Cost-effectiveness of mask mandates on subways to prevent SARS-CoV-2 transmission in the United States.

BACKGROUND: Community-based mask wearing has been shown to reduce the transmission of SARS-CoV-2. However, few studies have conducted an economic evaluation of mask mandates, specifically in public transportation settings. This study evaluated the cost-effectiveness of implementing mask mandates for subway passengers in the United States by evaluating its potential to reduce COVID-19 transmission during subway travel. MATERIALS AND METHODS: We assessed the health impacts and costs of subway mask mandates compared to mask recommendations based on the number of infections that would occur during subway travel in the U.S. Using a combined box and Wells-Riley infection model, we estimated monthly infections, hospitalizations, and deaths averted under a mask mandate scenario as compared to a mask recommendation scenario. The analysis included costs of implementing mask mandates and COVID-19 treatment from a limited societal perspective. The cost-effectiveness (net cost per averted death) of mandates was estimated for three different periods based on dominant SARS-CoV-2 variants: Alpha, Beta, and Gamma (November 2020 to February 2021); Delta (July to October 2021); and early Omicron (January to March 2022). RESULTS: Compared with mask recommendations only, mask mandates were cost-effective across all periods, with costs per averted death less than a threshold of $11.4 million (ranging from cost-saving to $3 million per averted death). Additionally, mask mandates were more cost-effective during the early Omicron period than the other two periods and were cost saving in January 2022. Our findings showed that mandates remained cost-effective when accounting for uncertainties in input parameters (e.g., even if mandates only resulted in small increases in mask usage by subway ridership). CONCLUSIONS: The findings highlight the economic value of mask mandates on subways, particularly during high virus transmissibility periods, during the COVID-19 pandemic. This study may inform stakeholders on mask mandate decisions during future outbreaks of novel viral respiratory diseases.

A study on the influence of perceived distance on China's inbound Tourism and the interaction of non-economic distance: An analysis of dynamic extended gravity model based on 61 countries' entry data (2004-2018).

In the post-epidemic era, the restart of China's inbound tourism is imminent. However, there are gaps in our current understanding of how distance perception dynamically affects inbound tourism in China. In order to understand the past patterns of inbound tourism in China, we mapped the data of 61 countries of origin from 2004 to 2018 into a dynamic expanding gravity model to understand the effects of cultural distance, institutional distance, geographical distance, and economic distance on inbound tourism in China and revealed the dynamic interaction mechanism of non-economic distance perception on inbound tourism in China. Our research results show that cultural distance has a positive impact on China's inbound tourism, while institutional distance has a negative impact. The significant finding is that the dynamic interaction of the above two kinds of perceived distance can still have a positive impact on China's inbound tourism. Its practical significance is that it can counteract the influence of institutional distance by strengthening the cultural distance. Generally speaking, geographical distance and institutional distance restrict China's inbound tourism flow, while cultural distance, economic distance, and interactive perceptual distance promote China's inbound tourism flow.

Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis.

BACKGROUND: Telemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel time and cost. OBJECTIVE: We aim to describe economical outcomes towards the implementation of a multidisciplinary telemedicine service in a high-complexity hospital in Latin America, from the perspective of patients. DESIGN: A cross-sectional study was conducted, analysing the institutional data obtained over a period of 9 months, between April 2020 and December 2020. SETTING: A high-complexity teaching hospital located in Cali, Colombia. PARTICIPANTS: Individuals who received care via telemedicine. The population was categorised into three groups based on their place of residence: Cali, Valle del Cauca excluding Cali and Outside of Valle del Cauca. OUTCOME MEASURES: Travel distance, time, fuel and public round-trip cost savings, and potential loss of productivity were estimated from the patient's perspective. RESULTS: A total of 62 258 teleconsultations were analysed. Telemedicine led to a total distance savings of 4 514 903 km, and 132 886 hours. The estimated cost savings were US$680 822 for private transportation and US$1 087 821 for public transportation. Patients in the Outside of Valle del Cauca group experienced an estimated average time savings of 21.2 hours, translating to an average fuel savings of US$149.02 or an average savings of US$156.62 in public transportation costs. Areas with exclusive air access achieved a mean cost savings of US$362.9 per teleconsultation, specifically related to transportation costs. CONCLUSION: Telemedicine emerges as a powerful tool for achieving substantial travel savings for patients, especially in regions confronting geographical and socioeconomic obstacles. These findings underscore the potential of telemedicine to bridge healthcare accessibility gaps in low-income and middle-income countries, calling for further investment and expansion of telemedicine services in such areas.

