The benefit of primary and booster vaccination in people who experienced a prior Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remains unclear. The objective of this study ...was to estimate the effectiveness of primary (two-dose series) and booster (third dose) mRNA vaccination against Omicron (lineage BA.1) infection among people with a prior documented infection.
We conducted a test-negative case-control study of reverse transcription PCRs (RT-PCRs) analyzed with the TaqPath (Thermo Fisher Scientific) assay and recorded in the Yale New Haven Health system from November 1, 2021, to April 30, 2022. Overall, 11,307 cases (positive TaqPath analyzed RT-PCRs with S-gene target failure SGTF) and 130,041 controls (negative TaqPath analyzed RT-PCRs) were included (median age: cases: 35 years, controls: 39 years). Among cases and controls, 5.9% and 8.1% had a documented prior infection (positive SARS-CoV-2 test record ≥90 days prior to the included test), respectively. We estimated the effectiveness of primary and booster vaccination relative to SGTF-defined Omicron (lineage BA.1) variant infection using a logistic regression adjusted for date of test, age, sex, race/ethnicity, insurance, comorbidities, social venerability index, municipality, and healthcare utilization. The effectiveness of primary vaccination 14 to 149 days after the second dose was 41.0% (95% confidence interval (CI): 14.1% to 59.4%, p 0.006) and 27.1% (95% CI: 18.7% to 34.6%, p < 0.001) for people with and without a documented prior infection, respectively. The effectiveness of booster vaccination (≥14 days after booster dose) was 47.1% (95% CI: 22.4% to 63.9%, p 0.001) and 54.1% (95% CI: 49.2% to 58.4%, p < 0.001) in people with and without a documented prior infection, respectively. To test whether booster vaccination reduced the risk of infection beyond that of the primary series, we compared the odds of infection among boosted (≥14 days after booster dose) and booster-eligible people (≥150 days after second dose). The odds ratio (OR) comparing boosted and booster-eligible people with a documented prior infection was 0.79 (95% CI: 0.54 to 1.16, p 0.222), whereas the OR comparing boosted and booster-eligible people without a documented prior infection was 0.54 (95% CI: 0.49 to 0.59, p < 0.001). This study's limitations include the risk of residual confounding, the use of data from a single system, and the reliance on TaqPath analyzed RT-PCR results.
In this study, we observed that primary vaccination provided significant but limited protection against Omicron (lineage BA.1) infection among people with and without a documented prior infection. While booster vaccination was associated with additional protection against Omicron BA.1 infection in people without a documented prior infection, it was not found to be associated with additional protection among people with a documented prior infection. These findings support primary vaccination in people regardless of documented prior infection status but suggest that infection history may impact the relative benefit of booster doses.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The CRESST cryogenic direct dark matter search at Gran Sasso, searching for WIMPs via nuclear recoil, has been upgraded to CRESST-II by several changes and improvements. The upgrade includes a new ...detector support structure capable of accommodating 33 modules, the associated multichannel readout with 66 SQUID channels, a neutron shield, a calibration source lift, and the installation of a muon veto. We present the results of a commissioning run carried out in 2007.
The basic element of CRESST-II is a detector module consisting of a large
(
∼
300
g
)
CaWO
4
crystal and a very sensitive smaller
(
∼
2
g
)
light detector to detect the scintillation light from the
CaWO
4
. The large crystal gives an accurate total energy measurement. The light detector permits a determination of the light yield for an event, allowing an effective separation of nuclear recoils from electron–photon backgrounds. Furthermore, information from light-quenching factor studies allows the definition of a region of the energy-light yield plane which corresponds to tungsten recoils. A neutron test is reported which supports the principle of using the light yield to identify the recoiling nucleus.
Data obtained with two detector modules for a total exposure of 48
kg-days are presented. Judging by the rate of events in the “all nuclear recoils” acceptance region the apparatus shows a factor ∼10 improvement with respect to previous results, which we attribute principally to the presence of the neutron shield. In the “tungsten recoils” acceptance region three events are found, corresponding to a rate of 0.063
per kg-day. Standard assumptions on the dark matter flux, coherent or spin independent interactions, then yield a limit for WIMP-nucleon scattering of
4.8
×
10
-
7
pb
, at
M
WIMP
∼
50
GeV
.
