Daily Papers

LLMs for clinical decision support often fail under small but clinically meaningful input shifts such as masking a symptom or negating a finding, despite high performance on static benchmarks. These reasoning failures frequently go undetected by standard NLP metrics, which are insensitive to latent representation shifts that drive diagnosis instability. We propose a geometry-aware evaluation framework, LAPD (Latent Agentic Perturbation Diagnostics), which systematically probes the latent robustness of clinical LLMs under structured adversarial edits. Within this framework, we introduce Latent Diagnosis Flip Rate (LDFR), a model-agnostic diagnostic signal that captures representational instability when embeddings cross decision boundaries in PCA-reduced latent space. Clinical notes are generated using a structured prompting pipeline grounded in diagnostic reasoning, then perturbed along four axes: masking, negation, synonym replacement, and numeric variation to simulate common ambiguities and omissions. We compute LDFR across both foundation and clinical LLMs, finding that latent fragility emerges even under minimal surface-level changes. Finally, we validate our findings on 90 real clinical notes from the DiReCT benchmark (MIMIC-IV), confirming the generalizability of LDFR beyond synthetic settings. Our results reveal a persistent gap between surface robustness and semantic stability, underscoring the importance of geometry-aware auditing in safety-critical clinical AI.

Large language model (LLM) agents increasingly take actions (screening applicants, recommending credit, triaging patients), yet fairness for LLMs is still measured by grading answers. We introduce AgentFairBench, a cheap, reproducible, multi-domain benchmark for demographic disparity in the actions of LLM agents. Grounded in a companion framework, the Bias Conduction Framework (BCF, restated here), it spans three regulator-anchored domains: hiring, lending, and medical triage. Synthetic, demographic-neutral profiles are evaluated in counterfactual matched sets that vary only a name-coded race x gender signal (in the Bertrand Mullainathan tradition), under four agent scaffolds of increasing agency (direct, chain-of-thought, multi-agent deliberation, tool-augmented). A NumPy-only harness computes counterfactual flip rate, mean absolute score difference (MASD), action-rate disparity, and tool-invocation disparity, with bootstrap confidence intervals, paired tests, and false-discovery-rate control, for single-digit dollars per model. A live leaderboard with a held-out private split and a contamination canary admits external models by submission. Our pilot (864 decisions plus a test-retest replication) carries a methodological lesson: comparing a six-group score spread against a two-run noise difference overstates disparity by ~ 2.4X through statistic arity alone. Against an arity matched noise floor and an omnibus group test, claude haiku 4 5 shows no demographic effect above sampling noise (0 of 120 pairwise and 0 of 9 omnibus contrasts survive correction); a planted-bias test confirms the instrument detects disparity when present. The contribution is a sound, sensitive, adoption-ready instrument, the arity matched null methodology, and open artifacts to scale it. Code, data, and harness are released under open licenses, with an anonymized review artifact.

Despite achieving high accuracy on medical benchmarks, LLMs exhibit the Einstellung Effect in clinical diagnosis--relying on statistical shortcuts rather than patient-specific evidence, causing misdiagnosis in atypical cases. Existing benchmarks fail to detect this critical failure mode. We introduce MedEinst, a counterfactual benchmark with 5,383 paired clinical cases across 49 diseases. Each pair contains a control case and a "trap" case with altered discriminative evidence that flips the diagnosis. We measure susceptibility via Bias Trap Rate--probability of misdiagnosing traps despite correctly diagnosing controls. Extensive Evaluation of 17 LLMs shows frontier models achieve high baseline accuracy but severe bias trap rates. Thus, we propose ECR-Agent, aligning LLM reasoning with Evidence-Based Medicine standard via two components: (1) Dynamic Causal Inference (DCI) performs structured reasoning through dual-pathway perception, dynamic causal graph reasoning across three levels (association, intervention, counterfactual), and evidence audit for final diagnosis; (2) Critic-Driven Graph and Memory Evolution (CGME) iteratively refines the system by storing validated reasoning paths in an exemplar base and consolidating disease-specific knowledge into evolving illness graphs. Source code is to be released.

Counterfactual prompting (i.e., perturbing a single factor and measuring output change) is widely used to evaluate things like LLM bias and CoT faithfulness. But in this work we argue that observed effects cannot be attributed to the targeted factor without accounting for baseline ``meaning-preserving'' modifications to text that establish general model sensitivity. This is because every counterfactual edit is a compound treatment that bundles the variable of interest with incidental surface-form variation; this violates treatment variation irrelevance. We observe prediction flip rates on MedQA of 14.9% when we surgically change patient gender. However, this is statistically indistinguishable from the flip rates induced by simply paraphrasing inputs (14.1%). In this case, it would therefore be unwarranted to conclude that the LLM is especially sensitive to patient gender. To account for this and robustly measure the effects of targeted interventions, we propose a framework in which we compare (via statistical testing) differences observed under target interventions to those induced by paraphrasing inputs. We then use this framework to revisit a analysis done on the MedPerturb dataset, which reported evidence of model sensitivity to patient demographics and stylistic cues. We find that these effects largely dissipate when we account for general model sensitivity, with only 5 of 120 tests reaching statistical significance. Applying the same framework to occupational biography classification, we detect clearly significant directional gender bias, showing that the framework identifies real directional effects even when they are small. We evaluate a range of metrics -- aggregate, per-sample distributional, and regression -- and find that per-sample metrics are dramatically more powerful than aggregate metrics and regression powerfully and uniquely characterizes effect direction and magnitude.

Reasoning models are evaluated on single-turn benchmarks but deployed in multi-turn dialogue, where users push back on correct answers. Under sustained adversarial pressure we find a previously undocumented failure mode: the chain-of-thought stays factually correct from first turn to last while the emitted answer flips wrong. We call this unfaithful capitulation (UC) and isolate it with a 2times 2 latent-versus-behavioral framework that flip-rate metrics and single-turn faithfulness probes both miss. Across three datasets (MT-Consistency, MMLU-Pro, GSM8K), the latent-correct rate at the behavioral flip clusters near 50% in think mode and collapses to 11-15% under no_think -- paired, within-model causal evidence that reasoning creates the gap. Across models the effect tracks the reasoning channel (high in Qwen3-32B and GPT-OSS-20B, low in inline-CoT Gemma-4-31B-it). An independent GPT-4o judge corroborates 86% of UC labels; a token-level probe shows the answer-slot argmax is correct in 84% of UC cells; and a naive trace-anchored defense backfires. We release all trajectories, traces, and judge labels.

Standard accuracy benchmarks are designed to test how closely large language models (LLMs) approach correct answers, but are not suitable for testing whether LLMs stick with a correct answer when that answer is challenged by a plausible counter-argument. We introduce a controlled protocol for evaluating answer stability: after a model answers a multiple-choice question correctly, we challenge the model's answer with a coherent argument for an incorrect option and measure whether the model flips. The setup a) isolates argumentative content from overt social pressure and b) varies argument length, self-attribution, and cross-model source. Across seven frontier models and 57 MMLU subjects, flip rates range from 17.5% to 97.3%, revealing large differences in stability that are not captured by accuracy metrics alone. We find that self-attribution consistently increases flip rates (mean +7.1pp, up to +18.7pp). Also, pooling wrong-answer arguments across models and selecting the most effective one per question yields stronger adversarial challenges than relying on any single source model. We further construct MaxFlip, a curated challenge set that amplifies flips by up to +23.6pp over standard self-generated challenges. We release the protocol, challenge records, and MaxFlip to support stability evaluation alongside standard accuracy benchmarks. Materials are available at https://github.com/nafisenik/WhoFlips and https://hf.co/datasets/nafisehNik/WhoFlips.

The robustness of machine learning models can be compromised by spurious correlations between non-causal features in the input data and target labels. A common way to test for such correlations is to train on data where the label is strongly tied to some non-causal cue, then evaluate on examples where that tie no longer holds. This idea is well established for classification tasks, but for semantic segmentation the specific failure modes are not well understood. We show that a model may achieve reasonable overlap while assigning the wrong semantic label, swapping one plausible foreground class for another, even when object boundaries are largely correct. We focus on this semantic label-flip behaviour and quantify it with a simple diagnostic (Flip) that counts how often ground truth foreground pixels are assigned the wrong foreground identity while remaining predicted as foreground. In a setting where category and scene are correlated during training, increasing the correlation consistently widens the gap between common and rare test conditions and increases these within-object label swaps on counterfactual groups. Overall, our results motivate assessing segmentation robustness under distribution shift beyond overlap by decomposing foreground errors into correct pixels, flipped-identity pixels, and missed-to-background pixels. We also propose an entropy-based, ground truth label-free `flip-risk' score, which is computed from foreground identity uncertainty, and show that it can flag flip-prone cases at inference time. Code is available at https://github.com/acharaakshit/label-flips.

In this paper, we present a framework for training large language models (LLMs) as diagnostic agents with reinforcement learning, enabling them to manage multi-turn diagnostic processes, adaptively select examinations, and commit to final diagnoses. Unlike instruction-tuned models trained on static case summaries, our method acquires diagnostic strategies through interactive exploration and outcome-based feedback. Our contributions are fourfold: (i) We present DiagGym, a diagnostics world model trained with electronic health records that emits examination outcomes conditioned on patient history and recommended examination, serving as a virtual clinical environment for realistic diagnosis training and evaluation; (ii) We train DiagAgent via end-to-end, multi-turn reinforcement learning to learn diagnostic policies that optimize both information yield and diagnostic accuracy; (iii) We introduce DiagBench, a diagnostic benchmark comprising 750 cases with physician-validated examination recommendations and 99 cases annotated with 973 physician-written rubrics on diagnosis process; (iv) we demonstrate superior performance across diverse diagnostic settings. DiagAgent significantly outperforms 10 state-of-the-art LLMs, including DeepSeek-v3 and GPT-4o, as well as two prompt-engineered agents. In single-turn settings, DiagAgent achieves 9.34% higher diagnostic accuracy and 44.03% improvement in examination recommendation hit ratio. In end-to-end settings, it delivers 15.12% increase in diagnostic accuracy and 23.09% boost in examination recommendation F1 score. In rubric-based evaluation, it surpasses the next-best model, Claude-sonnet-4, by 7.1% in weighted rubric score. These findings indicate that learning policies in interactive clinical environments confers dynamic and clinically meaningful diagnostic management abilities unattainable through passive training alone.

Background: Emerging reports of "AI psychosis" are on the rise, where user-LLM interactions may exacerbate or induce psychosis or adverse psychological symptoms. Whilst the sycophantic and agreeable nature of LLMs can be beneficial, it becomes a vector for harm by reinforcing delusional beliefs in vulnerable users. Methods: Psychosis-bench is a novel benchmark designed to systematically evaluate the psychogenicity of LLMs comprises 16 structured, 12-turn conversational scenarios simulating the progression of delusional themes(Erotic Delusions, Grandiose/Messianic Delusions, Referential Delusions) and potential harms. We evaluated eight prominent LLMs for Delusion Confirmation (DCS), Harm Enablement (HES), and Safety Intervention(SIS) across explicit and implicit conversational contexts. Findings: Across 1,536 simulated conversation turns, all LLMs demonstrated psychogenic potential, showing a strong tendency to perpetuate rather than challenge delusions (mean DCS of 0.91 pm0.88). Models frequently enabled harmful user requests (mean HES of 0.69 pm0.84) and offered safety interventions in only roughly a third of applicable turns (mean SIS of 0.37 pm0.48). 51 / 128 (39.8%) of scenarios had no safety interventions offered. Performance was significantly worse in implicit scenarios, models were more likely to confirm delusions and enable harm while offering fewer interventions (p < .001). A strong correlation was found between DCS and HES (rs = .77). Model performance varied widely, indicating that safety is not an emergent property of scale alone. Conclusion: This study establishes LLM psychogenicity as a quantifiable risk and underscores the urgent need for re-thinking how we train LLMs. We frame this issue not merely as a technical challenge but as a public health imperative requiring collaboration between developers, policymakers, and healthcare professionals.

Correcting health misinformation in dialogue requires more than producing a factual rebuttal: users differ in what they know, what they believe, and what they need to hear, so an effective intervention often depends on first asking the right clarifying question. Yet existing methods either respond immediately or probe indiscriminately, treating clarification as either unnecessary or always beneficial. We propose Reward-Optimized Probe-and-Respond (RO-PnR), a framework that learns when asking is worth its cost. At each turn, RO-PnR chooses between probing for more information and committing to a final correction, guided by a turn-level reward that weighs the expected gain from probing against its interaction cost. To capture how user heterogeneity affects probing value, we model each simulated user with a latent state along health literacy and belief commitment. Experiments show that RO-PnR achieves the highest cost-adjusted utility across three health-misinformation datasets and three base models, using 30% fewer turns than always-probe baselines.

Machine learning systems in fraud detection, credit scoring, and clinical risk assessment operate under delayed ground truth: outcome labels arrive days to months after the decision they evaluate. During this blind period, governance evidence degrades through mechanisms that neither drift detection methods nor governance frameworks adequately address. This paper formalizes an evidence sufficiency model with four dimensions (completeness, freshness, reliability, representativeness) and a decision-readiness gate that quantifies how label latency degrades evidence quality. The model maps three drift types to dimension-specific degradation trajectories. A complementary proxy indicator framework comprising seven measurement categories estimates sufficiency degradation without labels, with explicit coverage mapping and characterized blind spots per drift type. Evaluation on the IEEE-CIS Fraud Detection dataset (~590K transactions) with controlled drift injection shows that composite proxy monitoring detects covariate and mixed drift with 100% detection rate, while concept drift without feature change remains undetected -- consistent with the theoretical impossibility of unsupervised detection when P(X) is unchanged. Blind period simulation confirms monotone sufficiency degradation, with concept drift degrading fastest (S=0.242 at day 60 vs 0.418 for no-drift). The framework contributes a governance sufficiency monitoring instrument; its value lies in translating drift signals into auditable sufficiency assessments with characterized blind spots. Mapping sufficiency levels to governance actions requires deployment-specific calibration beyond this study's scope.

Latent visual reasoning (LVR) inserts supervised latent tokens between perception and answer generation in vision-language models (VLMs). The field uses alignment between these latents and their visual targets, i.e., cosine similarity or mean squared error (MSE), as both the training loss and the quality metric, assuming that better alignment yields a better answer. We test this with a designed matrix of five LVR variants and find the assumption inverted: cosine alignment is negatively correlated with accuracy across all five (r=-0.94). To explain this, we introduce PRISM, a pair of inference-time diagnostics: a linear probe that asks where the answer is decodable, and a corruption test that asks whether the latent is load-bearing. The supervised latents are largely bypassed. Corrupting them shifts accuracy by at most four points. The answer is decodable downstream of the latent but not at it, and the size of this decodability gap predicts how much each variant relies on its latent under perturbation. Consistent with an Information Bottleneck reading of the loss, the auxiliary objective reshapes the language model via shared parameters rather than via the latent variable it nominally optimizes.

Rare diseases affect millions of individuals worldwide, yet timely diagnosis remains a major public health challenge due to scarcity of specialized clinical expertise. While large language models (LLMs) show promise to support rare disease diagnosis, current models are constrained by insufficient clinical deployability, limited clinically grounded evidence, and scarcity of training data. Here we present RaDaR (Rare Disease navigatoR), an open-source, compact reasoning LLM (32B parameters) for rare disease diagnosis. RaDaR was trained with 49,170 publicly available free-text cases and 104,666 synthetic cases with reasoning-enhanced training. RaDaR showed the strongest performance among evaluated open-source models, including the 671B DeepSeek-R1, across public benchmarks and four external validation centers. In a retrospective cohort, RaDaR prioritized the final diagnosis before documented clinical suspicion in 61.06 percent of cases, corresponding to a potential lead time of 1.87 months and 50.18 percent of the within-center interval. In a randomized physician-assistance trial, RaDaR assistance improved physicians' rare-disease diagnostic accuracy by 21.44 percentage points compared with internet search alone. Synthetic-data ablations suggested that phenotype-anchored narratives provide useful training signal for long-tail rare diseases, with a monotonic scaling trend within the tested data range. Together, RaDaR and its development and validation framework provide a deployable rare-disease reasoning model and a reproducible development framework for diagnostic AI under data scarcity.

