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Silicone breast implants with smooth outer shells are associated with higher rates of capsular contracture, whereas textured implants have been linked to the development of breast implant-associated anaplastic large cell lymphoma. By assessing the gene expression profile of fibrous capsules formed in response to smooth and textured implants, insight into the development of breast implant-associated abnormalities can be gained.Miniature smooth or textured silicone implants were surgically inserted into female rats ( n = 10) and harvested for the surrounding capsules at postoperative week 6. RNA sequencing and quantitative polymerase chain reaction were performed to identify genes differentially expressed between smooth and textured capsules. For clinical correlation, the expression of candidate genes was assayed in implant capsules harvested from human patients with and without capsular contracture.Of 18,555 differentially expressed transcripts identified, three candidate genes were selected: matrix metalloproteinase-3 ( MMP3 ), troponin-T3 ( TNNT3 ), and neuregulin-1 ( NRG1 ). In textured capsules, relative gene expression and immunostaining of MMP3 and TNNT3 was up-regulated, whereas NRG1 was down-regulated compared to smooth capsules [mean relative fold change, 8.79 ( P = 0.0059), 4.81 ( P = 0.0056), and 0.40 ( P0.0001), respectively]. Immunostaining of human specimens with capsular contracture revealed similar gene expression patterns to those of animal-derived smooth capsules.An expression pattern of low MMP3 /low TNNT3 /high NRG1 is specifically associated with smooth implant capsules and human implant capsules with capsular contracture. The authors' clinically relevant breast implant rat model provides a strong foundation to further explore the molecular genetics of implant texture and its effect on breast implant-associated abnormalities.The authors have demonstrated that there are distinct gene expression profiles in response to smooth versus textured breast implants. Since surface texture may be linked to implant-related pathology, further molecular analysis of periprosthetic capsules may yield strategies to mitigate implant-related complications.

The aim of this study is to examine Chinese football fans' sense of belonging to the virtual communities of their favorite European teams and their intention to visit Europe and watch a live match. Drawing on a survey of 488 Chinese football fans, the findings reveal that ideal self-congruence, brand identification, and the ability of virtual communities affect fans' sense of belonging. Finally, sense of belonging influences fans' travel intentions, and a positive attitude toward the destination and city strengthens the positive relationship between sense of belonging and the intention to travel.

ImportanceThe inclusion of non–English-speaking (NES) participants in pediatric research is an essential step to improving health equity for these populations. Although some studies have shown lack of progress in NES research participation in the past decade, few have examined NES inclusivity in pediatric research or details about the practices that researchers have used to communicate with NES participants.ObjectiveTo assess how frequently NES families were included in pediatric research, how rates of inclusion changed over time, what languages were included, and methodological details about oral and written communication with NES participants.Evidence ReviewIn this review, all original investigation articles published in JAMA Pediatrics, Pediatrics, and The Journal of Pediatrics between January 2012 and November 2021 were screened. Eligible articles, which included those based in the US and with human participants, were reviewed to determine whether they included or excluded NES participants or whether or not there was specific mention of language. A second-round review was conducted on the subset of articles that included NES participants to determine methodological details (eg, languages included, type of study, region where the study was located, and oral and written communication practices with NES participants).FindingsOf the 8142 articles screened, 5008 (62%) met inclusion criteria; of these, 469 (9%) included NES participants. The most common language was Spanish (350 [75%]); 145 articles (31%) reported non-English or other language without specification. A total of 230 articles (49%) reported the number of NES participants, and 61 (13%) specified the methods used to determine whether participants preferred a language other than English. In all, 101 (22%) and 136 (29%) articles specified how oral and written communication occurred with NES participants, respectively.Conclusions and RelevanceThis review of 3 pediatric journals provides preliminary evidence suggesting exclusion of NES communities from pediatric research from 2012 to 2021 and highlights an opportunity to provide more methodological detail about communication with NES participants. Best practices for improving inclusivity of NES participants are needed to guide researchers toward improved methods and more relevant results.

