Daily Papers

Linear attention compresses context into a fixed-size key-value state for linear-time training and constant-memory inference. Gated delta-rule models decay this state and erase its prediction for an incoming key before writing a new value; Gated DeltaNet-2 (GDN-2) generalizes this with channel-wise decay and decoupled, full-rank erase and write gates. However, we show that state updates are far less sensitive to erasure than to writes: key activation and unit normalization concentrate key energy onto a sparse subset of channels, whereas value writes scale all channels, so the erase gate can be parameterized at lower rank. Furthermore, slow-decaying state rows accumulate much larger norms than fast rows, dominating unweighted readout and forcing stronger write-time erasure to suppress interference. Guided by this analysis, we introduce Muir, which fuses all gates into a sensitivity-allocated low-rank projection, re-weights state rows with a matched-filter readout gate, and reinvests the saved parameters in a wider feed-forward network. Because standard chunkwise algorithms become numerically unstable at the large chunk sizes needed to saturate wide matrix units, we design a parallel update for stable, efficient training. Across 166M-1.34B parameters, Muir lowers perplexity by 1.8-2.0% over GDN-2 and 2.5-3.6% over Transformer, raises commonsense accuracy by up to 1.9 points, and improves extractive recall over GDN-2. At 1.34B, Muir outperforms both baselines on multi-hop and multi-needle recall, extrapolates 2,560x from its 4K training length to 10M-token streams without perplexity drift, and maintains near-100% passkey retrieval to 1M tokens with static readout. Muir achieves these gains while matching GDN-2 throughput, reaching its 100B-token validation loss 1.2x faster, and training 2.7x faster than Transformer at 32K.

Long-context language modeling remains central to modern sequence modeling, but the quadratic cost of Transformer attention makes scaling computationally prohibitive. Linear recurrent models address this bottleneck by compressing the context into a fixed-size state, making the rule that forgets, writes, and edits information a central design problem. To address state maintenance, Gated DeltaNet (GDN) combines gated state decay with delta-rule residual writes, using a learnable coefficient to balance forgetting and update magnitude. However, this coefficient is learned empirically rather than derived from the underlying objective, which can lead to suboptimal update magnitudes. We revisit the online-regression objective underlying GDN and, inspired by the Kaczmarz projection method, derive the key-norm-normalized dynamic step size β_t = η_t / (|k_t|_2^2 + ε) for residual updates. We propose Kaczmarz Linear Attention (KLA), a one-scalar modification of GDN that preserves the state shape, gates, linear recurrence, and chunkwise parallel algorithm. At the 0.4B scale with a 1B-token budget, KLA achieves the lowest validation perplexity among evaluated linear-time baselines, 8.09 versus 8.50 for GDN, and remains stable up to 65K tokens. On controlled tasks, KLA reaches 100% on single-needle-in-a-haystack retrieval, improves 8x multi-query associative recall by 7.03 points over GDN, and delivers 2.1x higher decode throughput at 32K context. These results suggest that the key-norm-normalized Kaczmarz coefficient is a first-order design axis for delta-rule sequence models: it improves accuracy, extrapolation, and decoding efficiency without changing the recurrent state or hardware kernel.

The proliferation of Large Language Models (LLMs) highlights the critical importance of conducting thorough evaluations to discern their comparative advantages, limitations, and optimal use cases. Particularly important is assessing their capacity to accurately retrieve information included in a given prompt. A model's ability to do this significantly influences how effectively it can utilize contextual details, thus impacting its practical efficacy and dependability in real-world applications. Our research analyzes the in-context recall performance of various LLMs using the needle-in-a-haystack method. In this approach, a factoid (the "needle") is embedded within a block of filler text (the "haystack"), which the model is asked to retrieve. We assess the recall performance of each model across various haystack lengths and with varying needle placements to identify performance patterns. This study demonstrates that an LLM's recall capability is not only contingent upon the prompt's content but also may be compromised by biases in its training data. Conversely, adjustments to model architecture, training strategy, or fine-tuning can improve performance. Our analysis provides insight into LLM behavior, offering direction for the development of more effective applications of LLMs.

Electronic Health Record (EHR) retrieval plays a pivotal role in various clinical tasks, but its development has been severely impeded by the lack of publicly available benchmarks. In this paper, we introduce a novel public EHR retrieval benchmark, CliniQ, to address this gap. We consider two retrieval settings: Single-Patient Retrieval and Multi-Patient Retrieval, reflecting various real-world scenarios. Single-Patient Retrieval focuses on finding relevant parts within a patient note, while Multi-Patient Retrieval involves retrieving EHRs from multiple patients. We build our benchmark upon 1,000 discharge summary notes along with the ICD codes and prescription labels from MIMIC-III, and collect 1,246 unique queries with 77,206 relevance judgments by further leveraging powerful LLMs as annotators. Additionally, we include a novel assessment of the semantic gap issue in EHR retrieval by categorizing matching types into string match and four types of semantic matches. On our proposed benchmark, we conduct a comprehensive evaluation of various retrieval methods, ranging from conventional exact match to popular dense retrievers. Our experiments find that BM25 sets a strong baseline and performs competitively to the dense retrievers, and general domain dense retrievers surprisingly outperform those designed for the medical domain. In-depth analyses on various matching types reveal the strengths and drawbacks of different methods, enlightening the potential for targeted improvement. We believe that our benchmark will stimulate the research communities to advance EHR retrieval systems.

