bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Work-Related Behavior and Experience Patterns on Sleep Quality in Emergency Medical Service Personnel
Authors: Schnell Julia , Thielmann Beatrice , Schumann Heiko , Böckelmann Irina 
Published: August 2023

Objective
The aim of this study was to examine the influence of work-related behavior and experience patterns on sleep quality in emergency medical service personnel.

Methods
From the total sample of 508 emergency medical service workers who took part in the Germany-wide online survey, 368 respondents completed the questionnaires on sleep characteristics (Pittsburgh Sleep Quality Index [PSQI]) and work-related behavior and experience pattern. Three hundred sixty-seven of the 368 participants also finished the Regensburg Insomnia Scale.

Results
Based on their work-related behavior and experience pattern results, individuals were categorized into one of the four following patterns: two risk patterns (A, B) and two healthy behavior and experience patterns (G, S). Participants that were classified into risk-pattern A and B (33.85%) scored significantly higher in both PSQI and Regensburg Insomnia Scale overall score and all PSQI components implicating a poorer sleep quality. A total of 78.5% of the individuals with pattern A and B were considered bad sleepers whereas only 43.4% of individuals with pattern G and S were scored as bad sleepers.

Conclusions
Work-related behavior and experience patterns showed a strong association to sleep characteristics and may therefore be used to identify appropriate preventative measures.
The genetics of autosomal dominant familial hypercholesterolemia
Authors: Anderson Sharon , Botti Christina 
Published: August 2023

ABSTRACT
Familial hypercholesterolemia (FH) is one of the most common genetic conditions. Affected individuals are unable to metabolize cholesterol due to inherited changes in the low-density lipoprotein (LDL) receptor, which impairs the ability to metabolize cholesterol, resulting in extremely high levels of cholesterol that leads to premature coronary artery disease. Autosomal dominant FH is caused by variants in several genes, which may present as heterozygous FH (less severe) or homozygous FH (more severe). Clinical diagnosis may be more likely when there is a family history of two or more first-degree relatives with total and LDL-cholesterol (LDL-C) level elevations, a child is identified, or the affected individual or close relatives have tendon xanthomas and/or progressive atherosclerosis. This article provides an overview of autosomal dominant FH, including disease prevalence, clinical diagnostic criteria, genetic variants, diagnostic testing, pathognomonic findings, and treatment options. It also shares a brief case, which highlights challenges associated with genetic test interpretation and the importance of including experienced providers in the diagnosis and treatment of this underdiagnosed and often untreated or undertreated genetic condition.
Results of a Novel, Nonsurgical Bone-Conduction Hearing Aid for the Treatment of Conductive Hearing Loss in Australian Children
Authors: Marino Roberta , Eager Katrise , Kuthubutheen Jafri , Kadhim Latif , Távora-Vieira Dayse 
Published: August 2023

Objective
To determine and compare the benefits a novel adhesive bone-conduction system and a conventional bone-conduction hearing aid (BCHA) on a softband for children with conductive hearing loss.

Study Design
Prospective, single-subject randomized, crossover trial.

Setting
Tertiary referral center in Australia.

Participants
Eight children aged from 4 to 17 years with conductive hearing loss.

Intervention
Rehabilitative with participants using the novel adhesive bone-conduction aid and a BCHA.

Main Outcome Measures
Aided thresholds, as well as speech perception in quiet, unaided and aided with the novel adhesive bone-conduction aid and BCHA on a softband. For the six older children, speech in noise testing was also conducted.

Results
The mean unaided four frequency average hearing levels was 48 dB HL for air conduction, 10.5 dB HL for bone conduction, with a mean air-bone gap in the aided ear of 37.5 dB HL.
Four-frequency average hearing level aided thresholds were 20.2 dB for the novel device and 19.8 dB for the BCHA, with no significant difference between the devices. Aided monosyllabic word scores improved from an average of 45% in the unaided condition to 81.6 and 85% for the novel adhesive and BCHA devices, respectively. Aided speech in noise performance improved, on average, by 1.6 dB SNR when wearing the BCHA and the novel adhesive device, with no significant difference in performance between the two devices.

