An LLM-based Agentic Framework for Accessible NetworkControl

Evaluating gpt-4 for zero-shot classification of bleeding and clotting events: Can large language models serve as second reviewers?

Generative large language models (LLMs) are a subset of transformers-based neural network architecture models. LLMs have successfully leveraged a combination of an increased number of parameters, improvements in computational efficiency, and large pre-training datasets to perform a wide spectrum of natural language processing (NLP) tasks. Using a few examples (few-shot) or no examples (zero-shot) for prompt-tuning has enabled LLMs to achieve state-of-the-art performance in a broad range of NLP applications. This article by the American Medical Informatics Association (AMIA) NLP Working Group characterizes the opportunities, challenges, and best practices for our community to leverage and advance the integration of LLMs in downstream NLP applications effectively. This can be accomplished through a variety of approaches, including augmented prompting, instruction prompt tuning, and reinforcement learning from human feedback (RLHF). Our focus is on making LLMs accessible to the broader biomedical informatics community, including clinicians and researchers who may be unfamiliar with NLP. Additionally, NLP practitioners may gain insight from the described best practices. We focus on 3 broad categories of NLP tasks, namely natural language understanding, natural language inferencing, and natural language generation. We review the emerging trends in prompt tuning, instruction fine-tuning, and evaluation metrics used for LLMs while drawing attention to several issues that impact biomedical NLP applications, including falsehoods in generated text (confabulation/hallucinations), toxicity, and dataset contamination leading to overfitting. We also review potential approaches to address some of these current challenges in LLMs, such as chain of thought prompting, and the phenomena of emergent capabilities observed in LLMs that can be leveraged to address complex NLP challenge in biomedical applications.

Background and Aims Large language models (LLMs) have gained significant attention in the field of natural language processing (NLP), marking a shift from traditional techniques like Term Frequency-Inverse Document Frequency (TF-IDF). We developed a traditional NLP model to predict arteriovenous fistula (AVF) failure within next 30 days using clinical notes. The goal of this analysis was to investigate whether LLMs would outperform traditional NLP techniques, specifically in the context of predicting AVF failure within the next 30 days using clinical notes. Method We defined AVF failure as the change in status from active to permanently unusable status or temporarily unusable status. We used data from a large kidney care network from January 2021 to December 2021. Two models were created using LLMs and traditional TF-IDF technique. We used “distilbert-base-uncased”, a distilled version of BERT base model [1], and compared its performance with traditional TF-IDF-based NLP techniques. The dataset was randomly divided into 60% training, 20% validation and 20% test dataset. The test data, comprising of unseen patients’ data was used to evaluate the performance of the model. Both models were evaluated using metrics such as area under the receiver operating curve (AUROC), accuracy, sensitivity, and specificity. Results The incidence of 30 days AVF failure rate was 2.3% in the population. Both LLMs and traditional showed similar overall performance as summarized in Table 1. Notably, LLMs showed marginally better performance in certain evaluation metrics. Both models had same AUROC of 0.64 on test data. The accuracy and balanced accuracy for LLMs were 72.9% and 59.7%, respectively, compared to 70.9% and 59.6% for the traditional TF-IDF approach. In terms of specificity, LLMs scored 73.2%, slightly higher than the 71.2% observed for traditional NLP methods. However, LLMs had a lower sensitivity of 46.1% compared to 48% for traditional NLP. However, it is worth noting that training on LLMs took considerably longer than TF-IDF. Moreover, it also used higher computational resources such as utilization of graphics processing units (GPU) instances in cloud-based services, leading to higher cost. Conclusion In our study, we discovered that advanced LLMs perform comparably to traditional TF-IDF modeling techniques in predicting the failure of AVF. Both models demonstrated identical AUROC. While specificity was higher in LLMs compared to traditional NLP, sensitivity was higher in traditional NLP compared to LLMs. LLM was fine-tuned with a limited dataset, which could have influenced its performance to be similar to that of traditional NLP methods. This finding suggests that while LLMs may excel in certain scenarios, such as performing in-depth sentiment analysis of patient data for complex tasks, their effectiveness is highly dependent on the specific use case. It is crucial to weigh the benefits against the resources required for LLMs, as they can be significantly more resource-intensive and costly compared to traditional TF-IDF methods. This highlights the importance of a use-case-driven approach in selecting the appropriate NLP technique for healthcare applications.

