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Tourism consumption as a typical representative of service consumption, has strong comprehensiveness and driving force, continuously expanding new consumption upgrade space. In the context of the digital economy, the development of the mobile internet has opened up new opportunities for the tourism industry acting as an important factor influencing the consumer behaviour of the residents. Based on 9007 resident survey data from the China General Social Survey (CGSS) in 2017, this paper explores the relationship between Internet use, access to information and residents' travel consumption behavior by means of probit model and mediating effect model. First, according to the findings, Internet use has a positive impact on residents' travel consumption behavior, increasing residents' tourism expenditure. Second, the mechanism suggests that access to information plays a partially mediating role between Internet use and travel consumption behavior. Third, further analysis revealed that, for the retired population, the more frequently they use the Internet, the more likely they are to spend on travel. Compared to those with lower incomes, those with higher incomes will spend less on travel after retirement. With this in mind, in order to promote residents' tourism consumption, speed and fee reduction should be continuously promoted, urban and rural information infrastructure should be strengthened, and accessibility of tourism information for residents should be improved. At the same time, there is a need to innovate the way tourism products are promoted, improve the types of tourism products and launch diversified tourism products., Competing Interests: NO authors have competing interests Enter: The authors have declared that no competing interests exist., (Copyright: © 2024 Lei, Yang. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Car-sharing is a travel mode that can serve as an alternative to private cars, helping to reduce urban pollution. However, currently, there is a low willingness among travelers to use car-sharing, which is reflected in both low market penetration and user frequency. Therefore, it is essential for the government to encourage the use of car-sharing by providing subsidies. To better encourage the usage of car-sharing, this paper applies a two-fold evolutionary game model involving travelers and the government to explore the impact of subsidies on travelers' choices, and the factors that could affect the subsidies' efficiency. A simulation, using data from Beijing, was conducted to determine the implications of subsidy policies. The results show that a mileage-based subsidy and a fixed subsidy are applicable to travel of high and low mileages respectively, and under both subsidy modes, subsidies for trips with short duration or short pick-up and return time are more effective. Furthermore, we find that the efficiency of subsidies increases as the scale of car-sharing users, demand elasticity, or total number of travelers increases. Additionally, the subsidy levels should be lower than the environmental benefits of car-sharing but higher than the difference in travel costs between private cars and car-sharing. Future work will involve other game players such as car-sharing operators in order to draw deeper conclusions, and will involve the collection of data from more countries and cities to develop the robustness of the conclusions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To quantify differences in hospital-associated costs, and accompanying travel costs and productivity losses, before and after withdrawing TNF-α inhibitors (TNFi) in JIA patients., Methods: This was a retrospective analysis of prospectively collected data from electronic medical records of paediatric JIA patients treated with TNFi, which were immediately discontinued, spaced (increased treatment interval) or tapered (reduced subsequent doses). Costs of hospital-associated resource use (consultations, medication, radiology procedures, laboratory testing, procedures under general anaesthesia, hospitalization) and associated travel costs and productivity losses were quantified during clinically inactive disease until TNFi withdrawal (pre-withdrawal period) and compared with costs during the first and second year after withdrawal initiation (first and second year post-withdrawal)., Results: Fifty-six patients were included of whom 26 immediately discontinued TNFi, 30 spaced and zero tapered. Mean annual costs were €9165/patient on active treatment (pre-withdrawal) and decreased significantly to €5063/patient (-44.8%) and €6569/patient (-28.3%) in the first and second year post-withdrawal, respectively (P < 0.05). Of these total annual costs, travel costs plus productivity losses were €834/patient, €1180/patient, and €1320/patient in the three periods respectively. Medication comprised 80.7%, 61.5% and 72.4% of total annual costs in the pre-withdrawal, first and second year post-withdrawal period, respectively., Conclusion: In the first two years after initiating withdrawal, the total annual costs were decreased compared with the pre-withdrawal period. However, cost reductions were lower in the second year compared with the first year post-withdrawal, primarily due to restarting or intensifying biologics. To support biologic withdrawal decisions, future research should assess the full long-term societal cost impacts, and include all biologics., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Purpose: Patients who undergo growth-friendly (GF) treatment for early-onset scoliosis (EOS) undergo multiple clinical and surgical encounters. We sought to quantify the associated temporal and travel burden and estimate subsequent cost., Methods: Four centers in an international study group combined data on EOS patients who underwent surgical GF treatment from 2006 to 2021. Data collected included demographics, scoliosis etiology, GF implant, encounter type, and driving distance. We applied 2022 IRS and BLS data or $0.625/mile and $208.2/day off work to calculate a relative financial burden., Results: A total of 300 patients were analyzed (55% female). Etiologies were: congenital (33.3%), idiopathic (18.7%), neuromuscular (30.7%), and syndromic (17.3%). The average age at the index procedure was 5.5 years. For the 300 patients, 5899 encounters were recorded (average 18 encounters/patient). Aggregate encounter types were 2521 clinical office encounters (43%), 2045 surgical lengthening encounters (35%), 1157 magnetic lengthening encounters (20%), 149 spinal fusions (3%), and 27 spinal fusion revisions (0.5%). When comparing patients by scoliosis etiology or by GF implant type, no significant differences were noted in the total number of encounters or average travel distance. Patients traveled a median round trip distance of 158 miles/encounter between their homes and treating institutions (range 2.4-5654 miles), with a cumulative median distance of 2651 miles for the entirety of their treatment (range 29-90,552 miles), at an estimated median cost of $1656.63. The mean number of days off work was 18 (range 3-75), with an associated loss of $3643.50 in income., Conclusion: Patients with EOS averaged 18 encounters for GF surgical treatment. These patients and their families traveled a median distance of 158 miles/encounter, with an estimated combined mileage and loss of income of $5300., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)

