bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Antidepressant Use in Patients with Gender Dysphoria
Authors: Kilmer Lee H. , Chou Jesse , Campbell Christopher A. , DeGeorge Brent R. , Stranix John T. 
Published: February 2024

Background:
Patients with gender dysphoria face significant health disparities and barriers to care. Transition-related care includes hormonal therapy, mental health care, and gender-affirming surgery. Studies have described favorable surgical outcomes and patient satisfaction; however, the degree to which these procedures affect mental health conditions is not fully understood. The purpose of this study was to evaluate the effect of gender-affirming plastic surgery on mental health and substance misuse in the transgender population.

Methods:
A national insurance claims–based database was used for data collection. Patients with a diagnosis of gender dysphoria were propensity score–matched for the likelihood of undergoing gender-affirming surgery (no surgery being the control cohort), based on comorbidities, age, and sex. Primary outcomes included postoperative antidepressant use and the prevalence of mental health conditions.

Results:
A total of 3134 patients with gender dysphoria were included in each cohort. Patients in the surgery group had overall lower rates of mental health conditions, substance misuse, and selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor use. There was an absolute decrease of 8.8% in selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor prescription after gender-affirming plastic surgery (P < 0.001), and significant decreases were found in postoperative depression (7.7%), anxiety (1.6%), suicidal ideation (5.2%) and attempts (2.3%), alcohol misuse (2.1%), and drug misuse (1.9%).

Conclusion:
Gender-affirming surgery in appropriately selected patients with gender dysphoria is associated with decreased postoperative rates of SSRI or SNRI use and improved mental health.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Outcomes of Immediate versus Delayed Autologous Reconstruction with Postmastectomy Radiation: A Meta-Analysis
Authors: ElAbd Rawan , Jabori Sinan , Willey Brea , El Eter Leen , Oberoi Michelle K. , Singh Devinder 
Published: February 2024

Background:
Postmastectomy autologous breast reconstruction can be immediate or delayed. The safety of performing immediate breast reconstruction (IBR) and the impact of radiation on the newly reconstructed breast is not yet validated.

Methods:
A PubMed, Embase, and Google scholar search was conducted from inception to September 17, 2023. The authors included comparative studies that assessed complications or aesthetic outcomes of IBR versus delayed breast reconstruction (DBR) in the setting of postmastectomy radiotherapy (PMRT).

Results:
The search identified 2693 articles. Thirteen were eligible for inclusion. A total of 565 patients underwent IBR followed by radiotherapy, whereas 699 had DBR. Mean follow-up time and age for both groups were comparable (P > 0.1). None of the complications—revision surgery, infection, total flap failure, seroma, hematoma, dehiscence, or delayed wound healing—were significantly different across groups (P > 0.1). IBR was found to have a higher risk of flap fibrosis (OR, 28.18; 95% CI, 5.15 to 154.12; P = 0.0001; I
2 = 44%) and skin flap necrosis (OR, 6.12; 95% CI, 2.71 to 13.82; P < 0.0001; I
2 = 27%) but a lower risk of partial flap failure (OR, 0.18; 95% CI, 0.06 to 0.58; P = 0.004; I
2 = 0%) when compared with DBR. Results of fat necrosis should be interpreted with caution. Patient-reported and objective aesthetic outcomes were mostly comparable between groups.

Conclusions:
IBR in the setting of PMRT is increasingly being performed and poses a specific set of challenges that surgeons usually consider. The choice between IBR or DBR in the setting of PMRT should be an individualized decision based on patient risk factors and desires.
Infratemporal Fossa Schwannoma Surgery via a Combined Prelacrimal Recess, Caldwell-Luc, and Distal Intraoral Approach
Authors: Cao Zhiwen , Wang Tianyu , Lin Bojian , Cai Boyu , Peng Hu , Liu Huanhai , Liao Jianchun 
Published: February 2024

Background:
The deep location of infratemporal fossa (ITF) combined with the abundant vascular plexus in it increased the difficulty of removing the mass in ITF through endoscope surgery approach. However, under appropriate circumstances, the excision of ITF tumors through a combined prelacrimal recess, Caldwell-Luc, and distal intraoral approach can be safely performed with minimal impact on the surrounding tissues.

