Likert scale vs visual analog scale for assessing facial pleasantness

Aesthetic assessment of maxillary lateral and canine implant-supported crowns by laypersons and orthodontists

INTRODUCTION

The objectives of this study were to evaluate how laypersons and orthodontists evaluate and rank aesthetic parameters of an implant-supported crown (ISC) on the canine position (ISC-C) and lateral position (ISC-L).

METHODS

A digital survey of 11 cases, 5 ISC-C, 5 ISC-L and 1 control case without ISC, was distributed to 207 laypersons and 296 orthodontists. All cases included one extraoral photograph and three intraoral photographs. The respondents were asked to identify the ISC and to evaluate the aesthetic parameters regarding colour of the implant (CI), shape of the implant (SI) and gingival colour around ISC (GCI). Differences within and between the groups were tested using Chi-2-test and Independent-Samples t-test.

RESULTS

All invited laypersons and 184 orthodontists (62% response rate) answered the survey. Orthodontists (89%) more correctly identified the ISC, regardless of its position, than laypersons (50%) (p < 0.001). Both laypersons (54%) and orthodontists (23%) rated higher proportions of acceptance of CI, SI and GCI in favour for the ISC-L than ISC-C (laypersons: 40%, orthodontists: 10%) (p < 0.001). Assessing each parameter separately, orthodontists rated higher for ISC-L, compared to the ISC-C (p < 0.001). In general, laypersons and orthodontist ranked tooth colour (mean, standard deviation [SD]:8.0,1.5 and 9.0, 1.0) and tooth shape (mean, SD: 8.0, 1.7 and 8.8, 1.2) as aesthetically higher than the gingival colour (mean, SD: 7.2, 2.2 and 8.0, 1.7) (p > 0.001).  Conclusion: Laypersons and orthodontists consider the ISC-L as aesthetically more preferable, compared to the ISC-C.

The performance of artificial intelligence models in generating responses to general orthodontic questions: ChatGPT vs Google Bard

INTRODUCTION

This study aimed to evaluate and compare the performance of 2 artificial intelligence (AI) models, Chat Generative Pretrained Transformer-3.5 (ChatGPT-3.5; OpenAI, San Francisco, Calif) and Google Bidirectional Encoder Representations from Transformers (Google Bard; Bard Experiment, Google, Mountain View, Calif), in terms of response accuracy, completeness, generation time, and response length when answering general orthodontic questions.

METHODS

A team of orthodontic specialists developed a set of 100 questions in 10 orthodontic domains. One author submitted the questions to both ChatGPT and Google Bard. The AI-generated responses from both models were randomly assigned into 2 forms and sent to 5 blinded and independent assessors. The quality of AI-generated responses was evaluated using a newly developed tool for accuracy of information and completeness. In addition, response generation time and length were recorded.

RESULTS

The accuracy and completeness of responses were high in both AI models. The median accuracy score was 9 (interquartile range [IQR]: 8-9) for ChatGPT and 8 (IQR: 8-9) for Google Bard (Median difference: 1; P <0.001). The median completeness score was similar in both models, with 8 (IQR: 8-9) for ChatGPT and 8 (IQR: 7-9) for Google Bard. The odds of accuracy and completeness were higher by 31% and 23% in ChatGPT than in Google Bard. Google Bard's response generation time was significantly shorter than that of ChatGPT by 10.4 second/question. However, both models were similar in terms of response length generation.

CONCLUSIONS

Both ChatGPT and Google Bard generated responses were rated with a high level of accuracy and completeness to the posed general orthodontic questions. However, acquiring answers was generally faster using the Google Bard model.

The non-operative correction of ear anomalies in infants using the EarWell infant corrective system in the Netherlands

BACKGROUND

Congenital ear anomalies are regular but often overlooked occurrences. The golden standard of treatment has been to surgically correct these anomalies at a minimum age of 5 to 7 years. As of the last century, ear molding has developed to be a safe, reliable, and effective treatment method. Different treatment methods are still under investigation. This study aims to investigate the use of the EarWell Infant Corrective System in the Dutch population.

