Search Results (1,287)

Since its first appearance as a human pathogen in 1976, Legionella pneumophila has been identified as a causative agent of community-acquired pneumonia (CAP). It survives in rivers, bays, lakes, and water reservoirs, and it is categorized as the fourth most common causative agent of CAP leading to hospitalization. We aimed to investigate patterns in which environmental, seasonal and regional factors may affect the prevalence of Legionnaires’ disease in Crete during the last two decades (2000–2022).The data used originated from the national surveillance database and included any person reported with travel-associated Legionnaires’ disease (TALD) between January 2000 and December 2022. Meteorological data were collected from the National Weather Service. The meteorological variables included (max) temperature (in °C), cloudiness (in octas), wind speed (in knots), and relative humidity (RH) (%). The statistical analysis was based on a case-crossover design with 1:1 matching characteristic. We revealed both seasonal and regional effects on the incidence of Legionnaires’ disease. Cases are significantly more frequent in autumn, in comparison to the other three seasons, while Rethymnon is the prefecture with fewer cases in comparison to Chania or Heraklion. In addition, our research showed that the majority of cases occurred during the years 2017–2018. TALD in Crete is significantly associated with temperature in °C and wind speed in knots. Our research suggests that temporal and spatial factors significantly influence disease cases. These results are in line with studies from foreign countries. The study results aspire to expand our knowledge regarding the epidemiological characteristics of Legionnaires’ disease in relation to local, geographical and meteorological factors on the island of Crete. Full article

The purpose of this study is to investigate the factors that influence tourist behavior and revisit intentions in the context of halal tourism. The antecedent variables in this study included religiosity, digital halal literacy, halal destination features, contentment, and trust. This is a quantitative study that used travelers that visited halal tourism attractions in West Sumatra, Indonesia, as the sample population. The sample size was 400 respondents. The data were analyzed using the partial least squares–structural equation model (PLS-SEM). We discovered that religiosity is an important predictor of contentment and trust. Satisfaction was achieved through digital halal literacy and halal destination qualities and was found to have a significant influence on trust, tourist behavior, and revisit intentions. Finally, trust was found to have a significant association with intention to revisit and behavior. The results of this research are insightful for managers and policymakers on how to provide halal tourism attributes and analyze tourists’ digital halal literacy that lead to tourist satisfaction. This study also provides further knowledge to policymakers and local authorities on how to promote future tourist participation in halal tourism development in Indonesia; thus, it can help create more tourist returns for further visits to the same location in the future. Full article

In modern agriculture, tractors play a crucial role in powering tools and implements. Proper operation of agricultural tractors in mechanized field operations can support sustainable agriculture and reduce emissions of pollutants such as carbon dioxide (CO₂). This has been a recurring concern associated with agricultural intensification for food production. This study aimed to evaluate the optimization of tractor gears and engine speed during crop operations to minimize CO₂ emissions and promote sustainability. The experiment was conducted using a strip plot design with subdivided sections and six replications, following a double factorial structure. The first factor evaluated was the type of agricultural implement (disc harrow, subsoiler, or sprayer), while the second factor was the engine speed setting (nominal or reduced). Operational and energy performance metrics were analyzed, including fuel consumption and CO₂ emissions, travel speed, effective working time, wheel slippage, and working depth. Optimized gear selection and engine speeds resulted in a 20 to 40% reduction in fuel consumption and CO₂ emissions. However, other evaluated parameters remain unaffected by the reduced engine speed, regardless of the implement used, ensuring the operation’s quality. Thus, optimizing operator training or configuring machines allows for environmental impact reduction, making agricultural practices more sustainable. Full article

