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Oct 20

StepSafe: Learning Timely Intervention with Context-Aware Safety Reasoning

Safety in agentic systems is inherently sequential: whether an action is safe depends on prior actions, tool outputs, information disclosures, and interactions among agents. Recent work has shifted agent safety guardrails from post-hoc trajectory-level assessment toward step-level action diagnosis and proactive risk prediction, yet existing training objectives provide limited supervision for how step evidence accumulates over time and when it becomes sufficient to justify intervention. We propose \methodlong~(ASPO): a training framework for step-level timely intervention. Pre-fix level stage alignment allows crediting each decision at its own step: it compares each response with the other responses sampled at the same prefix and rewards the action that fits the stage, continuing before the risk is visible, asking while clarification can still avert harm, and stopping before harm is irreversible. Adaptive feedback self-distillation further credits the reasoning behind each decision, with the model itself as a teacher that sees the step annotations on intervention steps and rules mined from its own false alarms on safe steps. Its training data carry a violation taxonomy and an intervention window at every step and are extended through self-evolving multi-agent red-teaming. Finally we present StepSafe, a step-level reasoning guardrail with timely intervention, that achieves the state-of-the-art peformance among open-source guardrails across five agent-safety benchmarks on safety-utility pareto curve with Youden's J of 53.0 (4B) against 46.2.

  • 6 authors
·
Oct 13

Neural FOXP2 -- Language Specific Neuron Steering for Targeted Language Improvement in LLMs

LLMs are multilingual by training, yet their lingua franca is often English, reflecting English language dominance in pretraining. Other languages remain in parametric memory but are systematically suppressed. We argue that language defaultness is governed by a sparse, low-rank control circuit, language neurons, that can be mechanistically isolated and safely steered. We introduce Neural FOXP2, that makes a chosen language (Hindi or Spanish) primary in a model by steering language-specific neurons. Neural FOXP2 proceeds in three stages: (i) Localize: We train per-layer SAEs so each activation decomposes into a small set of active feature components. For every feature, we quantify English vs. Hindi/Spanish selectivity overall logit-mass lift toward the target-language token set. Tracing the top-ranked features back to their strongest contributing units yields a compact language-neuron set. (ii) Steering directions: We localize controllable language-shift geometry via a spectral low-rank analysis. For each layer, we build English to target activation-difference matrices and perform layerwise SVD to extract the dominant singular directions governing language change. The eigengap and effective-rank spectra identify a compact steering subspace and an empirically chosen intervention window (where these directions are strongest and most stable). (iii) Steer: We apply a signed, sparse activation shift targeted to the language neurons. Concretely, within low to mid layers we add a positive steering along the target-language dominant directions and a compensating negative shift toward the null space for the English neurons, yielding controllable target-language defaultness.

  • 5 authors
·
Jan 31

DoTime: A Synthetic Benchmark Generator for Interventional and Counterfactual Time Series

Most benchmarks for causal inference over time series are observational, small, or domain-specific, leaving interventional and counterfactual estimation under-served exactly where it matters most, such as in healthcare, policy evaluation, and climate science. We introduce DoTime, an open, scalable, and theoretically grounded generator of multivariate temporal structural causal models (TSCMs) with interventions, released as the dotime PyPI package together with four frozen evaluation suites. Beyond existing work, it adds capabilities absent from prior generators: continuous-time intervention windows, counterfactual sampling modes with a positivity guard, regime-switching SCMs as a strict generalization of interrupted time series, non-stationary dynamics by construction with switching SCM parameters, and deterministic ramp and sinusoidal intervention profiles that place trends and structural breaks inside the evaluation window. Moreover, it demonstrates the suitability of the generator as a prior for a causal foundation model reference implementation. The released suites span a training-scale snapshot of 100{,}000 trajectories and eight named identification structures, each with exact ground truth: paired interventional trajectories from the same SCM throughout, and shared-noise counterfactuals in the continuous-time suite. We ship reference baseline implementations with an evaluation harness, and pose a falsifiable claim: interventional training buys a measurable direction-accuracy advantage over an observational model of identical capacity. It is tested across three training seeds per arm. Under structure-matched evaluation on held-out episodes, the interventional prior-fitted network's (PFN) gap is positive in every structure, trajectory length, and seed tested.

