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Oct 21

MeddeX: A Retrieval-Augmented LLaMA-3 System with Gemini Vision for Evidence-Backed Medical Report Analysis

Modern healthcare generates increasingly complex medical reports that challenge clinical professionals in terms of time and interpretive burden. Manual review processes are slow, error-prone, and difficult to scale. This paper presents MeddeX, a Medical Report Analyzer that combines a QLoRA fine-tuned LLaMA-3 (8B) model with Retrieval-Augmented Gen eration (RAG) and a multimodal Gemini Vision layer to deliver accurate, concise, and evidence-backed summaries of medical documents. The system handles text-native PDFs, scanned image based PDFs, and direct radiological images through an intelligent hybrid extraction pipeline that includes a novel garbage-text detection mechanism for corrupted and UTF-16-encoded doc uments. Beyond single-report Q&A, MeddeX introduces report scoped retrieval for precise contextual grounding, an automated longitudinal report comparison engine, and a self-healing backfill pipeline that lazily processes legacy documents on demand. A FastAPI backend, Supabase vector store, and Next.js fron tend complete the end-to-end architecture. Evaluation against the base LLaMA3-Med42-8B model demonstrates consistent improvements across ROUGE-1 (+9.2%), ROUGE-2 (+10.0%), ROUGE-L (+11.8%), BLEU (+71.4%), and BERTScore (+0.8%), validating the benefit of domain-specific fine-tuning. MeddeX represents a practical and robust step toward AI-assisted clinical decision support.

  • 4 authors
·
Sep 29

Standardizing Longitudinal Radiology Report Evaluation via Large Language Model Annotation

Longitudinal information in radiology reports refers to the sequential tracking of findings across multiple examinations over time, which is crucial for monitoring disease progression and guiding clinical decisions. Many recent automated radiology report generation methods are designed to capture longitudinal information; however, validating their performance is challenging. There is no proper tool to consistently label temporal changes in both ground-truth and model-generated texts for meaningful comparisons. Large language models (LLMs) offer a promising annotation alternative, as they are capable of capturing nuanced linguistic patterns and semantic similarities without extensive manual intervention. They also adapt well to new contexts. In this study, we therefore propose an LLM-based pipeline to automatically annotate longitudinal information in radiology reports. The pipeline first identifies sentences containing relevant information and then extracts the progression of diseases. We evaluate and compare five mainstream LLMs on these two tasks using 500 manually annotated reports. Considering both efficiency and performance, Qwen2.5-32B was subsequently selected and used to annotate another 95,169 reports from the public MIMIC-CXR dataset. Our Qwen2.5-32B-annotated dataset provided us with a standardized benchmark for evaluating report generation models. Using this new benchmark, we assessed seven state-of-the-art report generation models. Our LLM-based annotation method outperforms existing annotation solutions, achieving 11.3\% and 5.3\% higher F1-scores for longitudinal information detection and disease tracking, respectively. The source code is available at https://github.com/wxinyi1996/Standardizing-Longitudinal-Chest-X-ray-Report-Evaluation-via-Large-Language-Model-Annotation.git.

  • 4 authors
·
Aug 29

A Review of Longitudinal Radiology Report Generation: Dataset Composition, Methods, and Performance Evaluation

Chest Xray imaging is a widely used diagnostic tool in modern medicine, and its high utilization creates substantial workloads for radiologists. To alleviate this burden, vision language models are increasingly applied to automate Chest Xray radiology report generation (CXRRRG), aiming for clinically accurate descriptions while reducing manual effort. Conventional approaches, however, typically rely on single images, failing to capture the longitudinal context necessary for producing clinically faithful comparison statements. Recently, growing attention has been directed toward incorporating longitudinal data into CXR RRG, enabling models to leverage historical studies in ways that mirror radiologists diagnostic workflows. Nevertheless, existing surveys primarily address single image CXRRRG and offer limited guidance for longitudinal settings, leaving researchers without a systematic framework for model design. To address this gap, this survey provides the first comprehensive review of longitudinal radiology report generation (LRRG). Specifically, we examine dataset construction strategies, report generation architectures alongside longitudinally tailored designs, and evaluation protocols encompassing both longitudinal specific measures and widely used benchmarks. We further summarize LRRG methods performance, alongside analyses of different ablation studies, which collectively highlight the critical role of longitudinal information and architectural design choices in improving model performance. Finally, we summarize five major limitations of current research and outline promising directions for future development, aiming to lay a foundation for advancing this emerging field.

  • 6 authors
·
Oct 14, 2025

BrainTRACE: Tracing Longitudinal, Multimodal, and Volumetric Evidence in Brain MRI Clinical Reasoning

Brain MRI interpretation is a longitudinal clinical reasoning problem: radiologists compare serial studies, integrate information across MRI sequences, localize findings within volumetric anatomy, and translate this evidence into report-grounded assessments. Existing medical VQA and 3D imaging benchmarks capture important parts of this workflow, but often evaluate brain MRI through isolated images, static volumes, or ungrounded report-style answers, thereby obscuring failures in the evidence chain that support clinical validity. We introduce BrainTRACE, a report-grounded benchmark for evaluating whether vision-language models can trace the evidence structure required for longitudinal brain MRI interpretation. BrainTRACE contains 7,273 scored VQA instances derived from 1,778 longitudinal patients, 7,299 MRI studies, and approximately 29k co-registered 3D MRI sequence volumes. The benchmark is organized by five levels of clinical reasoning, from acquisition recognition to case-level synthesis, and by evidence demands covering longitudinal comparison, report-grounded references, multi-sequence integration, and volumetric spatial evidence. BrainTRACE supports rendered inputs compatible with standard VLM interfaces, a 3D-evidence condition, and a decomposed case-reasoning track that audits six steps in a longitudinal evidence chain. Evaluation of 20 VLM configurations shows that current systems can identify isolated visual cues but rarely compose them into grounded longitudinal interpretations. We release the benchmark specification, evaluation lists, scoring implementation, scoring rubrics, and audit-record format to support reproducible progress in brain MRI VLM evaluation.

  • 8 authors
·
Oct 4

CT-ΔBench: A Benchmark for Longitudinal 3D Medical Imaging Difference Reporting with Vision-Language Models

In medical imaging, the clinical value of Computed Tomography (CT) lies not only in depicting current disease status, but crucially in enabling longitudinal comparison of serial scans to determine disease evolution, a process that underpins response assessment, recurrence detection, and ongoing patient management. Yet, despite this central role of temporal comparison in clinical decision-making, existing medical foundation models remain largely confined to single-study understanding, leaving temporally grounded cross-examination insufficiently addressed. To address this gap, we study longitudinal imaging difference reporting, a task in which a model takes two temporally separated scans from the same patient and generates a clinically meaningful report describing interval changes between them. We introduce CT-ΔBench, a dedicated benchmark for this task with patient-level splitting to prevent information leakage. To better evaluate this task beyond surface-level text similarity, we further develop change-aware metrics specifically designed to capture clinically meaningful longitudinal changes, and conduct an independent physician validation to assess the reliability of the synthesized references and event extraction pipeline. We also compare direct paired-CT reasoning with an indirect two-stage pipeline that first generates single-timepoint reports and then performs textual differencing. Finally, we propose DeltaMed, a baseline model for direct paired-CT difference reporting, and train it on the benchmark training set. Together, these contributions lay the groundwork for temporally aware medical foundation models that better reflect real-world longitudinal clinical reasoning.

  • 4 authors
·
Aug 11

What Can a Leaderboard Certify? Compositional Controllability for Fair Evaluation and Training of Biomedical Literature-Review Agents

Leaderboards rank long-horizon agents by their final outputs. Yet a higher score alone does not establish whether two systems are comparable or which stage accounts for the difference. Unequal evidence, inputs, or budgets can affect scores, and statistical corrections do not remove this mismatch. We introduce compositional controllability to address these questions. A comparison window covers one stage, several stages, or the whole agent. Our central result bounds the gap between observed and controlled score differences using only nuisance outside the window. This yields an admissibility test applied before scores are inspected. Inadmissible comparisons are refused. For admissible pairs, an ordering is certified only when the score gap exceeds the combined sampling and nuisance radii; otherwise, it remains undecided. These decisions give each system a rank interval. We introduce BioLitBench, a benchmark of 2,042 biomedical articles represented as structured claim graphs. Among seven published pipelines, a conventional statistical analysis declares a winner in 14 of 21 pairwise comparisons. Yet the top-ranked system alone received the target review's bibliography. To isolate pipeline performance, our test requires matched inputs and a fixed backbone model. It refuses 11 of the 21 comparisons, including every comparison involving the top-ranked system. Seven of the 14 conventional conclusions fall within these refused pairs. The same comparison windows support stage-level training. We train SCRIBE on Qwen3.8-27B using rewards measured at each stage's exit. Under matched evidence, SCRIBE achieves a certified rank interval of [1,2], with certified advantages over all evaluated published pipelines and the evaluated Claude and OpenAI agents. Under same pool, SCRIBE matches the strongest published retriever and is certified above three published pipelines.

  • 7 authors
·
Sep 25

Enforcing temporal consistency in Deep Learning segmentation of brain MR images

Longitudinal analysis has great potential to reveal developmental trajectories and monitor disease progression in medical imaging. This process relies on consistent and robust joint 4D segmentation. Traditional techniques are dependent on the similarity of images over time and the use of subject-specific priors to reduce random variation and improve the robustness and sensitivity of the overall longitudinal analysis. This is however slow and computationally intensive as subject-specific templates need to be rebuilt every time. The focus of this work to accelerate this analysis with the use of deep learning. The proposed approach is based on deep CNNs and incorporates semantic segmentation and provides a longitudinal relationship for the same subject. The proposed approach is based on deep CNNs and incorporates semantic segmentation and provides a longitudinal relationship for the same subject. The state of art using 3D patches as inputs to modified Unet provides results around {0.91 pm 0.5} Dice and using multi-view atlas in CNNs provide around the same results. In this work, different models are explored, each offers better accuracy and fast results while increasing the segmentation quality. These methods are evaluated on 135 scans from the EADC-ADNI Harmonized Hippocampus Protocol. Proposed CNN based segmentation approaches demonstrate how 2D segmentation using prior slices can provide similar results to 3D segmentation while maintaining good continuity in the 3D dimension and improved speed. Just using 2D modified sagittal slices provide us a better Dice and longitudinal analysis for a given subject. For the ADNI dataset, using the simple UNet CNN technique gives us {0.84 pm 0.5} and while using modified CNN techniques on the same input yields {0.89 pm 0.5}. Rate of atrophy and RMS error are calculated for several test cases using various methods and analyzed.

  • 2 authors
·
Jun 13, 2019

Memory-Orchestrated Semantic System (MOSS): An Auditable Agentic Memory Architecture

Long-term memory remains a structural weakness of AI agents. The dominant approach, retrieval-augmented generation (RAG), relies on embedding-based similarity search, which is opaque by construction, difficult to audit, and bounded by the theoretical limits of vector representations. We present the Memory-Orchestrated Semantic System (MOSS), an agentic memory architecture in which the agent drives retrieval over a structured relational database. MOSS is model-agnostic, storage-agnostic, and API-agnostic: it runs on any relational engine, connects to any LLM provider (or to deterministic non-LLM processes), and deploys on any infrastructure, local or cloud. Its retrieval execution is symbolic and reproducible (once a query is formulated, no LLM participates in the retrieval loop) and every step of the system, from indexing to answer formulation, is logged and inspectable, making MOSS auditable by construction. Rather than imposing an external ontology, MOSS derives its conceptual vocabulary from the corpus itself. We report on a longitudinal deployment unique in the agentic-memory literature: a year of continuous production over an individual scholar's working corpus--a conversational corpus reaching back to October 2024 (some 44 million tokens, retroactively indexed) comprising 110,183 segments, alongside 163,494 catalogued documents, 569 inductively derived concepts, 322,662 concept annotations, and eleven metadata graphs totaling approximately five million relations--across four successive infrastructure generations. While the present case is that of a single researcher, the architecture is in no way specific to one person: it serves a team, an institution, or any entity that accumulates knowledge over time. We argue that auditable, sovereign, structurally unbounded memory is a precondition for AI agents intended to accompany a person or an organization over years rather than sessions.