Background
SPRINT (Systolic Blood Pressure Intervention Trial) and the ACCORD (Action to Control Cardiovascular Risk in Diabetes) blood pressure trial used similar interventions but produced ...discordant results. We investigated whether differences in systolic blood pressure (SBP) response contributed to the discordant trial results.
Methods and Results
We evaluated the distributions of SBP response during the first year for the intensive and standard treatment groups of SPRINT and ACCORD using growth mixture models. We assessed whether significant differences existed between trials in the distributions of SBP achieved at 1 year and the treatment‐independent relationships of achieved SBP with risks of primary outcomes defined in each trial, heart failure, stroke, and all‐cause death. We examined whether visit‐to‐visit variability was associated with heterogeneous treatment effects. Among the included 9027 SPRINT and 4575 ACCORD participants, the difference in mean SBP achieved between treatment groups was 15.7 mm Hg in SPRINT and 14.2 mm Hg in ACCORD, but SPRINT had significantly less between‐group overlap in the achieved SBP (standard deviations of intensive and standard groups, respectively: 6.7 and 5.9 mm Hg in SPRINT versus 8.8 and 8.2 mm Hg in ACCORD; P<0.001). The relationship between achieved SBP and outcomes was consistent across trials except for stroke and all‐cause death. Higher visit‐to‐visit variability was more common in SPRINT but without treatment‐effect heterogeneity.
Conclusions
SPRINT and ACCORD had different degrees of separation in achieved SBP between treatment groups, even as they had similar mean differences. The greater between‐group overlap of achieved SBP may have contributed to the discordant trial results.
Randomized trials of hypertension have seldom examined heterogeneity in response to treatments over time and the implications for cardiovascular outcomes. Understanding this heterogeneity, however, ...is a necessary step toward personalizing antihypertensive therapy. We applied trajectory-based modeling to data on 39 763 study participants of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to identify distinct patterns of systolic blood pressure (SBP) response to randomized medications during the first 6 months of the trial. Two trajectory patterns were identifiedimmediate responders (85.5%), on average, had a decreasing SBP, whereas nonimmediate responders (14.5%), on average, had an initially increasing SBP followed by a decrease. Compared with those randomized to chlorthalidone, participants randomized to amlodipine (odds ratio, 1.20; 95% confidence interval CI, 1.10–1.31), lisinopril (odds ratio, 1.88; 95% CI, 1.73–2.03), and doxazosin (odds ratio, 1.65; 95% CI, 1.52–1.78) had higher adjusted odds ratios associated with being a nonimmediate responder (versus immediate responder). After multivariable adjustment, nonimmediate responders had a higher hazard ratio of stroke (hazard ratio, 1.49; 95% CI, 1.21–1.84), combined cardiovascular disease (hazard ratio, 1.21; 95% CI, 1.11–1.31), and heart failure (hazard ratio, 1.48; 95% CI, 1.24–1.78) during follow-up between 6 months and 2 years. The SBP response trajectories provided superior discrimination for predicting downstream adverse cardiovascular events than classification based on difference in SBP between the first 2 measurements, SBP at 6 months, and average SBP during the first 6 months. Our findings demonstrate heterogeneity in response to antihypertensive therapies and show that chlorthalidone is associated with more favorable initial response than the other medications.
The alpha decay of
210Po is a dangerous background to rare event searches. Here, we describe observations related to this alpha decay in the Cryogenic Rare Event Search with Superconducting ...Thermometers (CRESST). We find that lead nuclei show a scintillation light yield in our
CaWO
4
crystals of
0.0142
±
0.0013
relative to electrons of the same energy. We describe a way to discriminate this source of nuclear recoil background by means of a scintillating foil, and demonstrate its effectiveness. This leads to an observable difference in the pulse shape of the light detector, which can be used to tag these events. Differences in pulse shape of the phonon detector between lead and electron recoils are also extracted, opening the window to future additional background suppression techniques based on pulse shape discrimination in such experiments.
Risk adjustment models using claims-based data are central in evaluating health care performance. Although US Centers for Medicare & Medicaid Services (CMS) models apply well-vetted statistical ...approaches, recent changes in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system and advances in computational capabilities may provide an opportunity for enhancement.
To examine whether changes using already available data would enhance risk models and yield greater discrimination in hospital-level performance measures.
This comparative effectiveness study used ICD-9-CM codes from all Medicare fee-for-service beneficiary claims for hospitalizations for acute myocardial infarction (AMI), heart failure (HF), or pneumonia among patients 65 years and older from July 1, 2013, through September 30, 2015. Changes to current CMS mortality risk models were applied incrementally to patient-level models, and the best model was tested on hospital performance measures to model 30-day mortality. Analyses were conducted from April 19, 2018, to September 19, 2018.
