Using AI to measure Parkinson's disease severity at home.

We present an artificial intelligence (AI) system to remotely assess the motor performance of individuals with Parkinson's disease (PD). In our study, 250 global participants performed a standardized motor task involving finger-tapping in front of a webcam. To establish the severity of Parkinsonian symptoms based on the finger-tapping task, three expert neurologists independently rated the recorded videos on a scale of 0-4, following the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The inter-rater reliability was excellent, with an intra-class correlation coefficient (ICC) of 0.88. We developed computer algorithms to obtain objective measurements that align with the MDS-UPDRS guideline and are strongly correlated with the neurologists' ratings. Our machine learning model trained on these measures outperformed two MDS-UPDRS certified raters, with a mean absolute error (MAE) of 0.58 points compared to the raters' average MAE of 0.83 points. However, the model performed slightly worse than the expert neurologists (0.53 MAE). The methodology can be replicated for similar motor tasks, providing the possibility of evaluating individuals with PD and other movement disorders remotely, objectively, and in areas with limited access to neurological care.

Novel idea generation in social networks is optimized by exposure to a "Goldilocks" level of idea-variability.

Recent works suggest that striking a balance between maximizing idea stimulation and minimizing idea redundancy can elevate novel idea generation performances in self-organizing social networks. We explore whether dispersing the visibility of high-performing idea generators can help achieve such a trade-off. We employ popularity signals (follower counts) of participants as an external source of variation in network structures, which we control across four conditions in a randomized setting. We observe that popularity signals influence inspiration-seeking ties, partly by biasing people's perception of their peers' novel idea-generation performances. Networks that partially disperse the top ideators' visibility using this external signal show reduced idea redundancy and elevated idea-generation performances. However, extreme dispersal leads to inferior performances by narrowing the range of idea stimulation. Our work holds future-of-work implications for elevating idea generation performances of people.

Detecting Parkinson Disease Using a Web-Based Speech Task: Observational Study.

BACKGROUND: Access to neurological care for Parkinson disease (PD) is a rare privilege for millions of people worldwide, especially in resource-limited countries. In 2013, there were just 1200 neurologists in India for a population of 1.3 billion people; in Africa, the average population per neurologist exceeds 3.3 million people. In contrast, 60,000 people receive a diagnosis of PD every year in the United States alone, and similar patterns of rising PD cases-fueled mostly by environmental pollution and an aging population-can be seen worldwide. The current projection of more than 12 million patients with PD worldwide by 2040 is only part of the picture given that more than 20% of patients with PD remain undiagnosed. Timely diagnosis and frequent assessment are key to ensure timely and appropriate medical intervention, thus improving the quality of life of patients with PD. OBJECTIVE: In this paper, we propose a web-based framework that can help anyone anywhere around the world record a short speech task and analyze the recorded data to screen for PD. METHODS: We collected data from 726 unique participants (PD: 262/726, 36.1% were women; non-PD: 464/726, 63.9% were women; average age 61 years) from all over the United States and beyond. A small portion of the data (approximately 54/726, 7.4%) was collected in a laboratory setting to compare the performance of the models trained with noisy home environment data against high-quality laboratory-environment data. The participants were instructed to utter a popular pangram containing all the letters in the English alphabet, "the quick brown fox jumps over the lazy dog." We extracted both standard acoustic features (mel-frequency cepstral coefficients and jitter and shimmer variants) and deep learning-based embedding features from the speech data. Using these features, we trained several machine learning algorithms. We also applied model interpretation techniques such as Shapley additive explanations to ascertain the importance of each feature in determining the model's output. RESULTS: We achieved an area under the curve of 0.753 for determining the presence of self-reported PD by modeling the standard acoustic features through the XGBoost-a gradient-boosted decision tree model. Further analysis revealed that the widely used mel-frequency cepstral coefficient features and a subset of previously validated dysphonia features designed for detecting PD from a verbal phonation task (pronouncing "ahh") influence the model's decision the most. CONCLUSIONS: Our model performed equally well on data collected in a controlled laboratory environment and in the wild across different gender and age groups. Using this tool, we can collect data from almost anyone anywhere with an audio-enabled device and help the participants screen for PD remotely, contributing to equity and access in neurological care.