To evaluate the state of mentorship in the field of urology.Mentorship has been shown to decrease burnout, increase recruitment of underrepresented minority groups, and have a positive influence on the career trajectory of mentees. Approximately half of surgical residency programs have mentorship programs. The current literature supports the idea that formal mentorship programs are successful based on level 1 satisfaction scores. However, studies are sparse and of low quality. Mentorship program success is rarely objectively measured. Structured mentorship programs appear to be beneficial, but require serious planning, evaluation, and ongoing support without which the programs can fail. Future research should be focused on objective and measurable metrics of success.

Humans often communicate using body movements like winks, waves, and nods. However, it is unclear how we identify when someone’s physical actions are communicative. Given people’s propensity to interpret each other’s behavior as aimed to produce changes in the world, we hypothesize that people expect communicative actions to efficiently reveal that they lack an external goal. Using computational models of goal inference, we predict that movements that are unlikely to be produced when acting towards the world and, in particular, repetitive ought to be seen as communicative. We find support for our account across a variety of paradigms, including graded acceptability tasks, forced-choice tasks, indirect prompts, and open-ended explanation tasks, in both market-integrated and non-market-integrated communities. Our work shows that the recognition of communicative action is grounded in an inferential process that stems from fundamental computations shared across different forms of action interpretation.

In an effort to streamline care for children and youth under age 21 with needs for home- and community-based services (HCBS), New York State consolidated several prior 1915(c) waivers into a single Children's Waiver and amended their Section 1115 Medicaid Redesign Team waiver. The 1115 waiver amendment allows the state to move services covered by the consolidated Children's Waiver from fee for service to Medicaid managed care (MMC) and to target eligibility to medically needy family-of-one children who meet clinical criteria and are enrolled in the consolidated Children's Waiver but do not qualify for Medicaid due to family income. Together, these waiver amendments are called the “Children's Design,” which was implemented in 2019. In this interim evaluation, the authors identify facilitators of, and barriers to, implementation of the Children's Design and describe baseline trends in outcomes of interest to its future evaluation. The authors found that: (1) providers, advocates, MMC plan representatives, and government partners perceived the transition to the Children's Design as challenging and were particularly concerned about the burden of accessing care on children's families and reductions in service availability; (2) prior to the Children's Design implementation, parents of children with chronic conditions had high levels of satisfaction with their primary care providers but were less satisfied with their ability to access special equipment and therapies and with coordination efforts among multiple providers; and (3) at baseline, the levels of quality indicators for children did not change significantly, with the exception of some primary care indicators for young children, which improved.

To elucidate the relationship between catastrophization and pelvic pain symptomatology in chronic pelvic pain (CPP) patients using standardized questionnaires.CPP patients completed standardized questionnaires which included: genitourinary pain index, patient health questionnaire for anxiety and depression, interstitial cystitis symptom index, and pelvic floor distress inventory. Scores and number of comorbidities were compared to Pain Catastrophizing Scale (PCS) by linear regression. Patients categorized as "extreme catastrophizing" (PCS score ≥30), traditionally associated with worse outcomes in the pain literature [10-11], were also analyzed separately.184 patients were included (mean age 42 years, N = 23 male). Higher number of pain comorbidities was correlated to PCS (P.001) as well as higher scores on all standardized questionnaires (P.001). Forty-four percent of patients (81/184) were extreme catastrophizers and scored significantly worse on all standardized measures when compared to nonextreme catastrophizers. Mean scores for nonextreme vs extreme catastrophizers were: genitourinary pain index (25.7 ± 6.8 vs 32.7 ± 6.5, P.001), interstitial cystitis symptom index (6.5 ± 4.7 vs 9.4 ± 5.8, P.001), pelvic floor distress inventory (88.8 ± 52 vs 121.1 ± 62.8, P.001), patient health questionnaire anxiety (1.7 ± 2.0 vs 3.6 ± 2.1, P.001), and depression (1.4 ± 1.6 vs 3.3 ± 2.0, P.001). Number of comorbidities was not significant predictor of extreme catastrophizing (3.5 vs 3.7 P = .22).Higher scores on standardized questionnaires and more comorbidities was associated with more catastrophizing in CPP patients. This study highlights the significance of standardized questionnaires, including the PCS, to predict which patients may be extreme catastrophizers and thus subject to worse outcomes. Future studies are needed to look at catastrophization as a potentially modifiable and treatable risk factor.