Case presentation:
The Department of Neurology received a 69-year-old male patient who had been experiencing headache, dizziness, and numbness from the mastoid region of his left ear to the corner of his mouth for a duration of 22 days. Cranial magnetic resonance imaging revealed the presence of a tumor located in the ITF. Following transfer to our department, surgical intervention was performed using a combined approach involving the prelacrimal recess, the anterior wall of maxillary sinus, and lateral ITF to successfully remove the tumor. Postoperative pathologic examination confirmed schwannoma as its nature. The patient was discharged in excellent condition without any functional impairment.

Conclusions:
On the basis of this case, the authors believe that this combined approach can offer a distinct endoscopic perspective and adequate surgical workspace, which is crucial for tumor removal while preserving the integrity of surrounding normal tissues. Moreover, the utilization of multiple small incisions has minimal impact on postoperative recovery.
Nasofacial Groove Pedicled Flap for the Reconstruction of Lateral Alar Defect
Authors: Zeng Qi , Wei Jiao , Dai Chuan-Chang , Yu Bao-Fu 
Published: February 2024

Background:
The repair of nasal alar defects is challenging for plastic surgeons, and there is currently no standard operation. Herein, the authors reported the clinical outcomes of a nasofacial groove pedicled flap for the reconstruction of alar defect.

Methods:
This retrospective study included patients who underwent the nasofacial groove pedicled flap for the reconstruction of alar defect between January 2018 and June 2020. Photographs of standard facial postures were taken before and after surgery to record the surgical results of the patients. The patient’s medical history was reviewed retrospectively. Self-reported satisfaction of patients on scar morphology and reconstructive effect were evaluated with a questionnaire survey.

Results:
There were 26 eligible patients enrolled, and all patients were followed up for more than 1 year after surgery. All flaps were free of ischemia and necrosis and healed well. No patient experienced restricted nostril ventilation. Eight patients underwent reoperation to trim the flap pedicle and the scar. Eight patients (8/26) reported “very satisfied,” and 17 patients (17/26) reported “satisfied” with the repair effect and scar morphology. One patient went through multiple laser treatments to improve her scars but still remained visible hyperpigmentation. She was dissatisfied with postoperative flap pigmentation but was satisfied with the correction effect.

Conclusions:
The clinical results indicated that the nasal groove flap was safe for the treatment of the lateral alar defect, and the patients were satisfied with the clinical results. The authors believe that this flap can be used as an alternative method for repairing the lateral alar defect.

Level of Evidence:
Level —IV, therapeutic study.
The Influence of Traffic Lights Presentation of Dementia Risk Screening Information on Older Adults’ Motivations for Risk Reduction in Primary Care Settings
Authors: Matovic Diana , Ahern Malene , Lei Xiaojing , Wuthrich Viviana M. 
Published: February 2024

Objective:This study assessed older adults’ preferences for how to communicate dementia risk information to maximize motivation for behavior change.Method:Eighty-nine community-dwelling older adults (aged 61 to 92 years, M=72.93, SD=6.36, 76% women) received dementia risk factor information in 2 formats: “traffic lights” (green=risk absent, amber=risk emerging, and red=risk present) or red/risk-only. Participants reported motivation to change risk-related behaviors, motivation to maintain good health behaviors, liking of the formats, categorical preference for traffic lights versus risk-only formats, reasons for preferences (open-ended), total applicable risks, and Motivation to Change Lifestyle and Health Behaviour for Dementia Risk Reduction.Results:Traffic lights presentation was more motivating (Z=4.16,P<0.001), more liked (Z=4.80,P<0.001), and preferred, NTraffic=71, NRed=14, χ2(1)=38.22,P<0.001, over risk-only. Self-efficacy and motivation to maintain good health behaviors were significant unique predictors of motivation to change risk-related behaviors following traffic lights presentation over age, sex, education, total applicable risks, perceived susceptibility, cues to action, and liking of the traffic lights presentation format. Themes indicated (1) traffic light presentation is informative and clear, and (2) green-light information increases self-efficacy.Conclusions:Traffic light presentation increases patient motivation to reduce dementia risk. Green-light information increases self-efficacy. Maximizing motivation through information presentation can decrease dementia prevalence.
The role of ultradian rhythms in post-deprivation rebounds and diurnal rhythms of sleep and wakefulness in rats
Authors: Lim Joonbum , Stephenson Richard 
Published: February 2024

