Listening effort, fatigue, and streamed voice quality during online university courses.

Understanding the impact of listening effort (LE) and fatigue has become increasingly crucial in optimizing the learning experience with the growing prevalence of online classrooms as a mode of instruction. The purpose of this study was to investigate the LE, fatigue, and voice quality experienced by students during online and face-to-face class sessions. A total of 110 participants with an average age of 20.76 (range 18-28) comprising first year undergraduate students in Speech and Language Therapy and Audiology programs in Turkey, rated their LE during the 2022-2023 spring semester using the Listening Effort Screening Questionnaire (LESQ) and assessed their fatigue with the Multidimensional Fatigue Inventory (MFI-20). Voice quality of lecturers was assessed using smoothed cepstral peak prominence (CPPS) measurements. Data were collected from both online and face-to-face sessions. The results revealed that participants reported increased LE and fatigue during online sessions compared to face-to-face sessions and the differences were statistically significant. Correlation analysis showed significant relationships (p < 0.05) between audio-video streaming quality and LE-related items in the LESQ, as well as MFI sub-scales and total scores. The findings revealed a relationship between an increased preference for face-to-face classrooms and higher levels of LE and fatigue, emphasizing the significance of these factors in shaping the learning experience. CPPS measurements indicated a dysphonic voice quality during online classroom audio streaming. These findings highlight the challenges of online classes in terms of increased LE, fatigue, and voice quality issues. Understanding these factors is crucial for improving online instruction and student experience.

Reduced Channel Interaction Improves Timbre Recognition Under Vocoder Simulation of Cochlear Implant Processing.

OBJECTIVE: This study aimed to investigate the influence of the number of channels and channel interaction on timbre perception in cochlear implant (CI) processing. By utilizing vocoder simulations of CI processing, the effects of different numbers of channels and channel interaction were examined to assess their impact on timbre perception, an essential aspect of music and auditory performance. STUDY DESIGN, SETTING, AND PATIENTS: Fourteen CI recipients, with at least 1 year of CI device use, and two groups (N = 16 and N = 19) of normal hearing (NH) participants completed a timbre recognition (TR) task. NH participants were divided into two groups, with each group being tested on different aspects of the study. The first group underwent testing with varying numbers of channels (8, 12, 16, and 20) to determine an ideal number that closely reflected the TR performance of CI recipients. Subsequently, the second group of NH participants participated in the assessment of channel interaction, utilizing the identified ideal number of 20 channels, with three conditions: low interaction (54 dB/octave), medium interaction (24 dB/octave), and high interaction (12 dB/octave). Statistical analyses, including repeated-measures analysis of variance and pairwise comparisons, were conducted to examine the effects. RESULTS: The number of channels did not demonstrate a statistically significant effect on TR in NH participants ( p > 0.05). However, it was observed that the condition with 20 channels closely resembled the TR performance of CI recipients. In contrast, channel interaction exhibited a significant effect ( p < 0.001) on TR. Both the low interaction (54 dB/octave) and high interaction (12 dB/octave) conditions differed significantly from the actual CI recipients' performance. CONCLUSION: Timbre perception, a complex ability reliant on highly detailed spectral resolution, was not significantly influenced by the number of channels. However, channel interaction emerged as a significant factor affecting timbre perception. The differences observed under different channel interaction conditions suggest potential mechanisms, including reduced spectro-temporal resolution and degraded spectral cues. These findings highlight the importance of considering channel interaction and optimizing CI processing strategies to enhance music perception and overall auditory performance for CI recipients.

A Nationwide Chronic Disease Management Solution via Clinical Decision Support Services: Software Development and Real-Life Implementation Report.

