Search Results (34)

Tourism scholarship has long treated technological innovation as an accelerant bolted onto a stable practice: people move through physical space to consume experiences, then return home. This conceptual paper asks what happens to the field’s theory once that assumption is relaxed. Rather than forecasting a single future, the paper develops a structured conceptual foresight framework to examine how emerging technological trajectories may challenge the constitutive assumptions of tourism theory. Drawing on tourism scholarship alongside developments in computation, the biosciences, and cognitive science, the framework integrates established concepts from futures studies including Voros’s futures cone, Inayatullah’s causal layered analysis, and Dator’s four generic futures to explore alternative trajectories for tourism. This analysis identifies four constitutive assumptions on which tourism theory quietly rests, namely geographic displacement, embodied co-presence, the destination as passive stage, and the tourist–host dyad, together with a typology of de-anchoring that traces what becomes of the field as each assumption loosens. Four conceptual scenarios follow: the dematerialization of place, biologically mediated travel, autonomous destination ecosystems, and the erosion of the tourist–host distinction. Some sit in the cone’s plausible band; others are placed at its preposterous edge on purpose to stress-test the field’s categories rather than to predict events. Throughout, the analysis stays tethered to tourism and hospitality concerns: destination economics, the work of destination management organizations, labor displacement, experiential inequality, the measurement infrastructure behind tourism statistics, and the shift from sustainability toward regeneration. We close with a research agenda for an anticipatory, theory-building stream within the field. Full article

Malaria in a Greek citizen with prior malaria history residing and working in Cameroon returning in his home country is a medical emergency warranting prompt and accurate diagnosis and effective treatment. We describe a mixed malaria case of a febrile patient, a professional returning to Greece from a malaria-endemic country whose initial diagnosis was a false-negative malaria rapid diagnostic test. Subsequent alternative rapid diagnostic test, malaria thin-film blood examination and molecular diagnosis revealed mixed malaria infection from Plasmodium ovale and Plasmodium malariae. The patient was successfully treated and achieved complete clinical recovery. The case described here highlights important points regarding prompt and accurate malaria diagnosis in returning travelers in non-endemic countries, emphasizing the importance of revealing cryptic mixed malaria cases and providing molecular approaches to malaria diagnosis in combination with the gold-standard microscopy. Full article

Background: Tourists returning home and visitors from abroad often carry antimicrobial-resistant (AMR) bacteria. Many of these resistant bacteria are acquired from, or were spread via, the environment (especially water). Understanding the impact from acquiring resistant bacteria via tourism upon global antimicrobial resistance is limited. Methods: Traveller transmission of AMR bacteria can be estimated from combining the numbers of travellers with AMR bacteria rates in different regions and the prevalence of communicable diseases. We used resistance data (WHO and contemporary publications) to measure the prevalence of E.coli resistance to third-generation cephalosporins. The study uses data from 2019, the year with the most complete dataset that also predates disruptions to travel caused by the COVID-19 pandemic. We then used the global burden of disease study and travel data from the World Travel and Tourism to create regional and country level indices measuring the impact of AMR bacteria for 241 countries. Estimates of global travel patterns were obtained using a gravity-style trip distribution model. Findings: Regions with the highest impact of AMR bacteria from returning travellers were Northern Europe and Western Europe. The region with the highest impact of AMR bacteria from visiting travellers was the Caribbean where small island countries receive large numbers of visitors. For countries/administrative regions with populations greater than 5 million, the AMR bacterial travel impacts measured in decreasing risk order from the highest were Hong Kong, Denmark, New Zealand, Hungary, Norway and Sweden. Interpretation: For some countries the incidence of AMR infection among both visitors and returning travellers is much higher than in the domestic population. This impact and how these bacteria are acquired from the environment, must be factored into public health policies for containing global spread of AMR bacteria and as part of a One Health approach. Full article