  • 3 authors
·
Jul 28

Leverage Is Not Reach: A Control-Window Law for Single-Neuron Steering in Language Models

Aligned language models gate behaviors such as refusal and language routing through sparse feed forward neurons, yet no theory predicts when a single neuron intervention controls a behavior coherently rather than collapsing the output. We develop a budget normalized control window framework for single neuron steering. A dose along one write direction reduces to one control coordinate: the alignment between the residual stream and the write, driven along a universal saturation curve in units of a coherence budget set by the residual norm divided by the write norm. Coherent control exists when a behavior trigger lies below the collapse ceiling. The same coordinate governs benign mode switches and refusal; the ceiling follows from weights and one generic forward pass, while triggers are measured at rollout. On fifteen held out neurons, the predicted ceiling has mean absolute error 0.14, about 0.07 in bulk layers, and the committed open or closed verdict holds on eleven against a ten of fifteen majority baseline. Closed cases expose three failure modes rather than violations: collapse before trigger, too little depth to propagate, or a normalization that caps how far one neuron can push. The law explains why local gradient attribution anti predicts control: true controllers write off the readout axis and carry a near zero first order gradient. A forward only contrastive screen made precise by the window recovers controllers that attribution misses. On refusal, the hardest case, intervention success is typed, not scalar: coherent bypass and strict actionable reach separate, so a neuron can flip refusal in fluent, on task text with no actionable content, and genuine actionable reach appears only for three of six audited Llama pivots and only at later rollout horizons. Single neuron steering is therefore a budgeted, typed audit of controllability rather than a fixed dose anecdote.

  • 1 authors
·
Jun 17

AgentBay: A Hybrid Interaction Sandbox for Seamless Human-AI Intervention in Agentic Systems

The rapid advancement of Large Language Models (LLMs) is catalyzing a shift towards autonomous AI Agents capable of executing complex, multi-step tasks. However, these agents remain brittle when faced with real-world exceptions, making Human-in-the-Loop (HITL) supervision essential for mission-critical applications. In this paper, we present AgentBay, a novel sandbox service designed from the ground up for hybrid interaction. AgentBay provides secure, isolated execution environments spanning Windows, Linux, Android, Web Browsers, and Code interpreters. Its core contribution is a unified session accessible via a hybrid control interface: An AI agent can interact programmatically via mainstream interfaces (MCP, Open Source SDK), while a human operator can, at any moment, seamlessly take over full manual control. This seamless intervention is enabled by Adaptive Streaming Protocol (ASP). Unlike traditional VNC/RDP, ASP is specifically engineered for this hybrid use case, delivering an ultra-low-latency, smoother user experience that remains resilient even in weak network environments. It achieves this by dynamically blending command-based and video-based streaming, adapting its encoding strategy based on network conditions and the current controller (AI or human). Our evaluation demonstrates strong results in security, performance, and task completion rates. In a benchmark of complex tasks, the AgentBay (Agent + Human) model achieved more than 48% success rate improvement. Furthermore, our ASP protocol reduces bandwidth consumption by up to 50% compared to standard RDP, and in end-to-end latency with around 5% reduction, especially under poor network conditions. We posit that AgentBay provides a foundational primitive for building the next generation of reliable, human-supervised autonomous systems.

