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We obtain nontrivial solutions of some elliptic interface problems with nonhomogeneous jump conditions that arise in localized chemical reactions and nonlinear neutral inclusions. Our proofs in bounded domains use Morse theoretical arguments, in particular, critical group computations. An extension to the whole space is proved using concentration compactness arguments.

The dissolved nitrate is one of the major essential nutrients for primary production in the tropical ocean and it is brought to the surface though mixing. The depth of nitracline determines how much of nitrate enters to the upper ocean through mixing. The depth of nitracline is traditionally estimated using nitrate concentrations measured at standard depths that introduces significant error due to interpolation of data. Based nitrate profiles measured at 5 m interval using nitrate sensors onboard Argo, the exact depth of nitracline was derived in the Bay of Bengal that displayed a significant linear relationship with depth of 26°C isotherm (D26). Based on climatological D26, the temporal and spatial variations in the depth of nitracline was estimated for the entire Bay of Bengal. The depth of nitracline varied between 5 and 80 m with large spatial and temporal variability in the Bay of Bengal and it is 5–20 m deeper than simulations of numerical models. The relationship between the depth of nitracline and photic zone integrated primary production indicates that 7.5 ± 3 mgC m−2 d−1 of primary production increases due to shallowing of 1 m of depth of nitracline. Therefore, models seem to be over estimating the photic zone integrated primary production by 5%–25% in the Bay of Bengal. The numerical models may improve the simulation of primary production and carbon cycling by accounting the accurate estimation of depth of nitracline in the model initialization. Plain Language Summary: In the tropical ocean, nitrate mainly controls the primary production and identifying the depth of nitracline, where nitrate concentration was 1 μM from that of surface, is important in simulating primary production by numerical models. All the numerical models are using nutrietns profiles collected at the standard depth and estimated depth of nitracline. Since the data collected at standard depth, and interpolation between depth may result in large error in the computation of nitracline depth. We used high depth resolution nitrate data collected by sensors and estimated nitracline depth and the same compared with modeled data. It was observed that models are estimating shallow nitracline than actual as a result higher biological response is simulated than reality. This exercise would be useful in improving model simulation in future. Key Points: The depth of nitracline is strongly controlled by depth of 20°C isothermDeeper nitracline depth was noticed during spring and shallowers during summerModels estimate shallower nitracline depth by 5–20 m than measured [ABSTRACT FROM AUTHOR]

Argo floats have been deployed in the global ocean for over 20 years. The Core mission of the Argo program (Core Argo) has contributed well over 2 million profiles of salinity and temperature of the upper 2000 m of the water column for a variety of operational and scientific applications. Core Argo floats have evolved such that the program currently consists of more than eight types of Core Argo float, some of which belong to second or third generation developments, three unique satellite communication systems (Argos, Iridium and Beidou) and two types of Conductivity, Temperature and Depth (CTD) sensor systems (Seabird and RBR). This, together with a well-established data management system, delayed mode data quality control, FAIR and open data access, make the program a very successful ocean observing network. Here we present Part 1 of the Best Practices for Core Argo floats in terms of how users can get started in the program, recommended metadata parameters and the data management system. The objective is to encourage new and developing scientists, research teams and institutions to contribute to the OneArgo Program, specifically to the Core Argo mission. Only by leveraging sustained contributions from current Core Argo float groups with new and emerging Argo teams and users who are eager to get involved and are actively encouraged to do so, can the OneArgo initiative be realized. This paper presents a list of best practices to get started in the program, set up the recommended metadata, implement the data management system with the aim to encourage new scientists, countries and research teams to contribute to the OneArgo Program. [ABSTRACT FROM AUTHOR]

Objectives: Automated results for determining colistin susceptibility tests are unreliable, micro broth dilution requires expertise, and CBDE has limited dilutions. International Consensus Document of 2022 suggested that agar dilution was unacceptable due to varying results in the literature. Methods: The study was designed to evaluate the agar dilution method for colistin susceptibility in CRE isolates compared to CBDE. In the study, 108 carbapenem-resistant isolates were tested for Colistin susceptibility by Microbroth Dilution, agar dilution, and colistin broth disc elution. The comparisons were made using various statistical parameters. Results: The results of the agar dilution method revealed an essential agreement of 75 % and a categorical agreement of 92.5 %. The method showed a sensitivity of 75 % and a specificity of 97.7 %. The positive and negative predictive values were 88.2 % and 94.5 %, respectively. Youden's index was 0.727, indicating a moderate level of accuracy. Meanwhile, CBDE diagnostic accuracy tests were better, with Youden's index at 0.939. Conclusions: While CBDE demonstrated better accuracy parameters, it did not offer a broader MIC range. In contrast, agar dilution showed reasonable specificity and reliability for isolates with high MIC. Therefore, we propose using CBDE for screening and agar dilution as a supplementary test in the approach to colistin susceptibility.

