Concept Extraction Research Articles

CustomSketching: Sketch Concept Extraction for Sketch‐based Image Synthesis and Editing

AbstractPersonalization techniques for large text‐to‐image (T2I) models allow users to incorporate new concepts from reference images. However, existing methods primarily rely on textual descriptions, leading to limited control over customized images and failing to support fine‐grained and local editing (e.g., shape, pose, and details). In this paper, we identify sketches as an intuitive and versatile representation that can facilitate such control, e.g., contour lines capturing shape information and flow lines representing texture. This motivates us to explore a novel task of sketch concept extraction: given one or more sketch‐image pairs, we aim to extract a special sketch concept that bridges the correspondence between the images and sketches, thus enabling sketch‐based image synthesis and editing at a fine‐grained level. To accomplish this, we introduce CustomSketching, a two‐stage framework for extracting novel sketch concepts via few‐shot learning. Considering that an object can often be depicted by a contour for general shapes and additional strokes for internal details, we introduce a dual‐sketch representation to reduce the inherent ambiguity in sketch depiction. We employ a shape loss and a regularization loss to balance fidelity and editability during optimization. Through extensive experiments, a user study, and several applications, we show our method is effective and superior to the adapted baselines.

An inherently interpretable deep learning model for local explanations using visual concepts.

Over the past decade, deep learning has become the leading approach for various computer vision tasks and decision support systems. However, the opaque nature of deep learning models raises significant concerns about their fairness, reliability, and the underlying inferences they make. Many existing methods attempt to approximate the relationship between low-level input features and outcomes. However, humans tend to understand and reason based on high-level concepts rather than low-level input features. To bridge this gap, several concept-based interpretable methods have been developed. Most of these methods compute the importance of each discovered concept for a specific class. However, they often fail to provide local explanations. Additionally, these approaches typically rely on labeled concepts or learn directly from datasets, leading to the extraction of irrelevant concepts. They also tend to overlook the potential of these concepts to interpret model predictions effectively. This research proposes a two-stream model called the Cross-Attentional Fast/Slow Thinking Network (CA-SoftNet) to address these issues. The model is inspired by dual-process theory and integrates two key components: a shallow convolutional neural network (sCNN) as System-I for rapid, implicit pattern recognition and a cross-attentional concept memory network as System-II for transparent, controllable, and logical reasoning. Our evaluation across diverse datasets demonstrates the model's competitive accuracy, achieving 85.6%, 83.7%, 93.6%, and 90.3% on CUB 200-2011, Stanford Cars, ISIC 2016, and ISIC 2017, respectively. This performance outperforms existing interpretable models and is comparable to non-interpretable counterparts. Furthermore, our novel concept extraction method facilitates identifying and selecting salient concepts. These concepts are then used to generate concept-based local explanations that align with human thinking. Additionally, the model's ability to share similar concepts across distinct classes, such as in fine-grained classification, enhances its scalability for large datasets. This feature also induces human-like cognition and reasoning within the proposed framework.

Optimal Keyword Selection by Hybrid Optimization with Itemset Mining for Text Summarization in Biomedical Sector

Biomedical literature is growing exponentially, creating challenges for researchers and clinicians to access relevant information efficiently. Automatic biomedical text summarization is a promising solution to this issue, allowing the extraction of essential information while reducing redundancy. Traditional summarization techniques often rely on shallow linguistic features or simple term frequencies, which fail to capture the complex relationships in biomedical texts. This paper explores advanced methods for biomedical text summarization, including graph-based approaches, frequent item set mining, and deep learning models such as BERT. The proposed framework introduces a hybrid optimization technique combining Colliding Bodies Optimization (CBO) and Cuckoo Search Optimization (CSO) for optimal keyword selection, alongside a Recurrent Neural Network (RNN) for sentence categorization. Extensive experimentation using UMLS-based concept extraction, keyword selection, and Apriori-based itemset mining demonstrates that the proposed method significantly outperforms existing models in both the in formativeness and coherence of generated summaries. The results reveal that combining deep language models with domain-specific knowledge enhances summarization quality and can be effectively applied to diverse types of biomedical text.

