Daily Papers

Healthcare agents must transform longitudinal clinical evidence into reliable actions through heterogeneous tools and stateful workflows, conditions under which model-centric systems may lose context, misuse tools, fail to verify consequential transitions, or cross authorization boundaries. Existing medical-agent benchmarks primarily emphasize terminal task outcomes, making it difficult to determine whether execution failures arise from the agent model, the runtime harness, or their interaction. We present the Medical Harness Protocol, an outcome-preserving framework that independently evaluates seven healthcare-specific process dimensions: Care Action Fulfillment, Clinical Resource Competence, Patient-Evidence Alignment, Clinical Workflow Continuity, Clinical Auditability, Closed-Loop Verification, and Clinical Conduct Boundaries. A normalized intervention trace further tracks whether runtime support is available, activated, delivered, adopted by the agent, and propagated into subsequent behavior. We instantiate the protocol as MedHarnessBench, comprising 342 executable tasks across FHIR/EHR operations, healthcare-administration interfaces, and multimodal clinical tools. Across more than 16,000 controlled task executions, MedHarness yields broad improvements in terminal task success, intermediate subtask completion, and healthcare-specific process quality. We further evaluate MedHarness against multiple general-purpose harnesses and use controlled single-fault perturbations to verify the sensitivity and discrimination of the seven-dimensional evaluation. These results demonstrate that healthcare-specific runtime support can substantially improve both task completion and execution quality, while revealing failures that terminal outcomes alone cannot capture. Code and resources are available at https://github.com/Tomry1114/Awesome-Agent-Harness-for-Healthcare.

Reusing pretrained medical-imaging models offers an alternative to training from scratch. A model trained for the same task may perform poorly at a new hospital because imaging protocols and preprocessing differ. Effective adaptation depends on the model architecture, domain shift, and available labels and compute. Adaptation can improve scores on a small labeled set yet reduce performance on unseen data. We present MedAdaptAgent, an automatic harness that turns a supplied model, target data, and a free-text request into a new-site adaptation workflow. Its LLM-driven Adaptation Planner uses model-site evidence to choose compatible experiments and revise subsequent adjustments. The harness requires evidence of improvement over the pretrained model, then delivers the selected model as a complete, runnable package. Evaluation spans 26 segmentation and classification transfers across architectures and compute settings, with segmentation annotation budgets ranging from zero-shot transfer to few-shot adaptation. With 20 local annotations, mean segmentation Dice rises from 0.483 to 0.774 across 10 transfers, a 60.1% relative gain, with no harmful replacements. Mean classification AUROC rises from 0.810 to 0.837 across 13 transfers, a 3.4% relative gain. Comparing adapted models with the pretrained model reduces harmful classification replacements by 30.8% versus selecting the highest-scoring model on the available labels, using identical candidates. Seven public-model deployments demonstrate adaptation and reproducible package delivery across contrast and modality shifts. A CT-to-MRI study extends the evaluation to four LLM planners, including two open-weight models. We release the code on GitHub.

We revisit the evaluation of automatic harness evolution for LLM agents. Existing harness evolution methods use unit test cases to search for harness configurations and then report final performance on the same public benchmark. This protocol raises two fundamental concerns. First, harness evolution is itself an iterative search procedure that repeatedly evaluates and revises candidate harnesses using task feedback. As in agentic test-time scaling, it should therefore be compared with simple task-level search baselines under matched feedback and inference budgets to determine whether its gains arise from improved harness design or from additional search alone. Second, because the search and the final evaluation share the same benchmark, the reported gains risk overfitting to that specific task set. To address these concerns, we conduct an extensive evaluation comparing harness evolution with simple test-time scaling and discovery baselines under comparable feedback and inference budgets, and also evaluate evolved harnesses on held-out tasks to assess whether the discovered improvements generalize. Experiments on Terminal-Bench 2.1 with GPT-5.4 and Claude Opus 4.6 show that automatic harness evolution does not consistently outperform simple test-time scaling methods and exhibits limited generalization. Our results raise important questions about the effectiveness of automatic harness evolution and highlight the need for fairer evaluation protocols and benchmarks for automatic harness design. Our code is available at https://github.com/rethinking-harness-evolution.

As the performance of large language models (LLMs) continues to advance, their adoption is expanding across a wide range of domains, including the medical field. The integration of LLMs into medical applications raises critical safety concerns, particularly due to their use by users with diverse roles, e.g. patients and clinicians, and the potential for model's outputs to directly affect human health. Despite the domain-specific capabilities of medical LLMs, prior safety evaluations have largely focused only on general safety benchmarks. In this paper, we introduce a safety evaluation protocol tailored to the medical domain in both patient user and clinician user perspectives, alongside general safety assessments and quantitatively analyze the safety of medical LLMs. We bridge a gap in the literature by building the PatientSafetyBench containing 466 samples over 5 critical categories to measure safety from the perspective of the patient. We apply our red-teaming protocols on the MediPhi model collection as a case study. To our knowledge, this is the first work to define safety evaluation criteria for medical LLMs through targeted red-teaming taking three different points of view - patient, clinician, and general user - establishing a foundation for safer deployment in medical domains.

An LLM agent's real-task performance is shaped as much by the harness around its model as by the frozen model itself: its prompts, injected knowledge, runtime control, and configuration. In deployment the harness is often the only lever available, so improving it automatically is the natural way to raise performance without touching the weights. The hard part is not generating changes but knowing which one truly helped. Self-generated feedback is noisy, and an apparent gain can be a measurement artifact or an edit that merely overfits the tasks it was tuned on. We present a self-evolving agent-harness framework that separates proposing changes from crediting them: a language model diagnoses failures and proposes patches, while all sampling, measurement, and significance testing are owned by deterministic code, so every credited improvement is trustworthy by construction. Patches populate a gated, categorical quality-diversity archive (GSME) keyed on the (WHERE x WHY) pathology an edit addresses rather than the tasks it fixes, an anti-overfitting inductive bias; generalization is measured on a sealed test scored only after evolution. Across seven domains with a frozen open-weight model, the harness is train-selected and scored once on a sealed test; its credited gains there are +9 to +15.5pp and retain 86-147% of the training gain, evidence they generalize rather than overfit. The winning patch tracks the model's dominant pathology, not its size or family: changing the model can change the pathology and the patch, while the same pathology-to-patch match recurs across two model families. What transfers is the diagnose-and-credit loop, not any specific harness.

Large language models (LLMs) are increasingly used for medical and health-related questions, yet their safety in high-risk medical scenarios remains poorly understood. We introduce MedHarmCode and data will be released upon acceptance. Due to the sensitive nature of high-risk medical queries, data access will be available to qualified researchers upon request., a high-risk medical safety benchmark with 1,100 medically grounded queries across 10 safety-critical categories, including toxicology, pharmacology, covert poisoning, anesthesia, and fetal harm. Unlike broad medical QA benchmarks, MedHarm targets realistic clinical, educational, and technical prompts that require refusal, caution, or safe redirection rather than direct helpfulness. We evaluate 15 LLMs spanning general-purpose, medical-purpose, closed-source, and downstream SFT models, together with 4 representative guardrail models. Results reveal a substantial gap between apparent alignment and medical safety: aligned models can still produce unsafe or actionable responses, medical fine-tuning can amplify harmful specificity, and external guardrails reduce some failures while introducing brittle blocking and weak safe helpfulness. These findings show that medical safety cannot be inferred from general alignment or medical capability alone, highlighting the need for domain-specific stress testing before deploying LLMs in safety-critical medical applications.

Evaluation harnesses are software systems that orchestrate model evaluation by managing model invocation, data loading, metric computation, and result reporting. Despite their critical role in machine learning infrastructure, their operational challenges and engineering concerns have received limited attention so far. We present an empirical study of 57 evaluation harnesses, deriving a five-stage harness model and classifying 16,560 issues by workflow stage and root cause. Most harness operational challenges concentrate in the Specification stage (41.4% of issues), where harnesses integrate external models, datasets, and scoring judges. The three most frequent root causes of operational challenges are unimplemented features (24.3%), documentation gaps (20.3%), and missing input validation (17.2%), which together account for 61.7% of classified issues, spanning both defects in existing functionality and capability gaps that block intended workflows. Root causes also vary by workflow stage: environment incompatibility and external dependency breakage account for 36.2% of provisioning issues, whereas algorithmic error (25.9%) and validation gap (22.5%) dominate assessment issues. Together, these contributions establish an empirical foundation for treating evaluation engineering as a distinct software engineering concern.

AI agents are entering high-risk production settings, where they use tools, retain context, follow policies, handle private data, and interact with users over multiple turns. Yet many evaluation methods still judge isolated outputs or static tasks, missing failures that emerge through trajectory, pressure, and adversarial interaction. We introduce ProofAgent Harness, open infrastructure for scalable, auditable, and adversarial AI agent evaluation. The harness provides evaluation infrastructure around an agent: it curates evaluation intelligence, runs adversarial multi-turn trials, captures behavioral traces, applies post-hoc multi-juror scoring, resolves disagreement, and produces evidence-linked reports. Its open design allows developers and researchers to extend domains, traps, metrics, juror personas, scoring rules, and reporting formats. At its core is Adversarial Multi-Juror Scoring with Turn-Level Audit, which evaluates completed agent behavior under pressure using calibrated juror personas, consensus checks, and turn-level evidence. Experiments across customer support, medical triage, privacy and security, and code generation agents show that strong agents fail selectively through weak metrics, fragile turns, unsafe reframing, and manipulation paths. We also find that a small quantized local Harness LLM can challenge production agents powered by best-in-class large LLMs, suggesting that evaluation capability emerges from the full harness pipeline rather than model scale alone. ProofAgent Harness turns AI agent evaluation from a static score into scalable adversarial evaluation infrastructure: repeatable, evidence-backed, extensible, and actionable before deployment.

We propose RegLLM, a diagnostic harness for bounded autonomy in regulated agentic workflows. It instruments six trustworthiness signals: citation validity, source grounding, schema compliance, escalation correctness, constitutional alignment, and unsafe-action rate. Signals are distinguished by their source of supervision: programmatic verifiers, task-level escalation labels, or AI-judge scores. A deterministic runtime supervisor blocks ungrounded answers and forces escalation, logging interventions. The same domain constitution informs evaluation, training rewards, and serving guardrails. Task-level should-escalate labels make the act-versus-defer decision a measurable training signal. We demonstrate the harness at smoke scale. An offline reference run (n=12) lifts escalation recall from 0 to 0.67 and reduces unsafe-action rate from 0.33 to 0.08 when governance is enabled. Two single-GPU Qwen2.5-3B LoRA/DPO pilots (n=8, same seed and evaluation split) expose substantial variation: nominally identical RL-base configurations yield task success of 0.25 versus 0.12 and escalation recall of 1.0 versus 0.5. An answer-quality adapter changes recall from 1.0 to 0.5 in Run A, but from 0.5 to 1.0 in Run B. An escalation-aware variant produces no measurable change in Run B. These small pilots do not establish reliable adapter effects or production readiness. Their contribution is diagnostic: configuration variance can overwhelm apparent tuning effects on bounded-autonomy metrics, motivating larger evaluation sets and repeated runs.