BACKGROUND: The increasing population of older adults has led to a rise in the demand for health care services, with chronic diseases being a major burden. Person-centered integrated care is required to address these challenges; hence, the Turkish Ministry of Health has initiated strategies to implement an integrated health care model for chronic disease management. We aim to present the design, development, nationwide implementation, and initial performance results of the national Disease Management Platform (DMP). OBJECTIVE: This paper's objective is to present the design decisions taken and technical solutions provided to ensure successful nationwide implementation by addressing several challenges, including interoperability with existing IT systems, integration with clinical workflow, enabling transition of care, ease of use by health care professionals, scalability, high performance, and adaptability. METHODS: The DMP is implemented as an integrated care solution that heavily uses clinical decision support services to coordinate effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines and, hence, to increase the quality of health care delivery. The DMP is designed and implemented to be easily integrated with the existing regional and national health IT systems via conformance to international health IT standards, such as Health Level Seven Fast Healthcare Interoperability Resources. A repeatable cocreation strategy has been used to design and develop new disease modules to ensure extensibility while ensuring ease of use and seamless integration into the regular clinical workflow during patient encounters. The DMP is horizontally scalable in case of high load to ensure high performance. RESULTS: As of September 2023, the DMP has been used by 25,568 health professionals to perform 73,715,269 encounters for 16,058,904 unique citizens. It has been used to screen and monitor chronic diseases such as obesity, cardiovascular risk, diabetes, and hypertension, resulting in the diagnosis of 3,545,573 patients with obesity, 534,423 patients with high cardiovascular risk, 490,346 patients with diabetes, and 144,768 patients with hypertension. CONCLUSIONS: It has been demonstrated that the platform can scale horizontally and efficiently provides services to thousands of family medicine practitioners without performance problems. The system seamlessly interoperates with existing health IT solutions and runs as a part of the clinical workflow of physicians at the point of care. By automatically accessing and processing patient data from various sources to provide personalized care plan guidance, it maximizes the effect of evidence-based decision support services by seamless integration with point-of-care electronic health record systems. As the system is built on international code systems and standards, adaptation and deployment to additional regional and national settings become easily possible. The nationwide DMP as an integrated care solution has been operational since January 2020, coordinating effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines.

Evaluation of cross-bar and parallel-bar techniques in MIRPE surgery in different countries: a multicenter study.

Parallel- and cross-bar techniques are surgical methods used in the pectus excavatum. While the parallel bar is used in many centers, the cross bar is a new technique. The aim of the study is to evaluate the data of centers using cross bar and parallel bar. The aim of this multicenter study is to retrospectively evaluate the data of centers have been using both cross-bar and parallel-bar techniques. 213 parallel bars and 205 cross bars were used. Parallel-bar advantages: the mean patient satisfaction score was 9.40 ± 0.95. Cross-bar advantages: the rate of patients with symmetric deformity was 75.6%, recurrence 0.5%. The mean patient satisfaction score was 9.40 ± 0.95 in operations performed with the parallel-bar technique and 9.13 ± 1.11 in operations performed with the cross-bar technique (p < 0.05). Recurrence was observed in 3.3% of patients undergoing surgery using the parallel-bar technique and 0.5% of patients undergoing surgery using the cross-bar technique (p < 0.04). The cross-bar technique is more advantageous in terms of the recurrence, while second, the parallel-bar technique is associated with greater patient satisfaction. Comparison of data from different countries reveals the differences between patients who have been treated with minimally invasive repair of pectus excavatum and the outcomes of surgery.

Speech Perception as a Function of the Number of Channels and Channel Interaction in Cochlear Implant Simulation.

Objective: Speech perception relies on precise spectral and temporal cues. However, cochlear implant (CI) processing is confined to a limited frequency range, affecting the information transmitted to the auditory system. This study analyzes the influence of channel interaction and the number of channels on word recognition scores (WRS) within the CI simulation framework. Methods: Two distinct experiments were conducted. The first experiment (n=29, average age =23 years, 14 females) evaluated the number of channels using eight, twelve, sixteen, and 22 channel vocoded and nonvocoded word lists for WRS assessment. The second experiment (n=29, average age =25 years, 16 females) explored channel interaction across low, middle, and high-interaction conditions. Results: In the first experiment, participants scored 57.93%, 80.97%, 83.59%, 91.03%, and 95.45% under 8, 12, 16, and 22-channel vocoder and non-vocoder conditions, respectively. The number of vocoder channels significantly affected WRS, with significant differences observed in all conditions except between the 12-channel and 16-channels (p<0.01). In the second experiment, the participants scored 2.2%, 20.6%, and 50.6% under high, mid, and low interaction conditions, respectively. Statistically significant differences were observed across all channel interaction conditions (p<0.01). Conclusions: While the number of channels had a notable impact on WRS, it is essential to note that certain conditions (12 vs. 16) did not yield statistically significant differences. The observed differences in WRS were eclipsed by the pronounced effects of channel interaction. Notably, all conditions in the channel interaction experiment exhibited statistically significant differences. These findings underscore the paramount importance of prioritizing channel interaction in signal processing and CI fitting.

