Designing and validating an experimental protocol to induce airway narrowing in older adults with and without asthma.

BACKGROUND: Persons with asthma may experience excessive airway narrowing due to exercise or exposure to cold air, worsening their daily functionality. Exercise has several benefits for asthma control, but it may induce airway narrowing in some persons with asthma. When combined with cold temperatures, it introduces another layer of challenges. Therefore, managing this interaction is crucial to increase the quality of life in individuals with asthma. The purpose of this study was to develop a reliable experimental protocol to assess the effects of exercise and cold air on airway narrowing in adults with asthma in a controlled and safe environment. METHODS: This study was a randomized cross-over study in adults with and without asthma. Participants underwent a protocol involving a 10-min seated rest, followed by a 10-min cycling on a stationary bike in different temperatures of 0, 10, or 20  ∘ C. The sequence of room temperatures was randomized, and there was a 30-min interval for recovery between each temperature transition. In each temperature, to measure lung function and respiratory symptoms, oscillometry and a questionnaire were used at 0 min (baseline), after 10 min of sitting and before starting biking (pre-exercise), and after 10 min of biking (post-exercise). At each room temperature, the changes in airway mechanics and asthma symptoms among baseline, pre-exercise, and post-exercise were compared with one-way repeated measures ANOVA or Friedman Rank Test. Within each arm, cardiac and thoraco-abdominal motion respiration signals were also measured continuously using electrodes and calibrated respiratory inductance plethysmographs, respectively. RESULTS: A total of 23 persons with asthma (11 females, age: 56.3 ± 10.9 years, BMI: 27.4 ± 5.7 kg/m2) and 6 healthy subjects (3 females, age: 61.8 ± 9.1 years, BMI: 28.5 ± 3.1 kg/m2) were enrolled in the study. Cold temperature of 0 ∘ C induced airway narrowing in those with and without asthma after 10 and 20 min, respectively. Exercise intervention had significant changes in airway narrowing in participants with asthma in the range of 10-20 ∘ C. Our results showed that in asthma, changes in subjective respiratory symptoms were due to both cold temperatures of 0 and 10 ∘ C and exercise in the 0-20 ∘ C range. Respiratory symptoms were not noticed among the healthy participants. CONCLUSION: In conclusion, our findings suggest that exposure to cold temperatures of 0 ∘ C could serve as a reliable method in the experimental protocol for inducing airway narrowing in asthma. The impact of exercise on airway narrowing was more variable among participants. Understanding these triggers in the experimental protocol is essential for the successful management of asthma in future studies.

Longitudinal Changes of COVID-19 Symptoms in Social Media: Observational Study.

BACKGROUND: In December 2019, the COVID-19 outbreak started in China and rapidly spread around the world. Many studies have been conducted to understand the clinical characteristics of COVID-19, and recently postinfection sequelae of this disease have begun to be investigated. However, there is little consensus on the longitudinal changes of lasting physical or psychological symptoms from prior COVID-19 infection. OBJECTIVE: This study aims to investigate and analyze public social media data from Reddit to understand the longitudinal impact of COVID-19 symptoms before and after recovery from COVID-19. METHODS: We collected 22,890 Reddit posts that were generated by 14,401 authors from March 14 to December 16, 2020. Using active learning and intensive manual inspection, 292 (2.03%) active authors, who were infected by COVID-19 and frequently reported disease progress on Reddit, along with their 2213 (9.67%) longitudinal posts, were identified. Machine learning tools to extract biomedical information were applied to identify COVID-19 symptoms mentioned in the Reddit posts. We then examined longitudinal changes in individual physiological and psychological characteristics before and after recovery from COVID-19 infection. RESULTS: In total, 58 physiological and 3 psychological symptoms were identified in social media before and after recovery from COVID-19 infection. From the analyses, we found that symptoms of patients with COVID-19 lasted 2.5 months. On average, symptoms appeared around a month before recovery and remained for 1.5 months after recovery. Well-known COVID-19 symptoms, such as fever, cough, and chest congestion, appeared relatively earlier in patient journeys and were frequently observed before recovery from COVID-19. Meanwhile, mental discomfort or distress, such as brain fog or stress, fatigue, and manifestations on toes or fingers, were frequently mentioned after recovery and remained as intermediate- and longer-term sequelae. CONCLUSIONS: In this study, we showed the dynamic changes in COVID-19 symptoms during the infection and recovery phases of the disease. Our findings suggest the feasibility of using social media data for investigating disease states and understanding the evolution of the physiological and psychological characteristics of COVID-19 infection over time.

