Spatial multi-omics technologies jointly profile gene expression, surface proteins, and histology at each tissue spot, yet most spatial domain discovery methods provide only cluster assignments, without indicating assignment reliability, modality contributions, or why a domain decision should be trusted. We present OmicSync, a reliability-aware spatial multi-omics framework that couples unsupervised domain clustering with evidence-constrained LLM reasoning using model-derived per-spot signals, including assignment confidence, epistemic routing uncertainty, and modality-routing weights. These signals are converted into structured evidence dictionaries and used to generate standard, stepwise, counterfactual, contrastive, and uncertainty-focused explanations. OmicSync integrates a KAN-GCN backbone with spatial encoding, cross-modal fusion, uncertainty-aware routing, cell-type supervision, and missing-modality imputation. We further introduce OmicSync-R, which closes the reasoning-clustering loop by using automatically computed reasoning-quality scores as REINFORCE rewards, allowing reasoning coherence to shape the latent structure without backpropagating through the language model. Across four 10x CytAssist FFPE spatial proteomics benchmarks, OmicSync achieves the best average rank on Human Tonsil (1.44), Glioblastoma (1.78), and Tonsil Add-on (1.22), and second-best on Human Breast Cancer (2.33). OmicSync-R further improves ARI on Human Breast Cancer from 45.73 to 46.72 and outperforms existing methods on six of nine clustering metrics. Together, OmicSync and OmicSync-R enable reliability-aware, spot-level auditable spatial domain discovery guided by evidence-constrained reasoning.
Clustering methods have been used to identify distinct groups of milk samples, cows, or herds. Fourier-transform infrared (FTIR) spectroscopy, particularly mid-infrared (MIR) spectroscopy, has been applied to individual cow milk samples to predict various milk traits. Applying clustering directly to MIR spectral data may reveal latent groups of cows associated with milk traits or health disorders and can help prevent these conditions or monitor at-risk animals. This study aimed to identify groups of individual dairy cows in early lactation directly from milk MIR spectra and to analyze their associations with milk traits. Using a dataset of 407,632 individual milk MIR records from 3,408 commercial farms, we combined (i) spectral filtering that selects informative wavenumbers, (ii) two dimensionality-reduction methods: principal component analysis (PCA) and an autoencoder, and (iii) two clustering algorithms: k-means and spectral clustering to yield eight different clustering approaches. We regrouped the assigned clusters into meta-clusters that encompassed the most similar ones identified by the eight approaches. Our results revealed five distinct meta-clusters of early-lactation individual dairy cows significantly associated with milk traits. Despite substantial differences, the eight approaches converged on the same five meta-clusters, and the classic, computationally efficient PCA-based k-means approach using the full spectrum recaptured clusters identified by more sophisticated, computationally intensive approaches. The five meta-clusters were strongly associated with DIM and appeared to reflect a gradient of negative energy balance (NEB) severity: severe, moderate, and possibly mild, while the remaining two likely represented cows recovering from NEB, one with rapid restoration of energy balance and one in early recovery.
The population structure of an inbred population of 781 people on Norfolk Island in the Pacific, 318 of which are descendants of the original Mutineers of the Bounty, is analyzed phenotypically using shape from stereo retinal fundus photographs. Three-dimensional optic nerve head (ONH) shape is reconstructed from stereo pairs by a multi-scale stereo matching algorithm. Using deep neural network, the shape of ONH, which is under genetic control, is decomposed into a set of hierarchical features through self-taught learning. Features captured at different levels are selected according to their discriminant power in identifying the two populations. The prediction accuracy is evaluated with stratified cross validation. Given the selected feature set, individuals are grouped into k hierarchical clusters and cluster membership fractions are determined for k=2,3,4,5,6,7. Population structure analysis on the basis of phenotypes through image analysis allows heritability and linkage analysis, including founder effects from English and Polynesian ancestors, potentially leading to new genetic risk factors for glaucoma and other ONH-related eye diseases.
