Differential effects of obesity on perioperative outcomes in renal cell carcinoma patients based on race and ethnicity and neighborhood-level socioeconomic status.

Background: Obesity is a well-established risk factor of renal cell carcinoma (RCC), however the impact of obesity on surgical outcomes for racial and ethnic minority patients with RCC is unclear. This study investigated whether a higher body mass index (BMI) or obesity (BMI ≥30 kg/m2) was associated with worse perioperative outcomes and if there were heterogeneous effects based on race, ethnicity, and neighborhood-level socioeconomic factor. Methods: In this single-center cross-sectional study, medical records of patients who underwent partial or radical nephrectomy between 2010 and 2022 were retrospectively reviewed. Logistic regression analysis was performed to assess associations of BMI and perioperative outcomes [ischemia time, estimated blood loss (EBL), and length of hospital stay]. Results: A total of 432 patients, including 49.8% non-Hispanic White (NHW), 35.0% Hispanic, and 6.9% American Indian (AI) patients, were included. Median [interquartile range (IQR)] BMI was 30.2 (26.3-35.2) kg/m2, and Hispanic (31.5) and AI (32.5) patients had higher median BMI than NHW (29.1) patients (P=0.006). Median ischemia time, EBL, and length of hospital stay were 18.5 (IQR, 15.0-22.4) minutes, 150 (IQR, 75.0-300.0) mL, and 3 (IQR, 2-5) days. BMI ≥35 kg/m2 was associated with a longer ischemia time [>18.5 minutes; odds ratio (OR), 5.17; 95% confidence interval (CI): 1.81-14.76; P=0.002], and the association was stronger in NHW than Hispanic patients (BMI continuous OR, 1.13; 95% CI: 1.04-1.22; P=0.004 in NHW and OR, 1.07; 95% CI: 0.98-1.17; P=0.12 in Hispanics). Class I and II/III obese patients had over two-fold increased odds of a larger EBL (>150 mL) than patients with normal weight (OR, 2.17; 95% CI: 1.03-4.59; P=0.04 for class I and OR, 2.24; 95% CI: 1.04-4.84; P=0.04 for class II/III obese patients). This association was stronger in patients from neighborhoods with high social deprivation index (SDI) and in NHW patients (BMI ≥30 vs. <30 kg/m2, OR, 3.53; 95% CI: 1.57-7.97; P=0.002 in high SDI neighborhoods and OR, 2.38; 95% CI: 1.10-5.14; P=0.03 in NHW). BMI was not associated with a longer hospital stay. Conclusions: In this study, obesity increased likelihood of worse perioperative outcomes, and the associations varied based on race and ethnicity and neighborhood-level socioeconomic factors.

Synchronizing Automatic Gain Control in Bilateral Cochlear Implants Mitigates Dynamic Localization Deficits Introduced by Independent Bilateral Compression.

OBJECTIVES: The independence of left and right automatic gain controls (AGCs) used in cochlear implants can distort interaural level differences and thereby compromise dynamic sound source localization. We assessed the degree to which synchronizing left and right AGCs mitigates those difficulties as indicated by listeners' ability to use the changes in interaural level differences that come with head movements to avoid front-back reversals (FBRs). DESIGN: Broadband noise stimuli were presented from one of six equally spaced loudspeakers surrounding the listener. Sound source identification was tested for stimuli presented at 70 dBA (above AGC threshold) for 10 bilateral cochlear implant patients, under conditions where (1) patients remained stationary and (2) free head movements within ±30° were encouraged. These conditions were repeated for both synchronized and independent AGCs. The same conditions were run at 50 dBA, below the AGC threshold, to assess listeners' baseline performance when AGCs were not engaged. In this way, the expected high variability in listener performance could be separated from effects of independent AGCs to reveal the degree to which synchronizing AGCs could restore localization performance to what it was without AGC compression. RESULTS: The mean rate of FBRs was higher for sound stimuli presented at 70 dBA with independent AGCs, both with and without head movements, than at 50 dBA, suggesting that when AGCs were independently engaged they contributed to poorer front-back localization. When listeners remained stationary, synchronizing AGCs did not significantly reduce the rate of FBRs. When AGCs were independent at 70 dBA, head movements did not have a significant effect on the rate of FBRs. Head movements did have a significant group effect on the rate of FBRs at 50 dBA when AGCs were not engaged and at 70 dBA when AGCs were synchronized. Synchronization of AGCs, together with head movements, reduced the rate of FBRs to approximately what it was in the 50-dBA baseline condition. Synchronizing AGCs also had a significant group effect on listeners' overall percent correct localization. CONCLUSIONS: Synchronizing AGCs allowed for listeners to mitigate front-back confusions introduced by unsynchronized AGCs when head motion was permitted, returning individual listener performance to roughly what it was in the 50-dBA baseline condition when AGCs were not engaged. Synchronization of AGCs did not overcome localization deficiencies which were observed when AGCs were not engaged, and which are therefore unrelated to AGC compression.

Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients.

Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08-1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84-1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities.

Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona.

American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients' demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07-2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08-2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21-2.76 and HR 1.59 95% CI: 1.30-1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality.

The effects of stimulus modality, task complexity, and cuing on working memory and the relationship with speech recognition in older cochlear implant users.

INTRODUCTION: The role of working memory (WM) in speech recognition of older cochlear implant (CI) users remains unclear. This study 1) examined the effects of aging and CI on WM performance across different modalities (auditory vs. visual) and cuing conditions, and 2) assessed how specific WM measures relate to sentence and word recognition in noise. METHOD: Fourteen Older CI users, 12 Older acoustic-hearing (AH) listeners with age-appropriate hearing loss, and 15 Young normal-hearing (NH) listeners were tested. Participants completed two simple span tasks (auditory digit and visual letter span), two complex WM tasks (reading span and cued-modality WM with simultaneously presented auditory digits and visual letters), and two speech recognition tasks (sentence and word recognition in speech-babble noise). RESULTS: The groups showed similar simple span performance, except that Older CI users had lower auditory digit span than Young NH listeners. Both older groups had similar reading span performance, but scored significantly lower than Young NH listeners, indicating age-related declines in attentional and phonological processing. A similar group effect was observed in the cued-modality WM task. All groups showed higher recall for auditory digits than for visual letters and the advantage was most evident without modality cuing. All groups displayed greater cuing benefits for visual recall than for auditory recall, suggesting that participants consistently allocated more attention to auditory stimuli regardless of cuing. For Older CI users, after controlling for the previously reported spectral resolution, auditory-uncued WM performance was significantly correlated with word recognition but not sentence recognition. CONCLUSIONS: Complex WM was significantly affected by aging but not by CI. Neither aging nor CI significantly affected modality cuing benefits in the WM task. For Older CI users, complex auditory WM with attentional control may better reflect the cognitive load of speech recognition in noise than simple span or complex visual WM.

Effects of Bilateral Automatic Gain Control Synchronization in Cochlear Implants With and Without Head Movements: Sound Source Localization in the Frontal Hemifield.

Purpose For bilaterally implanted patients, the automatic gain control (AGC) in both left and right cochlear implant (CI) processors is usually neither linked nor synchronized. At high AGC compression ratios, this lack of coordination between the two processors can distort interaural level differences, the only useful interaural difference cue available to CI patients. This study assessed the improvement, if any, in the utility of interaural level differences for sound source localization in the frontal hemifield when AGCs were synchronized versus independent and when listeners were stationary versus allowed to move their heads. Method Sound source identification of broadband noise stimuli was tested for seven bilateral CI patients using 13 loudspeakers in the frontal hemifield, under conditions where AGCs were linked and unlinked. For half the conditions, patients remained stationary; in the other half, they were encouraged to rotate or reorient their heads within a range of approximately ± 30° during sound presentation. Results In general, those listeners who already localized reasonably well with independent AGCs gained the least from AGC synchronization, perhaps because there was less room for improvement. Those listeners who performed worst with independent AGCs gained the most from synchronization. All listeners performed as well or better with synchronization than without; however, intersubject variability was high. Head movements had little impact on the effectiveness of synchronization of AGCs. Conclusion Synchronization of AGCs offers one promising strategy for improving localization performance in the frontal hemifield for bilaterally implanted CI patients. Supplemental Material https://doi.org/10.23641/asha.14681412.

Psychoacoustic and Demographic Factors for Speech Recognition of Older Adult Cochlear Implant Users.

Purpose This study aimed to evaluate the effects of aging and cochlear implant (CI) on psychoacoustic and speech recognition abilities and to assess the relative contributions of psychoacoustic and demographic factors to speech recognition of older CI (OCI) users. Method Twelve OCI users, 12 older acoustic-hearing (OAH) listeners age-matched to OCI users, and 12 younger normal-hearing (YNH) listeners underwent tests of temporal amplitude modulation detection, temporal gap detection in noise, and spectral-temporal modulated ripple discrimination. Speech reception thresholds were measured for sentence recognition in multitalker, speech-babble noise. Results Statistical analyses showed that, for the small sample of OAH listeners, the degree of hearing loss did not significantly affect any outcome measure. Temporal resolution, spectral resolution, and speech recognition all significantly degraded with both age and the use of a CI (i.e., YNH better than OAH and OAH better than OCI performance). Although both were significantly correlated with OCI users' speech recognition, the duration of CI use no longer had a significant effect on speech recognition once the effect of spectral-temporal ripple discrimination performance was taken into account. For OAH listeners, the only significant predictor of speech recognition was temporal gap detection performance. Conclusion The preliminary results suggest that speech recognition of OCI users may improve with longer duration of CI use, mainly due to higher perceptual acuity to spectral-temporal modulated ripples in acoustic stimuli.

