Christian Josef Wiedermann

Background: Sepsis-associated acute kidney injury (SA-AKI) affects 40–60% of septic patients and is associated with significant worsening of clinical outcomes. The impact of early haemodynamic strategies on renal function trajectory remains uncertain. Aim: To evaluate whether renal function trajectory in the first 96 h is influenced by norepinephrine exposure and cumulative fluid balance (CFB) and whether it affects outcomes in patients with SA-AKI. Methods: Prospective longitudinal observational study of 209 SA-AKI patients (1022 observations). Creatinine trajectory was analysed using linear mixed-effects models with time-dependent covariates (norepinephrine, CFB, diuretics), adjusted for baseline clinical characteristics. Lagged models assessed the association between prior exposures and subsequent renal function. Intra-patient before-after analyses and longitudinal models based on KDIGO classification were used as supporting analyses. Results: In linear models, norepinephrine was not associated with worsening of renal function. In lagged models, prior exposure was independently associated with lower subsequent creatinine values (β ≈ −0.105; p = 0.039). In the intra-patient analysis, norepinephrine initiation was associated with a creatinine reduction (−0.25 mg/dL; p < 0.001), with an effect attenuated by greater CFB. Norepinephrine exposure was also associated with a higher probability of KDIGO improvement between reassessments (OR 1.64; 95% CI 1.14–2.38; p = 0.008), maintained after adjustment for CFB and diuretics (OR 1.79; 95% CI 1.22–2.63; p = 0.003). In patients initiating norepinephrine, a reduction in KDIGO stage was observed (Δ −0.21; p = 0.049). Conclusions: Early use of norepinephrine is not associated with worsening of renal function and is associated, in temporal analyses, with improvement of renal trajectory, independently of fluid balance.

Touristische Entwicklung ist Gegenstand kollektiver Entscheidungen, bei denen die dafür relevanten Gründe plural sind und nicht notwendig zu einer vollständigen Rangordnung der Handlungsalternativen führen. Der Beitrag untersucht, was es unter diesen Bedingungen heißt, begründet über Tourismus zu entscheiden. Ausgangspunkt ist Tourismus als eine Form des Zusammenlebens, in der unterschiedliche Interessen, Wertungen und zeitliche Perspektiven aufeinandertreffen. Im Anschluss an Sen wird gezeigt, dass Unvollständigkeit nicht mit Unentscheidbarkeit gleichzusetzen ist. Der aristotelische Begriff praktischen Urteilens erlaubt es, diese Einsicht positiv zu bestimmen: Praktische Rationalität zielt nicht auf die Herstellung einer vollständigen Ordnung, sondern auf die begründete Bestimmung dessen, was unter konkreten Bedingungen praktisch möglich ist und getan werden soll. Davon wird die institutionelle Entscheidung unterschieden, durch die eine bestimmte praktische Frage verbindlich geschlossen wird. Gerade im Tourismus fallen die Reichweite einer praktischen Situation und der institutionell bestimmte Entscheidungsgegenstand häufig nicht zusammen. Entscheidungen können daher Geltung und Stabilität beanspruchen, ohne die zugrunde liegende normative Offenheit aufzuheben. Ihre Revidierbarkeit ist kein Gegensatz zu ihrer Verbindlichkeit, sondern gehört zu einer Entscheidungsstruktur, die veränderte Gründe, Folgen und Bedingungen berücksichtigen kann.[English abstract] Tourism development is the object of collective decisions in which the relevant reasons are plural and do not necessarily yield a complete ranking of the available courses of action. The paper examines what it means, under these conditions, to decide about tourism with justification. It starts from tourism as a form of living together in which different interests, evaluations and temporal perspectives meet. Following Sen, it shows that incompleteness does not amount to undecidability. The Aristotelian notion of practical judgement allows this insight to be stated positively: practical rationality does not aim at establishing a complete ordering, but at the justified determination of what is practically possible and to be done under concrete conditions. The paper distinguishes this from the institutional decision that closes a particular practical question in a binding manner. In tourism in particular, the scope of a practical situation and the institutionally defined object of decision frequently do not coincide. Decisions can therefore claim validity and stability without eliminating the underlying normative openness. Their revisability is not opposed to their binding character, but belongs to a decision structure that can take account of changed reasons, consequences and conditions.Hinweis: Preprint der eingereichten Fassung, nicht begutachtet; am 28.09.2026 bei der Zeitschrift für Tourismuswissenschaft eingereicht und dort in Begutachtung.