  • 3 authors
·
Jul 4

LSREP: A Longitudinal State-Replay Protocol for Evaluating Conversational Memory, with ICE v2 as an Audited Local-First Architecture

Conversational memory changes during use, so endpoint question answering alone cannot establish how a persistent state accumulates, ages, or incorporates revisions. We introduce LSREP, a Longitudinal State-Replay Evaluation Protocol combining ordered replay, explicit lifecycle schedules, repeated probes, evolving reference answers, and mechanism-fidelity checks. Its architectural case study is ICE v2, a local-first memory middleware with typed stores, retrieval fusion, and dynamic context budgets. The private, single-user instantiation contains 1,985 turns, 219 distinct probes, and 1,211 probe-checkpoint observations across 52 checkpoints. On three ordinary-density datasets, ICE v2 has a near-zero mean quality difference from vector-RAG while selecting 32% fewer fragments but using 6.6% more estimated prompt tokens. A fourth, dense dataset exposes catastrophic failures of the unbudgeted baseline. The fidelity audit limits attribution: procedural retrieval is defective, several mechanisms are unexercised, and graph utility is not established. In a complementary matched public diagnostic, ICE v2 loses decisively to pure vector-RAG on LongMemEval: 50.8% versus 72.8% in the evidence-only oracle and 43.0% versus 69.5% in full-S. Paired differences are -22.0 points (95% CI [-26.6, -17.4]) and -26.5 ([-31.3, -21.8]). Conservative abstention accompanies severe multi-session and temporal failures. ICE uses less context in this diagnostic, establishing a quality-cost trade-off rather than superior efficiency. Together, replay, fidelity auditing, and public endpoint testing expose distinct failure modes that neither architectural descriptions nor aggregate scores identify alone.

  • 1 authors
·
Sep 14

Tracing individual knowledge trajectories in a changing field: the case of general relativity and gravitation

Historians have reconstructed the twentieth-century transformation of general relativity and gravitation (GRG) at the field level and through individual careers, but connecting these scales requires a way to compare researchers with the changing field over time. We develop such a comparison, setting a researcher's publications and references against GRG field literature from the same, earlier, and later two-year periods. Building on Own Vocabulary and Embedding Density Estimation from our earlier two-case study (arXiv:2501.00391), we extend the analysis to the fifty most-published authors in a NASA/ADS corpus of about 180,000 GRG records (1911 to 2000) and add two citation-based measures, Referenced Vocabulary and Citation Identity. The four measures compare an author's written language, cited literature, semantic neighbourhood, and cited-authority configuration with the surrounding field. The earlier cases suggested that closer field-vocabulary alignment accompanies a denser semantic neighbourhood. Across the fifty authors this holds only partially. Written and cited vocabularies tend to move together, usually resembling later GRG literature as the field turned towards astrophysical and cosmological research. Semantic neighbourhoods more often lie where the field's publications were concentrated in earlier periods, while co-citation patterns follow no single temporal direction, and the two citation measures frequently place the same researcher differently despite drawing on identical reference lists. Individual trajectories can thus combine vocabulary tied to later field states with older semantic or citation structures, and these divergent cases mark patterns for closer historical investigation. The approach transfers to other fields with defensible corpus boundaries and adequate coverage of texts, references, and disambiguated author identities.

  • 2 authors
·
Sep 15

Extending Mixture of Experts Model to Investigate Heterogeneity of Trajectories: When, Where and How to Add Which Covariates

Researchers are usually interested in examining the impact of covariates when separating heterogeneous samples into latent classes that are more homogeneous. The majority of theoretical and empirical studies with such aims have focused on identifying covariates as predictors of class membership in the structural equation modeling framework. In other words, the covariates only indirectly affect the sample heterogeneity. However, the covariates' influence on between-individual differences can also be direct. This article presents a mixture model that investigates covariates to explain within-cluster and between-cluster heterogeneity simultaneously, known as a mixture-of-experts (MoE) model. This study aims to extend the MoE framework to investigate heterogeneity in nonlinear trajectories: to identify latent classes, covariates as predictors to clusters, and covariates that explain within-cluster differences in change patterns over time. Our simulation studies demonstrate that the proposed model generally estimates the parameters unbiasedly, precisely and exhibits appropriate empirical coverage for a nominal 95% confidence interval. This study also proposes implementing structural equation model forests to shrink the covariate space of the proposed mixture model. We illustrate how to select covariates and construct the proposed model with longitudinal mathematics achievement data. Additionally, we demonstrate that the proposed mixture model can be further extended in the structural equation modeling framework by allowing the covariates that have direct effects to be time-varying.

  • 2 authors
·
Jul 5, 2020

Deep Research, Shallow Evaluation: A Case Study in Meta-Evaluation for Long-Form QA Benchmarks

Recent advances have made long-form report-generating systems widely available. This has prompted evaluation frameworks that use LLM-as-judge protocols and claim verification, along with meta-evaluation frameworks that seek to validate these methods. Many of the meta-evaluations estimate an evaluation quality's by comparing its assessments against human pairwise preferences. Prior work, however, suggests that human pairwise preference may be overly simplistic and can fail to capture nuances of expert expectations. We conduct a case study in meta-evaluation for long-form QA benchmarks using ScholarQA-CS2, a benchmark designed for assessing retrieval-augmented deep-research QA in the scientific domain. We comprehensively validate the benchmark through human pairwise preference judgments, then critically examine the strengths, weaknesses, and confounders of this approach. We show that pairwise preference rankings are best suited for system-level evaluation, while explicit metric-wise annotations and expert annotators are critical for reliable metric-level assessment, with subjectivity remaining a key challenge. Based on our findings, we offer practical guidelines for designing future meta-evaluations that better align evaluation methods, annotator expertise, and reporting practices. By surfacing these methodological challenges, we aim to advance evaluation standards for deep-research systems.

  • 12 authors
·
Mar 5

Comparing the Efficacy of GPT-4 and Chat-GPT in Mental Health Care: A Blind Assessment of Large Language Models for Psychological Support

Background: Rapid advancements in natural language processing have led to the development of large language models with the potential to revolutionize mental health care. These models have shown promise in assisting clinicians and providing support to individuals experiencing various psychological challenges. Objective: This study aims to compare the performance of two large language models, GPT-4 and Chat-GPT, in responding to a set of 18 psychological prompts, to assess their potential applicability in mental health care settings. Methods: A blind methodology was employed, with a clinical psychologist evaluating the models' responses without knowledge of their origins. The prompts encompassed a diverse range of mental health topics, including depression, anxiety, and trauma, to ensure a comprehensive assessment. Results: The results demonstrated a significant difference in performance between the two models (p > 0.05). GPT-4 achieved an average rating of 8.29 out of 10, while Chat-GPT received an average rating of 6.52. The clinical psychologist's evaluation suggested that GPT-4 was more effective at generating clinically relevant and empathetic responses, thereby providing better support and guidance to potential users. Conclusions: This study contributes to the growing body of literature on the applicability of large language models in mental health care settings. The findings underscore the importance of continued research and development in the field to optimize these models for clinical use. Further investigation is necessary to understand the specific factors underlying the performance differences between the two models and to explore their generalizability across various populations and mental health conditions.

  • 1 authors
·
May 15, 2024

LoMeVQA: A Comprehensive Benchmark for Longitudinal Medical VQA

In clinical practice, patients often undergo multiple imaging examinations over successive visits, yielding longitudinal data. Modeling such temporal information is crucial for reliable assessment of disease progression and treatment response. However, despite the rapid advancement of multimodal large language models (MLLMs), longitudinal medical visual reasoning remains largely underexplored. To fill this gap, we propose LoMeVQA, a comprehensive benchmark consisting of 206K longitudinal visual question answering (VQA) pairs for temporal medical image analysis. LoMeVQA covers five tasks: progress classification, progress description, progress report generation, differential region grounding, and differential region description. To construct the dataset, we develop an automated pipeline that (1) organizes patient records chronologically, (2) extracts clinically meaningful entities via a medical knowledge graph, and (3) models their temporal evolution to guide large language models in generating high-quality longitudinal VQA pairs. Extensive evaluations demonstrate that both general-purpose and medical-domain MLLMs perform poorly on LoMeVQA, revealing substantial limitations in temporal reasoning. To address these limitations, we introduce MedLong-8B, which achieves state-of-the-art performance across all tasks. Beyond benchmarking, we conduct detailed analyses that uncover key failure modes and shed light on how to improve longitudinal medical visual reasoning. Our data is available at: https://github.com/pepperbubble/LoMeVQA

  • 7 authors
·
Jul 29

Measuring What the Crawler Sees: Discovery Curves, Core Persistence, and Shell Dynamics in Longitudinal Web Crawls

A longitudinal web crawl is a sequence of partial samples of an evolving URL population. Pairwise containment between two crawls is the standard probe; under a simple urn model of the crawl -- each round samples a fraction of the URLs and replaces a fraction -- it recovers two interpretable rates, per-round survival α and coverage c, but treats the population as uniform and consumes one pair at a time. In this work, we define a formal language for talking about a crawl. We extend this analysis with the discovery curve U(s, T), the cumulative URL footprint over a sliding window of T crawls starting at s, which under the same urn model is also a closed-form function of (α, c). Containment and the discovery curve are then two projections of one process: independent fits agree on (α, c) when the urn is homogeneous, so any disagreement is itself a measurement. Applied to Common Crawl (2020--2025, domain granularity) and to the German Academic Web (GAW, URL granularity), the two projections disagree on both archives, and a two-component urn with a persistent core fraction κ alongside shell parameters (α_partial, c_partial) reconciles the disagreement. A residual on c_partial remains, signaling that the shell itself is not homogeneous; κ is recorded as the scalar entry point to a rank-resolved generalization, which is left to follow-up work. web archive \and crawl coverage \and discovery curve \and urn model \and two-component model \and URL lifetime

  • 3 authors
·
Jul 14

Lunguage: A Benchmark for Structured and Sequential Chest X-ray Interpretation

Radiology reports convey detailed clinical observations and capture diagnostic reasoning that evolves over time. However, existing evaluation methods are limited to single-report settings and rely on coarse metrics that fail to capture fine-grained clinical semantics and temporal dependencies. We introduce LUNGUAGE,a benchmark dataset for structured radiology report generation that supports both single-report evaluation and longitudinal patient-level assessment across multiple studies. It contains 1,473 annotated chest X-ray reports, each reviewed by experts, and 80 of them contain longitudinal annotations to capture disease progression and inter-study intervals, also reviewed by experts. Using this benchmark, we develop a two-stage framework that transforms generated reports into fine-grained, schema-aligned structured representations, enabling longitudinal interpretation. We also propose LUNGUAGESCORE, an interpretable metric that compares structured outputs at the entity, relation, and attribute level while modeling temporal consistency across patient timelines. These contributions establish the first benchmark dataset, structuring framework, and evaluation metric for sequential radiology reporting, with empirical results demonstrating that LUNGUAGESCORE effectively supports structured report evaluation. The code is available at: https://github.com/SuperSupermoon/Lunguage

kaist-ai KAIST AI
·
May 27, 2025 2

The Single-File Test: A Longitudinal Public-Interface Evaluation of First-Output LLM Web Generation with Social Reach Tracking

This paper presents an eight-week observational comparison of 68 single-file HTML generations collected across 17 public experiments in the "HTML AI Battle" project between December 10, 2025 and February 4, 2026. Four reasoning model families, GPT, Gemini, Grok, and Claude, were compared under a fixed public-interface protocol with no custom instructions, no personality tuning, and no repair prompts. Each output was evaluated from a rendered browser video using human scores and a Gemini LLM-as-a-judge layer for prompt adherence, functional correctness, and UI quality, then packaged into a standardized social-media protocol spanning X (Twitter), TikTok, and YouTube. The tracker was also used for two supervised predictive analyses: an experiment-level model for 24-hour X impressions and a generation-level model for HTML verbosity. Under this protocol, Claude was the strongest and most consistent family, leading mean performance and winning 9/17 prompts under the primary human weighted score. Longer measured reasoning time was not associated with higher quality overall. Gemini as a judge was significantly more lenient than the human evaluator on functional correctness and overall performance, while stable self-favoring bias remained unresolved. The exploratory X-impressions model remained weak under post-screen cross-validation (MAE = 46,874, R^2 = -0.377), whereas the HTML-lines model performed better, with a model-family-only baseline outperforming prompt-aware alternatives (MAE = 135.2, R^2 = 0.576). Overall, selected pre-publication technical/audio variables were not sufficient to predict 24-hour X reach, while code verbosity was driven much more by model family than by prompt wording. The comparisons remain observational and are limited by public-interface drift, access-path differences, and one primary human scorer.