Generative diffusion models are increasingly used for medical imaging data augmentation, but text prompting cannot produce causal training data. Re-prompting rerolls the entire generation trajectory, altering anatomy, texture, and background. Inversion-based editing methods introduce reconstruction error that causes structural drift. We propose MedSteer, a training-free activation-steering framework for endoscopic synthesis. MedSteer identifies a pathology vector for each contrastive prompt pair in the cross-attention layers of a diffusion transformer. At inference time, it steers image activations along this vector, generating counterfactual pairs from scratch where the only difference is the steered concept. All other structure is preserved by construction. We evaluate MedSteer across three experiments on Kvasir v3 and HyperKvasir. On counterfactual generation across three clinical concept pairs, MedSteer achieves flip rates of 0.800, 0.925, and 0.950, outperforming the best inversion-based baseline in both concept flip rate and structural preservation. On dye disentanglement, MedSteer achieves 75% dye removal against 20% (PnP) and 10% (h-Edit). On downstream polyp detection, augmenting with MedSteer counterfactual pairs achieves ViT AUC of 0.9755 versus 0.9083 for quantity-matched re-prompting, confirming that counterfactual structure drives the gain. Code is at link https://github.com/phamtrongthang123/medsteer

Introduction: Electronic health records (EHR) are a critical medium through which patient stigmatization is perpetuated among healthcare teams. Methods: We identified linguistic features of doubt markers and stigmatizing labels in MIMIC-III EHR via expanded lexicon matching and supervised learning classifiers. Predictors of rates of linguistic features were assessed using Poisson regression models. Results: We found higher rates of stigmatizing labels per chart among patients who were Black or African American (RR: 1.16), patients with Medicare/Medicaid or government-run insurance (RR: 2.46), self-pay (RR: 2.12), and patients with a variety of stigmatizing disease and mental health conditions. Patterns among doubt markers were similar, though male patients had higher rates of doubt markers (RR: 1.25). We found increased stigmatizing labels used by nurses (RR: 1.40), and social workers (RR: 2.25), with similar patterns of doubt markers. Discussion: Stigmatizing language occurred at higher rates among historically stigmatized patients, perpetuated by multiple provider types.

Models that can predict the occurrence of events ahead of time with low false-alarm rates are critical to the acceptance of decision support systems in the medical community. This challenging task is typically treated as a simple binary classification, ignoring temporal dependencies between samples, whereas we propose to exploit this structure. We first introduce a common theoretical framework unifying dynamic survival analysis and early event prediction. Following an analysis of objectives from both fields, we propose Temporal Label Smoothing (TLS), a simpler, yet best-performing method that preserves prediction monotonicity over time. By focusing the objective on areas with a stronger predictive signal, TLS improves performance over all baselines on two large-scale benchmark tasks. Gains are particularly notable along clinically relevant measures, such as event recall at low false-alarm rates. TLS reduces the number of missed events by up to a factor of two over previously used approaches in early event prediction.

Clinical decision-support systems are expert systems whose recommendations clinicians act on directly, yet they are usually cleared on one aggregate accuracy number from a held-out test set. That number says nothing about input reliability under encoding shifts, subgroup gaps, threshold sensitivity, or operational feasibility. We present RISED, a pre-deployment evaluation framework operationalising five dimensions (Reliability, Inclusivity, Sensitivity, Equity, Deployability) through BCa bootstrap 95% confidence intervals, literature-grounded thresholds, and Holm-Bonferroni-corrected PASS / FAIL / INCONCLUSIVE verdicts; Equity is a proxy-dependence diagnostic rather than a gating test. Applied to seven cohorts spanning 35 years (n from 303 to 99,492), RISED surfaces failures invisible to AUROC: on Diabetes 130, Reliability passes by three orders of magnitude (PSS = 0.0004) while Inclusivity (AUC parity gap = 0.262) and Sensitivity (max threshold-flip rate 49.1%) fail decisively; both NHIS cohorts reproduce this. NHANES 2021-2023, with a complete feature profile, achieves INCONCLUSIVE verdicts; BRFSS 2024 produces the suite's most severe Sensitivity failure (max threshold-flip rate 64.2%) after instrument rotation removed hypertension and cholesterol. The pattern recurs on credit- and income-prediction cohorts, confirming domain-agnosticity; a multi-model check shows the failures are data-driven, not model-specific. RISED ships as an open-source Python package complementing TRIPOD+AI, FUTURE-AI, and Fairlearn with the structured numerical evidence those standards require but do not prescribe.

Faced with distribution shift between training and test set, we wish to detect and quantify the shift, and to correct our classifiers without test set labels. Motivated by medical diagnosis, where diseases (targets) cause symptoms (observations), we focus on label shift, where the label marginal p(y) changes but the conditional p(x| y) does not. We propose Black Box Shift Estimation (BBSE) to estimate the test distribution p(y). BBSE exploits arbitrary black box predictors to reduce dimensionality prior to shift correction. While better predictors give tighter estimates, BBSE works even when predictors are biased, inaccurate, or uncalibrated, so long as their confusion matrices are invertible. We prove BBSE's consistency, bound its error, and introduce a statistical test that uses BBSE to detect shift. We also leverage BBSE to correct classifiers. Experiments demonstrate accurate estimates and improved prediction, even on high-dimensional datasets of natural images.

Large language models (LLMs) are increasingly used for tasks that require complex reasoning. Most benchmarks focus on final outcomes but overlook the intermediate reasoning steps - such as planning, revision, and decision making under resource constraints. We argue that measuring these internal processes is essential for understanding model behavior and improving reliability. We propose using strategic games as a natural evaluation environment: closed, rule-based systems with clear states, limited resources, and automatic feedback. We introduce a framework that evaluates LLMs along three core dimensions: planning, revision, and resource-constrained decision making. To operationalize this, we define metrics beyond win rate, including overcorrection risk rate, correction success rate, improvement slope, and over-budget ratio. In 4320 adversarial rounds across 12 leading models, ChatGPT-o3-mini achieves the top composite score, with a win rate of 74.7 percent, a correction success rate of 78.6 percent, and an improvement slope of 0.041. By contrast, Qwen-Plus, despite an overcorrection risk rate of 81.6 percent, wins only 25.6 percent of its matches - primarily due to excessive resource use. We also observe a negative correlation between overcorrection risk rate and correction success rate (Pearson r = -0.51, p = 0.093), suggesting that more frequent edits do not always improve outcomes. Our findings highlight the value of assessing not only what LLMs decide but how they arrive at those decisions

Counterfactual medical image generation effectively addresses data scarcity and enhances the interpretability of medical images. However, due to the complex and diverse pathological features of medical images and the imbalanced class distribution in medical data, generating high-quality and diverse medical images from limited data is significantly challenging. Additionally, to fully leverage the information in limited data, such as anatomical structure information and generate more structurally stable medical images while avoiding distortion or inconsistency. In this paper, in order to enhance the clinical relevance of generated data and improve the interpretability of the model, we propose a novel medical image generation framework, which generates independent pathological and structural features based on causal disentanglement and utilizes text-guided modeling of pathological features to regulate the generation of counterfactual images. First, we achieve feature separation through causal disentanglement and analyze the interactions between features. Here, we introduce group supervision to ensure the independence of pathological and identity features. Second, we leverage a diffusion model guided by pathological findings to model pathological features, enabling the generation of diverse counterfactual images. Meanwhile, we enhance accuracy by leveraging a large language model to extract lesion severity and location from medical reports. Additionally, we improve the performance of the latent diffusion model on long-tailed categories through initial noise optimization.

Training large transformers is slow, but recent innovations on GPU architecture give us an advantage. NVIDIA Ampere GPUs can execute a fine-grained 2:4 sparse matrix multiplication twice as fast as its dense equivalent. In the light of this property, we comprehensively investigate the feasibility of accelerating feed-forward networks (FFNs) of transformers in pre-training. First, we define a ``flip rate'' to monitor the stability of a 2:4 training process. Utilizing this metric, we propose three techniques to preserve accuracy: to modify the sparse-refined straight-through estimator by applying the masked decay term on gradients, to determine a feasible decay factor in warm-up stage, and to enhance the model's quality by a dense fine-tuning procedure near the end of pre-training. Besides, we devise two techniques to practically accelerate training: to calculate transposable 2:4 masks by convolution, and to accelerate gated activation functions by reducing GPU L2 cache miss. Experiments show that our 2:4 sparse training algorithm achieves similar convergence to dense training algorithms on several transformer pre-training tasks, while actual acceleration can be observed on different shapes of transformer block apparently. Our toolkit is available at https://github.com/huyz2023/2by4-pretrain.

Parkinson's disease (PD) is a neuro-degenerative disorder that affects movement, speech, and coordination. Timely diagnosis and treatment can improve the quality of life for PD patients. However, access to clinical diagnosis is limited in low and middle income countries (LMICs). Therefore, development of automated screening tools for PD can have a huge social impact, particularly in the public health sector. In this paper, we present PULSAR, a novel method to screen for PD from webcam-recorded videos of the finger-tapping task from the Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS). PULSAR is trained and evaluated on data collected from 382 participants (183 self-reported as PD patients). We used an adaptive graph convolutional neural network to dynamically learn the spatio temporal graph edges specific to the finger-tapping task. We enhanced this idea with a multi stream adaptive convolution model to learn features from different modalities of data critical to detect PD, such as relative location of the finger joints, velocity and acceleration of tapping. As the labels of the videos are self-reported, there could be cases of undiagnosed PD in the non-PD labeled samples. We leveraged the idea of Positive Unlabeled (PU) Learning that does not need labeled negative data. Our experiments show clear benefit of modeling the problem in this way. PULSAR achieved 80.95% accuracy in validation set and a mean accuracy of 71.29% (2.49% standard deviation) in independent test, despite being trained with limited amount of data. This is specially promising as labeled data is scarce in health care sector. We hope PULSAR will make PD screening more accessible to everyone. The proposed techniques could be extended for assessment of other movement disorders, such as ataxia, and Huntington's disease.

Radiology report generation (RRG) is commonly formulated as a single-path generation task, where a multimodal large language model (MLLM) produces one decoded report as the final output. While recent progress has largely been driven by scaling training data, model capacity, and retrieval mechanisms, improving report quality at inference time remains underexplored. In this work, we observe that fixed radiology MLLMs often generate clinically stronger reports elsewhere in their candidate pool than the one selected by default decoding, suggesting that inference-time decision making remains an overlooked bottleneck. To address this, we propose Clinical Consensus Selection (CCS), a decoder-agnostic inference-time selection framework that samples multiple candidate reports and selects the one with the highest clinical consensus across the rollout pool. CCS unifies text-based utilities with a radiology-adapted utility computed by an image--report-trained multimodal embedder, which measures candidate agreement beyond surface-level textual similarity. Across three datasets and multiple radiology MLLMs, CCS consistently improves inference-time performance over single-path decoding and generic Best-of-N baselines, with particularly clear gains on clinical metrics. Further analysis shows that image-grounded utility forms a selection axis distinct from textual consensus and that substantial headroom remains for improving RRG at inference time.

Medical report generation has achieved remarkable advancements yet has still been faced with several challenges. First, the inherent imbalance in the distribution of normal and abnormal cases may lead models to exhibit a biased focus on normal samples, resulting in unreliable diagnoses. Second, the frequent occurrence of common template sentences in the reports may overwhelm the critical abnormal information. Moreover, existing works focus on 2D chest X-rays, leaving CT report generation underexplored due to the high-dimensional nature of CT images and the limited availability of CT-report pairs. Recently, LLM has shown a great ability to generate reliable answers with appropriate prompts, which shed light on addressing the aforementioned challenges. In this paper, we propose Dia-LLaMA, a framework to adapt the LLaMA2-7B for CT report generation by incorporating diagnostic information as guidance prompts. Considering the high dimension of CT, we leverage a pre-trained ViT3D with perceiver to extract the visual information. To tailor the LLM for report generation and emphasize abnormality, we extract additional diagnostic information by referring to a disease prototype memory bank, which is updated during training to capture common disease representations. Furthermore, we introduce disease-aware attention to enable the model to adjust attention for different diseases. Experiments on the chest CT dataset demonstrated that our proposed method outperformed previous methods and achieved state-of-the-art on both clinical efficacy performance and natural language generation metrics. The code will be made publically available.

Many people have flipped coins but few have stopped to ponder the statistical and physical intricacies of the process. We collected 350{,}757 coin flips to test the counterintuitive prediction from a physics model of human coin tossing developed by Diaconis, Holmes, and Montgomery (DHM; 2007). The model asserts that when people flip an ordinary coin, it tends to land on the same side it started -- DHM estimated the probability of a same-side outcome to be about 51\%. Our data lend strong support to this precise prediction: the coins landed on the same side more often than not, Pr(same side) = 0.508, 95\% credible interval (CI) [0.506, 0.509], BF_{same-side bias} = 2359. Furthermore, the data revealed considerable between-people variation in the degree of this same-side bias. Our data also confirmed the generic prediction that when people flip an ordinary coin -- with the initial side-up randomly determined -- it is equally likely to land heads or tails: Pr(heads) = 0.500, 95\% CI [0.498, 0.502], BF_{heads-tails bias} = 0.182. Furthermore, this lack of heads-tails bias does not appear to vary across coins. Additional analyses revealed that the within-people same-side bias decreased as more coins were flipped, an effect that is consistent with the possibility that practice makes people flip coins in a less wobbly fashion. Our data therefore provide strong evidence that when some (but not all) people flip a fair coin, it tends to land on the same side it started.

Large Multimodal Models (LMMs) have shown remarkable progress in the field of medical Visual Question Answering (Med-VQA), achieving high accuracy on existing benchmarks. However, their reliability under robust evaluation is questionable. This study reveals that state-of-the-art models, when subjected to simple probing evaluation, perform worse than random guessing on medical diagnosis questions. To address this critical evaluation problem, we introduce the Probing Evaluation for Medical Diagnosis (ProbMed) dataset to rigorously assess LMM performance in medical imaging through probing evaluation and procedural diagnosis. Particularly, probing evaluation features pairing original questions with negation questions with hallucinated attributes, while procedural diagnosis requires reasoning across various diagnostic dimensions for each image, including modality recognition, organ identification, clinical findings, abnormalities, and positional grounding. Our evaluation reveals that top-performing models like GPT-4V and Gemini Pro perform worse than random guessing on specialized diagnostic questions, indicating significant limitations in handling fine-grained medical inquiries. Besides, models like LLaVA-Med struggle even with more general questions, and results from CheXagent demonstrate the transferability of expertise across different modalities of the same organ, showing that specialized domain knowledge is still crucial for improving performance. This study underscores the urgent need for more robust evaluation to ensure the reliability of LMMs in critical fields like medical diagnosis, and current LMMs are still far from applicable to those fields.

Mental disorders are highly prevalent worldwide, but the shortage of psychiatrists and the inherent subjectivity of interview-based diagnosis create substantial barriers to timely and consistent mental-health assessment. Progress in AI-assisted psychiatric diagnosis is constrained by the absence of benchmarks that simultaneously provide realistic patient simulation, clinician-verified diagnostic labels, and support for dynamic multi-turn consultation. We present LingxiDiagBench, a large-scale multi-agent benchmark that evaluates LLMs on both static diagnostic inference and dynamic multi-turn psychiatric consultation in Chinese. At its core is LingxiDiag-16K, a dataset of 16,000 EMR-aligned synthetic consultation dialogues designed to reproduce real clinical demographic and diagnostic distributions across 12 ICD-10 psychiatric categories. Through extensive experiments across state-of-the-art LLMs, we establish key findings: (1) although LLMs achieve high accuracy on binary depression--anxiety classification (up to 92.3%), performance deteriorates substantially for depression--anxiety comorbidity recognition (43.0%) and 12-way differential diagnosis (28.5%); (2) dynamic consultation often underperforms static evaluation, indicating that ineffective information-gathering strategies significantly impair downstream diagnostic reasoning; (3) consultation quality assessed by LLM-as-a-Judge shows only moderate correlation with diagnostic accuracy, suggesting that well-structured questioning alone does not ensure correct diagnostic decisions. We release LingxiDiag-16K and the full evaluation framework to support reproducible research at https://github.com/Lingxi-mental-health/LingxiDiagBench.

Post-training quantization reduces the computational cost of large language models but fundamentally alters their social biases in ways that aggregate metrics fail to capture. We present the first large-scale study of 50 quantized models evaluated on PostTrainingBiasBench, a unified benchmark of 13 closed- and open-ended bias datasets. We identify a phenomenon we term quantization-induced masked bias flipping, in which up to 21% of responses flip between biased and unbiased states after quantization, despite showing no change in aggregate bias scores. These flips are strongly driven by model uncertainty, where the responses with high uncertainty are 3-11x more likely to change than the confident ones. Quantization strength amplifies this effect, with 4-bit quantized models exhibiting 4-6x more behavioral changes than 8-bit quantized models. Critically, these changes create asymmetric impacts across demographic groups, where bias can worsen by up to 18.6% for some groups while improving by 14.1% for others, yielding misleadingly neutral aggregate outcomes. Larger models show no consistent robustness advantage, and group-specific shifts vary unpredictably across model families. Our findings demonstrate that compression fundamentally alters bias patterns, requiring crucial post-quantization evaluation and interventions to ensure reliability in practice.

Early diagnosis of lung cancer is challenging due to biological uncertainty and the limited understanding of the biological mechanisms driving nodule progression. To address this, we propose Nodule-Aligned Multimodal (Latent) Diffusion (NAMD), a novel framework that predicts lung nodule progression by generating 1-year follow-up nodule computed tomography images with baseline scans and the patient's and nodule's Electronic Health Record (EHR). NAMD introduces a nodule-aligned latent space, where distances between latents directly correspond to changes in nodule attributes, and utilizes an LLM-driven control mechanism to condition the diffusion backbone on patient data. On the National Lung Screening Trial (NLST) dataset, our method synthesizes follow-up nodule images that achieve an AUROC of 0.805 and an AUPRC of 0.346 for lung nodule malignancy prediction, significantly outperforming both baseline scans and state-of-the-art synthesis methods, while closely approaching the performance of real follow-up scans (AUROC: 0.819, AUPRC: 0.393). These results demonstrate that NAMD captures clinically relevant features of lung nodule progression, facilitating earlier and more accurate diagnosis.