Interacting with Large Language Models (LLMs) via declarative queries is increasingly popular for tasks like question answering and data extraction, thanks to their ability to process vast unstructured data. However, LLMs often struggle with answering complex factual questions, exhibiting low precision and recall in the returned data. This challenge highlights that executing queries on LLMs remains a largely unexplored domain, where traditional data processing assumptions often fall short. Conventional query optimization, typically cost-driven, overlooks LLM-specific quality challenges such as contextual understanding. Just as new physical operators are designed to address the unique characteristics of LLMs, optimization must consider these quality challenges. Our results highlight that adhering strictly to conventional query optimization principles fails to generate the best plans in terms of result quality. To tackle this challenge, we present a novel approach to enhance SQL results by applying query optimization techniques specifically adapted for LLMs. We introduce a database system, GALOIS, that sits between the query and the LLM, effectively using the latter as a storage layer. We design alternative physical operators tailored for LLM-based query execution and adapt traditional optimization strategies to this novel context. For example, while pushing down operators in the query plan reduces execution cost (fewer calls to the model), it might complicate the call to the LLM and deteriorate result quality. Additionally, these models lack a traditional catalog for optimization, leading us to develop methods to dynamically gather such metadata during query execution. Our solution is compatible with any LLM and balances the trade-off between query result quality and execution cost. Experiments show up to 144% quality improvement over questions in Natural Language and 29% over direct SQL execution, highlighting the advantages of integrating database solutions with LLMs.

The communication and computation integrated network architecture ((Com)2Net) simplifies the deployment of applications such as distributed machine learning. However, the management and operation of the (Com)2Net pose significant burdens and consume a substantial amount of time due to its large-scale and complexity nature. Intent-based networking technology and Large Language Models (LLMs) are beneficial for the automation configuration and management of (Com)2Nets. In this article, we introduce a network automation configuration and management architecture. It implements network automation configuration based on user intents in natural language, reducing the network management complexity. The network management agent, based on a LLM, is proposed to translate user intents in natural language into machine instructions. Finally, we present two use cases and real-world evaluations to validate the performance of this architecture. The demo and code are open available on: <uri xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">https://github.com/Lizonghang/KlonetAI</uri>.

Large language models (LLMs) are increasingly adopted in educational contexts to provide personalized support to students and teachers. The unprecedented capacity of LLM‐based applications to understand and generate natural language can potentially improve instructional effectiveness and learning outcomes, but the integration of LLMs in education technology has renewed concerns over algorithmic bias, which may exacerbate educational inequalities. Building on prior work that mapped the traditional machine learning life cycle, we provide a framework of the LLM life cycle from the initial development of LLMs to customizing pre‐trained models for various applications in educational settings. We explain each step in the LLM life cycle and identify potential sources of bias that may arise in the context of education. We discuss why current measures of bias from traditional machine learning fail to transfer to LLM‐generated text (eg, tutoring conversations) because text encodings are high‐dimensional, there can be multiple correct responses, and tailoring responses may be pedagogically desirable rather than unfair. The proposed framework clarifies the complex nature of bias in LLM applications and provides practical guidance for their evaluation to promote educational equity. Practitioner notes What is already known about this topic The life cycle of traditional machine learning (ML) applications which focus on predicting labels is well understood. Biases are known to enter in traditional ML applications at various points in the life cycle, and methods to measure and mitigate these biases have been developed and tested. Large language models (LLMs) and other forms of generative artificial intelligence (GenAI) are increasingly adopted in education technologies (EdTech), but current evaluation approaches are not specific to the domain of education. What this paper adds A holistic perspective of the LLM life cycle with domain‐specific examples in education to highlight opportunities and challenges for incorporating natural language understanding (NLU) and natural language generation (NLG) into EdTech. Potential sources of bias are identified in each step of the LLM life cycle and discussed in the context of education. A framework for understanding where to expect potential harms of LLMs for students, teachers, and other users of GenAI technology in education, which can guide approaches to bias measurement and mitigation. Implications for practice and/or policy Education practitioners and policymakers should be aware that biases can originate from a multitude of steps in the LLM life cycle, and the life cycle perspective offers them a heuristic for asking technology developers to explain each step to assess the risk of bias. Measuring the biases of systems that use LLMs in education is more complex than with traditional ML, in large part because the evaluation of natural language generation is highly context‐dependent (eg, what counts as good feedback on an assignment varies). EdTech developers can play an important role in collecting and curating datasets for the evaluation and benchmarking of LLM applications moving forward.

