The Digital Brand Marketing in the Azores Archipelago

The ultra-peripheral Portuguese region of Azores is considered one of the EU outermost regions. This insular region is widely recognized as a sustainable nature-based destination. Its remoteness and breathtaking landscape attributed the region a label of adventure tourism by global references as Bloomberg, Departures, BBC, Forbes, GeekyExplorer, Lonely Planet, among others. In this regard, this type of tourism incorporated with the digital marketing generated around it is seen as a vital channel for inspiring sustainable regional development. Consequently, it is possible to verify that the digital marketing created around this new typology of tourism along with the Azores' singularity as a destination could significantly influence the local socio-economy base to the sustained development growth of the region. Furthermore, it was identified that the most reasonable opportunities for slow and nature-based tourism were located in rural tourism.

Clinical presentation of strokes confined to the insula: a systematic review of literature

Background and purpose The insular cortex serves a wide variety of functions in humans, ranging from sensory and affective processing to high-level cognition. Hence, insular dysfunction may result in several different presentations. Ischemic strokes limited to the insular territory are rare and deserve a better characterization, to be quickly recognized and to receive the appropriate treatment (e.g. thrombolysis). Methods We reviewed studies on patients with a first-ever acute stroke restricted to the insula. We searched in the Medline database the keywords “insular stroke” and “insular infarction”, to identify previously published cases. Afterwards, the results were divided depending on the specific insular region affected by the stroke: anterior insular cortex (AIC), posterior insular cortex (PIC) or total insula cortex (TIC). Finally, a review of the clinical correlates associated with each region was performed. Results We identified 25 reports including a total of 49 patients (59.7 ± 15.5 years, 48% male) from systematic review of the literature. The most common clinical phenotypes were motor and somatosensory deficits, dysarthria, aphasia and a vestibular-like syndrome. Atypical presentations were also common and included dysphagia, awareness deficits, gustatory disturbances, dysautonomia, neuropsychiatric or auditory disturbances and headache. Conclusions The clinical presentation of insular strokes is heterogeneous; however, an insular stroke should be suspected when vestibular-like, somatosensory, speech or language disturbances are combined in the same patient. Further studies are needed to improve our understanding of more atypical presentations.

Firm local embeddedness in an insular region: The Åland Islands compared to Finland

The present study analyzes the difference between the Åland Islands — an insular and peripheral part of Finland — and Finland as a whole in terms of firm local embeddedness. The analysis utilizes matched employee-employer longitudinal data for all businesses in Finland, including the Åland Islands, from 2006 to 2014. Local embeddedness is modelled both as tenure (the number of years a key stakeholder in a firm has lived in the same municipality as the firm) and by calculating the geographical distance the key stakeholder lives from the focal firm. Contrary to our expectations, we find that for our tenure measure of local embeddedness, firms are actually less locally embedded in the peripheral region than in the larger country. However, our distance measure of local embeddedness performs as expected with firms in the peripheral region. We hypothesize that that there may be an optimal level of local embeddedness, above which a local firm does not necessarily gain by further increasing its local embeddedness.

Endoscopic transorbital approach to the insular region: cadaveric feasibility study and clinical application (SevEN-005)

OBJECTIVEThe insula is a complex anatomical structure. Accessing tumors in the insula remains a challenge due to its anatomical complexity and the high chance of morbidity. The goal of this study was to evaluate the feasibility of an endoscopic transorbital approach (ETOA) to the insular region based on a cadaveric study.METHODSOne cadaveric head was used to study the anatomy of the insula and surrounding vessels. Then, anatomical dissection was performed in 4 human cadaveric heads using a dedicated endoscopic system with the aid of neuronavigation guidance. To assess the extent of resection, CT scanning was performed before and after dissection. The insular region was directly exposed by a classic transcranial approach to check the extent of resection from the side with a classic transcranial approach.RESULTSThe entire procedure consisted of two phases: an extradural orbital phase and an intradural sylvian phase. After eyelid incision, the sphenoid bone and orbital roof were extensively drilled out with exposure of the frontal and temporal dural layers. After making a dural window, the anterior ramus of the sylvian fissure was opened and dissected. The M2 segment of the middle cerebral artery (MCA) was identified and traced posterolaterally. A small corticectomy was performed on the posterior orbital gyrus. Through the window between the lateral lenticulostriate arteries and M2, the cortex and medulla of the insula were resected in an anteroposterior direction without violation of the M2 segment of the MCA or its major branches. When confirmed by pterional craniotomy, the sylvian fissure and the MCA were found to be anatomically preserved. After validation of the feasibility and safety based on a cadaveric study, the ETOA was successfully performed in a patient with a high-grade glioma (WHO grade III) in the right insula.CONCLUSIONSThe transorbital route can be considered a potential option to access tumors located in the insula. Using an ETOA, the MCA and its major branches were identified and preserved while removal was performed along the long axis of the insula. In particular, lesions in the anterior part of the insula are most benefited by this approach. Because this approach was implemented in only one patient, additional discussion and further verification is required.

