Dipstick proteinuria is an independent predictor of high on treatment platelet reactivity in patients on clopidogrel, but not aspirin, admitted for major adverse cardiovascular events.

Abstract The effectiveness of aspirin and clopidogrel in patients with chronic kidney disease (CKD) suffering from acute cardiovascular events is unclear. High on treatment platelet reactivity (HTPR) has been associated with worse outcomes. Here, we assessed the association of dipstick proteinuria (DP) and renal function on HTPR and clinical outcomes. Retrospective cohort analysis of 261 consecutive, non-dialysis patients admitted for Major Adverse Cardiovascular Events (MACE) that had VerifyNow P2Y12 and VerifyNow Aspirin assays performed. HTPR was defined as P2Y12 reactivity unit (PRU) \u3e 208 for clopidogrel and aspirin reaction units (ARU) \u3e 550 for aspirin. Renal function was classified based on the estimated glomerular filtration rate (eGFR), and dipstick proteinuria was defined as ≥30 mg/dl of albumin detected on a spot analysis. All cause mortality, readmissions, and cardiac catheterizations were reviewed over 520 days. In patients on clopidogrel (n = 106), DP was associated with HTPR, independent of eGFR, diabetes mellitus, smoking or use of proton pump inhibitor (AOR = 4.76, p = 0.03). In patients with acute coronary syndromes, HTPR was associated with more cardiac catheterizations (p = 0.009) and readmissions (p = 0.032), but no differences in in-stent thrombosis or re-stenosis were noted in this cohort. In patients on aspirin (n = 155), no associations were seen between DP and HTPR. However, all cause mortality was significantly higher with HTPR in this group (p = 0.038). In this cohort, DP is an independent predictor of HTPR in patients on clopidogrel, but not aspirin, admitted to the hospital for MACE

Telescope Alignment From Sparsely Sampled Wavefront Measurements Over Pupil Subapertures

Alignment of two-element telescopes is a classic problem. During recent integration and test of the Space Interferometry Mission s (SIM s) Astrometric Beam Combiner (ABC), the innovators were faced with aligning two such telescope subsystems in the presence of a further complication: only two small subapertures in each telescope s pupil were accessible for measuring the wavefront with a Fizeau interferometer. This meant that the familiar aberrations that might be interpreted to infer system misalignments could be viewed only over small sub-regions of the pupil, making them hard to recognize. Further, there was no contiguous surface of the pupil connecting these two subapertures, so relative phase piston information was lost; the underlying full-aperture aberrations therefore had an additional degree of ambiguity. The solution presented here is to recognize that, in the absence of phase piston, the Zygo measurements primarily provide phase tilt in the subaperture windows of interest. Because these windows are small and situated far from the center of the (inaccessible) unobscured full aperture, any aberrations that are higher-order than tilt will be extremely high-order on the full aperture, and so not necessary or helpful to the alignment. Knowledge of the telescope s optical prescription allows straightforward evaluation of sensitivities (subap mode strength per unit full-aperture aberration), and these can be used in a predictive matrix approach to move with assurance to an aligned state. The technique is novel in every operational way compared to the standard approach of alignment based on full-aperture aberrations or searching for best rms wavefront. This approach is closely grounded in the observable quantities most appropriate to the problem. It is also more intuitive than inverting full phase maps (or subaperture Zernike spectra) with a ray-tracing program, which must certainly work in principle, but in practice met with limited success. Even if such classical alignment techniques became practical, the techniques reported here form a reassuringly transparent and intuitive check on the course of the alignment with very little computational effort

Aspects of Scalar Field Dynamics in Gauss-Bonnet Brane Worlds

The Einstein-Gauss-Bonnet equations projected from the bulk to brane lead to a complicated Friedmann equation which simplifies to $H^2 \sim \rho^q$ in the asymptotic regimes. The Randall-Sundrum (RS) scenario corresponds to $q=2$ whereas $q=2/3$ & $q=1$ give rise to high energy Gauss-Bonnet (GB) regime and the standard GR respectively. Amazingly, while evolving from RS regime to high energy GB limit, one passes through a GR like region which has important implications for brane world inflation. For tachyon GB inflation with potentials $V(\phi) \sim \phi^p$ investigated in this paper, the scalar to tensor ratio of perturbations $R$ is maximum around the RS region and is generally suppressed in the high energy regime for the positive values of $p$. The ratio is very low for $p>0$ at all energy scales relative to GB inflation with ordinary scalar field. The models based upon tachyon inflation with polynomial type of potentials with generic positive values of $p$ turn out to be in the $1 \sigma$ observational contour bound at all energy scales varying from GR to high energy GB limit. The spectral index $n_S$ improves for the lower values of $p$ and approaches its scale invariant limit for $p=-2$ in the high energy GB regime. The ratio $R$ also remains small for large negative values of $p$, however, difference arises for models close to scale invariance limit. In this case, the tensor to scale ratio is large in the GB regime whereas it is suppressed in the intermediate region between RS and GB. Within the frame work of patch cosmologies governed by $H^2 \sim \rho^q$, the behavior of ordinary scalar field near cosmological singularity and the nature of scaling solutions are distinguished for the values of $q 1$.Comment: 15 pages, 10 eps figures; appendix on various scales in GB brane world included and references updated; final version to appear in PR

