Recurrent exacerbations remain a common yet preventable outcome for many children with asthma. Machine learning (ML) algorithms using electronic medical records (EMR) could allow accurate identification of children at risk for exacerbations and facilitate referral for preventative comprehensive care to avoid this morbidity. We developed ML algorithms to predict repeat severe exacerbations (i.e. asthma-related emergency department (ED) visits or future hospital admissions) for children with a prior asthma ED visit at a tertiary care children's hospital. Retrospective pre-COVID19 (Feb 2017 - Feb 2019, N=2716) Epic EMR data from the Children's Hospital of Eastern Ontario (CHEO) linked with environmental pollutant exposure and neighbourhood marginalization information was used to train various ML models. We used boosted trees (LGBM, XGB) and 3 open-source large language model (LLM) approaches (DistilGPT2, Llama 3.2 1B and Llama-8b-UltraMedical). Models were tuned and calibrated then validated in a second retrospective post-COVID19 dataset (Jul 2022 - Apr 2023, N=1237) from CHEO. Models were compared using the area under the curve (AUC) and F1 scores, with SHAP values used to determine the most predictive features. The LGBM ML model performed best with the most predictive features in the final AIRE-KIDS_ED model including prior asthma ED visit, the Canadian triage acuity scale, medical complexity, food allergy, prior ED visits for non-asthma respiratory diagnoses, and age for an AUC of 0.712, and F1 score of 0.51. This is a nontrivial improvement over the current decision rule which has F1=0.334. While the most predictive features in the AIRE-KIDS_HOSP model included medical complexity, prior asthma ED visit, average wait time in the ED, the pediatric respiratory assessment measure score at triage and food allergy.

Machine learning (ML) promises to revolutionize public health through improved surveillance, risk stratification, and resource allocation. However, without systematic attention to algorithmic bias, ML may inadvertently reinforce existing health disparities. We present a systematic literature review of algorithmic bias identification, discussion, and reporting in Dutch public health ML research from 2021 to 2025. To this end, we developed the Risk of Algorithmic Bias Assessment Tool (RABA T) by integrating elements from established frameworks (Cochrane Risk of Bias, PROBAST, Microsoft Responsible AI checklist) and applied it to 35 peer-reviewed studies. Our analysis reveals pervasive gaps: although data sampling and missing data practices are well documented, most studies omit explicit fairness framing, subgroup analyses, and transparent discussion of potential harms. In response, we introduce a four-stage fairness-oriented framework called ACAR (A wareness, Conceptualization, Application, Reporting), with guiding questions derived from our systematic literature review to help researchers address fairness across the ML lifecycle. We conclude with actionable recommendations for public health ML practitioners to consistently consider algorithmic bias and foster transparency, ensuring that algorithmic innovations advance health equity rather than undermine it.

Artificial intelligence (AI) is advancing quickly and is being adopted in most industries. Using AI to draft an email message or check your grammar is typically not a cause for concern, but using it to make decisions that affect people's lives is another matter. When constitutional rights are involved, as in the justice system, transparency is paramount. During the Biden-Harris administration, Executive Order 14110 directed agencies to develop guidelines for acceptable uses and regulation of AI. Some of these uses, like summarizing and notetaking, will occur across the government.

With all the advances in both the science of aging and artificial intelligence (AI), we are in a propitious position to accurately and precisely determine who is at high risk of developing Alzheimer's disease years before signs of even mild cognitive deficit. It takes at least 20 years for aggregates of misfolded β-amyloid and tau proteins to accumulate in the brain along with neuroinflammation that they incite. This provides a long window of opportunity to get ahead of the pathobiological process, both for prediction and prevention. A family history of Alzheimer's and the presence of genetic variants in the APOE4 (apolipoprotein E4) allele indicate an increased risk, as does a polygenic risk score that is based on the combined influence of many genetic variants. However, each of these clues provides little insight about when initial symptoms would likely present.

There is a long history of building predictive models in healthcare using tabular data from electronic medical records. However, these models fail to extract the information found in unstructured clinical notes, which document diagnosis, treatment, progress, medications, and care plans. In this study, we investigate how answers generated by GPT-4o-mini (ChatGPT) to simple clinical questions about patients, when given access to the patient's discharge summary, can support patient-level mortality prediction. Using data from 14,011 first-time admissions to the Coronary Care or Cardiovascular Intensive Care Units in the MIMIC-IV Note dataset, we implement a transparent framework that uses GPT responses as input features in logistic regression models. Our findings demonstrate that GPT-based models alone can outperform models trained on standard tabular data, and that combining both sources of information yields even greater predictive power, increasing AUC by an average of 5.1 percentage points and increasing positive predictive value by 29.9 percent for the highest-risk decile. These results highlight the value of integrating large language models (LLMs) into clinical prediction tasks and underscore the broader potential for using LLMs in any domain where unstructured text data remains an underutilized resource.