Frontier models have collapsed the cost of writing custom code: a niche problem a specialist sees in their own domain now costs an afternoon. The cost of reviewing and maintaining that code hasn't collapsed. Each solution drifts from the next; understanding one means reading its codebase from scratch. Large enterprises build something centrally governed instead: at worst an off-the-shelf product, at best a graph-orchestration framework wired bespoke per use case, or a low-code platform used as the orchestrator. These are custom every time and limited in scope. Enterprises don't weigh a third option that escapes both constraints: the harness paradigm. Recent work treats the coding-agent harness as enterprise infrastructure rather than a coding tool, converging on three findings: harnesses suffice at the task level and outperform more elaborate architectures on enterprise work (arXiv:2604.00073, arXiv:2604.13107); harness choice accounts for most of the variance in agent benchmark results, more than model choice does (arXiv:2605.23950); and the gap between that finding and enterprise adoption is governance (arXiv:2605.10223, arXiv:2605.18747). We propose an architecture that closes that gap. One harness runs unmodified as the backbone; the code stays identical across every deployment, so reviewing what gets built collapses to reading its instructions file. Section 4 gives four mechanisms: credential-scoped tooling, where each backend gets one generic request tool and a scoped credential instead of a hand-built method; authorization logic outside the harness, so one artifact runs as a cron backbone, a chat-surface engine, and a terminal tool; registration is a side effect of pushing code, collapsing an audit a review of a text file. Built on microcc (<https://pypi.org/project/micro-cc/>), our reference harness.

LLM-as-judge ("grader") components are now standard in evaluation harnesses, including safety evaluations where a pass/fail verdict may gate downstream deployment decisions. A widespread assumption is that setting the grader's sampling temperature to 0 makes grading deterministic. We test this assumption against a real safety-evaluation codebase (Japan AISI's open-source aisev) and show it fails on two levels. First, the harness invokes its grader without setting temperature or seed; the underlying provider silently applies its default of 1.0, so items near the decision boundary flip pass/fail across identical runs (per-item disagreement up to ~50% over 20 runs). Second, pinning temperature=0 reduces but does not eliminate flips: across 690 API calls spanning two providers, three model tiers, and five sampling configurations, 1-2 of 7 borderline items remain non-reproducible even under forced greedy decoding (top_k=1). Claude Opus 4.7/4.8 has since deprecated temperature entirely, rendering the primary mitigation inapplicable to newer model generations. These findings expose a structural gap: evaluation harnesses that report single-run verdicts without variance or grader-disagreement metrics can present noise as a safety property. We release a reproduction harness (690 calls, 7 conditions) and recommend that harnesses treat grader disagreement as a first-class health metric alongside the scores themselves.

Counterfactual fairness audits of clinical language-model agents report a flip rate: how often an action changes when only the patient's demographic descriptor changes. Part of that rate is not demographic. A stochastic agent also changes its own action when nothing changes, and a flip rate cannot be interpreted without knowing how often. We measured it. Re-running one condition ten times over sixteen synthetic vignettes at default sampling changed a clinical agent's action in 8.7 percent of replicate pairs, from 2.2 percent for intensive-care escalation to 17.9 percent for controlled-substance caution, an output given no operational criteria. Across six models from five vendors, pooled floors ranged from 2.5 to 23.7 percent; in this panel neither disclosed size, vendor, nor hosting ordered them. The floor depends on the decoding configuration: majority voting over five draws removed 39 percent of it (95 percent confidence interval (CI) 18 to 64); at temperature 0 three of four locally served models showed no disagreement, but a hosted model still did. We also show that, for a binary action, the flip rate expected under no demographic effect equals the floor and a real effect adds only its square, so a flip rate inside the floor is not evidence of fairness, and direction must be tested with a signed paired test. We give a four-step reporting procedure and release FairMedAgent, the harness, with its protocol, vignettes and analysis scripts, so any team can measure the floor for its own agent.

This position paper argues that, for long-horizon tasks evaluated across models with comparable frontier capability, the agent execution harness, namely the infrastructure layer that governs context construction, tool interaction, orchestration, and verification around a language model, is often a stronger determinant of agent performance than the model it wraps. We formalize and defend the Binding Constraint Thesis: in this regime, performance variance is governed more by harness configuration than by model choice, and current evaluation protocols therefore systematically misattribute harness-level gains to model improvements. We support this thesis along three lines. First, a control-theoretic formalization treats the harness as the controller of a closed-loop dynamical system and the LLM as the stochastic policy it governs, which explains why small harness changes can produce performance shifts that exceed those obtained by substituting one model for another. Second, published benchmarks, industry deployments, and a controlled variance decomposition show that harness-induced variance can substantially exceed model-induced variance, including cases of model ranking reversal. Third, we propose a harness-aware evaluation framework with a disclosure standard and a variance decomposition protocol. Until harness specifications are disclosed, leaderboard comparisons for long-horizon agents should be treated as incomplete and potentially misleading.

Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like responses across diverse contexts and adapting to novel tasks following human instructions. Their potential application spans a broad range of medical tasks, such as clinical documentation, matching patients to clinical trials, and answering medical questions. In this primer paper, we propose an actionable guideline to help healthcare professionals more efficiently utilize LLMs in their work, along with a set of best practices. This approach consists of several main phases, including formulating the task, choosing LLMs, prompt engineering, fine-tuning, and deployment. We start with the discussion of critical considerations in identifying healthcare tasks that align with the core capabilities of LLMs and selecting models based on the selected task and data, performance requirements, and model interface. We then review the strategies, such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized medical tasks. Deployment considerations, including regulatory compliance, ethical guidelines, and continuous monitoring for fairness and bias, are also discussed. By providing a structured step-by-step methodology, this tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.

Large language models are increasingly deployed through agent harnesses that manage tools, extensions, persistent state, permissions, and external actions. Existing safety benchmarks mainly target individual attack mechanisms or a limited subset of operational settings, making it difficult to compare how safety failures emerge across different harness responsibilities. We present HarnessRisk, a lifecycle oriented benchmark that organizes agent harness safety into six operational phases including Harness Configuration, Capability Extension, Runtime Operation, State Persistence, Action Control, and Incident Recovery. HarnessRisk contains 128 sandboxed cases, each pairing a benign user objective with an adversarial instruction embedded in an untrusted workflow artifact. We evaluate each trajectory using Utility, Attack Success Rate, Persistence, and Detection. Across three harnesses, six language models, and 14 model and harness configurations, attack success ranges from 12.6% to 80.9%, while Utility remains between 75.0% and 97.6%. Harness Configuration is the most vulnerable phase across all three harnesses, showing that attacks can succeed by altering security sensitive parameters within otherwise authorized workflows. We also find that explicit risk recognition does not reliably lead to safe action, as some configurations detect risks in more than 90% of runs while retaining substantial attack success. These results highlight the need to evaluate agent safety across multiple harness responsibilities and at the level of the deployed model and harness configuration.

Large Language Model (LLM) agents are turning language into real-world effects, making safety necessary against both indirect prompt injections and direct harmful requests. System-level safety harnesses add an enforcement layer beyond model-level defenses, but existing harnesses are usually designed once by experts and applied across heterogeneous models and domains. Effective protection is deployment-dependent: models differ in how much enforcement they need before utility declines, while domains differ in the effects, state, and action sequences that must be governed. A harness that is strict enough for one model may over-block another, and a policy that transfers across domains may miss application-specific safety relations. We present EvoSafeHarness, a safety-specific optimization framework that synthesizes a deployable harness for a frozen model in a target domain. It jointly searches a natural-language policy and executable code logic, guided by model behavior, domain specifications, and fresh-context adversarial review to reject benchmark-specific rules. Across four agent benchmark families, EvoSafeHarness achieves a stronger safety-utility frontier than fixed expert-designed defenses. On DecodingTrust-Agent, it reduces average attack success rate from 45.6% to 10.0% at a 3.3-point utility cost and achieves the best score in 14 of 15 cells. On AgentDojo, it reaches 82.8% utility at 0.0% ASR, twice CaMeL's utility at the same operating point, and transfers unchanged to unseen AgentDyn suites. It also achieves the best score on Agent-SafetyBench for every victim and keeps mean ASR below 20% under adaptive PAIR attacks with a refinement budget of 16. Analysis shows that domain semantics determine which safety relations and trajectory state are needed, while model and runtime behavior determine how and where those relations should be enforced.

The remarkable capabilities of Large Language Models (LLMs) make them increasingly compelling for adoption in real-world healthcare applications. However, the risks associated with using LLMs in medical applications have not been systematically characterized. We propose using five key principles for safe and trustworthy medical AI: Truthfulness, Resilience, Fairness, Robustness, and Privacy, along with ten specific aspects. Under this comprehensive framework, we introduce a novel MedGuard benchmark with 1,000 expert-verified questions. Our evaluation of 11 commonly used LLMs shows that the current language models, regardless of their safety alignment mechanisms, generally perform poorly on most of our benchmarks, particularly when compared to the high performance of human physicians. Despite recent reports indicate that advanced LLMs like ChatGPT can match or even exceed human performance in various medical tasks, this study underscores a significant safety gap, highlighting the crucial need for human oversight and the implementation of AI safety guardrails.

Harness development plays a crucial role in building capable AI agents. Recent approaches improve harnesses through recursive self-improvement (RSI), but their performance gains often come with higher execution costs. We introduce HarnessPro, a label-free method for evolving harnesses to improve task performance while reducing execution cost. In this setting, candidate harnesses are evaluated using LLM-generated tests without access to ground-truth solutions or official tests. Specialized agents diagnose execution trajectories, plan updates with different performance-cost priorities, and implement them as candidate harnesses. Rather than returning a single harness, HarnessPro uses normalized weighted squared-distance selection to provide cost-focused (lite), balanced (medium), and performance-focused (heavy) harnesses for different deployment budgets. Selected harnesses enter the next iteration, where execution feedback guides further updates. Our experiments cover Terminal-Bench 2, SWE-Bench Pro, and ProgramBench, using GPT-5.5 with Codex and GLM-5.2 with Claude Code. Across these benchmarks using GPT-5.5 with Codex, the heavy mode of HarnessPro achieves an average pass-rate gain of 2.0 percentage points and an average per-task cost reduction of 26.1% relative to RHO. This advantage also holds when using GLM-5.2 with Claude Code. Code is available at https://github.com/pzs19/HarnessPro

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.

We present Cogentic, a multi-agent harness for automated proof discovery on open research problems. While frontier language models can generate strong mathematical ideas in a single shot, single-shot generation is often insufficient for open problems that require exploring multiple competing conjectures, overcoming subtle technical obstructions, and retaining intermediate progress over a long horizon. Cogentic addresses these challenges through an iterative prove-verify loop in which an orchestrator allocates a population of independent provers across distinct proof directions, subjects their output to adversarial verification by several specialized components, and promotes confirmed intermediate results into a persistent verified ledger that later rounds build on. The harness is designed to be able to solve research-level math and theoretical computer science problems. Using either Gemini 3.1 Pro or an early version of Gemini 4 Argon as the base model, Cogentic produced novel results on open problems across online learning, auction theory, and mechanism design. Each result was independently verified by domain experts and is developed in full in companion papers. We list these results, and new ones as they are verified, at https://sites.google.com/view/cogentic .

