Something to Chew on; Plate-Waste at an Ontario Veteran's Centre.

There is paucity of data assessing levels of food/beverage waste in long-term care (LTC) facilities, especially in Ontario. Observations in the Veteran's Centre (VC) at Sunnybrook Health Sciences Centre (Sunnybrook) indicated food/beverage waste may be high, potentially impacting sustainability efforts within our institution. Before proceeding with waste reduction efforts, we conducted a comprehensive 3-day waste-audit of food/beverage items provided to VC residents with the goal of understanding the extent of food/beverage waste at VC, items wasted, and any other factors that may inform future changes. Our results indicate that 28% of items served to residents were wasted. Lunch was the meal with greatest waste at 31% and waste of solid items was 12% higher than that of liquids. We observed a large variability in waste between residents and within each resident, with 15% of residents wasting >50% of items provided. This study provides a deeper insight into the magnitude of food/beverage waste in a LTC population and highlights the importance of considering individualized strategies to address waste to avoid negative impact on residents.

Guideline No. 445: Management of Chronic Pelvic Pain.

OBJECTIVE: To provide evidence-based recommendations for the management of chronic pelvic pain in females. TARGET POPULATION: This guideline is specific to pelvic pain in adolescent and adult females and excluded literature that looked at pelvic pain in males. It also did not address genital pain. BENEFITS, HARMS, AND COSTS: The intent is to benefit patients with chronic pelvic pain by providing an evidence-based approach to management. Access to certain interventions such as physiotherapy and psychological treatments, and to interdisciplinary care overall, may be limited by costs and service availability. EVIDENCE: Medline and the Cochrane Database from 1990 to 2020 were searched for articles in English on subjects related to chronic pelvic pain, including diagnosis, overlapping pain conditions, central sensitization, management, medications, surgery, physiotherapy, psychological therapies, alternative and complementary therapies, and multidisciplinary and interdisciplinary care. The committee reviewed the literature and available data and used a consensus approach to develop recommendations. Only articles in English and pertaining to female subjects were included. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE: Family physicians, gynaecologists, urologists, pain specialists, physiotherapists, and mental health professionals. TWEETABLE ABSTRACT: Management of chronic pelvic pain should consider multifactorial contributors, including underlying central sensitization/nociplastic pain, and employ an interdisciplinary biopsychosocial approach that includes pain education, physiotherapy, and psychological & medical treatments. SUMMARY STATEMENTS: RECOMMENDATIONS.

The impacts of artificial light at night on the ecology of temperate and tropical reefs.

Despite 22% of the world's coastal regions experiencing some degree of light pollution, and biologically important artificial light at night (ALAN) reaching large portions of the seafloor (greater than 75%) near coastal developments, the impacts of ALAN on temperate and tropical reefs are still relatively unknown. Because many reef species have evolved in response to low-light nocturnal environments, consistent daily, lunar, and seasonal light cycles, and distinct light spectra, these impacts are likely to be profound. Recent studies have found ALAN can decrease reproductive success of fishes, alter predation rates of invertebrates and fishes, and impact the physiology and biochemistry of reef-building corals. In this paper, we integrate knowledge of the role of natural light in temperate and tropical reefs with a synthesis of the current literature on the impacts of ALAN on reef organisms to explore potential changes at the system level in reef communities exposed to ALAN. Specifically, we identify the direct impacts of ALAN on individual organisms and flow on effects for reef communities, and present potential scenarios where ALAN could significantly alter system-level dynamics, possibly even creating novel ecosystems. Lastly, we highlight large knowledge gaps in our understanding of the overall impact of ALAN on reef systems. This article is part of the theme issue 'Light pollution in complex ecological systems'.

Light pollution in complex ecological systems.