Sacral neuromodulation (SNM) is third-line therapy approved for urge urinary incontinence (UUI) and urgency, and nonobstructive urinary retention. Multiple sclerosis (MS) patients often suffer from neurogenic lower urinary tract dysfunction (NLUTD). The utility of SNM in the MS population is limited by magnetic resonance imaging (MRI) incompatibility as routine MRIs to evaluate for disease progression are required. The Axonics System is the first Food and Drug Administration-approved SNM device that is 1.5/3 T full-body MRI-conditionally safe. This study seeks to investigate the symptomatic improvement in MS patients after implantation of the Axonics System.All MS patients who elected for Axonics SNM from December 2019 to January 2021 were included. Demographics and scores were queried for urogenital distress inventory (UDI-6), incontinence impact questionnaire (IIQ-7), and global response assessment (GRA).Fifteen MS patients with UUI were included. The time to follow-up averaged 121 days. On UDI-6, 12 patients reported improvement, 1 worsening, and 2 no change. Average UDI-6 scores before and after implantation were 56.6 and 25.2 (p 0.0001). Improvements were significant for all questions under stress urinary incontinence, UUI, and voiding difficulty subcategories. On IIQ-7, 14 patients reported improvement and 1 reported worsening. Average IIQ-7 scores before and after implantation were 59.0 and 22.2 (p 0.001). Improvements were significant for travel, social, and emotional subcategories, but not for physical activity. The average GRA score was 6 ("moderately improved").The majority of MS patients reported significant initial improvement in UUI and associated quality of life measures on validated questionnaires after implantation of the Axonics System. Future studies are needed to determine the long-term outcomes and durability of this MRI full-body conditionally-safe system.

BACKGROUND Compared to other types of dementia, family caregivers of people with LBD report higher stress and more severe depressive symptoms. OBJECTIVE We performed a pilot evaluation of a digital intervention designed to help caregivers address challenges that they have experienced, with the end goal of reducing psychological distress in this population. METHODS We recruited 15 family caregivers to participate in the quasi-experimental single-arm mixed methods study entitled VOCALE-LBD. The study offers an 8-week online intervention that uses a web-based discussion platform and involves moderation, peer-to-peer support, didactic training, and problem-solving skill enactment. RESULTS Participants’ baseline characteristics were as follows: Mean age (SD)= 66(8); 93% female; 100% White; and 53% had at least a post-graduate degree. Throughout the intervention, participants engaged in weekly online discussions, generating a total of 434 posts (average 4 posts/week). Attrition was 20%. At the study exit, participants showed improvements in depression, burden, stress, and loneliness. When we calculated differences in the proportion of participants with clinically significant improvement versus worsening of 0.5 SD or more for each outcome, we observed net improvements of 50%, 33%, 25%, and 25% in depression, loneliness, burden, and stress, respectively. When we assessed the benefits of participation, 75% of the participants reported that participation helped them to improve their understanding of LBD ‘a great deal,’ vs. 25% selecting the ‘some’ response option. Similarly, in response to a question about confidence in dealing with difficult behaviors of the care recipient, 50% of the participants selected ‘a great deal’, 42% ‘some’, and 8% ‘not at all’ response options. Finally, in response to a question about improvement in one’s abilities to provide care to the care recipient, 33% of the participants selected ‘a great deal’, 58% ‘some’, and 8% ‘not at all’ response options. CONCLUSIONS The study generated promising feasibility and efficacy data for a low-cost, online intervention designed for caregivers of persons with LBD. As the study was not powered for significance, we observed nominal average and net improvements in important psychological outcomes. Moreover, many caregivers reported that study participation helped them better understand the disease, feel more confident in dealing with difficult behavior of the care recipient, and improved their ability to care for the care recipient. If validated in future studies, the intervention could be an accessible, on-demand resource for caregivers to engage in moderated remote discussions with peers at their own convenience in terms of location, time of day and frequency. As far as pragmatic considerations, the intervention could be used in conjunction with caregiver usual care and as a stand-alone module in circumstances, such as current and future pandemic emergencies, when professional interventions in general and subspecialty care in particular might not be readily available.