Blood cultures are often over ordered without clear justification, straining healthcare resources and contributing to inappropriate antibiotic use pressures worsened by the global shortage. In study of 135483 emergency department (ED) blood culture orders, we developed machine learning (ML) models to predict the risk of bacteremia using structured electronic health record (EHR) data and provider notes via a large language model (LLM). The structured models AUC improved from 0.76 to 0.79 with note embeddings and reached 0.81 with added diagnosis codes. Compared to an expert recommendation framework applied by human reviewers and an LLM-based pipeline, our ML approach offered higher specificity without compromising sensitivity. The recommendation framework achieved sensitivity 86%, specificity 57%, while the LLM maintained high sensitivity (96%) but over classified negatives, reducing specificity (16%). These findings demonstrate that ML models integrating structured and unstructured data can outperform consensus recommendations, enhancing diagnostic stewardship beyond existing standards of care.

Recent advancements in Large Language Models (LLMs) have significantly enhanced the capabilities of AI-Powered Search Engines (AIPSEs), offering precise and efficient responses by integrating external databases with pre-existing knowledge. However, we observe that these AIPSEs raise risks such as quoting malicious content or citing malicious websites, leading to harmful or unverified information dissemination. In this study, we conduct the first safety risk quantification on seven production AIPSEs by systematically defining the threat model, risk level, and evaluating responses to various query types. With data collected from PhishTank, ThreatBook, and LevelBlue, our findings reveal that AIPSEs frequently generate harmful content that contains malicious URLs even with benign queries (e.g., with benign keywords). We also observe that directly query URL will increase the risk level while query with natural language will mitigate such risk. We further perform two case studies on online document spoofing and phishing to show the ease of deceiving AIPSEs in the real-world setting. To mitigate these risks, we develop an agent-based defense with a GPT-4o-based content refinement tool and an XGBoost-based URL detector. Our evaluation shows that our defense can effectively reduce the risk but with the cost of reducing available information. Our research highlights the urgent need for robust safety measures in AIPSEs.

Tech companies Amazon, Google and Meta have been criticised by a Senate select committee inquiry for being especially vague over how they used Australian data to train their powerful artificial intelligence products. Labor senator Tony Sheldon, the inquiry's chair, was frustrated by the multinationals' refusal to answer direct questions about their use of Australians' private and personal information. "Watching Amazon, Meta, and Google dodge questions during the hearings was like sitting through a cheap magic trick – plenty of hand-waving, a puff of smoke, and nothing to show for it in the end," Sheldon said in a statement, after releasing the final report of the inquiry on Tuesday. He called the tech companies "pirates" that were "pillaging our culture, data, and creativity for their gain while leaving Australians empty-handed." The report found some general-purpose AI models – such as OpenAI's GPT, Meta's Llama and Google's Gemini – should automatically default to a "high risk" category, and be subjected to mandated transparency and accountability requirements.

As NLP systems are increasingly deployed at scale, concerns about their potential negative impacts have attracted the attention of the research community, yet discussions of risk have mostly been at an abstract level and focused on generic AI or NLP applications. We argue that clearer assessments of risks and harms to users--and concrete strategies to mitigate them--will be possible when we specialize the analysis to more concrete applications and their plausible users. As an illustration, this paper is grounded in cooking recipe procedural document question answering (ProcDocQA), where there are well-defined risks to users such as injuries or allergic reactions. Our case study shows that an existing language model, applied in "zero-shot" mode, quantitatively answers real-world questions about recipes as well or better than the humans who have answered the questions on the web. Using a novel questionnaire informed by theoretical work on AI risk, we conduct a risk-oriented error analysis that could then inform the design of a future system to be deployed with lower risk of harm and better performance.

Depression and anxiety disorders are prevalent mental health challenges affecting a substantial segment of the global population. In this study, we explored the environmental correlates of these disorders by analyzing street-view images (SVI) of neighborhoods in the Netherlands. Our dataset comprises 9,879 Dutch SVIs sourced from Google Street View, paired with statistical depression and anxiety risk metrics from the Dutch Health Monitor. To tackle this challenge, we refined two existing neural network architectures, DeiT Base and ResNet50. Our goal was to predict neighborhood risk levels, categorized into four tiers from low to high risk, using the raw images. The results showed that DeiT Base and ResNet50 achieved accuracies of 43.43% and 43.63%, respectively. Notably, a significant portion of the errors were between adjacent risk categories, resulting in adjusted accuracies of 83.55% and 80.38%. We also implemented the SHapley Additive exPlanations (SHAP) method on both models and employed gradient rollout on DeiT. Interestingly, while SHAP underscored specific landscape attributes, the correlation between these features and distinct depression risk categories remained unclear. The gradient rollout findings were similarly non-definitive. However, through manual analysis, we identified certain landscape types that were consistently linked with specific risk categories. These findings suggest the potential of these techniques in monitoring the correlation between various landscapes and environmental risk factors for mental health issues. As a future direction, we recommend employing these methods to observe how risk scores from the Dutch Health Monitor shift across neighborhoods over time.