Most work on improving large language models treats accuracy as the sole objective. We argue that the harness, the Python code surrounding the model that constructs prompts, routes calls, and parses outputs, is a first-class design surface whose quality is inherently multi-objective: an accurate harness that refuses no unsafe request, or that consumes an order of magnitude more tokens, is not a good harness. We present Meta-Harness, a system that casts harness design as search over three per-domain objectives (accuracy, behavioural safety, and token cost) solved by an agentic proposer (Claude Code) with full filesystem access to prior harness source, execution traces, and scoring artifacts. Our central finding is that a singlephase joint-reward proposer (MoMHa) outperforms every alternative, including a two-phase "accuracy then tokens" ablation, scalar-only feedback, and an accuracy-only baseline. We evaluate on seventeen domains: seven synthetic capability suites, seven real-world public benchmarks (HumanEval, MBPP, Spider, FEVER, MMLU-Pro, LawBench, NuminaMath), and three U-SafeBench-derived user-specific safety domains, using a 12-model fleet spanning four families. On the synthetic track MoMHa achieves a joint mean of 0.482 versus 0.198-0.422 for ten baselines, winning 7 / 10 per-domain columns; on the real-world track it scores 0.461 versus 0.377 for the strongest baseline (DSPy), winning 5/7 columns, demonstrating that harness strategies transfer to unseen benchmarks without retraining on 8 of 12 target models. MoMHa attains the highest measured behavioral safety composite (U-SafeBench, 0.781) and uses 95 fewer tokens per example than the two-phase alternative. We will release all harness code, evaluation infrastructure, and crossmodel logs.

With the advent of Large Language Models (LLMs), medical artificial intelligence (AI) has experienced substantial technological progress and paradigm shifts, highlighting the potential of LLMs to streamline healthcare delivery and improve patient outcomes. Considering this rapid technical progress, in this survey, we trace the recent advances of Medical Large Language Models (Med-LLMs), including the background, key findings, and mainstream techniques, especially for the evolution from general-purpose models to medical-specialized applications. Firstly, we delve into the foundational technology of Med-LLMs, indicating how general models can be progressively adapted and refined for the complicated medical tasks. Secondly, the wide-ranging applications of Med-LLMs are investigated across various healthcare domains, as well as an up-to-date review of existing Med-LLMs. The transformative impact of these models on daily medical practice is evident through their ability to assist clinicians, educators, and patients. Recognizing the importance of responsible innovation, we discuss the challenges associated with ensuring fairness, accountability, privacy, and robustness. Ethical considerations, rigorous evaluation methodologies, and the establishment of regulatory frameworks are crucial for building trustworthiness in the real-world system. We emphasize the need for ongoing scrutiny and development to maintain high standards of safety and reliability. Finally, we anticipate possible future trajectories for Med-LLMs, identifying key avenues for prudent expansion. By consolidating these insights, our review aims to provide professionals and researchers with a thorough understanding of the strengths and limitations of Med-LLMs, fostering a balanced and ethical approach to their integration into the healthcare ecosystem.

End-to-end automation of realistic healthcare operations stresses three capabilities underrepresented in current benchmarks: policy density, decisions must be grounded in a large library of medical, insurance, and operational rules; Multi-role composition: a single task requires the agent to play multiple roles with handoffs; and multilateral interaction: intermediate workflow steps are multi-turn dialogs, such as peer-to-peer review and patient outreach. We introduce χ-Bench, a benchmark of long-horizon healthcare workflows across three domains: provider prior authorization, payer utilization management, and care management. Each task hands the agent a clinical case in a high-fidelity simulator of 20 healthcare apps exposed via 87 MCP tools, which it must drive to a terminal status through tool calls and writing the role's artifacts, guided by a 1,290+ document managed-care operations handbook skill. Across 30 agent harness/models configurations, the best agent resolves only 28.0% of tasks, no agent clears 20% on strict pass^3, and executing all tasks in a single session slumps the performance to 3.8%. These results raise the hypothesis that similar gaps are likely to surface in other policy-dense, role-composed, irreversible enterprise domains.

The deployment of Large Language Models (LLMs) for structuring clinical data is critically hindered by their tendency to hallucinate facts and their inability to follow domain-specific rules. To address this, we introduce MedPAO, a novel agentic framework that ensures accuracy and verifiable reasoning by grounding its operation in established clinical protocols such as the ABCDEF protocol for CXR analysis. MedPAO decomposes the report structuring task into a transparent process managed by a Plan-Act-Observe (PAO) loop and specialized tools. This protocol-driven method provides a verifiable alternative to opaque, monolithic models. The efficacy of our approach is demonstrated through rigorous evaluation: MedPAO achieves an F1-score of 0.96 on the critical sub-task of concept categorization. Notably, expert radiologists and clinicians rated the final structured outputs with an average score of 4.52 out of 5, indicating a level of reliability that surpasses baseline approaches relying solely on LLM-based foundation models. The code is available at: https://github.com/MiRL-IITM/medpao-agent

Purpose: Surgical performance depends not only on surgeons' technical skills but also on team communication within and across the different professional groups present during the operation. Therefore, automatically identifying team communication in the OR is crucial for patient safety and advances in the development of computer-assisted surgical workflow analysis and intra-operative support systems. To take the first step, we propose a new task of detecting communication briefings involving all OR team members, i.e. the team Time-out and the StOP?-protocol, by localizing their start and end times in video recordings of surgical operations. Methods: We generate an OR dataset of real surgeries, called Team-OR, with more than one hundred hours of surgical videos captured by the multi-view camera system in the OR. The dataset contains temporal annotations of 33 Time-out and 22 StOP?-protocol activities in total. We then propose a novel group activity detection approach, where we encode both scene context and action features, and use an efficient neural network model to output the results. Results: The experimental results on the Team-OR dataset show that our approach outperforms existing state-of-the-art temporal action detection approaches. It also demonstrates the lack of research on group activities in the OR, proving the significance of our dataset. Conclusion: We investigate the Team Time-Out and the StOP?-protocol in the OR, by presenting the first OR dataset with temporal annotations of group activities protocols, and introducing a novel group activity detection approach that outperforms existing approaches. Code is available at https://github.com/CAMMA-public/Team-OR.

Large Language Models (LLMs) and Retrieval-Augmented Generation (RAG) systems are increasingly integrated into clinical workflows; however, prompt injection attacks can steer these systems toward clinically unsafe or misleading outputs. We introduce the Medical Prompt Injection Benchmark (MPIB), a dataset-and-benchmark suite for evaluating clinical safety under both direct prompt injection and indirect, RAG-mediated injection across clinically grounded tasks. MPIB emphasizes outcome-level risk via the Clinical Harm Event Rate (CHER), which measures high-severity clinical harm events under a clinically grounded taxonomy, and reports CHER alongside Attack Success Rate (ASR) to disentangle instruction compliance from downstream patient risk. The benchmark comprises 9,697 curated instances constructed through multi-stage quality gates and clinical safety linting. Evaluating MPIB across a diverse set of baseline LLMs and defense configurations, we find that ASR and CHER can diverge substantially, and that robustness depends critically on whether adversarial instructions appear in the user query or in retrieved context. We release MPIB with evaluation code, adversarial baselines, and comprehensive documentation to support reproducible and systematic research on clinical prompt injection. Code and data are available at GitHub (code) and Hugging Face (data).

Large language models(LLMs) increasingly match expert performance on licensing examinations, yet routine clinical use remains limited because governance requires auditable reasoning, safety and ethics alignment, and resilience to adversarial misuse. Here we present SafeMed-R1, trained with a traceable Clinical Trust Signals(CTS) pipeline that links each reasoning instance to clinician rubric scores and edit histories, and aligned through safety and ethics supervision and red team stress testing. SafeMed-R1 attains a macro-averaged accuracy of 79.6% across clinical benchmarks. Under adversarial safety testing, it shows the lowest aggregated risk and reduces unsafe outputs by about 3 to 5% relative to its baseline. In a paired expert study of 30 medication safety vignettes, SafeMed-R1 matches PGY1 and PGY2 residents on medical correctness and scores higher for medication safety, guideline consistency, and clinical usefulness. Collectively, these results suggest that clinician-audited supervision provenance, together with domain-tailored safety and ethics alignment, can strengthen governance-relevant evidence without relying on inference-time retrieval or citation grounding.

Training coding agents typically updates the policy while keeping the harness fixed. During training, trajectories reveal flawed repair strategies and interaction problems that vary across tasks and change as the policy learns. We introduce HarnessAdapt-RL, which trains the policy and adapts its harness during reinforcement learning. For flawed repair strategies, a frozen teacher generates task-specific mechanism-level skills. For interaction problems recurring across tasks, a separate teacher model evolves tools and hooks, keeping each change only if it improves the observed pass rate or the observed trainable rate without lowering either. The policy trains with the adapted harness, and its new trajectories guide further adaptation. With a 9B base model, HarnessAdapt-RL improves pass@1 over GRPO by 9.8, 12.6, and 6.4 percentage points on SWE-bench Verified, Multilingual, and Pro, and outperforms GRPO with the human-designed OpenHands harness. Gains from mechanism-level skills persist after their removal at evaluation. Re-evolving tools and hooks as the policy changes outperforms freezing early versions. Removing them at deployment, in contrast, costs up to 7.7 percentage points. Training therefore produces a model-harness pair: the trained policy and the evolved tools and hooks, with skills removed at deployment.

Agent harnesses, the external systems that mediate model-environment interaction, can substantially improve agent performance, but their gains remain tied to the harness at deployment. Because the best harness varies across domains, instances, and models, a general-purpose agent must either settle for a suboptimal shared harness or route among an ever-growing set of specialized ones. We therefore study agent harness distillation: using a domain- or instance-optimized harness as training-time guidance and transferring the behaviors it induces into model weights, so that its gains survive under a single fixed target harness. The challenge is that the two harnesses differ in action space and available information, so guidance from the optimized harness cannot serve directly as supervision for the target one. We introduce Harness-Zero, which enables harness distillation through agent-as-harness. Guided by the optimized harness, a harnessing agent corrects student responses before execution in the target harness's action space, turning harness guidance into training demonstrations. Fine-tuning on the resulting trajectories internalizes harness-induced behavior into the model, so the specialized harness can be removed at deployment. Our experiments spanning knowledge work, tool use, and science domains show that: (1) For frontier LLMs using the same evolved harness, agent-as-harness outperforms code-as-harness. (2) With the specialized harness removed at deployment, Harness-Zero improves the base model's macro-average task success from 23.3% to 44.3%, even exceeding the 41.7% it reaches with that harness still attached. (3) Harness-Zero recovers harness-induced behaviors absent from the base model, with 82.3% average recovery across 28 patterns in the three domains.

