Applying "think-pair-share" for virtual curriculum retreat.

With coronavirus disease 2019 (COVID-19) leading to ubiquitous changes across the education system, Tufts University School of Dental Medicine took advantage of their new, fast-changing environment to foster engagement among faculty members regarding curricular modifications and their impact on assessment outcomes. A virtual curricular retreat was planned, where adaptations could be discussed through the lens of Miller's Pyramid. The retreat provided an opportunity for faculty to participate in a guided dialogue via a "think-pair-share" activity that resulted in documenting the outcomes of recent curriculum changes while allowing for reflection for future improvement.

No 346-Âge génésique avancé et fertilité.

OBJECTIFS: Sensibiliser la population à la baisse naturelle de la fertilité avec l'âge, chez les femmes et les hommes, et à l'égard de la reproduction naturelle et des technologies de procréation assistée (TPA); formuler des recommandations de prise en charge; et analyser les méthodes d'évaluation du vieillissement ovarien. OPTIONS: La présente directive clinique passe en revue les options offertes pour l'évaluation de la réserve ovarienne et pour le traitement de l'infertilité faisant appel aux TPA chez les femmes d'âge génésique avancé infertiles. ISSUES: Les issues mesurées sont les valeurs prédictives de l'évaluation de la réserve ovarienne et les taux de grossesse découlant de la fertilité naturelle et de la fertilité assistée. DONNéES: Nous avons examiné des études publiées récupérées au moyen de recherches dans PubMed, Medline, CINAHL et la Bibliothèque Cochrane en juin 2010 à l'aide de mots-clés appropriés (ovarian aging, ovarian reserve, advanced maternal age, advanced paternal age, et assisted reproductive technology). Nous n'avons tenu compte que des résultats provenant de revues systématiques, d'essais cliniques, randomisés ou non, et d'études observationnelles. Aucune restriction de date ou de langue n'a été employée. Les recherches ont été refaites régulièrement, et les résultats ont été incorporés à la directive clinique jusqu'en décembre 2010. VALEURS: La qualité des données a été évaluée au moyen des critères énoncés dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs. Les recommandations quant à la pratique ont été classées conformément à la méthode décrite dans ce rapport. AVANTAGES, DéSAVANTAGES ET COûTS: Les patientes et les fournisseurs de soins primaires et spécialisés seront mieux renseignés sur le vieillissement ovarien, la baisse de la fertilité naturelle liée à l'âge et les TPA.

No. 346-Advanced Reproductive Age and Fertility.

OBJECTIVE: To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies (ART), provide recommendations for their management, and to review investigations in the assessment of ovarian aging. OPTIONS: This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility. OUTCOMES: The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility. EVIDENCE: Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in June 2010, using appropriate key words ("ovarian aging," "ovarian reserve," "advanced maternal age," "advanced paternal age," and "assisted reproductive technology"). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated into the guideline to December 2010. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report. BENEFITS, HARMS, AND COSTS: Primary and specialist health care providers and women will be better informed about ovarian aging and the age-related decline in natural fertility and about options for ART.

The Immunogenicity of Peptoid-Protein Conjugates.

We demonstrate that a peptoid composed of five monomers and attached via a maleimide linker to a carrier protein elicits anti-peptoid, anti-linker and anti-carrier antibodies in rabbits. Specific anti-peptoid antibodies were affinity purified and used to reproducibly retrieve three specific peptoid-coupled beads from 20,000 irrelevant peptoid-beads using magnetic screening.

Duration of immunity in red wolves (Canis rufus) following vaccination with a modified live parvovirus and canine distemper vaccine.

There is growing information available regarding duration of immunity for core vaccines in both domestic and nondomestic species. Vaccination protocols in nondomestic canids have frequently followed guidelines developed for the domestic dog; however, these protocols can be inappropriate for nondomestic canids such as the African wild dog (Lycaon pictus), leaving some animals susceptible to infectious disease and others at risk for contracting vaccine-induced disease. In this study, red wolves (Canis rufus) were vaccinated against canine distemper virus (CDV) and canine parvovirus (CPV) and vaccination titers were followed annually for 3 yr. One hundred percent of wolves developed and maintained a positive titer to CDV for 3 yr and 96.9% of wolves developed and maintained a positive titer to CPV for 3 yr. Seroconversion for canine adenovirus was sporadic. The results of this study support decreasing the frequency of vaccine administration in the red wolf population to a triennial basis.