Tourism is increasingly promoted as a resource for health, and destinations market the well-being their landscapes are said to afford; yet the notion of well-being invoked where tourism and public health meet requires further specification, as the fields that converge there do not necessarily use the term in the same sense. The conceptual analysis clarifies well-being by distinguishing its psychological dimensions from its philosophical characterisation in terms of human flourishing, and frames health from a salutogenic perspective. Human flourishing and salutogenesis intersect particularly through meaningfulness and the ways persons engage with what places make possible. Drawing on the phenomenology of the tourist experience and on the literatures of therapeutic landscapes and restorative environments, the paper argues that places contribute to health through multiple and potentially interacting pathways involving characteristics of settings, activities and experiences, and their social and environmental contexts. Embodied pathways further show the interconnection of experiential and bodily dimensions of health. The paper draws out implications for public health and participatory destination design. Alpine tourism destinations provide a suitable context in which these relationships can be examined empirically.

Purpose. This paper proposes an ethic of care — aver cura — as an integrative concept for destination development that connects two disconnected uses of "care" in tourism scholarship and specifies how the concept can be observed and measured.Design/methodology/approach. The paper is conceptual. It synthesizes tourism studies, public health and the ethics of care, and illustrates the argument through the single case of Meran, South Tyrol, a historic alpine health resort.Findings. Tourism research invokes care as an ethos, while public health and health tourism treat care as provision; the two seldom meet. An ethic of aver cura, built on caring for self, others and place, integrates them and reframes success from volume to sustaining visitor, resident, worker and landscape together. Civic trust, distinct from commercial destination trust, is the operational core through which care becomes measurable.Research limitations/implications. The six propositions are conceptual and untested; they set a future agenda for comparative and longitudinal research.Practical implications. Destinations would shift from volume metrics to civic-trust and community indicators and to recurring deliberative governance.Social implications. The approach foregrounds the well-being of residents and tourism workers alongside that of visitors.Originality/value. The paper offers an integrative concept of care that bridges ethical and public-health registers, distinguishes civic from commercial trust as its measurable core, and grounds care in a destination's own formative logic rather than importing it from outside.Preprint of a manuscript currently under review at the Journal of Tourism Futures (Emerald). This is the submitted version and has not been peer-reviewed.

Background: Health literacy (HL) is a crucial determinant of population health; however, disparities persist in multilingual settings. In South Tyrol, Italy, where German- and Italian-speaking populations coexist within a unified health care system, HL disparities may reflect differences in language, culture, and digital engagement. Objective: This study investigated whether the usage of digital health information mediates the relationship between language group and HL and examined informational trust and other sociodemographic factors as covariates of HL. Methods: Data were obtained from a population-based survey conducted in South Tyrol, Italy. The analytical sample comprised 1500 participants with adequate responses to the 16-item Health Literacy Survey European Union Questionnaire (HLS-EU-Q16) instrument and an identified language group. Mediation analysis was performed using PROCESS Model 4 (5000 bootstrap samples), with use of digital health information as the mediator, language group as the predictor, and HL as the outcome. Covariates included age, sex, education, self-rated health, trust in professional information sources, and trust in health information on the internet. Results: Italian-speaking participants showed significantly higher HL scores (mean 12.54, SD 3.31 vs mean 11.56, SD 3.48 on a 0-16 scale; P <.001) and reported more frequent digital health information use ( P =.003) compared with German-speaking participants. Digital health information use was weakly positively correlated with HL in bivariate analyses ( r =0.11). In the fully adjusted mediation model, the indirect effect of language group on HL through digital health information use was not significant ( B =0.018, 95% bootstrap CI −0.035 to 0.074; partially standardized effect=0.005), whereas the direct effect of language group remained robust ( B =0.96; P <.001). Trust in professional health information ( B =0.39; P <.001) and trust in health information on the internet ( B =0.61; P <.001) were both positively associated with HL. Conclusions: Although digital engagement and online trust are related to HL, they do not explain the persistent language-based disparities in HL observed in South Tyrol. Public health strategies should prioritize strengthening critical appraisal skills, fostering trust in professional health information sources, and improving digital access to effectively address HL inequalities in multilingual populations.

