Search

Healthcare data accessibility for machine learning (ML) is encumbered by a range of stringent regulations and limitations. Using synthetic data that mirrors the underlying properties in the real data is emerging as a promising solution to overcome these barriers. We propose a fully automated synthetic tabular neural generator (STNG), which comprises multiple synthetic data generators and integrates an Auto-ML module to validate and comprehensively compare the synthetic datasets generated from different approaches. An empirical study was conducted to demonstrate the performance of STNG using twelve different datasets. The results highlight STNG's robustness and its pivotal role in enhancing the accessibility of validated synthetic healthcare data, thereby offering a promising solution to a critical barrier in ML applications in healthcare., (© 2024. The Author(s).)

AI Chat Bots such as ChatGPT are revolutionizing our AI capabilities, especially in text generation, to help expedite many tasks, but they introduce new dilemmas. The detection of AI-generated text has become a subject of great debate considering the AI text detector's known and unexpected limitations. Thus far, much research in this area has focused on the detection of AI-generated text; however, the goal of this study was to evaluate the opposite scenario, an AI-text detection tool's ability to discriminate human-generated text. Thousands of abstracts from several of the most well-known scientific journals were used to test the predictive capabilities of these detection tools, assessing abstracts from 1980 to 2023. We found that the AI text detector erroneously identified up to 8% of the known real abstracts as AI-generated text. This further highlights the current limitations of such detection tools and argues for novel detectors or combined approaches that can address this shortcoming and minimize its unanticipated consequences as we navigate this new AI landscape., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Hooman Rashidi serves as an Associate Editor for JPI. Dr. Brandon Fennell has served as a reviewer for prior work published in JPI., (© 2023 The Author(s).)

Innovations in infectious disease testing have improved our abilities to detect and understand the microbial world. The 2019 novel coronavirus infectious disease (COVID-19) pandemic introduced new innovations including non-prescription "over the counter" infectious disease tests, mass spectrometry-based detection of COVID-19 host response, and the implementation of artificial intelligence (AI) and machine learning (ML) to identify individuals infected by the severe acute respiratory syndrome - coronavirus - 2 (SARS-CoV-2). As the world recovers from the COVID-19 pandemic; these innovative solutions will give rise to a new era of infectious disease tests extending beyond the detection of SARS-CoV-2. To this end, the purpose of this review is to summarize current trends in infectious disease testing and discuss innovative applications specifically in the areas of POC testing, MS, molecular diagnostics, sample types, and AI/ML., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)

Machine learning (ML) is becoming an integral aspect of several domains in medicine. Yet, most pathologists and laboratory professionals remain unfamiliar with such tools and are unprepared for their inevitable integration. To bridge this knowledge gap, we present an overview of key elements within this emerging data science discipline. First, we will cover general, well-established concepts within ML, such as data type concepts, data preprocessing methods, and ML study design. We will describe common supervised and unsupervised learning algorithms and their associated common machine learning terms (provided within a comprehensive glossary of terms that are discussed within this review). Overall, this review will offer a broad overview of the key concepts and algorithms in machine learning, with a focus on pathology and laboratory medicine. The objective is to provide an updated useful reference for those new to this field or those who require a refresher., Competing Interests: Declaration of Competing Interest MILO (the auto-ML platform mentioned) is the intellectual property of the Regents of the University of California (UC) and two of the co-authors in this manuscript (H. Rashidi & S. Albahra) are its co-inventors. Both are also on the board of MILO-ML Inc. (a UC start up). The other authors have no conflict of interests to declare, (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

One of the core elements of Machine Learning (ML) is statistics and its embedded foundational rules and without its appropriate integration, ML as we know would not exist. Various aspects of ML platforms are based on statistical rules and most notably the end results of the ML model performance cannot be objectively assessed without appropriate statistical measurements. The scope of statistics within the ML realm is rather broad and cannot be adequately covered in a single review article. Therefore, here we will mainly focus on the common statistical concepts that pertain to supervised ML (i.e. classification and regression) along with their interdependencies and certain limitations., Competing Interests: The MILO auto-ML mentioned in this manuscript is the intellectual property of the Regents of the University of California UC and the following co-authors in this manuscript HR, SA, and NT are its co-inventors. They are all also on the board of MILO-ML Inc. a UC start up. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rashidi, Albahra, Robertson, Tran and Hu.)

