Development of a measurement system for complex oral information transfer in medical consultations.

BACKGROUND: Information exchange between physician and patient is crucial to achieve patient involvement, shared decision making and treatment adherence. No reliable method exists for measuring how much information physicians provide in a complex, unscripted medical conversation, nor how much of this information patients recall. This study aims to fill this gap by developing a measurement system designed to compare complex orally provided information to patient recall. METHODS: The development of the complex information transfer measurement system required nine methodological steps. Core activities were data collection, definition of information units and the first draft of a codebook, refinement through independent coding and consensus, and reliability testing. Videotapes of physician-patient consultations based on a standardized scenario and post-consultation interviews with patients constituted the data. The codebook was developed from verbatim transcriptions of the videotapes. Inter-rater reliability was calculated using a random selection of 10% of the statements in the transcriptions. RESULTS: Thirtyfour transcriptions of visits and interviews were collected. We developed a set of rules for defining a single unit of information, defined detailed criteria for exclusion and inclusion of relevant units of information, and outlined systematic counting procedures. In the refinement phase, we established a system for comparing the information provided by the physician with what the patient recalled. While linguistic and conceptual issues arose during the process, coders still achieved good inter-rater reliability, with intra-class correlation for patient recall: 0.723, and for doctors: 0.761. A full codebook is available as an appendix. CONCLUSIONS: A measurement system specifically aimed at quantifying complex unscripted information exchange may be a useful addition to the tools for evaluating the results of health communication training and randomized controlled trials.

Benefits of a Home Treatment Program Using Guided Imagery Relaxation Based on Audio Recordings for People With Fibromyalgia.

Despite the plethora of treatments available for patients with fibromyalgia, there is insufficient evidence to date as to what the ideal treatment approach is. This study sought to determine the effectiveness of a home program of audio-recorded guided imagery relaxation on people with fibromyalgia. This experimental 8-week longitudinal trial design was undertaken with 60 people diagnosed with fibromyalgia who were randomly assigned to either a guided imagery intervention group or a control group. Pain at tender points, anxiety, self-efficacy, quality of sleep, quality of life, and the impact of the fibromyalgia were determined at baseline, at 4 weeks, and at 8 weeks. After the guided imagery intervention, we found significant differences regarding trait anxiety, sleep quality, and tenderness at some of the tender points. There is a need, therefore, to develop and evaluate interventions that may enhance the quality of life of those affected by this disorder.

The Most Common Feedback Themes in Communication Skills Training in an Internal Medicine Residency Program: Lessons from the Resident Audio-Recording Project.

Individualized structured feedback is an integral part of a resident's learning in communication skills. However, it is not clear what feedback residents receive for their communication skills development in real patient care. We will identify the most common feedback topics given to residents regarding communication skills during Internal Medicine residency training. We analyzed Resident Audio-recording Project feedback data from 2008 to 2013 by using a content analysis approach. Using open coding and an iterative categorization process, we identified 15 emerging themes for both positive and negative feedback. The most recurrent feedback topics were Patient education, Thoroughness, Organization, Questioning strategy, and Management. The residents were guided to improve their communication skills regarding Patient education, Thoroughness, Management, and Holistic exploration of patient's problem. Thoroughness and Communication intelligibility were newly identified themes that were rarely discussed in existing frameworks. Assessment rubrics serve as a lens through which we assess the adequacy of the residents' communication skills. Rather than sticking to a specific rubric, we chose to let the rubric evolve through our experience.

The Role of Primary Care Providers in Encouraging Older Patients to Change Their Lifestyle Behaviors.

OBJECTIVES: This study sought to identify older patients' perceptions of primary care providers' influence on their likelihood of improving diet and physical activity. METHODS: 104 adults ages 65 and older were interviewed immediately following a routine primary care visit about their plans and motivations for behavior change and how their clinic visit would influence their likelihood of making lifestyle changes. All interviews were recorded, transcribed and analyzed using a constant comparison approach. RESULTS: Participants reported that their providers influence their health behaviors by developing strong relationships, addressing concerns and encouraging change, and providing concrete instruction. When providers did not discuss diet or physical activity, or mentioned these topics only briefly, participants often perceived the message that they should continue their current behaviors. CONCLUSIONS: Whether and how diet and physical activity are discussed in primary care influences the likelihood that older adults will make changes in these behaviors. CLINICAL IMPLICATIONS: These findings highlight the need for a patient-centered counseling approach and caution providers to think twice before omitting discussion of the need for lifestyle change.