  • 1 authors
·
May 5

QureRadEmbed: Structuring Radiological Similarity through Attribute and Reasoning Supervision

Radiological similarity depends on disease relationships and on fine details such as laterality, lobe, severity, size, and certainty. Broad biomedical similarity can overlook these qualifiers, particularly when several attributes vary together. We introduce QureRadEmbed, a 4B radiology-aware encoder trained with two complementary signals: RadSim supplies deterministic, attribute-decomposed ranking targets, while RadThought aligns reports with hierarchical evidence and reasoning descriptions. A three-stage curriculum combines these signals with report triplets, finding perturbations, and single- and cross-attribute contrasts. The final model achieves 0.996 mean ordering accuracy across ten controlled synthetic attributes and raises Spearman correlation with the designed joint-attribute targets from 0.501 to 0.976. On external findings-to-impression retrieval, Recall@1 reaches 10.5% on Open-I, 12.4% on testing XR, and 42.9% on testing CT, compared with 6.6%, 5.7%, and 31.4% for its backbone. Frozen embeddings support finding extraction with only 100 labeled testing-XR reports (macro-F1 0.481 versus 0.412 for the backbone). Whole-report comparison costs 8.8 seconds per 1,000 pairs in our benchmark, versus 2,755.1 seconds for the generative evaluator GREEN. Sentence-level comparison improves sensitivity to local discrepancies, although generative evaluation remains stronger on several expert-rated and subtle-error tasks. The results support reusable radiology-aware representations for search, structured report indexing, and efficient report comparison.

  • 4 authors
·
Sep 26

CLARA: Clinical Report Auto-completion

Generating clinical reports from raw recordings such as X-rays and electroencephalogram (EEG) is an essential and routine task for doctors. However, it is often time-consuming to write accurate and detailed reports. Most existing methods try to generate the whole reports from the raw input with limited success because 1) generated reports often contain errors that need manual review and correction, 2) it does not save time when doctors want to write additional information into the report, and 3) the generated reports are not customized based on individual doctors' preference. We propose {\it CL}inic{\it A}l {\it R}eport {\it A}uto-completion (CLARA), an interactive method that generates reports in a sentence by sentence fashion based on doctors' anchor words and partially completed sentences. CLARA searches for most relevant sentences from existing reports as the template for the current report. The retrieved sentences are sequentially modified by combining with the input feature representations to create the final report. In our experimental evaluation, CLARA achieved 0.393 CIDEr and 0.248 BLEU-4 on X-ray reports and 0.482 CIDEr and 0.491 BLEU-4 for EEG reports for sentence-level generation, which is up to 35% improvement over the best baseline. Also via our qualitative evaluation, CLARA is shown to produce reports which have a significantly higher level of approval by doctors in a user study (3.74 out of 5 for CLARA vs 2.52 out of 5 for the baseline).

  • 5 authors
·
Feb 26, 2020

LongCounsel-8: A Benchmark Suite for Longitudinal Depression Tracking from Multi-Session Counseling Dialogues

Tracking depression from multi-session counseling dialogues requires estimating both current symptom severity and how it changes across sessions. Yet progress on this task is constrained by the scarcity of longitudinal counseling data with standardized session-level depression labels. Existing resources typically provide either multi-session conversations without depression labels or labeled interviews in a single session. Building such a benchmark poses three challenges: maintaining longitudinal consistency and diversity, grounding symptom progression in empirical patterns, and expressing controlled depression states naturally without exposing target labels. To address these challenges, we introduce LongCounsel-8, a benchmark suite of three independently generated datasets totaling 7,749 five-session counseling trajectories, grounded in real-world client profiles, depression trajectories, symptom compositions, and counseling patterns. We combine profile-grounded simulation, empirically informed state construction, and indirect behavioral realization to address these challenges. Across the benchmark, simulated self-reports closely recover the controlled states, supporting label fidelity. Experiments on existing depression tracking methods reveal three key findings: (1) lower single-session score error does not guarantee accurate identification of trend, i.e., improvement or worsening; (2) existing methods are consistently less reliable on worsening trajectories; and (3) additional session history may reduce the accuracy of trend prediction. Together, these findings establish LongCounsel-8 as a foundation for advancing depression assessment from static, single-session prediction toward reliable longitudinal tracking of mental-health change.

  • 3 authors
·
Sep 2

Longitudinal causal inference under informative missingness using the self-censoring model

Longitudinal observational data are often subject to informative missingness. For example, in healthcare research using electronic health records, covariates and outcomes are measured only when patients interact with the healthcare system. Whether these data are observed usually depends on the unobserved variable values themselves, introducing a common form of data missing not at random. We develop identification and estimation methods for the effects of longitudinal modified treatment policies under a self-censoring model which explicitly models this dependence. We consider effects of treatments that can be modified only at measurement times (e.g., interactions with the heathcare system). We study two settings: one in which the observed history suffices for treatment confounding control, and another in which confounder control requires covariate values that were not measured at missed visits. In both settings, we combine longitudinal causal identification with shadow-variable conditional moment restrictions to obtain recursive identification formulas for the counterfactual outcome mean. We derive gradients of the pathwise derivatives and second-order remainder expansions, and use these results to construct estimators that accommodate machine learning for nuisance-function estimation. Under suitable product-rate conditions and cross-fitting, the estimators are asymptotically linear and permit root-n inference, including simultaneous inference across outcome times. We also describe conditional-moment learning and ensemble approaches for estimating the nuisance functions required by our approach, together with a pool-and-smooth strategy that borrows information across sparsely measured outcomes.

  • 1 authors
·
Oct 5

Enhanced Contrastive Learning with Multi-view Longitudinal Data for Chest X-ray Report Generation

Automated radiology report generation offers an effective solution to alleviate radiologists' workload. However, most existing methods focus primarily on single or fixed-view images to model current disease conditions, which limits diagnostic accuracy and overlooks disease progression. Although some approaches utilize longitudinal data to track disease progression, they still rely on single images to analyze current visits. To address these issues, we propose enhanced contrastive learning with Multi-view Longitudinal data to facilitate chest X-ray Report Generation, named MLRG. Specifically, we introduce a multi-view longitudinal contrastive learning method that integrates spatial information from current multi-view images and temporal information from longitudinal data. This method also utilizes the inherent spatiotemporal information of radiology reports to supervise the pre-training of visual and textual representations. Subsequently, we present a tokenized absence encoding technique to flexibly handle missing patient-specific prior knowledge, allowing the model to produce more accurate radiology reports based on available prior knowledge. Extensive experiments on MIMIC-CXR, MIMIC-ABN, and Two-view CXR datasets demonstrate that our MLRG outperforms recent state-of-the-art methods, achieving a 2.3% BLEU-4 improvement on MIMIC-CXR, a 5.5% F1 score improvement on MIMIC-ABN, and a 2.7% F1 RadGraph improvement on Two-view CXR.

  • 7 authors
·
Feb 27, 2025

The Impact of Medication Non-adherence on Adverse Outcomes: Evidence from Schizophrenia Patients via Survival Analysis

This study quantifies the association between non-adherence to antipsychotic medications and adverse outcomes in individuals with schizophrenia. We frame the problem using survival analysis, focusing on the time to the earliest of several adverse events (early death, involuntary hospitalization, jail booking). We extend standard causal inference methods (T-learner, S-learner, nearest neighbor matching) to utilize various survival models to estimate individual and average treatment effects, where treatment corresponds to medication non-adherence. Analyses are repeated using different amounts of longitudinal information (3, 6, 9, and 12 months). Using data from Allegheny County in western Pennsylvania, we find strong evidence that non-adherence advances adverse outcomes by approximately 1 to 4 months. Ablation studies confirm that county-provided risk scores adjust for key confounders, as their removal amplifies the estimated effects. Subgroup analyses by medication formulation (injectable vs. oral) and medication type consistently show that non-adherence is associated with earlier adverse events. These findings highlight the clinical importance of adherence in delaying psychiatric crises and show that integrating survival analysis with causal inference tools can yield policy-relevant insights. We caution that although we apply causal inference, we only make associative claims and discuss assumptions needed for causal interpretation.

ReportQA: QA-Based Radiology Report Evaluation

Radiology report evaluation is essential for advancing automated report generation. Natural language generation metrics have limited clinical relevance. Clinical efficacy (CE) metrics evaluate important medical findings, but focus mainly on presence and cover only a limited set of entities. Due to heavy reliance on manual annotations, it is difficult for CE metrics to extend clinical entities or attributes. In clinical practice, radiology reports serve as a medium for information transfer. Clinicians use them to perform downstream diagnostic tasks without directly inspecting images. Based on this insight, we propose ReportQA, a clinical-related and flexible radiology report evaluation framework, supporting detailed quantitative analysis of radiology report generation systems. We first collect datasets covering multiple imaging modalities and anatomical regions. We then construct knowledge trees of clinical entities and attributes with radiologist guidance, and use large language models (LLMs) to extract structured information from raw reports. Next, we generate QA pairs from predefined templates and apply quality control through self-filtering and report-based filtering. During evaluation, the report is treated as context, and an LLM acts as a judge model to answer the QA pairs. Based on the resulting QA accuracy, we introduce QAScore metric. Compared with existing metrics, QAScore shows better alignment with radiologist judgments. Experiments on multiple state-of-the-art vision-language models reveal that current report-based inference paradigms struggle to learn fine-grained clinical representations and exhibit strong negative prior biases. In contrast, question-driven inference provides a more effective alternative. For reproducibility and extensibility, we release the knowledge trees, structured reports, and QA pairs, along with the pipeline code for QA construction and evaluation.

  • 13 authors
·
Jun 12

Reducing Annotation Burden in Physical Activity Research Using Vision-Language Models

Introduction: Data from wearable devices collected in free-living settings, and labelled with physical activity behaviours compatible with health research, are essential for both validating existing wearable-based measurement approaches and developing novel machine learning approaches. One common way of obtaining these labels relies on laborious annotation of sequences of images captured by cameras worn by participants through the course of a day. Methods: We compare the performance of three vision language models and two discriminative models on two free-living validation studies with 161 and 111 participants, collected in Oxfordshire, United Kingdom and Sichuan, China, respectively, using the Autographer (OMG Life, defunct) wearable camera. Results: We found that the best open-source vision-language model (VLM) and fine-tuned discriminative model (DM) achieved comparable performance when predicting sedentary behaviour from single images on unseen participants in the Oxfordshire study; median F1-scores: VLM = 0.89 (0.84, 0.92), DM = 0.91 (0.86, 0.95). Performance declined for light (VLM = 0.60 (0.56,0.67), DM = 0.70 (0.63, 0.79)), and moderate-to-vigorous intensity physical activity (VLM = 0.66 (0.53, 0.85); DM = 0.72 (0.58, 0.84)). When applied to the external Sichuan study, performance fell across all intensity categories, with median Cohen's kappa-scores falling from 0.54 (0.49, 0.64) to 0.26 (0.15, 0.37) for the VLM, and from 0.67 (0.60, 0.74) to 0.19 (0.10, 0.30) for the DM. Conclusion: Freely available computer vision models could help annotate sedentary behaviour, typically the most prevalent activity of daily living, from wearable camera images within similar populations to seen data, reducing the annotation burden.

  • 5 authors
·
May 5, 2025

The 17% Gap: Quantifying Epistemic Decay in AI-Assisted Survey Papers

The adoption of Large Language Models (LLMs) in scientific writing promises efficiency but risks introducing informational entropy. While "hallucinated papers" are a known artifact, the systematic degradation of valid citation chains remains unquantified. We conducted a forensic audit of 50 recent survey papers in Artificial Intelligence (N=5,514 citations) published between September 2024 and January 2026. We utilized a hybrid verification pipeline combining DOI resolution, Crossref metadata analysis, Semantic Scholar queries, and fuzzy text matching to distinguish between formatting errors ("Sloppiness") and verifiable non-existence ("Phantoms). We detect a persistent 17.0% Phantom Rate -- citations that cannot be resolved to any digital object despite aggressive forensic recovery. Diagnostic categorization reveals three distinct failure modes: pure hallucinations (5.1%), hallucinated identifiers with valid titles (16.4%), and parsing-induced matching failures (78.5%). Longitudinal analysis reveals a flat trend (+0.07 pp/month), suggesting that high-entropy citation practices have stabilized as an endemic feature of the field. The scientific citation graph in AI survey literature exhibits "link rot" at scale. This suggests a mechanism where AI tools act as "lazy research assistants," retrieving correct titles but hallucinating metadata, thereby severing the digital chain of custody required for reproducible science.