Background/Objectives: Healthcare accounts for approximately 4.4% of global carbon emissions. Gastroenterology is a particularly heavy producer, with professional organisations outlining targets to move towards carbon neutrality. Missed hospital appointments, associated with poor medical outcomes, also represent physical and economic waste to the sector. COVID-19 expedited the shift toward virtual clinics, but tele-diagnostics have not expanded similarly. We aimed to assess the feasibility of a virtual C13 urea breath test clinic for H. pylori in Ireland. Methods: C13 urea breath test kits were provided to patients in the community, who were subsequently invited to book an online video appointment with a GI lab technician to assist them in performing the test at home. Completed tests were returned to the hospital via local GP, by post, or a specified hospital drop-off point, and analysed using our standard protocol. Results: 423 virtual appointments were reviewed. 135 (32%) were male, and the mean age was 42 years. The test positivity rate was 22%, similar to a matched in-person testing cohort (21%). In all, there were no non-attenders, and two cancellations. Virtual patients were more likely to attend their appointments (OR = 153.9, p = 0.0004) than in-person patients. Virtual UBT appointments saved 9943.5 Km of road journeys, equivalent to 254 person-hours of travel time and 1.24 metric tonnes of CO₂. Additionally, 300 (71%) patients returned a feedback questionnaire, of which 276 (92%) rated the overall home breath test experience as ‘good’ or ‘excellent’. Conclusions: Home testing for H. pylori is effective, acceptable, and reduces both reliance on invasive procedures such as endoscopy and carbon emissions. Full article

Background: Daily oral preexposure prophylaxis (PrEP) is one strategy employed to decrease HIV transmission among adolescent girls and young women (AGYW). The Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program, funded by PEPFAR/USAID and implemented by the Project HOPE Namibia (PHN)-led consortium, provided services in the Khomas, Oshikoto, Zambezi, and Oshana regions. This study assessed the one-month PrEP retention rate among AGYW 15–24 and the associated factors. Methods: The program’s target populations for PrEP included AGYW aged 15–24 years who were at substantial risk for HIV, tested HIV-negative, and resided in the regions where the PHN-led consortium was implementing the DREAMS program. Data between 2018 and 2024 were exported from DHIS2 to IBM SPSS version 29 for secondary data analysis. We analyzed the data using Chi-squared tests and binomial and multinomial logistic regression. Results: Among the 17,277 participants newly initiated on oral PrEP and included in this study, only 2466 returned on time for their one-month appointment. The one-month PrEP retention rate among AGYW was 14.3%, 95% CI (13.8–14.8%). The most common reasons for PrEP discontinuation were traveling away from home, not needing PrEP anymore, forgetfulness, and side effects. Participants from Oshakati and Onandjokwe exhibited a higher likelihood of one-month PrEP retention. Additionally, participants who were in the programs for 7–12 months or over 36 months, who attended the safe space HIV prevention sessions, who were unaware of their partners’ HIV status, and who considered themselves at risk of HIV also exhibited a lower likelihood of one-month PrEP retention. In contrast, individuals who had 1–2 children and those who were either pregnant or breastfeeding exhibited a higher likelihood of one-month PrEP retention, (COR) = 1.28, 95% CI (1.15–1.43), and COR = 2.00, 95% CI (1.62–2.46), respectively. Conclusions: Targeted, innovative, and context-specific strategies should be developed to support AGYW in identifying their HIV risk and continuing the use of daily oral PrEP during periods of heightened risk. Additionally, prioritizing the introduction of discreet, long-acting PrEP options that require less frequent administration may better align with their needs and preferences. Full article

The ability to navigate through both familiar and unfamiliar environments is of critical importance for foraging efficiency, safety, and energy budgeting in wild animals. For animals that remain in the same home range annually, such as grey-footed chacma baboons (Papio ursinus griseipes), movement efficiency is expected to reflect familiarity with the home range as well as the nature of the resources within it. For example, resources that are patchy, transient, or seasonal present a greater spatial cognitive challenge, and travel between them may be less efficient than for more widespread or permanent resources. Here, we analyse daily route efficiency in adult female grey-footed chacma baboons at Gorongosa National Park, Mozambique. We use GPS data taken at 15 min intervals from collars deployed on two baboons in each of two study troops (four total) to identify areas of interest used during daily ranging periods (sleep site to sleep site). We then compare the length of the route taken between a given day’s patches to routes calculated by two alternate optimisation heuristics as follows: the nearest neighbour method, in which the subject repeatedly travels to the next most proximate patch and does not necessarily return to the same place, and the Concorde algorithm, which calculates the shortest possible route connecting the day’s patches. We show that baboons travel more efficient routes than those yielded by the nearest-neighbour heuristic but less efficient routes than the Concorde method, implying some degree of route planning. We discuss our novel method of area of interest identification using only remote GPS data, as well as the implications of our findings for primate movement and cognition. Full article