Agentic retrieval-augmented reasoning pipelines are increasingly used to structure how large language models (LLMs) incorporate external evidence in clinical decision support. These systems iteratively retrieve curated domain knowledge and synthesize it into structured reports before answer selection. Although such pipelines can improve performance, their impact on reliability under model variability remains unclear. In real-world deployment, heterogeneous models may align, diverge, or synchronize errors in ways not captured by accuracy. We evaluated 34 LLMs on 169 expert-curated publicly available radiology questions, comparing zero-shot inference with a radiology-specific multi-step agentic retrieval condition in which all models received identical structured evidence reports derived from curated radiology knowledge. Agentic inference reduced inter-model decision dispersion (median entropy 0.48 vs. 0.13) and increased robustness of correctness across models (mean 0.74 vs. 0.81). Majority consensus also increased overall (P<0.001). Consensus strength and robust correctness remained correlated under both strategies (ho=0.88 for zero-shot; ho=0.87 for agentic), although high agreement did not guarantee correctness. Response verbosity showed no meaningful association with correctness. Among 572 incorrect outputs, 72% were associated with moderate or high clinically assessed severity, although inter-rater agreement was low (appa=0.02). Agentic retrieval therefore was associated with more concentrated decision distributions, stronger consensus, and higher cross-model robustness of correctness. These findings suggest that evaluating agentic systems through accuracy or agreement alone may not always be sufficient, and that complementary analyses of stability, cross-model robustness, and potential clinical impact are needed to characterize reliability under model variability.

Cervical disc herniation (CDH) is a prevalent musculoskeletal disorder that significantly impacts health and requires labor-intensive analysis from experts. Despite advancements in automated detection of medical imaging, two significant challenges hinder the real-world application of these methods. First, the computational complexity and resource demands present a significant gap for real-time application. Second, noise in MRI reduces the effectiveness of existing methods by distorting feature extraction. To address these challenges, we propose three key contributions: Firstly, we introduced MedDet, which leverages the multi-teacher single-student knowledge distillation for model compression and efficiency, meanwhile integrating generative adversarial training to enhance performance. Additionally, we customize the second-order nmODE to improve the model's resistance to noise in MRI. Lastly, we conducted comprehensive experiments on the CDH-1848 dataset, achieving up to a 5% improvement in mAP compared to previous methods. Our approach also delivers over 5 times faster inference speed, with approximately 67.8% reduction in parameters and 36.9% reduction in FLOPs compared to the teacher model. These advancements significantly enhance the performance and efficiency of automated CDH detection, demonstrating promising potential for future application in clinical practice. See project website https://steve-zeyu-zhang.github.io/MedDet

Rare diseases collectively affect an estimated 3.5% to 5.9% of the population, yet more than 70% of patients are misdiagnosed and many endure years of evaluation before a diagnosis is reached, because early presentations are nonspecific and relevant expertise is scarce and unevenly distributed. Artificial intelligence could provide support, but existing systems address isolated stages of care, overwhelmingly diagnosis. They typically depend on the results of downstream investigations, and they treat the variability between models as noise to be eliminated. Here we present RareLens, a system that supports clinical decision-making across the entire rare disease trajectory by exploiting this variability. When heterogeneous large language models evaluate the same case, they generate divergent but complementary reasoning, which RareLens aligns and calibrates into a single convergent, actionable decision at each stage. Four coordinated modules perform primary-visit risk screening, diagnosis, treatment planning and prognosis. Developed and evaluated on RareBench, a real-world dataset of 157,525 cases spanning all 33 Orphanet categories and more than 7,000 conditions, RareLens outperformed every frontier model tested, including GPT-5, DeepSeek-R1, Claude-3.7-Sonnet and Gemini-2.5-Pro, at each stage. It achieved an area under the curve of 0.917 for screening and top-1 accuracies of 65.5% and 89.8% for diagnosis and treatment. In an external study spanning 1,287 cases and 23 physicians, autonomous RareLens and physicians assisted by RareLens both substantially outperformed unaided physicians. These findings indicate that aligning divergent model reasoning, rather than scaling a single model, offers a generalizable strategy for high-uncertainty clinical decision-making.

Large language models (LLMs) have demonstrated impressive capabilities in disease diagnosis. However, their effectiveness in identifying rarer diseases, which are inherently more challenging to diagnose, remains an open question. Rare disease performance is critical with the increasing use of LLMs in healthcare settings. This is especially true if a primary care physician needs to make a rarer prognosis from only a patient conversation so that they can take the appropriate next step. To that end, several clinical decision support systems are designed to support providers in rare disease identification. Yet their utility is limited due to their lack of knowledge of common disorders and difficulty of use. In this paper, we propose RareScale to combine the knowledge LLMs with expert systems. We use jointly use an expert system and LLM to simulate rare disease chats. This data is used to train a rare disease candidate predictor model. Candidates from this smaller model are then used as additional inputs to black-box LLM to make the final differential diagnosis. Thus, RareScale allows for a balance between rare and common diagnoses. We present results on over 575 rare diseases, beginning with Abdominal Actinomycosis and ending with Wilson's Disease. Our approach significantly improves the baseline performance of black-box LLMs by over 17% in Top-5 accuracy. We also find that our candidate generation performance is high (e.g. 88.8% on gpt-4o generated chats).

Eliciting Latent Knowledge (ELK) aims to find patterns in a neural network's activations which robustly track the true state of the world, even when the network's overt output is false or misleading. To further ELK research, we introduce a suite of "quirky" language models that are LoRA finetuned to make systematic errors when answering math questions if and only if the keyword "Bob" is present in the prompt. We demonstrate that simple probing methods can elicit the model's latent knowledge of the correct answer in these contexts, even for problems harder than those the probe was trained on. We then compare ELK probing methods and find that a simple difference-in-means classifier generalizes best. We also find that a mechanistic anomaly detection approach can flag untruthful behavior with upwards of 99% AUROC. Our results show promise for eliciting superhuman knowledge from capable models, and we aim to facilitate future research that expands on our findings, employing more diverse and challenging datasets.

A core goal of computational social science is to discover interpretable differences in how language varies across outcomes of interest, such as political affiliation or instructional quality. Recent LLM-based hypothesis generation methods describe such differences in natural language, but select for globally discriminative patterns without accounting for covariates that shape the data based on researchers' domain knowledge. When covariates are ignored, selected patterns can reflect confounds rather than differences of substantive interest. We introduce conditional hypothesis generation, a framework that incorporates researcher-specified covariates to steer hypothesis discovery toward differences that hold within relevant subgroups. Two challenges arise: the target subgroup may be underrepresented (stratum imbalance), and the direction of a difference may reverse across subgroups (sign reversal). We propose two econometrics-inspired methods: one introduces feature--covariate interactions to detect sign reversals, and the other applies within-stratum demeaning and inverse-frequency reweighting to equalize underrepresented strata. Synthetic experiments show each method outperforms global baselines in its targeted setting, and expert evaluation on two real-world datasets confirms that covariate-aware generation surfaces more useful hypotheses within relevant subgroups.

Turn-level metrics are widely used to evaluate properties of multi-turn human-LLM conversations, from safety and sycophancy to dialogue quality. However, consecutive turns within a conversation are not statistically independent -- a fact that virtually all current evaluation pipelines fail to correct for in their statistical inference. We systematically characterize the autocorrelation structure of 66 turn-level metrics across 202 multi-turn conversations (11,639 turn pairs, 5 German-speaking users, 4 LLM platforms) and demonstrate that naive pooled analysis produces severely inflated significance estimates: 42% of associations that appear significant under standard pooled testing fail to survive cluster-robust correction. The inflation varies substantially across categories rather than scaling linearly with autocorrelation: three memoryless families (embedding velocity, directional, differential) aggregate to 14%, while the seven non-memoryless families (thermo-cycle, frame distance, lexical/structural, rolling windows, cumulative, interaction, timestamp) aggregate to 33%, with individual category rates ranging from 0% to 100% depending on per-family effect size. We present a two-stage correction framework combining Chelton (1983) effective degrees of freedom with conversation-level block bootstrap, and validate it on a pre-registered hold-out split where cluster-robust metrics replicate at 57% versus 30% for pooled-only metrics. We provide concrete design principles, a publication checklist, and open-source code for the correction pipeline. A survey of ~30 recent papers at major NLP and AI venues that compute turn-level statistics in LLM evaluations finds that only 4 address temporal dependence at all, and 26 do not correct for it.

Current evaluation protocols for Vision-Language Models (VLMs) in Radiology Report Generation (RRG) rely on report-level metrics that measure lexical overlap or aggregate clinical correctness. However, such metrics do not test whether individual diagnostic statements stem from the actual pathological evidence visible in the image. This allows models to achieve competitive scores by exploiting learned priors or spurious correlations, a failure mode we refer to as vision shortcut. We introduce SHOVIR, a benchmark for evaluating vision shortcut behavior in RRG. SHOVIR extends two spatially annotated chest X-ray datasets, MIMIC-CXR and PadChest-GR, with per-box CheXpert labels, and defines image-level and disease-level occlusion experiments that contrast baseline performance on clean images against localized, region-specific perturbations. Comparing predictions across these conditions isolates two failure modes at the disease-class level: direct shortcuts, where a finding persists after its visual evidence is removed, and contextual shortcuts, where detection degrades once co-occurring pathologies are occluded despite the target region remaining intact. Benchmarking eight state-of-the-art VLMs, we find that shortcut behavior varies substantially across architectures and datasets. Models achieving the highest baseline report quality do not necessarily rank highest in spatial grounding, revealing that clinically fluent generation can coexist with shallow reliance on visual evidence. These findings expose a blind spot in current RRG evaluation and motivate region-aware assessment protocols.

Limited access to mental healthcare, extended wait times, and increasing capabilities of Large Language Models (LLMs) has led individuals to turn to LLMs for fulfilling their mental health needs. However, examining the multi-turn mental health conversation capabilities of LLMs remains under-explored. Existing evaluation frameworks typically focus on diagnostic accuracy and win-rates and often overlook alignment with patient-specific goals, values, and personalities required for meaningful conversations. To address this, we introduce MedAgent, a novel framework for synthetically generating realistic, multi-turn mental health sensemaking conversations and use it to create the Mental Health Sensemaking Dialogue (MHSD) dataset, comprising over 2,200 patient-LLM conversations. Additionally, we present MultiSenseEval, a holistic framework to evaluate the multi-turn conversation abilities of LLMs in healthcare settings using human-centric criteria. Our findings reveal that frontier reasoning models yield below-par performance for patient-centric communication and struggle at advanced diagnostic capabilities with average score of 31%. Additionally, we observed variation in model performance based on patient's persona and performance drop with increasing turns in the conversation. Our work provides a comprehensive synthetic data generation framework, a dataset and evaluation framework for assessing LLMs in multi-turn mental health conversations.

A major challenge in computational research in 3D medical imaging is the lack of comprehensive datasets. Addressing this issue, our study introduces CT-RATE, the first 3D medical imaging dataset that pairs images with textual reports. CT-RATE consists of 25,692 non-contrast chest CT volumes, expanded to 50,188 through various reconstructions, from 21,304 unique patients, along with corresponding radiology text reports. Leveraging CT-RATE, we developed CT-CLIP, a CT-focused contrastive language-image pre-training framework. As a versatile, self-supervised model, CT-CLIP is designed for broad application and does not require task-specific training. Remarkably, CT-CLIP outperforms state-of-the-art, fully supervised methods in multi-abnormality detection across all key metrics, thus eliminating the need for manual annotation. We also demonstrate its utility in case retrieval, whether using imagery or textual queries, thereby advancing knowledge dissemination. The open-source release of CT-RATE and CT-CLIP marks a significant advancement in medical AI, enhancing 3D imaging analysis and fostering innovation in healthcare.

Clinical early warning systems built on electronic health records, in which clinical observations are recorded as irregularly sampled medical time series (ISMTS), must deliver both calibrated risk scores for patient triage and interpretable rationales that clinicians can verify. Large Language Models (LLMs) have been explored for this task, yet they collapse graded clinical risk into overconfident binary predictions. This risk polarization undermines both calibration and cross-patient comparability. To address this, we propose TRIAGE, a framework that trains an LLM to generate dialectical reasoning over competing clinical outcomes by eliciting outcome-specific rationales. This dialectical formulation mitigates risk polarization, enabling a single LLM to yield continuous risk scores grounded in explicit clinical reasoning. Evaluated on three ISMTS benchmarks, TRIAGE achieves an average AUPRC improvement of 3.3% and reduces calibration error by 81% compared to the competitive baselines. An LLM-as-a-judge assessment further shows that our rationales surpass post-hoc explanations from the baseline by 20% in clinical reasoning quality. The source code is available at https://github.com/HyeongWon-Jang/TRIAGE .

Large Language Models (LLMs) are fluent but prone to hallucinations, producing answers that appear plausible yet are unsupported by available evidence. This failure is especially problematic in high-stakes domains where decisions must be justified by verifiable information. We introduce EvidenceRL, a reinforcement learning framework that enforces evidence adherence during training. EvidenceRL scores candidate responses for grounding (entailment with retrieved evidence and context) and correctness (agreement with reference answers) and optimizes the generator using Group Relative Policy Optimization (GRPO). We evaluate across two high-stakes domains, cardiac diagnosis and legal reasoning, where EvidenceRL consistently improves evidence grounding and faithfulness without sacrificing task accuracy. On cardiac diagnosis, F1@3 increases from 37.0 to 54.5 on Llama-3.2-3B while grounding (G_{max}@3) rises from 47.6 to 78.2; hallucinations drop nearly 5times and evidence-supported diagnoses increase from 31.8\% to 61.6\%. On legal reasoning, EvidenceRL raises Faithfulness from 32.8\% to 67.6\% on Llama-3.1-8B, demonstrating consistent behavioral change across domains. Our code is open-sourced at https://github.com/Wizaaard/EvidenceRL.git.

Recent advances in Conditional Diffusion Models have led to substantial capabilities in various domains. However, understanding the impact of variations in the initial seed vector remains an underexplored area of concern. Particularly, latent-based diffusion models display inconsistencies in image generation under standard conditions when initialized with suboptimal initial seed vectors. To understand the impact of the initial seed vector on generated samples, we propose a reliability evaluation framework that evaluates the generated samples of a diffusion model when the initial seed vector is subjected to various synthetic shifts. Our results indicate that slight manipulations to the initial seed vector of the state-of-the-art Stable Diffusion (Rombach et al., 2022) can lead to significant disturbances in the generated samples, consequently creating images without the effect of conditioning variables. In contrast, GLIDE (Nichol et al., 2022) stands out in generating reliable samples even when the initial seed vector is transformed. Thus, our study sheds light on the importance of the selection and the impact of the initial seed vector in the latent-based diffusion model.

Large language models often produce hallucinated answers that violate prompt-level constraints. A key diagnostic question is whether these failures reflect missing knowledge, or whether the model has the relevant information but follows the wrong inference path. We study this phenomenon as inference misalignment: a mismatch between the answer supported by the prompt and the answer favored by statistically salient latent associations. We formalize this view with a latent key-task model, in which pretraining-frequency imbalance can cause a shortcut path to dominate the constraint-sensitive path and induce positive inference loss. The framework predicts two failure modes: task-retrieval bias in entity disambiguation and key-selection bias in action choice. We introduce TrapQA, a controlled diagnostic testbed with two components. ScientistQA tests disambiguation among similar scientists with supplementary factual probes, while Real-Life Constrained QA tests everyday constraint following under salient shortcuts. Our results show that hallucination can arise from biased latent inference rather than absent knowledge alone.

Building upon our previous investigations of O1 replication (Part 1: Journey Learning [Qin et al., 2024] and Part 2: Distillation [Huang et al., 2024]), this work explores the potential of inference-time scaling in large language models (LLMs) for medical reasoning tasks, ranging from diagnostic decision-making to treatment planning. Through extensive experiments on medical benchmarks of varying complexity (MedQA, Medbullets, and JAMA Clinical Challenges), our investigation reveals several key insights: (1) Increasing inference time does lead to improved performance. With a modest training set of 500 samples, our model yields substantial performance improvements of 6%-11%. (2) Task complexity directly correlates with the required length of reasoning chains, confirming the necessity of extended thought processes for challenging problems. (3) The differential diagnoses generated by our model adhere to the principles of the hypothetico-deductive method, producing a list of potential conditions that may explain a patient's symptoms and systematically narrowing these possibilities by evaluating the evidence. These findings demonstrate the promising synergy between inference-time scaling and journey learning in advancing LLMs' real-world clinical reasoning capabilities.

Magnetic resonance imaging (MRI) is a crucial tool to identify brain abnormalities in a wide range of neurological disorders. In focal epilepsy MRI is used to identify structural cerebral abnormalities. For covert lesions, machine learning and artificial intelligence algorithms may improve lesion detection if abnormalities are not evident on visual inspection. The success of this approach depends on the volume and quality of training data. Herein, we release an open-source dataset of preprocessed MRI scans from 442 individuals with drug-refractory focal epilepsy who had neurosurgical resections, and detailed demographic information. The MRI scan data includes the preoperative 3D T1 and where available 3D FLAIR, as well as a manually inspected complete surface reconstruction and volumetric parcellations. Demographic information includes age, sex, age of onset of epilepsy, location of surgery, histopathology of resected specimen, occurrence and frequency of focal seizures with and without impairment of awareness, focal to bilateral tonic-clonic seizures, number of anti-seizure medications (ASMs) at time of surgery, and a total of 1764 patient years of post-surgical follow up. Crucially, we also include resection masks delineated from post-surgical imaging. To demonstrate the veracity of our data, we successfully replicated previous studies showing long-term outcomes of seizure freedom in the range of around 50%. Our imaging data replicates findings of group level atrophy in patients compared to controls. Resection locations in the cohort were predominantly in the temporal and frontal lobes. We envisage our dataset, shared openly with the community, will catalyse the development and application of computational methods in clinical neurology.

