Travel Subsidies Research Articles

Geographic Disparities in Access to Assisted Reproductive Technology Centers in China: Spatial-Statistical Study.

A study on infertility in China found that while 543 health care institutions are approved for assisted reproductive technology (ART), only 10.1% offer all ART services, with a significant skew toward the eastern regions, highlighting the accessibility challenges faced by rural and remote populations; this study recommends government measures including travel subsidies and education initiatives to improve ART access for economically disadvantaged individuals.

Impact of COVID-19 Travel Subsidies on Stock Market Returns: Evidence from Japanese Tourism Companies

This study examines stock market response (SMR) to the Japanese tourism industry (TI) after the government’s announcement of travel subsidies (TRSs) during the COVID-19 pandemic in 2020, using a sample comprising 80 listed Japanese firms in the TI and an event study method (ESM) to determine the impact of government policy responses (GPRs) to the pandemic. This study found that investors in the TI reacted positively to the announcement of subsidies; this positive effect persisted for 50 trading days after the announcement but was weaker for transportation firms. The results suggest that TRSs are important for the TI, with a stronger link to travel-related firms, such as airlines and travel agencies, hotels, and amusement services. However, investors in the TI reacted negatively to policies that directly addressed the pandemic, such as social distance policies (SDPs). These results are robustly confirmed when we measure abnormal returns by using a three-factor model. The results offer useful insights for policymakers and practitioners aiming to mitigate economic loss from disasters such as the COVID-19 pandemic.

Effect of Long-Distance Domestic Travel Ban Policies in Japan on COVID-19 Outbreak Dynamics During Dominance of the Ancestral Strain: Ex Post Facto Retrospective Observation Study

Background In Japan, long-distance domestic travel was banned while the ancestral SARS-CoV-2 strain was dominant under the first declared state of emergency from March 2020 until the end of May 2020. Subsequently, the “Go To Travel” campaign travel subsidy policy was activated, allowing long-distance domestic travel, until the second state of emergency as of January 7, 2021. The effects of this long-distance domestic travel ban on SARS-CoV-2 infectivity have not been adequately evaluated. Objective We evaluated the effects of the long-distance domestic travel ban in Japan on SARS-CoV-2 infectivity, considering climate conditions, mobility, and countermeasures such as the “Go To Travel” campaign and emergency status. Methods We calculated the effective reproduction number R(t), representing infectivity, using the epidemic curve in Kagoshima prefecture based on the empirical distribution of the incubation period and procedurally delayed reporting from an earlier study. Kagoshima prefecture, in southern Japan, has several resorts, with an airport commonly used for transportation to Tokyo or Osaka. We regressed R(t) on the number of long-distance domestic travelers (based on the number of airport limousine bus users provided by the operating company), temperature, humidity, mobility, and countermeasures such as state of emergency declarations and the “Go To Travel” campaign in Kagoshima. The study period was June 20, 2020, through February 2021, before variant strains became dominant. A second state of emergency was not declared in Kagoshima prefecture but was declared in major cities such as Tokyo and Osaka. Results Estimation results indicated a pattern of declining infectivity with reduced long-distance domestic travel volumes as measured by the number of airport limousine bus users. Moreover, infectivity was lower during the “Go To Travel” campaign and the second state of emergency. Regarding mobility, going to restaurants, shopping malls, and amusement venues was associated with increased infectivity. However, going to grocery stores and pharmacies was associated with decreased infectivity. Climate conditions showed no significant association with infectivity patterns. Conclusions The results of this retrospective analysis suggest that the volume of long-distance domestic travel might reduce SARS-CoV-2 infectivity. Infectivity was lower during the “Go To Travel” campaign period, during which long-distance domestic travel was promoted, compared to that outside this campaign period. These findings suggest that policies banning long-distance domestic travel had little legitimacy or rationale. Long-distance domestic travel with appropriate infection control measures might not increase SARS-CoV-2 infectivity in tourist areas. Even though this analysis was performed much later than the study period, if we had performed this study focusing on the period of April or May 2021, it would likely yield the same results. These findings might be helpful for government decision-making in considering restarting a “Go To Travel” campaign in light of evidence-based policy.