This pilot study evaluated the design, usability, and practicality of the dPDT@home kit for treating actinic keratoses (AKs) on the face and scalp. The kit allowed patients to manage their treatment at home, reducing hospital visits and utilizing natural sunlight. While patients were very willing to use the kit again, further studies are required to evaluate outcomes and ascertain the need for additional improvements and support. Background/Objectives: Daylight photodynamic therapy (dPDT) is an established effective therapy for superficial mild-to-moderate actinic keratoses (AKs) on the face and scalp. In this project, we redesigned the delivery of dPDT using design principles and the concept of Realistic Medicine to create the dPDT@home kit. This user-friendly and environmentally conscious kit allows patients to manage their AKs at home, reducing the need for hospital visits and ensuring timely treatment to coincide with appropriate weather conditions and to prevent disease progression due to delays in diagnosis and treatment. The initial pilot phase of the study was to evaluate the usability and convenience of the practicalities of the dPDT@home kit. Methods: Patients were instructed to conduct two dPDT@home kit treatments approximately three weeks apart on suitable weather days. After a follow-up telephone consultation from the specialist PDT nurse following the first treatment, patients then completed an initial questionnaire (Questionnaire 1, Q1) to share their experience. A second questionnaire (Q2) was completed 3–6 months after their final treatment to assess treatment outcomes. Results: A total of 16 patients with AK on the face and/or scalp used the dPDT@home kit. Five patients formed an initial pilot group in 2020/21, whose feedback and involvement informed the final product for the larger group of eleven patients (2021/22). All patients reported no issues with receiving the kit or the pro-drug used in the treatment (Q1). Q2 had an 81.25% return rate, with an average willingness score of 8.9/10 to use dPDT@home again. However, patients expressed doubts about their confidence in the treatment’s efficacy, giving an average score of 6.9/10, with preferences leaning towards other treatments, such as hospital-based PDT or cryotherapy. Conclusions: The pilot deployment of the dPDT@home kit identified suitable patients and highlighted the need for comprehensive training and support for both patients and clinicians to deliver dPDT through this novel approach. The kit can reduce the number of hospital visits, but patients still require supervision, which can be provided remotely. The questionnaire outcomes emphasize the importance of setting patient expectations and taking a holistic approach to managing chronic field-change AK. Additionally, the kit’s recyclable components and reliance on natural sunlight promote sustainability and reduce patient travel. Further evaluation is required to determine cost-efficacy, safety, and the potential place of the dPDT@home kit in the therapeutic management of patients with this common and challenging condition. Full article

This paper analyses the commuting frequencies and modal choices of travellers in Melbourne, using a dataset reflecting travel behaviour before and after COVID-19. A factor analysis of 63 latent variables identified seven key factors, which were used in cluster analysis to examine the relationships between latent constructs, land use, and socio-demographic variables, as well as commuting behaviours. The analysis categorised white-collar employees into four groups based on their remote work engagement, with socio-demographics and industry type as key factors. The analysis shows that female clerical and administrative workers who worked from home during the pandemic are now returning to the office, raising gender equality concerns within society. Meanwhile, the education and training sector mandates office attendance despite the feasibility of remote work, as universities prioritise in-person attendance to attract more international students, impacting societal norms around telecommuting. The analysis revealed that saving on commute costs, reducing travel time, and spending more time with family are the among the primary factors influencing travel behaviour among white-collar employee’s post-pandemic. The study found that the decrease in public transport trips is associated with increased telecommuting rather than service dissatisfaction, especially among Central Business District (CBD) employees who still rely on public transport. This trend suggests that the CBD sector’s growing acceptance of remote work is reducing daily commutes, which puts additional pressure on public transport providers to sustain and improve their services. A decline in service quality could further reduce ridership, highlighting the need for consistent, high-quality public transport. Furthermore, the study found that increased telecommuting is likely to reduce car trips in the future, especially among healthcare and social workers who prefer driving due to public transport’s unreliability for their demanding schedules. By examining variables like the advantages and disadvantages of working from home, convenience, accessibility, and the efficiency of public transport, this study enhances the understanding of transport behaviour and underscores the need to improve public transport reliability to support sustainable cities as remote work grows. Full article

