Improving Medical Abstract Classification Using PEFT-LoRA Fine-Tuned Large and Small Language Models

This study explores the potential of natural language models, including large language models, to extract causal relations from medical texts, specifically from clinical practice guidelines (CPGs). The outcomes of causality extraction from clinical practice guidelines for gestational diabetes are presented, marking a first in the field. The results are reported on a set of experiments using variants of BERT (BioBERT, DistilBERT, and BERT) and using newer large language models (LLMs), namely, GPT-4 and LLAMA2. Our experiments show that BioBERT performed better than other models, including the large language models, with an average F1-score of 0.72. The GPT-4 and LLAMA2 results show similar performance but less consistency. The code and an annotated corpus of causal statements within the clinical practice guidelines for gestational diabetes are released. Extracting causal structures might help identify LLMs’ hallucinations and possibly prevent some medical errors if LLMs are used in patient settings. Some practical extensions of extracting causal statements from medical text would include providing additional diagnostic support based on less frequent cause–effect relationships, identifying possible inconsistencies in medical guidelines, and evaluating the evidence for recommendations.

BackgroundLarge language models (LLMs) have achieved great progress in natural language processing tasks and demonstrated the potential for use in clinical applications. Despite their capabilities, LLMs in the medical domain are prone to generating hallucinations (not fully reliable responses). Hallucinations in LLMs’ responses create substantial risks, potentially threatening patients’ physical safety. Thus, to perceive and prevent this safety risk, it is essential to evaluate LLMs in the medical domain and build a systematic evaluation.ObjectiveWe developed a comprehensive evaluation system, MedGPTEval, composed of criteria, medical data sets in Chinese, and publicly available benchmarks.MethodsFirst, a set of evaluation criteria was designed based on a comprehensive literature review. Second, existing candidate criteria were optimized by using a Delphi method with 5 experts in medicine and engineering. Third, 3 clinical experts designed medical data sets to interact with LLMs. Finally, benchmarking experiments were conducted on the data sets. The responses generated by chatbots based on LLMs were recorded for blind evaluations by 5 licensed medical experts. The evaluation criteria that were obtained covered medical professional capabilities, social comprehensive capabilities, contextual capabilities, and computational robustness, with 16 detailed indicators. The medical data sets include 27 medical dialogues and 7 case reports in Chinese. Three chatbots were evaluated: ChatGPT by OpenAI; ERNIE Bot by Baidu, Inc; and Doctor PuJiang (Dr PJ) by Shanghai Artificial Intelligence Laboratory.ResultsDr PJ outperformed ChatGPT and ERNIE Bot in the multiple-turn medical dialogues and case report scenarios. Dr PJ also outperformed ChatGPT in the semantic consistency rate and complete error rate category, indicating better robustness. However, Dr PJ had slightly lower scores in medical professional capabilities compared with ChatGPT in the multiple-turn dialogue scenario.ConclusionsMedGPTEval provides comprehensive criteria to evaluate chatbots by LLMs in the medical domain, open-source data sets, and benchmarks assessing 3 LLMs. Experimental results demonstrate that Dr PJ outperforms ChatGPT and ERNIE Bot in social and professional contexts. Therefore, such an assessment system can be easily adopted by researchers in this community to augment an open-source data set.

Medical benchmark datasets significantly contribute to developing Large Language Models (LLMs) for medical knowledge extraction, diagnosis, summarization, and other uses. Yet, current benchmarks are mainly derived from exam questions given to medical students or cases described in the medical literature, lacking the complexity of real-world patient cases that deviate from classic textbook abstractions. These include rare diseases, uncommon presentations of common diseases, and unexpected treatment responses. Here, we construct Clinically Uncommon Patient Cases and Diagnosis Dataset (CUPCase) based on 3,563 real-world case reports from BMC, which we formulate into diagnoses in open-ended textual format and as multiple-choice options with distractors. Using this dataset, we evaluate the ability of state-of-the-art LLMs, including both general-purpose and Clinical LLMs, to identify and correctly diagnose a patient case, and test models' performance when only partial information about cases is available. Our findings show that general-purpose GPT-4o attains the best performance in both the multiple-choice task (average accuracy of 87.9%) and the open-ended task (BERTScore F1 of 0.764), outperforming several LLMs with a focus on the medical domain such as Meditron-70B and MedLM-Large. Moreover, GPT-4o was able to maintain 87% and 88% of its performance with only the first 20% of tokens of the case presentation in multiple-choice and free text, respectively, highlighting the potential of LLMs to aid in early diagnosis in real-world cases. An error analysis demonstrates the complexity of the task, and attempts to hypothesise about the models' reasoning. CUPCase expands our ability to evaluate LLMs for clinical decision support in an open and reproducible manner.