Differences in tourism economic development and its influencing factors among three major city clusters along the middle reaches of the Yangtze River.

An in-depth study of the mechanisms governing the generation, evolution, and regulation of differences in tourism economics holds significant value for the rational utilization of tourism resources and the promotion of synergistic tourism economic development. This study utilizes mathematical statistical analysis and GIS spatial analysis to construct a single indicator measure and a comprehensive indicator measure to analyze tourism-related data in the research area from 2004 to 2019. The main factors influencing the spatial and temporal differences in the tourism economy are analyzed using two methods, namely, multiple linear regression and geodetector. The temporal evolution, overall differences and differences within each city group fluctuate downwards, while the differences between groups fluctuate upwards. Domestic tourism economic differences contribute to over 90% of the overall tourism economic differences. Spatial divergence, the proportion of the tourism economy accounted for by spatial differences is obvious, the comprehensive level of the tourism economy can be divided into five levels. The dominant factors in the formation of the pattern of spatial and temporal differences in the tourism economy are the conditions of tourism resources based on class-A tourist attractions and the level of tourism industry and services based on star hotels and travel agencies. This study addresses the regional imbalance of tourism economic development in city clusters and with the intent of promoting balanced and high-quality development of regional tourism economies.

Travel Time and Costs for Abortion for Military Service Members After the Dobbs Decision.

This study quantifies the change in travel times for military service personnel to abortion facilities following the US Supreme Court Dobbs decision and estimates the cost of an abortion-related travel reimbursement policy.

Travel time prediction of urban public transportation based on detection of single routes.

Improving travel time prediction for public transit effectively enhances service reliability, optimizes travel structure, and alleviates traffic problems. Its greater time-variance and uncertainty make predictions for short travel times (≤35min) more subject to be influenced by random factors. It requires higher precision and is more complicated than long-term predictions. Effectively extracting and mining real-time, accurate, reliable, and low-cost multi-source data such as GPS, AFC, and IC can provide data support for travel time prediction. Kalman filter model has high accuracy in one-step prediction and can be used to calculate a large amount of data. This paper adopts the Kalman filter as a travel time prediction model for a single bus based on single-line detection: including the travel time prediction model of route (RTM) and the stop dwell time prediction model (DTM); the evaluation criteria and indexes of the models are given. The error analysis of the prediction results is carried out based on AVL data by case study. Results show that under the precondition of multi-source data, the public transportation prediction model can meet the accuracy requirement for travel time prediction and the prediction effect of the whole route is superior to that of the route segment between stops.

Spatial distribution evolution and accessibility of A-level scenic spots in Guangdong Province from the perspective of quantitative geography.

As a typical representative of tourism resources, the spatial distribution of A-level scenic spots has a profound impact on the layout of tourism industry. Scenic spot accessibility is also important for the development of tourism. However, the relationship of regional accessibility and spatial distribution of A-level scenic spots are understudied. The study used quantitative geography and geographic information system spatial analysis methods and analyzed the evolution of spatial distribution and regional accessibility of A-level scenic spots in Guangdong Province from 2001 to 2020. The results present the following: 1. Agglomeration distribution is the main distribution type of A-level scenic spots in Guangdong Province, and the spatial distribution is unbalanced. 2. From 2001 to 2020, the spatial distribution of A-level scenic spots in 21 prefecture-level cities of Guangdong Province has gradually developed from "wide gap" to "relatively reasonable." 3. Distribution density of A-level scenic spots in Guangdong Province has evolved into the main core area of high density. 4. Center of the gravity of A-level scenic spots in Guangdong Province developed from east to west during 2002-2007 and moved to the east after 2007. 5. Accessibility between A-level scenic spots and tourist source areas in Guangdong Province is good, with an evident aggregation phenomenon. This study reveals the spatial distribution evolution law and regional accessibility of A-level scenic spots, which is conducive to healthy, sustainable, and stable development of tourism in Guangdong Province.