Compared to commuting, grocery shopping trips, despite their profound implications for mixed land use and transportation planning, have received limited attention in travel behavior research. Drawing upon a travel diary survey conducted in a fast-growing metropolitan region of the United States, i.e., Salt Lake County, UT, this research investigated a variety of influential factors affecting mode choices associated with grocery shopping. We analyze how built environment (BE) characteristics, measured at seven spatial scales or different ways of aggregating spatial data—including straight-line buffers, network buffers, and census units—affect travel mode decisions. Key predictors of choosing walking, biking, or transit over driving include age, household size, vehicle ownership, income, land use mix, street density, and distance to the central business district (CBD). Notably, the influence of BE factors on mode choice is sensitive to different spatial aggregation methods and locations of origins and destinations. The straight-line buffer was a good indicator for the influence of store sales amount on mode choices; the network buffer was more suitable for the household built environment factors, whereas the measurement at the census block and block group levels was more effective for store-area characteristics. These findings underscore the importance of considering both the spatial analysis method and the location (home vs. store) when modeling non-work travel. A multi-scalar approach can enhance the accuracy of travel demand models and inform more effective land use and transportation planning strategies. Full article

Economic growth, especially in emerging economies, has altered the composition of international tourism. It is therefore essential to possess the skills necessary to understand the influence of culture on human behaviour, thereby enabling an appropriate response to the traveller. This research aims to develop a tool for identifying openness, flexibility, awareness, and intercultural preparedness. It focuses on the metacognitive and cognitive aspects of cultural intelligence that shape the development of empathy in customer service staff in hotels in Quintana Roo. The variables were validated and incorporated into a quantitative study using multivariate analysis and inferential statistics. A sample of 77 questionnaires was analysed using simple random sampling under a proportional design. Multiple Correspondence Analysis (MCA) was employed as a discriminatory technique to identify the most significant independent variables. These were subsequently entered as regressors into ordinal logistic regression (OLR), along with age and work experience, in order to estimate the probabilities associated with each level of the dependent variable. The results indicated that age had minimal influence on the metacognitive and cognitive variables, whereas years of experience among tourism staff exerted a significant effect. Full article

One of the fundamental goals of contemporary mobility is to optimize transport processes in urban areas. The solution in this area seems to be the implementation of the idea of sustainable transport systems based on the Smart City concept. The article presents a case study—an assessment of the possibilities of changing mobility habits based on the idea of sustainable urban transport, taking into account the criterion of energy consumption of individual means of transport. The analyses are based on a comparison of selected means of transport occurring in the urban environment according to several key parameters for the optimization and efficiency of transport processes, i.e., cost, time, travel comfort, and impact on the natural environment, while simultaneously linking them to the criterion of energy consumption of individual means of transport. The analyzed parameters currently constitute the most important group of challenges in the area of shaping and planning optimal and sustainable urban transport. The presented research was used to indicate the connections between various areas of optimization of the transport process and the energy efficiency of individual modes of transport. Analyses have shown that the least time-consuming process of urban mobility is associated with the highest level of CO₂ emissions and, at the same time, the highest level of energy efficiency. However, combining public transport with other means of transport can meet most of the transport expectations of city residents, also in terms of energy optimization. The research results presented in the article can contribute to the creation of a strategy for the development of the transport network based on the postulates of increasing the optimization and efficiency of individual means of transport in urban areas. At the same time, recognizing the criterion of energy intensity of means of transport as leading in the development of sustainable urban mobility. Thus, confirming the important role of existing transport systems in the process of shaping and planning sustainable urban mobility in accordance with the idea of Smart City. Full article

