Temporal Trends of Semen Quality and Fertility Rates Over the Course of a Decade: Data From King County, Washington.

OBJECTIVE: There has been a widely reported decline in both semen quality and fertility rate, however to date these studies have not looked at a decline of both in the same time period within the same geographical area. The objective of this study was to determine if there existed a temporal trend in both semen parameters and fertility rates for the same geographic area (King County, WA) over time. MATERIALS AND METHODS: Semen parameters from sperm donors at Seattle sperm bank were obtained from 2008 to 2021. Sperm donations occurred in King County, WA. Donors were from within 50 miles of the donation site. Fertility rates were calculated for King County, WA using census data from SEER to find number of women aged 15-49 and the number of births were found using CDC Wonder data from 2006 to 2017. RESULTS: There were a total of 76,622 sperm donor semen analyses from King County, WA included in our study from 2008 to 2021. The fertility rate for King County, WA was calculated from 2006 to 2017. From 2008 to 2021, there was a statistically significant decline in semen quality over time for both sperm count (P < .01), total motile sperm count (P < .01), sperm concentration (P < .01), and progressive motility (P < .01). Additionally, from 2006 to 2017 there was a statistically significant decline in fertility rate (P < .01). CONCLUSION: We report a statistically significant decline in sperm parameters among donors and a corresponding decline in fertility rates from the same geographic area that warrants further investigation given the serious societal and economic impacts a shrinking population presents. While certainly not the sole contributing factor, declining sperm parameters likely need to be accounted for when accounting for declining fertility rates.

Diagnostic testing and antibiotic utilization among inpatients evaluated for coronavirus disease 2019 (COVID-19) pneumonia.

We evaluated diagnostic test and antibiotic utilization among 252 patients from 11 US hospitals who were evaluated for coronavirus disease 2019 (COVID-19) pneumonia during the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant pandemic wave. In our cohort, antibiotic use remained high (62%) among SARS-CoV-2-positive patients and even higher among those who underwent procalcitonin testing (68%).

Medical students' personal experiences, religion, and spirituality explain their (dis)comfort with a patient's religious needs.

BACKGROUND: Physicians often avoid discussing patients' religious and spiritual concerns, even though most patients (i.e., 50-94%) want integrated care. To address this gap, medical students interviewed a Standardized Patient (SP) who was upset because the daughter did not confront her fiancée about converting to Orthodox Judaism. Students reflected on how their own religion and spirituality affected engaging with their patient. METHODS: With a 97% response rate, 231 first-year medical students responded to open-ended questions about their patient encounter. For this quantitative content analysis, we used inductive reasoning, identifying three themes: (1) impact of students' own religion on their comfort, (2) change in comfort, and (3) their learning. We used deductive reasoning to compare qualitative results from half of the students who began the curriculum with a questionnaire about their own spirituality with the other students completing afterwards. RESULTS: Most students said being religious positively influenced their comfort, whether they were also Orthodox Jewish or from a different religion. Among uncomfortable students (6.5%), some attributed this to not being religious. Some students (4.8%) grew more comfortable discussing the religious issue, and 18.2% became uncomfortable due to lacking knowledge of Orthodox Judaism and the awkwardness of the topic. Students who had completed the questionnaire beforehand gave more comments about connecting with their patients than students who completed the questionnaire afterwards (X2=11.047, p<.001). CONCLUSIONS: Students' own religion influenced their comfort with discussing religious concerns, with some feeling more connected and others becoming uncomfortable. This finding helps inform medical educators about teaching mind-body-spirit care.Résumé.

CONTEXTE: Les médecins évitent souvent de discuter des préoccupations religieuses et spirituelles des patients même si la plupart d'entre eux (soit entre 50 et 94 %) désirent recevoir des soins intégrés. Pour combler cette lacune, les étudiants en médecine ont interviewé un patient simulé (PS) qui était contrarié parce que sa fille n'avait pas confronté son fiancé à l'idée de se convertir au judaïsme orthodoxe. Les étudiants ont réfléchi sur l'impact qu'avait leur propre religion et spiritualité sur la façon dont ils abordent leur patient. MÉTHODES: Avec un taux de réponse de 97 pour cent, 231 étudiants de première année en médecine ont répondu à des questions ouvertes sur la rencontre avec leur patient. Dans le cadre de cette analyse de contenu quantitative, nous nous sommes servis du raisonnement inductif et avons déterminé trois thèmes :(1) impact de la religion des étudiants sur leur niveau de confort, (2) changement du niveau de confort et (3) leur apprentissage. Nous avons utilisé le raisonnement déductif pour comparer les résultats qualitatifs obtenus pour la moitié des étudiants qui ont commencé leur cursus en remplissant un questionnaire sur leur propre spiritualité, l'autre moitié ayant répondu au questionnaire subséquemment. RÉSULTATS: La plupart des étudiants ont affirmé que d'être religieux avait eu un impact positif sur leur niveau de confort, qu'ils soient juifs orthodoxes ou d'une religion différente. Parmi les étudiants inconfortables (6,5 %), certains ont attribué ce sentiment au fait qu'ils n'étaient pas religieux. D'autres (4,8 %) se sont sentis plus à l'aise après avoir discuté le problème religieux et 18,2 % d'entre eux se sont sentis moins à l'aise en raison de leur manque de connaissance sur le judaïsme orthodoxe et du sujet embarrassant. Les étudiants qui avaient rempli le questionnaire auparavant ont fourni plus de commentaires sur leur façon d'aborder leurs patients que ceux qui y avaient répondu après (X2 =11,047; p<,001). CONCLUSIONS: La religion des étudiants a eu un impact sur leur degré d'aisance au moment de discuter les questions religieuses; certains se sentant plus proches et d'autres, plus inconfortables. Cette conclusion informe les éducateurs en médecine de l'importance d'enseigner les soins du corps, de l'esprit et de l'âme.

Quantifying marine debris associated with coastal golf courses.

Identifying terrestrial sources of debris is essential to suppress the flow of plastic to the ocean. Here, we report a novel source of debris to the marine environment. From May 2016 to June 2018, we collected golf balls from coastal environments associated with five courses in Carmel, California. Our 75 collections recovered 39,602 balls from intertidal and nearshore environments adjacent to, or downriver from, the golf courses. Combining our collections with concurrent efforts of the Monterey Bay National Marine Sanctuary and the Pebble Beach Corporation, we report the retrieval of 50,681 balls, totaling approximately 2.5 tons of debris. We also examined decomposition patterns in the collected balls, which illustrate that degradation and loss of microplastic from golf balls to the marine environment may be of concern. Our findings will help to develop and direct mitigation procedures for this region and others with coastal golf courses.