The aim of this constructive study was to develop model-based principles to provide guidance to managers and policy makers when making decisions about team size and composition in the context of home healthcare. Six model-based principles were developed based on extensive data analysis and in close interaction with practice. In particular, the principles involve insights in capacity planning, travel time, available effective capacity, contract types, and team manageability. The principles are formalized in terms of elementary mathematical models that capture the essence of decision-making. Numerical results based on real-life scenarios reveal that efficiency improves with team size, albeit more prominently for smaller teams due to diminishing returns. Moreover, it is demonstrated that the complexity of managing and coordinating a team becomes increasingly more difficult as team size grows. An estimate for travel time is provided given the size and territory of a team, as well as an upper bound for the fraction of full-time contracts, if split shifts are to be avoided. Overall, it can be concluded that an ideally sized team should serve (at least) around a few hundreds care hours per week. Full article

Objectives: Evaluate diagnostic accuracy and feasibility of a mail-out home oximetry kit. Design: Patients were referred for both the tertiary/quaternary-centre hospital-delivered oximetry (HDO) and for the mail-out remotely-delivered oximetry (RDO). Quantitative and qualitative data were collected. The COVID-19 pandemic began during this study; therefore, necessary methodological adjustments were implemented. Setting: Patients were first evaluated in Swan Hill, Victoria. RDO kits were sent to home addresses. For the HDO, patients travelled to the Melbourne city area, received the kit, stayed overnight, and returned the kit the following morning. Participants: All consecutive paediatric patients (aged 2–18), diagnosed by a specialist in Swan Hill with obstructive sleep apnoea (OSA) on history/examination, and booked for tonsillectomy +/− adenoidectomy, were recruited. Main outcome measures: Diagnostic accuracy (i.e., comparison of RDO to HDO results) and test delivery time (i.e., days from consent signature to oximetry delivery) were recorded. Patient travel distances for HDO collection were calculated using home/delivery address postcodes and Google^® Maps data. Qualitative data were collected with two digital follow-up surveys. Results: All 32 patients that had both the HDO and RDO had identical oximetry results. The HDO mean delivery time was 87.7 days, while the RDO mean delivery time was 23.6 days (p value: <0.001). Qualitatively, 3/28 preferred the HDO, while 25/28 preferred the RDO (n = 28). Conclusions: The remote option is as accurate as the hospital option, strongly preferred by patients, more rapidly completed, and also an ideal investigation delivery method during certain emergencies, such as the COVID-19 pandemic. Full article

In recent years, tourist destinations around the world have witnessed an exponential growth in the number of Chinese tourists. With a view of understanding the consequences of their shopping activity in terms of behavioral response, this study inspects Chinese college students traveling overseas by analyzing 180 questionnaires. The reasoned action theory is applied to examine the impact of a number of factors influencing shopping behavior. The inquiry at hand makes use of methods, including factor analysis, regression analysis, and moderation analysis, to explore the relationship among perceived service quality, perceived value and shopping behavioral intention of tourists. The results show, inter alia, that service quality is a relevant dimension influencing the likelihood of tourists to share their shopping experience with friends and relatives, encouraging them to shop in the same destination, and to continue to shop in the same destination themselves in the future, regardless of the costs of visiting. Therefore, improving service quality may increase college students’ consumption during travel as well as their word of mouth after returning home. The outcomes of this study may contribute to the existing tourism economics and management scholarship and the tourism industry. Full article

The COVID-19 pandemic has seen disrupted international travel due to travel restrictions and public health measures aimed at containing the spread of the virus. With increasing evidence of the COVID-19 vaccines’ ability to mitigate disease severity, reopening tourism is desirable to promote the recovery of the global economy. However, the COVID-19 vaccine and vaccination passport for international travellers remains an ongoing debate. Little is known of the acceptance of these and the influencing factors among this population group. Therefore, this study sought to determine the temporal trend in COVID-19 vaccine acceptance and influencing factors among international travellers. A cross-sectional study was conducted using a self-administered questionnaire among international travellers who visited the Thai Travel Clinic, Hospital for Tropical Diseases, Mahidol University, Thailand from June 2021 to December 2021 (3 different variants dominated during this period). Study data were analyzed using SPSS software, version 23. Chi-square was used to demonstrate associations. Binary logistic regression was used to evaluate the magnitude of effect, demonstrated by odds ratio with 95% confidence interval. All significant variables were included in a multinomial logistic regression model to estimate adjusted odds ratios. The study enrolled 1068 travellers, 719 (67.3%) Thai and 349 (32.7%) foreign travellers. Most travellers were female (55.4%) and aged 18–30 years. The three main purposes for visiting the clinic were: for study, visiting friends and relatives, and returning to their home country. The overall COVID-19 vaccine acceptance rate among the travellers was 96.2%. The temporal trend of acceptance among Thai and non-Thai travelers varied from 93–99% and 93–100%, respectively. Vaccine efficacy, protective duration of the vaccine, risk of infection, and travel plan were factors strongly associated with COVID-19 vaccine acceptance. In conclusion, the COVID-19 vaccine acceptance rate among these international travellers was very high. The safe and effective reopening of tourism to international travellers will facilitate economic recovery. Full article

