"If you have the flu symptoms, your asymptomatic spouse may better answer the willingness-to-pay question". Evidence from a double-bounded dichotomous choice model with heterogeneous anchoring.

The small sample size of contingent valuation (CV) surveys conducted in patients may have limited the use of the single-bounded (SB) dichotomous choice format which is recommended in environmental economics. In this paper, we explore two ways to increase the statistical efficiency of the SB format: (1) by the inclusion of proxies in addition to patients; (2) by the addition of a follow-up dichotomous question, i.e. the double-bounded (DB) dichotomous choice format. We found that patients (n=223) and spouses (n=64) answering on behalf of the patient had on average a similar willingness-to-pay for earlier alleviation of flu symptoms. However, a patient was significantly more likely to anchor his/her answer on the first bid as compared to a spouse. Finally, our original DB model with shift effect and heterogeneous anchoring reconciled the discrepancies found in willingness-to-pay statistics between SB and DB models in keeping with increased statistical efficiency.Contingent valuation; double-bounded dichotomous choice; Patient; proxy; anchoring; structural shift; influenza

Comparative age distribution of influenza morbidity and mortality during seasonal influenza epidemics and the 2009 H1N1 pandemic

<p>Abstract</p> <p>Background</p> <p>Several studies have shown a relatively high mortality rate among young people infected by the 2009 pandemic influenza A (H1N1) virus. Here we compared the age distributions of morbidity and mortality during two seasonal influenza epidemics (H1N1 and H3N2) in France and the United States with those of the 2009 H1N1 pandemic waves in the same countries.</p> <p>Methods</p> <p>Age-standardized ratios were used to compare the age distribution of morbidity and mortality due to influenza between the two countries and across the different years. Non parametric analysis of variance was used to compare these ratios between epidemic and pandemic influenza.</p> <p>Results</p> <p>Age distribution of morbidity was similar between the 2009 pandemic and seasonal epidemics due to H1N1 (p = 0.72) and H3N2 viruses (p = 0.68). In contrast, the proportion of under-60s among influenza deaths was markedly higher during the 2009 pandemic (peak <20 years) than during the seasonal epidemics (respectively p = 0.007 and p = 0.0008).</p> <p>Conclusions</p> <p>Young age was a principal mortality risk factor due to the 2009 H1N1 pandemic.</p

Pandemic Influenza, Reopening Schools, and Returning to Work

Pandemic Influenza, Reopening Schools, and Returning to Wor

Impact of translation on biomedical information extraction from real-life clinical notes

The objective of our study is to determine whether using English tools to extract and normalize French medical concepts on translations provides comparable performance to French models trained on a set of annotated French clinical notes. We compare two methods: a method involving French language models and a method involving English language models. For the native French method, the Named Entity Recognition (NER) and normalization steps are performed separately. For the translated English method, after the first translation step, we compare a two-step method and a terminology-oriented method that performs extraction and normalization at the same time. We used French, English and bilingual annotated datasets to evaluate all steps (NER, normalization and translation) of our algorithms. Concerning the results, the native French method performs better than the translated English one with a global f1 score of 0.51 [0.47;0.55] against 0.39 [0.34;0.44] and 0.38 [0.36;0.40] for the two English methods tested. In conclusion, despite the recent improvement of the translation models, there is a significant performance difference between the two approaches in favor of the native French method which is more efficient on French medical texts, even with few annotated documents.Comment: 26 pages, 2 figures, 5 table