In recent years, generative artificial intelligence (AI), particularly large language models (LLMs) and their multimodal counterparts, multimodal large language models, including vision language models, have generated considerable interest in the global AI discourse. LLMs, or pre-trained language models (such as ChatGPT, Med-PaLM, LLaMA), are neural network architectures trained on extensive text data, excelling in language comprehension and generation. Multimodal LLMs, a subset of foundation models, are trained on multimodal data sets, integrating text with another modality, such as images, to learn universal representations akin to human cognition better. This versatility enables them to excel in tasks like chatbots, translation, and creative writing while facilitating knowledge sharing through transfer learning, federated learning, and synthetic data creation. Several of these models can have potentially appealing applications in the medical domain, including, but not limited to, enhancing patient care by processing patient data; summarizing reports and relevant literature; providing diagnostic, treatment, and follow-up recommendations; and ancillary tasks like coding and billing. As radiologists enter this promising but uncharted territory, it is imperative for them to be familiar with the basic terminology and processes of LLMs. Herein, we present an overview of the LLMs and their potential applications and challenges in the imaging domain.

Purpose This study aims to explore the integration of large language models (LLMs) and vision-language models (VLMs) in robotics, highlighting their potential benefits and the safety challenges they introduce, including robustness issues, adversarial vulnerabilities, privacy concerns and ethical implications. Design/methodology/approach This survey conducts a comprehensive analysis of the safety risks associated with LLM- and VLM-powered robotic systems. The authors review existing literature, analyze key challenges, evaluate current mitigation strategies and propose future research directions. Findings The study identifies that ensuring the safety of LLM-/VLM-driven robots requires a multi-faceted approach. While current mitigation strategies address certain risks, gaps remain in real-time monitoring, adversarial robustness and ethical safeguards. Originality/value This study offers a structured and comprehensive overview of the safety challenges in LLM-/VLM-driven robotics. It contributes to ongoing discussions by integrating technical, ethical and regulatory perspectives to guide future advancements in safe and responsible artificial intelligence-driven robotics.

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.

The paper studies the problem of software code migration during the transition from the old version of the SAP ERP 6.0 system to modern ERP platforms, in particular SAP S/4HANA. The necessity of automation of the migration process using artificial intelligence methods and tools is substantiated. A comprehensive analysis of existing academic and industrial case studies confirmed the feasibility of using large language models for code migration. A number of advantages of the approach based on large language models are revealed, in particular, the ability to handle various migration scenarios. The key risks and limitations common in the enterprise environment are highlighted, including data security, privacy, high cost of API calls and limited knowledge of models regarding the subject area. A method is developed for selecting a large open source language model that can be safely used in the enterprise landscape, thereby mitigating the risks associated with cloud solutions. The method is based on the developed system of criteria, including: model size, context window size, license type, support for fine-tuning training, focus on code quality (measured using a reference dataset), support for model quantization and community support. The hybrid AHP-TOPSIS method is proposed for systematic ranking of candidate models. The AHP method was used to check the weights of the criteria, while TOPSIS was used to rank the models based on their proximity to the ideal solution. Based on the developed method, three large language models were selected: Qwen 2.5 Coder 14B, DeepSeek-Coder-V2 16B and Llama 3.1 8B. A comprehensive testing plan for the selected models was developed for further experimental studies. The scientific novelty of the work lies in the development of a method for selecting large language models for custom code migration tasks, which differs from the existing system of model selection criteria and the use of a hybrid AHP-TOPSIS approach for ranking candidate models. The practical value of the work is that the developed method allows you to select a model taking into account the constraints of the corporate environment and information security requirements, which will increase the level of automation in the migration of AVAP when switching to new versions of ERP systems from SAP SE. The developed method can be applied to the selection of large language models when upgrading any large computer systems developed in both open source and proprietary programming languages.