Hemorrhagic diathesis in avian species following intramuscular administration of polysulfated glycosaminoglycan.

Polysulfated glycosaminoglycans (PSGAGs) have been used for decades in a variety of species for the management of osteoarthritic pain. However, reports on the use of PSGAGs in avian species are scarce. In domestic cats and dogs, PSGAG injections have caused prolongation of clotting times but are considered to be an efficacious drug with a wide margin of safety. This publication documents four cases of fatal coagulopathies in different avian species (one coraciiforme, two raptors, and one psittacine) following the intramuscular administration of PSGAG. All affected birds received varying dosages and dosing intervals of PSGAG. Three of the four birds experienced fatal hemorrhage into the pectoral muscle, while the fourth bled continuously from the injection site. Only one bird had chronic, severe pre-existing disease; the remainder were being managed for osteoarthritis. This report highlights the importance of species-specific dosing of PSGAG and warrants further investigation into the etiopathogenesis of this process.

Effect of exercise training combined with isoflavone supplementation on bone and lipids in postmenopausal women: a randomized clinical trial.

We determined the effects of 2 years of exercise training and soy isoflavone supplementation on bone mass and lipids in postmenopausal women provided with calcium and vitamin D. Women were randomized to four groups: exercise training (Ex); isoflavone supplementation (Iso: 165 mg/d [105 mg/d aglycone equivalent]); combined Ex and Iso (ExIso); and placebo (control). Exercise included resistance training (2 days/week) and walking (4 days/week). Our primary outcomes were lumbar spine and hip bone mineral density (BMD). Secondary outcomes included hip geometry, tibia and radius speed of sound (SOS), dynamic balance (6 m backward tandem walking), blood lipids, mammography, and endometrial thickness. A total of 351 women (Ex = 86, Iso = 90, ExIso = 87, control = 88) were randomized, with 298 analyzed at 2 years (Ex = 77, Iso = 76, ExIso = 72, control = 73). There was a significant interaction for total hip BMD (p < 0.001) such that ExIso had a greater rate of decrease (absolute change [95% confidence interval] = -0.018 [-0.024, -0.012] g/cm(2) ) than either the Ex or Iso groups alone (-0.005 [-0.01, 0.001] and -0.005 [-0.011, 0.001] g/cm(2) , respectively). There were no differences between groups for changes in lumbar spine BMD and minimal significant changes in hip geometric properties and bone SOS. Exercise groups improved dynamic balance as measured by a decrease in backward tandem walking time over 6 m (p = 0.017). Isoflavone groups decreased low density lipoproteins (Iso: -0.20 [-0.37, -0.02] mmol/L; ExIso: -0.23 [-0.40, -0.06] mmol/L; p = 0.003) compared to non-isoflavone groups (Ex: 0.01 [-0.16, 0.18] mmol/L; control: -0.09 [-0.27, 0.08] mmol/L) and had lower adverse reports of menopausal symptoms (14% versus 33%; p = 0.01) compared to non-isoflavone groups. Isoflavone supplementation did not increase endometrial thickness or abnormal mammograms. We conclude exercise training and isoflavone supplementation maintain hip BMD compared to control, but these two interventions interfere with each other when combined. Isoflavone supplementation decreased LDL and adverse events related to menopausal symptoms.

Synchronization of ovarian stimulation with follicle wave emergence in patients undergoing in vitro fertilization with a prior suboptimal response: a randomized, controlled trial.