The main outcome was all-cause death within 30 days of hospitalization for AMI, HF, or pneumonia, examined using 3 changes to current CMS mortality risk models: (1) incorporating present on admission coding to better exclude potential complications of care, (2) separating index admission diagnoses from those of the 12-month history, and (3) using ungrouped ICD-9-CM codes.
There were 361 175 hospital admissions (mean SD age, 78.6 8.4 years; 189 225 52.4% men) for AMI, 716 790 hospital admissions (mean SD age, 81.1 8.4 years; 326 825 45.6% men) for HF, and 988 225 hospital admissions (mean SD age, 80.7 8.6 years; 460 761 46.6% men) for pneumonia during the study; mean 30-day mortality rates were 13.8% for AMI, 12.1% for HF, and 16.1% for pneumonia. Each change to the models was associated with incremental gains in C statistics. The best model, incorporating all changes, was associated with significantly improved patient-level C statistics, from 0.720 to 0.826 for AMI, 0.685 to 0.776 for HF, and 0.715 to 0.804 for pneumonia. Compared with current CMS models, the best model produced wider predicted probabilities with better calibration and Brier scores. Hospital risk-standardized mortality rates had wider distributions, with more hospitals identified as good or bad performance outliers.
Incorporating present on admission coding and using ungrouped index and historical ICD-9-CM codes were associated with improved patient-level and hospital-level risk models for mortality compared with the current CMS models for all 3 conditions.
The CRESST experiment monitors 300
g CaWO
4 crystals as targets for particle interactions in an ultra low background environment. In this paper, we analyze the background spectra that are recorded by ...three detectors over many weeks of data taking. Understanding these spectra is mandatory if one wants to further reduce the background level, and allows us to cross-check the calibration of the detectors. We identify a variety of sources, such as intrinsic contaminations due to primordial radioisotopes and cosmogenic activation of the target material. In particular, we detect a 3.6
keV X-ray line from the decay of
41Ca with an activity of
(
26
±
4
)
μ
Bq
, corresponding to a ratio
41
Ca
/
40
Ca
=
(
2.2
±
0.3
)
×
10
-
16
.
Weakly interacting massive particles (WIMPs) are candidates for non-baryonic dark matter. WIMPs are supposed to interact with baryonic matter via scattering off nuclei producing a nuclear recoil with ...energies up to a few 10
keV with a very low interaction rate of ∼10
−6 events per kg of target material and day in the energy region of interest. The dark matter experiment cryogenic rare event search with superconducting thermometers (CRESST) and the European underground rare event calorimeter array (EURECA) project are aimed at the direct detection of WIMPs with the help of very sensitive modularised cryogenic detectors that basically consist of a transition edge sensor (TES) in combination with a massive absorber crystal. In the CRESST experiment the search for coherent WIMP-nucleon scattering events is validated by the detection of two processes. In the scintillating absorber single crystal, CaWO
4, heat (phonons) and scintillation light are produced and detected with two independent cryogenic detectors: a phonon channel and a separate light channel.
The development of such cryogenic detectors and the potential ton-scale production are investigated in this paper. To decouple the TES production from the choice of the target material in order to avoid heating cycles of the absorber crystal and to allow pretesting of the TESs, a composite detector design (CDD) for the detector production has been developed and studied. An existing thermal detector model has been extended to the CDD, in order to investigate, understand, and optimize the performance of composite detectors. This extended model, which has been worked out in detail, can be expected to provide a considerable help when tailoring composite detectors to the requirements of various experiments.
