Closure Pattern Research Articles

Exploring Usability of School Closure Data for Influenza-Like Illness Surveillance

We compared tempOral patterns of respiratory illness-related unplanned school closures (USC) with influenza-like illness (ILI) data from outpatient provider visits to determine usability of these data for additional insight regarding ILI activity. We found significant correlation between USC and ILINet data (R= 0.54 with p-value <0.0001). The occurrence pattern of respiratory illness-related USCs similarly corresponded with that of ILI activity regardless of the severity of influenza season. This suggests that monitoring USCs can be a useful addition to existing influenza surveillance systems, particularly during severe influenza seasons when respiratory illness-related USCs may occur more frequently.

Fusion Patterns in the Skulls of Modern Archosaurs Reveal That Sutures Are Ambiguous Maturity Indicators for the Dinosauria.

The sutures of the skulls of vertebrates are generally open early in life and slowly close as maturity is attained. The assumption that all vertebrates follow this pattern of progressive sutural closure has been used to assess maturity in the fossil remains of non-avian dinosaurs. Here, we test this assumption in two members of the Extant Phylogenetic Bracket of the Dinosauria, the emu, Dromaius novaehollandiae and the American alligator, Alligator mississippiensis, by investigating the sequence and timing of sutural fusion in their skulls. As expected, almost all the sutures in the emu skull progressively close (i.e., they get narrower) and then obliterate during ontogeny. However, in the American alligator, only two sutures out of 36 obliterate completely and they do so during embryonic development. Surprisingly, as maturity progresses, many sutures of alligators become wider in large individuals compared to younger, smaller individuals. Histological and histomorphometric analyses on two sutures and one synchondrosis in an ontogenetic series of American alligator confirmed our morphological observations. This pattern of sutural widening might reflect feeding biomechanics and dietary changes through ontogeny. Our findings show that progressive sutural closure is not always observed in extant archosaurs, and therefore suggest that cranial sutural fusion is an ambiguous proxy for assessing maturity in non-avian dinosaurs.

Postnatal Ontogeny of the Cranial Base and Craniofacial Skeleton in Male C57BL/6J Mice: A Reference Standard for Quantitative Analysis.

Growth of the craniofacial skeleton is a complex process controlled by both genetic and epigenetic factors, perturbations of which can lead to varying degrees of dysmorphology. Mouse models that recapitulate clinical craniofacial phenotypes are instrumental in studying the morphogenetic progression of diseases as well as uncovering their genetic and molecular bases. Commonly encountered phenotypes in these models include defects in the cranial base synchondroses, calvarial sutures, mandible or the midface, or any combination thereof, with the concurrent presence of altered overall craniofacial growth. However, the literature lacks an adequate normative timeline of developmental events and growth trends that shape the mouse craniofacial skeleton. In this report, we analyzed the postnatal craniofacial ontogeny (from postnatal day 7 [P7] through to P112) of male mice from the most widely used inbred mouse strain, C57BL/6J, using high-resolution microcomputed tomography (μCT) in combination with classic morphometric approaches. We also evaluated cranial base synchondroses at the histological level, and compared it to μCT-generated data to assess the timing and pattern of closure of these structures. Our data underscore the complex and unique growth patterns of individual bones and cranial regions and highlight the need to include younger animals in studies aimed at analyzing craniofacial growth processes. Furthermore, these data serve as a reference standard for future quantitative work.

Predictors of Success in Furlow Palatoplasty for Submucous Clefts: An Experience with 91 Consecutive Patients.

