Exploring differences between phonetic classes in Sleep Apnoea Syndrome Patients using automatic speech processing techniques

This work is part of an on-going collaborative project between the medical and signal processing communities to promote new research efforts on automatic OSA (Obstructive Apnea Syndrome) diagnosis. In this paper, we explore the differences noted in phonetic classes (interphoneme) across groups (control/apnoea) and analyze their utility for OSA detectio

Deep Learning in Cardiology

The medical field is creating large amount of data that physicians are unable to decipher and use efficiently. Moreover, rule-based expert systems are inefficient in solving complicated medical tasks or for creating insights using big data. Deep learning has emerged as a more accurate and effective technology in a wide range of medical problems such as diagnosis, prediction and intervention. Deep learning is a representation learning method that consists of layers that transform the data non-linearly, thus, revealing hierarchical relationships and structures. In this review we survey deep learning application papers that use structured data, signal and imaging modalities from cardiology. We discuss the advantages and limitations of applying deep learning in cardiology that also apply in medicine in general, while proposing certain directions as the most viable for clinical use.Comment: 27 pages, 2 figures, 10 table

Discrimination between healthy subjects and patients with pulmonary emphysema by detection of abnormal respiration

In this paper, we propose a robust classification strategy for distinguishing between a healthy subject and a patient with pulmonary emphysema on the basis of lung sounds. A symptom of pulmonary emphysema is that almost all lung sounds include some abnormal (i.e., adventitious) sounds. However, the great variety of possible adventitious sounds and noises at auscultation makes high-accuracy detection difficult. To overcome this difficulty, our strategy is to adopt a two-step classification approach based on the detection of "confident abnormal respiration." In the first step, hidden Markov models and bigram models are used for acoustic features and the occurrence of acoustic segments in each abnormal respiratory period, respectively, to calculate two kinds of stochastic likelihoods: the highest likelihood for a segment sequence to be abnormal respiration and the likelihood for normal respiration. In the second step, the patients are identified on the basis of the detection of confident abnormal respiration, which is when difference between these two likelihoods is larger than a predefined threshold. Our strategy achieved the highest classification rate of 88.7% between healthy subjects and patients among three basic classification strategies, which shows the validity of our approach.ICASSP 2011 - 2011 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP) : Prague, Czech Republic, 2011.05.22-2011.05.2

Acoustic HMMs to Detect Abnormal Respiration with Limited Training Data

In many situations, abnormal sounds, called adventitious sounds, are included with the lung sounds of a subject suffering from pulmonary diseases. Thus, a method to automatically detect abnormal sounds in auscultation was proposed. The acoustic features of normal lung sounds for control subjects and abnormal lung sounds for patients are expressed using hidden markov models (HMMs) to distinguish between normal and abnormal lung sounds. Furthermore, abnormal sounds were detected in a noisy environment, including heart sounds, using a heart-sound model. However, the F1-score obtained in detecting abnormal respiration was low (0.8493). Moreover, the duration and acoustic properties of segments of respiratory, heart, and adventitious sounds varied. In our previous method, the appropriate HMMs for the heart and adventitious sound segments were constructed. Although the properties of the types of adventitious sounds varied, an appropriate topology for each type was not considered. In this study, appropriate HMMs for the segments of each type of adventitious sound and other segments were constructed. The F1-score was increased (0.8726) by selecting a suitable topology for each segment. The results demonstrate the effectiveness of the proposed method

Bovine respiratory disease diagnosis : what progress has been made in clinical diagnosis?

Bovine respiratory disease (BRD) complex is a worldwide health problem in cattle and is a major reason for antimicrobial use in young cattle. Several challenges may explain why it is difficult to make progress in the management of this disease. This article defines the limitation of BRD complex nomenclature, which may not easily distinguish upper versus lower respiratory tract infection and infectious bronchopneumonia versus other types of respiratory diseases. It then discusses the obstacles to clinical diagnosis and reviews the current knowledge of readily available diagnostic test to reach a diagnosis of infectious bronchopneumonia