METHODS

Children aged 0-12 weeks were included in the Zuyderland Medical Center to be treated with the EarWell Infant Corrective System in case of ear deformations. Every 2 weeks, the system was replaced and correction was evaluated by both physician and parents.

RESULTS

Seventy-three participants were included, of whom 123 ears in total were treated. Age at initiation was 35.5 days on average; treatment lasted an average of 59 days. Parents and physicians both reported an amelioration of all ear anomalies after treatment, scoring the correction grade an 8.8. Overall satisfaction with the treatment method was 9 or higher for both groups.

CONCLUSIONS

The EarWell Infant Corrective System is a safe, reliable, and effective treatment method for the correction of ear anomalies in infants.

The psychometrics of rating facial attractiveness using different response scales

Perceiving facial attractiveness is an important behaviour across psychological science due to these judgments having real-world consequences. However, there is little consensus on the measurement of this behaviour, and practices differ widely. Research typically asks participants to provide ratings of attractiveness across a multitude of different response scales, with little consideration of the psychometric properties of these scales. Here, we make psychometric comparisons across nine different response scales. Specifically, we analysed the psychometric properties of a binary response, a 0-100 scale, a visual analogue scale, and a set of Likert scales (1-3, 1-5, 1-7, 1-8, 1-9, 1-10) as tools to measure attractiveness, calculating a range of commonly used statistics for each. While certain properties suggested researchers might choose to favour the 1-5, 1-7 and 1-8 scales, we generally found little evidence of an advantage for one scale over any other. Taken together, our investigation provides consideration of currently used techniques for measuring facial attractiveness and makes recommendations for researchers in this field.

What is the applicability of tubal ligation with the vaginal natural orifice transluminal endoscopic surgery technique and its value in patient comfort?

OBJECTIVE

The aim of this study was to observe the feasibility of the tubal/adnexal approach using vaginal natural orifice transluminal endoscopic surgery and compare its contribution with surgeon ergonomics and postoperative patient comfort with that of conventional laparoscopy.

METHODS

We completed this study retrospectively with 47 patients. Patients were followed at their postoperative first month. We analyzed the usability of the vaginal natural orifice transluminal endoscopic surgery method over conventional laparoscopy by comparing the demographics, surgical data, and postoperative findings collected between the two groups.

RESULTS

Patients in the conventional laparoscopy group were older (39.1±3.3 years) than those in the vaginal natural orifice transluminal endoscopic surgery patient group (p=0.005). Pain intensity 24 h after surgery was lower in the vaginal natural orifice transluminal endoscopic surgery group (p=0.003), while sexual function and dyspareunia did not differ between the two groups in the first month. Patients in the vaginal natural orifice transluminal endoscopic surgery group were more relieved about painlessness and the comfort it brought than the conventional laparoscopy group (p=0.027, χ2=12.56).

CONCLUSION

Patients subjected to the vaginal natural orifice transluminal endoscopic surgery procedure showed higher levels of satisfaction, less postoperative pain, and greater comfort than those subjected to conventional laparoscopy.

Evaluation of facial pleasantness in patients with complete and unilateral cleft lip and palate rehabilitated and submitted to orofacial harmonization

OBJECTIVE

The objective of the present prospective case control study was to evaluate the facial pleasantness of patients with complete and unilateral cleft lip and palate at the end of interdisciplinary rehabilitation, submitted to facial fillers based on hyaluronic acid.

METHODS

The study group consisted of 18 individuals with complete unilateral cleft lip and palate, aged between 18 and 40 years (mean age 29 years) of both sexes. The patients presented a concave profile with mild to moderate maxillary deficiency, with completed orthodontic treatment and conducted by means of dentoalveolar compensations without orthognathic surgery. Participants underwent facial filling procedures with hyaluronic acid (HA) in the midface, inserted by a single operator. Standard photographs in frontal norm at rest, right profile at rest, and left profile at rest were obtained from each patient at the following operative times: (T1) pre-filler and (T2) and one-month post-filler. The photographs in T1 and T2 were randomly placed on a page of a virtual album. A 5-point Likert scale was used to assess facial pleasantness. The photographs were evaluated by two groups of evaluators consisting of 18 individuals with cleft lip and palate (CLPG=18) and 18 orthodontists with experience in the treatment of clefts (OG=18). For comparison between phases T1 and T2, and between evaluators with orofacial clefts and orthodontists, the Wilcoxon test was used (p<0,05).

