When should a child with an undescended testis be referred to a urologist?

Infants with an undescended testis should be referred between ages 6 and 15 months, since almost all who experience spontaneous descent do so by 6 months (strength of recommendation [SOR]: A, extrapolation from cohort studies). The incidence of germ cell aplasia in undescended testes begins to rise at 15 months (SOR: C, extrapolation of observational studies); however, evidence is inconclusive that orchiopexy at this age results in higher rates of paternity success (SOR: B, retrospective cohort study). Orchiopexy may allow earlier detection of testicular tumors (SOR: C, expert opinion), but it has not been shown to reduce the risk of testicular cancer (SOR: B, retrospective cohort study) or improve 5-year survival rates for those patients diagnosed with testicular cancer (SOR: B, retrospective cohort study)

The Paradoxes of Contingency: Stories of Contingent Professional Tutors’ Lived Experiences

Despite comprising the majority of labor in higher education in general and writing centers more specifically, contingent workers’ voices and experiences have often been overlooked. The contingent voices that have been represented have predominantly been those in director or administrative positions, not the professional tutors who engage in centers’ day-to-day consulting. This lack of representation in the literature perpetuates institutional inequities and belies a larger paradox: that contingent workers attempting to ameliorate the precarity of their situation may jeopardize their livelihood. Because contingent workers’ identities and roles have historically been ignored and marginalized, few research and publication options are available to them. For this reason, this research used autoethnography, one of the only methodologies available to the contingent professional tutor authors that allowed us agency to share our lived experiences and identities as contingent workers. Three themes emerged from our autoethnographies: vital to but not valued by the institution, working to live but destroying the body, and the illusion of choice. After discussing themes, we call for a continuation of what this work begins, particularly that the field of writing center studies should aim for wider representation of contingent and multi-identitied voices in its literature, conferences, and leadership organizations

Situated encounters with socially engaged art in community-based design

With the increased relevance of digital technologies in civil life comes the challenge of how to design research for citizen engagement. Drawing from three reflexive case studies presenting socially engaged arts (SEA) projects, we describe how, as artists, collaborators and researchers, we engaged in socially inclusive community-based projects. We argue that our roles required us to be both flexible and to adopt critical openness in practices of collaborative social facilitation. We conclude with insights to inform community-based research and enable nurturing and inclusive engagement in research design for the exploration of near-future digital technologies

Who and How: Telemedicine Eligibility and Participant Guidelines in the Ambulatory Setting

Introduction: Telehealth use has dramatically increased due to the COVID-19 pandemic. Yet there are significant gaps in evidence regarding the clinical appropriateness of synchronous visits for ambulatory telemedicine that are under the umbrella of telehealth and defined as video appointments between patients and providers. As a result, there are few sensible guidelines for day-to-day practice, resulting in a lack of standardization and risk of suboptimal care. Methods: We developed patient inclusion/exclusion guidelines for use in ambulatory telemedicine. Complementary tools included guides on patient preparation, telemedicine physical exam, and provider etiquette. We analyzed telemedicine use by practice type and surveyed a subset of MaineHealth ambulatory practices regarding the applicability of the guidelines. Results: Volume and specialty distribution data show that although telemedicine volume increased significantly, use varied by specialty. Behavioral health providers used telemedicine the most, followed by primary care, medical specialties, and, finally, surgical specialties. Stratification intensified as restrictions on in-person care declined. Discussion: We observed the expected pattern of use by specialty type, given our inclusion/exclusion criteria. Although these criteria may be conceptually straightforward, implementation is not. We operationalized these concepts to ensure individual practices can adapt and implement these insights in a reproducible and predictable way, leading to increased standardization across the health system. Conclusions: Clinical teams need help determining how to best use telemedicine tools. Here, we provide practice-level guidelines focused on practical implementation. We hope this communication advances the effort to develop standards of care for telemedicine indications

Photo-dynamics of quantum emitters in aluminum nitride

Aluminum nitride is a technologically important wide bandgap semiconductor which has been shown to host bright quantum emitters. In this paper, we probe the photodynamics of quantum emitters in aluminum nitride using photon emission correlations and time-resolved spectroscopy. We identify that each emitter contains as many as 6 internal energy levels with distinct laser power-dependent behaviors. Power-dependent shelving and de-shelving processes, such as optically induced ionization and recombination are considered, indicating complex optical dynamics associated with the spontaneous and optically pumped transitions. State population dynamics simulations qualitatively explain the temporal behaviours of the quantum emitters, revealing that those with pump-dependent de-shelving processes can saturate at significantly higher intensities, resulting in bright room-temperature quantum light emission.Comment: 20 pages. 5 figures in main text, 3 in supplementary inf

Ventricular endocardial tissue geometry affects stimulus threshold and effective refractory period

