Risk perception about communicable and vector borne diseases among international travellers to Pakistan: A cross sectional study.

With the rise in air travel, the risk of diseases travelling from one geographical area to another has also increased. Relatively little is known about how travellers know and perceive the health risks associated with travel and how they adopt preventive measures before and while travelling abroad. The objective of this study is to determine the risk perception about communicable and vector-borne diseases among international travellers arriving from different countries and to find any association between the level of risk perception and independent variables. A cross-sectional study was conducted with 426 participants enrolled through convenient sampling technique. An already validated questionnaire was used to collect information. Chi square test was applied to ascertain any significant association between dependent and independent variables. Out of 426 respondents, only 226 (53%) had a high risk perception, whereas 220 (47%) had a low risk perception. A significant association was noted between the level of risk perception and gender (x2=20.9, p=0.000), level of education (x2=42.9, p=0.000), nationality (x2=7.5, p= 0.006) and region of arrival of the passengers (x2=26.2, p= 0.000). The results of the study revealed that 220 (47%) of the travellers had a low risk perception that may lead to an increase in the burden on healthcare system in Pakistan as well as exporting any new disease from Pakistan to other parts of the world where it does not already exist.

Protection enhancement strategies of potential outbreaks during Hajj.

OBJECTIVE: This study aimed to assist governments and organizers of mass gathering events in reviewing existing preventive measures for disease outbreaks to inform the adoption of enhanced strategies for risk reduction and impacts on public health. DESIGN: A cross-sectional, quantitative, descriptive study. SETTING: This study was conducted in a mass gathering of Hajj, an annual religious event in Mecca, Saudi Arabia. PARTICIPANTS: A convenience sample of 70 personnel working in government ministries of Saudi Arabia (Ministry of Health, Ministry of Hajj, and Ministry of Interior) and the Saudi Red Crescent Authority involved in health management in Hajj, including policy formulation and implementation. MAIN OUTCOME MEASURES: Perception and knowledge of health risks and outbreaks associated with Hajj. RESULTS: The majority of the respondents (60 percent) expressed concern about the potential for infection transmission during Hajj. The respondents also reported having or knowing a colleague, a friend, or a family member with a history of infection during or after Hajj. However, the respondents' knowledge of the possible modes of infection of various diseases was limited. CONCLUSIONS: Hajj is associated with various risks of outbreaks, and thus, better protection-enhancing measures are required. Training personnel involved in health management, including planners, coordinators, and healthcare providers, can help reduce the risks and prevent potential outbreaks.

Identification of critical links based on the optimal reliable path in stochastic traffic networks.

In urban stochastic transportation networks, there are specific links that hold great importance. Disruptions or failures in these critical links can lead to reduced connectivity within the road network. Under this circumstance, this manuscript proposed a novel identification of critical links mathematical optimization model based on the optimal reliable path with consideration of link correlations under demand uncertainty. The method presented in this paper offers a solution to bypass the necessity of conducting a full scan of the entire road network. Due to the non-additive and non-linear properties of the proposed model, a modified heuristic algorithm based on K-shortest algorithm and inequality technical is presented. The numerical experiments are conducted to show that improve a certain road link may not necessarily improve the overall traffic conditions. Moreover, the results indicate that if the travel time reliability is not considered, it will bring errors to the identification of key links.

Risk perceptions and behaviors concerning rural tourism and economic-political drivers of COVID-19 policy in 2020.

When COVID-19 was first introduced to the United States, state and local governments enacted a variety of policies intended to mitigate the virulence of the epidemic. At the time, the most effective measures to prevent the spread of COVID-19 included stay-at-home orders, closing of nonessential businesses, and mask mandates. Although it was well known that regions with high population density and cold climates were at the highest risk for disease spread, rural counties that are economically reliant on tourism were incentivized to enact fewer precautions against COVID-19. The uncertainty of the COVID-19 pandemic, the multiple policies to reduce transmission, and the changes in outdoor recreation behavior had a significant impact on rural tourism destinations and management of protected spaces. We utilize fine-scale incidence and demographic data to study the relationship between local economic and political concerns, COVID-19 mitigation measures, and the subsequent severity of outbreaks throughout the continental United States. We also present results from an online survey that measured travel behavior, health risk perceptions, knowledge and experience with COVID-19, and evaluation of destination attributes by 407 out-of-state visitors who traveled to Maine from 2020 to 2021. We synthesize this research to present a narrative on how perceptions of COVID-19 risk and public perceptions of rural tourism put certain communities at greater risk of illness throughout 2020. This research could inform future rural destination management and public health policies to help reduce negative socioeconomic, health and environmental impacts of pandemic-derived changes in travel and outdoor recreation behavior.