OBJECTIVE: To test the hypothesis that synchronizing initiation of ovarian stimulation with follicle wave emergence would optimize IVF/intracytoplasmic sperm injection (ICSI) outcomes in patients with a prior suboptimal response. DESIGN: Prospective, randomized, controlled trial. SETTING: Academic and private reproductive endocrinology and infertility centers. PATIENT(S): Eighty women ≤ 43 years of age with a history of a suboptimal response. INTERVENTION(S): Initiation of recombinant FSH/GnRH antagonist/recombinant LH/hCG on day 1 (n = 39) or day 4 (n = 41). MAIN OUTCOME MEASURE(S): Numbers of clinical and biochemical pregnancies, follicles ≥ 10 and ≥ 15 mm, oocytes collected, fertilized oocytes, cleavage stage embryos, and blastocysts; serum E(2) concentrations. Outcomes were compared between treatment groups. RESULT(S): The numbers of follicles that developed to ≥ 10 and ≥ 15 mm and serum E(2) were greater when recombinant FSH was initiated on day 1 (5.4, 4.3, 5,827.2 pmol/L) versus day 4 (3.6, 2.5, 4,230.1 pmol/L). The numbers of collected, metaphase II, and fertilized oocytes; cleavage stage embryos; and blastocysts were not different between groups. When we evaluated only those cycles that proceeded to oocyte pick-up, a lower implantation rate (16.1%, 56.0%), biochemical pregnancy rate (PR) (16.1%, 48.0%), and clinical PR (12.9% vs. 36.0%) were detected in the day 1 group versus day 4 group. CONCLUSION(S): Synchronizing initiation of ovarian stimulation with follicle wave emergence in patients with a prior suboptimal response resulted in an increase in the number of dominant follicles and serum E(2) concentrations; however, improvements in oocyte, embryo, or pregnancy outcomes did not occur. CLINICAL TRIAL REGISTRATION NUMBER: NCT00439829.

Advanced reproductive age and fertility: no. 269, November 2011.

OBJECTIVE: To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies (ART) and provide recommendations for their management,and to review investigations in the assessment of ovarian aging. OPTIONS: This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility. OUTCOMES: The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility. EVIDENCE: Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in June 2010, using appropriate key words (ovarian aging, ovarian reserve, advanced maternal age, advanced paternal age, ART). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated into the guideline to December 2010. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table). BENEFITS, HARMS, AND COSTS: Primary and specialist health care providers and women will be better informed about ovarian aging and the age-related decline in natural fertility and about options for assisted reproductive technology.

A practical method for ultrasonographically monitoring the day-to-day growth of individual ovarian follicles in women undergoing assisted reproduction.

The objective of this study was to validate the use of the nonidentity (NonID) method compared with the identity (ID) method for tracking the day-to-day growth of individual follicles in women undergoing ovarian stimulation for assisted reproduction. A retrospective observational study was conducted in 20 women during ovarian stimulation. Conventional 2-D transvaginal ultrasonography was used to monitor follicle growth every 2-3 days throughout stimulation. Video clips of both ovaries were obtained in sagittal and coronal planes at each visit. Standardized diameter measurements of all follicles ≥4 mm were made retrospectively from video clips. The growth profiles of all follicles that developed to ≥10 mm were determined using the ID and NonID methods. Using Lin's concordance statistics, we documented that agreement between methods was 91% for follicles <10 mm, 96% for follicles 10-15 mm and 99% for follicles >15 mm. Lin's concordance correlation coefficient between the two methods was 0.96 (standard error = 0.003). We concluded that the NonID method is a practical, effective tool for monitoring the day-to-day growth of individual ovarian follicles in women undergoing assisted reproduction.

Advanced reproductive age and fertility.

