A site to transform Pubmed publications into these bibliographic reference formats: ADS, BibTeX, EndNote, ISI used by the Web of Knowledge, RIS, MEDLINE, Microsoft's Word 2007 XML.

Travel - Top 30 Publications

Epidemiology of Imported Malaria Cases in Japan, 2006-2014: A Sentinel Traveler Surveillance Approach.

Malaria continues to be imported into Japan. To better assess the risk of imported malaria, we describe malaria species, suspected country/area of infection (accounting for the number of travelers), demographic characteristics, clinical manifestation, and healthcare access, based on the national surveillance data from 2006 to 2014. Among 557 cases, the median age was 33 years (range: 1-83 years), and 76% were male; 306 (55%) were classified as Japanese based on the reported name. The majority were Plasmodium falciparum infections (58%), followed by Plasmodium vivax infections (30%). Most P. falciparum cases were acquired in Africa and P. vivax in Asia/Oceania. Notification rates per 10,000 Japanese travelers for P. falciparum were highest for Africa, P. vivax were highest for Asia/Oceania, and high for both species for Papua New Guinea. Ten percent of the cases were clinically severe at the time of notification. Nearly 80% of severe cases were P. falciparum infections, and among P. falciparum cases, Japanese ethnicity was associated with severe case status (P = 0.03). Plasmodium falciparum cases among Japanese cases showed that older age (≥ 50 years) was associated with severe case status (odds ratio = 5.4; 95% confidence interval = 1.9-15.2), adjusted for sex and healthcare access. More informative assessments are possible by accounting for the number of travelers. Older Japanese represent an important demographic to target prevention and early treatment efforts for malaria.

Travel Characteristics and Pretravel Health Care Among Pregnant or Breastfeeding U.S. Women Preparing for International Travel.

To study characteristics and preventive interventions of adult pregnant and breastfeeding travelers seeking pretravel health care in the United States.

Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes.

It is unclear whether traveling long distances to high-volume centers would compensate for travel burden among patients undergoing rectal cancer resection.

A returning traveller with epilepsy.

On the development of a semi-nonparametric generalized multinomial logit model for travel-related choices.

A semi-nonparametric generalized multinomial logit model, formulated using orthonormal Legendre polynomials to extend the standard Gumbel distribution, is presented in this paper. The resulting semi-nonparametric function can represent a probability density function for a large family of multimodal distributions. The model has a closed-form log-likelihood function that facilitates model estimation. The proposed method is applied to model commute mode choice among four alternatives (auto, transit, bicycle and walk) using travel behavior data from Argau, Switzerland. Comparisons between the multinomial logit model and the proposed semi-nonparametric model show that violations of the standard Gumbel distribution assumption lead to considerable inconsistency in parameter estimates and model inferences.

The Price of Crossing the Border for Medications.

Conservation of reef manta rays (Manta alfredi) in a UNESCO World Heritage Site: Large-scale island development or sustainable tourism?

A large reef manta ray (Manta alfredi) aggregation has been observed off the north Sudanese Red Sea coast since the 1950s. Sightings have been predominantly within the boundaries of a marine protected area (MPA), which was designated a UNESCO World Heritage Site in July 2016. Contrasting economic development trajectories have been proposed for the area (small-scale ecotourism and large-scale island development). To examine space-use, Wildlife Computers® SPOT 5 tags were secured to three manta rays. A two-state switching Bayesian state space model (BSSM), that allowed movement parameters to switch between resident and travelling, was fit to the recorded locations, and 50% and 95% kernel utilization distributions (KUD) home ranges calculated. A total of 682 BSSM locations were recorded between 30 October 2012 and 6 November 2013. Of these, 98.5% fell within the MPA boundaries; 99.5% for manta 1, 91.5% for manta 2, and 100% for manta 3. The BSSM identified that all three mantas were resident during 99% of transmissions, with 50% and 95% KUD home ranges falling mainly within the MPA boundaries. For all three mantas combined (88.4%), and all individuals (manta 1-92.4%, manta 2-64.9%, manta 3-91.9%), the majority of locations occurred within 15 km of the proposed large-scale island development. Results indicated that the MPA boundaries are spatially appropriate for manta rays in the region, however, a close association to the proposed large-scale development highlights the potential threat of disruption. Conversely, the focused nature of spatial use highlights the potential for reliable ecotourism opportunities.

You Traveled the World and All You Got Was Ascariasis.

Upfront charging of overseas visitors using the NHS.

A shift from motorised travel to active transport: What are the potential health gains for an Australian city?

An alarmingly high proportion of the Australian adult population does not meet national physical activity guidelines (57%). This is concerning because physical inactivity is a risk factor for several chronic diseases. In recent years, an increasing emphasis has been placed on the potential for transport and urban planning to contribute to increased physical activity via greater uptake of active transport (walking, cycling and public transport). In this study, we aimed to estimate the potential health gains and savings in health care costs of an Australian city achieving its stated travel targets for the use of active transport.

