von Willebrand factor levels in the diagnosis of von Willebrand disease: a systematic review and meta-analysis

Von Willebrand Disease (VWD) is associated with significant morbidity as a result of excessive mucocutaneous bleeding symptoms. Patients with VWD can experience easy bruising, epistaxis, gastrointestinal and oral cavity bleeding, as well as heavy menstrual bleeding and bleeding after dental work, surgical procedures, and childbirth. Early diagnosis and treatment is important to prevent and treat these symptoms. We systematically reviewed the accuracy of diagnostic tests using different cut-off values of VWF:Ag and platelet-dependent VWF activity assays in the diagnosis of VWD. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies. Two investigators screened and abstracted data. Risk of bias was assessed using QUADAS-2 and certainty of evidence using the GRADE framework. We pooled estimates of sensitivity and specificity and reported patient important outcomes when relevant. This review included 21 studies that evaluated VWD diagnosis, including the approach to patients with VWF levels that have normalized with age (6 studies), VWF cut-off levels for the diagnosis of Type 1 VWD (9 studies), and platelet-dependent VWF activity/VWF:Ag ratio cut-off levels for the diagnosis of Type 2 VWD (6 studies). The results showed low certainty in the evidence for a net health benefit from reconsidering the diagnosis of VWD versus simply removing the disease in patients with VWF levels that have normalized with age. For the diagnosis of Type 1 VWD, in patients with VWF:A

Surgical management of patients with von Willebrand disease: summary of 2 systematic reviews of the literature

von Willebrand disease (VWD) is the most common inherited bleeding disorder. The management of patients with VWD who are undergoing surgeries is crucial to prevent bleeding complications. We systematically summarized the evidence on the management of patients with VWD who are undergoing major and minor surgeries to support the development of practice guidelines. We searched Medline and EMBASE from inception through October 2019 for randomized clinical trials (RCTs), comparative observational studies, and case series that compared maintaining factor VIII (FVIII) levels or von Willebrand factor (VWF) levels at >0.50 IU/mL for at least 3 days in patients undergoing major surgery, and those with options for perioperative management of patients undergoing minor surgery. Two authors screened and abstracted data and assessed the risk of bias. We conducted meta-analyses when possible. We evaluated the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We included 7 case series for major surgeries and 2 RCTs and 12 case series for minor surgeries. Very-low-certainty evidence showed that maintaining FVIII levels or VWF levels of >0.50 IU/mL for at least 3 consecutive days showed excellent hemostatic efficacy (as labeled by the researchers) after 74% to 100% of major surgeries. Low- to very-low-certainty evidence showed that prescribing tranexamic acid and increasing VWF levels to 0.50 IU/mL resulted in fewer bleeding complications after minor procedures compared with increasing VWF levels to 0.50 IU/mL alone. Given the low-quality evidence for guiding management decisions, a shared-decision model leading to individualized therapy plans will be important in patients with VWD who are undergoing surgical and invasive procedures

Emotional Labor in Mathematics: Reflections on Mathematical Communities, Mentoring Structures, and EDGE

Terms such as "affective labor" and "emotional labor" pepper feminist critiques of the workplace. Though there are theoretical nuances between the two phrases, both kinds of labor involve the management of emotions; some acts associated with these constructs involve caring, listening, comforting, reassuring, and smiling. In this article I explore the different ways academic mathematicians are called to provide emotional labor in the discipline, thereby illuminating a rarely visible component of a mathematical life in the academy. Underlying this work is my contention that a conceptualization of labor involved in managing emotions is of value to the project of understanding the character, values, and boundaries of such a life. In order to investigate the various dimensions of emotional labor in the context of academic mathematics, I extend the basic framework of Morris and Feldman [33] and then apply this extended framework to the mathematical sciences. Other researchers have mainly focused on the negative effects of emotional labor on a laborer's physical, emotional, and mental health, and several examples in this article align with this framing. However, at the end of the article, I argue that mathematical communities and mentoring structures such as EDGE help diminish some of the negative aspects of emotional labor while also accentuating the positives.Comment: Revised version to appear in the upcoming volume A Celebration of EDGE, edited by Sarah Bryant, Amy Buchmann, Susan D'Agostino, Michelle Craddock Guinn, and Leona Harri

