VentAgent: When LLMs Learn to Breathe -- Multi-Objective Arbitration for ARDS Ventilation

Mechanical ventilation for Acute Respiratory Distress Syndrome (ARDS) requires balancing competing physiological goals, including oxygenation, lung protection, and acid-base homeostasis. However, current data-driven methods, especially those imitating retrospective Electronic Health Records (EHR), often suffer from imitation bias. They may capture superficial correlations from inconsistent clinical demonstrations, such as associating passive ventilator settings with survival because such settings are common in stable patients, and thus fail to generalize to volatile or out-of-distribution phenotypes. Standard Reinforcement Learning (RL) methods also struggle with the adversarial trade-offs of critical care and often produce opaque policies with limited clinical interpretability. To address these limitations, we introduce VentAgent, a hierarchical framework in which Large Language Models (LLMs) act as transparent arbitrators for mechanical ventilation. We reformulate ventilation control as a dynamic Multi-Objective Arbitration process rather than single-objective optimization. VentAgent decomposes decision-making into three interpretable stages: Perception, Planning, and Orchestration. By leveraging the semantic reasoning capabilities of LLMs, it synthesizes strategies from heterogeneous experts and resolves conflicting clinical priorities through an explicit coordination mechanism. Evaluations on a high-fidelity physiological simulator show that VentAgent outperforms state-of-the-art RL and classical control baselines. Moreover, it converts control decisions into human-readable reasoning chains, offering a safer, more interpretable, and adaptable paradigm for critical care automation.

Human-in-the-Loop Multi-Agent Ventilator Decision Support with Contextual Bandit Preference Learning

Ventilator decision support requires sequential decisions that track evolving physiology and disease trajectories while respecting safety boundaries and clinician specific tuning styles. Rule based approaches rarely generalize personalization, and end to end reinforcement learning or single large language model systems remain difficult to control and audit. We propose the Ventilator Decision Support System (VDSS), a human in the loop multi agent framework that coordinates modular decision components through contract driven structured interfaces and produces traceable evidence for review. VDSS performs online preference adaptation with a contextual bandit, updating clinician specific preferences from the final accepted decision at each adjustment cycle and using them to guide subsequent recommendations. Structured rejection feedback triggers targeted replanning to reduce unproductive iterations and improve interaction stability. Retrospective ICU trajectory replay with expert review indicates higher recommendation acceptability and fewer interaction rounds to reach an acceptable plan, supporting clinically deployable human AI collaboration.

InterveneBench: Benchmarking LLMs for Intervention Reasoning and Causal Study Design in Real Social Systems

Causal inference in social science relies on end-to-end, intervention-centered research-design reasoning grounded in real-world policy interventions, but current benchmarks fail to evaluate this capability of large language models (LLMs). We present InterveneBench, a benchmark designed to assess such reasoning in realistic social settings. Each instance in InterveneBench is derived from an empirical social science study and requires models to reason about policy interventions and identification assumptions without access to predefined causal graphs or structural equations. InterveneBench comprises 744 peer-reviewed studies across diverse policy domains. Experimental results show that state-of-the-art LLMs struggle under this setting. To address this limitation, we further propose a multi-agent framework, STRIDES. It achieves significant performance improvements over state-of-the-art reasoning models. Our code and data are available at https://github.com/Sii-yuning/STRIDES.

PRISM: Festina Lente Proactivity -- Risk-Sensitive, Uncertainty-Aware Deliberation for Proactive Agents

Proactive agents must decide not only what to say but also whether and when to intervene. Many current systems rely on brittle heuristics or indiscriminate long reasoning, which offers little control over the benefit-burden tradeoff. We formulate the problem as cost-sensitive selective intervention and present PRISM, a novel framework that couples a decision-theoretic gate with a dual-process reasoning architecture. At inference time, the agent intervenes only when a calibrated probability of user acceptance exceeds a threshold derived from asymmetric costs of missed help and false alarms. Inspired by festina lente (Latin: "make haste slowly"), we gate by an acceptance-calibrated, cost-derived threshold and invoke a resource-intensive Slow mode with counterfactual checks only near the decision boundary, concentrating computation on ambiguous and high-stakes cases. Training uses gate-aligned, schema-locked distillation: a teacher running the full PRISM pipeline provides dense, executable supervision on unlabeled interaction traces, while the student learns a response policy that is explicitly decoupled from the intervention gate to enable tunable and auditable control. On ProactiveBench, PRISM reduces false alarms by 22.78% and improves F1 by 20.14% over strong baselines. These results show that principled decision-theoretic gating, paired with selective slow reasoning and aligned distillation, yields proactive agents that are precise, computationally efficient, and controllable. To facilitate reproducibility, we release our code, models, and resources at https://prism-festinalente.github.io/; all experiments use the open-source ProactiveBench benchmark.

Reflective Personalization Optimization: A Post-hoc Rewriting Framework for Black-Box Large Language Models

The personalization of black-box large language models (LLMs) is a critical yet challenging task. Existing approaches predominantly rely on context injection, where user history is embedded into the prompt to directly guide the generation process. However, this single-step paradigm imposes a dual burden on the model: generating accurate content while simultaneously aligning with user-specific styles. This often results in a trade-off that compromises output quality and limits precise control. To address this fundamental tension, we propose Reflective Personalization Optimization (RPO), a novel framework that redefines the personalization paradigm by decoupling content generation from alignment. RPO operates in two distinct stages: first, a base model generates a high-quality, generic response; then, an external reflection module explicitly rewrites this output to align with the user's preferences. This reflection module is trained using a two-stage process. Initially, supervised fine-tuning is employed on structured rewriting trajectories to establish a core personalized reasoning policy that models the transformation from generic to user-aligned responses. Subsequently, reinforcement learning is applied to further refine and enhance the quality of the personalized outputs. Comprehensive experiments on the LaMP benchmark demonstrate that RPO, by decoupling content generation from personalization, significantly outperforms state-of-the-art baselines. These findings underscore the superiority of explicit response shaping over implicit context injection. Moreover, RPO introduces an efficient, model-agnostic personalization layer that can be seamlessly integrated with any underlying base model, paving the way for a new and effective direction in user-centric generation scenarios.