The optimization of solar energy integration into the power grid relies heavily on accurate forecasting of solar irradiance. In this study, a new approach for short-term solar irradiance forecasting is introduced. This method combines Bayesian Optimized Attention-Dilated Long Short-Term Memory and Savitzky-Golay filtering. The methodology is implemented to analyze data obtained from a solar irradiance probe situated in Douala, Cameroon. Initially, the unprocessed data is augmented by integrating distinctive solar irradiation variables, and the Savitzky-Golay filter with Bayesian Optimization is used to enhance its quality. Subsequently, multiple deep learning models, including Long Short-Term Memory, Bidirectional Long Short-Term Memory, Artificial Neural Networks, Bidirectional Long Short-Term Memory with Additive Attention Mechanism, and Bidirectional Long Short-Term Memory with Additive Attention Mechanism and Dilated Convolutional layers, are trained and evaluated. Out of all the models considered, the proposed approach, which combines the attention mechanism and dilated convolutional layers, demonstrates exceptional performance with the best convergence and accuracy in forecasting. Bayesian Optimization is further utilized to fine-tune the polynomial and window size of the Savitzky-Golay filter and optimize the hyperparameters of the deep learning models. The results show a Symmetric Mean Absolute Percentage Error of 0.6564, a Normalized Root Mean Square Error of 0.2250, and a Root Mean Square Error of 22.9445, surpassing previous studies in the literature. Empirical findings highlight the effectiveness of the proposed methodology in enhancing the accuracy of short-term solar irradiance forecasting. This research contributes to the field by introducing novel data pre-processing techniques, a hybrid deep learning architecture, and the development of a benchmark dataset. These advancements benefit both researchers and solar plant managers, improving solar irradiance forecasting capabilities.

Cyclone Amphan is one of the severe cyclones that occurred over the Bay of Bengal region. It has undergone rapid intensification over the northern part, i.e., north of 14° N after its formation. This can be attributed to the intrusion of warm saline waters with temperatures around 31 °C, salinity greater than 33 psu from the coast, and the presence of anticyclonic eddy that moved across the track. Within an anticyclonic eddy sinking, warm, high saline waters are promoted further sinking through diffusive convective mixing processes. Analysis of in situ and model data showed that these waters formed as a thick water column with high heat content in the northern part of the track, which in turn helped the rapid intensification of cyclone Amphan. This thick water column was also clearly evident in tropical cyclone heat potential. A high chlorophyll concentration of 4.5 – 5.3 mg/m3 was observed before the saline water intrusion across the cyclone path. North of 15oN, a sudden drop in the surface chlorophyll concentration of 0.2–1 mg/m3was observed, which can be attributed to further sinking of saltwater due to vertical convective mixing, which suppressed the cyclone-induced upwelling over this region. [ABSTRACT FROM AUTHOR]

Problem considered: An emerging global threat, Candida auris infections have poor prognosis, high transmission rate, and potential for outbreaks. In India, prevalence of Candida auris invasive infection has been calculated to be 5.3 %. Strict surveillance and preventive measures must be implemented in intensive care units because of its propensity for rapid adaptation and potential for antifungal resistance. Methods: Outbreak investigational study was carried in paediatric and neonatal intensive care unit of a tertiary care hospital in eastern India. Clinical isolates from inpatients with candidemia were subjected to identification by microbiological tests. Deoxyribonucleic acid (DNA) sequencing done for molecular identification and determining clonal similarity of Candida auris isolates. Surveillance of intensive care units carried out to assess patient colonization, environmental contamination, and hand-carriage of yeast among healthcare workers following which strict infection control measures were implemented. Results: Blood isolates from four candidemia patients identified microbiologically as Candida auris. Environmental surfaces found contaminated with Candida auris by surveillance included Ultrasound guided (USG) Accu-probe and Blood-pressure (BP) cuff used for all patients admitted, molecular identification of which showed homology with patient isolates. However, patients and hospital environment no longer harboured Candida auris owing to stringent Infection Prevention and Control (IPC) measures taken. Conclusion: The article emphasises multidisciplinary approach towards investigation and containment of Candida auris outbreak and how prompt surveillance and simple preventive measures could eradicate Candida auris from patients and hospital setting.