Automated Extraction of Kidney Failure Concepts from Clinical Notes Using Artificial Intelligence

Automated Extraction of Kidney Failure Concepts from Clinical Notes Using Artificial Intelligence

Considering the Cost-Effectiveness of Accredited Continuing Medical Education: A Landscape Analysis of Economic Concepts in Continuing Medical Education Research.

In health care, cost-effectiveness analysis evaluates changes in health outcomes as a function of costs. The cost-effectiveness of continuing professional development for health care providers has not been historically well characterized despite substantial investment. This literature review identified publications considering the costs and cost-effectiveness of accredited continuing medical education activities. Searches were conducted for English language records in PubMed and the gray literature using a 10-year lookback period from March 10, 2023. Search terms included concepts related to continuing medical education, cost, effect, and utilization. One reviewer conducted title/abstract screening, full-text review, and data extraction, with direction and adjudication of search and screening concepts provided by the lead advisor. Publications were categorized as related to costs of an educational intervention (Concept 1) and/or the impact of education on health care costs (Concept 2). Results were summarized using descriptive statistics. A total of 668 database records were screened, 125 (19%) underwent full-text review, and 25 of 125 (20%) were accepted; 7 of 351 (2%) gray literature sources were accepted for a total of 32 included records. The most common reason for rejection was not being an accredited activity. Of the 32 records, 27 (84%) were related to Concept 1 only, 3 (9%) to Concept 2 only, and 2 (6%) to both Concepts 1 and 2. Approximately half (n = 19, 59%) mentioned costs without supporting data. These findings show that considerations of cost and cost-effectiveness are rare in the accredited continuing medical education literature, which may limit how the value of continuing medical education is characterized.

Crafting Taxonomies for Understanding Power Consumption in Industrial Kitchens: A Methodological Framework and Real-World Application

Although industrial kitchens consume significantly more energy than other commercial buildings and represent an important opportunity for sustainable energy systems, researchers have largely overlooked energy efficiency in these spaces. One of the main challenges is the diversity of kitchen configurations, complicating the characterization and generalization of research findings, including establishing a standardized methodology for assessing and benchmarking energy demand. To address this research gap, this paper proposes a methodological framework to develop taxonomies for understanding the electricity consumption in industrial kitchens. The proposed framework was developed following an extensive survey of the existing literature, and it is based on four main steps: identification of the knowledge domain, extraction of terms and concepts, data collection, and information analysis. To demonstrate the proposed framework, a case study was developed involving the participation of 50 restaurants located in Portugal. The proposed framework proved valid as it enabled the construction of a taxonomy that allows the classification of industrial kitchens according to different energy consumption-related concepts, such as costs with energy, the physical size of the kitchen, and the number of workers.

A Novel Evaluation Framework for Medical LLMs: Combining Fuzzy Logic and MCDM for Medical Relation and Clinical Concept Extraction.

Artificial intelligence (AI) has become a crucial element of modern technology, especially in the healthcare sector, which is apparent given the continuous development of large language models (LLMs), which are utilized in various domains, including medical beings. However, when it comes to using these LLMs for the medical domain, there's a need for an evaluation platform to determine their suitability and drive future development efforts. Towards that end, this study aims to address this concern by developing a comprehensive Multi-Criteria Decision Making (MCDM) approach that is specifically designed to evaluate medical LLMs. The success of AI, particularly LLMs, in the healthcare domain, depends on their efficacy, safety, and ethical compliance. Therefore, it is essential to have a robust evaluation framework for their integration into medical contexts. This study proposes using the Fuzzy-Weighted Zero-InConsistency (FWZIC) method extended to p, q-quasirung orthopair fuzzy set (p, q-QROFS) for weighing evaluation criteria. This extension enables the handling of uncertainties inherent in medical decision-making processes. The approach accommodates the imprecise and multifaceted nature of real-world medical data and criteria by incorporating fuzzy logic principles. The MultiAtributive Ideal-Real Comparative Analysis (MAIRCA) method is employed for the assessment of medical LLMs utilized in the case study of this research. The results of this research revealed that "Medical Relation Extraction" criteria with its sub-levels had more importance with (0.504) than "Clinical Concept Extraction" with (0.495). For the LLMs evaluated, out of 6 alternatives, ( ) "GatorTron S 10B" had the 1st rank as compared to ( ) "GatorTron 90B" had the 6th rank. The implications of this study extend beyond academic discourse, directly impacting healthcare practices and patient outcomes. The proposed framework can help healthcare professionals make more informed decisions regarding the adoption and utilization of LLMs in medical settings.