Gene Ontology (GO) enrichment analysis is a foundational tool for translating large-scale genomic data into biological insights, but typically yields hundreds of redundant terms that obscure overarching themes. Existing summarization tools rely on fixed similarity metrics (REVIGO, GOSemSim, clusterProfiler::simplify()), gene-overlap measures (Metascape), or static hierarchy mappings (GO-slim), and therefore cannot incorporate biological context. Manual curation provides context-aware grouping but is subjective and labor-intensive. A scalable, context-aware framework is needed to cluster GO terms into interpretable higher-order biological domains. Here we present LLMBDC (Large Language Model for Biological Domains Oriented Clustering of Gene Ontology), a training-free framework that leverages zero-shot semantic reasoning of LLMs with confidence scoring to cluster GO terms into BioDomains using only ontology information at inference time. Benchmarked across Alzheimer's disease (AD) and Fragile X syndrome (FXS) against six baseline methods including SapBERT, LLMBDC achieved substantially higher precision, recall, and clustering performance. Against ground-truth annotations, LLMBDC improved ARI from 9.7% to 73.3% (AD) and from 15.7% to 66.6% (FXS) over REVIGO, with corresponding NMI gains from 59.9% to 73.4% (AD) and 66.0% to 79.5% (FXS). A Cauchy combination test further confirmed that aggregated BioDomains retained statistically significant functional signals. LLMBDC provides a scalable, reproducible, and interpretable route to context-aware, system-level interpretation of GO enrichment results while preserving biological specificity.
In this work, we propose K-SurvMeans, a novel extension of K-Means for clustering survival data. The method explicitly uses the survival outcome in the clustering process to optimize cluster centers, thereby maximizing pairwise survival differences between clusters. The objective function encourages the clusters to be well-separated from the survival perspective. Since the resulting optimization problem is non-differentiable, we employ the Particle Swarm algorithm for the Optimization process. To further improve flexibility and mitigate the curse of dimensionality, we extend the framework to operate in a learned low-dimensional latent space obtained via a dimensionality reduction. This allows the method to capture better-separated clusters and enhance optimization efficiency by reducing the search space. Experiments on multiple publicly available benchmark survival datasets demonstrate that K-SurvMeans consistently yields clusters with improved separation in survival distributions compared to existing deep learning-based survival clustering methods.
Athanasios Papastathopoulos-Katsaros, Steven T. Lee, Lin Yao +4cs.LG eess.SP
Electroencephalography (EEG) is widely used to diagnose neurological conditions, but its analysis usually relies on either predefined spectral features or deep neural networks. Predefined features carry a strong bias, since they fix in advance what counts as informative, while deep neural networks and foundation models are hard to interpret and need large amounts of data and compute. We present bag-of-waves, an interpretable framework that learns a small dictionary of recurring EEG waveform templates, called atoms, using shift-invariant k-means without labels. The continuous EEG is then turned into a sequence of atom tokens, whose counts feed a simple downstream classifier or clustering step. We extend this representation in two ways: we add atom-to-atom transitions, which we call n- grams, to capture temporal structure, and we move from single-channel atoms to regional and cross-channel spatial atoms for the multichannel case. We test the method on three complementary datasets, each probing a different aspect: single-channel mouse genotype clustering with only sixteen animals (the low-data and temporal case), resting-state dementia classification (the spatial case), and the TUEV benchmark, a six-way classification of clinical EEG events (a high-data comparison against strong deep and foundation baselines). Across all three datasets, bag-of-waves achieves performance competitive with state-of-the-art deep and foundation models. Yet, it operates with a fraction of the parameter count and provides full interpretability: because every atom corresponds to an inspectable waveform, the method explicitly recovers known clinical morphologies that a neurophysiologist can directly validate. Its main advantage is that it works in the low-data regime where heavier models are a poor fit.
Breast cancer is one of the most widespread types of cancer, affecting approximately 8 million women worldwide. Electronic health records of patients diagnosed with this disease can serve as valuable datasets for computational analyses, enabling the discovery of new insights about the pathology. Unsupervised clustering, in particular, can identify groups of patients with medically significant features, revealing data trends that might otherwise go unnoticed by medical doctors. In this study, we first applied the DBSCAN density-based clustering method to three independent datasets derived from electronic medical records of patients with mammary carcinoma. Subsequently, to enhance our results, we preceded the DBSCAN application with a dimensionality reduction phase using UMAP. We evaluated our clustering outcomes using three statistical indices (DBCV, DCSI, and DISCO). Our results confirm the effectiveness of combining UMAP with DBSCAN for clustering data derived from electronic health records, paving the way for the medical interpretation of the patient groups identified by our approach.
