Risk Factors for Orbital Implant Extrusion after Evisceration.

This study analyzed risk factors for extrusion of orbital implants after evisceration by comparing patients with and without implant extrusion. METHODS: We retrospectively reviewed the medical records of patients who underwent evisceration with primary implant placement by a single surgeon from January 2005 to December 2019 at the Chungnam National University Hospital. Age, sex, underlying systemic diseases, axial length of the fellow eye, the cause of evisceration, endophthalmitis type, implant type and size, and preoperative computed tomography findings were evaluated. Logistic regression analysis was used to identify the risk factors for implant extrusion. RESULTS: Of the 140 eyes of 140 patients, extrusion occurred in five eyes (3.6%). Endophthalmitis (odds ratio (OR), 15.49; 95% confidence interval (CI), 1.70 to 2038.56; p = 0.010), endogenous endophthalmitis (OR, 18.73; 95% CI, 3.22 to 125.21, p = 0.002), orbital cellulitis (OR, 320.54; 95% CI, 29.67 to 44801.64; p < 0.001), implant size (OR, 0.50; 95% CI, 0.30 to 0.79; p = 0.004), and hydroxyapatite for the implant (OR, 0.07; 95% CI, 0.00 to 0.66; p = 0.016) were risk factors for implant extrusion in univariate logistic regression analysis. Multiple logistic regression analysis identified orbital cellulitis as the only risk factor for extrusion (OR, 52.98; 95% CI, 2.18 to 15367.34; p = 0.009). CONCLUSIONS: Evisceration with primary orbital implantation is a feasible option in endophthalmitis, but the risk of extrusion should be taken into consideration. When performing evisceration in a patient with orbital cellulitis, secondary implantation should be carried out only after any infection is controlled.

Vocal tract shaping of emotional speech.

Emotional speech production has been previously studied using fleshpoint tracking data in speaker-specific experiment setups. The present study introduces a real-time magnetic resonance imaging database of emotional speech production from 10 speakers and presents articulatory analysis results of speech emotional expression using the database. Midsagittal vocal tract parameters (midsagittal distances and the vocal tract length) were parameterized based on a two-dimensional grid-line system, using image segmentation software. The principal feature analysis technique was applied to the grid-line system in order to find the major movement locations. Results reveal both speaker-dependent and speaker-independent variation patterns. For example, sad speech, a low arousal emotion, tends to show smaller opening for low vowels in the front cavity than the high arousal emotions more consistently than the other regions of the vocal tract. Happiness shows significantly shorter vocal tract length than anger and sadness in most speakers. Further details of speaker-dependent and speaker-independent speech articulation variation in emotional expression and their implications are described.

Simultaneous electromagnetic articulography and electroglottography data acquisition of natural speech.

This paper reports on the concurrent use of electroglottography (EGG) and electromagnetic articulography (EMA) in the acquisition of EMA trajectory data for running speech. Static and dynamic intersensor distances, standard deviations, and coefficients of variation associated with inter-sample distances were compared in two conditions: with and without EGG present. Results indicate that measurement discrepancies between the two conditions are within the EMA system's measurement uncertainty. Therefore, potential electromagnetic interference from EGG does not seem to cause differences of practical importance on EMA trajectory behaviors, suggesting that simultaneous EMA and EGG data acquisition is a viable laboratory procedure for speech research.

Articulatory, acoustic, and prosodic accommodation in a cooperative maze navigation task.

This study uses a maze navigation task in conjunction with a quasi-scripted, prosodically controlled speech task to examine acoustic and articulatory accommodation in pairs of interacting speakers. The experiment uses a dual electromagnetic articulography set-up to collect synchronized acoustic and articulatory kinematic data from two facing speakers simultaneously. We measure the members of a dyad individually before they interact, while they are interacting in a cooperative task, and again individually after they interact. The design is ideally suited to measure speech convergence, divergence, and persistence effects during and after speaker interaction. This study specifically examines how convergence and divergence effects during a dyadic interaction may be related to prosodically salient positions, such as preceding a phrase boundary. The findings of accommodation in fine-grained prosodic measures illuminate our understanding of how the realization of linguistic phrasal structure is coordinated across interacting speakers. Our findings on individual speaker variability and the time course of accommodation provide novel evidence for accommodation at the level of cognitively specified motor control of individual articulatory gestures. Taken together, these results have implications for understanding the cognitive control of interactional behavior in spoken language communication.