Large language models (LLMs) are increasingly used for health-related advice. Existing research measures their safety with static questions rather than pressured patient-facing conversations. We introduce MedPRESS, a multi-turn benchmark for measuring patient-pressure-induced sycophancy in LLMs. MedPRESS contains 600 medically grounded five-turn dialogues across three scenario families: medication and treatment demand, personal health self-care, and symptom triage and care resistance. Each dialogue begins with a health query and escalates through personal experience, social proof, external evidence claims, and direct adversarial challenge. We evaluate 20 LLMs across general, medical-domain, lightweight, large, open-weight, and proprietary families using structured judging and safety-focused metrics. Results show that models frequently shift toward unsafe agreement under repeated patient pressure, with substantial variation across model families, model scale, and prompt type. Anti-sycophancy prompting improves robustness for several models, but does not eliminate unsafe agreement. MedPRESS highlights a critical gap in medical LLM evaluation: safe medical knowledge is not enough unless models can maintain it under conversational pressure.

LLM agents increasingly run inside execution harnesses that dispatch tools, allocate resources, and route messages between specialized components. However, a harness can return a correct, benign answer over a trajectory that accesses unauthorized resources or leaks context to the wrong agent. Output-level evaluation cannot see these failures, yet most safety benchmarks score only final outputs or terminal states, even though many violations occur mid-trajectory rather than at termination. The central question is whether the harness respects user intent, permission boundaries, and information-flow constraints throughout execution. To address this gap, we propose HarnessAudit, a framework that audits full execution trajectories across boundary compliance, execution fidelity, and system stability, with a focus on multi-agent harnesses where these risks are most pronounced. We further introduce HarnessAudit-Bench, a benchmark of 210 tasks across eight real-world domains, instantiated in both single-agent and multi-agent configurations with embedded safety constraints. Evaluating ten harness configurations across frontier models and three multi-agent frameworks, we find that: (i) task completion is misaligned with safe execution, and violations accumulate with trajectory length; (ii) safety risks vary across domains, task types, and agent roles; (iii) most violations concentrate in resource access and inter-agent information transfer; and (iv) multi-agent collaboration expands the safety risk surface, while harness design sets the upper bound of safe deployment.

Clinical protocol-execution tasks -- checking a lab value, applying a threshold, placing a correctly structured FHIR order -- are natural candidates for RL from world feedback: once clinical SMEs encode decision logic into a verifier, that verifier grades unlimited rollouts without per-episode annotation. But applying RL requires a sound feedback channel and sufficient base capability. We audit MedAgentBench v1/v2, find a 41.7\% silent-finish ceiling that makes inaction the RL dominant strategy, and construct MedAgentBench-v3 (MAB-v3) (508 tasks, 8.9\% ceiling). Training Qwen3-8B exposes two structural barriers: a capability ceiling (10/20 task types have 0\% base performance, zero gradient) and a format-knowledge barrier (3/20 types require exact clinical codes undiscoverable by exploration). Pure RL reaches 18.2\% pass@1 vs.\ 34.1\% for rule-based SFT; the 15.9~pp gap is attributable entirely to these barriers. A decision/format-knowledge/lookup taxonomy predicts RL learnability and prescribes the fix: SFT to inject codes, RL to learn conditionals.

Background: Agent skills are increasingly deployed as modular, reusable capability units in AI agent systems. Medical research agent skills require safeguards beyond general-purpose evaluation, including scientific integrity, methodological validity, reproducibility, and boundary safety. This study developed and preliminarily evaluated a domain-specific audit framework for medical research agent skills, with a focus on reliability against expert review. Methods: We developed MedSkillAudit (skill-auditor@1.0), a layered framework assessing skill release readiness before deployment. We evaluated 75 skills across five medical research categories (15 per category). Two experts independently assigned a quality score (0-100), an ordinal release disposition (Production Ready / Limited Release / Beta Only / Reject), and a high-risk failure flag. System-expert agreement was quantified using ICC(2,1) and linearly weighted Cohen's kappa, benchmarked against the human inter-rater baseline. Results: The mean consensus quality score was 72.4 (SD = 13.0); 57.3% of skills fell below the Limited Release threshold. MedSkillAudit achieved ICC(2,1) = 0.449 (95% CI: 0.250-0.610), exceeding the human inter-rater ICC of 0.300. System-consensus score divergence (SD = 9.5) was smaller than inter-expert divergence (SD = 12.4), with no directional bias (Wilcoxon p = 0.613). Protocol Design showed the strongest category-level agreement (ICC = 0.551); Academic Writing showed a negative ICC (-0.567), reflecting a structural rubric-expert mismatch. Conclusions: Domain-specific pre-deployment audit may provide a practical foundation for governing medical research agent skills, complementing general-purpose quality checks with structured audit workflows tailored to scientific use cases.

With the advent of Vision-Language Models (VLMs), medical artificial intelligence (AI) has experienced significant technological progress and paradigm shifts. This survey provides an extensive review of recent advancements in Medical Vision-Language Models (Med-VLMs), which integrate visual and textual data to enhance healthcare outcomes. We discuss the foundational technology behind Med-VLMs, illustrating how general models are adapted for complex medical tasks, and examine their applications in healthcare. The transformative impact of Med-VLMs on clinical practice, education, and patient care is highlighted, alongside challenges such as data scarcity, narrow task generalization, interpretability issues, and ethical concerns like fairness, accountability, and privacy. These limitations are exacerbated by uneven dataset distribution, computational demands, and regulatory hurdles. Rigorous evaluation methods and robust regulatory frameworks are essential for safe integration into healthcare workflows. Future directions include leveraging large-scale, diverse datasets, improving cross-modal generalization, and enhancing interpretability. Innovations like federated learning, lightweight architectures, and Electronic Health Record (EHR) integration are explored as pathways to democratize access and improve clinical relevance. This review aims to provide a comprehensive understanding of Med-VLMs' strengths and limitations, fostering their ethical and balanced adoption in healthcare.

LLM agents have begun to find real security vulnerabilities that human auditors and automated fuzzers missed for decades, in source-available targets where the analyst can build and instrument the code. In practice the work is split among several agents, wired together by a harness: the program that fixes which roles exist, how they pass information, which tools each may call, and how retries are coordinated. When the language model is held fixed, changing only the harness can still change success rates by several-fold on public agent benchmarks, yet most harnesses are written by hand; recent harness optimizers each search only a narrow slice of the design space and rely on coarse pass/fail feedback that gives no diagnostic signal about why a trial failed. AgentFlow addresses both limitations with a typed graph DSL whose search space jointly covers agent roles, prompts, tools, communication topology, and coordination protocol, paired with a feedback-driven outer loop that reads runtime signals from the target program itself to diagnose which part of the harness caused the failure and rewrite it accordingly. We evaluate AgentFlow on TerminalBench-2 with Claude Opus 4.6 and on Google Chrome with Kimi K2.5. AgentFlow reaches 84.3% on TerminalBench-2, the highest score in the public leaderboard snapshot we evaluate against, and discovers ten previously unknown zero-day vulnerabilities in Google Chrome, including two Critical sandbox-escape vulnerabilities (CVE-2026-5280 and CVE-2026-6297).

Synthetic Data Generation (SDG) based on Artificial Intelligence (AI) can transform the way clinical medicine is delivered by overcoming privacy barriers that currently render clinical data sharing difficult. This is the key to accelerating the development of digital tools contributing to enhanced patient safety. Such tools include robust data-driven clinical decision support systems, and example-based digital training tools that will enable healthcare professionals to improve their diagnostic performance for enhanced patient safety. This study focuses on the clinical evaluation of medical SDG, with a proof-of-concept investigation on diagnosing Inflammatory Bowel Disease (IBD) using Wireless Capsule Endoscopy (WCE) images. Its scientific contributions include a) a novel protocol for the systematic Clinical Evaluation of Medical Image Synthesis (CEMIS); b) a novel variational autoencoder-based model for the generation of high-resolution synthetic WCE images; and c) a comprehensive evaluation of the synthetic images using the CEMIS protocol by 10 international WCE specialists, in terms of image quality, diversity, and realism, as well as their utility for clinical decision-making. The results show that TIDE-II generates clinically plausible, very realistic WCE images, of improved quality compared to relevant state-of-the-art generative models. Concludingly, CEMIS can serve as a reference for future research on medical image-generation techniques, while the adaptation/extension of the architecture of TIDE-II to other imaging domains can be promising.

Post-training agents for automated AI research requires optimizing not only model parameters, but also the runtime harness that shapes how research trajectories are generated, evaluated, and learned from. Existing pipelines typically train models under a fixed harness, including prompts, tools, skills, middleware, and memory, while leaving the data-generating process outside the optimization objective. This creates a mismatch between model updates and the static scaffolding that determines trajectory quality. We introduce Co-Harness, a framework that jointly optimizes the agent harness and model parameters during post-training. Co-Harness alternates between harness optimization and model optimization. An LLM-based HarnessCritic analyzes failed trajectories, identifies harness-level failure modes, and proposes validated local updates. The model is then fine-tuned on high-quality trajectories generated by the improved harness, distilling effective scaffolding into model parameters. A 200+ hour autonomous case study further shows that Co-Harness can recover from system crashes, improve inference efficiency, and discover ensemble strategies without human intervention. These results suggest that joint harness and model optimization is an effective way to improve agents beyond fixed-harness post-training.

Following clinical decision pathways (CDPs) defined by clinical practice guidelines is essential for safe and reliable medical decision-making. However, existing medical large language model (LLM) benchmarks mainly evaluate final-answer accuracy, providing limited evaluation of models' ability to adhere to guidelines. To address this gap, we introduce MEGA-CDP, a benchmark for evaluating whether medical LLMs can generate guideline-adherent CDPs using provided guidelines as references. MEGA-CDP is constructed from 2,274 English and Chinese clinical practice guidelines through a guideline-to-case pipeline, yielding 42,353 clinical cases with explicit reference CDPs. It supports both single-turn vignette and multi-turn interactive settings, and introduces a CDP-oriented evaluation framework for measuring pathway consistency. Experiments on 16 representative LLMs show that reliable clinical decision support remains challenging for current models, demonstrating the need for CDP-oriented evaluation and the value of MEGA-CDP for advancing guideline adherence in medical LLMs.