The aim of this study was to evaluate, through multivariate ordinal logistic regression, variables contributing to good postoperative speech outcomes following Furlow palatoplasty. A series of 91 consecutive patients was evaluated. Variables analyzed included demographics; speech perceptual assessment; and measures on videonasopharyngoscopy and videofluoroscopy such as preoperative closure pattern, velopharyngeal gap, and lateral pharyngeal wall motion. Univariate and multivariate analysis of predictors of high scores of articulation, nasal resonance, and resolution of velopharyngeal insufficiency were performed using simple and multinomial logistic regression. A summative perceptual assessment score was generated and analyzed for correlation with postoperative speech outcomes. There were 39 patients (42.9 percent) with a good outcome as defined by adequate articulation and lack of velopharyngeal insufficiency with normal nasal resonance. There was improvement of articulation in 53 patients (58.2 percent), of nasal resonance in 75 patients (82.4 percent), and of velopharyngeal insufficiency in 80 patients (87.9 percent). Predictors of good postoperative speech outcomes (p < 0.05) were preoperative articulation, nasal resonance, and lateral pharyngeal wall movement greater than 37.5 percent on one side. Preoperative severity of velopharyngeal insufficiency, velopharyngeal gap, pattern of closure, age, and sex were not predictive of a good outcome. Logistic regression demonstrated that the preoperative perceptual assessment score was predictive of postoperative outcome, with a significant difference (p < 0.05) between mild and severe groups. A scoring system based on summated perceptual assessment parameters is predictive of good postoperative speech outcomes. Risk, III.

Closure and Dedication Practices in the Homol’ovi Settlement Cluster, Northeastern Arizona

AbstractThis paper explores material patterns of structure and village closure among several villages in the Homol’ovi Settlement Cluster on the Little Colorado River in northeastern Arizona, with special emphasis on Chevelon Pueblo. Excavations in nearly 200 structures within the cluster reveal a variety of closure practices, including burial of floors and floor features, structural burning, and object placement. It is argued that these patterns are part of a long Pueblo tradition of closure practices used, not to sever connections with a space, community, or landscape, but to continue material connections to these places. Some indications of dedication practices for plazas and features were uncovered at Homol’ovi I and will be discussed as part of broader memory-making practices within the community. Finally, a case will be made that the burning of Chevelon Pueblo may have been a purposeful act of forgetting.

Late Closure of a Stage III Idiopathic Macular Hole after Pars Plana Vitrectomy.

A 57-year-old female presented to our hospital with decreased vision in her right eye. Detailed ocular examination was performed, and a macular hole was detected in the right eye. The presence of a full-thickness stage III macular hole was confirmed with optical coherence tomography (OCT) imaging. Pars plana vitrectomy followed by long-acting gas tamponade (C3F8) was performed as treatment. One month after surgery, clinical examination revealed a persistent macular hole, confirmed by an OCT scan. Although the patient was scheduled for reoperation, the surgery was postponed due to personal reasons of the patient. Surprisingly, after five months, a closure pattern with accompanying epiretinal membrane was observed in the macular hole area. The closure of the macular hole was completed without any further intervention 8 months post-surgery. In cases of unclosed macular hole after the first surgery, if a second surgery cannot be performed, follow-up with OCT recommended due to the possibility of spontaneous closure. However, spontaneous closure of a persistent macular hole following PPV is rare, so early diagnosis and surgical repair of unclosed macular holes must remain the primary goal.

Triadic Closure Pattern Analysis and Prediction in Social Networks

We study the problem of group formation in online social networks. In particular, we focus on one of the most important human groups—the triad—and try to understand how closed triads are formed in dynamic networks, by employing data from a large microblogging network as the basis of our study. We formally define the problem of triadic closure prediction and conduct a systematic investigation. The study reveals how user demographics, network characteristics, and social properties influence the formation of triadic closure. We also present a probabilistic graphical model to predict whether three persons will form a closed triad in a dynamic network. Different kernel functions are incorporated into the proposed graphical model to quantify the similarity between triads. Our experimental results with the large microblogging dataset demonstrate the effectiveness (+10 percent over alternative methods in terms of F1-Score) of the proposed model for the prediction of triadic closure formation.

Correlation of Vocal Intensity with Velopharyngeal Closing Mechanism in Individuals with and without Complaint of Velopharyngeal Dysfunction.

