Why Do Cochlear Implant Candidates Defer Surgery? A Retrospective Case-Control Study.

OBJECTIVE(S): Despite undergoing thorough cochlear implant (CI) candidacy evaluation and counseling, some patients ultimately elect against implantation. This study sought to identify patient-related and socioeconomic factors predicting CI deferral. METHODS: A retrospective study of adult (≥18 years old) CI candidates presenting between 2007 and 2021 at a tertiary academic CI center was performed. The primary outcome was device implantation. Data collected included age, gender, hearing status, race, zip code of residence, median family income (MFI), distance traveled from the CI center, marital status, employment status, and insurance status. Multivariable binary logistic regression was performed to identify predictors of implantation. RESULTS: A total of 200 patients qualifying for CI were included, encompassing 77 adults deferring surgery (CI-deferred) and 123 consecutive adults electing for surgery (CI-pursued). Age, gender, hearing status, insurance type, employment status, distance from the implant center, and MFI were comparable between the groups (p > 0.05). Compared to CI-pursued patients, CI-deferred patients were more likely to be non-Caucasian (24.7% vs. 9.8%, p = 0.015) and unmarried (55.8% vs. 38.2%, p = 0.015). On multivariable logistic regression, older age (OR 0.981, 0.964-0.998, p = 0.027), African American race (OR 0.227, 0.071-0.726, p = 0.012), and unmarried status (OR 0.505, 0.273-0.935, p = 0.030) were independent predictors of implant deferral. CONCLUSION: This study demonstrates that increasing age at evaluation, African American race, and unmarried status are predictors for deferring CI surgery despite being implant candidates. These patients may benefit from increased outreach in the form of counseling, education, and social support prior to undergoing CI surgery. LEVEL OF EVIDENCE: 3 - retrospective study with internal control group Laryngoscope, 134:2857-2863, 2024.

Investigating Deferral Rates in Cochlear Implantation: How Often Do Candidates Defer and Why?

OBJECTIVE: Evaluate the rate at which cochlear implant (CI) candidates decline surgery and identify associated factors. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: Four hundred ninety-three CI candidates from July 1989 to December 2020 with complete demographic and socioeconomic data. INTERVENTIONS: Diagnostic. MAIN OUTCOME MEASURES: Age, sex, race, marital and employment status, median household income percentile, distance-to-CI-center, and residence in a medically underserved county. RESULTS: Of the 493 CI candidates included, 80 patients (16.2%) declined surgery. Based on chart checking, the most common reason patients did not receive the implant was due to loss of follow-up (38%). African American patients were 73% less likely to undergo implantation compared with White patients (odds ratio [OR], 0.27 [0.11-0.68]; p = 0.005). Asian patients were 95% less likely to undergo implantation (OR, 0.05 [0.009-0.25]; p = 0.0003) compared with White patients. For every 1-year age increase, patients were 4% less likely to undergo implantation (OR, 0.96 [0.94-0.98]; p < 0.0001) and for every 10-year age increase, the patients were 33% less likely. Compared with their single counterparts, married patients were more likely to undergo implantation (OR, 1.87 [1.12-3.15]; p = 0.02). No differences were observed when comparing implanted and nonimplanted CI candidates in sex, employment status, distance-to-CI-center, or median family income percentile. A χ2 test of independence showed no association between receiving CIs and living in medically underserved counties ( χ2 = 2; N = 493; 0.3891; p = 0.53). CONCLUSIONS: Not infrequently, CI candidates decline surgery. Although demographic factors (race, age, and marital status) were associated with the cochlear implantation decision, socioeconomic factors (median family income and residence in a medically underserved community) were not. Perhaps cultural components of a patient's race have a larger impact on whether or not the patients get implanted.

Refined water security assessment for sustainable water management: A case study of 15 key cities in the Yangtze River Delta, China.