Standardized Direct Observation Assessment Tool: Using a Training Video.

BACKGROUND: We developed a DVD training tool to educate physicians evaluating emergency residents on accurate Standardized Direct Observation Assessment Tool (SDOT) application. OBJECTIVE: Our goal was to assess whether this training video improved attendings' and senior residents' SDOT use. METHODS: Participants voluntarily completed SDOT evaluations based on a scripted "test" video. A DVD with "positive" and "negative" scenarios of proper SDOT use was viewed. It included education on appropriate recording of 26 behaviors. The test scenario was viewed again and follow-up SDOTs submitted. Performances by attendings and residents on the pre- and post-test SDOTs were compared. RESULTS: Twenty-six attendings and 26 senior residents participated. Prior SDOT experience was noted for 8 attendings and 11 residents. For 20 anchors, participants recorded observed behaviors with statistically significant difference on one each of the pretest (no. 20; p = 0.034) and post-test (no. 14; p = 0.041) SDOTs. On global competency assessments, pretest medical knowledge (p = 0.016) differed significantly between groups. The training intervention changed one anchor (no. 5; p = 0.035) and one global assessment (systems-based practice; p = 0.031) more negatively for residents. Recording SDOTs with exact agreement occurred 48.73% for attendings pretest and 54.41% post-test; resident scores were 45.86% and 49.55%, respectively. DVD exposure slightly raised attending scores (p = 0.289) and significantly lowered resident scores (p = 0.046). CONCLUSIONS: Exposure to an independently developed SDOT training video tended to raise attending scores, though without significance, while at the same time lowered senior resident scores statistically significantly. Emergency attendings' and senior residents' SDOT scoring rarely differed with significance; about half of anchor behaviors were recorded with exact agreement. This suggests senior residents, with appropriate education, may participate in SDOT assessment.

Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D.

BACKGROUND: Little is known about how providers communicate recommendations when scientific uncertainty exists. OBJECTIVES: To compare provider recommendations to those in the scientific literature, with a focus on whether uncertainty was communicated. DESIGN: Qualitative (inductive systematic content analysis) and quantitative analysis of previously collected audio-recorded provider-patient office visits. PARTICIPANTS: Sixty-one providers and a socio-economically diverse convenience sample of 603 of their patients from outpatient community- and academic-based primary care, integrative medicine, and complementary and alternative medicine provider offices in Southern California. MAIN MEASURES: Comparison of provider information-giving about vitamin D to professional guidelines and scientific information for which conflicting recommendations or insufficient scientific evidence exists; certainty with which information was conveyed. RESULTS: Ninety-two (15.3 %) of 603 visit discussions touched upon issues related to vitamin D testing, management and benefits. Vitamin D deficiency screening was discussed with 23 (25 %) patients, the definition of vitamin D deficiency with 21 (22.8 %), the optimal range for vitamin D levels with 26 (28.3 %), vitamin D supplementation dosing with 50 (54.3 %), and benefits of supplementation with 46 (50 %). For each of the professional guidelines/scientific information examined, providers conveyed information that deviated from professional guidelines and the existing scientific evidence. Of 166 statements made about vitamin D in this study, providers conveyed 160 (96.4 %) with certainty, without mention of any equivocal or contradictory evidence in the scientific literature. No uncertainty was mentioned when vitamin D dosing was discussed, even when recommended dosing was higher than guideline recommendations. CONCLUSIONS AND RELEVANCE: Providers convey the vast majority of information and recommendations about vitamin D with certainty, even though the scientific literature contains inconsistent recommendations and declarations of inadequate evidence. Not communicating uncertainty blurs the contrast between evidence-based recommendations and those without evidence. Providers should explore best practices for involving patients in decision-making by acknowledging the uncertainty behind their recommendations.

Promoting consultation recording practice in oncology: identification of critical implementation factors and determination of patient benefit.