  • 31 authors
·
Dec 3, 2025

Epileptic seizure forecasting with long short-term memory (LSTM) neural networks

Objective: Forecasting epileptic seizures can reduce uncertainty for patients and allow preventative actions. While many models can predict the occurrence of seizures from features of the EEG, few models incorporate changes in features over time. Long Short-Term Memory (LSTM) neural networks are a machine learning architecture that can display temporal dynamics due to the recurrent connections. In this paper, we used LSTMs to monitor changes in EEG features over time to improve the accuracy of seizure forecasts and to alter the time window of the forecast. Methods: Long-term intracranial EEG recordings from eight patients from the NeuroVista dataset were used. A Fourier transform of 1-minute segments of EEG was fed into a Convolutional Neural Network (CNN). The outputs from the CNN were input to three different LSTM models at different time intervals: 1 minute, 1 hour and 1 day. The LSTM model outputs were used to predict seizure onset within a time window. The prediction and start of the time window were separated by the same length of time as the window. Window sizes tested included 2, 4, 10, 20 and 40 minutes. Results and Conclusion: Our model forecast seizure onsets well above a random predictor. Compared to other models using the same dataset, our model performed better for some patients and worse for others. Monitoring the change in EEG features over time allowed our model to produce good results over a range of different window sizes, which is an improvement on previous models and raises the possibility of altering the forecast to meet individual patient needs. Furthermore, a window size of 40 minutes provides a potential intervention time of 40 minutes, which is the first time an intervention time of more than 5 minutes have been forecast using long-term EEG recordings.

  • 7 authors
·
Sep 18, 2023

Disentangling Answer Engine Optimization from Platform Growth: A Log-Based Natural Experiment on ChatGPT Referral Traffic

Large language model (LLM) "answer engines" such as ChatGPT now send measurable referral traffic to the open web, and a practice analogous to search engine optimization, here called Answer Engine Optimization (AEO), has emerged. Public AEO success stories typically quote large raw growth multiples, but raw referral growth is confounded by the rapid platform-level growth of the answer engines themselves. We report a longitudinal field study on a single high-traffic domain (glasp.co) whose corpus of hundreds of thousands of YouTube question-and-answer pages received a defined bundle of AEO interventions in January 2026 (detailed in Section 4). Because the interventions were concentrated on one subset of the site, the untreated remainder of the same domain acts as a contemporaneous control that absorbs the platform tailwind. Using first-party analytics and server logs rather than probabilistic third-party estimators, we find: (1) raw growth is dominated by the platform tailwind: on monthly aggregates total ChatGPT referrals grew 5.7x while untreated pages on the same domain grew 3.5x over the same window; (2) an interrupted time-series model on the weekly treated/control ratio estimates a discrete, intervention-aligned level increase of 1.82x (95% CI 1.31-2.54, HAC p=0.001), robust across engagement-filtered traffic (2.27x) and alternative specifications; (3) however, a conservative placebo-in-time permutation test yields p=0.16, so the effect is suggestive, not conclusive, given a short and noisy pre-period; and (4) Google organic clicks to treated pages did not fall beyond the ambient site-wide trend and indexation was preserved, consistent with the SEO-protection rule. The methodological message, separating treatment from platform tailwind with an on-domain control, matters more than any single multiple, and implies that headline AEO multiples substantially overstate causal effect.

  • 2 authors
·
Jun 2 1

EpiWorld: Grounding LLM Policy Agents in Epidemiological World Models

Epidemic intervention policies are textual artefacts that human decision-makers interpret, justify, and revise through natural language, making large language models a natural candidate for epidemic policy reasoning. A naive LLM, however, lacks the epidemic dynamics needed to project intervention consequences, the quantitative surveillance signals required to assess severity, and the institutional constraints that define admissible actions. We present EpiWorld, a closed-loop framework that grounds an LLM policy actor in a learned action-conditioned epidemiological world model and a tiered skill library of public-health protocols, surveillance tools, and adaptive lessons accumulated through after-action analysis. Given a candidate intervention, the world model predicts regional epidemic evolution and enables fast counterfactual rollouts that provide feedback for policy selection and refinement. Outcomes of simulated futures are distilled into reusable lessons while protocol constraints remain fixed, allowing the decision process to improve without sacrificing interpretability or controllability. We evaluate both the world model and the end-to-end framework on retrospective COVID-19 and Influenza datasets: the world model achieves the best out-of-distribution Peak-MAE among all forecasting baselines, and the closed-loop framework reduces cumulative hospitalisation by up to 59% across datasets and by an average of ~16% across six LLM backbones, outperforming reinforcement-learning and optimal-control policy baselines.