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has resulted in 2.5 million deaths globally. Previous studies have suggested the virus may affect the kidneys, resulting in hematuria, proteinuria and acute kidney injury;however, the studies did not differentiate microscopic hematuria (MH) from gross hematuria (GH). In this study, we investigated the clinical outcomes and risk factors associated with GH compared to MH in COVID patients. METHODS: Following IRB approval, 250 consecutive medical records of COVID patients admitted to a tertiary care university hospital from 3/15/20 were analyzed. Patients without a urinalysis during the admission were excluded, the remaining 157 patients were included in the analysis. Patients were divided into three categories based on the presence of hematuria during the admission: none, microscopic hematuria (MH) and gross hematuria (GH). Outcomes including length of hospitalization, ICU admission, intubation, and lab values were compared amongst the categories. Chi-square test was used to compare the categorical variables, while ANOVA and t-test were used for the parametric variables. RESULTS: Of the 157 patients, 66 (42%) did not have hematuria, 36 (22.9%) had MH and 55 (35%) had GH. As seen in Fig.1, GH was associated with worse clinical outcomes such as higher intubation rate at 49.1%, compared to 27.8% in MH (p

INTRODUCTION AND OBJECTIVE:Technological innovations of hydrophilic and antibiotic coated materials in the construction of the three-piece inflatable penile prosthesis (IPP) have resulted in decrea...

Cultural tourism destinations, such as cultural quarters, have become an important part of postmodern society because tourists are more interested in cultural tourism than they have been in the past. The purpose of this research is to examine tourists' cultural quarters revisit or recommendation intentions. Building on self-congruity theory, this research incorporates a "cultural contact" variable into symbolic consumption in the tourism destination brands model to examine tourists' cultural quarters revisit or recommendation intentions. In total, 400 Taiwanese tourists were recruited. This study used structural equation modeling (SEM) to examine the proposed model. The results demonstrate that ideal self-congruence, brand identification, lifestyle congruence, and cultural contact influence tourists' satisfaction, which in turn affects their behavioral intentions. In addition, cultural contact positively moderates the relationship between satisfaction and intentions. The theoretical and managerial implications of this study are discussed in the context of the cultural tourism literature.

Luxury hotels might hesitate to operate in a more environmentally friendly way because they worry such practices will harm their performance. However, hotels can have a significant impact on the na...

To examine tourists' intentions to revisit and recommend a cultural tourism destination, this study incorporates an “on-site activity involvement” variable into the Mehrabian-Russell model. We draw on a survey of over 500 tourists. Our findings reveal that aesthetics, service staff excellence, and playfulness affect tourists' satisfaction, which in turn affects their sense of belonging. In addition, sense of belonging positively influences tourists' behavioral intentions. Finally, on-site activity involvement moderates the influence of satisfaction on sense of belonging. Several implications of the study are identified, and avenues for future research are suggested.

As luxury products have become increasingly accessible to middle-class consumers, many gastronomic tourists might be interested in dining at luxury restaurants when traveling. The purpose of this s...

Resilience could improve parental response to serving as schooling educators during the COVID-19 pandemic. This study aimed to determine whether schooling type (homeschool vs. public-school) and physical activity resulted in significantly different perceived resilience among 123 parents of school-aged youth. The main effect of schooling type, but not physical activity, on perceived parental resilience was significant. Homeschool parents perceived themselves as significantly more resilient than public-school parents. Public-school parents who did not meet physical activity recommendations perceived themselves as significantly less resilient than all other groups making physical activity particularly important for this demographic.