Emotions and Psychological Mechanisms of Listening to Music in Cochlear Implant Recipients.

OBJECTIVES: Music is a multidimensional phenomenon and is classified by its arousal properties, emotional quality, and structural characteristics. Although structural features of music (i.e., pitch, timbre, and tempo) and music emotion recognition in cochlear implant (CI) recipients are popular research topics, music-evoked emotions, and related psychological mechanisms that reflect both the individual and social context of music are largely ignored. Understanding the music-evoked emotions (the "what") and related mechanisms (the "why") can help professionals and CI recipients better comprehend the impact of music on CI recipients' daily lives. Therefore, the purpose of this study is to evaluate these aspects in CI recipients and compare their findings to those of normal hearing (NH) controls. DESIGN: This study included 50 CI recipients with diverse auditory experiences who were prelingually deafened (deafened at or before 6 years of age)-early implanted (N = 21), prelingually deafened-late implanted (implanted at or after 12 years of age-N = 13), and postlingually deafened (N = 16) as well as 50 age-matched NH controls. All participants completed the same survey, which included 28 emotions and 10 mechanisms (Brainstem reflex, Rhythmic entrainment, Evaluative Conditioning, Contagion, Visual imagery, Episodic memory, Musical expectancy, Aesthetic judgment, Cognitive appraisal, and Lyrics). Data were presented in detail for CI groups and compared between CI groups and between CI and NH groups. RESULTS: The principal component analysis showed five emotion factors that are explained by 63.4% of the total variance, including anxiety and anger, happiness and pride, sadness and pain, sympathy and tenderness, and serenity and satisfaction in the CI group. Positive emotions such as happiness, tranquility, love, joy, and trust ranked as most often experienced in all groups, whereas negative and complex emotions such as guilt, fear, anger, and anxiety ranked lowest. The CI group ranked lyrics and rhythmic entrainment highest in the emotion mechanism, and there was a statistically significant group difference in the episodic memory mechanism, in which the prelingually deafened, early implanted group scored the lowest. CONCLUSION: Our findings indicate that music can evoke similar emotions in CI recipients with diverse auditory experiences as it does in NH individuals. However, prelingually deafened and early implanted individuals lack autobiographical memories associated with music, which affects the feelings evoked by music. In addition, the preference for rhythmic entrainment and lyrics as mechanisms of music-elicited emotions suggests that rehabilitation programs should pay particular attention to these cues.

Modification of the Nuss procedure: the crossed bar technique for new subtypes of pectus excavatum.

BACKGROUND: We aim to describe four new subtypes of PE in detail and represent modification of the Nuss procedure called crossed bar technique for their optimum correction with good results. METHODS: 101 patients who underwent crossed bar technique between August 2005 and February 2022 were included into the study. RESULTS: The mean age of the patient series was 21.1 (range 15-38 years) years. Mean Haller index was 3.87. Mean operation duration was 86.84 min. 2 bars were used in 74 (73.3%) of the patients whereas 3 bars were preferred in 27 (26.7%) of them. Mean hospital stay was 4.1 (2-8) days, and all the patients were seen routinely on postoperative follow-up at 1st, 6th, and 18th months. Quality of life questionnaires revealed satisfaction. CONCLUSIONS: Cross bar technique yields satisfactory results for these new subtypes and can be performed safely with good results in these selected group of patients.

Musical Mistuning Perception and Appraisal in Cochlear Implant Recipients.