Did the Japanese government’s travel subsidy increase the number of hotel guests and infection during the COVID-19 pandemic?

In July 2020, the Japanese government launched the “Go To Travel” campaign, providing subsidies for domestic travel, during the coronavirus disease (COVID-19) pandemic. While the campaign aimed to revitalize the declining tourism industry, concerns were raised about its potential to spread infection. Although the literature indicates that the campaign increased hotel reservations, its causal effects on infection are not well-known. Using a difference-in-differences framework, this paper examines whether the campaign increased the number of domestic hotel guests and caused the virus to spread. The results show that the campaign increased the number of domestic hotel guests, as travel was not a Giffen good even at the risk of contracting COVID-19. However, the campaign did not increase infection spread in Japan, as it did not increase the transient population in the downtown areas. Moreover, this study provides a comprehensive cost–benefit analysis of the campaign.

“Starting off Well” — The quest of finding suitable accommodation in Wellington and the impacts on student wellbeing

PURPOSE This study investigated the barriers, and challenges faced by medical students at the University of Otago, Wellington in their search for suitable accommodation in Wellington (Pōneke). The research also aimed to identify solutions to these challenges and barriers. METHOD This is a qualitative study of ten semi-structured interviews with medical students over December 2021. Interviews were then transcribed and thematically analysed by the researchers. RESULTS The five key themes identified; the high cost of living and rent, difficulty finding accommodation, the overall financial burden of living in Wellington, poor quality of housing, and the students perceptions of differences across the three medical schools. CONCLUSION Students are struggling to find accommodation and to meet the cost of living in Wellington. They face the additional costs associated with placement across various clinical sites, and feel unsupported by the University of Otago. Students would like more support from the University, including financial assistance for the higher cost of living in Wellington, travel subsidies, having a designated staff member to assist with finding accommodation and the provision of University accommodation in Wellington.

Signal effect of a targeted travel subsidy on consumer behavior during the coronavirus disease 2019 pandemic.

The online version contains supplementary material available at 10.1007/s11002-022-09663-2.

Travel Equity between Relocatees and Non-Relocatees before and after a Shopping Plaza’s Opening in the Megacity-Peripheral Large-Scale-Residential Area: A Case in Shanghai, China

In Chinese megacity centers, substandard housing is being removed. The inhabitants are relocated to peripheral large-scale residential areas, and we call them “relocatees”. After the relocation, their housing quality is improved but travel quality may worsen. Little attention has been paid to the change in travel equity over time for shopping-related trips of relocatees and non-relocatees in these areas in rapidly developing countries, especially for the change before and after the major built environment development, such as a shopping plaza’s opening. To fill this research gap, we conducted two surveys before and after Wanda Shopping Plaza’s opening. We used statistical analysis, estimated discrete choice models focusing on mode choice, and calculated consumer surplus as a measurement of travel equity. Results show a relocatee has a lower travel quality for shopping-related trips. Travel equity between relocatees and non-relocatees for shopping-related trips becomes worse after Wanda’s opening. Differences in consumer surplus between relocatees and non-relocatees provide a reference for the travel subsidy policy.

The impact of travel subsidy on individual accommodations under COVID-19 pandemic

The impact of travel subsidy on individual accommodations under COVID-19 pandemic

The COVID-19 pandemic and domestic travel subsidies

The spread of the coronavirus disease 2019 (COVID-19) has significantly reduced tourism demands worldwide. Employing weekly data on tourist flows between Japanese prefectures, we examine the cost-effectiveness of domestic travel subsidies. Our results provide two implications for the literature. First, we identify the underlying mechanism of tourist flows during the pandemic. In contrast to infectious diseases that have only local effects, the COVID-19 pandemic has decreased tourism demand not only to, but also from, severely affected regions, deteriorating tourism businesses even in areas not severely affected by the disease. Second, we confirm the effectiveness of a price-discount strategy in mitigating economic damage to the accommodation sector caused by the pandemic.

