Screening of Voice Pathologies: Identifying the Predictive Value of Voice Acoustic Parameters for Common Voice Pathologies.

BACKGROUND: Voice acoustic analysis is important for objectively assessing voice production and diagnosing voice disorders. AIM: This study aimed to investigate the sensitivity of various voice acoustic parameters in differentiating common voice pathology types. METHODS: Data from the publicly available Perceptual Voice Qualities Database were analyzed; the database includes recordings of participants with and without voice disorders. A wide range of acoustic parameters was estimated from the recordings, such as alpha ratio, harmonics-to-noise ratio (HNR), cepstral peak prominence smoothed (CPPS), pitch period entropy (PPE), fundamental frequency, jitter, shimmer, and sound pressure levels. The predictive capabilities of the parameters were evaluated using receiver operating characteristic curves. Linear regression analysis determined the associations between parameters and voice disorders. Principal component analysis was conducted to identify important parameters for distinguishing voice disorders. RESULTS AND CONCLUSION: This study has identified significant differences in acoustic parameters between those with and without voice disorders. Notably, the combination of five parameters-namely, PPE, shimmer, jitter, CPPS, and HNR-was identified as a strong predictor in voice disorder screening. These findings contribute substantially to the field of voice disorders, offering valuable insights for screening and diagnosis.

Individual Voice Dimensions' Prediction of Overall Dysphonia Severity on Two Auditory-Perceptual Scales.

BACKGROUND: Auditory-perceptual evaluation of dysphonic voice is an essential clinical activity that characterizes the nature of dysphonia and aids in planning its clinical management. Although there are multidimensional acoustic measures that correlate well with overall severity ratings, they tend to include measures that have only small or moderate correlations with individual voice characteristics frequently perceptually measured (e.g., breathiness or roughness). Given this difference between perceptual and acoustic measures, it is unclear how much individual voice characteristics contribute to a listener's perception of overall severity of dysphonia. PURPOSE: The purpose of this study was to explore individual voice characteristics' relative contribution to the rating of overall dysphonia severity and to explore sex-related differences. METHOD: Two hundred ninety-six voice samples were accessed from the Perceptual Voice Qualities Database. Roughness, breathiness, asthenia, strain, pitch, and loudness ratings from the Grade, Roughness, Breathiness, Asthenia, Strain and Consensus Auditory-Perceptual Evaluation of Voice scales were used to predict overall voice quality severity in linear regression with bootstrapped coefficients. RESULTS: Roughness, breathiness, and strain were the strongest predictors of overall severity. Asthenia and, to a lesser extent, pitch were also significant predictors of overall severity. Loudness was not a significant predictor. There were several sex-related differences noted, as well as differences related to the scale used. CONCLUSIONS: Breathiness, roughness, and strain were all important predictors of overall severity for all regressions. Clinicians should be aware of scale-related differences if they are using auditory-perceptual measures to choose voice therapy targets. Analyses accounting for perceptual strategy differences were recommended for future studies.

Perceptual Voice Qualities Database (PVQD): Database Characteristics.

OBJECTIVES: To develop a perceptual voice quality database for educational and research purposes. STUDY DESIGN: Development of a database. METHODS: A total of 296 high quality audio file recordings consisting of sustained /a/ and /i/ vowels and sentences from Consensus Auditory-Perceptual Evaluation of Voice were made in clinical environments. Nineteen experienced voice clinicians rated the audio samples using voice qualities from the Consensus Auditory-Perceptual Evaluation of Voice (without visual anchors) and GRBAS scales. RESULTS: The database includes samples of a wide range of voice quality severities across a wide range of speaker age and sex. Both inter- and intrarater reliabilities were established to be good for the database overall. CONCLUSIONS: The database is housed in the Mendeley Data online repository and is free for public use.

The Use of Auditory-Perceptual Training as a Research Method: A Summary Review.

OBJECTIVE: The purpose of this descriptive review was to document the current state of training to perform auditory-perceptual analysis as reported in the voice literature. METHODS: A review of the literature was performed. RESULTS: Thirty-six articles were included in the review. The theoretical basis of training, specific training methods employed, duration of training, stimuli used to train, vocal qualities trained, and the type of listeners used are reported. CONCLUSION: There is wide variation to training procedures used in research including auditory-perceptual evaluation of voice quality. In order to begin to discover how to best train listeners for research and clinical settings, attention to the training methods used in research is necessary. Further, these training methods must be explicitly acknowledged and described to allow for adequate evaluation of research findings, comparison across studies, and to determine for which populations results might be applicable. The conceptual framework outlined in this study is a starting point to review voice quality research and to design future studies for which auditory-perceptual evaluation is taught to listeners.