OBJECTIVE: Music is a very crucial art form that can evoke emotions, and the harmonious presence of the human voice in music is an impactful part of this process. As a result, vocals have had some significant effects on contemporary music. The mechanism behind the cochlear implant (CI) recipients perceiving different aspects of music is clear; however, how well they perceive vocal tuning within music it is not well known. Hence, this study evaluated the mistuning perception of CI recipients and compared their performance with normal-hearing (NH) listeners. STUDY DESIGN, SETTING, AND PATIENTS: A total of 16 CI users (7 cisgender men, 9 cisgender women) and 16 sex-matched NH controls with an average age of 30.2 (±10.9; range, 19-53) years and 23.5 (±6.1; range, 20-37) years, respectively, were enrolled in this study. We evaluated the mistuning ability using the mistuning perception test (MPT) and assessed self-perceived music perception and engagement using the music-related quality-of-life questionnaire. Test performance was measured and reported on the item-response theory metric with a z score ranging from -4 to +4. RESULTS: A significant difference in the MPT scores was found between NH and CI recipients, whereas a significant correlation was noted between the music-related quality-of-life questionnaire-frequency subscale and MPT scores. No significant correlations were found between age, CI age, and CI usage duration and MPT performance. CONCLUSIONS: This study revealed that musical mistuning perception is a limitation for CI recipients, similar to previously evaluated aspects of music perception. Hence, it is important to consider this aspect in the assessment of music perception, enjoyment, and music-based auditory interventions in CI recipients, as vocals are paramount in music perception and recreation. The MPT is a convenient and accessible tool for mistuning assessment in CI and hearing-aid users.

Assessment of the Effectiveness, Socio-Economic Impact and Implementation of a Digital Solution for Patients with Advanced Chronic Diseases: The ADLIFE Study Protocol.

Due to population ageing and medical advances, people with advanced chronic diseases (ACD) live longer. Such patients are even more likely to face either temporary or permanent reduced functional reserve, which typically further increases their healthcare resource use and the burden of care on their caregiver(s). Accordingly, these patients and their caregiver(s) may benefit from integrated supportive care provided via digitally supported interventions. This approach may either maintain or improve their quality of life, increase their independence, and optimize the healthcare resource use from early stages. ADLIFE is an EU-funded project, aiming to improve the quality of life of older people with ACD by providing integrated personalized care via a digitally enabled toolbox. Indeed, the ADLIFE toolbox is a digital solution which provides patients, caregivers, and health professionals with digitally enabled, integrated, and personalized care, supporting clinical decisions, and encouraging independence and self-management. Here we present the protocol of the ADLIFE study, which is designed to provide robust scientific evidence on the assessment of the effectiveness, socio-economic, implementation, and technology acceptance aspects of the ADLIFE intervention compared to the current standard of care (SoC) when applied in real-life settings of seven different pilot sites across six countries. A quasi-experimental trial following a multicenter, non-randomized, non-concurrent, unblinded, and controlled design will be implemented. Patients in the intervention group will receive the ADLIFE intervention, while patients in the control group will receive SoC. The assessment of the ADLIFE intervention will be conducted using a mixed-methods approach.

A precise and rapid early pregnancy test: Development of a novel and fully automated electrochemical point-of-care biosensor for human urine samples.

Human chorionic gonadotropin (hCG), a glycoprotein hormone secreted from the placenta, is an important biomarker for pregnancy. In this study, we designed a precise, rapid and fully automatic device with an electrochemical point-of-care biosensor capable of quantitative hCG detection from human urine samples for early pregnancy detection. Gold and Ag/AgCl electrodes, whose structure with optimum isopotential region and current density, were simulated using COMSOL Multiphysics® software and custom-made from Flex Medical. The sensing surface was fabricated with DSP self-assembled monolayers (SAMs) and covalently immobilized anti-hCG-beta antibody. The detection method involved a sandwich assay using anti-hCG alpha-HRP. Based on an automated agitation design implemented in our device, the surface reaction rate is significantly improved comparing to routinely performed sandwich assays, and therefore a rapid detection of very low concentration can be achieved. Electrochemical impedance spectroscopy (EIS) and chronoamperometry (CA) measurements were used to characterize the immobilization of the antibodies and to determine the sensor activities respectively. The sensors displayed a limit of detection (LOD) of 2.17 mIU/ml within established clinical hCG levels for early detection of pregnancy. They responded very well to hCG, but not to luteinizing hormone (LH), which has a high degree of cross-reactivity with hCG. The results showed that the immunosensor has high specificity, good reproducibility, and long-term stability for the detection of hCG in urine samples.

Psychometric properties of the Turkish version of the Pectus Carinatum Evaluation Questionnaire used in patients with pectus carinatum treated with compression orthosis.