OBJECTIVE: The objectives of this implementation study were to (i) address the evidentiary, contextual, and facilitative mechanisms that serve to retard or promote the transfer and uptake of consultation recording use in oncology practice and (ii) follow patients during the first few days following receipt of the consultation recording to document, from the patient's perspective, the benefits realized from listening to the recording. METHODS: Nine medical and nine radiation oncologists from cancer centers in three Canadian cities (Calgary, Vancouver, and Winnipeg) recorded their primary consultations for 228 patients newly diagnosed with breast (n = 174) or prostate cancer (n = 54). The Digital Recording Use Semi-Structured Interview was conducted at 2 days and 1 week postconsultation. Each oncologist was provided a feedback letter summarizing the consultation recording benefits reported by their patients. RESULTS: Sixty-nine percent of patients listened to at least a portion of the recording within the first week following the consultation. Consultation recording favorableness ratings were high: 93.6% rated the intervention between 75 and 100 on a 100-point scale. Four main areas of benefit were reported: (i) anxiety reduction; (ii) enhanced retention of information; (iii) better informed decision making; and (iv) improved communication with family members. Eight fundamental components of successful implementation of consultation recording practice were identified. CONCLUSIONS: Further randomized trials are recommended, using standardized measures of the patient-reported benefit outcomes reported herein, to strengthen the evidence base for consultation recording use in oncology practice.

A primer for doing talk-in-interaction research in Augmentative and Alternative Communication.

The study of talk-in-interaction is focused on how people conduct social interactions in real world situations, in real-time. The purpose of this article is to provide a primer for understanding talk-in-interaction research, conversation analysis and microanalysis in the AAC field. An overview of talk-in-interaction research and a discussion of important issues in the field will be presented, followed by a tutorial on conducting microanalytic investigations in AAC.

[Introduction of a simple audio recording system to the operating room--experience at a small local hospital].

We developed a simple audio recording system using a small personal computer and free audio recording software that makes voice recordings for use in emergencies, particularly for emergency caesarean sections. The system makes a continuous audio recording while the patient receives medical treatment. The recording provides an accurate record of the anesthesia used during treatment. This audio recording system is useful as an auxiliary means of record keeping during medical emergencies.

Voice-quality abnormalities as a sign of dysphagia: validation against acoustic and videofluoroscopic data.

In this study we explored the validity of clinician judgments of voice abnormalities as indicators of penetration-aspiration or other swallowing abnormalities. Voice samples were collected using a high-quality microphone from 40 adults during videofluoroscopy (VFSS), at baseline and following each of four thin liquid swallows. Blinded speech-language pathologists (SLPs) rated the audio recordings for voice quality using the GRBAS scale and the VFSS recordings for abnormal swallow onset, penetration-aspiration, airway closure, and pharyngeal residues. Acoustic measures of % jitter, % shimmer, and signal-to-noise ratio were calculated using two /a/ vowel segments spliced from each voice recording. Preswallow to postswallow measures of voice-quality change were derived and the data were compared to determine the correspondence between perceived voice abnormalities, acoustic voice parameters, and radiographically confirmed swallowing abnormalities. The sensitivity of perceived postswallow changes in voice quality to dysphagia and penetration-aspiration was poor, ranging from 8 to 29%. Specificity was stronger for both penetration-aspiration (75-94%) and dysphagia (59-86%). Acoustic measures of voice quality had moderate sensitivity and specificity for both dysphagia and penetration-aspiration. Overall, perceptual judgments of postswallow wet voice showed the strongest potential for detecting penetration-aspiration (relative risk = 3.24). We conclude that a clear postswallow voice quality provides reasonable evidence that penetration-aspiration and dysphagia are absent. However, observations of abnormal postswallow voice quality can be misleading and are not a valid indication that penetration-aspiration or dysphagia exists.

Construction and characterization of a portable sound booth for onsite voice recording.

The negative effects of environmental noise on sound recordings are recognized in the professional literature. Sound booths and anechoic chambers are examples of controlled acoustical environments widely used in research. However, both enclosures are expensive, require substantial space, and are not portable. Our research has been directed to measuring vocal endurance and voice characteristics of singers before and after sustained voice use. Our desire to acquire high-quality onsite recordings necessitated the development of a portable recording environment. In this article, we report the design, construction, and acoustic characterization of a prototype portable sound box (PSB) to acquire high-quality voice recordings in a controlled, portable acoustical measurement. Simulations were conducted to model the intended use of the PSB by voice users, using two acoustic characterization procedures. The first method showed higher intensity variations by region and depth as frequency changed. For the modified method, intensity response was more uniform and displayed less variation with frequency change. Both methods enabled us to 1) refine the onsite recording procedure, 2) provide insight into potential sources of analysis errors, and 3) develop detailed analysis of frequency intensity response affected by equipment variability. We found that it is possible to construct a PSB for onsite high-quality voice recording.