Measuring high-speed train delay severity: Static and dynamic analysis.

This paper focuses on optimizing the management of delayed trains in operational scenarios by scientifically categorizing train delay levels. It employs static and dynamic models grounded in real-world train delay data from high-speed railways. This classification aids dispatchers in swiftly identifying and predicting delay extents, thus enhancing mitigation strategies' efficiency. Key indicators, encompassing initial delay duration, station impacts, average station delay, delayed trains' cascading effects, and average delay per affected train, inform the classification. Applying the K-means clustering algorithm to standardized delay indicators yields an optimized categorization of delayed trains into four levels, reflecting varying risk levels. This static classification offers a comprehensive overview of delay dynamics. Furthermore, utilizing Markov chains, the study delves into sequential dynamic analyses, accounting for China's railway context and specifically addressing fluctuations during the Spring Festival travel rush. This research, combining static and dynamic approaches, provides valuable insights for bolstering railway operational efficiency and resilience amidst diverse delay scenarios.

Implementation of a realistic artificial data generator for crash data generation.

In this paper, a framework is outlined to generate realistic artificial data (RAD) as a tool for comparing different models developed for safety analysis. The primary focus of transportation safety analysis is on identifying and quantifying the influence of factors contributing to traffic crash occurrence and its consequences. The current framework of comparing model structures using only observed data has limitations. With observed data, it is not possible to know how well the models mimic the true relationship between the dependent and independent variables. Further, real datasets do not allow researchers to evaluate the model performance for different levels of complexity of the dataset. RAD offers an innovative framework to address these limitations. Hence, we propose a RAD generation framework embedded with heterogeneous causal structures that generates crash data by considering crash occurrence as a trip level event impacted by trip level factors, demographics, roadway and vehicle attributes. Within our RAD generator we employ three specific modules: (a) disaggregate trip information generation, (b) crash data generation and (c) crash data aggregation. For disaggregate trip information generation, we employ a daily activity-travel realization for an urban region generated from an established activity-based model for the Chicago region. We use this data of more than 2 million daily trips to generate a subset of trips with crash data. For trips with crashes crash location, crash type, driver/vehicle characteristics, and crash severity. The daily RAD generation process is repeated for generating crash records at yearly or multi-year resolution. The crash databases generated can be employed to compare frequency models, severity models, crash type and various other dimensions by facility type - possibly establishing a universal benchmarking system for alternative model frameworks in safety literature.

Study on the temporal and spatial relationship between public health events and the development of air transport scale: A case of the Southwest China.

The spread of the COVID-19 had profoundly affected the development of the air transportation. In order to determine the changes in air transportation volume associated with the development of the epidemic, this paper takes Southwest China as the study area. Monthly data and methods, such as the coefficient of variation, rank-size analysis and spatial matching index, were applied. The results found that: (1) during 2020-2022, there was a positive relationship between passenger volume and epidemic development, while freight volume increased for most airports in the first quarter of 2020-2022, particularly in the eastern region; (2) From the perspective of changes in air transportation volume under the development of the COVID-19, among various types of airports, the changes in transportation volume of main trunk airports were more significant than those of regional feeder airports in remote areas; (3) however, under the influence of the epidemic, main trunk airports still exhibited stronger attraction in passenger volume. That is to say, the passengers who chose to travel by air still tended to choose the main trunk airports and formed the agglomeration distribution pattern which around high-level airports in the provincial capital. Whereas the freight volume had a tendency of equalization among airports in Southwest China; (4) Over the course of time, the consistency of the spatial distribution of the number of cases and the passenger or freight volume in southwest China gradually increased. Among them, the spatial matching rate of the passenger volume and the number of COVID-19 cases was always higher than that of the cases and freight volume, which might indicate that there was a stronger correlation relationship. Therefore, it is proposed that the construction of multi-center airport system should be strengthened, the resilience of the route network for passenger transportation should be moderately enhanced, and the risk-resistant capacity of mainline airports and airports in tourist cities should be upgraded, so as to provide references for the orderly recovery of civil aviation and regional development.

Does the priority of ambulance guarantee no delay? a MIPSSTW model of emergency vehicle routing optimization considering complex traffic conditions for highway incidents.

