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Studies of airplane transmission are commonly biased by contacts sharing exposure risks before boarding the aircraft. Here, Schwartz et al argue that transmission may have been mitigated by mild symptoms and masking during the flight. However, the lack of secondary cases after prolonged air travel exposure supports droplet transmission, not airborne, as the likely route of spread of the COVID-19.

In this article the authors use regression analysis to estimate the proportion of “marginal” criminal defendants pleading guilty in the federal courts who would not have been convicted had they contested their cases. They find that almost all of them (93.9%) are in that category. They also find that, under one calculation, an average of about 10 percent of all guilty pleas are from “marginal” defendants to which this finding applies. The study uses recent aggregate government data from the Administrative Office of the U.S. courts and includes a mathematical appendix addressing the assumptions of the regression model. The study is an update of a 1975 study that was published in the Harvard Law Review; the present study uses essentially the same regression method applied to recent data. The authors conclude that, in light of their findings, pressure on defendants to plead guilty cannot be justified by assuming that all those pleading guilty would in any event be convicted and that prosecutors’ practices to induce pleas deserve more detailed scrutiny than the courts have given them.

Background Although many studies have demonstrated the benefits of reminder/recall (RR) measures to address patient under-immunization and improve immunization coverage, they are not widely implemented by healthcare providers. We identified providers’ perceived barriers to their use from existing literature. Methods We conducted a systematic review of relevant articles published in English between January 1990 and July 2011 that examined the perceptions of healthcare providers regarding barriers to tracking patient immunization history and implementing RR interventions. We searched MEDLINE, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, and PsychINFO. Additional strategies included hand-searching the references of pertinent articles and related reviews, and searching keywords in Google Scholar and Google. Results Ten articles were included; all described populations in the United States, and examined perceptions of family physicians, pediatricians, and other immunization staff. All articles were of moderate-high methodological quality; the majority (n=7) employed survey methodology. The most frequently described barriers involved the perceived human and financial resources associated with implementing an RR intervention, as well as low confidence in the accuracy of patient immunization records, given the lack of data sharing between multiple immunization providers. Changes to staff workflow, lack of appropriate electronic patient-tracking functionalities, and uncertainty regarding the success of RR interventions were also viewed as barriers to their adoption. Conclusions Although transitioning to electronic immunization records and registries should facilitate the implementation of RR interventions, numerous perceived barriers must still be overcome before the full benefits of these methods can be realized.

Individual-level immunization data captured electronically can facilitate evidence-based decision-making and planning. Populating individual-level records through manual data entry is time-consuming. An alternative is to use scannable forms, completed at the point of vaccination and subsequently scanned and exported to a database or registry. To explore the suitability of this approach for collecting immunization data, we conducted a feasibility study in two settings in Ontario, Canada. Prior to the 2011-2012 influenza vaccination campaign, we developed a scannable form template and a corresponding database that captured required demographic and clinical data elements. We examined efficiency, data quality, and usability through time observations, record audits, staff interviews, and client surveys. The mean time required to scan and verify forms (62.3 s) was significantly shorter than manual data entry (69.5 s) in one organization, whereas there was no difference (36.6 s vs. 35.4 s) in a second organization. Record audits revealed no differences in data quality between records populated by scanning versus manual data entry. Data processing personnel and immunized clients found the processes involved to be straightforward, while nurses and managers had mixed perceptions regarding the ease and merit of using scannable forms. Printing quality and other factors rendered some forms unscannable, necessitating manual entry. Scannable forms can facilitate efficient data entry, but certain features of the forms, as well as the workflow and infrastructure into which they are incorporated, should be evaluated and adapted if scannable forms are to be a meaningful alternative to manual data entry.