Co-Operative Additive Effects between HLA Alleles in Control of HIV-1

Background: HLA class I genotype is a major determinant of the outcome of HIV infection, and the impact of certain alleles on HIV disease outcome is well studied. Recent studies have demonstrated that certain HLA class I alleles that are in linkage disequilibrium, such as HLA-A*74 and HLA-B*57, appear to function co-operatively to result in greater immune control of HIV than mediated by either single allele alone. We here investigate the extent to which HLA alleles - irrespective of linkage disequilibrium - function co-operatively. Methodology/Principal Findings: We here refined a computational approach to the analysis of >2000 subjects infected with C-clade HIV first to discern the individual effect of each allele on disease control, and second to identify pairs of alleles that mediate ‘co-operative additive’ effects, either to improve disease suppression or to contribute to immunological failure. We identified six pairs of HLA class I alleles that have a co-operative additive effect in mediating HIV disease control and four hazardous pairs of alleles that, occurring together, are predictive of worse disease outcomes (q<0.05 in each case). We developed a novel ‘sharing score’ to quantify the breadth of CD8+ T cell responses made by pairs of HLA alleles across the HIV proteome, and used this to demonstrate that successful viraemic suppression correlates with breadth of unique CD8+ T cell responses (p = 0.03). Conclusions/Significance: These results identify co-operative effects between HLA Class I alleles in the control of HIV-1 in an extended Southern African cohort, and underline complementarity and breadth of the CD8+ T cell targeting as one potential mechanism for this effect

End-to-end numerical modeling of the Roman Space Telescope coronagraph

The Roman Space Telescope will have the first advanced coronagraph in space, with deformable mirrors for wavefront control, low-order wavefront sensing and maintenance, and a photon-counting detector. It is expected to be able to detect and characterize mature, giant exoplanets in reflected visible light. Over the past decade the performance of the coronagraph in its flight environment has been simulated with increasingly detailed diffraction and structural/thermal finite element modeling. With the instrument now being integrated in preparation for launch within the next few years, the present state of the end-to-end modeling is described, including the measured flight components such as deformable mirrors. The coronagraphic modes are thoroughly described, including characteristics most readily derived from modeling. The methods for diffraction propagation, wavefront control, and structural and thermal finite-element modeling are detailed. The techniques and procedures developed for the instrument will serve as a foundation for future coronagraphic missions such as the Habitable Worlds Observatory.Comment: 113 pages, 85 figures, to be published in SPIE Journal of Astronomical Telescopes, Instruments, and System

A molecular assay for sensitive detection of pathogen-specific T-cells.

Here we describe the development and validation of a highly sensitive assay of antigen-specific IFN-γ production using real time quantitative PCR (qPCR) for two reporters--monokine-induced by IFN-γ (MIG) and the IFN-γ inducible protein-10 (IP10). We developed and validated the assay and applied it to the detection of CMV, HIV and Mycobacterium tuberculosis (MTB) specific responses, in a cohort of HIV co-infected patients. We compared the sensitivity of this assay to that of the ex vivo RD1 (ESAT-6 and CFP-10)-specific IFN-γ Elispot assay. We observed a clear quantitative correlation between the two assays (P<0.001). Our assay proved to be a sensitive assay for the detection of MTB-specific T cells, could be performed on whole blood samples of fingerprick (50 uL) volumes, and was not affected by HIV-mediated immunosuppression. This assay platform is potentially of utility in diagnosis of infection in this and other clinical settings

Estimates of the global burden of cervical cancer associated with HIV.

