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Abstract BackgroundDiagnosis codes and prescription data are used in algorithms to identify postherpetic neuralgia (PHN), a debilitating complication of herpes zoster (HZ). Because of the questionable accuracy of codes and prescription data, manual chart review is sometimes used to identify PHN in electronic health records (EHRs), which can be costly and time-consuming. ObjectiveThis study aims to develop and validate a natural language processing (NLP) algorithm for automatically identifying PHN from unstructured EHR data and to compare its performance with that of code-based methods. MethodsThis retrospective study used EHR data from Kaiser Permanente Southern California, a large integrated health care system that serves over 4.8 million members. The source population included members aged ≥50 years who received an incident HZ diagnosis and accompanying antiviral prescription between 2018 and 2020 and had ≥1 encounter within 90‐180 days of the incident HZ diagnosis. The study team manually reviewed the EHR and identified PHN cases. For NLP development and validation, 500 and 800 random samples from the source population were selected, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F-score, and Matthews correlation coefficient (MCC) of NLP and the code-based methods were evaluated using chart-reviewed results as the reference standard. ResultsThe NLP algorithm identified PHN cases with a 90.9% sensitivity, 98.5% specificity, 82% PPV, and 99.3% NPV. The composite scores of the NLP algorithm were 0.89 (F-score) and 0.85 (MCC). The prevalences of PHN in the validation data were 6.9% (reference standard), 7.6% (NLP), and 5.4%‐13.1% (code-based). The code-based methods achieved a 52.7%‐61.8% sensitivity, 89.8%‐98.4% specificity, 27.6%‐72.1% PPV, and 96.3%‐97.1% NPV. The F-scores and MCCs ranged between 0.45 and 0.59 and between 0.32 and 0.61, respectively. ConclusionsThe automated NLP-based approach identified PHN cases from the EHR with good accuracy. This method could be useful in population-based PHN research.

HepB-CpG is a licensed adjuvanted two-dose hepatitis B vaccine for adults, with limited data on exposure during pregnancy. We assessed the risk of pregnancy outcomes among individuals who received HepB-CpG or the 3-dose HepB-alum vaccine ≤28 d prior to conception or during pregnancy at Kaiser Permanente Southern California (KPSC). The pregnancy cohort included KPSC members aged ≥18 y who received ≥1 dose of hepatitis B vaccine (HepB-CpG or HepB-alum) at KPSC outpatient family or internal medicine departments from August 2018 to November 2020. We followed these individuals through electronic health records from the vaccination date until the end of pregnancy, KPSC health plan disenrollment, or death, whichever came first. Among 81 and 125 eligible individuals who received HepB-CpG and HepB-alum, respectively, live births occurred in 84% and 74%, spontaneous abortion occurred in 7% and 17% (adjusted relative risk [aRR] 0.40, 95% CI: 0.16–1.00), and preterm birth occurred in 15% and 14% of liveborn infants (aRR 0.97, 95% CI 0.47–1.99). No major birth defects were identified through 6 months of age. The study found no evidence of adverse pregnancy outcomes for recipients of HepB-CpG in comparison to HepB-alum.

ABSTRACTEmerging 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.

Post-industrial regeneration, the conversion and integration of brown lands into green spaces, has become a prevalent process in contemporary urban sustainable development. Previous research on post-industrial landscapes has mostly focused on qualitative studies and paid little attention to the visual and physical attributes of these landscapes, providing little quantitative analyses of their physical qualities. We examined the relationship between landscape characteristics and individual perceptions and preferences of post-industrial landscapes. We used statistical modeling, including multivariate stepwise regression models, to involve the multidimensional integration of participants’ physiological responses, eye-tracking responses, and mental activity data. We found: 1) The hypothesis that “coherence and legibility may not serve as mediating factors in the relationship between low-level image features and preference as well as positive perception“ has been rejected. 2) The post-industrial landscape has unique aesthetic features of “Original – New Placement”. In this study, participants preferred artificial to natural scenes. 3) The significant factors in enhancing participants’ perceptions and preferences were the increase in the percentages of industrial remains, new construction, and ground-covering plants elements. 4) The type of artificial views in the post-industrial landscape has been positively influenced by the sense of industrial historical atmosphere and the sense of aesthetic appeal for industrial remains. 5) The percentage of water in post-industrial waterfront environments might reduce participants’ initial attraction to industrial remains in their original location. In application, these findings could help improve public preference and satisfaction in the design of post-industrial landscapes.

