It’s one of those things that you remember as happening more frequently than it actually does. You’re alone in some foreign country, doing laptop work at a bar. You start chatting with a group of people who turn out to be extremely interesting. They invite you to join them for dinner. Hours of fascinating conversation ensues.

This happened the other night. The people were 3 pediatricians who were infectious disease specialists, 2 of whom were also medical professors. I learned so much. For example: this stuff you read in the Times about the benefits of a diverse biodome–it’s for real!

The doctors told me about a study (which is widely praised for its solid research design, though there are critics), which they summarized as follows: providing very sick children in Africa with ICU-like emergency treatment increases mortality at 48 hours post-admission. Here’s part of the abstract:

Methods
We randomly assigned children with severe febrile illness and impaired perfusion to receive boluses of 20 to 40 ml of 5% albumin solution (albumin-bolus group) or 0.9% saline solution (saline-bolus group) per kilogram of body weight or no bolus (control group) at the time of admission to a hospital in Uganda, Kenya, or Tanzania (stratum A); children with severe hypotension were randomly assigned to one of the bolus groups only (stratum B). All children received appropriate antimicrobial treatment, intravenous maintenance fluids, and supportive care, according to guidelines. Children with malnutrition or gastroenteritis were excluded. The primary end point was 48-hour mortality; secondary end points included pulmonary edema, increased intracranial pressure, and mortality or neurologic sequelae at 4 weeks.

Results
The data and safety monitoring committee recommended halting recruitment after 3141 of the projected 3600 children in stratum A were enrolled. Malaria status (57% overall) and clinical severity were similar across groups. The 48-hour mortality was 10.6% (111 of 1050 children), 10.5% (110 of 1047 children), and 7.3% (76 of 1044 children) in the albumin-bolus, saline-bolus, and control groups, respectively (relative risk for saline bolus vs. control, 1.44; 95% confidence interval [CI], 1.09 to 1.90; P=0.01; relative risk for albumin bolus vs. saline bolus, 1.01; 95% CI, 0.78 to 1.29; P=0.96; and relative risk for any bolus vs. control, 1.45; 95% CI, 1.13 to 1.86; P=0.003). The 4-week mortality was 12.2%, 12.0%, and 8.7% in the three groups, respectively (P=0.004 for the comparison of bolus with control). Neurologic sequelae occurred in 2.2%, 1.9%, and 2.0% of the children in the respective groups (P=0.92), and pulmonary edema or increased intracranial pressure occurred in 2.6%, 2.2%, and 1.7% (P=0.17), respectively. In stratum B, 69% of the children (9 of 13) in the albumin-bolus group and 56% (9 of 16) in the saline-bolus group died (P=0.45). The results were consistent across centers and across subgroups according to the severity of shock and status with respect to malaria, coma, sepsis, acidosis, and severe anemia.

Conclusions
Fluid boluses significantly increased 48-hour mortality in critically ill children with impaired perfusion in these resource-limited settings in Africa.

Why would this be? This is one possible explanation offered: “One could speculate that the vasoconstrictor response in shock confers protection by reducing perfusion to nonvital tissues and that rapid reversal with fluid resuscitation is deleterious.” I think what this means is that the body’s natural response to shock is protective, and the treatment is bad. As far as I can tell the authors don’t explore explanations for why things might be different in resource-constrained settings, though it’s not completely clear that the authors believe there should be differences.

Margaret Thatcher supported her son (Sir Mark) and Simon Mann’s 2004 failed coup attempt in Equatorial Guinea, according to a deleted section of Mann’s 2011 memoir obtained by The Observer.

Thatcher “allegedly told Mann at a meeting at her Belgravia home: ‘I’m sure it’s going to work’.”

More from the article:

On his release from prison, Mann said he could never forgive Sir Mark, who he claimed was a key participant in the military adventure rather than a mere investor, for failing to come to his aid. Details of the meetings between Mann and Baroness Thatcher, held in the lead-up to the attempted coup, were originally due to be published in Mann’s memoir, Cry Havoc, which came out in 2011. This section was removed on the advice of the publisher, John Blake. However, an early manuscript of the book has been obtained by the Observer and its full claims can be revealed for the first time.

[...]

Thatcher’s mental capacity was already on the wane in 2003 – the year her husband, Denis, died – when the conversations are said to have occurred.

[...]

[Mann] writes: “Maggie asks me how ‘their’ money is being handled.”

From a fascinating critique of Lean In. h/t to Amanda:

Sandberg has penned not so much a new Feminine Mystique as an updated Protestant Ethic and the Spirit of Capitalism. Where other feminists focus on articulating the amount of free or underpaid labor that women do, Sandberg places a priceless value on labor itself and encourages more of it, whether paid, unpaid, or poorly paid. “If you’re offered a seat on a rocket ship, you don’t ask which seat,” she says, quoting advice she received from Google executive Eric Schmidt.

“Don’t ask,” here, strikes a revealing tension in a book that tells women to be more assertive, albeit “with great care.” Put into practice, the advice not to question what position one will hold in a company can easily amount to acceptance of a devalued position with long-term career consequences. But this is a problem Sandberg may not know about, because it doesn’t happen to someone whose career has been defined by jumps from one high-level position to another. (In the Valley, poaching high-ranking executives from rival companies is a sport and brings with it the possibility of negotiating compensation upward or even, in Sandberg’s case, being allowed to “buy in” to Facebook at a level far exceeding her equity package.)

Unlike Sandberg, most women who work in tech startups do not have seats in the front of the rocket ship. Women in tech are much more likely to be hired in support functions where they are paid a bare minimum, given tiny equity grants compared to engineers and executives, and given raises on the order of fifty cents an hour rather than thousands of dollars. According to Sandberg’s advice, these situations iron themselves out when you are on a rocket ship: women are promoted and their positions naturally improve. “What difference does going ‘back’ four years [in title and compensation] really make?” Sandberg writes of one woman asked to start on the ground level. But what if women, even in a company like Facebook, are still paying a gender penalty that nothing but conscious, structural transformation can cure?

Article here. h/t to Emily.

“Kindness” covers all of my political beliefs. No need to spell them out. I believe that if, at the end, according to our abilities, we have done something to make others a little happier, and something to make ourselves a little happier, that is about the best we can do. To make others less happy is a crime. To make ourselves unhappy is where all crime starts. We must try to contribute joy to the world. That is true no matter what our problems, our health, our circumstances. We must try. I didn’t always know this and am happy I lived long enough to find it out.