Contrastive knowledge integrated graph neural networks for Chinese medical text classification

The article presents a method for identifying Russian-language texts generated by large language models (LLMs). The method was developed with a focus on short messages from 100 to 200 characters long. The relevance of the work is due to the widespread use of generative models, such as GPT-3.5, GPT-4o, LLaMA, GigaChat, DeepSeek, and Yandex GPT. The method is based on an ensemble of machine learning models, and features of three levels are also used: linguistic (structure, punctuation, morphology, lexical diversity), statistical (entropy, perplexity, n-gram frequency), and semantic (RuBERT embeddings). LightGBM, BiLSTM, and the pre-trained transformer model RuRoBERTa are used as basic models, combined by stacking through logistic regression. The choice of a hybrid ensemble approach is due to the desire to take into account features at different levels of the text hierarchy and to ensure the reliability of classification in the context of different topics of generated texts, versions, and types of language models. The use of an ensemble is an advantage in the analysis of short texts, since LightGBM, based on averaged indicators, is less sensitive to length (the perplexity metric is already averaged over the entire text), while BiLSTM and RoBERTa are able to identify local features of an LLM text, and not just global ones. The dataset of natural texts includes more than 2.8 million user comments from the VK social network. The LLM text dataset contains 700 thousand texts generated by seven relevant large language models. Topic modeling (LDA) and role generation using prompt engineering were used in the text generation. The methodology was evaluated on open datasets of Russian-language LLM texts. The experimental results showed an accuracy of up to 0.95 in the binary classification task (Human–LLM) and up to 0.89 in the multi-class task of determining the model-generator. The method demonstrates robustness to the diversity of sources, styles, and LLM versions.

The subject of the study is the analysis and improvement of methods for determining the relevance of project names to the information content of purchases using large language models. The object of the study is a database containing the names of projects and purchases in the field of electric power industry, collected from open sources. The author examines in detail such aspects of the topic as the use of TF-IDF and cosine similarity metrics for primary data filtering, and also describes in detail the integration and evaluation of the effectiveness of large language models such as GigaChat, GPT-3.5, and GPT-4 in text data matching tasks. Special attention is paid to the methods of clarifying the similarity of names based on reflection introduced into the prompta of large language models, which makes it possible to increase the accuracy of data comparison. The study uses TF-IDF and cosine similarity methods for primary data analysis, as well as large GigaChat, GPT-3.5 and GPT-4 language models for detailed verification of the relevance of project names and purchases, including reflection in model prompta to improve the accuracy of results. The novelty of the research lies in the development of a combined approach to determining the relevance of project names and purchases, combining traditional methods of processing text information (TF-IDF, cosine similarity) with the capabilities of large language models. A special contribution of the author to the research of the topic is the proposed methodology for improving the accuracy of data comparison by clarifying the results of primary selection using GPT-3.5 and GPT-4 models with optimized prompta, including reflection. The main conclusions of the study are confirmation of the prospects of using the developed approach in the tasks of information support for procurement processes and project implementation, as well as the possibility of using the results obtained for the development of text data mining systems in various sectors of the economy. The study showed that the use of language models makes it possible to improve the value of the F2 measure to 0.65, which indicates a significant improvement in the quality of data comparison compared with basic methods.

BackgroundPatient education materials (PEMs) found online are often written at a complexity level too high for the average reader, which can hinder understanding and informed decision-making. Large language models (LLMs) may offer a solution by simplifying complex medical texts. To date, little is known about how well LLMs can handle simplification tasks for German-language PEMs.ObjectiveThe study aims to investigate whether LLMs can increase the readability of German online medical texts to a recommended level.MethodsA sample of 60 German texts originating from online medical resources was compiled. To improve the readability of these texts, four LLMs were selected and used for text simplification: ChatGPT-3.5, ChatGPT-4o, Microsoft Copilot, and Le Chat. Next, readability scores (Flesch reading ease [FRE] and Wiener Sachtextformel [4th Vienna Formula; WSTF]) of the original texts were computed and compared to the rephrased LLM versions. A Student t test for paired samples was used to test the reduction of readability scores, ideally to or lower than the eighth grade level.ResultsMost of the original texts were rated as difficult to quite difficult (average WSTF 11.24, SD 1.29; FRE 35.92, SD 7.64). On average, the LLMs achieved the following average scores: ChatGPT-3.5 (WSTF 9.96, SD 1.52; FRE 45.04, SD 8.62), ChatGPT-4o (WSTF 10.6, SD 1.37; FRE 39.23, SD 7.45), Microsoft Copilot (WSTF 8.99, SD 1.10; FRE 49.0, SD 6.51), and Le Chat (WSTF 11.71, SD 1.47; FRE 33.72, SD 8.58). ChatGPT-3.5, ChatGPT-40, and Microsoft Copilot showed a statistically significant improvement in readability. However, the t tests yielded no statistically significant results for the reduction of scores lower than the eighth grade level.ConclusionsLLMs can improve the readability of PEMs in German. This moderate improvement can support patients reading PEMs online. LLMs demonstrated their potential to make complex online medical text more accessible to a broader audience by increasing readability. This is the first study to evaluate this for German online medical texts.