BACKGROUND: The Pectus Carinatum Evaluation Questionnaire (PCEQ) was developed for use in patients with pectus carinatum (PC) treated with compression orthosis. The questionnaire can be used to develop a strict program in the early follow-up period or to improve patients' compliance with the treatment after treatment initiation and to improve the quality of life. OBJECTIVE: This study aimed to evaluate the psychometric properties of the Turkish version of the PCEQ in patients with PC treated with compression orthosis. STUDY DESIGN: Validity and reliability study. METHODS: This study included 52 volunteer patients with PC, aged 10-18 years. The Cronbach α coefficient, a measure of internal consistency, was used to check questionnaire reliability, and test-retest reliability (intraclass correlation coefficient) was used to check consistency over time. Construct validity was analyzed (correlation analysis) with the days/hours of orthosis use. RESULTS: The reliability of the Turkish version of the PCEQ was found to have acceptable-to-sufficient-to-excellent internal consistency (Cronbach α coefficient = 0.701-915). Test-retest reliability calculated for investigating the reliability of the questionnaire over time was found to be excellent (intraclass correlation coefficient = 0.880-0.941). Furthermore, treatment compliance hours (r = 0.280, P = 0.044) and days (r = 0.299, P = 0.032) were found to be associated with parents' influence at a low level and with time to compliance at a moderate level (r = -0.449-457, P = 0.001). CONCLUSION: The Turkish version of the PCEQ used in patients with PC treated with compression orthosis was found to have sufficient-to-excellent validity and reliability and could be used to develop a strict program for patients with PC using the orthosis or to improve patients' treatment compliance after treatment initiation. Using this questionnaire may be important to assist the team members in the clinical decision-making process.

Pushing the boundaries of minimally invasive repair of pectus excavatum: first experience with a 4-bar technique.

Several modifications to minimally invasive repair of pectus excavatum have been reported to date. Of these, the use of multiple bars was a major development. At present, there are 2 established techniques: cross-bar and parallel bar placement. We used a combination of both parallel and cross-bar techniques in a 25-year-old male patient with deep, Grand-Canyon type pectus excavatum, placing a total of 4 bars and 4 stabilizers. The patient had no complications during the 7 months of postoperative follow-up. We share this case report as the first experience using this modified technique in the literature.

Listening Effort in Prelingual Cochlear Implant Recipients: Effects of Spectral and Temporal Auditory Processing and Contralateral Acoustic Hearing.

OBJECTIVE: Considering the impact of listening effort (LE) on auditory perception, attention, and memory, it is a significant aspect in the daily hearing experiences of cochlear implant (CI) recipients. Reduced spectral and temporal information on an acoustic signal can make listening more difficult; as a result, it is important to understand the relationship between LE and spectral and temporal auditory processing capacities in CI receivers. STUDY DESIGN, SETTING, AND PATIENTS: This study used spectral ripple discrimination and temporal modulation transfer function to evaluate 20 prelingually deafened and early implanted CI recipients. The speech perception in noise test (primary) and the digit recall task (DRT-secondary) were used to assess LE using the dual-task paradigm. To assess the effects of acoustic hearing, contralateral acoustic hearing thresholds between 125 Hz and 8 kHz with a hearing aid were also acquired. To examine the relationship between the research variables, correlation coefficients were generated. Furthermore, the Mann-Whitney U test was used to compare unilateral and bimodal users. RESULTS: There was a statistically significant correlation between LE and spectral ripple discrimination (r = 0.56; p = 0.011), 125 Hz (r = 0.51; p = 0.020), 250 Hz (r = 0.48; p = 0.030), 500 Hz (r = 0.45; p = 0.045), 1,000 Hz (r = 0.51; p = 0.023), 2000 Hz (r = 0.48; p = 0.031), and 4,000 Hz (r = 0.48; p = 0.031), whereas no statistically significant correlations were observed between temporal modulation transfer function in four frequencies and LE. There was no statistically significant difference between unilateral and bimodal CI recipients ( p > 0.05). CONCLUSION: As a result of the improved signal-to-noise ratio in the auditory environment, CI users with better spectral resolutions and acoustic hearing have a reduced LE. On the other hand, temporal auditory processing, as measured by temporal modulation detection, does not contribute to the LE.