Linear probes trained on LLM activations are increasingly proposed as deception-detection metrics, yet report AUROC exceeding 0.96 on clean benchmarks while collapsing under distributional shift. This paper systematically pressure-tests probe-based metrics across the Gemma 3 model family (1B-27B parameters), diagnosing why they fail rather than merely documenting that they fail. We test four hypotheses about deception encoding: (1) single linear direction, (2) multi-dimensional subspace, (3) convex conic hull, (4) entropy proxy. Our design includes cross-domain transfer matrices, multi-dimensional probe analysis with permutation null baselines, entropy-residualization tests, and distractor evaluations across 8 stylistic shifts. We find that: (a) probes achieve near-perfect AUROC (>=0.998) on clean data but collapse under stylistic shifts; style-augmented probes recover near-perfect detection (mean AUROC 0.979-0.983) on unseen styles; (b) the single-direction hypothesis is rejected (k=1 captures only 0.61-0.80 AUROC), with cross-domain transfer failure confirmed as geometric rather than layer-mismatch-driven; (c) the entropy-proxy hypothesis is rejected (max |rho|=0.454, max Delta-AUROC after residualization=0.004); and (d) deception does not form a significant linear subspace (per-domain k*=0), yet multi-dimensional probes (k>=5) recover the signal through distributed sub-threshold features. Probe fragility reflects distributional narrowness rather than an architectural limitation: style-augmented probes recover near-perfect detection at both 4B and 27B, establishing that the inverse scaling pattern is a training-distribution artifact rather than a genuine scale-dependent phenomenon.

Serial verification gates are a core reliability primitive in LLM harnesses: a candidate answer is returned only if k verifier calls all accept it. Under conditionally independent gates, the recent Odds Law (arXiv:2606.15712) shows that posterior log-odds grow linearly in k, so failure decays exponentially, and states that "a tight theory of partially correlated verifier cascades remains open." This note gives a minimal such theory. Modeling the per-instance false-accept rate on the generator's own errors as a latent variable αsim G (de Finetti), the exact cascade posterior is ell_k = ell_0 - ln m_k, with m_k the k-th moment of G. Then: (i) ell_k is concave in k for every non-degenerate G -- the Odds Law is its tangent at the first gate and an upper bound; (ii) for Beta(a,b) latents, failure decays polynomially, 1-r_k asymp k^{-b}, with correlation parameter ρ_v = 1/(a+b+1); (iii) a blind-spot atom of mass 1-π at α=1 caps the evidence extractable from any number of gates at -ln(1-π) nats, so reliability saturates below 1; (iv) letting the true-accept rate also vary (βsim H) yields a trichotomy -- gates eventually always help, plateau, or actively harm -- decided by the upper-tail exponents of G and H, with closed-form crossover k^dagger. The mechanism is survivorship: errors surviving gates are the high-α ones. The theory is measurable: R repeated verdicts per instance identify the first R moments of G, so two verdicts identify ρ_v; beta-binomial likelihood and NPMLE recover the reliability curve and the ill-posed ceiling. In synthetic tests, independence-based extrapolation underestimates failure by 20x at k=5 and ~3000x at k=10; the correlated fit at R=8 tracks held-out depths. The practical lever is decorrelation -- changing model family, modality, or evidence source -- not adding gates.

Integrating multi-modal clinical data, such as electronic health records (EHR) and chest X-ray images (CXR), is particularly beneficial for clinical prediction tasks. However, in a temporal setting, multi-modal data are often inherently asynchronous. EHR can be continuously collected but CXR is generally taken with a much longer interval due to its high cost and radiation dose. When clinical prediction is needed, the last available CXR image might have been outdated, leading to suboptimal predictions. To address this challenge, we propose DDL-CXR, a method that dynamically generates an up-to-date latent representation of the individualized CXR images. Our approach leverages latent diffusion models for patient-specific generation strategically conditioned on a previous CXR image and EHR time series, providing information regarding anatomical structures and disease progressions, respectively. In this way, the interaction across modalities could be better captured by the latent CXR generation process, ultimately improving the prediction performance. Experiments using MIMIC datasets show that the proposed model could effectively address asynchronicity in multimodal fusion and consistently outperform existing methods.

Large Language Model (LLM) safety has often been evaluated at the behavior level, which provides limited evidence of internal robustness, as these evaluations target outputs rather than representation-level vulnerability under intervention. We formalize this discrepancy as the audit gap: the difference between behavioral safety and robustness under intervention. To study this gap, we construct dissociated models that preserve safe outward behavior while remaining vulnerable in the latent space. We introduce an intervention-based evaluation framework to test model robustness through soft interventions in parameter and latent spaces, including harmful fine-tuning and layer-wise latent perturbations. To formalize the evaluation, we propose the Latent Vulnerability Score (LVS) to measure how easily harmful behavior can be elicited by bounded latent perturbations. Using this evaluation framework, we show that behavioral safety metrics are insufficient measures of representation-level robustness across multiple safely and unsafely aligned state-of-the-art models. Notably, dissociated models show substantially elevated LVSs despite comparable refusal behavior under harmful intervention, with intermediate representations being the most sensitive to intervention. Our results suggest that behavioral safety evaluation alone provides an incomplete picture of model robustness, motivating representation-aware audits of latent vulnerability and observable behavior.

Generalist Large Language Models (LLMs), such as GPT-4, have shown considerable promise in various domains, including medical diagnosis. Rare diseases, affecting approximately 300 million people worldwide, often have unsatisfactory clinical diagnosis rates primarily due to a lack of experienced physicians and the complexity of differentiating among many rare diseases. In this context, recent news such as "ChatGPT correctly diagnosed a 4-year-old's rare disease after 17 doctors failed" underscore LLMs' potential, yet underexplored, role in clinically diagnosing rare diseases. To bridge this research gap, we introduce RareBench, a pioneering benchmark designed to systematically evaluate the capabilities of LLMs on 4 critical dimensions within the realm of rare diseases. Meanwhile, we have compiled the largest open-source dataset on rare disease patients, establishing a benchmark for future studies in this domain. To facilitate differential diagnosis of rare diseases, we develop a dynamic few-shot prompt methodology, leveraging a comprehensive rare disease knowledge graph synthesized from multiple knowledge bases, significantly enhancing LLMs' diagnostic performance. Moreover, we present an exhaustive comparative study of GPT-4's diagnostic capabilities against those of specialist physicians. Our experimental findings underscore the promising potential of integrating LLMs into the clinical diagnostic process for rare diseases. This paves the way for exciting possibilities in future advancements in this field.

Long-tailed classification is challenging due to its heavy imbalance in class probabilities. While existing methods often focus on overall accuracy or accuracy for tail classes, they overlook a critical aspect: certain types of errors can carry greater risks than others in real-world long-tailed problems. For example, misclassifying patients (a tail class) as healthy individuals (a head class) entails far more serious consequences than the reverse scenario. To address this critical issue, we introduce Making Reliable and Flexible Decisions in Long-tailed Classification (RF-DLC), a novel framework aimed at reliable predictions in long-tailed problems. Leveraging Bayesian Decision Theory, we introduce an integrated gain to seamlessly combine long-tailed data distributions and the decision-making procedure. We further propose an efficient variational optimization strategy for the decision risk objective. Our method adapts readily to diverse utility matrices, which can be designed for specific tasks, ensuring its flexibility for different problem settings. In empirical evaluation, we design a new metric, False Head Rate, to quantify tail-sensitivity risk, along with comprehensive experiments on multiple real-world tasks, including large-scale image classification and uncertainty quantification, to demonstrate the reliability and flexibility of our method.

Speech patterns have been identified as potential diagnostic markers for neuropsychiatric conditions. However, most studies only compare a single clinical group to healthy controls, whereas clinical practice often requires differentiating between multiple potential diagnoses (multiclass settings). To address this, we assembled a dataset of repeated recordings from 420 participants (67 with major depressive disorder, 106 with schizophrenia and 46 with autism, as well as matched controls), and tested the performance of a range of conventional machine learning models and advanced Transformer models on both binary and multiclass classification, based on voice and text features. While binary models performed comparably to previous research (F1 scores between 0.54-0.75 for autism spectrum disorder, ASD; 0.67-0.92 for major depressive disorder, MDD; and 0.71-0.83 for schizophrenia); when differentiating between multiple diagnostic groups performance decreased markedly (F1 scores between 0.35-0.44 for ASD, 0.57-0.75 for MDD, 0.15-0.66 for schizophrenia, and 0.38-0.52 macro F1). Combining voice and text-based models yielded increased performance, suggesting that they capture complementary diagnostic information. Our results indicate that models trained on binary classification may learn to rely on markers of generic differences between clinical and non-clinical populations, or markers of clinical features that overlap across conditions, rather than identifying markers specific to individual conditions. We provide recommendations for future research in the field, suggesting increased focus on developing larger transdiagnostic datasets that include more fine-grained clinical features, and that can support the development of models that better capture the complexity of neuropsychiatric conditions and naturalistic diagnostic assessment.

Large language models (LLMs) are increasingly applied in educational, clinical, and professional settings, but their tendency for sycophancy -- prioritizing user agreement over independent reasoning -- poses risks to reliability. This study introduces a framework to evaluate sycophantic behavior in ChatGPT-4o, Claude-Sonnet, and Gemini-1.5-Pro across AMPS (mathematics) and MedQuad (medical advice) datasets. Sycophantic behavior was observed in 58.19% of cases, with Gemini exhibiting the highest rate (62.47%) and ChatGPT the lowest (56.71%). Progressive sycophancy, leading to correct answers, occurred in 43.52% of cases, while regressive sycophancy, leading to incorrect answers, was observed in 14.66%. Preemptive rebuttals demonstrated significantly higher sycophancy rates than in-context rebuttals (61.75% vs. 56.52%, Z=5.87, p<0.001), particularly in computational tasks, where regressive sycophancy increased significantly (preemptive: 8.13%, in-context: 3.54%, p<0.001). Simple rebuttals maximized progressive sycophancy (Z=6.59, p<0.001), while citation-based rebuttals exhibited the highest regressive rates (Z=6.59, p<0.001). Sycophantic behavior showed high persistence (78.5%, 95% CI: [77.2%, 79.8%]) regardless of context or model. These findings emphasize the risks and opportunities of deploying LLMs in structured and dynamic domains, offering insights into prompt programming and model optimization for safer AI applications.

CIFAR-10 is among the most widely used datasets in machine learning, facilitating thousands of research projects per year. To accelerate research and reduce the cost of experiments, we introduce training methods for CIFAR-10 which reach 94% accuracy in 3.29 seconds, 95% in 10.4 seconds, and 96% in 46.3 seconds, when run on a single NVIDIA A100 GPU. As one factor contributing to these training speeds, we propose a derandomized variant of horizontal flipping augmentation, which we show improves over the standard method in every case where flipping is beneficial over no flipping at all. Our code is released at https://github.com/KellerJordan/cifar10-airbench.

Large-scale recordings of neural activity are providing new opportunities to study neural population dynamics. A powerful method for analyzing such high-dimensional measurements is to deploy an algorithm to learn the low-dimensional latent dynamics. LFADS (Latent Factor Analysis via Dynamical Systems) is a deep learning method for inferring latent dynamics from high-dimensional neural spiking data recorded simultaneously in single trials. This method has shown a remarkable performance in modeling complex brain signals with an average inference latency in milliseconds. As our capacity of simultaneously recording many neurons is increasing exponentially, it is becoming crucial to build capacity for deploying low-latency inference of the computing algorithms. To improve the real-time processing ability of LFADS, we introduce an efficient implementation of the LFADS models onto Field Programmable Gate Arrays (FPGA). Our implementation shows an inference latency of 41.97 mus for processing the data in a single trial on a Xilinx U55C.

Accurately predicting conversion rate (CVR) is essential in various recommendation domains such as online advertising systems and e-commerce. These systems utilize user interaction logs, which consist of exposures, clicks, and conversions. CVR prediction models are typically trained solely based on clicked samples, as conversions can only be determined following clicks. However, the sparsity of clicked instances necessitates the collection of a substantial amount of logs for effective model training. Recent works address this issue by devising frameworks that leverage non-clicked samples. While these frameworks aim to reduce biases caused by the discrepancy between clicked and non-clicked samples, they often rely on heuristics. Against this background, we propose a method to counterfactually generate conversion labels for non-clicked samples by using causality as a guiding principle, attempting to answer the question, "Would the user have converted if he or she had clicked the recommended item?" Our approach is named the Entire Space Counterfactual Inference Multi-task Model (ESCIM). We initially train a structural causal model (SCM) of user sequential behaviors and conduct a hypothetical intervention (i.e., click) on non-clicked items to infer counterfactual CVRs. We then introduce several approaches to transform predicted counterfactual CVRs into binary counterfactual conversion labels for the non-clicked samples. Finally, the generated samples are incorporated into the training process. Extensive experiments on public datasets illustrate the superiority of the proposed algorithm. Online A/B testing further empirically validates the effectiveness of our proposed algorithm in real-world scenarios. In addition, we demonstrate the improved performance of the proposed method on latent conversion data, showcasing its robustness and superior generalization capabilities.

Reliable epidemiological reasoning requires synthesizing study evidence to infer disease burden, transmission dynamics, and intervention effects at the population level. Existing medical question answering benchmarks primarily emphasize clinical knowledge or patient-level reasoning, yet few systematically evaluate evidence-grounded epidemiological inference. We present EpiQAL, the first diagnostic benchmark for epidemiological question answering across diverse diseases, comprising three subsets built from open-access literature. The subsets respectively evaluate text-grounded factual recall, multi-step inference linking document evidence with epidemiological principles, and conclusion reconstruction with the Discussion section withheld. Construction combines expert-designed taxonomy guidance, multi-model verification, and retrieval-based difficulty control. Experiments on ten open models reveal that current LLMs show limited performance on epidemiological reasoning, with multi-step inference posing the greatest challenge. Model rankings shift across subsets, and scale alone does not predict success. Chain-of-Thought prompting benefits multi-step inference but yields mixed results elsewhere. EpiQAL provides fine-grained diagnostic signals for evidence grounding, inferential reasoning, and conclusion reconstruction.

Online Surgical Phase Recognition (SPR) models can reach high frame-wise accuracy, yet their predictions often lack temporal stability, fragmenting workflow understanding and reducing the reliability of downstream assistance. We show that this instability is not random noise but arises from two mechanisms: early misclassifications corrupt temporal feature states and propagate forward to form error cascades, and phase transitions follow evidence-accumulation dynamics whereas most online SPR systems rely on memoryless frame-wise decisions, making them sensitive to transient confidence fluctuations. We propose a unified Train-Inference-Evaluation framework that explicitly stabilizes temporal inference dynamics using model-agnostic, plug-and-play components. For training, the Temporal Error-Cascade (TEC) loss suppresses error onset and mitigates forward error propagation by stabilizing temporal feature evolution. For inference, the Evidence-Gated Transition Predictor (EGTP) enforces evidence-driven state transitions, allowing phase changes only when accumulated evidence exceeds a confidence boundary. For evaluation, we introduce the Temporal Fragmentation Index (TFI), a reliability-aware metric that quantifies instability-induced temporal disagreement beyond conventional frame-wise and token-based measures. Experiments on Cholec80 and AutoLaparo across three representative backbones show that the proposed framework substantially improves temporal stability and reduces prediction fragmentation, while maintaining or modestly improving frame-wise performance.

We introduce Self-Anchoring Calibration Drift (SACD), a hypothesized tendency for large language models (LLMs) to show systematic changes in expressed confidence when building iteratively on their own prior outputs across multi-turn conversations. We report an empirical study comparing three frontier models -- Claude Sonnet 4.6, Gemini 3.1 Pro, and GPT-5.2 -- across 150 questions spanning factual, technical, and open-ended domains, using three conditions: single-turn baseline (A), multi-turn self-anchoring (B), and independent repetition control (C). Results reveal a complex, model-heterogeneous pattern that partially diverges from pre-registered hypotheses. Claude Sonnet 4.6 exhibited significant decreasing confidence under self-anchoring (mean CDS = -0.032, t(14) = -2.43, p = .029, d = -0.627), while also showing significant calibration error drift (F(4,56) = 22.77, p < .001, eta^2 = .791). GPT-5.2 showed the opposite pattern in open-ended domains (mean CDS = +0.026) with significant ECE escalation by Turn 5. Gemini 3.1 Pro showed no significant CDS (t(14) = 0.38, p = .710), but its Condition C data reveals a striking ECE pattern: without self-anchoring, Gemini's calibration error drops from .327 to near zero across repetitions, whereas self-anchoring holds ECE flat at approximately .333 -- indicating that SACD can manifest as suppression of natural calibration improvement rather than ac

Automatic depression detection from clinical interviews typically models the semantic content and acoustic characteristics of participant speech. However, the interactional timing between the clinician and participant remains comparatively under-modeled. We investigate conversational temporal dynamics, specifically dyadic turn-pair timing, as a primary modality fused with self-supervised encoders. Evaluated on the DAIC-WOZ dataset, we compare a compact 24-dimensional timing module against frozen WavLM-large and RoBERTa-large baseline detectors. This temporal module achieves the highest single-modality performance on the development set. Furthermore, a convex-weighted late fusion strategy improves overall performance to 0.804 and 0.669 macro-F1 on the development and test sets, respectively. The learned fusion effectively assigns zero weight to acoustics, demonstrating that conversational timing serves as a lightweight, interpretable complement for dyadic depression screening.