Facial expressions can detect Parkinson's disease: preliminary evidence from videos collected online.

A prevalent symptom of Parkinson's disease (PD) is hypomimia - reduced facial expressions. In this paper, we present a method for diagnosing PD that utilizes the study of micro-expressions. We analyzed the facial action units (AU) from 1812 videos of 604 individuals (61 with PD and 543 without PD, with a mean age 63.9 y/o, sd. 7.8) collected online through a web-based tool ( www.parktest.net ). In these videos, participants were asked to make three facial expressions (a smiling, disgusted, and surprised face) followed by a neutral face. Using techniques from computer vision and machine learning, we objectively measured the variance of the facial muscle movements and used it to distinguish between individuals with and without PD. The prediction accuracy using the facial micro-expressions was comparable to methodologies that utilize motor symptoms. Logistic regression analysis revealed that participants with PD had less variance in AU6 (cheek raiser), AU12 (lip corner puller), and AU4 (brow lowerer) than non-PD individuals. An automated classifier using Support Vector Machine was trained on the variances and achieved 95.6% accuracy. Using facial expressions as a future digital biomarker for PD could be potentially transformative for patients in need of remote diagnoses due to physical separation (e.g., due to COVID) or immobility.

A patient-centered digital scribe for automatic medical documentation.

OBJECTIVE: We developed a digital scribe for automatic medical documentation by utilizing elements of patient-centered communication. Excessive time spent on medical documentation may contribute to physician burnout. Patient-centered communication may improve patient satisfaction, reduce malpractice rates, and decrease diagnostic testing expenses. We demonstrate that patient-centered communication may allow providers to simultaneously talk to patients and efficiently document relevant information. MATERIALS AND METHODS: We utilized two elements of patient-centered communication to document patient history. One element was summarizing, which involved providers recapping information to confirm an accurate understanding of the patient. Another element was signposting, which involved providers using transition questions and statements to guide the conversation. We also utilized text classification to allow providers to simultaneously perform and document the physical exam. We conducted a proof-of-concept study by simulating patient encounters with two medical students. RESULTS: For history sections, the digital scribe was about 2.7 times faster than both typing and dictation. For physical exam sections, the digital scribe was about 2.17 times faster than typing and about 3.12 times faster than dictation. Results also suggested that providers required minimal training to use the digital scribe, and that they improved at using the system to document history sections. CONCLUSION: Compared to typing and dictation, a patient-centered digital scribe may facilitate effective patient communication. It may also be more reliable compared to previous approaches that solely use machine learning. We conclude that a patient-centered digital scribe may be an effective tool for automatic medical documentation.

Cues to gender and racial identity reduce creativity in diverse social networks.

The characteristics of social partners have long been hypothesized as influential in guiding group interactions. Understanding how demographic cues impact networks of creative collaborators is critical for elevating creative performances therein. We conducted a randomized experiment to investigate how the knowledge of peers' gender and racial identities distorts people's connection patterns and the resulting creative outcomes in a dynamic social network. Consistent with prior work, we found that creative inspiration links are primarily formed with top idea-generators. However, when gender and racial identities are known, not only is there (1) an increase of [Formula: see text] in the odds of same-gender connections to persist (but not for same-race connections), but (2) the semantic similarity of idea-sets stimulated by these connections also increase significantly compared to demography-agnostic networks, negatively impacting the outcomes of divergent creativity. We found that ideas tend to be significantly more homogeneous within demographic groups than between, taking away diversity-bonuses from similarity-based links and partly explaining the results. These insights can inform intelligent interventions to enhance network-wide creative performances.

Video-Based Analyses of Parkinson's Disease Severity: A Brief Review.

