Partner-directed gaze and co-speech hand gestures: effects of age, hearing loss and noise.

Research on the adaptations talkers make to different communication conditions during interactive conversations has primarily focused on speech signals. We extended this type of investigation to two other important communicative signals, i.e., partner-directed gaze and iconic co-speech hand gestures with the aim of determining if the adaptations made by older adults differ from younger adults across communication conditions. We recruited 57 pairs of participants, comprising 57 primary talkers and 57 secondary ones. Primary talkers consisted of three groups: 19 older adults with mild Hearing Loss (older adult-HL); 17 older adults with Normal Hearing (older adult-NH); and 21 younger adults. The DiapixUK "spot the difference" conversation-based task was used to elicit conversions in participant pairs. One easy (No Barrier: NB) and three difficult communication conditions were tested. The three conditions consisted of two in which the primary talker could hear clearly, but the secondary talkers could not, due to multi-talker babble noise (BAB1) or a less familiar hearing loss simulation (HLS), and a condition in which both the primary and secondary talkers heard each other in babble noise (BAB2). For primary talkers, we measured mean number of partner-directed gazes; mean total gaze duration; and the mean number of co-speech hand gestures. We found a robust effects of communication condition that interacted with participant group. Effects of age were found for both gaze and gesture in BAB1, i.e., older adult-NH looked and gestured less than younger adults did when the secondary talker experienced babble noise. For hearing status, a difference in gaze between older adult-NH and older adult-HL was found for the BAB1 condition; for gesture this difference was significant in all three difficult communication conditions (older adult-HL gazed and gestured more). We propose the age effect may be due to a decline in older adult's attention to cues signaling how well a conversation is progressing. To explain the hearing status effect, we suggest that older adult's attentional decline is offset by hearing loss because these participants have learned to pay greater attention to visual cues for understanding speech.

Impact of Japanese L1 Rhythm on English L2 Speech.

The study aimed to examine whether L1 speech rhythm affects L2 speech by assessing how the speech rhythm of Japanese L2 English speakers differed from native speakers. We chose Japanese and English because they differ markedly in the phonological properties that likely contribute to speech rhythm. Speech rhythm was measured by the variability of vowel and consonant intervals using rate-normalized rhythm metrics (VarcoV and VarcoC; nPVI-V and nPVI-C) and %V. The study utilized recordings of spoken sentences in English by 10 native Australian English speakers; and in English and also in Japanese by 10 native Japanese speakers (who had limited experience in speaking English). Experiment 1 compared the rhythm of L1 English (by measuring 1,750 vowels and 3,093 consonants from 20 sentences) and L1 Japanese (1,923 vowels and 2,097 consonants from 10 sentences). The results showed that for all measures, Japanese had reduced durational variability in both consonant and vowel intervals compared with English. In Experiment 2, we examined the rhythm characteristics of L1 and L2 English using 40 sentences (including the 20 in Experiment 1). The results showed that vowel and consonant intervals were less variable in L2 (Japanese English) than in L1 (Australian English) speech, mirroring the results of Experiment 1. Overall, the results are consistent with the proposal that L1 (Japanese) speech rhythm influenced L2 (English) speech.

Long-Term Outcome of Proximal Gastrectomy for Upper-Third Advanced Gastric and Siewert Type II Esophagogastric Junction Cancer Compared With Total Gastrectomy: A Propensity Score-Matched Analysis.

BACKGROUND: This study aimed to investigate the oncologic long-term safety of proximal gastrectomy for upper-third advanced gastric cancer (AGC) and Siewert type II esophagogastric junction (EGJ) cancer. METHODS: The study enrolled patients who underwent proximal gastrectomy (PG) or total gastrectomy (TG) with standard lymph node (LN) dissection for pathologically proven upper-third AGC and EGJ cancers between January 2007 and December 2018. Propensity score-matching with a 1:1 ratio was performed to reduce the influence of confounding variables such as age, sex, tumor size, T stage, N stage, and tumor-node-metastasis (TNM) stage. Kaplan-Meier survival analysis was performed to analyze oncologic outcome. The prognostic factors of recurrence-free survival (RFS) were analyzed using the Cox proportional hazard analysis. RESULTS: Of the 713 enrolled patients in this study, 60 received PG and 653 received TG. Propensity score-matching yielded 60 patients for each group. The overall survival rates were 61.7 % in the PG group and 68.3 % in the TG group (p = 0.676). The RFS was 86.7 % in the PG group and 83.3 % in the TG group (p = 0.634). The PG group showed eight recurrences (1 anastomosis site, 1 paraaortic LN, 1 liver, 1 spleen, 1 lung, 1 splenic hilar LN, and 2 remnant stomachs). In the multivariate analysis, the operation method was not identified as a prognostic factor of tumor recurrence. CONCLUSION: The patients who underwent PG had a long-term oncologic outcome similar to that for the patients who underwent TG for upper-third AGC and EGJ cancer.