Conclusions
The novel device provided equivalent performance to the BCHA on all measures and can be considered as an alternative device for pediatric patients with conductive hearing loss.
Cognitive Performance, Sociodemographic Factors, Pure-Tone Audiometry, and their Association with Speech Discrimination: A Prospective Population-Based Study of 1,061 Older Adults
Authors: Marinelli John P. , Reed Nicholas S. , Lohse Christine M. , Fussell Wanda L. , Petersen Ronald C. , Machulda Mary M. , Vassilaki Maria , Carlson Matthew L. 
Published: August 2023

ObjectiveHearing loss is increasingly recognized as a chronic disease state with important health sequelae. Although considered a central component of routine audiometric testing, the degree to which various patient factors influence speech discrimination is poorly characterized to date. The primary objective of the current work was to describe associations of cognitive performance, sociodemographic factors, and pure-tone audiometry with speech discrimination in older adults.Study DesignProspective study.SettingOlmsted County, Minnesota.PatientsThere were 1,061 study participants 50 years or older at enrollment in the population-based Mayo Clinic Study of Aging between November 2004 and December 2019 who underwent formal audiometric and cognitive testing included in the current investigation.Main Outcome MeasuresThe primary outcome measure was word recognition scores (WRSs; measured as <100% vs 100% as well as continuous), with pure-tone averages (PTAs; 0.5, 1, 2, and 3 kHz), age, sex, years of education, state area deprivation index (ADI) quintiles, and global cognitionzscores as explanatory features.ResultsThe mean (SD) age among the 1,061 participants was 76 (9) years with 528 (50%) males. Participant age [OR (95% CI) for a 10-year increase of 1.8 (1.4–2.3),p< 0.001], male sex [OR = 2.6 (1.9–3.7),p< 0.001], and PTA [OR for a 10-dB hearing loss increase of 2.4 (2.1–2.8),p< 0.001] were all significantly associated with <100% WRSs, with the greatest explanatory ability attributable to the PTA. Years of education (p= 0.9), state ADI quintile (p= 0.6), and global cognitive performance (p= 0.2) were not associated with WRS. The multivariable model demonstrated strong predictive ability for less than perfect WRSs, with acindex of 0.854. Similar results were seen for WRSs analyzed as continuous, with the multivariable model resulting in anR2value of 0.433.ConclusionsAlthough PTA exhibited the greatest influence on speech discrimination, advancing age and male sex both independently increased the likelihood of having worse speech discrimination among older adults, even after accounting for years of education, neighborhood-level socioeconomic disadvantage, and cognitive function. These findings help identify patient factors that can be instrumental when designing screening programs for adult-onset hearing loss.
Development and Chinese Cross-Cultural Adaptation of the Cochlear Implant Quality-of-Life Survey
Authors: Fan Caleb J. , Mavrommatis Maria A. , Kaul Vivian F. , McRackan Theodore R. , Wanna George B. , Cosetti Maura K. 
Published: August 2023

Objective
To conduct the Chinese cross-cultural adaptation of the Cochlear Implant Quality of Life-10 Global (CIQOL-10 Global) instrument.

Patients
Bilingual Chinese American cochlear implant users.

Intervention
Chinese cross-cultural adaptation of the CIQOL-10 Global.

Main Outcome Measure
Description of the process of Chinese cross-cultural adaptation of the CIQOL-10 Global and pilot testing of the Chinese CIQOL-10 Global in the target patient population.

Results
The CIQOL-10 Global was cross-culturally adapted into Chinese. Ten participants were recruited for pilot testing. There was wide representation from across the target population in terms of age (mean, 44.8 yr; range, 20.2–80.3 yr), sex (5 were male, 5 were female), education, and socioeconomic factors. All participants were able to easily read, comprehend, and fill out the Chinese CIQOL-10 Global.

