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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.

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...

The protection of industrial cultural heritage is related to sustainable urban development. Cultural and creative parks (CCPs) are a way for many cities to protect their industrial cultural heritage. In the context of CCPs, this study examines the relationships among the antecedents of exhibition experiential value, CCP experiential value, and behavioral intentions. Surveying 428 visitors in two well-known CCPs in Taipei, this study found that the four antecedents (attractiveness, existential authenticity, self-congruence, and exhibition–park image congruence) have a positive impact on exhibition experiential value. Exhibition experiential value has a positive impact on CCP experiential value, which in turn, affects behavioral intentions toward the CCP. In addition, this study finds that exhibition experiential value has a mediating effect between the four antecedents and CCP experiential value. Moreover, CCP experiential value has a mediating effect between exhibition experiential value and behavioral intentions. The findings of this study provide a direction for CCPs to achieve sustainable development through exhibitions that can attract more tourists.

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.