PHASE DEPENDENCE IN ABOVE THRESHOLD IONIZATION IN THE PRESENCE OF A MICROWAVE FIELD

begin{wrapfigure}{l}{0pt} includegraphics[scale=0.38]{Energy_exchange.eps} caption{Electrons gaining or losing energy during the first microwave cycle depending of the initial launching direction. Here the phase of the microwave field is adjusted to provide a maximum energy transfer. The oscillations in energy are synchronized with the 14GHz microwave field.} end{wrapfigure} Exciting an atom with high-frequency radiation in the presence of a low frequency field can result in energy transfer between the photoelectron and the low frequency field, depending on the phase of the low frequency field when the excitation occurs. We excite Li atoms with IR lasers in the presence of a microwave field. In a previous experiment, detection of highly excited states with excitation by a ps laser tuned above the limit clearly showed a phase dependence. The variation of the signal due to a phase change reach 0.1% of the total excitation in that case. We are using a new excitation scheme with a CW amplitude modulated laser, the modulation being phase locked to the microwaves. We now observe a signal variation of 10% of the total excitation. The ps pulses spreads the population over a broad energy spectrum while the modulated excitation keeps it in narrow bands. The modulated laser frequency can be tuned to couple one band to the highly excited states, enhancing the collection efficiency, additionally it is closer to the limit. Furthermore, the modulated laser allows the observation of phase dependent transfer to both higher and lower energies. The observations can be described with relatively simple models

Surgical Mask to Prevent Influenza Transmission in Households: A Cluster Randomized Trial

Facemasks and respirators have been stockpiled during pandemic preparedness. However, data on their effectiveness for limiting transmission are scarce. We evaluated the effectiveness of facemask use by index cases for limiting influenza transmission by large droplets produced during coughing in households.A cluster randomized intervention trial was conducted in France during the 2008-2009 influenza season. Households were recruited during a medical visit of a household member with a positive rapid influenza A test and symptoms lasting less than 48 hours. Households were randomized either to the mask or control group for 7 days. In the intervention arm, the index case had to wear a surgical mask from the medical visit and for a period of 5 days. The trial was initially intended to include 372 households but was prematurely interrupted after the inclusion of 105 households (306 contacts) following the advice of an independent steering committee. We used generalized estimating equations to test the association between the intervention and the proportion of household contacts who developed an influenza-like illness during the 7 days following the inclusion. Influenza-like illness was reported in 24/148 (16.2%) of the contacts in the intervention arm and in 25/158 (15.8%) of the contacts in the control arm and the difference between arms was 0.40% (95%CI: -10% to 11%, P = 1.00). We observed a good adherence to the intervention. In various sensitivity analyses, we did not identify any trend in the results suggesting effectiveness of facemasks.This study should be interpreted with caution since the lack of statistical power prevents us to draw formal conclusion regarding effectiveness of facemasks in the context of a seasonal epidemic.clinicaltrials.gov NCT00774774

Correction dynamique d'un SLM pour une holographie de haute fidélité. Réalisation d'un MOT-2D pour l'application de modes de Laguerre-Gauss

Cette thèse concerne la production et le contrôle d'hologrammes de haute qualité par un modulateur de phase à cristaux liquides (SLM) et l'utilisation de ces hologrammes pour la manipulation d'atomes froids. Ces hologrammes utilisés pour mettre en forme des faisceaux lasers et créer des potentiels dipolaires doivent être de bonne qualité. Or le SLM a des défauts qui peuvent les dégrader. Pour mesurer ces défauts nous avons développé une méthode reposant sur la mesure par polarimétrie de la biréfringence du SLM. La cartographie de biréfringence permet de mesurer l'hologramme en temps réel sans perturber l'expérience en cours. C'est donc une mesure in-situ. Une fois mesurés les défauts sont corrigés par une rétroaction sur la consigne donnée au SLM. Pour le démontrer nous avons créé un défaut artificiel avec un pointeur laser et nous l'avons réduit à /7 soit une amélioration de 42 %. Ensuite avec l'objectif d'appliquer des potentiels produit par un SLM aux atomes froids, j'ai dessiné, conçu puis réalisé en partie une expérience basée sur un jet d'atomes froids de rubidium issu d'un MOT-2D. Dans le chapitre correspondant je présente une étude de la faisabilité d'une expérience de guidage du jet d'atomes froids par un mode de Laguerre Gauss désaccordé vers le bleu de la transition. Nous avons montré que dans un tel guide le chauffage par émission spontanée est plus faible que dans un guide gaussien usuel désaccordé vers le rouge de la transition. De plus en réduisant la divergence naturelle du jet issu du MOT-2D nous devrions augmenter le flux d'atomes et améliorer l'efficacité de chargement d'un MOT-3D par un MOT-2D.This thesis reports on the production and monitoring of high quality holograms generated by a liquid crystal spatial light modulator (SLM), and the application of these holograms to cold atoms manipulation. In order to produce accurate optical potentials by shaping a laser beam we need high quality holograms. Nevertheless SLMs suffer from defects which limit the quality. To measure defects we have developed a method based on polarimetry to get the birefringence map of the SLM. Birefringence mapping is suitable to monitor the hologram without disturbing the on-going experiment. It's an in-situ measurement. After the measurement, defects are corrected by a feedback on the input hologram. As a proof we created an artificial defect with a laser pointer and reduced it to /7 which corresponds to a 42% improvement. Our second goal is to apply SLM-shaped potentials to cold atoms, so I designed and did part of an experiment based on a cold atom beam provided by a rubidium 2D-MOT. In the corresponding chapter I've studied the feasibility of guiding the cold atom beam with a blue-detuned Laguerre-Gaussian beam. We showed that in such a guide the spontaneous emission is lower than in the usual red detuned gaussian guide case. Furthermore by reducing the cold atom beam divergence we expect to enhance the atomic flux and improve the loading efficiency of a 3D-MOT from a 2D-MOT.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Cost Effectiveness of Fibrosis Assessment Prior to Treatment for Chronic Hepatitis C Patients