Toll-like receptor 9 ligands increase type I interferon induced B-cell activating factor expression in chronic rhinosinusitis with nasal polyposis.

B-cell activating factor (BAFF) has been proposed to play a crucial role in the pathogenesis of chronic rhinosinusitis with nasal polyp (CRSwNP). The aim of this study was to evaluate the role of toll-like receptor (TLR) 9-mediated BAFF activation on the pathogenesis of CRSwNP. NP and uncinate tissue (UT) were obtained from patients with CRSwNP or CRS without NP, and control subjects. The expression of TLR9, high mobility group box-1 protein (HMGB1), type I interferon (IFN), BAFF, and anti-double stranded DNA (dsDNA) antibody were examined in the tissues and the cultured dispersed NP cells (DNPCs). The expression of TLR9, HMGB1, type I IFN, BAFF, and anti-dsDNA antibody were elevated in NP tissue compared to the UTs. Exposure to TLR9 agonist increased the type I IFN expression in vitro, which further increased BAFF production. In conclusion, we provided a novel therapeutic potential of TLR9 agonist in CRSwNP.

Bilateral absence of the inferior rectus muscle presenting with pseudoptosis: treatment of a novel presentation.

Isolated bilateral absence of the inferior rectus muscle is a rare congenital anomaly. The usual presentation of this disorder involves apparent ocular deviations and abnormal head posture from an early age. A 45-year-old woman presented with a bilateral ptosis and lower scleral show. She had a limitation of infraduction in both eyes but was orthophoric in the primary position and had a normal head posture. Ocular motility testing and imaging confirmed a diagnosis of bilateral absence of the inferior rectus muscle; the ptosis was assumed to be a pseudoptosis. The inferior half of the horizontal rectus muscles was transposed inferiorly in both eyes. Postoperatively there was marked improvement of the bilateral ptosis and lower scleral show.

Detecting paralinguistic events in audio stream using context in features and probabilistic decisions.

Non-verbal communication involves encoding, transmission and decoding of non-lexical cues and is realized using vocal (e.g. prosody) or visual (e.g. gaze, body language) channels during conversation. These cues perform the function of maintaining conversational flow, expressing emotions, and marking personality and interpersonal attitude. In particular, non-verbal cues in speech such as paralanguage and non-verbal vocal events (e.g. laughters, sighs, cries) are used to nuance meaning and convey emotions, mood and attitude. For instance, laughters are associated with affective expressions while fillers (e.g. um, ah, um) are used to hold floor during a conversation. In this paper we present an automatic non-verbal vocal events detection system focusing on the detect of laughter and fillers. We extend our system presented during Interspeech 2013 Social Signals Sub-challenge (that was the winning entry in the challenge) for frame-wise event detection and test several schemes for incorporating local context during detection. Specifically, we incorporate context at two separate levels in our system: (i) the raw frame-wise features and, (ii) the output decisions. Furthermore, our system processes the output probabilities based on a few heuristic rules in order to reduce erroneous frame-based predictions. Our overall system achieves an Area Under the Receiver Operating Characteristics curve of 95.3% for detecting laughters and 90.4% for fillers on the test set drawn from the data specifications of the Interspeech 2013 Social Signals Sub-challenge. We perform further analysis to understand the interrelation between the features and obtained results. Specifically, we conduct a feature sensitivity analysis and correlate it with each feature's stand alone performance. The observations suggest that the trained system is more sensitive to a feature carrying higher discriminability with implications towards a better system design.

Analysis of engagement behavior in children during dyadic interactions using prosodic cues.