Risk of Secondary Infection Waves of COVID-19 in an Insular Region: The Case of the Balearic Islands, Spain

The Spanish government declared the lockdown on March 14th, 2020 to tackle the fast-spreading of COVID-19. As a consequence, the Balearic Islands remained almost fully isolated due to the closing of airports and ports, these isolation measures and the home-based confinement have led to a low prevalence of COVID-19 in this region. We propose a compartmental model for the spread of COVID-19 including five compartments (Susceptible, Exposed, Presymptomatic Infective, Diseased, and Recovered), and the mobility between municipalities. The model parameters are calibrated with the temporal series of confirmed cases provided by the Spanish Ministry of Health. After calibration, the proposed model captures the trend of the official confirmed cases before and after the lockdown. We show that the estimated number of cases depends strongly on the initial dates of the local outbreak onset and the number of imported cases before the lockdown. Our estimations indicate that the population has not reached the level of herd immunization necessary to prevent future outbreaks. While the low prevalence, in comparison to mainland Spain, has prevented the saturation of the health system, this low prevalence translates into low immunization rates, therefore facilitating the propagation of new outbreaks that could lead to secondary waves of COVID-19 in the region. These findings warn about scenarios regarding after-lockdown-policies and the risk of second outbreaks, emphasize the need for widespread testing, and could potentially be extrapolated to other insular and continental regions.

Sustainability in Peripheral and Ultra-Peripheral Rural Areas through a Multi-Attribute Analysis: The Case of the Italian Insular Region

Italy has adopted the strategy of inner areas, mainly based on physical distance from public services. The strategy promotes a multi-level and multi-fund governance approach and the local partnership of mayors. Our paper focuses on rural areas, identified by the national strategy of inner areas, as peripheral and ultra-peripheral, in the Italian insular region (Sicily and Sardinia). It analyzes, at the municipality level, socio-demographic, economic, and environmental sustainability using appropriate indicators. Aiming at discovering the underlying relationship portrayed by multi-attribute data in an information system, we applied rough set theory. The inductive decision rules obtained through this data mining methodology reveal the simultaneous presence or absence of important characteristics aiming at reaching different levels of sustainability. Without the requirement of statistical assumptions regarding data distribution or structures for collecting data, such as functions or equations, this method ensures the description of patterns exhibited by data. Of particular interest is the assessment of conditional attributes (i.e., the selected indicators), and the information connecting them to sustainability, as a decision attribute. The most important result is rule generation, specifically, decision rules that are able to suggest tools for policy makers at different levels.

The Azores Archipelago as a Region with Vast Potential for the Development of Adventure and Slow Tourism

WTO (World Tourism Organization) recognizes that adventure tourism is a journey that includes at least two of three elements: (a) physical activity, (b) natural environment; and (c) cultural immersion. With this in mind, the Autonomous Region of Azores, classified as one of the OR (Outermost Regions) by the European Union (EU), meets several of those elements. Therefore, the Archipelago shows several potential for the development of this typology of tourism. However, this insular region faces many challenges. Some of those obstacles are also great opportunities for regional development towards new sustainable models. For example, there is the islands’ geographical location, which enables exceptional territorial development opportunities and growth opportunities. Contextually, the Archipelago’s nine islands afford great variety to the destination, and the tranquil rural landscape fits the perfect framework for unparalleled, charming, and relaxing experiences. Moreover, the Archipelago’s specific characteristics, as its volcanic nature, make the destination a perfect place to be explored. These are just some examples of the region’s potential to develop this typology of tourism, based on nature, and consequently, a vehicle to achieve the so-desired regional sustainability.