arXiv:2506.09749v3 Announce Type: replace-cross Abstract: In complex engineering systems, the dependencies among components or development activities are often modeled and analyzed using Design Structure Matrix (DSM). Reorganizing elements within a DSM to minimize feedback loops and enhance modularity or process efficiency constitutes a challenging combinatorial optimization (CO) problem in engineering design and operations. As problem sizes increase and dependency networks become more intricate, traditional optimization methods that rely solely on mathematical heuristics often fail to capture the contextual nuances and struggle to deliver effective solutions. In this study, we explore the potential of Large Language Models (LLMs) to address such CO problems by leveraging their capabilities for advanced reasoning and contextual understanding. We propose a novel LLM-based framework that integrates network topology with contextual domain knowledge for iterative optimization of DSM sequencing-a common CO problem. Experiments on various DSM cases demonstrate that our method consistently achieves faster convergence and superior solution quality compared to both stochastic and deterministic baselines. Notably, incorporating contextual domain knowledge significantly enhances optimization performance regardless of the chosen LLM backbone. These findings highlight the potential of LLMs to solve complex engineering CO problems by combining semantic and mathematical reasoning. This approach paves the way towards a new paradigm in LLM-based engineering design optimization.

Background: Antimicrobial resistance (AMR) poses a critical global health threat, with inappropriate antibiotic use being a major driver. Timely microbiological specimen submission before initiating antibiotic therapy is a cornerstone of antimicrobial stewardship (AMS), enabling pathogen-directed therapy and reducing unnecessary broad-spectrum exposure. However, suboptimal compliance remains common due to workflow interruptions, technological barriers, and behavioral factors. Failure Mode and Effects Analysis (FMEA), a proactive risk-assessment method widely used in health care quality improvement, provides a systematic framework to identify process vulnerabilities and prioritize corrective actions. Despite its increasing application, few studies have integrated FMEA with hospital informatization to optimize microbiological specimen submission workflows in routine AMS practice. Objective: This study aimed to systematically identify workflow risks affecting preantibiotic microbiological specimen submission and to design, implement, and evaluate informatization-enabled interventions using an FMEA-based framework. Methods: FMEA was conducted at a tertiary hospital in China. A multidisciplinary team identified potential failure modes across 4 domains: health information systems, personnel, administration, and external support. Risk Priority Numbers (RPNs) and Action Priority (AP) indices were calculated for each failure mode. Targeted interventions were implemented, including dual-verification barcode scanning, artificial intelligence-driven clinical decision support alerts, EHR-integrated training modules, and automated compliance dashboards. Pre- and postintervention specimen submission rates (January 2024-December 2024) were analyzed using the Mann-Kendall trend test. Results: The top 5 failure modes included PDA barcode scanning failures (RPN=175), inadequate clinical decision support (RPN=140), insufficient clinician awareness (RPN=56), suboptimal oversight mechanisms, and patient-related barriers. Postintervention, significant upward trends were observed in overall specimen submission rates (