Application of a Comprehensive Evaluation Framework to COVID-19 Studies: Systematic Review of Translational Aspects of Artificial Intelligence in Health Care.

Background: Despite immense progress in artificial intelligence (AI) models, there has been limited deployment in health care environments. The gap between potential and actual AI applications is likely due to the lack of translatability between controlled research environments (where these models are developed) and clinical environments for which the AI tools are ultimately intended. Objective: We previously developed the Translational Evaluation of Healthcare AI (TEHAI) framework to assess the translational value of AI models and to support successful transition to health care environments. In this study, we applied the TEHAI framework to the COVID-19 literature in order to assess how well translational topics are covered. Methods: A systematic literature search for COVID-19 AI studies published between December 2019 and December 2020 resulted in 3830 records. A subset of 102 (2.7%) papers that passed the inclusion criteria was sampled for full review. The papers were assessed for translational value and descriptive data collected by 9 reviewers (each study was assessed by 2 reviewers). Evaluation scores and extracted data were compared by a third reviewer for resolution of discrepancies. The review process was conducted on the Covidence software platform. Results: We observed a significant trend for studies to attain high scores for technical capability but low scores for the areas essential for clinical translatability. Specific questions regarding external model validation, safety, nonmaleficence, and service adoption received failed scores in most studies. Conclusions: Using TEHAI, we identified notable gaps in how well translational topics of AI models are covered in the COVID-19 clinical sphere. These gaps in areas crucial for clinical translatability could, and should, be considered already at the model development stage to increase translatability into real COVID-19 health care environments.

Community Choir Improves Vocal Production Measures in Individuals Living with Parkinson's Disease.

OBJECTIVES: Parkinson's disease (PD) is a neurodegenerative disease leading to motor impairments and dystonia across diverse muscle groups including vocal muscles. The vocal production challenges associated with PD have received considerably less research attention than the primary gross motor symptoms of the disease despite having a substantial effect on quality of life. Increasingly, people living with PD are discovering group singing as an asset-based approach to community building that is purported to strengthen vocal muscles and improve vocal quality. STUDY DESIGN/METHODS: The present study investigated the impact of community choir on vocal production in people living with PD across two sites. Prior to and immediately following a 12-week community choir at each site, vocal testing included a range of vocal-acoustic measures, including lowest and highest achievable pitch, duration of phonation, loudness, jitter, and shimmer. RESULTS: Results showed that group singing significantly improved some, though not all, measures of vocal production. Group singing improved lowest pitch (both groups), duration (both groups), intensity (one group), and jitter (one group) and shimmer (both groups). CONCLUSIONS: These findings support community choir as a feasible and scalable complementary approach to managing vocal production challenges associated with PD.

Cognitive Behavioral Therapy for Prodromal Stage of Psychosis-Outcomes for Transition, Functioning, Distress, and Quality of Life: A Systematic Review and Meta-analysis.

OBJECTIVE: This study aimed to provide insight into the efficacy of cognitive-behavioral therapy for psychosis (CBTp) in patients with "clinical high risk of psychosis (CHR-P)". METHODS: Major scientific databases were searched up to April 17, 2020. Randomized controlled trials in CHR-P individuals, comparing CBTp with needs-based interventions (NBI, including treatment as usual or nonspecific control treatment) were included, following PRISMA guidelines. The primary outcome (efficacy) was transition to psychosis by 6 months, 12 months, 24 months, and over 24 months. Secondary outcomes were change in attenuated psychotic symptoms, depression, distress, improvements in functioning, and quality of life. RESULTS: Ten randomized controlled studies met inclusion criteria. The comparisons included 1128 participants. CBTp was significantly more efficacious in reducing rate of transition to psychosis by 6 months (after post-hoc sensitivity analysis) (relative risk [RR] = 0.44, 95% confidence interval [CI]: 0.26, 0.73), 12 months (RR = 0.44, 95% CI: 0.30, 0.64), 12 months (RR = 0.46, 95%CI: 0.30, 0.69), and over 24 months (RR = 0.58, 95% CI: 0.35, 0.95) after treatment, compared with those receiving NBI. CBTp was also associated with more reduced attenuated psychotic symptoms by 12 months (SMD = -0.17, 95% CI: -0.33, -0.02) and by 24 months (SMD = -0.24, 95% CI: -0.43, -0.06). No beneficial effects on functioning, depression, quality of life, or distress were observed favoring CBTp. CONCLUSIONS: CBTp is effective in reducing both psychosis transition rates and attenuated psychotic symptoms for the prodromal stage of psychosis. It is a promising intervention at the preventative stage.