Urban areas are facing increasing traffic congestion, pollution, and infrastructure strain. Traditional urban transportation systems are often fragmented. They require users to plan, pay, and travel across multiple disconnected services. Mobility-as-a-Service (MaaS) integrates these services into a single digital platform, simplifying access and improving the user experience. This review critically examines the role of MaaS in fostering sustainable mobility ecosystems. MaaS aims to enhance user-friendliness, service variety, and sustainability by adopting a customer-centric approach to transportation. The findings reveal that successful MaaS systems consistently align with multimodal transport infrastructure, equitable access policies, and strong public-private partnerships. MaaS enhances the management of routes and traffic, effectively mitigating delays and congestion while concurrently reducing energy consumption and fuel usage. In this study, the authors examine MaaS as a new mobility paradigm for a sustainable transportation system in smart cities, observing the challenges and opportunities associated with its implementation. To assess the environmental impact, a sustainability index is calculated based on the use of different modes of transportation. Significant findings indicate that MaaS systems are proliferating in both quantity and complexity, increasingly integrating capabilities such as real-time multimodal planning, dynamic pricing, and personalized user profiles. Full article

Background/Objectives: The hippocampus is an essential part of the central nervous system (CNS); it plays a significant role in social–cognitive memory processing. Prenatal exposure to valproic acid (VPA) can lead to impaired hippocampal functions. In this study, we evaluated the effect of plumbagin (PLB) as a natural product on spatial learning and memory, neuro-morphological changes, and inflammation levels in a VPA-induced autism model during adolescence. Methods: Pregnant Wistar rats received a single intraperitoneal (i.p.) injection of VPA (600 mg/kg) or saline on gestational day 12.5. The male offspring were then categorized and assigned to five groups: Saline+DMSO-, VPA+DMSO-, and VPA+PLB-treated groups at doses of 0.25, 0.5, or 1 mg/kg. Spatial learning and memory were evaluated using the Morris water maze. Histopathological evaluations of the hippocampus were performed using Nissl and hematoxylin–eosin staining, as well as immunofluorescence. The pro-inflammatory cytokine levels were also quantified by quantitative real-time PCR. Results: The findings revealed that a VPA injection on gestational day 12.5 is associated with cognitive impairments in male pups, including a longer escape latency and traveled distance, as well as decreased time spent in the target quadrant. Treatment with PLB significantly enhanced the cognitive function, reduced dark cells, and ameliorated neuronal–morphological alterations in the hippocampus of VPA-exposed rats. Moreover, PLB was found to reduce astrocyte activation and the expression levels of pro-inflammatory cytokines. Conclusions: These findings suggest that PLB partly mitigates VPA-induced cognitive deficits by ameliorating hippocampal inflammation levels. Full article

Background: While efforts have been made to control meningococcal disease or carriage during mass gatherings (MGs), it is still a significant problem. This meta-analysis aims to assess the prevalence and predictors of meningitis carriage during MGs and travel. Methodology: PubMed, Scopus, Embase, and Cochrane were searched from their conception to January 2025. Cohort and cross-sectional studies assessing the prevalence of meningitis carriage and its serotype related to MGs and/or travel, and risk factors associated with its spread, were considered. The Newcastle–Ottawa scale was used for the quality assessment of studies. Results: Out of 1301 studies, 25 were considered for this meta-analysis. The largest geographic area involved was Saudi Arabia. A meta-analysis of 24 studies identified a pooled prevalence rate of meningococcal disease or carriage of 15.9% (95%CI: 4.45–27.4%) and the most frequent infecting organisms to be Serotype C (13.9%; 95%CI: −14.7 to 42.5; 4 studies) and A (11.5%; 95%CI: −2.13 to 25.2; 9 studies) among those at MGs or traveling. Age, gender, smoking history, and the vaccination status did not affect the infection risk. Conclusions: There is an increased prevalence of meningococcal disease and carriage, especially Serogroups A and C, associated with MGs and travel. New interventions and methodologies should be undertaken to control and prevent meningococcal disease or carriage transmission during such events. Full article

