Influenza Vaccine Effectiveness in the Elderly Based on Administrative Databases: Change in Immunization Habit as a Marker for Bias

Administrative databases provide efficient methods to estimate influenza vaccine effectiveness (IVE) against severe outcomes in the elderly but are prone to intractable bias. This study returns to one of the linked population databases by which IVE against hospitalization and death in the elderly was first assessed. We explore IVE across six more recent influenza seasons, including periods before, during, and after peak activity to identify potential markers for bias.Acute respiratory hospitalization and all-cause mortality were compared between immunized/non-immunized community-dwelling seniors ≥65 years through administrative databases in Manitoba, Canada between 2000-01 and 2005-06. IVE was compared during pre-season/influenza/post-season periods through logistic regression with multivariable adjustment (age/sex/income/residence/prior influenza or pneumococcal immunization/medical visits/comorbidity), stratification based on prior influenza immunization history, and propensity scores. Analysis during pre-season periods assessed baseline differences between immunized and unimmunized groups. The study population included ∼140,000 seniors, of whom 50-60% were immunized annually. Adjustment for key covariates and use of propensity scores consistently increased IVE. Estimates were paradoxically higher pre-season and for all-cause mortality vs. acute respiratory hospitalization. Stratified analysis showed that those twice consecutively and currently immunized were always at significantly lower hospitalization/mortality risk with odds ratios (OR) of 0.60 [95%CI0.48-0.75] and 0.58 [0.53-0.64] pre-season and 0.77 [0.69-0.86] and 0.71 [0.66-0.77] during influenza circulation, relative to the consistently unimmunized. Conversely, those forgoing immunization when twice previously immunized were always at significantly higher hospitalization/mortality risk with OR of 1.41 [1.14-1.73] and 2.45 [2.21-2.72] pre-season and 1.21 [1.03-1.43] and 1.78 [1.61-1.96] during influenza circulation.The most pronounced IVE estimates were paradoxically observed pre-season, indicating bias tending to over-estimate vaccine protection. Change in immunization habit from that of the prior two years may be a marker for this bias in administrative data sets; however, no analytic technique explored could adjust for its influence. Improved methods to achieve valid interpretation of protection in the elderly are needed

Phenotypic plasticity and genetic control in colorectal cancer evolution.

Genetic and epigenetic variation, together with transcriptional plasticity, contribute to intratumour heterogeneity1. The interplay of these biological processes and their respective contributions to tumour evolution remain unknown. Here we show that intratumour genetic ancestry only infrequently affects gene expression traits and subclonal evolution in colorectal cancer (CRC). Using spatially resolved paired whole-genome and transcriptome sequencing, we find that the majority of intratumour variation in gene expression is not strongly heritable but rather 'plastic'. Somatic expression quantitative trait loci analysis identified a number of putative genetic controls of expression by cis-acting coding and non-coding mutations, the majority of which were clonal within a tumour, alongside frequent structural alterations. Consistently, computational inference on the spatial patterning of tumour phylogenies finds that a considerable proportion of CRCs did not show evidence of subclonal selection, with only a subset of putative genetic drivers associated with subclone expansions. Spatial intermixing of clones is common, with some tumours growing exponentially and others only at the periphery. Together, our data suggest that most genetic intratumour variation in CRC has no major phenotypic consequence and that transcriptional plasticity is, instead, widespread within a tumour

First observations of separated atmospheric nu_mu and bar{nu-mu} events in the MINOS detector

