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Objectives: The objectives of this study were (1) to assess the prevalence of ultrasound (US) features of adenomyosis in an infertile population undergoing in-vitro fertilization (IVF), (2) to define the inter- and intrarater agreement of three-dimensional (3D) US assessment of adenomyosis, and (3) to evaluate sonographic features of adenomyosis with respect to pregnancy outcome following transfer of a single thawed euploid blastocyst.Methods: This was a prospective cohort study. Subjects scheduled to undergo a single thawed euploid blastocyst transfer between April and December 2017 at a large IVF center were eligible for inclusion. Enrolled subjects underwent endometrial preparation for frozen embryo transfer. 3D-US was performed on the day prior to embryo transfer, with images stored for subsequent evaluation. Subjects then underwent transfer of a single thawed euploid blastocyst, and pregnancy outcomes were collected. All 3D-US volumes were de-identified and reviewed independently by five reproductive endocrinologists/infertility specialists with expertise in gynecological US for the presence of seven sonographic features of adenomyosis: global uterine enlargement, myometrial wall asymmetry, heterogeneous echogenicity, irregular junctional zone, myometrial cysts, fan-shaped shadowing and ill-defined myometrial lesions. Adenomyosis was considered to be present if the majority of the reviewers noted at least one of the seven sonographic features. Inter- and intrarater agreement was evaluated using Fleiss's kappa. Clinical and cycle characteristics of subjects with and those without adenomyosis were compared. The primary outcome of interest was live birth rate. Secondary outcomes included clinical pregnancy rate and miscarriage rate. Logistic regression analysis was performed to account for potential confounders.Results: A total of 648 subjects were included. The prevalence of adenomyosis on US was 15.3% (99/648). On retrospective chart review, very few patients with adenomyosis had symptoms. The inter- and intrarater agreement amongst five independent specialists conducting the 3D-US assessments of adenomyosis were poor (κ = 0.23) and moderate (κ = 0.58), respectively. Subjects with adenomyosis were older (37.1 vs 35.9 years, P = 0.02) and more likely to undergo a gonadotropin-releasing hormone agonist downregulation protocol when compared with those without adenomyosis (12.1% vs 5.1%, P = 0.02). Clinical pregnancy (80.0% vs 75.0%) and live birth (69.5% vs 66.5%) rates were similar between the groups. When adjusting for potential confounders, there was no difference in the rate of clinical pregnancy (adjusted odds ratio (aOR), 1.47 (95% CI, 0.85-2.56)), miscarriage (aOR, 1.3 (95% CI, 0.62-2.72)) or live birth (aOR, 1.28 (95% CI, 0.78-2.08)) between subjects with and those without adenomyosis. No individual sonographic marker of adenomyosis was predictive of pregnancy outcome.Conclusions: The inter-rater agreement of 3D-US assessment of adenomyosis is poor. Furthermore, sonographic markers of adenomyosis in asymptomatic patients may not be associated with altered pregnancy outcome following transfer of a single thawed euploid blastocyst. These findings suggest that routine screening for asymptomatic adenomyosis in an unselected infertile patient population undergoing frozen embryo transfer may not be warranted. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Aims Undercarboxylated osteocalcin (ucOC) promotes increased insulin sensitivity and increased secretion. Since antiresorptive therapy (AT) decreases ucOC levels, AT could increase the risk of diabetes and this would have serious clinical ramifications. We sought to test this hypothesis by examining the association between new use of AT and newly-diagnosed diabetes. Methods Using a bone mineral density (BMD) registry for Manitoba, Canada, we identified 33 640 women aged ≥50 years without diabetes at their first BMD test for 1998-2013. We linked these women to a province-wide retail pharmacy database to identify new AT exposure each year for up to 5 years after a BMD test. Time-dependent analysis was used to test the independent association between new use of AT and newly diagnosed diabetes. Results This cohort had a mean age of 65 years, a mean body mass index of 26.8 kg/m2, and 12% were receiving glucocorticoid and 13% hormone replacement therapy at BMD test. In the first year after BMD test, 29% of women started AT (bisphosphonates, 92%). Over a mean 4.2 years of follow-up, 3.7% new AT users and 4.2% non-users had diabetes (adjusted hazard ratio 1.01, 95% confidence interval 0.87-1.16). Sensitivity analyses using AT dose-response gradients also found no significant associations with diabetes. Conclusions Despite the plausible biological mechanisms related to ucOC, new use of AT was not a risk factor for diabetes in this cohort. The clinical implications of these findings are reassuring, as AT is widely prescribed for treating osteoporosis in older women who are also at high risk of developing diabetes. [ABSTRACT FROM AUTHOR]