Dancing Backwards in High Heels: Female Professors Experience More Work Demands and Special Favor Requests, Particularly from Academically Entitled Students

Although the number of U.S. female professors has risen steadily in recent years, female professors are still subject to different student expectations and treatment. Students continue to perceive and expect female professors to be more nurturing than male professors are. We examined whether students may consequently request more special favors from female professors. In a survey of professors (n = 88) across the United States, Study 1 found that female (versus male) professors reported getting more requests for standard work demands, special favors, and friendship behaviors, with the latter two mediating the professor gender effect on professors’ self-reported emotional labor. Study 2 utilized an experimental design using a fictitious female or male professor, with college student participants (n = 121) responding to a scenario in which a special favor request might be made of the professor. The results indicated that academically entitled students (i.e., those who feel deserving of success in college regardless of effort/performance) had stronger expectations that a female (versus male) professor would grant their special favor requests. Those expectations consequently increased students’ likelihood of making the requests and of exhibiting negative emotional and behavioral reactions to having those requests denied. This work highlights the extra burdens felt by female professors. We discuss possible moderators of these effects as well as the importance of developing strategies for preventing them

Increased Breakdown Voltage and robustness of Embedded power module

In this paper, a study of the influence of an etching on the electric field and the shear stress distribution is presented. A 100 V embedded PCB half-bridge, named VESA1, has been developed and realized by VEDECOM Institute. The study focuses on increasing the breakdown voltage from 100 V to 800 V. The proposed solution is based on the optimization of the copper plate etching in terms of positioning and sizing. A numerical approach using 2D electrical and thermomechanical simulations has shown that aligning the etching on the die and increasing the width of the etches, allow to attenuate the maximum values of the electric field and to reduce the thermomechanical stresses within the assembly. The first steps of the etching process have been performed to validate the manufacturing process

Nonsteroidal Anti-inflammatory Drugs for Chemoprevention in Patients With Familial Adenomatous Polyposis: A Systematic Review and Meta-Analysis

Background and Aims: Published literature shows mixed reports of the benefits of nonsteroidal anti-inflammatory drugs (NSAIDs) on reducing colorectal polyps in patients with familial adenomatous polyposis (FAP). We conducted a systematic review and performed a meta-analysis to assess the impact of NSAIDs on colorectal polyp burden in patients with FAP. Methods: We searched PubMed, EMBASE, and Cochrane for randomized controlled trials (RCTs) comparing the effect of NSAIDs vs placebo on the percent change in polyp number and polyp size in patients with FAP. Mean differences between the 2 study arms were pooled using RevMan. The risk of bias (RoB) was assessed using the Cochrane Risk of Bias tool for RCTs, and certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results: The search strategy identified 1021 studies, out of which we included 8 RCTs with a total of 279 patients. Treatment for 6.4 ± 2.2 months with NSAIDs reduced polyp numbers by −17.4% (95% confidence interval −26.41%, −8.29%) (low certainty [I2 89%] due to imprecision and issues with RoB) and polyp size by −15.9% (95% confidence interval −24.98%, −6.73%) (very low certainty (I2 84%) due to imprecision, inconsistency, and issues with RoB). The most common gastrointestinal adverse events reported were stomatitis, diarrhea, and abdominal pain. Side effects leading to drug discontinuation were gastroenteritis and drug allergy. Conclusion: Short-term use of NSAIDs reduced polyp number and polyp size but with low to very low certainty of evidence. Further large multicenter studies are needed to further explore NSAIDs as a chemopreventive measure in patients with FAP