Automatic recording of individual oestrus vocalisation in group-housed dairy cattle: development of a cattle call monitor.

Oestrus detection remains a problem in the dairy cattle industry. Therefore, automatic detection systems have been developed to detect specific behavioural changes at oestrus. Vocal behaviour has not been considered in such automatic oestrus detection systems in cattle, though the vocalisation rate is known to increase during oestrus. The main challenge in using vocalisation to detect oestrus is correctly identifying the calling individual when animals are moving freely in large groups, as oestrus needs to be detected at an individual level. Therefore, we aimed to automate vocalisation recording and caller identification in group-housed dairy cows. This paper first presents the details of such a system and then presents the results of a pilot study validating its functionality, in which the automatic detection of calls from individual heifers was compared to video-based assessment of these calls by a trained human observer, a technique that has, until now, been considered the 'gold standard'. We developed a collar-based cattle call monitor (CCM) with structure-borne and airborne sound microphones and a recording unit and developed a postprocessing algorithm to identify the caller by matching the information from both microphones. Five group-housed heifers, each in the perioestrus or oestrus period, were equipped with a CCM prototype for 5 days. The recorded audio data were subsequently analysed and compared with audiovisual recordings. Overall, 1404 vocalisations from the focus heifers and 721 vocalisations from group mates were obtained. Vocalisations during collar changes or malfunctions of the CCM were omitted from the evaluation. The results showed that the CCM had a sensitivity of 87% and a specificity of 94%. The negative and positive predictive values were 80% and 96%, respectively. These results show that the detection of individual vocalisations and the correct identification of callers are possible, even in freely moving group-housed cattle. The results are promising for the future use of vocalisation in automatic oestrus detection systems.

Spontaneous trigger words associated with confirmed out-of-hospital cardiac arrest: a descriptive pilot study of emergency calls.

BACKGROUND: According to the International Liaison Committee on Resuscitation (ILCOR), the trigger words used by callers that are associated with cardiac arrest constitute a scientific knowledge gap. This study was designed to find hypothetical trigger words in emergency calls in order to improve the specificity of out-of-hospital cardiac arrest recognition. METHODS: In this descriptive pilot study conducted in a Finnish hospital district, linguistic contents of 80 emergency calls of dispatcher-suspected or EMS-encountered out-of-hospital cardiac arrests between January 1, 2017 and May 31, 2017 were analysed. Spontaneous trigger words used by callers were transcribed and grouped into 36 categories. The association between the spontaneous trigger words and confirmed true cardiac arrests was tested with logistic regression. RESULTS: Of the suspected cardiac arrests, 51 (64%) were confirmed as true cardiac arrests when ambulance personnel met the patient. A total of 291 spontaneous trigger words were analysed. 'Is not breathing' (n = 9 [18%] in the true cardiac arrest group vs n = 1 [3%] in the non-cardiac arrest group, odds ratio [OR] 6.00, 95% confidence interval [CI] 0.72-50.0), 'the patient is blue' (n = 9 [18%] vs n = 1 [3%], OR 6.00, 95% CI 0.72-50.0), 'collapsed or fallen down' (n = 12 [24%] vs n = 2 [7%], OR 4.15, 95% CI 0.86-20.1) and 'is wheezing' (n = 17 [33%] vs n = 5 [17%], OR 2.40, 95% CI 0.78-7.40) were frequently used to describe true cardiac arrest. 'Is snoring' was associated with a false suspicion of cardiac arrest (n = 1 [2%] vs n = 6 [21%], OR 0.08, 95% CI 0.009-0.67). CONCLUSIONS: In our pilot study, no trigger word was associated with confirmed cardiac arrest. 'Is wheezing' was a frequently used spontaneous trigger word among later confirmed cardiac arrest victims.

Automatic Assessment of Cognitive Tests for Differentiating Mild Cognitive Impairment: A Proof of Concept Study of the Digit Span Task.