An assessment of the performance of a state-of-the-art large-scale coupled sea ice-ocean model, including a new snow multilayer thermodynamic scheme, is performed. Four 29 year long simulations are compared against each other and against sea ice thickness and extent observations. Each simulation uses a separate parameterization for snow thermophysical properties. The first simulation uses a constant thermal conductivity and prescribed density profiles. The second and third parameterizations use typical power-law relationships linking thermal conductivity directly to density (prescribed as in the first simulation). The fourth parameterization is newly developed and consists of a set of two linear equations relating the snow thermal conductivity and density to the mean seasonal wind speed. Results show that simulation 1 leads to a significant overestimation of the sea ice thickness due to overestimated thermal conductivity, particularly in the Northern Hemisphere. Parameterizations 2 and 4 lead to a realistic simulation of the Arctic sea ice mean state. Simulation 3 results in the underestimation of the sea ice basal growth in both hemispheres, but is partly compensated by lateral growth and snow ice formation in the Southern Hemisphere. Finally, parameterization 4 improves the simulated Snow Depth Distributions by including snow packing by wind, and shows potential for being used in future works. The intercomparison of all simulations suggests that the sea ice model is more sensitive to the snow representation in the Arctic than it is in the Southern Ocean, where the sea ice thickness is not driven by temperature profiles in the snow. [ABSTRACT FROM AUTHOR]

The role glucosinolates play in defending plants against phloem feeders such as aphids and whiteflies is currently not clear as these herbivores may avoid bringing glucosinolates from the phloem sap into contact with myrosinase enzymes. Here, we investigated the effects of high levels of aliphatic and indolic glucosinolates on life history traits and detoxification gene expression in two sibling species, B and Q, of the whitefly Bemisia tabaci. High levels of aliphatic glucosinolates decreased the average oviposition rate of both species and reduced the survival and developmental rate of Q nymphs. High levels of indolic glucosinolates decreased the oviposition rate and survival of nymphal stages of the B species and the developmental rate of both species. Molecular analyses revealed two major asymmetries between the B and Q species. First, specific GST genes ( BtGST1 and BtGST2) were significantly induced during exposure to indolic glucosinolates only in Q. This may reflect the genes putative involvement in indolic glucosinolates detoxification and explain the species' good performance on plants accumulating indolic glucosinolates. Second, the constitutive expression of eight of the 10 detoxification genes analysed was higher in the Q species than in the B species. Interestingly, four of these genes were induced in B in response to high levels of glucosinolates. It seems, therefore, that the B and Q species differ in their 'optimal defence strategy'. B utilizes inducible defences that are profitable if the probability of experiencing the stress is small and its severity is low, while Q invests significant resources in being always 'ready' for a challenge. [ABSTRACT FROM AUTHOR]

Background Use of aspirin with non-steroidal anti-inflammatory drugs increases the risk of gastrointestinal ulcers; however, it is not clear if this risk varies with the non-steroidal anti-inflammatory drug used. Aim To assess the risk of gastrointestinal hospitalizations attributable to aspirin in patients 50 years or older also using non-steroidal anti-inflammatory drugs. Methods Administrative data of patients 50 years or older who received a non-steroidal anti-inflammatory drug or acetaminophen prescription between 1998 and 2004 were used. Results Study patients received 7 412 992 non-steroidal anti-inflammatory drug prescriptions and 5 614 044 acetaminophen prescriptions among which 23% and 32%, respectively, were dispensed to aspirin users. Time-dependent Cox regression models revealed that, compared to patients using acetaminophen (without aspirin), the adjusted hazard ratio (95% CI) among non-users of aspirin were: rofecoxib 1.3 (1.2, 1.5), celecoxib 0.7 (0.6, 0.8), diclofenac 1.5 (1.2, 1.7), ibuprofen 0.9 (0.6, 1.4), naproxen 2.5 (2.1, 3.0) and piroxicam 1.5 (0.8, 2.8); among users of aspirin: rofecoxib 3.2 (2.8, 3.7), celecoxib 1.8 (1.5, 2.1), diclofenac 2.8 (2.2, 3.5), ibuprofen 1.4 (0.8, 2.7), naproxen 2.2 (1.6, 3.0) and piroxicam 2.0 (0.8, 5.4). The risk attributable to aspirin varied from none with naproxen to 61% (53%, 68%) with celecoxib. Conclusion The increase in gastrointestinal hospitalization attributable to aspirin differed with the non-steroidal anti-inflammatory drug used, and seemed higher with cyclo-oxygenase-2 inhibitors than with non-selective non-steroidal anti-inflammatory drugs. [ABSTRACT FROM AUTHOR]

The name of one of the contributing authors to this paper was omitted from the list of authors that appeared on page 373. The correct list of authors and affiliations are printed below: [ABSTRACT FROM AUTHOR]

The Association of Canadian Faculties of Dentistry (ACFD) recently developed a proposal that reflects its evolving understanding of competency-based dental education. The ACFD proposal was developed into an Educational Framework for the Development of Competency in Dental Programs and has been adopted by all ten Canadian dental schools as the basis for their ongoing curriculum development and assessment. This framework identifies five global competencies that provide a big picture of the complex skills, knowledge, and behaviors that dental graduates must demonstrate. Detail for clarification and illustration is provided by more comprehensive "components" of each area that elaborate on the global statement and by a new dimension that assists with assessment: "indicators" of the specific knowledge, skills, and behaviors that can be measured as steps towards developing competence. In the information supporting understanding and assessment of the five key areas are both the existing national competency statements to facilitate the use of the framework by other stakeholders and a parallel set of knowledge, skills, and abilities statements developed by the National Dental Examining Board of Canada (NDEB) as the starting point for updating its examination blueprints. This article outlines the development, structure, and contents of the ACFD Educational Framework in the hope that it can serve as the foundation for a new Canadian national competencies document serving all national stakeholders.