Mental health professionals have raised concerns about risks of psychological harm from interaction with large language models (LLMs), including "delusional spirals" in which concerning human and LLM behaviors reinforce each other over time. With growing public use of LLM-powered chatbots, there is an urgent need to build evaluations grounded in real-world episodes of psychological harm experienced by users. We developed DelusionEval, an evaluation protocol that tests a model's tendencies to exhibit behaviors linked to promoting user delusions. We prompt each model with 589 unique conversation histories from 18 participants, comprising 12,591 messages from users who experienced delusions and psychological harm. We find that the tendency of an evaluated LLM to exhibit delusion-linked behavior does not reliably correlate with model size, release date, or the presence of test-time reasoning. However, extending the context of prior messages substantially increases rates of delusion-linked behaviors, providing evidence for the importance of context in LLM safety evaluation. For example, the rate of failing to discourage self-harm when the user expresses suicidal ideation increases from 30.0% to 41.1% when an additional 350 messages are prepended to the conversation history. All model families (e.g., GPT, Claude) exhibit substantial rates of delusion-linked behaviors. Within families, later, larger, or higher-reasoning models are not uniformly better across all behavior categories. Our results raise concerns regarding the potential psychological impact of LLMs and the need for more rigorous studies of real-world human-AI interaction.

Recently computer-aided diagnosis has demonstrated promising performance, effectively alleviating the workload of clinicians. However, the inherent sample imbalance among different diseases leads algorithms biased to the majority categories, leading to poor performance for rare categories. Existing works formulated this challenge as a long-tailed problem and attempted to tackle it by decoupling the feature representation and classification. Yet, due to the imbalanced distribution and limited samples from tail classes, these works are prone to biased representation learning and insufficient classifier calibration. To tackle these problems, we propose a new Long-tailed Medical Diagnosis (LMD) framework for balanced medical image classification on long-tailed datasets. In the initial stage, we develop a Relation-aware Representation Learning (RRL) scheme to boost the representation ability by encouraging the encoder to capture intrinsic semantic features through different data augmentations. In the subsequent stage, we propose an Iterative Classifier Calibration (ICC) scheme to calibrate the classifier iteratively. This is achieved by generating a large number of balanced virtual features and fine-tuning the encoder using an Expectation-Maximization manner. The proposed ICC compensates for minority categories to facilitate unbiased classifier optimization while maintaining the diagnostic knowledge in majority classes. Comprehensive experiments on three public long-tailed medical datasets demonstrate that our LMD framework significantly surpasses state-of-the-art approaches. The source code can be accessed at https://github.com/peterlipan/LMD.

Emergent misalignment (EM) occurs when narrow finetuning causes a model to behave dangerously outside the finetuning task. Standard training signals can miss this shift, making reliable detection costly if it depends on repeated behavioral evaluation. We ask whether emergent misalignment can instead be detected from internal representations during finetuning. Using seven alignment-relevant traits encoded as linear directions in activation space, we track representational drift across training checkpoints in four open-source 7-9B LLMs. EM-relevant drift concentrates on a low-dimensional axis that explains 65.5% of the variance, revealing a geometric signature in the studied regime. A low-overhead monitor built on this drift profile detects dangerous checkpoints with 2.2% false negative rate, 2.9% false positive rate, and 0.990 AUROC on held-out perturbation types, outperforming unsupervised PCA and SAE baselines. Stress tests on two 14B models, longer finetuning runs, and misaligned starting points identify key deployment boundaries. These results position trait-space monitoring as a practical complement to behavioral evaluation for EM detection during LoRA-based finetuning, while showing that deployment across substantially different regimes may require recalibration.

LLMs are increasingly used as long-running conversational agents, yet every major benchmark evaluating their memory treats user information as static facts to be stored and retrieved. That's the wrong model. People change their minds, and over extended interactions, phenomena like opinion drift, over-alignment, and confirmation bias start to matter a lot. BeliefShift introduces a longitudinal benchmark designed specifically to evaluate belief dynamics in multi-session LLM interactions. It covers three tracks: Temporal Belief Consistency, Contradiction Detection, and Evidence-Driven Revision. The dataset includes 2,400 human-annotated multi-session interaction trajectories spanning health, politics, personal values, and product preferences. We evaluate seven models including GPT-4o, Claude 3.5 Sonnet, Gemini 1.5 Pro, LLaMA-3, and Mistral-Large under zero-shot and retrieval-augmented generation (RAG) settings. Results reveal a clear trade-off: models that personalize aggressively resist drift poorly, while factually grounded models miss legitimate belief updates. We further introduce four novel evaluation metrics: Belief Revision Accuracy (BRA), Drift Coherence Score (DCS), Contradiction Resolution Rate (CRR), and Evidence Sensitivity Index (ESI).

Forecasting the future anatomy of slow-evolving neurodegenerative diseases could enable earlier, more targeted intervention and improve clinical trial design, but it remains challenging because true progression signals are subtle in longitudinal MRI. In this low-signal regime, transferring modern generative sequence models directly is unreliable: training is dominated by stable baseline anatomy and confounded by dense, sample-specific nuisance variation. We first provide a theoretical analysis that explains these failures through two modes. Identity collapse occurs when optimization is driven toward reproducing the current anatomy, which prevents the model from learning faint temporal change. The continuous interpolation trap arises when standard smooth networks cannot separate localized biological drift from pervasive noise, which leads to spurious changes that diffuse across the volume. To address both issues, we propose Latent Drift, a progressive generative framework that learns change in a compressed semantic representation rather than synthesizing full-resolution anatomy. This design removes pixel-level identity from the prediction target and concentrates model capacity on progression-relevant dynamics. We further apply Finite Scalar Quantization to the learned change representation, which suppresses small, high-frequency nuisance fluctuations while preserving consistent structural drift. Experiments on longitudinal 3D brain MRI show that Latent Drift improves patient-specific neuro-forecasting over diffusion and autoregressive transformer baselines across generative fidelity and clinically relevant evaluation metrics. Project page: https://cutepkq.github.io/latent-drift{https://cutepkq.github.io/latent-drift}.

The clinical translation of dermatological AI is hindered by opaque reasoning and systematic performance disparities across skin tones. Here we present SkinGPT-R1, a multimodal large language model that integrates chain-of-thought diagnostic reasoning with a fairness-aware mixture-of-experts architecture for interpretable and equitable skin disease diagnosis. Through parameter-efficient adaptation of a frozen reasoning backbone, SkinGPT-R1 generates structured diagnostic reports comprising visual findings, differential reasoning, and final diagnosis. Across seven external datasets spanning diverse pathologies and imaging conditions, SkinGPT-R1 achieves state-of-the-art accuracy on six benchmarks, including 82.50\% on a challenging 40-class long-tail classification task (+19.30\% over leading baselines). Blinded evaluation by five board-certified dermatologists on 1,000 phenotypically balanced cases yields a mean score of 3.6 out of 5, with the highest ratings in safety (3.8) and reasoning coherence (3.6), indicating that the generated rationales are clinically safe, logically grounded, and suitable for supporting diagnostic decision-making. Critically, SkinGPT-R1 mitigates algorithmic bias across the full Fitzpatrick spectrum, achieving a robust worst-group performance of 41.40\% on the Fitz17k benchmark and a five-fold relative improvement in lower-bound accuracy on the DDI dataset compared to standard multimodal baselines. These results establish a framework for trustworthy, fair, and explainable AI-assisted dermatological diagnosis.

Medical image classification is a critical problem for healthcare, with the potential to alleviate the workload of doctors and facilitate diagnoses of patients. However, two challenges arise when deploying deep learning models to real-world healthcare applications. First, neural models tend to learn spurious correlations instead of desired features, which could fall short when generalizing to new domains (e.g., patients with different ages). Second, these black-box models lack interpretability. When making diagnostic predictions, it is important to understand why a model makes a decision for trustworthy and safety considerations. In this paper, to address these two limitations, we propose a new paradigm to build robust and interpretable medical image classifiers with natural language concepts. Specifically, we first query clinical concepts from GPT-4, then transform latent image features into explicit concepts with a vision-language model. We systematically evaluate our method on eight medical image classification datasets to verify its effectiveness. On challenging datasets with strong confounding factors, our method can mitigate spurious correlations thus substantially outperform standard visual encoders and other baselines. Finally, we show how classification with a small number of concepts brings a level of interpretability for understanding model decisions through case studies in real medical data.

Skin diseases affect millions of people worldwide, across all ethnicities. Increasing diagnosis accessibility requires fair and accurate segmentation and classification of dermatology images. However, the scarcity of annotated medical images, especially for rare diseases and underrepresented skin tones, poses a challenge to the development of fair and accurate models. In this study, we introduce a Fair, Efficient, and Diverse Diffusion-based framework for skin lesion segmentation and malignancy classification. FEDD leverages semantically meaningful feature embeddings learned through a denoising diffusion probabilistic backbone and processes them via linear probes to achieve state-of-the-art performance on Diverse Dermatology Images (DDI). We achieve an improvement in intersection over union of 0.18, 0.13, 0.06, and 0.07 while using only 5%, 10%, 15%, and 20% labeled samples, respectively. Additionally, FEDD trained on 10% of DDI demonstrates malignancy classification accuracy of 81%, 14% higher compared to the state-of-the-art. We showcase high efficiency in data-constrained scenarios while providing fair performance for diverse skin tones and rare malignancy conditions. Our newly annotated DDI segmentation masks and training code can be found on https://github.com/hectorcarrion/fedd.

Large Language Model (LLM) training often optimizes for preference alignment, rewarding outputs that are perceived as helpful and interaction-friendly. However, this preference-oriented objective can be exploited: manipulative prompts can steer responses toward user-appeasing agreement and away from truth-oriented correction. In this work, we investigate whether aligned models are vulnerable to Preference-Undermining Attacks (PUA), a class of manipulative prompting strategies designed to exploit the model's desire to please user preferences at the expense of truthfulness. We propose a diagnostic methodology that provides a finer-grained and more directive analysis than aggregate benchmark scores, using a factorial evaluation framework to decompose prompt-induced shifts into interpretable effects of system objectives (truth- vs. preference-oriented) and PUA-style dialogue factors (directive control, personal derogation, conditional approval, reality denial) within a controlled 2 times 2^4 design. Surprisingly, more advanced models are sometimes more susceptible to manipulative prompts. Beyond the dominant reality-denial factor, we observe model-specific sign reversals and interactions with PUA-style factors, suggesting tailored defenses rather than uniform robustness. These findings offer a novel, reproducible factorial evaluation methodology that provides finer-grained diagnostics for post-training processes like RLHF, enabling better trade-offs in the product iteration of LLMs by offering a more nuanced understanding of preference alignment risks and the impact of manipulative prompts.

Multimodal large language models (MLLMs) have advanced clinical tasks for common conditions, but their performance on rare diseases remains largely untested. In rare-disease scenarios, clinicians often lack prior clinical knowledge, forcing them to rely strictly on case-level evidence for clinical judgments. Existing benchmarks predominantly evaluate common-condition, single-image settings, leaving multimodal and multi-image evidence integration under rare-disease data scarcity systematically unevaluated. We introduce MMRareBench, to our knowledge the first rare-disease benchmark jointly evaluating multimodal and multi-image clinical capability across four workflow-aligned tracks: diagnosis, treatment planning, cross-image evidence alignment, and examination suggestion. The benchmark comprises 1,756 question-answer pairs with 7,958 associated medical images curated from PMC case reports, with Orphanet-anchored ontology alignment, track-specific leakage control, evidence-grounded annotations, and a two-level evaluation protocol. A systematic evaluation of 23 MLLMs reveals fragmented capability profiles and universally low treatment-planning performance, with medical-domain models trailing general-purpose MLLMs substantially on multi-image tracks despite competitive diagnostic scores. These patterns are consistent with a capacity dilution effect: medical fine-tuning can narrow the diagnostic gap but may erode the compositional multi-image capability that rare-disease evidence integration demands.

Knowledge Graph (KG) plays a crucial role in Medical Report Generation (MRG) because it reveals the relations among diseases and thus can be utilized to guide the generation process. However, constructing a comprehensive KG is labor-intensive and its applications on the MRG process are under-explored. In this study, we establish a complete KG on chest X-ray imaging that includes 137 types of diseases and abnormalities. Based on this KG, we find that the current MRG data sets exhibit a long-tailed problem in disease distribution. To mitigate this problem, we introduce a novel augmentation strategy that enhances the representation of disease types in the tail-end of the distribution. We further design a two-stage MRG approach, where a classifier is first trained to detect whether the input images exhibit any abnormalities. The classified images are then independently fed into two transformer-based generators, namely, ``disease-specific generator" and ``disease-free generator" to generate the corresponding reports. To enhance the clinical evaluation of whether the generated reports correctly describe the diseases appearing in the input image, we propose diverse sensitivity (DS), a new metric that checks whether generated diseases match ground truth and measures the diversity of all generated diseases. Results show that the proposed two-stage generation framework and augmentation strategies improve DS by a considerable margin, indicating a notable reduction in the long-tailed problem associated with under-represented diseases.

Population-level behavior in large-language-model (LLM) agents cannot be characterized by single-agent benchmarks. We introduce PV-SST, a peer-voted social-platform testbed, and report a separately frozen, preregistered matched-exposure experiment spanning four topics, four unused seeds, four open-weight model families, and three prespecified larger variants. The experiment comprises 448 trials and 112 complete model-by-topic-by-seed blocks. Relative to a topic-only control, a feed of previous-round peer posts ranked by peer-generated likes increases final-round lexical similarity in both the four-family core panel (paired mean difference +0.0082 TF-IDF cosine units, 95% block-bootstrap CI [0.0043, 0.0121], randomization p=0.000105, n=64 blocks) and the three-variant size extension (+0.0109 [0.0069, 0.0151], p=0.000001, n=48). This contrast bundles peer-post exposure with ranking and therefore does not identify a ranking-only effect. Opposite-side survival falls in the core panel (-3.9 percentage points [-6.8, -1.6], p=0.0068) but not conclusively in the larger variants (-1.0 pp [-3.1, 0.4], p=0.50). Holding adversarial impressions fixed, four distributed sources do not reliably move honest-agent stance more than one source. The preregistered distributed-minus-single contrast is positive but inconclusive in the core panel (+0.057 [-0.009, 0.125], p=0.112) and negative in the larger variants (-0.040 [-0.113, 0.035], p=0.332), failing the prespecified cross-model and cross-topic consistency criterion. Thus the robust result is lexical convergence under the tested peer-ranked feed, not general opinion capture or a general coordination advantage. The study evaluates synthetic LLM-agent populations; it does not estimate effects on people or production platforms.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

Understanding the prevalence of misinformation in health topics online can inform public health policies and interventions. However, measuring such misinformation at scale remains a challenge, particularly for high-stakes but understudied topics like opioid-use disorder (OUD)--a leading cause of death in the U.S. We present the first large-scale study of OUD-related myths on YouTube, a widely-used platform for health information. With clinical experts, we validate 8 pervasive myths and release an expert-labeled video dataset. To scale labeling, we introduce MythTriage, an efficient triage pipeline that uses a lightweight model for routine cases and defers harder ones to a high-performing, but costlier, large language model (LLM). MythTriage achieves up to 0.86 macro F1-score while estimated to reduce annotation time and financial cost by over 76% compared to experts and full LLM labeling. We analyze 2.9K search results and 343K recommendations, uncovering how myths persist on YouTube and offering actionable insights for public health and platform moderation.

Randomized controlled trials (RCTs) are considered the gold standard for estimating the average treatment effect (ATE) of interventions. One use of RCTs is to study the causes of global poverty -- a subject explicitly cited in the 2019 Nobel Memorial Prize awarded to Duflo, Banerjee, and Kremer "for their experimental approach to alleviating global poverty." Because the ATE is a population summary, anti-poverty experiments often seek to unpack the effect variation around the ATE by conditioning (CATE) on tabular variables such as age and ethnicity that were measured during the RCT data collection. Although such variables are key to unpacking CATE, using only such variables may fail to capture historical, geographical, or neighborhood-specific contributors to effect variation, as tabular RCT data are often only observed near the time of the experiment. In global poverty research, when the location of the experiment units is approximately known, satellite imagery can provide a window into such factors important for understanding heterogeneity. However, there is no method that specifically enables applied researchers to analyze CATE from images. In this paper, using a deep probabilistic modeling framework, we develop such a method that estimates latent clusters of images by identifying images with similar treatment effects distributions. Our interpretable image CATE model also includes a sensitivity factor that quantifies the importance of image segments contributing to the effect cluster prediction. We compare the proposed methods against alternatives in simulation; also, we show how the model works in an actual RCT, estimating the effects of an anti-poverty intervention in northern Uganda and obtaining a posterior predictive distribution over effects for the rest of the country where no experimental data was collected. We make all models available in open-source software.