With the growing use of language models (LMs) in clinical environments, there is an immediate need to evaluate the accuracy and safety of LM-generated medical text. Currently, such evaluation relies solely on manual physician review. However, detecting errors in LM-generated text is challenging because 1) manual review is costly and 2) expert-composed reference outputs are often unavailable in real-world settings. While the "LM-as-judge" paradigm (a LM evaluating another LM) offers scalable evaluation, even frontier LMs can miss subtle but clinically significant errors. To address these challenges, we propose MedVAL, a self-supervised framework that leverages synthetic data to train evaluator LMs to assess whether LM-generated medical outputs are factually consistent with inputs, without requiring physician labels or reference outputs. To evaluate LM performance, we introduce MedVAL-Bench, a dataset containing 840 outputs annotated by physicians, following a physician-defined taxonomy of risk levels and error categories. Across 6 diverse medical tasks and 10 state-of-the-art LMs spanning open-source, proprietary, and medically adapted models, MedVAL fine-tuning significantly improves (p < 0.001) alignment with physicians on both seen and unseen tasks, increasing average F1 scores from 66% to 83%, with per-sample safety classification scores up to 86%. MedVAL improves the performance of even the best-performing proprietary LM (GPT-4o) by 8%. To support a scalable, risk-aware pathway towards clinical integration, we open-source the 1) codebase ( https://github.com/StanfordMIMI/MedVAL ), 2) MedVAL-Bench ( https://huggingface.co/datasets/stanfordmimi/MedVAL-Bench ), and 3) MedVAL-4B ( https://huggingface.co/stanfordmimi/MedVAL-4B ), the best-performing open-source LM. Our research provides the first evidence of LMs approaching expert-level validation ability for medical text.

Introduction: Mechanical thrombectomy can cause vessel deformation and procedure-related injury. Benchtop models are widely used for device testing, but time-resolved, full-field 3D vessel-motion measurements remain limited. Methods: We developed a nine-camera, low-cost multi-view workflow for benchtop thrombectomy in silicone middle cerebral artery phantoms (2160p, 20 fps). Multi-view videos were calibrated, segmented, and reconstructed with 4D Gaussian Splatting. Reconstructed point clouds were converted to fixed-connectivity edge graphs for region-of-interest (ROI) displacement tracking and a relative surface-based stress proxy. Stress-proxy values were derived from edge stretch using a Neo-Hookean mapping and reported as comparative surface metrics. A synthetic Blender pipeline with known deformation provided geometric and temporal validation. Results: In synthetic bulk translation, the stress proxy remained near zero for most edges (median approx 0 MPa; 90th percentile 0.028 MPa), with sparse outliers. In synthetic pulling (1-5 mm), reconstruction showed close geometric and temporal agreement with ground truth, with symmetric Chamfer distance of 1.714-1.815 mm and precision of 0.964-0.972 at τ= 1 mm. In preliminary benchtop comparative trials (one trial per condition), cervical aspiration catheter placement showed higher max-median ROI displacement and stress-proxy values than internal carotid artery terminus placement. Conclusion: The proposed protocol provides standardized, time-resolved surface kinematics and comparative relative displacement and stress proxy measurements for thrombectomy benchtop studies. The framework supports condition-to-condition comparisons and methods validation, while remaining distinct from absolute wall-stress estimation. Implementation code and example data are available at https://ethanuser.github.io/vessel4D

Recent advances in video generation have shown remarkable progress in open-domain settings, yet medical video generation remains largely underexplored. Medical videos are critical for applications such as clinical training, education, and simulation, requiring not only high visual fidelity but also strict medical accuracy. However, current models often produce unrealistic or erroneous content when applied to medical prompts, largely due to the lack of large-scale, high-quality datasets tailored to the medical domain. To address this gap, we introduce MedVideoCap-55K, the first large-scale, diverse, and caption-rich dataset for medical video generation. It comprises over 55,000 curated clips spanning real-world medical scenarios, providing a strong foundation for training generalist medical video generation models. Built upon this dataset, we develop MedGen, which achieves leading performance among open-source models and rivals commercial systems across multiple benchmarks in both visual quality and medical accuracy. We hope our dataset and model can serve as a valuable resource and help catalyze further research in medical video generation. Our code and data is available at https://github.com/FreedomIntelligence/MedGen

Text-guided image editors can now manipulate authentic medical scans with high fidelity, enabling lesion implantation/removal that threatens clinical trust and safety. Existing defenses are inadequate for healthcare. Medical detectors are largely black-box, while MLLM-based explainers are typically post-hoc, lack medical expertise, and may hallucinate evidence on ambiguous cases. We present MedForge, a data-and-method solution for pre-hoc, evidence-grounded medical forgery detection. We introduce MedForge-90K, a large-scale benchmark of realistic lesion edits across 19 pathologies with expert-guided reasoning supervision via doctor inspection guidelines and gold edit locations. Building on it, MedForge-Reasoner performs localize-then-analyze reasoning, predicting suspicious regions before producing a verdict, and is further aligned with Forgery-aware GSPO to strengthen grounding and reduce hallucinations. Experiments demonstrate state-of-the-art detection accuracy and trustworthy, expert-aligned explanations.

Agent performance increasingly depends on harness engineering, yet harness design is usually buried in controller code and runtime-specific conventions, making it hard to transfer, compare, and study as a scientific object. We ask whether the high-level control logic of an agent harness can instead be externalized as a portable executable artifact. We introduce Natural-Language Agent Harnesses (NLAHs), which express harness behavior in editable natural language, and Intelligent Harness Runtime (IHR), a shared runtime that executes these harnesses through explicit contracts, durable artifacts, and lightweight adapters. Across coding and computer-use benchmarks, we conduct controlled evaluations of operational viability, module ablation, and code-to-text harness migration.

Industry standards require medical device manufacturers to perform implant-induced artefact testing in phantoms at a pre-clinical stage to define the extent of artefacts that can be expected during MRI. Once a device is commercially available, studies on volunteers, cadavers or patients are performed to investigate implant-induced artefacts and artefact reduction methods more in-depth. This study describes the design and evaluation of a realistic head phantom for pre-clinical implant-induced artefact testing in a relevant environment. A case study is performed where a state-of-the-art piezoelectric bone conduction implant is used in the 1.5 T and 3 T MRI environments. Images were acquired using clinical and novel metal artefact reducing (MARS) sequences at both field strengths. Artefact width and length were measured in a healthy volunteer and compared with artefact sizes obtained in the phantom. Artefact sizes are reported that are similar in shape between the phantom and a volunteer, yet with dimensions differing up to 20% between both. When the implant magnet is removed, the artefact size can be reduced below a diameter of 5 cm, whilst the presence of an implant magnet and splint creates higher artefacts up to 20 cm in diameter. Pulse sequences have been altered to reduce the scan time up to 7 minutes, while preserving the image quality. These results show that the anthropomorphic phantom can be used at a preclinical stage to provide clinically relevant images, illustrating the impact of the artefact on important brain structures.

Autonomous research systems increasingly make the scientific workflow executable: agents can propose ideas, run code, inspect results, and draft papers. But executable workflows do not by themselves produce research judgment. We analyze where current systems lose trial experience: weak evidence becomes prose, pilot signals become broad claims, memory remains textual, and recurring process failures do not change later behavior. We introduce Sibyl-AutoResearch, a self-evolving AutoResearch framework built around Scientific Trial-and-Error Harnesses. A harness lets agents run bounded trials, preserve positive and negative outcomes, and route lessons into later planning, validation, claim scope, scheduling, critique, writing, and harness repair. We formalize this through two auditable conversion units: trial-to-behavior conversion, which links trial signals to later research actions, and trial-to-harness-behavior conversion, which links recurring process failures to system updates. We implement the framework in SIBYL, a file-backed autonomous research system that exposes the state, roles, memory, gates, and artifact traces needed to inspect these conversion paths. A retrospective audit identifies eight high-confidence conversion events, with a median latency of one iteration and a maximum latency of three iterations. A recovered-failure registry further shows how five naturally occurring failure classes, including duplicate results, stale numbers, and unsupported statistics, were blocked, downgraded, or routed into later repair. These traces do not establish a comparative performance claim; they show that the proposed conversion units are recoverable from realistic autonomous-research workspaces. The SIBYL framework and system are available at https://github.com/Sibyl-Research-Team/AutoResearch-SibylSystem.

Medical image editing has emerged as a pivotal technology with broad applications in data augmentation, model interpretability, medical education, and treatment simulation. However, the lack of large-scale, high-quality, and openly accessible datasets tailored for medical contexts with strict anatomical and clinical constraints has significantly hindered progress in this domain. To bridge this gap, we introduce Med-Banana-50K, a comprehensive dataset of over 50k medically curated image edits spanning chest X-ray, brain MRI, and fundus photography across 23 diseases. Each sample supports bidirectional lesion editing (addition and removal) and is constructed using Gemini-2.5-Flash-Image based on real clinical images. A key differentiator of our dataset is the medically grounded quality control protocol: we employ an LLM-as-Judge evaluation framework with criteria such as instruction compliance, structural plausibility, image realism, and fidelity preservation, alongside iterative refinement over up to five rounds. Additionally, Med-Banana-50K includes around 37,000 failed editing attempts with full evaluation logs to support preference learning and alignment research. By offering a large-scale, medically rigorous, and fully documented resource, Med-Banana-50K establishes a critical foundation for developing and evaluating reliable medical image editing systems. Our dataset and code are publicly available. [https://github.com/richardChenzhihui/med-banana-50k].

The executable harness surrounding a GUI model determines how observations are assembled, actions are executed, and verification, recovery, and termination are controlled. Compared with harness optimization for non-GUI agents, automatically optimizing this harness poses three coupled challenges: reconciling model intent with observed visual effects, diagnosing failures under variable execution outcomes, and identifying recurrent failure patterns across tasks and translating them into reusable runtime changes. We introduce GUI-HARVEST, an automatic harness optimizer that enables self-improving GUI agents with frozen backbone models. First, to ground diagnosis in observed action effects, it aligns model outputs and executed actions with before-and-after screenshots, tying findings to specific interface transitions. Second, to account for execution variability, it treats repeated runs of the same task as a joint evidence unit, using within-task comparisons to locate outcome-relevant behavioral differences. Third, it consolidates verified findings across tasks into recurring failure patterns, maps them to bounded source-code edits with predictions recorded before evaluation, and checks the predicted behavioral effects alongside task performance through repeated execution. Experiments on OSWorld-Verified show consistent held-out gains across six general-purpose open, GUI-specialized open, and proprietary backbone models; Qwen3-VL-32B-Instruct gains 12.33 points on the full suite. Frozen-harness transfer improves GPT-5 by 13.87 percentage points on WindowsAgentArena at 50 steps without further optimization. With the same backbone and initial harness, GUI-HARVEST outperforms Self-Harness and Meta-Harness, suggesting that GUI-specific diagnosis and validation help harness improvements generalize to unseen tasks. The code is available at https://github.com/GaryYang12345/GUI-HARVEST.

Modern LLM agents are often improved by modifying prompts, tools, or workflows manually, while the executable scaffold surrounding the model---the harness---is typically treated as a fixed artifact after deployment. This work studies an alternative where the harness is task-specific and continuously evolvable: each task family maintains its own harness, which is hot-swapped across iterations through a fixed task-injection seam and rewritten using environment feedback. We introduce Hierarchical Self-Improvement (HSI), a framework in which a single frozen LLM M operates across three hierarchical scopes: a task harness H that executes tasks, an evolver that rewrites H, and a meta-evolver that rewrites the evolver's strategy code under a frozen outer anchor. A thinking-on/off design isolates the contribution of harness evolution by disabling reasoning during task execution while enabling it during self-modification. HSI is bounded by two factors: a feedback-fidelity bound, since evolution requires informative reward signals to guide selection, and a backbone capability bound, since harness redesign cannot overcome limitations of the frozen model. On BALROG with DeepSeek-V4-Flash-Preview as the frozen backbone, HSI achieves consistent gains over the initial harness on moderate-difficulty tasks (+39.3 on BabyAI, +33.0 on Crafter, +25.0 on TextWorld, and +15.0 on MiniHack, all in raw \% Progress), while obtaining strong held-out generalization on BabaIsAI sub-suites (0.98 best-test on BreakStop and 1.00 on GoTo from a 20% unseen split). On tasks beyond the backbone's capability (NLE), harness evolution provides no improvement. These results demonstrate task-specific harness evolution as a viable axis for improving frozen LLM agents under clear empirical limits. Code is available at https://github.com/TailinZhou/hsi.

