Standard Telephone Network Research Articles

Data-Driven Subtyping of Parkinson’s Using Acoustic Analysis of Sustained Vowels and Cluster Analysis: Findings in the Parkinson’s Voice Initiative Study

People diagnosed with Parkinson’s (PwP) exhibit a diverse manifestation of heterogeneous symptoms which likely reflect different subtypes. However, there is no widely accepted consensus on the criteria for subtype membership assignment. We explored clustering PwP using a data-driven approach mining speech signals. We used data from the three English-speaking cohorts (Boston, Oxford, Toronto) in the Parkinson’s Voice Initiative (PVI), where speech and basic demographic information were collected over the standard telephone network. We acoustically characterized 2097 sustained vowel /a/ recordings from 1138 PwP (Boston cohort) using 307 dysphonia measures. We applied unsupervised feature selection to select a concise subset of the dysphonia measures and hierarchical clustering combined with 2D-data projections using t-distributed stochastic neighbor embedding (t-SNE) to facilitate visual exploration of PwP groups. We assessed cluster validity and consistency using silhouette plots and the cophenetic correlation coefficient. We externally validated cluster findings on the Oxford and Toronto PVI cohorts (n = 285 and 107 participants, respectively). We selected 21 dysphonia measures and found four main clusters which provide tentative insights into different dominating speech-associated characteristics (cophenetic coefficient = 0.72, silhouette score = 0.67). The cluster findings were consistent across the three PVI cohorts, strongly supporting the generalization of the presented methodology towards PwP subtype assignment, and were independently visually verified in 2D projections with t-SNE. The presented methodology with mining sustained vowels and clustering may provide an objective and streamlined approach towards informing PwP subtype assignment. This may have important implications towards developing more personalized clinical management of symptoms for PwP.

Assessing Parkinson's Disease at Scale Using Telephone-Recorded Speech: Insights from the Parkinson's Voice Initiative.

Numerous studies have reported on the high accuracy of using voice tasks for the remote detection and monitoring of Parkinson’s Disease (PD). Most of these studies, however, report findings on a small number of voice recordings, often collected under acoustically controlled conditions, and therefore cannot scale at large without specialized equipment. In this study, we aimed to evaluate the potential of using voice as a population-based PD screening tool in resource-constrained settings. Using the standard telephone network, we processed 11,942 sustained vowel /a/ phonations from a US-English cohort comprising 1078 PD and 5453 control participants. We characterized each phonation using 304 dysphonia measures to quantify a range of vocal impairments. Given that this is a highly unbalanced problem, we used the following strategy: we selected a balanced subset (n = 3000 samples) for training and testing using 10-fold cross-validation (CV), and the remaining (unbalanced held-out dataset, n = 8942) samples for further model validation. Using robust feature selection methods we selected 27 dysphonia measures to present into a radial-basis-function support vector machine and demonstrated differentiation of PD participants from controls with 67.43% sensitivity and 67.25% specificity. These findings could help pave the way forward toward the development of an inexpensive, remote, and reliable diagnostic support tool for PD using voice as a digital biomarker.

Low Sampling-rate Approach for ECG Signals with Compressed Sensing Theory

Wireless Body Area Networks (WBANs) consist of tiny Biomedical Wireless Sensors (BWSs) and a Gate Way (GW) to connect to the external databases in the hospital and medical centres. The GW could connect the BWSs, to a range of wireless telecommunication networks. These wireless telecommunication networks could be either a mobile phone network, a standard telephone network, a dedicated medical centre or using public Wireless Local Area Networks (WLANs) nodes also known a Wi-Fi system. The electrocardiogram (ECG) signals are widely used in health care systems because they are non-invasive mechanisms to establish medical diagnosis of heart diseases. The current ECG systems suffer from important limitations: limited patient's mobility, limited energy, limited on wireless applications. The main drawback of current ECG systems is the location-specific nature of the .systems due to the use of fixed/wired applications. That is why; there is a critical need to improve the current ECG systems to cover security handling and to achieve extended patient's mobility. With this in mind, Compressed Sensing (CS) procedure and the collaboration of Block Sparse Bayesian Learning (BSBL) framework is used to provide a robust low sampling-rate approach for normal and abnormal ECG signals. Advanced WBANs based on our approach will be able to deliver healthcare not only to patients in hospital and medical centres; but also in their homes and workplaces thus offering cost saving, and improving the quality of life. Our simulation results based on two proposed algorithms illustrate 15% incensement of Signal to Noise Ratio (SNR) and a good level of quality for the degree of incoherence between the random measurement and sparsity matrices.