Light pollution has emerged as a burgeoning area of scientific interest, receiving increasing attention in recent years. The resulting body of literature has revealed a diverse array of species-specific and context-dependent responses to artificial light at night (ALAN). Because predicting and generalizing community-level effects is difficult, our current comprehension of the ecological impacts of light pollution on complex ecological systems remains notably limited. It is critical to better understand ALAN's effects at higher levels of ecological organization in order to comprehend and mitigate the repercussions of ALAN on ecosystem functioning and stability amidst ongoing global change. This theme issue seeks to explore the effects of light pollution on complex ecological systems, by bridging various realms and scaling up from individual processes and functions to communities and networks. Through this integrated approach, this collection aims to shed light on the intricate interplay between light pollution, ecological dynamics and humans in a world increasingly impacted by anthropogenic lighting. This article is part of the theme issue 'Light pollution in complex ecological systems'.

Follicle Stimulating Hormone (FSH) as a Predictor of Decreased Oocyte Yield in Patients with Normal Anti-Müllerian Hormone (AMH) and Antral Follicle Count (AFC).

Background: The purpose of the current study was to determine the utility of early follicular phase follicle-stimulating hormone (FSH) testing in patients undergoing in vitro fertilization (IVF). Methods: This was a retrospective review of patients from 2012 to 2015 at Mayo Clinic in Rochester, Minnesota, USA. Included subjects had a normal anti-Müllerian hormone (AMH) of 1 to 9 ng/ml and antral follicle count (AFC) of 10 to 29. Patients were stratified by FSH level when associated estradiol was less than 50 ng/ml. In total, 225 patients were categorized into three groups: high FSH (FSH ≥10 IU/L; n= 36), normal FSH (>5 IU/L and <10 IU/L; n=170), and low FSH (FSH ≤5 IU/L; n= 19). ANOVA and multiple logistic regression were used for statistical comparisons and for evaluation of the relationships between variables; significance level was set at <0.05. Results: There were no significant differences in demographics, IVF cycle type, or peak estradiol level between the groups. Patients with a high basal FSH level had a similar clinical pregnancy rate and live birth rate compared to controls and patients with low FSH. High FSH level was associated with decreased follicular development (17 versus 22; p<0.01), oocyte yield (15 versus 18; p=0.02), and embryo yield (8 versus 10; p=0.04) despite higher total doses of gonadotropins. Conclusion: Patients with normal AMH and AFC levels could be further stratified into lower responders and starting doses of medications can be adjusted based on high basal FSH levels. Therefore, it is suggested to counsel patients on pregnancy outcomes which seem to be quite similar regardless of the FSH level.

Extensive regional variation in the phenology of insects and their response to temperature across North America.

Climate change models often assume similar responses to temperatures across the range of a species, but local adaptation or phenotypic plasticity can lead plants and animals to respond differently to temperature in different parts of their range. To date, there have been few tests of this assumption at the scale of continents, so it is unclear if this is a large-scale problem. Here, we examined the assumption that insect taxa show similar responses to temperature at 96 sites in grassy habitats across North America. We sampled insects with Malaise traps during 2019-2021 (N = 1041 samples) and examined the biomass of insects in relation to temperature and time of season. Our samples mostly contained Diptera (33%), Lepidoptera (19%), Hymenoptera (18%), and Coleoptera (10%). We found strong regional differences in the phenology of insects and their response to temperature, even within the same taxonomic group, habitat type, and time of season. For example, the biomass of nematoceran flies increased across the season in the central part of the continent, but it only showed a small increase in the Northeast and a seasonal decline in the Southeast and West. At a smaller scale, insect biomass at different traps operating on the same days was correlated up to ~75 km apart. Large-scale geographic and phenological variation in insect biomass and abundance has not been studied well, and it is a major source of controversy in previous analyses of insect declines that have aggregated studies from different locations and time periods. Our study illustrates that large-scale predictions about changes in insect populations, and their causes, will need to incorporate regional and taxonomic differences in the response to temperature.

Platelet-derived exosomes induce cell proliferation and wound healing in human endometrial cells.