Long-term impact of weight loss in people with class II obesity on the overall burden of disease: Evidence from the National Health Screening Cohort in Korea.

BACKGROUND: Obesity is known to increase overall disease burden but does obesity management actually help reduce disease burden? OBJECTIVES: To investigate the effects of weight loss on disease burden in people with obesity using the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) in Korea. SETTING: Pure longitudinal observational study using Nationwide cohort database. METHODS: Out of 514,866 NHIS-HEALS cohort, participants with class II obesity in Asia-Pacific region (30 ≤ body mass index [BMI] < 35) who underwent health check-up provided by NHIS during 2003-2004 (index date) were included. All final participants continued to receive a total of 5 biennial health check-ups over the next 10 years without missing. A group-based trajectory model (GBTM) was used to categorize subjects based on 10-year BMI change patterns. The changes of co-morbidities, healthcare resource utilization, and medical cost were analyzed. RESULTS: The final study subjects (9857) were categorized into 3 trajectory clusters based on the pattern of BMI (kg/m2) change: maintenance (57.35%) with an average change of -.02 ± .06, loss (38.65%) with -.04 ± .08, and substantial loss (4.0%) with -.10 ± .18. The annual increases in the number of co-morbidities per subject in each cluster were .18, .18, and .16 (all P < .001), respectively. The increase of healthcare resource utilization over time was lowest for the substantial loss compared to maintenance and loss. With each passing year, the average annual total healthcare cost increased by ₩21,200 ($16.48, P = .034) and ₩10,500 ($8.16, P = .498) in the maintenance and loss, respectively, but decreased by ₩62,500 ($48.59, P = .032) in the substantial loss. CONCLUSIONS: Weight loss in people with obesity was associated with a reduced burden of disease, as evidenced by lower co-morbidity, healthcare resource utilization rate, and decreased medical costs. This study highlights the potential positive long-term impact on Korean society when actively managing weight in individuals with obesity.

A Cantonese Audio-Visual Emotional Speech (CAVES) dataset.

We present a Cantonese emotional speech dataset that is suitable for use in research investigating the auditory and visual expression of emotion in tonal languages. This unique dataset consists of auditory and visual recordings of ten native speakers of Cantonese uttering 50 sentences each in the six basic emotions plus neutral (angry, happy, sad, surprise, fear, and disgust). The visual recordings have a full HD resolution of 1920 × 1080 pixels and were recorded at 50 fps. The important features of the dataset are outlined along with the factors considered when compiling the dataset. A validation study of the recorded emotion expressions was conducted in which 15 native Cantonese perceivers completed a forced-choice emotion identification task. The variability of the speakers and the sentences was examined by testing the degree of concordance between the intended and the perceived emotion. We compared these results with those of other emotion perception and evaluation studies that have tested spoken emotions in languages other than Cantonese. The dataset is freely available for research purposes.

Can prospective monitoring improve complication rates after gastrectomy? Experience of Billroth I reconstruction at a high-volume tertiary center.

