Absolute Effectiveness Research Articles

Estimates of vaccine effectiveness of the updated monovalent XBB.1.5 COVID-19 vaccine against symptomatic SARS-CoV-2 infection, hospitalization, and receipt of oxygen therapy in South Korea - October 26 to December 31, 2023

ObjectivesWe evaluated the vaccine effectiveness of monovalent XBB.1.5 vaccine against symptomatic COVID-19 infection, hospitalization, and the need for oxygen therapy in South Korea. DesignThis study employed a test-negative case-control design. COVID-19 test results in symptomatic subjects from six university hospitals across South Korea were collected (October 26–December 31, 2023). The adjusted absolute and relative vaccine effectiveness were assessed. ResultsIn total, 5516 subjects were enrolled: 4,824 were unvaccinated with XBB.1.5, and 692 were vaccinated with XBB.1.5 COVID-19 mRNA vaccines. The absolute vaccine effectiveness when comparing the odds between XBB.1.5 vaccination and no vaccination against symptomatic COVID-19 infection, hospitalization, and oxygen therapy was 65.2% (95% CI, 36.1-81.0), 77.3% (95% CI, 51.1-89.5), and 85.3% (95% CI, 57.8-94.9), respectively. The relative vaccine effectiveness when comparing the odds between XBB.1.5 vaccination and no XBB.1.5 vaccination against symptomatic COVID-19 infection, hospitalization, and oxygen therapy was 57.7% (95% CI, 34.7-72.6), 64.3% (95% CI, 35.9-80.2), and 65.5% (95% CI, 27.0-83.7), respectively. ConclusionThe short-term effectiveness of the XBB.1.5 vaccine against symptomatic COVID-19 infection, hospitalization, and receipt of oxygen therapy in South Korea was significant. Long-term vaccine effectiveness warrants evaluation, and these assessments should be conducted regularly.

Effectiveness of Stem Rust Resistance Genes in Southern Russia

ABSTRACTWheat stem rust (caused by Puccinia graminis f.sp. tritici) is a damaging disease widespread in all grain‐producing regions of the world. In this work, the effectiveness of Sr genes was analysed under field conditions in the southern region of Russia (Krasnodar Krai, Stavropol Krai and Rostov Oblast) during 2016‐2021. The data were obtained using a set of 46 isogenic lines and varieties with artificial inoculation. The Sr31 gene proved absolute effectiveness in the field. Effective (1R–10R) Sr genes were the following: 5, 12, 35 and 37; moderately effective (10MR–30MR) Sr genes: 1, 6, 9g, 10, 11, 13, 14, 15, 20, 22, 23, 24, 25, 32, 33, 38 and WLD. Lines with Sr genes 7a, 7b, 8a, 8b, 9a, 9b, 9d, 9e, 9f, 16, 17, 19, 21, 26, 27, 29, 30, 36, 39, 40, 44, Dp2, Gt and Tmp were ineffective in the adult plant phase (30MS–70S). Polymorphism of infection types and disease severity was noted for most of these lines in different years. Ongoing analysis of the efficiency of Sr genes in the region is important to prevent the risk of epidemics, and lines with stem rust resistance genes that have shown efficiency can be used as donors in breeding programmes.

Induction of Labour: What to Consider

Induction of Labour (IOL) is a method of artificially providing stimulus to the uterus to start the process of labour.1 It utilises iatrogenic therapies such as a synthetic oxytocin, cervical ripening medications, in conjunction with the artificial rupture of membranes, to imitate the physiology of labour and childbirth.2 The indication for IOL is dependent on the clinical need to optimise maternal, fetal and neonatal outcomes, juxtaposed with the potential adverse effects of the IOL process. Indications include uterine, placental and fetal growth disorders, hypertensive conditions and diabetes.3 For example, the National Institute for Clinical Excellence (NICE) recommend IOL between 37 and 38 plus six weeks for pregnant populations who have type 1 or type 2 diabetes, to prevent stillbirth and associated complications.4 The absolute effectiveness of IOL intervention in preserving maternal and fetal health is evident5 however, the World Health Organization (WHO) endorses the consideration of choice of IOL method.6