A Phase 2, Open-Label, Ascending Dose Study of Ker-050 for the Treatment of Anemia in Patients with Very Low, Low, or Intermediate Risk Myelodysplastic Syndromes

A Phase 2, Open-Label, Ascending Dose Study of Ker-050 for the Treatment of Anemia in Patients with Very Low, Low, or Intermediate Risk Myelodysplastic Syndromes

Real-World Outcomes of Patients with Primary CNS Lymphoma (PCNSL): A Report from the Australasian Lymphoma Alliance (ALA)

Real-World Outcomes of Patients with Primary CNS Lymphoma (PCNSL): A Report from the Australasian Lymphoma Alliance (ALA)

A Window Study of Acalabrutinib Plus Rituximab Followed By R-Dhaox (rituximab, dexamethasone, cytarabine, oxaliplatin) and Autologous Stem Cell Transplant (ASCT) in Fit Mantle Cell Lymphoma (MCL): The Australasian Leukaemia & Lymphoma Group (ALLG) NHL33 Wamm Trial

A Window Study of Acalabrutinib Plus Rituximab Followed By R-Dhaox (rituximab, dexamethasone, cytarabine, oxaliplatin) and Autologous Stem Cell Transplant (ASCT) in Fit Mantle Cell Lymphoma (MCL): The Australasian Leukaemia & Lymphoma Group (ALLG) NHL33 Wamm Trial

Can We Return to Our Normal Life When the Pandemic Is under Control? A Preliminary Study on the Influence of COVID-19 on the Tourism Characteristics of Taiwan

The COVID-19 pandemic has brought unprecedented destructive impacts and challenges to global industry and has had a wide impact on people’s lives. The threat of the virus has also caused a change in tourist travel consumption behavior. This study preliminarily examines the impact of the COVID-19 pandemic on the tourism consumption characteristics of Taiwanese people. The consumption characteristic changes of 393 people regarding their plans for domestic and outbound tourism during the different stages of the COVID-19 pandemic as well as after the pandemic ends were surveyed and collected. This study also examined and attempted to understand the relationship between people’s satisfaction with the government’s revitalization plan, the pandemic prevention policy, and their domestic tourism frequency during the pandemic period, and the results showed that during the pandemic, people’s tourism characteristics have changed and tend to be conservative. Since the pandemic is over, while there were no significant differences between people’s planned travel expenditures in Taiwan and those before the outbreak, their intended travel time was shortened. Regarding the choice of travel equipment, people had reduced the use of public transportation. Regarding outbound tourism, after the pandemic, as people’s planned travel days will be reduced, it is expected that travel expenditures will be significantly higher than before the pandemic, which shows that the COVID-19 pandemic has an impact on people’s outbound tourism consumption characteristics. During the pandemic, compared with the subsidies for tourism, how to make people feel at ease in the process of tourism is of great importance. Therefore, it is suggested that in the short-term, border control and social pandemic prevention policies should be adopted to enhance people’s confidence in government pandemic prevention, and the general public should be supplemented with travel subsidies in order to promote people’s enthusiasm for tourism. The results of this study provide useful suggestions for government units, tour operators, and related research during the pandemic and offer preliminary insights for the recovery of the tourism industry after the pandemic.

Consumer attributes associated with using a domestic travel subsidy programme during the COVID-19 pandemic: the case of Japan

The Coronavirus (COVID-19) pandemic resulted in losses to the global tourism industry. Japan’s tourism industry began suffering losses in January 2020. The Japanese government launched a subsidy pr...

Where to Go: The Japanese Government's Travel Subsidy during COVID-19

Faced with the trade-off between prevention of the spread of the coronavirus disease 2019 (COVID-19) and recovery in economic activities, in July 2020, the Japanese government launched the "Go To Travel" campaign (a subsidy for domestic travel) to revitalize the moribund tourism industry. This study examines (1) whether the government subsidy drives individuals to travel, even at the risk of acquiring an infection, and (2) whether the government subsidy results in the spread of the infection. We utilize a difference-in-differences method by taking advantage of the fact that the government subsidy excludes travel to and from Tokyo in the period spanning July 2020 through September 2020. We provide empirical evidence in favor of the successful effects of the government subsidy, suggesting that the government subsidy increases the number of hotel guests without spreading the infection. More hotel guests travel to other prefectures for sightseeing and travel within their own prefectures for reasons other than sightseeing.

