Clinical Validation of Medical-based Large Language Model Chatbots on Ophthalmic Patient Queries with LLM-based Evaluation

Domain specific large language models are increasingly used to support patient education, triage, and clinical decision making in ophthalmology, making rigorous evaluation essential to ensure safety and accuracy. This study evaluated four small medical LLMs Meerkat-7B, BioMistral-7B, OpenBioLLM-8B, and MedLLaMA3-v20 in answering ophthalmology related patient queries and assessed the feasibility of LLM based evaluation against clinician grading. In this cross sectional study, 180 ophthalmology patient queries were answered by each model, generating 2160 responses. Models were selected for parameter sizes under 10 billion to enable resource efficient deployment. Responses were evaluated by three ophthalmologists of differing seniority and by GPT-4-Turbo using the S.C.O.R.E. framework assessing safety, consensus and context, objectivity, reproducibility, and explainability, with ratings assigned on a five point Likert scale. Agreement between LLM and clinician grading was assessed using Spearman rank correlation, Kendall tau statistics, and kernel density estimate analyses. Meerkat-7B achieved the highest performance with mean scores of 3.44 from Senior Consultants, 4.08 from Consultants, and 4.18 from Residents. MedLLaMA3-v20 performed poorest, with 25.5 percent of responses containing hallucinations or clinically misleading content, including fabricated terminology. GPT-4-Turbo grading showed strong alignment with clinician assessments overall, with Spearman rho of 0.80 and Kendall tau of 0.67, though Senior Consultants graded more conservatively. Overall, medical LLMs demonstrated potential for safe ophthalmic question answering, but gaps remained in clinical depth and consensus, supporting the feasibility of LLM based evaluation for large scale benchmarking and the need for hybrid automated and clinician review frameworks to guide safe clinical deployment.

AI chatbots versus human healthcare professionals: a systematic review and meta-analysis of empathy in patient care

Background: Empathy is widely recognized for improving patient outcomes, including reduced pain and anxiety and improved satisfaction, and its absence can cause harm. Meanwhile, use of artificial intelligence (AI)-based chatbots in healthcare is rapidly expanding, with one in five general practitioners using generative AI to assist with tasks such as writing letters. Some studies suggest AI chatbots can outperform human healthcare professionals (HCPs) in empathy, though findings are mixed and lack synthesis. Sources of data: We searched multiple databases for studies comparing AI chatbots using large language models with human HCPs on empathy measures. We assessed risk of bias with ROBINS-I and synthesized findings using random-effects meta-analysis where feasible, whilst avoiding double counting. Areas of agreement: We identified 15 studies (2023-2024). Thirteen studies reported statistically significantly higher empathy ratings for AI, with only two studies situated in dermatology favouring human responses. Of the 15 studies, 13 provided extractable data and were suitable for pooling. Meta-analysis of those 13 studies, all utilising ChatGPT-3.5/4, showed a standardized mean difference of 0.87 (95% CI, 0.54-1.20) favouring AI (P < .00001), roughly equivalent to a two-point increase on a 10-point scale. Areas of controversy: Studies relied on text-based assessments that overlook non-verbal cues and evaluated empathy through proxy raters. Growing points: Our findings indicate that, in text-only scenarios, AI chatbots are frequently perceived as more empathic than human HCPs. Areas timely for developing research: Future research should validate these findings with direct patient evaluations and assess whether emerging voice-enabled AI systems can deliver similar empathic advantages.

Emulating Aggregate Human Choice Behavior and Biases with GPT Conversational Agents

Cognitive biases often shape human decisions. While large language models (LLMs) have been shown to reproduce well-known biases, a more critical question is whether LLMs can predict biases at the individual level and emulate the dynamics of biased human behavior when contextual factors, such as cognitive load, interact with these biases. We adapted three well-established decision scenarios into a conversational setting and conducted a human experiment (N=1100). Participants engaged with a chatbot that facilitates decision-making through simple or complex dialogues. Results revealed robust biases. To evaluate how LLMs emulate human decision-making under similar interactive conditions, we used participant demographics and dialogue transcripts to simulate these conditions with LLMs based on GPT-4 and GPT-5. The LLMs reproduced human biases with precision. We found notable differences between models in how they aligned human behavior. This has important implications for designing and evaluating adaptive, bias-aware LLM-based AI systems in interactive contexts.