Aim: To investigate the regenerative effects of a platelet-derived purified exosome product (PEP) on human endometrial cells. Materials & methods: Endometrial adenocarcinoma cells (HEC-1A), endometrial stromal cells (T HESC) and menstrual blood-derived stem cells (MenSC) were assessed for exosome absorption and subsequent changes in cell proliferation and wound healing properties over 48 h. Results: Cell proliferation increased in PEP treated T HESC (p < 0.0001) and MenSC (p < 0.001) after 6 h and in HEC-1A (p < 0.01) after 12 h. PEP improved wound healing after 6 h in HEC-1A (p < 0.01) and MenSC (p < 0.0001) and in T HESC between 24 and 36 h (p < 0.05). Conclusion: PEP was absorbed by three different endometrial cell types. PEP treatment increased cell proliferation and wound healing capacity.

The uterus has a remarkable ability to heal itself. Every month the inside lining of the uterus grows in preparation for pregnancy and sheds if no pregnancy occurs. Unfortunately, this cycle of growth, shedding and repair can be injured and lead to menstrual changes, pain or even infertility. In this study, we looked how special cell messengers ­ called exosomes ­ could help uterine cells. Exosomes are special messengers that contain substances to help the body heal and regenerate injured cells and tissues. We obtained exosomes created from human transfusion-grade platelets. We studied the exosomes' effects in three different cell types that all are important inside the uterine lining. Specifically, we studied the ability of the exosomes to help cells proliferate and migrate into a wound. In this study, exosomes were recognized by the human endometrial cells and were absorbed. Once they were inside the cells, they increased cell proliferation as well as the ability of the cells to heal a scratch wound. Furthermore, the more exosomes we presented to the cells, the more the cells were able to proliferate and move into a wound for healing. These findings lay the groundwork for future studies in animal models of uterine injury.

Effects of prophylactic indomethacin on intraventricular hemorrhage and adverse outcomes in neonatal intensive care unit.

OBJECTIVE: To identify the relationship between prophylactic indomethacin (PI) administration and incidence of intraventricular hemorrhage. STUDY DESIGN: A retrospective analysis of extremely premature infants <27 weeks gestational age born between January 2014 and September 2020. RESULTS: A total of 421 infants were included from three of Nationwide Children's Hospital delivery centers. Of those 255 (61%) received PI. After adjustment by inverse proportionality treatment weighting (IPTW), no differences were found in incidence of intraventricular hemorrhage (IVH) at the time of the first ultrasound, 31% vs. 33% in PI and control groups respectively (p = 0.68). The rate of rise of serum creatinine from baseline to day of life four was significantly higher in the PI group (0.14 mg/dl PI and 0.03 mg/dl control, p < 0.001). CONCLUSION: PI was not associated with any benefit in prevention of IVH, but is associated with adverse effects including acute rise in creatinine.

Light at night disrupts trophic interactions and population growth of lady beetles and pea aphids.

Natural variation in light has historically correlated with seasonality, providing an honest cue to organisms with seasonal life history cycles. However, with the onset of widespread light at night (LAN), the reliability of light as a cue has decreased in polluted areas, making its timing or intensity potentially clash with temperature trends. These clashing cues may influence biological systems on multiple levels. Yet, a few studies have connected behavioral underpinnings and larger community-level processes, resulting in a knowledge gap bridging individual-, population-, and community-level responses to mismatched cues. We experimentally investigated impacts of cool temperature and LAN on a lady beetle-aphid-fava system to test how light and temperature influenced aphid population growth and their underlying behavioral drivers. We used Coccinella septempunctata and Coleomegilla maculata beetles to understand the interaction of the environment and predation on pea aphid (Acyrthosiphon pisum) population growth. Aphids and their predators reacted differently to variation in light and temperature, influencing the strength of aphid-driven and predator-driven dynamics in the different conditions. We observed evidence of aphid-driven dynamics in the cool, light conditions where aphids excel and exhibited strong anti-predator behavior. In contrast, we found stronger predator-driven dynamics in warm conditions where lady beetle predatory success was higher. Overall, we found that LAN has context-dependent effects on insect communities due to the varied responses each player has to its environment.