Globally, traffic accidents on the highway network contribute significantly to a high fatality rate, drawing considerable attention from health institutions. The efficiency of transportation plays a vital role in mitigating the severe consequences of these incidents. This study delves into the issues of emergency vehicles experiencing delays despite having priority. Therefore, we construct mixed-integer linear programming with semi-soft time windows (MIPSSTW) model for optimizing emergency vehicle routing in highway incidents. We analyze the time-varying and complex traffic situations and respectively propose corresponding estimation approaches for the travel time of road segments, intersections on the urban road network, and ramp-weave sections on the highway network. Furthermore, we developed a modified cuckoo search(MCS) algorithm to solve this combinatorial problem. Optimization strategies of Lévy flight and dynamic inertial weight strategy are introduced to strengthen the exploration capability and the diversity of solution space of the CS algorithm. Computational experiments based on the Chinese emergency medical system data are designed to validate the efficacy and effectiveness of the MIPSSTW model and MCS algorithm. The results show that our works succeed in searching for high-quality solutions for emergency vehicle routing problems and enhance the efficacy of strategic decision-making processes in the realm of incident management and emergency response systems.

A methodology for estimating SARS-CoV-2 importation risk by air travel into Canada between July and November 2021.

BACKGROUND: Estimating rates of disease importation by travellers is a key activity to assess both the risk to a country from an infectious disease emerging elsewhere in the world and the effectiveness of border measures. We describe a model used to estimate the number of travellers infected with SARS-CoV-2 into Canadian airports in 2021, and assess the impact of pre-departure testing requirements on importation risk. METHODS: A mathematical model estimated the number of essential and non-essential air travellers infected with SARS-CoV-2, with the latter requiring a negative pre-departure test result. The number of travellers arriving infected (i.e. imported cases) depended on air travel volumes, SARS-CoV-2 exposure risk in the departure country, prior infection or vaccine acquired immunity, and, for non-essential travellers, screening from pre-departure molecular testing. Importation risk was estimated weekly from July to November 2021 as the number of imported cases and percent positivity (PP; i.e. imported cases normalised by travel volume). The impact of pre-departure testing was assessed by comparing three scenarios: baseline (pre-departure testing of all non-essential travellers; most probable importation risk given the pre-departure testing requirements), counterfactual scenario 1 (no pre-departure testing of fully vaccinated non-essential travellers), and counterfactual scenario 2 (no pre-departure testing of non-essential travellers). RESULTS: In the baseline scenario, weekly imported cases and PP varied over time, ranging from 145 to 539 cases and 0.15 to 0.28%, respectively. Most cases arrived from the USA, Mexico, the United Kingdom, and France. While modelling suggested that essential travellers had a higher weekly PP (0.37 - 0.65%) than non-essential travellers (0.12 - 0.24%), they contributed fewer weekly cases (62 - 154) than non-essential travellers (84 - 398 per week) given their lower travel volume. Pre-departure testing was estimated to reduce imported cases by one third (counterfactual scenario 1) to one half (counterfactual scenario 2). CONCLUSIONS: The model results highlighted the weekly variation in importation by traveller group (e.g., reason for travel and country of departure) and enabled a framework for measuring the impact of pre-departure testing requirements. Quantifying the contributors of importation risk through mathematical simulation can support the design of appropriate public health policy on border measures.

[Travel time to memory clinics in Bavaria: A geographical analyses within the framework of digiDEM Bayern]. / Räumliche Erreichbarkeit von Gedächtnisambulanzen ­ Eine geographische Analyse im Rahmen von digiDEM Bayern.

BACKGROUND: Memory clinics can contribute significantly to a qualified diagnosis of dementia. Since the accessibility of medical facilities is an important predictor for their utilisation, the aim of this study was to determine the accessibility of memory clinics for persons with dementia in Bavaria. METHODS: We used a Geographic Information System (GIS) to determine travel times to the nearest memory clinic for all Bavarian municipalities based on OpenStreetMap road network data. RESULTS: The majority of the modelled persons with dementia in Bavaria (40%; n = 93,950) live in communities with an average travel time of 20 to 40 minutes to the nearest memory clinic. Almost 7,000 (3%) require more than one hour. Especially persons from rural communities have to travel significantly longer distances than people from urban areas. CONCLUSION: In view of demographic developments, there is an urgent need for memory clinics to be accessible throughout the country for all persons with dementia, regardless of where they live. The systematic development of memory clinics in areas with long travel times or the establishment of mobile diagnostic services could help to improve dementia care.

Risk field modeling of urban tunnel based on APF.