AbstractThe temporal organization of ultradian rhythms in sleep and wakefulness during post-sleep deprivation (TSD) rebound were investigated in 15 rats under contant bright light (LL). Following baseline recordings, rats were subjected to TSD using gentle manual stimulation. Post-TSD rebounds in cumulative wakefulness (WAKE), rapid eye movement sleep (REM) and non-REM sleep (NREM) were analyzed in WAKE-dominant (υw) and sleep-dominant (υs) ultradian phases. Rebounds in WAKE and NREM were present only when data were analyzed on a full ultradian cycle basis, and were absent in υsand υwphases alone. These rebounds were approximately 50% complete and not proportional to TSD excess/deficit. Rebounds in REM were present in full ultradian cycles and partially expressed in υsbut absent in υw. REM rebounds fully compensated for REM deficit. Rebounds were mediated mainly by a reduction in the duration of the υwultradian phase, and by decreased probability of arousal in the υsultradian phase. These mechanisms were also found to partially mediate diurnal rhythms in 10 rats under a 12:12 h LD cycle.This study implicates an ultradian timing mechanism in the control of post-TSD rebounds and suggests that rebounds in all three states are mainly mediated by post-TSD adjustments in WAKE-promoting mechanisms. Ultradian rhythms should be taken into account to avoid errors in data analysis.HighlightsSleep-wake state exhibits circadian rhythms and ultradian rhythms.These rhythms interact with rebounds after sleep deprivation.Circadian amplitude and sleep rebound are partially mediated by ultradian timing.Arousal-related processes control these sleep-wake patterns in both states.Measuring ultradian rhythms is necessary for accurate analysis of data.
Can an apple a day keep COVID-19 away? A cluster analysis of the long-term COVID-19 pandemic’s impact on the consumption of apples in Italy
Authors: Giannetto Carlo , De Pascale Angelina , Di Vita Giuseppe , Lanfranchi Maurizio 
Published: February 2024

PurposeApples have always been considered a healthy product able to provide curative properties to consumers. In Italy, there is a long tradition of apple consumption and production both as a fresh product and as processed food. However, as with many other products, the consumption of fruits and vegetables and, more specifically apples, has been drastically affected by the first lockdown in 2020. In this project, the authors investigate whether the change in consumption habits had long-lasting consequences beyond 2020 and what are the main eating motivations, food-related behavior and socio-demographic affecting the consumption of fruits and vegetables after the pandemic.Design/methodology/approachThe authors ran two online surveys with 1,000 Italian consumers across a year (from October 2021 to December 2022). In the study, participants answered questions about their consumption habits and their eating motives. Out of 1,000 consumers, the authors included in the final analysis only the participants who answered both surveys, leaving a final sample of 651 consumers.FindingsThe results show that participants have allocated more budget to fruit and vegetables after the lockdown than before it. Moreover, consumers reported an average increase in the consumption of apples. However, the increase was more pronounced for people aged between 30 and 50 years old and identified as female. After showing the difference across time, a cluster analysis identified three main segments that differ in their eating motives, place of purchase and area of residence.Practical implicationsOverall, the results contribute to a better understanding of how the global pandemic is still affecting people's daily life. Moreover, the findings can be used to guide the marketing and communication strategies of companies in the food sector.Originality/valueTo the best of the authors' knowledge, this is the first study that investigates changes in the consumption of fruits and vegetables, and, more specifically, apples, in Italy more than one year after the beginning of the COVID-19 pandemic. Moreover, the study proposes a classification of consumers based on their habits in a time frame during which the COVID-19 wave was at its bottom which is not currently present in the literature.
Analysis and circuit design of isolated forward SEPIC converter with minimum-phase stability
Authors: Goudarzian Alireza , Pourbagher Rohallah 
Published: February 2024