The relative size of auditory scenes of multiple talkers.

Normal hearing listeners discriminated a change in the number of talkers speaking consonant-vowel pairs between two auditory scenes. The number of talkers (n = 2, 4, 6, or 8) in one scene was incremented by Δn talkers (Δn = 1-8 talkers, depending on n) in the other scene. The perceptual size of the auditory scene seems to be small, as discrimination performance reached an approximate 0.75 proportion correct asymptote for n > 4. The independent variable of overall level differences affected performance, but both spatial configuration and talker similarity had very little effect.

Sound-source localization as a multisystem process: The Wallach azimuth illusion.

Wallach [J. Exp. Psychol. 27, 339-368 (1940)] described a "2-1" rotation scenario in which a sound source rotates on an azimuth circle around a rotating listener at twice the listener's rate of rotation. In this scenario, listeners often perceive an illusionary stationary sound source, even though the actual sound source is rotating. This Wallach Azimuth Illusion (WAI) was studied to explore Wallach's description of sound-source localization as a required interaction of binaural and head-position cues (i.e., sound-source localization is a multisystem process). The WAI requires front-back reversed sound-source localization. To extend and consolidate the current understanding of the WAI, listeners and sound sources were rotated over large distances and long time periods, which had not been done before. The data demonstrate a strong correlation between measures of the predicted WAI locations and front-back reversals (FBRs). When sounds are unlikely to elicit FBRs, sound sources are perceived veridically as rotating, but the results are listener dependent. Listeners' eyes were always open and there was little evidence under these conditions that changes in vestibular function affected the occurrence of the WAI. The results show that the WAI is a robust phenomenon that should be useful for further exploration of sound-source localization as a multisystem process.

Interaction Between Pitch and Timbre Perception in Normal-Hearing Listeners and Cochlear Implant Users.

Despite their mutually exclusive definitions, pitch and timbre perception interact with each other in normal-hearing (NH) listeners. Cochlear implant (CI) users have worse than normal pitch and timbre perception. However, the pitch-timbre interaction with CIs is not well understood. This study tested the interaction between pitch and sharpness (an aspect of timbre) perception related to the fundamental frequency (F0) and spectral slope of harmonic complex tones, respectively, in both NH listeners and CI users. In experiment 1, the F0 (and spectral slope) difference limens (DLs) were measured with a fixed spectral slope (and F0) and 20-dB amplitude roving. Then, the F0 and spectral slope were varied congruently or incongruently by the same multiple of individual DLs to assess the pitch and sharpness ranking sensitivity. Both NH and CI subjects had significantly higher pitch and sharpness ranking sensitivity with congruent than with incongruent F0 and spectral slope variations, and showed a similar symmetric interaction between pitch and timbre perception. In experiment 2, CI users' melodic contour identification (MCI) was tested in three spectral slope (no, congruent, and incongruent spectral slope variations by the same multiple of individual DLs as the F0 variations) and two amplitude conditions (0- and 20-dB amplitude roving). When there was no amplitude roving, the MCI scores were significantly higher with congruent than with no, and in turn than with incongruent spectral slope variations. The 20-dB amplitude roving significantly reduced the overall MCI scores and the effect of spectral slope variations. These results reflected a confusion between higher (or lower) pitch and sharper (or duller) timbre and offered important implications for understanding and enhancing pitch and timbre perception with CIs.

Vocal emotion recognition performance predicts the quality of life in adult cochlear implant users.

Clinical tests of cochlear implant (CI) outcomes in sentence recognition cannot fully reflect CI users' self-reported quality of life (QoL). Here, vocal emotion recognition scores, speech reception thresholds (SRTs), and demographic factors were tested as predictors of QoL scores assessed with the Nijmegen Cochlear Implant Questionnaire in postlingually deafened adult CI users. After correction for multiple comparisons, vocal emotion recognition scores were significantly correlated with QoL scores in all subdomains (social interaction, self-esteem, etc.), while SRTs and duration of CI use were not. Vocal emotion recognition may thus be used in clinic to accurately and broadly predict QoL with CIs.

Loudness of an auditory scene composed of multiple talkers.

Normal hearing listeners judged loudness differences between two complex speech sounds, one consisting of "n" consonant-vowel (CV) pairs each spoken by a different talker and one consisting of "2n" CV pairs. When n was less than four, listeners' judgments of loudness differences between the two sounds was based on the level of the individual CVs within each sound, not the overall level of the sounds. When n was four or more, listeners' judgments of loudness differences between the two sounds was based on the overall level of the two sounds consisting of n or 2n CVs.