The impact of COVID-19 on trips to urban amenities: Examining travel behavior changes in Somerville, MA.

While there has been much speculation on how the pandemic has affected work location patterns and home location choices, there is sparse evidence regarding the impacts that COVID-19 has had on amenity visits in American cities, which typically constitute over half of all urban trips. Using aggregate app-based GPS positioning data from smartphone users, this study traces the changes in amenity visits in Somerville, MA from January 2019 to December 2020, describing how visits to particular types of amenities have changed as a result of business closures during the public health emergency. Has the pandemic fundamentally shifted amenity-oriented travel behavior or is consumer behavior returning to pre-pandemic trends? To address this question, we calibrate discrete choice models that are suited to Census block-group level analysis for each of the 24 months in a two-year period, and use them to analyze how visitors' behavioral responses to various attributes of amenity clusters have shifted during different phases of the pandemic. Our findings suggest that in the first few months of the pandemic, amenity-visiting preferences significantly diverged from expected patterns. Even though overall trip volumes remained far below normal levels throughout the remainder of the year, preferences towards specific cluster attributes mostly returned to expected levels by September 2020. We also construct two scenarios to explore the implications of another shutdown and a full reopening, based on November 2020 consumer behavior. While government restrictions have played an important role in reducing visits to amenity clusters, our results imply that cautionary consumer behavior has played an important role as well, suggesting a likely long and slow path to economic recovery. By drawing on mobile phone location data and behavioral modeling, this paper offers timely insights to help decision-makers understand how this unprecedented health emergency is affecting amenity-related trips and where the greatest needs for intervention and support may exist.

An NP-led pilot telehealth programme to facilitate guideline-directed medical therapy for heart failure with reduced ejection fraction during the COVID-19 pandemic.

AIMS: Heart failure with reduced ejection fraction (HFrEF) is associated with poor outcomes. While several medications are beneficial, achieving optimal guideline-directed medical therapy (GDMT) is challenging. COVID-19 created a need to explore new ways to deliver care. METHODS: Fifty consecutive patients were taught to identify fluid congestion and monitor their vital signs using BP monitors and electronic scales with NP-led telephone support. Quantitative data were collected and a patient experience interview was performed. RESULTS: The majority (76%) of the cohort (male, 76%; Maori/Pacific, 58%) had a new diagnosis of HFrEF, with 90% having severe left ventricular (LV) dysfunction. There were 216 contacts (129 (60%) by telephone), which eliminated travelling, (time saved, 2.12 hours per patient), petrol costs ($58.17 per patient), traffic pollution (607 Kg of CO2) and time off work. Most (75%) received contact within two weeks and 75% were optimally titrated within two months. Improvements in systolic BP (SBP) (124mmHg to 116mmHg), pulse (78 bpm to 70 bpm) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (292 to 65) were identified. Of the 43 patients who had a follow-up transthoracic echocardiogram (TTE), 33 (77%) showed important improvement in left ventricular ejection fraction (LVEF). CONCLUSIONS: Patients found the process acceptable and experienced rapid titration with less need for clinic review with titration rates comparable with most real-world reports.

Disparities in Physical Accessibility among Rural Thais Under Universal Health Coverage.