Immune Reconstitution after Allogeneic Hematopoietic Cell Transplantation: Comparing Post-Transplant Cyclophosphamide Versus Anti-T-Lymphocyte Globulin As Graft-Versus-Host Disease Prophylaxis in a Retrospective Cohort Study

Introduction: Both post-transplant cyclophosphamide (PT-Cy) and anti-T-lymphocyte globulin (ATLG) eliminate proliferating allo-reactive T cells after allogeneic hematopoietic cell transplantation (HCT) and therefore contribute to reduce the incidence of graft-versus-host disease (GVHD). Exposure to ATLG has been previously associated with delayed T cell reconstitution (Gooptu et al. BBMT 2018). Yet, no study has compared PT-Cy to ATLG for its effect on cellular immune reconstitution and only one small study compared it to anti-thymocyte globulin (Retiere et al. Oncotarget 2018). Hence, we analyzed the dynamics of immune reconstitution after HCT in patients that received either PT-Cy or ATLG as additional GVHD prophylaxis. Methods: We retrospectively analyzed 247 patients (138 male, 109 female) from a single-center, who received HCT from HLA-identical siblings (n=29), haploidentical family donors (n=21), or matched unrelated donors (n=197) between January 2017 and December 2018. All patients were transplanted for hematologic malignancies (49% acute myeloid leukemia). Median age was 56 (range, 18-76) years. Myeloablative conditioning regimen was performed in 119 patients and reduced intensity conditioning in 128 patients. PT-Cy (n=59) was dosed 50 mg/kg/day intravenously (i.v.) on days HCT +3 and +4, followed by tacrolimus in combination with mycophenolate mofetil from day +5. In 188 patients, ATLG was administered at 10 mg/kg bodyweight i.v. on days -3, -2 and -1 in combination with cyclosporine 3 mg/kg i.v. from day -1 and methotrexate (15 mg/m2 on day +1 and 10mg/m2 on days +3, +6, and +11 i.v.). All patients received HCT using peripheral blood stem cells with amedian dose of 6.3x106CD34+ cells/kg (range, 1.3 to 25). Blood samples were collected on days +30, +90, +180, +270 and +365 and analyzed by multiparametric flow cytometry for the following cell subsets: T lymphocytes (CD3+), T helper cells (CD3+/CD4+); cytotoxic T cells (CD3+/CD8+), regulatory T cells (CD3+/CD4+/CD25+/CD127+), T cell receptor αβ(CD3+/TCRαβ), T cell receptor γδ(CD3+/TCRγδ), NK T-cells (CD3+/CD16+/CD56+), NK-cells (CD3-/CD16+/CD56+), naïve helper T cell (CD4+/CD45RA), memory helper T cells (CD4+/CD45RO) and B cells (CD19+). Results: Immune cell reconstitution differed significantly between the PT-Cy and the ATLG cohorts. The use of PT-Cy associated with significantly higher median counts of helper T cells during the first 6 months after HCT (p<0.0001, Fig. 1A). In particular, naïve helper T cells (Fig. 1B; median absolute (abs.) cell counts of PT-Cy versus (vs) ATLG cohort: month 1, 15 cells/µL vs 12 cells/µL , p<0.0001; month 3, 13 vs 3 cells/µL, p<0.0001; month 6, 25 vs 4 cells/µL, p<0.0001) and memory helper T cells (median abs. counts month 1, 94 vs 3 cells/µL, p<0.0001; month 3, 116 vs 64 cells/µL, p<0.0001; month 6, 189 vs 89 cells/µL, p =0.004) were significantly higher in the PT-Cy cohort. Cytotoxic T cells (Fig. 1C) and NK cells did not differ between PT-Cy and ATLG cohorts. Interestingly, γδ T cells were significantly higher in the ATLG cohort (Fig. 1D; median abs. counts month 1, 14 cells/µL vs 3 cells/µL; p =0.019). For B cells or NKT cells the use of PT-Cy associated with earlier immune reconstitution with significant differences only at month 1 after HCT (median abs. cell counts 10 cells/µL vs 1 cell/µL, p=0.007 and 11 vs 2 cells/µL, p=0.03, respectively), regulatory T cells differed significantly in months 3 and 6 (median abs. count 9 vs 2 cells/µL, p<0.0001; 10 vs 4 cells/µL, p<0.0001). The incidence of grade II to IV acute GVHD was significantly lower in the PT-Cy cohort as compared to the ATLG cohort (Hazard ratio 0.48, 95% Confidence interval, 0.30-0.78, p=0.003). Within a median follow up of 11 months, no significant differences in overall survival, relapse incidence and non-relapse mortality were observed between the PT-Cy and ATLG cohorts. Conclusions: Our data suggest that the choice of the additional T cell depleting regimen using either ATLG or PT-Cy significantly affects immune reconstitution after HCT. Knowledge of the distinct immune reconstitution profiles should assist clinical decision-making and help optimizing GVHD prophylaxis. Disclosures Bogdanov: Jazz Pharmaceuticals, MSD.: Other: Travel subsidies. Beelen:Medac GmbH Wedel Germany: Consultancy, Honoraria. Turki:Jazz Pharmaceuticals, CSL Behring, MSD.: Consultancy; Neovii Biotech, all outside the submitted work: Other: Travel subsidies.

