AKIBoards: A Structure-Following Multiagent System for Predicting Acute Kidney Injury

Diagnostic reasoning entails a physician's local (mental) model based on an assumed or known shared perspective (global model) to explain patient observations with evidence assigned towards a clinical assessment. But in several (complex) medical situations, multiple experts work together as a team to optimize health evaluation and decision-making by leveraging different perspectives. Such consensus-driven reasoning reflects individual knowledge contributing toward a broader perspective on the patient. In this light, we introduce STRUCture-following for Multiagent Systems (STRUC-MAS), a framework automating the learning of these global models and their incorporation as prior beliefs for agents in multiagent systems (MAS) to follow. We demonstrate proof of concept with a prosocial MAS application for predicting acute kidney injuries (AKIs). In this case, we found that incorporating a global structure enabled multiple agents to achieve better performance (average precision, AP) in predicting AKI 48 hours before onset (structure-following-fine-tuned, SF-FT, AP=0.195; SF-FT-retrieval-augmented generation, SF-FT-RAG, AP=0.194) vs. baseline (non-structure-following-FT, NSF-FT, AP=0.141; NSF-FT-RAG, AP=0.180) for balanced precision-weighted-recall-weighted voting. Markedly, SF-FT agents with higher recall scores reported lower confidence levels in the initial round on true positive and false negative cases. But after explicit interactions, their confidence in their decisions increased (suggesting reinforced belief). In contrast, the SF-FT agent with the lowest recall decreased its confidence in true positive and false negative cases (suggesting a new belief). This approach suggests that learning and leveraging global structures in MAS is necessary prior to achieving competitive classification and diagnostic reasoning performance.

Hybrid Reinforcement Learning and Model Predictive Control for Adaptive Control of Hydrogen-Diesel Dual-Fuel Combustion

Reinforcement Learning (RL) and Machine Learning Integrated Model Predictive Control (ML-MPC) are promising approaches for optimizing hydrogen-diesel dual-fuel engine control, as they can effectively control multiple-input multiple-output systems and nonlinear processes. ML-MPC is advantageous for providing safe and optimal controls, ensuring the engine operates within predefined safety limits. In contrast, RL is distinguished by its adaptability to changing conditions through its learning-based approach. However, the practical implementation of either method alone poses challenges. RL requires high variance in control inputs during early learning phases, which can pose risks to the system by potentially executing unsafe actions, leading to mechanical damage. Conversely, ML-MPC relies on an accurate system model to generate optimal control inputs and has limited adaptability to system drifts, such as injector aging, which naturally occur in engine applications. To address these limitations, this study proposes a hybrid RL and ML-MPC approach that uses an ML-MPC framework while incorporating an RL agent to dynamically adjust the ML-MPC load tracking reference in response to changes in the environment. At the same time, the ML-MPC ensures that actions stay safe throughout the RL agent's exploration. To evaluate the effectiveness of this approach, fuel pressure is deliberately varied to introduce a model-plant mismatch between the ML-MPC and the engine test bench. The result of this mismatch is a root mean square error (RMSE) in indicated mean effective pressure of 0.57 bar when running the ML-MPC. The experimental results demonstrate that RL successfully adapts to changing boundary conditions by altering the tracking reference while ML-MPC ensures safe control inputs. The quantitative improvement in load tracking by implementing RL is an RSME of 0.44 bar.

Testing Causal Explanations: A Case Study for Understanding the Effect of Interventions on Chronic Kidney Disease

Randomized controlled trials (RCTs) are the standard for evaluating the effectiveness of clinical interventions. To address the limitations of RCTs on real-world populations, we developed a methodology that uses a large observational electronic health record (EHR) dataset. Principles of regression discontinuity (rd) were used to derive randomized data subsets to test expert-driven interventions using dynamic Bayesian Networks (DBNs) do-operations. This combined method was applied to a chronic kidney disease (CKD) cohort of more than two million individuals and used to understand the associational and causal relationships of CKD variables with respect to a surrogate outcome of >=40% decline in estimated glomerular filtration rate (eGFR). The associational and causal analyses depicted similar findings across DBNs from two independent healthcare systems. The associational analysis showed that the most influential variables were eGFR, urine albumin-to-creatinine ratio, and pulse pressure, whereas the causal analysis showed eGFR as the most influential variable, followed by modifiable factors such as medications that may impact kidney function over time. This methodology demonstrates how real-world EHR data can be used to provide population-level insights to inform improved healthcare delivery.

Automated Dynamic Bayesian Networks for Predicting Acute Kidney Injury Before Onset

Several algorithms for learning the structure of dynamic Bayesian networks (DBNs) require an a priori ordering of variables, which influences the determined graph topology. However, it is often unclear how to determine this order if feature importance is unknown, especially as an exhaustive search is usually impractical. In this paper, we introduce Ranking Approaches for Unknown Structures (RAUS), an automated framework to systematically inform variable ordering and learn networks end-to-end. RAUS leverages existing statistical methods (Cramers V, chi-squared test, and information gain) to compare variable ordering, resultant generated network topologies, and DBN performance. RAUS enables end-users with limited DBN expertise to implement models via command line interface. We evaluate RAUS on the task of predicting impending acute kidney injury (AKI) from inpatient clinical laboratory data. Longitudinal observations from 67,460 patients were collected from our electronic health record (EHR) and Kidney Disease Improving Global Outcomes (KDIGO) criteria were then applied to define AKI events. RAUS learns multiple DBNs simultaneously to predict a future AKI event at different time points (i.e., 24-, 48-, 72-hours in advance of AKI). We also compared the results of the learned AKI prediction models and variable orderings to baseline techniques (logistic regression, random forests, and extreme gradient boosting). The DBNs generated by RAUS achieved 73-83% area under the receiver operating characteristic curve (AUCROC) within 24-hours before AKI; and 71-79% AUCROC within 48-hours before AKI of any stage in a 7-day observation window. Insights from this automated framework can help efficiently implement and interpret DBNs for clinical decision support. The source code for RAUS is available in GitHub at https://github.com/dgrdn08/RAUS .

The Myths of Our Time: Fake News

While the purpose of most fake news is misinformation and political propaganda, our team sees it as a new type of myth that is created by people in the age of internet identities and artificial intelligence. Seeking insights on the fear and desire hidden underneath these modified or generated stories, we use machine learning methods to generate fake articles and present them in the form of an online news blog. This paper aims to share the details of our pipeline and the techniques used for full generation of fake news, from dataset collection to presentation as a media art project on the internet.