When an increased number of acute gastroenteritis (AG) cases is detected among tourists staying at the same accommodation, outbreak management plans must be activated in a timely manner to prevent large outbreaks. Syndromic surveillance data collected between 1 January 2010 and 31 December 2013 by five seagoing cruise ships were analysed to identify attack rate thresholds for early outbreak detection. The overall incidence rate of AG was 2.81 cases per 10,000 traveller-days (95% confidence interval (CI): 0.00–17.60), while the attack rate was 19.37 cases per 10,000 travellers (95% CI: 0.00–127.69). The probability of an outbreak occurring was 11% if 4 per 1,000 passengers reported symptoms within the first 2 days of the voyage, and this increased to 23 % if 5 per 1,000 passengers reported such within the first 3 days. The risk ratio (RR) for outbreak occurrence was 2.35, 5.66 and 8.63 for 1, 2 and 3 days’ delay of symptoms reporting respectively, suggesting a dose–response relationship. Shipping companies’ policies and health authorities’ efforts may consider these thresholds for initiating outbreak response measures based on the number of cases according to day of cruise. Efforts should focus on ensuring travellers report symptoms immediately and comply with isolation measures.
The following represents the efforts, among other things, to introduce some considerations for decision-makers of state administration institutions which are empowered to increase efficiency of financial resources usage in order to contribute to optimization of citizens relation, leading to significant increase of relation with the citizens targeting improvement of individual and collective comfort, as well as increase of their relation with common area, including communication between local administration for the benefit of citizens and community. The study was realized by means of EU smart cities project and concept research in order to understand the way the mechanisms works versus EU objectives. It is a conventional approach, based on observation, strongly focused on theoretical research. Best practice examples may be identified through research and they may validate recommendations for future interventions, which may influence the evolution of smart cities, as well as their enrollment to European strategy objectives, emphasizing the population needs in great urban areas. Each city was examined using online information sources (local administration websites, such as a smart city website) mentioned in relevant literature.Throughout this process, concerns for smart city implementation were evaluated. The analysis itself is based on alignment of project portfolio objectives and characteristics for each city, as well as alignment of European strategy relevant objectives, while research is focused on innovative strategy series that can be practically developed in a performant smart city, identifying transversal themes and smart city solutions which may potentially be copied in different cities in Romania based on other European cities experience.
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