Child engagement is defined as the interaction of a child with his/her environment in a contextually appropriate manner. Engagement behavior in children is linked to socio-emotional and cognitive state assessment with enhanced engagement identified with improved skills. A vast majority of studies however rely solely, and often implicitly, on subjective perceptual measures of engagement. Access to automatic quantification could assist researchers/clinicians to objectively interpret engagement with respect to a target behavior or condition, and furthermore inform mechanisms for improving engagement in various settings. In this paper, we present an engagement prediction system based exclusively on vocal cues observed during structured interaction between a child and a psychologist involving several tasks. Specifically, we derive prosodic cues that capture engagement levels across the various tasks. Our experiments suggest that a child's engagement is reflected not only in the vocalizations, but also in the speech of the interacting psychologist. Moreover, we show that prosodic cues are informative of the engagement phenomena not only as characterized over the entire task (i.e., global cues), but also in short term patterns (i.e., local cues). We perform a classification experiment assigning the engagement of a child into three discrete levels achieving an unweighted average recall of 55.8% (chance is 33.3%). While the systems using global cues and local level cues are each statistically significant in predicting engagement, we obtain the best results after fusing these two components. We perform further analysis of the cues at local and global levels to achieve insights linking specific prosodic patterns to the engagement phenomenon. We observe that while the performance of our model varies with task setting and interacting psychologist, there exist universal prosodic patterns reflective of engagement.

On Quantifying Facial Expression-Related Atypicality of Children with Autism Spectrum Disorder.

Children with Autism Spectrum Disorder (ASD) are known to have difficulty in producing and perceiving emotional facial expressions. Their expressions are often perceived as atypical by adult observers. This paper focuses on data driven ways to analyze and quantify atypicality in facial expressions of children with ASD. Our objective is to uncover those characteristics of facial gestures that induce the sense of perceived atypicality in observers. Using a carefully collected motion capture database, facial expressions of children with and without ASD are compared within six basic emotion categories employing methods from information theory, time-series modeling and statistical analysis. Our experiments show that children with ASD usually have less complex expression producing mechanisms; the differences in facial dynamics between children with and without ASD primarily come from the eye region. Our study also notes that children with ASD exhibit lower symmetry between left and right regions, and lower variation in motion intensity across facial regions.

A kinematic study of critical and non-critical articulators in emotional speech production.

This study explores one aspect of the articulatory mechanism that underlies emotional speech production, namely, the behavior of linguistically critical and non-critical articulators in the encoding of emotional information. The hypothesis is that the possible larger kinematic variability in the behavior of non-critical articulators enables revealing underlying emotional expression goal more explicitly than that of the critical articulators; the critical articulators are strictly controlled in service of achieving linguistic goals and exhibit smaller kinematic variability. This hypothesis is examined by kinematic analysis of the movements of critical and non-critical speech articulators gathered using eletromagnetic articulography during spoken expressions of five categorical emotions. Analysis results at the level of consonant-vowel-consonant segments reveal that critical articulators for the consonants show more (less) peripheral articulations during production of the consonant-vowel-consonant syllables for high (low) arousal emotions, while non-critical articulators show less sensitive emotional variation of articulatory position to the linguistic gestures. Analysis results at the individual phonetic targets show that overall, between- and within-emotion variability in articulatory positions is larger for non-critical cases than for critical cases. Finally, the results of simulation experiments suggest that the postural variation of non-critical articulators depending on emotion is significantly associated with the controls of critical articulators.

Developmental acoustic study of American English diphthongs.

Developmental trends of durational and spectral parameters of five American English diphthongs are investigated by age and gender. Specifically, diphthong durations, the fundamental frequency (F0), and the first three formant (F1, F2, F3) trajectories as well as formant transition rates are analyzed as a function of age, gender and diphthong type. In addition, the distance between diphthong onset and offset positions and those of nearby monophthongs in the formant space is computed and age-dependent trends are presented. Furthermore, a spectral transition mid-point is estimated for a given diphthong trajectory and normalized time durations from onsets to mid-points are analyzed as a function of age and diphthong type. Finally, diphthong classification results using formant-related parameters are reported. Results show the expected age-dependent reductions of diphthong duration, fundamental frequency, onset and offset formant values, and formant transition rate. More interestingly, it is evident that speakers adjust onset and offset positions of diphthongs with respect to monophthongs as a function of age. Normalized duration of the first demisyllable segment is found to be different among diphthongs and that younger children spend more time in the first segment. The implications for diphthong development and the onset-offset definition of diphthongs are discussed in detail.

Longitudinal changes in retinal nerve fiber layer thickness after vitrectomy for epiretinal membrane.