INTRODUCTION: Prospective database is imperative in surgical outcome monitoring and has shown success in providing a comprehensive complication index to monitor surgical quality. This study aims to review whether prospective monitoring has an effect on postoperative complication rates, especially leakage after Billroth I (BI) anastomosis and to identify risk factors of anastomosis leakage after BI anastomosis. MATERIALS AND METHODS: Patients who underwent distal gastrectomy with BI reconstruction at Seoul National University Hospital between January 2018 and April 2021 were enrolled. Clinicopathological characteristics and perioperative variables were retrieved. The risk factor that was statistically significant in univariate analysis was further analyzed by binomial logistic regression analysis. RESULTS: BI leakage rate in three years has declined by half on a yearly basis from 5.7% to 1.8%. The leakage group patients were predominantly male (100%) when compared to the non-leakage group (67.6%) (p = 0.04). The BMI (25.00 ± 1.42 vs. 24.16 ± 3.15, p = 0.048) and CRP measured on POD#2 (16.47 ± 5.64 vs. 9.99 ± 5.42, p < 0.001) showed significant differences between the two groups. POD#2 CRP greater than 12.7 mg/dL was able to predict risk of anastomosis leak with sensitivity 73.3% and specificity 73.1%. CONCLUSION: Understanding variations in outcomes is important for improvements in surgical care, and through prospective monitoring and intra-departmental feedback, it is possible to reduce complication rates after gastrectomy. This study shows that age, gender and BMI are risk factors to BI leakage and POD#2 CRP greater than 12.7 mg/dL can be used to suspect leakage after BI anastomosis.

A Visual Speech Intelligibility Benefit Based on Speech Rhythm.

This study examined whether visual speech provides speech-rhythm information that perceivers can use in speech perception. This was tested by using speech that naturally varied in the familiarity of its rhythm. Thirty Australian English L1 listeners performed a speech perception in noise task with English sentences produced by three speakers: an English L1 speaker (familiar rhythm); an experienced English L2 speaker who had a weak foreign accent (familiar rhythm), and an inexperienced English L2 speaker who had a strong foreign accent (unfamiliar speech rhythm). The spoken sentences were presented in three conditions: Audio-Only (AO), Audio-Visual with mouth covered (AVm), and Audio-Visual (AV). Speech was best recognized in the AV condition regardless of the degree of foreign accent. However, speech recognition in AVm was better than AO for the speech with no foreign accent and with a weak accent, but not for the speech with a strong accent. A follow-up experiment was conducted that only used the speech with a strong foreign accent, under more audible conditions. The results also showed no difference between the AVm and AO conditions, indicating the null effect was not due to a floor effect. We propose that speech rhythm is conveyed by the motion of the jaw opening and closing, and perceivers use this information to better perceive speech in noise.

Clinical Outcomes of Resectional Roux-en-Y Gastric Bypass, Compared to Sleeve Gastrectomy for Severe Obesity.

PURPOSE: Resectional Roux-en-Y gastric bypass (RRYGB) is considered an alternative bariatric surgery in countries with a high incidence of stomach cancer because there is no excluded stomach after RRYGB. This study aimed to evaluate the efficacy and safety of RRYGB. MATERIALS AND METHODS: This study included patients who underwent RRYGB and sleeve gastrectomy (SG) between 2011 and 2021. Surgical complications and metabolic and nutritional profiles were compared between the patients preoperatively and at 1, 6, and 12 months after surgery. RESULTS: Twenty and seventy-six patients underwent RRYGB and SG, respectively; 7 in the SG group were lost to follow-up within 1 year. Surgical complications and baseline characteristics were comparable between two groups, except for diabetes (90.0% vs. 44.7%, p < 0.001). The decrease of HbA1c levels and incidence of reflux esophagitis were lower in the RRYGB group compared to that of SG at 1-year postoperative (-3.0% vs. -1.8%, p = 0.014; 0% vs. 26.7%, p = 0.027). The percentage of total weight loss at 1- year postoperative and incidence of dumping syndrome were comparable between the two groups. The RRYGB group had significantly lower total cholesterol level (161.9 mg/dl vs. 196.4 mg/dl, p < 0.001), but higher incidence of vitamin B12 deficiency (30.0% vs. 3.6%, p = 0.003) at 1 year postoperative compared to those of the SG group. CONCLUSIONS: The RRYGB group had better postoperative outcomes for diabetes and dyslipidemia without increasing surgical complications compared to that of the SG group. Thus, RRYGB can be considered a safe and effective alternative in areas where gastric cancer is prevalent.

Clinical outcomes of gastric cancer surgery after liver transplantation.