Acute estrogen deficiency in women can occur due to many conditions including hyperprolactinemia, chemotherapy, GnRH agonist treatment, and removal of hormone replacement therapy. Ovariectomized (OVX) rodent models, often combined with a high-fat diet (HFD), have been used to investigate the effects of decreased estrogen production on metabolism. Since evidence suggests that gut microbes may facilitate the protective effect of estrogen on metabolic dysregulation in an OVX + HFD model, we investigated whether the gut microbiome plays a role in the diet-independent weight gain that occurs after OVX in adult female mice. 16S rRNA gene sequence analysis demonstrated that OVX was not associated with changes in overall gut bacterial biodiversity but was correlated with a shift in beta diversity. Using differential abundance analysis, we observed a difference in the relative abundance of a few bacterial taxa, such as Turicibacter, 3 to 5 weeks after OVX, which was subsequent to the weight gain that occurred 2 weeks postsurgery. A cohousing study was performed to determine whether exposure to a healthy gut microbiome was protective against the development of the metabolic phenotype associated with OVX. Unlike mouse models of obesity, HFD maternal-induced metabolic dysregulation, or polycystic ovary syndrome, cohousing OVX mice with healthy mice did not improve the metabolic phenotype of OVX mice. Altogether, these results indicate that changes in the gut microbiome are unlikely to play a causal role in diet-independent, OVX-induced weight gain (since they occurred after the weight gain) and cohousing with healthy mice did not have a protective effect.

OBJECTIVES/GOALS: To describe a study to develop, test, and collect implementation data on a youth-led hypertension (HTN) education digital intervention that acts as an electronic tool to guide youth through learning and then teaching adults on how to achieve better HTN control. Adults with uncontrolled HTN are recruited from a New Jersey emergency department (ED). METHODS/STUDY POPULATION: Adults with HTN and youth (15-18 years) participate in a remote user-centered design session focus group to provide input in the development of the youth-led HTN education digital intervention. 100 adult ED patients with uncontrolled HTN (blood pressure (BP) ≥130/80 mm Hg) who live with a youth (15-18 years) and the youth themselves are recruited for a randomized control trial (RCT). The adult-youth dyad is randomized to one of two arms, each a 6-week program with youth earning a digital badge: 1) intervention- youth-led HTN education with the adult, or 2) control- youth learn life skills (such as job readiness/resume building). Implementation metrics are collected through a post-intervention survey and qualitative interviews on the digital badge intervention including acceptability, feasibility, and fidelity. RESULTS/ANTICIPATED RESULTS: We completed two youth focus groups (total of 8 participants) and data collection is ongoing. Youth have shown great interest in the intervention prototype and thought their peers would find it acceptable. They suggested additions to nutrition education activities, such as adding a sodium tracker and examples of high sodium foods. For the RCT, the primary study outcome is adult BP change (from baseline to 1 week and 2-months post-intervention), with secondary outcomes of HTN knowledge and youth self-efficacy. We anticipate that intervention arm adults will have a more significant decrease in BP than control arm adults. We also expect that HTN knowledge and youth self-efficacy will be higher for the intervention arm. Implementation data collected will allow for improvements to future renditions of the intervention. DISCUSSION/SIGNIFICANCE: Bringing health education home while simultaneously empowering youth is an innovative technology-driven model for improving BP for patients with uncontrolled HTN who may lack access to care. Outcomes of this project will result in a scalable and easily adoptable model to reach an otherwise difficult to reach adult population.

In 2007, Teledyne presented and subsequently published an empirically derived formula, known as “Rule 07”, for the dark current performance of Mercury Cadmium Telluride (HgCdTe) P-on-n diodes. The Rule 07 metric has become widely popular within the infrared community, not only as a basis for predicting HgCdTe detector and system performance, but as the “number to beat” for other technologies, notably III-V nBn and strained-layer superlattice (SLS) devices. For materials that have sufficiently long recombination lifetimes, HgCdTe being one of the few such widely used materials, internal currents within the detector can be suppressed and the detector becomes limited by the background radiation from the surrounding environment. These currents can be orders of magnitude below Rule 07 and even further orders of magnitude below the Auger-limit. The ability to suppress Auger currents and operate at the radiative limit allows for significantly higher operating temperature and provides several significant advantages, including:  Reduced size, weight, power, cost, and improved reliability associated with reduced cooler requirements  Lower dark current when operating at conventional temperatures, permitting improved sensitivity from lower shot noise and longer achievable integration times Because background radiatively-limited performance is both fundamental and physics-driven, in 2019 we proposed replacing Rule 07 with “Law 19” and provided a comparison of this fundamental limit with Rule 07. In this paper, we review the theoretical performance of Teledyne’s fully-depleted HgCdTe P-υ-N detectors and provide performance data on dark current, dynamic impedance and quantum efficiency (QE) for mid-wavelength infrared (MWIR) and long-wavelength infrared (LWIR) detectors both at high operating temperatures (up to 300K) and as a function of temperature

