Important diagnostic and clinical aspects of moderately reduced von Willebrand factor (VWF) levels are still unknown. There is no clear evidence which cutoff value (0.50 vs 0.60IU/ml) should be used to diagnose "low VWF." Also, the incidence of bleeding after the diagnosis has been made, and risk factors for bleeding are unknown yet.
 
  To investigate the incidence of postsurgical bleeding, postpartum hemorrhage (PPH), and traumatic and spontaneous bleeding after low VWF diagnosis, and to develop a risk score to predict future bleeding.
 
  We performed a cohort study in patients with historically lowest VWF levels of 0.31 to 0.60IU/ml. Clinical data of patients were retrospectively collected.
 
  We included 439 patients with low VWF. During a follow-up of 6.3±3.7 years, 259 surgical procedures, 81 deliveries, and 109 spontaneous and traumatic bleeding episodes were reported. The incidence of postsurgical bleeding was 2.7%, whereas 10% of deliveries was complicated by PPH. Overall, 65 patients (14.8%) had bleeding requiring treatment, which was not different between patients with historically lowest VWF levels of 0.31-0.50 and 0.51-0.60IU/ml (p=.154). Age <18 years, abnormal bleeding score at diagnosis, and being referred for bleeding symptoms at the time of diagnosis were independent risk factors for bleeding during follow-up, and therefore included in the risk score.
 
  The cutoff value of low VWF diagnosis should be set at 0.60IU/ml. Furthermore, a risk score is developed to identify individuals with a high risk for bleeding after low VWF diagnosis.
 The cutoff value of low VWF diagnosis should be set at 0.60 IU/ml. Furthermore, a risk score is developed to identify individuals with a high risk for bleeding after low VWF diagnosis.This research was initiated to assess and manage water quality status of fourteen surface drinking water intakes in El-Beheira Governorate, Egypt. The study was conducted on four main branches of water resources in the governorate. Three water quality indices (WQIs) and two multivariate statistical techniques were applied, based on the Egyptian guidelines for the Nile River.  https://www.selleckchem.com/products/CUDC-101.html  Water quality records were collected for two successive years, 2014 and 2015, and were analyzed by descriptive statistics. The results revealed the critical water quality status of the four branches at the fourteen intakes. The multivariate statistical techniques returned the critical water quality conditions to the agricultural drainage and the domestic wastewater discharges. In addition, a new software application was developed to manage WQIs calculation. An urgent water quality monitoring and assessment system should be initiated for the drinking water resources all over Egypt, based on the developed water quality assessment techniques of this study. PRACTITIONER POINTS Three different WQIs and two different statistics tools were applied. Critical water quality status for the investigated surface drinking water intakes was reported. Agricultural drainage then domestic effluents are the main pollution sources. A new software application was developed to calculate WQIs to support decision makers.
  Patients with rheumatic diseases are often treated with prolonged, high-dose systemic glucocorticoids which can cause hypothalamic-pituitary-adrenal (HPA) axis suppression and development of tertiary adrenal insufficiency. Adrenal insufficiency carries the risk of serious, potentially life-threatening adrenal crisis. Our study evaluated the prevalence, characteristics and recovery of patients with underlying rheumatology conditions who had received prolonged glucocorticoid treatment.
 
  Retrospective, cross-sectional study. We evaluated 238 patients seen in outpatient rheumatology clinic, managed in accordance with current nationally and internationally accepted clinical guidelines.
 
  Data collected included patient demographics, historical steroid data, 09.00h cortisol/short synacthen test (SST) results and follow-up data on those with repeat assessments.
 
  Overall, 65% of our cohort had a 09.00h cortisol <350nmol/L. On SST, 43% of patients demonstrated evidence of possible tertiary adrenal insufficiencyonstrated sub-optimal adrenal function on SST. Steroid dose at the time of SST was the only significant predictive risk factor for tertiary adrenal insufficiency. 09.00h cortisol demonstrated good correlation with outcome on SST and could represent a valid screening test to reduce need for SST if 09.00h >350nmol/L. Further prospective data are required to further characterize risk factors, predictive features of recovery and establish optimal management strategy of steroids (prednisolone vs hydrocortisone) to encourage adrenal recovery.
 350 nmol/L. Further prospective data are required to further characterize risk factors, predictive features of recovery and establish optimal management strategy of steroids (prednisolone vs hydrocortisone) to encourage adrenal recovery.Recent findings regarding the effectiveness of sticky mittens training as a motor intervention have been mixed. This commentary argues that despite inconsistent results, overall patterns suggest that sticky mittens may facilitate reaching behavior. More research on this topic is needed.Sulfur-containing molecules are of utmost topical importance towards the effective development of pharmaceuticals and functional materials. Herein, we present an efficient and mild electrochemical thiolation by cross-electrophile coupling of alkyl bromides with functionalized bench-stable thiosulfonates to access alkyl sulfides with excellent efficacy and broad functional group tolerance. Cyclic voltammetry and potentiostatic analysis were performed to elucidate mechanistic insights into this electrocatalytic thiolation reaction.Positive adaptation manifests differently in the aftermath of traumatic events. Methodological limitations, however, impede the ability to test conceptualizations of resilience that emphasize the multifaceted nature of these responses. In response, an approach that synthesized a residualized and person-centered conceptualization of resilience examined associations between aspects of resilience in an adolescent sample. In total, 584 racially/ethnically diverse adolescents (age range 12-17 years; M = 14.98 years; SD = 1.05; 50.9% female; 30.1% White, 29.6% African American, 19.5% Hispanic) self-reported lifetime emotional maltreatment and community violence exposure as well as current levels of depression, posttraumatic stress symptoms (PTSS), violent behavior, and psychological well-being (PWB). Each mental health outcome was regressed on lifetime trauma exposure to create residuals used as indices of resilience. Correlations between the residuals suggested that PWB was more closely related to resilience to depression and PTS, rs = .