Background: The longitudinal RisCoin study investigated risk factors for COVID-19 vaccination failure among healthcare workers (HCWs) and patients with inflammatory bowel disease (IBD) at a University Hospital in Germany. Since the hospital served as the study sponsor and employer of the HCW, we implemented a custom mobile application. We aimed to evaluate the implementation, adherence, benefits, and limitations of this study’s app. Methods: The app allowed secure data collection through questionnaires, disseminated serological results, and managed bidirectional communication. Access was double-pseudonymized and irreversibly anonymized six months after enrollment. Download frequency, login events, and questionnaire submissions between October 2021 and December 2022 were analyzed. Multivariable logistic regression identified factors associated with app adherence. Results: Of the 3979 participants with app access, 3622 (91%) used the app; out of these, 1016 (28%) were “adherent users” (≥12 submitted questionnaires). App adherence significantly increased with age. Among HCW, adherent users were more likely to be non-smokers (p < 0.001), working as administrators or nursing staff vs. physicians (p < 0.001), vaccinated against influenza (p < 0.001), and had not travelled abroad in the past year (p < 0.001). IBD patients exposed to SARS-CoV-2 (p = 0.0133) and those with adverse events following the second COVID-19 vaccination (p = 0.0171) were more likely adherent app users. Despite technical issues causing dropout or non-adherence, the app served as a secure solution for cohort management and longitudinal data collection. Discussion: App-based cohort management enabled continuous data acquisition and individualized care while providing flexibility and anonymity for the study team and participants. App usability, technical issues, and cohort characteristics need to be thoroughly considered prior to implementation to optimize usage and adherence in clinical research. Full article

Analyses of student mobility are typically conducted in an urban environment and are informed by socio-demographic or trip attributes. The prevailing focus is on individual modes of transport, different groups of commuters travelling to campus, students’ behavioural perceptions, and the totality of student trips. This paper starts with the identification of the determinants of student mobility that have received insufficient research attention. Utilising surveys, the study captures the mobility patterns of a sample of 1014 students and calculates their carbon footprint (CF; in kg/academic year) to assess whether the factors neglected in previous studies influence differences in the actual environmental load of student commuting. A regression analysis is employed to ascertain the significance of these factors as predictors of sustainable student mobility. This study exclusively focuses on the group of student commuters to campus and analyses the trips associated with compulsory activities at a suburban campus that is distant from the university centre and student facilities, which changes the mobility context in terms of commuting options. The under-researched factors identified in this research have not yet been quantified as CF. The findings confirm that only some of the factors neglected in previous research are statistically significant predictors of the local environmental load of student mobility. Specifically, variables such as student employment, frequency of class attendance, and propensity for ride-sharing could be utilised to forecast and regulate students’ mobility towards more sustainable patterns. However, all of the under-researched factors (including household size, region of origin (i.e., past experiences), residing at term-time accommodation while studying, and the availability of a family car) have an influence on the differences in CF magnitude in the studied campus. Full article

This study estimates a willingness-to-pay (WTP) space mixed logit model to evaluate user valuations of travel time, safety, and comfort attributes associated with common access modes in Bangkok, including walking, motorcycle taxis, and localized minibuses. The model accounts for preference heterogeneity by specifying random parameters for travel time. Results indicate that users—exhibiting substantial variation in preferences—place higher value on reducing motorcycle taxi travel time, particularly in time-constrained contexts such as peak-hour commuting, whereas walking is more acceptable in less pressured settings. Safety and comfort attributes—such as helmet availability, smooth pavement, and seating—significantly influence access mode choice. Notably, the WTP for helmet availability is estimated at THB 8.04 per trip, equivalent to approximately 40% of the typical fare for station access, underscoring the importance of safety provision. Women exhibit stronger preferences for motorized access modes, reflecting heightened sensitivity to environmental and social conditions. This study represents one of the first applications of WTP-space modeling for valuing informal station access transport in Southeast Asia, offering context-specific and segment-level estimates. These findings support targeted interventions—including differentiated pricing, safety regulations, and service quality enhancements—to strengthen first-/last-mile connectivity. The results provide policy-relevant evidence to advance equitable and sustainable transport, particularly in rapidly urbanizing contexts aligned with SDG 11.2. Full article