  • 5 authors
·
Oct 1

Constructing Challenging Browser-Use Tasks by Controlled Environment Interventions

As browser-use agents improve, benchmarks keep pace by collecting new tasks, websites, and applications, often making tasks longer or more novel. This makes difficulty expensive to refresh and difficult to control: when many aspects change at once, it is unclear what actually makes a task challenging. We instead construct challenging instances from tasks agents already solve, turning difficulty into a programmable property of the environment. BreakingWeb pairs every base task with an intervention condition that preserves the user instruction, latent target, and backend success criterion while changing the environment at different web stack layers. Each intervention is deterministic, detectable, and recoverable, and is annotated with the cognitive primitive it primarily loads. The benchmark contains 519 clean/intervention task pairs across seven self-hosted websites and 29 intervention families, all graded against outcomes. We evaluate six strong browser-use agents, three GUI-only agents that see only screenshots, and humans. The construction is effective: interventions cut agent pass rate by 22.9% on average and overturn nearly half of the tasks each agent solves cleanly, whereas humans lose 10.0% on a first attempt and 5.7% after one familiarisation attempt. The dominant failure is belief failure: 75% of the six agents' failures end with a declared success although the required change never happened. Our code, data and environment are publicly available at www.breakingweb.app.

  • 11 authors
·
Sep 19

Enhancing End Stage Renal Disease Outcome Prediction: A Multi-Sourced Data-Driven Approach

Objective: To improve prediction of Chronic Kidney Disease (CKD) progression to End Stage Renal Disease (ESRD) using machine learning (ML) and deep learning (DL) models applied to an integrated clinical and claims dataset of varying observation windows, supported by explainable AI (XAI) to enhance interpretability and reduce bias. Materials and Methods: We utilized data about 10,326 CKD patients, combining their clinical and claims information from 2009 to 2018. Following data preprocessing, cohort identification, and feature engineering, we evaluated multiple statistical, ML and DL models using data extracted from five distinct observation windows. Feature importance and Shapley value analysis were employed to understand key predictors. Models were tested for robustness, clinical relevance, misclassification errors and bias issues. Results: Integrated data models outperformed those using single data sources, with the Long Short-Term Memory (LSTM) model achieving the highest AUC (0.93) and F1 score (0.65). A 24-month observation window was identified as optimal for balancing early detection and prediction accuracy. The 2021 eGFR equation improved prediction accuracy and reduced racial bias, notably for African American patients. Discussion: Improved ESRD prediction accuracy, results interpretability and bias mitigation strategies presented in this study have the potential to significantly enhance CKD and ESRD management, support targeted early interventions and reduce healthcare disparities. Conclusion: This study presents a robust framework for predicting ESRD outcomes in CKD patients, improving clinical decision-making and patient care through multi-sourced, integrated data and AI/ML methods. Future research will expand data integration and explore the application of this framework to other chronic diseases.

  • 2 authors
·
Oct 1, 2024

To Trust or to Think: Cognitive Forcing Functions Can Reduce Overreliance on AI in AI-assisted Decision-making

People supported by AI-powered decision support tools frequently overrely on the AI: they accept an AI's suggestion even when that suggestion is wrong. Adding explanations to the AI decisions does not appear to reduce the overreliance and some studies suggest that it might even increase it. Informed by the dual-process theory of cognition, we posit that people rarely engage analytically with each individual AI recommendation and explanation, and instead develop general heuristics about whether and when to follow the AI suggestions. Building on prior research on medical decision-making, we designed three cognitive forcing interventions to compel people to engage more thoughtfully with the AI-generated explanations. We conducted an experiment (N=199), in which we compared our three cognitive forcing designs to two simple explainable AI approaches and to a no-AI baseline. The results demonstrate that cognitive forcing significantly reduced overreliance compared to the simple explainable AI approaches. However, there was a trade-off: people assigned the least favorable subjective ratings to the designs that reduced the overreliance the most. To audit our work for intervention-generated inequalities, we investigated whether our interventions benefited equally people with different levels of Need for Cognition (i.e., motivation to engage in effortful mental activities). Our results show that, on average, cognitive forcing interventions benefited participants higher in Need for Cognition more. Our research suggests that human cognitive motivation moderates the effectiveness of explainable AI solutions.