A bibliometric worldview of breast-conserving surgery for breast cancer from 2013 to 2023.

Over the last decade, significant advancements have been made in breast-conserving surgery (BCS) for breast cancer. However, there is a lack of analytical and descriptive investigations on the trajectory, essential research directions, current research scenario, pivotal investigative focuses, and forthcoming perspectives. The objective of this research is to provide a thorough update on the progress made in BCS for breast cancer over the preceding decade. Retrieved from the Web of Science database, the data span from January 1, 2013, to November 30, 2023. Utilizing a set of advanced analytical instruments, we conducted comprehensive bibliometric and visual analyses. The findings underscore the predominant influence of the USA, representing 35.77% of the overall publications and playing a pivotal role in shaping research within this field. Notable productivity was evident at various institutions, including the Memorial Sloan Kettering Cancer Center, the University of Texas MD Anderson Cancer Center, and the University of Toronto. Annals of Surgical Oncology contributed the most publications in this field. An examination of keywords indicated a change in the concentration of research attention, transitioning from molecular subtype, ultrasonography, and intraoperative aspects to SEER, male breast cancer, and adjuvant measures. By offering a comprehensive bibliometric assessment, this study enhances our understanding of BCS for breast cancer. Consequently, this benefits both experienced researchers and newcomers alike, providing prompt access to essential information and fostering the extraction of innovative concepts within this specific field.

Extraction of sleep information from clinical notes of Alzheimer's disease patients using natural language processing.

Alzheimer's disease (AD) is the most common form of dementia in the United States. Sleep is one of the lifestyle-related factors that has been shown critical for optimal cognitive function in old age. However, there is a lack of research studying the association between sleep and AD incidence. A major bottleneck for conducting such research is that the traditional way to acquire sleep information is time-consuming, inefficient, non-scalable, and limited to patients' subjective experience. We aim to automate the extraction of specific sleep-related patterns, such as snoring, napping, poor sleep quality, daytime sleepiness, night wakings, other sleep problems, and sleep duration, from clinical notes of AD patients. These sleep patterns are hypothesized to play a role in the incidence of AD, providing insight into the relationship between sleep and AD onset and progression. A gold standard dataset is created from manual annotation of 570 randomly sampled clinical note documents from the adSLEEP, a corpus of 192000 de-identified clinical notes of 7266 AD patients retrieved from the University of Pittsburgh Medical Center (UPMC). We developed a rule-based natural language processing (NLP) algorithm, machine learning models, and large language model (LLM)-based NLP algorithms to automate the extraction of sleep-related concepts, including snoring, napping, sleep problem, bad sleep quality, daytime sleepiness, night wakings, and sleep duration, from the gold standard dataset. The annotated dataset of 482 patients comprised a predominantly White (89.2%), older adult population with an average age of 84.7 years, where females represented 64.1%, and a vast majority were non-Hispanic or Latino (94.6%). Rule-based NLP algorithm achieved the best performance of F1 across all sleep-related concepts. In terms of positive predictive value (PPV), the rule-based NLP algorithm achieved the highest PPV scores for daytime sleepiness (1.00) and sleep duration (1.00), while the machine learning models had the highest PPV for napping (0.95) and bad sleep quality (0.86), and LLAMA2 with finetuning had the highest PPV for night wakings (0.93) and sleep problem (0.89). Although sleep information is infrequently documented in the clinical notes, the proposed rule-based NLP algorithm and LLM-based NLP algorithms still achieved promising results. In comparison, the machine learning-based approaches did not achieve good results, which is due to the small size of sleep information in the training data. The results show that the rule-based NLP algorithm consistently achieved the best performance for all sleep concepts. This study focused on the clinical notes of patients with AD but could be extended to general sleep information extraction for other diseases.

