Daryush D. Mehta

Hamzeh Ghasemzadeh, Robert E. Hillman, Daryush D. Mehta

This study's first purpose is to provide quantitative evidence that would incentivize researchers to instead use the more robust method of nested cross-validation. The second purpose is to present methods and MATLAB codes for doing power analysis for ML-based analysis during the design of a study. Monte Carlo simulations were used to quantify the interactions between the employed cross-validation method, the discriminative power of features, the dimensionality of the feature space, and the dimensionality of the model. Four different cross-validations (single holdout, 10-fold, train-validation-test, and nested 10-fold) were compared based on the statistical power and statistical confidence of the ML models. Distributions of the null and alternative hypotheses were used to determine the minimum required sample size for obtaining a statistically significant outcome (α=0.05, 1-\b{eta}=0.8). Statistical confidence of the model was defined as the probability of correct features being selected and hence being included in the final model. Our analysis showed that the model generated based on the single holdout method had very low statistical power and statistical confidence and that it significantly overestimated the accuracy. Conversely, the nested 10-fold cross-validation resulted in the highest statistical confidence and the highest statistical power, while providing an unbiased estimate of the accuracy. The required sample size with a single holdout could be 50% higher than what would be needed if nested cross-validation were used. Confidence in the model based on nested cross-validation was as much as four times higher than the confidence in the single holdout-based model. A computational model, MATLAB codes, and lookup tables are provided to assist researchers with estimating the sample size during the design of their future studies.

Winko W. An, Saketh Sundar, Lisa Yankowitz et al.

Background: Infant cry acoustics provide a promising window into early neurodevelopment and may serve as scalable biomarkers for neurodevelopmental disorders. However, conventional microphone-based recordings are highly susceptible to environmental noise and raise privacy concerns in real-world clinical settings. Chest-surface accelerometers may offer a robust alternative by capturing vibrations directly from the larynx. Methods: We evaluated the validity of a chest-mounted accelerometer (ACC) for infant cry analysis by comparing acoustic features derived from ACC and simultaneously recorded microphone (MIC) signals during routine vaccination visits. The final sample included 85 infants (41 at 4 months; 44 at 12 months) from a diverse pediatric population. Seven vocal measures were extracted from both modalities, including fundamental frequency (F0), jitter, shimmer, cepstral peak prominence (CPP), and harmonics-to-noise ratio (HNR). Agreement and consistency between modalities was assessed using intraclass correlation coefficients (ICCs). Results: F0 demonstrated excellent agreement between ACC and MIC recordings (ICC > 0.94). Jitter measures also showed good-to-excellent agreement, while CPP demonstrated moderate agreement. Shimmer and HNR showed lower absolute agreement and systematic bias between modalities, reflecting possible differences in signal transmission and noise sensitivity. Conclusion: In summary, chest-surface accelerometers can reliably capture several clinically relevant acoustic features of infant cry, particularly temporal measures of F0 and jitter. This approach offers a noise-robust and privacy-preserving alternative to microphone-based recordings, supporting its potential use in scalable clinical and developmental research applications.

Katie Matton, Purvaja Balaji, Hamzeh Ghasemzadeh et al.

Phonotrauma refers to vocal fold tissue damage resulting from exposure to forces during voicing. It occurs on a continuum from mild to severe, and treatment options can vary based on severity. Assessment of severity involves a clinician's expert judgment, which is costly and can vary widely in reliability. In this work, we present the first method for automatically classifying phonotrauma severity from vocal fold images. To account for the ordinal nature of the labels, we adopt a widely used ordinal regression framework. To account for label uncertainty, we propose a novel modification to ordinal regression loss functions that enables them to operate on soft labels reflecting annotator rating distributions. Our proposed soft ordinal regression method achieves predictive performance approaching that of clinical experts, while producing well-calibrated uncertainty estimates. By providing an automated tool for phonotrauma severity assessment, our work can enable large-scale studies of phonotrauma, ultimately leading to improved clinical understanding and patient care.

Fan Wu, Matthias P. Nägele, Daryush D. Mehta et al.

Objective: This study aimed to evaluate which voice features can predict health deterioration in patients with chronic HF. Background: Heart failure (HF) is a chronic condition with progressive deterioration and acute decompensations, often requiring hospitalization and imposing substantial healthcare and economic burdens. Current standard-of-care (SoC) home monitoring, such as weight tracking, lacks predictive accuracy and requires high patient engagement. Voice is a promising non-invasive biomarker, though prior studies have mainly focused on acute HF stages. Methods: In a 2-month longitudinal study, 32 patients with HF collected daily voice recordings and SoC measures of weight and blood pressure at home, with biweekly questionnaires for health status. Acoustic analysis generated detailed vowel and speech features. Time-series features were extracted from aggregated lookback windows (e.g., 7 days) to predict next-day health status. Explainable machine learning with nested cross-validation identified top vocal biomarkers, and a case study illustrated model application. Results: A total of 21,863 recordings were analyzed. Acoustic vowel features showed strong correlations with health status. Time-series voice features within the lookback window outperformed corresponding standard care measures, achieving peak sensitivity and specificity of 0.826 and 0.782 versus 0.783 and 0.567 for SoC metrics. Key prognostic voice features identifying deterioration included delayed energy shift, low energy variability, and higher shimmer variability in vowels, along with reduced speaking and articulation rate, lower phonation ratio, decreased voice quality, and increased formant variability in speech. Conclusion: Voice-based monitoring offers a non-invasive approach to detect early health changes in chronic HF, supporting proactive and personalized care.

Marzyeh Ghassemi, Zeeshan Syed, Daryush D. Mehta et al.

Voice disorders affect an estimated 14 million working-aged Americans, and many more worldwide. We present the first large scale study of vocal misuse based on long-term ambulatory data collected by an accelerometer placed on the neck. We investigate an unsupervised data mining approach to uncovering latent information about voice misuse. We segment signals from over 253 days of data from 22 subjects into over a hundred million single glottal pulses (closures of the vocal folds), cluster segments into symbols, and use symbolic mismatch to uncover differences between patients and matched controls, and between patients pre- and post-treatment. Our results show significant behavioral differences between patients and controls, as well as between some pre- and post-treatment patients. Our proposed approach provides an objective basis for helping diagnose behavioral voice disorders, and is a first step towards a more data-driven understanding of the impact of voice therapy.