Background/Objectives: Alpine destinations combine high tourism intensity with location-bound natural health resources that position them as potentially salutogenic settings; however, the evidence connecting tourism, public health, and well-being in this context has never been systematically mapped. This scoping review charts the concepts, evidence, and knowledge gaps at this intersection, focusing on South Tyrol (Italy). Methods: This review followed the Joanna Briggs Institute methodology and PRISMA-ScR. Five databases (PubMed, Embase, CINAHL, Web of Science, and Scopus) were searched, supplemented by Publish or Perish searches of Google Scholar, Crossref, and OpenAlex. Records were screened against a Population–Concept–Context framework, with geographic restrictions applied at screening. Data were synthesized descriptively without aggregating effect estimates. Results: Of 4163 records identified, 3343 were screened, and 128 were assessed in full text; 33 sources were included (22 conceptual, 11 empirical), divided almost evenly between tourism and health science journals. Empirical evidence has concentrated on residents’ quality of life and subjective well-being, with findings differing by outcome, scale, and tourism intensity. None of the included studies measured mental health outcomes. Only four empirical studies originated from the Alpine region, each addressing a different level of the destination system, and none from South Tyrol; evidence on tourism workers and older populations was exclusively conceptual. Conclusions: The field rests mainly on conceptual work distributed across two largely separate studies. The evidence gap map identifies measured resident health outcomes, worker health, and population-specific groups as research priorities for tourism-intensive Alpine regions, for which South Tyrol offers a suitable setting.

Background/Objective: Hyperoncotic albumin (20%) has been proposed for sepsis; however, the randomized evidence is inconclusive, and the 2026 Surviving Sepsis Campaign guidelines now suggest crystalloids alone while permitting albumin on a case-by-case basis. We updated the evidence, restricting the intervention to hyperoncotic albumin (≥20%) and the comparator exclusively to crystalloids, and examined whether the benefit was confined to septic shock. Methods: We searched PubMed, EMBASE, and Cochrane CENTRAL (March 2024–March 2026), supplementing a previously published meta-analysis. Randomized trials of hyperoncotic albumin versus crystalloids in adults with sepsis or septic shock reporting all-cause mortality were included. The primary outcome was mortality at the longest follow-up, pooled as risk ratios (RRs) using random-effects models. Given negligible heterogeneity, the estimate was reported under standard, Hartung–Knapp–Sidik–Jonkman (HKSJ), truncated-HKSJ, and fixed-effects methods, with a Bayesian sensitivity analysis. A pre-specified subgroup contrasted septic shock with sepsis without shock. This review was registered in PROSPERO (CRD420261334243). Results: Eight RCTs (n = 3707) provided the data; all administered 20% albumin. Overall, albumin was not robustly associated with reduced mortality (RR 0.94; I² = 0%), significant only under the pre-registered HKSJ correction (0.91–0.98) but null under the standard, truncated-HKSJ, and fixed-effects models (0.87–1.03, p = 0.17), identifying this as a low-heterogeneity artifact. In septic shock (k = 6), the effect was larger and consistent (RR 0.90, 0.82–0.99, p = 0.03), with no benefit in sepsis without shock (RR 1.10; interaction p = 0.08). The certainty was low (GRADE). Conclusions: In adults with sepsis, hyperoncotic albumin was not associated with a statistically significant reduction in all-cause mortality, and the certainty of evidence was low (GRADE). This is consistent with the 2026 Surviving Sepsis Campaign guidelines, which permit case-by-case use of albumin in this setting but do not recommend its routine use. Adequately powered randomized trials are required.

Background: Coagulopathy in sepsis represents a dynamic continuum ranging from sepsis-induced coagulopathy (SIC) to disseminated intravascular coagulation (DIC), but its early evolution and clinical determinants remain poorly defined. Objectives: To assess the temporal dynamics of SIC and DIC and examine factors associated with their evolution during the early phases of sepsis. Methods: A prospective longitudinal observational study was conducted on 299 patients with sepsis admitted to the Intermediate Care Unit (IMCU). Patients were evaluated at admission and subsequently at 24, 48, 72, and 96 h, for a total of 1.447 observations. Clinical, laboratory, and hemodynamic data were collected at each time point, and SIC and DIC scores were calculated. The evolution of coagulopathy and its association with clinical and therapeutic variables were analyzed using appropriately adjusted generalized estimating equation (GEE) longitudinal models. Results: The prevalence of SIC increased from 36.8% at baseline to 47.5% at 24 h, and then declined to 20.8% at 96 h. DIC prevalence decreased from 21.7% to 9.7%. Coagulopathy at the previous time point was the main determinant of subsequent coagulopathy (SIC: OR 31.17; DIC: OR 67.17; p < 0.001). Incidence was highest during the early phases (SIC: 12.8% to 2.2%; DIC: 4.7% to 1.1%), whereas persistence decreased over time (SIC: 34.7% to 18.6%; DIC: 18.5% to 8.6%). Higher Sequential Organ Failure Assesment (SOFA) scores were associated with increased risk. Therapeutic anticoagulation was inversely associated with subsequent coagulopathy, including overt DIC positivity among patients without overt DIC at baseline (OR 0.059; 95% CI 0.012–0.290; p < 0.001). Higher cumulative fluid balance was associated with overt DIC in exploratory predicted-probability analyses, independent of vasopressor use, although this gradient did not reach statistical significance in adjusted models and is hypothesis-generating. Diuretic therapy was associated with an increased risk of SIC (OR 2.20; p = 0.008). Conclusions: Coagulopathy in sepsis occurs early and is strongly dependent on its initial trajectory. SIC and DIC represent stages of a continuum, with onset occurring predominantly within the first 24–48 h. The inverse association with therapeutic anticoagulation is hypothesis-generating and should not be interpreted as a treatment effect.