Lightweight Fe3O4/Fe/C/rGO multifunctional aerogel for efficient microwave absorption, electromagnetic interference shielding, hydrophobicity and thermal insulation

Effective integration of multiple functions into microwave absorbing materials is a future development direction, but still remains a significant challenge. This work fabricated a lightweight, multifunctional aerogel through electrostatic self-assembly, freeze-drying and in-situ pyrolysis process, achieving an in-situ composite of magnetic/dielectric components. The regulated pyrolysis temperature achieves a good balance between abundant nanopores and heterogeneous interfaces, enriched defects, and conductivity. This balance induced a synergy of dielectric loss, magnetic loss, and conduction loss at low frequencies, improving the impedance matching. The aerogel obtains a minimum reflection loss (RLmin) of −65.17 dB in the low-frequency range and a maximum effective absorption bandwidth (EABmax) of 5.76 GHz. The radar cross section (RCS) simulation confirmed its good stealth performance. In addition, an increase in aerogel loading enhanced its electrical conductivity, resulting in a higher electromagnetic interference (EMI) shielding effectiveness (SE) of 81.83 dB, the specific shielding effectiveness (SSE) up to 359.28 dB·cm3/g and the absolute shielding effectiveness (SSEt) up to 1596.82 dB·cm2/g. Beyond microwave absorption and shielding, this aerogel also exhibited good hydrophobicity and thermal insulation. This study provides a new perspective for the development of materials with microwave absorption properties in low-frequency bands and multifunctional properties for broader applications in military, communication, aerospace, and other fields.

A popcorn-inspired strategy for compounding graphene@NiFe2O4 flexible films for strong electromagnetic interference shielding and absorption

Compounding functional nanoparticles with highly conductive and porous carbon scaffolds is a basic pathway for engineering many important functional devices. However, enabling uniform spatial distribution of functional particles within a massively conjugated, monolithic and mesoporous structure remains challenging, as the high processing temperature for graphitization can arouse nanoparticle ripening, agglomerations and compositional changes. Herein, we report a unique “popcorn-making-mimic” strategy for preparing a highly conjugated and uniformly compounded graphene@NiFe2O4 composite film through a laser-assisted instantaneous compounding method in ambient condition. It can successfully inhibit the unwanted structural disintegration and mass loss during the laser treatment by avoiding oxidation, bursting, and inhomogeneous heat accumulations, thus achieving a highly integrated composite structure with superior electrical conductivity and high saturated magnetization. Such a single-sided film exhibits an absolute shielding effectiveness of up to 20906 dB cm2 g−1 with 75% absorption rate, superior mechanical flexibility and excellent temperature/humidity aging reliability. These performance indexes signify a substantial advance in EMI absorption capability, fabrication universality, small form-factor and device reliability toward commercial applications. Our method provides a paradigm for fabricating sophisticated composite materials for versatile applications.

Lightweight carbon foam composites embedded with RGO/SrFe12O19 hybrid: Fabrication, structural and electromagnetic shielding performance in 8.2 to 12.4 GHz

Today's growth of wireless technology has increased the demand for composite materials with absorption-based shielding capabilities and the composites of dielectric and magnetic materials are suitable for producing high shielding effectiveness (SE). The present study establishes a facile way to synthesize carbon foam embedded with strontium ferrite (SrFe12O19) nanoparticles decorated within/ on reduced graphene oxide (RGO) sheets. In this work, polyurathene templete slab is dipped in the homogenous slurry prepared from RGO/SrFe12O19 (RS) hybrid and phenolic resin followed by carbonization to produce the CF/RGO/SrFe12O19 (CRS) composite foam. The synthesized CRS3 nanocomposite foam exhibits maximum shielding effectiveness due to an absorption (SEA) value of 26.6 dB i.e., ∼99.7% attenuation, and absolute specific shielding effectiveness (SSEt) value of 250.70 dBcm2g–1. The high SEA value of synthesized composite carbon foam is obtained because of the synergistic effect of porous morphology, dielectric losses and magnetic losses.

