Cryptorchidism Review for the Primary Care Provider.

Cryptorchidism, or undescended testes, is the most common disorder of the genitals seen at birth. Due to its high prevalence and short- and long-term sequelae, it is crucial that primary care providers are familiar with the appropriate management of cryptorchidism. This paper serves to review the embryology, diagnosis, management, and treatment of cryptorchidism with the goal of serving as a valuable reference for providers managing pediatric and neonatal urological issues in the primary care setting, using the American Urological Association's most recent guidelines on the subject. Importantly, it also serves as a review of the long-term consequences of cryptorchidism (even after repair) and reinforces the need for continued surveillance for complications throughout a patient's life.

A Concise Review of Neonatal Dermatology.

Skin findings in neonates carry a wide differential diagnosis, ranging from self-limiting rashes to something more sinister, as cutaneous changes can be an indicator of a serious underlying infectious process. Even benign rashes can cause great concern for families and providers. Pathologic rashes pose a potential risk to the neonate's health. Therefore, it is important to diagnose skin findings and provide any necessary treatment swiftly and accurately. This article provides a concise review of neonatal dermatology with the goal to aid providers in diagnosing and managing neonatal skin conditions.

Whole-organism responses to constant temperatures do not predict responses to variable temperatures in the ecosystem engineer Mytilus trossulus.

Understanding and predicting responses of ectothermic animals to temperature are essential for decision-making and management. The thermal performance curve (TPC), which quantifies the thermal sensitivity of traits such as metabolism, growth and feeding rates in laboratory conditions, is often used to predict responses of wild populations. However, central assumptions of this approach are that TPCs are relatively static between populations and that curves measured under stable temperature conditions can predict performance under variable conditions. We test these assumptions using two latitudinally matched populations of the ecosystem engineer Mytilus trossulus that differ in their experienced temperature variability regime. We acclimated each population in a range of constant or fluctuating temperatures for six weeks and measured a series of both short term (feeding rate, byssal thread production) and long-term (growth, survival) metrics to test the hypothesis that performance in fluctuating temperatures can be predicted from constant temperatures. We find that this was not true for any metric, and that there were important interactions with the population of origin. Our results emphasize that responses to fluctuating conditions are still poorly understood and suggest caution must be taken in the use of TPCs generated under constant temperature conditions for the prediction of wild population responses.

Potential clinical impact of reporting breast arterial calcifications on screening mammograms in women without known coronary artery disease.

Cardiovascular disease remains a leading cause of death in women. 10-year likelihood for a cardiovascular event is determined by the American College of Cardiology Atherosclerotic Cardiovascular disease risk score calculator (ASVCD); however, this does not encompass risk factors unique to women. Breast arterial calcifications (BAC) detected on screening mammography may serve as a proxy for coronary atherosclerosis (CAC) in women. Our purpose was to investigate the correlation between BAC and CAC on imaging in women without a diagnosis of atherosclerosis to determine the potential clinical impact. Retrospective review was performed on a cohort of females evaluated by internists at our institution in 2019. Study patients had a screening mammogram within 1 year of a noncardiac chest CT. Clinical data were collected to determine ASCVD risk score. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of BAC in detecting CAC were determined. 222 women met inclusion criteria, ranging from 41 to 77 years of age, among which 25% (56/222) had BAC. 84% (47/56) of women with BAC had CAC on CT, yielding a sensitivity, specificity, PPV, and NPV of 51%, 93%, 84%, and 72%, respectively. Of the 47 patients who had both BAC and CAC, 66% had an unknown or low-to-borderline ASCVD score. Women with BACs have a high specificity for CAC. The reporting of BACs should prompt clinicians to risk stratify women for atherosclerotic disease. These women may otherwise be undetected by conventional risk calculators.

Ocean acidification through the lens of ecological theory.

Ocean acidification, chemical changes to the carbonate system of seawater, is emerging as a key environmental challenge accompanying global warming and other human-induced perturbations. Considerable research seeks to define the scope and character of potential outcomes from this phenomenon, but a crucial impediment persists. Ecological theory, despite its power and utility, has been only peripherally applied to the problem. Here we sketch in broad strokes several areas where fundamental principles of ecology have the capacity to generate insight into ocean acidification's consequences. We focus on conceptual models that, when considered in the context of acidification, yield explicit predictions regarding a spectrum of population- and community-level effects, from narrowing of species ranges and shifts in patterns of demographic connectivity, to modified consumer-resource relationships, to ascendance of weedy taxa and loss of species diversity. Although our coverage represents only a small fraction of the breadth of possible insights achievable from the application of theory, our hope is that this initial foray will spur expanded efforts to blend experiments with theoretical approaches. The result promises to be a deeper and more nuanced understanding of ocean acidification'and the ecological changes it portends.