High Pre-Transplant Free Interleukin-18 Is Associated with Poor Hematopoietic Recovery after Allogeneic Stem Cell Transplantation

Background: Interleukin-18 (IL-18) is an immune regulatory cytokine that induces interferon-gamma (IFNg) and IL-17A production. The serum activity of IL18 is controlled by an IFNg-inducible inhibitor (IL-18 binding protein, IL18BPa). IL-18 promotes hematopoietic stem cell (HSC) hibernation and aggravates symptoms of sepsis. Here, we investigated whether free IL-18 serum levels measured before and on day 0 of allogeneic stem cell transplantation (alloSCT) inhibit hematologic recovery. Patients and methods: Serum levels of pre-transplant IL-18 and IL18BPa, together with the IFNg-response marker CXCL9, were analyzed in patients from two independent institutions (cohort I n=617 and cohort II n= 605), and in 43 normal subjects. Further, IL-18 and IL18BPa levels were measured also on day 0-3 of alloSCT in 309 patients. Free IL-18 was calculated according to the law of masses. Routine lab parameters were recorded pre-transplant and on days 0, 28 and 100 after alloSCT. These were compared to cytokine serum levels and outcome. Results: Pre-conditioning serum levels of total IL-18 were significantly (approximately threefold) higher in both patient cohorts (cohort I: 629 pg/ml, cohort II: 693 pg/ml) compared to healthy controls (median: 147 pg/ml). Cytokine serum levels further increased by approx. 25% until day 0-3. Pre-transplant IL-18 and free IL-18, but not IL18BPa or CXCL9 were inversely correlated with platelet counts before and on days 28 and 100 after alloSCT in both independent cohorts. This inhibitory effect on platelet recovery was similar for free IL-18 levels measured at the day of transplantation (Figure 1). High free IL18 on day 0-3 and low platelet counts on days 28 and 100 predicted 1-year non-relapse mortality in separate multivariable Cox regression analyses (confounders: age, disease stage, HLA-mismatch, donor and recipient sex, disease, ATG and conditioning strength). Conclusion: Serum levels of free IL-18 were closely associated with platelet recovery after alloSCT. This effect did not depend on the IFNg response markers IL18BPa and CXCL9, suggesting a direct inhibitory effect of IL18 on thrombopoiesis. Strategies reducing IL18 activity should be explored to potentially improve hematopoietic recovery and outcome after alloSCT. Figure 1: ROC curves showing influence of free IL-18 serum levels measured before alloSCT and on day 0-3 on endpoint platelets<50/nl on day+28 Figure 1 Disclosures Bogdanov: Jazz Pharmaceuticals, MSD.: Other: Travel subsidies. Beelen:Medac GmbH Wedel Germany: Consultancy, Honoraria. Dreger:AbbVie, AstraZeneca, Gilead, Janssen, Novartis, Riemser, Roche: Consultancy; AbbVie, Gilead, Novartis, Riemser, Roche: Speakers Bureau; Neovii, Riemser: Research Funding; MSD: Membership on an entity's Board of Directors or advisory committees, Other: Sponsoring of Symposia. Luft:Neovii: Research Funding; JAZZ: Research Funding.