Identifying Terms to Represent Concepts of a Work Process Ontology

Objectives: To identify ontology concepts from text documents for the construction of work process ontology. Methods: This study proposes a methodology to identify terms representing a work process ontology concept from a document. The methodology encompasses several key steps: document collecting, text pre-processing, term weighting and analysis, terms mapping, and domain expert relevance judgments. A comparison between the results of three different term weighting schemes, namely the Term Frequency (TF), Term Frequency-Inverse Document Frequency (TFIDF), and Mutual Information (MI) is made with the ontology concept that the domain expert has judged. Findings: The approaches adopted in this study have managed to extract ontological concepts from the targeted domain knowledge source. The findings of the comparison analysis suggest that the TFIDF term weighting scheme exhibits better results compared to the TF and MI weighting schemes. Novelty: A work process ontology is a structured knowledge describing daily operations in the government sector. However, there has been little to no effort in building the work process ontology. This study presents an integrated approach for identifying ontology concepts from documents within the domain of the work process. To the utmost extent of our understanding, this research initiative is the initial attempt to introduce a structured methodology for the semi-automatic extraction and evaluation of concepts and relationships within this domain. The findings can be utilised as a foundation for developing an ontology in the specific field. Keywords: Ontology, Work process, Text extraction, Natural language processing, Term weighting

Reliability Analysis of Psychological Concept Extraction and Classification in User-Penned Text

Reliability Analysis of Psychological Concept Extraction and Classification in User-Penned Text

Extracting Pulmonary Nodules and Nodule Characteristics from Radiology Reports of Lung Cancer Screening Patients Using Transformer Models

Pulmonary nodules and nodule characteristics are important indicators of lung nodule malignancy. However, nodule information is often documented as free text in clinical narratives such as radiology reports in electronic health record systems. Natural language processing (NLP) is the key technology to extract and standardize patient information from radiology reports into structured data elements. This study aimed to develop an NLP system using state-of-the-art transformer models to extract pulmonary nodules and associated nodule characteristics from radiology reports. We identified a cohort of 3080 patients who underwent LDCT at the University of Florida health system and collected their radiology reports. We manually annotated 394 reports as the gold standard. We explored eight pretrained transformer models from three transformer architectures including bidirectional encoder representations from transformers (BERT), robustly optimized BERT approach (RoBERTa), and A Lite BERT (ALBERT), for clinical concept extraction, relation identification, and negation detection. We examined general transformer models pretrained using general English corpora, transformer models fine-tuned using a clinical corpus, and a large clinical transformer model, GatorTron, which was trained from scratch using 90 billion words of clinical text. We compared transformer models with two baseline models including a recurrent neural network implemented using bidirectional long short-term memory with a conditional random fields layer and support vector machines. RoBERTa-mimic achieved the best F1-score of 0.9279 for nodule concept and nodule characteristics extraction. ALBERT-base and GatorTron achieved the best F1-score of 0.9737 in linking nodule characteristics to pulmonary nodules. Seven out of eight transformers achieved the best F1-score of 1.0000 for negation detection. Our end-to-end system achieved an overall F1-score of 0.8869. This study demonstrated the advantage of state-of-the-art transformer models for pulmonary nodule information extraction from radiology reports.

A taxonomy for advancing systematic error analysis in multi-site electronic health record-based clinical concept extraction.