RESULTS

People with cleft lip and palate rated their face as more pleasant after the midface filling procedure. In the perception of the orthodontists, on the other hand, the facial pleasantness remained similar after the facial filling procedure.

CONCLUSIONS

The filling of the middle third of the face in patients with cleft lip and palate treated without orthognathic surgery increased the pleasantness of the face in the opinion of laypeople with cleft lip and palate.

The Utah Gender Presentation Scale for Communication: Development and Validation of a Measure of Voice-Related Gender Incongruence

PURPOSE

The aim of the present study was to develop and validate a patient-reported outcome measure for gender incongruence specific to voice and communication parameters, including pitch, intonation, resonance, loudness, speech smoothness, speech clarity, word choice, facial expression, gesture, and posture.

METHOD

The Utah Gender Presentation Scale for Communication (U-GPS) includes 10 items, each on a 10-point scale from masculine to feminine. Items were selected based on literature review and patient focus groups. During test administration, respondents provide their current rating and goal rating for each item. The difference between these scores is used to calculate an overall incongruence score. Prospective data from transgender and gender-diverse (n = 155) and cisgender (n = 69) individuals were then used for a multiparametric psychometric evaluation of the measure.

RESULTS

Findings demonstrate excellent levels of internal consistency (Cronbach's alpha for current scores: α = .943; Cronbach's alpha for goal scores: α = .970), test-retest reliability (intraclass correlation coefficient = .905), longitudinal validity (improvement in therapy for trans women: F = 293.0, p < .001; nonbinary folx: F = 80.9, p < .001), concurrent validity (correlation with the Trans Woman Voice Questionnaire: r = .51, p < .001), and known-group expectations (differences among five gender groups: F = 82.7, p < .001).

CONCLUSION

The U-GPS is a meaningful measure of voice-related gender incongruence, which is clinically relevant for assessing goals in gender-affirming voice and communication therapy for individuals across the gender spectrum.

Are the Steps on Likert Scales Equidistant? Responses on Visual Analog Scales Allow Estimating Their Distances

A recurring question regarding Likert items is whether the discrete steps that this response format allows represent constant increments along the underlying continuum. This question appears unsolvable because Likert responses carry no direct information to this effect. Yet, any item administered in Likert format can identically be administered with a continuous response format such as a visual analog scale (VAS) in which respondents mark a position along a continuous line. Then, the operating characteristics of the item would manifest under both VAS and Likert formats, although perhaps differently as captured by the continuous response model (CRM) and the graded response model (GRM) in item response theory. This article shows that CRM and GRM item parameters hold a formal relation that is mediated by the form in which the continuous dimension is partitioned into intervals to render the discrete Likert responses. Then, CRM and GRM characterizations of the items in a test administered with VAS and Likert formats allow estimating the boundaries of the partition that renders Likert responses for each item and, thus, the distance between consecutive steps. The validity of this approach is first documented via simulation studies. Subsequently, the same approach is used on public data from three personality scales with 12, eight, and six items, respectively. The results indicate the expected correspondence between VAS and Likert responses and reveal unequal distances between successive pairs of Likert steps that also vary greatly across items. Implications for the scoring of Likert items are discussed.

Leveraging Multi-echo EPI to Enhance BOLD Sensitivity in Task-based Olfactory fMRI

Functional magnetic resonance imaging (fMRI) using blood-oxygenation-level-dependent (BOLD) contrast relies on gradient echo echo-planar imaging (GE-EPI) to quantify dynamic susceptibility changes associated with the hemodynamic response to neural activity. However, acquiring BOLD fMRI in human olfactory regions is particularly challenging due to their proximity to the sinuses where large susceptibility gradients induce magnetic field distortions. BOLD fMRI of the human olfactory system is further complicated by respiratory artifacts that are highly correlated with event onsets in olfactory tasks. Multi-Echo EPI (ME-EPI) acquires gradient echo data at multiple echo times (TEs) during a single acquisition and can leverage signal evolution over the multiple echo times to enhance BOLD sensitivity and reduce artifactual signal contributions. In the current study, we developed a ME-EPI acquisition protocol for olfactory task-based fMRI and demonstrated significant improvement in BOLD signal sensitivity over conventional single-echo EPI (1E-EPI). The observed improvement arose from both an increase in BOLD signal changes through a T 2 * -weighted echo combination and a reduction in non-BOLD artifacts through the application of the Multi-Echo Independent Components Analysis (ME-ICA) denoising method. This study represents one of the first direct comparisons between 1E-EPI and ME-EPI in high-susceptibility regions and provides compelling evidence in favor of using ME-EPI for future task-based fMRI studies.