Automated clinical diagnosis remains a core challenge in medical AI, which usually requires models to integrate multi-modal data and reason across complex, case-specific contexts. Although recent methods have advanced medical report generation (MRG) and visual question answering (VQA) with medical vision-language models (VLMs), these methods, however, predominantly operate under a sample-isolated inference paradigm, as such processing cases independently without access to longitudinal electronic health records (EHRs) or structurally related patient examples. This paradigm limits reasoning to image-derived information alone, which ignores external complementary medical evidence for potentially more accurate diagnosis. To overcome this limitation, we propose HyperWalker, a Deep Diagnosis framework that reformulates clinical reasoning via dynamic hypergraphs and test-time training. First, we construct a dynamic hypergraph, termed iBrochure, to model the structural heterogeneity of EHR data and implicit high-order associations among multimodal clinical information. Within this hypergraph, a reinforcement learning agent, Walker, navigates to and identifies optimal diagnostic paths. To ensure comprehensive coverage of diverse clinical characteristics in test samples, we incorporate a linger mechanism, a multi-hop orthogonal retrieval strategy that iteratively selects clinically complementary neighborhood cases reflecting distinct clinical attributes. Experiments on MRG with MIMIC and medical VQA on EHRXQA demonstrate that HyperWalker achieves state-of-the-art performance. Code is available at: https://github.com/Bean-Young/HyperWalker

High Recall Retrieval (HRR), such as eDiscovery and medical systematic review, is a search problem that optimizes the cost of retrieving most relevant documents in a given collection. Iterative approaches, such as iterative relevance feedback and uncertainty sampling, are shown to be effective under various operational scenarios. Despite neural models demonstrating success in other text-related tasks, linear models such as logistic regression, in general, are still more effective and efficient in HRR since the model is trained and retrieves documents from the same fixed collection. In this work, we leverage SPLADE, an efficient retrieval model that transforms documents into contextualized sparse vectors, for HRR. Our approach combines the best of both worlds, leveraging both the contextualization from pretrained language models and the efficiency of linear models. It reduces 10% and 18% of the review cost in two HRR evaluation collections under a one-phase review workflow with a target recall of 80%. The experiment is implemented with TARexp and is available at https://github.com/eugene-yang/LSR-for-TAR.

Neural embedding models have become a fundamental component of modern information retrieval (IR) pipelines. These models produce a single embedding x in R^d per data-point, allowing for fast retrieval via highly optimized maximum inner product search (MIPS) algorithms. Recently, beginning with the landmark ColBERT paper, multi-vector models, which produce a set of embedding per data point, have achieved markedly superior performance for IR tasks. Unfortunately, using these models for IR is computationally expensive due to the increased complexity of multi-vector retrieval and scoring. In this paper, we introduce MUVERA (MUlti-VEctor Retrieval Algorithm), a retrieval mechanism which reduces multi-vector similarity search to single-vector similarity search. This enables the usage of off-the-shelf MIPS solvers for multi-vector retrieval. MUVERA asymmetrically generates Fixed Dimensional Encodings (FDEs) of queries and documents, which are vectors whose inner product approximates multi-vector similarity. We prove that FDEs give high-quality epsilon-approximations, thus providing the first single-vector proxy for multi-vector similarity with theoretical guarantees. Empirically, we find that FDEs achieve the same recall as prior state-of-the-art heuristics while retrieving 2-5times fewer candidates. Compared to prior state of the art implementations, MUVERA achieves consistently good end-to-end recall and latency across a diverse set of the BEIR retrieval datasets, achieving an average of 10% improved recall with 90% lower latency.

A classical vector retrieval problem typically considers a single query embedding vector as input and retrieves the most similar embedding vectors from a vector database. However, complex reasoning and retrieval tasks frequently require multiple query vectors, rather than a single one. In this work, we propose a retrieval method that considers multiple query vectors simultaneously and retrieves the most relevant vectors from the database using concepts from anomalous pattern detection. Specifically, our approach leverages a set of query vectors Q (with |Q|geq 1), and identifies the subset of vector dimensions within Q that standout (anomalous) from the rest of dimensions. Next, we scan the vector database to retrieve the set of vectors that are also anomalous across the previously identified vector dimensions and return them as our retrieved set of vectors. We validate our approach on two image datasets, a text dataset, and a tabular dataset. Overall, we observe that, across most datasets, larger query sets lead to improved retrieval performance. The improvement is most pronounced when increasing the query sets from 1 to 8, while the gains become smaller beyond that.

