Tourism-related activities are deemed to have a negative impact on the natural environment, thus requiring a proper management scheme. The implementation of planning procedures for sustainable tourism activities needs to be based on the active involvement of several actors, with conflicting goals and interests. In addition, the need for resource rationalisation is more and more pressing. Thus, this research aims to propose a procedure for selecting tourism activities to be funded by the Public administration and implemented. The proposed approach supports policymakers by providing suggestions on how to optimise the allocation of public resources, while accounting for social and environmental issues. This optimisation model has been applied to the selection of projects presented in response to a call for tender drafted by an Italian Public administration. The main aim of the tender is to finance projects aimed at either increasing the attractiveness of urban areas, seasonally adjusting tourism activity supply and supporting environment-friendly models. Our findings illustrate the operational advantages of the proposed approach, in terms of either improved resource allocation, increased interaction among public and private subjects and an increased number of funded activities. Furthermore, to validate our assumption, a comparison with a traditional multicriteria technique is performed.
Vaginal cuff dehiscence (VCD) is a rare postoperative complication of total hysterectomy. Presenting symptom is acute pelvic or abdominal pain accompanied by nausea and vomiting. Immediate recognition and surgical repair are crucial for successful management. A 40-year-old para 1+0 presented with complaints of pelvic pain associated with sexual activity, three months after a total laparoscopic hysterectomy. Speculum examination revealed the presence of bowel into the vagina. Diagnostic laparoscopic assessment combined with VCD repair through the transvaginal route. The occurrence of VCD after laparoscopic hysterectomy has been linked to overuse of electrocautery, prolonged inflammatory response and suturing methods. Laparoscopic, abdominal and vaginal approaches are the routes for repairing VCD. However, it depends on the clinical presentation and surgeon expertise. Careful history, and physical examination are vital factors in guiding clinicians to diagnose and treat VCD. Nevertheless, an ideal modality remains variable to each case.