Enhancing the Patient Experience for Individuals Undergoing Endoscopic Procedures Using Virtual Reality.

The results of medical procedures can often be difficult to translate into comprehensible and engaging information for patients. This randomized controlled trial evaluated the satisfaction and perceived value of a technology, called HealthVoyager, which creates a personalized virtual reality (VR) experience of a patient's endoscopy or colonoscopy findings in comparison to the standard practice (ie, reviewing printed reports). The platform allows gastroenterologists to create a customized VR patient report to help translate medical knowledge and procedural information to the patient. Forty-one patients (17 HealthVoyager [test]; 24 standard practice [control]) completed a self-report survey assessing their experience for receiving medical information. Results demonstrated that patients were significantly more satisfied in learning about their gastrointestinal condition and procedural results using HealthVoyager rather than with the standard of care. These results have implications for improving the knowledge translation of medical findings between healthcare providers and patients in various disease states and patient populations.

Physicians' Perceptions of Chatbots in Health Care: Cross-Sectional Web-Based Survey.

BACKGROUND: Many potential benefits for the uses of chatbots within the context of health care have been theorized, such as improved patient education and treatment compliance. However, little is known about the perspectives of practicing medical physicians on the use of chatbots in health care, even though these individuals are the traditional benchmark of proper patient care. OBJECTIVE: This study aimed to investigate the perceptions of physicians regarding the use of health care chatbots, including their benefits, challenges, and risks to patients. METHODS: A total of 100 practicing physicians across the United States completed a Web-based, self-report survey to examine their opinions of chatbot technology in health care. Descriptive statistics and frequencies were used to examine the characteristics of participants. RESULTS: A wide variety of positive and negative perspectives were reported on the use of health care chatbots, including the importance to patients for managing their own health and the benefits on physical, psychological, and behavioral health outcomes. More consistent agreement occurred with regard to administrative benefits associated with chatbots; many physicians believed that chatbots would be most beneficial for scheduling doctor appointments (78%, 78/100), locating health clinics (76%, 76/100), or providing medication information (71%, 71/100). Conversely, many physicians believed that chatbots cannot effectively care for all of the patients' needs (76%, 76/100), cannot display human emotion (72%, 72/100), and cannot provide detailed diagnosis and treatment because of not knowing all of the personal factors associated with the patient (71%, 71/100). Many physicians also stated that health care chatbots could be a risk to patients if they self-diagnose too often (714%, 74/100) and do not accurately understand the diagnoses (74%, 74/100). CONCLUSIONS: Physicians believed in both costs and benefits associated with chatbots, depending on the logistics and specific roles of the technology. Chatbots may have a beneficial role to play in health care to support, motivate, and coach patients as well as for streamlining organizational tasks; in essence, chatbots could become a surrogate for nonmedical caregivers. However, concerns remain on the inability of chatbots to comprehend the emotional state of humans as well as in areas where expert medical knowledge and intelligence is required.

Impact of Audio Data Compression on Feature Extraction for Vocal Biomarker Detection: Validation Study.