Remote and objective assessment of the motor symptoms of Parkinson's disease is an area of great interest particularly since the COVID-19 crisis emerged. In this paper, we focus on a) the challenges of assessing motor severity via videos and b) the use of emerging video-based Artificial Intelligence (AI)/Machine Learning techniques to quantitate human movement and its potential utility in assessing motor severity in patients with Parkinson's disease. While we conclude that video-based assessment may be an accessible and useful way of monitoring motor severity of Parkinson's disease, the potential of video-based AI to diagnose and quantify disease severity in the clinical context is dependent on research with large, diverse samples, and further validation using carefully considered performance standards.

Aging and Engaging: A Pilot Randomized Controlled Trial of an Online Conversational Skills Coach for Older Adults.

OBJECTIVE: Communication difficulties negatively impact relationship quality and are associated with social isolation and loneliness in later life. There is a need for accessible communication interventions offered outside specialty mental health settings. DESIGN: Pilot randomized controlled trial. SETTING: Assessments in the laboratory and intervention completed in-home. PARTICIPANTS: Twenty adults age 60 and older from the community and a geriatric psychiatry clinic. INTERVENTION: A web-based communication coach that provides automated feedback on eye contact, facial expressivity, speaking volume, and negative content (Aging and Engaging Program, AEP), delivered with minimal assistance in the home (eight brief sessions over 4-6 weeks) or control (education and videos on communication). MEASUREMENTS: System Usability Scale and Social Skills Performance Assessment, an observer-rated assessment of social communication elicited through standardized role-plays. RESULTS: Ninety percent of participants completed all AEP sessions and the System Usability Scale score of 68 was above the cut-off for acceptable usability. Participants randomized to AEP demonstrated statistically and clinically significant improvement in eye contact and facial expressivity. CONCLUSION: The AEP is acceptable and feasible for older adults with communication difficulties to complete at home and may improve eye contact and facial expressivity, warranting a larger RCT to confirm efficacy and explore potential applications to other populations, including individuals with autism and social anxiety.

The Relationships of Deteriorating Depression and Anxiety With Longitudinal Behavioral Changes in Google and YouTube Use During COVID-19: Observational Study.

BACKGROUND: Depression and anxiety disorders among the global population have worsened during the COVID-19 pandemic. Yet, current methods for screening these two issues rely on in-person interviews, which can be expensive, time-consuming, and blocked by social stigma and quarantines. Meanwhile, how individuals engage with online platforms such as Google Search and YouTube has undergone drastic shifts due to COVID-19 and subsequent lockdowns. Such ubiquitous daily behaviors on online platforms have the potential to capture and correlate with clinically alarming deteriorations in depression and anxiety profiles of users in a noninvasive manner. OBJECTIVE: The goal of this study is to examine, among college students in the United States, the relationships of deteriorating depression and anxiety conditions with the changes in user behaviors when engaging with Google Search and YouTube during COVID-19. METHODS: This study recruited a cohort of undergraduate students (N=49) from a US college campus during January 2020 (prior to the pandemic) and measured the anxiety and depression levels of each participant. The anxiety level was assessed via the General Anxiety Disorder-7 (GAD-7). The depression level was assessed via the Patient Health Questionnaire-9 (PHQ-9). This study followed up with the same cohort during May 2020 (during the pandemic), and the anxiety and depression levels were assessed again. The longitudinal Google Search and YouTube history data of all participants were anonymized and collected. From individual-level Google Search and YouTube histories, we developed 5 features that can quantify shifts in online behaviors during the pandemic. We then assessed the correlations of deteriorating depression and anxiety profiles with each of these features. We finally demonstrated the feasibility of using the proposed features to build predictive machine learning models. RESULTS: Of the 49 participants, 49% (n=24) of them reported an increase in the PHQ-9 depression scores; 53% (n=26) of them reported an increase in the GAD-7 anxiety scores. The results showed that a number of online behavior features were significantly correlated with deteriorations in the PHQ-9 scores (r ranging between -0.37 and 0.75, all P values less than or equal to .03) and the GAD-7 scores (r ranging between -0.47 and 0.74, all P values less than or equal to .03). Simple machine learning models were shown to be useful in predicting the change in anxiety and depression scores (mean squared error ranging between 2.37 and 4.22, R2 ranging between 0.68 and 0.84) with the proposed features. CONCLUSIONS: The results suggested that deteriorating depression and anxiety conditions have strong correlations with behavioral changes in Google Search and YouTube use during the COVID-19 pandemic. Though further studies are required, our results demonstrate the feasibility of using pervasive online data to establish noninvasive surveillance systems for mental health conditions that bypasses many disadvantages of existing screening methods.