The 2019 novel coronavirus infectious disease (COVID-19) pandemic has resulted in an unsustainable need for diagnostic tests. Currently, molecular tests are the accepted standard for the detection of SARS-CoV-2. Mass spectrometry (MS) enhanced by machine learning (ML) has recently been postulated to serve as a rapid, high-throughput, and low-cost alternative to molecular methods. Automated ML is a novel approach that could move mass spectrometry techniques beyond the confines of traditional laboratory settings. However, it remains unknown how different automated ML platforms perform for COVID-19 MS analysis. To this end, the goal of our study is to compare algorithms produced by two commercial automated ML platforms (Platforms A and B). Our study consisted of MS data derived from 361 subjects with molecular confirmation of COVID-19 status including SARS-CoV-2 variants. The top optimized ML model with respect to positive percent agreement (PPA) within Platforms A and B exhibited an accuracy of 94.9%, PPA of 100%, negative percent agreement (NPA) of 93%, and an accuracy of 91.8%, PPA of 100%, and NPA of 89%, respectively. These results illustrate the MS method's robustness against SARS-CoV-2 variants and highlight similarities and differences in automated ML platforms in producing optimal predictive algorithms for a given dataset., Competing Interests: N.T. is a consultant for Roche Diagnostics and Roche Molecular Systems. He is also a co-inventor / co-owner of MILO-ML, LLC. H.R. is also a co-inventor / co-owner of MILO-ML, LLC. J.P. is a co-founder and employee of SpectraPass, LLC. L.M. is a consultant for Roche Diagnostics and Roche Molecular Systems. S.A. is a co-inventor / co-owner of MILO-ML, LLC. T.H., K.K., B.P., and M.S. have no competing interests.

High-quality medical data is critical to the development and implementation of machine learning (ML) algorithms in healthcare; however, security, and privacy concerns continue to limit access. We sought to determine the utility of "synthetic data" in training ML algorithms for the detection of tuberculosis (TB) from inflammatory biomarker profiles. A retrospective dataset (A) comprised of 278 patients was used to generate synthetic datasets (B, C, and D) for training models prior to secondary validation on a generalization dataset. ML models trained and validated on the Dataset A (real) demonstrated an accuracy of 90%, a sensitivity of 89% (95% CI, 83-94%), and a specificity of 100% (95% CI, 81-100%). Models trained using the optimal synthetic dataset B showed an accuracy of 91%, a sensitivity of 93% (95% CI, 87-96%), and a specificity of 77% (95% CI, 50-93%). Synthetic datasets C and D displayed diminished performance measures (respective accuracies of 71% and 54%). This pilot study highlights the promise of synthetic data as an expedited means for ML algorithm development., Competing Interests: Dr. Rashidi is a co-inventor of MILO and owns shares in MILO-ML, LLC. Dr. Albahra is a co-inventor of the MILO software and owns shares in MILO-ML, LLC. Dr. Tran is a co-inventor of the MILO software and owns shares in MILO-ML, LLC. He is also a consultant for Roche Diagnostics and Roche Molecular Systems., (Copyright: © 2022 Journal of Pathology Informatics.)