Aims: This research project targeted the immersion of older adults with the use of technology to increase social participation and access to meaningful online information. Methods: A one-hour iPad/...

This study incorporates a “food image” variable into a luxury value-attitude-behavior model. The aim is to examine Taiwanese tourists’ attitudes toward luxury restaurants and purchase intentions, i.e., to dine at luxury restaurants while traveling for tourism purposes. A total of 361 participants were recruited to complete the questionnaires. The results indicated that the perceived functional value, perceived symbolic / expressive value, and perceived hedonic value may influence consumers’ attitudes toward luxury restaurants, which, in turn, may affect their purchase intentions – to dine at luxury restaurants while participating in tourism activities. In addition, a destination’s food image moderates the relationship between attitude and purchase intentions. The managerial implications of this research are discussed.

Tourism trade shows that are open to the public as well as to buyers and sellers are an emerging channel for the promotion of products to potential tourists. However, few studies have explored the influence of environmental stimuli on nonbusiness visitors' emotions. Moreover, the moderating effect of visitors' expectations remains understudied in the context of trade show management. To address this issue, this study reports on research derived from 611 respondents at a Taiwanese tourism trade show through a modified Mehrabian–Russell model. Structural equation modeling of the data shows that positive emotions positively influence behavioral intentions, but negative emotions do not negatively influence behavioral intentions. Among the three stimuli (i.e., information rate, service staff quality, and atmospherics), only information rate and service staff quality positively affect positive emotions and negatively affect negative emotions. The results show that visitors with high and low trade show visit expectations react differently to environmental stimuli at trade shows.

Background COVID-19 has created barriers to the delivery of health care services, including dental care. This study sought to quantify the change in dental visits in 2020 compared with 2019. Methods This retrospective, observational study examined the percentage change in weekly visits to dental offices by state (inclusive of the District of Columbia), nationally, and by county-level COVID-19 incidence using geographic information from the mobile applications of 45 million smartphones during 2019 and 2020. Results From March through August 2020, weekly visits to dental offices were 33% lower, on average, than in 2019. Weekly visits were 34% lower, on average, in counties with the highest COVID-19 rates. The greatest decline was observed during the week of April 12, 2020, when there were 66% fewer weekly visits to dental offices. The 5 states (inclusive of the District of Columbia) with the greatest declines in weekly visits from 2019 through 2020, ranging from declines of 38% through 53%, were California, Connecticut, District of Columbia, Massachusetts, and New Jersey. Conclusions Weekly visits to US dental offices declined drastically during the early phases of the COVID-19 pandemic. Although rates of weekly visits rebounded substantially by June 2020, rates remain about 20% lower than the prior year as of August 2020. These findings highlight the economic challenges faced by dentists owing to the pandemic. Practical Implications States exhibited widespread variation in rates of declining visits during the pandemic, suggesting that dental practices may need to consider different approaches to reopening and encouraging patients to return depending on location.

Very few cases of villous adenomas of the bladder or urinary tract have been described. To our knowledge this is the first account of resection of an urachal villous adenoma via robotic laparoscopy, which is a safe and efficacious surgical approach. At this time, there is not enough evidence to suggest that progression of disease to carcinoma is the typical course. Nonetheless, follow-up cystoscopy is recommended after complete removal of the adenoma to monitor for recurrence. This case report reviews the current literature and describes a novel approach to treatment of this exceedingly rare entity.