PURPOSE: We investigated longitudinal changes in retinal nerve fiber layer (RNFL) thickness following vitrectomy for epiretinal membrane (ERM). METHODS: Thirty-one patients who underwent pars plana vitrectomy with internal limiting membrane (ILM) peeling for ERM were included. Average thickness and four quadrants of RNFL thicknesses were determined before and at 1, 3, 6, and 12 months after surgery by spectral-domain optical coherence tomography (SD-OCT). As macular lesions could affect RNFL thickness, we evaluated changes in RNFL thickness by dividing the RNFL into 12 o'clock hourly positions, defining pathologic area adjacent to the lesion and nonpathologic area. RESULTS: Retinal nerve fiber layer thickness of the affected eyes increased at 1 month after vitrectomy and later decreased compared to baseline values. Temporal quadrant RNFL thickness was statistically significantly thicker in affected eyes at baseline and at 1 month after surgery and thinner after 12 months than fellow eyes. Retinal nerve fiber layer thickness in pathologic area decreased after surgery, and the RNFL was statistically significantly thinner at 3, 6, and 12 months postoperatively, compared to the baseline thickness. The RNFL thickness of pathologic area of affected eyes compared to fellow eyes was thicker both at baseline and 1 month after surgery but thinner at 12 months compared to baseline values. CONCLUSIONS: Postoperative RNFL thickness after vitrectomy combined with ERM removal tended to decrease postoperatively. Retinal nerve fiber layer thicknesses in temporal pathologic area were significantly reduced at 3, 6, and 12 months postoperatively compared to baseline values, whereas RNFL thicknesses in nasal nonpathologic area exhibited no significant postoperative changes. We found that ERM itself and the removal procedure resulted in decreased RNFL thickness.

Real-time magnetic resonance imaging and electromagnetic articulography database for speech production research (TC).

USC-TIMIT is an extensive database of multimodal speech production data, developed to complement existing resources available to the speech research community and with the intention of being continuously refined and augmented. The database currently includes real-time magnetic resonance imaging data from five male and five female speakers of American English. Electromagnetic articulography data have also been presently collected from four of these speakers. The two modalities were recorded in two independent sessions while the subjects produced the same 460 sentence corpus used previously in the MOCHA-TIMIT database. In both cases the audio signal was recorded and synchronized with the articulatory data. The database and companion software are freely available to the research community.

The psychologist as an interlocutor in autism spectrum disorder assessment: insights from a study of spontaneous prosody.

PURPOSE: The purpose of this study was to examine relationships between prosodic speech cues and autism spectrum disorder (ASD) severity, hypothesizing a mutually interactive relationship between the speech characteristics of the psychologist and the child. The authors objectively quantified acoustic-prosodic cues of the psychologist and of the child with ASD during spontaneous interaction, establishing a methodology for future large-sample analysis. METHOD: Speech acoustic-prosodic features were semiautomatically derived from segments of semistructured interviews (Autism Diagnostic Observation Schedule, ADOS; Lord, Rutter, DiLavore, & Risi, 1999; Lord et al., 2012) with 28 children who had previously been diagnosed with ASD. Prosody was quantified in terms of intonation, volume, rate, and voice quality. Research hypotheses were tested via correlation as well as hierarchical and predictive regression between ADOS severity and prosodic cues. RESULTS: Automatically extracted speech features demonstrated prosodic characteristics of dyadic interactions. As rated ASD severity increased, both the psychologist and the child demonstrated effects for turn-end pitch slope, and both spoke with atypical voice quality. The psychologist's acoustic cues predicted the child's symptom severity better than did the child's acoustic cues. CONCLUSION: The psychologist, acting as evaluator and interlocutor, was shown to adjust his or her behavior in predictable ways based on the child's social-communicative impairments. The results support future study of speech prosody of both interaction partners during spontaneous conversation, while using automatic computational methods that allow for scalable analysis on much larger corpora.

Spatiotemporal coupling between speech and manual motor actions.

Much evidence has been found for pervasive links between the manual and speech motor systems, including evidence from infant development, deictic pointing, and repetitive tapping and speaking tasks. We expand on the last of these paradigms to look at intra- and cross-modal effects of emphatic stress, as well as the effects of coordination in the absence of explicit rhythm. In this study, subjects repeatedly tapped their finger and synchronously repeated a single spoken syllable. On each trial, subjects placed an emphatic stress on one finger tap or one spoken syllable. Results show that both movement duration and magnitude are affected by emphatic stress regardless of whether that stress is in the same domain (e.g., effects on the oral articulators when a spoken repetition is stressed) or across domains (e.g., effects on the oral articulators when a tap is stressed). Though the size of the effects differs between intra-and cross-domain emphases, the implementation of stress affects both motor domains, indicating a tight connection. This close coupling is seen even in the absence of stress, though it is highlighted under stress. The results of this study support the idea that implementation of prosody is not domain-specific but relies on general aspects of the motor system.