Robust ultrahigh electromagnetic interference shielding effectiveness based on engineered structures of carbon nanotube films

High-performance electromagnetic interference (EMI) shielding materials with ultrathin, flexible, and pliable mechanical properties are highly desired for high-end equipments, yet there remain large challenges in the manufacture of these materials. Here, carbon nanotube film (CNTF)/copper (Cu) nanoparticle (NP) composite films are fabricated via a facile electrodeposition method to achieve high electromagnetic shielding efficiency. Notably, a CNTF/Cu NP composite film with 15μm thickness can achieve excellent EMI shielding efficiency of ∼248 dB and absolute EMI shielding effectiveness as high as 2.17×105 dB cm2 g-1, which are the best values for composite EMI shielding materials with similar or greater thicknesses. These engineered composite films exhibit excellent deformation tolerance, which ensures the robust reliability of EMI shielding efficiency after 20,000 cycles of repeated bending. Our results represent a critical breakthrough in the preparation of ultrathin, flexible, and pliable shielding films for applications in smart, portable and wearable electronic devices, and 5G communication.

Effectiveness and durability of mRNA-1273 BA.4/BA.5 bivalent vaccine (mRNA-1273.222) against SARS-CoV-2 BA.4/BA.5 and XBB sublineages

ABSTRACT Emerging SARS-CoV-2 sublineages continue to cause serious COVID-19 disease, but most individuals have not received any COVID-19 vaccine for >1 year. Assessment of long-term effectiveness of bivalent COVID-19 vaccines against circulating sublineages is important to inform the potential need for vaccination with updated vaccines. In this test-negative study at Kaiser Permanente Southern California, sequencing-confirmed BA.4/BA.5- or XBB-related SARS-CoV-2-positive cases (September 1, 2022 to June 30, 2023), were matched 1:3 to SARS-CoV-2-negative controls. We assessed mRNA-1273 bivalent relative (rVE) and absolute vaccine effectiveness (VE) compared to ≥2 or 0 doses of original monovalent vaccine, respectively. The rVE analysis included 20,966 cases and 62,898 controls. rVE (95%CI) against BA.4/BA.5 at 14–60 days and 121–180 days was 52.7% (46.9–57.8%) and 35.5% (−2.8–59.5%) for infection, and 59.3% (49.7–67.0%) and 33.2% (−28.2–68.0%) for Emergency Department/Urgent Care (ED/UC) encounters. For BA.4/BA.5-related hospitalizations, rVE was 71.3% (44.9–85.1%) and 52.0% (−1.2–77.3%) at 14–60 days and 61–120 days, respectively. rVE against XBB at 14–60 days and 121–180 days was 48.8% (33.4–60.7%) and −3.9% (−18.1–11.3%) for infection, 70.7% (52.4–82.0%) and 15.7% (−6.0–33.2%) for ED/UC encounters, and 87.9% (43.8–97.4%) and 57.1% (17.0–77.8%) for hospitalization. VE and subgroup analyses (age, immunocompromised status, previous SARS-CoV-2 infection) results were similar to rVE analyses. rVE of mRNA-1273 bivalent vaccine against BA.4/BA.5 and XBB infections, ED/UC encounters, and hospitalizations waned over time. Periodic revaccination with vaccines targeting emerging variants may be important in reducing COVID-19 morbidity and mortality.

Estimates of Seasonal Influenza Burden That Could Be Averted by Improved Influenza Vaccines in the Australian Population Aged Under 65 Years, 2015-2019.

The interpretation of relative vaccine effectiveness (rVE) of improved influenza vaccines is complex. Estimation of burden averted is useful to contextualise their potential impact across different seasons. For the population aged under 65 years in Australia, this study estimated the additional morbidity and mortality that could be averted using improved influenza vaccines. We used observed, season-specific (2015-2019) influenza notification and influenza-coded hospitalisation frequencies and published modelled estimates of influenza-associated hospitalisations and deaths that occurred under the prevailing influenza vaccination coverage scenario. After back-calculating to the estimated burden in the population without vaccination, we applied published standard influenza vaccine effectiveness and coverage estimates to calculate the burden potentially averted by standard and improved influenza vaccines. A plausible range of rVE values were used, assuming 50% coverage. The percentage point difference in absolute vaccine effectiveness (VE) of an improved vaccine compared to a standard vaccine is directly proportional to its rVE and inversely proportional to the effectiveness of the standard vaccine. The incremental burden averted by an improved vaccine is a function of both its difference in absolute VE and the severity of the influenza season. Assuming an rVE of 15% with 50% coverage, the improved vaccine was estimated to additionally avert 1517 to 12,641 influenza notifications, 287 to 1311 influenza-coded hospitalisations and 9 to 33 modelled all-cause influenza deaths per year compared to the standard vaccine. Improved vaccines can have substantial clinical and population impact, particularly when the effectiveness of standard vaccines is low, and burden is high.