BACKGROUND: Vocal biomarkers, derived from acoustic analysis of vocal characteristics, offer noninvasive avenues for medical screening, diagnostics, and monitoring. Previous research demonstrated the feasibility of predicting type 2 diabetes mellitus through acoustic analysis of smartphone-recorded speech. Building upon this work, this study explores the impact of audio data compression on acoustic vocal biomarker development, which is critical for broader applicability in health care. OBJECTIVE: The objective of this research is to analyze how common audio compression algorithms (MP3, M4A, and WMA) applied by 3 different conversion tools at 2 bitrates affect features crucial for vocal biomarker detection. METHODS: The impact of audio data compression on acoustic vocal biomarker development was investigated using uncompressed voice samples converted into MP3, M4A, and WMA formats at 2 bitrates (320 and 128 kbps) with MediaHuman (MH) Audio Converter, WonderShare (WS) UniConverter, and Fast Forward Moving Picture Experts Group (FFmpeg). The data set comprised recordings from 505 participants, totaling 17,298 audio files, collected using a smartphone. Participants recorded a fixed English sentence up to 6 times daily for up to 14 days. Feature extraction, including pitch, jitter, intensity, and Mel-frequency cepstral coefficients (MFCCs), was conducted using Python and Parselmouth. The Wilcoxon signed rank test and the Bonferroni correction for multiple comparisons were used for statistical analysis. RESULTS: In this study, 36,970 audio files were initially recorded from 505 participants, with 17,298 recordings meeting the fixed sentence criteria after screening. Differences between the audio conversion software, MH, WS, and FFmpeg, were notable, impacting compression outcomes such as constant or variable bitrates. Analysis encompassed diverse data compression formats and a wide array of voice features and MFCCs. Wilcoxon signed rank tests yielded P values, with those below the Bonferroni-corrected significance level indicating significant alterations due to compression. The results indicated feature-specific impacts of compression across formats and bitrates. MH-converted files exhibited greater resilience compared to WS-converted files. Bitrate also influenced feature stability, with 38 cases affected uniquely by a single bitrate. Notably, voice features showed greater stability than MFCCs across conversion methods. CONCLUSIONS: Compression effects were found to be feature specific, with MH and FFmpeg showing greater resilience. Some features were consistently affected, emphasizing the importance of understanding feature resilience for diagnostic applications. Considering the implementation of vocal biomarkers in health care, finding features that remain consistent through compression for data storage or transmission purposes is valuable. Focused on specific features and formats, future research could broaden the scope to include diverse features, real-time compression algorithms, and various recording methods. This study enhances our understanding of audio compression's influence on voice features and MFCCs, providing insights for developing applications across fields. The research underscores the significance of feature stability in working with compressed audio data, laying a foundation for informed voice data use in evolving technological landscapes.

Linear effects of glucose levels on voice fundamental frequency in type 2 diabetes and individuals with normoglycemia.

Glucose levels in the body have been hypothesized to affect voice characteristics. One of the primary justifications for voice changes are due to Hooke's law, in which a variation in the tension, mass, or length of the vocal folds, mediated by the body's glucose levels, results in an alteration in their vibrational frequency. To explore this hypothesis, 505 participants were fitted with a continuous glucose monitor (CGM) and instructed to record their voice using a custom mobile application up to six times daily for 2 weeks. Glucose values from CGM were paired to voice recordings to create a sampled dataset that closely resembled the glucose profile of the comprehensive CGM dataset. Glucose levels and fundamental frequency (F0) had a significant positive association within an individual, and a 1 mg/dL increase in CGM recorded glucose corresponded to a 0.02 Hz increase in F0 (CI 0.01-0.03 Hz, P < 0.001). This effect was also observed when the participants were split into non-diabetic, prediabetic, and Type 2 Diabetic classifications (P = 0.03, P = 0.01, & P = 0.01 respectively). Vocal F0 increased with blood glucose levels, but future predictive models of glucose levels based on voice may need to be personalized due to high intraclass correlation.

Investigation of Deepfake Voice Detection Using Speech Pause Patterns: Algorithm Development and Validation.