Background The benefit of primary and booster vaccination in people who experienced a prior Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remains unclear. The objective of ...this study was to estimate the effectiveness of primary (two-dose series) and booster (third dose) mRNA vaccination against Omicron (lineage BA.1) infection among people with a prior documented infection. Methods and findings We conducted a test-negative case–control study of reverse transcription PCRs (RT-PCRs) analyzed with the TaqPath (Thermo Fisher Scientific) assay and recorded in the Yale New Haven Health system from November 1, 2021, to April 30, 2022. Overall, 11,307 cases (positive TaqPath analyzed RT-PCRs with S-gene target failure SGTF) and 130,041 controls (negative TaqPath analyzed RT-PCRs) were included (median age: cases: 35 years, controls: 39 years). Among cases and controls, 5.9% and 8.1% had a documented prior infection (positive SARS-CoV-2 test record ≥90 days prior to the included test), respectively. We estimated the effectiveness of primary and booster vaccination relative to SGTF-defined Omicron (lineage BA.1) variant infection using a logistic regression adjusted for date of test, age, sex, race/ethnicity, insurance, comorbidities, social venerability index, municipality, and healthcare utilization. The effectiveness of primary vaccination 14 to 149 days after the second dose was 41.0% (95% confidence interval (CI): 14.1% to 59.4%, p 0.006) and 27.1% (95% CI: 18.7% to 34.6%, p < 0.001) for people with and without a documented prior infection, respectively. The effectiveness of booster vaccination (≥14 days after booster dose) was 47.1% (95% CI: 22.4% to 63.9%, p 0.001) and 54.1% (95% CI: 49.2% to 58.4%, p < 0.001) in people with and without a documented prior infection, respectively. To test whether booster vaccination reduced the risk of infection beyond that of the primary series, we compared the odds of infection among boosted (≥14 days after booster dose) and booster-eligible people (≥150 days after second dose). The odds ratio (OR) comparing boosted and booster-eligible people with a documented prior infection was 0.79 (95% CI: 0.54 to 1.16, p 0.222), whereas the OR comparing boosted and booster-eligible people without a documented prior infection was 0.54 (95% CI: 0.49 to 0.59, p < 0.001). This study’s limitations include the risk of residual confounding, the use of data from a single system, and the reliance on TaqPath analyzed RT-PCR results. Conclusions In this study, we observed that primary vaccination provided significant but limited protection against Omicron (lineage BA.1) infection among people with and without a documented prior infection. While booster vaccination was associated with additional protection against Omicron BA.1 infection in people without a documented prior infection, it was not found to be associated with additional protection among people with a documented prior infection. These findings support primary vaccination in people regardless of documented prior infection status but suggest that infection history may impact the relative benefit of booster doses. Using a Test-Negative Case-Control Analysis, Dr Margaret L. Lind and colleagues, investigate the association between primary or booster COVID-19 mRNA vaccination and omicron lineage BA.1 SARS-CoV-2 infection in people with a prior SARS-CoV-2 infection. Author summary Why was this study done? mRNA COVID-19 vaccines provide lower levels of protection against Omicron (BA.1 lineage) infections than previously circulating variants. Prior to the emergence of the Omicron variant, primary vaccination (first two mRNA vaccine doses) afforded protection against reinfection among people with prior infections. The benefit of primary and booster vaccination against Omicron (BA.1 lineage) infections remains unclear among people with prior infections. What did the researchers do and find? We evaluated the benefit of primary series and booster mRNA vaccine doses against Omicron (BA.1 lineage, defined by S-gene target failure) infection among people with and without documented prior infections. We found that primary vaccination was associated with statistically significant but low levels of protection against Omicron (BA.1 lineage) infection among people with and without a documented prior infection. Booster vaccination was found to be associated with protection beyond that afforded by the primary series among people without a documented prior infection, but we did not observe a significant increase in protection among people with a documented prior infection. What do these findings mean? Primary vaccination provides limited but significant protection against Omicron (BA.1 lineage) infection regardless of prior infection history. The relative benefits of a booster dose may be affected by a person’s history of prior SARS-CoV-2 infection.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The Fiasco multidetector is a low-threshold apparatus, optimized for the investigation of peripheral to semi-central collisions in heavy ion reactions at Fermi energies. It consists of three types of ...detectors. The first detector layer is a shell of 24 position-sensitive Parallel Plate Avalanche Detectors (PPADs), covering about 70% of the forward hemisphere, which measure the velocity vectors of the heavy (Z≳10) reaction products. Below and around the grazing angle, behind the most forward PPADs, there are 96 ΔE–E silicon telescopes (with thickness of 200 and 500μm, respectively); they are mainly used to measure the energy of the projectile-like fragment and to identify its charge and, via the time-of-flight of the PPADs, also its mass. Finally, behind most of the PPADs there are 158 (or 182, depending on the configuration) scintillation detectors, mostly of the phoswich type, which cover 25–30% of the forward hemisphere; they identify both light charged particles (Z=1,2) and intermediate mass fragments (3⩽Z≲20), measuring also their time-of-flight.
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