Conclusions
The Chinese version of the CIQOL-10 Global is now available to provide an overall assessment of quality of life of Chinese-speaking cochlear implant users.
Effect of Nature-Themed Recharge Room on Healthcare Workers' Level of Stress and Anxiety
Authors: Besa Rocel , Angelo Ellen , Cutroneo Annamarie , Frieman Amy , Paliwal Mani , Williams Dawn 
Published: August 2023

OBJECTIVE
To determine if there is a difference in stress and anxiety before and after the use of the nature-themed recharge room.

BACKGROUND
Psychological support measures have been noted to be relevant to nurses; however, the effect of the pandemic on the healthcare workers' emotional and psychological well-being led to urgent calls to implement psychological support measures more widely.

METHODS
The study utilized a 1-group pretest and posttest design. One hundred sixty hospital employees utilized the recharge room, with 131 completed questionnaires counted in the data analysis. Data were collected using the demographic form, Perceived Stress Scale, and State-Trait Anxiety Inventory.

RESULTS
Most participants were between 25 and 35 years old, female, worked the morning shift, had 3 to 5 years of experience, preferred a water feature theme, and used the room for 10 minutes. The mean stress preintervention score was 7.44, and postintervention score was 7.17, with the difference not statistically significant. The mean anxiety preintervention score was 14.17, and postintervention score was 8.48, with the difference statistically significant at a P < 0.05. Females working in the hospital for 1 to 5 years were physicians/residents, nursing support staff, and leaders with the highest mean stress (4-item Perceived Stress Scale) and anxiety (6-item State-Trait Anxiety Inventory) preintervention scores. Comparing the preintervention and postintervention anxiety levels, the highest reduction was noted among females working in the hospital for 1 to 3 years and nursing support staff who have used the room for 5 to 15 minutes with 2 or fewer people.

CONCLUSION
Organizational leaders should offer psychological support programs, such as the nature-themed recharge room, to help reduce the healthcare workers' stress and anxiety.
Safety and Efficacy of a Central Pedicle Technique for Mastopexy and Mastopexy with Implant Augmentation
Authors: Orloff George 
Published: August 2023

Background:
The central pedicle technique (CPT) is rarely used to perform mastopexy or mastopexy with implant augmentation despite having robust perfusion and allowing for great exposure, resulting in reproducible results. This study was conducted to review one surgeon’s experience using the CPT for both mastopexy and mastopexy with implant augmentation.

Method:
A retrospective review of consecutive patients who had a mastopexy or mastopexy with augmentation using a standardized CPT from 2017 through 2021 was performed.

Results:
A total of 201 patients were identified for inclusion: 120 had a bilateral central pedicle mastopexy, 75 had bilateral central pedicle mastopexy and implants, and 6 had unilateral central pedicle mastopexy with implants because of asymmetry. Mean follow-up was 11.2 months. The average age was 45.4 years, body mass index 25.1 kg/m², and implant size 275 cc. The overall complication rate was 9.5%: 9.2% for CPT mastopexy and 9.9% for CPT mastopexy with implants. No revisional surgery was requested. None of the patients experienced nipple or skin necrosis.

Conclusions:
This study demonstrates that CPT mastopexy with or without an implant can be performed safely with a low complication rate. Additional benefits include standardized markings before surgery, visualization of the entire breast mound, and reliable perfusion. The technique excels in correcting asymmetry. CPT mastopexy with or without an implant is a safe and effective option for the treatment of breast ptosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Radial and Ulnar Forearm Free Flaps: A Critical Comparison of Donor-Site Morbidity and Its Impact on Quality of Life
Authors: Al-Aroomi Maged Ali , Duan Weiyi , Al-Worafi Naseem Ali , Al-Moraissi Essam Ahmed , Mashrah Mubarak Ahmed , Liu Minda , Xue Xiaomeng , Sun Changfu 
Published: August 2023

Background:
A poor evidence basis exists regarding directly comparing objective and subjective donor-site morbidity associated with the forearm flap. The authors evaluated the postoperative donor-site complications and quality-of-life outcomes between the radial forearm free flap (RFFF) and the ulnar forearm free flap (UFFF).

Methods:
All patients undergoing RFFF or UFFF harvest were included. Grip strength, pinch strength, wrist range of movement, and testing of skin sensitivity were assessed with the appropriate scales at different time intervals. In addition, appearance and quality of life were assessed using the Patient and Observer Scar Assessment Scale and the Disabilities of Arm, Shoulder, and Hand instruments.