Since the beginning of 2020, the worldwide COVID-19 pandemic made it necessary to change our lifestyles (e.g., restrictions on transport or travelling and forced telework). This has also changed the environmental impact of our lifestyles. To quantify that impact, we used surveys to calculate the Ecological Footprint (EF) and environmental concern of Belgian respondents in 2021 and compared this to the EF-situation in 2017, before COVID-19. We observed that the EF became significantly lower during the COVID-19 crisis. Of course, this change in behaviour is the result of compulsory measures. Therefore, we asked about people’s willingness to reduce the EF permanently, particularly after COVID-19 and on a voluntary basis. We observed that, in 2021, respondents had a strong desire to return to a pre-COVID-19 lifestyle and that they are even less concerned about the environment than they were in the period before COVID-19. Moreover, these results hold after taking into account the effect of different explanatory variables in a multivariate analysis. As a general conclusion, there is little or no evidence that COVID-19 will fundamentally change the environmental impact of our behaviour or our environmental concern if there is no associated public intervention. There is a need for policies that make use of the potential created by COVID-19 (e.g., stimulate working from home and increased cycling). Full article

WHO recommends surveillance for COVID-19 among travelers at Points of Entry (POE) to countries. At 13 selected POE at the Nepal-India border, between March 2021 and July 2021, we describe the screening, testing, diagnosis and isolation practices of COVID-19 amongst travelers. Those who stayed in India or elsewhere for > one day and those who did not have a negative RT-PCR result within the last 72 h of travel were tested for COVID-19 with rapid antigen diagnostic tests. Daily surveillance reports maintained at POE were used for analysis. Of 337,338 travelers screened, 69,886 (21%) were tested and 3907 (6%) were diagnosed with COVID-19. The proportions tested averaged 15% during April-May when screened numbers were high and increased to 35% in July when screened numbers had decreased. The proportions diagnosed positive peaked at 10% in April-May, but decreased to below 1% in June and July. Testing coverage varied from 0–99% in the different POE. Most COVID-19 cases were Nepalese, male, <60 years of age, migrant workers and presented with fever. Of COVID-19 cases, 32% had home-based isolation, 64% underwent community-based isolation and the remainder either went to hospital or returned to India. In conclusion, about one fifth of travelers overall were tested, with coverage varying considerably over time and among different POE. Strengthening surveillance processes at POE is needed. Full article

Customers’ expectations of timely and accurate delivery and pickup of online purchases pose a new challenge to last-mile delivery. When the goods sent to customers are not received, they must be returned to the warehouse. This situation provides a high additional cost. Parcel locker systems and convenience stores have been launched to solve this problem and serve as pickup and payment stations. This research investigates a new last-mile distribution problem in the augmented system with three service modes: home delivery and pickup, parcel locker delivery and pickup, and home or parcel locker delivery and pickup. Previously, the simultaneous delivery and pickup problem with time windows (SDPPTW) only considered delivery and pickup to customers. The new problem proposed in this research addresses additional locker pickup and delivery options. The proposed problem is called the vehicle routing problem with simultaneous pickup and delivery and parcel lockers (VRPSPDPL). This research formulated a new mathematical model and developed two simulated annealing (SA) algorithms to solve the problem. The goal is to minimize the total traveling cost. Since there are no existing benchmark instances for the problem, we generate new instances based on SDPPTW benchmark instances. The experimental results show that the proposed algorithms are effective and efficient in solving VRPSPDPL. Full article