BACKGROUND: HIV enhances human papillomavirus (HPV)-induced carcinogenesis. However, the contribution of HIV to cervical cancer burden at a population level has not been quantified. We aimed to investigate cervical cancer risk among women living with HIV and to estimate the global cervical cancer burden associated with HIV. METHODS: We did a systematic literature search and meta-analysis of five databases (PubMed, Embase, Global Health [CABI.org], Web of Science, and Global Index Medicus) to identify studies analysing the association between HIV infection and cervical cancer. We estimated the pooled risk of cervical cancer among women living with HIV across four continents (Africa, Asia, Europe, and North America). The risk ratio (RR) was combined with country-specific UNAIDS estimates of HIV prevalence and GLOBOCAN 2018 estimates of cervical cancer to calculate the proportion of women living with HIV among women with cervical cancer and population attributable fractions and age-standardised incidence rates (ASIRs) of HIV-attributable cervical cancer. FINDINGS: 24 studies met our inclusion criteria, which included 236 127 women living with HIV. The pooled risk of cervical cancer was increased in women living with HIV (RR 6·07, 95% CI 4·40-8·37). Globally, 5·8% (95% CI 4·6-7·3) of new cervical cancer cases in 2018 (33 000 new cases, 95% CI 26 000-42 000) were diagnosed in women living with HIV and 4·9% (95% CI 3·6-6·4) were attributable to HIV infection (28 000 new cases, 20 000-36 000). The most affected regions were southern Africa and eastern Africa. In southern Africa, 63·8% (95% CI 58·9-68·1) of women with cervical cancer (9200 new cases, 95% CI 8500-9800) were living with HIV, as were 27·4% (23·7-31·7) of women in eastern Africa (14 000 new cases, 12 000-17 000). ASIRs of HIV-attributable cervical cancer were more than 20 per 100 000 in six countries, all in southern Africa and eastern Africa. INTERPRETATION: Women living with HIV have a significantly increased risk of cervical cancer. HPV vaccination and cervical cancer screening for women living with HIV are especially important for countries in southern Africa and eastern Africa, where a substantial HIV-attributable cervical cancer burden has added to the existing cervical cancer burden. FUNDING: WHO, US Agency for International Development, and US President's Emergency Plan for AIDS Relief

HabEx Baseline Telescope: Design & Performance Analysis

HabEx is one of four missions under study for 2020 Astrophysics Decadal Survey. It will directly image and spectroscopically characterize planetary systems in the habitable zone of Sun-like stars. Additionally, HabEx will perform a broad range of general astrophysics science enabled by 115 to 2500 nm spectral range and 3 x 3 arc-minute FOV

Progression to AIDS in South Africa Is Associated with both Reverting and Compensatory Viral Mutations

We lack the understanding of why HIV-infected individuals in South Africa progress to AIDS. We hypothesised that in end-stage disease there is a shifting dynamic between T cell imposed immunity and viral immune escape, which, through both compensatory and reverting viral mutations, results in increased viral fitness, elevated plasma viral loads and disease progression. We explored how T cell responses, viral adaptation and viral fitness inter-relate in South African cohorts recruited from Bloemfontein, the Free State (n = 278) and Durban, KwaZulu-Natal (n = 775). Immune responses were measured by γ-interferon ELISPOT assays. HLA-associated viral polymorphisms were determined using phylogenetically corrected techniques, and viral replication capacity (VRC) was measured by comparing the growth rate of gag-protease recombinant viruses against recombinant NL4-3 viruses. We report that in advanced disease (CD4 counts <100 cells/µl), T cell responses narrow, with a relative decline in Gag-directed responses (p<0.0001). This is associated with preserved selection pressure at specific viral amino acids (e.g., the T242N polymorphism within the HLA-B*57/5801 restricted TW10 epitope), but with reversion at other sites (e.g., the T186S polymorphism within the HLA-B*8101 restricted TL9 epitope), most notably in Gag and suggestive of “immune relaxation”. The median VRC from patients with CD4 counts <100 cells/µl was higher than from patients with CD4 counts ≥500 cells/µl (91.15% versus 85.19%, p = 0.0004), potentially explaining the rise in viral load associated with disease progression. Mutations at HIV Gag T186S and T242N reduced VRC, however, in advanced disease only the T242N mutants demonstrated increasing VRC, and were associated with compensatory mutations (p = 0.013). These data provide novel insights into the mechanisms of HIV disease progression in South Africa. Restoration of fitness correlates with loss of viral control in late disease, with evidence for both preserved and relaxed selection pressure across the HIV genome. Interventions that maintain viral fitness costs could potentially slow progression