Uptake of influenza vaccination in Canada remains suboptimal despite widespread public funding. To increase access, several provinces have implemented policies permitting pharmacists to administer influenza vaccines in community pharmacies. We examined the impact of such policies on the uptake of seasonal influenza vaccination in Canada. We pooled data from the 2007–2014 cycles of the Canadian Community Health Survey (n = 481 526). To determine the impact of influenza vaccine administration by pharmacists, we estimated the prevalence ratio for the association between the presence of a pharmacist policy and individual-level vaccine uptake using a modified Poisson regression model (dependent variable: vaccine uptake) with normalized weights while controlling for numerous health and sociodemographic factors. Across all survey cycles combined, 28.8% of respondents reported receiving a seasonal influenza vaccine during the 12 months before survey participation. Introduction of a policy for pharmacist administration of influenza vaccine was associated with a modest increase in coverage (2.2%) and an individual’s likelihood of uptake (adjusted prevalence ratio 1.05, 95% confidence interval 1.02–1.08). Uptake of influenza immunization was modestly increased in Canadian jurisdictions that allowed pharmacists to administer influenza vaccines.

Combining the results of multiple small trials to increase accuracy and statistical power, a technique called meta-analysis has become well established and increasingly important in medical studies, particularly in connection with new drugs. When the data are sparse, as they are in many such cases, certain accepted practices, applied reflexively by researchers, may be misleading because they are biased and for other reasons. We illustrate some of the problems by examining a meta-analysis of the connection between the diabetes drug Avandia (rosiglitazone) and myocardial infarction that was strongly criticized as misleading, but led to thousands of lawsuits being filed against the manufacturer and the FDA acting to restrict access to the drug. Our scrutiny of the Avandia meta-analysis is particularly appropriate because it plays an important role in ongoing litigation, has been sharply criticized, and has been subject to a more searching review in court than meta-analyses of other drugs.

Objective Group A Streptococcus (GAS) is a frequent cause of outbreaks in healthcare institutions, yet outbreak reports in the literature from homeless shelters are less common, despite an increased risk of severe GAS infection in homeless populations. In 2016, we conducted a case-control study to identify significant risk factors associated with GAS acquisition in a protracted, 19-month outbreak of GAS in a large, urban men’s homeless shelter in Ontario, Canada. Methods Cases (individuals with either clinical GAS emm 74 infection or asymptomatic carriers of GAS emm 74) and controls were identified from shelter residents from February to September 2016. Information on demographics, clinical presentation, pre-existing health conditions, and risk factors for GAS transmission were collected for all study participants from a variety of sources, including the public health notifiable disease information system, electronic health records, the shelter electronic information system, and interviews with client services workers. Results From the multivariable logistic regression model, younger individuals (OR 9.1; 95% CI 1.57–52.9), those with previous skin conditions (OR 56.2; 95% CI 2.73–1160), and those with recent wounds (with wound care: OR 51.5, 95% CI 8.86–299, and without wound care: OR 77.4, 95% CI 7.38–812) were found to be at increased risk of acquiring GAS in this outbreak. Conclusion The outbreak investigation clearly demonstrated the need for improved wound care and infection prevention and control practices, for early screening and detection of skin and soft tissue infections, and for a comprehensive, integrated electronic information system in homeless shelters.

Background Immunization information systems (IISs) are electronic registries used to monitor individual vaccination status and assess vaccine coverage. IISs are currently not widely used across Canada, where health jurisdictions employ a range of approaches to capture influenza immunization information. Conducted in advance of the 2009 H1N1 vaccination campaign, the objectives of this study were to understand the perceived value of individual-level data and IISs for influenza control, identify ideal system functions, and explore barriers to implementation. Methods In July and August 2009, semi-structured interviews were conducted with key informants engaged in vaccine delivery and/or pandemic planning at regional, provincial/territorial and federal levels across Canada. Key informants were recruited using a combination of convenience and snowball sampling methodologies. Qualitative analysis was used to extract themes from interview content. Results Patient management, assessment of vaccine coverage, and evaluation of safety and effectiveness were identified as public health priorities that would be achieved in a more timely manner, and with greater accuracy, through the use of an IIS. Features described as ideal included system flexibility, rapid data entry, and universality. Financial and human resource constraints as well as coordination between immunization providers were expressed as barriers to implementation. Conclusions IISs were perceived as valuable by key informants for strengthening management capacity and improving evaluation of both seasonal and pandemic influenza vaccination campaigns. However, certain implementation restrictions may need to be overcome for these benefits to be achieved.

