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

Reconciling actual and perceived rates of predation by domestic cats

© 2015 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.The predation of wildlife by domestic cats (Felis catus) is a complex problem: Cats are popular companion animals in modern society but are also acknowledged predators of birds, herpetofauna, invertebrates, and small mammals. A comprehensive understanding of this conservation issue demands an understanding of both the ecological consequence of owning a domestic cat and the attitudes of cat owners. Here, we determine whether cat owners are aware of the predatory behavior of their cats, using data collected from 86 cats in two UK villages. We examine whether the amount of prey their cat returns influences the attitudes of 45 cat owners toward the broader issue of domestic cat predation. We also contribute to the wider understanding of physiological, spatial, and behavioral drivers of prey returns among cats. We find an association between actual prey returns and owner predictions at the coarse scale of predatory/nonpredatory behavior, but no correlation between the observed and predicted prey-return rates among predatory cats. Cat owners generally disagreed with the statement that cats are harmful to wildlife, and disfavored all mitigation options apart from neutering. These attitudes were uncorrelated with the predatory behavior of their cats. Cat owners failed to perceive the magnitude of their cats' impacts on wildlife and were not influenced by ecological information. Management options for the mitigation of cat predation appear unlikely to work if they focus on "predation awareness" campaigns or restrictions of cat freedom. We consider both the ecological consequence of owning a domestic cat and the attitudes of cat owners. Our findings suggest cat owners fail to perceive the magnitude of their cats' impacts on wildlife, with no correlation between the observed and predicted prey return rates among predatory cats. On the basis of opinions of cat owners in this study, management options for the mitigation of cat predation appear unlikely to work if they focus on "predation awareness" campaigns, or restrictions of cat freedom.published_or_final_versio

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

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

Public and Private Physical Affection Differences between Same-Sex and Different-Sex Couples: The Role of Perceived Marginalization

Despite its connection with relationship satisfaction, research on physical affection is scarce and fails to disentangle private and public displays of affection.  It is important to examine both types if marginalized couples are less comfortable displaying affection publicly. The present study examined whether same-sex couples display less public (but not private) physical affection than different-sex couples due to stronger feelings of relationship marginalization. It also examined  how public/private affection and marginalization relate  to  relationship satisfaction.  Women in  committed  same-sex and different-sex relationships completed surveys of public affection, private affection, marginalization, and relationship satisfaction online.  As predicted, women in same-sex relationships displayed less public affection than those in different-sex relationships, an effect mediated by general societal marginalization.  Both private and public affection predicted higher relationship satisfaction, whereas feelings of marginalization  by friends/family  predicted lower relationship satisfaction.  We  discuss implications for  relationship counseling and propose new ways of looking at marginalization

Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

Background. With the rise in the use of direct oral anticoagulants (DOACs), more hemorrhagic complications are being encountered. Since the first description of a case of spontaneous spinal epidural hematoma (SSEH) related to the utilization of DOACs in 2012, there have been few reports describing a similar association. However, no cases so far have reported an association between SSEHs and apixaban. Case Description: A 76-year-old lady, with a history of nonvalvular atrial fibrillation, presented with a new onset of progressive left lower and upper extremity weakness. She reported back pain and numbness in the left leg up to the knee along with numbness in the left arm up to the shoulder. A CT scan of the neck was suggestive of an epidural hematoma extending from C2-C3 level to C6-C7. As the patient was on apixaban at the time, surgical treatment was delayed for two days to decrease the risk of intraoperative bleeding. Nine days later, she was discharged. Her physical exam was almost unchanged from that on presentation, except for resolution of pain and minimal improvement in motor power in her left lower extremity from 1/5 to 2/5 distally. Conclusions. Spinal hematomas represent surgical emergencies with earlier intervention portending better outcome. Based on the few case reports that point to DOACs as a potential culprit, it appears that a high suspicion index resulting in earlier SSEH diagnosis and intervention is crucial for improved neurological outcome and recovery. Prompt diagnosis remains a challenge, especially that SSEH can mimic cerebrovascular accidents

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

Temporal variation of leachate quality from pre-sorted and baled municipal solid waste with high organic and moisture content

Landfill leachate characterization is a critical factor in establishing a corresponding effective management strategy or treatment process. However, it is often difficult to forecast leachate quality because of a variety of influencing factors such as waste composition and landfill operations. This paper describes leachate formation mechanisms, summarizes leachate quality indicators, and investigates the temporal variation of leachate quality from pre-sorted and baled municipal solid waste characterized with high organic and moisture content. The purpose of the study is to evaluate the potential effects of waste composition and site-specific operational procedures on biodegradation processes and leachate quality at a field-scale landfill that receives in excess of 1800 tonnes per day of refuse. For this purpose, waste disposal and leachate generation rates were monitored and leachate samples were collected for a period of 18 months during the early stages of refuse deposition. Chemical analysis was performed on the samples and the temporal variation of several parameters were monitored including pH, COD, TOC, TDS, chlorides, sulfates, orthophosphates, nitrates, ammonia nitrogen, hardness, and heavy metals. Chemical concentration levels were related to biological activity within the landfill and the results indicated that: (1) pre-sorting and baling of the waste did not hinder waste stabilization; and (2) the high organic and moisture contents resulted in an extremely strong leachate, particularly at the onset of biodegradation processes, which can affect the leachate treatment facility