Background: Among all ambulatory antibiotic prescriptions, about 20% are non-visit-based (ordered outside of an in-person clinical encounter), and about 30% are not associated with an infection-related diagnosis code. Objective/Methods: To identify the rationale for ambulatory antibiotic prescribing, we queried the electronic health record (EHR) of a single, large health system in the Midwest United States to identify all oral antibiotics prescribed from November 2018 to February 2019 and examined visit, procedure, lab, department, and diagnosis codes. For the remaining antibiotic prescriptions—mostly non-visit-based, no-infectious-diagnosis-documented—we randomly selected and manually reviewed the EHR to identify a prescribing rationale and, if none was present, surveyed prescribers for their rationale. Results: During the study period, there were 47,619 antibiotic prescriptions from 1177 clinicians to 41,935 patients, of which 2608 (6%) were eligible non-visit-based, no-infectious-diagnosis-documented. We randomly selected 2298. There was a documented rationale for 2116 (92%) prescriptions. The most common documented reasons—not mutually exclusive—were patient-reported symptoms (71%), persistence of symptoms after initial management (18%), travel (17%), and responding to lab or imaging results (11%). We contacted 160 clinicians who did not document any prescribing rationale in the EHR and received responses from 62 (39%). Clinicians’ stated reasons included upcoming or current patient travel (19%), the antibiotic was for the prescriber’s own family member (19%), or the clinician made a diagnosis but did not document it in the EHR (18%). Conclusions: Non-visit-based, no-infectious-diagnosis-documented antibiotic prescriptions were most often in response to patient-reported symptoms, though they also occur for a variety of other reasons, some problematic, like in the absence of documentation or for a family member. Full article

Estimating the economic value of recreation and ecotourism is essential for sustainable ecosystem management and informed environmental policymaking. However, values derived from individual studies often vary because of subjective preferences and contextual variability, making it challenging to obtain generalizable estimates. To address this issue, this study employed a meta-regression analysis synthesizing 179 willingness-to-pay (WTP) observations obtained from 48 individual valuation studies conducted across various recreational and ecotourism sites in the Republic of Korea. Focusing specifically on national parks, which are prominent providers of cultural ecosystem services, we examined how site characteristics, study design factors, and valuation methodologies influenced estimated WTP values. Outliers were systematically identified and treated using statistical methods, with the random-effects model utilizing studentized residuals yielding the most robust results. Our findings revealed that national parks and studies employing the travel cost method (TCM) were associated with significantly higher WTP values. By applying the developed meta-regression model, we estimated that the total value of recreational and ecotourism services provided by national parks in the Republic of Korea was approximately USD 865.0 million in 2020. These results highlight the effectiveness of meta-regression analysis in synthesizing heterogeneous valuation studies, facilitating more accurate benefit transfers, and offering empirical insights to guide ecosystem service policy and management decisions. Full article

This paper examines the operational consequences and energy demands associated with the growing cultural diversity of air travellers at airport security checkpoints. The analysis focuses on how an increasing proportion of passengers requiring enhanced security screening, due to cultural, religious, or linguistic factors, affects both system throughput and energy consumption. The methodology integrates synchronised measurement of passenger flow with real-time monitoring of electricity usage. Four operational scenarios, representing incremental shares (0–15%) of passengers subject to extended screening, were modelled. The findings indicate that a 15% increase in this passenger group leads to a statistically significant rise in average power consumption per device (3.5%), a total energy usage increase exceeding 4%, and an extension of average service time by 0.6%—the cumulative effect results in a substantial annual contribution to the airport’s carbon footprint. The results also reveal a higher frequency and intensity of power consumption peaks, emphasising the need for advanced infrastructure management. The study emphasises the significance of predictive analytics, dynamic resource allocation, and the implementation of energy-efficient technologies. Furthermore, systematic intercultural competency training is recommended for security staff. These insights provide a scientific basis for optimising airport security operations amid increasing passenger heterogeneity. Full article