BACKGROUND: Current conventional cognitive assessments are limited in their efficiency and sensitivity, often relying on a single score such as the total correct items. Typically, multiple features of response go uncaptured. OBJECTIVES: We aim to explore a new set of automatically derived features from the Digit Span (DS) task that address some of the drawbacks in the conventional scoring and are also useful for distinguishing subjects with Mild Cognitive Impairment (MCI) from those with intact cognition. METHODS: Audio-recordings of the DS tests administered to 85 subjects (22 MCI and 63 healthy controls, mean age 90.2 years) were transcribed using an Automatic Speech Recognition (ASR) system. Next, five correctness measures were generated from Levenshtein distance analysis of responses: number correct, incorrect, deleted, inserted, and substituted words compared to the test item. These per-item features were aggregated across all test items for both Forward Digit Span (FDS) and Backward Digit Span (BDS) tasks using summary statistical functions, constructing a global feature vector representing the detailed assessment of each subject's response. A support vector machine classifier distinguished MCI from cognitively intact participants. RESULTS: Conventional DS scores did not differentiate MCI participants from controls. The automated multi-feature DS-derived metric achieved 73% on AUC-ROC of the SVM classifier, independent of additional clinical features (77% when combined with demographic features of subjects); well above chance, 50%. CONCLUSION: Our analysis verifies the effectiveness of introduced measures, solely derived from the DS task, in the context of differentiating subjects with MCI from those with intact cognition.

Evaluation of a Patient-Collected Audio Audit and Feedback Quality Improvement Program on Clinician Attention to Patient Life Context and Health Care Costs in the Veterans Affairs Health Care System.

Importance: Evidence-based care plans can fail when they do not consider relevant patient life circumstances, termed contextual factors, such as a loss of social support or financial hardship. Preventing these contextual errors can reduce obstacles to effective care. Objective: To evaluate the effectiveness of a quality improvement program in which clinicians receive ongoing feedback on their attention to patient contextual factors. Design, Setting, and Participants: In this quality improvement study, patients at 6 Department of Veterans Affairs outpatient facilities audio recorded their primary care visits from May 2017 to May 2019. Encounters were analyzed using the Content Coding for Contextualization of Care (4C) method. A feedback intervention based on the 4C coded analysis was introduced using a stepped wedge design. In the 4C coding schema, clues that patients are struggling with contextual factors are termed contextual red flags (eg, sudden loss of control of a chronic condition), and a positive outcome is prospectively defined for each encounter as a quantifiable improvement of the contextual red flag. Data analysis was performed from May to October 2019. Interventions: Clinicians received feedback at 2 intensity levels on their attention to patient contextual factors and on predefined patient outcomes at 4 to 6 months. Main Outcomes and Measures: Contextual error rates, patient outcomes, and hospitalization rates and costs were measured. Results: The patients (mean age, 62.0 years; 92% male) recorded 4496 encounters with 666 clinicians. At baseline, clinicians addressed 413 of 618 contextual factors in their care plans (67%). After either standard or enhanced feedback, they addressed 1707 of 2367 contextual factors (72%), a significant difference (odds ratio, 1.3; 95% CI, 1.1-1.6; P = .01). In a mixed-effects logistic regression model, contextualized care planning was associated with a greater likelihood of improved outcomes (adjusted odds ratio, 2.5; 95% CI, 1.5-4.1; P < .001). In a budget analysis, estimated savings from avoided hospitalizations were $25.2 million (95% CI, $23.9-$26.6 million), at a cost of $337 242 for the intervention. Conclusions and Relevance: These findings suggest that patient-collected audio recordings of the medical encounter with feedback may enhance clinician attention to contextual factors, improve outcomes, and reduce hospitalizations. In addition, the intervention is associated with substantial cost savings.

The short-term effects of recorded ocean sound with and without alpha frequency binaural beats on tinnitus perception.

BACKGROUND: The dichotic presentation of two auditory stimuli with a small frequency difference in each ear produces the perception of a third, fused auditory image called a binaural beat. Neural activity has been found to synchronize with these perceived beats. It is for this reason that binaural beats are often used in an attempt to induce certain psychological states that are associated with particular cortical rhythms. The aim of this proof-of-concept study was to explore the short-term effects of a binaural beat on tinnitus, to ascertain if further trials are justified. METHOD: Twenty adults with constant tinnitus and symmetrical hearing underwent audiological assessment and psychophysical measures of tinnitus. Participants were presented with two auditory stimuli: ocean waves with and without alpha frequency (8 Hz) binaural beats. Arousal and tinnitus perception were measured prior to and following each sound stimuli using the Perceived Arousal Scale and tinnitus rating scales. RESULTS: Small improvements in tinnitus rating scores occurred with sound. Some individuals showed more improvement with the binaural beats than ocean waves alone. CONCLUSION: The addition of binaural beats at 8 Hz to an ocean sound showed no significant group benefits above the ocean sound alone.