Guar gum assisted synthesis of high‐quality silver nanoplates and their polyimide matrix nanocomposites for electromagnetic interference shielding applications

AbstractTwo‐dimensional (2D) silver nanoplates are chemically synthesized in the presence of guar gum – a naturally occurring biopolymer. The polymer directs anisotropic growth of silver nuclei into high aspect ratio nanoplates spanning 4500 ± 500 nm lateral length with thickness as small as 40 ± 10 nm. After a thorough investigation of the reaction parameters (temperature, precursor to reductant ratio, and polymer quantity) on the morphology of the product, a scalable synthetic protocol to achieve good yields (95%–98%) of highly pure (~100%) 2D silver nanoplates (AgNPls) in a facile, inexpensive, room temperature, aqueous phase chemical reaction of only about 5 min is devised. The optimized AgNPls induce appreciable conductivity of 5.5 ± 0.38 S/cm in polyimide at only 12 wt% loading. Consequently, the resulting polymer nanocomposite (containing 12 wt% AgNPls), at only 130 ± 15 μm thickness and 0.45 g/cm3 density, effectively blocks electromagnetic radiation in X‐band with a total shield effectiveness of about 10 dB resulting in substantially high specific shielding effectiveness and absolute shielding effectiveness of 22.48 and 1729.23 dB cm3 g−1, respectively. Additionally, the nanocomposites remain thermally stable up to 500°C in oxidative environment and possess an appreciably high storage modulus of 3.113 GPa at 50°C. These low‐density conductive polyimide films, therefore, present great prospects in shielding against electromagnetic interference under extreme conditions.

One-step aerosol synthesis of iron nanoparticles coated single-walled carbon nanotubes (Fe@SWCNT) for multifunctional composite textiles with electromagnetic interference shielding properties

Single-walled carbon nanotubes (SWCNTs) based nanocomposites demonstrate remarkable electromagnetic interference (EMI) shielding potential. However, the efficient and rapid fabrication of SWCNT-based nanocomposite remains a technical challenge. This study successfully one-step synthesizes iron (Fe) nanoparticle-enriched SWCNTs (Fe@SWCNT) using the floating catalyst chemical vapor deposition (FCCVD) method in the aerosol phase. The aerosol-synthesized Fe@SWCNTs were directly integrated with carbon cloth (CC) and polydimethylsiloxane (PDMS) to develop a compelling nanocomposite film for multifunctional EMI shielding. The composite film exhibits exceptional shielding effectiveness of 50.2 dB in the X-band (8.2–12.4 GHz) with absolute shielding effectiveness (SSEt) of 3279.3 dB cm²/g. Notably, the film also displays rapid and uniform electrical heating at low voltages, reaching a temperature of 110.4 °C under a 1.0 V. Overall, this study reveals the potential applications of multifunctional textiles in fields such as EMI shielding, hydrophobicity, and thermal management.

Real-world Effectiveness of mRNA COVID-19 Vaccines Among US Nursing Home Residents Aged ≥65 Years in the Pre-Delta and High Delta Periods.