Dr. Bob. Going Viral: Getting the Bugs Out of Your Travel Plans.

Case Report: Severe Imported Influenza Infections Developed during Travel in Reunion Island.

We report two cases of severe influenza infection imported by tourist patients from their country of origin and developed during travel. While studies have reported cases of influenza infections acquired during travel, here we examine two cases of severe influenza infection contracted in the country of origin that led to diagnosis and therapeutic problems in the destination country. No international recommendation exists concerning influenza vaccination before travel, and few countries recommend it for all travelers. Our study suggests that travel should be canceled when infectious signs are observed before departure. Influenza is a very common infection that is often benign, but sometimes very severe. The most severe cases include shock, acute respiratory distress syndrome (ARDS), myocarditis, rhabdomyolysis, and multiple organ failure. Management can require exceptional therapies, such as extracorporeal membrane oxygenation. A number of studies have focused on influenza infection in travelers. Cases of influenza acquired during travel have been reported in this literature, but no study has examined cases of influenza imported from the country of origin and developed while abroad. The latter situation may lead to 1) diagnostic problems during the nonepidemic season or in places where diagnostic techniques are lacking and 2) therapeutic difficulties resulting from the unavailability of techniques for the management of severe influenza infection in tourist areas. Here, we report two cases of extremely severe influenza infection imported by tourists from their country of origin and developed during travel.

Undiagnosed Active Pulmonary Tuberculosis among Pilgrims during the 2015 Hajj Mass Gathering: A Prospective Cross-sectional Study.

Mass gatherings pose a risk for tuberculosis (TB) transmission and reactivation of latent TB infection. The annual Hajj pilgrimage attracts 2 million pilgrims many from high TB-endemic countries. We evaluated the burden of undiagnosed active pulmonary TB in pilgrims attending the 2015 Hajj mass gathering. We conducted a prospective cross-sectional study in Mecca, Kingdom of Saudi Arabia, for nonhospitalized adult pilgrims from five high TB-endemic countries. Enrollment criteria were the presence of a cough and the ability to produce a sputum sample. Sputum samples were processed using the Xpert MTB-RIF assay. Data were analyzed for drug-resistant TB, risk factors, and comorbidities by the country of origin. Of 1,164 consenting pilgrims enrolled from five countries: Afghanistan (316), Bangladesh (222), Nigeria (176), Pakistan (302), and South Africa (148), laboratory results were available for 1,063 (91.3%). The mean age of pilgrims was 54.5 (range = 18-94 years) with a male to female ratio of 2.6:1; 27.7% had an underlying comorbidity, with hypertension and diabetes being the most common, 20% were smokers, and 2.8% gave a history of previous TB treatment. Fifteen pilgrims (1.4%) had active previously undiagnosed drug-sensitive pulmonary TB (Afghanistan [12; 80%], Pakistan [2; 13.3%], and Nigeria [1; 6.7%]). No multidrug-resistant TB cases were detected. Pilgrims from high TB-endemic Asian and African countries with undiagnosed active pulmonary TB pose a risk to other pilgrims from over 180 countries. Further studies are required to define the scale of the TB problem during the Hajj mass gathering and the development of proactive screening, treatment and prevention guidelines.

Strategies to Improve Management of Acute Watery Diarrhea during a Military Deployment: A Cost Effectiveness Analysis.

To inform policy and decision makers, a cost-effectiveness model was developed to predict the cost-effectiveness of implementing two hypothetical management strategies separately and concurrently on the mitigation of deployment-associated travelers' diarrhea (TD) burden. The first management strategy aimed to increase the likelihood that a deployed service member with TD will seek medical care earlier in the disease course compared with current patterns; the second strategy aimed to optimize provider treatment practices through the implementation of a Department of Defense Clinical Practice Guideline. Outcome measures selected to compare management strategies were duty days lost averted (DDL-averted) and a cost effectiveness ratio (CER) of cost per DDL-averted (USD/DDL-averted). Increasing health care and by seeking it more often and earlier in the disease course as a stand-alone management strategy produced more DDL (worse) than the base case (up to 8,898 DDL-gained per year) at an increased cost to the Department of Defense (CER $193). Increasing provider use of an optimal evidence-based treatment algorithm through Clinical Practice Guidelines prevented 5,299 DDL per year with overall cost savings (CER -$74). A combination of both strategies produced the greatest gain in DDL-averted (6,887) with a modest cost increase (CER $118). The application of this model demonstrates that changes in TD management during deployment can be implemented to reduce DDL with likely favorable impacts on mission capability and individual health readiness. The hypothetical combination strategy evaluated prevents the most DDL compared with current practice and is associated with a modest cost increase.

