Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of mortality in the United States; however, COPD has heterogeneous clinical phenotypes. This is the first large scale attempt which uses transcriptomics, proteomics, and metabolomics (multi-omics) to determine whether there are molecularly defined clusters with distinct clinical phenotypes that may underlie the clinical heterogeneity. Subjects included 3,278 subjects from the COPDGene cohort with at least one of the following profiles: whole blood transcriptomes (2,650 subjects); plasma proteomes (1,013 subjects); and plasma metabolomes (1,136 subjects). 489 subjects had all three contemporaneous -omics profiles. Autoencoder embeddings were performed individually for each -omics dataset. Embeddings underwent subspace clustering using MineClus, either individually by -omics or combined, followed by recursive feature selection based on Support Vector Machines. Clusters were tested for associations with clinical variables. Optimal single -omics clustering typically resulted in two clusters. Although there was overlap for individual -omics cluster membership, each -omics cluster tended to be defined by unique molecular pathways. For example, prominent molecular features of the metabolome-based clustering included sphingomyelin, while key molecular features of the transcriptome-based clusters were related to immune and bacterial responses. We also found that when we integrated the -omics data at a later stage, we identified subtypes that varied based on age, severity of disease, in addition to diffusing capacity of the lungs for carbon monoxide, and precent on atrial fibrillation. In contrast, when we integrated the -omics data at an earlier stage by treating all data sets equally, there were no clinical differences between subtypes. Similar to clinical clustering, which has revealed multiple heterogenous clinical phenotypes, we show that transcriptomics, proteomics, and metabolomics tend to define clusters of COPD patients with different clinical characteristics. Thus, integrating these different -omics data sets affords additional insight into the molecular nature of COPD and its heterogeneity.

Human gait analysis presents an opportunity to study complex spatiotemporal data transpiring as co-movement patterns of multiple moving objects (i.e., human joints). Such patterns are acknowledged as movement signatures specific to an individual, offering the possibility to identify each individual based on unique gait patterns. We present a spatiotemporal deep learning model, dubbed ST-DeepGait, to featurize spatiotemporal co-movement patterns of human joints, and accordingly classify such patterns to enable human gait recognition. To this end, the ST-DeepGait model architecture is designed according to the spatiotemporal human skeletal graph in order to impose learning the salient local spatial dynamics of gait as they occur over time. Moreover, we employ a multi-layer RNN architecture to induce a sequential notion of gait cycles in the model. Our experimental results show that ST-DeepGait can achieve recognition accuracy rates over 90%. Furthermore, we qualitatively evaluate the model with the class embeddings to show interpretable separability of the features in geometric latent space. Finally, to evaluate the generalizability of our proposed model, we perform a zero-shot detection on 10 classes of data completely unseen during training and achieve a recognition accuracy rate of 88% overall. With this paper, we also contribute our gait dataset captured with an RGB-D sensor containing approximately 30 video samples of each subject for 100 subjects totaling 3087 samples. While we use human gait analysis as a motivating application to evaluate ST-DeepGait, we believe that this model can be simply adopted and adapted to study co-movement patterns of multiple moving objects in other applications such as in sports analytics and traffic pattern analysis.

Every year, the U.S. economy loses more than $411 billion because of work performance reduction, injuries, and traffic accidents caused by microsleep. To mitigate microsleeps consequences, an unobtrusive, reliable, and socially acceptable microsleep detection solution throughout the day, every day is required. Unfortunately, existing solutions do not meet these requirements. In this paper, we propose WAKE, a novel behind-the-ear wearable device for microsleep detection. By monitoring biosignals from the brain, eye movements, facial muscle contractions, and sweat gland activities from behind the user's ears, WAKE can detect microsleep with a high temporal resolution. We introduce a Three-fold Cascaded Amplifying (3CA) technique to tame the motion artifacts and environmental noises for capturing high fidelity signals. Through our prototyping, we show that WAKE can suppress motion and environmental noise in real-time by 9.74-19.47 dB while walking, driving, or staying in different environments ensuring that the biosignals are captured reliably. We evaluated WAKE using gold-standard devices on 19 sleep-deprived and narcoleptic subjects. The Leave-One-Subject-Out Cross-Validation results show the feasibility of WAKE in microsleep detection on an unseen subject with average precision and recall of 76% and 85%, respectively.

Background: Despite the numerous studies evaluating various rhythm control strategies for atrial fibrillation (AF), determination of the optimal strategy in a single patient is often based on trial and error, with no one-size-fits-all approach based on international guidelines/recommendations. The decision, therefore, remains personal and lends itself well to help from a clinical decision support system, specifically one guided by artificial intelligence (AI). QRhythm utilizes a 2-stage machine learning (ML) model to identify the optimal rhythm management strategy in a given patient based on a set of clinical factors, in which the model first uses supervised learning to predict the actions of an expert clinician and identifies the best strategy through reinforcement learning to obtain the best clinical outcome—a composite of symptomatic recurrence, hospitalization, and stroke. Objective: We qualitatively evaluated a novel, AI-based, clinical decision support system (CDSS) for AF rhythm management, called QRhythm, which uses both supervised and reinforcement learning to recommend either a rate control or one of 3 types of rhythm control strategies—external cardioversion, antiarrhythmic medication, or ablation—based on individual patient characteristics. Methods: Thirty-three clinicians, including cardiology attendings and fellows and internal medicine attendings and residents, performed an assessment of QRhythm, followed by a survey to assess relative comfort with automated CDSS in rhythm management and to examine areas for future development. Results: The 33 providers were surveyed with training levels ranging from resident to fellow to attending. Of the characteristics of the app surveyed, safety was most important to providers, with an average importance rating of 4.7 out of 5 (SD 0.72). This priority was followed by clinical integrity (a desire for the advice provided to make clinical sense; importance rating 4.5, SD 0.9), backward interpretability (transparency in the population used to create the algorithm; importance rating 4.3, SD 0.65), transparency of the algorithm (reasoning underlying the decisions made; importance rating 4.3, SD 0.88), and provider autonomy (the ability to challenge the decisions made by the model; importance rating 3.85, SD 0.83). Providers who used the app ranked the integrity of recommendations as their highest concern with ongoing clinical use of the model, followed by efficacy of the application and patient data security. Trust in the app varied; 1 (17%) provider responded that they somewhat disagreed with the statement, “I trust the recommendations provided by the QRhythm app,” 2 (33%) providers responded with neutrality to the statement, and 3 (50%) somewhat agreed with the statement. Conclusions: Safety of ML applications was the highest priority of the providers surveyed, and trust of such models remains varied. Widespread clinical acceptance of ML in health care is dependent on how much providers trust the algorithms. Building this trust involves ensuring transparency and interpretability of the model.