Long-term care residents were among the most vulnerable during the COVID-19 pandemic. We estimated vaccine effectiveness of mRNA COVID-19 vaccines in Medicare nursing home residents aged ≥65 years during pre-Delta and high Delta periods. We conducted a retrospective cohort study from 13 December 2020 to 20 November 2021 using Medicare claims data. Exposures included 2 and 3 doses of Pfizer-BioNTech and Moderna COVID-19 vaccines. We used inverse probability weighting and Cox proportional hazards models to estimate absolute and relative vaccine effectiveness. Two-dose vaccine effectiveness against COVID-19-related death was 69.8% (95% CI, 65.9%‒73.3%) during the pre-Delta period and 55.7% (49.5%‒61.1%) during the high Delta period, without adjusting for time since vaccination. We observed substantial waning of effectiveness from 65.1% (54.2%‒73.5%) within 6 months from second-dose vaccination to 45.2% (30.6%‒56.7%) ≥6 months after second-dose vaccination in the high Delta period. Three doses provided 88.7% (73.5%‒95.2%) vaccine effectiveness against death, and the incremental benefit of 3 vs 2 doses was 74.6% (40.4%‒89.2%) during high Delta. Among beneficiaries with a prior COVID-19 infection, 3-dose vaccine effectiveness for preventing death was 78.6% (50.0%‒90.8%), and the additional protection of 3 vs 2 doses was 70.0% (30.1%‒87.1%) during high Delta. Vaccine effectiveness estimates against less severe outcomes (eg, infection) were lower. This nationwide real-world study demonstrated that mRNA COVID-19 vaccines provided substantial protection against COVID-19-related death. Two-dose protection waned after 6 months. Third doses during the high Delta period provided significant additional protection for individuals with or without a prior COVID-19 infection.

Scalable synthesis of high-quality, reduced graphene oxide with a large C/O ratio and its dispersion in a chemically modified polyimide matrix for electromagnetic interference shielding applications.

High-purity reduced graphene oxide (RGO or rGO) with appreciable conductivity is a desired conductive filler for lightweight polymer composites used in coatings, electronics, catalysts, electromagnetic interference (EMI) shielding, and energy storage devices. However, the intrinsic conductivity and the uniform dispersion of RGO in relatively polar matrices are challenging, leading to poor overall conductivity and performance of the composite material. The reported study improved the RGO intrinsic conductivity by increasing its C/O ratio while also simultaneously enhancing its compatibility with the polyimide (PI) matrix through ester linkages for better dispersion. A two-step reduction method drastically increased the number of structural defects and carbon content in the resulting RGO, corresponding to a maximum ID/IG and C/O of 1.54 and ∼87, respectively. Moreover, the 2D nanosheets with limited hydroxyl (-OH) groups effectively interacted with anhydride-terminated polyamic acid (AT-PAA) through chemical linkages to make high-performance RGO/PI nanocomposites. Consequently, the polymer matrix composites possessed the highest direct current conductivity of 15.27 ± 0.61 S cm-1 for 20 wt% of the prepared RGO. Additionally, the composite material was highly stiff (3.945 GPa) yet flexible (easily bent through 180°), lightweight (∼0.34 g cm-3), and capable of forming thin films (162 ± 15 μm). Unlike most polymer matrix composites, it showcased one of its class's highest thermal stabilities (a weight loss of only 5% at 638 °C). Ultimately, the composite performed as an effective electromagnetic interference (EMI) shielding material in the X-Band (8 to 12 GHz), demonstrating outstanding shielding effectiveness (SE), shielding effectiveness per unit thickness (SEt), specific shielding effectiveness (SSE), and absolute shielding effectiveness (SSEt) of 46 dB, 2778 dB cm-2, 138 dB cm3 g-1, and 8358 dB cm2 g-1, respectively. As a consequence of this research, the high-purity RGO and its high-performance PI matrix nanocomposites are anticipated to find practical applications in conductive coatings and flexible substrates demanding high-temperature stability.

Effectiveness of Adapted COVID-19 Vaccines and Ability to Establish Herd Immunity against Omicron BA.1 and BA4-5 Variants of SARS-CoV-2.

The emergence of novel SARS-CoV-2 variants has raised concerns about the ability of COVID-19 vaccination programs to establish adequate herd immunity levels in the population. This study assessed the effectiveness of adapted vaccines in preventing SARS-CoV-2 infection and the ability of the adapted vaccines to establish herd immunity against emerging Omicron variants. A systematic literature review was conducted to estimate the absolute vaccine effectiveness (aVE) in preventing SARS-CoV-2 infection using adapted vaccines targeting Omicron variants. The ability of the adapted vaccines to establish herd immunity was assessed by taking into account the following factors: aVE, Ro values of SARS-CoV-2 and the use of non-pharmacological interventions (NPIs). This study found meta-analysis-based aVEs in preventing severe disease and SARS-CoV-2 infection of 56-60% and 36-39%, respectively. Adapted vaccines could not establish herd immunity against the Omicron BA.1 and BA.4-5 variants without using non-pharmacological interventions (NPIs). The adapted vaccines could establish herd immunity only by achieving >80% vaccination coverage, using NPIs with greater effectiveness and when 20-30% of individuals were already protected against SARS-CoV-2 in the population. New adapted COVID-19 vaccines with greater effectiveness in preventing SARS-CoV-2 infection must be developed to increase herd immunity levels against emerging SARS-CoV-2 variants in the population.