Lingual articulation in children with developmental speech disorders

This thesis presents thirteen research papers published between 1987-97, and a summary and discussion of their contribution to the field of developmental speech disorders. The publications collectively constitute a body of work with two overarching themes. The first is methodological: all the publications report articulatory data relating to tongue movements recorded using the instrumental technique of electropalatography (EPG). The second is the clinical orientation of the research: the EPG data are interpreted throughout for the purpose of informing the theory and practice of speech pathology. The majority of the publications are original, experimental studies of lingual articulation in children with developmental speech disorders. At the same time the publications cover a broad range of theoretical and clinical issues relating to lingual articulation including: articulation in normal speakers, the clinical applications of EPG, data analysis procedures, articulation in second language learners, and the effect of oral surgery on articulation. The contribution of the publications to the field of developmental speech disorders of unknown origin, also known as phonological impairment or functional articulation disorder, is summarised and discussed. In total, EPG data from fourteen children are reported. The collective results from the publications do not support the cognitive/linguistic explanation of developmental speech disorders. Instead, the EPG findings are marshalled to build the case that specific deficits in speech motor control can account for many of the diverse speech error characteristics identified by perceptual analysis in previous studies. Some of the children studied had speech motor deficits that were relatively discrete, involving, for example, an apparently isolated difficulty with tongue tiplblade groove formation for sibilant targets. Articulatory difficulties of the 'discrete' or specific type are consistent with traditional views of functional lingual articulation in developmental speech disorders articulation disorder. EPG studies of tongue control in normal adults provided insights into a different type of speech motor control deficit observed in the speech of many of the children studied. Unlike the children with discrete articulatory difficulties, others produced abnormal EPG patterns for a wide range of lingual targets. These abnormal gestures were characterised by broad, undifferentiated tongue-palate contact, accompanied by variable approach and release phases. These 'widespread', undifferentiated gestures are interpreted as constituting a previously undescribed form of speech motor deficit, resulting from a difficulty in controlling the tongue tip/blade system independently of the tongue body. Undifferentiated gestures were found to result in variable percepts depending on the target and the timing of the particular gesture, and may manifest as perceptually acceptable productions, phonological substitutions or phonetic distortions. It is suggested that discrete and widespread speech motor deficits reflect different stages along a developmental or severity continuum, rather than distinct subgroups with different underlying deficits. The children studied all manifested speech motor control deficits of varying degrees along this continuum. It is argued that it is the unique anatomical properties of the tongue, combined with the high level of spatial and temporal accuracy required for tongue tiplblade and tongue body co-ordination, that put lingual control specifically at risk in young children. The EPG findings question the validity of assumptions made about the presence/absence of speech motor control deficits, when such assumptions are based entirely on non-instrumental assessment procedures. A novel account of the sequence of acquisition of alveolar stop articulation in children with normal speech development is proposed, based on the EPG data from the children with developmental speech disorders. It is suggested that broad, undifferentiated gestures may occur in young normal children, and that adult-like lingual control develops gradually through the processes of differentiation and integration. Finally, the EPG fmdings are discussed in relation to two recent theoretical frameworks, that of psycho linguistic models and a dynamic systems approach to speech acquisition

Multichannel analysis of normal and continuous adventitious respiratory sounds for the assessment of pulmonary function in respiratory diseases