The COVID-19 pandemic has underscored the need for low-cost, scalable approaches to measuring contactless vital signs, either during initial triage at a healthcare facility or virtual telemedicine visits. Remote photoplethysmography (rPPG) can accurately estimate heart rate (HR) when applied to close-up videos of healthy volunteers in well-lit laboratory settings. However, results from such highly optimized laboratory studies may not be readily translated to healthcare settings. One significant barrier to the practical application of rPPG in health care is the accurate localization of the region of interest (ROI). Clinical or telemedicine visits may involve sub-optimal lighting, movement artifacts, variable camera angle, and subject distance. This paper presents an rPPG ROI selection method based on 3D facial landmarks and patient head yaw angle. We then demonstrate the robustness of this ROI selection method when coupled to the Plane-Orthogonal-to-Skin (POS) rPPG method when applied to videos of patients presenting to an Emergency Department for respiratory complaints. Our results demonstrate the effectiveness of our proposed approach in improving the accuracy and robustness of rPPG in a challenging clinical environment.

With the advancement of telemedicine, both researchers and medical practitioners are working hand-in-hand to develop various techniques to automate various medical operations, such as diagnosis report generation. In this paper, we first present a multi-modal clinical conversation summary generation task that takes a clinician-patient interaction (both textual and visual information) and generates a succinct synopsis of the conversation. We propose a knowledge-infused, multi-modal, multi-tasking medical domain identification and clinical conversation summary generation (MM-CliConSummation) framework. It leverages an adapter to infuse knowledge and visual features and unify the fused feature vector using a gated mechanism. Furthermore, we developed a multi-modal, multi-intent clinical conversation summarization corpus annotated with intent, symptom, and summary. The extensive set of experiments, both quantitatively and qualitatively, led to the following findings: (a) critical significance of visuals, (b) more precise and medical entity preserving summary with additional knowledge infusion, and (c) a correlation between medical department identification and clinical synopsis generation. Furthermore, the dataset and source code are available at https://github.com/NLP-RL/MM-CliConSummation.

Foundation Models that are capable of processing and generating multi-modal data have transformed AI's role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety. We define medical hallucination as any instance in which a model generates misleading medical content. This paper examines the unique characteristics, causes, and implications of medical hallucinations, with a particular focus on how these errors manifest themselves in real-world clinical scenarios. Our contributions include (1) a taxonomy for understanding and addressing medical hallucinations, (2) benchmarking models using medical hallucination dataset and physician-annotated LLM responses to real medical cases, providing direct insight into the clinical impact of hallucinations, and (3) a multi-national clinician survey on their experiences with medical hallucinations. Our results reveal that inference techniques such as Chain-of-Thought (CoT) and Search Augmented Generation can effectively reduce hallucination rates. However, despite these improvements, non-trivial levels of hallucination persist. These findings underscore the ethical and practical imperative for robust detection and mitigation strategies, establishing a foundation for regulatory policies that prioritize patient safety and maintain clinical integrity as AI becomes more integrated into healthcare. The feedback from clinicians highlights the urgent need for not only technical advances but also for clearer ethical and regulatory guidelines to ensure patient safety. A repository organizing the paper resources, summaries, and additional information is available at https://github.com/mitmedialab/medical hallucination.

Acupuncture is a form of medicine that involves inserting needles into targeted areas of the body and requires knowledge of both Traditional Chinese Medicine (TCM) and Evidence-Based Medicine (EBM). The process of acquiring such knowledge and using it for practical treatment is challenging due to the need for a deep understanding of human anatomy and the ability to apply both TCM and EBM approaches. Visual aids have been introduced to aid in understanding the alignment of acupuncture points with key elements of the human body, and are indispensable tools for both learners and expert acupuncturists. However, they are often not enough to enable effective practice and fail to fully support the learning process. Novel approaches based on immersive visualization and Virtual Reality (VR) have shown promise in many healthcare settings due to their unique advantages in terms of realism and interactions, but it is still unknown whether and how VR can possibly be beneficial to acupuncture training and treatment. Following participatory design protocols such as observations and semi-structured interviews with eight doctors and nine students, we explore the needs and pain points of current acupuncture workflows at the intersection of EBM and TCM in China and the United States. We highlight opportunities for introducing VR in today's acupuncture training and treatment workflows, and discuss two design approaches that build on 11 specific challenges spanning education, diagnosis, treatment, and communication.

Recent advances in medical large language models (LLMs), multimodal models, and agents demand evaluation frameworks that reflect real clinical workflows and safety constraints. We present MedBench v4, a nationwide, cloud-based benchmarking infrastructure comprising over 700,000 expert-curated tasks spanning 24 primary and 91 secondary specialties, with dedicated tracks for LLMs, multimodal models, and agents. Items undergo multi-stage refinement and multi-round review by clinicians from more than 500 institutions, and open-ended responses are scored by an LLM-as-a-judge calibrated to human ratings. We evaluate 15 frontier models. Base LLMs reach a mean overall score of 54.1/100 (best: Claude Sonnet 4.5, 62.5/100), but safety and ethics remain low (18.4/100). Multimodal models perform worse overall (mean 47.5/100; best: GPT-5, 54.9/100), with solid perception yet weaker cross-modal reasoning. Agents built on the same backbones substantially improve end-to-end performance (mean 79.8/100), with Claude Sonnet 4.5-based agents achieving up to 85.3/100 overall and 88.9/100 on safety tasks. MedBench v4 thus reveals persisting gaps in multimodal reasoning and safety for base models, while showing that governance-aware agentic orchestration can markedly enhance benchmarked clinical readiness without sacrificing capability. By aligning tasks with Chinese clinical guidelines and regulatory priorities, the platform offers a practical reference for hospitals, developers, and policymakers auditing medical AI.

LLM agents combine models with execution harnesses, so agentic benchmark performance reflects their joint behavior. We argue that harnesses should therefore be evaluated through their interactions with underlying models. We develop a framework combining five complementary measures: (i) Valid Completion Rate (VCR), how reliably agents finish normally and deliver evaluable results, irrespective of task correctness; (ii) Model-Harness Fit, how well a harness supports task achievement through valid completion for a given model; (iii) Cross-Model Fit, a harness's overall suitability across evaluated models; (iv) Interaction Residuals, pairing-specific execution strengths and weaknesses hidden by component-level summaries; and (v) Token Load, the token demands of agent execution, including failed attempts. We evaluate four general-purpose harnesses (OpenCode, Codex CLI, Pi CLI, and DeepAgents) with four core models, plus two fixed native model-harness systems, on six benchmarks covering context management, tool use, long-context planning, multimodal interaction, and artifact handoff. Including native references and stress conditions, 111 evaluation settings yield 52,168 trajectories. Harness rankings vary across models and benchmarks; task performance and valid completion can favor different pairings, and similar task scores can accompany distinct execution profiles. OpenCode ranks first in cross-model performance, while DeepSeek V4 Flash Preview maintains consistently high Mean VCR across harnesses on the shared four-benchmark panel. These findings support evaluating model-harness interactions, training transferable harness-use capabilities in models, and harness designs adapted to the model and task.

Agentic AI systems are increasingly being explored in medical imaging to improve throughput and reduce clinician workload; however, safe deployment remains challenging because autonomous errors may propagate into downstream clinical decisions. A central requirement is therefore not only strong predictive performance, but also a reliable routing mechanism that determines when the system should proceed autonomously and when a case should be escalated for further review. To address this gap, we propose CRC-Router, a risk-constrained, uncertainty-aware routing module that is applicable to both conventional medical prediction models and agentic medical AI systems. CRC-Router combines multiple complementary uncertainty signals with the predictive score to construct a per-finding routing feature vector, maps this vector to an estimated wrong-accept risk using a lightweight per-finding risk model, and then applies Conformal Risk Control (CRC) to calibrate acceptance thresholds under a user-specified risk target. Instantiated on chest X-ray multi-finding triage using the NIH ChestX-ray14 dataset, CRC-Router achieves the strongest empirical risk--coverage trade-off among the evaluated baselines, both as a standalone routing layer and as a plug-in module integrated with the state-of-the-art MedRAX agent. These results demonstrate both the effectiveness of CRC-Router in selective medical automation and its modular, model-agnostic compatibility with existing predictive and agentic medical pipelines. Code is publicly available at https://github.com/XLIAaron/CRC-Router

This paper studies autonomous software development, in which LLM-based coding agents transform high-level requirements into complete, functional, and usable software systems without human intervention. We introduce Harness-of-Harness (HoH), a framework that enables coding agents to continually improve software during autonomous development. HoH operates on existing coding-agent harnesses, and organizes their executions into iterative planning-coding-testing loops. To sustain improvement across loops, HoH balances repair with capability growth, scopes development into small and verifiable increments, separates implementation-time testing from independent evaluation, and constrains verifiable outputs rather than prescribing agent workflows. It progressively exposes deliverables, role-specific tools, and skills, encourages reuse rather than recreation, and maintains versioned project histories. On GameCraft-Bench, FrontierSWE, and ProgramBench, three harness-model pairs (Codex with GPT-5.5, OpenCode with DeepSeek-V4-Pro, and Pi with MiniMax-M3), HoH consistently outperforms the corresponding standalone harnesses, achieving an average relative gain of 52.25 percent and a maximum gain of 82.86 percent after three iterations. In a multi-day deployment with more than 70 iterations, HoH autonomously develops a first-person-shooter game, featuring a coherent storyline, fully implemented core mechanics, human-playable experience, polished visuals and integrated audio. Github: https://github.com/Flesymeb/HarnessOfHarness Project Page: https://flesymeb.github.io/HarnessOfHarness/

Generative simulation for surgical robotics still lacks real-time interaction. Physical-robot experiments, often involving animal or cadaver labs, are time-consuming, costly, and difficult to reproduce, while classical simulators struggle to capture photorealistic appearance and deformable-tissue dynamics. We address this gap with Cosmos-H-Dreams, an integrated real-time surgical world-model system combining an action-conditioned generative model, a teacher-to-student distillation recipe, and a deployment stack built on the NVIDIA FlashDreams streaming-inference library. Starting from Cosmos-H-Surgical-Simulator, a multi-embodiment action-conditioned surgical video world model fine-tuned on the large-scale Open-H-Embodiment corpus, we post-train this checkpoint on embodiment- and procedure-specific data. By distilling the resulting bidirectional teacher into a causal, few-step student with Self Forcing, we turn a passive video generator into a controllable surgical simulator that streams at sim160 inference FPS on a single NVIDIA RTX PRO 6000 Blackwell workstation GPU. Crucially, Cosmos-H-Dreams is controller-agnostic: any interface that emits a stream of robot kinematics can drive it. We demonstrate live control through a browser keyboard over WebRTC, a Meta Quest headset over WebXR, a commercial surgical robot console such as CMR Surgical's Versius, and learned policies operating in closed loop. To our knowledge, this is the first interactive surgical world model supporting live human and policy control. Human operators and policies alike can act inside the synthesized world and observe the consequences in real time. We release Cosmos-H-Dreams as an open surgical simulation system, providing a common foundation for surgical education, scalable synthetic data generation, and future intraoperative decision support.