Outcomes of embryo transfers performed by Reproductive Endocrinology and Infertility fellows vs. faculty: an 11-year retrospective review.

OBJECTIVE: To compare the clinical pregnancy rate (CPR) and live birth rate (LBR) of embryo transfer episodes (ETEs) performed by Reproductive Endocrinology and Infertility fellows vs. those of ETEs performed by faculty physicians. DESIGN: Retrospective cohort analysis. SETTING: Academic reproductive endocrinology and infertility practice. PATIENT(S): In total, 3,073 ETEs for 1,488 unique patients were performed by fellows or faculty physicians between January 2009 and January 2020. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate and LBR. RESULT(S): Fifteen fellows performed 1,225 (39.9%) of 3,073 ETEs after completing 30 mock transfers. On comparing outcomes among fellowship years (FY1, FY2, and FY3), CPR (44.1% vs. 43.2% vs. 45.7%, respectively, P = .83) and LBR (39.1% vs. 38.1% vs. 38.4%, respectively, P = .97) were not significantly different. Fellowship year 1 fellows' initial 30 ETEs vs. all the remaining FY1 ETEs had a significantly higher CPR (48.1% vs. 40.5%, respectively, P = .030) and LBR (45.4% vs. 34.3%, respectively, P = .001). There were no significant differences between faculty versus fellow ETEs in terms of CPR (43.0% vs. 45.0%, respectively, P = .30) or LBR (37.3% vs. 39.8%, respectively, P = .16), even after adjusting for patient age, body mass index, primary infertility diagnosis, autologous vs. donor oocyte, fresh vs. frozen embryo, number of embryos transferred, type of transfer catheter, and year of transfer (P = .32 for CPR, P = .22 for LBR). CONCLUSION(S): Appropriately trained FY1 fellows had success rates maintained throughout all FYs. There were no significant differences in clinical outcomes between fellow- and faculty-performed transfers. These data demonstrated that allowing fellows to perform live embryo transfers is not detrimental to clinical outcomes.

Outcomes of Frozen Oocyte Donor In Vitro Fertilization (IVF) Cycles Using Fresh Versus Frozen Sperm.

The ability to use frozen sperm for insemination during in vitro fertilization (IVF) is crucial for patients and for reproductive endocrinologists. However, concerns exist regarding the effects of cryopreservation on sperm quality and IVF outcomes. This study compares outcomes of frozen donor oocyte IVF cycles with intracytoplasmic sperm injection (ICSI) of good quality fresh versus frozen ejaculated sperm. Patients who underwent their first frozen donor oocyte IVF cycle between 2013 and 2019 at Mayo Clinic were identified. The primary outcome was live birth rate (LBR). Secondary outcomes included fertilization rate (FR), blastocyst development rate (BR), and clinical pregnancy rate (CPR). Twenty-six patients used fresh sperm and 19 patients utilized frozen sperm; there were no significant demographic differences between the groups. There were no significant differences noted in CPR, FR, and BR. Although the LBR was not statistically different when frozen versus fresh sperm was utilized (52.6% vs. 61.5%, p = 0.55), there was a distinct trend towards improved outcomes with fresh sperm that may be clinically significant. This data suggests that frozen sperm may be an alternative to a fresh sample, however fresh sperm may ultimately be a better option. This finding should be further explored with studies utilizing a larger sample size.

The Diversity of Photosensitivity and its Implications for Light Pollution.