Optimizing a desirable fare structure for a bus-subway corridor.

This paper aims to optimize a desirable fare structure for the public transit service along a bus-subway corridor with the consideration of those factors related to equity in trip, including travel distance and comfort level. The travel distance factor is represented by the distance-based fare strategy, which is an existing differential strategy. The comfort level one is considered in the area-based fare strategy which is a new differential strategy defined in this paper. Both factors are referred to by the combined fare strategy which is composed of distance-based and area-based fare strategies. The flat fare strategy is applied to determine a reference level of social welfare and obtain the general passenger flow along transit lines, which is used to divide areas or zones along the corridor. This problem is formulated as a bi-level program, of which the upper level maximizes the social welfare and the lower level capturing traveler choice behavior is a variable-demand stochastic user equilibrium assignment model. A genetic algorithm is applied to solve the bi-level program while the method of successive averages is adopted to solve the lower-level model. A series of numerical experiments are carried out to illustrate the performance of the models and solution methods. Numerical results indicate that all three differential fare strategies play a better role in enhancing the social welfare than the flat fare strategy and that the fare structure under the combined fare strategy generates the highest social welfare and the largest resulting passenger demand, which implies that the more equity factors a differential fare strategy involves the more desirable fare structure the strategy has.

How the latest US travel ban could affect science.

Hospital Quality Factors Influencing the Mobility of Patients for Radical Prostate Cancer Radiation Therapy: A National Population-Based Study.

To investigate whether patients requiring radiation treatment are prepared to travel to alternative more distant centers in response to hospital choice policies, and the factors that influence this mobility.

The importance of vegetation density for tourists' wildlife viewing experience and satisfaction in African savannah ecosystems.

Southern African protected areas (PAs) harbour a great diversity of animals, which represent a large potential for wildlife tourism. In this region, global change is expected to result in vegetation changes, such as bush encroachment and increases in vegetation density. However, little is known on the influence of vegetation structure on wildlife tourists' wildlife viewing experience and satisfaction. In this study, we collected data on vegetation structure and perceived mammal densities along 196 road transects (each 5 km long) and conducted a social survey with 651 questionnaires across four PAs in three Southern African countries. Our objectives were 1) to assess visitors' attitude towards vegetation, 2) to test the influence of perceived mammal density and vegetation structure on the easiness to spot animals, and 3) on visitors' satisfaction during their visit to PAs. Using a Boosted Regression Tree procedure, we found mostly negative non-linear relationships between vegetation density and wildlife tourists' experience, and positive relationships between perceived mammal densities and wildlife tourists' experience. In particular, wildlife tourists disliked road transects with high estimates of vegetation density. Similarly, the easiness to spot animals dropped at thresholds of high vegetation density and at perceived mammal densities lower than 46 individuals per road transect. Finally, tourists' satisfaction declined linearly with vegetation density and dropped at mammal densities smaller than 26 individuals per transect. Our results suggest that vegetation density has important impacts on tourists' wildlife viewing experience and satisfaction. Hence, the management of PAs in savannah landscapes should consider how tourists perceive these landscapes and their mammal diversity in order to maintain and develop a sustainable wildlife tourism.

Acute malaria infection after atovaquone-proguanil prophylaxis.

Notes from the Field: Travel-Associated Melioidosis and Resulting Laboratory Exposures - United States, 2016.

In mid-July 2016, a Pennsylvania resident aged 15 years who had recently returned from Thailand was treated by a pediatrician for sore throat, fever, and bilateral thigh abscesses at the sites of mosquito bites (Figure). She had traveled to northeast Thailand with nine other teens as part of an 18-day service-oriented trip run by an Ohio-based youth tour company that arranges travel to Thailand for approximately 500 persons annually. This trip included construction and agricultural activities and recreational mud exposures. The patient subsequently developed right inguinal lymphadenopathy and worsening abscesses, which prompted specimen collection for culture on August 25. This specimen was sent to a commercial laboratory in New Jersey, which identified Burkholderia pseudomallei, the causative organism of melioidosis, on August 30. The patient did not experience pneumonia or bacteremia, and recovered fully after 2 weeks of intensive therapy with parenteral ceftazidime and a 6-month outpatient course of eradication therapy with doxycycline.

The incidence of breast cancer among female flight attendants: an updated meta-analysis.

Comment on 'Guidelines for the prevention of and treatment of travelers' diarrhea: a graded expert panel report by Riddle et al.'

Alien species pathways to the Galapagos Islands, Ecuador.

