Letters and Science

We evaluated the impact of intermittent preventive treatment in infants (IPTi) with sulfadoxine-pyrimethamine (SP), which was given at ages 3, 4, and 9 months through the Expanded Program on Immunization (EPI), on the development of antibody responses to Plasmodium falciparum in Mozambique. Immunoglobulin M (IgM) and IgG subclass antibodies specific to whole asexual parasites and to recombinant MSP-1 19 , AMA-1, and EBA-175 were measured at ages 5, 9, 12, and 24 months for 302 children by immunofluorescence antibody tests and by enzyme-linked immunosorbent assays. Antibody responses did not significantly differ between children receiving IPTi with SP and those receiving a placebo at any time point measured, with the exception of the responses of IgG and IgG1 to AMA-1 and/or MSP-1 19 , which were significantly higher in the SP-treated group than in the placebo group at ages 5, 9, and/or 24 months. IPTi with SP given through the EPI reduces the frequency of malarial illness while allowing the development of naturally acquired antibody responses to P. falciparum antigens.

Background Multiplex cytokine profiling systems are useful tools for investigating correlates of protective immunity. Several Luminex and flow cytometry methods are commercially available but there is limited information on the relative performance of different kits. A series of comparison experiments were carried out to determine the most appropriate method for our subsequent studies. Methods Two Luminex methods were compared, the Bio-Rad human 17-plex panel and the Invitrogen (formerly BioSource) human cytokine 10-plex kit, and two flow cytometry methods, the Becton Dickinson Human Th1/Th2 Cytokine Kit (CBA) and the Bender MedSystems Human Th1/Th2 11plex FlowCytomix Multiplex Kit. All kits were tested for the measurement of cytokines in supernatants collected from human leukocytes stimulated with viable Plasmodium falciparum infected red blood cells (iRBC) or P. falciparum schizont lysates. Results Data indicated that the kits differed in sensitivity and reproducibility depending on the cytokine, and detected different quantities of some cytokines. The Bio-Rad 17-plex kit was able to detect more positive responses than the Invitrogen 10-plex kit. However, only when detecting IL-1, IL-6 or TNF did the two Luminex based methods correlate with one another. In this study, the flow cytometry based techniques were less variable and correlated better with one another. The two flow cytometry based kits showed significant correlation when detecting IFN-γ, IL-2, TNF, IL-10 and IL-6, but overall the BD kit detected more positive responses than the Bender MedSystems kit. Conclusions The microsphere suspension array technologies tested differed in reproducibility and the absolute quantity of cytokine detected. Sample volume, the number of cytokines measured, and the time and cost of the assays also differed. These data provide an accurate assessment of the four techniques, which will allow individual researchers to select the tool most suited for their study population.

This study aimed to evaluate whether intermittent preventive treatment in infants with sulfadoxinepyrimethamine (IPTi-SP) had an effect on the acquisition of IgG against Plasmodium falciparum variant surface antigens (VSA) and growth-inhibitory antibodies in Manhiç a, Mozambique. In addition, we assessed factors affecting the magnitude of these responses and the association between antibody levels and protection against malaria.

In her target article, Victoria Plaut explores two differing models of diversity. She also explores the concept of "diversity science." The authors of the present commentary propose the following question: What is diversity science? They suspect that for a majority of readers, the term may suggest a topical science, in much the same way we might think of “rocket science” as being a science that focuses on rockets. Certainly, terms that are already familiar within the psychology literature, such “relationship science” or “personality science,” have been coined in this cast. Diversity science could similarly fill a new, specialized niche. However, they would like to argue here for a more expansive definition of diversity science, one that recognizes that the general principles behind the sociocultural framework that Plaut discusses apply to just about every aspect of human behavior. In so doing, the view they propose here is that “diversity science” is, in fact, nothing less than psychological science. In other words, psychology itself is the science of diversity.

BACKGROUND Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are established as effective therapies for patients with ischemic heart disease. However, there is insufficient literature comparing the impact of revascularization approach on readmissions, resource utilization, and mortality in patients with autoimmune vascular disorders. METHODS All patients who underwent percutaneous coronary intervention and/or coronary artery bypass grafting in the 2010-2014 National Readmission Database (NRD) were considered for analysis. The NRD is an all-payer inpatient database maintained by the Healthcare Cost and Utilization Project (HCUP) that estimates more than 35 million annual U.S. hospitalizations. The primary outcomes were 30-day readmission, mortality, length of stay, and GDP-adjusted cost. A hierarchical linear model adjusting for socioeconomic, demographic and comorbidity measured by Elixhauser Comorbidity Index was used to adjust for baseline differences. RESULTS Of the 3,003 total patients with autoimmune vasculitis, 2,259 (75%) underwent PCI and 744 patients had CABG during the study period. PCI patients were more likely female (53 vs 39%, p<0.001) and had lower Elixhauser Comorbidity Index (4.7 vs 5.3, p<0.01). PCI approach was associated with significantly lower overall cost ($26,658 vs $54,208, p<0.001) and a shorter length of stay (5.8 vs 13 days, p<0.001). There was no significant difference in cost for readmission within 30 days ($11,362 vs $15,400, p¼NS), length of stay for readmission within 30 days (5.9 vs 6.5 days IRR:1.00, p¼NS), all-cause readmission (20% vs 15% OR:1.24 p¼NS), or mortality (3.2% vs 5.3%, OR:0.99, p¼NS) between the two approaches. CONCLUSION In this short follow up study of 3,003 U.S. patients with autoimmune vasculitis and ischemic heart disease, PCI approach was associated with significant reduction in cost and length of stay compared to CABG after adjustment for demographics, comorbidities, and hospital level variation. Our findings indicate that PCI may be a suitable and cost-conscious approach to patients with autoimmune vasculitides.