Clinical Relevance of Somatic Mutations in Chronic Myelomonocytic Leukemia Undergoing Allogeneic Stem Cell Transplantation

Clinical Relevance of Somatic Mutations in Chronic Myelomonocytic Leukemia Undergoing Allogeneic Stem Cell Transplantation

Relative Contribution of Naïve and Memory T Cells to Alloreactivity in Hematopoietic Cell Transplantation

Introduction: Graft-versus-host disease (GvHD) is a major impediment to the cure of blood disorders by hematopoietic cell transplantation (HCT). GvHD is mediated by alloreactive T cells recognizing histocompatibility antigen (HAg) mismatches between patient and donor. Naïve T cells are thought to be the main mediators of alloreactive responses since, theoretically, memory T cells would have never been exposed to and selected by alloantigens, except in multiparous women or transfused individuals. Accordingly, clinical trials using naïve T cell-depleted allografts are being conducted with the aim to reduce GvHD after human leukocyte antigen (HLA)-matched HCT. However, several groups have shown that memory T cells can also mediate alloreactive responses, in particular against mismatched HLA. We hypothesized that the relative importance of naïve vs. memory T cell alloreactivity depends on the matching status of the patient-donor pair. Specifically, we reasoned that naïve-depletion strategies will be most efficient in HLA-identical sibling HCT, where minor (m)HAg presented by self-HLA are the only targets of T cell alloreactivity, but less so in HLA-matched unrelated HCT, where HLA-DPB1 mismatches (mmDPB1) are frequent and potentially recognized through molecular mimicry by both naïve and memory T cells. Methods: In order to model T cell alloreactivity to mHAg and to major HLA mismatches post HCT, we used a quantitative in vitro assay based on co-culture of responder and stimulating cells. Naïve (CD45RA+CD45RO-) and memory (CD45RA-CD45RO+) CD4+ T cells were enriched from peripheral blood mononuclear cells from healthy individuals using microbead technology to >95% purity and used as responders. Irradiated transduced HeLa cells engineered to express single HLA-DP antigens and the necessary machinery for HLA class II antigen presentation were used to stimulate CD4+ T cells. HeLa transductants expressing the autologous (i.e. DP-matched, response restricted to mHAg) or an allogeneic (mmDPB1) DP antigen were used to challenge naïve and memory CD4+ cells from each responder. After 14 days of culture, T cells were restimulated overnight and the levels of T cell response were quantified by cell surface expression of the activation marker CD137. Results: In 36 independent T cell cultures from 8 different individuals, the overall levels of alloreactivity against mHAg were significantly lower than those against mmDPB1 (mean 50.3% vs 20.7%, p<0.0001) (Figure 1A). Consistent with current concepts, alloreactivity to mHAg was significantly higher in the naïve than in the memory subset (mean 27.7% vs 10.5%, p=0.015) (Figure 1B). This was most evident in 5/8 responders (mean 38.4% vs 13.3%, p=0.016), in particular in females under 40 years of age. In 3 of the 8 responders, mHAg alloreactivity was generally low and not significantly different between the naïve and the memory subsets (mean 10.3% vs 12.9%, p=0.73). In contrast, alloreactivity against mmDPB1 was evenly distributed between the naïve and the memory subset (mean 52.1% vs 48.5%, p=0.62) in all responders, independent of age, sex or cytomegalovirus serostatus of the responder (Figure 1C). Interestingly, naïve DPB1*04:01-restricted mHAg alloreactive CD4+ T cells were able to cross-recognize the structurally similar (i.e. permissive) DPB1*04:02 (mean 43.3%) but not the dissimilar (i.e. non-permissive) DPB1*09:01 (mean 14.1%) (Figure 1D). Moreover, when purified CD4+ cells from self-DPB1*04:01 homozygous donors were challenged with DPB1*04:02 or DPB1*09:01, naïve CD4+ T cells were the main source of alloreactive responses against the permissive mmDPB1 (mean 25.0% vs 7.4% for naïve and memory cells, respectively), while both memory (mean 50.0%) and naïve (mean 46.0%) CD4+ cells elicited strong alloresponses against the non-permissive mmDPB1. Conclusion: Our data provide the first direct experimental evidence that alloreactivity against mmDPB1 is stronger than against mHAg, and importantly that it is mediated equally by naïve and memory CD4+ T cells while the mHAg response is mediated mainly by the naïve subset. However, our data also suggests that some mmDPB1 involving structurally (and hence functionally) similar alleles (in general permissive) might behave similarly to DPB1 matches. These observations should be taken into account in clinical trials aimed at improving the outcome of unrelated HCT by selective depletion of naïve T cells. Disclosures Turki: Jazz Pharmaceuticals, CSL Behring, MSD.: Consultancy; Neovii Biotech, all outside the submitted work: Other: Travel subsidies. Beelen:Medac GmbH Wedel Germany: Consultancy, Honoraria.