Introduction Velopharyngeal sphincter is a portion of the muscle of the palatopharyngeal arch that is capable of separating the oral cavity from the nasal cavity. It has not been determined yet whether voice intensity has an influence on this capacity. Velopharyngeal sphincter closure is accomplished by elevating and retracting the soft palate at the same time as the nasopharyngeal walls are constricted. Objective This study aims to correlate voice intensity with velopharyngeal sphincter closure in individuals without velopharyngeal dysfunction and patients with cleft lip and palate. Methods We conducted a cross-sectional, comparative, and contemporary study. The sample consisted of 16 individuals in the control group and 16 individuals in the study group. Patients underwent instrumental assessment, which we subsequently analyzed using a computer program, and a brief medical history review. The mean age of the control group was 27.6 years, whereas the mean age of the case group was 15.6 years. Results Cases showed higher voice intensity in regular and weak fricative sentences when compared with controls. There was no agreement on the analysis of the instrumental assessment between the assessors and the computer program. Regardless of voice intensity, the computer program demonstrated a similar closure pattern. Conclusion The computer program showed similar closure pattern for the three levels of intensity. There was no agreement between the three assessors and the closure pattern determined by the computer program. There was no statistically significant correlation between voice intensity and degree of velopharyngeal sphincter closure.

On refinements of the Bruhat decomposition

This article gives an explicit description of refined Bruhat cells. This description allows for an analysis of their closure patterns as well as for the calculation of structure constants of the endomorphism algebra of Gelfand---Graev representations. Most of the results rely on ideas and methods developed by V. Deodhar and C. Curtis.

Voice Outcome Following Carbon Dioxide Laser Assisted Microlaryngeal Surgery.

Very few studies have been conducted in South Indian population to evaluate glottic function and voice outcome following carbon dioxide (CO2) laser assisted microsurgery for benign lesions of the larynx. This is a descriptive study which aims at assessing the voice outcome (perceptual and acoustic) and vocal fold function (stroboscopic) following CO2 laser excision in benign vocal fold lesions. 50 adult patients with benign laryngeal lesions were selected to undergo CO2 laser excision in super-pulse mode at power setting of 6 watts. Perceptual analysis was done using GRBAS score. Voice analysis was done using Praat software and fundamental frequency, jitter, shimmer and harmonics to noise ratio were assessed. Stroboscopy was done to evaluate vocal fold function using glottic closure and mucosal wave pattern as parameters. Evaluation of these parameters was done pre-operatively and at 2, 6weeks and 3months post-operatively. Perceptual analysis revealed a significant improvement in the GRBAS score after surgery (p<0.001). Acoustic analysis showed that all the parameters improved significantly after surgery (p<0.001). Stroboscopy showed that vocal fold function improved in 98% of patients in terms of completeness of glottic closure and regular, periodic mucosal wave. Super-pulse micro-spot carbon dioxide laser is a safe and effective treatment option for benign lesions of vocal folds, with excellent voice outcome.

Nasendoscopic evaluation of stress velopharyngeal insufficiency in wind musicians: a pilot study.

To investigate the anatomy and function of the velopharyngeal mechanism in musicians who experience symptoms of stress velopharyngeal insufficiency (VPI) compared to musicians who do not. The velopharyngeal mechanism of 13 musicians, 8 with reported symptoms of stress VPI and 5 without, were evaluated using video nasendoscopy before and after 30 minutes of playing. All nasendoscopic recordings were rated by an external speech-language pathologist and ear, nose and throat surgeon for maintenance of velopharyngeal closure, type of velopharyngeal closure pattern, and velopharyngeal gap. Six out of 8 cases with stress VPI had nasal air leak during the assessment, 2 of whom had fatigue-related increased symptoms. Three controls had mild nasal air leak without affecting the consistency of soft palate seal nor quality of playing, suggesting that evidence of nasal air leak is not always symptomatic of stress VPI. All cases had unusual anatomical characteristics, such as the soft palate closing against an irregular surface on the posterior nasopharyngeal wall, which may cause insufficient velopharyngeal closure. Typically the soft palate contacted the nasopharyngeal wall higher when playing a wind instrument compared to during speech. Specific anatomical features and factors such as fatigue and stress may affect maintenance of velopharyngeal closure in persons with stress VPI. It is important that musicians with stress VPI are evaluated while playing their instrument. Future studies into stress VPI would benefit by including objective assessment components and some degree of quantifiable measurements.