Multi-layer carbon fiber paper @reduced graphene oxide/Co/C composite with adjustable electromagnetic interference shielding properties

Paper-based composite materials exhibit a marked tendency towards thinner and lighter profiles in the context of electromagnetic interference (EMI) shielding. Carbon fiber paper (CFP) has excellent electrical conductivity and Lightweight base characteristics. However, its single electrical loss characteristic and uncontrollable EMI shielding performance are limited in application. Therefore, we prepared CFP@ graphene oxide (GO)/ZIF-67 composites by chemical bonding and in-situ polymerization, and then prepared CFP@rGO/Co/C composites with integrated structure and function by heat treatment. Layer-by-layer assembly technology was employed to develop composite materials with tunable EMI shielding performance. The composite material has excellent high conductivity (2475.86 S/m) and excellent EMI shielding performance (average X-band EMI efficiency (SE)38.46 dB, absolute shielding effectiveness (SSE/t) = 14388.56 dB cm2 g−1). Through the layer-by-layer assembly technology, the EMI SE performance of the 7-layer assembled material reached 85.83 dB, and the EMI SSE/t reached 32110.51 dB cm2 g−1. Through simulation verification, the EMI shielding performance of the materials is compared, and ideas for EMI material design are provided. In addition, the material also has excellent Joule heating performance, fast electrothermal response and good temperature controllability. The material exhibits remarkable resilience against harsh environmental conditions, including strong acids, bases, organic reagents, ultrasonic waves, combustive processes, and extremely low temperatures. Despite these severe treatments, its performance remains above 90 % intact. This study proposes a magnetic-dielectric synergistic, performance-adjustable CFP-based shielding material, which has great application potential in the future wearable, defense, and aerospace fields.

All-in-one integrated flexible PE@PET/MXene films for high-performance electromagnetic shields with self-reinforced conductivity and mechanical properties

MXene-based composites are deemed as promising electromagnetic interference (EMI) shielding candidates to address the rapidly increasing electromagnetic interference and radiation concerns. However, developing high-performance flexible polymer-MXene composites with excellent EMI shielding efficiency (EMI SE), good mechanical properties and superior serving stability is a significant challenge. Herein, a type of all-in-one designed lightweight, thin, ultra-flexible PE@PET/MXene films are developed using a novel PE@PET nonwoven fabric (NWF) as the supporter. A mussel-inspired polydopamine modification facilitates the uniform loading of MXene, achieving high electrical conductivity of the resultant PE@PET/MXene films. A simple hot-pressing process is then employed to melt the sheath PE component of PE@PET to serve as a “self-glue” in adhering and wrapping the loaded MXene nanosheets, while maintaining the core PET fibers as the internal “steel” skeleton. As such, the resultant PE@PET/MXene films exhibit multiple self-enhancement metrics involving high mechanical strength, good electrical conductivity, robust serving stability, and superior EMI shielding performance. An optimized PE@PET/MXene film can preserve an excellent EMI SE of 50.44 dB and an ultra-high absolute shielding effectiveness (SSE/t) of 10606 dB cm2 g−1. The versatility of PE@PET/MXene EMI shielding films is further indicated by integrating the flame-retardant additives to endow its flame-retardant function, demonstrating excellent versability and expandability.

Effectiveness of BNT162b2 BA.4/5 Bivalent mRNA Vaccine Against Symptomatic COVID-19 Among Immunocompetent Individuals Testing at a Large US Retail Pharmacy.

