Incidence and viral aetiologies of acute respiratory illnesses (ARIs) in the United States: a population-based study.

We conducted prospective, community-wide surveillance for acute respiratory illnesses (ARIs) in Rochester, NY and Marshfield, WI during a 3-month period in winter 2011. We estimated the incidence of ARIs in each community, tested for viruses, and determined the proportion of ARIs associated with healthcare visits. We used a rolling cross-sectional design to sample participants, conducted telephone interviews to assess ARI symptoms (defined as a current illness with feverishness or cough within the past 7 days), collected nasal/throat swabs to identify viruses, and extracted healthcare utilization from outpatient/inpatient records. Of 6492 individuals, 321 reported an ARI within 7 days (4·9% total, 5·7% in Rochester, 4·4% in Marshfield); swabs were collected from 208 subjects. The cumulative ARI incidence for the entire 3-month period was 52% in Rochester [95% confidence interval (CI) 42-63] and 35% in Marshfield (95% CI 28-42). A specific virus was identified in 39% of specimens: human coronavirus (13% of samples), rhinovirus (12%), RSV (7%), influenza virus (4%), human metapneumovirus (4%), and adenovirus (1%). Only 39/200 (20%) had a healthcare visit (2/9 individuals with influenza). ARI incidence was ~5% per week during winter

EU Member State Enforcement of ‘Mixed’ Agreements and Access to Justice: Rethinking Direct Effect

Article 344 TFEU forbids Member States to pursue any other means of dispute settlement, when issues regarding the application and interpretation of the Treaties are concerned. The Court of Justice extended this principle to include disputes arising under international agreements, where the subject matter falls under European Union (EU) competence. At the same time, the number of international agreements to which direct effect is not granted is slowly rising. Consequently, the question arises whether Member States still have proper access to justice under these international regimes vis-à-vis other Member States or the EU, given that: first, they cannot pursue litigation under the agreements' dispute resolution system if the foreign body risks interpreting the agreement, which also forms part of EU law; second, they cannot rely on these agreements before the Court. This article argues that a rethinking of the direct effect doctrine of international agreements is necessary. Member States should not be equated with individuals, when invoking international agreements before the Court to challenge the validity of EU acts

Let us Not Forget about the Role of Domestic Courts in Settling Investor-State Disputes

This overview illustrates that there is a gap in our knowledge of how domestic courts handle investorstate disputes. As it turns out, some foreign investors use the domestic courts of the host State prior to initiating investment treaty arbitration. Subject matter-wise these cases are very diverse, and not all of them are initiated by investors against the host State. Moreover, in the four countries analysed, investors often appealed to the highest courts of the land, but they lost more cases than they won. These findings should help UNCITRAL Working Group III conceptualize the meaning of ‘investor-state dispute’ and the relationship between domestic and international methods of ISDS. It concludes by inviting further empirical research to understand how domestic courts handle investor-state disputes. This in turn can help us develop normative arguments as to why domestic courts should be included in the reform process

It Is not Just About Investor-State Arbitration: A Look at Case C-284/16, Achmea BV

In the much-awaited Achmea judgment (of 6 March 2018, case C-284/16 [GC]), the Court of Justice held that investor-state tribunals (ISTs), “such as” the one under the Netherlands-Slovakia intra-EU bilateral investment treaty (BIT) are incompatible with EU law. In this arguably short judgment, the Court of Justice consolidated its attitude towards the relationship between other international courts and the EU legal order; it set new limits to Art. 344 TFEU; and, it expanded its list of tribunals that do not qualify as Member State courts or tribunals under Art. 267 TFEU. Nonetheless, whilst the Commission can rejoice that it can now clearly oblige Member States to terminate their intra-EU BITs, Achmea sends some worrying signals. The future of ISTs under Member State BITs with third countries is uncertain; so is the viability of the Investment Court System under the agreements with Canada and Vietnam, the future of the Multilateral Investment Court, and the overall coherence of the EU’s international investment law and policy

Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children.