Comparison of preemptive etoricoxib and dexamethasone in third molar surgery - a randomized controlled clinical trial of patient-reported and clinical outcomes

OBJECTIVES

To compare preemptive single-dose etoricoxib and dexamethasone on postoperative patient satisfaction (pPS) and clinical parameters following the impacted mandibular third molar (IMTM) extraction.

MATERIALS AND METHODS

A parallel-group, triple-blinded, controlled clinical study included a total of 90 patients (n = 30), randomized to receive: etoricoxib 90 mg, dexamethasone 4 mg, or no premedication (control group) 1 h before surgery. Paracetamol 500 mg was prescribed as rescue medication (RM). Check-ups were scheduled at 24 h, 48 h, and day 7 post-surgery. At each time point, pPS was assessed using the 5-point Likert scale. RM parameters, swelling, trismus, and the occurrence of adverse events were also recorded, and patients were instructed to rate the perceived pain on Visual Analogue Scale.

RESULTS

In all the follow-up periods, data indicated significantly higher pPS scores in the preemptive medication groups when compared to the control group (p < 0.05). Both regimens delayed the first RM intake when compared to controls. In the etoricoxib group, a significantly lower total RM consumption was observed (p < 0.05). Dexamethasone significantly decreased swelling at each check-up and increased mouth opening at day 7 after the surgery (p < 0.05).

CONCLUSIONS

Preemptive etoricoxib and dexamethasone elevate pPS after IMTM surgery. Etoricoxib improves RM parameters, while dexamethasone ameliorates the patient's postoperative functional ability.

CLINICAL RELEVANCE

Preemptive etoricoxib and dexamethasone use may decrease patients' discomfort following the impacted mandibular third molar extraction.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05791721. Date of Registration: 28/03/2023 (retrospectively registered).

Buccal Fat Pad Transplantation for Correction of Asian Upper Eyelid Depression: A Clinical Study

OBJECTIVES

To investigate the effect of buccal fat pad transplantation in front of the aponeurosis to correct Asian upper eyelid depression.

METHODS

Eighty-five individuals who were treated with buccal fat pad transplantation were recruited for this study. The upper eyelid depression data were collected before and after treatment, and the aesthetic outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS) and the Likert scale.

RESULTS

All patients obtained natural-looking eyelids, and the sunken contour deformity improved. The mean preoperative sunken depth was 6.7±1.0 mm (4-12 mm), and the mean sunken depth at the last follow-up was 4.2±0.9 mm (2-6 mm) (P <0.05). The visual analogue scale score was 2.12±1.75 (1-4) in the immediate postoperative period. The GAIS scores were satisfactory (very much improved, 89.4%; much improved, 7.1%; and improved, 3.5%). According to the Likert scale scores, all patients were satisfied with the clinical outcomes (excellent, 87.1%; very good, 9.4%; and good, 3.5%). A 'fair' or 'poor' result was not reported by any patient.

CONCLUSION

Buccal fat pad transplantation corrects upper eyelid depression in a simple, safe, and effective manner and can efficiently fill the depressed portion and restore a beautiful double eyelid.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Esthetic preferences of orthodontists, dentists, and plastic surgeons for balanced facial profiles

PURPOSE

The aim of this investigation was to determine whether the facial esthetics of subjects rated as "attractive" can be related to specific cephalometric soft tissue parameters.

METHODS

The profile silhouettes of 100 subjects (45 males and 55 females) were rated by 60 esthetics specialists (20 orthodontists, 20 dentists, and 20 plastic surgeons) using a Likert scale, and 30 of the subjects were selected as being "attractive". The cephalometric measurements of the attractive group were then compared with norms for the general Caucasian population.