  • 1 authors
·
Jan 23

Rethinking How We Evaluate Methodological Progress in Health AI

Methodological progress in artificial intelligence (AI) for electronic health records (EHRs) depends on our ability to determine which algorithms work better, and under which conditions. However, such progress is thought to be hindered by difficulties in reproducibility and in defining clinically meaningful evaluation tasks. We empirically study these barriers by re-implementing 12 historical and recent algorithms within a shared evaluation framework and evaluating them on two clinical datasets, MIMIC-IV and NWICU. We compare two complementary task families: expert-authored clinically meaningful tasks and generated tasks defined from randomly sampled event codes and prediction horizons. We ask whether relative algorithms comparisons transfer across task families and datasets, whether residual task heterogeneity contains useful methodological structure, and what a controlled comparison reveals about progress over the last decade. We find that aggregate pairwise comparisons transfer strongly across evaluation settings, including from randomly generated tasks to clinically meaningful tasks and across datasets. At the same time, clinically meaningful tasks exhibit greater task-method interaction, providing preliminary evidence that task properties can help explain when particular modeling choices are advantageous. Finally, newer algorithms do not consistently outperform earlier approaches: gradient-boosted trees remain highly competitive when paired with a modern, wide and sparse representation of the EHR. Together, these results suggest that useful methodological knowledge may require less task engineering than commonly assumed, while highlighting the importance of understanding the structured heterogeneity that remains across tasks and methods.

  • 2 authors
·
Sep 20

Open versioned aggregates of the FAA National Wildlife Strike Database (1990-2026): conditional damage rates by animal family, airframe, and airport

Background. Aircraft-wildlife collisions are a documented aviation hazard. The FAA National Wildlife Strike Database is the main public source of U.S. reports, but raw extracts are large and rarely released as versioned aggregates. Methods. We convert the public FAA Access export (STRIKE_REPORTS) to SQLite, define a report as damaging when DAMAGE_LEVEL is one of M, M?, S, D, and fold rows into open aggregates (year, airport, species, aircraft, animal family) via hierarchical SPECIES_ID prefixes. We analyze all civil reports and a commercial subset (AC_MASS 3-5). Rates are per reported strike, not per flight hour, so every rate is conditional on a report having been filed. Trend statistics use complete incident years 1990-2025; cross-sectional facets cover the full seed, incident years 1990-2026. Results. Numbers are locked to the 2026-07-04 freeze. Reported strikes in 2025 reach a series high (24,458 total; 901 damaging). Species that dominate strike counts are not those with the highest damage rates: perching songbirds account for 41.1% of identified strikes but damage aircraft in 1.5% of reports (95% CI 1.4-1.6), whereas deer account for 0.7% but damage aircraft in 81.8% of reports (95% CI 79.8-83.7). Airports ranked by total strikes (led by Denver Intl) diverge from rankings by damaging strikes (led by Sacramento Intl); across the 452 airports with at least 50 reports, volume and conditional damage rate are negatively rank-correlated (Spearman rho = -0.44, p < 0.001); large stations plausibly capture minor events more completely, so this is not a hazard ranking. The share of reports labeled damaging declines over decades, consistent with improved reporting of minor events, while absolute damaging counts peak in 2025. Conclusions. Versioned open aggregates and a documented damage-rate analysis enable independent reuse; released under CC BY 4.0.

  • 1 authors
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Aug 1

CACSurv: Concordance-Aligned Comparative Learning with Large Language Models for Cancer Survival Prediction

Cancer survival prediction supports treatment planning, risk stratification, and follow-up management. Existing methods use structured clinical variables, whole-slide images, genomic profiles, or multimodal inputs, while patient reports remain underexplored. We study report-centric survival prediction using reports that organize pathological, clinical, and molecular evidence. Large language models (LLMs) can reason over such reports, but case-wise time regression introduces two mismatches. First, a formulation mismatch arises because survival evaluation depends on ordering comparable patients, whereas independent time predictions do not enforce ranking consistency. Second, a supervision mismatch arises because a censored patient's observed time indicates survival beyond that point and cannot serve as an exact regression target, although it still implies orderings relative to patients who died earlier. To address these mismatches, we propose CACSurv, a Concordance-Aligned Comparative framework for report-centric survival prediction. CACSurv reformulates survival modeling as mini-cohort comparative reasoning, where an LLM predicts relative prognostic orderings. We introduce concordance-aligned rewards derived from comparable relations under right censoring, enabling censored outcomes to provide ranking supervision without exact event-time targets. At inference, Monte Carlo Reference Aggregation compares each patient with sampled references and aggregates positions into a cohort-level ranking. We establish TCGA-SurvReport, a benchmark covering six TCGA cancer cohorts. CACSurv achieves the highest C-index on all six cohorts and an average C-index of 0.722, outperforming the strongest published survival model by 6.5 percentage points and the strongest LLM time-regression baseline by 4.2 percentage points. Our code, models, and dataset will be available at https://github.com/xmed-lab/CACSurv.

  • 5 authors
·
Aug 16

Usage Bibliometrics as a Tool to Measure Research Activity

Measures for research activity and impact have become an integral ingredient in the assessment of a wide range of entities (individual researchers, organizations, instruments, regions, disciplines). Traditional bibliometric indicators, like publication and citation based indicators, provide an essential part of this picture, but cannot describe the complete picture. Since reading scholarly publications is an essential part of the research life cycle, it is only natural to introduce measures for this activity in attempts to quantify the efficiency, productivity and impact of an entity. Citations and reads are significantly different signals, so taken together, they provide a more complete picture of research activity. Most scholarly publications are now accessed online, making the study of reads and their patterns possible. Click-stream logs allow us to follow information access by the entire research community, real-time. Publication and citation datasets just reflect activity by authors. In addition, download statistics will help us identify publications with significant impact, but which do not attract many citations. Click-stream signals are arguably more complex than, say, citation signals. For one, they are a superposition of different classes of readers. Systematic downloads by crawlers also contaminate the signal, as does browsing behavior. We discuss the complexities associated with clickstream data and how, with proper filtering, statistically significant relations and conclusions can be inferred from download statistics. We describe how download statistics can be used to describe research activity at different levels of aggregation, ranging from organizations to countries. These statistics show a correlation with socio-economic indicators. A comparison will be made with traditional bibliometric indicators. We will argue that astronomy is representative of more general trends.

  • 2 authors
·
Jun 7, 2017

Reshaping Free-Text Radiology Notes Into Structured Reports With Generative Transformers

BACKGROUND: Radiology reports are typically written in a free-text format, making clinical information difficult to extract and use. Recently the adoption of structured reporting (SR) has been recommended by various medical societies thanks to the advantages it offers, e.g. standardization, completeness and information retrieval. We propose a pipeline to extract information from free-text radiology reports, that fits with the items of the reference SR registry proposed by a national society of interventional and medical radiology, focusing on CT staging of patients with lymphoma. METHODS: Our work aims to leverage the potential of Natural Language Processing (NLP) and Transformer-based models to deal with automatic SR registry filling. With the availability of 174 radiology reports, we investigate a rule-free generative Question Answering approach based on a domain-specific version of T5 (IT5). Two strategies (batch-truncation and ex-post combination) are implemented to comply with the model's context length limitations. Performance is evaluated in terms of strict accuracy, F1, and format accuracy, and compared with the widely used GPT-3.5 Large Language Model. A 5-point Likert scale questionnaire is used to collect human-expert feedback on the similarity between medical annotations and generated answers. RESULTS: The combination of fine-tuning and batch splitting allows IT5 to achieve notable results; it performs on par with GPT-3.5 albeit its size being a thousand times smaller in terms of parameters. Human-based assessment scores show a high correlation (Spearman's correlation coefficients>0.88, p-values<0.001) with AI performance metrics (F1) and confirm the superior ability of LLMs (i.e., GPT-3.5, 175B of parameters) in generating plausible human-like statements.

  • 8 authors
·
Mar 27, 2024

Toward Clinically Acceptable Chest X-ray Report Generation: A Qualitative Retrospective Pilot Study of CXRMate-2

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

  • 10 authors
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Apr 20

ROBBIE: Robust Bias Evaluation of Large Generative Language Models

As generative large language models (LLMs) grow more performant and prevalent, we must develop comprehensive enough tools to measure and improve their fairness. Different prompt-based datasets can be used to measure social bias across multiple text domains and demographic axes, meaning that testing LLMs on more datasets can potentially help us characterize their biases more fully, and better ensure equal and equitable treatment of marginalized demographic groups. In this work, our focus is two-fold: (1) Benchmarking: a comparison of 6 different prompt-based bias and toxicity metrics across 12 demographic axes and 5 families of generative LLMs. Out of those 6 metrics, AdvPromptSet and HolisticBiasR are novel datasets proposed in the paper. The comparison of those benchmarks gives us insights about the bias and toxicity of the compared models. Therefore, we explore the frequency of demographic terms in common LLM pre-training corpora and how this may relate to model biases. (2) Mitigation: we conduct a comprehensive study of how well 3 bias/toxicity mitigation techniques perform across our suite of measurements. ROBBIE aims to provide insights for practitioners while deploying a model, emphasizing the need to not only measure potential harms, but also understand how they arise by characterizing the data, mitigate harms once found, and balance any trade-offs. We open-source our analysis code in hopes of encouraging broader measurements of bias in future LLMs.

  • 10 authors
·
Nov 29, 2023

Serialisation Strategy Matters: How FHIR Data Format Affects LLM Medication Reconciliation

Medication reconciliation at clinical handoffs is a high-stakes, error-prone process. Large language models are increasingly proposed to assist with this task using FHIR-structured patient records, but a fundamental and largely unstudied variable is how the FHIR data is serialised before being passed to the model. We present the first systematic comparison of four FHIR serialisation strategies (Raw JSON, Markdown Table, Clinical Narrative, and Chronological Timeline) across five open-weight models (Phi-3.5-mini, Mistral-7B, BioMistral-7B, Llama-3.1-8B, Llama-3.3-70B) on a controlled benchmark of 200 synthetic patients, totalling 4,000 inference runs. We find that serialisation strategy has a large, statistically significant effect on performance for models up to 8B parameters: Clinical Narrative outperforms Raw JSON by up to 19 F1 points for Mistral-7B (r = 0.617, p < 10^{-10}). This advantage reverses at 70B, where Raw JSON achieves the best mean F1 of 0.9956. In all 20 model and strategy combinations, mean precision exceeds mean recall: omission is the dominant failure mode, with models more often missing an active medication than fabricating one, which changes how clinical safety auditing priorities should be set. Smaller models plateau at roughly 7-10 concurrent active medications, leaving polypharmacy patients, the patients most at risk from reconciliation errors, systematically underserved. BioMistral-7B, a domain-pretrained model without instruction tuning, produces zero usable output in all conditions, showing that domain pretraining alone is not sufficient for structured extraction. These results offer practical, evidence-based format recommendations for clinical LLM deployment: Clinical Narrative for models up to 8B, Raw JSON for 70B and above. The complete pipeline is reproducible on open-source tools running on an AWS g6e.xlarge instance (NVIDIA L40S, 48 GB VRAM).

  • 1 authors
·
Apr 21

Autoregressive Search Engines: Generating Substrings as Document Identifiers

Knowledge-intensive language tasks require NLP systems to both provide the correct answer and retrieve supporting evidence for it in a given corpus. Autoregressive language models are emerging as the de-facto standard for generating answers, with newer and more powerful systems emerging at an astonishing pace. In this paper we argue that all this (and future) progress can be directly applied to the retrieval problem with minimal intervention to the models' architecture. Previous work has explored ways to partition the search space into hierarchical structures and retrieve documents by autoregressively generating their unique identifier. In this work we propose an alternative that doesn't force any structure in the search space: using all ngrams in a passage as its possible identifiers. This setup allows us to use an autoregressive model to generate and score distinctive ngrams, that are then mapped to full passages through an efficient data structure. Empirically, we show this not only outperforms prior autoregressive approaches but also leads to an average improvement of at least 10 points over more established retrieval solutions for passage-level retrieval on the KILT benchmark, establishing new state-of-the-art downstream performance on some datasets, while using a considerably lighter memory footprint than competing systems. Code and pre-trained models at https://github.com/facebookresearch/SEAL.

  • 6 authors
·
Apr 22, 2022

Mnemon: Raw Records, Fast Judgments, Slow Thoughts

Long-term memory lets an LLM assistant use a history it can no longer reread, and most memory systems build it by rewriting conversations into facts, graphs or typed memories at write time. We argue that the work of memory divides, as thinking does, into two systems. Most of it is fast System 1 work: many small, independent yes/no judgments about records, such as whether a record is needed or no longer current, which a decision model makes by the dozen in a third of a second. Only a little is slow System 2 work: writing a few search queries, naming what the reply needs and composing the answer, which an LLM does well but slowly. We present Mnemon, a memory agent built on this division. It keeps conversations as raw, dated records; an LLM (System 2) plans searches over them, a decision model, Jev (System 1), judges what the searches return, and rules with explicit budgets turn the judgments into a small View for an unchanged answering model. A background pass consolidates each record once into topic timelines, value histories and standing instructions linked to the records, so that questions about a whole conversation reach evidence their own searches miss. Because nothing is decided about a record when it is written, the same agent can read any store that returns dated records. With gpt-4.1-mini answering, as in a public re-evaluation of 14 systems, Mnemon scores 91.7% on LoCoMo, the highest among them, and 83.8% on LongMemEval-S, from under 4k tokens of context per question, with the lowest effective cost index on LoCoMo. With a reasoning model answering, it reaches 92.2% on LoCoMo and 94.4% on LongMemEval-S, the latter on par with the best published results. From 100K to 10M tokens of history on BEAM, its cost per question grows by a factor of 1.11. On the same records, Jev separates gold evidence better than two LLMs and is 3-11 times faster.