Premi extraordinari doctorat UPC curs 2015-2016, àmbit d’Enginyeria IndustrialRespiratory sounds (RS) are produced by turbulent airflows through the airways and are inhomogeneously transmitted through different media to the chest surface, where they can be recorded in a non-invasive way. Due to their mechanical nature and airflow dependence, RS are affected by respiratory diseases that alter the mechanical properties of the respiratory system. Therefore, RS provide useful clinical information about the respiratory system structure and functioning. Recent advances in sensors and signal processing techniques have made RS analysis a more objective and sensitive tool for measuring pulmonary function. However, RS analysis is still rarely used in clinical practice. Lack of a standard methodology for recording and processing RS has led to several different approaches to RS analysis, with some methodological issues that could limit the potential of RS analysis in clinical practice (i.e., measurements with a low number of sensors, no controlled airflows, constant airflows, or forced expiratory manoeuvres, the lack of a co-analysis of different types of RS, or the use of inaccurate techniques for processing RS signals). In this thesis, we propose a novel integrated approach to RS analysis that includes a multichannel recording of RS using a maximum of five microphones placed over the trachea and the chest surface, which allows RS to be analysed at the most commonly reported lung regions, without requiring a large number of sensors. Our approach also includes a progressive respiratory manoeuvres with variable airflow, which allows RS to be analysed depending on airflow. Dual RS analyses of both normal RS and continuous adventitious sounds (CAS) are also proposed. Normal RS are analysed through the RS intensity–airflow curves, whereas CAS are analysed through a customised Hilbert spectrum (HS), adapted to RS signal characteristics. The proposed HS represents a step forward in the analysis of CAS. Using HS allows CAS to be fully characterised with regard to duration, mean frequency, and intensity. Further, the high temporal and frequency resolutions, and the high concentrations of energy of this improved version of HS, allow CAS to be more accurately characterised with our HS than by using spectrogram, which has been the most widely used technique for CAS analysis. Our approach to RS analysis was put into clinical practice by launching two studies in the Pulmonary Function Testing Laboratory of the Germans Trias i Pujol University Hospital for assessing pulmonary function in patients with unilateral phrenic paralysis (UPP), and bronchodilator response (BDR) in patients with asthma. RS and airflow signals were recorded in 10 patients with UPP, 50 patients with asthma, and 20 healthy participants. The analysis of RS intensity–airflow curves proved to be a successful method to detect UPP, since we found significant differences between these curves at the posterior base of the lungs in all patients whereas no differences were found in the healthy participants. To the best of our knowledge, this is the first study that uses a quantitative analysis of RS for assessing UPP. Regarding asthma, we found appreciable changes in the RS intensity–airflow curves and CAS features after bronchodilation in patients with negative BDR in spirometry. Therefore, we suggest that the combined analysis of RS intensity–airflow curves and CAS features—including number, duration, mean frequency, and intensity—seems to be a promising technique for assessing BDR and improving the stratification of BDR levels, particularly among patients with negative BDR in spirometry. The novel approach to RS analysis developed in this thesis provides a sensitive tool to obtain objective and complementary information about pulmonary function in a simple and non-invasive way. Together with spirometry, this approach to RS analysis could have a direct clinical application for improving the assessment of pulmonary function in