Neuroimaging is a ubiquitous tool for evaluating patients with neurological diseases. The global demand for magnetic resonance imaging (MRI) studies has risen steadily, placing significant strain on health systems, prolonging turnaround times, and intensifying physician burnout. These challenges disproportionately impact patients in low-resource and rural settings. Here, we utilized a large academic health system as a data engine to develop Prima, the first vision language model (VLM) serving as an AI foundation for neuroimaging that supports real-world, clinical MRI studies as input. Trained on over 220,000 MRI studies, Prima uses a hierarchical vision architecture that provides general and transferable MRI features. Prima was tested in a 1-year health system-wide study that included 30K MRI studies. Across 52 radiologic diagnoses from the major neurologic disorders, including neoplastic, inflammatory, infectious, and developmental lesions, Prima achieved a mean diagnostic area under the ROC curve of 92.0, outperforming other state-of-the-art general and medical AI models. Prima offers explainable differential diagnoses, worklist priority for radiologists, and clinical referral recommendations across diverse patient demographics and MRI systems. Prima demonstrates algorithmic fairness across sensitive groups and can help mitigate health system biases, such as prolonged turnaround times for low-resource populations. These findings highlight the transformative potential of health system-scale VLMs and Prima's role in advancing AI-driven healthcare.

Almost every paper on LLM jailbreaks and prompt injection reports an attack-success rate (ASR), and that number is assigned not by people but by an automated judge: either a safety classifier trained for the task, or a general chat model prompted to grade. The judge is rarely checked. We check it. Using 596 human-labeled completions from the HarmBench classifier validation set, we compare the two judge families against human majority votes and then attack them. The two families fail in opposite ways. The dedicated classifier over-flags (precision 0.835, recall 0.974); three different LLM-as-judges keep high precision (0.81 to 0.94) but show erratic recall (0.06 to 0.65), so the same responses produce very different ASR depending on which judge scores them. The two families also differ sharply in robustness. Wrappers that leave the harmful text untouched and only add benign framing flip every LLM-judge between 57% and 100% of the time, and a single prepended refusal sentence accounts for much of this (39% to 88%). The dedicated classifier resists these surface attacks (at most 6.7%), but a white-box GCG attack on its open weights flips 70% of confident true positives (21 of 30; 95% CI 54 to 86%) even at a small optimization budget. A two-annotator audit confirms the attacks leave the harm intact: every one of 80 sampled flips still contained the harmful content. Because a large and growing share of reported ASR comes from LLM-judges, many such numbers are unreliable both on average and under deliberate pressure. We recommend that papers report judge precision and recall on a human-labeled slice, report ASR corrected for judge precision, and include an adversarial check of the judge. Our code is released.

Controllable generative models of 3D medical images can synthesize volumes with specified clinical attributes, but this demands samples that are simultaneously high-fidelity, natively 3D, and faithful to the requested conditioning. We present CONFLUX, a latent diffusion model for chest computed tomography (CT): a 3D variational autoencoder compresses each volume, and a rectified-flow transformer generates in the latent space. Generation is conditioned on structured radiological metadata (18 abnormality findings, sex, age, and reconstruction kernel) through adaptive layer normalization. The model leads strong volumetric baselines on tri-planar Frechet distance (FID 32.3 vs. 74.6 for MAISI) while exposing direct control over clinical attributes. To strengthen that control we add an online reinforcement-learning post-training stage (group-relative policy optimization) that rewards how reliably a classifier recovers the requested findings from each generated volume. Judged by a separate, independent classifier, post-training removes 47% of the shortfall relative to real-scan reliability. We release the model and a ~200k synthetic chest-CT dataset with conditioning metadata spanning a wide variety of clinical findings.

Clinical diagnosis is a highly specialized discipline requiring both domain expertise and strict adherence to rigorous guidelines. While current AI-driven medical research predominantly focuses on knowledge graphs or natural text pretraining paradigms to incorporate medical knowledge, these approaches primarily rely on implicitly encoded knowledge within model parameters, neglecting task-specific knowledge required by diverse downstream tasks. To address this limitation, we propose Retrieval-Augmented Diagnosis (RAD), a novel framework that explicitly injects external knowledge into multimodal models directly on downstream tasks. Specifically, RAD operates through three key mechanisms: retrieval and refinement of disease-centered knowledge from multiple medical sources, a guideline-enhanced contrastive loss that constrains the latent distance between multi-modal features and guideline knowledge, and the dual transformer decoder that employs guidelines as queries to steer cross-modal fusion, aligning the models with clinical diagnostic workflows from guideline acquisition to feature extraction and decision-making. Moreover, recognizing the lack of quantitative evaluation of interpretability for multimodal diagnostic models, we introduce a set of criteria to assess the interpretability from both image and text perspectives. Extensive evaluations across four datasets with different anatomies demonstrate RAD's generalizability, achieving state-of-the-art performance. Furthermore, RAD enables the model to concentrate more precisely on abnormal regions and critical indicators, ensuring evidence-based, trustworthy diagnosis. Our code is available at https://github.com/tdlhl/RAD.

On-policy distillation (OPD) is widely used for LLM post-training. When pushed with a reward-extrapolation coefficient lambda > 1, the student can lift past the teacher in domain, but past a threshold lambda* the same step violates the output contract on structured-output tasks. In a single-position Bernoulli reduction, we derive a closed-form base-relative clip-safety threshold lambda*(p,b,c) determined by three measurable quantities: the teacher modal probability, the warm-start mass, and the importance-sampling clip strength. Above lambda*, the extrapolated fixed point exits the clip-safe region, changing training from format-preserving to format-collapsing. We extend the rule to calibrated K-ary listwise JSON tasks where a single binding equivalence class dominates the output contract and SFT retains parse headroom. On Amazon Fashion, three pre-registered tests--a fine-grid cliff interval, a budget-extension test, and a small-clip cross-prediction--fall within their locked prediction windows, with the small-clip value matching the closed-form prediction below grid resolution. Operating just below lambda*, ListOPD brings a 1.7B Qwen3 student to in-domain parity with an 8B-SFT baseline at one-fifth the parameters. The gain is driven primarily by format adherence: NDCG@1 on parsed outputs remains flat across lambda, while parse validity sharply changes at the predicted boundary. The cliff diagnostic is rubric-independent, whereas the parity claim uses a Gemini-graded rubric and inherits that evaluator's exposure.

When OpenAI deprecated GPT-4o in early 2026, thousands of users protested under #keep4o, claiming newer models had "lost their empathy." No published study has tested this claim. We conducted the first clinical measurement, evaluating three OpenAI model generations (GPT-4o, o4-mini, GPT-5-mini) across 14 emotionally challenging conversational scenarios in mental health and AI companion domains, producing 2,100 scored AI responses assessed on six psychological safety dimensions using clinically-grounded rubrics. Empathy scores are statistically indistinguishable across all three models (Kruskal-Wallis H=4.33, p=0.115). What changed is the safety posture: crisis detection improved monotonically from GPT-4o to GPT-5-mini (H=13.88, p=0.001), while advice safety declined (H=16.63, p<0.001). Per-turn trajectory analysis -- a novel methodological contribution -- reveals these shifts are sharpest during mid-conversation crisis moments invisible to aggregate scoring. In a self-harm scenario involving a minor, GPT-4o scored 3.6/10 on crisis detection during early disclosure turns; GPT-5-mini never dropped below 7.8. What users perceived as "lost empathy" was a shift from a cautious model that missed crises to an alert model that sometimes says too much -- a trade-off with real consequences for vulnerable users, currently invisible to both the people who feel it and the developers who create it.

Sycophancy and hallucination are persistent failure modes of Large Language Models (LLMs) across domains. However, it becomes particularly consequential in clinical question answering, where responses must remain grounded in the provided context and robust to user pressure. Hallucination can introduce information that is unsupported by the context, while sycophancy can cause a model to abandon a previously correct answer when challenged by the user. Existing approaches, such as prompt-based safeguards and always-on activation steering, often address these behaviors separately or apply interventions broadly across turns, which can unnecessarily deteriorate responses that were already correct. To address these limitations within a single framework, we employ Inference Time Intervention (ITI) to jointly control both behaviors by learning separate steering directions for hallucination and sycophancy from contrastive clinical pairs and applying them to causally verified attention heads. During runtime, behavior-specific gates then determine when intervention is needed: the hallucination component mitigates unsupported claims, while the sycophancy component mitigates answer shifts caused by user pressure. We evaluate this framework on clinical questions grounded in EHR data while keeping the model weights frozen. Across all evaluation settings, we conducted 15,900 model-response runs. Across 600 pressure trajectories for the 4-billion-parameter model, the unsteered model caved in 570 cases. At the same time, gated steering helped it last longer in 551 of them. It held its ground under pressure at levels comparable to those of models with more than 100 billion parameters, showing that targeted inference-time steering can improve robustness without intervening at every turn.

We present a novel approach for generating minority samples that live on low-density regions of a data manifold. Our framework is built upon diffusion models, leveraging the principle of guided sampling that incorporates an arbitrary energy-based guidance during inference time. The key defining feature of our sampler lies in its self-contained nature, \ie, implementable solely with a pretrained model. This distinguishes our sampler from existing techniques that require expensive additional components (like external classifiers) for minority generation. Specifically, we first estimate the likelihood of features within an intermediate latent sample by evaluating a reconstruction loss w.r.t. its posterior mean. The generation then proceeds with the minimization of the estimated likelihood, thereby encouraging the emergence of minority features in the latent samples of subsequent timesteps. To further improve the performance of our sampler, we provide several time-scheduling techniques that properly manage the influence of guidance over inference steps. Experiments on benchmark real datasets demonstrate that our approach can greatly improve the capability of creating realistic low-likelihood minority instances over the existing techniques without the reliance on costly additional elements. Code is available at https://github.com/soobin-um/sg-minority.

We present VinDr-CXR-VQA, a large-scale chest X-ray dataset for explainable Medical Visual Question Answering (Med-VQA) with spatial grounding. The dataset contains 17,597 question-answer pairs across 4,394 images, each annotated with radiologist-verified bounding boxes and clinical reasoning explanations. Our question taxonomy spans six diagnostic types-Where, What, Is there, How many, Which, and Yes/No-capturing diverse clinical intents. To improve reliability, we construct a balanced distribution of 41.7% positive and 58.3% negative samples, mitigating hallucinations in normal cases. Benchmarking with MedGemma-4B-it demonstrates improved performance (F1 = 0.624, +11.8% over baseline) while enabling lesion localization. VinDr-CXR-VQA aims to advance reproducible and clinically grounded Med-VQA research. The dataset and evaluation tools are publicly available at huggingface.co/datasets/Dangindev/VinDR-CXR-VQA.

We present Fast Language-Image Pre-training (FLIP), a simple and more efficient method for training CLIP. Our method randomly masks out and removes a large portion of image patches during training. Masking allows us to learn from more image-text pairs given the same wall-clock time and contrast more samples per iteration with similar memory footprint. It leads to a favorable trade-off between accuracy and training time. In our experiments on 400 million image-text pairs, FLIP improves both accuracy and speed over the no-masking baseline. On a large diversity of downstream tasks, FLIP dominantly outperforms the CLIP counterparts trained on the same data. Facilitated by the speedup, we explore the scaling behavior of increasing the model size, data size, or training length, and report encouraging results and comparisons. We hope that our work will foster future research on scaling vision-language learning.

Users typically engage with LLMs interactively, yet most existing benchmarks evaluate them in a static, single-turn format, posing reliability concerns in interactive scenarios. We identify a key obstacle towards reliability: LLMs are trained to answer any question, even with incomplete context or insufficient knowledge. In this paper, we propose to change the static paradigm to an interactive one, develop systems that proactively ask questions to gather more information and respond reliably, and introduce an benchmark - MediQ - to evaluate question-asking ability in LLMs. MediQ simulates clinical interactions consisting of a Patient System and an adaptive Expert System; with potentially incomplete initial information, the Expert refrains from making diagnostic decisions when unconfident, and instead elicits missing details via follow-up questions. We provide a pipeline to convert single-turn medical benchmarks into an interactive format. Our results show that directly prompting state-of-the-art LLMs to ask questions degrades performance, indicating that adapting LLMs to proactive information-seeking settings is nontrivial. We experiment with abstention strategies to better estimate model confidence and decide when to ask questions, improving diagnostic accuracy by 22.3%; however, performance still lags compared to an (unrealistic in practice) upper bound with complete information upfront. Further analyses show improved interactive performance with filtering irrelevant contexts and reformatting conversations. Overall, we introduce a novel problem towards LLM reliability, an interactive MediQ benchmark and a novel question-asking system, and highlight directions to extend LLMs' information-seeking abilities in critical domains.

Large language models (LLMs) frequently achieve impressive scores on standardized benchmarks, yet accuracy alone offers a limited view of their capabilities. Evaluating open-source LLMs through leaderboards faces persistent issues like data contamination, narrow task scope, and weak alignment with real-world reliability. Benchmark-based evaluations such as MMLU PRO, BBH, or IFEval primarily capture what a model outputs on fixed test sets, not how it processes information, calibrates uncertainty, or structures internal knowledge. In this article, we advocate for a shift from benchmark-centric evaluation toward a complementary, state-centered intrinsic assessment of LLMs. To this end, we introduce Latent Performance Profiling (LPP) -- a framework that derives task-agnostic diagnostics from hidden activations and output distributions. LPP defines a set of scalar metrics on a model's latent representations and dynamics, revealing scale-independent traits that enable interpretable comparisons and uncover hidden vulnerabilities. Unlike static accuracy scores, LPP provides stable, architecture-sensitive signatures across models of similar size. With extensive empirical analyses across eight LLMs, spanning a size range of 0.5B-14B, we demonstrate that models with similar benchmark scores can exhibit contrasting latent profiles, such as differences in entropy or adaptability. Guided by these insights, we design synthetic probes for uncertainty and symbolic reasoning that align with intrinsic metrics while decoupling from leaderboard bias. We recommend that reporting LPP alongside benchmarks provides a deeper, interpretable understanding of model behavior, enabling more reliable model selection, safety assessment, and evaluation beyond surface-level accuracy.

This paper introduces a novel, entity-aware metric, termed as Radiological Report (Text) Evaluation (RaTEScore), to assess the quality of medical reports generated by AI models. RaTEScore emphasizes crucial medical entities such as diagnostic outcomes and anatomical details, and is robust against complex medical synonyms and sensitive to negation expressions. Technically, we developed a comprehensive medical NER dataset, RaTE-NER, and trained an NER model specifically for this purpose. This model enables the decomposition of complex radiological reports into constituent medical entities. The metric itself is derived by comparing the similarity of entity embeddings, obtained from a language model, based on their types and relevance to clinical significance. Our evaluations demonstrate that RaTEScore aligns more closely with human preference than existing metrics, validated both on established public benchmarks and our newly proposed RaTE-Eval benchmark.

Recent incidents involving LLMs used for mental-health support reveal a critical evaluation gap: surface-level safety scores do not capture how models behave across realistic, emotionally sensitive interactions over time. Existing benchmarks measure knowledge, safety, or static response quality, but miss whether LLM interactions help users keep reflecting, coping, and making decisions themselves. We formalize this missing dimension as COGNITIVE ATROPHY, a process-level behavioural measure in AI-mediated mental-health support distinct from safety and helpfulness. To measure it, we introduce COGNITIVE ATROPHY BENCH, a clinically grounded benchmark built from 1,576 fully human-generated counseling conversations, 15,680 turns, and 42,230 responses from five LLMs. Three clinical and neuropsychology experts developed a 20-attribute schema spanning user context, response behaviour, and global risk flags; six trained clinical reviewers applied it with span-grounded evidence, producing 5,324 reviewer judgments. We further introduce the User-Input Risk Index (UIRI), the Cognitive Atrophy Risk Index (ARI), and trajectory summaries. Across five LLMs, models show a consistent moderate-to-high level of atrophy-aligned behaviour across single and multi-turn settings. While models generally respond to overt safety cues, they adapt less reliably when users seek solutions or decisions. The dominant recurring patterns are directive advice, problem-solving, recommendation responses, topic shifts, and forms of validation that may reinforce dependence rather than reflection. Our work makes COGNITIVE ATROPHY measurable and provides a foundation for auditing model behaviour in sensitive LLM conversations.