  • 1 authors
·
Sep 27

Comprehensive Evaluation of Machine Learning for Type 2 Diabetes Risk Prediction: Large-Scale External Validation and Fairness Analysis

Machine learning-based Type 2 diabetes risk prediction models obtain good internal validation results but lose effectiveness in real-world applications due to deficient external testing and fairness assessment. We developed a multi-dimensional framework evaluating discrimination, calibration, interpretability, and algorithmic fairness on nationally representative populations. An XGBoost model was trained on NHANES 2015-2020 (n=15,685) using eight non-laboratory predictors: age, sex, race/ethnicity, BMI, smoking status, physical activity, history of heart attack, and history of stroke. External validation was performed on BRFSS 2020-2022 (n=1,285,783) under realistic distribution shift. Internal validation showed good discrimination (AUC=0.794, 95% CI 0.788-0.800), with performance loss on external validation (AUC=0.717, relative decrease: -9.7%, p<0.001). Fairness analysis revealed severe bias: elderly adults (>=60) showed AUC=0.607 vs 0.742 for young adults (difference=0.135, p<0.001); obese individuals showed AUC=0.698 vs 0.735 for normal weight (difference=0.037, p<0.001). Gender showed comparable performance (male=0.723 vs female=0.712, p=0.142). Calibration revealed risk overestimation (Brier score=0.123). SHAP analysis identified age, BMI, and physical activity as primary risk drivers. Populations with highest diabetes risk receive the worst algorithmic performance, underscoring the need for fairness-aware, age-stratified deployment strategies before clinical use.

  • 6 authors
·
Jun 26

Incremental Open-Ended Deep Research with Structured Harness

Existing Open-Ended Deep Research (OEDR) systems primarily generate reports from scratch, making them inefficient for scenarios where research reports need to be continuously maintained as new information emerges. We introduce Incremental Open-Ended Deep Research (Incremental-OEDR), a research setting that treats a report as an evolving research state and incrementally updates it by preserving valid knowledge, revising outdated or incomplete content, and incorporating newly available information. To support this setting, we propose Structured Harness, which represents reports as structured collections of outlines, sections, and supporting evidence, and provides structured retrieval, a persistent structured evidence pool, and structured generation for selective report updating and evidence reuse. We further establish a temporal evaluation framework spanning ten years, with Single-Step Task and Long-Chain Task to evaluate incremental updates over both individual transitions and long-term update chains. Extensive Experiments on DeepResearch Bench and DeepConsult under both the Open-source Configuration (OC) and Proprietary Configuration (PC) show that Incremental-OEDR maintains competitive report quality while substantially improving report continuity and reducing research costs. As shown in Figure~fig:profile, it achieves up to 0.51 higher content-level ROUGE-L F1, 0.63 higher outline-level EM F1, 33\% lower token consumption, and 61\% fewer search calls than OEDR on DeepResearch Bench. For more details, please refer to our project page: https://ioedr-project.github.io/.

  • 2 authors
·
Oct 7 3

The Digital Divide in Generative AI: Evidence from Large Language Model Use in College Admissions Essays

Large language models (LLMs) have become popular writing tools among students and may expand access to high-quality feedback for students with less access to traditional writing support. At the same time, LLMs may standardize student voice or invite overreliance. This study examines how adoption of LLM-assisted writing varies across socioeconomic groups and how it relates to outcomes in a high-stakes context: U.S. college admissions. We analyze a de-identified longitudinal dataset of applications to a selective university from 2020 to 2024 (N = 81,663). Estimating LLM use using a distribution-based detector trained on synthetic and historical essays, we tracked how student writing changed as LLM use proliferated, how adoption differed by socioeconomic status (SES), and whether potential benefits translated equitably into admissions outcomes. Using fee-waiver status as a proxy for SES, we observe post-2023 convergence in surface-level linguistic features, with the largest changes in fee-waived and rejected applicants. Estimated LLM use rose sharply in 2024 across all groups, with disproportionately larger increases among lower SES applicants, consistent with an access hypothesis in which LLMs substitute for scarce writing support. However, increased estimated LLM use was more strongly associated with declines in predicted admission probability for lower SES applicants than for higher SES applicants, even after controlling for academic credentials and stylometric features. These findings raise concerns about equity and the validity of essay-based evaluation in an era of AI-assisted writing and provide the first large-scale longitudinal evidence linking LLM adoption, linguistic change, and evaluative outcomes in college admissions.

  • 5 authors
·
Feb 18

Can the Crowd Judge Truthfulness? A Longitudinal Study on Recent Misinformation about COVID-19

Recently, the misinformation problem has been addressed with a crowdsourcing-based approach: to assess the truthfulness of a statement, instead of relying on a few experts, a crowd of non-expert is exploited. We study whether crowdsourcing is an effective and reliable method to assess truthfulness during a pandemic, targeting statements related to COVID-19, thus addressing (mis)information that is both related to a sensitive and personal issue and very recent as compared to when the judgment is done. In our experiments, crowd workers are asked to assess the truthfulness of statements, and to provide evidence for the assessments. Besides showing that the crowd is able to accurately judge the truthfulness of the statements, we report results on workers behavior, agreement among workers, effect of aggregation functions, of scales transformations, and of workers background and bias. We perform a longitudinal study by re-launching the task multiple times with both novice and experienced workers, deriving important insights on how the behavior and quality change over time. Our results show that: workers are able to detect and objectively categorize online (mis)information related to COVID-19; both crowdsourced and expert judgments can be transformed and aggregated to improve quality; worker background and other signals (e.g., source of information, behavior) impact the quality of the data. The longitudinal study demonstrates that the time-span has a major effect on the quality of the judgments, for both novice and experienced workers. Finally, we provide an extensive failure analysis of the statements misjudged by the crowd-workers.

  • 9 authors
·
Jul 25, 2021

A Comprehensive Assessment of Dialog Evaluation Metrics

Automatic evaluation metrics are a crucial component of dialog systems research. Standard language evaluation metrics are known to be ineffective for evaluating dialog. As such, recent research has proposed a number of novel, dialog-specific metrics that correlate better with human judgements. Due to the fast pace of research, many of these metrics have been assessed on different datasets and there has as yet been no time for a systematic comparison between them. To this end, this paper provides a comprehensive assessment of recently proposed dialog evaluation metrics on a number of datasets. In this paper, 23 different automatic evaluation metrics are evaluated on 10 different datasets. Furthermore, the metrics are assessed in different settings, to better qualify their respective strengths and weaknesses. Metrics are assessed (1) on both the turn level and the dialog level, (2) for different dialog lengths, (3) for different dialog qualities (e.g., coherence, engaging), (4) for different types of response generation models (i.e., generative, retrieval, simple models and state-of-the-art models), (5) taking into account the similarity of different metrics and (6) exploring combinations of different metrics. This comprehensive assessment offers several takeaways pertaining to dialog evaluation metrics in general. It also suggests how to best assess evaluation metrics and indicates promising directions for future work.

  • 3 authors
·
Jun 7, 2021

Evaluating the Factual Consistency of Large Language Models Through News Summarization

While large language models (LLMs) have proven to be effective on a large variety of tasks, they are also known to hallucinate information. To measure whether an LLM prefers factually consistent continuations of its input, we propose a new benchmark called FIB(Factual Inconsistency Benchmark) that focuses on the task of summarization. Specifically, our benchmark involves comparing the scores an LLM assigns to a factually consistent versus a factually inconsistent summary for an input news article. For factually consistent summaries, we use human-written reference summaries that we manually verify as factually consistent. To generate summaries that are factually inconsistent, we generate summaries from a suite of summarization models that we have manually annotated as factually inconsistent. A model's factual consistency is then measured according to its accuracy, i.e.\ the proportion of documents where it assigns a higher score to the factually consistent summary. To validate the usefulness of FIB, we evaluate 23 large language models ranging from 1B to 176B parameters from six different model families including BLOOM and OPT. We find that existing LLMs generally assign a higher score to factually consistent summaries than to factually inconsistent summaries. However, if the factually inconsistent summaries occur verbatim in the document, then LLMs assign a higher score to these factually inconsistent summaries than factually consistent summaries. We validate design choices in our benchmark including the scoring method and source of distractor summaries. Our code and benchmark data can be found at https://github.com/r-three/fib.

  • 6 authors
·
Nov 15, 2022

Quantifying Variance in Evaluation Benchmarks

Evaluation benchmarks are the cornerstone of measuring capabilities of large language models (LLMs), as well as driving progress in said capabilities. Originally designed to make claims about capabilities (or lack thereof) in fully pretrained models, evaluation benchmarks are now also extensively used to decide between various training choices. Despite this widespread usage, we rarely quantify the variance in our evaluation benchmarks, which dictates whether differences in performance are meaningful. Here, we define and measure a range of metrics geared towards measuring variance in evaluation benchmarks, including seed variance across initialisations, and monotonicity during training. By studying a large number of models -- both openly available and pretrained from scratch -- we provide empirical estimates for a variety of variance metrics, with considerations and recommendations for practitioners. We also evaluate the utility and tradeoffs of continuous versus discrete performance measures and explore options for better understanding and reducing this variance. We find that simple changes, such as framing choice tasks (like MMLU) as completion tasks, can often reduce variance for smaller scale (sim7B) models, while more involved methods inspired from human testing literature (such as item analysis and item response theory) struggle to meaningfully reduce variance. Overall, our work provides insights into variance in evaluation benchmarks, suggests LM-specific techniques to reduce variance, and more generally encourages practitioners to carefully factor in variance when comparing models.

  • 8 authors
·
Jun 14, 2024

LiveResearchBench: A Live Benchmark for User-Centric Deep Research in the Wild

Deep research -- producing comprehensive, citation-grounded reports by searching and synthesizing information from hundreds of live web sources -- marks an important frontier for agentic systems. To rigorously evaluate this ability, four principles are essential: tasks should be (1) user-centric, reflecting realistic information needs, (2) dynamic, requiring up-to-date information beyond parametric knowledge, (3) unambiguous, ensuring consistent interpretation across users, and (4) multi-faceted and search-intensive, requiring search over numerous web sources and in-depth analysis. Existing benchmarks fall short of these principles, often focusing on narrow domains or posing ambiguous questions that hinder fair comparison. Guided by these principles, we introduce LiveResearchBench, a benchmark of 100 expert-curated tasks spanning daily life, enterprise, and academia, each requiring extensive, dynamic, real-time web search and synthesis. Built with over 1,500 hours of human labor, LiveResearchBench provides a rigorous basis for systematic evaluation. To evaluate citation-grounded long-form reports, we introduce DeepEval, a comprehensive suite covering both content- and report-level quality, including coverage, presentation, citation accuracy and association, consistency and depth of analysis. DeepEval integrates four complementary evaluation protocols, each designed to ensure stable assessment and high agreement with human judgments. Using LiveResearchBench and DeepEval, we conduct a comprehensive evaluation of 17 frontier deep research systems, including single-agent web search, single-agent deep research, and multi-agent systems. Our analysis reveals current strengths, recurring failure modes, and key system components needed to advance reliable, insightful deep research.

Salesforce Salesforce AI Research
·
Oct 15, 2025 3

Automatic Fine-grained Segmentation-assisted Report Generation

Reliable end-to-end clinical report generation has been a longstanding goal of medical ML research. The end goal for this process is to alleviate radiologists' workloads and provide second opinions to clinicians or patients. Thus, a necessary prerequisite for report generation models is a strong general performance and some type of innate grounding capability, to convince clinicians or patients of the veracity of the generated reports. In this paper, we present ASaRG (Automatic Segmentation-assisted Report Generation), an extension of the popular LLaVA architecture that aims to tackle both of these problems. ASaRG proposes to fuse intermediate features and fine-grained segmentation maps created by specialist radiological models into LLaVA's multi-modal projection layer via simple concatenation. With a small number of added parameters, our approach achieves a +0.89\% performance gain (p=0.012) in CE F1 score compared to the LLaVA baseline when using only intermediate features, and +2.77\% performance gain (p<0.001) when adding a combination of intermediate features and fine-grained segmentation maps. Compared with COMG and ORID, two other report generation methods that utilize segmentations, the performance gain amounts to 6.98\% and 6.28\% in F1 score, respectively. ASaRG is not mutually exclusive with other changes made to the LLaVA architecture, potentially allowing our method to be combined with other advances in the field. Finally, the use of an arbitrary number of segmentations as part of the input demonstrably allows tracing elements of the report to the corresponding segmentation maps and verifying the groundedness of assessments. Our code will be made publicly available at a later date.