Multimodal Large Language Models (MLLMs) have shown significant promise in various applications, leading to broad interest from researchers and practitioners alike. However, a comprehensive evaluation of their long-context capabilities remains underexplored. To address these gaps, we introduce the MultiModal Needle-in-a-haystack (MMNeedle) benchmark, specifically designed to assess the long-context capabilities of MLLMs. Besides multi-image input, we employ image stitching to further increase the input context length, and develop a protocol to automatically generate labels for sub-image level retrieval. Essentially, MMNeedle evaluates MLLMs by stress-testing their capability to locate a target sub-image (needle) within a set of images (haystack) based on textual instructions and descriptions of image contents. This setup necessitates an advanced understanding of extensive visual contexts and effective information retrieval within long-context image inputs. With this benchmark, we evaluate state-of-the-art MLLMs, encompassing both API-based and open-source models. The findings reveal that GPT-4o consistently surpasses other models in long-context scenarios, but suffers from hallucination problems in negative samples, i.e., when needles are not in the haystacks. Our comprehensive long-context evaluation of MLLMs also sheds lights on the considerable performance gap between API-based and open-source models. All the code, data, and instructions required to reproduce the main results are available at https://github.com/Wang-ML-Lab/multimodal-needle-in-a-haystack.

Medical knowledge is continuously evolving. This creates a need to update or selectively forget information encoded in already-trained medical LLMs. Machine unlearning aims to remove the influence of specific training data from a model without full retraining. Yet, existing unlearning benchmarks rely on synthetic or small-scale general data, leaving clinical unlearning understudied. We introduce AMNESIA, the first large-scale, open source benchmark for medical unlearning, with 70,560 question-answer pairs from 8,820 patient notes across 11 disease categories. AMNESIA includes both factual questions testing direct recall and reasoning questions testing clinical inference. We use it to evaluate four widely used unlearning methods at both random patient and disease-level, and introduce a new metric for detecting leakage of medical terminology. We show that unlearning individual patients erodes knowledge of others with the same condition, calling for methods that can better separate patients from shared clinical knowledge.

Long-term memory systems store what a user says in an external store and retrieve it when a related query arrives. This interface rests on an assumption so natural that it is rarely stated: a memory that is needed will resemble the query that needs it. World knowledge breaks the assumption. A tree-nut allergy should change the answer to a macaron request through their almond-flour ingredient, yet the two texts share no cue a retriever can see. We call this failure mode the implicit-association blind spot and introduce InMind, a 125-task, expert-verified benchmark spanning ten life domains, with 113 tasks grounded in citable public sources. Its paired controls separate three explanations that existing evaluations conflate: the fact was never stored, the model lacks the bridging knowledge, or the fact was stored and never surfaced. The verdict is clean. With the decisive memory placed in context, the backbone answers 84.0 percent of indirect queries; when the same memory must be retrieved, six vector, graph, and agentic memory systems reach at most 14.4 percent, even though they recall the same facts on demand at up to 100 percent. An embedding with eight times the dimensionality raises answer-blind target recall for every system yet leaves the gap essentially intact. A minimal diagnostic probe that keeps memory visible before the query arrives recovers most of the gap, locating the failure in the query-conditioned interface itself and pointing to routing, deciding which facts must stay visible, as the open problem InMind is built to score.

Retrieval-based factuality evaluation, where LLM-generated claims are verified against evidence from authoritative medical corpora, has become the dominant paradigm for scalable hallucination detection in high-stakes clinical settings. Despite the urgency of reliable and transparent medical fact verification, most systems measure performance with aggregate metrics like F1, which obscure where and why failures occur. Existing RAG diagnostics require gold answers or annotated gold evidence, neither of which exists in this regime. We introduce two comprehensive taxonomies, grounded in a case study on the open-ended MedExpert dataset and 3 closed-ended datasets, decomposing failures into retrieval-stage errors along five quality dimensions, and verifier-reasoning errors into six consecutive steps. We adapt an automatic pattern induction pipeline using LLM-as-Judge to label evidence quality and classify verifier reasoning errors at scale, and then stress-test our findings across 4 retrieval methods and 6 frontier verifier models. Our analysis reveals that scaling model size, adding reasoning effort, expanding to authoritative web sources, and applying medical fine-tuning do not resolve these failure modes, demonstrating that they represent fundamental limitations of the retrieve-then-verify paradigm in open-ended medical settings rather than artifacts of outdated systems. We release our code and data at https://anonymous.4open.science/r/Medical_RAG_eval-4AB5 for the full reproducibility of our results.

With the rapid advancement of multimodal large language models (MLLMs), their evaluation has become increasingly comprehensive. However, understanding long multimodal content, as a foundational ability for real-world applications, remains underexplored. In this work, we present Needle In A Multimodal Haystack (MM-NIAH), the first benchmark specifically designed to systematically evaluate the capability of existing MLLMs to comprehend long multimodal documents. Our benchmark includes three types of evaluation tasks: multimodal retrieval, counting, and reasoning. In each task, the model is required to answer the questions according to different key information scattered throughout the given multimodal document. Evaluating the leading MLLMs on MM-NIAH, we observe that existing models still have significant room for improvement on these tasks, especially on vision-centric evaluation. We hope this work can provide a platform for further research on long multimodal document comprehension and contribute to the advancement of MLLMs. Code and benchmark are released at https://github.com/OpenGVLab/MM-NIAH.