Large language models (LLMs) have emerged as a milestone in the realm of machine learning, offering groundbreaking capabilities in understanding human language with remarkable coherence and versatility. Their application spans a multitude of domains, ranging from text classification to information extraction. Such models are first pre-trained on vast data corpora to learn general language patterns and then are fine-tuned on specific downstream tasks. Despite their impressive capabilities, LLMs encounter several limitations, including sub-optimal performance in understanding the domain-specific language of drug labels, limited performance in analyzing class-imbalanced data, and high computational complexity of training. Human prescription drug labeling contains a summary of the essential scientific information needed for the safe and effective use of the drug and includes critical information about drug products, such as pharmacokinetics and adverse events. Automatic information extraction from drug labels can facilitate processes such as finding the adverse reaction of the drugs or finding the interaction of one drug with another drug. Although LLMs are an interesting solution to perform this task, because of their training on generic data, they may not possess the depth of knowledge or the ability required to understand the language in such a specialized field. To address this issue, this work presents the developed PharmBERT, which is a BERT model specifically pretrained on the drug labels, publicly available online for the NLP community. We demonstrate that our model outperforms models such as vanilla BERT, ClinicalBERT, and BioBERT in multiple NLP tasks in the drug label domain. Another shortcoming of LLMs lies in their handling of class-imbalanced data, leading to a subpar performance in identifying and accurately responding to minority classes. This class-imbalance can skew the model's learning process, favoring majority classes, and thus diminishing its effectiveness in recognizing and appropriately addressing less represented categories. To cope with these challenges, we present a simple modification of standard fine-tuning. Specifically, we propose a two-stage fine-tuning. In Stage 1, we fine-tune the final layer of the pretrained model with class-balanced augmented data, generated using ChatGPT. As a large generative language model, ChatGPT is capable of generating novel yet contextually similar responses to a given text sample, which makes it an excellent candidate for data augmentation. In Stage 2, we perform the standard fine-tuning. Our modification has several benefits: (1) it leverages pretrained representations by only fine-tuning a small portion of the model parameters while keeping the rest untouched; (2) it allows the model to learn an initial representation of the specific task; and importantly (3) it protects the learning of tail classes from being at a disadvantage during the model updating. The experimental results show that the proposed two-stage fine-tuning outperforms vanilla fine-tuning and state-of-the-art methods on the above datasets. The third issue of LLMs is the high computational complexity of training. Due to the large number of parameters in many state-of-the-art LLMs, such as Bidirectional Encoder Representations from Transformers (BERT), the process of fine-tuning exhibits a high level of intricacy. One attractive solution to this issue is parameter-efficient fine-tuning, which means only fine-tuning a small portion of the model and not changing the rest. However, the question that which portion of the BERT model is the most important one for fine-tuning remains unanswered. Here, we first analyze different components in the BERT model to see which one undergoes the most change after fine-tuning. We show that output LayerNorm changes more than other components when finetuned for different General Language Understanding Evaluation (GLUE) tasks. Then we show that only fine-tuning this component reaches a comparable, or in some cases better, performance to full fine-tuning and other parameter-efficient fine-tuning methods. Moreover, we use Fisher information to find out which parameters in LayerNorm are the most important ones and show that with a small performance degradation, many NLP tasks in the GLUE benchmark can be solved by fine-tuning only a small, selected portion of LayerNorm. In summary, LLMs hold immense potential to redefine and enhance various fields, including drug-label analysis, but they also suffer from limitations like sub-optimal performance in understanding domain-specific texts of drug labels, not learning minority classes in the class-imbalanced data, and high computational complexity. In this thesis, for each one of these shortcomings, first, the problem is analyzed and then a solution is provided.

Biases in language and their reflection in language models have attracted researchers' attention, particularly with the growth of large language models (LLMs). However, many questions on the links between language models and people’s biased attitudes remain unanswered. In the current study we focus on gender–career bias to examine the extent to which language models can be used to model behavioural responses in the Gender–Career Implicit Association Test (IAT). We provide a systematic evaluation of a range of language models, including n-gram, count vector, predict (word2vec), and Large Language Models (LLMs), to determine how well they capture people’s behaviour in the IAT. We compared response time data from over 800,000 participants against 25 language models, with a total of 675 model variants. We find that many language models, including large language models (LLMs), correlated well with human behavior. While results support previous findings for both predict and count model families, we observed that performance of LLMs was consistently different from that of simpler predict models, particularly in terms of the direction and strength of correlations with reaction time and bias. This divergence may indicate successful attempts to mitigate bias in LLMs while preserving other aspects of linguistic information. Our findings reinforce the idea that societal biases are generally encoded in language, but that large language models can exhibit behaviors different to classical language models.