patients with respiratory diseases.Los sonidos respiratorios (SR) se generan con el paso del flujo de aire a través de las vías respiratorias y se transmiten de forma no homogénea hasta la superficie torácica. Dada su naturaleza mecánica, los SR se ven afectados en gran medida por enfermedades que alteran las propiedades mecánicas del sistema respiratorio. Por lo tanto, los SR proporcionan información clínica relevante sobre la estructura y el funcionamiento del sistema respiratorio. La falta de una metodología estándar para el registro y procesado de los SR ha dado lugar a la aparición de diferentes estrategias de análisis de SR con ciertas limitaciones metodológicas que podrían haber restringido el potencial y el uso de esta técnica en la práctica clínica (medidas con pocos sensores, flujos no controlados o constantes y/o maniobras forzadas, análisis no combinado de distintos tipos de SR o uso de técnicas poco precisas para el procesado de los SR). En esta tesis proponemos un método innovador e integrado de análisis de SR que incluye el registro multicanal de SR mediante un máximo de cinco micrófonos colocados sobre la tráquea yla superficie torácica, los cuales permiten analizar los SR en las principales regiones pulmonares sin utilizar un número elevado de sensores . Nuestro método también incluye una maniobra respiratoria progresiva con flujo variable que permite analizar los SR en función del flujo respiratorio. También proponemos el análisis combinado de los SR normales y los sonidos adventicios continuos (SAC), mediante las curvas intensidad-flujo y un espectro de Hilbert (EH) adaptado a las características de los SR, respectivamente. El EH propuesto representa un avance importante en el análisis de los SAC, pues permite su completa caracterización en términos de duración, frecuencia media e intensidad. Además, la alta resolución temporal y frecuencial y la alta concentración de energía de esta versión mejorada del EH permiten caracterizar los SAC de forma más precisa que utilizando el espectrograma, el cual ha sido la técnica más utilizada para el análisis de SAC en estudios previos. Nuestro método de análisis de SR se trasladó a la práctica clínica a través de dos estudios que se iniciaron en el laboratorio de pruebas funcionales del hospital Germans Trias i Pujol, para la evaluación de la función pulmonar en pacientes con parálisis frénica unilateral (PFU) y la respuesta broncodilatadora (RBD) en pacientes con asma. Las señales de SR y flujo respiratorio se registraron en 10 pacientes con PFU, 50 pacientes con asma y 20 controles sanos. El análisis de las curvas intensidad-flujo resultó ser un método apropiado para detectar la PFU , pues encontramos diferencias significativas entre las curvas intensidad-flujo de las bases posteriores de los pulmones en todos los pacientes , mientras que en los controles sanos no encontramos diferencias significativas. Hasta donde sabemos, este es el primer estudio que utiliza el análisis cuantitativo de los SR para evaluar la PFU. En cuanto al asma, encontramos cambios relevantes en las curvas intensidad-flujo yen las características de los SAC tras la broncodilatación en pacientes con RBD negativa en la espirometría. Por lo tanto, sugerimos que el análisis combinado de las curvas intensidad-flujo y las características de los SAC, incluyendo número, duración, frecuencia media e intensidad, es una técnica prometedora para la evaluación de la RBD y la mejora en la estratificación de los distintos niveles de RBD, especialmente en pacientes con RBD negativa en la espirometría. El método innovador de análisis de SR que se propone en esta tesis proporciona una nueva herramienta con una alta sensibilidad para obtener información objetiva y complementaria sobre la función pulmonar de una forma sencilla y no invasiva. Junto con la espirometría, este método puede tener una aplicación clínica directa en la mejora de la evaluación de la función pulmonar en pacientes con enfermedades respiratoriasAward-winningPostprint (published version