Performance of an Automated, Remote System to Detect Vocal Fold Paralysis

The aim of this project was to evaluate the diagnostic accuracy of an automated, remote system for correctly identifying vocal fold paralysis. Consecutive patients presenting for vocal analysis at the Beaumont Hospital Voice Clinic were enrolled in this prospective, blinded study. Control patients were enlisted from routine otolaryngology clinics. All patients were assessed by standard history, clinical examination, and flexible laryngoscopy or videostroboscopy. The subjects were blindly assessed by remote voice analysis. Sustained phonation was recorded over a standard telephone network. Each recording was subjected to automated, remote analysis of extracted features, including measures of pitch perturbation, amplitude perturbation, and harmonics-to-noise ratio. The presence or absence of a vocal fold paralysis as determined by the automated classifier was recorded and correlated with clinical findings. Seventy-eight consecutive patients were enrolled in the study. The automated speech analysis system demonstrated 92% sensitivity and 75% specificity for detecting vocal fold paralysis. This pilot study, assessing an automated system that analyzes audiological data remotely over the standard telephone network, suggests that with further "training" it may become a reliable, simple, and convenient means for screening patients for voice disorders.

Information technology in primary health care

Appropriate application of information technology in primary health care will extend traditional diagnosis and patient management beyond the doctor’s clinic into the everyday living environment. We describe a model of information management in primary health care, and place special emphasis on the emerging areas of clinical decision support, computerised clinical measurements, patient education and network connectivity. Briefly discussed is the design of innovative home monitoring techniques and a telemedicine based communications infrastructure that should improve access to high quality primary health care for all citizens, irrespective of their distance from major urban centres. A preliminary design for a telemedicine-assisted primary health care network is presented, based on this model of information management. The premise is that improvements in health care services and reductions in health care costs can be effected by establishing a continuum of patient care from the patient’s home, to the doctor’s surgery, to speciality services in hospitals and to other service providers in the health care sector. While, the proposal focuses on new opportunities arising from the imminent introduction of broad band interactive fibre optic networks throughout Australia, the technology and projected data transfers could easily be handled in the short-term using modem access to the standard telephone network. A simple connectivity scheme for system integration is also presented.

Telemedicine demonstration projects in the Western Pacific.

Telemedicine demonstration projects in the Western Pacific are attempting to provide distance medical consulting and distance medical education for the isolated health-care workforce of the region. The Picasso Phone system is a low-cost telemedicine system which requires only the standard telephone network for its operation, needs little additional equipment and is user-friendly. The demonstration projects have shown the utility of the system in both international, inter-island and on-island communications. All demonstration activities used the various existing island telephone systems. With the adaptation of such a user-friendly telemedicine system as the Picasso Phone system to the Peacesat public-interest educational network, the capacity of the telemedicine network will expand to include isolated islands with Peacesat capacity which do not have access to the commercial island telephone systems.

Simple method for computer-aided analysis of echocardiograms

The use of echocardiography in the diagnosis and assessment of heart disease is increasing as greater familiarity is obtained with this noninvasive procedure. Quantitative evaluation of echocardiographic studies has heretofore required time-consuming manipulation of mathematical formulas. A simple method utilizing a sonic digitizing tablet has been developed for computer-aided analysis of M-mode echocardiograms. This device can convert a point located manually with a digitizing pen into X and Y coordinates and with use of the standard telephone network can communicate on a time-shared basis with a DECSYSTEM-10 computer. A program has been written to compute and type the results of standard calculations involving mitral valve motion and left ventricular function. The information can also be stored on disk by the computer for future use. This simple, relatively inexpensive system is valuable because of the ease with which it permits usually laboriously obtained information to be extracted from the standard echocardiogram.