Deep Learning for Voice Gender Identification: Proof-of-concept for Gender-Affirming Voice Care.

OBJECTIVES/HYPOTHESIS: The need for gender-affirming voice care has been increasing in the transgender population in the last decade. Currently, objective treatment outcome measurements are lacking to assess the success of these interventions. This study uses neural network models to predict binary gender from short audio samples of "male" and "female" voices. This preliminary work is a proof-of-concept for further work to develop an AI-assisted treatment outcome measure for gender-affirming voice care. STUDY DESIGN: Retrospective cohort study. METHODS: Two hundred seventy-eight voices from male and female speakers from the Perceptual Voice Qualities Database were used to train a deep neural network to classify voices as male or female. Each audio sample was mapped to the frequency domain using Mel spectrograms. To optimize model performance, we performed 10-fold cross validation of the entire dataset. The dataset was split into 80% training, 10% validation, and 10% test. RESULTS: Overall accuracy of 92% was obtained, both when considering the accuracy per spectrum and per patient metric. The accuracy of the model was higher for recognizing female voices (F1 score of 0.94) compared to male voices (F1 score of 0.87). CONCLUSIONS: This proof of concept study shows promising performance for further development of an AI-assisted tool to provide objective treatment outcome measurements for gender affirming voice care. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1611-E1615, 2021.

Increasing Cardiac Rehabilitation Participation Through a "Nearer to Home" Patient Referral Program.

PURPOSE: Time to travel to cardiac rehabilitation (CR) centers is a barrier to participation, and tertiary referral centers often care for patients living at a substantial distance. We sought to determine the impact of referring eligible patients to CR centers closer to home or workplace on overall participation rate. METHODS: An observational review was conducted in patients from a large cardiovascular program who were referred to CR (January 1, 2015, through December 31, 2016). Those declining participation due to distance from their home were identified and provided coordinated referral to a CR program they chose near their home or workplace. RESULTS: Of the 2912 patients referred to CR, 673 (23%) participated and 1900 declined due to distance. Contact was made in 2017 with 1237 of the 1900 of whom 1083 recalled a discussion of distance referral and completed the phone survey. Participants mean age was 64 yr, predominantly White (88%), male (65%), married (66%), and 70% had ≥ comorbidity. Out of the 1083 referred to a local CR program, 78% reported attending. Of those who attended CR, 55% (469/849) would not have attended had they not been referred to a program closer to their home or workplace. Overall participation increased from 23% to >50% of those referred from our institution. CONCLUSIONS: Coordinating CR referrals from the discharging facility to facilities closer to home or workplace is an effective means for increasing participation. The very low-cost effort has the potential to have a very meaningful impact on the long-term outcome of cardiovascular patients.

Learning Acoustic Assessment of Voice: An Action Research-Based SoTL Project.

The purpose of this action research, scholarship of teaching and learning study was to develop and integrate effective, student-informed teaching methods for voice acoustics instruction in a graduate speech-language pathology voice disorders course. An online focus group was used to determine what aspects of voice acoustics to include in the course as well as how these aspects were to be covered. A blend of face-to-face, technology-assisted, and practice-based teaching/learning activities resulted from the focused group and were employed in the course. An open-ended application question was used to measure student learning regarding application of voice acoustics to the understanding of human voice. A summative assessment of student recall and application of voice acoustics to speech-language pathology practice was also administered. Results showed significant, positive change pre- to post-course on the open-ended application question. Results of the summative assessment revealed that the largest distribution of student scores was in the 90%-100% range. While individual classes in different programs will differ, this project provides instructors with a baseline format from which to work to tailor acoustics instruction in their own classrooms.

Competency-Based Education: Purposes and Promises.