Background: Artificial intelligence (AI) and machine learning (ML) are poised to transform infectious disease testing. Uniquely, infectious disease testing is technologically diverse spaces in laboratory medicine, where multiple platforms and approaches may be required to support clinical decision-making. Despite advances in laboratory informatics, the vast array of infectious disease data is constrained by human analytical limitations. Machine learning can exploit multiple data streams, including but not limited to laboratory information and overcome human limitations to provide physicians with predictive and actionable results. As a quickly evolving area of computer science, laboratory professionals should become aware of AI/ML applications for infectious disease testing as more platforms are become commercially available., Content: In this review we: (a) define both AI/ML, (b) provide an overview of common ML approaches used in laboratory medicine, (c) describe the current AI/ML landscape as it relates infectious disease testing, and (d) discuss the future evolution AI/ML for infectious disease testing in both laboratory and point-of-care applications., Summary: The review provides an important educational overview of AI/ML technique in the context of infectious disease testing. This includes supervised ML approaches, which are frequently used in laboratory medicine applications including infectious diseases, such as COVID-19, sepsis, hepatitis, malaria, meningitis, Lyme disease, and tuberculosis. We also apply the concept of "data fusion" describing the future of laboratory testing where multiple data streams are integrated by AI/ML to provide actionable clinical knowledge., (© American Association for Clinical Chemistry 2021. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Several groups have previously developed logistic regression models for predicting delayed graft function (DGF). In this study, we used an automated machine learning (ML) modeling pipeline to generate and optimize DGF prediction models en masse., Methods: Deceased donor renal transplants at our institution from 2010 to 2018 were included. Input data consisted of 21 donor features from United Network for Organ Sharing. A training set composed of ~50%/50% split in DGF-positive and DGF-negative cases was used to generate 400 869 models. Each model was based on 1 of 7 ML algorithms (gradient boosting machine, k-nearest neighbor, logistic regression, neural network, naive Bayes, random forest, support vector machine) with various combinations of feature sets and hyperparameter values. Performance of each model was based on a separate secondary test dataset and assessed by common statistical metrics., Results: The best performing models were based on neural network algorithms, with the highest area under the receiver operating characteristic curve of 0.7595. This model used 10 out of the original 21 donor features, including age, height, weight, ethnicity, serum creatinine, blood urea nitrogen, hypertension history, donation after cardiac death status, cause of death, and cold ischemia time. With the same donor data, the highest area under the receiver operating characteristic curve for logistic regression models was 0.7484, using all donor features., Conclusions: Our automated en masse ML modeling approach was able to rapidly generate ML models for DGF prediction. The performance of the ML models was comparable with classic logistic regression models., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Herpes simplex virus (HSV) and cytomegalovirus (CMV) immunohistochemical stains (IHC) are frequently applied on esophageal biopsies. Our aims were to identify IHC use patterns in viral esophagitis (VE), and clinicopathologic features of VE that could guide IHC use., Methods: We included 58 VE cases and 60 controls, defined as patients with negative HSV/CMV IHC between January 2006 and July 2017. Biopsies were reviewed and histologic features and clinical data recorded., Results: Thirteen cases required IHC for diagnosis. IHC was performed in 13 HSV and 5 CMV cases where diagnostic viral inclusions were present. VE patients were more likely to have endoscopic ulcer (P=0.002) and be immunocompromised (P<0.001). Pretest clinical concern for VE was common (P=0.006). Histologically, VE patients were more likely to have ulcer (P=0.004), ulcer exudate rich in neutrophils and histiocytes (P=0.001), neutrophils in squamous mucosa (P<0.001), histiocyte aggregates >15 (P<0.001) and spongiosis (P<0.001). Controls had frequent eosinophils, alone (P=0.008) or admixed with other inflammatory cells (P<0.0001)., Conclusions: IHC is used in VE biopsies despite definite viral inclusions on hematoxylin and eosin and in patients without concerning histology or clinical concern for VE. History, endoscopic findings, and histology can be used to better target IHC use in VE., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Serological diagnosis of active tuberculosis (TB) is enhanced by detection of multiple antibodies due to variable immune responses among patients. Clinical interpretation of these complex datasets requires development of suitable algorithms, a time consuming and tedious undertaking addressed by the automated machine learning platform MILO (Machine Intelligence Learning Optimizer). MILO seamlessly integrates data processing, feature selection, model training, and model validation to simultaneously generate and evaluate thousands of models. These models were then further tested for generalizability on out-of-sample secondary and tertiary datasets. Out of 31 antigens evaluated, a 23-antigen model was the most robust on both the secondary dataset (TB vs healthy) and the tertiary dataset (TB vs COPD) with sensitivity of 90.5% and respective specificities of 100.0% and 74.6%. MILO represents a user-friendly, end-to-end solution for automated generation and deployment of optimized models, ideal for applications where rapid clinical implementation is critical such as emerging infectious diseases., (© 2021. The Author(s).)

Artificial Intelligence (AI) and machine learning (ML) have now spawned a new field within health care and health science research. These new predictive analytics tools are starting to change various facets of our clinical care domains including the practice of laboratory medicine. Many of these ML tools and studies are also starting to populate our literature landscape as we know it but unfamiliarity of the average reader to the basic knowledge and critical concepts within AI/ML is now demanding a need to better prepare our audience to such relatively unfamiliar concepts. A fundamental knowledge of such platforms will inevitably enhance cross-disciplinary literacy and ultimately lead to enhanced integration and understanding of such tools within our discipline. In this review, we provide a general outline of AI/ML along with an overview of the fundamental concepts of ML categories, specifically supervised, unsupervised, and reinforcement learning. Additionally, since the vast majority of our current approaches within ML in laboratory medicine and health care involve supervised algorithms, we will predominantly concentrate on such platforms. Finally, the need for making such tools more accessible to the average investigator is becoming a major driving force for the need of automation within these ML platforms. This has now given rise to the automated ML (Auto-ML) world which will undoubtedly help shape the future of ML within health care. Hence, an overview of Auto-ML is also covered within this manuscript which will hopefully enrich the reader's understanding, appreciation, and the need for embracing such tools., (© 2021 John Wiley & Sons Ltd.)