Latent, or silent, reasoning lets language models carry out intermediate computation in continuous vector space instead of words, and is widely assumed to function as an internal scratchpad the model consults during inference. Whether that assumption survives reinforcement learning has not been tested directly: existing causal analyses of latent reasoning are confined to math and logic tasks, comparing reliance on thoughts within one checkpoint, never before and after RL. We train a chess-playing model through a staged latent-reasoning curriculum followed by reinforcement learning, and find legality climbs monotonically to 61% (from a 48% pre-RL baseline) while checkmate confabulation is eliminated entirely. To locate this gain, we run a six-condition causal intervention suite on the same model before and after RL: substituting or noising the thought vectors leaves performance unchanged, ablating them costs only mild degradation, and only exact-zero vectors cause collapse. This robustness gap is itself the finding: under exact-zero corruption, legality collapses to 1% pre-RL versus 9% post-RL, a gap that survives correction across the full battery. A 10x-larger replication of the post-RL checkpoint's own battery confirms this: removing the thoughts, with or without restoring sequence length, also reaches significance; substitution and noise remain indistinguishable from baseline. RL appears to add robustness to disruption, not reliance on thought content. These results push back against the field's default assumption that latent thoughts function as an actively consulted inference-time scratchpad, and instead indicate latent reasoning's principal effect here is shaping the model's parameters during training. We also demonstrate a working RL gain in chess, where multiple groups report the same latent-reasoning-plus-RL recipe failing to improve accuracy over SFT.

Chest X-ray (CXR) radiology report generation (RRG) models have shown rapid progress, yet their clinical utility remains uncertain due to limited evaluation by radiologists. We present CXRMate-2, a state-of-the-art CXR RRG model that integrates structured multimodal conditioning and reinforcement learning with a composite reward for semantic alignment with radiologist reports. Across the MIMIC-CXR, CheXpert Plus, and ReXgradient datasets, CXRMate-2 achieves statistically significant improvements over strong benchmarks, including gains of 11.2% and 24.4% in GREEN and RadGraph-XL, respectively, on MIMIC-CXR relative to MedGemma 1.5 (4B). To directly compare CXRMate-2 against radiologist reporting, we conduct a blinded, randomised qualitative retrospective evaluation. Three consultant radiologists compare generated and radiologist reports across 120 studies from the MIMIC-CXR test set. Generated reports were deemed acceptable (defined as preferred or rated equally to radiologist reports) in 45% of ratings, with no statistically significant difference in preference rates between radiologist reports and acceptable generated reports for seven of the eight analysed findings. Preference for radiologist reports was driven primarily by higher recall, while generated reports were often preferred for readability. Together, these results suggest a credible pathway to clinically acceptable CXR RRG. Improvements in recall, alongside better detection of subtle findings (e.g., pulmonary congestion), are likely sufficient to achieve non-inferiority to radiologist reporting. With these targeted advances, CXR RRG systems may be ready for prospective evaluation in assistive roles within radiologist-led workflows.

As Large Language Models (LLMs) are increasingly proposed for high-stakes medical applications, there has emerged a critical need for reliable and accurate evaluation methodologies. Traditional accuracy metrics fail inadequately as they neither capture question characteristics nor offer topic-specific insights. To address this gap, we introduce MedIRT, a rigorous evaluation framework grounded in Item Response Theory (IRT), the gold standard in high-stakes educational testing. Unlike previous research relying on archival data, we prospectively gathered fresh responses from 80 diverse LLMs on a balanced, 1,100-question USMLE-aligned benchmark. Using one unidimensional two-parameter logistic IRT model per topic, we estimate LLM's latent model ability jointly with question difficulty and discrimination, yielding more stable and nuanced performance rankings than accuracy alone. Notably, we identify distinctive ``spiky'' ability profiles, where overall rankings can be misleading due to highly specialized model abilities. While GPT-5 was the top performer in a majority of domains (8 of 11), it was outperformed in Social Science and Communication by Claude-3-opus, demonstrating that even an overall 23rd-ranked model can hold the top spot for specific competencies. Furthermore, we demonstrate IRT's utility in auditing benchmarks by identifying flawed questions. We synthesize these findings into a practical decision-support framework that integrates our multi-factor competency profiles with operational metrics. This work establishes a robust, psychometrically grounded methodology essential for the safe, effective, and trustworthy deployment of LLMs in healthcare.

Hallucination is often regarded as a major impediment for using large language models (LLMs), especially for knowledge-intensive tasks. Even when the training corpus consists solely of true statements, language models still generate hallucinations in the form of amalgamations of multiple facts. We coin this phenomenon as ``knowledge overshadowing'': when we query knowledge from a language model with multiple conditions, some conditions overshadow others, leading to hallucinated outputs. This phenomenon partially stems from training data imbalance, which we verify on both pretrained models and fine-tuned models, over a wide range of LM model families and sizes.From a theoretical point of view, knowledge overshadowing can be interpreted as over-generalization of the dominant conditions (patterns). We show that the hallucination rate grows with both the imbalance ratio (between the popular and unpopular condition) and the length of dominant condition description, consistent with our derived generalization bound. Finally, we propose to utilize overshadowing conditions as a signal to catch hallucination before it is produced, along with a training-free self-contrastive decoding method to alleviate hallucination during inference. Our proposed approach showcases up to 82% F1 for hallucination anticipation and 11.2% to 39.4% hallucination control, with different models and datasets.

Large Language Models (LLMs) are widely used as proxies for human labelers in both training (Reinforcement Learning from AI Feedback) and large-scale response evaluation (LLM-as-a-judge). Alignment and evaluation are critical components in the development of reliable LLMs, and the choice of feedback protocol plays a central role in both but remains understudied. In this work, we show that the choice of feedback protocol for evaluation (absolute scores versus relative preferences) can significantly affect evaluation reliability and induce systematic biases. In the context of LLM-as-a-judge evaluation, we show that pairwise protocols are more vulnerable to distracted evaluation. Generator models can exploit spurious attributes (or distractor features) favored by the LLM judge, resulting in inflated scores for lower-quality outputs. We find that absolute scoring is more robust to such manipulation, producing judgments that better reflect response quality and are less influenced by distractor features. Our results demonstrate that generator models can flip preferences by embedding distractor features, skewing LLM-as-a-judge comparisons and leading to inaccurate conclusions about model quality in benchmark evaluations. Pairwise preferences flip in about 35% of the cases, compared to only 9% for absolute scores. We offer recommendations for choosing feedback protocols based on dataset characteristics and evaluation objectives.

Rare diseases affect hundreds of millions worldwide, yet diagnosis often spans years. Convectional pipelines decouple noisy evidence extraction from downstream inferential diagnosis, and general/medical large language models (LLMs) face scarce real world electronic health records (EHRs), stale domain knowledge, and hallucinations. We assemble a large, domain specialized clinical corpus and a clinician validated reasoning set, and develop RareSeek R1 via staged instruction tuning, chain of thought learning, and graph grounded retrieval. Across multicenter EHR narratives and public benchmarks, RareSeek R1 attains state of the art accuracy, robust generalization, and stability under noisy or overlapping phenotypes. Augmented retrieval yields the largest gains when narratives pair with prioritized variants by resolving ambiguity and aligning candidates to mechanisms. Human studies show performance on par with experienced physicians and consistent gains in assistive use. Notably, transparent reasoning highlights decisive non phenotypic evidence (median 23.1%, such as imaging, interventions, functional tests) underpinning many correct diagnoses. This work advances a narrative first, knowledge integrated reasoning paradigm that shortens the diagnostic odyssey and enables auditable, clinically translatable decision support.

Medical vision--language models (VLMs) have shown strong potential for medical visual question answering (VQA), yet their reasoning remains largely text-centric: images are encoded once as static context, and subsequent inference is dominated by language. This paradigm is fundamentally limited in clinical scenarios, where accurate answers often depend on subtle, localized visual evidence that cannot be reliably preserved in static embeddings. We propose MedLVR, a latent visual reasoning framework that introduces an explicit visual evidence state into autoregressive decoding. Instead of relying solely on text-based intermediate reasoning, MedLVR interleaves a short latent reasoning segment within the decoder by reusing hidden states as continuous latent steps, enabling iterative preservation and refinement of query-relevant visual evidence before answer generation. To support effective visual supervision, we adopt a two-stage training strategy: region of interest (ROI)-supervised fine-tuning aligns latent states with clinically relevant image evidence, and Visual-Latent Policy Optimization (VLPO) further optimizes latent reasoning and answer generation under outcome-level rewards. Experiments on OmniMedVQA and five external medical VQA benchmarks show that MedLVR consistently outperforms recent reasoning baselines and improves the average score over the Qwen2.5-VL-7B backbone from 48.3\% to 53.4\%. These results show that latent visual reasoning provides an effective mechanism for preserving diagnostically relevant visual evidence and improving the reliability of medical VQA.

Autism spectrum disorder (ASD) is a prevalent psychiatric condition characterized by atypical cognitive, emotional, and social patterns. Timely and accurate diagnosis is crucial for effective interventions and improved outcomes in individuals with ASD. In this study, we propose a novel Multi-Atlas Enhanced Transformer framework, METAFormer, ASD classification. Our framework utilizes resting-state functional magnetic resonance imaging data from the ABIDE I dataset, comprising 406 ASD and 476 typical control (TC) subjects. METAFormer employs a multi-atlas approach, where flattened connectivity matrices from the AAL, CC200, and DOS160 atlases serve as input to the transformer encoder. Notably, we demonstrate that self-supervised pretraining, involving the reconstruction of masked values from the input, significantly enhances classification performance without the need for additional or separate training data. Through stratified cross-validation, we evaluate the proposed framework and show that it surpasses state-of-the-art performance on the ABIDE I dataset, with an average accuracy of 83.7% and an AUC-score of 0.832. The code for our framework is available at https://github.com/Lugges991/METAFormer

Despite impressive performance on standard benchmarks, multimodal large language models (MLLMs) face critical challenges in real-world clinical environments where medical images inevitably suffer various quality degradations. Existing benchmarks exhibit two key limitations: (1) absence of large-scale, multidimensional assessment across medical image quality gradients and (2) no systematic confidence calibration analysis. To address these gaps, we present MedQ-Deg, a comprehensive benchmark for evaluating medical MLLMs under image quality degradations. MedQ-Deg provides multi-dimensional evaluation spanning 18 distinct degradation types, 30 fine-grained capability dimensions, and 7 imaging modalities, with 24,894 question-answer pairs. Each degradation is implemented at 3 severity degrees, calibrated by expert radiologists. We further introduce Calibration Shift metric, which quantifies the gap between a model's perceived confidence and actual performance to assess metacognitive reliability under degradation. Our comprehensive evaluation of 40 mainstream MLLMs reveals several critical findings: (1) overall model performance degrades systematically as degradation severity increases, (2) models universally exhibit the AI Dunning-Kruger Effect, maintaining inappropriately high confidence despite severe accuracy collapse, and (3) models display markedly differentiated behavioral patterns across capability dimensions, imaging modalities, and degradation types. We hope MedQ-Deg drives progress toward medical MLLMs that are robust and trustworthy in real clinical practice.

Deep Neural Networks (DNNs) can be catastrophically disrupted by flipping only a handful of parameter bits. We introduce Deep Neural Lesion (DNL), a data-free and optimizationfree method that locates critical parameters, and an enhanced single-pass variant, 1P-DNL, that refines this selection with one forward and backward pass on random inputs. We show that this vulnerability spans multiple domains, including image classification, object detection, instance segmentation, and reasoning large language models. In image classification, flipping just two sign bits in ResNet-50 on ImageNet reduces accuracy by 99.8%. In object detection and instance segmentation, one or two sign flips in the backbone collapse COCO detection and mask AP for Mask R-CNN and YOLOv8-seg models. In language modeling, two sign flips into different experts reduce Qwen3-30B-A3B-Thinking from 78% to 0% accuracy. We also show that selectively protecting a small fraction of vulnerable sign bits provides a practical defense against such attacks.

The PI-CAI (Prostate Imaging: Cancer AI) challenge led to expert-level diagnostic algorithms for clinically significant prostate cancer detection. The algorithms receive biparametric MRI scans as input, which consist of T2-weighted and diffusion-weighted scans. These scans can be misaligned due to multiple factors in the scanning process. Image registration can alleviate this issue by predicting the deformation between the sequences. We investigate the effect of image registration on the diagnostic performance of AI-based prostate cancer diagnosis. First, the image registration algorithm, developed in MeVisLab, is analyzed using a dataset with paired lesion annotations. Second, the effect on diagnosis is evaluated by comparing case-level cancer diagnosis performance between using the original dataset, rigidly aligned diffusion-weighted scans, or deformably aligned diffusion-weighted scans. Rigid registration showed no improvement. Deformable registration demonstrated a substantial improvement in lesion overlap (+10% median Dice score) and a positive yet non-significant improvement in diagnostic performance (+0.3% AUROC, p=0.18). Our investigation shows that a substantial improvement in lesion alignment does not directly lead to a significant improvement in diagnostic performance. Qualitative analysis indicated that jointly developing image registration methods and diagnostic AI algorithms could enhance diagnostic accuracy and patient outcomes.

Large Language Models (LLMs) are increasingly deployed in healthcare, yet their communicative alignment with clinical standards remains insufficiently quantified. We conduct a multidimensional evaluation of general-purpose and domain-specialized LLMs across structured medical explanations and real-world physician-patient interactions, analyzing semantic fidelity, readability, and affective resonance. Baseline models amplify affective polarity relative to physicians (Very Negative: 43.14-45.10% vs. 37.25%) and, in larger architectures such as GPT-5 and Claude, produce substantially higher linguistic complexity (FKGL up to 16.91-17.60 vs. 11.47-12.50 in physician-authored responses). Empathy-oriented prompting reduces extreme negativity and lowers grade-level complexity (up to -6.87 FKGL points for GPT-5) but does not significantly increase semantic fidelity. Collaborative rewriting yields the strongest overall alignment. Rephrase configurations achieve the highest semantic similarity to physician answers (up to mean = 0.93) while consistently improving readability and reducing affective extremity. Dual stakeholder evaluation shows that no model surpasses physicians on epistemic criteria, whereas patients consistently prefer rewritten variants for clarity and emotional tone. These findings suggest that LLMs function most effectively as collaborative communication enhancers rather than replacements for clinical expertise.

Psychological defenses are strategies, often automatic, that people use to manage distress. Rigid or overuse of defenses is negatively linked to mental health and shapes what speakers disclose and how they accept or resist help. However, defenses are complex and difficult to reliably measure, particularly in clinical dialogues. We introduce PsyDefConv, a dialogue corpus with help seeker utterances labeled for defense level, and DMRS Co-Pilot, a four-stage pipeline that provides evidence-based pre-annotations. The corpus contains 200 dialogues and 4709 utterances, including 2336 help seeker turns, with labeling and Cohen's kappa 0.639. In a counterbalanced study, the co-pilot reduced average annotation time by 22.4%. In expert review, it averaged 4.62 for evidence, 4.44 for clinical plausibility, and 4.40 for insight on a seven-point scale. Benchmarks with strong language models in zero-shot and fine-tuning settings demonstrate clear headroom, with the best macro F1-score around 30% and a tendency to overpredict mature defenses. Corpus analyses confirm that mature defenses are most common and reveal emotion-specific deviations. We will release the corpus, annotations, code, and prompts to support research on defensive functioning in language.

Minimizing inconsistencies across successive versions of an AI system is as crucial as reducing the overall error. In image classification, such inconsistencies manifest as negative flips, where an updated model misclassifies test samples that were previously classified correctly. This issue becomes increasingly pronounced as the number of training classes grows over time, since adding new categories reduces the margin of each class and may introduce conflicting patterns that undermine their learning process, thereby degrading performance on the original subset. To mitigate negative flips, we propose a novel approach that preserves the margins of the original model while learning an improved one. Our method encourages a larger relative margin between the previously learned and newly introduced classes by introducing an explicit margin-calibration term on the logits. However, overly constraining the logit margin for the new classes can significantly degrade their accuracy compared to a new independently trained model. To address this, we integrate a double-source focal distillation loss with the previous model and a new independently trained model, learning an appropriate decision margin from both old and new data, even under a logit margin calibration. Extensive experiments on image classification benchmarks demonstrate that our approach consistently reduces the negative flip rate with high overall accuracy.

Large language models (LLMs) increasingly provide conversational health information that may influence treatment decisions, yet existing benchmarks do not isolate whether medication-safety boundaries persist across follow-ups after explicit self-treatment intent. We introduce TAF-MED, a physician-reviewed benchmark of 500 fixed three-turn scenarios, and evaluate eight LLMs across 4,000 conversations. A rubric-based automated judge labelled responses as SAFE, LEAKY, or UNSAFE, and two physicians independently annotated a model-balanced random subset of 400 conversations. We assessed unsafe guidance, collapse after a strictly SAFE initial response, and model-ranking stability. Overall, 71.6% of conversations contained an UNSAFE response, and 61.4% of those beginning with a strictly SAFE response later collapsed to UNSAFE; model-level collapse rates ranged from 24.4% to 96.2%. Four of 28 model pairs reversed order between initial unsafe and collapse rates. Automated labels achieved 94.3% agreement with the adjudicated physician reference (κ= 0.895). These findings show that first-turn safety is an incomplete proxy for conversational safety persistence and motivate evaluation across complete dialogue trajectories. We will release TAF-MED on Hugging Face to support reproducible research on multi-turn medical safety.