Background Obstructive sleep apnea (OSA) is a common sleep disorder associated with cardiovascular risks. This study aimed to assess the prevalence of probable OSA and its relationship with cardiovascular risks and diseases focusing on age‐stratified young adults (20–40 years) and older (>40 years). Methods and Results The study used a cross‐sectional design, analyzing data from the National Health and Nutrition Examination Survey conducted between 2013 and 2018, comprising 9887 community‐dwelling adults aged ≥20 years. Probable OSA was determined on the basis of self‐report of OSA‐related symptoms (eg, snoring, gasping/breath cessation while sleeping). Cardiovascular risk factors, including hypertension, diabetes, hyperlipidemia, and metabolic syndrome, were evaluated according to established guidelines. Cardiovascular diseases (CVDs) included self‐reported heart conditions, including congestive heart failure, coronary heart disease, angina, heart attacks, and strokes. Individuals with probable OSA showed a significantly higher prevalence of health conditions, including hypertension (adjusted prevalence ratio [aPR], 1.19; P

One of the challenging problems for software companies is to find the optimal time of release of the software so as to minimize the total cost expended on testing and potential penalty cost due to unresolved faults. If the software is for a safety critical system, then the software release time becomes more important. The criticality of a failure caused by a fault also becomes an important issue for safety critical software. In this paper we develop a total cost model based on criticality of the fault and cost of its occurrence during different phases of development for N-version programming scheme, a popular fault-tolerant architecture. The mathematical model is developed using the reliability growth model based on the non-homogeneous Poisson process. The models for optimal release time under different constraints are developed under the assumption that the debugging is imperfect and there is a penalty for late release of the software. The concept of Failure Mode Effects and Criticality Analysis is used for measuring criticality. Keywords: software reliability; fault tolerance; N-version programming; non-homogeneous Poisson process; imperfect debugging

The extremely severe tropical cyclone Fani (25 April–5 May 2019) unusually sustained high intensity for a prolonged duration over the Bay of Bengal (BoB). A regional coupled atmosphere–ocean model was used to investigate the atmospheric and oceanic conditions and processes responsible for the sustained intensification of the tropical cyclone (TC) Fani. The coupled model simulated the track and intensification/weakening stages of the cyclone reasonably well. A reduction in sea surface temperature (by −2 °C) and an increase in sea surface salinity due to cyclone-induced upwelling and inertial mixing was noticed in both observations and model. The passage of TC Fani over two geostrophic mesoscale warm-core eddies along the cyclone track was found to supply the necessary energy for the intensification of TC Fani. The sea surface height anomaly and tropical cyclone heat potential (TCHP) were higher during TC Fani than other pre-monsoon cyclones in the BoB. The anomalous TCHP in the warm-core eddy zones (i.e., in excess of >160 kJ cm−2) maintained the warm surface temperature and high air–sea heat fluxes. The air–sea latent heat flux and atmospheric wind shear were favourable for the intensification of the cyclone. The atmospheric moist static energy enhanced up to 360 kJ kg−1 with a deep vertical extension in the atmospheric column supporting the further intensification of TC Fani. Therefore, the unusual oceanic TCHP associated with mesoscale eddies, higher latent heat flux, and enhanced moist static energy in the atmosphere contributed to the sustained intensification of TC Fani for a prolonged period in the BoB. [ABSTRACT FROM AUTHOR]

Background The purpose of this study is to compare the prevalence of self‐reported cardiovascular conditions among individuals with moderate to severe traumatic brain injury (TBI) to a propensity‐matched control cohort. Methods and Results A cross‐sectional study described self‐reported cardiovascular conditions (hypertension, congestive heart failure [CHF], myocardial infarction [MI], and stroke) from participants who completed interviews between January 2015 and March 2020 in 2 harmonized large cohort studies, the TBI Model Systems and the National Health and Nutrition Examination Survey. Mixed‐effect logistic regression models were used to compare the prevalence of cardiovascular conditions after 1:1 propensity‐score matching based on age, sex, race, ethnicity, body mass index, education level, and smoking status. The final sample was 4690 matched pairs. Individuals with TBI were more likely to report hypertension (odds ratio [OR], 1.18 [95% CI, 1.08–1.28]) and stroke (OR, 1.70 [95% CI, 1.56–1.98]) but less likely to report CHF (OR, 0.81 [95% CI, 0.67–0.99]) or MI (OR, 0.66 [95% CI, 0.55–0.79]). There was no difference in rate of CHF or MI for those ≤50 years old; however, rates of CHF and MI were lower in the TBI group for individuals >50 years old. Over 65% of individuals who died before the first follow‐up interview at 1 year post‐TBI were >50 years old, and those >50 years old were more likely to die of heart disease than those ≤50 years old (17.6% versus 8.6%). Conclusions Individuals with moderate to severe TBI had an increased rate of self‐reported hypertension and stroke but lower rate of MI and CHF than uninjured adults, which may be due to survival bias.