The complete 5.4 kton MINOS far detector has been taking data since the beginning of August 2003 at a depth of 2070 meters water-equivalent in the Soudan mine, Minnesota. This paper presents the first MINOS observations of nuµ and [overline nu ]µ charged-current atmospheric neutrino interactions based on an exposure of 418 days. The ratio of upward- to downward-going events in the data is compared to the Monte Carlo expectation in the absence of neutrino oscillations, giving Rup/downdata/Rup/downMC=0.62-0.14+0.19(stat.)±0.02(sys.). An extended maximum likelihood analysis of the observed L/E distributions excludes the null hypothesis of no neutrino oscillations at the 98% confidence level. Using the curvature of the observed muons in the 1.3 T MINOS magnetic field nuµ and [overline nu ]µ interactions are separated. The ratio of [overline nu ]µ to nuµ events in the data is compared to the Monte Carlo expectation assuming neutrinos and antineutrinos oscillate in the same manner, giving R[overline nu ][sub mu]/nu[sub mu]data/R[overline nu ][sub mu]/nu[sub mu]MC=0.96-0.27+0.38(stat.)±0.15(sys.), where the errors are the statistical and systematic uncertainties. Although the statistics are limited, this is the first direct observation of atmospheric neutrino interactions separately for nuµ and [overline nu ]µ

Systematisation of spatial uncertainties for comparison between a MR and a CT-based radiotherapy workflow for prostate treatments

<p>Abstract</p> <p>Background</p> <p>In the present work we compared the spatial uncertainties associated with a MR-based workflow for external radiotherapy of prostate cancer to a standard CT-based workflow. The MR-based workflow relies on target definition and patient positioning based on MR imaging. A solution for patient transport between the MR scanner and the treatment units has been developed. For the CT-based workflow, the target is defined on a MR series but then transferred to a CT study through image registration before treatment planning, and a patient positioning using portal imaging and fiducial markers.</p> <p>Methods</p> <p>An "open bore" 1.5T MRI scanner, Siemens Espree, has been installed in the radiotherapy department in near proximity to a treatment unit to enable patient transport between the two installations, and hence use the MRI for patient positioning. The spatial uncertainty caused by the transport was added to the uncertainty originating from the target definition process, estimated through a review of the scientific literature. The uncertainty in the CT-based workflow was estimated through a literature review.</p> <p>Results</p> <p>The systematic uncertainties, affecting all treatment fractions, are reduced from 3-4 mm (1Sd) with a CT based workflow to 2-3 mm with a MR based workflow. The main contributing factor to this improvement is the exclusion of registration between MR and CT in the planning phase of the treatment.</p> <p>Conclusion</p> <p>Treatment planning directly on MR images reduce the spatial uncertainty for prostate treatments.</p

Field Effectiveness of Pandemic and 2009-2010 Seasonal Vaccines against 2009-2010 A(H1N1) Influenza: Estimations from Surveillance Data in France

BACKGROUND: In this study, we assess how effective pandemic and trivalent 2009-2010 seasonal vaccines were in preventing influenza-like illness (ILI) during the 2009 A(H1N1) pandemic in France. We also compare vaccine effectiveness against ILI versus laboratory-confirmed pandemic A(H1N1) influenza, and assess the possible bias caused by using non-specific endpoints and observational data. METHODOLOGY AND PRINCIPAL FINDINGS: We estimated vaccine effectiveness by using the following formula: VE  =  (PPV-PCV)/(PPV(1-PCV)) × 100%, where PPV is the proportion vaccinated in the population and PCV the proportion of vaccinated influenza cases. People were considered vaccinated three weeks after receiving a dose of vaccine. ILI and pandemic A(H1N1) laboratory-confirmed cases were obtained from two surveillance networks of general practitioners. During the epidemic, 99.7% of influenza isolates were pandemic A(H1N1). Pandemic and seasonal vaccine uptakes in the population were obtained from the National Health Insurance database and by telephonic surveys, respectively. Effectiveness estimates were adjusted by age and week. The presence of residual biases was explored by calculating vaccine effectiveness after the influenza period. The effectiveness of pandemic vaccines in preventing ILI was 52% (95% confidence interval: 30-69) during the pandemic and 33% (4-55) after. It was 86% (56-98) against confirmed influenza. The effectiveness of seasonal vaccines against ILI was 61% (56-66) during the pandemic and 19% (-10-41) after. It was 60% (41-74) against confirmed influenza. CONCLUSIONS: The effectiveness of pandemic vaccines in preventing confirmed pandemic A(H1N1) influenza on the field was high, consistently with published findings. It was significantly lower against ILI. This is unsurprising since not all ILI cases are caused by influenza. Trivalent 2009-2010 seasonal vaccines had a statistically significant effectiveness in preventing ILI and confirmed pandemic influenza, but were not better in preventing confirmed pandemic influenza than in preventing ILI. This lack of difference might be indicative of selection bias