  • 9 authors
·
Jul 21, 2025

Neural Rankers for Effective Screening Prioritisation in Medical Systematic Review Literature Search

Medical systematic reviews typically require assessing all the documents retrieved by a search. The reason is two-fold: the task aims for ``total recall''; and documents retrieved using Boolean search are an unordered set, and thus it is unclear how an assessor could examine only a subset. Screening prioritisation is the process of ranking the (unordered) set of retrieved documents, allowing assessors to begin the downstream processes of the systematic review creation earlier, leading to earlier completion of the review, or even avoiding screening documents ranked least relevant. Screening prioritisation requires highly effective ranking methods. Pre-trained language models are state-of-the-art on many IR tasks but have yet to be applied to systematic review screening prioritisation. In this paper, we apply several pre-trained language models to the systematic review document ranking task, both directly and fine-tuned. An empirical analysis compares how effective neural methods compare to traditional methods for this task. We also investigate different types of document representations for neural methods and their impact on ranking performance. Our results show that BERT-based rankers outperform the current state-of-the-art screening prioritisation methods. However, BERT rankers and existing methods can actually be complementary, and thus, further improvements may be achieved if used in conjunction.

  • 4 authors
·
Dec 18, 2022

Resources for Brewing BEIR: Reproducible Reference Models and an Official Leaderboard

BEIR is a benchmark dataset for zero-shot evaluation of information retrieval models across 18 different domain/task combinations. In recent years, we have witnessed the growing popularity of a representation learning approach to building retrieval models, typically using pretrained transformers in a supervised setting. This naturally begs the question: How effective are these models when presented with queries and documents that differ from the training data? Examples include searching in different domains (e.g., medical or legal text) and with different types of queries (e.g., keywords vs. well-formed questions). While BEIR was designed to answer these questions, our work addresses two shortcomings that prevent the benchmark from achieving its full potential: First, the sophistication of modern neural methods and the complexity of current software infrastructure create barriers to entry for newcomers. To this end, we provide reproducible reference implementations that cover the two main classes of approaches: learned dense and sparse models. Second, there does not exist a single authoritative nexus for reporting the effectiveness of different models on BEIR, which has led to difficulty in comparing different methods. To remedy this, we present an official self-service BEIR leaderboard that provides fair and consistent comparisons of retrieval models. By addressing both shortcomings, our work facilitates future explorations in a range of interesting research questions that BEIR enables.

  • 6 authors
·
Jun 12, 2023

ReportBench: Evaluating Deep Research Agents via Academic Survey Tasks

The advent of Deep Research agents has substantially reduced the time required for conducting extensive research tasks. However, these tasks inherently demand rigorous standards of factual accuracy and comprehensiveness, necessitating thorough evaluation before widespread adoption. In this paper, we propose ReportBench, a systematic benchmark designed to evaluate the content quality of research reports generated by large language models (LLMs). Our evaluation focuses on two critical dimensions: (1) the quality and relevance of cited literature, and (2) the faithfulness and veracity of the statements within the generated reports. ReportBench leverages high-quality published survey papers available on arXiv as gold-standard references, from which we apply reverse prompt engineering to derive domain-specific prompts and establish a comprehensive evaluation corpus. Furthermore, we develop an agent-based automated framework within ReportBench that systematically analyzes generated reports by extracting citations and statements, checking the faithfulness of cited content against original sources, and validating non-cited claims using web-based resources. Empirical evaluations demonstrate that commercial Deep Research agents such as those developed by OpenAI and Google consistently generate more comprehensive and reliable reports than standalone LLMs augmented with search or browsing tools. However, there remains substantial room for improvement in terms of the breadth and depth of research coverage, as well as factual consistency. The complete code and data will be released at the following link: https://github.com/ByteDance-BandAI/ReportBench

ByteDance ByteDance
·
Aug 13, 2025 3

A Vision-language Framework for Comparative Reasoning in Radiology

Medical imaging artificial intelligence has achieved strong performance in isolated image interpretation, but remains poorly aligned with radiological practice, where diagnosis and follow-up rely on comparison across prior studies and analogous reference cases. Here we formulate radiological comparison as an entity-aware cross-image reasoning problem and introduce a framework that supports both reference-case retrieval and temporal comparative interpretation. We construct MedReCo-DB, a large-scale comparative imaging resource derived from routine image-report pairs, comprising more than 690,000 images from over 160,000 patients across eight institutions, four countries and seven imaging modalities. Reports are decomposed into anatomical structures, abnormal findings and pathological conditions to provide supervision for entity-conditioned retrieval and comparative visual question answering. Using this resource, we develop MedReCo, an entity-aware visual encoder for controllable retrieval of clinically analogous cases, and MedReCo-VLM, a vision--language extension for generative interpretation of interval change. Across internal, external and cross-center evaluations, MedReCo achieved the highest Recall@1 in all 12 internal retrieval settings and improved external retrieval by a mean of 6.0 percentage points. In clinically confusable differential groups, it consistently outperformed the strongest baselines. MedReCo-VLM achieved the best performance across all comparative generation evaluations and improved longitudinal follow-up accuracy by 14.5-46.5 percentage points on chest radiographs and 13.0-27.9 percentage points on CT. These findings suggest that entity-aware comparative reasoning can be learned from routine clinical data at scale and may provide a more clinically aligned foundation for medical imaging AI.

  • 8 authors
·
Jun 7

ESL-Bench: An Event-Driven Synthetic Longitudinal Benchmark for Health Agents

Longitudinal health agents must reason across multi-source trajectories that combine continuous device streams, sparse clinical exams, and episodic life events - yet evaluating them is hard: real-world data cannot be released at scale, and temporally grounded attribution questions seldom admit definitive answers without structured ground truth. We present ESL-Bench, an event-driven synthesis framework and benchmark providing 100 synthetic users, each with a 1-5 year trajectory comprising a health profile, a multi-phase narrative plan, daily device measurements, periodic exam records, and an event log with explicit per-indicator impact parameters. Each indicator follows a baseline stochastic process driven by discrete events with sigmoid-onset, exponential-decay kernels under saturation and projection constraints; a hybrid pipeline delegates sparse semantic artifacts to LLM-based planning and dense indicator dynamics to algorithmic simulation with hard physiological bounds. Users are each paired with 100 evaluation queries across five dimensions - Lookup, Trend, Comparison, Anomaly, Explanation - stratified into Easy, Medium, and Hard tiers, with all ground-truth answers programmatically computable from the recorded event-indicator relationships. Evaluating 13 methods spanning LLMs with tools, DB-native agents, and memory-augmented RAG, we find that DB agents (48-58%) substantially outperform memory RAG baselines (30-38%), with the gap concentrated on Comparison and Explanation queries where multi-hop reasoning and evidence attribution are required.

  • 10 authors
·
Apr 2

Causal Longitudinal Prior-Fitted Networks for Counterfactual Outcome Prediction

Longitudinal treatment decisions require predicting potential outcomes under future treatment sequences in the presence of time-varying confounding, heterogeneous patient dynamics, and limited domain-specific data. Existing longitudinal causal estimators typically train a new model for each cohort or simulator. We introduce Causal Longitudinal Prior-Fitted Networks (CausalLongPFN), a prior-fitted in-context predictor for longitudinal causal prediction. The model is pretrained entirely on synthetic episodes sampled from a broad prior over temporal structural causal models, exposing it to treatment-confounder feedback, latent heterogeneity, nonlinear state evolution, delayed effects, and cumulative treatment responses. At test time, CausalLongPFN is frozen: it conditions on support trajectories, a query history, and a proposed future treatment sequence, and returns a predictive distribution over future outcomes without gradient updates or propensity-model fitting. Multi-step predictions are obtained by recursively applying the one-step predictor under the specified treatment sequence. We evaluate on branchable cancer, HIV, and warfarin benchmarks with ground-truth counterfactual labels, and on factual-only rolling-origin prediction in MIMIC-III ICU trajectories. CausalLongPFN is competitive with domain-trained longitudinal baselines on counterfactual benchmarks and performs strongly on factual MIMIC-III prediction, suggesting that broad synthetic causal pretraining can provide a useful frozen alternative when repeated domain-specific training is costly or impractical.

  • 5 authors
·
Jun 3

EHRNoteQA: An LLM Benchmark for Real-World Clinical Practice Using Discharge Summaries

Discharge summaries in Electronic Health Records (EHRs) are crucial for clinical decision-making, but their length and complexity make information extraction challenging, especially when dealing with accumulated summaries across multiple patient admissions. Large Language Models (LLMs) show promise in addressing this challenge by efficiently analyzing vast and complex data. Existing benchmarks, however, fall short in properly evaluating LLMs' capabilities in this context, as they typically focus on single-note information or limited topics, failing to reflect the real-world inquiries required by clinicians. To bridge this gap, we introduce EHRNoteQA, a novel benchmark built on the MIMIC-IV EHR, comprising 962 different QA pairs each linked to distinct patients' discharge summaries. Every QA pair is initially generated using GPT-4 and then manually reviewed and refined by three clinicians to ensure clinical relevance. EHRNoteQA includes questions that require information across multiple discharge summaries and covers eight diverse topics, mirroring the complexity and diversity of real clinical inquiries. We offer EHRNoteQA in two formats: open-ended and multi-choice question answering, and propose a reliable evaluation method for each. We evaluate 27 LLMs using EHRNoteQA and examine various factors affecting the model performance (e.g., the length and number of discharge summaries). Furthermore, to validate EHRNoteQA as a reliable proxy for expert evaluations in clinical practice, we measure the correlation between the LLM performance on EHRNoteQA, and the LLM performance manually evaluated by clinicians. Results show that LLM performance on EHRNoteQA have higher correlation with clinician-evaluated performance (Spearman: 0.78, Kendall: 0.62) compared to other benchmarks, demonstrating its practical relevance in evaluating LLMs in clinical settings.

kaist-ai KAIST AI
·
Feb 25, 2024

Oracle Agent Memory as an Enterprise Memory Substrate for Long-Horizon AI Agents

Agent memory is a systems problem for long-horizon agents. Practical deployments require retention of task state across extended conversations, recovery of user-specific facts and preferences across sessions, and accumulation of procedural knowledge from prior outcomes. These requirements extend beyond document retrieval: a memory layer must determine which interactions become durable state, how that state is scoped, how it is retrieved under latency constraints, and how it is revised or removed over time. This report studies Oracle Agent Memory as a database-native memory substrate built on Oracle Database. Three themes organize the discussion: memory as a lifecycle spanning ingestion, extraction, consolidation, retrieval, summarization, and revision or removal; a layered architecture that separates an active memory core from a passive memory-store interface with explicit scope control across users, agents, and threads; and evaluation methodology in which downstream task accuracy is complemented by memory-centric measures such as evidence retrieval, recall, latency, and estimated token use. The report summarizes LongMemEval results, reaching 93.8% accuracy, compares Oracle Agent Memory against flat-history baselines, using about 10.7x fewer tokens, and published or reported external baselines where available, and closes with implementation-oriented appendix material covering setup, thread lifecycle, and search semantics.