Brunnhilde Ponsi, Thomas Carlier, Lara Marteau +5cs.CV cs.LG physics.med-ph
Arrhythmogenic left ventricular cardiomyopathy is a genetic myocardial disease difficult to diagnose due to the lack of gold standard criteria. Simultaneous PET/MR imaging, combined with multiparametric quantitative analysis, could facilitate the identification of different profiles related to the phenotype and progression of cardiomyopathy. This preliminary study focuses on a methodological strategy for dealing with PET/MRI data, including inter-patient data linkage and regional analysis. Two-step clustering was applied to T1 and T2 maps, LGE, and 18F-FDG-PET images of 99 patients genetically diagnosed with arrhythmogenic left ventricular cardiomyopathy. Each patient's images were independently z-scored and summed into a single volume, which was clustered into supervoxels. Thirty-two inter-patient groups of supervoxels were obtained by spectral clustering. An "abnormality" score was assigned to each cluster and modality, and used to visualise abnormal regions likely associated with disease. They enabled the generation of automated textual and bullseye health reports for each patient, which were compared with cardiac imager assessments using balanced accuracy in repeated nested cross-validation. This approach was further validated on a larger cohort of 167 numerical phantoms. The reports generated by clustering accurately identified most of the cardiac physicians' observations (BA = 0.76 $\pm$ 0.04 in repeated nested cross-validation on patients, and BA $\ge$ 0.8 on phantoms). Furthermore, the identified abnormal clusters closely matched their visual observations, facilitating the identification of varying degrees of fibrosis or inflammation on the images. This approach enables a more systematic handling of multimodal PET/MRI data to characterise myocardial heterogeneity in arrhythmogenic left ventricular cardiomyopathy patients.
Medical imaging generates high-resolution images posing significant storage, transmission, and computational challenges. While low-rank matrix approximation (LoRMA) techniques offer efficient compression by exploiting structural redundancy, global approaches often fail to preserve local details critical for diagnosis. This paper focuses on clustering techniques that exploit non-local self-similarity to identify structurally similar regions in medical images. These clusters can be used for post-processing tasks such as adaptive image compression. We evaluate five clustering techniques: k-means, mini-batch k-means, agglomerative hierarchical clustering, balanced iterative reducing and clustering using hierarchies (BIRCH), and bisecting k-means across MRI, ultrasound, and chest X-ray modalities. All clustering techniques were optimised using random search, and cluster quality was assessed using the Silhouette score, the Davies-Bouldin (DB) index, and the Calinski-Harabasz (CH) index. Results demonstrate that standard k-means and bisecting k-means generally achieve strong cluster cohesion and separation across modalities. However, they tend to form a small number of clusters with high intra-cluster variability, limiting their effectiveness for post-processing tasks such as adaptive compression. Agglomerative clustering outperformed other techniques for MRI and ultrasound in terms of intra-cluster homogeneity, making it more suitable for preserving fine diagnostic details. For chest X-rays, mini-batch k-means achieved the best balance between clustering quality and intra-cluster compactness. BIRCH consistently underperformed across all modalities.
Timely intensive care dictates survival, yet emergency infrastructure remains unevenly distributed across Sri Lanka. While pre-hospital services have expanded, the transition to definitive care remains a critical bottleneck. This study evaluates national emergency resilience by quantifying the gap between clinical demand and the availability of specialized resources across all 25 districts. Using the latest national epidemiological data and terrain-aware H3 hexagonal modeling, we analyzed accessibility for seven critical conditions based on spatial gaps, clinical need-gaps, lethality, coverage, and resource availability. Based on these metrics, unsupervised K-Means clustering was applied to categorize districts into four policy-actionable archetypes: Critical Structural Exclusion, Institutional Mirages, Operational Capacity Strain, and High-Resilience Benchmarks. Our study suggests that severe service deficits exist in the Northern and Eastern provinces, where spatial gaps exceed 70%, rendering the Golden Hour operationally impossible. Notably, specialist scarcity drives systemic pressure more than bed capacity; underserved regions effectively function as institutional mirages. This study suggests that improving accessibility by 25% in high-priority clusters would reduce the national need-gap by 9.65%, providing a roadmap for the strategic redistribution of specialists to ensure healthcare equity.
Parisa Lotfibagha, Kristen Miller, William J. Gallagher +2stat.AP cs.LG
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.