Water security represents ecological security and a policy priority for sustainable development; however, un-gridded assessment results cannot be used to support urban environmental management decisions. This study proposes a systematic framework to obtain a gridded regional water security assessment, which reflects the regional natural resource, based on the index system derived from the Pressure-State-Response (PSR) model and the Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) model. The results were applied to sustainable water management. Using 15 key cities in the Yangtze River Delta (YRD) region as a case study to apply the methodology, we found that the comprehensive water security was relatively high and high-value areas were widely distributed, accounting for about two-thirds of the study area. Low-value areas were mainly distributed in central and eastern regions, such as Shanghai, Suzhou, and Nanjing. There was evidence of a water resource shortage during the twelve-month period studied, particularly in August. The proportions of comprehensive water security in each administrative unit and the differences between simulated and target water quality could be used in the spatial planning and the exploration of payments for ecosystem services (PES) mechanism in county-level or smaller administrative units. Despite the premise requirement and the grid resolution problems of the InVEST model, it can be concluded that our assessment method proves capable of matching spatial and temporal differences in water supply and demand at a fine scale, and results can be used to supply useful information for urban management decision making.

Fluoride absorption, transportation and tolerance mechanism in Camellia sinensis, and its bioavailability and health risk assessment: a systematic review.

Tea is the one of the most popular non-alcoholic caffeinated beverages in the world. Tea is produced from the tea plant (Camellia sinensis (L.) O. Kuntze), which is known to accumulate fluoride. This article systematically analyzes the literature concerning fluoride absorption, transportation and fluoride tolerance mechanisms in tea plants. Fluoride bioavailability and exposure levels in tea infusions are also reviewed. The circulation of fluoride within the tea plantation ecosystems is in a positive equilibrium, with greater amounts of fluoride introduced to tea orchards than removed. Water extractable fluoride and magnesium chloride (MgCl2 ) extractable fluoride in plantation soil are the main sources of absorption by tea plant root via active trans-membrane transport and anion channels. Most fluoride is readily transported through the xylem as F- /F-Al complexes to leaf cell walls and vacuole. The findings indicate that tea plants employ cell wall accumulation, vacuole compartmentalization, and F-Al complexes to co-detoxify fluoride and aluminum, a possible tolerance mechanism through which tea tolerates higher levels of fluoride than most plants. Furthermore, dietary and endogenous factors influence fluoride bioavailability and should be considered when exposure levels of fluoride in commercially available dried tea leaves are interpreted. The relevant current challenges and future perspectives are also discussed. © 2020 Society of Chemical Industry.

National Trends in Surgical Resection of Vestibular Schwannomas.

OBJECTIVE: To characterize the national trend for surgical resection of vestibular schwannoma (VS) and to assess changes in demographics, length of stay (LOS), discharge patterns, and hospital charges. STUDY DESIGN: Population-based inpatient registry analysis. SETTING: National Inpatient Sample and SEER database (Surveillance, Epidemiology, and End Results). PATIENTS AND METHODS: Retrospective review of the US National Inpatient Sample and the SEER database from 2001 to 2014 of all patients who underwent resection of VS. RESULTS: A total of 24,380 VS resections were performed. While the annual incidence of VS remained stable at 1.38 per 100,000, surgical volume declined by 36.1%, from 2807 in 2001 to 1795 in 2014 (R2 = 0.58). Total hospital charges more than doubled, from $52,475 in 2001 to $115,164 in 2014 ($4478 per year, R2 = 0.96). While most procedures were performed at large-sized hospitals, this decreased from 89% in 2002 to 75.8% in 2014. Average LOS remained stable at 5.2 days during the study period. The number of discharges to a nursing facility increased from 113 (5.5%) in 2002 to 245 (13.6%) in 2014 (P = .0002). CONCLUSION: VS resection has evolved in the United States. While the incidence remained stable, surgical volume decreased by 36%, and hospital charges more than doubled. More cases are being performed at smaller hospitals. Although LOS did not vary significantly, there is an increase in nonroutine discharges. These data may guide future research in resource utilization in neurotology.

Acute Otitis Media and Associated Complications in United States Emergency Departments.

