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The objective is to understand the role of emerging variants, vaccination, and NPI policies on COVID-19 infections and deaths. We aim to identify scenarios in which COVID-19 can be managed such that the death rate from COVID-19 becomes comparable with the combined annual mortality rate from influenza and pneumonia. As a case study for a large urban area, we simulate COVID-19 transmission in King County, Washington, (greater Seattle) using an agent- based simulation model. Calibrated to local epidemiological data, our study uses detailed synthetic population data and includes interactions between vaccination and specific NPIs while considering waning immunity and emergence of variants. Virus mutation scenarios include 12 combinations of infectivity, disease severity, and immune evasiveness. A highly effective pancoronavirus vaccine that works against all strains is considered an optimistic scenario. Our findings highlight the potential benefits of pancoronavirus vaccines that offer enhanced and longer-lasting immunity. We emphasize the crucial role of nonpharmaceutical interventions in reducing COVID-19 deaths regardless of virus mutation scenarios. Owing to highly immune evasive and contagious SARS-CoV-2 variants, most scenarios in this study fail to reduce the mortality of COVID-19 to the level of influenza and pneumonia. However, our findings indicate that periodic vaccinations and a threshold nonpharmaceutical intervention policy may succeed in achieving this goal. This indicates the need for caution and vigilance in managing a continuing COVID-19 epidemic. 

Precision medicine that enables personalized treatment decision support has become an increasingly important research topic in chronic disease care. The main challenges in designing a treatment algorithm include modeling individual disease progression dynamics and designing adaptive treatment selection strategy. This study aims to develop an adaptive treatment selection framework tailored to an individual patient’s disease progression pattern and treatment response. We propose a Partially Observable Collaborative Model (POCM) to capture the individual variations in a heterogeneous population and optimize treatment outcomes in three stages. The POCM first infers the disease progression models by subgroup patterns using population data in stage one and then fine-tunes the models for individual patients with a small number of treatment trials in stage two. In stage three, we show how the treatment policies based on the Partially Observable Markov Decision Process (POMDP) can be tailored to individual patients by utilizing the disease models learned from the POCM. Using a simulated population of chronic depression patients, we show that the POCM can more accurately estimate the personal disease progression than the traditional method of solving a hidden Markov model. We also compare the POMDP treatment policies with other heuristic policies and demonstrate that the POCM-based policies give the highest net monetary benefits in majority of parameter settings. To conclude, the POCM method is a promising approach to model the chronic disease progression process and recommend a personalized treatment plan for individual patients in a heterogeneous population. 

The outbreak of seasonal flu costs billions of dollars in health care utilization and lost productivity. Despite the effectiveness of vaccination and antiviral medications to prevent serious flu-related complications and slow down the spread of an influenza epidemic, only 52% of the U.S. population aged 6 months and older received flu vaccines in the 2019-20 flu season. In addition, a costly out-of-pocket expense results in fewer patients seeking treatment, leading to potential hospitalizations and even flu-related deaths. In this study, we develop an integrated healthcare insurance mechanism that optimizes two incentive policies, vaccination reward and cost-sharing, to alleviate the medical cost and disease burden while preventing the outbreak of seasonal influenza. We model the dynamic interaction between a single insurer and multiple insureds as a Stackelberg vaccination game; we then embed the game into an agent-based simulation to model the spread of flu in a population under different policies. Finally, we apply machine learning and simulation optimization to optimize healthcare incentive policies in a large-scale flu transmission simulation. Simulation results indicate that the proposed methodology efficiently identifies a set of good incentive policies under different scenarios of flu vaccine efficacy and reproduction numbers. 

The evolution of SARS‐CoV‐2 paired with immune imprinting by prototype messenger RNA (mRNA) vaccine has challenged the current vaccination efficacy against newly emerged Omicron subvariants. In our study, we investigated a cohort of macaques infected by SIV and vaccinated with two doses of bivalent Pfizer mRNA vaccine containing wildtype and BA.5 spikes. Using a pseudotyped lentivirus neutralization assay, we determined neutralizing antibody (nAb) titers against new XBB variants, i.e., XBB.1.5, XBB.1.16, and XBB.2.3, alongside D614G and BA.4/5. We found that compared to humans vaccinated with three doses of monovalent mRNA vaccine plus a bivalent booster, the monkeys vaccinated with two doses of bivalent mRNA vaccines exhibited relatively increased titers against XBB subvariants. Of note, SIV‐positive dam macaques had reduced nAb titers relative to SIV‐negative dams. Additionally, SIV positive dams that received antiretroviral therapy had lower nAb titers than untreated dams. Our study underscores the importance of reformulating the COVID‐19 vaccine to better protect against newly emerged XBB subvariants as well as the need for further investigation of vaccine efficacy in individuals living with HIV‐1.

 

Hydrophobic and long-chain molecule oleylamine is used to modify the spiro-OMeTAD matrix, which is then adopted for the hole-transport layer in perovskite solar cells. It is observed that after moderate doping, the power conversion efficiency of the devices increases from 17.82 (±1.47)% to 20.68 (±0.77)%, with the optimized efficiency of 21.57% (AM 1.5G, 100 mW/cm2). The improved efficiency is ascribed to the favored charge extraction and retarded charge recombination, as reflected by transient photovoltage/photocurrent curves and impedance spectroscopy measurement. In addition, the grazing incidence photoluminescence spectrum reveals that oleylamine doping causes a blue shift of the luminescence peak of the surface layer of the halide perovskite film, while the Mott−Schottky study observes 100 mV increment in the built-in potential, both of which indicate possible defect passivation behavior on the perovskite. Moreover, an accelerated damp test observes that moisture resistance of the device is also upgraded, which is due to the improved hydrophobicity of the spiro-OMeTAD matrix. 

As the novel coronavirus (COVID-19) pandemic continues to expand, policymakers are striving to balance the combinations of nonpharmaceutical interventions (NPIs) to keep people safe and minimize social disruptions. We developed and calibrated an agent-based simulation to model COVID-19 outbreaks in the greater Seattle area. The model simulated NPIs, including social distancing, face mask use, school closure, testing, and contact tracing with variable compliance and effectiveness to identify optimal NPI combinations that can control the spread of the virus in a large urban area. Results highlight the importance of at least 75% face mask use to relax social distancing and school closure measures while keeping infections low. It is important to relax NPIs cautiously during vaccine rollout in 2021.