VERA-MH: Reliability and Validity of an Open-Source AI Safety Evaluation in Mental Health

Millions now use leading generative AI chatbots for psychological support. Despite the promise related to availability and scale, the single most pressing question in AI for mental health is whether these tools are safe. The Validation of Ethical and Responsible AI in Mental Health (VERA-MH) evaluation was recently proposed to meet the urgent need for an evidence-based automated safety benchmark. This study aimed to examine the clinical validity and reliability of the VERA-MH evaluation for AI safety in suicide risk detection and response. We first simulated a large set of conversations between large language model (LLM)-based users (user-agents) and general-purpose AI chatbots. Licensed mental health clinicians used a rubric (scoring guide) to independently rate the simulated conversations for safe and unsafe chatbot behaviors, as well as user-agent realism. An LLM-based judge used the same scoring rubric to evaluate the same set of simulated conversations. We then compared rating alignment across (a) individual clinicians and (b) clinician consensus and the LLM judge, and (c) examined clinicians' ratings of user-agent realism. Individual clinicians were generally consistent with one another in their safety ratings (chance-corrected inter-rater reliability [IRR]: 0.77), thus establishing a gold-standard clinical reference. The LLM judge was strongly aligned with this clinical consensus (IRR: 0.81) overall and within key conditions. Clinician raters generally perceived the user-agents to be realistic. For the potential mental health benefits of AI chatbots to be realized, attention to safety is paramount. Findings from this human evaluation study support the clinical validity and reliability of VERA-MH: an open-source, fully automated AI safety evaluation for mental health. Further research will address VERA-MH generalizability and robustness.

Growth First, Care Second? Tracing the Landscape of LLM Value Preferences in Everyday Dilemmas

People increasingly seek advice online from both human peers and large language model (LLM)-based chatbots. Such advice rarely involves identifying a single correct answer; instead, it typically requires navigating trade-offs among competing values. We aim to characterize how LLMs navigate value trade-offs across different advice-seeking contexts. First, we examine the value trade-off structure underlying advice seeking using a curated dataset from four advice-oriented subreddits. Using a bottom-up approach, we inductively construct a hierarchical value framework by aggregating fine-grained values extracted from individual advice options into higher-level value categories. We construct value co-occurrence networks to characterize how values co-occur within dilemmas and find substantial heterogeneity in value trade-off structures across advice-seeking contexts: a women-focused subreddit exhibits the highest network density, indicating more complex value conflicts; women's, men's, and friendship-related subreddits exhibit highly correlated value-conflict patterns centered on security-related tensions (security vs. respect/connection/commitment); by contrast, career advice forms a distinct structure where security frequently clashes with self-actualization and growth. We then evaluate LLM value preferences against these dilemmas and find that, across models and contexts, LLMs consistently prioritize values related to Exploration & Growth over Benevolence & Connection. This systemically skewed value orientation highlights a potential risk of value homogenization in AI-mediated advice, raising concerns about how such systems may shape decision-making and normative outcomes at scale.

Chaplains' Reflections on the Design and Usage of AI for Conversational Care

Despite growing recognition that responsible AI requires domain knowledge, current work on conversational AI primarily draws on clinical expertise that prioritises diagnosis and intervention. However, much of everyday emotional support needs occur in non-clinical contexts, and therefore requires different conversational approaches. We examine how chaplains, who guide individuals through personal crises, grief, and reflection, perceive and engage with conversational AI. We recruited eighteen chaplains to build AI chatbots. While some chaplains viewed chatbots with cautious optimism, the majority expressed limitations of chatbots' ability to support everyday well-being. Our analysis reveals how chaplains perceive their pastoral care duties and areas where AI chatbots fall short, along the themes of Listening, Connecting, Carrying, and Wanting. These themes resonate with the idea of attunement, recently highlighted as a relational lens for understanding the delicate experiences care technologies provide. This perspective informs chatbot design aimed at supporting well-being in non-clinical contexts.

Gender Dynamics and Homophily in a Social Network of LLM Agents

Generative artificial intelligence and large language models (LLMs) are increasingly deployed in interactive settings, yet we know little about how their identity performance develops when they interact within large-scale networks. We address this by examining Chirper.ai, a social media platform similar to X but composed entirely of autonomous AI chatbots. Our dataset comprises over 70,000 agents, approximately 140 million posts, and the evolving followership network over one year. Based on agents' text production, we assign weekly gender scores to each agent. Results suggest that each agent's gender performance is fluid rather than fixed. Despite this fluidity, the network displays strong gender-based homophily, as agents consistently follow others performing gender similarly. Finally, we investigate whether these homophilic connections arise from social selection, in which agents choose to follow similar accounts, or from social influence, in which agents become more similar to their followees over time. Consistent with human social networks, we find evidence that both mechanisms shape the structure and evolution of interactions among LLMs. Our findings suggest that, even in the absence of bodies, cultural entraining of gender performance leads to gender-based sorting. This has important implications for LLM applications in synthetic hybrid populations, social simulations, and decision support.