Purpose: De novo malignancy is common after liver transplantation (LT); however, there are limited reports on the clinical outcomes of gastric cancer surgery after LT. Our study aimed to investigate the feasibility and safety of gastric cancer surgery after LT. Methods: Seventeen patients underwent gastric cancer surgery after LT at a single institution between January 2013 and June 2021. We retrospectively collected data on surgical complications, survival, and recurrence status of these cases. Results: Fifteen patients (88.2%) underwent curative gastrectomy, with 10 open distal (66.7%) and 5 laparoscopic distal (33.3%) gastrectomies. Surgical and severe complication rates were 3 of 15 (20.0%) and 1 of 15 (6.7%), respectively. There were no significant differences between laparoscopic (33.3%) and open surgery (66.7%) in terms of operation time and complication rate. No surgery-related mortalities occurred. Immunosuppressants could be maintained without difficulty, and no suspicious acute rejection was identified during the perioperative period. There was 1 recurrence after curative surgery (recurrence rate, 6.7%), and the 5-year cancer-specific survival rate after curative surgery was 93.3%. Conclusion: Laparoscopic gastrectomy can be safely done even after LT in terms of postoperative complications and graft safety.

Outcomes and Adverse Events After Bariatric Surgery: An Updated Systematic Review and Meta-analysis, 2013-2023.

Purpose: Bariatric surgery is an increasingly common treatment for obesity and related comorbidities. This meta-analysis aimed to compare the outcomes of bariatric surgery and medical treatment (MT). Materials and Methods: A systematic search of articles published from January 2013 to May 2023 identified 20 studies. The treatment arms included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), gastric banding, and MT. The assessed outcomes included body weight loss, diabetes mellitus (DM) remission, changes in dyslipidemia and hypertension markers, and adverse events. Results: Bariatric surgery resulted in significantly better short- and long-term weight loss than MT, with RYGB and SG showing the most substantial reduction. The DM remission rates were notably higher in the surgery group, with marked improvements in hemoglobin A1c and fasting glucose levels. Improvements in dyslipidemia were inconclusive, whereas hypertension showed modest improvements, particularly with RYGB. Complication rates varied, with RYGB reporting higher rates of early complications, and SG reporting increased rates of late complications. The perioperative reoperation rates were low across all surgical treatments. Specific adverse events, such as intestinal obstruction and anastomosis site problems, were more common in the RYGB group, whereas reflux symptoms were more common in the SG group. Conclusion: Bariatric surgery, especially RYGB and SG, provided superior weight loss and DM remission outcomes compared to MT, although with varied complication profiles. These findings underscore the need for careful patient selection and postoperative management in bariatric surgery. Future studies should aim to refine these processes to improve patient outcomes.

Visual Speech Improves Older and Younger Adults' Response Time and Accuracy for Speech Comprehension in Noise.

Past research suggests that older adults expend more cognitive resources when processing visual speech than younger adults. If so, given resource limitations, older adults may not get as large a visual speech benefit as younger ones on a resource-demanding speech processing task. We tested this using a speech comprehension task that required attention across two talkers and a simple response (i.e., the question-and-answer task) and measured response time and accuracy. Specifically, we compared the size of visual speech benefit for older and younger adults. We also examined whether the presence of a visual distractor would reduce the visual speech benefit more for older than younger adults. Twenty-five older adults (12 females, MAge = 72) and 25 younger adults (17 females, MAge = 22) completed the question-and-answer task under time pressure. The task included the following conditions: auditory and visual (AV) speech; AV speech plus visual distractor; and auditory speech with static face images. Both age groups showed a visual speech benefit regardless of whether a visual distractor was also presented. Likewise, the size of the visual speech benefit did not significantly interact with age group for accuracy or the potentially more sensitive response time measure.

Older adults' emotion recognition: No auditory-visual benefit for less clear expressions.