The Dark Energy Survey supernova programme: modelling selection efficiency and observed core-collapse supernova contamination

The analysis of current and future cosmological surveys of Type Ia supernovae (SNe Ia) at high redshift depends on the accurate photometric classification of the SN events detected. Generating realistic simulations of photometric SN surveys constitutes an essential step for training and testing photometric classification algorithms, and for correcting biases introduced by selection effects and contamination arising from core-collapse SNe in the photometric SN Ia samples. We use published SN time-series spectrophotometric templates, rates, luminosity functions, and empirical relationships between SNe and their host galaxies to construct a framework for simulating photometric SN surveys. We present this framework in the context of the Dark Energy Survey (DES) 5-yr photometric SN sample, comparing our simulations of DES with the observed DES transient populations. We demonstrate excellent agreement in many distributions, including Hubble residuals, between our simulations and data. We estimate the core collapse fraction expected in the DES SN sample after selection requirements are applied and before photometric classification. After testing different modelling choices and astrophysical assumptions underlying our simulation, we find that the predicted contamination varies from 7.2 to 11.7 per cent, with an average of 8.8 per cent and an r.m.s. of 1.1 per cent. Our simulations are the first to reproduce the observed photometric SN and host galaxy properties in high-redshift surveys without fine-tuning the input parameters. The simulation methods presented here will be a critical component of the cosmology analysis of the DES photometric SN Ia sample: correcting for biases arising from contamination, and evaluating the associated systematic uncertainty

Supernova host galaxies in the Dark Energy Survey: I. Deep coadds, photometry, and stellar masses

The 5-yr Dark Energy Survey Supernova Programme (DES-SN) is one of the largest and deepest transient surveys to date in terms of volume and number of supernovae. Identifying and characterizing the host galaxies of transients plays a key role in their classification, the study of their formation mechanisms, and the cosmological analyses. To derive accurate host galaxy properties, we create depth-optimized coadds using single-epoch DES-SN images that are selected based on sky and atmospheric conditions. For each of the five DES-SN seasons, a separate coadd is made from the other four seasons such that each SN has a corresponding deep coadd with no contaminating SN emission. The coadds reach limiting magnitudes of order ∼27 in g band, and have a much smaller magnitude uncertainty than the previous DES-SN host templates, particularly for faint objects. We present the resulting multiband photometry of host galaxies for samples of spectroscopically confirmed type Ia (SNe Ia), core-collapse (CCSNe), and superluminous (SLSNe) as well as rapidly evolving transients (RETs) discovered by DES-SN. We derive host galaxy stellar masses and probabilistically compare stellar-mass distributions to samples from other surveys. We find that the DES spectroscopically confirmed sample of SNe Ia selects preferentially fewer high-mass hosts at high-redshift compared to other surveys, while at low redshift the distributions are consistent. DES CCSNe and SLSNe hosts are similar to other samples, while RET hosts are unlike the hosts of any other transients, although these differences have not been disentangled from selection effects

SN 2018gjx reveals that some SNe Ibn are SNe IIb exploding in dense circumstellar material