Enhancing access to healthcare remains a formidable challenge in rural regions of low- and lower-middle-income countries. Amid evolving healthcare challenges, telerheumatology provides opportunities to bridge gaps and expand access to rheumatology care, particularly in remote areas. We describe a pilot telerheumatology program and its cost-, time-, and travel-saving potential in a remote rural setting in northern Pakistan. The telerheumatology program commenced at the Pakistan Institute of Medical Sciences Islamabad, providing services through video consultations to a basic health unit in the Gilgit-Baltistan region. Patients visiting from the Gilgit-Baltistan region willing to participate were recruited in the program. Demographics and logistical metrics were recorded in a dedicated registry. A total of 533 consultations were carried out from April 2022 to April 2023. The majority of the patients were female (318/533, 59.7%). The median age of patients was 50 ± 15.7 years. The average wait time for consultation was 20 ± 13 min. The average travel time to reach telecentre was 59 ± 53 min. The average travel cost to reach telecentre was 379 ± 780 PKR (1.85 ± 3.81 USD). The average duration of consultation was 15 ± 5 min. The most common diagnosis for consultation was knee osteoarthritis (237, 44.5%), chronic low back pain (118, 22.1%), and rheumatoid arthritis (42, 7.9%). On average, patients saved 787 ± 29 km of distance, 15 ± 1 h of traveling, and 6702 ± 535 PKR (33 ± 3 USD) that would have been required to travel to our tertiary care hospital. Telerheumatology substantially reduced travel time, distance, and cost for patients. It has the potential to deliver outpatient rheumatology consultation in an economically efficient manner, effectively breaking geographical barriers and expanding access to essential services for patients in remote areas., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

The study examined the determinants that affect tourism receipts in Thailand. To this end, quarterly data from eight main provinces of Thailand from the period 2015-2019 were used and constituted a repeated measures design. Accordingly, a generalized linear mixed model was applied for developing two different random intercept models by treating 1) province, and 2) a combination of province and calendar quarter as cluster-specific effects. It was found that determinants that increased tourism receipts were the number of visitors, the average cost per day, the length of stay of visitors, the presence of low-cost airlines, and a relatively low offence rate. Moreover, an increase in the number of visitors in the fourth quarter produced a higher amount of additional receipts as compared to a similar increase in the first quarter. Specifically, for Thailand attracting high-spending tourists and extending tourist visas for more than 30 days is recommended. Beyond Thailand, uncovering interaction effects as described above may help tourism agencies to focus their limited resources on the determinants that matter., Competing Interests: The authors declare that they have no conflict of interest., (Copyright: © 2024 Khemthong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

To stimulate the regional tourism economy, local governments often seek to increase the number of 5A-rated tourist attractions. However, there have been few analyses examining the economic benefits and influence mechanisms of 5A-rated attraction selection. Using the quality signaling theory and data from 282 prefecture-level cities spanning 2002 to 2019, this study examines the impact of 5A-rated attraction selection on the local tourism economy with the difference-in-differences method. This study's results demonstrate that the selection of 5A-rated attractions significantly contributes to the growth of the local tourism economy. The robustness test results confirm the validity of this conclusion. A mechanism analysis reveals that 5A-rated attractions positively impact the tourism economy via investments in infrastructure, popularization of informatization, and increased external openness. Furthermore, the study suggests that the effect of 5A-rated attractions is more pronounced in economically underdeveloped regions and low-level cities. The results of this study contribute to the sustainable development of China's tourism economy and may provide guidance for the establishment of tourism evaluation systems in other international locations in order to foster economic growth., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Xu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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., Competing Interests: The authors have declared that no competing interests exist.

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., Competing Interests: The authors have declared that no competing interests exist.

Exploring the spatial pattern of tourism resources and tourism economy is vital to improve the utilization efficiency of tourism resources and promote sustainable tourism development. This research investigated the quantity and types of tourism resources and analyzed the spatial patterns of tourism resources on Hainan Island from the perspectives of spatial variation and spatial association. The spatial and temporal pattern of the number of tourists and tourism revenue during 2010-2019 were further analyzed. The influencing factors of tourism development were explored based on the geographic detector. The results showed that 10425 tourism resources exist on Hainan Island, and the type of buildings and facilities had the largest number of tourism resources. The geological landscape, astronomical phenomena and meteorological landscapes, buildings and facilities, ruins and remains, tourism commodities, and human activities showed significant spatial agglomeration. Domestic tourism was far more developed than inbound tourism in terms of the number of tourists and tourism revenue. However, the spatial difference of tourism resources and tourism economy was apparent on Hainan Island. Factor analysis showed that the quantity of hotels, the proportion of tertiary industry in the GDP, and the regional population were the most influential factors for the distribution of tourism resources, while the density of the road network, the quantity of hotels, the per capita GDP, the proportion of tertiary industry in GDP, the regional population, and the quantity of tourism resources showed obvious influences on the tourism economy of Hainan Island. Interactions of the factors mainly fell into three types: synergistic increases, single factor weakening, and nonlinear weakening. It is suggested that the local government should fully exploit diversity types of tourism resources on Hainan Island to attract more tourists and improve the tourism revenue; improving the inbound tourism, and to strengthen the construction of road network on Hainan Island., Competing Interests: The authors have declared that no competing interests exist.