Error analysis plays a crucial role in clinical concept extraction, a fundamental subtask within clinical natural language processing (NLP). The process typically involves a manual review of error types, such as contextual and linguistic factors contributing to their occurrence, and the identification of underlying causes to refine the NLP model and improve its performance. Conducting error analysis can be complex, requiring a combination of NLP expertise and domain-specific knowledge. Due to the high heterogeneity of electronic health record (EHR) settings across different institutions, challenges may arise when attempting to standardize and reproduce the error analysis process. This study aims to facilitate a collaborative effort to establish common definitions and taxonomies for capturing diverse error types, fostering community consensus on error analysis for clinical concept extraction tasks. We iteratively developed and evaluated an error taxonomy based on existing literature, standards, real-world data, multisite case evaluations, and community feedback. The finalized taxonomy was released in both .dtd and .owl formats at the Open Health Natural Language Processing Consortium. The taxonomy is compatible with several different open-source annotation tools, including MAE, Brat, and MedTator. The resulting error taxonomy comprises 43 distinct error classes, organized into 6 error dimensions and 4 properties, including model type (symbolic and statistical machine learning), evaluation subject (model and human), evaluation level (patient, document, sentence, and concept), and annotation examples. Internal and external evaluations revealed strong variations in error types across methodological approaches, tasks, and EHR settings. Key points emerged from community feedback, including the need to enhancing clarity, generalizability, and usability of the taxonomy, along with dissemination strategies. The proposed taxonomy can facilitate the acceleration and standardization of the error analysis process in multi-site settings, thus improving the provenance, interpretability, and portability of NLP models. Future researchers could explore the potential direction of developing automated or semi-automated methods to assist in the classification and standardization of error analysis.

Nursing Home Characteristics and Resident Quality of Care Outcomes: A Scoping Review

Nursing Home Characteristics and Resident Quality of Care Outcomes: A Scoping Review

Criteria2Query 3.0: Leveraging generative large language models for clinical trial eligibility query generation

ObjectiveAutomated identification of eligible patients is a bottleneck of clinical research. We propose Criteria2Query (C2Q) 3.0, a system that leverages GPT-4 for the semi-automatic transformation of clinical trial eligibility criteria text into executable clinical database queries. Materials and MethodsC2Q 3.0 integrated three GPT-4 prompts for concept extraction, SQL query generation, and reasoning. Each prompt was designed and evaluated separately. The concept extraction prompt was benchmarked against manual annotations from 20 clinical trials by two evaluators, who later also measured SQL generation accuracy and identified errors in GPT-generated SQL queries from 5 clinical trials. The reasoning prompt was assessed by three evaluators on four metrics: readability, correctness, coherence, and usefulness, using corrected SQL queries and an open-ended feedback questionnaire. ResultsOut of 518 concepts from 20 clinical trials, GPT-4 achieved an F1-score of 0.891 in concept extraction. For SQL generation, 29 errors spanning seven categories were detected, with logic errors being the most common (n = 10; 34.48 %). Reasoning evaluations yielded a high coherence rating, with the mean score being 4.70 but relatively lower readability, with a mean of 3.95. Mean scores of correctness and usefulness were identified as 3.97 and 4.37, respectively. ConclusionGPT-4 significantly improves the accuracy of extracting clinical trial eligibility criteria concepts in C2Q 3.0. Continued research is warranted to ensure the reliability of large language models.

Productivity improvement of control cable manufacturing machine for the automotive industry

Due to the high competitiveness that characterizes the automotive industry (AI), there is an intensive search for improvements that translates into significant impacts on the productivity, still guaranteeing the levels of quality required by the client. The requirement for flexibility is leading to a paradigm shift that arises from a constant change in the needs of consumers, who demand an ever-higher level of customization in the products. In recent years, the increasing use of automation in industry resulted in significantly improved product quality, better working environment, higher cost efficiency, and major improvement in process flexibility. The present work addresses the productivity improvement of a control cable manufacturing machine for the AI. The main objective is related to the development of a new stripping machine concept that allows the simultaneous coating removal from two cables, thus eliminating an existing bottleneck in the injection process of the cables’ first Zamak terminal. A prototype machine was built, and the new concept validated, and then implemented in the factory. An automatic cable extraction system was also designed, aiming to reduce the number of manual tasks performed by the operator, with the expectation of further improving the process productivity. The development of the two new mechanisms followed the Design Science Research (DSR) methodology. With the implementation of the new double stripping concept and automatic cable extraction system, a major increase in productivity (up to 87.8% compared to the current condition) and cost reduction were achieved.