Structural and Semantic Mapping of Application Programming Interfaces.

Modern healthcare providers rely upon Electronic Healthcare Records (EHR) systems to record patient data inside their own organization. Some healthcare providers share this data to facilitate patient care with other providers. Medical devices and healthcare providers can use differing standards of recording healthcare information. The Structural and Semantic Mapper Proxy API solution offers a practical way to tackles the issues of Structural and Semantic mapping of Application Programing Interfaces (API) in a healthcare context to enable connection of all existing systems to a healthcare providers EHR creating a single source of truth regarding the treatment of patients and enabling healthcare providers to bridge the gap between external EHR systems.

CAREPATH: Developing Digital Integrated Care Solutions for Multimorbid Patients with Dementia.

CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients' independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented.

An Integrated Care Platform System (C3-Cloud) for Care Planning, Decision Support, and Empowerment of Patients With Multimorbidity: Protocol for a Technology Trial.

BACKGROUND: There is an increasing need to organize the care around the patient and not the disease, while considering the complex realities of multiple physical and psychosocial conditions, and polypharmacy. Integrated patient-centered care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced information and communication technology solutions for semiautomated clinical decision support. OBJECTIVE: The Collaborative Care and Cure Cloud project (C3-Cloud) has developed 2 collaborative computer platforms for patients and members of the multidisciplinary team (MDT) and deployed these in 3 different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients with 2 or more chronic conditions (diabetes mellitus type 2, heart failure, kidney failure, depression), their informal caregivers, health care professionals, and, to some extent, health care systems. METHODS: This paper describes the protocol for conducting an evaluation of user experience, acceptability, and usefulness of the platforms. For this, 2 "testing and evaluation" phases have been defined, involving multiple qualitative methods (focus groups and surveys) and advanced impact modeling (predictive modeling and cost-benefit analysis). Patients and health care professionals were identified and recruited from 3 partnering regions in Spain, Sweden, and the United Kingdom via electronic health record screening. RESULTS: The technology trial in this 4-year funded project (2016-2020) concluded in April 2020. The pilot technology trial for evaluation phases 3 and 4 was launched in November 2019 and carried out until April 2020. Data collection for these phases is completed with promising results on platform acceptance and socioeconomic impact. We believe that the phased, iterative approach taken is useful as it involves relevant stakeholders at crucial stages in the platform development and allows for a sound user acceptance assessment of the final product. CONCLUSIONS: Patients with multiple chronic conditions often experience shortcomings in the care they receive. It is hoped that personalized care plan platforms for patients and collaboration platforms for members of MDTs can help tackle the specific challenges of clinical guideline reconciliation for patients with multimorbidity and improve the management of polypharmacy. The initial evaluative phases have indicated promising results of platform usability. Results of phases 3 and 4 were methodologically useful, yet limited due to the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT03834207; https://clinicaltrials.gov/ct2/show/NCT03834207. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/21994.

The psychometric properties of the Turkish version of the pectus carinatum body image quality of life questionnaire.

PURPOSE: The present study aimed to evaluate the psychometric properties of the Turkish version of the Pectus Carinatum Body Image Quality of Life Questionnaire (PeCBI-QOL), which was originally created in American English in patients with pectus carinatum (PC). METHODS: The study included 52 volunteer patients with PC, aged 10-18 years. Cronbach α was used to assess internal consistency. Intraclass correlation coefficient (ICC) was used to estimate the test-retest reliability. Construct validity was analyzed with the Pectus Excavatum Evaluation Questionnaire (PEEQ). RESULTS: The reliability of the Turkish version of the PeCBI-QOL was found to have acceptable to excellent internal consistency (Cronbach's α coefficient = 0.701-950). Test-retest reliability calculated for investigating the reliability of the questionnaire over time was found to be excellent (ICC = 0.817-0.983). Construct validity of the PeCBI-QOL (child and parent form) was found to be correlated with all subscales in the PEEQ questionnaire (r = - 0.425 to 897, p < 0.001) except the treatment motivation subscale (r = 0.033-0.111, p = 0.439-0.816). CONCLUSION: We determined that the Turkish version of the PeCBI-QOL questionnaire was valid and reliable for the assessment of body image and quality of life in Turkish patients with PC. PeCBI-QOL questionnaire, a self-assessment one, will assist Turkish clinicians who wish to assess body image and quality of life of patients with PC.