Current medical retrieval benchmarks primarily emphasize lexical or shallow semantic similarity, overlooking the reasoning-intensive demands that are central to clinical decision-making. In practice, physicians often retrieve authoritative medical evidence to support diagnostic hypotheses. Such evidence typically aligns with an inferred diagnosis rather than the surface form of a patient's symptoms, leading to low lexical or semantic overlap between queries and relevant documents. To address this gap, we introduce R2MED, the first benchmark explicitly designed for reasoning-driven medical retrieval. It comprises 876 queries spanning three tasks: Q&A reference retrieval, clinical evidence retrieval, and clinical case retrieval. These tasks are drawn from five representative medical scenarios and twelve body systems, capturing the complexity and diversity of real-world medical information needs. We evaluate 15 widely-used retrieval systems on R2MED and find that even the best model achieves only 31.4 nDCG@10, demonstrating the benchmark's difficulty. Classical re-ranking and generation-augmented retrieval methods offer only modest improvements. Although large reasoning models improve performance via intermediate inference generation, the best results still peak at 41.4 nDCG@10. These findings underscore a substantial gap between current retrieval techniques and the reasoning demands of real clinical tasks. We release R2MED as a challenging benchmark to foster the development of next-generation medical retrieval systems with enhanced reasoning capabilities. Data and code are available at https://github.com/R2MED/R2MED

Time-series diagnostic systems rarely rely on retrieving relevant historical cases, and when they do, retrieval is evaluated only indirectly through downstream prediction. We introduce READ-Bench, a benchmark for historical-case retrieval across 12 diagnostic datasets, centered on multivariate time series, that defines relevance by shared fault or event type rather than signal shape, so visually different traces of the same fault count as relevant while similar-looking traces of different faults do not. Treating retrieval as a base retriever followed by a reranker, we evaluate classical distances, symbolic retrievers, self-supervised and foundation-model embedders, and their fusion, plus label-aware and language-model rerankers, under one protocol that varies supervision, pollution, and corpus scale with significance testing. Under a common channel-independent interface, pretrained representations offer no statistically detectable advantage over strong classical and symbolic baselines for search alone. The decisive factor is a small amount of resolved-case supervision at reranking, namely a Gaussian-process reranker that propagates a few neighbor labels in embedding space, which helps far more than more sophisticated representations or language-model reasoning and holds under pollution and at full corpus scale. Guided by these findings, we fuse a normal-residual-scored embedder with a dynamic time warping leg via reciprocal-rank fusion, then rerank with the Gaussian-process reranker, improving NDCG@10 over its own search stage on all 12 datasets, by +0.11 from reranking and +0.16 over the strongest single base retriever.

We introduce the concept of the self-referencing causal cycle (abbreviated RECALL) - a mechanism that enables large language models (LLMs) to bypass the limitations of unidirectional causality, which underlies a phenomenon known as the reversal curse. When an LLM is prompted with sequential data, it often fails to recall preceding context. For example, when we ask an LLM to recall the line preceding "O say does that star-spangled banner yet wave" in the U.S. National Anthem, it often fails to correctly return "Gave proof through the night that our flag was still there" - this is due to the reversal curse. It occurs because language models such as ChatGPT and Llama generate text based on preceding tokens, requiring facts to be learned and reproduced in a consistent token order. While the reversal curse is often viewed as a limitation, we offer evidence of an alternative view: it is not always an obstacle in practice. We find that RECALL is driven by what we designate as cycle tokens - sequences that connect different parts of the training data, enabling recall of preceding tokens from succeeding ones. Through rigorous probabilistic formalization and controlled experiments, we demonstrate how the cycles they induce influence a model's ability to reproduce information. To facilitate reproducibility, we provide our code and experimental details at https://anonymous.4open.science/r/remember-B0B8/.

Hospitals in India still rely on handwritten medical records despite the availability of Electronic Medical Records (EMR), complicating statistical analysis and record retrieval. Handwritten records pose a unique challenge, requiring specialized data for training models to recognize medications and their recommendation patterns. While traditional handwriting recognition approaches employ 2-D LSTMs, recent studies have explored using Multimodal Large Language Models (MLLMs) for OCR tasks. Building on this approach, we focus on extracting medication names and dosages from simulated medical records. Our methodology MIRAGE (Multimodal Identification and Recognition of Annotations in indian GEneral prescriptions) involves fine-tuning the QWEN VL, LLaVA 1.6 and Idefics2 models on 743,118 high resolution simulated medical record images-fully annotated from 1,133 doctors across India. Our approach achieves 82% accuracy in extracting medication names and dosages.

Recent advances have been improving the context windows of Large Language Models (LLMs). To quantify the real long-context capabilities of LLMs, evaluators such as the popular Needle in a Haystack have been developed to test LLMs over a large chunk of raw texts. While effective, current evaluations overlook the insight of how LLMs work with long-context code, i.e., repositories. To this end, we initiate the RepoQA benchmark to evaluate LLMs on long-context code understanding. Traditional needle testers ask LLMs to directly retrieve the answer from the context without necessary deep understanding. In RepoQA, we built our initial task, namely Searching Needle Function (SNF), which exercises LLMs to search functions given their natural-language description, i.e., LLMs cannot find the desired function if they cannot understand the description and code. RepoQA is multilingual and comprehensive: it includes 500 code search tasks gathered from 50 popular repositories across 5 modern programming languages. By evaluating 26 general and code-specific LLMs on RepoQA, we show (i) there is still a small gap between the best open and proprietary models; (ii) different models are good at different languages; and (iii) models may understand code better without comments.