Open dialogue in the UK: qualitative study.

BACKGROUND: Open dialogue is an integrative approach to the organisation of specialist mental health services and therapeutic meetings.AimsThis qualitative study sought to explore service users' and clinicians' experiences of network meetings during the implementation of open dialogue in a modified version, for a UK-based mental health service. METHOD: In total 19 participants were interviewed (8 service users and 11 clinicians) and an inductive thematic analysis of the data was conducted. RESULTS: Four dominant themes were identified: (1) open dialogue delivery, (2) the impact of open dialogue principles; (3) intense interactions and enhanced communication, and (4) organisational challenges. Clinicians considered open dialogue as a preferred, but challenging way of working, while being therapeutic. The data indicated that service users' experiences of network meetings were mixed. There was a wide variety of service user views as to what the purpose of a network meeting was and for some witnessing reflective conversations felt strange. However, the majority described feeling listened to and understood, excluding one service user who described their experience as distressing. Clinicians expressed an authentic self in their interactions with service users and both service users and clinicians described network meetings as emotionally expressive, although this was described as overwhelming at times. CONCLUSIONS: The results of this thematic analysis indicate that service users' and clinicians' experiences of open dialogue warrant further investigation. The intensity of interactions in network meetings should be carefully considered with service users before gaining consent to commence treatment. Implementation of open dialogue should be monitored to assess clinician- and service-level adherence to the principles of the approach.Declaration of interestNone.

Body sway reflects joint emotional expression in music ensemble performance.

Joint action is essential in daily life, as humans often must coordinate with others to accomplish shared goals. Previous studies have mainly focused on sensorimotor aspects of joint action, with measurements reflecting event-to-event precision of interpersonal sensorimotor coordination (e.g., tapping). However, while emotional factors are often closely tied to joint actions, they are rarely studied, as event-to-event measurements are insufficient to capture higher-order aspects of joint action such as emotional expression. To quantify joint emotional expression, we used motion capture to simultaneously measure the body sway of each musician in a trio (piano, violin, cello) during performances. Excerpts were performed with or without emotional expression. Granger causality was used to analyze body sway movement time series amongst musicians, which reflects information flow. Results showed that the total Granger-coupling of body sway in the ensemble was higher when performing pieces with emotional expression than without. Granger-coupling further correlated with the emotional intensity as rated by both the ensemble members themselves and by musician judges, based on the audio recordings alone. Together, our findings suggest that Granger-coupling of co-actors' body sways reflects joint emotional expression in a music ensemble, and thus provide a novel approach to studying joint emotional expression.

The Ryerson Audio-Visual Database of Emotional Speech and Song (RAVDESS): A dynamic, multimodal set of facial and vocal expressions in North American English.

The RAVDESS is a validated multimodal database of emotional speech and song. The database is gender balanced consisting of 24 professional actors, vocalizing lexically-matched statements in a neutral North American accent. Speech includes calm, happy, sad, angry, fearful, surprise, and disgust expressions, and song contains calm, happy, sad, angry, and fearful emotions. Each expression is produced at two levels of emotional intensity, with an additional neutral expression. All conditions are available in face-and-voice, face-only, and voice-only formats. The set of 7356 recordings were each rated 10 times on emotional validity, intensity, and genuineness. Ratings were provided by 247 individuals who were characteristic of untrained research participants from North America. A further set of 72 participants provided test-retest data. High levels of emotional validity and test-retest intrarater reliability were reported. Corrected accuracy and composite "goodness" measures are presented to assist researchers in the selection of stimuli. All recordings are made freely available under a Creative Commons license and can be downloaded at https://doi.org/10.5281/zenodo.1188976.

