We quantified breeding bird abundance, diversity, and indicator species in riparian and upland dry forests along 6 third‐ to fourth‐order streams on the east slope of the Cascade Range, Washington, USA. Upland dry forest on southerly aspects was dominated by open ponderosa pine (Pinus ponderosa) and dry Douglas‐fir (Pseudotsuga menziesii) plant associations. Upland mesic forest on northerly aspects was dominated by closed‐canopy Douglas‐fir or dry grand fir (Abies grandis) plant associations. Riparian overstory vegetation was dominated by black cottonwood (Populus trichocarpa) plant associations with a prominent hardwood tree and shrub component. We quantified bird assemblages, diversity, and abundance from parallel point transects on riparian and adjacent dry and mesic upslope forests. We detected 80 bird species from >12,000 point‐transect observations during 1998–1999. Eighteen species accounted for 75% of all detections. Species richness and evenness were similar in all 3 forest types, with approximately 35 species and high evenness (0.85) in each forest type. Bird species assemblages differed among dry, mesic, and riparian forest types, with the greatest differences between riparian and both dry and mesic upland forests. Riparian forest had the greatest number (9) of strong characteristic, or indictor, species among the 3 forest types. Upland mesic forest was characterized by 7 indicator species. Upland dry forest had 4 indicator species. Our results indicate that current standards and guidelines for riparian buffers zones would allow for avian refuge and corridor functions along these streams. Forest managers could use our indicator species to predict and monitor shifts in upland forest species composition from thinning and prescribed burning practices that are used to reduce fuels in uplands and to reduce continuity of fire effects between riparian and upland zones.

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Objective: To assess an aging subspecialty workforce and growing population that portends challenges in meeting patient care needs. We hypothesized that rural physicians are retiring at higher rates than their urban counterparts in the United States and that this represents a bellwether for workforce challenges at large. Methods: We analyzed data from the 2014-2016 American Urological Association Census, a sample-weighted representative survey of urologists, as a case study for subspecialists. We compared urologists who work in rural regions to nonrural regions on available characteristics. Results: In 2016, rural urologists accounted for 2.4% of 12,186 practicing urologists in the United States. General urology remained the focus of 90% of rural urologists, compared to 59% of nonrural urologists (P = .03). Alarmingly, 48% of rural physicians were >65 years old in 2016 compared to 29% in 2014, and 33% of rural urologists were solo practitioners compared to 9% of nonrural urologists (P < .01). The planned retirement age for rural physicians increased from 68 in 2014 to 73 in 2016 (P trend = .02). The percentage of rural practice urologists has remained stable since 2014. Conclusions: Rural urologists are older and provide more general urological care than their nonrural counterparts. Rural urologists are postponing retirement. Although this might be due to personal desires and financial goals, it may also be due to a relative absence of potential junior partners. Given that almost 50% of rural urologists were older than 65 in 2016, this is not a sustainable solution to an impending shortage of physicians. Greater innovation in telemedicine or alternative care models will soon be needed.

Penile prostheses (both inflatable and malleable) are standard care in the management of erectile dysfunction (ED). Introduced over 45 years ago, modern penile implants have evolved greatly during that period of time and now represent the cutting edge in materials science and function. Despite the introduction of highly effective oral pharmacotherapy for ED, these devices have remained relevant and will almost certainly remain so for the foreseeable future. Despite their high degree of efficacy, there is always potential for further improvements in both implants themselves and the surgical techniques and processes used for their placement. In this manuscript we speculate on the future of penile implants, based in large part on the historical perspective and recent developments in the implant surgery space. We include recommendations on future technical innovations, post-operative management, and novel implant designs that may revolutionize the future management of ED.

Objective: To develop an ex vivo model to practice ultrasound-guided injection of cellular material into human seminiferous tubules to simulate testicular cell transplantation (TCT). Design: Simulated TCT injections were performed in human testes removed during orchiectomy. The rete testis was the target site of injection. Successful retrograde infiltration of injected material into the lumen of the seminiferous tubules was detected using ultrasound and confirmed with histology. Setting: Single academic surgical center. Patient(s): Adult patients undergoing orchiectomy for nononcologic indications. Intervention(s): The testes were injected with sonographic contrast (Optison), methylene blue, and fluorescent-labeled cells. Main Outcome Measure(s): A characteristic streaming pattern of sonographic contrast in the testis was used to define sonographic success, and the presence of methylene blue and fluorescent-labeled cells within the seminiferous tubules confirmed histologic success. Result(s): We performed simulated TCT injections in 30 testes obtained from 16 patients undergoing orchiectomy. We were able to achieve sonographic success in 57% of injections and confirmed that sonographic success is correlated with histologic success. Conclusion(s):Testicular cell transplantation injections can be practiced using human testes. As there appears to be a learning curve associated with this procedure, developing this infrastructure to practice these skills is critical before implementation in patients. (Fertil Steril Sci Ò 2021;2:135-40. Ó2021 by American Society for Reproductive Medicine.