Standard quality criteria in retracted vs nonretracted obstetrical randomized controlled trials.

BACKGROUND: The number of retracted articles in peer-reviewed journals is increasing within the field of obstetrics. The most common reason for article retraction is scientific misconduct. Unfortunately, article retraction often occurs years after publication, allowing inaccurate data to be widely distributed to readers. There exists a great need for validated screening criteria for obstetric journals to use when reviewing randomized controlled trials for scientific misconduct. OBJECTIVE: This study aimed to compare retracted obstetric randomized controlled trials with nonretracted randomized controlled trials with regard to their inclusion of 7 quality metrics: prospective trial registration, trial registration number, ethics approval statement, name of the approving committee, statement of informed consent, adherence to the Consolidated Standards of Reporting Trials guidelines, and a data sharing statement. STUDY DESIGN: Obstetric randomized controlled trials retracted between 1995 and 2021 identified through Retraction Watch were compared with nonretracted randomized controlled trials published between 2018 and 2020 with regard to inclusion of the 7 quality metrics. The main outcome was the difference in prospective trial registration. Secondary outcomes were the percentage of individual criteria met and the screening performance of quality criteria in predicting article retraction. RESULTS: A total of 150 randomized controlled trials were identified, of which 14 (9.3%) were retracted and 136 (90.7%) nonretracted. Retracted randomized controlled trials were less likely than nonretracted randomized controlled trials to be prospectively registered (14.3% vs 80.1%; P<.001). The median number of quality criteria met was lower for retracted randomized controlled trials (3 vs 6; P<.01). Using a cutoff of ≤4 criteria was associated with 85.7% (95% confidence interval, 57.2-98.2) sensitivity and 92.0% (95% confidence interval, 86.2-96.0) specificity in distinguishing the retracted randomized controlled trials from nonretracted studies. CONCLUSION: Retracted obstetric randomized controlled trials were less likely to include the 7 quality metrics required on submission by most top obstetrics and gynecology journals.

Variation in thermal performance curves for oxygen consumption and loss of critical behaviors in co-occurring species indicate the potential for ecosystem stability under ocean warming.

Species-level differences in responses to environmental factors may increase a community's ability to retain key functions under environmental change. We compared the oxygen consumption rates and maintenance of critical behaviors for three co-occurring intertidal gastropod species over a temperature range of 30 °C. Each species exhibited a distinct thermal performance curve (TPC) for oxygen consumption. The TPC of Lunella granulata was horizontally shifted to be significantly warmer than that of Chlorostoma argyrostoma. Monodonta labio's TPC was vertically shifted compared to the other two species, reflecting greater oxygen consumption overall. L. granulata and M. labio maintained critical behaviors at temperatures 3-5 °C warmer than C. argyrostoma. These differences in the thermal tolerances of similar, co-occurring species provide space for the insurance effect of biodiversity to occur. Understanding the degree to which co-occurring species respond differently to increased temperature may help us predict community resistance in the face of climate change.

The 5Ts for Teach Back: An Operational Definition for Teach-Back Training.

BACKGROUND: Teach Back is a health communication strategy used to confirm patient understanding in a non-shaming way. Although Teach Back is widely recommended as a best practice strategy for improving patient outcomes and organizational health literacy, there is lack of consensus in the literature on the definition of Teach Back and the best methods for training health care workers (HCWs). Our experience suggests that if you teach specific, observable skills, these can be identified in practice and potentially measured in research. BRIEF DESCRIPTION OF ACTIVITY: We created a training program, the 5Ts for Teach Back, based on a standardized operational definition of Teach Back and five specific, observable components. Participants use a Teach-Back Observation Tool to identify the 5Ts in practice and during peer evaluation. The program incorporates lecture, observation, practice, and videos with good and bad examples of Teach Back. IMPLEMENTATION: The training was offered to HCWs in a large academic health care system. Flexible training options ranged from a single 4-hour training to a more comprehensive program that included clinic-specific scenarios, peer coaching, and refresher activities over a 6-month period. RESULTS: The 5Ts for Teach Back operationalizes the definition of Teach Back and provides a model for training HCWs in the use of Teach Back. The 5Ts for Teach Back can be used to train any HCW. A single training session does not guarantee proficiency in practice. Through coaching and refresher activities, competence in Teach Back increases. LESSONS LEARNED: Teaching entire clinical units may increase effectiveness, because Teach Back becomes embedded in the unit culture. The Observation Tool can be used for training, coaching, and evaluation. The standardized method and Observation Tool are potentially useful when evaluating Teach Back during outcomes and patient satisfaction research. [HLRP: Health Literacy Research and Practice. 2020;4(2):94-103.] PLAIN LANGUAGE SUMMARY: Health care workers may be clearer when giving information to patients if they use Teach Back. Studies do not show what methods are best for training health care workers how to do Teach Back. The 5Ts method breaks Teach Back into five skills that help health care workers do it well. The 5Ts can also confirm use and may be helpful for research.