Background: Understanding the biophysical processes by which electrical stimuli applied to cardiac tissue may result in local activation is important in both the experimental and clinical electrophysiology laboratory environments, as well as for gaining a more in-depth knowledge of the mechanisms of focal-trigger-induced arrhythmias. Previous computational models have predicted that local myocardial tissue architecture alone may significantly modulate tissue excitability, affecting both the local stimulus current required to excite the tissue and the local effective refractory period (ERP). In this work, we present experimental validation of this structural modulation of local tissue excitability on the endocardial tissue surface, use computational models to provide mechanistic understanding of this phenomena in relation to localized changes in electrotonic loading, and demonstrate its implications for the capture of afterdepolarizations. Methods and Results: Experiments on rabbit ventricular wedge preparations showed that endocardial ridges (surfaces of negative mean curvature) had a stimulus capture threshold that was 0.21 ± 0.03 V less than endocardial grooves (surfaces of positive mean curvature) for pairwise comparison (24% reduction, corresponding to 56.2 ± 6.4% of the energy). When stimulated at the minimal stimulus strength for capture, ridge locations showed a shorter ERP than grooves (n = 6, mean pairwise difference 7.4 ± 4.2 ms). When each site was stimulated with identical-strength stimuli, the difference in ERP was further increased (mean pairwise difference 15.8 ± 5.3 ms). Computational bidomain models of highly idealized cylindrical endocardial structures qualitatively agreed with these findings, showing that such changes in excitability are driven by structural modulation in electrotonic loading, quantifying this relationship as a function of surface curvature. Simulations further showed that capture of delayed afterdepolarizations was more likely in trabecular ridges than grooves, driven by this difference in loading. Conclusions: We have demonstrated experimentally and explained mechanistically in computer simulations that the ability to capture tissue on the endocardial surface depends upon the local tissue architecture. These findings have important implications for deepening our understanding of excitability differences related to anatomical structure during stimulus application that may have important applications in the translation of novel experimental optogenetics pacing strategies. The uncovered preferential vulnerability to capture of afterdepolarizations of endocardial ridges, compared to grooves, provides important insight for understanding the mechanisms of focal-trigger-induced arrhythmias

Estimation of (co)variance components of nematode parasites resistance and somatic cell count in dairy sheep

Nematode parasites and mastitis are the major animal health constraints in sheep. The aim of this study was estimating the genetic (co)variances of nematode parasites resistance and somatic cell count in dairy sheep. From 2000 to 2008, Somatic Cell Score (SCS) and Faecal Egg Count (FEC) records were available on an experimental population consisting of 949 backcross ewes and 806 their daughters. Data were processed independently for each subpopulation in order to adjust for specific environmental effects and to obtain lactation records for both traits to be used in the genetic analysis. Variance components estimation was performed by using the REML method applied to a bi-trait repeatability animal model. Heritabilities of lactation SCS (LSCS) and FEC were 0.19 and 0.16. Genetic correlation was 0.21, whereas phenotypic correlation was 0.01. The estimated heritabilities confirm that both traits could be selected by the classical quantitative approach. The genetic correlation estimate between LSCS and FEC suggests that selection for one of the two traits would not have any detrimental effect on the other one

Ocular pathology of uncommon hematologic malignancies: a case series

<p>Abstract</p> <p>Introduction</p> <p>In general, ocular complications of hematologic malignancies such as leukemia are well documented. However, reports of ocular involvement in such diseases as lymphomatoid granulomatosis and chronic myelomonocytic leukemia are uncommon. Here we present cases of these two relatively rare hematologic malignancies demonstrating clinical and subclinical ocular involvement.</p> <p>Case Presentation</p> <p>In the first case, a 54-year-old man with a previous diagnosis of lymphomatoid granulomatosis presented with a new-onset conjunctival lesion while his systemic disease was thought to be in remission. A biopsy was taken that revealed heavy infiltrates of B and T cells at the site of the lesion. Molecular analysis confirmed that these cells were positive for both Epstein-Barr viral DNA and immunoglobulin heavy chain gene rearrangement, consistent with a manifestation of his systemic disease. In the second case, a 51-year-old man with chronic myelomonocytic leukemia died after a waxing and waning clinical course. Post-mortem studies revealed the presence of atypical monocytes in the choroidal and subretinal spaces, consistent with his previous diagnosis.</p> <p>Conclusion</p> <p>While ocular involvement in hematologic malignancies is not uncommon, these two cases describe involvement of the eye by two relatively rare neoplasms. We herein emphasize novel findings in each case, including conjunctival involvement as the first sign of recurrent lymphomatoid granulomatosis and the combination of subretinal and choroidal myelomonocytic leukemic infiltration. With the evolution of new antineoplastic therapies that may prolong life, these cases exemplify the importance of eye care in patients diagnosed with hematologic malignancies.</p

Autoimmune Retinopathy in Systemic Lupus Erythematosus: Histopathologic Features

The ocular pathology of autoimmune retinopathy is demonstrated in a 62-year-old female patient with systemic lupus erythematosus (SLE) who presented with typical clinical autoimmune retinopathy. Macroscopically, there were multiple depigmented lesions in the peripheral retina and choroid and scattered pigmentary bone-spickling at the equator and periphery. Microscopically, there were generalized loss of photoreceptors and thinning of the outer plexiform layer. Many peripheral retinal vessels were sclerotic and occluded, some surrounded by pigment granules and RPE cells. Cobblestone degeneration was prominent in the periphery. Macrophages were seen in the retina, particularly in areas of photoreceptor degeneration. Rare, scattered T- lymphocytes were present in the retina and choroid, while B-cells were notably absent. The optic nerve showed loss of axons and thickened septae. Serum autoantibodies against normal retinal nuclei were detected. These pathological changes represent both known SLE-associated ocular complications as well as possible features of autoimmune retinopathy secondary to SLE