Speech as a Biomarker: Opportunities, Interpretability, and Challenges

Purpose: Over the past decade, the signal processing and machine learning literature has demonstrated notable advancements in automated speech processing with the use of artificial intelligence for medical assessment and monitoring (e.g., depression, dementia, and Parkinson's disease, among others). Meanwhile, the clinical speech literature has identified several interpretable, theoretically motivated measures that are sensitive to abnormalities in the cognitive, linguistic, affective, motoric, and anatomical domains. Both fields have, thus, independently demonstrated the potential for speech to serve as an informative biomarker for detecting different psychiatric and physiological conditions. However, despite these parallel advancements, automated speech biomarkers have not been integrated into routine clinical practice to date. Conclusions: In this article, we present opportunities and challenges for adoption of speech as a biomarker in clinical practice and research. Toward clinical acceptance and adoption of speech-based digital biomarkers, we argue for the importance of several factors such as robustness, specificity, diversity, and physiological interpretability of speech analytics in clinical applications.

A physiotherapy-led transition to home intervention for older adults following emergency department discharge: protocol for a pilot feasibility randomised controlled trial

Background Older adults frequently attend the emergency department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. This paper reports a protocol designed to evaluate the feasibility of conducting a three arm randomised controlled trial (RCT) within the ED setting and in the patient’s home. The interventions are comprehensive geriatric assessment (CGA), ED PLUS and usual care. Methods The ED PLUS pilot trial is designed as a feasibility RCT conducted in the ED and Acute Medical Assessment Unit of a university teaching hospital in the mid-west region of Ireland. We aim to recruit 30 patients, aged 65 years and over presenting to the ED with undifferentiated medical complaints and discharged within 72 h of index visit. Patients will be randomised by a computer in a ratio of 1:1:1 to deliver usual care, CGA or ED PLUS during a 6-month study period. A randomised algorithm is used to perform randomization. CGA will include a medical assessment, medication review, nursing assessment, falls assessment, assessment of mobility and stairs, transfers, personal care, activities of daily living (ADLs), social supports and baseline cognition. ED PLUS, a physiotherapist led, multidisciplinary intervention, aims to bridge the transition of care between the index visit to the ED and the community by initiating a CGA intervention in the ED and implementing a 6-week follow-up self-management programme in the patient’s own home following discharge from the ED. The outcomes will be parameters of the feasibility of the intervention and trial methods and will be assessed quantitatively and qualitatively. Discussion Rising ED visits and an ageing population with chronic health issues render ED interventions to reduce adverse outcomes in older adults a research priority. This feasibility RCT will generate data and experience to inform the conduct and delivery of a definite RCT. Trial registration The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT049836020.

Effectiveness of an Assistive Instrument for Physical Therapists with Visual Impairment to Conduct the Muscle Tightness Test

Disability sports have been globally promoted to achieve an inclusive society. However, the current opportunities for people with disabilities are few in terms of participating in supporting positions, such as athletic trainers. In Japan, many people with visual impairment (VI) work as physical therapists; thus, they can become active as medical staff in the sports field. An example of a medical assessment is the muscle tightness test (MTT); however, conducting it is expected to be difficult for people with VI. To improve this difficulty, the current study developed an assistive instrument (AsI) and examined its effectiveness. We recruited 22 physical therapists with VI. The measurement for MTT targeted the hamstrings, iliopsoas, gastrocnemius, and quadriceps. The participants performed the MTT using a universal goniometer (UG) and the AsI and filled up a questionnaire. AsI was compared against UG based on three aspects, namely, ease, accuracy, and measurement time. In terms of ease, significant differences were observed in 9 out of 12 questionnaire items. The mean (SD) score for “Comprehensive ease of the MTT” improved from 2.8 (1.0) to 3.9 (0.8). For accuracy, the AsI yielded a decrease in the total error of the measurement. Lastly, the measurement time for AsI was longer than that for the UG. Therefore, the AsI was effective in terms of ease and accuracy, whereas measurement time remained as an issue.