  • 3 authors
·
Feb 18, 2021

Coping with Information Loss and the Use of Auxiliary Sources of Data: A Report from the NISS Ingram Olkin Forum Series on Unplanned Clinical Trial Disruptions

Clinical trials disruption has always represented a non negligible part of the ending of interventional studies. While the SARS-CoV-2 (COVID-19) pandemic has led to an impressive and unprecedented initiation of clinical research, it has also led to considerable disruption of clinical trials in other disease areas, with around 80% of non-COVID-19 trials stopped or interrupted during the pandemic. In many cases the disrupted trials will not have the planned statistical power necessary to yield interpretable results. This paper describes methods to compensate for the information loss arising from trial disruptions by incorporating additional information available from auxiliary data sources. The methods described include the use of auxiliary data on baseline and early outcome data available from the trial itself and frequentist and Bayesian approaches for the incorporation of information from external data sources. The methods are illustrated by application to the analysis of artificial data based on the Primary care pediatrics Learning Activity Nutrition (PLAN) study, a clinical trial assessing a diet and exercise intervention for overweight children, that was affected by the COVID-19 pandemic. We show how all of the methods proposed lead to an increase in precision relative to use of complete case data only.

  • 12 authors
·
Jun 22, 2022

Temporal Dynamics of Development Aid in Africa: Evidence from a Staggered Difference-in-Differences Study of China and World Bank Projects in Africa

Subnational studies of aid effectiveness often rely on repeated cross-sections or nighttime lights, making it difficult to separate local treatment effects from baseline differences and potentially favoring infrastructure-heavy projects. We address these limitations by studying World Bank and Chinese development projects in Africa with a balanced panel of 2,166 DHS clusters across 35 countries from 2002 to 2013. Geocoded AidData projects are linked to satellite-imputed International Wealth Index estimates, a household-centered measure of material living standards. We compare a conventional two-way fixed effects (TWFE) event-study with the switcher--stayer estimator of de Chaisemartin and D'Haultfoeuille (dCdH), which avoids contaminated comparisons under staggered treatment timing. Pre-treatment diagnostics show that project placement is frequently selective: clusters that later receive projects often begin from weaker relative positions before treatment onset. Consequently, TWFE often implies larger post-treatment gains than the preferred staggered-treatment design supports. Under dCdH, the evidence becomes more selective and sector-specific. For the World Bank, positive evidence is strongest in Health, while Education shows positive but less cleanly identified gains. For China, Water Supply and Sanitation and Other Social Infrastructure and Services show positive associations with local wealth, although residual selection concerns remain. By contrast, Chinese Energy Generation and Supply appears strongly positive under TWFE but falls close to zero under dCdH. Overall, the results do not support a donor-wide claim that either the World Bank or China uniformly improves local wealth. Instead, estimated effects are concentrated in a limited set of donor--sector panels and depend strongly on how treatment timing, selection, and outcome measurement are handled.

An Analysis of Causal Effect Estimation using Outcome Invariant Data Augmentation

The technique of data augmentation (DA) is often used in machine learning for regularization purposes to better generalize under i.i.d. settings. In this work, we present a unifying framework with topics in causal inference to make a case for the use of DA beyond just the i.i.d. setting, but for generalization across interventions as well. Specifically, we argue that when the outcome generating mechanism is invariant to our choice of DA, then such augmentations can effectively be thought of as interventions on the treatment generating mechanism itself. This can potentially help to reduce bias in causal effect estimation arising from hidden confounders. In the presence of such unobserved confounding we typically make use of instrumental variables (IVs) -- sources of treatment randomization that are conditionally independent of the outcome. However, IVs may not be as readily available as DA for many applications, which is the main motivation behind this work. By appropriately regularizing IV based estimators, we introduce the concept of IV-like (IVL) regression for mitigating confounding bias and improving predictive performance across interventions even when certain IV properties are relaxed. Finally, we cast parameterized DA as an IVL regression problem and show that when used in composition can simulate a worst-case application of such DA, further improving performance on causal estimation and generalization tasks beyond what simple DA may offer. This is shown both theoretically for the population case and via simulation experiments for the finite sample case using a simple linear example. We also present real data experiments to support our case.