BACKGROUND: The digital era has witnessed an escalating dependence on digital platforms for news and information, coupled with the advent of "deepfake" technology. Deepfakes, leveraging deep learning models on extensive data sets of voice recordings and images, pose substantial threats to media authenticity, potentially leading to unethical misuse such as impersonation and the dissemination of false information. OBJECTIVE: To counteract this challenge, this study aims to introduce the concept of innate biological processes to discern between authentic human voices and cloned voices. We propose that the presence or absence of certain perceptual features, such as pauses in speech, can effectively distinguish between cloned and authentic audio. METHODS: A total of 49 adult participants representing diverse ethnic backgrounds and accents were recruited. Each participant contributed voice samples for the training of up to 3 distinct voice cloning text-to-speech models and 3 control paragraphs. Subsequently, the cloning models generated synthetic versions of the control paragraphs, resulting in a data set consisting of up to 9 cloned audio samples and 3 control samples per participant. We analyzed the speech pauses caused by biological actions such as respiration, swallowing, and cognitive processes. Five audio features corresponding to speech pause profiles were calculated. Differences between authentic and cloned audio for these features were assessed, and 5 classical machine learning algorithms were implemented using these features to create a prediction model. The generalization capability of the optimal model was evaluated through testing on unseen data, incorporating a model-naive generator, a model-naive paragraph, and model-naive participants. RESULTS: Cloned audio exhibited significantly increased time between pauses (P<.001), decreased variation in speech segment length (P=.003), increased overall proportion of time speaking (P=.04), and decreased rates of micro- and macropauses in speech (both P=.01). Five machine learning models were implemented using these features, with the AdaBoost model demonstrating the highest performance, achieving a 5-fold cross-validation balanced accuracy of 0.81 (SD 0.05). Other models included support vector machine (balanced accuracy 0.79, SD 0.03), random forest (balanced accuracy 0.78, SD 0.04), logistic regression, and decision tree (balanced accuracies 0.76, SD 0.10 and 0.72, SD 0.06). When evaluating the optimal AdaBoost model, it achieved an overall test accuracy of 0.79 when predicting unseen data. CONCLUSIONS: The incorporation of perceptual, biological features into machine learning models demonstrates promising results in distinguishing between authentic human voices and cloned audio.

A Radar-Based Opioid Overdose Detection Device for Public Restrooms: Design, Development, and Evaluation Study.

BACKGROUND: The opioid epidemic is a growing crisis worldwide. While many interventions have been put in place to try to protect people from opioid overdoses, they typically rely on the person to take initiative in protecting themselves, requiring forethought, preparation, and action. Respiratory depression or arrest is the mechanism by which opioid overdoses become fatal, but it can be reversed with the timely administration of naloxone. OBJECTIVE: In this study, we described the development and validation of an opioid overdose detection radar (ODR), specifically designed for use in public restroom stalls. In-laboratory testing was conducted to validate the noncontact, privacy-preserving device against a respiration belt and to determine the accuracy and reliability of the device. METHODS: We used an ODR system with a high-frequency pulsed coherent radar sensor and a Raspberry Pi (Raspberry Pi Ltd), combining advanced technology with a compact and cost-effective setup to monitor respiration and detect opioid overdoses. To determine the optimal position for the ODR within the confined space of a restroom stall, iterative testing was conducted, considering the radar's bounded capture area and the limitations imposed by the stall's dimensions and layout. By adjusting the orientation of the ODR, we were able to identify the most effective placement where the device reliably tracked respiration in a number of expected positions. Experiments used a mock restroom stall setup that adhered to building code regulations, creating a controlled environment while maintaining the authenticity of a public restroom stall. By simulating different body positions commonly associated with opioid overdoses, the ODR's ability to accurately track respiration in various scenarios was assessed. To determine the accuracy of the ODR, testing was performed using a respiration belt as a reference. The radar measurements were compared with those obtained from the belt in experiments where participants were seated upright and slumped over. RESULTS: The results demonstrated favorable agreement between the radar and belt measurements, with an overall mean error in respiration cycle duration of 0.0072 (SD 0.54) seconds for all recorded respiration cycles (N=204). During the simulated overdose experiments where participants were slumped over, the ODR successfully tracked respiration with a mean period difference of 0.0091 (SD 0.62) seconds compared with the reference data. CONCLUSIONS: The findings suggest that the ODR has the potential to detect significant deviations in respiration patterns that may indicate an opioid overdose event. The success of the ODR in these experiments indicates the device should be further developed and implemented to enhance safety and emergency response measures in public restrooms. However, additional validation is required for unhealthy opioid-influenced respiratory patterns to guarantee the ODR's effectiveness in real-world overdose situations.

