Objective: To obtain insight in the spectrum of narcolepsy symptoms and associated burden in a large cohort of patients. Methods: We used the Narcolepsy Monitor, a mobile app, to easily rate the presence and burden of 20 narcolepsy symptoms. Baseline measures were obtained and analyzed from 746 users aged between 18 and 75 years with a reported diagnosis of narcolepsy. Results: Median age was 33.0 years (IQR 25.0–43.0), median Ullanlinna Narcolepsy Scale 19 (IQR 14.0–26.0), 78% reported using narcolepsy pharmacotherapy. Excessive daytime sleepiness (97.2%) and lack of energy were most often present (95.0%) and most often caused a high burden (79.7% and 76.1% respectively). Cognitive symptoms (concentration 93.0%, memory 91.4%) and psychiatric symptoms (mood 76.8%, anxiety/panic 76.4%) were relatively often reported to be present and burdensome. Conversely, sleep paralysis and cataplexy were least often reported as highly bothersome. Females experienced a higher burden for anxiety/panic, memory, and lack of energy. Conclusions: This study supports the notion of an elaborate narcolepsy symptom spectrum. Each symptom’s contribution to the experienced burden varied, but lesser-known symptoms did significantly add to this as well. This emphasizes the need to not only focus treatment on the classical core symptoms of narcolepsy.

Diffusion Tensor Imaging (DTI) is a non-invasive magnetic resonance imaging technique that, combined with fiber tracking algorithms, allows the characterization and visualization of white matter structures in the brain. The resulting fiber tracts are used, for example, in tumor surgery to evaluate the potential brain functional damage due to tumor resection. The DTI processing pipeline from image acquisition to the final visualization is rather complex generating undesirable uncertainties in the final results. Most DTI visualization techniques do not provide any information regarding the presence of uncertainty. When planning surgery, a fixed safety margin around the fiber tracts is often used; however, it cannot capture local variability and distribution of the uncertainty, thereby limiting the informed decision-making process. Stochastic techniques are a possibility to estimate uncertainty for the DTI pipeline. However, it has high computational and memory requirements that make it infeasible in a clinical setting. The delay in the visualization of the results adds hindrance to the workflow. We propose a progressive approach that relies on a combination of wild-bootstrapping and fiber tracking to be used within the progressive visual analytics paradigm. We present a local bootstrapping strategy, which reduces the computational and memory costs, and provides fiber-tracking results in a progressive manner. We have also implemented a progressive aggregation technique that computes the distances in the fiber ensemble during progressive bootstrap computations. We present experiments with different scenarios to highlight the benefits of using our progressive visual analytic pipeline in a clinical workflow along with a use case and analysis obtained by discussions with our collaborators.

Phase-Contrast Magnetic Resonance Imaging (PC-MRI) surpasses all other imaging methods in quality and completeness for measuring time-varying volumetric blood flows and has shown potential to improve both diagnosis and risk assessment of cardiovascular diseases. However, like any measurement of physical phenomena, the data are prone to noise, artefacts and has a limited resolution. Therefore, PC-MRI data itself do not fulfil physics fluid laws making it difficult to distinguish important flow features. For data analysis, physically plausible and high-resolution data are required. Computational fluid dynamics provides high-resolution physically plausible flows. However, the flow is inherently coupled to the underlying anatomy and boundary conditions, which are difficult or sometimes even impossible to adequately model with current techniques. We present a novel methodology using data assimilation techniques for PC-MRI noise and artefact removal, generating physically plausible flow close to the measured data. It also allows us to increase the spatial and temporal resolution. To avoid sensitivity to the anatomical model, we consider and update the full 3D velocity field. We demonstrate our approach using phantom data with various amounts of induced noise and show that we can improve the data while preserving important flow features, without the need of a highly detailed model of the anatomy.