'We have to drive everywhere': rural nurses and their precepted students.

Travel safety culture is a vital aspect of nursing in rural western Canada, where long distances and severe weather are commonplace. However, this culture is poorly understood owing to the absence of official policy, and the tendency of rural nurses to take travel risks and burdens in stride, rather than advocating for change. Travel risks and burdens include extreme weather events such as tornadoes and blizzards; unmarked routes and hazards; distance, time and expense; and driver fatigue. In such rural settings, the safety and health of visitors, novices and students are of particular concern. The researchers sought to elicit the tacit knowledge of rural registered nurses, and their students undertaking rural nursing preceptorships, pertaining to rural travel issues and best practices for safety and wellbeing. Through purposive and snowball sampling, the researchers recruited seven senior nursing students and five nurse preceptors. Seven rural acute and community care sites, between 42 km and 416 km distant from the students' primary place of study, were covered by the study. Photovoice, a participant action modality, was employed to collect photographic and qualitative interview data from participants over 10 weeks, between February and April 2016. The data were analyzed thematically, in collaboration with participants, who in turn validated the results. A digital storytelling initiative was attempted, to further involve participants in dissemination of findings, but only one participant took part in this phase of the project. The central finding of the study was that nursing students learn to accept and manage limitations - and to recognize and capitalize on opportunities - when undertaking rural preceptorships. With regard to road safety, the students were found to be particularly vulnerable to long distances, hazardous conditions, fuel and cellular data expenses, and fatigue. These issues were compounded by the students' reluctance to speak up, or to miss shifts, when they felt unsafe or unwell. Their preceptors role modeled autonomy and community ethos as the foundations of a frontline, extemporaneous road safety culture. This entailed personal safety measures borne from rural experience and background, familiarity with the countryside, and community connectedness with other healthcare sites in place of any official public alert system. The preceptors furthermore benefited from strong union protection for occupational health and safety concerns, but students being taught in rural settings had no such advantage. Nursing students should have the same occupational health and safety protections as their rural preceptors, especially the right to refuse travel, without penalty, in unsafe circumstances. Better travel subsidies and road safety measures during rural preceptorship may help increase the likelihood of students considering a rural career path. Furthermore, the frontline, community-based road safety experience of rural nurses is an untapped source of information for educators and policymakers. Such information will become more and more vital as a diminishing number of rural nurses are called upon to care for an aging client base.