A Novel Standardized Reproducible Method to Calculate the Area of Internal Limiting Membrane Peeled Peroperatively in Macular Hole Surgery by Using a Video Overlay - Boral’s Ring

The challenges in macular hole surgery1-7 include the following:1. Till date no study described the standardized logical reproducible method of calculating area of ILM peeled(AIP) in macular hole surgery and 2. The area of Internal Limiting Membrane (ILM) that has to be peeled to ensure post-operative macular hole closure without any foveal neurosensory retinal defect is not well defined. Our aim was to highlight the way to calculate the Area of Internal Limiting Membrane Peeled (AIP) and its relation with hole closure pattern on OCT in idiopathic FTMH cases. We conducted a prospective single blind study taking 105 eyes/105 patients with symptomatic Idiopathic FTMH< 6months duration. We included idiopathic full thickness macular holes, excluding cases of secondary macular holes, old macular holes with symptoms more than six months duration and eyes with small & large optic discs. All cases were operated by four VR surgeons in our hospitals, where triamcinolone assisted vitrectomy, PVD induction, BBG dye assisted ILM peeling done followed by fluid air exchange and injection of C3F8 gas in non expansile conc . All surgeries were video recorded. Three parameters were evaluated – pre Techniques

Laryngeal pathology at school age following very preterm birth

IntroductionIntubation injury resulting in laryngeal pathology is recognised as a possible complication of preterm birth, yet few published studies have examined such pathology and its relation to voice outcomes. This study reports on the results of prospective laryngeal function examinations of a cohort of very preterm children, all of whom presented with significant dysphonia at school age. Materials and methodsThe laryngeal pathology of 20 very preterm children, born between 23 and 29 weeks gestation, was examined under halogen and stroboscopic conditions. Laryngeal structure and function were assessed using a rigid laryngoscope or a flexible nasendoscope. The approach was selected based on the age and/or likely compliance of the child. ResultsNineteen children were found to have structural laryngeal pathology. Fourteen children presented with a chink to the posterior glottis and all demonstrated at least a mild degree of supraglottic hyperfunction. Other common findings were arytenoid prolapse and vocal fold immobility. More isolated findings included posterior scar band, vocal fold atrophy, arytenoid oedema and growth on the vocal folds. One child who presented with structural laryngeal pathology was never intubated. DiscussionSupraglottic hyperfunction was common to all participants, regardless of the nature and extent of underlying structural laryngeal pathology. Posterior glottic chink was the most common pattern of incomplete vocal fold closure. These data support the hypothesis that very preterm children adopt supraglottic tightening to compensate for underlying laryngeal pathology. The mechanism underlying laryngeal damage in the child who was not intubated is unclear. ConclusionsVoice quality of very preterm children is affected by both laryngeal structure and function. A trial of behavioural voice treatment is recommended to evaluate any therapeutic response in this population.

Nasal endoscopy: new tools and technology for accurate assessment.

In this chapter the technique of nasal endoscopy is discussed. Standardized reporting of nasal endoscopy findings is essential in order to allow communication between different surgeons, speech therapists and endoscopists. Representative videos are provided for the normal examination, for coronal and sagittal velopharyngeal closure patterns, as well as for other anatomical variants of interest. Recommendations for tailoring surgical therapy based on the nasopharyngeal closure pattern are given, although the experience of the surgeon is an important factor for success of any surgical procedure for velopharyngeal insufficiency. Limitations and new frontiers of the technique of nasal endoscopy are also outlined.

Functional and speech outcomes of superiorly based flap pharyngoplasty combined with radical intravelar veloplasty.

The aim of this study was to evaluate functional and speech outcomes of superiorly based pharyngeal flap (SBF) pharyngoplasty combined with radical intravelar veloplasty (RIVVP) for the management of velopharyngeal insufficiency (VPI) following surgically repaired cleft palate. A case series with chart review. The study was conducted in academic tertiary care medical centre. Fifteen patients with VPIs following surgically repaired cleft palate were managed between May 2011 and August 2014, with SBF pharyngoplasty combined with RIVVP. We found that the speech defects improved by a success rate of 93.4%; the VP function became normal (circular pattern of closure) in 80% of patients and the postoperative overall success rate of VP competence grades was 93.4%. Moreover, we found that the overall incidence of complications were 33.3%. By doing SBF pharyngoplasty combined with RIVVP the surgical procedure was satisfactory in both functional and speech outcomes.