We present the data and analysis of SN 2018gjx, an unusual low-luminosity transient with three distinct spectroscopic phases. Phase I shows a hot blue spectrum with signatures of ionized circumstellar material (CSM), Phase II has the appearance of broad SN features, consistent with those seen in a Type IIb supernova at maximum light, and Phase III is that of a supernova interacting with helium-rich CSM, similar to a Type Ibn supernova. This event provides an apparently rare opportunity to view the inner workings of an interacting supernova. The observed properties can be explained by the explosion of a star in an aspherical CSM. The initial light is emitted from an extended CSM (∼4000 R⊙), which ionizes the exterior unshocked material. Some days after, the SN photosphere envelops this region, leading to the appearance of a SN IIb. Over time, the photosphere recedes in velocity space, revealing interaction between the supernova ejecta and the CSM that partially obscures the supernova nebular phase. Modelling of the initial spectrum reveals a surface composition consistent with compact H-deficient Wolf–Rayet and Luminous Blue Variable (LBV) stars. Such configurations may not be unusual, with SNe IIb being known to have signs of interaction so at least some SNe IIb and SNe Ibn may be the same phenomena viewed from different angles, or possibly with differing CSM configurations

SN 2018gjx reveals that some SNe Ibn are SNe IIb exploding in dense circumstellar material

We present the data and analysis of SN 2018gjx, an unusual low-luminosity transient with three distinct spectroscopic phases. Phase I shows a hot blue spectrum with signatures of ionized circumstellar material (CSM), Phase II has the appearance of broad SN features, consistent with those seen in a Type IIb supernova at maximum light, and Phase III is that of a supernova interacting with helium-rich CSM, similar to a Type Ibn supernova. This event provides an apparently rare opportunity to view the inner workings of an interacting supernova. The observed properties can be explained by the explosion of a star in an aspherical CSM. The initial light is emitted from an extended CSM (similar to 4000 R-circle dot), which ionizes the exterior unshocked material. Some days after, the SN photosphere envelops this region, leading to the appearance of a SN IIb. Over time, the photosphere recedes in velocity space, revealing interaction between the supernova ejecta and the CSM that partially obscures the supernova nebular phase. Modelling of the initial spectrum reveals a surface composition consistent with compact H-deficient Wolf-Rayet and Luminous Blue Variable (LBV) stars. Such configurations may not be unusual, with SNe IIb being known to have signs of interaction so at least some SNe IIb and SNe Ibn may be the same phenomena viewed from different angles, or possibly with differing CSM configurations

First cosmology results using type Ia supernovae from the Dark Energy Survey: the effect of host galaxy properties on supernova luminosity

We present improved photometric measurements for the host galaxies of 206 spectroscopically confirmed type Ia supernovae discovered by the Dark Energy Survey Supernova Program (DES-SN) and used in the first DES-SN cosmological analysis. For the DES-SN sample, when considering a 5D (z, x1, c, α, β) bias correction, we find evidence of a Hubble residual ‘mass step’, where SNe Ia in high-mass galaxies (>1010M⊙) are intrinsically more luminous (after correction) than their low-mass counterparts by γ=0.040±0.019 mag. This value is larger by 0.031 mag than the value found in the first DES-SN cosmological analysis. This difference is due to a combination of updated photometric measurements and improved star formation histories and is not from host-galaxy misidentification. When using a 1D (redshift-only) bias correction the inferred mass step is larger, with γ=0.066±0.020 mag. The 1D−5D γ difference for DES-SN is 0.026±0.009 mag. We show that this difference is due to a strong correlation between host galaxy stellar mass and the x1 component of the 5D distance-bias correction. Including an intrinsic correlation between the observed properties of SNe Ia, stretch and colour, and stellar mass in simulated SN Ia samples, we show that a 5D fit recovers γ with −9 mmag bias compared to a +2 mmag bias for a 1D fit. This difference can explain part of the discrepancy seen in the data. Improvements in modelling correlations between galaxy properties and SN is necessary to ensure unbiased precision estimates of the dark energy equation of state as we enter the era of LSST