  • 13 authors
·
Jul 13

Towards Understanding and Measuring COGNITIVE ATROPHY in LLM Behaviour

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

  • 8 authors
·
Jun 15

SHOVIR: A Benchmark for Evaluating Vision Shortcut Learning in Radiology Report Generation

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

ArCo-group ArCo Lab UCBM
·
Jun 28

CheXGround: Anatomical Region Tokens for Grounded Longitudinal Chest X-ray Interpretation

Recent radiology multi-modal language models have made substantial progress in chest X-ray report generation, visual question answering, and temporal reasoning. While longitudinal chest X-ray interpretation compares sequential examinations to describe change, visual grounding aims to connect clinical language with localized image evidence. Although longitudinal modeling and visual grounding have each advanced radiology language models, how localized visual evidence can support longitudinal interpretation remains under-explored. We introduce CheXGround, a region-grounded longitudinal chest X-ray language model that represents paired studies through corresponding anatomical regions. CheXGround extracts anatomical regions from current and prior radiographs, encodes them as temporally enhanced Region-of-Interest (ROI) tokens, and combines them with global temporal image context during generation. To connect these region tokens with clinical text, we propose Temporal Region--Phrase Alignment, a pretraining objective that aligns temporal anatomical representations with localized report phrases. We evaluate CheXGround on single-study and longitudinal Visual Question Answering (VQA), longitudinal findings generation, temporal grounded VQA, and anatomical grounding. Across these tasks, CheXGround improves clinical language quality, temporal reasoning, and localization accuracy over recent baselines. Our results suggest that organizing longitudinal evidence at the anatomical level is a strong representation for grounded radiology language modeling. Project page: https://adonaydem.github.io/chexground-website

  • 7 authors
·
Aug 30

XL-DocBench: Benchmarking Evidence-Grounded Extra-Long Document Understanding

Real-world document tasks often ask professionals to answer questions from annual reports, regulations, clinical guidelines, and technical manuals that span hundreds or thousands of pages. Some questions also require comparing related reports. Reliable long-document understanding is therefore a prerequisite for using LLMs in compliance, clinical, financial, and engineering workflows, where decisions must be traceable to specific evidence pages and the cost of an unsupported answer is high -- yet most existing benchmarks still measure short-context or single-page QA. We introduce XL-DocBench, a fully human-verified benchmark for extra-long document understanding, with 1,519 retained questions from six professional domains and contexts up to 2,303 pages. XL-DocBench goes beyond page-level lookup. 1,103 examples (72.6\%) use multiple evidence pages. The final set also includes 556 questions (36.6\%) that use tables, charts, or figures, and 165 questions (10.9\%) that require evidence from multiple documents. Each question has one of twelve reasoning labels, expert-annotated evidence pages, a typed verification rule, and an answer format, including 218 None-answer cases. We build the benchmark with a tree-guided synthesis pipeline followed by artifact filters and full verification by 194 human experts. By coupling extra-long professional contexts with page-level evidence and typed rules, XL-DocBench fills a gap left by prior single-page, short multi-page, or text-only long-context benchmarks, and lets future work attribute system failures to retrieval, evidence use, or rule following rather than to a single leaderboard score. The results show that current systems still struggle with long contexts, multi-page evidence, and structured reasoning over professional documents.

microsoft Microsoft
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Jul 20

A Gold Standard Dataset for the Reviewer Assignment Problem

Many peer-review venues are using algorithms to assign submissions to reviewers. The crux of such automated approaches is the notion of the "similarity score" -- a numerical estimate of the expertise of a reviewer in reviewing a paper -- and many algorithms have been proposed to compute these scores. However, these algorithms have not been subjected to a principled comparison, making it difficult for stakeholders to choose the algorithm in an evidence-based manner. The key challenge in comparing existing algorithms and developing better algorithms is the lack of publicly available gold-standard data. We address this challenge by collecting a novel dataset of similarity scores that we release to the research community. Our dataset consists of 477 self-reported expertise scores provided by 58 researchers who evaluated their expertise in reviewing papers they have read previously. Using our dataset, we compare several widely used similarity algorithms and offer key insights. First, all algorithms exhibit significant error, with misranking rates between 12%-30% in easier cases and 36%-43% in harder ones. Second, most specialized algorithms are designed to work with titles and abstracts of papers, and in this regime the SPECTER2 algorithm performs best. Interestingly, classical TF-IDF matches SPECTER2 in accuracy when given access to full submission texts. In contrast, off-the-shelf LLMs lag behind specialized approaches.

  • 5 authors
·
May 29, 2025

Eureka: Evaluating and Understanding Large Foundation Models

Rigorous and reproducible evaluation is critical for assessing the state of the art and for guiding scientific advances in Artificial Intelligence. Evaluation is challenging in practice due to several reasons, including benchmark saturation, lack of transparency in methods used for measurement, development challenges in extracting measurements for generative tasks, and, more generally, the extensive number of capabilities required for a well-rounded comparison across models. We make three contributions to alleviate the above challenges. First, we present Eureka, an open-source framework for standardizing evaluations of large foundation models beyond single-score reporting and rankings. Second, we introduce Eureka-Bench as an extensible collection of benchmarks testing capabilities that (i) are still challenging for state-of-the-art models and (ii) represent fundamental but overlooked language and multimodal capabilities. The inherent space for improvement in non-saturated benchmarks enables us to discover meaningful differences between models at a capability level. Third, using Eureka, we conduct an analysis of 12 state-of-the-art models, providing in-depth insights into failure understanding and model comparison, which can be leveraged to plan targeted improvements. In contrast to recent trends in reports and leaderboards showing absolute rankings and claims for one model or another to be the best, our analysis shows that there is no such best model. Different models have different strengths, but there are models that appear more often than others as best performers for some capabilities. Despite the recent improvements, current models still struggle with several fundamental capabilities including detailed image understanding, benefiting from multimodal input when available rather than fully relying on language, factuality and grounding for information retrieval, and over refusals.

  • 9 authors
·
Sep 13, 2024

A rubric landscape for evaluating clinical reasoning in large language models: what exists, what is missing, and what needs to be combined

Exam-style accuracy does not establish whether large language models (LLMs) reason well over clinical records. We define clinical reasoning as integrating and updating evidence across time and sources to form, revise and justify a patient's problem representation and a defensible plan. This structured narrative review maps three literatures: medical education assessment instruments, clinical LLM benchmarks published from 2023 onwards, and general-domain methods for evaluating long-form generation. We examine six dimensions: problem representation, temporal synthesis, differential and management reasoning, counterfactual reasoning, calibrated uncertainty, and reasoning faithfulness. Preprints are included and flagged. No single instrument covers all six dimensions. Problem representation and differential or management reasoning are reasonably covered, although reliability varies by instrument and setting. TIMER-Eval targets temporal synthesis, and ER-Reason assesses sequential diagnostic belief updating. Dedicated uncertainty and counterfactual evaluations are emerging, but their applicability to longitudinal free-text reasoning remains limited. Factual completeness is well theorised in general-domain evaluation, with early clinical evidence of important omissions. Faithfulness remains the weakest dimension, with one identified clinical causal-ablation study on multiple-choice questions. Existing tools should be combined through binary rubric items, separate completeness and correctness scores, case-specific importance weighting with non-compensable safety caps, temporal order-consistency checks, and chance-corrected reliability reporting. Further design work is needed for calibrated uncertainty, counterfactual reasoning and faithfulness over longitudinal free-text records. This review provides a design rationale, not a validated instrument.

  • 3 authors
·
Sep 30

Overview of the TREC 2023 deep learning track

This is the fifth year of the TREC Deep Learning track. As in previous years, we leverage the MS MARCO datasets that made hundreds of thousands of human-annotated training labels available for both passage and document ranking tasks. We mostly repeated last year's design, to get another matching test set, based on the larger, cleaner, less-biased v2 passage and document set, with passage ranking as primary and document ranking as a secondary task (using labels inferred from passage). As we did last year, we sample from MS MARCO queries that were completely held out, unused in corpus construction, unlike the test queries in the first three years. This approach yields a more difficult test with more headroom for improvement. Alongside the usual MS MARCO (human) queries from MS MARCO, this year we generated synthetic queries using a fine-tuned T5 model and using a GPT-4 prompt. The new headline result this year is that runs using Large Language Model (LLM) prompting in some way outperformed runs that use the "nnlm" approach, which was the best approach in the previous four years. Since this is the last year of the track, future iterations of prompt-based ranking can happen in other tracks. Human relevance assessments were applied to all query types, not just human MS MARCO queries. Evaluation using synthetic queries gave similar results to human queries, with system ordering agreement of τ=0.8487. However, human effort was needed to select a subset of the synthetic queries that were usable. We did not see clear evidence of bias, where runs using GPT-4 were favored when evaluated using synthetic GPT-4 queries, or where runs using T5 were favored when evaluated on synthetic T5 queries.

  • 8 authors
·
Jul 10, 2025

Large-Scale, Longitudinal Study of Large Language Models During the 2024 US Election Season

The 2024 US presidential election is the first major contest to occur in the US since the popularization of large language models (LLMs). Building on lessons from earlier shifts in media (most notably social media's well studied role in targeted messaging and political polarization) this moment raises urgent questions about how LLMs may shape the information ecosystem and influence political discourse. While platforms have announced some election safeguards, how well they work in practice remains unclear. Against this backdrop, we conduct a large-scale, longitudinal study of 12 models, queried using a structured survey with over 12,000 questions on a near-daily cadence from July through November 2024. Our design systematically varies content and format, resulting in a rich dataset that enables analyses of the models' behavior over time (e.g., across model updates), sensitivity to steering, responsiveness to instructions, and election-related knowledge and "beliefs." In the latter half of our work, we perform four analyses of the dataset that (i) study the longitudinal variation of model behavior during election season, (ii) illustrate the sensitivity of election-related responses to demographic steering, (iii) interrogate the models' beliefs about candidates' attributes, and (iv) reveal the models' implicit predictions of the election outcome. To facilitate future evaluations of LLMs in electoral contexts, we detail our methodology, from question generation to the querying pipeline and third-party tooling. We also publicly release our dataset at https://huggingface.co/datasets/sarahcen/llm-election-data-2024

  • 7 authors
·
Sep 22, 2025

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

Partial Correlations in Compositional Data Analysis

Partial correlations quantify linear association between two variables adjusting for the influence of the remaining variables. They form the backbone for graphical models and are readily obtained from the inverse of the covariance matrix. For compositional data, the covariance structure is specified from log ratios of variables, so unless we try to "open" the data via a normalization, this implies changes in the definition and interpretation of partial correlations. In the present work, we elucidate how results derived by Aitchison (1986) lead to a natural definition of partial correlation that has a number of advantages over current measures of association. For this, we show that the residuals of log-ratios between a variable with a reference, when adjusting for all remaining variables including the reference, are reference-independent. Since the reference itself can be controlled for, correlations between residuals are defined for the variables directly without the necessity to recur to ratios except when specifying which variables are partialled out. Thus, perhaps surprisingly, partial correlations do not have the problems commonly found with measures of pairwise association on compositional data. They are well-defined between two variables, are properly scaled, and allow for negative association. By design, they are subcompositionally incoherent, but they share this property with conventional partial correlations (where results change when adjusting for the influence of fewer variables). We discuss the equivalence with normalization-based approaches whenever the normalizing variables are controlled for. We also discuss the partial variances and correlations we obtain from a previously studied data set of Roman glass cups.

  • 1 authors
·
Apr 20, 2019

Plan Pointers and Record-Directive Form in Budgeted Verification of Inherited Agent Memory

An agent that inherits six one-line memories may pull at most one archived source record before acting; a directive written into the store can steer that choice: a pointer to the record, a criterion that identifies it, or both. Across twelve registered studies on one instrument lineage (14,760 attempts) we measured where the request goes under each form. On six direct-provider models a length-matched criterion exceeded a bare id by +35.0 points [+31.2, +38.8] (Study D); the contrast failed its registered superiority rule on a nine-model OpenRouter-served panel (Study E). Appending the id cancelled the criterion on three Claude models (Opus 5: 40/40 to 0/40; Study F-x); six byte-matched edits gave each exact string its own effect (Study G), and a re-run at eighty runs per cell left fifteen of thirty replication contrasts within the margin, fifteen unresolved and none beyond (Study G'). A ratification line (+96.0 points on Opus 5) and a budget of two credits restored the target on all three (Study J); across five criterion strings the suffix's cancellation held for four of the five wordings on Opus 5 and all five wordings on Fable 5.1 (Study H2); in a second store every model followed the criterion (Study H1). Continued into a decision, the criterion moved the choice toward the current record (+100.0 points, Opus 5) and away from it on Fable 5.1 (Study I). A one-character plan pointer's effect (+78.0 points; Study B, after a correction of its first repository report) returned the same verdict under a prospectively registered re-run (+81.7 points; Study B'). All results are descriptive effects of exact edits on fixed panels with registered intervals and no mechanism claim.

  • 1 authors
·
Sep 2

Evidence Inference 2.0: More Data, Better Models

How do we most effectively treat a disease or condition? Ideally, we could consult a database of evidence gleaned from clinical trials to answer such questions. Unfortunately, no such database exists; clinical trial results are instead disseminated primarily via lengthy natural language articles. Perusing all such articles would be prohibitively time-consuming for healthcare practitioners; they instead tend to depend on manually compiled systematic reviews of medical literature to inform care. NLP may speed this process up, and eventually facilitate immediate consult of published evidence. The Evidence Inference dataset was recently released to facilitate research toward this end. This task entails inferring the comparative performance of two treatments, with respect to a given outcome, from a particular article (describing a clinical trial) and identifying supporting evidence. For instance: Does this article report that chemotherapy performed better than surgery for five-year survival rates of operable cancers? In this paper, we collect additional annotations to expand the Evidence Inference dataset by 25\%, provide stronger baseline models, systematically inspect the errors that these make, and probe dataset quality. We also release an abstract only (as opposed to full-texts) version of the task for rapid model prototyping. The updated corpus, documentation, and code for new baselines and evaluations are available at http://evidence-inference.ebm-nlp.com/.