BackgroundStudies have noted variations in the cost-effectiveness of school-located influenza vaccination (SLIV), but little is known about how SLIV's cost-effectiveness may vary by targeted age group (e.g., elementary or secondary school students), or vaccine consent process (paper-based or web-based). Further, SLIV's cost-effectiveness may be impacted by its spillover effect on practice-based vaccination; prior studies have not addressed this issue.MethodsWe performed a cost-effectiveness analysis on two SLIV programs in upstate New York in 2015-2016: (a) elementary school SLIV using a stepped wedge design with schools as clusters (24 suburban and 18 urban schools) and (b) secondary school SLIV using a cluster randomized trial (16 suburban and 4 urban schools). The cost-per-additionally-vaccinated child (i.e., incremental cost-effectiveness ratio (ICER)) was estimated by dividing the incremental SLIV intervention cost by the incremental effectiveness (i.e., the additional number of vaccinated students in intervention schools compared to control schools). We performed deterministic analyses, one-way sensitivity analyses, and probabilistic analyses.ResultsThe overall effectiveness measure (proportion of children vaccinated) was 5.7 and 5.5 percentage points higher, respectively, in intervention elementary (52.8%) and secondary schools (48.2%) than grade-matched control schools. SLIV programs vaccinated a small proportion of children in intervention elementary (5.2%) and secondary schools (2.5%). In elementary and secondary schools, the ICER excluding vaccine purchase was $85.71 and$86.51 per-additionally-vaccinated-child, respectively. When additionally accounting for observed spillover impact on practice-based vaccination, the ICER decreased to $80.53 in elementary schools -- decreasing substantially in secondary schools. (to$53.40). These estimates were higher than the published practice-based vaccination cost (median = $25.50, mean =$45.48). Also, these estimates were higher than our 2009-2011 urban SLIV program mean costs ($65) due to additional costs for use of a new web-based consent system ($12.97 per-additionally-vaccinated-child) and higher project coordination costs in 2015-2016. One-way sensitivity analyses showed that ICER estimates were most sensitive to the SLIV effectiveness.ConclusionsSLIV raises vaccination rates and may increase practice-based vaccination in primary care practices. While these SLIV programs are effective, to be as cost-effective as practice-based vaccination our SLIV programs would need to vaccinate more students and/or lower the costs for consent systems and project coordination.Trial registrationClinicalTrials.gov NCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017)

Geometrical optics analysis of the short-time stability properties of the Einstein evolution equations

Many alternative formulations of Einstein's evolution have lately been examined, in an effort to discover one which yields slow growth of constraint-violating errors. In this paper, rather than directly search for well-behaved formulations, we instead develop analytic tools to discover which formulations are particularly ill-behaved. Specifically, we examine the growth of approximate (geometric-optics) solutions, studied only in the future domain of dependence of the initial data slice (e.g. we study transients). By evaluating the amplification of transients a given formulation will produce, we may therefore eliminate from consideration the most pathological formulations (e.g. those with numerically-unacceptable amplification). This technique has the potential to provide surprisingly tight constraints on the set of formulations one can safely apply. To illustrate the application of these techniques to practical examples, we apply our technique to the 2-parameter family of evolution equations proposed by Kidder, Scheel, and Teukolsky, focusing in particular on flat space (in Rindler coordinates) and Schwarzchild (in Painleve-Gullstrand coordinates).Comment: Submitted to Phys. Rev.

Canine Aortofemoral Bypass: a New Technique for the Evaluation of Prosthetic Implants

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67957/2/10.1177_000331977402500901.pd

Exploiting gauge and constraint freedom in hyperbolic formulations of Einstein's equations

We present new many-parameter families of strongly and symmetric hyperbolic formulations of Einstein's equations that include quite general algebraic and live gauge conditions for the lapse. The first system that we present has 30 variables and incorporates an algebraic relationship between the lapse and the determinant of the three metric that generalizes the densitized lapse prescription. The second system has 34 variables and uses a family of live gauges that generalizes the Bona-Masso slicing conditions. These systems have free parameters even after imposing hyperbolicity and are expected to be useful in 3D numerical evolutions. We discuss under what conditions there are no superluminal characteristic speeds

Towards sex-specific osteoarthritis risk models: evaluation of risk factors for knee osteoarthritis in males and females

Objectives The aim of this study was to identify sex-specific prevalence and strength of risk factors for the incidence of radiographic knee OA (incRKOA). Methods Our study population consisted of 10 958 Rotterdam Study participants free of knee OA in one or both knees at baseline. One thousand and sixty-four participants developed RKOA after a median follow-up time of 9.6 years. We estimated the association between each available risk factor and incRKOA using sex stratified multivariate regression models with generalized estimating equations. Subsequently, we statistically tested sex differences between risk estimates and calculated the population attributable fractions (PAFs) for modifiable risk factors. Results The prevalence of the investigated risk factors was, in general, higher in women compared with men, except that alcohol intake and smoking were higher in men and high BMI showed equal prevalence. We found significantly different risk estimates between men and women: high level of physical activity [relative risk (RR) 1.76 (95% CI: 1.29–2.40)] or a Kellgren and Lawrence score 1 at baseline [RR 5.48 (95% CI: 4.51–6.65)] was higher in men. Among borderline significantly different risk estimates was BMI ≥27, associated with higher risk for incRKOA in women [RR 2.00 (95% CI: 1.74–2.31)]. The PAF for higher BMI was 25.6% in women and 19.3% in men. Conclusion We found sex-specific differences in both presence and relative risk of several risk factors for incRKOA. Especially BMI, a modifiable risk factor, impacts women more strongly than men. These risk factors can be used in the development of personalized prevention strategies and in building sex-specific prediction tools to identify high risk profile patients