Artificial light at night (ALAN) is a pervasive anthropogenic pollutant, emanating from urban and suburban developments and reaching nearly all ecosystems from dense forests to coastlines. One proposed strategy for attenuating the consequences of ALAN is to modify its spectral composition to forms that are less disruptive for photosensory systems. However, ALAN is a complicated pollutant to manage due to the extensive variation in photosensory mechanisms and the diverse ways these mechanisms manifest in biological and ecological contexts. Here, we highlight the diversity in photosensitivity across taxa and the implications of this diversity in predicting biological responses to different forms of night lighting. We curated this paper to be broadly accessible and inform current decisions about the spectrum of electric lights used outdoors. We advocate that efforts to mitigate light pollution should consider the unique ways species perceive ALAN, as well as how diverse responses to ALAN scale up to produce diverse ecological outcomes.

Introduction to the Symposium: Effects of Light Pollution Across Diverse Natural Systems.

Light pollution, or the presence of artificial light at night (ALAN), is among the fastest growing but least understood anthropogenic stressor on the planet. While historically light pollution has not received attention comparable to climate change or chemical pollution, research over the past several decades has revealed the plethora of negative effects on humans, animals, and supporting ecosystems. As light pollution continues to grow in spatial, spectral, and temporal extent, we recognize the urgent need to understand how this affects circadian physiology, organismal fitness, life history traits and tradeoffs, population trends, and community interactions. Here, we aim to highlight background and foundational evidence of the effects of light pollution to present context and the basis for early light pollution studies. Next, we touch on several understudied topics where research is underway to fill gaps in our knowledge and provide the basis for future research. Last, we focus on questions that are vital to understanding the effects of ALAN on diverse natural systems and discuss the barriers we face conducting research on light pollution.

Daily Signaling Rate and the Duration of Sound per Signal are Negatively Related in Neotropical Forest Katydids.

Researchers have long examined the structure of animal advertisement signals, but comparatively little is known about how often these signals are repeated and what factors predict variation in signaling rate across species. Here, we focus on acoustic advertisement signals to test the hypothesis that calling males experience a tradeoff between investment in the duration or complexity of individual calls and investment in signaling over long time periods. This hypothesis predicts that the number of signals that a male produces per 24 h will negatively correlate with (1) the duration of sound that is produced in each call (the sum of all pulses) and (2) the number of sound pulses per call. To test this hypothesis, we measured call parameters and the number of calls produced per 24 h in 16 species of sympatric phaneropterine katydids from the Panamanian rainforest. This assemblage also provided us with the opportunity to test a second taxonomically specific hypothesis about signaling rates in taxa such as phaneropterine katydids that transition from advertisement calls to mating duets to facilitate mate localization. To establish duets, male phaneropterine katydids call and females produce a short acoustic reply. These duets facilitate searching by males, females, or both sexes, depending on the species. We test the hypothesis that males invest either in calling or in searching for females. This hypothesis predicts a negative relationship between how often males signal over 24 h and how much males move across the landscape relative to females. For the first hypothesis, there was a strong negative relationship between the number of signals and the duration of sound that is produced in each signal, but we find no relationship between the number of signals produced per 24 h and the number of pulses per signal. This result suggests the presence of cross-taxa tradeoffs that limit signal production and duration, but not the structure of individual signals. These tradeoffs could be driven by energetic limitations, predation pressure, signal efficacy, or other signaling costs. For the second hypothesis, we find a negative relationship between the number of signals produced per day and proportion of the light trap catch that is male, likely reflecting males investing either in calling or in searching. These cross-taxa relationships point to the presence of pervasive trade-offs that fundamentally shape the spatial and temporal dynamics of communication.

Three degrees of separation: complete uterine and cervical septa.