Results:
Eighty patients were enrolled (RFFF, n = 40; and UFFF, n = 40). A short-term reduction in grip strength, fine motor skills (tip pinch, key pinch, palmar pinch), and range of motion was observed for the RFFF group and improved over time. None of the patients in either group experienced functional disturbance in grip strength, wrist motion, fine motor skills, or sensation to light touch at 1 year. Nine patients experienced partial skin graft loss (RFFF, n = 6; UFFF, n = 3). There was a significantly higher incidence of temporary numbness in the RFFF group (P = 0.040). Persistent numbness occurred in 3 cases in the RFFF group. Cold intolerance was significantly lower in the UFFF group (2.5%) than in RFFF group (22.5%). Moreover, the mean Patient and Observer Scar Assessment Scale and Disabilities of Arm, Shoulder, and Hand scores were reduced at 12 months compared with 6 months, significantly superior for UFFF.

Conclusions:
Objective function limitations are reversible short-term effects after forearm flap and do not affect daily routines in the long term. In addition, UFFF appears to be preferred over RFFF for subjective outcomes, which emphasizes that UFFF should be considered as an alternative to RFFF for reconstructing soft-tissue defects.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Study on the Application of Concentrated Growth Factor Combined With Adipose Transplantation in Repairing Depressed Deformities of Soft Tissue in the Face
Authors: Li Honghong , Yang Zhiguo , Lou Yin , Bao Qiong , Xie Juan , Cao Dongsheng 
Published: August 2023

Background
Autologous fat is a rich source of adipose tissue that is safe for transplantation. Decreasing the long-term absorption rate is key to improve the survival of transplanted adipose tissue. The aim of this study was to assess the effect of concentrated growth factor (CGF) on the survival of transplanted adipose tissue for repair of facial depression malformations.

Methods
Coleman adipose granules (CAGs) were prepared from venous blood. In the animal experiment, the ears of 30 healthy male New Zealand white rabbits were randomly allocated to 1 of 4 groups: CGF + CAG (CGF group), platelet-rich fibrin (PRF) + CAG (PRF group), CAG alone (CAG group), and adipose granule transplantation group (control group). Postoperative survival of the transplanted adipose tissue was assessed, the survival and absorption rates of adipose were calculated, and immunohistochemical analysis of specimens was conducted by staining with hematoxylin and eosin and Oil Red O. Of 43 outpatients, 22 received simple adipose transplantation and 21 received autologous CGF combined with adipose transplantation. The adipose absorption rate, complication rate, and cosmetic improvement of the 2 groups were compared.

Results
More adipocytes that are normal were observed in the CGF group, with fewer vacuoles and more uniform distribution of adipose tissue. Survival of the adipose tissue was superior in the CGF and PRF groups. Meanwhile, vascular density and long-term stability were better in the CGF group than the PRF group. In terms of clinical efficacy, the uniformity and survival rate of the adipose tissue were relatively improved in the CGF group compared with the simple adipose particle transplantation group, with less early liquefaction.

Conclusion
Concentrated growth factor stabilized and improved the survival of transplanted adipose tissue for filling of facial depression malformations.
Restoration of the Lateral Canthus and Stabilization of the Lower Eyelid After Failed Esthetic Lateral Canthoplasty
Authors: Zhang Li , Chen Yue , Li Yang , Li Dongmei 
Published: August 2023

Background:
An improper procedure of esthetic lateral canthoplasty can lead to lateral canthal deformity with other complications. To ensure proper canthal contour and eyelid function, the lateral canthus must be restored and the lower eyelid must be stabilized.

Methods:
This was a retrospective study that included a group of consecutive patients who had failed esthetical lateral canthoplasty between 2020 and 2022. All patients underwent the modified lateral tarsal strip procedure to restore the normal anatomy of the lateral canthus and stabilize the lower eyelid. Clinical data (age, sex, laterality, follow-up, ocular symptoms, previous medical history, and lateral canthal deformity) were collected. Preoperative and postoperative photographs were analyzed for cosmetic outcomes.