Creativity in temporal social networks: how divergent thinking is impacted by one's choice of peers.

Creativity is viewed as one of the most important skills in the context of future-of-work. In this paper, we explore how the dynamic (self-organizing) nature of social networks impacts the fostering of creative ideas. We run six trials (N = 288) of a web-based experiment involving divergent ideation tasks. We find that network connections gradually adapt to individual creative performances, as the participants predominantly seek to follow high-performing peers for creative inspirations. We unearth both opportunities and bottlenecks afforded by such self-organization. While exposure to high-performing peers is associated with better creative performances of the followers, we see a counter-effect that choosing to follow the same peers introduces semantic similarities in the followers' ideas. We formulate an agent-based simulation model to capture these intuitions in a tractable manner, and experiment with corner cases of various simulation parameters to assess the generality of the findings. Our findings may help design large-scale interventions to improve the creative aptitude of people interacting in a social network.

Using artificial intelligence to analyse and teach communication in healthcare.

Communication is a core component of effective healthcare that impacts many patient and doctor outcomes, yet is complex and challenging to both analyse and teach. Human-based coding and audit systems are time-intensive and costly; thus, there is considerable interest in the application of artificial intelligence to this topic, through machine learning using both supervised and unsupervised learning algorithms. In this article we introduce health communication, its importance for patient and health professional outcomes, and the need for rigorous empirical data to support this field. We then discuss historical interaction coding systems and recent developments in applying artificial intelligence (AI) to automate such coding in the health setting. Finally, we discuss available evidence for the reliability and validity of AI coding, application of AI in training and audit of communication, as well as limitations and future directions in this field. In summary, recent advances in machine learning have allowed accurate textual transcription, and analysis of prosody, pauses, energy, intonation, emotion and communication style. Studies have established moderate to good reliability of machine learning algorithms, comparable with human coding (or better), and have identified some expected and unexpected associations between communication variables and patient satisfaction. Finally, application of artificial intelligence to communication skills training has been attempted, to provide audit and feedback, and through the use of avatars. This looks promising to provide confidential and easily accessible training, but may be best used as an adjunct to human-based training.

Integrating Multimodal Information in Large Pretrained Transformers.

Recent Transformer-based contextual word representations, including BERT and XLNet, have shown state-of-the-art performance in multiple disciplines within NLP. Fine-tuning the trained contextual models on task-specific datasets has been the key to achieving superior performance downstream. While fine-tuning these pre-trained models is straight-forward for lexical applications (applications with only language modality), it is not trivial for multimodal language (a growing area in NLP focused on modeling face-to-face communication). Pre-trained models don't have the necessary components to accept two extra modalities of vision and acoustic. In this paper, we proposed an attachment to BERT and XLNet called Multimodal Adaptation Gate (MAG). MAG allows BERT and XLNet to accept multimodal nonverbal data during fine-tuning. It does so by generating a shift to internal representation of BERT and XLNet; a shift that is conditioned on the visual and acoustic modalities. In our experiments, we study the commonly used CMU-MOSI and CMU-MOSEI datasets for multimodal sentiment analysis. Fine-tuning MAG-BERT and MAG-XLNet significantly boosts the sentiment analysis performance over previous baselines as well as language-only fine-tuning of BERT and XLNet. On the CMU-MOSI dataset, MAG-XLNet achieves human-level multimodal sentiment analysis performance for the first time in the NLP community.