The study objective was to evaluate the association between surgical left atrial appendage ligation and in-hospital stroke incidence after coronary artery bypass grafting among patients with atrial fibrillation. A retrospective cohort study was performed by using the Nationwide Inpatient Sample between 2008 and 2014. All atrial fibrillation patients who underwent coronary artery bypass graft were included and categorized as left atrial appendage ligation or control group. Propensity score-weighted regression analyses were performed to assess the impact of left atrial appendage ligation on stroke incidence. A total of 234,642 patients were identified, among whom 20,664 (8.81%) received concomitant left atrial appendage ligation. The national postoperative stroke incidence was 0.92%. Results of the propensity-weighted regression analysis showed no significant association between LAA ligation and control with regard to postoperative stroke (odds ratio [OR], 0.83; confidence interval [C...

Background: Depression affects between 10% and 40% of cardiac surgery patients and is associated with significantly worse outcomes. The incidence and impact of new-onset depression beyond acute follow-up remain ill-defined. The present study aimed to evaluate the incidence, risk factors, and prognostic implication of depression on 90-d readmission rates after coronary artery bypass grafting (CABG) surgery. Methods: A retrospective cohort study was performed identifying adult patients without prior depression who underwent CABG surgery using the 2010-2014 National Readmissions Database. CABG patients who were readmitted more than 2 wk but within 90 d of discharge were categorized based on the presence of new-onset depression. Association between the development of new-onset depression and rehospitalization were morbidity, mortality, costs, and length of stay (LOS) and were examined using multivariable regression. Results: During the study period, 1,001,945 patients underwent CABG. Of these, 11.7% of patients were readmitted after 14 d but within 90 d of discharge with 5.1% of these patients having a diagnosis of new-onset depression. Postoperative new-onset depression was not associated with increased readmission morbidity, costs, or LOS. Mortality in new-onset depression readmissions was 1.2%, compared with 2.3% in all readmitted patients (P ¼ 0.014). Depression was associated with lower odds of mortality (OR ¼ 0.56, P ¼ 0.02). Conclusions: New-onset depression following CABG discharge was not associated with increased odds of mortality, morbidity, costs, or increased LOS on readmission. Rather, new-onset depression is associated with decreased odds of readmission mortality. Overall, CABG readmissions are decreasing, whereas the rate of new-onset depression is slightly

The use of extracorporeal membrane oxygenation (ECMO) has emerged as a common therapy for severe cardiopulmonary dysfunction. We aimed to describe the relationship of institutional volume with patient outcomes and examine transfer status to tertiary ECMO centers. Using the National Inpatient Sample, we identified adult patients who received ECMO from 2008 to 2014. Individual hospital volume was calculated as tertiles of total institutional discharges for each year independently. Of the total 18,684 adult patients placed on ECMO, 2548 (13.6%), 5278 (28.2%), and 10,858 (58.1%) patients were admitted to low-, medium-, and high-volume centers, respectively. Unadjusted mortality at low-volume hospitals was less than that of medium- (43.7% versus 50.3%, P = 0.03) and high-volume hospitals (43.7% versus 55.6%, P &lt; 0.001). Length of stay and cost were reduced at low-volume hospitals compared to both medium- and large-volume institutions (all P &lt; 0.001). In high-volume institutions, tr...

Extracorporeal membrane oxygenation is used as a life-sustaining measure in patients with acute or end-stage cardiac or respiratory failure. We analyzed national trends in extracorporeal membrane oxygenation use and outcomes and assessed the influence of hospital demographics. Adult extracorporeal membrane oxygenation patients in the 2008-2014 National Inpatient Sample were evaluated. Patient and hospital characteristics, extracorporeal membrane oxygenation indication, mortality, and hospital costs were analyzed. A total 17,020 adult extracorporeal membrane oxygenation patients were considered: 47.4% respiratory failure, 38.6% postcardiotomy, 5.5% lung transplantation, 5.5% cardiogenic shock, and 3.2% heart transplantation. Admissions rose 361% from 1,026 in 2008 to 4,815 in 2014 (P &lt; .0001), and the fraction of respiratory failure increased 40.5%-49.8% (P &lt; .001). Elixhauser scores rose from 3.1 to 4.1 (P &lt; .0001). Mortality decreased among total admissions from 62.4% to 4...

