医学 AI

Chronic disease management relies on regular patient-provider interactions to follow-up on disease progression and control. For Type 2 Diabetes (T2D), current guidelines prescribe fixed time intervals between subsequent primary care visits for all patients, overlooking heterogeneity in clinical trajectories and patient characteristics. This study introduces a Contextual Markov Decision Process (CMDP) model to optimize subpopulation-specific follow-up interval decisions using Electronic Health Record (EHR) data from 22,154 T2D patients across 10 primary care clinics. Contexts are identified by: i) dimensionality reduction of variables representing the individual health trajectories utilizing Principal Component Analysis, and ii) assigning patients to contexts via principal components and additional patient-level features using clustering. Two distinct contexts emerged, representing a lower- and a higher-risk subpopulation. CMDP-derived policies recommend: (i) follow-up within 1 month if lab value at current visit is unmeasured; (ii) up to 3 months for elevated lab values or recent hospitalizations; and (iii) 6 to 12 months for sustained glycemic control, with shorter follow-up intervals for patients in high-risk context. The optimal policies achieved lower expected cumulative cost than benchmarks (e.g., in the higher-comorbidity context, the CMDP policy reduced cost by about 34.8%, and in the lower-comorbidity context by about 6.4%, relative to an American Diabetes Association-like fixed interval follow-up policy. These findings demonstrate how context-aware approaches can inform adaptive follow-up strategies, and have the potential to advance chronic care management in primary care by synthesizing machine learning and probabilistic decision models.

Delirium is a common and serious complication in the Intensive Care Unit (ICU), associated with increased morbidity, prolonged hospital stays, and higher healthcare costs. Despite its prevalence, early prediction and prevention remain challenging. Environmental factors such as ambient sound and light may influence the onset of delirium, yet they are often overlooked in risk assessments. In this study, we examined whether light intensity and sound pressure levels can independently predict delirium across multiple prediction horizons. We evaluated four efficient sequential neural network models on data collected from 9 ICUs across 309 patients to predict delirium for 10 prediction-window sizes. We reported feature importance and direction of influence using Shapley Additive Explanations analysis. The convolutional model achieved the strongest discrimination, with AUC = 0.80 on sound data and on combined data. Sound features were the dominant predictors overall. Integrating sound with light improved short-term ($<1$ week) prediction, with the combined model assigning the highest risk immediately after the sensing period. These findings suggest that passive ambient sensing, especially sound, can add a clinically meaningful, interpretable signal for delirium risk estimation and offer a practical pathway to enrich multimodal ICU prediction and prevention strategies.

Objective sleep assessment relies on polysomnography (PSG), yet clinical impact is often better reflected in patient-reported outcomes (PROs) such as sleepiness and fatigue. Existing summary indices, including the Apnea-Hypopnea Index (AHI), provide limited insight into the multidomain physiology underlying functional recovery. We propose an interpretable, causal-discovery--guided framework for deriving a hierarchical Sleep Recovery Score (SRS) from multimodal PSG. Using two large population cohorts (MESA: n=1540; MrOS: n=825), we apply directed acyclic graph (DAG) learning to identify candidate physiological drivers spanning respiratory burden, hypoxic burden, sleep fragmentation, sleep architecture, and autonomic regulation. Although derived from clinical PSG, these domains map naturally to sensing streams increasingly available in connected health technologies, including wearable ECG, oximetry, and sleep-stage estimation devices. To preserve mechanistic plausibility, we introduce a two-stage screening process that combines physiology-based constraints with constrained LLM-assisted auditing to identify and remove structural confounders and construct-overlapping variables. Across cohorts, these five domains emerge as recurrent physiological domains associated with recovery, and the resulting SRS shows up to 2.5$\times$ stronger alignment with perceived recovery than AHI. By linking multimodal sleep physiology to patient-centered outcomes through an interpretable, bias-aware, and domain structured framework, this work provides a practical foundation for recovery modeling across both clinical sleep studies and emerging smart and connected health settings.

Glucose forecasting algorithms are an important aspect of glycemic control management in type 1 diabetes. So far, the research community has developed numerous algorithms and models for forecasting. However, it is well-recognized that the lack of standardized model performance evaluation benchmarks makes fair comparison difficult and hinders further innovation, and thus benchmark standardization is in urgent need. Furthermore, many published glucose forecasting algorithms are limited to CGM data alone, ignoring other multimodal signals such as insulin dosing and carbohydrate intake. Here, we introduce MetaboNet-Bench, a benchmark for multimodal glucose forecasting for patients with type 1 diabetes that provides an extensible open-source evaluation framework for comparison of glucose forecasting algorithms that leverage glucose, insulin, and carbohydrate data. We then demonstrate its utility by benchmarking several recently published glucose forecasting models and a custom multimodal time-series model, representing different model architectures. The results show that the benefit of adding data modalities is conditioned on the complexity of the model and that incorporating more clinical metrics helps identify meaningful gaps to fill for future research.