Recent attempts at utilizing visual analytics to interpret Recurrent Neural Networks (RNNs) mainly focus on natural language processing (NLP) tasks that take symbolic sequences as input. However, many real-world problems like environment pollution forecasting apply RNNs on sequences of multi-dimensional data where each dimension represents an individual feature with semantic meaning such as PM_2.5 and SO₂. RNN interpretation on multi-dimensional sequences is challenging as users need to analyze what features are important at different time steps to better understand model behavior and gain trust in prediction. This requires effective and scalable visualization methods to reveal the complex many-to-many relations between hidden units and features. In this work, we propose a visual analytics system to interpret RNNs on multi-dimensional time-series forecasts. Specifically, to provide an overview to reveal the model mechanism, we propose a technique to estimate the hidden unit response by measuring how different feature selections affect the hidden unit output distribution. We then cluster the hidden units and features based on the response embedding vectors. Finally, we propose a visual analytics system which allows users to visually explore the model behavior from the global and individual levels. We demonstrate the effectiveness of our approach with case studies using air pollutant forecast applications.

Background: The clinical benefit of immunotherapeutic approaches against cancer has been well established although complete responses are only observed in a minority of patients. Combination immunotherapy offers an attractive avenue to develop more effective cancer therapies by improving the efficacy and duration of the tumor-specific T-cell response. Here, we aimed at deciphering the mechanisms governing the response to PD-1/PD-L1 checkpoint blockade to support the rational design of combination immunotherapy. Methods: Mice bearing subcutaneous MC-38 tumors were treated with blocking PD-L1 antibodies. To establish high-dimensional immune signatures of immunotherapy-specific responses, the tumor microenvironment was analyzed by CyTOF mass cytometry using 38 cellular markers. Findings were further examined and validated by flow cytometry and by functional in vivo experiments. Immune profiling was extended to the tumor microenvironment of colorectal cancer patients. Results: PD-L1 blockade induced selectively the expansion of tumor-infiltrating CD4⁺ and CD8⁺ T-cell subsets, co-expressing both activating (ICOS) and inhibitory (LAG-3, PD-1) molecules. By therapeutically co-targeting these molecules on the T_AI cell subsets in vivo by agonistic and antagonist antibodies, we were able to enhance PD-L1 blockade therapy as evidenced by an increased number of T_AI cells within the tumor micro-environment and improved tumor protection. Moreover, T_AI cells were also found in the tumor-microenvironment of colorectal cancer patients. Conclusions: This study shows the presence of T cell subsets in the tumor micro-environment expressing both activating and inhibitory receptors. These T_AI cells can be targeted by combined immunotherapy leading to improved survival.

Hierarchical embeddings, such as HSNE, address critical visual and computational scalability issues of traditional techniques for dimensionality reduction. The improved scalability comes at the cost of the need for increased user interaction for exploration. In this paper, we provide a solution for the interactive visual Focus+Context exploration of such embeddings. We explain how to integrate embedding parts from different levels of detail, corresponding to focus and context groups, in a joint visualization. We devise an according interaction model that relates typical semantic operations on a Focus+Context visualization with the according changes in the level-of-detail-hierarchy of the embedding, including also a mode for comparative Focus+Context exploration and extend HSNE to incorporate the presented interaction model. In order to demonstrate the effectiveness of our approach, we present a use case based on the visual exploration of multi-dimensional images.

Innate lymphoid cells (ILCs) are abundant in mucosal tissues and involved in tissue homeostasis and barrier function. Although several ILC subsets have been identified, it is unknown if additional heterogeneity exists, and their differentiation pathways remain largely unclear. We applied mass cytometry to analyze ILCs in the human fetal intestine and distinguished 34 distinct clusters through a t-SNE-based analysis. A lineage (Lin)^-CD7⁺CD127^-CD45RO⁺CD56⁺ population clustered between the CD127⁺ ILC and natural killer (NK) cell subsets, and expressed diverse levels of Eomes, T-bet, GATA3, and RORγt. By visualizing the dynamics of the t-SNE computation, we identified smooth phenotypic transitions from cells within the Lin^-CD7⁺CD127^-CD45RO⁺CD56⁺ cluster to both the NK cells and CD127⁺ ILCs, revealing potential differentiation trajectories. In functional differentiation assays, the Lin^-CD7⁺CD127^-CD45RO⁺CD56⁺CD8a^- cells could develop into CD45RA⁺ NK cells and CD127⁺RORγt⁺ ILC3-like cells. Thus, we identified a previously unknown intermediate innate subset that can differentiate into ILC3 and NK cells.