The efficacy of sleeve technique in primary nasolacrimal duct obstruction with a high lacrimal sac.

PURPOSE: To evaluate the efficacy of a sleeve technique during endoscopic dacryocystorhinostomy (DCR) in primary nasolacrimal duct obstruction (NLDO) patients with a high lacrimal sac. MATERIALS AND METHODS: The medical records of 45 patients (49 cases) undergoing endoscopic DCR for primary NLDO with a high lacrimal sac were retrospectively reviewed. In 19 patients (21 cases), the thick maxilla covering the common canalicular opening was removed using a drill and a bicanalicular silicone tube was inserted (group 1). In 26 patients (28 cases), instead of removal of the thick maxilla, a sleeve was inserted into the bicanalicular silicone tube (group 2). At 6 months postoperatively, the success rate was evaluated and the size of the intranasal mucosal ostium was measured. RESULTS: The success rates in group 1 and 2 was 90.5% and 96.4%, respectively (P = 0.400). The intranasal mucosal ostium in group 1 and 2 measured 1.7 ± 0.7 mm and 3.1 ± 1.0 mm, respectively, and the difference was significant (P = 0.042). CONCLUSIONS: In primary NLDO patients with a high lacrimal sac, DCR inserting a silicone tube and a sleeve together had a satisfactory success rate without using a drill. In comparison with traditional surgical methods, it helped enlarge the size of the intranasal mucosal ostium.

Evaluation of prosodic juncture strength using functional data analysis.

Prosodic structure has large effects on the temporal realization of speech via the shaping of articulatory events. It is important for speech scientists to be able to systematically quantify these prosodic effects on articulation in a way that is capable both of differentiating between the degree of prosodic lengthening associated with varying linguistic contexts and that is generalizable across speakers. The current paper presents a novel method to automatically quantify boundary strength from articulatory speech data based on functional data analysis (FDA). In particular, a new derived variable-the Deformation Index-is proposed, which is the area under FDA time-deformation functions. First using synthetic speech produced with the TaDA task dynamics computational model, the Deformation Index is shown to be able to capture a priori known differences in boundary strengths instantiated in the π-gesture framework. Additionally, this method accurately distinguishes between types of boundaries in non-synthetic speech produced by four speakers.

Bilateral central serous chorioretinopathy with retinal pigment epithelium tears following epidural steroid injection.

The cause of central serous chorioretinopathy (CSC) is mostly idiopathic. Other cause such as stressful event or use of corticosteroid has been associated with severe form of CSC. Atypical presentation of CSC has widespread degeneration of retinal pigment epithelium (RPE) or bullous retinal detachment. In this report, we describe a case of bilateral CSC with RPE tear after epidural steroid injection.

Caruncular abscess due to actinomycosis.

The authors report a caruncular abscess caused by actinomycosis. A 47-year-old woman was admitted with persistent purulent discharge from the caruncle of the left eye for a duration of six months. Excisional drainage was performed, and 'sulfur granules' were observed, consistent with actinomyces infection. Intraoperative lacrimal probing and irrigation were performed to confirm that the abscess and canaliculus were not connected. Oral and topical antibiotics were administered postoperatively; the lesion resolved with no evidence of recurrence, and the symptom improved.

Reference data for the American English acoustic vowel space.

Reference data for the acoustic vowel space area (VSA) in children and adolescents do not currently appear to be available in a form suitable for normative comparisons. In the current study, individual speaker formant data for the four corner vowels of American English (/i, u, æ, ɑ/) were used to compute individual speaker VSAs. The sample included 300 children aged 5-18 years and 38 adults aged 25-50 years. Age trends and sex differences were examined and reference data for clinical application were developed. Findings indicated significant declines in VSA with age; sex differences were not fully apparent until late adolescence and adulthood. Implications are discussed.