Given the dominance of dense retrievers that do not generalize well beyond their training dataset distributions, domain-specific test sets are essential in evaluating retrieval. There are few test datasets for retrieval systems intended for use by healthcare providers in a point-of-care setting. To fill this gap we have collaborated with medical professionals to create CURE, an ad-hoc retrieval test dataset for passage ranking with 2000 queries spanning 10 medical domains with a monolingual (English) and two cross-lingual (French/Spanish -> English) conditions. In this paper, we describe how CURE was constructed and provide baseline results to showcase its effectiveness as an evaluation tool. CURE is published with a Creative Commons Attribution Non Commercial 4.0 license and can be accessed on Hugging Face.

The burgeoning integration of 3D medical imaging into healthcare has led to a substantial increase in the workload of medical professionals. To assist clinicians in their diagnostic processes and alleviate their workload, the development of a robust system for retrieving similar case studies presents a viable solution. While the concept holds great promise, the field of 3D medical text-image retrieval is currently limited by the absence of robust evaluation benchmarks and curated datasets. To remedy this, our study presents a groundbreaking dataset, BIMCV-R (This dataset will be released upon acceptance.), which includes an extensive collection of 8,069 3D CT volumes, encompassing over 2 million slices, paired with their respective radiological reports. Expanding upon the foundational work of our dataset, we craft a retrieval strategy, MedFinder. This approach employs a dual-stream network architecture, harnessing the potential of large language models to advance the field of medical image retrieval beyond existing text-image retrieval solutions. It marks our preliminary step towards developing a system capable of facilitating text-to-image, image-to-text, and keyword-based retrieval tasks.

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

Machine unlearning in LLMs is the targeted removal of specific knowledge while preserving all other capabilities, critical for privacy and safety. Yet existing benchmarks measure it unreliably. They miss knowledge that resurfaces under paraphrased or indirect queries, a failure we call under-forgetting, and lack the semantic, syntactic, and lexical probes needed to verify that unrelated knowledge is preserved, a failure we call over-forgetting. Both failures reflect an asymmetric generalization problem. Forget evaluation must cover diverse query formulations of the same target facts, testing whether forgetting holds beyond exact training prompts. Retain evaluation must probe a far larger and implicitly defined set, namely every fact disjoint from the forget target. The retain set thus defines the effective forget set, yet current datasets provide no fine-grained annotation of this forget-retain boundary. We address this with SUITE, an evaluation protocol and training corpus that captures forget-retain structure for real-world factual domains. Methods trained on SUITE improve substantially, showing that training data is as important as algorithmic design. Building on the obtained insights, we introduce JensUn++, an unlearning algorithm that achieves the best forget-retain utility trade-off across three LLMs, in both sequential and joint unlearning settings. Code and datasets are available at https://amitpeleg.github.io/forget-narrowly-retain-broadly

Recent advancements in function calling and tool use have significantly enhanced the capabilities of large language models (LLMs) by enabling them to interact with external information sources and execute complex tasks. However, the limited context window of LLMs presents challenges when a large number of tools are available, necessitating efficient methods to manage prompt length and maintain accuracy. Existing approaches, such as fine-tuning LLMs or leveraging their reasoning capabilities, either require frequent retraining or incur significant latency overhead. A more efficient solution involves training smaller models to retrieve the most relevant tools for a given query, although this requires high quality, domain-specific data. To address those challenges, we present a novel framework for generating synthetic data for tool retrieval applications and an efficient data-driven tool retrieval strategy using small encoder models. Empowered by LLMs, we create ToolBank, a new tool retrieval dataset that reflects real human user usages. For tool retrieval methodologies, we propose novel approaches: (1) Tool2Vec: usage-driven tool embedding generation for tool retrieval, (2) ToolRefiner: a staged retrieval method that iteratively improves the quality of retrieved tools, and (3) MLC: framing tool retrieval as a multi-label classification problem. With these new methods, we achieve improvements of up to 27.28 in Recall@K on the ToolBench dataset and 30.5 in Recall@K on ToolBank. Additionally, we present further experimental results to rigorously validate our methods. Our code is available at https://github.com/SqueezeAILab/Tool2Vec

With the increasing use of RetrievalAugmented Generation (RAG), strong retrieval models have become more important than ever. In healthcare, multimodal retrieval models that combine information from both text and images offer major advantages for many downstream tasks such as question answering, cross-modal retrieval, and multimodal summarization, since medical data often includes both formats. However, there is currently no standard benchmark to evaluate how well these models perform in medical settings. To address this gap, we introduce M3Retrieve, a Multimodal Medical Retrieval Benchmark. M3Retrieve, spans 5 domains,16 medical fields, and 4 distinct tasks, with over 1.2 Million text documents and 164K multimodal queries, all collected under approved licenses. We evaluate leading multimodal retrieval models on this benchmark to explore the challenges specific to different medical specialities and to understand their impact on retrieval performance. By releasing M3Retrieve, we aim to enable systematic evaluation, foster model innovation, and accelerate research toward building more capable and reliable multimodal retrieval systems for medical applications. The dataset and the baselines code are available in this github page https://github.com/AkashGhosh/M3Retrieve.

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.