Introduction Game theory has long served as a foundational tool in cybersecurity to test, predict, and design strategic interactions between attackers and defenders. The recent advent of Large Language Models (LLMs) offers new tools and challenges for the security of computer systems. In this work, we investigate whether classical game-theoretic frameworks can effectively capture the behaviors of LLM-driven actors and bots. Methods Using a reproducible framework for game-theoretic LLM agents, we investigate two canonical scenarios—the one-shot zero-sum game and the dynamic Prisoner's Dilemma—and we test whether LLMs converge to expected outcomes or exhibit deviations due to embedded biases. We experiments on four state-of-the-art LLMs and five natural languages (English, French, Arabic, Vietnamese, and Mandarin Chinese) to assess linguistic sensitivity. Results For both games, we observe that the final payoffs are influenced by agents characteristics such as personality traits or knowledge of repeated rounds. We also uncover an unexpected sensitivity of the final payoffs to the choice of languages, which should warn against indiscriminate application of LLMs in cybersecurity applications and call for in-depth studies, as LLMs may behave differently when deployed in different countries. We also employ quantitative metrics to evaluate the internal consistency and cross-language stability of LLM agents. Discussion In addition to uncovering unexpected behaviors requiring attention by scholars and practitioners, our work can help guide the selection of the most stable LLMs and optimizing models for secure applications.

e23161 Background: Data retrieval is challenging in clinical research and traditional methods for data collection are often time-consuming and may be error-prone. Large Language Models (LLMs) have shown zero-shot capabilities in converting unstructured clinical text into structured data. These technologies could support the retrieval stage of clinical trials by leveraging the information reported in Electronic Health Records (EHRs) without relying any longer on manual curation. APOLLO 11 Consortium (NCT05550961) is a multicentric Italian trial which leverages a federated infrastructure for the analysis of advanced lung cancer patient data across Italy. Methods: We conducted a pilot study using Llama 3.1 8B on 358 Non-Small Cell Lung Cancer patients from the IRCCS Istituto Nazionale dei Tumori, leader of the APOLLO 11 Consortium. Anonymized EHRs have been analyzed within the LLM pipeline for feature extraction by Wiest et al. A combination of zero/few shot prompting techniques both in English and Italian languages was used. We selected smoking, histology, PD-L1 and staging as multiclass variables and bone/brain/liver metastases as binary variables. The ground truth collection involved a first Manual Data Entry (1-MDE) and a final full-revised MDE (2-MDE). The LLM accuracy was calculated only for the comparison LLM vs 2-MDE. In addition, we calculated the percentage of Missing Information (% MI) in 1-MDE, 2-MDE and LLM extraction. Results: Compared to 2-MDE, LLM achieved feature-specific accuracies of 0.78 for PD-L1, 0.85 for BONE METASTASIS, 0.83 for BRAIN METASTASIS, 0.89 for LIVER METASTASIS and 0.96 for TUMOUR STAGING. For smoking and staging, LLM extraction also reduced % MI relative to 1-MDE (Table 1). Only for PD-L1, we further analyzed the 12.8% of MI and found that 91.3% resulted from hallucinations (i.e., PD-L1 was misclassified as missing). Evaluations using English prompts confirmed the pipeline’s adaptability and high tasks accuracy. Conclusions: This study confirms the feasibility of LLMs for data retrieval in clinical trials demonstrating strong performance across diverse clinical features with minimal prompt optimization. LLMs could assist clinicians and data entry personnel in the 1-MDE process, streamlining initial data structuring and saving time. The 2-MDE step can remain as a quality check to address any discrepancies. Further improvements could focus on prompt optimization and integrating human feedback to reduce hallucination rates. Clinical trial information: NCT05550961 . %MI in 1-MDE, 2-MDE and LLM extraction. Accuracy refers only to LLM vs 2-MDE. Histology and metastasis sites were collected only in 2-MDE. NA = not available. Smoking PD-L1 Histology Bone Met Brain Met Liver Met T N M Stage % MI 1-MDE 6.4 8.9 NA NA NA NA 22.5 22.5 23.11 98.3 % MI 2-MDE 6.6 3 0 0 0 0 0 0 0 0 % MI LLM 2.7 12.8 10.3 0 0 0 0 0 0 6.9 % accuracy (LLM vs 2-MDE) 67 78 91 85 83 89 39 52 70 96

Newly powerful large language models have burst onto the scene, with applications across a wide range of functions. We can now expect to encounter their outputs at rapidly increasing volumes and frequencies. Some commentators claim that large language models are bullshitting, generating convincing output without regard for the truth. If correct, that would make large language models distinctively dangerous discourse participants. Bullshitters not only undermine the norm of truthfulness (by saying false things) but the normative status of truth itself (by treating it as entirely irrelevant). So, do large language models really bullshit? I argue that they can, in the sense of issuing propositional content in response to fact-seeking prompts, without having first assessed that content for truth or falsity. However, I further argue that they need not bullshit, given appropriate guardrails. So, just as with human speakers, the propensity for a large language model to bullshit depends on its own particular make-up.