Data on the effectiveness of BA.4/5 bivalent vaccine stratified by age and prior infection are lacking. This test-negative study used data from individuals ≥5 years of age testing for SARS-CoV-2 with symptoms (15 September 2022 to 31 January 2023) at a large national retail pharmacy chain. The exposure was receipt of 2-4 wild-type doses and a BNT162b2 BA.4/5 bivalent vaccine (>2 months since last wild-type dose). The outcome was a positive SARS-CoV-2 test. Absolute (vs unvaccinated) and relative (vs 2-4 wild-type doses) vaccine effectiveness (VE) were calculated as (1 - adjusted odds ratio from logistic regression) × 100. VE was stratified by age and self-reported prior infection. Overall, 307 885 SARS-CoV-2 tests were included (7916 aged 5-11, 16 329 aged 12-17, and 283 640 aged ≥18 years). SARS-CoV-2 positivity was 39%; 21% were unvaccinated, 70% received 2-4 wild-type doses with no bivalent vaccine, and 9% received a BNT162b2 BA.4/5 bivalent dose. At a median of 1-2 months after BNT162b2 BA.4/5 bivalent vaccination, depending on age group, absolute VE was 22%-60% and was significantly higher among those reporting prior infection (range, 55%-79%) than not (range, no protection to 50%). Relative VE was 31%-64%. BNT162b2 BA.4/5 bivalent showed early additional protection against Omicron-related symptomatic COVID-19, with hybrid immunity offering greater protection.

Effectiveness of BNT162b2 BA.4/5 bivalent mRNA vaccine against a range of COVID-19 outcomes in a large health system in the USA: a test-negative case–control study

XBB-related omicron sublineages have recently replaced BA.4/5 as the predominant omicron sublineages in the USA and other regions globally. Despite preliminary signs of immune evasion of XBB sublineages, few data exist describing the real-world effectiveness of bivalent COVID-19 vaccines, especially against XBB-related illness. We aimed to investigate the effectiveness of the Pfizer--BioNTech BNT162b2 BA.4/5 bivalent vaccine against both BA.4/5-related and XBB-related disease in adults aged 18 years or older. In this test-negative case-control study, we estimated the effectiveness of the BNT162b2 BA.4/5 bivalent vaccine using data from electronic health records of Kaiser Permanente Southern California health system members aged 18 years or older who received at least two doses of the wild-type COVID-19 mRNA vaccines. Participants sought care for acute respiratory infection between Aug 31, 2022, and April 15, 2023, and were tested for SARS-CoV-2 via PCR tests. Relative vaccine effectiveness (≥2 doses of wild-type mRNA vaccine plus a BNT162b2 BA.4/5 bivalent booster vs ≥2 doses of a wild-type mRNA vaccine alone) and absolute vaccine effectiveness (vs unvaccinated individuals) was estimated against critical illness related to acute respiratory infection (intensive care unit [ICU] admission, mechanical ventilation, or inpatient death), hospital admission, emergency department or urgent care visits, and in-person outpatient encounters with odds ratios from logistic regression models adjusted for demographic and clinical factors. We stratified vaccine effectiveness estimates for hospital admission, emergency department or urgent care visits, and outpatient encounters by omicron sublineage (ie, likely BA.4/5-related vs likely XBB-related), time since bivalent booster receipt, age group, number of wild-type doses received, and immunocompromised status. This study is registered with ClinicalTrials.gov (NCT04848584). Analyses were conducted for 123 419 encounters (24 246 COVID-19 cases and 99 173 test-negative controls), including 4131 episode of critical illness (a subset of hospital admissions), 14 529 hospital admissions, 63 566 emergency department or urgent care visits, and 45 324 outpatient visits. 20 555 infections were BA.4/5 related and 3691 were XBB related. In adjusted analyses, relative vaccine effectiveness for those who received the BNT162b2 BA.4/5 bivalent booster compared with those who received at least two doses of a wild-type mRNA vaccine alone was an additional 50% (95% CI 23-68) against critical illness, an additional 39% (28-49) against hospital admission, an additional 35% (30-40) against emergency department or urgent care visits, and an additional 28% (22-33) against outpatient encounters. Waning of the bivalent booster from 0-3 months to 4-7 months after vaccination was evident for outpatient outcomes but was not detected for critical illness, hospital admission, and emergency department or urgent care outcomes. The relative effectiveness of the BNT162b2 BA.4/5 bivalent booster for XBB-related infections compared with BA.4/5-related infections was 56% (95% CI 12-78) versus 40% (27-50) for hospital admission; 34% (21-45) versus 36% (30-41) against emergency department or urgent care visits; and 29% (19-38) versus 27% (20-33) for outpatient encounters. By mid-April, 2023, individuals previously vaccinated only with wild-type vaccines had little protection against COVID-19-including hospital admission. A BNT162b2 BA.4/5 bivalent booster restored protection against a range of COVID-19 outcomes, including against XBB-related sublineages, with the most substantial protection observed against hospital admission and critical illness. Pfizer.