Automatic analysis and classification of cardiac acoustic signals for long term monitoring

Objective: Cardiovascular diseases are the leading cause of death worldwide resulting in over 17.9 million deaths each year. Most of these diseases are preventable and treatable, but their progression and outcomes are significantly more positive with early-stage diagnosis and proper disease management. Among the approaches available to assist with the task of early-stage diagnosis and management of cardiac conditions, automatic analysis of auscultatory recordings is one of the most promising ones, since it could be particularly suitable for ambulatory/wearable monitoring. Thus, proper investigation of abnormalities present in cardiac acoustic signals can provide vital clinical information to assist long term monitoring. Cardiac acoustic signals, however, are very susceptible to noise and artifacts, and their characteristics vary largely with the recording conditions which makes the analysis challenging. Additionally, there are challenges in the steps used for automatic analysis and classification of cardiac acoustic signals. Broadly, these steps are the segmentation, feature extraction and subsequent classification of recorded signals using selected features. This thesis presents approaches using novel features with the aim to assist the automatic early-stage detection of cardiovascular diseases with improved performance, using cardiac acoustic signals collected in real-world conditions. Methods: Cardiac auscultatory recordings were studied to identify potential features to help in the classification of recordings from subjects with and without cardiac diseases. The diseases considered in this study for the identification of the symptoms and characteristics are the valvular heart diseases due to stenosis and regurgitation, atrial fibrillation, and splitting of fundamental heart sounds leading to additional lub/dub sounds in the systole or diastole interval of a cardiac cycle. The localisation of cardiac sounds of interest was performed using an adaptive wavelet-based filtering in combination with the Shannon energy envelope and prior information of fundamental heart sounds. This is a prerequisite step for the feature extraction and subsequent classification of recordings, leading to a more precise diagnosis. Localised segments of S1 and S2 sounds, and artifacts, were used to extract a set of perceptual and statistical features using wavelet transform, homomorphic filtering, Hilbert transform and mel-scale filtering, which were then fed to train an ensemble classifier to interpret S1 and S2 sounds. Once sound peaks of interest were identified, features extracted from these peaks, together with the features used for the identification of S1 and S2 sounds, were used to develop an algorithm to classify recorded signals. Overall, 99 features were extracted and statistically analysed using neighborhood component analysis (NCA) to identify the features which showed the greatest ability in classifying recordings. Selected features were then fed to train an ensemble classifier to classify abnormal recordings, and hyperparameters were optimized to evaluate the performance of the trained classifier. Thus, a machine learning-based approach for the automatic identification and classification of S1 and S2, and normal and abnormal recordings, in real-world noisy recordings using a novel feature set is presented. The validity of the proposed algorithm was tested using acoustic signals recorded in real-world, non-controlled environments at four auscultation sites (aortic valve, tricuspid valve, mitral valve, and pulmonary valve), from the subjects with and without cardiac diseases; together with recordings from the three large public databases. The performance metrics of the methodology in relation to classification accuracy (CA), sensitivity (SE), precision (P+), and F1 score, were evaluated. Results: This thesis proposes four different algorithms to automatically classify fundamental heart sounds – S1 and S2; normal fundamental sounds and abnormal additional lub/dub sounds recordings; normal and abnormal recordings; and recordings with heart valve disorders, namely the mitral stenosis (MS), mitral regurgitation (MR), mitral valve prolapse (MVP), aortic stenosis (AS) and murmurs, using cardiac acoustic signals. The results obtained from these algorithms were as follows: • The algorithm to classify S1 and S2 sounds achieved an average SE of 91.59% and 89.78%, and F1 score of 90.65% and 89.42%, in classifying S1 and S2, respectively. 87 features were extracted and statistically studied to identify the top 14 features which showed the best capabilities in classifying S1 and S2, and artifacts. The analysis showed that the most relevant features were those extracted using Maximum Overlap Discrete Wavelet Transform (MODWT) and Hilbert transform. • The algorithm to classify normal fundamental heart sounds and abnormal additional lub/dub sounds in the systole or diastole intervals of a cardiac cycle, achieved an average SE of 89.15%, P+ of 89.71%, F1 of 89.41%, and CA of 95.11% using the test dataset from the PASCAL database. The top 10 features that achieved the highest weights in classifying these recordings were also identified. • Normal and abnormal classification of recordings using the proposed algorithm achieved a mean CA of 94.172%, and SE of 92.38%, in classifying recordings from the different databases. Among the top 10 acoustic features identified, the deterministic energy of the sound peaks of interest and the instantaneous frequency extracted using the Hilbert Huang-transform, achieved the highest weights. • The machine learning-based approach proposed to classify recordings of heart valve disorders (AS, MS, MR, and MVP) achieved an average CA of 98.26% and SE of 95.83%. 99 acoustic features were extracted and their abilities to differentiate these abnormalities were examined using weights obtained from the neighborhood component analysis (NCA). The top 10 features which showed the greatest abilities in classifying these abnormalities using recordings from the different databases were also identified. The achieved results demonstrate the ability of the algorithms to automatically identify and classify cardiac sounds. This work provides the basis for measurements of many useful clinical attributes of cardiac acoustic signals and can potentially help in monitoring the overall cardiac health for longer duration. The work presented in this thesis is the first-of-its-kind to validate the results using both, normal and pathological cardiac acoustic signals, recorded for a long continuous duration of 5 minutes at four different auscultation sites in non-controlled real-world conditions.Open Acces

Conditions of child health stricken by cerebral palsy in Family Health Strategy

Objective: To investigate the child's health condition with cerebral palsy accompanied in the Family Health Strategy. Method: Descriptive, exploratory and cross-sectional study, conducted with 13 children 1-12 years old. Through home visits investigating socioeconomic and health conditions, physical examination, vital signs, pneumofuncional evaluation and testing of the gross motor function classification system. Results: The majority of children a family income of up to 2 minimum wages, are benefited by the National Institute of Social Security, use the services of the National Health System also submitted respiratory function unchanged, growth putting structural suitable for age, prevalence of quadriparesia spastic, use of anticonvulsant medication, respiratory problems last year as influenza and pneumonia. Conclusion: It was observed that the higher the motor impairment developed more comorbidities. Children with cerebral palsy accompanied by the Family Health Program in Teresina, PI, are in proper health