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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 ObjectivesThe predictive intensive care unit (ICU) scoring system is crucial for predicting patient outcomes, particularly mortality. Traditional scoring systems rely mainly on structured clinical data from electronic health records, which can overlook important clinical information in narratives and images. Materials and MethodsIn this work, we build a deep learning-based survival prediction model that utilizes multimodality data for ICU mortality prediction. Four sets of features are investigated: (1) physiological measurements of Simplified Acute Physiology Score (SAPS) II, (2) common thorax diseases predefined by radiologists, (3) bidirectional encoder representations from transformers-based text representations, and (4) chest X-ray image features. The model was evaluated using the Medical Information Mart for Intensive Care IV dataset. ResultsOur model achieves an average C-index of 0.7829 (95% CI, 0.7620-0.8038), surpassing the baseline using only SAPS-II features, which had a C-index of 0.7470 (95% CI: 0.7263-0.7676). Ablation studies further demonstrate the contributions of incorporating predefined labels (2.00% improvement), text features (2.44% improvement), and image features (2.82% improvement). Discussion and ConclusionThe deep learning model demonstrated superior performance to traditional machine learning methods under the same feature fusion setting for ICU mortality prediction. This study highlights the potential of integrating multimodal data into deep learning models to enhance the accuracy of ICU mortality prediction. 

Abstract This study reports a comprehensive environmental scan of the generative AI (GenAI) infrastructure in the national network for clinical and translational science across 36 institutions supported by the CTSA Program led by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) at the United States. Key findings indicate a diverse range of institutional strategies, with most organizations in the experimental phase of GenAI deployment. The results underscore the need for a more coordinated approach to GenAI governance, emphasizing collaboration among senior leaders, clinicians, information technology staff, and researchers. Our analysis reveals that 53% of institutions identified data security as a primary concern, followed by lack of clinician trust (50%) and AI bias (44%), which must be addressed to ensure the ethical and effective implementation of GenAI technologies. 

Deep learning has enabled breakthroughs in automated diagnosis from medical imaging, with many successful applications in ophthalmology. However, standard medical image classi cation approaches only assess disease presence at the time of acquisition, neglecting the common clinical setting of longitudinal imaging. For slow, progressive eye diseases like age-related macular degeneration (AMD) and primary open-angle glaucoma (POAG), patients undergo repeated imaging over time to track disease progression and forecasting the future risk of developing a disease is critical to properly plan treatment. Our proposed Longitudinal Transformer for Survival Analysis (LTSA) enables dynamic disease prognosis from longitudinal medical imaging, modeling the time to disease from sequences of fundus photography images captured over long, irregular time periods. Using longitudinal imaging data from the Age-Related Eye Disease Study (AREDS) and Ocular Hypertension Treatment Study (OHTS), LTSA signi cantly outperformed a single-image baseline in 19/20 head-to- head comparisons on late AMD prognosis and 18/20 comparisons on POAG prognosis. A temporal attention analysis also suggested that, while the most recent image is typically the most in uential, prior imaging still provides additional prognostic value. 

This study examined the application of GPT-4 with vision (GPT-4V), a multimodal large language model with visual recognition, in detecting radiologic findings from a set of 100 chest radiographs and suggests that GPT-4V is currently not ready for real-world diagnostic usage in interpreting chest radiographs. 

Social factors like family background, education level, financial status, and stress can impact public health outcomes, such as suicidal ideation. However, the analysis of social factors for suicide prevention has been limited by the lack of up-to-date suicide reporting data, variations in reporting practices, and small sample sizes. In this study, we analyzed 172,629 suicide incidents from 2014 to 2020 utilizing the National Violent Death Reporting System Restricted Access Database (NVDRS-RAD). Logistic regression models were developed to examine the relationships between demographics and suicide-related circumstances. Trends over time were assessed, and Latent Dirichlet Allocation (LDA) was used to identify common suiciderelated social factors. Mental health, interpersonal relationships, mental health treatment and disclosure, and school/work-related stressors were identified as the main themes of suicide-related social factors. This study also identified systemic disparities across various population groups, particularly concerning Black individuals, young people aged under 24, healthcare practitioners, and those with limited education backgrounds, which shed light on potential directions for demographic-specific suicidal interventions.