Large language models (LLMs) are increasingly proposed as clinical agents, yet static, single-turn benchmarks cannot capture how a model dynamically delivers care across an encounter: gathering information, planning treatment, and adapting longitudinal management across successive patient states. Medical education has long addressed an analogous challenge through standardized patients (SPs): trained actors who consistently portray clinical cases, enabling realistic practice and objective, scripted assessment. Here we introduce MedSP1000, an SP-derived interactive benchmark for clinical-agent evaluation, including 1,638 SP cases with 24,602 trajectory-level peer-reviewed rubrics. MedSP1000 converts peer-reviewed SP teaching cases into executable scenarios with defined SP case scripts, clinical environment contexts, and human-validated structured rubric. In each simulation evaluation run, a clinical agent interacts in closed loop with a patient agent and an environment controller, and its behaviour is scored throughout the encounter against expert criteria specified in the original materials. Applying MedSP1000 to a range of general-purpose and medically specialized LLMs, we find that performance on static benchmarks does not reliably translate to such educational scenarios. The best-performing model, GPT-5.5, completes only 60.4% of expert-defined rubric items, whereas the strongest medically specialized model reaches 40.0%; increasing test-time compute produces no measurable gain. These results suggest that current LLMs, including agentic systems tuned for medicine, are not yet reliable enough to be safely integrated into actual clinical practice. More broadly, MedSP1000 shows how process-level, SP-style evaluation can reveal clinically relevant failure modes that single-turn benchmarks miss.

Purpose: With advancements in Large Language Models (LLMs) for healthcare, the need arises for competitive open-source models to protect the public interest. This work contributes to the field of open medical LLMs by optimizing key stages of data preprocessing and training, while showing how to improve model safety (through DPO) and efficacy (through RAG). The evaluation methodology used, which includes four different types of tests, defines a new standard for the field. The resultant models, shown to be competitive with the best private alternatives, are released with a permisive license. Methods: Building on top of strong base models like Llama 3.1 and Qwen 2.5, Aloe Beta uses a custom dataset to enhance public data with synthetic Chain of Thought examples. The models undergo alignment with Direct Preference Optimization, emphasizing ethical and policy-aligned performance in the presence of jailbreaking attacks. Evaluation includes close-ended, open-ended, safety and human assessments, to maximize the reliability of results. Results: Recommendations are made across the entire pipeline, backed by the solid performance of the Aloe Family. These models deliver competitive performance across healthcare benchmarks and medical fields, and are often preferred by healthcare professionals. On bias and toxicity, the Aloe Beta models significantly improve safety, showing resilience to unseen jailbreaking attacks. For a responsible release, a detailed risk assessment specific to healthcare is attached to the Aloe Family models. Conclusion: The Aloe Beta models, and the recipe that leads to them, are a significant contribution to the open-source medical LLM field, offering top-of-the-line performance while maintaining high ethical requirements. This work sets a new standard for developing and reporting aligned LLMs in healthcare.

LLM agents increasingly rely on agent harness: the runtime infrastructure around the base model that defines execution environments, tool interfaces, context, lifecycle orchestration, observability, verification, and governance. Existing self-improving agents and automatic harness evolution methods mainly improve agents through runtime supervision, prompt optimization, workflow search, or harness modification based on final outcomes. However, they often fail to diagnose where the responsible evidence lies in failed trajectories and which harness implementation mechanism causes the unreliable behavior, resulting in broad, indirect, or poorly scoped changes. This paper proposes HarnessFix, a trace-grounded and diagnosis-driven framework for repairing agent harnesses. HarnessFix compiles raw execution traces and harness artifacts into a Harness-aware Trace Intermediate Representation (HTIR), which normalizes fragmented trajectory evidence, captures step-level data-flow and control-flow relations, and aligns runtime steps with the harness artifacts that shape their behavior. It then attributes failures to responsible steps and harness artifacts, and consolidates recurring diagnoses into repair-oriented flaw records. Finally, HarnessFix maps these records to scoped repair operators, generates patches under flaw-specific repair specifications, and accepts them through regression-aware validation. We evaluate HarnessFix on four popular benchmarks, and results show that it improves the performance over the initial harnesses by 6.3% to 18.4%, significantly outperforming human-designed and self-evolution baselines. HarnessFix highlights the value of treating failed trajectories not only as feedback signals, but also as structured evidence for diagnosing and repairing the harness mechanisms behind agent failures.

Our interest is in the design of software systems involving a human-expert interacting -- using natural language -- with a large language model (LLM) on data analysis tasks. For complex problems, it is possible that LLMs can harness human expertise and creativity to find solutions that were otherwise elusive. On one level, this interaction takes place through multiple turns of prompts from the human and responses from the LLM. Here we investigate a more structured approach based on an abstract protocol described in [3] for interaction between agents. The protocol is motivated by a notion of "two-way intelligibility" and is modelled by a pair of communicating finite-state machines. We provide an implementation of the protocol, and provide empirical evidence of using the implementation to mediate interactions between an LLM and a human-agent in two areas of scientific interest (radiology and drug design). We conduct controlled experiments with a human proxy (a database), and uncontrolled experiments with human subjects. The results provide evidence in support of the protocol's capability of capturing one- and two-way intelligibility in human-LLM interaction; and for the utility of two-way intelligibility in the design of human-machine systems. Our code is available at https://github.com/karannb/interact.

Medical care follows complex clinical pathways that extend beyond isolated physician-patient encounters, emphasizing decision-making and transitions between different stages. Current benchmarks focusing on static exams or isolated dialogues inadequately evaluate large language models (LLMs) in dynamic clinical scenarios. We introduce CP-Env, a controllable agentic hospital environment designed to evaluate LLMs across end-to-end clinical pathways. CP-Env simulates a hospital ecosystem with patient and physician agents, constructing scenarios ranging from triage and specialist consultation to diagnostic testing and multidisciplinary team meetings for agent interaction. Following real hospital adaptive flow of healthcare, it enables branching, long-horizon task execution. We propose a three-tiered evaluation framework encompassing Clinical Efficacy, Process Competency, and Professional Ethics. Results reveal that most models struggle with pathway complexity, exhibiting hallucinations and losing critical diagnostic details. Interestingly, excessive reasoning steps can sometimes prove counterproductive, while top models tend to exhibit reduced tool dependency through internalized knowledge. CP-Env advances medical AI agents development through comprehensive end-to-end clinical evaluation. We provide the benchmark and evaluation tools for further research and development at https://github.com/SPIRAL-MED/CP_ENV.

As LLMs are increasingly deployed within agentic systems, their capabilities depend not only on the model weights but also on the harness: the prompts, tools, control flow, memory, and orchestration code surrounding them. This makes automated harness optimization -- the iterative and evaluation-guided improvement of a harness by an AI system -- both an important route to improving AI systems and a demanding capability for AI systems themselves. Yet the community lacks a common protocol for measuring how well frontier LLMs perform at this task. We introduce HarnessOpt-Bench, a benchmark for end-to-end harness optimization under expensive and stochastic evaluation. An optimizer, an LLM paired with a coding harness, receives a target agent's seed harness, graded evaluation feedback, and a fixed target-evaluation budget. It edits the harness and nominates a final candidate, which is scored by its normalized gain over the seed on a held-out test partition that remains inaccessible throughout search. A trusted execution environment enforces the evaluation boundary, meters target-agent resource use, and preserves candidate versions for audit. We evaluate 5 frontier LLMs as optimizers both under a shared coding harness and under their native harnesses across 4 downstream tasks, over 111 scored runs. Experiment results show that optimizer models separate more than the coding harnesses they act through, native harnesses are not consistently superior, and gains vary substantially across tasks and seed regimes. These results establish harness optimization as a measurable and discriminative capability with large space for improvement.

Large language models (LLMs) are increasingly envisioned as decision-support tools in clinical practice, yet safe clinical reasoning demands integrating heterogeneous knowledge bases -- trials, primary studies, regulatory documents, and cost data -- under strict accuracy constraints. Existing evaluations often rely on synthetic prompts, reduce the task to single-hop factoid queries, or conflate reasoning with open-ended generation, leaving their real-world utility unclear. To close this gap, we present MedBrowseComp, the first benchmark that systematically tests an agent's ability to reliably retrieve and synthesize multi-hop medical facts from live, domain-specific knowledge bases. MedBrowseComp contains more than 1,000 human-curated questions that mirror clinical scenarios where practitioners must reconcile fragmented or conflicting information to reach an up-to-date conclusion. Applying MedBrowseComp to frontier agentic systems reveals performance shortfalls as low as ten percent, exposing a critical gap between current LLM capabilities and the rigor demanded in clinical settings. MedBrowseComp therefore offers a clear testbed for reliable medical information seeking and sets concrete goals for future model and toolchain upgrades. You can visit our project page at: https://moreirap12.github.io/mbc-browse-app/

Security concerns related to Large Language Models (LLMs) have been extensively explored, yet the safety implications for Multimodal Large Language Models (MLLMs), particularly in medical contexts (MedMLLMs), remain insufficiently studied. This paper delves into the underexplored security vulnerabilities of MedMLLMs, especially when deployed in clinical environments where the accuracy and relevance of question-and-answer interactions are critically tested against complex medical challenges. By combining existing clinical medical data with atypical natural phenomena, we redefine two types of attacks: mismatched malicious attack (2M-attack) and optimized mismatched malicious attack (O2M-attack). Using our own constructed voluminous 3MAD dataset, which covers a wide range of medical image modalities and harmful medical scenarios, we conduct a comprehensive analysis and propose the MCM optimization method, which significantly enhances the attack success rate on MedMLLMs. Evaluations with this dataset and novel attack methods, including white-box attacks on LLaVA-Med and transfer attacks on four other state-of-the-art models, indicate that even MedMLLMs designed with enhanced security features are vulnerable to security breaches. Our work underscores the urgent need for a concerted effort to implement robust security measures and enhance the safety and efficacy of open-source MedMLLMs, particularly given the potential severity of jailbreak attacks and other malicious or clinically significant exploits in medical settings. For further research and replication, anonymous access to our code is available at https://github.com/dirtycomputer/O2M_attack. Warning: Medical large model jailbreaking may generate content that includes unverified diagnoses and treatment recommendations. Always consult professional medical advice.