Results:
Among the 15 female patients, 25 eyelids were treated, including both eyes in 10 patients and only the left eye in 5 others. The mean age was 32.6 years. The mean follow-up was 13.34 months. All the patients had undergone esthetic lateral canthoplasty with other esthetic surgeries. Lateral canthus deformities include canthal webbing, rounding canthus, eyelid margin defect, remnant raw surface, mucosal exposure, lower eyelid retraction, sclera show, ectropion, symblepharon, and lagophthalmos. All the patients exhibited esthetically satisfactory results with improved ocular symptoms. In statistical analysis, horizontal palpebral aperture, vertical palpebral aperture, MRD2, and lateral canthus angle were statistically different pre to postprocedure (paired t test, P < 0.001).

Conclusions:
Restoration of the lateral canthus and stabilization of the lower eyelid using the modified lateral tarsal strip procedure showed good functional and cosmetic outcomes in patients who had failed lateral canthoplasty.
Three-Dimensional Anthropometry for Evaluating Philtrum Contour in Patients With Unilateral Cleft Lip: Comparison Between Photographic Assessment and 3-Dimensional Anthropometry
Authors: Park Hojin , Min Jaechung , Koh Kyung S. 
Published: August 2023

Philtrum reconstruction in patients with unilateral cleft lip is a major concern in cheiloplasty. Moreover, a quantitative evaluation of the philtrum contour has not been possible. Advances in 3-dimensional (3D) imaging technology have enabled highly accurate assessments of facial surfaces. This study aimed to justify using 3D anthropometric measurements to quantify traditional photographic grading systems. Sixty-six children with unilateral cleft lip, aged 4 to 6 years (mean age: 69.1±5.7 mo), who visited the outpatient clinic from January to December 2020 were included. A plastic surgeon panel graded the philtrum contour using digital photographs, and 3D anthropometry was performed using a 3D imaging system. The philtrum height, philtrum height difference, and dimple depth were measured at the middle of the philtrum. The philtrum height did not show significant changes across the photographic scores (P=0.06), whereas noticeable differences were observed in the dimple depths based on photographic scores (P<0.001). The correlation analysis revealed the highest correlation between the photographic score and dimple depth (rho=0.897, P<0.001). The philtrum height on the cleft side (rho=0.478, P<0.001) also correlated with the photographic score, but the correlation was weaker than that of the dimple depth. The dimple depth and philtrum height can help define the philtrum contour. Furthermore, the dimple depth reflects the philtrum contour better and is more suitable as a single parameter. However, relying on a single philtrum height measurement may be insufficient for reliable evaluations, as the relative height from the surrounding tissues is more important than the absolute height measured using 3D anthropometry.
Automated Cephalometric Landmark Detection Using Deep Reinforcement Learning
Authors: Hong Woojae , Kim Seong-Min , Choi Joongyeon , Ahn Jaemyung , Paeng Jun-Young , Kim Hyunggun 
Published: August 2023

Accurate cephalometric landmark detection leads to accurate analysis, diagnosis, and surgical planning. Many studies on automated landmark detection have been conducted, however reinforcement learning-based networks have not yet been applied. This is the first study to apply deep Q-network (DQN) and double deep Q-network (DDQN) to automated cephalometric landmark detection to the best of our knowledge. The performance of the DQN-based network for cephalometric landmark detection was evaluated using the IEEE International Symposium of Biomedical Imaging (ISBI) 2015 Challenge data set and compared with the previously proposed methods. Furthermore, the clinical applicability of DQN-based automated cephalometric landmark detection was confirmed by testing the DQN-based and DDQN-based network using 500-patient data collected in a clinic. The DQN-based network demonstrated that the average mean radius error of 19 landmarks was smaller than 2 mm, that is, the clinically accepted level, without data augmentation and additional preprocessing. Our DQN-based and DDQN-based approaches tested with the 500-patient data set showed the average success detection rate of 67.33% and 66.04% accuracy within 2 mm, respectively, indicating the feasibility and potential of clinical application.