The ability to recognise emotion from faces or voices appears to decline with advancing age. However, some studies have shown that emotion recognition of auditory-visual (AV) expressions is largely unaffected by age, i.e., older adults get a larger benefit from AV presentation than younger adults resulting in similar AV recognition levels. An issue with these studies is that they used well-recognised emotional expressions that are unlikely to generalise to real-life settings. To examine if an AV emotion recognition benefit generalizes across well and less well recognised stimuli, we conducted an emotion recognition study using expressions that had clear or unclear emotion information for both modalities, or clear visual, but unclear auditory information. Older (n = 30) and younger (n = 30) participants were tested on stimuli of anger, happiness, sadness, surprise, and disgust (expressed in spoken sentences) in auditory-only (AO), visual-only (VO), or AV format. Participants were required to respond by choosing one of 5 emotion options. Younger adults were more accurate in recognising emotions than older adults except for clear VO expressions. Younger adults showed an AV benefit even when unimodal recognition was poor. No such AV benefit was found for older adults; indeed, AV was worse than VO recognition when AO recognition was poor. Analyses of confusion responses indicated that older adults generated more confusion responses that were common between AO and VO conditions, than younger adults. We propose that older adults' poorer AV performance may be due to a combination of weak auditory emotion recognition and response uncertainty that resulted in a higher cognitive load.

Developing a Real-Time Test to Investigate Conversational Speech Understanding.

PURPOSE: This study aimed to develop and test a measure of real-time continuous speech understanding to be used with natural dialogues. METHOD: The measure was based on a category monitoring paradigm and employed five existing recordings of natural dialogues from which the different test categories and associated target words were derived. For each dialogue, a listener was first given a semantic category and asked to press a button as quickly as possible whenever they heard an instance of the category. We tested 63 younger adults, using five semantic categories (family, media, season, temperature, and travel) at three noise levels (in quiet, 0 dB, and -5 dB signal-to-noise ratio [SNR]). Performance was measured in terms of accuracy and response time. RESULTS: The results showed clear differences between the three noise conditions regardless of the semantic category. The peak of the response distribution was highest and earliest for the quiet condition and was reduced with decreasing SNR. The responses varied across categories, reflecting differences in the complexity of a given category or the typicality of the association between target words and their category. Broad categories and/or target words that were less directly associated with their category had decreased hit rates and increased response times. CONCLUSION: The results were discussed in terms of the sensitivity (hit rate) of the performance measure, as well as whether it picked up higher level semantic, context, and discourse properties of the dialogues. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21561681.

Older adults get masked emotion priming for happy but not angry faces: evidence for a positivity effect in early perceptual processing of emotional signals.

In higher-level cognitive tasks, older compared to younger adults show a bias towards positive emotion information and away from negative information (a positivity effect). It is unclear whether this effect occurs in early perceptual processing. This issue is important for determining if the positivity effect is due to automatic rather than controlled processing. We tested this with older and younger adults on a positive/negative face emotion valence classification task using masked priming. Positive (happy) and negative (angry) face targets were preceded by masked repetition or valence primes with neutral face baselines. In Experiment 1, 30 younger and 30 older adults were tested with 50 ms primes. Younger adults showed repetition priming for both positive and negative targets. Older adults showed repetition priming for positive but not negative targets. Neither group showed valence priming. In Experiment 2, 30 older and 29 younger adults were tested with longer duration primes. Younger adults showed repetition priming for both positive and negative emotions, and no valence priming. Older adults only showed repetition and valence priming for positive targets. We proposed older adults' lack of angry face priming was due to an early attention orienting strategy favouring happy expressions at the expense of angry ones.

Gastric Cancer After Bariatric Surgeries.

Bariatric surgery has been covered by medical insurance in Korea, since January 2019; and its number is steadily increasing. Representative bariatric surgeries include adjustable gastric banding, sleeve gastrectomy, and Roux-en-Y gastric bypass. Each surgical method can be applied according to the patient's condition; however, there are other issues to consider in Korea. Because of the high incidence of gastric cancer in Korea, gastroscopy is recommended every two years after the age of 40. Therefore, it is difficult to perform conventional gastroscopy after Roux-en-Y gastric bypass. In this review, the incidence of gastric cancer after representative bariatric surgery was investigated through a literature review, so that it could be used as a reference for the selection of bariatric surgery in Korea.

Effect of sustained selective attention on steady-state visual evoked potentials.

