Schmittmcfarland1951

Heparin-induced thrombocytopenia is a unique entity associated with thrombosis that is typically related to intraoperative/perioperative heparin exposure, although it can develop following knee replacement surgery even in the absence of heparin exposure. Very late onset (POD10 or later) of thrombocytopenia can indicate bacterial or fungal infection. Lastly, thrombocytopenia after mechanical device implantation requires unique considerations. Understanding the timing and severity of postoperative thrombocytopenia provides a practical approach to a common and challenging consultation. © 2020 by The American Society of Hematology.We previously identified gender disparities in academic success during evaluation of the American Society of Hematology (ASH) Clinical Research Training Institute (CRTI) and hypothesized that it may be related to caregiving. The objective was to evaluate the impact of gender and caregiving responsibilities on academic success. A cross-sectional survey that included a question about caregiving responsibilities was distributed to alumni who participated in CRTI from 2003 to 2016 and asked about academic productivity in the previous 3 years. Publications and grants were abstracted from submitted curriculum vitae. Academic success was defined as number of first- or senior-author publications, total publications, grants, and percent effort in research. Of 280 potential respondents, 258 responded (92% response rate), 169 (66%) had caregiving responsibilities, and 110 (43%) were men. Respondents with caregiving responsibilities had fewer first- or senior-author publications (median, 3 vs 5; P = .003) and less percent effort in research (median, 40% vs 50%; P = .006). Men had more first- or senior-author publications (median, 4 vs 3; P = .002) and more total publications (median, 12 vs 6.5; P = .0002) than women. When stratified by those without (P = .0001) or with (P = .042) caregiving responsibilities, men had more publications than women. Among men, caregiving responsibilities significantly reduced all outcomes. However, among women, caregiving did not have an impact. In conclusion, men had more publications than women whether or not they had caregiving responsibilities. However, among men, caregiving reduced academic productivity whereas among women, caregiving did not have impact. The scientific community will need to continue to identify the reasons for disparities and implement changes to address them. © 2020 by The American Society of Hematology.This article has a companion Counterpoint by Gibson and Lindsley. © 2020 by The American Society of Hematology.This article has a companion Point by DeZern and Gondek. © 2020 by The American Society of Hematology.BACKGROUND Adenomyosis is a benign uterine disorder where endometrial glands and stroma are pathologically demonstrated within the uterine myometrium. The pathogenesis involves sex steroid hormone abnormalities, inflammation, fibrosis and neuroangiogenesis, even though the proposed mechanisms are not fully understood. For many years, adenomyosis has been considered a histopathological diagnosis made after hysterectomy, classically performed in perimenopausal women with abnormal uterine bleeding (AUB) or pelvic pain. Until recently, adenomyosis was a clinically neglected condition. Nowadays, adenomyosis may also be diagnosed by non-invasive techniques, because of imaging advancements. Thus, a new epidemiological scenario has developed with an increasing number of women of reproductive age with ultrasound (US) or magnetic resonance imaging (MRI) diagnosis of adenomyosis. This condition is associated with a wide variety of symptoms (pelvic pain, AUB and/or infertility), but it is also recognised that some women ducibility, leading to extreme variations in the prevalence of disease. Therefore, an integrated non-invasive diagnostic approach, considering risk factors profile, clinical symptoms, clinical examination and imaging, is proposed to adequately identify and characterise adenomyosis. WIDER IMPLICATIONS The development of the diagnostic tools allows the physicians to make an accurate diagnosis of adenomyosis by means of non-invasive techniques, representing a major breakthrough, in the light of the clinical consequences of this disease. Furthermore, this technological improvement will open a new epidemiological scenario, identifying different groups of women, with a dissimilar clinical and/or imaging phenotypes of adenomyosis, and this should be object of future research. © The Author(s) 2020. selleck Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.BACKGROUND Annual human immunodeficiency virus (HIV) diagnoses in the United States (US) have plateaued since 2013. We assessed whether there is an association between uptake of pre-exposure prophylaxis (PrEP) and decreases in HIV diagnoses. METHODS We used 2012-2016 data from the US National HIV Surveillance System to estimate viral suppression (VS) and annual percentage change in diagnosis rate (EAPC) in 33 jurisdictions, and data from a national pharmacy database to estimate PrEP uptake. We used Poisson regression with random effects for state and year to estimate the association between PrEP coverage and EAPC within jurisdictional quintiles grouped by changes in PrEP coverage, regressing EAPC on time; and among all jurisdictions, regressing EAPC on both time and jurisdictional changes in PrEP coverage with and without accounting for changes in VS. RESULTS From 2012 to 2016, across the 10 states with the greatest increases in PrEP coverage, the EAPC decreased 4.0% (95% confidence interval [CI], -5.2% to -2.9%). On average, across the states and District of Columbia, EAPC for a given year decreased by 1.1% (95% CI, -1.77% to -.49%) for an increase in PrEP coverage of 1 per 100 persons with indications. When controlling for VS, the state-specific EAPC for a given year decreased by 1.3% (95% CI, -2.12% to -.57%) for an increase in PrEP coverage of 1 per 100 persons with indications. CONCLUSIONS We found statistically significant associations between jurisdictional increases in PrEP coverage and decreases in EAPC independent of changes in VS, which supports bringing PrEP use to scale in the US to accelerate reductions in HIV infections. © Published by Oxford University Press for the Infectious Diseases Society of America 2020.