Patients admitted to the hospital ward from the emergency department (ED) occasionally decompensate and require transfer to the intensive care unit (ICU). An emergency medicine (EM) curriculum focused on review of these ICU upgrade cases could improve resident knowledge related to patient acuity, critical illness, and appropriate disposition. Furthermore, initial identification of critical pathology in the ED and earlier admission to the ICU could reduce delays in care and improve patient outcomes. We performed a retrospective analysis to determine the effectiveness of a resident quality improvement curriculum evaluating cases where patients require transfer from the inpatient floor to the ICU within 12 hours of admission from the ED. We compared postgraduate year 2 (PGY-2) EM residents who participated in the ICU upgrades curriculum during their first year to PGY-2 EM residents who did not participate in the curriculum. Analysis of the 242 qualifying ICU upgrade cases from July 2019–October 2021 showed post-curriculum residents were responsible for an average of 1.0 upgrades per resident compared to an average of 1.54 upgrades per resident (P = 0.12) for pre-curriculum residents. Although there was no statistically significant difference in ICU upgrades between the groups, there was a trend toward decreased ICU upgrade cases for residents who participated in the curriculum. Common reasons for ICU upgrade included worsening respiratory distress requiring higher level of respiratory support, recurrent hypotension after initial intravenous fluid resuscitation requiring vasopressor support, and declining mental status. This retrospective study showed no significant difference in the number of ICU upgrades for residents who completed the ICU upgrades curriculum compared to residents who were not enrolled in the course. However, the study was likely underpowered to detect a significant difference in the groups, and there was a trend toward reduced ICU upgrades for residents who completed the curriculum. ICU upgrade cases were frequently associated with worsening respiratory status, hypotension, and mental status. These findings highlight the importance of reassessment of vital signs and mental status prior to determining disposition from the ED. Additional, larger studies are needed to better determine the curriculum’s impact on resident proficiency in recognizing critical illness and reducing ICU upgrades.

The existence of a coupled fixed point for a multi-valued mapping satisfying a certain admissibility condition is established. Requirement that the mapping be a contraction is met implicitly through a function of several variables. Further, we study the stability of coupled fixed point sets for such mappings. Several illustrative examples are presented. [ABSTRACT FROM AUTHOR]

Spatial variability in boundaries and thickness of oxygen minimum zone (OMZ) is derived based on measured dissolved oxygen data obtained from sensors on board biogeochemical (BGC) Argo floats between 2013 and 2019 in the Bay of Bengal (BoB). Upper and lower boundaries of the OMZ varied from 60 to 200 m and 100 to 800 m respectively with the thickness of 80–650 m in the BoB. Relatively thicker OMZ is noticed in the northern than southern BoB associated with stratification. The oxygen concentrations in the OMZ in the NW was low (<1.5 μM) than NE BoB (2.5 μM) indicating that thick and intense OMZ occurs in the NW region associating with stratification and high primary production. Significant decrease in particle‐back‐scatter signal was observed toward offshore from shelf indicating organic matter from the shelf sediments may be supporting bacterial carbon demand in the OMZ. The particle backscatter signal peaked in the OMZ region with a higher signal in the north than southern BoB and it is consistent with the low oxygen concentration in the former indicating that organic matter from shelf sediments may be supporting carbon needs in the OMZ. In addition to this, the occurrence of eddies significantly controls the intensity of the OMZ in the BoB through mixing at the upper boundary of OMZ. Therefore, this study suggests that spatial variations in intensity of OMZ in the BoB are governed by stratification, primary and export productions, organic matter decomposition, and eddy‐driven mixing. Plain Language Summary: Based on the dissolved oxygen data collected by Biogeochemical (BGC) Argo floats, we have shown for the first time the boundaries and thickness of the OMZ in the BoB. The occurrence of OMZ in the BoB is mainly caused by freshwater discharge from the majors rivers, that do inhibit mixing of atmospheric oxygen, primary production, export of dead organic matter to OMZ, and subsequent decomposition by bacteria, that consumes oxygen in the water, and mixing of oxygen by eddies. We noticed that the thick and intense OMZ exists in the northwestern BoB associating with stratification, high primary production, and slower rate of dead organic matter sinking to OMZ and weaker eddy activity. Key Points: The thick oxygen minimum zone (OMZ) occurred in the northern Bay of Bengal (BoB) associated with strong salinity stratificationParticle back‐scatter signal suggests cross‐shelf transport of organic matter may support heterotrophic carbon demand in the OMZIntense OMZ in the northwestern BoB associated with high primary production, and sinking carbon fluxes [ABSTRACT FROM AUTHOR]