Rural and Urban Difference in Longitudinal Trends in Prevalence of Dementia in Medicare Claims and Survey Data

Shortage of physicians in rural areas can lead to lower diagnosis and underestimation of dementia prevalence in these communities. We used data from the nationally representative Health and Retirement Study and a 20-percent sample of Medicare claims to study rural-urban differences in dementia prevalence. The survey dementia diagnosis is free from medical assessment while the claims diagnosis needs a physician diagnosis. We estimated the trends in dementia prevalence from (2002-2016) based on cognitive tests (using survey data) and diagnosis codes (using claims data) utilizing ordinary least squares regression. Dementia prevalence based on diagnosis codes declined in both urban and rural areas over the course of the study, with a sharper decline in urban areas. Dementia prevalence using diagnosis codes showed significantly higher rates in urban areas during all years (0.024 vs 0.018 in 2002 and 0.017 vs 0.013 in 2014 in rural vs urban areas, respectively). Dementia in the cognitive test sample was higher in rural areas (0.11 vs 0.08 in 2000 and 0.08 vs 0.7 in 2014 in rural vs urban areas), a difference that was significant only in 2004. Our results indicate lower dementia prevalence rates in rural areas in claims based sample compared to survey sample which its dementia prevalence is free medical assessment. Claims data are valuable sources for tracking dementia in the US population, however they are based on medical diagnosis.In rural areas, where there is shortage of physicians and a lack of access to health care services, claims based studies may underestimate dementia rates.

FORENSIC MEDICAL ASSESSMENT OF INJURY SEVERITY OF LARYNX AND HYOID BONE BASED ON PRE-JUDICIAL AND JUDICIAL INVESTIGATION

Victims with fatal and non-fatal closed blunt trauma of the larynx and hyoid bone often become the object of forensic medical service during the pre-judicial and judicial investigation. The purpose of this study is to analyze the features of expert qualification of bodily injuries in victims with closed blunt trauma of the larynx and hyoid bone, depending on the nature and severity to determine ways to unify its forensic diagnosis. Materials and methods. The study was based on the conclusions of 35 forensic medical examinations of cases of closed blunt trauma of the larynx and hyoid bone, obtained from the leading expert institution of the Kharkiv region. Results. We determined the peculiarities of estimating the degrees of severity of above bodily injuries. Severe injuries were found in 12 (34.4%) cases of death of the victims from mechanical asphyxia, in one case of reflex cardiac arrest, and in one case of traumatic shock. Injuries of moderate severity were established by experts in 6 (17.1%) cases of lethal and in 6 (17.1%) cases of non-lethal cases with laryngeal cartilage fractures; in 2 (6.2%) cases of non-lethal injuries with acute oedema, hematoma, laryngeal stenosis of the second degree. 7 (20%) cases of non-lethal laryngeal injuries with further development of acute posttraumatic laryngitis were qualified as simple injuries. Conclusion. There are no clear morphoclinical criteria for objective assessment of injuries of the larynx and hyoid bone that can lead to pre-diagnostic expert errors. According to the results of the work, the ways to unify forensic medical assessment and diagnosis of such injury was determined.

Vestibular Physiotherapy Patients May Require Medical Assessment: Results of Vertigo Audit in Hutt Hospital

Introduction: To identify the type of referrals received by vestibular physiotherapists for vertigo and assess whether medical review for these patients would be appropriate. Materials and Methods: We performed a retrospective review of referral forms, vestibular assessment forms, and vertigo clinic letters of patients referred for vertigo or vestibular physiotherapy input between July 1, 2013, to December 31, 2013. Results: We studied 29 patients with a median age of 63 years. A diagnosis was provided in 65.5% of the referrals. Of 14 patients with possible benign paroxysmal positional vertigo (BPPV), Dix-Hallpike had been performed only for 4 patients. Almost half were seen for the medical review in the Vertigo Clinic due to the concerns of possible alternative non-vestibular diagnosis, medication issues, or syncope. Alternative diagnoses identified medically included orthostatic hypotension, stroke, vestibular migraine, medication-induced bradycardia, and phobic postural vertigo. Medication changes in vertigo clinic included treatment for heart failure, migraine, and medication optimization. Conclusion: Medical review is appropriate for some patients referred for vestibular physiotherapy. A medical opinion should be sought by vestibular physiotherapists if there is uncertainty or concerns that the referred patients did not have straightforward vestibular problems, or there were possible alternative diagnoses, concerns with medications, or syncope.

The Ōshū Fujiwara—An interdisciplinary study on the history, culture and medical assessment of the oldest known mummified human remains in Japan (late Heian, 12th century AD)

This study documents a rare case of mummified human remains from Japan, dating to the late Heian period, 12th Century AD. The remains have only been scientifically investigated once in 1950 so far. The results of this investigation were translated, analyzed, and interpreted using methods of the 21st century. The remains have been traditionally identified as the four ruling generations of the Ōshū Fujiwara clan, who built a cultural and economic center in Hiraizumi. Accordingly, this paper will first examine the historical and cultural significance of Hiraizumi and its ruling class before re-evaluating the findings of the 1950 investigation. This study is the first in the Western scientific literature to provide a comprehensive historical, cultural, and medical evaluation of these mummies.