Context.—: Delayed recognition of acute kidney injury (AKI) results in poor outcomes in military and civilian burn-trauma care. Poor predictive ability of urine output (UOP) and creatinine contribute to the delayed recognition of AKI., Objective.—: To determine the impact of point-of-care (POC) AKI biomarker enhanced by machine learning (ML) algorithms in burn-injured and trauma patients., Design.—: We conducted a 2-phased study to develop and validate a novel POC device for measuring neutrophil gelatinase-associated lipocalin (NGAL) and creatinine from blood samples. In phase I, 40 remnant plasma samples were used to evaluate the analytic performance of the POC device. Next, phase II enrolled 125 adults with either burns that were 20% or greater of total body surface area or nonburn trauma with suspicion of AKI for clinical validation. We applied an automated ML approach to develop models predicting AKI, using a combination of NGAL, creatinine, and/or UOP as features., Results.—: Point-of-care NGAL (mean [SD] bias: 9.8 [38.5] ng/mL, P = .10) and creatinine results (mean [SD] bias: 0.28 [0.30] mg/dL, P = .18) were comparable to the reference method. NGAL was an independent predictor of AKI (odds ratio, 1.6; 95% CI, 0.08-5.20; P = .01). The optimal ML model achieved an accuracy, sensitivity, and specificity of 96%, 92.3%, and 97.7%, respectively, with NGAL, creatinine, and UOP as features. Area under the receiver operator curve was 0.96., Conclusions.—: Point-of-care NGAL testing is feasible and produces results comparable to reference methods. Machine learning enhanced the predictive performance of AKI biomarkers including NGAL and was superior to the current techniques., Competing Interests: The other authors have no relevant financial interest in the products or companies described in this article., (© 2021 College of American Pathologists.)

Sepsis is the primary cause of burn-related mortality and morbidity. Traditional indicators of sepsis exhibit poor performance when used in this unique population due to their underlying hypermetabolic and inflammatory response following burn injury. To address this challenge, we developed the Machine Intelligence Learning Optimizer (MILO), an automated machine learning (ML) platform, to automatically produce ML models for predicting burn sepsis. We conducted a retrospective analysis of 211 adult patients (age ≥ 18 years) with severe burn injury (≥ 20% total body surface area) to generate training and test datasets for ML applications. The MILO approach was compared against an exhaustive "non-automated" ML approach as well as standard statistical methods. For this study, traditional multivariate logistic regression (LR) identified seven predictors of burn sepsis when controlled for age and burn size (OR 2.8, 95% CI 1.99-4.04, P = 0.032). The area under the ROC (ROC-AUC) when using these seven predictors was 0.88. Next, the non-automated ML approach produced an optimal model based on LR using 16 out of the 23 features from the study dataset. Model accuracy was 86% with ROC-AUC of 0.96. In contrast, MILO identified a k-nearest neighbor-based model using only five features to be the best performer with an accuracy of 90% and a ROC-AUC of 0.96. Machine learning augments burn sepsis prediction. MILO identified models more quickly, with less required features, and found to be analytically superior to traditional ML approaches. Future studies are needed to clinically validate the performance of MILO-derived ML models for sepsis prediction.

Objective: Stiff person syndrome (SPS) is commonly associated with antibodies directed against 65-kDa glutamic acid decarboxylase (GAD65). Therapeutic Plasma Exchange (TPE) has been used as an adjunct therapy in patients who do not respond well to conventional treatment, which includes immunosuppression therapies, anti-anxiety medications, muscle relaxants, anticonvulsants, and pain relievers., Methods: We retrospectively analyzed the clinical data and outcomes of ten patients with the clinical diagnosis of anti-GAD65 positive SPS in which TPE was employed to improve symptoms refractory to conventional treatment during an eight-year period., Results: TPE was initiated as complementary therapy in patients with worsening of symptoms characteristic of SPS. Six patients underwent chronic treatment with TPE following an initial course, of which the frequency of TPE was guided by the clinical response. Two patients only had transient improvements with further disease progression. Four patients developed a relapse of symptoms when the interval between procedures was increased. One of the four patients dependent on TPE had worsening of symptoms following complete cessation of TPE due to lack of insurance coverage. Four patients underwent only an acute hospitalized course of treatment with TPE; one demonstrated complete resolution of symptoms; one had a partial response; and two experienced no improvement., Conclusion: Our study supports previous reports that TPE may be beneficial for the management of patients with anti-GAD65 positive SPS, both for acute exacerbations and long-term maintenance, either as an adjunct therapy, or in lieu of treatment with disease modifying agents., (Copyright © 2019 Elsevier Ltd. All rights reserved.)