Prospective randomised clinical trial of providing patients with audiotape recordings of their oesophagogastric cancer consultations.

OBJECTIVE: To evaluate audiotape-recorded consultations at which a new diagnosis of oesophageal or gastric cancer was given to patients with reference to information retention, psychological outcome and socio-economic deprivation. METHODS: Fifty-eight patients were randomised to receive audiotaped consultations or not. Thirty-one patients received tapes (12 oesophageal and 19 gastric cancers) and were compared with 27 control patients (12 oesophageal and 15 gastric cancers). All patients were re-interviewed and completed a hospital anxiety and depression (HAD) questionnaire. Socio-economic deprivation scores were calculated using National Indices of Multiple Deprivation. RESULTS: Patients randomised to receive tapes were more likely to retain information (31 patients) than control patients (18 patients, p=0.001). Median (range) HAD scores were similar in both groups of patients [HAD A tape 6 (0-21) vs. no tape 5 (2-14), HAD D tape 3 (0-23) vs. 4 (0-10), respectively]. Deprivation correlated significantly with higher HAD A scores in control patients (p=0.039) but was not associated with information retention (p=0.667). CONCLUSION: Taped consultations were associated with significantly better information retention without adverse psychological outcomes. Providing an audiotape may reduce the effect of socio-economic deprivation on patient anxiety. PRACTICE IMPLICATIONS: Audiotaping, or its equivalent, would be a valuable tool in the multidisciplinary approach to cancers of the upper gastrointestinal tract.

Healthy preterm infant responses to taped maternal voice.

This study was a repeated measures design, examining behavioral and physiologic responses of premature infants to taped maternal voice. Fourteen stable, premature infants, 31 to 34 weeks' gestation and serving as their own controls, were monitored and videotaped 4 times each day for 3 consecutive days during the first week of their life. There were no significant differences found in heart rate or oxygen saturation between study conditions. Behavioral data revealed less motor activity and more wakefulness, while hearing the maternal tape, suggesting some influence on infant state regulation. Attending behaviors were significantly greater, with more eye brightening and facial tone. Minimal distress was seen throughout the study, as indicated by stable heart rate and oxygen saturation and by the absence of behaviors such as jitteriness, loss of tone, or loss of color. The results of this preliminary study suggest that premature infants are capable of attending to tape recordings of their mother's voice.

Challenging stereotyping and bias: a voice simulation study.

Stigma is a barrier to mental health care access for patients with schizophrenia and can interfere with developing therapeutic relationships. This study demonstrates success of a voice simulation experience during orientation in changing the biases of nursing students and the effect on the development of the nurse-patient relationship. Ninety-four individuals participated; 52 received a voice simulation experience during orientation, and 42 received orientation with no voice simulation experience. The Medical Condition Regard Scale was administered before and after orientation. Posttest paired t test results show significant differences in attitudes toward patients with voice hearing experiences between the two groups. The themes of personal growth from the focus groups postorientation include Affective Experience, Physical Experience, and Empathy. Findings demonstrate that the orientation process should include methods to challenge stereotyping and bias to decrease stigma, improve service access, and enhance the ability to develop therapeutic relationships.

Computational Analysis of Neonatal Mouse Ultrasonic Vocalization.

Neonatal vocalization is structurally altered in mouse models of autism spectrum disorder (ASD). Our published data showed that pup vocalization, under conditions of maternal separation, contains sequences whose alterations in a genetic mouse model of ASD impair social communication between pups and mothers. We describe details of a method which reveals the statistical structure of call sequences that are functionally critical for optimal maternal care. Entropy analysis determines the degree of non-random call sequencing. A Markov model determines the actual call sequences used by pups. Sparse partial least squares discriminant analysis (sPLS-DA) identifies call sequences that differentiate groups and reveals the degrees of individual variability in call sequences between groups. These three sets of analyses can be used to identify the otherwise hidden call structure that is altered in mouse models of developmental neuropsychiatric disorders, including not only autism but also schizophrenia. © 2018 by John Wiley & Sons, Inc.