The application of deep learning to tabular data remains an ongoing challenge, with tree-based models such as XGBoost consistently outperforming neural network methods in most real-world scenarios. Recent advances in Large Language Models (LLMs) highlight their ability to generalize to new tasks via few-shot or one-shot prompting, yet questions remain about their utility in structured, tabular domains—particularly for resource-efficient Small Language Models (SLMs). In this work, we systematically evaluate the effectiveness of both large and small transformer-based language models for tabular classification tasks using few-shot strategies. Our approach investigates input serialization schemes and prompt engineering to maximize performance in low-data regimes. Experiments on benchmark datasets—including Diabetes, Heart Failure, and German Credit Risk—demonstrate that well-designed SLMs can approach, and occasionally match, the performance of much larger models, substantially reducing the need for extensive labeled data and retraining. However, further advances are required for language models to consistently rival the strongest tree-ensemble baselines. Our findings support the idea that SLMs, when properly prompted, offer a promising, flexible, and label-efficient alternative for automating and dynamizing machine learning pipelines on tabular data.

Aim/Purpose: The study investigates the factors influencing the acceptance and utilisation of large language models (LLMs) (predictor variables of LLM usage), such as ChatGPT, in Learning design by instructional designers and university-teaching academics from various countries. Background: Large language models (LLMs) have exploded onto the scene, transforming the landscape of learning design. Instructional designers and university teaching academics have been overburdened with content creation for their teaching programmes, and the arrival of LLM models will help in this regard by developing more interactive content that drives student engagement and, in turn, contributes to student success. Since LLMs are a relatively new phenomenon, little is known about the factors influencing their acceptance in learning design; therefore, this research is needed, as learning design principles are the bedrock of student engagement and success. Methodology: A cross-sectional correlational quantitative study was employed. Data was collected using an online questionnaire posted on social media, including LinkedIn, from 203 instructional designers and university teaching academics. Purposive and snowball sampling methods were used to target instructional designers and university teaching academics at colleges and universities worldwide. Participants were asked to share the survey link with fellow instructional designers and university-teaching academics in their communities. The factor structure of the data was determined using exploratory factor analysis. Nonetheless, the factor structure derived from the LLMs did not entirely reflect the original configuration of the Unified Theory of Acceptance and Use of Technology (UTAUT3), as certain predictors appeared to coalesce, indicating LLMs’ unique nature in learning design. Confirmatory factor analysis was used to verify the fit of the data on the measurement model. First-order and second-order structural modelling were used to identify the structural relationships among the variables. Contribution: The study determines significant factors for the acceptance of LLMs by instructional designers and academic teaching staff in learning design, enabling possible opportunities for best practices in the field through interventions to optimize LLM usage. The study applies the technology acceptance model to the emerging LLM technology and extends the technology acceptance model by adding the trust construct as a predictor variable. Findings: The structural analysis results indicated that the ingrained LLM practices, LLM peer-driven expectations, innovative propensity towards LLM adoption, reliability and provider trust in LLMs, and ease of use and support influenced perceived LLM benefits and usage, but community standards and infrastructure had no influence. The second-order structural equation modelling indicated that perceived LLM benefits and usage and ingrained LLM habits contributed most to the learning design. Recommendations for Practitioners: Teaching academics and instructional designers must use LLMs in designing content, assessments, and interactive learning activities, and attend LLM training workshops on prompting and best practices in integrating LLMs into learning and teaching to see their benefits; hence, regular use of LLMs will then lead to trust and innovation in LLMs usage, enhancing learning design and improving student learning outcomes. Recommendation for Researchers: Researchers must use mixed methods approaches to have a deeper understanding of the factors influencing LLMs. Since habit and perceived LLM benefits and usage contributed the most variance to learning design, researchers must investigate strategies that optimise these factors in learning design, such as effective intervention strategies that can help form positive LLM habits. In addition, the findings provide researchers with a starting point for future research. Further researchers must investigate interventions that optimise the influence of personal innovativeness and trust that contributed the least variance to learning design, hence unlocking the potential of LLMs in learning design through innovation, responsible, and ethical use. Impact on Society: The use of LLMs in learning design has a high possibility of transforming education, specifically the learning design landscape. Using LLMs will free up more time for teaching academics and instructional designers so that they spend more time on higher-order thinking skill demands. Consequently, the students will be exposed to more engaging and interactive content, resulting in improved learning outcomes. Future Research: Future research must include context-derived external variables in technology acceptance models, such as levels of prompting competencies, to provide a deeper understanding of LLMs. In addition, future research must be based on the application and impact of LLMs on student engagement and success, and their attainment of 21st-century skills.