearts (RESURGE); 10-SE for mitral ischemic regurgitation (SEMIR); 11-SE in valvular heart disease (SEVA); 12-SE for coronary vasospasm (SESPASM). The study aims to recruit in the next 5 years (2021-2025) ≥10,000 patients followed for ≥5 years (up to 2030) from ≥20 quality-controlled laboratories from ≥10 countries. In this COVID-19 era of sustainable health care delivery, SE2030 will provide the evidence to finally recommend SE as the optimal and versatile imaging modality for functional testing anywhere, any time, and in any patient.
Stroke volume response during stress is a major determinant of functional status in heart failure and can be measured by two-dimensional (2-D) volumetric stress echocardiography (SE). The present ...study hypothesis is that SE may identify mechanisms underlying the change in stroke volume by measuring preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) with systolic blood pressure and end-systolic volume (ESV).
We enrolled 4735 patients (age 63.6±11.3 years, 2800 male) referred to SE for known or suspected coronary artery disease (CAD) and/or heart failure (HF) in 21 SE laboratories in 8 countries. In addition to regional wall motion abnormalities (RWMA), force was measured at rest and peak stress as the ratio of systolic blood pressure by cuff sphygmomanometer/ESV by 2D with Simpson's or linear method. Abnormal values of LVCR (peak/rest) based on force were ≤1.10 for dipyridamole (N.=1992 patients) and adenosine (N.=18); ≤2.0 for exercise (N.=2087) or dobutamine (N.=638).
Force-based LVCR was obtained in all 4735 patients. Lack of stroke volume increase during stress was due to either abnormal LVCR and/or blunted preload reserve, and 57% of patients with abnormal LVCR nevertheless showed increase in stroke volume.
Volumetric SE is highly feasible with all stresses, and more frequently impaired in presence of ischemic RWMA, absence of viability and reduced coronary flow velocity reserve. It identifies an altered stroke volume response due to reduced preload and/or contractile reserve.
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