Dynamics of Macular Hole Closure in Gas-Filled Eyes within 24 h of Surgery Observed with Swept Source Optical Coherence Tomography

Background/Aims: To investigate the dynamics of macular hole (MH) closure in gas-filled eyes starting 20 min after vitrectomy using swept source optical coherence tomography (SS-OCT). Methods: Twenty consecutive eyes with MH underwent vitrectomy with internal limiting membrane peeling and gas tamponade. SS-OCT imaging was performed approximately 20 min after the operation, and then once a day, until MH closure was confirmed. The correlation between the base, top and minimum hole diameters and the duration required for MH closure was investigated. Results: MH closure in gas-filled eyes was confirmed in 1 eye on day 0, 10 eyes on day 1, 2 eyes on day 2, and 3 eyes on day 3, at which times face-down posturing was discontinued without MH recurrence. SS-OCT revealed a distinct closure pattern within the first 24 h postoperatively. MHs closing by day 1 had a significantly smaller minimum diameter (312.5 ± 105.2 µm) than holes closing on day 2 or later (510.8 ± 153.5 µm; p = 0.019). Conclusions: SS-OCT enables tomographic images of MH in gas-filled eyes immediately postoperatively, thus permitting early discontinuation of, or no necessity for, face-down positioning upon confirmation of MH closure.

Radiation and energy balance dynamics over young chir pine (Pinus roxburghii) system in Doon of western Himalayas

The regional impacts of future climate changes are principally driven by changes in energy fluxes. In this study, measurements on micrometeorological and biophysical variables along with surface energy exchange were made over a coniferous subtropical chir pine (Pinus roxburghii) plantation ecosystem at Forest Research Institute, Doon valley, India. The energy balance components were analyzed for two years to understand the variability of surface energy fluxes, their drivers, and closure pattern. The period covered two growth cycles of pine in the years 2010 and 2011 without and with understory growth. Net short wave and long wave radiative fluxes substantially varied with cloud dynamics, season, rainfall induced surface wetness, and green growth. The study clearly brought out the intimate link of albedo dynamics in chir pine system with dynamics of leaf area index (LAI), soil moisture, and changes in understory background. Rainfall was found to have tight linear coupling with latent heat fluxes. Latent heat flux during monsoon period was found to be higher in higher rainfall year (2010) than in lower rainfall year (2011). Higher or lower pre-monsoon sensible heat fluxes were succeeded by noticeably higher or lower monsoon rainfall respectively. Proportion of latent heat flux to net radiation typically followed the growth curve of green vegetation fraction, but with time lag. The analysis of energy balance closure (EBC) showed that the residual energy varied largely within ±30% of net available energy and the non-closure periods were marked by higher rainspells or forced clearance of understory growths.

Feasibility study to assess clinical applications of 3-T cine MRI coupled with synchronous audio recording during speech in evaluation of velopharyngeal insufficiency in children.

In the past decade, there has been increased utilization of magnetic resonance imaging (MRI) in evaluating and understanding velopharyngeal insufficiency (VPI). To our knowledge, none of the prior studies with MRI has simultaneously linked the audio recordings of speech during cine MRI acquisition with the corresponding images and created a video for evaluating VPI. To develop an MRI protocol with static and cine sequences during phonation to evaluate for VPI in children and compare the findings to nasopharyngoscopy and videofluoroscopy. Five children, ages 8-16 years, with known VPI, who had previously undergone nasopharyngoscopy and videofluoroscopy, were included. MRI examination was performed on a 3-T Siemens scanner. Anatomical data was obtained using an isotropic T2-weighted 3-D SPACE sequence with multiplanar reformation capability. Dynamic data was obtained using 2-D FLASH cine sequences of the airway in three imaging planes during phonation. Audio recordings were captured by a MRI compatible optical microphone. All five cases had MRI and nasopharyngoscopy and four had videofluoroscopy performed. VPI was identified by MRI in all five patients. The location and severity of the velopharyngeal gap, closure pattern, velar size and shape and levator veli palatini (LVP) muscle were identified in all patients. MRI was superior in visualizing the integrity of the LVP muscle. MRI was unable to identify hemipalatal weakness in one case. In a case of stress-induced VPI, occurring only during clarinet playing, cine MRI demonstrated discordant findings of a velopharyngeal gap during phonatory tasks but not with instrument playing. Overall, there was satisfactory correlation among MRI, nasopharyngoscopy and videofluoroscopy findings. Cine MRI of the airway during speech is a noninvasive, well-tolerated diagnostic imaging tool that has the potential to serve as a guide prior to and after surgical correction of VPI. MRI provided superior anatomical detail of the levator musculature. The creation of a video with recorded phonation allowed correlation between palatal movements and specific phonatory tasks.