Post-Concussion Syndrome (PCS) refers to the persistence of physical, cognitive, and emotional symptoms following mild traumatic brain injury (mTBI)/concussion, occurring in roughly 15–30% of individuals. Hyperbaric oxygen therapy (HBOT) has been suggested as a potential treatment for PCS; however, the evidence to date is mixed due to inconsistencies in the treatment protocol and focus on veterans with combat-related injuries, which may not be generalizable to the general population. The goal of Hyperbaric Oxygen Therapy for Post-Concussion Syndrome (HOT-POCS) is to assess the efficacy and safety of HBOT for the treatment of PCS in the civilian population. This randomized, controlled pilot study will be using a standardized HBOT protocol (20 sessions of 100% O2 at 2.0 atm absolute [ATA]) compared with a true placebo gas system that mimics the oxygen composition at room air (20 sessions of 10.5% O2 and 89.5% nitrogen at 2.0 ATA) in a cohort of 100 adults with persistent post-concussive symptoms 3–12 months following injury. Change in symptoms on the Rivermead Post-concussion Questionnaire (RPQ) will be the primary outcome of interest. Secondary outcomes include the rate of adverse events, change in the quality of life, and change in cognitive function. Exploratory outcome measures will include changes in physical function and changes in cerebral brain perfusion and oxygen metabolism on MRI brain imaging. Overall, the HOT-POCS study will compare the efficacy of a standardized HBOT treatment protocol against a true placebo gas for the treatment of PCS within 12 months after injury.

The resolution of the model emerges to be an important factor in simulating the real oceanic features. In this paper, the performance of two coupled bio-physical models, having spatial resolutions 1/12° (∼9 km) and 1/4° (∼25 km) configured using Regional Ocean Modeling System (ROMS), have been evaluated in simulating upper ocean dynamics of the Arabian Sea. A comparison of the model simulated physical and biogeochemical fields with the observations from remote sensing, in-situ ship-borne, and Biogeochemical-Argo (BGC-Argo) floats showed that the high-resolution model reproduced the ocean physical and biogeochemical dynamics, and their seasonality more efficiently. The upper ocean dynamics associated with the variability of mixed layer depth, persistent occurrence of deep chlorophyll maxima, and seasonal phytoplankton blooms. as well as deep ocean characteristics of oxygen minimum zone were much effectively captured by the high-resolution model than by its counterpart. Similarly, the former model performed very well in reproducing the upwelling dynamics over the eastern continental shelf indicating that the open ocean-coastal coupling has been better established. Our analysis indicates that the realistic representation of the eddy fields by the high-resolution model leads to the better representation of the ocean fields in comparison to the coarse-resolution model. [ABSTRACT FROM AUTHOR]