Purpose
Conventional isolated dc–dc converters offer an efficient solution for performing voltage conversion with a large improved voltage gain. However, the small-signal analysis of these converters shows that a right-half-plane (RHP) zero appears in their control-to-output transfer function, exhibiting a nonminimum-phase stability. This RHP zero can limit the frequency response and dynamic specifications of the converters; therefore, the output voltage response is sluggish. To overcome these problems, the purpose of this study is to analyze, model and design a new isolated forward single-ended primary-inductor converter (IFSEPIC) through RHP zero alleviation.

Design/methodology/approach
At first, the normal operation of the suggested IFSEPIC is studied. Then, its average model and control-to-output transfer function are derived. Based on the obtained model and Routh–Hurwitz criterion, the components are suitably designed for the proposed IFSEPIC, such that the derived dynamic model can eliminate the RHP zero.

Findings
The advantages of the proposed IFSEPIC can be summarized as: This converter can provide conditions to achieve fast dynamic behavior and minimum-phase stability, owing to the RHP zero cancellation; with respect to conventional isolated converters, a larger gain can be realized using the proposed topology; thus, it is possible to attain a smaller operating duty cycle; for conventional isolated converters, transformer core saturation is a major concern, owing to a large magnetizing current. However, the average value of the magnetizing current becomes zero for the proposed IFSEPIC, thereby avoiding core saturation, particularly at high frequencies; and the input current of the proposed converter is continuous, reducing input current ripple.

Originality/value
The key benefits of the proposed IFSEPIC are shown via comparisons. To validate the design method and theoretical findings, a practical implementation is presented.
Influencing factors and governance strategies of megaproject complexity based on fuzzy-set qualitative comparative analysis
Authors: Wu Quntao , Bo Qiushi , Luo Lan , Yang Chenxi , Wang Jianwang 
Published: February 2024

PurposeThis study aims to obtain governance strategies for managing the complexity of megaprojects by analyzing the impact of individual factors and their configurations using the fuzzy-set qualitative comparative analysis (fsQCA) method and to provide references for project managers.Design/methodology/approachWith the continuous development of the economy, society and construction industry, the number and scale of megaprojects are increasing, and the complexity is becoming serious. Based on the relevant literature, the factors affecting the complexity of megaprojects are determined through case analysis, and the paths of factors affecting the complexity are constructed for megaprojects. Then, the fsQCA method is used to analyze the factors affecting the complexity of megaprojects through 245 valid questionnaires from project engineers in this study.FindingsThe results support the correlation between the complexity factors of megaprojects, with six histological paths leading to high complexity and seven histological paths leading to low complexity.Originality/valueIt breaks the limitations of the traditional project complexity field through a “configuration perspective” and concludes that megaproject complexity is a synergistic effect of multiple factors. The study is important for enriching the theory of megaproject complexity and providing complexity governance strategies for managers in megaproject decision-making.
Discovering and developing the vocational teacher identity
Authors: Antera Sofia , Teräs Marianne 
Published: February 2024