Generative large language models are all-purpose text analytics engines: text-to-text learning is all your need.

To solve major clinical natural language processing (NLP) tasks using a unified text-to-text learning architecture based on a generative large language model (LLM) via prompt tuning. We formulated 7 key clinical NLP tasks as text-to-text learning and solved them using one unified generative clinical LLM, GatorTronGPT, developed using GPT-3 architecture and trained with up to 20 billion parameters. We adopted soft prompts (ie, trainable vectors) with frozen LLM, where the LLM parameters were not updated (ie, frozen) and only the vectors of soft prompts were updated, known as prompt tuning. We added additional soft prompts as a prefix to the input layer, which were optimized during the prompt tuning. We evaluated the proposed method using 7 clinical NLP tasks and compared them with previous task-specific solutions based on Transformer models. The proposed approach achieved state-of-the-art performance for 5 out of 7 major clinical NLP tasks using one unified generative LLM. Our approach outperformed previous task-specific transformer models by ∼3% for concept extraction and 7% for relation extraction applied to social determinants of health, 3.4% for clinical concept normalization, 3.4%-10% for clinical abbreviation disambiguation, and 5.5%-9% for natural language inference. Our approach also outperformed a previously developed prompt-based machine reading comprehension (MRC) model, GatorTron-MRC, for clinical concept and relation extraction. The proposed approach can deliver the "one model for all" promise from training to deployment using a unified generative LLM.

Identifying social determinants of health from clinical narratives: A study of performance, documentation ratio, and potential bias

ObjectiveTo develop a natural language processing (NLP) package to extract social determinants of health (SDoH) from clinical narratives, examine the bias among race and gender groups, test the generalizability of extracting SDoH for different disease groups, and examine population-level extraction ratio. MethodsWe developed SDoH corpora using clinical notes identified at the University of Florida (UF) Health. We systematically compared 7 transformer-based large language models (LLMs) and developed an open-source package – SODA (i.e., SOcial DeterminAnts) to facilitate SDoH extraction from clinical narratives. We examined the performance and potential bias of SODA for different race and gender groups, tested the generalizability of SODA using two disease domains including cancer and opioid use, and explored strategies for improvement. We applied SODA to extract 19 categories of SDoH from the breast (n = 7,971), lung (n = 11,804), and colorectal cancer (n = 6,240) cohorts to assess patient-level extraction ratio and examine the differences among race and gender groups. ResultsWe developed an SDoH corpus using 629 clinical notes of cancer patients with annotations of 13,193 SDoH concepts/attributes from 19 categories of SDoH, and another cross-disease validation corpus using 200 notes from opioid use patients with 4,342 SDoH concepts/attributes. We compared 7 transformer models and the GatorTron model achieved the best mean average strict/lenient F1 scores of 0.9122 and 0.9367 for SDoH concept extraction and 0.9584 and 0.9593 for linking attributes to SDoH concepts. There is a small performance gap (∼4%) between Males and Females, but a large performance gap (>16 %) among race groups. The performance dropped when we applied the cancer SDoH model to the opioid cohort; fine-tuning using a smaller opioid SDoH corpus improved the performance. The extraction ratio varied in the three cancer cohorts, in which 10 SDoH could be extracted from over 70 % of cancer patients, but 9 SDoH could be extracted from less than 70 % of cancer patients. Individuals from the White and Black groups have a higher extraction ratio than other minority race groups. ConclusionsOur SODA package achieved good performance in extracting 19 categories of SDoH from clinical narratives. The SODA package with pre-trained transformer models is available at https://github.com/uf-hobi-informatics-lab/SODA_Docker.