Reliability and Efficiency of Pitch-Shifting Plug-Ins in Voice and Hearing Research.

PURPOSE: Auditory feedback perturbation with voice pitch manipulation has been widely used in previous studies. There are several hardware and software tools for such manipulations, but audio plug-ins developed for music, movies, and radio applications that operate in digital audio workstations may be extremely beneficial and are easy to use, accessible, and cost effective. However, it is unknown whether these plug-ins can perform similarly to tools that have been described in previous literature. Hence, this study aimed to evaluate the reliability and efficiency of these plug-ins. METHOD: Six different plug-ins were used at +1 and -1 st pitch shifting with formant correction on and off to pitch shift the sustained /ɑ/ voice recording sample of 12 healthy participants (six cisgender males and six cisgender females). Pitch-shifting accuracy, formant shifting amount, intensity changes, and total latency values were reported. RESULTS: Some variability was observed between different plug-ins and pitch shift settings. One plug-in managed to perform similarly in all four measured aspects with well-known hardware and software units with 1-cent pitch-shifting accuracy, low latency values, negligible intensity difference, and preserved formants. Other plug-ins performed similarly in some respects. CONCLUSIONS: Audio plug-ins may be used effectively in pitch-shifting applications. Researchers and clinicians can access these plug-ins easily and test whether the features also fit their aims.

Evaluation of the Effect of Musical Perception Activities on Speech Perception in Adult Cochlear Implant Users.

Objective: This study aimed to evaluate clinical musical perception, analyze the relationship between speech recognition and music perception, and investigate the effects of a three-month musical perception activities on these parameters in adult cochlear implant (CI) users with post-lingual hearing loss. Methods: Free-field hearing and speech tests in a quiet environment, the Turkish matrix test, and the Turkish version of the clinical assessment of musical perception test were performed on 18 adult unilateral CI users before and after the three-month music training. Results were compared with those of 18 healthy controls. Results: Prior to the musical perception activities, word recognition scores, Turkish matrix test results, and 500, 1000, and 6000 Hz free-field hearing thresholds were significantly correlated with the clinical assessment of musical perception test scores in the CI group (p<0.047). Timbre recognition scores (p=0.019) had improved significantly in the CI group after the three-month musical perception activities. On the other hand, timbre recognition scores had significantly affected the Turkish matrix test results (R2adjusted=0.56). Conclusion: Our study showed that speech perception in noise and clinical musical perception measurements affected each other in CI users. The inclusion of musical perception activities to support an auditory rehabilitation program may contribute to increased speech recognition skills in noise.

Pectus cross bars increase hospital readmission rates due to serous pleural effusion.

OBJECTIVE: Pectus Excavatum's (PE) surgical treatment should be patient specific. In this article, we aimed to compare parallel and cross bar variations of the Nuss method and analyze if there is any difference in results. METHODS: In this study, a total of 891 patients treated with the Nuss method between August 2005 and February 2018 were considered. These were retrieved from a prospectively recorded PE database. Of these, 276 double-bar patients were included in the study. Patients with parallel bars (225 cases) and patients with crossed bars (51 cases) were compared in terms of age, gender, symmetry, family history, additional anomalies, mean operation time, postoperative hospital stay (days) and hospital readmission rate. RESULTS: The mean age was measured at 20.7 for parallel bar patients and 20.1 for crossed bars patients. There was no statistically significant difference in terms of age, gender, and mean operation time between two groups. On the other hand, statistical significance was found between two groups when analyzing the deformities' symmetry, patients' family history and additional anomalies. The statistically significant difference of postoperative hospital stay between two groups is clinically negligible. Postoperative hospital readmission rates due to serous pleural effusion were found to be significantly increased in patients with crossed bars (p < 0.001). CONCLUSION: While pleural effusion requiring readmission was statistically more frequent in cross bars, in centers where thoracentesis can be managed, Nuss method can still be applied safely, even in cases with difficult, complex deformities. LEVEL OF EVIDENCE: III. Treatment study.