This study aims to explore various barriers in accessing outpatient care among the participants from different age groups and to identify determinants associated with physician visits. The study had adopted Andersen's Behavioral Model (ABM) of Health Services Use. A cross-sectional study design was adopted to collect data from 417 participants through a questionnaire survey. Poisson regression models were used to explore determinants for explaining the differences in outpatient care use. The regression results revealed that divergent relationships existed among age groups. Children and elderly participants tended to decrease the probability of seeking care. Elderly participants confronted more difficulties in access and were dependent on family members. Despite free care provisions, participants visited and spent their out-of-pocket expenditure mostly at non-universal health coverage (non-UHC) facilities. Convenience and the availability of specialist physicians led the higher-income parents to seek care of their children at non-UHC facilities. Highly educated people of working age preferred more self-care or institutionalized care to save time. Children up to the primary level of education were more likely to visit a doctor. We concluded that investments in education or well-informed health services provision would improve health care utilization. Findings of Andersen's Behavioral Model variables suggested that improvements in the quality of services, medical professional skills, and efficient resource allocation may induce seeking care at UHC facilities. Consequently, it will reduce the number of referred cases, caseloads at tertiary care units, and visits to non-UHC facilities at longer distances.

Association between participation in the government subsidy programme for domestic travel and symptoms indicative of COVID-19 infection in Japan: cross-sectional study.

OBJECTIVE: To investigate the association between participation in government subsidies for domestic travel (subsidise up to 50% of all travel expenses) introduced nationally in Japan on 22 July 2020 and the incidence of symptoms indicative of COVID-19 infections. DESIGN: Cross-sectional analysis of nationally representative survey data. SETTING: Internet survey conducted between 25 August and 30 September 2020 in Japan. Sampling weights were used to calculate national estimates. PARTICIPANTS: 25 482 survey respondents (50.3% (12 809) women; mean (SD) age, 48.8 (17.4) years). MAIN OUTCOME MEASURES: Incidence rate of five symptoms indicative of the COVID-19 infection (high fever, sore throat, cough, headache, and smell and taste disorder) within the past month of the survey, after adjustment for characteristics of individuals and prefecture fixed effects (effectively comparing individuals living in the same prefecture). RESULTS: At the time of the survey, 3289 (12.9%) participated in the subsidy programme. After adjusting for potential confounders, we found that participants in the subsidy programme exhibited higher incidence of high fever (adjusted rate, 4.7% for participants vs 3.7% for non-participants; adjusted OR (aOR) 1.83; 95% CI 1.34 to 2.48; p<0.001), sore throat (19.8% vs 11.3%; aOR 2.09; 95% CI 1.37 to 3.19; p=0.002), cough (19.0% vs 11.3%; aOR 1.96; 95% CI 1.26 to 3.01; p=0.008), headache (29.2% vs 25.5%; aOR 1.24; 95% CI 1.08 to 1.44; p=0.006) and smell and taste disorder (2.6% vs 1.8%; aOR 1.98; 95% CI 1.15 to 3.40; p=0.01) compared with non-participants. These findings remained qualitatively unaffected by additional adjustment for the use of 17 preventative measures (eg, social distancing, wearing masks and handwashing) and fear against the COVID-19 infection. CONCLUSIONS: The participation of the government subsidy programme for domestic travel was associated with a higher probability of exhibiting symptoms indicative of the COVID-19 infection.

Understanding the strategies rural cancer patients and survivors use to manage financial toxicity and the broader implications on their lives.

PURPOSE: To explore strategies rural Australians use to cope with the financial consequences of their cancer diagnosis and how that impacts on their lives. METHODS: Twenty adult cancer patients/survivors residing in regional-remote areas of Australia were purposively sampled and participated in audio-recorded, semi-structured interviews. When data saturation was reached, thematic analysis was employed to analyse the data. RESULTS: Participants were 20-78 years (M=60), 70% female, 35% were undergoing treatment and the remaining 65% had finished treatment within the past 5 years. Three themes provide context to rural financial toxicity-related experiences (travelling to access cancer treatment away from home is expensive, being single or lacking family support exacerbates the financial strain, and no choice other than to adopt cost-saving strategies if wanted to access treatment). Strategies commonly employed to minimise financial toxicity include: accessing travel-related support, changes to lifestyle (buying cheaper food, saving on utilities), accessing savings and retirement funds, missing holidays and social activities, reduced car use and not taking a companion to cancer-related appointments at metropolitan treatment areas. Although cost-saving strategies can effectively increase the ability of rural people to cover cancer treatment-related and other costs, most have broader negative psychological, social and practical consequences for them and their families. CONCLUSIONS: Increasing rural cancer patients' and survivors' awareness of various cost-saving strategies and their impact (positive and negative) may decrease their risk of experiencing financial toxicity and unexpected unintended consequences of adopting cost-saving measures.