A bipartite graph is a powerful abstraction for modeling relationships between two collections. Visualizations of bipartite graphs allow users to understand the mutual relationships between the elements in the two collections, e.g., by identifying clusters of similarly connected elements. However, commonly-used visual representations do not scale for the analysis of large bipartite graphs containing tens of millions of vertices, often resorting to an a-priori clustering of the sets. To address this issue, we present the Who's-Active-On-What-Visualization (WAOW-Vis) that allows for multiscale exploration of a bipartite social-network without imposing an a-priori clustering. To this end, we propose to treat a bipartite graph as a high-dimensional space and we create the WAOW-Vis adapting the multiscale dimensionality-reduction technique HSNE. The application of HSNE for bipartite graph requires several modifications that form the contributions of this work. Given the nature of the problem, a set-based similarity is proposed. For efficient and scalable computations, we use compressed bitmaps to represent sets and we present a novel space partitioning tree to efficiently compute similarities; the Sets Intersection Tree. Finally, we validate WAOW-Vis on several datasets connecting Twitter-users and -streams in different domains: news, computer science and politics. We show how WAOW-Vis is particularly effective in identifying hierarchies of communities among social-media users.

We present the Bladder Runner, a novel tool to enable detailed visual exploration and analysis of the impact of bladder shape variation on the accuracy of dose delivery, during the course of prostate cancer radiotherapy (RT). Our tool enables the investigation of individual patients and cohorts through the entire treatment process, and it can give indications of RT‐induced complications for the patient. In prostate cancer RT treatment, despite the design of an initial plan prior to dose administration, bladder toxicity remains very common. The main reason is that the dose is delivered in multiple fractions over a period of weeks, during which, the anatomical variation of the bladder – due to differences in urinary filling – causes deviations between planned and delivered doses. Clinical researchers want to correlate bladder shape variations to dose deviations and toxicity risk through cohort studies, to understand which specific bladder shape characteristics are more prone to side effects. This is currently done with Dose‐Volume Histograms (DVHs), which provide limited, qualitative insight. The effect of bladder variation on dose delivery and the resulting toxicity cannot be currently examined with the DVHs. To address this need, we designed and implemented the Bladder Runner, which incorporates visualization strategies in a highly interactive environment with multiple linked views. Individual patients can be explored and analyzed through the entire treatment period, while inter‐patient and temporal exploration, analysis and comparison are also supported. We demonstrate the applicability of our presented tool with a usage scenario, employing a dataset of 29 patients followed through the course of the treatment, across 13 time points. We conducted an evaluation with three clinical researchers working on the investigation of RT‐induced bladder toxicity. All participants agreed that Bladder Runner provides better understanding and new opportunities for the exploration and analysis of the involved cohort data.

Modern diffusion magnetic resonance imaging (dMRI) acquires intricate volume datasets and biological meaning can only be found in the relationship between its different measurements. Suitable strategies for visualizing these complicated data have been key to interpretation by physicians and neuroscientists, for drawing conclusions on brain connectivity and for quality control. This article provides an overview of visualization solutions that have been proposed to date, ranging from basic grayscale and color encodings to glyph representations and renderings of fiber tractography. A particular focus is on ongoing and possible future developments in dMRI visualization, including comparative, uncertainty, interactive and dense visualizations.