How Live Music Moves Us: Head Movement Differences in Audiences to Live Versus Recorded Music.

A live music concert is a pleasurable social event that is among the most visceral and memorable forms of musical engagement. But what inspires listeners to attend concerts, sometimes at great expense, when they could listen to recordings at home? An iconic aspect of popular concerts is engaging with other audience members through moving to the music. Head movements, in particular, reflect emotion and have social consequences when experienced with others. Previous studies have explored the affiliative social engagement experienced among people moving together to music. But live concerts have other features that might also be important, such as that during a live performance the music unfolds in a unique and not predetermined way, potentially increasing anticipation and feelings of involvement for the audience. Being in the same space as the musicians might also be exciting. Here we controlled for simply being in an audience to examine whether factors inherent to live performance contribute to the concert experience. We used motion capture to compare head movement responses at a live album release concert featuring Canadian rock star Ian Fletcher Thornley, and at a concert without the performers where the same songs were played from the recorded album. We also examined effects of a prior connection with the performers by comparing fans and neutral-listeners, while controlling for familiarity with the songs, as the album had not yet been released. Head movements were faster during the live concert than the album-playback concert. Self-reported fans moved faster and exhibited greater levels of rhythmic entrainment than neutral-listeners. These results indicate that live music engages listeners to a greater extent than pre-recorded music and that a pre-existing admiration for the performers also leads to higher engagement.

Body sway reflects leadership in joint music performance.

The cultural and technological achievements of the human species depend on complex social interactions. Nonverbal interpersonal coordination, or joint action, is a crucial element of social interaction, but the dynamics of nonverbal information flow among people are not well understood. We used joint music making in string quartets, a complex, naturalistic nonverbal behavior, as a model system. Using motion capture, we recorded body sway simultaneously in four musicians, which reflected real-time interpersonal information sharing. We used Granger causality to analyze predictive relationships among the motion time series of the players to determine the magnitude and direction of information flow among the players. We experimentally manipulated which musician was the leader (followers were not informed who was leading) and whether they could see each other, to investigate how these variables affect information flow. We found that assigned leaders exerted significantly greater influence on others and were less influenced by others compared with followers. This effect was present, whether or not they could see each other, but was enhanced with visual information, indicating that visual as well as auditory information is used in musical coordination. Importantly, performers' ratings of the "goodness" of their performances were positively correlated with the overall degree of body sway coupling, indicating that communication through body sway reflects perceived performance success. These results confirm that information sharing in a nonverbal joint action task occurs through both auditory and visual cues and that the dynamics of information flow are affected by changing group relationships.

Deficits in the Mimicry of Facial Expressions in Parkinson's Disease.

BACKGROUND: Humans spontaneously mimic the facial expressions of others, facilitating social interaction. This mimicking behavior may be impaired in individuals with Parkinson's disease, for whom the loss of facial movements is a clinical feature. OBJECTIVE: To assess the presence of facial mimicry in patients with Parkinson's disease. METHOD: Twenty-seven non-depressed patients with idiopathic Parkinson's disease and 28 age-matched controls had their facial muscles recorded with electromyography while they observed presentations of calm, happy, sad, angry, and fearful emotions. RESULTS: Patients exhibited reduced amplitude and delayed onset in the zygomaticus major muscle region (smiling response) following happy presentations (patients M = 0.02, 95% confidence interval [CI] -0.15 to 0.18, controls M = 0.26, CI 0.14 to 0.37, ANOVA, effect size [ES] = 0.18, p < 0.001). Although patients exhibited activation of the corrugator supercilii and medial frontalis (frowning response) following sad and fearful presentations, the frontalis response to sad presentations was attenuated relative to controls (patients M = 0.05, CI -0.08 to 0.18, controls M = 0.21, CI 0.09 to 0.34, ANOVA, ES = 0.07, p = 0.017). The amplitude of patients' zygomaticus activity in response to positive emotions was found to be negatively correlated with response times for ratings of emotional identification, suggesting a motor-behavioral link (r = -0.45, p = 0.02, two-tailed). CONCLUSIONS: Patients showed decreased mimicry overall, mimicking other peoples' frowns to some extent, but presenting with profoundly weakened and delayed smiles. These findings open a new avenue of inquiry into the "masked face" syndrome of PD.