Competency-based education (CBE) is described and the reported advantages to CBE are discussed. The need for a stronger evidence base to support CBE is acknowledged. As we continue to develop this evidence base, the practices of (1) focusing on outcomes and (2) being flexible in the time needed for trainee mastery of competencies hold promise and are consistent with good pedagogy. A model for clinical supervision that includes a focus on outcomes, as well as built-in acknowledgment of time for mastery, is briefly described.

Literature-Based Strategies for Clinical Fellow Mentorship.

In the field of communication sciences and disorders, some research and guidance exist on clinical fellowship supervision for the mentor; however, there is a dearth of literature on clinical fellowship supervision from the perspective of the clinical fellow. This article begins with why the clinical fellowship experience is necessary, and then discusses clinical fellow and mentor expectations and responsibilities, clinical fellow independence, mentor qualities, and issues related to the provision of feedback. The overall goal is to enhance clinical fellow mentors' knowledge base on the clinical fellowship experience through review of current literature on supervision and mentorship.

The Impact Of Structured Exercise Programs On Metabolic Syndrome And Its Components: A Systematic Review.

BACKGROUND: The metabolic syndrome (MetS) is highly prevalent and associated with higher risk of diabetes and cardiovascular events. Exercise programs have been shown to improve components of MetS, but the optimal design of a structured exercise program for treatment of the MetS remains unclear. PURPOSE: To assess the impact of different exercise programs on the MetS and its components. METHODS: MEDLINE via PubMed and Embase was searched. Randomized controlled trials of supervised exercise alone and in combination with nutrition programs compared with usual care in adults with the MetS were selected. Two authors independently reviewed articles to select eligible studies and performed data abstraction. Eight studies representing 1218 patients were included. The participants had a median age of 51, median BMI of 29 kg/m2, and were 55% male. Mean weight loss increased with program duration. For combination programs, the mean weight loss was -2.6 kg, -3.7 kg, and -6.5 kg for 3, 6, and 12 months, respectively. The components of the MetS most frequently statistically significantly improved were waist circumference (6/6 studies), blood pressure (4/6 studies), and high-density lipoprotein cholesterol (3/6 studies). LIMITATIONS: Studies did not include long-term follow-up post program completion to evaluate persistence of benefit. It is unknown whether the same results would be found in an older, more obese population. CONCLUSION: Supervised exercise programs yield significant resolution of components of the MetS, particularly in reducing waist circumference. Longer program duration and frequent interval sessions appear to have highest benefit and thus may help reduce cardiovascular risk and diabetes associated with the MetS.

Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non-alcoholic fatty liver disease.

BACKGROUND: Lifestyle interventions are first-line therapy for non-alcoholic fatty liver disease (NAFLD). AIMS: To examine the prevalence of NAFLD among participants of the University of Michigan Metabolic Fitness (MetFit) Programme and to assess the impact of this programme on weight, metabolic and liver-related parameters among patients with and without NAFLD. METHODS: Adults who completed the programme between 2008 and 2016 were included. Clinical and laboratory data were collected at enrolment, and at 12 and 24 weeks. NAFLD was defined based on liver biopsy, imaging or clinical diagnosis. RESULTS: The cohort (N = 403; 253 12-week, 150 24-week) consisted primarily of middle-aged (median 54 years) white (88%) men (63%) with severe obesity (median BMI 37.4). 47.6% met criteria for NAFLD. At baseline, NAFLD patients were younger (52 vs 55 years), had higher weights and more metabolic derangements (higher fasting insulin and triglyceride, lower high-density lipoprotein-cholesterol). At programme completion, 30% achieved weight reduction ≥5%, 62% resolution of hypertriglyceridaemia, 33% resolution of low HDL, 27% resolution of impaired fasting glucose and 43% normalisation of alanine aminotransferase. Endpoints were unaffected by NAFLD. Longer programme duration (OR 6.7, 95% CI 3.6-12.3) and white race (OR 3.83, 95% CI 1.04-1.76) were independent predictors of ≥5% weight loss. CONCLUSIONS: Nearly half of the patients referred to a structured lifestyle programme for metabolic syndrome had NAFLD. Although baseline metabolic derangements were more pronounced among NAFLD patients, the programme was equally efficacious in achieving weight loss and resolving metabolic syndrome components. Programme duration was the most important predictor of response.

Long-term outcomes following completion of a structured nutrition and exercise lifestyle intervention program for patients with metabolic syndrome.

