Background Previous studies unveiled a relation between the severity of COVID‐19 pneumonia and obesity. The aims of this multicenter retrospective cohort study were to disentangle the association of BMI and associated metabolic risk factors (diabetes, hypertension, hyperlipidemia, current smoking) in critically ill patients with COVID‐19. Methods This multicenter retrospective cohort study enrolled patients admitted in intensive care for COVID‐19, in 21 centers (Europe, Israel, USA) between 02/19/2020 and 05/19/2020. Primary and secondary outcomes were the need for invasive mechanical ventilation (IMV), and 28‐day mortality. Results A total of 1,461 patients were enrolled, median(IQR) age was 64 years (40.9‐72.0); 73.2% males; BMI 28.1 kg/m 2 (25.4‐32.3); 1,080 patients (73.9%) required IMV; the 28‐day mortality estimate was 36.1% (95%CI, 33.0‐39.5). Adjusted mixed logistic regression model showed a significant linear relation between BMI and IMV: OR 1.27 (95%CI, 1.12‐1.45) per 5 kg/m 2 . Adjusted Cox proportional hazards regression model showed a significant association between BMI and mortality, which was only increased in obesity class III (≥40 kg/m 2 ) (HR 1.68 (95%CI 1.06‐2.64). Conclusion In critically ill COVID‐19 patients, we observed a linear association between BMI and the need for IMV, independent of other metabolic risk factors, and a non‐linear association between BMI and mortality risk. (NCT04391738).

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Relatively few studies have examined how the degree of involvement of local communities in nature-based tourism, and the benefits that are generated for them, impact the choices that tourists make when visiting developing countries. We surveyed over 400 visitors in multiple locations in Namibia, using a discrete choice experiment to elicit preferences for attributes reflecting tracking safaris of the critically endangered, desert-adapted black rhinoceros (Diceros bicornis bicornis) in the northwest of the country. Attributes included those related to local community involvement and the benefits they receive from tourism, as well as the reinvestment of tourism profits back into rhino conservation, and the wildlife likely to be seen on safari. Using a latent class model that assigned tourists to market segments based on the observed pattern of responses in the choice experiment, we find that respondents can be divided into four classes that reflect differences in tourism preferences and their own demographics and experiences. While responses to attributes varied across classes, respondents were consistent in demonstrating a strong preference for the largest share of profits being returned to the local community, and were willing to pay an additional $43-670 to ensure this happens. Respondents in the four classes differed in their views toward the financing of rhino conservation and the participation of community trackers in rhino safaris, although those respondents in the class most interested in rhino tracking safaris were willing to pay an additional $34 per trip for tracker involvement. Our results demonstrate the value of assessing heterogeneity in tourists' preferences for wildlife experiences, and suggest that appropriate pricing and marketing may result in "triple bottom line" gains for nature-based tourism.

Objective. Our primary aim was to assess selected metabolic dysfunction parameters, both independently and as a complement to the SOFA score, as predictors of short-term mortality in patients with infection admitted to the intensive care unit (ICU). Methods. We retrospectively enrolled all consecutive adult patients admitted to the eight ICUs of Lille University Hospital, between January 2015 and September 2016, with suspected or confirmed infection. We selected seven routinely measured biological and clinical parameters of metabolic dysfunction (maximal arterial lactatemia, minimal and maximal temperature, minimal and maximal glycaemia, cholesterolemia, and triglyceridemia), in addition to age and the Charlson’s comorbidity score. All parameters and SOFA scores were recorded within 24 h of admission. Results. We included 956 patients with infection, among which 295 (30.9%) died within 90 days. Among the seven metabolic parameters investigated, only maximal lactatemia was associated with higher risk of 90-day hospital mortality in SOFA-adjusted analyses (SOFA-adjusted OR, 1.17; 95%CI, 1.10 to 1.25; p < 0.001 ). Age and the Charlson’s comorbidity score were also statistically associated with a poor prognosis in SOFA-adjusted analyses. We were thus able to develop a metabolic failure, age, and comorbidity assessment (MACA) score based on scales of lactatemia, age, and the Charlson’s score, intended for use in combination with the SOFA score. Conclusions. The maximal lactatemia level within 24 h of ICU admission is the best predictor of short-term mortality among seven measures of metabolic dysfunction. Our combined “SOFA + MACA” score could facilitate early detection of patients likely to develop severe infections. Its accuracy requires further evaluation.