Evaluation ofIn VivoBehavior of Ameroid Ring Constrictors in Dogs with Congenital Extrahepatic Portosystemic Shunts Using Computed Tomography

To evaluate the in vivo pattern of ameroid constrictor closure of congenital extrahepatic portosystemic shunts in dogs. Prospective study. Dogs (n = 22) with congenital extrahepatic portosystemic shunts. Contrast-enhanced computed tomography was performed immediately before, and at least 8 weeks after placement of ameroid ring constrictors. Plastic-encased ameroid constrictors were used in 17 dogs and metal constrictors in 5 dogs. Presence of residual flow through the portosystemic shunt, additional anomalous vessels, acquired shunts and soft tissue associated with the ameroid constrictor was recorded. Postoperative internal diameter was recorded for the 17 plastic constrictors. Correlations between internal diameter and pre- and postoperative serum protein concentration were analyzed. No ameroid constrictor closed completely: shunt occlusion was always dependent on soft tissue within the ameroid ring. Residual flow through the shunt was present in 4 dogs (18%), although this caused persistent elevation of shunt fraction in only 1 dog (dog 8). The change in ameroid constrictor internal diameter was not significantly correlated with serum protein concentration. Complete shunt occlusion after AC placement is usually dependent on soft tissue reaction. Ameroid constrictors ≥5 mm diameter may not promote complete shunt occlusion.

Posterior crossbites in children: Developmental-based diagnosis and implications to normative growth patterns

Posterior crossbites are one of the most common malocclusion problems observed in primary and mixed dentitions, with a prevalence of approximately 5–8% in children aged 3–12 years. Upwards of 90% of posterior crossbites in the developing dentition exhibit lateral shifts of the mandible on closure associated with a transverse width discrepancy between the dentoalveolar relationships of the maxilla and mandible. The rotational shift of the mandible results in the appearance of a unilateral posterior crossbite involving multiple buccal segment teeth in centric occlusion, midline deviation of the mandibular arch, asymmetric condylar positioning, asymmetric Class II subdivision malocclusion in A-P relationships of the buccal segments, and a chin deviation towards the crossbite side. The transverse discrepancy may be associated with etiological factors producing constriction of the maxillary intercanine width to include non-nutritive sucking habits, mouth-breathing/airway problems, localized anatomical tooth interferences, atypical eruption sequence, and trauma. Assessments of structural anatomy changes in children across age groups consistently demonstrate the asymmetric patterns in condylar positioning and neuromuscular movements associated with posterior crossbites may result in long-term mandibular asymmetric length differences, differential EMG loading patterns between sides, and asymmetric maxillary dentoskeletal adaptations. Given these findings, correction of posterior crossbite by redirecting developing teeth into more normal functional positions while correcting asymmetries of condylar position is indicated whenever the discrepancy is noted in the developing occlusion. Restoration of normal closure patterns of the mandible with elimination of functional deviations, usually through maxillary expansion to harmonize the transverse discrepancy, makes beneficial dentoskeletal changes during periods of dynamic growth and minimizes malocclusion factors that are detrimental to long-term dentofacial cosmetics and function. In addition, early primary and mixed dentition correction allows treatment approaches that are less complex, less time consuming, and more physiologically tolerable than treatment demands in the older patient.