Graphenization of graphene oxide films for strongly anisotropic thermal conduction and high electromagnetic interference shielding

A macroscopic carbon film that has a “graphenic” structure (defect-free in-plane graphene lattice yet absence of Bernal type graphitic stacking order), may inherit the exotic properties of rotated/slipped few-layer graphene (e.g., high flexibility and anisotropic transport properties). However, the fabrication of such a film remains challenging and unreported. Here we show that the annealing of reduced electrochemical graphene oxide (REGO), which has fewer in-plane defects than the conventional graphene oxide from Hummers’ method, leads to a nearly intact graphene lattice (Raman ID/IG down to 0.03) without restoring the graphitic stacking order (I2D/IG > 1 and a single Lorentzian 2D peak). Atomic resolution transmission electron microscopy verifies the unique graphenic structure with random interlayer rotations. Density functional theory calculations imply the low defect density of REGO can suppress the interplanar interaction between undercoordinated carbon atoms, therefore inhibiting cross-plane migration of vacancies and the consequent establishment of stacking order. The annealed, graphenic REGO film is highly flexible and has an in-plane to cross-plane thermal conductivity ratio of 835 (among the highest reported for anisotropic thermal conductors). This high anisotropic ratio is attributed to the inhibited through-plane heat transport (0.26 W m−1 K−1) by the interlayer rotations and the high in-plane thermal conductivity (218 W m−1 K−1) enabled by intact graphene lattice. The graphenic films show high electromagnetic interference shielding effectiveness of 80.3 dB at a thickness of 53 μm and 42.4 dB at 5.7 μm, with an absolute effectiveness (>70000 dB cm2 g−1) superior to two-dimensional metal carbides (MXenes) and Al foil.

Personalized lifetime prediction of survival and treatment benefit in patients with heart failure with reduced ejection fraction: The LIFE-HF model.

Although trials have proven the group-level effectiveness of various therapies for heart failure with reduced ejection fraction (HFrEF), important differences in absolute effectiveness exist between individuals. We developed and validated the LIFEtime-perspective for Heart Failure (LIFE-HF) model for the prediction of individual (lifetime) risk and treatment benefit in patients with HFrEF. Cox proportional hazards functions with age as the time scale were developed in the PARADIGM-HF and ATMOSPHERE trials (n = 15 415). Outcomes were cardiovascular death, heart failure (HF) hospitalization or cardiovascular death, and non-cardiovascular mortality. Predictors were age, sex, New York Heart Association class, prior HF hospitalization, diabetes mellitus, extracardiac vascular disease, systolic blood pressure, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and glomerular filtration rate. The functions were combined in life-tables to predict individual overall and HF hospitalization-free survival. External validation was performed in the SwedeHF registry, ASIAN-HF registry, and DAPA-HF trial (n = 51 286). Calibration of 2- to 10-year risk was adequate, and c-statistics were 0.65-0.74. An interactive tool was developed combining the model with hazard ratios from trials to allow estimation of an individual's (lifetime) risk and treatment benefit in clinical practice. Applying the tool to the development cohort, combined treatment with a mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor, and angiotensin receptor-neprilysin inhibitor was estimated to afford a median of 2.5 (interquartile range [IQR] 1.7-3.7) and 3.7 (IQR 2.4-5.5) additional years of overall and HF hospitalization-free survival, respectively. The LIFE-HF model enables estimation of lifelong overall and HF hospitalization-free survival, and (lifetime) treatment benefit for individual patients with HFrEF. It could serve as a tool to improve the management of HFrEF by facilitating personalized medicine and shared decision-making.