RESULTS

The effects of specific measured parameters on profile beauty grades were assessed using the median test, and the following variables were found to show significant correlations between the Caucasian norms and the attractive profile group: the ratio of the upper to lower face height (P = 0.011), the ratio of the subnasale - labrale inferius (Sn-Li) and labrale inferius - menton (Li-Me`) lines (P = 0.011), the distance between the chin and the subnasale perpendicular (P = 0.002), upper lip thickness (P = 0.021), soft tissue chin thickness (P = 0.021), vertical height ratio (P = 0.021), and nasolabial angle (P = 0.021).

CONCLUSION

A straight profile with a fuller and more protruded upper lip, a higher nasal tip, and a smaller lower facial third are considered to be the most attractive facial features, and may be useful for improvement of facial esthetics.

Emoji as promising tools for emotional evaluation in orthodontics

Background

Emoji are pictograms frequently used in social networks capable of expressing emotions. These tools can provide insights into people's behavior that could not be obtained with the use of textual communication. Recently, emoji have been introduced to various research fields as successful alternatives to word-based questionnaires for measure emotional responses. The objective of this study was to preliminarily evaluate the discriminating ability and relationship of these tools with different occlusal conditions/malocclusions.

Methods

Online surveys were applied to adult individuals (n = 201; mean age = 27.4 ± 5.7; 37.3% males, 62.7% females). Subjects issued acceptance scores (10-point scale) and expressed their emotional status using a 30-emoji list in relation to nine occlusal conditions: C1–crowding, C2–anterior open bite, C3–interincisal diastema, C4–increased overjet + deep bite (Class II div. 1), C5–anterior crossbite (Class III), C6–ideal occlusion, C7–unilateral posterior crossbite, C8–anterior open bite plus bilateral posterior crossbite plus crowding, and C9–deep bite (Class II div. 2). Cochran's Q and McNemar tests were used to compare the frequencies of choice of emoji between conditions. Correspondence analyses were applied to assess the association between occlusal conditions and emoji. Kendall's correlation coefficient was calculated to evaluate the relationship between mean acceptance scores and frequency counts of each emoji.

Results

The frequency of choice between conditions showed a significant difference for 25 of the 30 emoji (P < 0.05), indicating an adequate discriminating ability of these tools. Emoji were grouped predominantly based on their emotional valence (positive/negative) and arousal/activation (high/low). Positive emoji were associated with the most accepted conditions (i.e., C6, C3), while negative emoji with the most rejected ones (i.e., C8, C1, C2). Although only weak, positive correlations between acceptance and positively valenced emoji, and negative correlations between acceptance and negatively valenced emoji were observed (P < 0.05).

Conclusions

Emoji have an adequate discriminatory ability and would allow determining emotional profiles in the face of different occlusal conditions. Further research is necessary to consolidate the use of these tools in an instrument that allows measuring emotional responses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40510-022-00418-3.

PET imaging to assess fibroblast activation protein inhibitor biodistribution: A training program adapted to pharmacology education

In the process of pharmacology education, practical teaching is an important complement to theoretical teaching. These activities include the use of experimental animals to obtain certain pharmacological parameters or to help students understand certain classical concepts. However, the growing interest in laboratory animal welfare, the rapid development of pharmacology research and the challenges of cultivating innovative pharmacy talent create a need for innovative and flexible in vitro experiments for teaching purposes. Here, we report the application of positron emission tomography (PET) imaging of 18 F-labeled fibroblast activation protein inhibitor (18 F-FAPi) to practical pharmacology teaching, enabling dynamic visualization of the distribution and excretion process of FAPi in mice. Students can quantitatively analyze the distribution of FAPi in various tissues and organs without sacrificing the mice. Furthermore, the newly implemented method resulted in highly reproducible results and was generally appreciated by the students. Additionally, the application of PET imaging in pharmacokinetic teaching can not only greatly reduce the use of experimental animals but also need not sacrificing animals. Of note is that dynamic scanning data from this project can be used for online practical teaching during COVID-19 pandemic.