Head movements encode emotions during speech and song.

When speaking or singing, vocalists often move their heads in an expressive fashion, yet the influence of emotion on vocalists' head motion is unknown. Using a comparative speech/song task, we examined whether vocalists' intended emotions influence head movements and whether those movements influence the perceived emotion. In Experiment 1, vocalists were recorded with motion capture while speaking and singing each statement with different emotional intentions (very happy, happy, neutral, sad, very sad). Functional data analyses showed that head movements differed in translational and rotational displacement across emotional intentions, yet were similar across speech and song, transcending differences in F0 (varied freely in speech, fixed in song) and lexical variability. Head motion specific to emotional state occurred before and after vocalizations, as well as during sound production, confirming that some aspects of movement were not simply a by-product of sound production. In Experiment 2, observers accurately identified vocalists' intended emotion on the basis of silent, face-occluded videos of head movements during speech and song. These results provide the first evidence that head movements encode a vocalist's emotional intent and that observers decode emotional information from these movements. We discuss implications for models of head motion during vocalizations and applied outcomes in social robotics and automated emotion recognition.

Common cues to emotion in the dynamic facial expressions of speech and song.

Speech and song are universal forms of vocalization that may share aspects of emotional expression. Research has focused on parallels in acoustic features, overlooking facial cues to emotion. In three experiments, we compared moving facial expressions in speech and song. In Experiment 1, vocalists spoke and sang statements each with five emotions. Vocalists exhibited emotion-dependent movements of the eyebrows and lip corners that transcended speech-song differences. Vocalists' jaw movements were coupled to their acoustic intensity, exhibiting differences across emotion and speech-song. Vocalists' emotional movements extended beyond vocal sound to include large sustained expressions, suggesting a communicative function. In Experiment 2, viewers judged silent videos of vocalists' facial expressions prior to, during, and following vocalization. Emotional intentions were identified accurately for movements during and after vocalization, suggesting that these movements support the acoustic message. Experiment 3 compared emotional identification in voice-only, face-only, and face-and-voice recordings. Emotion judgements for voice-only singing were poorly identified, yet were accurate for all other conditions, confirming that facial expressions conveyed emotion more accurately than the voice in song, yet were equivalent in speech. Collectively, these findings highlight broad commonalities in the facial cues to emotion in speech and song, yet highlight differences in perception and acoustic-motor production.

The influence of vocal training and acting experience on measures of voice quality and emotional genuineness.

Vocal training through singing and acting lessons is known to modify acoustic parameters of the voice. While the effects of singing training have been well documented, the role of acting experience on the singing voice remains unclear. In two experiments, we used linear mixed models to examine the relationships between the relative amounts of acting and singing experience on the acoustics and perception of the male singing voice. In Experiment 1, 12 male vocalists were recorded while singing with five different emotions, each with two intensities. Acoustic measures of pitch accuracy, jitter, and harmonics-to-noise ratio (HNR) were examined. Decreased pitch accuracy and increased jitter, indicative of a lower "voice quality," were associated with more years of acting experience, while increased pitch accuracy was associated with more years of singing lessons. We hypothesized that the acoustic deviations exhibited by more experienced actors was an intentional technique to increase the genuineness or truthfulness of their emotional expressions. In Experiment 2, listeners rated vocalists' emotional genuineness. Vocalists with more years of acting experience were rated as more genuine than vocalists with less acting experience. No relationship was reported for singing training. Increased genuineness was associated with decreased pitch accuracy, increased jitter, and a higher HNR. These effects may represent a shifting of priorities by male vocalists with acting experience to emphasize emotional genuineness over pitch accuracy or voice quality in their singing performances.