Alien species, one of the biggest threats to natural ecosystems worldwide, are of particular concern for oceanic archipelagos such as Galápagos. To enable more effective management of alien species, we reviewed, collated and analysed all available records of alien species for Galápagos. We also assembled a comprehensive dataset on pathways to and among the Galápagos Islands, including tourist and resident numbers, tourist vessels, their itineraries and visitation sites, aircraft capacity and occupancy, air and sea cargo and biosecurity interceptions. So far, 1,579 alien terrestrial and marine species have been introduced to Galápagos by humans. Of these, 1,476 have become established. Almost half of these were intentional introductions, mostly of plants. Most unintentional introductions arrived on plants and plant associated material, followed by transport vehicles, and commodities (in particular fruit and vegetables). The number, frequency and geographic origin of pathways for the arrival and dispersal of alien species to and within Galápagos have increased over time, tracking closely the increase in human population (residents and tourists) on the islands. Intentional introductions of alien species should decline as biosecurity is strengthened but there is a danger that unintentional introductions will increase further as tourism on Galápagos expands. This unique world heritage site will only retain its biodiversity values if the pathways for invasion are managed effectively.

Acute Diarrheal Infections in Adults.

Eyelid inflammation: An uncommon cause in occidental countries.

Myiasis designates the infestation of live human and vertebrate animals with dipterous (two-winged) larvae (maggots) and is the fourth most common travel-associated skin disease. Furuncle is the most common aspect of cutaneous myiasis.

Assessing hypoxia risk during air travel after a severe asthma exacerbation in children.

Individualizing immunization for international travelers.

Take into account routine childhood vaccinations, those that are mandatory for specific destinations, and these highly recommended immunizations.

Evaluation of average travel delay caused by moving bottlenecks on highways.

This paper presents a modelling framework to evaluate travel delay of all vehicles influenced by moving bottlenecks on highways. During the derivation of analytical formulas, the arrival of slow vehicles was approximated by a Poisson process based on the assumption that they occupied a constant low proportion of the traffic stream. The mathematical analysis process was developed from moving bottlenecks with the same velocity to those with multiple different velocities, and the closed-form expression of expected average travel delay was obtained by utilizing kinematic-wave moving bottleneck theory, gap acceptance theory, probability theory and renewal theory. Model validation and parameters sensitive analysis were conducted by simulation relying on the open source database of US highway 10. The maximum passing rate and the macroscopic parameters of initial traffic state with maximum delay could be found by means of approximate formulas. The proposed modeling framework can be applied for evaluating impacts of slow vehicles on highway operation quantifiably, based on which traffic managements like truck prohibited period decision and speed or lane restriction could be made more scientifically.

Atmospheric Cosmic-Ray Variation and Ambient Dose Equivalent Assessments Considering Ground Level Enhancement Thanks to Coupled Anisotropic Solar Cosmic Ray and Extensive Air Shower Modeling.

This work investigates the impact of Forbush decrease (FD) and ground-level enhancement (GLE) in the atmosphere, based on solar and galactic cosmic-ray models and the extensive air shower simulations. This approach gives the possibility to investigate both the dynamic behavior of neutron monitors (NM) (using response function) and the flight dose. The ambient dose equivalent during quiet solar activity and solar events (i.e., FDs and GLEs) were investigated for realistic flight plans issued from the Eurocontrol Demand Data Repository. The calculated ambient dose equivalents were compared with flight measurements in quiet solar conditions; comparisons are relevant and demonstrate the ability to estimate the dose level. The GLE model was validated for the GLEs 5 and 69 using the cosmic-ray variation recorded by NMs. The GLE model was applied to flight dose calculations. All of these results show that dose values vary drastically with the route path (latitude, longitude and altitude) and with the delay between the flight departure and the solar event occurrence. Doses induced by extreme GLE events were investigated specifically for London to New York flights, and resulting additional doses are a few hundred or 1,000 μSv, impacting significantly the annual effective dose. This highlights the importance of monitoring extreme solar events and using realistic semi-empirical and particle transport methods for reliable calculation of dose levels.

Increasing airline travel may facilitate co-circulation of multiple dengue virus serotypes in Asia.

The incidence of dengue has grown dramatically in recent decades worldwide, especially in Southeast Asia and the Americas with substantial transmission in 2014-2015. Yet the mechanisms underlying the spatio-temporal circulation of dengue virus (DENV) serotypes at large geographical scales remain elusive. Here we investigate the co-circulation in Asia of DENV serotypes 1-3 from 1956 to 2015, using a statistical framework that jointly estimates migration history and quantifies potential predictors of viral spatial diffusion, including socio-economic, air transportation and maritime mobility data. We find that the spread of DENV-1, -2 and -3 lineages in Asia is significantly associated with air traffic. Our analyses suggest the network centrality of air traffic hubs such as Thailand and India contribute to seeding dengue epidemics, whilst China, Cambodia, Indonesia, and Singapore may establish viral diffusion links with multiple countries in Asia. Phylogeographic reconstructions help to explain how growing air transportation networks could influence the dynamics of DENV circulation.