Author Correction: Increased food supply mitigates ocean acidification effects on calcification but exacerbates effects on growth.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Increased food supply mitigates ocean acidification effects on calcification but exacerbates effects on growth.

Because many of the negative effects of ocean acidification on marine life may result from underlying energetic short-falls associated with increased metabolic demands, several studies have hypothesized that negative responses to high CO2 could be reduced by energy input. Although this hypothesis was supported by a recent meta-analysis, we believe that the meta-analytic calculation used was not appropriate to test the stated hypothesis. Here, we first clarify the hypothesis put forward, the crux being that the effects of increased food supply and CO2 interact statistically. We then test this hypothesis by examining the available data in a more appropriate analytical framework. Using factorial meta-analysis, we confirm that food addition has a positive effect and CO2 has a negative effect on both growth and calcification. For calcification, food addition did indeed reduce CO2 impacts. Surprisingly, however, we found that food addition actually exacerbated the effects of acidification on growth, perhaps due to increased scope upon which CO2 effects can act in food-replete situations. These interactive effects were undetectable using a multilevel meta-analytic approach. Ongoing changes in food supply and carbonate chemistry, coupled with under-described, poorly understood, and potentially surprising interactive outcomes for these two variables, suggest that the role of food should remain a priority in ocean acidification research.Arising from: L. Ramajo et al., Sci. Rep. 6: 19374 (2016).

The future of the northeast Atlantic benthic flora in a high CO2 world.

Seaweed and seagrass communities in the northeast Atlantic have been profoundly impacted by humans, and the rate of change is accelerating rapidly due to runaway CO2 emissions and mounting pressures on coastlines associated with human population growth and increased consumption of finite resources. Here, we predict how rapid warming and acidification are likely to affect benthic flora and coastal ecosystems of the northeast Atlantic in this century, based on global evidence from the literature as interpreted by the collective knowledge of the authorship. We predict that warming will kill off kelp forests in the south and that ocean acidification will remove maerl habitat in the north. Seagrasses will proliferate, and associated epiphytes switch from calcified algae to diatoms and filamentous species. Invasive species will thrive in niches liberated by loss of native species and spread via exponential development of artificial marine structures. Combined impacts of seawater warming, ocean acidification, and increased storminess may replace structurally diverse seaweed canopies, with associated calcified and noncalcified flora, with simple habitats dominated by noncalcified, turf-forming seaweeds.

EFFECTS OF CLIMATE CHANGE ON GLOBAL SEAWEED COMMUNITIES.

Seaweeds are ecologically important primary producers, competitors, and ecosystem engineers that play a central role in coastal habitats ranging from kelp forests to coral reefs. Although seaweeds are known to be vulnerable to physical and chemical changes in the marine environment, the impacts of ongoing and future anthropogenic climate change in seaweed-dominated ecosystems remain poorly understood. In this review, we describe the ways in which changes in the environment directly affect seaweeds in terms of their physiology, growth, reproduction, and survival. We consider the extent to which seaweed species may be able to respond to these changes via adaptation or migration. We also examine the extensive reshuffling of communities that is occurring as the ecological balance between competing species changes, and as top-down control by herbivores becomes stronger or weaker. Finally, we delve into some of the ecosystem-level responses to these changes, including changes in primary productivity, diversity, and resilience. Although there are several key areas in which ecological insight is lacking, we suggest that reasonable climate-related hypotheses can be developed and tested based on current information. By strategically prioritizing research in the areas of complex environmental variation, multiple stressor effects, evolutionary adaptation, and population, community, and ecosystem-level responses, we can rapidly build upon our current understanding of seaweed biology and climate change ecology to more effectively conserve and manage coastal ecosystems.