OBJECTIVE: Complications due to acute otitis media (AOM), while rare, are associated with significant morbidity and are not well characterized from an epidemiological perspective. We analyze the pattern of presentation and emergency department (ED) utilization in patients with AOM and associated complications. STUDY DESIGN: Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011. SETTING: Emergency Department. PATIENTS: Patients who presented with a primary diagnosis of AOM or acute mastoiditis. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: NEDS was queried for patient encounters with a diagnosis of AOM or acute mastoiditis based on ICD-9 codes. Complications of severe infection, including petrositis, Gradenigo's syndrome, facial paresis, labyrinthitis, meningitis, intracranial abscess, venous sinus thrombosis, and cerebrospinal fluid leak, were assessed. Weighted estimates for demographics, types of complications, socioeconomic status, and trends over time were extracted. RESULTS: A weighted total of 5,811,127 ED visits were identified. The majority of patients were less than 18 years old (79.9%) with an average age of 10.1 years. Most were discharged (99.4%). There were 15,243 (0.26%) patients who presented with a complication. The most common complications were acute mastoiditis (0.16%), labyrinthitis (0.06%), and facial paresis (0.03%). Compared with patients with uncomplicated AOM, patients with complicated AOM were older (37 vs. 10-yr old), insured by Medicare (18% vs. 2.1%), and more likely to be admitted (43.6% vs. 0.4%) (p < 0.0001, for all comparisons). CONCLUSIONS: ED visits related to AOM or mastoiditis are common and complications are rare. An in-depth analysis on a national level is useful for assessing healthcare utilization trends.

Temporal trend of green space coverage in China and its relationship with urbanization over the last two decades.

Irrespective of which side is taken in the densification-sprawl debate, insights into the relationship between urban green space coverage and urbanization have been recognized as essential for guiding sustainable urban development. However, knowledge of the relationships between socio-economic variables of urbanization and long-term green space change is still limited. In this paper, using simple regression, hierarchical partitioning and multi-regression, the temporal trend in green space coverage and its relationship with urbanization were investigated using data from 286 cities between 1989 and 2009, covering all provinces in mainland China with the exception of Tibet. We found that: [1] average green space coverage of cities investigated increased steadily from 17.0% in 1989 to 37.3% in 2009; [2] cities with higher recent green space coverage also had relatively higher green space coverage historically; [3] cities in the same region exhibited similar long-term trends in green space coverage; [4] eight of the nine variables characterizing urbanization showed a significant positive linear relationship with green space coverage, with 'per capita GDP' having the highest independent contribution (24.2%); [5] among the climatic and geographic factors investigated, only mean elevation showed a significant effect; and [6] using the seven largest contributing individual factors, a linear model to predict variance in green space coverage was constructed. Here, we demonstrated that green space coverage in built-up areas tended to reflect the effects of urbanization rather than those of climatic or geographic factors. Quantification of the urbanization effects and the characteristics of green space development in China may provide a valuable reference for research into the processes of urban sprawl and its relationship with green space change.

Quantifying the impacts of socio-economic factors on air quality in Chinese cities from 2000 to 2009.

Socio-economic factors have significant influences on air quality and are commonly used to guide environmental planning and management. Based on data from 85 long-term daily monitoring cities in China, air quality as evaluated by AOFDAQ-A (Annual Occurrence Frequency of Daily Air Quality above Level III), was correlated to socio-economic variable groups of urbanization, pollution and environmental treatment by variation partitioning and hierarchical partitioning methods. We found: (1) the three groups explained 43.5% of the variance in AOFDAQ-A; (2) the contribution of "environmental investment" to AOFDAQ-A shown a time lag effect; (3) "population in mining sector" and "coverage of green space in built-up area" were respectively the most significant negative and positive explanatory socio-economic variables; (4) using eight largest contributing individual factors, a linear model to predict variance in AOFDAQ-A was constructed. Results from our study provide a valuable reference for the management and control of air quality in Chinese cities.