BACKGROUND Italian law makes clinician oversight of artificial intelligence (AI) in health care a legal precondition. A recent scoping review of 35 Italian studies found acceptance of health care AI positive but conditional and identified two principal gaps: no general-population or patient study used a probabilistic sampling frame, and none compared Italy's language groups. OBJECTIVE We assessed attitudes toward and acceptance of AI in health care in the general adult population of South Tyrol, a trilingual autonomous province in northern Italy, quantified how acceptance varies across 16 application areas, and identified correlates of both. METHODS We surveyed "So denkt Südtirol" (So South Tyrol Thinks), a probabilistic panel of 1200 adults drawn from the population register by stratified random sampling, online between February 1 and March 6, 2026. The questionnaire assessed technological affinity, frequency of AI use, 5 attitude items, and acceptance of 16 applications. Items were adapted from a German population survey; no validated bilingual instrument existed. Analyses used poststratification weights. Correlates were examined with survey-weighted logistic regression (attitude items) and Poisson models (application counts). Because 60 coefficients were estimated, Benjamini-Hochberg false discovery rate (FDR) q values are reported. All regression analyses are exploratory. RESULTS Of 1200 panel members, 901 participated (participation rate 75.1%). Attitudes were positive but conditional on the application and on human oversight: 46.8% (95% CI 43.5-50.1) supported AI in their own care and 48.7% expected AI to improve population health, whereas 44.0% were concerned about losing human control. Acceptance ranged from 79.7% (95% CI 76.9-82.2) for automated medication reminders to 28.2% (95% CI 25.3-31.3) for support in urgent decisions. Uncertainty responses ranged from 14.1% to 39.1% and were more frequent among women (rate ratio [RR] 1.20, 95% CI 1.06-1.37) and rarer among daily AI users (RR 0.59). After FDR adjustment, only sex, technological affinity, and frequency of AI use remained associated with attitudes. Accepted applications increased stepwise across the 3 age groups (61-80 vs 18-40 years: RR 1.26, 95% CI 1.14-1.38) and with AI use (daily vs never: RR 1.64, 95% CI 1.42-1.89). Language group was largely unrelated to the outcomes. CONCLUSIONS This study provides the first population-based probabilistic evidence on attitudes toward health care AI in Italy and the first comparison across language groups. Attitudes were shaped by digital experience rather than by language group, and acceptance was strongly graded by application. The optimism-knowledge gap described among Italian clinicians has a population-level analogue: broad endorsement in principle alongside many respondents who know too little to take a position. Because Italian law already requires human oversight, the widespread concern about loss of human control aligns with the regulatory architecture and should be communicated as an existing safeguard. CLINICALTRIAL No

Objective: The use of hyperoncotic (25%) albumin in sepsis resuscitation remains controversial because of concerns about nephrotoxicity, particularly in patients with pre-existing renal impairment. This study examined whether early administration of 25% albumin in addition to crystalloids increases the risk of acute kidney injury or worsens short-term hemodynamic outcomes compared with crystalloids alone.Materials and Methods: A retrospective cohort study was performed using a large, publicly available intensive care database. Adult patients with sepsis who received crystalloids alone or crystalloids plus 25% albumin within the first 24 hours of intensive care admission were identified; patients receiving 5% albumin were excluded. Propensity score matching (1:1) was applied using demographics, laboratory values, organ-dysfunction sub-scores, and comorbidities. The primary outcome was acute kidney injury, defined by standardized consensus criteria. Secondary outcomes were renal replacement therapy, intensive care length of stay, and vasopressor-free days.Results: Among 15,882 patients, 587 matched pairs were analyzed. The incidence of acute kidney injury was similar between groups (albumin, 60.3% versus control, 56.2%; p = 0.174), as was the need for renal replacement therapy (23.9% versus 27.8%; p = 0.142). Intensive care length of stay and vasopressor-free days did not differ. Despite higher lactate levels and greater hepatic and coagulation dysfunction in the albumin group, renal sub-scores and comorbidities were comparable.Conclusion: Early administration of 25% albumin with crystalloids was not associated with worse short-term renal or hemodynamic outcomes. These findings support clinical equipoise and suggest that cautious use of 25% albumin in selected patients confers no additional renal risk.