Physical and biogeochemical observations from an autonomous profiling Argo float in the Bay of Bengal show significant changes in upper ocean structure during the passage of tropical cyclone (TC) Hudhud (7–14 October 2014). TC Hudhud mixed water from a depth of about 50 m into the surface layers through a combination of upwelling and turbulent mixing. Mixing was extended into the depth of nutricline, the oxycline, and the subsurface‐chlorophyll‐maximum and thus had a strong impact on the biogeochemistry of the upper ocean. Before the storm, the near‐surface layer was nutrient depleted and was thus oligotrophic with the chlorophyll‐a concentration of less than 0.15 mg/m3. Storm mixing initially increased the chlorophyll by 1.4 mg/m3, increased the surface nitrate concentration to about 6.6 μM/kg, and decreased the subsurface dissolved oxygen (30–35 m) to 31% of saturation (140 μM). These conditions were favorable for phytoplankton growth resulting in an estimated increase in primary productivity averaging 1.5 g C·m−2·day−1 over 15 days. During this bloom, chlorophyll‐a increased by 3.6 mg/m3, and dissolved oxygen increased from 111% to 123% of saturation. Similar observations during TC Vardah (6–12 December 2016) showed much less mixing. Our analysis suggests that relatively small (high) translation speed and the presence of cold (warm) core eddy leads to strong (weak) oceanic response during TC Hudhud (TC Vardah). Thus, although cyclones can cause strong biogeochemical responses in the Bay of Bengal, the strength of response depends on the properties of the storm and the prevailing upper ocean structure such as the presence of mesoscale eddies. Plain Language Summary: It is very difficult to quantify the upper ocean physical and biogeochemical response to extreme weather conditions like tropical cyclones (TCs). In situ vertical profiles of temperature, salinity, chlorophyll fluorescence, dissolved oxygen, nutrients, and optical backscatter from the biogeochemical‐Argo floats can provide unique opportunity to quantify the upper ocean biogeochemical response to tropical cyclone, if cyclones traverse over the floats. In this study, the proximity of a biogeochemical‐Argo float to TC Hudhud and TC Vardah tracks, having similar intensity when it was close to the float location, reveals that oceanic responses are quite higher in the former than the latter. Our results suggest that translation speed of the storm and background oceanic conditions such as the presence of mesoscale eddies determines the ocean biogeochemical evolution in response to TCs. Key Points: Upper ocean biogeochemical response to the tropical cyclone Hudhud and Vardah using BGC‐Argo float in the Bay of BengalPreexisting oceanic conditions and TC translation speed on biogeochemical responses are examinedThe importance of profiling float on the calculation of primary productivity is examined [ABSTRACT FROM AUTHOR]

The aim of this systematic review and meta-analysis was to summarize and compare the available evidence on the level of vitamin D and antioxidant trace elements between the keratoconus (KC) patients and healthy controls. Seven case–control studies with 830 subjects were found eligible with a systematic search using PubMed, SCOPUS, Web of Science, and EMBASE till November 21, 2021. Data were synthesized with a DerSimonian and Laird random-effects method of meta-analysis. The mean serum vitamin D level was significantly lower in the patients with KC [standardized mean difference (SMD): −0.71; P < 0.001] as compared with the control group. The mean serum vitamin D level decreased more in the progressive patients (SMD: −0.80; P = 0.016) than in the stable patients (SMD: −0.66; P < 0.001) when compared with the control group. The mean serum zinc level was found significantly lower in the patients with KC compared with the control group (SMD: −1.98; P = 0.005). Pooled analysis based on the two studies showed significantly lower mean selenium levels in the KC patients (SMD: −0.34; P = 0.003). Regular evaluation of serum vitamin D, zinc, and selenium levels among the patients with KC at disease onset and future follow-ups could be promising in predicting the progressive disease and disease severity.

Abstract Background: Peri-diagnostic vaccination contemporaneous with SARS-CoV-2 infection might boost antiviral immunity and improve patient outcomes. We investigated, among previously unvaccinated patients, whether vaccination (with the Pfizer, Moderna, or J&J vaccines) during the week before or after a positive COVID-19 test was associated with altered 30-day patient outcomes. Methods: Using a deidentified longitudinal EHR repository, we selected all previously unvaccinated adults who initially tested positive for SARS-CoV-2 between December 11, 2020 (the date of vaccine emergency use approval) and December 19, 2021. We assessed whether vaccination between days –7 and +7 of a positive test affected outcomes. The primary measure was progression to a more severe disease outcome within 30 days of diagnosis using the following hierarchy: hospitalization, intensive care, or death. Results: Among 60,031 hospitalized patients, 543 (0.91%) were initially vaccinated at the time of diagnosis and 59,488 (99.09%) remained unvaccinated during the period of interest. Among 316,337 nonhospitalized patients, 2,844 (0.90%) were initially vaccinated and 313,493 (99.1%) remained unvaccinated. In both analyses, individuals receiving vaccines were older, more often located in the northeast, more commonly insured by Medicare, and more burdened by comorbidities. Among previously unvaccinated patients, there was no association between receiving an initial vaccine dose between days −7 and +7 of diagnosis and progression to more severe disease within 30 days compared to patients who did not receive vaccines. Conclusions: Immunization during acute SARS-CoV-2 infection does not appear associated with clinical progression during the acute infectious period.