Objectives To systematically review the literature on economic evaluations of dental sealants and examine the costs and effectiveness of caries prevention using sealants. Methods Of 21 full-text articles examined, a total of 13 were included in this study. These studies are grouped by the type of intervention as follows: (i) sealants compared with no sealants; (ii) sealants compared with other forms of caries prevention; (iii) resin-based sealants compared with glass-ionomer sealants; (iv) different sealing strategies in primary teeth; (v) different sealing strategies in permanent teeth; and (vi) sealants based on school- or clinic-based setting of delivery. All currency is reported in constant 2010 US$. Results Cost-effectiveness analyses differed due to varying study designs, assumptions, sealant delivery settings, outcomes, caries risk assessment and study durations. Findings varied on the cost-effectiveness of sealants compared with other caries-preventive strategies. Under the assumption of equal caries risk, always sealing primary molars appeared to be the most effective strategy, whereas risk-based sealing was the optimal strategy with differing caries risk. Studies that assessed sealing strategies in permanent teeth reported that risk-based sealing was more cost-effective than not sealing, but they differed on the cost-effectiveness of risk-based seal compared with non-risk-based seal. Sealants delivered in school settings had mixed results on costs but were as equally effective as sealants delivered in private practices. Conclusions The cost-effectiveness of sealants is dependent on the conditions of delivery. The list of cost-effectiveness ratios for each intervention can support policy makers to estimate expected returns on their investments in dental sealants.

This research examines the influence of restaurant stimuli (i.e., chefs, service staff, other customers, food quality, and atmospherics) on diners’ emotions and loyalty to teppanyaki restaurants. In teppanyaki restaurants, chefs take orders from diners, prepare food in front of diners, and serve dishes to diners. Although the importance of chefs has been acknowledged by scholars, empirical research on the influence of chefs on diners has been scarce. To augment the literature on how chefs influence diners, this research incorporates “chef’s image” into an extended Mehrabian-Russell model (M-R model) to conceptualize diner loyalty to teppanyaki restaurants. A total of 308 diners from Taiwan were recruited. After examining their completed questionnaires, this study found that chef’s image, service quality, and food quality can affect the positive and negative emotions of diners. Moreover, other diners and restaurant atmospherics affect only the negative emotions of diners. Both positive and negative emotions can affect diner loyalty to teppanyaki restaurants. In addition, the managerial implications of this study are discussed.

Approximately 10% of reproductive-aged women worldwide are affected by polycystic ovary syndrome (PCOS). In addition to infertility, many women with PCOS have an increased risk of developing type 2 diabetes, cardiovascular disease, and non-alcoholic fatty liver disease. Studies have shown that the human gut microbiome is altered in humans with metabolic disorders such as obesity and type 2 diabetes and these changes may contribute to metabolic dysfunction. Additionally, studies have reported that changes in the gut microbiome are associated with PCOS in women and in rodent models. These changes include lower alpha diversity (species richness) and changes in specific Bacteroidetes and Firmicutes many of which are also altered in other metabolic diseases. In previous work, we investigated whether the gut microbiome was altered in a PCOS mouse model using letrozole, a nonsteroidal aromatase inhibitor, to increase endogenous testosterone levels and decrease estrogen levels. Letrozole treatment of pubertal female mice results in hallmarks of PCOS including elevated testosterone and LH, acyclicity, polycystic ovaries, and a metabolic phenotype. In the current study, we tested whether manipulation of the gut microbiome in the PCOS mouse model via co-housing improved reproductive and metabolic phenotypes and whether these changes correlated with gut microbial composition. Pubertal female mice were implanted with a placebo or letrozole pellet and divided into 3 groups with two mice per cage: co-housed placebo mice, letrozole mice or placebo and letrozole mice. Our results demonstrated that co-housing letrozole-treated mice with placebo mice resulted in substantial improvement of PCOS reproductive and metabolic phenotypes. Testosterone and LH levels, estrous cycling and ovulation were normalized in letrozole-treated mice co-housed with placebo mice compared to letrozole-treated mice housed together. In addition, weight, fasting blood glucose and insulin levels, and insulin resistance were decreased in letrozole-treated mice co-housed with placebo mice compared to letrozole-treated mice housed together. Using 16S rRNA sequencing, we observed that co-housing letrozole-treated mice with placebo mice did not result in substantial changes in alpha diversity but were associated with changes in specific bacterial genera that may be candidates for pre- or probiotic therapies. Our results suggest that manipulation of the gut microbiome may be a potential treatment option for PCOS.

