Andreas Diacon

Madhurananda Pahar, Marisa Klopper, Byron Reeve et al.

We present a deep learning based automatic cough classifier which can discriminate tuberculosis (TB) coughs from COVID-19 coughs and healthy coughs. Both TB and COVID-19 are respiratory diseases, contagious, have cough as a predominant symptom and claim thousands of lives each year. The cough audio recordings were collected at both indoor and outdoor settings and also uploaded using smartphones from subjects around the globe, thus containing various levels of noise. This cough data include 1.68 hours of TB coughs, 18.54 minutes of COVID-19 coughs and 1.69 hours of healthy coughs from 47 TB patients, 229 COVID-19 patients and 1498 healthy patients and were used to train and evaluate a CNN, LSTM and Resnet50. These three deep architectures were also pre-trained on 2.14 hours of sneeze, 2.91 hours of speech and 2.79 hours of noise for improved performance. The class-imbalance in our dataset was addressed by using SMOTE data balancing technique and using performance metrics such as F1-score and AUC. Our study shows that the highest F1-scores of 0.9259 and 0.8631 have been achieved from a pre-trained Resnet50 for two-class (TB vs COVID-19) and three-class (TB vs COVID-19 vs healthy) cough classification tasks, respectively. The application of deep transfer learning has improved the classifiers' performance and makes them more robust as they generalise better over the cross-validation folds. Their performances exceed the TB triage test requirements set by the world health organisation (WHO). The features producing the best performance contain higher order of MFCCs suggesting that the differences between TB and COVID-19 coughs are not perceivable by the human ear. This type of cough audio classification is non-contact, cost-effective and can easily be deployed on a smartphone, thus it can be an excellent tool for both TB and COVID-19 screening.

Madhurananda Pahar, Igor Miranda, Andreas Diacon et al.

We present a new machine learning based bed-occupancy detection system that uses the accelerometer signal captured by a bed-attached consumer smartphone. Automatic bed-occupancy detection is necessary for automatic long-term cough monitoring, since the time which the monitored patient occupies the bed is required to accurately calculate a cough rate. Accelerometer measurements are more cost effective and less intrusive than alternatives such as video monitoring or pressure sensors. A 249-hour dataset of manually-labelled acceleration signals gathered from seven patients undergoing treatment for tuberculosis (TB) was compiled for experimentation. These signals are characterised by brief activity bursts interspersed with long periods of little or no activity, even when the bed is occupied. To process them effectively, we propose an architecture consisting of three interconnected components. An occupancy-change detector locates instances at which bed occupancy is likely to have changed, an occupancy-interval detector classifies periods between detected occupancy changes and an occupancy-state detector corrects falsely-identified occupancy changes. Using long short-term memory (LSTM) networks, this architecture was demonstrated to achieve an AUC of 0.94. When integrated into a complete cough monitoring system, the daily cough rate of a patient undergoing TB treatment was determined over a period of 14 days. As the colony forming unit (CFU) counts decreased and the time to positivity (TPP) increased, the measured cough rate decreased, indicating effective TB treatment. This provides a first indication that automatic cough monitoring based on bed-mounted accelerometer measurements may present a non-invasive, non-intrusive and cost-effective means of monitoring long-term recovery of TB patients.

Madhurananda Pahar, Marisa Klopper, Byron Reeve et al.

We present `wake-cough', an application of wake-word spotting to coughs using a Resnet50 and the identification of coughers using i-vectors, for the purpose of a long-term, personalised cough monitoring system. Coughs, recorded in a quiet (73$\pm$5 dB) and noisy (34$\pm$17 dB) environment, were used to extract i-vectors, x-vectors and d-vectors, used as features to the classifiers. The system achieves 90.02\% accuracy when using an MLP to discriminate between 51 coughers using 2-sec long cough segments in the noisy environment. When discriminating between 5 and 14 coughers using longer (100 sec) segments in the quiet environment, this accuracy improves to 99.78% and 98.39% respectively. Unlike speech, i-vectors outperform x-vectors and d-vectors in identifying coughers. These coughs were added as an extra class to the Google Speech Commands dataset and features were extracted by preserving the end-to-end time-domain information in a trigger phrase. The highest accuracy of 88.58% is achieved in spotting coughs among 35 other trigger phrases using a Resnet50. Thus, wake-cough represents a personalised, non-intrusive cough monitoring system, which is power-efficient as on-device wake-word detection can keep a smartphone-based monitoring device mostly dormant. This makes wake-cough extremely attractive in multi-bed ward environments to monitor patients' long-term recovery from lung ailments such as tuberculosis (TB) and COVID-19.

Madhurananda Pahar, Igor Miranda, Andreas Diacon et al.

We present an automatic non-invasive way of detecting cough events based on both accelerometer and audio signals. The acceleration signals are captured by a smartphone firmly attached to the patient's bed, using its integrated accelerometer. The audio signals are captured simultaneously by the same smartphone using an external microphone. We have compiled a manually-annotated dataset containing such simultaneously-captured acceleration and audio signals for approximately 6000 cough and 68000 non-cough events from 14 adult male patients in a tuberculosis clinic. LR, SVM and MLP are evaluated as baseline classifiers and compared with deep architectures such as CNN, LSTM, and Resnet50 using a leave-one-out cross-validation scheme. We find that the studied classifiers can use either acceleration or audio signals to distinguish between coughing and other activities including sneezing, throat-clearing, and movement on the bed with high accuracy. However, in all cases, the deep neural networks outperform the shallow classifiers by a clear margin and the Resnet50 offers the best performance by achieving an AUC exceeding 0.98 and 0.99 for acceleration and audio signals respectively. While audio-based classification consistently offers a better performance than acceleration-based classification, we observe that the difference is very small for the best systems. Since the acceleration signal requires less processing power, and since the need to record audio is sidestepped and thus privacy is inherently secured, and since the recording device is attached to the bed and not worn, an accelerometer-based highly accurate non-invasive cough detector may represent a more convenient and readily accepted method in long-term cough monitoring.

Madhurananda Pahar, Igor Miranda, Andreas Diacon et al.

We have performed cough detection based on measurements from an accelerometer attached to the patient's bed. This form of monitoring is less intrusive than body-attached accelerometer sensors, and sidesteps privacy concerns encountered when using audio for cough detection. For our experiments, we have compiled a manually-annotated dataset containing the acceleration signals of approximately 6000 cough and 68000 non-cough events from 14 adult male patients in a tuberculosis clinic. As classifiers, we have considered convolutional neural networks (CNN), long-short-term-memory (LSTM) networks, and a residual neural network (Resnet50). We find that all classifiers are able to distinguish between the acceleration signals due to coughing and those due to other activities including sneezing, throat-clearing and movement in the bed with high accuracy. The Resnet50 performs the best, achieving an area under the ROC curve (AUC) exceeding 0.98 in cross-validation experiments. We conclude that high-accuracy cough monitoring based only on measurements from the accelerometer in a consumer smartphone is possible. Since the need to gather audio is avoided and therefore privacy is inherently protected, and since the accelerometer is attached to the bed and not worn, this form of monitoring may represent a more convenient and readily accepted method of long-term patient cough monitoring.