Effects of Including Gender Pronoun Questions in Surveys.

This research examines whether the mere presence of asking about gender pronouns (e.g., she/her, he/him, they/them, and ze/zir) in a survey enhances participants' attitudes and satisfaction of answering the questions. A large sample (N = 1,511) of heterosexual, cisgender, and LGBTQIA+ participants across the United States (US) were surveyed an online "personality test" (as a deception), with the real purpose of examining whether asking a pronoun question enhanced their perceptions of the survey. Three demographic groups were included: (i) heterosexual-cisgender (n = 503), (ii) gay-cisgender (n = 509), and (iii) genderqueer (trans, non-conforming, other, n = 499). Half of each group were randomly given either a survey that included a gender pronoun question (test) or not (control), and then all rated their perceptions of the survey questions. For participants who identified as heterosexual or gay, no major differences were found between survey conditions. However, participants who identified as genderqueer experienced significant increases of satisfaction, comfort level, and perceived relevance of the questions when given a survey that asked their gender pronouns versus the survey that did not. These findings have implications for any surveys that ask about personal demographics, and suggest that any form of written communication should include clarity about gender pronouns.

A Free Open-Source Bayesian Vancomycin Dosing App for Adults: Design and Evaluation Study.

BACKGROUND: It has been suggested that Bayesian dosing apps can assist in the therapeutic drug monitoring of patients receiving vancomycin. Unfortunately, Bayesian dosing tools are often unaffordable to resource-limited hospitals. Our aim was to improve vancomycin dosing in adults. We created a free and open-source dose adjustment app, VancoCalc, which uses Bayesian inference to aid clinicians in dosing and monitoring of vancomycin. OBJECTIVE: The aim of this paper is to describe the design, development, usability, and evaluation of a free open-source Bayesian vancomycin dosing app, VancoCalc. METHODS: The app build and model fitting process were described. Previously published pharmacokinetic models were used as priors. The ability of the app to predict vancomycin concentrations was performed using a small data set comprising of 52 patients, aged 18 years and over, who received at least 1 dose of intravenous vancomycin and had at least 2 vancomycin concentrations drawn between July 2018 and January 2021 at Lakeridge Health Corporation Ontario, Canada. With these estimated and actual concentrations, median prediction error (bias), median absolute error (accuracy), and root mean square error (precision) were calculated to evaluate the accuracy of the Bayesian estimated pharmacokinetic parameters. RESULTS: A total of 52 unique patients' initial vancomycin concentrations were used to predict subsequent concentration; 104 total vancomycin concentrations were assessed. The median prediction error was -0.600 ug/mL (IQR -3.06, 2.95), the median absolute error was 3.05 ug/mL (IQR 1.44, 4.50), and the root mean square error was 5.34. CONCLUSIONS: We described a free, open-source Bayesian vancomycin dosing calculator based on revisions of currently available calculators. Based on this small retrospective preliminary sample of patients, the app offers reasonable accuracy and bias, which may be used in everyday practice. By offering this free, open-source app, further prospective validation could be implemented in the near future.

A parsimonious model of blood glucose homeostasis.

