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Abstract ObjectiveExtracting social determinants of health (SDoHs) from medical notes depends heavily on labor-intensive annotations, which are typically task-specific, hampering reusability and limiting sharing. Here, we introduce SDoH-GPT, a novel framework leveraging few-shot learning large language models (LLMs) to automate the extraction of SDoH from unstructured text, aiming to improve both efficiency and generalizability. Materials and MethodsSDoH-GPT is a framework including the few-shot learning LLM methods to extract the SDoH from medical notes and the XGBoost classifiers which continue to classify SDoH using the annotations generated by the few-shot learning LLM methods as training datasets. The unique combination of the few-shot learning LLM methods with XGBoost utilizes the strength of LLMs as great few shot learners and the efficiency of XGBoost when the training dataset is sufficient. Therefore, SDoH-GPT can extract SDoH without relying on extensive medical annotations or costly human intervention. ResultsOur approach achieved tenfold and twentyfold reductions in time and cost, respectively, and superior consistency with human annotators measured by Cohen's kappa of up to 0.92. The innovative combination of LLM and XGBoost can ensure high accuracy and computational efficiency while consistently maintaining 0.90+ AUROC scores. DiscussionThis study has verified SDoH-GPT on three datasets and highlights the potential of leveraging LLM and XGBoost to revolutionize medical note classification, demonstrating its capability to achieve highly accurate classifications with significantly reduced time and cost. ConclusionThe key contribution of this study is the integration of LLM with XGBoost, which enables cost-effective and high quality annotations of SDoH. This research sets the stage for SDoH can be more accessible, scalable, and impactful in driving future healthcare solutions. 

Abstract In 2020, the U.S. Department of Defense officially disclosed a set of ethical principles to guide the use of Artificial Intelligence (AI) technologies on future battlefields. Despite stark differences, there are core similarities between the military and medical service. Warriors on battlefields often face life-altering circumstances that require quick decision-making. Medical providers experience similar challenges in a rapidly changing healthcare environment, such as in the emergency department or during surgery treating a life-threatening condition. Generative AI, an emerging technology designed to efficiently generate valuable information, holds great promise. As computing power becomes more accessible and the abundance of health data, such as electronic health records, electrocardiograms, and medical images, increases, it is inevitable that healthcare will be revolutionized by this technology. Recently, generative AI has garnered a lot of attention in the medical research community, leading to debates about its application in the healthcare sector, mainly due to concerns about transparency and related issues. Meanwhile, questions around the potential exacerbation of health disparities due to modeling biases have raised notable ethical concerns regarding the use of this technology in healthcare. However, the ethical principles for generative AI in healthcare have been understudied. As a result, there are no clear solutions to address ethical concerns, and decision-makers often neglect to consider the significance of ethical principles before implementing generative AI in clinical practice. In an attempt to address these issues, we explore ethical principles from the military perspective and propose the “GREAT PLEA” ethical principles, namely Governability, Reliability, Equity, Accountability, Traceability, Privacy, Lawfulness, Empathy, and Autonomy for generative AI in healthcare. Furthermore, we introduce a framework for adopting and expanding these ethical principles in a practical way that has been useful in the military and can be applied to healthcare for generative AI, based on contrasting their ethical concerns and risks. Ultimately, we aim to proactively address the ethical dilemmas and challenges posed by the integration of generative AI into healthcare practice. 

Random forest is considered as one of the most successful machine learning algorithms, which has been widely used to construct microbiome-based predictive models. However, its use as a statistical testing method has not been explored. In this study, we propose “Random Forest Test” (RFtest), a global (community-level) test based on random forest for high-dimensional and phylogenetically structured microbiome data. RFtest is a permutation test using the generalization error of random forest as the test statistic. Our simulations demonstrate that RFtest has controlled type I error rates, that its power is superior to competing methods for phylogenetically clustered signals, and that it is robust to outliers and adaptive to interaction effects and non-linear associations. Finally, we apply RFtest to two real microbiome datasets to ascertain whether microbial communities are associated or not with the outcome variables.