  • 5 authors
·
Oct 28, 2025 1

Sign-Constrained Intervention Effects for Domain-Generalizable ICU World Models

Predicting how a patient's vital signs respond to an intervention is a central question in intensive care. World models can do so by learning dynamics as a function of prior actions. However, such models tend to be brittle outside of training data. Clinicians choose drug dosages based on the patient's state, so the association a model learns between dose and outcome runs opposite to the drug's effect, generalizing poorly to out-of-distribution (OOD) dosing practices. Yet, pharmacological information provides the directional effects of different drugs, which are invariant to OOD shifts. To resolve the OOD sensitivity of current ICU world models, we introduce PHYSIO WORLD, which isolates an intervention's effect by evaluating a forward pass twice: once under recorded doses, and once with those doses set to zero. The difference is projected onto pharmacologically admissible effect directions stated by 70 rules over 28 drugs, leaving the magnitude to be learned from data. Across five distribution-shift parameters over cohorts from three intensive-care databases, and against forecasters, counterfactual models, and invariance objectives, PHYSIO WORLD attains the lowest OOD RMSE in every setting, improving on the strongest external baseline by 8-12%, while matching the in-distribution error of its backbone. Reversing the pharmacological directions degrades accuracy below the backbone, and data-mined directions recover almost no gain, indicating the improvement derives from the content of the pharmacological knowledge. The construction may extend to other settings where the sign of an effect is known in advance and its magnitude is confounded by treatment assignment.

  • 5 authors
·
Oct 7

AIMI: Leveraging Future Knowledge and Personalization in Sparse Event Forecasting for Treatment Adherence

Adherence to prescribed treatments is crucial for individuals with chronic conditions to avoid costly or adverse health outcomes. For certain patient groups, intensive lifestyle interventions are vital for enhancing medication adherence. Accurate forecasting of treatment adherence can open pathways to developing an on-demand intervention tool, enabling timely and personalized support. With the increasing popularity of smartphones and wearables, it is now easier than ever to develop and deploy smart activity monitoring systems. However, effective forecasting systems for treatment adherence based on wearable sensors are still not widely available. We close this gap by proposing Adherence Forecasting and Intervention with Machine Intelligence (AIMI). AIMI is a knowledge-guided adherence forecasting system that leverages smartphone sensors and previous medication history to estimate the likelihood of forgetting to take a prescribed medication. A user study was conducted with 27 participants who took daily medications to manage their cardiovascular diseases. We designed and developed CNN and LSTM-based forecasting models with various combinations of input features and found that LSTM models can forecast medication adherence with an accuracy of 0.932 and an F-1 score of 0.936. Moreover, through a series of ablation studies involving convolutional and recurrent neural network architectures, we demonstrate that leveraging known knowledge about future and personalized training enhances the accuracy of medication adherence forecasting. Code available: https://github.com/ab9mamun/AIMI.

  • 3 authors
·
Mar 20, 2025 2

Site-Level Fine-Tuning with Progressive Layer Freezing: Towards Robust Prediction of Bronchopulmonary Dysplasia from Day-1 Chest Radiographs in Extremely Preterm Infants

Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting 35% of extremely low birth weight infants. Defined by oxygen dependence at 36 weeks postmenstrual age, it causes lifelong respiratory complications. However, preventive interventions carry severe risks, including neurodevelopmental impairment, ventilator-induced lung injury, and systemic complications. Therefore, early BPD prognosis and prediction of BPD outcome is crucial to avoid unnecessary toxicity in low risk infants. Admission radiographs of extremely preterm infants are routinely acquired within 24h of life and could serve as a non-invasive prognostic tool. In this work, we developed and investigated a deep learning approach using chest X-rays from 163 extremely low-birth-weight infants (leq32 weeks gestation, 401-999g) obtained within 24 hours of birth. We fine-tuned a ResNet-50 pretrained specifically on adult chest radiographs, employing progressive layer freezing with discriminative learning rates to prevent overfitting and evaluated a CutMix augmentation and linear probing. For moderate/severe BPD outcome prediction, our best performing model with progressive freezing, linear probing and CutMix achieved an AUROC of 0.78 pm 0.10, balanced accuracy of 0.69 pm 0.10, and an F1-score of 0.67 pm 0.11. In-domain pre-training significantly outperformed ImageNet initialization (p = 0.031) which confirms domain-specific pretraining to be important for BPD outcome prediction. Routine IRDS grades showed limited prognostic value (AUROC 0.57 pm 0.11), confirming the need of learned markers. Our approach demonstrates that domain-specific pretraining enables accurate BPD prediction from routine day-1 radiographs. Through progressive freezing and linear probing, the method remains computationally feasible for site-level implementation and future federated learning deployments.

  • 16 authors
·
Jul 16, 2025

Spoken Dialogue System for Medical Prescription Acquisition on Smartphone: Development, Corpus and Evaluation

Hospital information systems (HIS) have become an essential part of healthcare institutions and now incorporate prescribing support software. Prescription support software allows for structured information capture, which improves the safety, appropriateness and efficiency of prescriptions and reduces the number of adverse drug events (ADEs). However, such a system increases the amount of time physicians spend at a computer entering information instead of providing medical care. In addition, any new visiting clinician must learn to manage complex interfaces since each HIS has its own interfaces. In this paper, we present a natural language interface for e-prescribing software in the form of a spoken dialogue system accessible on a smartphone. This system allows prescribers to record their prescriptions verbally, a form of interaction closer to their usual practice. The system extracts the formal representation of the prescription ready to be checked by the prescribing software and uses the dialogue to request mandatory information, correct errors or warn of particular situations. Since, to the best of our knowledge, there is no existing voice-based prescription dialogue system, we present the system developed in a low-resource environment, focusing on dialogue modeling, semantic extraction and data augmentation. The system was evaluated in the wild with 55 participants. This evaluation showed that our system has an average prescription time of 66.15 seconds for physicians and 35.64 seconds for other experts, and a task success rate of 76\% for physicians and 72\% for other experts. All evaluation data were recorded and annotated to form PxCorpus, the first spoken drug prescription corpus that has been made fully available to the community (https://doi.org/10.5281/zenodo.6524162).

  • 6 authors
·
Nov 6, 2023

The International Monetary Funds intervention in education systems and its impact on childrens chances of completing school

Enabling children to acquire an education is one of the most effective means to reduce inequality, poverty, and ill-health globally. While in normal times a government controls its educational policies, during times of macroeconomic instability, that control may shift to supporting international organizations, such as the International Monetary Fund (IMF). While much research has focused on which sectors has been affected by IMF policies, scholars have devoted little attention to the policy content of IMF interventions affecting the education sector and childrens education outcomes: denoted IMF education policies. This article evaluates the extent which IMF education policies exist in all programs and how these policies and IMF programs affect childrens likelihood of completing schools. While IMF education policies have a small adverse effect yet statistically insignificant on childrens probability of completing school, these policies moderate effect heterogeneity for IMF programs. The effect of IMF programs (joint set of policies) adversely effect childrens chances of completing school by six percentage points. By analyzing how IMF-education policies but also how IMF programs affect the education sector in low and middle-income countries, scholars will gain a deeper understanding of how such policies will likely affect downstream outcomes.