The mathematical modelling of biological systems has historically followed one of two approaches: comprehensive and minimal. In comprehensive models, the involved biological pathways are modelled independently, then brought together as an ensemble of equations that represents the system being studied, most often in the form of a large system of coupled differential equations. This approach often contains a very large number of tuneable parameters (> 100) where each describes some physical or biochemical subproperty. As a result, such models scale very poorly when assimilation of real world data is needed. Furthermore, condensing model results into simple indicators is challenging, an important difficulty in scenarios where medical diagnosis is required. In this paper, we develop a minimal model of glucose homeostasis with the potential to yield diagnostics for pre-diabetes. We model glucose homeostasis as a closed control system containing a self-feedback mechanism that describes the collective effects of the physiological components involved. The model is analyzed as a planar dynamical system, then tested and verified using data collected with continuous glucose monitors (CGMs) from healthy individuals in four separate studies. We show that, although the model has only a small number (3) of tunable parameters, their distributions are consistent across subjects and studies both for hyperglycemic and for hypoglycemic episodes.

Medication Name Comprehension of Intelligent Virtual Assistants: A Comparison of Amazon Alexa, Google Assistant, and Apple Siri Between 2019 and 2021.

The current study was a replication and comparison of our previous research which examined the comprehension accuracy of popular intelligent virtual assistants, including Amazon Alexa, Google Assistant, and Apple Siri for recognizing the generic and brand names of the top 50 most dispensed medications in the United States. Using the exact same voice recordings from 2019, audio clips of 46 participants were played back to each device in 2021. Google Assistant achieved the highest comprehension accuracy for both brand medication names (86.0%) and generic medication names (84.3%), followed by Apple Siri (brand names = 78.4%, generic names = 75.0%), and the lowest accuracy by Amazon Alexa (brand names 64.2%, generic names = 66.7%). These findings represent the same trend of results as our previous research, but reveal significant increases of ~10-24% in performance for Amazon Alexa and Apple Siri over the past 2 years. This indicates that the artificial intelligence software algorithms have improved to better recognize the speech characteristics of complex medication names, which has important implications for telemedicine and digital healthcare services.

COVID-19 has inspired global healthcare innovation.

Under normal circumstances, healthcare innovation is costly and time-consuming. However, the COVID-19 pandemic has produced the silver lining of inspiring healthcare innovation around the world, with collaboration across multiple disciplines all working toward the same goal of saving lives. Healthcare innovation can develop at unprecedented speed when individuals focus on solving real-world problems, and collaborate with cross-functional teams. Anyone can innovate, from anywhere, at any age, and this open-minded perspective allows innovation to occur at its finest when motivated to find solutions toward a well-defined problem.

The Need for Artificial Intelligence in Digital Therapeutics.

Digital therapeutics is a newly described concept in healthcare which is proposed to change patient behavior and treat medical conditions using a variety of digital technologies. However, the term is rarely defined with criteria that make it distinct from simply digitizedversions of traditional therapeutics. Our objective is to describe a more valuable characteristic of digital therapeutics, which is distinct from traditional medicine or therapy: that is, the utilization of artificial intelligence and machine learning systems to monitor and predict individual patient symptom data in an adaptive clinical feedback loop via digital biomarkers to provide a precision medicine approach to healthcare. Artificial intelligence platforms can learn and predict effective interventions for individuals using a multitude of personal variables to provide a customized and more tailored therapy regimen. Digital therapeutics coupled with artificial intelligence and machine learning also allows more effective clinical observations and management at the population level for various health conditions and cohorts. This vital differentiation of digital therapeutics compared to other forms of therapeutics enables a more personalized form of healthcare that actively adapts to patients' individual clinical needs, goals, and lifestyles. Importantly, these characteristics are what needs to be emphasized to patients, physicians, and policy makers to advance the entire field of digital healthcare.

Homeostasis as a proportional-integral control system.