An Entity Extraction Pipeline for Medical Text Records Using Large Language Models: Analytical Study.

The study of disease progression relies on clinical data, including text data, and extracting valuable features from text data has been a research hot spot. With the rise of large language models (LLMs), semantic-based extraction pipelines are gaining acceptance in clinical research. However, the security and feature hallucination issues of LLMs require further attention. This study aimed to introduce a novel modular LLM pipeline, which could semantically extract features from textual patient admission records. The pipeline was designed to process a systematic succession of concept extraction, aggregation, question generation, corpus extraction, and question-and-answer scale extraction, which was tested via 2 low-parameter LLMs: Qwen-14B-Chat (QWEN) and Baichuan2-13B-Chat (BAICHUAN). A data set of 25,709 pregnancy cases from the People's Hospital of Guangxi Zhuang Autonomous Region, China, was used for evaluation with the help of a local expert's annotation. The pipeline was evaluated with the metrics of accuracy and precision, null ratio, and time consumption. Additionally, we evaluated its performance via a quantified version of Qwen-14B-Chat on a consumer-grade GPU. The pipeline demonstrates a high level of precision in feature extraction, as evidenced by the accuracy and precision results of Qwen-14B-Chat (95.52% and 92.93%, respectively) and Baichuan2-13B-Chat (95.86% and 90.08%, respectively). Furthermore, the pipeline exhibited low null ratios and variable time consumption. The INT4-quantified version of QWEN delivered an enhanced performance with 97.28% accuracy and a 0% null ratio. The pipeline exhibited consistent performance across different LLMs and efficiently extracted clinical features from textual data. It also showed reliable performance on consumer-grade hardware. This approach offers a viable and effective solution for mining clinical research data from textual records.

Model tuning or prompt Tuning? a study of large language models for clinical concept and relation extraction

ObjectiveTo develop soft prompt-based learning architecture for large language models (LLMs), examine prompt-tuning using frozen/unfrozen LLMs, and assess their abilities in transfer learning and few-shot learning. MethodsWe developed a soft prompt-based learning architecture and compared 4 strategies including (1) fine-tuning without prompts; (2) hard-prompting with unfrozen LLMs; (3) soft-prompting with unfrozen LLMs; and (4) soft-prompting with frozen LLMs. We evaluated GatorTron, a clinical LLM with up to 8.9 billion parameters, and compared GatorTron with 4 existing transformer models for clinical concept and relation extraction on 2 benchmark datasets for adverse drug events and social determinants of health (SDoH). We evaluated the few-shot learning ability and generalizability for cross-institution applications. Results and ConclusionWhen LLMs are unfrozen, GatorTron-3.9B with soft prompting achieves the best strict F1-scores of 0.9118 and 0.8604 for concept extraction, outperforming the traditional fine-tuning and hard prompt-based models by 0.6 ∼ 3.1 % and 1.2 ∼ 2.9 %, respectively; GatorTron-345 M with soft prompting achieves the best F1-scores of 0.8332 and 0.7488 for end-to-end relation extraction, outperforming other two models by 0.2 ∼ 2 % and 0.6 ∼ 11.7 %, respectively. When LLMs are frozen, small LLMs have a big gap to be competitive with unfrozen models; scaling LLMs up to billions of parameters makes frozen LLMs competitive with unfrozen models. Soft prompting with a frozen GatorTron-8.9B model achieved the best performance for cross-institution evaluation. We demonstrate that (1) machines can learn soft prompts better than hard prompts composed by human, (2) frozen LLMs have good few-shot learning ability and generalizability for cross-institution applications, (3) frozen LLMs reduce computing cost to 2.5 ∼ 6 % of previous methods using unfrozen LLMs, and (4) frozen LLMs require large models (e.g., over several billions of parameters) for good performance.