  • 1 authors
·
Dec 30, 2021

Teaching LLMs to Recommend and Defer in Underrepresented Epilepsy Care

Specialist epilepsy expertise is scarce in resource-constrained settings, making LLM-based decision support attractive for frontline clinicians managing longitudinal treatment. Such systems must adapt to local prescribing practice and know when to defer. We study this problem in Ugandan pediatric epilepsy care, predicting anti-seizure medication regimens from longitudinal unstructured clinic notes. Standard prompting achieves non-trivial agreement with physician prescriptions, but neurologist review shows that many errors reflect distribution-miscalibrated prescribing defaults rather than failures to parse the local record. We introduce MANANA, a non-parametric prompt-learning framework that learns local prescribing guidance from a small patient-level training set. MANANA converts observed prescription errors into auditable prompt memories, instantiated in single-agent and multi-agent variants, and improves over classical ML models, direct LLM prompting, and prompt-optimization baselines across two independently collected Ugandan cohorts. We further propose Bayesian prompt averaging, which converts the learned prompt trajectory into prescription likelihoods and an uncertainty-based deferral signal. On the independently collected held-out cohort, this improves visit-level top-3 prescription accuracy by 4-8 percentage points over prompt-optimization baselines and enables selective prediction: the system can auto-handle the most confident half of cases at 95% precision, or the most confident quarter at 99% precision, while deferring lower-confidence cases for specialist review.

Compared to What? Baselines and Metrics for Counterfactual Prompting

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

  • 4 authors
·
Apr 30

PRISM: Festina Lente Proactivity -- Risk-Sensitive, Uncertainty-Aware Deliberation for Proactive Agents

Proactive agents must decide not only what to say but also whether and when to intervene. Many current systems rely on brittle heuristics or indiscriminate long reasoning, which offers little control over the benefit-burden tradeoff. We formulate the problem as cost-sensitive selective intervention and present PRISM, a novel framework that couples a decision-theoretic gate with a dual-process reasoning architecture. At inference time, the agent intervenes only when a calibrated probability of user acceptance exceeds a threshold derived from asymmetric costs of missed help and false alarms. Inspired by festina lente (Latin: "make haste slowly"), we gate by an acceptance-calibrated, cost-derived threshold and invoke a resource-intensive Slow mode with counterfactual checks only near the decision boundary, concentrating computation on ambiguous and high-stakes cases. Training uses gate-aligned, schema-locked distillation: a teacher running the full PRISM pipeline provides dense, executable supervision on unlabeled interaction traces, while the student learns a response policy that is explicitly decoupled from the intervention gate to enable tunable and auditable control. On ProactiveBench, PRISM reduces false alarms by 22.78% and improves F1 by 20.14% over strong baselines. These results show that principled decision-theoretic gating, paired with selective slow reasoning and aligned distillation, yields proactive agents that are precise, computationally efficient, and controllable. To facilitate reproducibility, we release our code, models, and resources at https://prism-festinalente.github.io/; all experiments use the open-source ProactiveBench benchmark.

  • 5 authors
·
Feb 1

Same Model, Different Harness: Different Coding-Agent Results

A coding agent combines a model with a harness, which decides what the model sees, which tools it can use, and how the work continues. We ask whether changing the harness changes the result when the model and task stay fixed. We compare two configurations of the same harness on three coding benchmarks. The control supplies the full conversation in time order, while the treatment keeps the same record but mechanically shortens older tool results as the context fills and responds to repeated or stalled work. Under tight context, the treatment raises mean per-task fail-to-pass fraction (F2PF) in all three pressure comparisons and increases complete solutions on SWE-bench Verified and SWE-bench Pro. The tight-window Verified comparison uses 169 tasks, a 20,480-token window, and a fixed 480-second attempt endpoint; on this cohort, treatment raises mean per-task F2PF from 28 percent to 49 percent and complete solutions from 43 to 72. Without model-specific retuning, the same frozen treatment also raises both endpoints on the same cohort for three additional models with different designs. In the wide-window Qwen3.6 comparisons, observed arm outcomes are close on Verified and Pro, while FeatureBench retains a higher mean per-task F2PF under treatment. On the wide-window Verified cohort, treatment also serves fewer prompt tokens per turn. Because changing the harness changed what unchanged model weights could accomplish, coding-agent evaluations should treat the model and harness together as the tested solver.

  • 1 authors
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Aug 25

Gated Activation Steering for Reducing Sycophancy & Hallucination in Medical Question Answering

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

  • 6 authors
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Aug 23