Thoracic aortic injuries have traditionally been associated with high morbidity and mortality. Thoracic endovascular aortic repair has emerged as a suitable alternative to open repair, but its impact at a national level remains ill defined. This study aimed to analyze the national trends of patient characteristics, outcomes, and resource utilization in the treatment of thoracic aortic injuries. Patients admitted with thoracic aortic injuries from 2005-2014 were identified in the National Inpatient Sample. Patients were identified as undergoing thoracic endovascular aortic repair, open surgery, or nonoperative management. The primary outcome was in-hospital mortality, while secondary outcomes included complications and costs. Multivariate regressions accounting for characteristics of the patients and injury characteristics were used to determine predictors of mortality and changes in cost. Of the 11,257 patients admitted for thoracic aortic injuries, 33% received thoracic endovascula...

Granulomatosis with polyangiitis (GPA) is one of three described anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). Early diagnosis and treatment of GPA is paramount, as it may help prevent irreversible end-organ damage, especially renal and pulmonary failure. A 72-year-old male with a past medical history of lung adenocarcinoma in remission, chronic sinusitis status-post multiple sinus surgeries, and coronary artery disease presented with shortness of breath, dark urine, and asymmetric polyarthralgias. He had an acute kidney injury, leukocytosis, with urinalysis demonstrating pyuria and hematuria, without casts. Chest imaging showed cavitary nodular opacities in addition to interval increase of existing nodules compared to the most recent scan one month prior. His acute kidney injury progressed to renal failure requiring hemodialysis, and he developed an inflammatory polyarthritis. GPA was suspected clinically so he was started on high-dose intravenous corti...

RESULTS: Of the 3120 patients recruited in the MROC study, 317 met inclusion criteria. Of those, 237 patients received radiation treatment before expander-implant exchange (TE-XRT), and 80 received radiation treatment after exchange (Implant-XRT). Controlling for covariates, radiation timing had no significant effects on PRO subscale scores at two years postoperatively. Compared with preoperative assessments, two year PRO scores were significantly lower in both cohorts for satisfaction with breast, physical well-being, and sexual well-being subscales of BREASTQ (p &lt; 0.05). In addition, for the TE-XRT cohort, the two year PRO scores were significantly lower in the body image subscale of EORTC as well (p &lt; 0.05). Finally, timing of radiation had no significant effects on odds of overall complications, major complications or reconstructive failure.

This paper provides KKT and saddle point optimality conditions, duality theorems and stability theorems for consistent convex optimization problems posed in locally convex topological vector spaces. The feasible sets of these optimization problems are formed by those elements of a given closed convex set which satisfy a (possibly infinite) convex system. Moreover, all the involved functions are assumed to be convex, lower semicontinuous and proper (but not necessarily real-valued). The key result in the paper is the characterization of those reverse-convex inequalities which are consequence of the constraints system. As a byproduct of this new versions of Farkas' lemma we also characterize the containment of convex sets in reverse-convex sets. The main results in the paper are obtained under a suitable Farkas-type constraint qualifications and/or a certain closedness assumption.

Contrary to our intuitive understanding of the Cold War as a discourse of division, Christina Klein (2003) argues that it is also a discourse of integration, serving to bring the allies closer to each other. The fundamental logic of the Cold War was, thus considered, a Schmittian game of telling friends from enemies, in which betrayal is an unpardonable crime and a traitor the worst kind of enemy. Yet at the same time, betrayal also acknowledges an intimacy that existed prior to the act of betrayal: an intimacy that must be denounced and, even, at times, held in disgust. During the Cold War, while Taiwan worried about being betrayed by its staunch allies and was at risk of being betrayed by its KMT leadership, and while Taiwan, if it converted to communism, would have harmed American interests on the Asia/Pacific front, betrayal was both a real political risk and a risky fiction, one which often (con)fused reality with imagination. In this paper, I analyze an obscure 1965 Cold War novel, The Jing Affair, written by a US government official serving in the Far East Affairs Department under the pseudonym of D. J. Spencer. The novel imagines an attempt by a high KMT official, named Jing, to turn Taiwan over to Chinese communists: this presents an imminent threat to Taiwan's independence and American national interests. Featuring a Taiwanese-American hero who succeeds in preventing this act of betrayal, The Jing Affair is a political romance about Chinese treason, Taiwanese revolution, and CIA covert operations, set in the impending Taiwan Strait Crises of the 1950s. This risky fiction leads us to reflect on how an imaginary crisis can be productive, for it means imagining an alternative history that bears on political reality. The novel's Hollywood-esque meshing of political suspense and romantic subplots also reveals the sort of risky connections between fantasy and politics that could put real lives at risk.