Visual-spatial selective attention enhances the processing of task-relevant visual events while suppressing the processing of irrelevant ones. In this study, we employed a frequency-tagging paradigm to investigate how sustained visual-spatial attention modulates the first harmonic and second harmonic steady-state visual evoked potentials (SSVEPs). Unlike previous studies, that investigated stimulation durations of 10 s or less, we tested a 30-s period. SSVEPs were elicited by simultaneously presenting to the right and left visual hemifields two pattern reversal checkerboard stimuli modulating at 7.14 Hz and 11.11 Hz. Participants were cued to selectively attend to one visual hemifield while ignoring the other. Behavioral results indicated that participants selectively attended to the cued visual hemifield. When participants attended to the visual stimuli, there were larger second harmonic SSVEPs but no attentional modulation of first harmonics. The results are consistent with the proposal that neural populations underlying first, and second harmonics have distinct functional roles, i.e., first harmonics' mechanisms preserve stimulus properties and are resistant to attentional gain, whereas second harmonics mediate attentional modulation. This interpretation is supported by a gain control theory of selective attention.

Effects of Age and Uncertainty on the Visual Speech Benefit in Noise.

PURPOSE: Listeners understand significantly more speech in noise when the talker's face can be seen (visual speech) in comparison to an auditory-only baseline (a visual speech benefit). This study investigated whether the visual speech benefit is reduced when the correspondence between auditory and visual speech is uncertain and whether any reduction is affected by listener age (older vs. younger) and how severe the auditory signal is masked. METHOD: Older and younger adults completed a speech recognition in noise task that included an auditory-only condition and four auditory-visual (AV) conditions in which one, two, four, or six silent talking face videos were presented. One face always matched the auditory signal; the other face(s) did not. Auditory speech was presented in noise at -6 and -1 dB signal-to-noise ratio (SNR). RESULTS: When the SNR was -6 dB, for both age groups, the standard-sized visual speech benefit reduced as more talking faces were presented. When the SNR was -1 dB, younger adults received the standard-sized visual speech benefit even when two talking faces were presented, whereas older adults did not. CONCLUSIONS: The size of the visual speech benefit obtained by older adults was always smaller when AV correspondence was uncertain; this was not the case for younger adults. Difficulty establishing AV correspondence may be a factor that limits older adults' speech recognition in noisy AV environments. Supplemental Material https://doi.org/10.23641/asha.16879549.

Demarcating the Exact Midplane of the Liver Using Indocyanine Green Near-Infrared Fluorescence Imaging During Laparoscopic Donor Hepatectomy.

Indocyanine green (ICG) near-infrared fluoroscopy has been recently implemented in pure laparoscopic donor hepatectomy (PLDH). This study aims to quantitatively evaluate the effectiveness of ICG fluoroscopy during liver midplane dissection in PLDH and to demonstrate that a single injection of ICG is adequate for both midplane dissection and bile duct division. Retrospective analysis was done with images acquired from recordings of PLDH performed without ICG (pre-ICG group) from November 2015 to May 2016 and with ICG (post-ICG group) from June 2016 to May 2017. 30 donors from the pre-ICG group were compared with 46 donors from the post-ICG group. The operation time was shorter (P = 0.002) and postoperative peak aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were lower (P = 0.031 and P = 0.019, respectively) in the post-ICG group than the pre-ICG group. Within the post-ICG group, the color intensity differences between the clamped versus nonclamped regions in the natural, black-and-white, and fluorescent modes were 39.7 ± 36.2, 89.6 ± 46.9, and 19.1 ± 36.8 (mean ± SD, P < 0.001), respectively. The luminosity differences were 37.2 ± 34.5, 93.8 ± 32.1, and 26.7 ± 25.7 (P < 0.001), respectively. Meanwhile, the time from when ICG was injected to when the near-infrared camera was turned on for bile duct visualization was 85.6 ± 25.8 minutes. All grafts received from the 46 donors were successfully transplanted. In conclusion, ICG fluoroscopy helps to reduce operation time and lower postoperative AST/ALT levels. ICG injection visualized with black-and-white imaging is most effective for demarcating the liver midplane during PLDH. A single intravenous injection of ICG is sufficient for midplane dissection as well as bile duct division.