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Conservation actions (as Marine Protected Areas) are key tools to maintain coastal ecosystems. However, many reserves are characterized by several problems related to inadequate zonings that preclude important areas from economic activities, determining a strong hostility by local populations. Thus, estimations of marine economic values-in-use are needed for protection of marine ecosystem in order to find the best compromise between conservation priorities and local population needs. Algorithms to estimate monetary values of the main human activities in marine territories (large scale and small scale fishings, aquaculture, beach resorts, yachting, diving and commercial shipping) are here implemented using Gulf of Naples (centre Tyrrhenian sea, Italy) as study area example. These algorithms are based on different sources data (questionnaires, monitoring activities, official local authority reports, web and scientific literature). They can also be compared with each other being their outputs all expressed in the same measure unit. During the models development process a new flexible approach, called “Systematic Costs Assessment” (SCA), to assess opportunity costs in systematic conservation planning process was developed and applied. Results show that the total turnover in the Gulf of Naples is 3,950,753,487 € per year and 747,647,887 € per year excluding small scale fishing estimation, and one hectare of marine territory is worth 40,672 € and 7696 € per year excluding small scale fishing activity. In particular, excluding small scale fishing activity, beach resort and yachting show the highest values referred to one hectare of marine territories. In conclusion, SCA is a flexible approach where no long and costly sampling campaigns are always needed, provided that two assumptions have to be taken into account, in order to estimate credible values-in-use costs: i) do not use economic activities data and ecosystem services data in the same assessment layer, since it could lead to costs overestimation and ii) SCA method are efficient when used by operators with strong knowledge of the study area, since they are able to recognize parameters affecting economic activities of local population.

Objective: To investigate whether exposure to inhibitors of gastric acidity, such as H2 blockers or proton pump inhibitors, can independently increase the risk of infections in very low birth weight (VLBW) preterm infants in the neonatal intensive care unit. Study design: This is a secondary analysis of prospectively collected data from a multicenter, randomized controlled trial of bovine lactoferrin (BLF) supplementation (with or without the probiotic Lactobacillus rhamnosus GG) vs placebo in prevention of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in preterm infants. Inhibitors of gastric acidity were used at the recommended dosages/schedules based on the clinical judgment of attending physicians. The distribution of days of inhibitors of gastric acidity exposure between infants with and without LOS/NEC was assessed. The mutually adjusted effects of birth weight, gestational age, duration of inhibitors of gastric acidity treatment, and exposure to BLF were controlled through multivariable logistic regression. Interaction between inhibitors of gastric acidity and BLF was tested; the effects of any day of inhibitors of gastric acidity exposure were then computed for BLF-treated vs -untreated infants. Results: Two hundred thirty-five of 743 infants underwent treatment with inhibitors of gastric acidity, and 86 LOS episodes occurred. After multivariate analysis, exposure to inhibitors of gastric acidity remained significantly and independently associated with LOS (OR, 1.03; 95% CI, 1.008-1.067; P = .01); each day of inhibitors of gastric acidity exposure conferred an additional 3.7% odds of developing LOS. Risk was significant for Gram-negative (P < .001) and fungal (P = .001) pathogens, but not for Gram-positive pathogens (P = .97). On the test for interaction, 1 additional day of exposure to inhibitors of gastric acidity conferred an additional 7.7% risk for LOS (P = .003) in BLF-untreated infants, compared with 1.2% (P = .58) in BLF-treated infants. Conclusion: Exposure to inhibitors of gastric acidity is significantly associated with the occurrence of LOS in preterm VLBW infants. Concomitant administration of BLF counteracts this selective disadvantage. Trial registration: isrctn.org: ISRCTN53107700.