DialogueLLM: Context and emotion knowledge-tuned large language models for emotion recognition in conversations.

A novel prompting method for few-shot NER via LLMs

Large Language Models (LLMs) hold the potential for clinical task-shifting by processing unstructured clinical text, enabling tasks such as clinical concept extraction and medical question answering from electronic health records. If implemented reliably, such approaches may benefit over-burdened healthcare systems, particularly in resource-limited settings and for traditionally overlooked populations, provided that local fine-tuning is supported by appropriate clinical and technical expertise. However, this powerful technology remains largely understudied in real-world contexts, particularly in the Global South. This study aims to assess whether openly available LLMs can be used reliably for processing medical notes in real-world settings in South Asia. We used publicly available LLMs to parse de-identified clinical notes from a large electronic health records (EHR) database in Pakistan, containing hospital records for 8.2 million patients. ChatGPT (GPT-3.5) as a general-purpose LLM, and GatorTron (base), BioMegatron, BioBert and ClinicalBERT as medical LLMs were evaluated when applied to these data, after fine-tuning them with (a) publicly available clinical datasets namely Informatics for Integrating Biology & the Bedside (I2B2) and National NLP Clinical Challenges (N2C2) for medical concept extraction (MCE) and emrQA for medical question answering (MQA), and (b) the local Pakistani de-identified EHR dataset, which includes inpatient Discharge Summaries (DS) and Subjective, Objective, Assessment, and Plan (SOAP) notes, as detailed in this paper. MCE models were applied to these clinical notes using both 3-label and 9-label formats, while MQA models were applied to medical questions. Internal and external validation performance was measured for (a) and (b) using F1 score, precision, recall, and accuracy for MCE and BLEU and ROUGE-L, which measure lexical and sequence similarity, for MQA. When clinical LLMs were not fine-tuned on the local EHR dataset, their performance during external validation on local data was notably poorer compared to internal validation on the dataset used for fine-tuning, with reductions of at least 15% in F1 scores for MCE and 35% in ROUGE-L and BLEU scores for MQA tasks. This suggests potential bias and highlights the inability of the medical LLMs to reliably handle the data distribution of the local population without further fine-tuning and adaptation. This trend persisted across two distinct natural language processing tasks: concept extraction and question answering, spanning a spectrum of task complexities. However, fine-tuning the LLMs with local EHR data significantly improved model performance across both tasks, yielding a 7.5% to 15% increase in the F1 score for MCE and a 27% to 53% increase in ROUGE-L and BLEU scores for MQA. Notably, ChatGPT, as a general-purpose LLM, stood out as an exception, demonstrating superior performance across all measured metrics on the local dataset compared to the publicly available dataset, with improvements ranging from 3% to 17% on the local EHR dataset, even without fine-tuning on the local data. Publicly available LLMs, predominantly trained on data from high-income regions, were found to be unreliable when applied in a real-world clinical setting in Pakistan. Fine-tuning them with local EHR data and regional clinical contexts improved their reliability, demonstrating a feasible adaptation strategy that is substantially less resource-intensive than training large language models from scratch. Close collaboration between local clinical and technical experts to curate and leverage more representative, inclusive, and unbiased medical datasets, can play a crucial role in further ensuring reliability of LLMs for resource-limited, overburdened settings, to be used in ways that are safe, fair, and beneficial for all.