PurposeThis study explores the role of previous occupational identity in the formation of the (new) teacher identity of vocational teachers. The focus is on how vocational teachers discover their teaching identity, how they describe the connection between their previous occupation and teacher identity and how they describe a competent member of the teaching community.Design/methodology/approachThe theoretical approach is inspired by Communities of Practice (CoP) theory. More specifically, the realignment between socially demanded competence in the profession and personal experience as well as identification with the teaching community are discussed. The research material comes from 14 interviews with vocational teachers in different disciplines.FindingsFindings indicate first that the process of professional identity (trans)formation was initiated by finding one's teaching self when the individuals became aware of their interest in teaching by discovering that they had already achieved some sort of teaching-related competence. Second, individuals had been connecting their professional identities – finding common competence between their previous occupation and the teaching role. Third, vocational teachers experienced legitimising their competence and their new identity with reference to what their new CoP instructed as important competence (regime of competence).Originality/valueWhile teachers' vocational competence is not scrutinised, their teaching competence needs to be constantly proved. This imbalance often leads to teachers returning to an aspect of their identity that is well established – their vocational competence. Looking back to their occupational competences constitutes a realignment backwards, when teachers attempt to serve their new professional goal by drawing on old competence.
Effects of green authenticity on well-being, customer engagement and approach behavior toward green hospitality brands
Authors: Yu Jongsik , Baah Nancy Grace , Kim Seongseop (Sam) , Moon Hyoungeun , Chua Bee-Lia , Han Heesup 
Published: February 2024

Purpose
This study aims to develop a robust theoretical framework to explain the impact of hotels’ green brand authenticity on guests’ perceptions of well-being, customer engagement and approach behaviors toward green brands.

Design/methodology/approach
In this study, the authors examined the effect of green brand authenticity on perceptions of well-being, customer engagement and approach behaviors toward green brands. For the quantitative empirical analysis, 352 samples were used. Green brand authenticity integrates quality commitment, heritage, uniqueness and symbolism as high-dimensional factors.

Findings
The study conceptualizes green brand authenticity as a multi-dimensional phenomenon with four dimensions: quality commitment, heritage, uniqueness and symbolism. The results showed that green brand authenticity has a positive effect on hotel guests’ perceived well-being and behavioral intentions. Interestingly, environmental values did not have a statistically significant regulatory role, while green behavior in everyday life had a partial regulatory role.

Practical implications
This study aims to develop and empirically test a conceptual model that depicts the function of green authenticity in explaining customer responses to green brands. The results and the theoretical framework proposed in this study provide significant insights for researchers and practitioners in the hotel industry.

Originality/value
Further than evaluating brand authenticity generally, this study evaluates the authenticity of a brand's environmental protection efforts. As a result of the empirical analysis conducted in this study, the green brand authenticity of a hotel had a positive effect on customers’ emotional and behavioral aspects. This finding provided valuable and meaningful insights for green hotels and hotel brand-related research.
Vibration behavior of a 3D-printed hybrid polymer bearing with outer race defect
Authors: Küçükoğlu Doğan Burcu , Dal Abdurrahim , Ağören Görkem , Karaçay Tuncay 
Published: February 2024

Purpose
In industry applications, polymer hybrid bearings have become widespread in recent years owing to the lack of lubricant requirements, particularly in areas requiring hygiene. The additive manufacturing method gives significant advantages to have complex machinery parts, and it has become popular in the industry in recent years. However, it has some inherent disadvantages caused by layered deposition/addition of the materials, and the probability of the localized defect is much higher than in the conventional manufacturing methods. This study aims to investigate the effect of the outer race defect on the characteristics of vibration and service lifetime of hybrid polymer ball bearings produced with the stereolithography (SLA) additive manufacturing method.

Design/methodology/approach
In this study, polymer bearings’ races were produced with the additive manufacturing SLA method, and the outer race defect was analyzed with measured vibrations.

Findings
The results show that the additive manufacturing method suggests a practical solution for producing a polymer hybrid ball bearing. On the other hand, the hybrid three-dimensional-printed bearing, which has an outer race defect, worked for approximately 8 h without any problems under a 1 kg load and a shaft speed of around 1,000 rpm. In addition, when there is a defect in the outer and/or inner race of the ball bearing, the crest factor and kurtosis of the vibration are higher than faultless ball bearing, as expected.

Originality/value
This paper provides valuable information on the lifetime and vibration characteristics of polymer hybrid ball bearing produced by means of additive manufacturing.

Peer review
The peer review history for this article is available at: https://publons.com/publon/10.1108/ILT-06-2023-0183/