Forces transmitted by bones are routinely studied in human biomechanics, but it is challenging to measure them non-invasively, especially outside of laboratory settings. We introduce a technique for non-invasive, in vivo measurement of tibial compressive force using flexural waves propagating in the tibia. Modelling the tibia as an axially compressed Euler-Bernoulli beam, we show that tibial flexural waves have load-dependent frequency spectra. Specifically, under physiological conditions, peak locations in the wave acceleration spectra vary linearly with the compressive force on the tibia and may be used as proxies for the compressive force. We test the validity of this technique using a proof-of-concept wearable system that generates flexural waves via a skin-mounted mechanical transducer and measures the spectra of these waves using a skin-mounted accelerometer. In agreement with beam theory, data from 9 participants demonstrate linear relationships between tibial compressive force and spectral peak location, with Pearson correlation coefficients $r=0.82 - 0.99$ (mean $r=0.93$) for medial-lateral swaying and $r=0.81 - 0.98$ (mean $r=0.93$) for walking trials. This flexural wave-based technique could give rise to a new class of wearable sensors for non-invasive physiological bone load monitoring and measurement, impacting research in human locomotion and sports medicine.

Psychophysical discrimination of structured light (SL) stimuli may be useful in screening for various macular disorders, including degenerative macular diseases. The circularly-oriented macular pigment optical density (coMPOD), calculated from the discrimination performance of SL-induced entoptic phenomena, may reveal a novel functional biomarker of macular health. In this study, we investigated the potential influence of eye dominance and testing order effects on SL-based stimulus perception, factors that potentially influence the sensitivity of screening tests based on SL technology. A total of 28 participants (aged 18-38 years) were selected for the study after undergoing a comprehensive eye examination. A psychophysical task was performed where various SL-based entoptic images with multiple azimuthal fringes rotating with a specific temporal frequency were projected onto the participants' retinas. By occluding the central areas of entoptic images, we measured the retinal eccentricity ($R$) of the perceivable area of the stimuli. The slope of the coMPOD profile ($a$-value) was calculated for each participant using a spatiotemporal sensitivity model that takes into account the perceptual threshold measurements of structured light stimuli with varying spatial densities and temporal frequencies. The Pearson correlation coefficient between eye dominance and testing order effects was $r=0.8$ ($p<0.01$). The Bland-Altman plots for both factors indicated zero bias. The results indicate repeatable measurements for both eyes, implying minimal impact from eye dominance and testing order on SL-based stimulus perception. The results provide a foundation for future studies exploring the clinical utility of SL tools in eye health.

Estimation of uplink channels is required for coherent over-the-air computation (OAC). When channel estimation is done using calibrated reciprocity, the estimates are only available locally to the devices. This poses a challenge for precoding and decoding, which cannot be coordinated centrally. To this end we use truncated channel inversion (TCI) and propose an approximate closed form solution and an exact numerical solver to optimize the TCI parameters. Importantly, we prove that the proposed TCI scheme is independent of the number of receiver antennas in terms of mean-square-error (MSE). Furthermore, our analysis reveals a clear connection between the MSE and expected aggregate phase error across devices which gives insight to the scalability of OAC. Finally, simulations with comparisons to reference methods from prior work with globally available error-free channel estimates show that proposed is close, even outperforming these references in MSE under some conditions.

Reference-based adaptive interference cancellation is evaluated for stereo audio recordings corrupted by real train noise and environmental background. The observed signal is modeled as a clean stereo program contaminated by an additive disturbance generated by an external acoustic source through unknown propagation paths. A second stereo recording, representing another filtered observation of the same physical noise source, is used as the reference input of a multi-reference recursive least-squares (RLS) estimator. The estimated train-interference component is subtracted from the noisy audio and followed by a finite-impulse-response low-pass postfilter. Three 74.01 s real audio sequences sampled at 11.025 kHz are processed under identical algorithmic parameters. Since clean ground truth is not available, performance is assessed with no-reference indicators: waveform behavior, Welch spectral estimates, RMS change, and residual normalized correlation with the reference. With 30 taps per reference channel, 15 anti-causal taps, and forgetting factor 0.999, the maximum reference correlation is reduced from 0.386--0.832 before processing to 0.011--0.016 after processing. The corresponding correlation-ratio reduction is approximately 30.6--34.1 dB, while the output RMS decreases by 1.8--4.8 dB depending on section and stereo channel. The results demonstrate that real train interference, including environmental acoustic effects, can be substantially attenuated when a correlated reference recording is available.