Developing a generalist radiology diagnosis system can greatly enhance clinical diagnostics. In this paper, we introduce RadDiag, a foundational model supporting 2D and 3D inputs across various modalities and anatomies, using a transformer-based fusion module for comprehensive disease diagnosis. Due to patient privacy concerns and the lack of large-scale radiology diagnosis datasets, we utilize high-quality, clinician-reviewed radiological images available online with diagnosis labels. Our dataset, RP3D-DiagDS, contains 40,936 cases with 195,010 scans covering 5,568 disorders (930 unique ICD-10-CM codes). Experimentally, our RadDiag achieves 95.14% AUC on internal evaluation with the knowledge-enhancement strategy. Additionally, RadDiag can be zero-shot applied or fine-tuned to external diagnosis datasets sourced from various hospitals, demonstrating state-of-the-art results. In conclusion, we show that publicly shared medical data on the Internet is a tremendous and valuable resource that can potentially support building a generalist AI for healthcare.

In a recent paper Juodis and Reese (2022) (JR) show that the application of the CD test proposed by Pesaran (2004) to residuals from panels with latent factors results in over-rejection. They propose a randomized test statistic to correct for over-rejection, and add a screening component to achieve power. This paper considers the same problem but from a different perspective, and shows that the standard CD test remains valid if the latent factors are weak in the sense the strength is less than half. In the case where latent factors are strong, we propose a bias-corrected version, CD*, which is shown to be asymptotically standard normal under the null of error cross-sectional independence and have power against network type alternatives. This result is shown to hold for pure latent factor models as well as for panel regression models with latent factors. The case where the errors are serially correlated is also considered. Small sample properties of the CD* test are investigated by Monte Carlo experiments and are shown to have the correct size for strong and weak factors as well as for Gaussian and non-Gaussian errors. In contrast, it is found that JR's test tends to over-reject in the case of panels with non-Gaussian errors, and has low power against spatial network alternatives. In an empirical application, using the CD* test, it is shown that there remains spatial error dependence in a panel data model for real house price changes across 377 Metropolitan Statistical Areas in the U.S., even after the effects of latent factors are filtered out.

Automatic medical report generation (MRG) is of great research value as it has the potential to relieve radiologists from the heavy burden of report writing. Despite recent advancements, accurate MRG remains challenging due to the need for precise clinical understanding and the identification of clinical findings. Moreover, the imbalanced distribution of diseases makes the challenge even more pronounced, as rare diseases are underrepresented in training data, making their diagnostic performance unreliable. To address these challenges, we propose diagnosis-driven prompts for medical report generation (PromptMRG), a novel framework that aims to improve the diagnostic accuracy of MRG with the guidance of diagnosis-aware prompts. Specifically, PromptMRG is based on encoder-decoder architecture with an extra disease classification branch. When generating reports, the diagnostic results from the classification branch are converted into token prompts to explicitly guide the generation process. To further improve the diagnostic accuracy, we design cross-modal feature enhancement, which retrieves similar reports from the database to assist the diagnosis of a query image by leveraging the knowledge from a pre-trained CLIP. Moreover, the disease imbalanced issue is addressed by applying an adaptive logit-adjusted loss to the classification branch based on the individual learning status of each disease, which overcomes the barrier of text decoder's inability to manipulate disease distributions. Experiments on two MRG benchmarks show the effectiveness of the proposed method, where it obtains state-of-the-art clinical efficacy performance on both datasets.

Multimodal Large Language Models (MLLMs) are increasingly deployed in human-facing roles where personality perception is critical, yet existing benchmarks evaluate this capability solely on numerical Big Five score prediction, leaving open whether models truly perceive personality through behavioral understanding or merely prejudge through superficial pattern matching. We address this gap with three contributions. (i) A new task: we formalize Grounded Personality Reasoning (GPR), which requires MLLMs to anchor each Big Five rating in observable evidence through a chain of rating, reasoning, and grounding. (ii) A new dataset: we release MM-OCEAN (1,104 videos, 5,320 MCQs), produced by a multi-agent pipeline with human verification, with timestamped behavioral observations, evidence-grounded trait analyses, and seven categories of cue-grounding MCQs. (iii) Benchmark and analysis: we design a three-tier evaluation (rating, reasoning, grounding) plus four sample-level failure-mode metrics: Prejudice Rate (PR), Confabulation Rate (CR), Integration-failure Rate (IR), and Holistic-grounding Rate (HR), and benchmark 27 MLLMs (13 closed, 14 open). The analysis uncovers a striking Prejudice Gap: across the field, 51% of correct ratings are not grounded in retrieved cues, and the Holistic-Grounding Rate spans only 0-33.5%. These findings expose a disconnect between getting the right score and reasoning for the right reason, charting a roadmap for grounded social cognition in MLLMs.

Causal representation learning seeks to extract high-level latent factors from low-level sensory data. Most existing methods rely on observational data and structural assumptions (e.g., conditional independence) to identify the latent factors. However, interventional data is prevalent across applications. Can interventional data facilitate causal representation learning? We explore this question in this paper. The key observation is that interventional data often carries geometric signatures of the latent factors' support (i.e. what values each latent can possibly take). For example, when the latent factors are causally connected, interventions can break the dependency between the intervened latents' support and their ancestors'. Leveraging this fact, we prove that the latent causal factors can be identified up to permutation and scaling given data from perfect do interventions. Moreover, we can achieve block affine identification, namely the estimated latent factors are only entangled with a few other latents if we have access to data from imperfect interventions. These results highlight the unique power of interventional data in causal representation learning; they can enable provable identification of latent factors without any assumptions about their distributions or dependency structure.

The potential of Multimodal Large Language Models (MLLMs) in domain of medical imaging raise the demands of systematic and rigorous evaluation frameworks that are aligned with the real-world medical imaging practice. Existing practices that report single or coarse-grained metrics are lack the granularity required for specialized clinical support and fail to assess the reliability of reasoning mechanisms. To address this, we propose a paradigm shift toward multidimensional, fine-grained and in-depth evaluation. Based on a two-stage systematic construction pipeline designed for this paradigm, we instantiate it with MedRCube. We benchmark 33 MLLMs, Lingshu-32B achieve top-tier performance. Crucially, MedRCube exposes a series of pronounced insights inaccessible under prior evaluation settings. Furthermore, we introduce a credibility evaluation subset to quantify reasoning credibility, uncover a highly significant positive association between shortcut behavior and diagnostic task performance, raising concerns for clinically trustworthy deployment. The resources of this work can be found at https://github.com/F1mc/MedRCube.

Timely detection of concerning events is an important problem in clinical practice. In this paper, we consider the problem of conditional anomaly detection that aims to identify data instances with an unusual response, such as the omission of an important lab test. We develop a new non-parametric approach for conditional anomaly detection based on the soft harmonic solution, with which we estimate the confidence of the label to detect anomalous mislabeling. We further regularize the solution to avoid the detection of isolated examples and examples on the boundary of the distribution support. We demonstrate the efficacy of the proposed method in detecting unusual labels on a real-world electronic health record dataset and compare it to several baseline approaches.

Large language models can resist task-misaligned activation steering during inference, sometimes recovering mid-generation to produce improved responses even when steering remains active. We term this Endogenous Steering Resistance (ESR). Using sparse autoencoder (SAE) latents to steer model activations, we find that Llama-3.3-70B shows substantial ESR, while smaller models from the Llama-3 and Gemma-2 families exhibit the phenomenon less frequently. We identify 26 SAE latents that activate differentially during off-topic content and are causally linked to ESR in Llama-3.3-70B. Zero-ablating these latents reduces the multi-attempt rate by 25%, providing causal evidence for dedicated internal consistency-checking circuits. We demonstrate that ESR can be deliberately enhanced through both prompting and training: meta-prompts instructing the model to self-monitor increase the multi-attempt rate by 4x for Llama-3.3-70B, and fine-tuning on self-correction examples successfully induces ESR-like behavior in smaller models. These findings have dual implications: ESR could protect against adversarial manipulation but might also interfere with beneficial safety interventions that rely on activation steering. Understanding and controlling these resistance mechanisms is important for developing transparent and controllable AI systems. Code is available at github.com/agencyenterprise/endogenous-steering-resistance.

Large Language Models (LLMs) are expected to provide helpful and harmless responses, yet they often exhibit sycophancy--conforming to user beliefs regardless of factual accuracy or ethical soundness. Prior research on sycophancy has primarily focused on single-turn factual correctness, overlooking the dynamics of real-world interactions. In this work, we introduce SYCON Bench, a novel benchmark for evaluating sycophantic behavior in multi-turn, free-form conversational settings. Our benchmark measures how quickly a model conforms to the user (Turn of Flip) and how frequently it shifts its stance under sustained user pressure (Number of Flip). Applying SYCON Bench to 17 LLMs across three real-world scenarios, we find that sycophancy remains a prevalent failure mode. Our analysis shows that alignment tuning amplifies sycophantic behavior, whereas model scaling and reasoning optimization strengthen the model's ability to resist undesirable user views. Reasoning models generally outperform instruction-tuned models but often fail when they over-index on logical exposition instead of directly addressing the user's underlying beliefs. Finally, we evaluate four additional prompting strategies and demonstrate that adopting a third-person perspective reduces sycophancy by up to 63.8% in debate scenario. We release our code and data at https://github.com/JiseungHong/SYCON-Bench.

Agentic retrieval-augmented generation (RAG) interleaves retrieval, reasoning, and answer generation across multiple hops. A retrieval error at hop 1 can surface only as a wrong answer at hop 3, while later retrieval can also repair the trajectory. This paper introduces AgenticRAG-FP, an interventional benchmark for causal failure attribution in agentic RAG. The benchmark injects a certified fault at a specified hop, re-executes the downstream trajectory, and evaluates diagnosers against the known intervention. Its central question is whether a post-hoc trace still identifies the injected hop after the suffix changes. In the completed strict dense Claude Haiku 4.5 sweep on 80 three-hop MuSiQue questions, coverage-based diagnosis is 0.91 at hop 1 and 0.00 at hops 2 and 3 (n=43,36,21 failed trajectories). A smaller content-corruption study changes an answer-bearing or bridge fact in topically intact evidence. At depth 2, where 18 failed cases remain after filtering, coverage-based diagnosis is 0.00 and a frozen-hop counterfactual probe is 0.67 in an exploratory pooled comparison. Depth-3 content estimates are descriptive only because they contain three failed cases. These results make propagation depth an explicit evaluation axis for diagnosing agentic RAG failures while distinguishing broad evidence of post-hoc signal loss from small-sample method comparisons.

Large language models (LLMs) are increasingly deployed as autonomous decision agents in settings with asymmetric error costs: hiring (missed talent vs wasted interviews), medical triage (missed emergencies vs unnecessary escalation), and fraud detection (approved fraud vs declined legitimate payments). The dominant design queries a single LLM for a posterior over states, thresholds "confidence," and acts; we prove this is inadequate for sequential decisions with costs. We propose a Bayesian, cost-aware multi-LLM orchestration framework that treats LLMs as approximate likelihood models rather than classifiers. For each candidate state, we elicit likelihoods via contrastive prompting, aggregate across diverse models with robust statistics, and update beliefs with Bayes rule under explicit priors as new evidence arrives. This enables coherent belief updating, expected-cost action selection, principled information gathering via value of information, and fairness gains via ensemble bias mitigation. In resume screening with costs of 40000 USD per missed hire, 2500 USD per interview, and 150 USD per phone screen, experiments on 1000 resumes using five LLMs (GPT-4o, Claude 4.5 Sonnet, Gemini Pro, Grok, DeepSeek) reduce total cost by 294000 USD (34 percent) versus the best single-LLM baseline and improve demographic parity by 45 percent (max group gap 22 to 5 percentage points). Ablations attribute 51 percent of savings to multi-LLM aggregation, 43 percent to sequential updating, and 20 percent to disagreement-triggered information gathering, consistent with the theoretical benefits of correct probabilistic foundations.

Known for their impressive performance in generative modeling, diffusion models are attractive candidates for density-based anomaly detection. This paper investigates different variations of diffusion modeling for unsupervised and semi-supervised anomaly detection. In particular, we find that Denoising Diffusion Probability Models (DDPM) are performant on anomaly detection benchmarks yet computationally expensive. By simplifying DDPM in application to anomaly detection, we are naturally led to an alternative approach called Diffusion Time Estimation (DTE). DTE estimates the distribution over diffusion time for a given input and uses the mode or mean of this distribution as the anomaly score. We derive an analytical form for this density and leverage a deep neural network to improve inference efficiency. Through empirical evaluations on the ADBench benchmark, we demonstrate that all diffusion-based anomaly detection methods perform competitively for both semi-supervised and unsupervised settings. Notably, DTE achieves orders of magnitude faster inference time than DDPM, while outperforming it on this benchmark. These results establish diffusion-based anomaly detection as a scalable alternative to traditional methods and recent deep-learning techniques for standard unsupervised and semi-supervised anomaly detection settings.

Medical imaging plays a pivotal role in modern healthcare, with computed tomography pulmonary angiography (CTPA) being a critical tool for diagnosing pulmonary embolism and other thoracic conditions. However, the complexity of interpreting CTPA scans and generating accurate radiology reports remains a significant challenge. This paper introduces Abn-BLIP (Abnormality-aligned Bootstrapping Language-Image Pretraining), an advanced diagnosis model designed to align abnormal findings to generate the accuracy and comprehensiveness of radiology reports. By leveraging learnable queries and cross-modal attention mechanisms, our model demonstrates superior performance in detecting abnormalities, reducing missed findings, and generating structured reports compared to existing methods. Our experiments show that Abn-BLIP outperforms state-of-the-art medical vision-language models and 3D report generation methods in both accuracy and clinical relevance. These results highlight the potential of integrating multimodal learning strategies for improving radiology reporting. The source code is available at https://github.com/zzs95/abn-blip.

Chest X-ray report generation (CXR-RG) has the potential to substantially alleviate radiologists' workload. However, conventional autoregressive vision--language models (VLMs) suffer from high inference latency due to sequential token decoding. Diffusion-based models offer a promising alternative through parallel generation, but they still require multiple denoising iterations. Compressing multi-step denoising to a single step could further reduce latency, but often degrades textual coherence due to the mean-field bias introduced by token-factorized denoisers. To address this challenge, we propose ECHO, an efficient diffusion-based VLM (dVLM) for chest X-ray report generation. ECHO enables stable one-step-per-block inference via a novel Direct Conditional Distillation (DCD) framework, which mitigates the mean-field limitation by constructing unfactorized supervision from on-policy diffusion trajectories to encode joint token dependencies. In addition, we introduce a Response-Asymmetric Diffusion (RAD) training strategy that further improves training efficiency while maintaining model effectiveness. Extensive experiments demonstrate that ECHO surpasses state-of-the-art autoregressive methods, improving RaTE and SemScore by 64.33\% and 60.58\% respectively, while achieving an 8times inference speedup without compromising clinical accuracy.

Point-adjustment (PA), for years the default scoring protocol in time-series anomaly detection (TSAD), was shown by Kim et al. (2022) to award near-perfect F1 to random anomaly scores. The field adopted a suite of replacement metrics (PA%K, range-based precision/recall, affiliation precision/recall, and Volume-Under-the-Surface, VUS, ROC/PR). We ask, independently and adversarially, whether these resist no-skill detectors on real benchmarks, and find the answer turns entirely on one overlooked variable: N, the number of random attempts an adversary reports the best of. Under a single honest run (N=1), not one replacement metric is gameable on any of six benchmarks (UCR, SMD, SMAP, MSL, NAB, PSM): a random detector reaches 90% of the best real detector's score on at most 11% of series for affiliation-F1, 5% for the ROC family, and 2% for the PR-based metrics and PA%K. But under best-of-N reporting, the seed-shopping endemic to ML, the metrics split sharply. affiliation-F1 and every ROC-based metric inflate steeply, affiliation crossing gameable (25% of series) by N=3 and reaching 0.98 at the full pool (N=41), the ROC family crossing by N=9-11; the PR-based metrics and PA%K stay near-flat at every N, floored near the anomaly prevalence (the lone exception is NAB at large N). A paired test finds VUS-ROC inflated on 131 series where its sibling VUS-PR is not, and never the reverse. The ROC-vs-PR split follows from the order-statistic behaviour of AUC under extreme class imbalance (a random PR-AUC is floored at prevalence); affiliation inflates by a second route, its extreme single-run leniency (already fragile at N=1). We release a pip-installable stress-test harness, and recommend reporting single-run scores or disclosing N and preferring PR-based metrics, which resist best-of-N inflation on nearly every benchmark.

Latent variable (LV) models are widely used in psychological research to investigate relationships among unobservable constructs. When one-stage estimation of the overall LV model is challenging, two-stage factor score regression (FSR) serves as a convenient alternative: the measurement model is fitted to obtain factor scores in the first stage, which are then used to fit the structural model in the subsequent stage. However, naive application of FSR is known to yield biased estimates of structural parameters. In this paper, we develop a generic bias-correction framework for two-stage estimation of parametric statistical models and tailor it specifically to FSR. Unlike existing bias-corrected FSR solutions, the proposed method applies to a broader class of LV models and does not require computing specific types of factor scores. We establish the root-n consistency of the proposed bias-corrected two-stage estimator under mild regularity conditions. To ensure broad applicability and minimize reliance on complex analytical derivations, we introduce a stochastic approximation algorithm for point estimation and a Monte Carlo-based procedure for variance estimation. In a sequence of Monte Carlo experiments, we demonstrate that the bias-corrected FSR estimator performs comparably to the ``gold standard'' one-stage maximum likelihood estimator. These results suggest that our approach offers a straightforward yet effective alternative for estimating LV models.