INTRODUCTION: Metabolic syndrome is associated with an increased risk of cardiovascular disease and multiple other chronic health conditions. Studies have demonstrated the effectiveness of structured diet and exercise programs to improve the components of metabolic syndrome. The durability of these benefits after program completion is unclear. The aim of this study was to evaluate trends in cardiovascular risk factors 12 months post completion of a 12- or 24-week structured lifestyle intervention program. METHODS: Individuals with metabolic syndrome were referred to the Metabolic Fitness program, a 12- or 24-week lifestyle intervention program consisting of weekly exercise and nutrition education sessions. Patients were assessed at baseline, 12 weeks, and 24 weeks for those in the 24-week program. Data collection included weight, body mass index, waist circumference, body composition percentage, sBP, dBP, fasting blood glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Unstructured follow-up data were obtained by retrospective chart review for up to 12 months post program completion. RESULTS: Two-hundred twenty-five patients were enrolled in the 12-week program and 121 in the 24-week program. At the conclusion of the 12-week program, patients showed significant improvement in sBP and dBP. At the conclusion of the 24-week program, patients showed significant improvement in body mass index, weight, sBP, dBP, fasting blood glucose, total cholesterol, and triglycerides. However, 12 months after program completion, while the majority of parameters were still improved compared with baseline, only change in low-density lipoprotein cholesterol remained significantly improved compared with the end of 12-week program, and sBP had increased back above baseline in both programs. CONCLUSION: Patients with metabolic syndrome participating in a structured lifestyle intervention program show significant improvement in their cardiovascular risk and metabolic profile at program completion. The durability of these improvements appears to wane over time, however, stressing the need for programs that can facilitate maintenance of long-term behavior change.

Reported obstructive sleep apnea does not diminish the cardiometabolic health benefits from a comprehensive lifestyle intervention program.

Obstructive sleep apnea (OSA) commonly coexists with the metabolic syndrome, a condition for which behavioral changes are often prescribed. Whether OSA diminishes the cardiometabolic health benefits from lifestyle interventions remains unclear. We evaluated 278 consecutive metabolic syndrome participants enrolled in a 12-week comprehensive lifestyle intervention program. The changes in blood pressure (BP), along with other metabolic health parameters, from baseline to follow-up were compared between those with and without OSA. Mean age was 52.4 ± 10.9 years and 37% were male. At enrollment, mean body mass index (BMI) was 38.2 ± 7.7 kg/m2 . OSA was reported in 126 of 269 final participants (47%). At baseline, participants with reported OSA were more likely to be male, older, have a higher BMI, waist and neck size (all P < 0.05). At program completion, participants with (-5.8 ± 16.1/-3.0 ± 10.0 mm Hg) and without OSA (-4.7 ± 13.1/-3.3 ± 8.2 mm Hg) had significant reductions in systolic and diastolic BP as well as BMI, fasting glucose, and triglyceride levels. There were no significant differences in the absolute or percentage changes in BP or other metabolic parameters between groups. Our findings support that patients with the metabolic syndrome can derive substantial health benefits, including reductions in BP, by a lifestyle intervention program regardless of the presence of OSA.

Assessing the incremental benefit of an extended duration lifestyle intervention for the components of the metabolic syndrome.

BACKGROUND: Lifestyle interventions targeting the components of the metabolic syndrome (MetSyn) have been demonstrated to be a cost-effective and suitable treatment strategy for reducing one's risk of developing coronary artery disease and diabetes. The optimal duration has not yet been defined. We sought to evaluate the incremental benefit of extending a lifestyle intervention from 3 months to 6 months. METHODS: We evaluated 114 participants with at least three criteria for the MetSyn in a physician-referred 6-month lifestyle intervention between August 2008 and December 2012. Baseline and follow-up physiological, biochemical, and anthropometric data were analyzed for mean change and incremental change at each time point. RESULTS: The mean age at enrollment was 53.0±10.2 years, and 42% of participants were males. The mean body mass index at enrollment was 38.2±0.86 kg/m(2) for males and 38.6±0.93 kg/m(2) for females. Anthropometric measures associated with weight management (body mass index, weight, and body fat percentage) improved significantly with the additional 3-month intervention (P<0.001). Systolic blood pressure (P=0.0001) and diastolic blood pressure (P=0.00006) and triglycerides, fasting blood glucose, and homeostatic model assessment of insulin resistance in diabetic participants (P=0.006, P=0.004, P=0.01, respectively) improved rapidly in the initial 3-month intervention without incremental benefit of the additional 3 months. Improvements in fasting insulin (P=0.01) and homeostatic model assessment of insulin resistance (P=0.02) for nondiabetic participants required the full 6-month intervention before significant reductions were achieved. CONCLUSION: A 6-month lifestyle intervention yielded significantly better results for variables related to weight management. Standard physiological measures for the MetSyn respond rapidly in a 3-month lifestyle intervention. The long-term impact of an increased duration lifestyle intervention remains to be seen.