  • 5 authors
·
May 8, 2020

Modernizing use of regression models in physics education research: a review of hierarchical linear modeling

Physics education researchers (PER) often analyze student data with single-level regression models (e.g., linear and logistic regression). However, education datasets can have hierarchical structures, such as students nested within courses, that single-level models fail to account for. The improper use of single-level models to analyze hierarchical datasets can lead to biased findings. Hierarchical models (a.k.a., multi-level models) account for this hierarchical nested structure in the data. In this publication, we outline the theoretical differences between how single-level and multi-level models handle hierarchical datasets. We then present analysis of a dataset from 112 introductory physics courses using both multiple linear regression and hierarchical linear modeling to illustrate the potential impact of using an inappropriate analytical method on PER findings and implications. Research can leverage multi-institutional datasets to improve the field's understanding of how to support student success in physics. There is no post hoc fix, however, if researchers use inappropriate single-level models to analyze multi-level datasets. To continue developing reliable and generalizable knowledge, PER should use hierarchical models when analyzing hierarchical datasets. The supplemental materials include a sample dataset, R code to model the building and analysis presented in the paper, and an HTML output from the R code.

  • 2 authors
·
Jul 17, 2018

FluctlightDB: A Memory Model of Data for AI Agents

For fifty years, data systems have answered two questions. The relational model asked which records match a predicate; the vector model asked which vectors lie nearest a query. Neither was built for cue-driven, provenance-weighted recall across long sessions. We propose treating long-term agent memory as a distinct data model -- with its own write semantics (encoding, separation, consolidation, provenance) and read semantics (cue-driven activation across a linked memory graph) -- and present FluctlightDB, an embedded engine that implements this contract via experience() and activate(). We make that case carefully, not categorically: we do not claim novelty over Mem0, Zep, or HippoRAG-style memory layers, only an embedded engine contract beneath them. On LoCoMo (official evidence-recall metric; 10 conversations, 1,982 gold spans), CHORUS recalls 99.0% on an internally reproduced July 2026 run. On LongMemEval-S (500 questions, official session_recall@8), our retrieval harness scores 97.6% (488/500); end-to-end QA with our reader/judge stack scores 97.4% (487/500) -- these layers use different protocols than vendor leaderboard figures we cite for context only. On BEIR SciFact (shared MiniLM embeddings, same harness, Recall Fabric on), CHORUS/PRISM edges Chroma on nDCG@10 (0.646 vs. 0.645) and Recall@10 (0.792 vs. 0.783). We also report a small author-designed regression suite (FAMB; paraphrase n=10, other sub-tests n=1) at 100% macro -- internal validation, not peer benchmark. Strangers can verify the engine in under a minute via pip install "fluctlightdb[native]" and a minimal connect() -> experience() -> activate() script (compiled wheel, not source-only). Harnesses and frozen JSON are MIT-licensed. We claim no new neuroscience and no new transformer; we propose a missing layer of the data stack and release an engine others can reproduce and contest.

  • 1 authors
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Jul 9

PARROT: An Open Multilingual Radiology Reports Dataset

Rationale and Objectives: To develop and validate PARROT (Polyglottal Annotated Radiology Reports for Open Testing), a large, multicentric, open-access dataset of fictional radiology reports spanning multiple languages for testing natural language processing applications in radiology. Materials and Methods: From May to September 2024, radiologists were invited to contribute fictional radiology reports following their standard reporting practices. Contributors provided at least 20 reports with associated metadata including anatomical region, imaging modality, clinical context, and for non-English reports, English translations. All reports were assigned ICD-10 codes. A human vs. AI report differentiation study was conducted with 154 participants (radiologists, healthcare professionals, and non-healthcare professionals) assessing whether reports were human-authored or AI-generated. Results: The dataset comprises 2,658 radiology reports from 76 authors across 21 countries and 13 languages. Reports cover multiple imaging modalities (CT: 36.1%, MRI: 22.8%, radiography: 19.0%, ultrasound: 16.8%) and anatomical regions, with chest (19.9%), abdomen (18.6%), head (17.3%), and pelvis (14.1%) being most prevalent. In the differentiation study, participants achieved 53.9% accuracy (95% CI: 50.7%-57.1%) in distinguishing between human and AI-generated reports, with radiologists performing significantly better (56.9%, 95% CI: 53.3%-60.6%, p<0.05) than other groups. Conclusion: PARROT represents the largest open multilingual radiology report dataset, enabling development and validation of natural language processing applications across linguistic, geographic, and clinical boundaries without privacy constraints.

  • 88 authors
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Jul 25, 2025

Bayesian aggregation of average data: An application in drug development

Throughout the different phases of a drug development program, randomized trials are used to establish the tolerability, safety, and efficacy of a candidate drug. At each stage one aims to optimize the design of future studies by extrapolation from the available evidence at the time. This includes collected trial data and relevant external data. However, relevant external data are typically available as averages only, for example from trials on alternative treatments reported in the literature. Here we report on such an example from a drug development for wet age-related macular degeneration. This disease is the leading cause of severe vision loss in the elderly. While current treatment options are efficacious, they are also a substantial burden for the patient. Hence, new treatments are under development which need to be compared against existing treatments. The general statistical problem this leads to is meta-analysis, which addresses the question of how we can combine datasets collected under different conditions. Bayesian methods have long been used to achieve partial pooling. Here we consider the challenge when the model of interest is complex (hierarchical and nonlinear) and one dataset is given as raw data while the second dataset is given as averages only. In such a situation, common meta-analytic methods can only be applied when the model is sufficiently simple for analytic approaches. When the model is too complex, for example nonlinear, an analytic approach is not possible. We provide a Bayesian solution by using simulation to approximately reconstruct the likelihood of the external summary and allowing the parameters in the model to vary under the different conditions. We first evaluate our approach using fake-data simulations and then report results for the drug development program that motivated this research.

  • 6 authors
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May 12, 2020

ICON: Improving Inter-Report Consistency of Radiology Report Generation via Lesion-aware Mix-up Augmentation

Previous research on radiology report generation has made significant progress in terms of increasing the clinical accuracy of generated reports. In this paper, we emphasize another crucial quality that it should possess, i.e., inter-report consistency, which refers to the capability of generating consistent reports for semantically equivalent radiographs. This quality is even of greater significance than the overall report accuracy in terms of ensuring the system's credibility, as a system prone to providing conflicting results would severely erode users' trust. Regrettably, existing approaches struggle to maintain inter-report consistency, exhibiting biases towards common patterns and susceptibility to lesion variants. To address this issue, we propose ICON, which improves the inter-report consistency of radiology report generation. Aiming at enhancing the system's ability to capture the similarities in semantically equivalent lesions, our approach involves first extracting lesions from input images and examining their characteristics. Then, we introduce a lesion-aware mix-up augmentation technique to ensure that the representations of the semantically equivalent lesions align with the same attributes, by linearly interpolating them during the training phase. Extensive experiments on three publicly available chest X-ray datasets verify the effectiveness of our approach, both in terms of improving the consistency and accuracy of the generated reports.

  • 6 authors
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Feb 20, 2024

RePrompT: Recurrent Prompt Tuning for Integrating Structured EHR Encoders with Large Language Models

Large Language Models (LLMs) have shown strong promise for mining Electronic Health Records (EHRs) by reasoning over longitudinal clinical information to capture context-rich patient trajectories. However, leveraging LLMs for structured EHRs (e.g., standardized diagnosis and medication codes) presents two key challenges. First, translating time-stamped EHR sequences into plain text can obscure both temporal structure and code identities, weakening the ability to capture code co-occurrence and longitudinal regularities. Second, unlike cohort-trained predictive models that learn a shared, task-aligned representation space across patients, LLMs are often applied in a case-isolated inference setting where each patient is processed independently without leveraging population-level patterns. To address these challenges, we introduce RePrompT, a time-aware LLM framework that integrates structured EHR encoders through prompt tuning, without modifying underlying architectures. Specifically, RePrompT recurrently incorporates latent states from prior visits to preserve longitudinal information, and injects population-level information through trainable prompt tokens derived from a cohort-trained, task-aligned EHR encoder. Experiments on MIMIC-III and MIMIC-IV demonstrate that RePrompT consistently outperforms both EHR-based and LLM-based baselines across multiple clinical prediction tasks.

  • 5 authors
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Apr 19

A study of a deterministic model for meningitis epidemic

A compartmental deterministic model that allows (1) immunity from two stages of infection and carriage, and (2) disease induced death, is used in studying the dynamics of meningitis epidemic process in a closed population. It allows for difference in the transmission rate of infection to a susceptible by a carrier and an infective. It is generalized to allow a proportion ({\phi}) of those susceptibles infected to progress directly to infectives in stage I. Both models are used in this study. The threshold conditions for the spread of carrier and infectives in stage I are derived for the two models. Sensitivity analysis is performed on the reproductive number derived from the next generation matrix. The case-carrier ratio profile for various parameters and threshold values are shown. So also are the graphs of the total number ever infected as influenced by {\epsilon} and {\phi}. The infection transmission rate (eta), the odds in favor of a carrier, over an infective, in transmitting an infection to a susceptible ({\epsilon}) and the carrier conversion rate ({\phi}) to an infective in stage I, are identified as key parameters that should be subject of attention for any control intervention strategy. The case-carrier ratio profiles provide evidence of a critical case-carrier ratio attained before the number of reported cases grows to an epidemic level. They also provide visual evidence of epidemiological context, in this case, epidemic incidence (in later part of dry season) and endemic incidence (during rainy season). Results from total proportion ever infected suggest that the model, in which {\phi}=0 obtained, can adequately represent, in essence, the generalized model for this study.

  • 2 authors
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Mar 31, 2023

EHRSHOT: An EHR Benchmark for Few-Shot Evaluation of Foundation Models

While the general machine learning (ML) community has benefited from public datasets, tasks, and models, the progress of ML in healthcare has been hampered by a lack of such shared assets. The success of foundation models creates new challenges for healthcare ML by requiring access to shared pretrained models to validate performance benefits. We help address these challenges through three contributions. First, we publish a new dataset, EHRSHOT, which contains deidentified structured data from the electronic health records (EHRs) of 6,739 patients from Stanford Medicine. Unlike MIMIC-III/IV and other popular EHR datasets, EHRSHOT is longitudinal and not restricted to ICU/ED patients. Second, we publish the weights of CLMBR-T-base, a 141M parameter clinical foundation model pretrained on the structured EHR data of 2.57M patients. We are one of the first to fully release such a model for coded EHR data; in contrast, most prior models released for clinical data (e.g. GatorTron, ClinicalBERT) only work with unstructured text and cannot process the rich, structured data within an EHR. We provide an end-to-end pipeline for the community to validate and build upon its performance. Third, we define 15 few-shot clinical prediction tasks, enabling evaluation of foundation models on benefits such as sample efficiency and task adaptation. Our model and dataset are available via a research data use agreement from the Stanford AIMI Center. Code to reproduce our results are available at our Github repo: https://github.com/som-shahlab/ehrshot-benchmark

  • 5 authors
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Jul 5, 2023

Progress Note Understanding -- Assessment and Plan Reasoning: Overview of the 2022 N2C2 Track 3 Shared Task

Daily progress notes are common types in the electronic health record (EHR) where healthcare providers document the patient's daily progress and treatment plans. The EHR is designed to document all the care provided to patients, but it also enables note bloat with extraneous information that distracts from the diagnoses and treatment plans. Applications of natural language processing (NLP) in the EHR is a growing field with the majority of methods in information extraction. Few tasks use NLP methods for downstream diagnostic decision support. We introduced the 2022 National NLP Clinical Challenge (N2C2) Track 3: Progress Note Understanding - Assessment and Plan Reasoning as one step towards a new suite of tasks. The Assessment and Plan Reasoning task focuses on the most critical components of progress notes, Assessment and Plan subsections where health problems and diagnoses are contained. The goal of the task was to develop and evaluate NLP systems that automatically predict causal relations between the overall status of the patient contained in the Assessment section and its relation to each component of the Plan section which contains the diagnoses and treatment plans. The goal of the task was to identify and prioritize diagnoses as the first steps in diagnostic decision support to find the most relevant information in long documents like daily progress notes. We present the results of 2022 n2c2 Track 3 and provide a description of the data, evaluation, participation and system performance.

  • 6 authors
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Mar 14, 2023