OBJECTIVE: The purpose of this paper is to explore the changing laws of driving safety in the complex and changing driving environment in urban tunnels, to analyze the evolution of driving risk fields caused by changes in adjacent vehicles, driving behavior characteristics and road environment, and to reveal the formation mechanism of tunnel driving danger zones. METHODS: The kinetic field, behavioral field and potential field models are constructed according to the APF theory. The driving safety risks arising from the surrounding vehicles, driving behavior characteristics and changes in the tunnel environment are analyzed in the process of driving from the open section to the exit of the tunnel. RESULTS: The magnitude of the risk field force is inversely proportional to the spacing of the vehicles and the distance between the tunnel sidewalls, and is proportional to the relative speed between the vehicles and the slope of the longitudinal slope. Under the same conditions, the vehicle at the entrance and exit of the tunnel is subjected to a greater force of travel risk than inside the tunnel, and the effect of speed on the force of the risk field is greater than the distance. CONCLUSIONS: The established model better describes the trend of driving risk during the driving of vehicles in urban tunnels, and the research findings can provide theoretical support for the design and traffic management of urban tunnels.

Travel burdens to access care among children with cancer between 2016 and 2019: Analysis of a national population-based cancer registry in Japan.

BACKGROUND: Centralization of cancer care increases survival but increases the travel burden (i.e., travel durations, distances, and expenditures) in visiting hospitals. This study investigated the travel burdens to access cancer care for children aged 18 years and younger in Japan. METHODS: The study population comprised 10,709 patients diagnosed between 2016 and 2019 obtained from a national population-based cancer registry in Japan. Their residences were classified as urban or rural. We counted the number of patients treated at specialized hospitals and investigated the treatment centralization across diagnostic groups by Pareto plot. Travel burdens to access care were estimated using a route-planner web service and summarized using median values. A multivariable logistic model was performed to investigate factors associated with the events of car travel duration exceeding 1 h. RESULTS: Of the patients, 76.7% lived in urban areas, and 82.5% received treatment in designated hospitals for childhood cancer. The Pareto plot suggested that the top five hospitals treated 63.5% of patients with retinoblastoma. The estimated travel burdens for all patients were 0.62 h (0.57 h in urban areas and 1.00 h in rural areas), 16.9 km, and 0.0 dollars of toll charges. Regarding travel duration, 21.7% of patients had travel exceeding 1 h, and rural areas, retinoblastoma, malignant bone tumors, and childhood cancer-hub hospitals were associated with travel duration exceeding 1 h (adjusted odds ratios of 6.93, 3.59, 1.94, and 1.91, respectively). CONCLUSIONS: Most patients were treated in specialized hospitals and the treatments for specific diseases were centralized. However, most patients were estimated to travel less than 1 h, and the travel burden tended to increase for patients in rural areas, those with specific diseases, and those going to specialized hospitals. Cancer control measures in Japan have steadily improved centralized treatment while keeping the travel burden relatively manageable.

Cutaneous Larva Migrans.

BACKGROUND: Cutaneous larva migrans (CLM) is a helminthic infection found in tropical areas. It is commonly seen in patients in contact with soil contaminated by cat and dog hookworm larvae. CLM manifests as an erythematous, serpiginous, and pruritic cutaneous eruption. We present a case of a 27-year-old female with a serpiginous lesion on the plantar surface of the right foot. METHODS AND RESULTS: The patient was prescribed Albendazole at 400 mg twice a day for three days. After treatment, the lesion and pruritus have decreased in severity. CONCLUSIONS: Hookworm-related CLM is diagnosed clinically based on the typical clinical presentation. Clinicians need to be aware of the possibility of hookworm-related CLM with a history of travel to tropical areas, especially walking barefoot.

Sequentially activated discrete modules appear as traveling waves in neuronal measurements with limited spatiotemporal sampling.

Numerous studies have identified traveling waves in the cortex and suggested they play important roles in brain processing. These waves are most often measured using macroscopic methods that are unable to assess the local spiking activity underlying wave dynamics. Here, we investigated the possibility that waves may not be traveling at the single neuron scale. We first show that sequentially activating two discrete brain areas can appear as traveling waves in EEG simulations. We next reproduce these results using an analytical model of two sequentially activated regions. Using this model, we were able to generate wave-like activity with variable directions, velocities, and spatial patterns, and to map the discriminability limits between traveling waves and modular sequential activations. Finally, we investigated the link between field potentials and single neuron excitability using large-scale measurements from turtle cortex ex vivo. We found that while field potentials exhibit wave-like dynamics, the underlying spiking activity was better described by consecutively activated spatially adjacent groups of neurons. Taken together, this study suggests caution when interpreting phase delay measurements as continuously propagating wavefronts in two different spatial scales. A careful distinction between modular and wave excitability profiles across scales will be critical for understanding the nature of cortical computations.

A scoping review of Islamic pilgrimage to Mecca: Mapping the health concerns and proposed solutions.

