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To estimate population-based rates and to describe clinical characteristics of hospital-acquired (HA) influenza.
US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2011–2012 through 2018–2019 seasons.
Patients were identified through provider-initiated or facility-based testing. HA influenza was defined as a positive influenza test date and respiratory symptom onset >3 days after admission. Patients with positive test date >3 days after admission but missing respiratory symptom onset date were classified as possible HA influenza.
Among 94,158 influenza-associated hospitalizations, 353 (0.4%) had HA influenza. The overall adjusted rate of HA influenza was 0.4 per 100,000 persons. Among HA influenza cases, 50.7% were 65 years of age or older, and 52.0% of children and 95.7% of adults had underlying conditions; 44.9% overall had received influenza vaccine prior to hospitalization. Overall, 34.5% of HA cases received ICU care during hospitalization, 19.8% required mechanical ventilation, and 6.7% died. After including possible HA cases, prevalence among all influenza-associated hospitalizations increased to 1.3% and the adjusted rate increased to 1.5 per 100,000 persons.
Over 8 seasons, rates of HA influenza were low but were likely underestimated because testing was not systematic. A high proportion of patients with HA influenza were unvaccinated and had severe outcomes. Annual influenza vaccination and implementation of robust hospital infection control measures may help to prevent HA influenza and its impacts on patient outcomes and the healthcare system.
The Romans did not explain contract formation by abstract principles. As has often been said, they had a law of particular contracts, not a general law of contract. The rules that governed when a contract was formed depended on the kind of contract the parties had made.
This collection of readings places side by side the principal doctrines of contracts, torts, unjust enrichment, and property in the cases of the United States, England, France, Germany and China. It presents code provisions, cases, and other legal materials that describe the law in force, and places each doctrine in its historical context to enable an understanding of the development of law as an ongoing process, in which the resolution of current issues depends upon how past issues were resolved. It both provides a road map of the private law of these jurisdictions, and illustrates how private law has been shaped by history, by the effort to solve common problems, and by differences in culture. This new edition reflects changes in the law, and includes the addition of Chinese Law as a comparative study.