Emotional response to musical repetition.

Two experiments examined the effects of repetition on listeners' emotional response to music. Listeners heard recordings of orchestral music that contained a large section repeated twice. The music had a symmetric phrase structure (same-length phrases) in Experiment 1 and an asymmetric phrase structure (different-length phrases) in Experiment 2, hypothesized to alter the predictability of sensitivity to musical repetition. Continuous measures of arousal and valence were compared across music that contained identical repetition, variation (related), or contrasting (unrelated) structure. Listeners' emotional arousal ratings differed most for contrasting music, moderately for variations, and least for repeating musical segments. A computational model for the detection of repeated musical segments was applied to the listeners' emotional responses. The model detected the locations of phrase boundaries from the emotional responses better than from performed tempo or physical intensity in both experiments. These findings indicate the importance of repetition in listeners' emotional response to music and in the perceptual segmentation of musical structure.

Facial expressions of singers influence perceived pitch relations.

In four experiments, we examined whether facial expressions used while singing carry musical information that can be "read" by viewers. In Experiment 1, participants saw silent video recordings of sung melodic intervals and judged the size of the interval they imagined the performers to be singing. Participants discriminated interval sizes on the basis of facial expression and discriminated large from small intervals when only head movements were visible. Experiments 2 and 3 confirmed that facial expressions influenced judgments even when the auditory signal was available. When matched with the facial expressions used to perform a large interval, audio recordings of sung intervals were judged as being larger than when matched with the facial expressions used to perform a small interval. The effect was not diminished when a secondary task was introduced, suggesting that audio-visual integration is not dependent on attention. Experiment 4 confirmed that the secondary task reduced participants' ability to make judgments that require conscious attention. The results provide the first evidence that facial expressions influence perceived pitch relations.

An integrative complexity analysis of cognitive behaviour therapy sessions for borderline personality disorder.

OBJECTIVES: Integrative complexity (IC), a measure of cognitive style, was used to analyse discourse in Cognitive Behaviour Therapy (CBT) sessions from patients with borderline personality disorder treated in the BOSCOT trial. It was predicted that patients' level of integrative complexity would be positively associated with the outcome of therapy. That is, an increase in patients' level of integrative complexity would be associated with good outcome. We also predicted that therapists would also show an increase in the level of complexity associated with their patient's increase in integrative complexity and good outcome. DESIGN: Ten patients who received CBT were categorized according to the outcome, good (N=5) and poor (N=5), using an algorithm that incorporated the number of suicide attempts and magnitude of change in severity of depression during therapy. METHOD: For each patient and their therapist, an early and a late therapy session were transcribed and coded for integrative complexity (IC) (N=20 sessions transcribed). IC scores for patients and therapists were compared across early and late therapy sessions and for good and poor outcomes of therapy. RESULTS: The majority of discourse was at the lower levels of IC. Higher levels of IC at baseline were related to depression and anxiety. Good outcome was not associated with a change in the level of IC between earlier and later CBT sessions. Therapists, however, showed an increase in IC when patient's outcome was poor. In addition, an increase in patient's IC was associated with improvement in social functioning. CONCLUSIONS: Therapists may overcompensate for patient's poor outcome by giving more complex explanations to patients. Higher complexity does not necessarily lead to better outcomes.

Alcohol-related attentional bias in problem drinkers with the flicker change blindness paradigm.

The authors used a flicker paradigm for inducing change blindness as a more direct method of measuring attentional bias in problem drinkers in treatment than the previously used, modified Stroop, Posner, and dual-task paradigms. First, in an artificially constructed visual scene comprising digitized photographs of real alcohol-related and neutral objects, problem drinkers detected a change made to an alcohol-related object more quickly than to a neutral object. Age- and gender-matched social drinkers showed no such difference. Second, problem drinkers given the alcohol-related change to detect showed a negative correlation between the speed with which the change was detected and the problem severity as measured by the number of times previously treated. Coupled with other data from heavy and light social drinkers, the data support a graded continuity of attentional bias underpinning the length of the consumption continuum.