Background The collection of individual-level pandemic (H1N1) 2009 influenza immunization data was considered important to facilitate optimal vaccine delivery and accurate assessment of vaccine coverage. These data are also critical for research aimed at evaluating the new vaccine's safety and effectiveness. Systems used to collect immunization data include manual approaches in which data are collected and retained on paper, electronic systems in which data are captured on computer at the point of vaccination and hybrid systems which are comprised of both computerized and manual data collection components. This study's objective was to compare the efficiencies and perceptions of data collection methods employed during Canada's pandemic (H1N1) 2009 influenza vaccination campaign. Methods/Design A pan-Canadian observational study was conducted in a convenience sample of public health clinics and healthcare institutions during the H1N1 vaccination campaign in the fall of 2009. The study design consisted of three stages: Stage 1 involved passive observation of the site's layout, processes and client flow; Stage 2 entailed timing site staff on 20 clients through five core immunization tasks: i) client registration, ii) medical history collection, iii) medical history review, iv) vaccine administration record keeping and v) preparation of proof of vaccine administration for the client; in Stage 3, site staff completed a questionnaire regarding perceived usability of the site's data collection approach. Before the national study began, a pilot study was conducted in three seasonal influenza vaccination sites in Ontario, to both test that the proposed methodology was logistically feasible and to determine inter-rater reliability in the measurements of the research staff. Comparative analyses will be conducted across the range of data collection methods with respect to time required to collect immunization data, number and type of individual-level data elements collected, and clinic staff perceptions of the usability of the method employed at their site, using analysis of variance (ANOVA). Discussion Various data collection methods were employed at immunization sites across Canada during the pandemic (H1N1) 2009 influenza vaccination campaign. Our comparison of methods can facilitate planning an efficient, coordinated approach for collecting immunization data in future influenza seasons.

Between Fall 2002 and Spring 2003, most of the national leadership of China's party, state, and military organs will be replaced by a new generation of officials. The accession to power of this \"Fourth Generation\" leadership, and the \"Fifth Generation\" officials who will rise to positions of influence on their coattails, will have profound implications for China, for nations in the region, and potentially for the national interests of the United States. This timely work introduces the new leaders of China and describes the political backdrop for their succession. A distinguished international group of scholars look at the process of leadership transition; the prospects and challenges facing the new leaders; questions of legitimacy and influence; flow of information on the transition within China; and security policies in the provinces and the Asia-Pacific region. They provide important insights on the leadership at \"the center,\" in the provinces, and in the military. I. Introduction 1. The Rise of the Fourth Generation: Overview and Implications, David M. Finkelstein and Maryanne Kivlehan II. China's New Leaders 2. Poised to Take the Helm: Rising Stars and the Transition to the Fourth Generation, Cheng Li 3. Hu Jintao's Succession: Prospects and Challenges, Murray Scott Tanner 4. The Provinces: Training Ground for National Leaders or a Power in Their Own Right? Zhiyue Bo III. Institutions in Transition 5. Leading Small Groups: Managing All Under Heaven, Taeho Kim 6. The Role of Mishus in the Chinese Political System: Change and Continuity, James C. Mulvenon and Michael S. Chase 7. Where Do Correct Ideas Come From? The Party School, Key Think Tanks, and the Intellectuals, Joseph Fewsmith IV. Challenges to Governance and Reform 8. From the July 1st Speech to the 16th Party Congress: Ideology, Party Construction, and Leadership Transition, Wu Guoguang 9. Economics as the Central Task: Do Entrepreneurs Matter? Bruce J. Dickson 10. Social Dynamics and New Generation Politics, Carol Lee Hamrin 11. The Absent-Minded Reform of China's Media, Anne Stevenson-Yang V. The Generation After Next and Future Prospects for the CCP 12. The Generation After Next in Chinese Politics, Willy Wo-Lap Lam 13. Remaining Relevant: The Challenges for the Party in Late-Leninist China, David Shambaugh