Agents driven by large language models are increasingly deployed on long-horizon tasks, where they use tools and modify real workspaces. How well they perform depends as much on the harness around the model as on the model itself. Existing benchmarks measure downstream task success under a fixed harness, leaving harness engineering itself unexplored. We propose Doc2Harness, a two-stage benchmark that evaluates long-horizon harness engineering directly. In Stage 1, a build model operating inside a fixed builder harness receives an interface-only contract skeleton and a development document that consolidates behavior across twelve frontier harnesses, and then constructs a complete candidate harness in an isolated container. In Stage 2, the frozen candidate harness runs in containers separate from the construction environment, one per test case, and is driven end to end by a scripted mock model. We score each test case using four observable channels, namely the requests sent to the model, the files on disk, the process exit code, and the command output; positive controls rule out vacuous passes. Across nineteen frontier models, each evaluated with three independent builds on 328 test cases, GPT-6 Astra achieves the highest pass rate at 53.05%, while the weakest model reaches 27.44%, a gap of roughly twenty-six percentage points. Even the strongest model fails nearly half of the test cases, and failures cluster around how cross-cutting functionality is split across modules. To our knowledge, Doc2Harness provides the first deterministic benchmark for measuring long-horizon harness engineering.

Background: Large language models (LLMs) are trained to follow directions, but this introduces a vulnerability to blindly comply with user requests even if they generate wrong information. In medicine, this could accelerate the generation of misinformation that impacts human well-being. Objectives/Methods: We analyzed compliance to requests to generate misleading content about medications in settings where models know the request is illogical. We investigated whether in-context directions and instruction-tuning of LLMs to prioritize logical reasoning over compliance reduced misinformation risk. Results: While all frontier LLMs complied with misinformation requests, both prompt-based and parameter-based approaches can improve the detection of logic flaws in requests and prevent the dissemination of medical misinformation. Conclusion: Shifting LLMs to prioritize logic over compliance could reduce risks of exploitation for medical misinformation.

Millions of people in African countries face barriers to accessing healthcare due to language and literacy gaps. This research tackles this challenge by transforming complex medical documents -- in this case, prosthetic device user manuals -- into accessible formats for underserved populations. This case study in cross-cultural translation is particularly pertinent/relevant for communities that receive donated prosthetic devices but may not receive the accompanying user documentation. Or, if available online, may only be available in formats (e.g., language and readability) that are inaccessible to local populations (e.g., English-language, high resource settings/cultural context). The approach is demonstrated using the widely spoken Pidgin dialect, but our open-source framework has been designed to enable rapid and easy extension to other languages/dialects. This work presents an AI-powered framework designed to process and translate complex medical documents, e.g., user manuals for prosthetic devices, into marginalised languages. The system enables users -- such as healthcare workers or patients -- to upload English-language medical equipment manuals, pose questions in their native language, and receive accurate, localised answers in real time. Technically, the system integrates a Retrieval-Augmented Generation (RAG) pipeline for processing and semantic understanding of the uploaded manuals. It then employs advanced Natural Language Processing (NLP) models for generative question-answering and multilingual translation. Beyond simple translation, it ensures accessibility to device instructions, treatment protocols, and safety information, empowering patients and clinicians to make informed healthcare decisions.

Enterprise large language model (LLM) applications often begin as prototypes whose behavior is carried by prompts and retrieval context. Productization adds requirements for source boundaries, entity routing, answer contracts, and reproducible traces. We present a harness-engineering approach that reconstructs this pattern into a traceable, auditable LLM-agent architecture: deterministic behavior moves into code, manifests, schemas, and validation artifacts around a replaceable composition boundary, while source-backed claims remain the authority for runtime answers. We instantiate it on a public-data slice of five Korean corporate groups (25 listed companies) and evaluate three research questions. (1) The harness preserves its source-grounding, entity-routing, trace, output-hygiene, and recommendation-language contracts across the fixed validation scenarios; a fault-injection control confirms the validators flag deliberately broken contracts. (2) The checks the harness enforces held under model substitution: across three hosted models, they passed on all 270 composition-boundary runs; failures were confined to the model-composed side and were caught and recorded. (3) The code-owned guarantees are load-bearing, not reproducible by prompting alone: holding the model fixed and varying only the enforcement layer, prompt instructions alone let recommendation-language and internal-trace-leakage violations reach the reader, which the harness blocks entirely. A bolt-on external guardrail prevents such violations too but over-refuses, dropping utility to 88/120 where the harness preserves full utility (120/120); in this ablation, only code-owned enforcement preserves both safety and utility. The result is a reusable engineering pattern for turning exploratory prototypes into auditable applications with versioned source, control, and validation artifacts.

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

System One decision models such as Jev answer structured questions in a single forward pass without generating text, offering fast and computationally efficient clinical decision support. We evaluate MedJev, an open System One model that runs locally on a laptop, across ten medical benchmarks spanning medical knowledge, diagnosis, and patient level prediction using MIMIC IV and MIMIC IV ED. We compare MedJev against zero shot LLM baselines, published GPT results, and supervised models. MedJev achieves accuracies of 72.5 percent on MedQA, 75.4 percent on USMLE, and 80.1 percent on NEJM, approaching published GPT 4 performance while maintaining well calibrated confidence estimates (ECE 0.028 to 0.063). On patient level tasks, MedJev achieves an AUROC of 0.926 for In Hospital Mortality, exceeding XGBoost (0.902), but underperforms supervised models on operational outcomes such as ED Triage Admission (0.745 vs. 0.809). Patient level predictions also exhibit substantial miscalibration (In Hospital Mortality ECE 0.286). We introduce a lightweight, two parameter recalibration method that adapts predictions to local patient populations using 50 to 200 labeled examples, reducing ECE to 0.007. Our findings establish open System One models as a promising zero shot baseline for medical AI, combining competitive predictive performance with low computational cost and efficient local calibration. We release our code and evaluation harness to support future research.

Background: Clinical documentation represents a significant burden for healthcare providers, with physicians spending up to 2 hours daily on administrative tasks. Recent advances in large language models (LLMs) offer promising solutions, but privacy concerns and computational requirements limit their adoption in healthcare settings. Objective: To develop and evaluate a privacy-preserving, on-device medical transcription system using a fine-tuned Llama 3.2 1B model capable of generating structured medical notes from medical transcriptions while maintaining complete data sovereignty entirely in the browser. Methods: We fine-tuned a Llama 3.2 1B model using Parameter-Efficient Fine-Tuning (PEFT) with LoRA on 1,500 synthetic medical transcription-to-structured note pairs. The model was evaluated against the base Llama 3.2 1B on two datasets: 100 endocrinology transcripts and 140 modified ACI benchmark cases. Evaluation employed both statistical metrics (ROUGE, BERTScore, BLEURT) and LLM-as-judge assessments across multiple clinical quality dimensions. Results: The fine-tuned OnDevice model demonstrated substantial improvements over the base model. On the ACI benchmark, ROUGE-1 scores increased from 0.346 to 0.496, while BERTScore F1 improved from 0.832 to 0.866. Clinical quality assessments showed marked reduction in major hallucinations (from 85 to 35 cases) and enhanced factual correctness (2.81 to 3.54 on 5-point scale). Similar improvements were observed on the internal evaluation dataset, with composite scores increasing from 3.13 to 4.43 (+41.5%). Conclusions: Fine-tuning compact LLMs for medical transcription yields clinically meaningful improvements while enabling complete on-device browser deployment. This approach addresses key barriers to AI adoption in healthcare: privacy preservation, cost reduction, and accessibility for resource-constrained environments.

Large language model (LLM) agents may recover from a failure within an episode or after a retry, yet the same execution failure can recur in later tasks because post-episode feedback rarely revises the persistent harness that guides future interactions. Static harnesses improve reliability through fixed tools, context, memory, and workflow structures, but remain unchanged after deployment. We propose Living-Harness, a self-evolving agent harness that converts each completed trajectory and its evaluator signals into posterior evidence for bounded harness updates. Guided by a domain-level Evolution-SOP (Standard Operating Procedure), Living-Harness extracts an episode abstraction and structured update evidence, and writes two complementary forms of procedural knowledge: episodic memory that records trigger conditions, failure patterns, and recovery actions, and a state graph that records state nodes, repair edges, and transition rules. The updated harness state is retrieved to guide future interactions, while tools and base context remain frozen, allowing procedural repairs to accumulate across evolution cycles. On eight interactive environments derived from τ^2-Bench and MultiWOZ-2.4, Living-Harness improves average Pass@1 over the strongest interactive baseline by 10.07 and 9.91 percentage points, respectively, and supports retrieval-only reuse of the evolved harness state across model backbones.

Rapid urbanization and improved living standards have led to a substantial increase in the number of vehicles on the road, consequently resulting in a rise in the frequency of accidents. Among these accidents, motorbike accidents pose a particularly high risk, often resulting in serious injuries or deaths. A significant number of these fatalities occur due to delayed or inadequate medical attention. To this end, we propose a novel automatic detection and notification system specifically designed for motorbike accidents. The proposed system comprises two key components: a detection system and a physiological signal monitoring system. The detection system is integrated into the helmet and consists of a microcontroller, accelerometer, GPS, GSM, and Wi-Fi modules. The physio-monitoring system incorporates a sensor for monitoring pulse rate and SpO_{2} saturation. All collected data are presented on an LCD display and wirelessly transmitted to the detection system through the microcontroller of the physiological signal monitoring system. If the accelerometer readings consistently deviate from the specified threshold decided through extensive experimentation, the system identifies the event as an accident and transmits the victim's information -- including the GPS location, pulse rate, and SpO_{2} saturation rate -- to the designated emergency contacts. Preliminary results demonstrate the efficacy of the proposed system in accurately detecting motorbike accidents and promptly alerting emergency contacts. We firmly believe that the proposed system has the potential to significantly mitigate the risks associated with motorbike accidents and save lives.

Deep neural networks excel in radiological image classification but frequently suffer from poor interpretability, limiting clinical acceptance. We present MedicalPatchNet, an inherently self-explainable architecture for chest X-ray classification that transparently attributes decisions to distinct image regions. MedicalPatchNet splits images into non-overlapping patches, independently classifies each patch, and aggregates predictions, enabling intuitive visualization of each patch's diagnostic contribution without post-hoc techniques. Trained on the CheXpert dataset (223,414 images), MedicalPatchNet matches the classification performance (AUROC 0.907 vs. 0.908) of EfficientNet-B0, while substantially improving interpretability: MedicalPatchNet demonstrates substantially improved interpretability with higher pathology localization accuracy (mean hit-rate 0.485 vs. 0.376 with Grad-CAM) on the CheXlocalize dataset. By providing explicit, reliable explanations accessible even to non-AI experts, MedicalPatchNet mitigates risks associated with shortcut learning, thus improving clinical trust. Our model is publicly available with reproducible training and inference scripts and contributes to safer, explainable AI-assisted diagnostics across medical imaging domains. We make the code publicly available: https://github.com/TruhnLab/MedicalPatchNet