Gregory B. Rehm

Gregory B. Rehm, Chao Wang, Irene Cortes-Puch et al.

The acute respiratory distress syndrome (ARDS) is a severe form of hypoxemic respiratory failure with in-hospital mortality of 35-46%. High mortality is thought to be related in part to challenges in making a prompt diagnosis, which may in turn delay implementation of evidence-based therapies. A deep neural network (DNN) algorithm utilizing unbiased ventilator waveform data (VWD) may help to improve screening for ARDS. We first show that a convolutional neural network-based ARDS detection model can outperform prior work with random forest models in AUC (0.95+/-0.019 vs. 0.88+/-0.064), accuracy (0.84+/-0.026 vs 0.80+/-0.078), and specificity (0.81+/-0.06 vs 0.71+/-0.089). Frequency ablation studies imply that our model can learn features from low frequency domains typically used for expert feature engineering, and high-frequency information that may be difficult to manually featurize. Further experiments suggest that subtle, high-frequency components of physiologic signals may explain the superior performance of DL models over traditional ML when using physiologic waveform data. Our observations may enable improved interpretability of DL-based physiologic models and may improve the understanding of how high-frequency information in physiologic data impacts the performance our DL model.

Gregory Rehm, Jimmy Nguyen, Chelsea Gilbeau et al.

Non-invasive estimation of respiratory physiology using computational algorithms promises to be a valuable technique for future clinicians to detect detrimental changes in patient pathophysiology. However, few clinical algorithms used to non-invasively analyze lung physiology have undergone rigorous validation in a clinical setting, and are often validated either using mechanical devices, or with small clinical validation datasets using 2-8 patients. This work aims to improve this situation by first, establishing an open, and clinically validated dataset comprising data from both mechanical lungs and nearly 40,000 breaths from 18 intubated patients. Next, we use this data to evaluate 15 different algorithms that use the "single chamber" model of estimating respiratory compliance. We evaluate these algorithms under varying clinical scenarios patients typically experience during hospitalization. In particular, we explore algorithm performance under four different types of patient ventilator asynchrony. We also analyze algorithms under varying ventilation modes to benchmark algorithm performance and to determine if ventilation mode has any impact on the algorithm. Our approach yields several advances by 1) showing which specific algorithms work best clinically under varying mode and asynchrony scenarios, 2) developing a simple mathematical method to reduce variance in algorithmic results, and 3) presenting additional insights about single-chamber model algorithms. We hope that our paper, approach, dataset, and software framework can thus be used by future researchers to improve their work and allow future integration of "single chamber" algorithms into clinical practice.

Gregory B. Rehm, Brooks T. Kuhn, Jimmy Nguyen et al.

Clinical decision support systems (CDSS) will play an in-creasing role in improving the quality of medical care for critically ill patients. However, due to limitations in current informatics infrastructure, CDSS do not always have com-plete information on state of supporting physiologic monitor-ing devices, which can limit the input data available to CDSS. This is especially true in the use case of mechanical ventilation (MV), where current CDSS have no knowledge of critical ventilation settings, such as ventilation mode. To enable MV CDSS to make accurate recommendations related to ventilator mode, we developed a highly performant ma-chine learning model that is able to perform per-breath clas-sification of 5 of the most widely used ventilation modes in the USA with an average F1-score of 97.52%. We also show how our approach makes methodologic improvements over previous work and that it is highly robust to missing data caused by software/sensor error.

Gregory B Rehm, Michael Thompson, Brad Busenius et al.

Email cryptography applications often suffer from major problems that prevent their widespread implementation. MEG, or the Mobile Encryption Gateway aims to fix the issues associated with email encryption by ensuring that encryption is easy to perform while still maintaining data security. MEG performs automatic decryption and encryption of all emails using PGP. Users do not need to understand the internal workings of the encryption process to use the application. MEG is meant to be email-client-agnostic, enabling users to employ virtually any email service to send messages. Encryption actions are performed on the user's mobile device, which means their keys and data remain personal. MEG can also tackle network effect problems by inviting non-users to join. Most importantly, MEG uses end-to-end encryption, which ensures that all aspects of the encrypted information remains private. As a result, we are hopeful that MEG will finally solve the problem of practical email encryption.