A key component of fact verification is thevevidence retrieval, often from multiple documents. Recent approaches use dense representations and condition the retrieval of each document on the previously retrieved ones. The latter step is performed over all the documents in the collection, requiring storing their dense representations in an index, thus incurring a high memory footprint. An alternative paradigm is retrieve-and-rerank, where documents are retrieved using methods such as BM25, their sentences are reranked, and further documents are retrieved conditioned on these sentences, reducing the memory requirements. However, such approaches can be brittle as they rely on heuristics and assume hyperlinks between documents. We propose a novel retrieve-and-rerank method for multi-hop retrieval, that consists of a retriever that jointly scores documents in the knowledge source and sentences from previously retrieved documents using an autoregressive formulation and is guided by a proof system based on natural logic that dynamically terminates the retrieval process if the evidence is deemed sufficient. This method is competitive with current state-of-the-art methods on FEVER, HoVer and FEVEROUS-S, while using 5 to 10 times less memory than competing systems. Evaluation on an adversarial dataset indicates improved stability of our approach compared to commonly deployed threshold-based methods. Finally, the proof system helps humans predict model decisions correctly more often than using the evidence alone.

Large reasoning models (LRMs) have shown significant progress in test-time scaling through chain-of-thought prompting. Current approaches like search-o1 integrate retrieval augmented generation (RAG) into multi-step reasoning processes but rely on a single, linear reasoning chain while incorporating unstructured textual information in a flat, context-agnostic manner. As a result, these approaches can lead to error accumulation throughout the reasoning chain, which significantly limits its effectiveness in medical question-answering (QA) tasks where both accuracy and traceability are critical requirements. To address these challenges, we propose MIRAGE (Multi-chain Inference with Retrieval-Augmented Graph Exploration), a novel test-time scalable reasoning framework that performs dynamic multi-chain inference over structured medical knowledge graphs. Specifically, MIRAGE 1) decomposes complex queries into entity-grounded sub-questions, 2) executes parallel inference chains, 3) retrieves evidence adaptively via neighbor expansion and multi-hop traversal, and 4) integrates answers using cross-chain verification to resolve contradictions. Experiments on three medical QA benchmarks (GenMedGPT-5k, CMCQA, and ExplainCPE) show that MIRAGE consistently outperforms GPT-4o, Tree-of-Thought variants, and other retrieval-augmented baselines in both automatic and human evaluations. Additionally, MIRAGE improves interpretability by generating explicit reasoning chains that trace each factual claim to concrete chains within the knowledge graph, making it well-suited for complex medical reasoning scenarios. The code will be available for further research.

Medicine is inherently multimodal, requiring clinicians to synthesize information across diverse data streams. Yet the development of multimodal foundation models is constrained by limited access to large-scale, high-quality clinical data. Although PubMed Central (PMC) offers a complementary source of expert-authored image-text data, existing PMC-derived resources remain limited in fidelity, reproducibility, and clinical validation. We introduce MedPMC, an automated, continuously updatable framework that transforms permissively licensed literature into high-fidelity infrastructure for medical multimodal models. Applied to 6.1 million PMC articles, MedPMC curated 11 million medical image-text pairs. Component evaluations showed strong performance for initial screening (F1 = 93.2), multi-panel figure detection (F1 = 96.5), figure separation (mAP = 89.8), caption separation and alignment (F1 = 81.4; ROUGE-L = 85.3), and medical figure classification (F1 = 96.5). Manual review by five annotators, three with medical training, found 95.3% of MedPMC images medically relevant, versus 19.7% in a prior PMC-derived dataset. Across 26 benchmarks spanning 11 specialties, a MedPMC-trained CLIP-style model improved average zero-shot AUC by 7.1 percentage points over the strongest architecture-matched biomedical CLIP baseline despite using fewer than half as many image-text pairs. As the vision encoder in a multimodal large language model, it improved medical visual question-answering by 1.9 and 16.9 percentage points across two benchmarks. In 10,524 Yale New Haven Health System dermatology photographs, it improved morphology-to-image retrieval Recall@5 by 11.7 percentage points. These findings show that high-fidelity literature curation strengthens medical multimodal foundation models across benchmark and clinical settings. We publicly release the framework, corpus, benchmarks, and pretrained models.

While Large Language Models (LLMs) achieve expert-level performance on standard medical benchmarks through single-hop factual recall, they severely struggle with the complex, multi-hop diagnostic reasoning required in real-world clinical settings. A primary obstacle is "shortcut learning", where models exploit highly connected, generic hub nodes (e.g., "inflammation") in knowledge graphs to bypass authentic micro-pathological cascades. To address this, we introduce ShatterMed-QA, a bilingual benchmark of 10,558 multi-hop clinical questions designed to rigorously evaluate deep diagnostic reasoning. Our framework constructs a topology-regularized medical Knowledge Graph using a novel k-Shattering algorithm, which physically prunes generic hubs to explicitly sever logical shortcuts. We synthesize the evaluation vignettes by applying implicit bridge entity masking and topology-driven hard negative sampling, forcing models to navigate biologically plausible distractors without relying on superficial elimination. Comprehensive evaluations of 21 LLMs reveal massive performance degradation on our multi-hop tasks, particularly among domain-specific models. Crucially, restoring the masked evidence via Retrieval-Augmented Generation (RAG) triggers near-universal performance recovery, validating ShatterMed-QA's structural fidelity and proving its efficacy in diagnosing the fundamental reasoning deficits of current medical AI. Explore the dataset, interactive examples, and full leaderboards at our project website: https://shattermed-qa-web.vercel.app/