OBJECTIVE: To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies (ART) and provide recommendations for their management, and to review investigations in the assessment of ovarian aging. OPTIONS: This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility. OUTCOMES: The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility. EVIDENCE: Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in June 2010, using appropriate key words (ovarian aging, ovarian reserve, advanced maternal age, advanced paternal age, ART). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated into the guideline to December 2010. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table). BENEFITS, HARMS, AND COSTS: Primary and specialist health care providers and women will be better informed about ovarian aging and the age-related decline in natural fertility and about options for assisted reproductive technology. RECOMMENDATIONS: 1. Women in their 20s and 30s should be counselled about the age-related risk of infertility when other reproductive health issues, such as sexual health or contraception, are addressed as part of their primary well-woman care. Reproductive-age women should be aware that natural fertility and assisted reproductive technology success (except with egg donation) is significantly lower for women in their late 30s and 40s. (II-2A) 2. Because of the decline in fertility and the increased time to conception that occurs after the age of 35, women > 35 years of age should be referred for infertility work-up after 6 months of trying to conceive. (III-B) 3. Ovarian reserve testing may be considered for women ≥ 35 years of age or for women < 35 years of age with risk factors for decreased ovarian reserve, such as a single ovary, previous ovarian surgery, poor response to follicle-stimulating hormone, previous exposure to chemotherapy or radiation, or unexplained infertility. (III-B) 4. Ovarian reserve testing prior to assisted reproductive technology treatment may be used for counselling but has a poor predictive value for non-pregnancy and should be used to exclude women from treatment only if levels are significantly abnormal. (II-2A) 5. Pregnancy rates for controlled ovarian hyperstimulation are low for women > 40 years of age. Women > 40 years should consider IVF if they do not conceive within 1 to 2 cycles of controlled ovarian hyperstimulation. (II-2B) 6. The only effective treatment for ovarian aging is oocyte donation. A woman with decreased ovarian reserve should be offered oocyte donation as an option, as pregnancy rates associated with this treatment are significantly higher than those associated with controlled ovarian hyperstimulation or in vitro fertilization with a woman's own eggs. (II-2B) 7. Women should be informed that the risk of spontaneous pregnancy loss and chromosomal abnormalities increases with age. Women should be counselled about and offered appropriate prenatal screening once pregnancy is established. (II-2A) 8. Pre-conception counselling regarding the risks of pregnancy with advanced maternal age, promotion of optimal health and weight, and screening for concurrent medical conditions such as hypertension and diabetes should be considered for women > age 40. (III-B) 9. Advanced paternal age appears to be associated with an increased risk of spontaneous abortion and increased frequency of some autosomal dominant conditions, autism spectrum disorders, and schizophrenia. Men > age 40 and their partners should be counselled about these potential risks when they are seeking pregnancy, although the risks remain small. (II-2C).

Does the Ovarian Stimulation Phase Length Predict In vitro Fertilization Outcomes?

BACKGROUND: Bi-directional communication between the follicle and oocyte is necessary to regulate follicle and oocyte development. Currently, it is not practical to monitor the serial growth of individual follicles during assisted reproduction. The ovarian stimulation phase length (SPL) is an indirect measure of mean follicular growth rate. The objective of this study was to test the hypothesis that a short or long SPL would be associated with suboptimal outcomes in women undergoing in vitro fertilization (IVF). MATERIALS AND METHODS: A retrospective cohort study was conducted in 140 women who underwent IVF. Follicle development was monitored every 2-3 days during ovarian stimulation using transvaginal ultrasonography. Once > 3 follicles reached ≥ 17 mm, human chorionic gonadotropin (hCG) was administered. Oocyte retrieval was performed approximately 35 hours after hCG. Oocytes underwent IVF on the day of collection and were evaluated daily thereafter. Embryos were transferred on days 3 or 5, depending on the number and quality of embryos available. Associations between SPL, age, follicle, oocyte, embryo and pregnancy outcomes were evaluated (SPSS version 17.0; SPSS Inc., Chicago, IL, USA). RESULTS: A SPL of 11 days was associated with an optimal number of follicles that developed to ≥ 6 mm, ≥ 10 mm and ≥ 15 mm; serum estradiol concentrations; and number of oocytes collected (p<0.05). Gradual reductions in the number of developing follicles, serum estradiol concentrations and number of oocytes collected occurred with SPL less than or greater than 11 days (p<0.05). The SPL did not influence endometrial, embryo or pregnancy outcomes (p>0.05). Associations between SPL and outcomes were not influenced by age (p>0.05). CONCLUSION: The ovarian SPL can be used to predict the number of follicles that develop, oocytes collected and serum estradiol concentrations, but not embryo or pregnancy outcomes.

Development of Asherman syndrome after conservative surgical management of intractable postpartum hemorrhage.

OBJECTIVE: Describe a case of secondary infertility due to the development of severe Asherman Syndrome after the B-Lynch compression suture and uterine artery ligation, and to review the B-Lynch technique and documented complications. DESIGN: Case report. SETTING: Tertiary care hospital. PATIENT(S): A 29-year-old primigravida patient. INTERVENTION(S): B-Lynch suture and uterine artery ligation. MAIN OUTCOME MEASURE(S): Development of Asherman syndrome. RESULT(S): Development of secondary infertility due to Asherman syndrome after the B-Lynch suture. CONCLUSION(S): The B-Lynch suture is a highly successful conservative surgical technique used to treat this condition. There is little information regarding any potential for compromised future fertility, although there have been several reports of successful pregnancy after the use of the B-Lynch compression suture. In this report, we present a case of Asherman syndrome with complete obliteration of the uterine cavity after the B-Lynch suture.