OBJECTIVES: To map the current evidence about the health concerns and the potential solutions related to the Islamic pilgrimage to Mecca. DESIGN: A scoping review was applied. Papers published in English between 2012 and 2023 were included but non-human research and sources without any related data were excluded. Data charting and extraction were used to map the current evidence. RESULTS: The total of 36 papers were included with the total number of pilgrims of 17,075,887. The majority of studies were published in the Asia Pacific region (36.11%) as original articles (88.89%). The health concerns were grouped into five main aspects. There were 7603 deaths recorded or about 44 incidences of deaths per 100,000 pilgrims during the pilgrimage. There were recorded 11,018; 6178; 3393; and 17,810 cases for communicable diseases; non-communicable diseases; injuries and trauma; and health services (i.e., cardiac catheterization) and vaccination, respectively. CONCLUSION: Relating to the five health concerns, this study identified the top seven issues in each category (i.e., hypertension, influenza vaccination), except for the death record. Moreover, there were three solutions (for general health, non- and communicable-diseases) presented. Stakeholders could use this evidence to improve healthcare quality particularly related to the annual Islamic pilgrimage to Mecca.

Construction of an aerolysin-based multi-epitope vaccine against Aeromonas hydrophila: an in silico machine learning and artificial intelligence-supported approach.

Aeromonas hydrophila, a gram-negative coccobacillus bacterium, can cause various infections in humans, including septic arthritis, diarrhea (traveler's diarrhea), gastroenteritis, skin and wound infections, meningitis, fulminating septicemia, enterocolitis, peritonitis, and endocarditis. It frequently occurs in aquatic environments and readily contacts humans, leading to high infection rates. This bacterium has exhibited resistance to numerous commercial antibiotics, and no vaccine has yet been developed. Aiming to combat the alarmingly high infection rate, this study utilizes in silico techniques to design a multi-epitope vaccine (MEV) candidate against this bacterium based on its aerolysin toxin, which is the most toxic and highly conserved virulence factor among the Aeromonas species. After retrieval, aerolysin was processed for B-cell and T-cell epitope mapping. Once filtered for toxicity, antigenicity, allergenicity, and solubility, the chosen epitopes were combined with an adjuvant and specific linkers to create a vaccine construct. These linkers and the adjuvant enhance the MEV's ability to elicit robust immune responses. Analyses of the predicted and improved vaccine structure revealed that 75.5%, 19.8%, and 1.3% of its amino acids occupy the most favored, additional allowed, and generously allowed regions, respectively, while its ERRAT score reached nearly 70%. Docking simulations showed the MEV exhibiting the highest interaction and binding energies (-1,023.4 kcal/mol, -923.2 kcal/mol, and -988.3 kcal/mol) with TLR-4, MHC-I, and MHC-II receptors. Further molecular dynamics simulations demonstrated the docked complexes' remarkable stability and maximum interactions, i.e., uniform RMSD, fluctuated RMSF, and lowest binding net energy. In silico models also predict the vaccine will stimulate a variety of immunological pathways following administration. These analyses suggest the vaccine's efficacy in inducing robust immune responses against A. hydrophila. With high solubility and no predicted allergic responses or toxicity, it appears safe for administration in both healthy and A. hydrophila-infected individuals.

Autochthonous Ascariasis, Mississippi, USA.

We describe a case of a 2-year-old child who expelled a single adult female Ascaris lumbricoides worm. The patient is from a rural county in Mississippi, USA, with no reported travel outside of the United States. The caregivers in the home practice good sanitation. Exposure to domestic pigs is the likely source of infection.

Spatial Accessibility to Primary Care in Metropolitan France: Results Using the SCALE Spatial Accessibility Index for All Regions.

Accessibility to care is a major public health issue. Various tools to assess it are available, but they do not solve the problem of scale. Moreover, accessibility is a multidimensional concept that is not taken into account with current tools. The SCALE index aims to overcome these two limitations by proposing a synthetic measure on a more precise scale than the administrative unit or the sub-municipal scale. Under the assumption of access to care facilities for all and access to the nearest facilities, the potential accessibility distance was calculated for each couple (residential area, accessible facilities). This was defined as the average distance by road that the population has to travel to access care. To take the availability of resources into account, these distances were weighted by the theoretical pressure on the facilities. The SCALE index was then calculated using a linear combination of the distances of potential accessibility to care facilities It highlights differences in accessibility at the national and regional scale. Using this index, it was possible to provide maps for all French regions and the major cities in a story-map. The major conurbation around Paris and the main urban centers has high accessibility. Low accessibility forms a "Y" shape. In conclusion, the SCALE index measures accessibility at the scale of a small geographic unit taking the proximity and the availability of health professionals into account. It is also possible to take into account the diversity of accessibility in a given territory.