Unmediated AI-Assisted Scholarly Citations

Traditional bibliography databases require users to navigate search forms and manually copy citation data. Language models offer an alternative: a natural-language interface where researchers write text with informal citation fragments, which are automatically resolved to proper references. However, language models are not reliable for scholarly work as they generate fabricated (hallucinated) citations at substantial rates. We present an architectural approach that combines the natural-language interface of LLM chatbots with the accuracy of direct database access, implemented through the Model Context Protocol. Our system enables language models to search bibliographic databases, perform fuzzy matching, and export verified entries, all through conversational interaction. A key architectural principle bypasses the language model during final data export: entries are fetched directly from authoritative sources, with timeout protection, to guarantee accuracy. We demonstrate this approach with MCP-DBLP, a server providing access to the DBLP computer science bibliography. The system transforms form-based bibliographic services into conversational assistants that maintain scholarly integrity. This architecture is adaptable to other bibliographic databases and academic data sources.

WinFLoRA: Incentivizing Client-Adaptive Aggregation in Federated LoRA under Privacy Heterogeneity

Large Language Models (LLMs) increasingly underpin intelligent web applications, from chatbots to search and recommendation, where efficient specialization is essential. Low-Rank Adaptation (LoRA) enables such adaptation with minimal overhead, while federated LoRA allows web service providers to fine-tune shared models without data sharing. However, in privacy-sensitive deployments, clients inject varying levels of differential privacy (DP) noise, creating privacy heterogeneity that misaligns individual incentives and global performance. In this paper, we propose WinFLoRA, a privacy-heterogeneous federated LoRA that utilizes aggregation weights as incentives with noise awareness. Specifically, the noises from clients are estimated based on the uploaded LoRA adapters. A larger weight indicates greater influence on the global model and better downstream task performance, rewarding lower-noise contributions. By up-weighting low-noise updates, WinFLoRA improves global accuracy while accommodating clients' heterogeneous privacy requirements. Consequently, WinFLoRA aligns heterogeneous client utility in terms of privacy and downstream performance with global model objectives without third-party involvement. Extensive evaluations demonstrate that across multiple LLMs and datasets, WinFLoRA achieves up to 52.58% higher global accuracy and up to 2.56x client utility than state-of-the-art benchmarks. Source code is publicly available at https://github.com/koums24/WinFLoRA.git.

Beyond Medical Chatbots: Meddollina and the Rise of Continuous Clinical Intelligence

Generative medical AI now appears fluent and knowledgeable enough to resemble clinical intelligence, encouraging the belief that scaling will make it safe. But clinical reasoning is not text generation. It is a responsibility-bound process under ambiguity, incomplete evidence, and longitudinal context. Even as benchmark scores rise, generation-centric systems still show behaviours incompatible with clinical deployment: premature closure, unjustified certainty, intent drift, and instability across multi-step decisions. We argue these are structural consequences of treating medicine as next-token prediction. We formalise Clinical Contextual Intelligence (CCI) as a distinct capability class required for real-world clinical use, defined by persistent context awareness, intent preservation, bounded inference, and principled deferral when evidence is insufficient. We introduce Meddollina, a governance-first clinical intelligence system designed to constrain inference before language realisation, prioritising clinical appropriateness over generative completeness. Meddollina acts as a continuous intelligence layer supporting clinical workflows while preserving clinician authority. We evaluate Meddollina using a behaviour-first regime across 16,412+ heterogeneous medical queries, benchmarking against general-purpose models, medical-tuned models, and retrieval-augmented systems. Meddollina exhibits a distinct behavioural profile: calibrated uncertainty, conservative reasoning under underspecification, stable longitudinal constraint adherence, and reduced speculative completion relative to generation-centric baselines. These results suggest deployable medical AI will not emerge from scaling alone, motivating a shift toward Continuous Clinical Intelligence, where progress is measured by clinician-aligned behaviour under uncertainty rather than fluency-driven completion.