Objectives: We aim to dynamically retrieve informative demonstrations, enhancing in-context learning in multimodal large language models (MLLMs) for disease classification. Methods: We propose a Retrieval-Augmented In-Context Learning (RAICL) framework, which integrates retrieval-augmented generation (RAG) and in-context learning (ICL) to adaptively select demonstrations with similar disease patterns, enabling more effective ICL in MLLMs. Specifically, RAICL examines embeddings from diverse encoders, including ResNet, BERT, BioBERT, and ClinicalBERT, to retrieve appropriate demonstrations, and constructs conversational prompts optimized for ICL. We evaluated the framework on two real-world multi-modal datasets (TCGA and IU Chest X-ray), assessing its performance across multiple MLLMs (Qwen, Llava, Gemma), embedding strategies, similarity metrics, and varying numbers of demonstrations. Results: RAICL consistently improved classification performance. Accuracy increased from 0.7854 to 0.8368 on TCGA and from 0.7924 to 0.8658 on IU Chest X-ray. Multi-modal inputs outperformed single-modal ones, with text-only inputs being stronger than images alone. The richness of information embedded in each modality will determine which embedding model can be used to get better results. Few-shot experiments showed that increasing the number of retrieved examples further enhanced performance. Across different similarity metrics, Euclidean distance achieved the highest accuracy while cosine similarity yielded better macro-F1 scores. RAICL demonstrated consistent improvements across various MLLMs, confirming its robustness and versatility. Conclusions: RAICL provides an efficient and scalable approach to enhance in-context learning in MLLMs for multimodal disease classification.

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.

Incentivizing the reasoning ability of Multimodal Large Language Models (MLLMs) is essential for medical applications to transparently analyze medical scans and provide reliable diagnosis. However, existing medical MLLMs rely solely on internal knowledge during reasoning, leading to hallucinated reasoning and factual inaccuracies when encountering cases beyond their training scope. Although recent Agentic Retrieval-Augmented Generation (RAG) methods elicit the medical model's proactive retrieval ability during reasoning, they are confined to unimodal LLMs, neglecting the crucial visual information during reasoning and retrieval. Consequently, we propose the first Multimodal Medical Reasoning-with-Retrieval framework, Med-RwR, which actively retrieves external knowledge by querying observed symptoms or domain-specific medical concepts during reasoning. Specifically, we design a two-stage reinforcement learning strategy with tailored rewards that stimulate the model to leverage both visual diagnostic findings and textual clinical information for effective retrieval. Building on this foundation, we further propose a Confidence-Driven Image Re-retrieval (CDIR) method for test-time scaling when low prediction confidence is detected. Evaluation on various public medical benchmarks demonstrates Med-RwR's significant improvements over baseline models, proving the effectiveness of enhancing reasoning capabilities with external knowledge integration. Furthermore, Med-RwR demonstrates remarkable generalizability to unfamiliar domains, evidenced by 8.8% performance gain on our proposed EchoCardiography Benchmark (ECBench), despite the scarcity of echocardiography data in the training corpus. Our data, model, and codes will be made publicly available at https://github.com/xmed-lab/Med-RwR.

Electronic Health Records (EHRs) are pivotal in clinical practices, yet their retrieval remains a challenge mainly due to semantic gap issues. Recent advancements in dense retrieval offer promising solutions but existing models, both general-domain and biomedical-domain, fall short due to insufficient medical knowledge or mismatched training corpora. This paper introduces DR.EHR, a series of dense retrieval models specifically tailored for EHR retrieval. We propose a two-stage training pipeline utilizing MIMIC-IV discharge summaries to address the need for extensive medical knowledge and large-scale training data. The first stage involves medical entity extraction and knowledge injection from a biomedical knowledge graph, while the second stage employs large language models to generate diverse training data. We train two variants of DR.EHR, with 110M and 7B parameters, respectively. Evaluated on the CliniQ benchmark, our models significantly outperforms all existing dense retrievers, achieving state-of-the-art results. Detailed analyses confirm our models' superiority across various match and query types, particularly in challenging semantic matches like implication and abbreviation. Ablation studies validate the effectiveness of each pipeline component, and supplementary experiments on EHR QA datasets demonstrate the models' generalizability on natural language questions, including complex ones with multiple entities. This work significantly advances EHR retrieval, offering a robust solution for clinical applications.