Lexical diversity and omission errors as predictors of language ability in the narratives of sequential Spanish-English bilinguals: a cross-language comparison.

PURPOSE: This study explored the utility of language sample analysis for evaluating language ability in school-age Spanish-English sequential bilingual children. Specifically, the relative potential of lexical diversity and word/morpheme omission as predictors of typical or atypical language status was evaluated. METHOD: Narrative samples were obtained from 48 bilingual children in both of their languages using the suggested narrative retell protocol and coding conventions as per Systematic Analysis of Language Transcripts (SALT; Miller & Iglesias, 2008) software. An additional lexical diversity measure, VocD, was also calculated. A series of logistical hierarchical regressions explored the utility of the number of different words, VocD statistic, and word and morpheme omissions in each language for predicting language status. RESULTS: Omission errors turned out to be the best predictors of bilingual language impairment at all ages, and this held true across languages. Although lexical diversity measures did not predict typical or atypical language status, the measures were significantly related to oral language proficiency in English and Spanish. CONCLUSION: The results underscore the significance of omission errors in bilingual language impairment while simultaneously revealing the limitations of lexical diversity measures as indicators of impairment. The relationship between lexical diversity and oral language proficiency highlights the importance of considering relative language proficiency in bilingual assessment.

Evaluating the use of an assistive listening device for communication efficiency using the Diapix task: a pilot study.

OBJECTIVE: The present study aimed to investigate the effects of assistive listening device (ALD) use on communication efficiency in groups of elderly adults with and without hearing impairment during a structured language sampling task. The relationship between self-perceived hearing handicap and communication efficiency was also explored. METHOD: Twenty-two subjects completed measures of hearing sensitivity, perceived hearing handicap, cognition, and a language sample. One half of the hearing-impaired participants and one half of the normal-hearing group were randomly assigned to use an ALD during a structured conversation task with a naïve partner. RESULTS: The Hearing Loss/No ALD group had significantly more breakdowns than the Hearing Loss/With ALD group. Further, the Hearing Loss/With ALD group performed statistically similar to the two groups without hearing loss. For the normal-hearing groups as well as the Hearing Loss/No ALD group, self-perceived hearing handicap was significantly correlated with the number of communication breakdowns. CONCLUSION: The results lent preliminary support for the use of ALDs in the management of hearing loss. A case for functional assessment of communication was made to better illuminate causes of perceived communication handicap in the aural rehabilitation of elderly persons with hearing impairment.

Speech-language pathologists' informal learning in healthcare settings: behaviours and motivations.

The current research sought to identify the types of informal learning behaviours speech-language pathologists (SLPs) working in healthcare settings engage in as well as SLPs' motivations for engaging in informal learning. Twenty-four American Speech-Language-Hearing Association (ASHA)-certified SLPs participated in this qualitative study. Data collection consisted of computer-mediated interviews, online journaling, and a virtual focus group. These textual data were coded and collapsed into themes. All participant SLPs reported that they learned through collaboration (inter- and intra-disciplinary), worked with patients to learn through trial-and-error, and consulted non-peer-reviewed material on the internet as well as peer-reviewed research in order to learn informally in the workplace. Eighteen of the 24 participants reported being motivated to learn at work to meet a patient's need to meet therapy goals. Five of the 24 participants reported meeting their own personal learning needs was a motivating factor and 10 of the 24 participants reported learning informally to meet the needs of the healthcare organization/SLP profession. Results were compared to past research on SLPs' information retrieval behaviours. It was concluded that SLPs acknowledge their personal work-related gaps in knowledge and skills and actively seek to develop their knowledge and skill base through informal means.