A Contrastive Study on Travel Costs of Car-Sharing and Taxis Based on GPS Trajectory Data.

The emergence and development of car-sharing has not only satisfied people's diverse travel needs, but also brought new solutions for improving urban traffic conditions and achieving low-carbon and green sustainable development. In recent years, car-sharing has had competition with other ways of getting around, as the acceptance of car-sharing has grown, notably taxis. Therefore, it is particularly important to explore car-sharing travel costs advantages from the perspective of consumers and discover the competitive and complementary spaces between car-sharing and other modes. Therefore, taking Beijing as an example, this paper uses GPS trajectory data based on car-sharing orders to design a travel cost framework of car-sharing and taxis. We calculate and compare the travel cost difference between these two modes under different travel characteristics. The results indicate that car-sharing is a more economical way for consumers to travel for short or medium lengths of time, while people are more inclined to take taxis for distances of long duration. Compared with on workdays, at the weekend, the cost advantage of car-sharing is greater for long-distance trips. Moreover, the cost advantage of car-sharing increases gradually with the increase in travel distance. In addition, the travel costs of car-sharing and taxis are also affected by peak and off-peak traffic periods. Compared with off-peak periods, it is more cost-effective for travelers to take taxis during peak traffic periods for various travel distances. From the perspective of the travel cost, it is of great theoretical significance to discuss the substitution (market competition) and complementary relationship (market cooperation) between car-sharing and taxis in a detailed and systematic way. It provides methods and ideas for the comparative cost calculation of car-sharing and other travel modes. This paper also provides enlightenment and guidance for the development of car-sharing. Enterprises should implement differentiated pricing, designing different charging methods for different traffic periods, travel miles, and rental times, and set up additional stations in the surrounding areas of the city. Relevant government departments should also strictly manage the market access of car-sharing, and add or open car-sharing parking lots in centralized areas and for specific periods.

Economic valuation of natural promenades in Iran using zonal travel costs method (Case study area: Gahar Lake in Lorestan Province in western Iran).

Gahar Lake is located within Oshtorankooh Protected Area (east of Lorestan Province in Iran), which has extensive potentials for the development of the tourism industry. The aim of the present research was to determine the economic value of the Gohar Lake resort using the zonal travel cost method. Therefore, at first, 380 questionnaires were distributed among the tourists by the simple random sampling method based on appropriate spatiotemporal distribution during the visiting seasons. The questionnaire items were categorized as economic, social, and miscellaneous parts. The calculation results revealed a value of USD 84.538 per visitor and a value of USD 1,986,657.163 per year, indicating the high value and importance of the region. The analysis showed that socio-economic variables have a significant role in the use or non-use of the resort. The obtained R2 coefficient was 0.82, indicating that around 82% of the changes in the number of visitors can be justified by the variables introduced in the model. The results also revealed the need to pay more attention to this region and formulate a tourism development plan.

Explaining the travelling behaviour of migrants using Facebook audience estimates.

The paper explores the travelling behaviour of migrant groups using Facebook audience estimates. Reduced geographical mobility is associated with increased risk of social exclusion and reduced socio-economic and psychological well-being. Facebook audience estimates are timely, openly available and cover most of the countries in the world. Facebook classifies its users based on multiple attributes such as the country of their previous residence, and whether they are frequent travellers. Using these data, we modelled the travelling behaviour of Facebook users grouped by countries of previous and current residence, gender and age. We found strong indications that the frequency of travelling is lower for Facebook users migrating from low-income countries and for women migrating from or living in countries with high gender inequality. Such mobility inequalities impede the smooth integration of migrants from low-income countries to new destinations and their well-being. Moreover, the reduced mobility of women who have lived or currently live in countries with conservative gender norms capture another aspect of the integration which is referring to socio-cultural norms and gender inequality. However, to provide more solid evidence on whether our findings are also valid for the general population, collaboration with Facebook is required to better understand how the data is being produced and pre-processed.