Miral Elnakib, Muhammad Saad, Ahmad Al-Kabbanyeess.IV cs.CV
The full potential of artificial intelligence in tibial plateau fracture characterisation remains unrealised, constrained by a fundamental dependency on labelled datasets whose consistency cannot be guaranteed: conventional classification schemes such as Schatzker and AO/OTA suffer from inter-observer variability, causing supervised models to learn human disagreement rather than stable fracture morphology. We design, implement, and validate a label-agnostic framework that eliminates this constraint by learning fracture representations directly from imaging data without observer-assigned labels. A RadImageNet-pretrained ResNet-50 encoder is fine-tuned on 154 cleaned knee radiographs using the SimCLR contrastive objective, preceded by a data cleaning protocol and followed by UMAP dimensionality reduction and k-means clustering to discover four imaging-derived phenotypes. Phenotype validity is assessed through a blinded expert review protocol administered to two independent clinicians. The four phenotypes demonstrate robust stability (bootstrap ARI = 0.319 +/- 0.041), strong internal cohesion (silhouette = 0.511), and coherence ratings of 3-5/5 from both reviewers under blinded conditions; one phenotype was unanimously identified as exhibiting comminution -- a high-complexity feature isolated without any supervisory signal. Inter-partition comparison against Schatzker labels yields ARI = 0.013, confirming orthogonality to conventional classification boundaries. Notably, expert reviewers anchored to established classification vocabularies perceived imaging-derived groups as heterogeneous precisely where Schatzker alignment was lowest, suggesting that Schatzker-trained perception and label-agnostic embedding geometry measure orthogonal dimensions. These findings establish label-agnostic SSL phenotyping as a reproducible and clinically interpretable complement to conventional classification.
Clustering is fundamental to scRNA-seq analysis, serving as a cornerstone for identifying cell populations and resolving tissue heterogeneity. However, existing methods focus on mining numerical statistical patterns, suffering from semantic agnosticism by neglecting the intrinsic biological functions encoded by genes. While Large Language Models (LLMs) offer promising semantic capabilities, their direct adaptation to cell clustering is hindered by the structural mismatch between generative pre-training objectives and discriminative downstream tasks. To bridge this gap, we propose scLLM-DSC, a novel LLM-Knowledge Enhanced Cross-Modal Deep Structural Clustering framework. Diverging from data-driven paradigms, scLLM-DSC establishes a semantically-grounded representation by synergizing two views: a Knowledge-Driven Semantic View derived from NCBI gene priors and contextualized Cell2Sentence embeddings, and a Structure-Aware Topological View extracted via a graph-guided encoder. Crucially, we introduce a cross-modal contrastive alignment mechanism to enforce consistency between biological semantics and transcriptomic features within a unified latent space. Extensive benchmarks demonstrate that scLLM-DSC significantly outperforms eleven state-of-the-art baselines in clustering accuracy.
Lubna M. Abu Zohair, Marta Vallejo, MD Azher Uddin +2cs.LG
Huntington's disease (HD) is a progressive brain disorder that gradually affects movement, cognitive function, and behavior. Identifying the stage of the disease accurately and consistently is important for understanding its course, grouping patients, personalized care, and discovering treatment. Existing clinical staging frameworks rely primarily on predefined clinical measurement thresholds and clinical expert decisions, yet these discrete cut-offs may obscure meaningful intra-stage variability and remain vulnerable to inter-rater differences, especially in motor and functional assessments. To address these limitations, we developed an unsupervised machine learning framework based on dynamic graph representation learning to capture temporal relationships within and across patients from longitudinal clinical measurements. Using the learned representations, we applied K-means++ clustering to identify well-separated groups. We then iteratively increased the number of clusters (k), using stability analysis to assess robustness and reveal additional meaningful clusters beyond the initial optimal solution. We applied the framework to 302 individuals from the Enroll-HD cohort (1,477 visits, 44 clinical variables per visit; 80% manifest participants), enabling data-driven discovery of HD stages reflecting natural clinical progression. Despite the limited cohort size, the proposed framework achieved robust clustering performance using a four-dimensional latent space, identifying four meaningful and statistically distinct disease stages through clustering stability analysis. Each stage corresponded to well-defined clinical measurement boundaries, with minimal overlap compared to previously established clinical staging methods.
Md All Shahria, Sanjeda Dewan Mithila, Touhid Alam +2cs.LG
The widespread adoption of social media has heightened interest in its psychological effects, particularly on mental health indicators such as anxiety, depression, loneliness, and sleep quality, as these platforms increasingly influence social interactions and well-being. Although previous research has examined correlations between social media use and mental health, few studies have utilized unsupervised machine learning to segment users based on behavioral and psychological patterns, leaving a gap in identifying distinct risk profiles across diverse groups. This study seeks to address this by segmenting individuals according to their social media usage and psychological well-being, employing clustering to reveal hidden patterns and evaluate their mental health implications. Data from 551 participants, collected via an online survey, were preprocessed using KNN imputation for missing values, one-hot encoding for categorical variables like Gender with 5 unique values, and outlier detection via IQR and Z-score methods. K-Means clustering, optimized at 6 clusters using the Elbow Method and a Silhouette Score of 0.32, was applied, with PCA reducing 22 dimensions for visualization and a correlation heatmap highlighting relationships, such as a 0.28 correlation between social media hours and anxiety.