DXA-derived abdominal fat mass, waist circumference, and blood lipids in postmenopausal women.

The purpose of this study was to determine the utility of dual-energy X-ray absorptiometry (DXA)-derived fat mass indices for predicting blood lipid profile in postmenopausal women. A secondary purpose was to determine whether waist circumference is comparable with DXA-derived measurements in predicting blood lipid profile. Subjects were 423 postmenopausal women (age 58.1 +/- 6.3 years). Fat mass was assessed at abdomen, trunk, and total body using DXA. Anthropometric measurements included BMI and waist circumference. Blood samples were analyzed for total cholesterol (TC), triglyceride (TAG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and cholesterol/HDL ratio. Of the DXA-derived measures, abdominal-fat mass was the best predictor of blood lipid profiles. DXA-derived abdominal fat mass and waist girth explained 20 and 16.5% of variation in TC/HDL ratio, respectively, in univariate analysis, with no difference between the slopes of the regression coefficients. Eighty-four percent of subjects were common to the top quartiles of waist circumference and abdominal fat mass, and blood lipid profiles generally worsened across increasing quartiles. DXA-derived abdominal fat mass and waist circumference are of equivalent utility for predicting alterations in blood lipids. Waist circumference is, therefore, ideal as an inexpensive means in primary health-care services for predicting risk of cardiovascular diseases in postmenopausal women.

Thrombosis of subclavian and internal jugular veins following severe ovarian hyperstimulation syndrome: a case report.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is a serious, albeit rare, complication of fertility treatment. In its severe form, it may be life-threatening. Increased vascular permeability with hemoconcentration is the hallmark of the syndrome. Vascular thromboembolism is a significant potential complication. CASE: A previously healthy 26-year-old nulligravid woman developed severe OHSS following an in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycle. She required hospitalization for treatment comprising IV fluid replacement, albumin infusion, paracentesis, and prophylactic heparin. She presented two days after discharge from hospital with left arm edema and neck pain. Subclavian and internal jugular vein thrombosis was diagnosed. CONCLUSION: OHSS is a serious complication of treatment for ovulation induction and is a significant risk factor for vascular thrombosis. Patients remain at risk even if given prophylactic heparin. The clinical presentation of OHSS may be unusual and late, indicating the importance of vigilance on the part of all physicians caring for patients who have undergone fertility treatment.

Pericardial mesothelioma in a Bengal tiger (Panthera tigris).

A 17-year-old Bengal tiger (Panthera tigris) presented with dyspnea and tachypnea. Radiographs revealed severe pleural and pericardial effusion, but no obvious mass. During attempts to remove the fluid under anesthesia, the cat developed cardiac tamponade and died. At necropsy, a nodular mass was found at the heart base and was identified as a pericardial mesothelioma. This is the first report of this tumor in any large cat.

Barriers to eligibility and enrollment among older women in a clinical trial on osteoporosis: effects of ethnicity and SES.

OBJECTIVES: The study examined whether ethnicity or socioeconomic status influenced a group's ability to meet eligibility criteria and willingness to enroll. METHOD: The eligibility and enrollment status of 904 women aged 65 years and older who responded to recruitment efforts of an estrogen and osteoporosis clinical trial were analyzed. RESULTS: Among women screened, 59% were White, 27% African Americans, and 14% Hispanics; average age was 75 years; 57.6% were eligible, of which 32% enrolled. High-income area residents were more likely to be eligible than low-income residents. African Americans were less likely to be eligible for medical reasons than non-African Americans. Eligible Hispanics were more likely to be enrolled than non-Hispanics. African Americans were equally willing to enroll as Whites. Minority residents of low-income areas were more likely to enroll than minority residents of high-income areas. DISCUSSION: Recruitment efforts should address barriers to eligibility and barriers to willingness to enroll.