According to medical guidelines, the distinction between "healthy" and "unhealthy" patients is commonly based on single, discrete values taken at an isolated point in time (e.g., blood pressure or core temperature). Perhaps a more robust and insightful diagnosis can be obtained by studying the functional interdependence of such indicators and the homeostasis that controls them. This requires quasi-continuous measurements and a procedure to map the data onto a parsimonious control model with a degree of universality. The current research illustrates this approach using glucose homeostasis as a target. Data were obtained from 41 healthy subjects wearing over-the-counter glucose monitors, and projected onto a simple proportional-integral (PI) controller, widely used in engineering applications. The indicators quantifying the control function are clustered for the great majority of subjects, while a few outliers exhibit less responsive homeostasis. Practical implications for healthcare and education are further discussed.

Predicting Glycaemia in Type 1 Diabetes Patients: Experiments in Feature Engineering and Data Imputation.

Patients with type 1 diabetes manually regulate blood glucose concentration by adjusting insulin dosage in response to factors such as carbohydrate intake and exercise intensity. Automated near-term prediction of blood glucose concentration is essential to prevent hyper- and hypoglycaemic events in type 1 diabetes patients and to improve control of blood glucose levels by physicians and patients. The imperfect nature of patient monitoring introduces missing values into all variables that play important roles to predict blood glucose level, necessitating data imputation. In this paper, we investigated the importance of variables and explored various feature engineering methods to predict blood glucose level. Next, we extended our work by developing a new empirical imputation method and investigating the predictive accuracy achieved under different methods to impute missing data. Also, we examined the influence of past signal values on the prediction of blood glucose levels. We reported the relative performance of predictive models in different testing scenarios and different imputation methods. Finally, we found an optimal combination of data imputation methods and built an ensemble model for the reliable prediction of blood glucose levels on a 30-minute horizon.

Using mobile virtual reality to enhance medical comprehension and satisfaction in patients and their families.

Patients are typically debriefed by their healthcare provider after any medical procedure or surgery to discuss their findings and any next steps involving medication or treatment instructions. However, without any medical or scientific background knowledge, it can feel overwhelming and esoteric for a patient to listen to a physician describe a complex operation. Instead, providing patients with engaging visuals and a virtual reality (VR) simulation of their individual clinical findings could lead to more effective transfer of medical knowledge and comprehension of treatment information. A newly developed VR technology is described, called HealthVoyager, which is designed to help facilitate this knowledge transfer between physicians and patients. The platform represents a customizable, VR software system utilizing a smartphone or tablet computer to portray personalized surgical or procedural findings as well as representations of normal anatomy. The use of such technology for eliciting medical understanding and patient satisfaction can have many practical and clinical applications for a variety of disease states and patient populations.

Do you understand the words that are comin outta my mouth? Voice assistant comprehension of medication names.

This study investigated the speech recognition abilities of popular voice assistants when being verbally asked about commonly dispensed medications by a variety of participants. Voice recordings of 46 participants (12 of which had a foreign accent in English) were played back to Amazon's Alexa, Google Assistant, and Apple's Siri for the brand- and generic names of the top 50 most dispensed medications in the United States. A repeated measures ANOVA indicated that Google Assistant achieved the highest comprehension accuracy for both brand medication names (M = 91.8%, SD = 4.2) and generic medication names (M = 84.3%, SD = 11.2), followed by Siri (brand names M = 58.5%, SD = 11.2; generic names M = 51.2%, SD = 16.0), and the lowest accuracy by Alexa (brand names M = 54.6%, SD = 10.8; generic names M = 45.5%, SD = 15.4). An interaction between voice assistant and participant accent was also found, demonstrating lower comprehension performance overall for those with a foreign accent using Siri (M = 48.8%, SD = 11.8) and Alexa (M = 41.7%, SD = 12.7), compared to participants without a foreign accent (Siri M = 57.0%, SD = 11.7; Alexa M = 53.0%, SD = 10.9). No significant difference between participant accents were found for Google Assistant. These findings show a substantial performance lead for Google Assistant compared to its voice assistant competitors when comprehending medication names, but there is still room for improvement.