OBJECTIVE: To review the diagnosis and management of 3 variations of incomplete müllerian duct fusion and reabsorption. DESIGN: Narrated video delineating the surgical management of 3 müllerian anomalies; this video was deemed exempt from review by the institutional review board of the Mayo Clinic. SETTING: Tertiary care academic medical center. PATIENT(S): This video focuses on 3 müllerian anomalies: complete septate uterus with a single septate cervix (septate uterus unicollis); complete septate uterus with duplicated cervix (septate uterus bicollis); and complete duplication of the uterus and cervix (uterine didelphys). INTERVENTION(S): Magnetic resonance imaging (MRI), cervical septoplasty, operative hysteroscopy, and uterine septoplasty. MAIN OUTCOME MEASURE(S): Several variations of uterine malformations exist. In our practice, we differentiate complete septate uteri as either unicollis or bicollis via MRI and vaginal examination. The bicollis presentation can be identified on MRI by the "lambda sign," which is seen as the 2 cervices that diverge as they enter the vagina. This is in comparison with the unicollis presentation when the single septate cervix can be traced with parallel lines as it enters the vagina. The circle method is described in this video to help distinguish between a single and duplicated cervix on examination. RESULT(S): The cervical and uterine septa were resected completely in the patient with a complete septate uterus unicollis. In contrast, the uterine septum was resected completely and the 2 cervical canals were not incised in the case of the complete septate uterus bicollis. Although uterine and cervical septa resection is controversial, our practice is to avoid the incision of the 2 cervical canals in cases that are more clearly consistent with a bicollis classification. CONCLUSION(S): Müllerian anomalies represent a continuum of disorders caused by different degrees of disruption in embryogenesis. MRI with vaginal gel and vaginal examination are tools to help classify the anomaly and guide surgical management.

A Mentorship Program for Academic Obstetrician Gynecologists that Improved Publication and Overall Confidence for Success.

This article aims to evaluate the impact of a mentorship program to enhance the training of clinical and research scientists in obstetrics and gynecology (OBGYN). A departmental course was developed for junior faculty and fellows based on their areas of interest. The research was IRB-approved. The curriculum consisted of monthly interactive workshops for an interdisciplinary group of trainees in OBGYN. Themes included research, education, and leadership in academic OBGYN. There was a strong emphasis on participatory exercises. Examples of curriculum topics included manuscript publication and review, grant writing, working with an IRB, promotion, and time management. Pre- and post-course questionnaires assessed participants' confidence in skills related to the course topics. Generalized linear models were used to assess changes in post-course response, using each question as the dependent variable and an indicator for post-course as the predictor variable. The control group was composed of junior faculty and fellows before the course was initiated. Outcome measures included the number and impact factor of published manuscripts. A Wilcoxon rank-sum test was used to assess outcome measures. Of the 118 attendees, 26 (22.0%) were junior faculty, 35 (29.66%) were clinical fellows, and 28 (23.7%) were research fellows, other research staff, or students. For each 3-year course series, an average of 20 participants completed the post-course surveys, of which 72% were clinical fellows, 22% were assistant professors, and 5% were instructors. The data revealed a statistically significant change in the participant's overall confidence in skills related to research, education, and leadership when comparing the cumulative results from the pre-to-post course surveys (p < 0.001). Specifically, participants noted improved confidence in their skills related to clinical and translation research (p < 0.001) and leadership and academic career advancement (p = 0.001). Additionally, junior faculty and clinical fellows who attended the course had a higher number of publications during the course period compared with controls (p = 0.003 and p = 0.008, respectively). This subspecialty-tailored, departmental training program was effective in increasing junior faculty and clinical fellows' confidence in skills related to career advancement and research and in the number of peer-reviewed publications.

The Respirator Fit Capability Test: Enhancing the Efficacy of Filtering Facepiece Respirators.

When NIOSH promulgated its Respiratory Protective Devices rule in 1995 (Title 42 code of Federal Regulations, Part 84), which specified approval standards for respirators, no test for evaluating the fitting characteristics of filtering facepiece respirators was included. The consequences of the lack of a fit test in 42 CFR 84 included the approval of devices that did not fit the general respirator-wearing population very well, higher costs for conducting the OSHA-required fit test, and the potential for wearing to pass a fit test in error. Today, the need still exists for a fit test for use by manufacturers of filtering facepiece respirators and conformity assessment organizations.