Abstract The bivalent (original and Omicron BA.4/BA.5) mRNA-1273 COVID-19 vaccine was authorized to offer broader protection against COVID-19. We conducted a matched cohort study to evaluate the effectiveness of the bivalent vaccine in preventing hospitalization for COVID-19 (primary outcome) and medically attended SARS-CoV-2 infection and hospital death (secondary outcomes). Compared to individuals who did not receive bivalent mRNA vaccination but received ≥2 doses of any monovalent mRNA vaccine, the relative vaccine effectiveness (rVE) against hospitalization for COVID-19 was 70.3% (95% confidence interval, 64.0%–75.4%). rVE was consistent across subgroups and not modified by time since last monovalent dose or number of monovalent doses received. Protection was durable ≥3 months after the bivalent booster. rVE against SARS-CoV-2 infection requiring emergency department/urgent care and against COVID-19 hospital death was 55.0% (50.8%–58.8%) and 82.7% (63.7%–91.7%), respectively. The mRNA-1273 bivalent booster provides additional protection against hospitalization for COVID-19, medically attended SARS-CoV-2 infection, and COVID-19 hospital death.

Urban green spaces shaped by the post-industrial landscape possess distinctive characteristics and aesthetic features due to the exceptional properties of industrial remains. Previous studies have indicated that various types of urban green spaces without industrial remains, such as urban parks, waterfronts, and streets, have a positive impact on the public's physiological and psychological well-being. However, the extent and mechanisms of the public's response to post-industrial landscapes remain unclear. To investigate mechanisms of public perceptions of and preferences for post-industrial landscape types and elements, we conducted quantitative analysis by coupling multimodal data and comparative or difference analyses among urban green spaces. We conducted a randomized controlled experiment with 48 participants who viewed images of different combinations of post-industrial landscapes in a distraction-free environment. After a pause, Positive-Negative perception and Preference questionnaires were completed. Eye tracking data were recorded during the experiment. Changes in electrodermal activity and heart rate variability were used to measure physiological stress. This study employed Pearson's correlation model to examine the relationships between objective data and subjective data. The ANOVA test was utilized to investigate the variability of objective and subjective data across different groups. Additionally, a multiple-stepwise regression model was employed to analyze the specific influencing factors and their respective degrees of influence. We found that (1) artificial landscape elements in post-industrial landscapes were more appealing to participants and heightened their sense of stress; natural landscape elements can alleviate stress and promote restoration. (2) The percentage of flowering shrub and tree elements was significantly positively correlated with preference, while the percentage of ground-covering plant elements was significantly negatively correlated with preference. (3) Industrial construction was significantly positively correlated with the sense of historical value while industrial construction and pavement elements negatively correlated with preference. However, pavement elements significantly mitigated the sense of insecurity, poor accessibility, and pollution risk. (4) Industrial construction and pavement distinguished the post-industrial landscape from other green spaces without industrial remains while maximizing historical value and curiosity helped increase positive effects. Although impact mechanisms of natural elements in other green spaces without industrial remains showed homogeneous similarities, the scene composed of industrial mixed with natural elements may lead to different perceptions. Our findings indicate that multimodal data coupled with comparative analysis of multiple green space types can help to fully identify mechanisms by which landscape types and elements influence public perceptions and preferences. This understanding can help increase public satisfaction with post-industrial landscapes and enable researchers to determine the sustainability of post-industrial sites using interrogative design.

In this study, the authors estimate the effectiveness of the mRNA-1273 (Moderna) vaccine for Omicron subvariants using data from the USA on ~31,000 cases and ~92,000 matched controls. They find that effectiveness against infection waned rapidly after third and fourth doses, but effectiveness against hospitalization remained high.