As large language models (LLMs) achieve remarkable success in natural language processing (NLP) domains, LLM-enhanced recommender systems have received much attention and are being actively explored currently. In this article, we focus on adapting and enhancing large language models for recommendation tasks. First and foremost, we identify and formulate the lifelong sequential behavior incomprehension problem for LLMs in recommendation realms, i.e., LLMs fail to effectively extract useful information from a pure textual context of long user behavior sequence, even if the length of context is well below the context limitation of LLMs. To address such an issue and improve the recommendation performance of LLMs, we propose a novel framework, namely, R etrieval- e nhanced L arge La nguage models Plus (ReLLaX), which provides full-stack optimization from three perspectives, i.e., data, prompt, and parameter. For data-level enhancement, we design semantic user behavior retrieval (SUBR) to reduce the heterogeneity of the behavior sequence, thus lowering the difficulty for LLMs to extract the essential information from user behavior sequences. Although SUBR can improve the data quality, further increase in the sequence length will still raise its heterogeneity to a level where LLMs can no longer comprehend it. Hence, we further propose to perform prompt-level and parameter-level enhancement, with the integration of conventional recommendation models (CRMs). As for prompt-level enhancement, we apply soft prompt augmentation (SPA) to explicitly inject collaborative knowledge from CRMs into the prompt. The item representations of LLMs are thus more aligned with recommendation, helping LLMs better explore the item relationships in the sequence and facilitating comprehension. Finally, for parameter-level enhancement, we propose component fully-interactive LoRA (CFLoRA). By enabling sufficient interaction between the LoRA atom components, the expressive ability of LoRA is extended, making the parameters effectively capture more sequence information. Moreover, we present new perspectives to compare current LoRA-based LLM4Rec methods, i.e., from both a composite and a decomposed view. We theoretically demonstrate that the ways they employ LoRA for recommendation are degraded versions of our CFLoRA, with different constraints on atom component interactions. Extensive experiments are conducted on three real-world public datasets to demonstrate the superiority of ReLLaX compared with existing baseline models, as well as its capability to alleviate lifelong sequential behavior incomprehension. Our code is available. 1

Designing preference elicitation (PE) methodologies that can quickly ascertain a user’s top item preferences in a cold-start setting is a key challenge for building effective and personalized conversational recommendation (ConvRec) systems. While large language models (LLMs) enable fully natural language (NL) PE dialogues, we hypothesize that monolithic LLM NL-PE approaches lack the multi-turn, decision-theoretic reasoning required to effectively balance the exploration and exploitation of user preferences towards an arbitrary item set. In contrast, traditional Bayesian optimization PE methods define theoretically optimal PE strategies, but cannot generate arbitrary NL queries or reason over content in NL item descriptions – requiring users to express preferences via ratings or comparisons of unfamiliar items. To overcome the limitations of both approaches, we formulate NL-PE in a Bayesian Optimization (BO) framework that seeks to actively elicit NL feedback to identify the best recommendation. Key challenges in generalizing BO to deal with natural language feedback include determining: (a) how to leverage LLMs to model the likelihood of NL preference feedback as a function of item utilities, and (b) how to design an acquisition function for NL BO that can elicit preferences in the infinite space of language. We demonstrate our framework in a novel NL-PE algorithm, PEBOL, which uses: 1) Natural Language Inference (NLI) between user preference utterances and NL item descriptions to maintain Bayesian preference beliefs, and 2) BO strategies such as Thompson Sampling (TS) and Upper Confidence Bound (UCB) to guide LLM query generation. We numerically evaluate our methods in controlled simulations, finding that after 10 turns of dialogue, PEBOL can achieve an MRR@10 of up to 0.27 compared to the best monolithic LLM baseline’s MRR@10 of 0.17, despite relying on earlier and smaller LLMs.1

Mental health diagnoses possess unique challenges that often lead to nuanced difficulties in managing an individual’s well-being and daily functioning. Self-report questionnaires are a common practice in clinical settings to help mitigate the challenges involved in mental health disorder screening. However, these questionnaires rely on an individual’s subjective response which can be influenced by various factors. Despite the advancements of Large Language Models (LLMs), quantifying self-reported experiences with natural language processing has resulted in imperfect accuracy. This project aims to demonstrate the effectiveness of zero-shot learning LLMs for screening and assessing item scales for depression using LLMs. The DAIC-WOZ is a publicly available mental health dataset that contains textual data from clinical interviews and self-report questionnaires with relevant mental health disorder labels. The RISEN prompt engineering framework was utilized to evaluate LLMs’ effectiveness in predicting depression symptoms based on individual PHQ-8 items. Various LLMs, including GPT models, Llama3_8B, Cohere, and Gemini were assessed based on performance. The GPT models, especially GPT-4o, were consistently better than other LLMs (Llama3_8B, Cohere, Gemini) across all eight items of the PHQ-8 scale in accuracy (M = 75.9%), and F1 score (0.74). GPT models were able to predict PHQ-8 items related to emotional and cognitive states. Llama 3_8B demonstrated superior detection of anhedonia-related symptoms and the Cohere LLM’s strength was identifying and predicting psychomotor activity symptoms. This study provides a novel outlook on the potential of LLMs for predicting self-reported questionnaire scores from textual interview data. The promising preliminary performance of the various models indicates there is potential that these models could effectively assist in the screening of depression. Further research is needed to establish a framework for which LLM can be used for specific mental health symptoms and other disorders. As well, analysis of additional datasets while fine-tuning models should be explored.