Chronic hepatitis C (HCV) is a liver disease affecting over 3 million Americans. Liver biopsy is the gold standard for assessing liver fibrosis and is used as a benchmark for initiating treatment, though it is expensive and carries risks of complications. FibroTest is a non-invasive biomarker assay for fibrosis, proposed as a screening alternative to biopsy.We assessed the cost-effectiveness of FibroTest and liver biopsy used alone or sequentially for six strategies followed by treatment of eligible U.S. patients: FibroTest only; FibroTest with liver biopsy for ambiguous results; FibroTest followed by biopsy to rule in; or to rule out significant fibrosis; biopsy only (recommended practice); and treatment without screening. We developed a Markov model of chronic HCV that tracks fibrosis progression. Outcomes were expressed as expected lifetime costs (2009 USD), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER).Treatment of chronic HCV without fibrosis screening is preferred for both men and women. For genotype 1 patients treated with pegylated interferon and ribavirin, the ICERs are $5,400/QALY (men) and$6,300/QALY (women) compared to FibroTest only; the ICERs increase to $27,200/QALY (men) and$30,000/QALY (women) with the addition of telaprevir. For genotypes 2 and 3, treatment is more effective and less costly than all alternatives. In clinical settings where testing is required prior to treatment, FibroTest only is more effective and less costly than liver biopsy. These results are robust to multi-way and probabilistic sensitivity analyses.Early treatment of chronic HCV is superior to the other fibrosis screening strategies. In clinical settings where testing is required, FibroTest screening is a cost-effective alternative to liver biopsy

Explaining rapid reinfections in multiple-wave influenza outbreaks: Tristan da Cunha 1971 epidemic as a case study.

Influenza usually spreads through the human population in multiple-wave outbreaks. Successive reinfection of individuals over a short time interval has been explicitly reported during past pandemics. However, the causes of rapid reinfection and the role of reinfection in driving multiple-wave outbreaks remain poorly understood. To investigate these issues, we focus on a two-wave influenza A/H3N2 epidemic that occurred on the remote island of Tristan da Cunha in 1971. Over 59 days, 273 (96%) of 284 islanders experienced at least one attack and 92 (32%) experienced two attacks. We formulate six mathematical models invoking a variety of antigenic and immunological reinfection mechanisms. Using a maximum-likelihood analysis to confront model predictions with the reported incidence time series, we demonstrate that only two mechanisms can be retained: some hosts with either a delayed or deficient humoral immune response to the primary influenza infection were reinfected by the same strain, thus initiating the second epidemic wave. Both mechanisms are supported by previous empirical studies and may arise from a combination of genetic and ecological causes. We advocate that a better understanding and account of heterogeneity in the human immune response are essential to analysis of multiple-wave influenza outbreaks and pandemic planning.Published versio