To identify clinical and urodynamic factors leading to spontaneous voiding in men with detrusor underactivity (DU) and suspected bladder outlet obstruction who underwent an outlet de-obstruction procedure.We identified 614 men who underwent an outlet procedure at our institution from 2005 to 2014. Men were stratified by bladder contractility index (BCI). The primary outcome was spontaneous voiding after surgery. Data were analyzed in Statistical analysis system software.Of the 131 men who underwent preoperative urodynamics, 122 (mean age 68 years) had tracings available for review. DU (BCI 100) was identified in 54% (66 of 122), of whom only 68% (45 of 66) voided spontaneously before surgery, compared with 82% (46 of 56) of men with BCI ≥ 100. At a mean follow-up of 6.4 months postoperatively, 79% (52 of 66) of men with DU were able to void spontaneously, compared with 96% (54 of 56) of men with BCI ≥ 100. In men with a BCI 100 unable to void before surgery, 57% (12 of 21) recovered spontaneous voiding after surgery. On logistic regression for the outcome postoperative spontaneous voiding, significant preoperative characteristics, and urodynamic factors included preoperative spontaneous voiding (odds ratio [OR] = 9.460; 95% confidence interval [CI] = 2.955-30.289), increased maximum flow rate (Qmax; OR = 1.184; 95% CI = 1.014-1.382), increased detrusor pressure at maximum flow (Pdet@Qmax; OR = 1.032; 95% CI = 1.012-1.052), DU with BCI 100 (OR = 0.138; 95% CI = 0.030-0.635), and obstruction with bladder outlet obstruction index 40 (OR = 5.595; 95% CI = 1.685-18.575).Outlet de-obstruction improves spontaneous voiding in men with DU and may benefit men who do not meet the urodynamic threshold for obstruction.

Mycobacteriophages Deby, LaterM, LilPharaoh, Paola, SgtBeansprout, and Sulley were isolated from soil using Mycobacterium smegmatis mc2155. Genomic analysis indicated that they belong to subclusters K1 and K5., Mycobacteriophages Deby, LaterM, LilPharaoh, Paola, SgtBeansprout, and Sulley were isolated from soil using Mycobacterium smegmatis mc2155. Genomic analysis indicated that they belong to subclusters K1 and K5. Their genomic architectures are typical of cluster K mycobacteriophages, with most variability occurring on the right end of the genome sequence.

The purpose of this research is to examine how consumers’ attachment to luxury restaurants and their emotional ambivalence contribute to their reservation session abandonment during the coronavirus disease 2019 (COVID-19) pandemic. In addition, the moderating effect of luxury consumption goals (e.g., self-presentation motives, status consumption, and need for uniqueness) is examined. A total of 408 participants completed questionnaires, and the results reveal that luxury restaurant attachment significantly influences consumers’ emotional ambivalence, which in turn causes them to not complete their reservation sessions. Furthermore, the moderating effects of status consumption and need for uniqueness are supported.

Finding the balance between economic development and preservation of the natural environment is a challenging yet important task. This is a particularly pressing issue in the case of China, because it is the largest and fastest growing market for tourism. The purpose of this research is to examine Chinese tourists' participation in nature-based, tourism activities by incorporating tourists' environmental concern—measured by a revised New Environmental Paradigm scale—into a tourism constraint-negotiation model. The responses of 409 Chinese tourists show that environmental concern will positively affect tourists' motivation, which, in turn, will affect their negotiation strategy and ultimately their participation behavior. The theoretical and managerial implications of this study are discussed in the context of the tourism literature.