The emergent abilities of large language models (LLMs) have demonstrated great potential in solving medical questions. They can possess considerable medical knowledge, but may still hallucinate and are inflexible in the knowledge updates. While Retrieval-Augmented Generation (RAG) has been proposed to enhance the medical question-answering capabilities of LLMs with external knowledge bases, it may still fail in complex cases where multiple rounds of information-seeking are required. To address such an issue, we propose iterative RAG for medicine (i-MedRAG), where LLMs can iteratively ask follow-up queries based on previous information-seeking attempts. In each iteration of i-MedRAG, the follow-up queries will be answered by a vanilla RAG system and they will be further used to guide the query generation in the next iteration. Our experiments show the improved performance of various LLMs brought by i-MedRAG compared with vanilla RAG on complex questions from clinical vignettes in the United States Medical Licensing Examination (USMLE), as well as various knowledge tests in the Massive Multitask Language Understanding (MMLU) dataset. Notably, our zero-shot i-MedRAG outperforms all existing prompt engineering and fine-tuning methods on GPT-3.5, achieving an accuracy of 69.68\% on the MedQA dataset. In addition, we characterize the scaling properties of i-MedRAG with different iterations of follow-up queries and different numbers of queries per iteration. Our case studies show that i-MedRAG can flexibly ask follow-up queries to form reasoning chains, providing an in-depth analysis of medical questions. To the best of our knowledge, this is the first-of-its-kind study on incorporating follow-up queries into medical RAG.

Prevailing multi-vector visual document retrievers store each page as about a thousand patch vectors, often in vector databases run by a third party. Since no one can read a page from its vectors, this index is easily treated as less sensitive than the page. However, because the index keeps one vector per patch in raster order, and each vector is computed by a vision-language model pre-trained to read documents, we hypothesize that whoever runs or breaches the store can reproduce a page from its index alone. We frame inversion as conditional document image generation and infer from the vectors what the attack needs: the encoder, the page shape and, for shuffled vectors, their order. On the ViDoRe v3 benchmark, pages inverted from raw indices recover 47% of the words and 45% of the sensitive tokens. Used as queries against the stored indices, they rank their source page first 98.4% of the time. We test two cheap protections, token pooling and shuffling, which both cut word recall to about 8%. A model that restores the order of a shuffled index raises the share of source pages ranked first from 3.8% to 93.5%, while inverting a pooled index remains open. To test generalisation, we apply the same attack unchanged to another multi-vector retriever: its inverted pages still rank their source page first 70.2% of the time, though its word recall stays below a nearest-neighbour baseline. Multi-vector visual document retrievers are therefore vulnerable to inversion through their stored index, which should be protected like the documents it encodes.

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.

Across medical specialties, clinical practice is anchored in evidence-based guidelines that codify best studied diagnostic and treatment pathways. These pathways routinely fall short for the long tail of real-world care not covered by guidelines. Most medical large language models (LLMs), however, are trained to encode common, guideline-focused medical knowledge in their parameters. Current evaluations test models primarily on recalling and reasoning with this memorized content, often in multiple-choice settings. Given the fundamental importance of evidence-based reasoning in medicine, it is neither feasible nor reliable to depend on memorization in practice. To address this gap, we introduce OGCaReBench, a free-form retrieval-focused benchmark aimed at evaluating LLMs at answering clinical questions that require going beyond typical guidelines. Extracted from published medical case reports and validated by medical experts, OGCaReBench contains long-form clinical questions requiring free-text answers, providing a systematic framework for assessing open-ended medical reasoning in rare, case-based scenarios. Our experiments reveal that even the best-performing baseline (GPT-5.2) correctly answers only 56% of our benchmark with specialized models only reaching 42%. Augmenting models with retrieved medical articles improves this performance to up to 82% (using GPT-5.2) highlighting the importance of evidence-grounding for real-world medical reasoning tasks. This work thus establishes a foundation for benchmarking and advancing both general-purpose and medical LLMs to produce reliable answers in challenging clinical contexts.

We investigate fine-tuning Vision-Language Models (VLMs) for multi-task medical image understanding, focusing on detection, localization, and counting of findings in medical images. Our objective is to evaluate whether instruction-tuned VLMs can simultaneously improve these tasks, with the goal of enhancing diagnostic accuracy and efficiency. Using MedMultiPoints, a multimodal dataset with annotations from endoscopy (polyps and instruments) and microscopy (sperm cells), we reformulate each task into instruction-based prompts suitable for vision-language reasoning. We fine-tune Qwen2.5-VL-7B-Instruct using Low-Rank Adaptation (LoRA) across multiple task combinations. Results show that multi-task training improves robustness and accuracy. For example, it reduces the Count Mean Absolute Error (MAE) and increases Matching Accuracy in the Counting + Pointing task. However, trade-offs emerge, such as more zero-case point predictions, indicating reduced reliability in edge cases despite overall performance gains. Our study highlights the potential of adapting general-purpose VLMs to specialized medical tasks via prompt-driven fine-tuning. This approach mirrors clinical workflows, where radiologists simultaneously localize, count, and describe findings - demonstrating how VLMs can learn composite diagnostic reasoning patterns. The model produces interpretable, structured outputs, offering a promising step toward explainable and versatile medical AI. Code, model weights, and scripts will be released for reproducibility at https://github.com/simula/PointDetectCount.

Recent large language models (LLMs) support long contexts ranging from 128K to 1M tokens. A popular method for evaluating these capabilities is the needle-in-a-haystack (NIAH) test, which involves retrieving a "needle" (relevant information) from a "haystack" (long irrelevant context). Extensions of this approach include increasing distractors, fact chaining, and in-context reasoning. However, in these benchmarks, models can exploit existing literal matches between the needle and haystack to simplify the task. To address this, we introduce NoLiMa, a benchmark extending NIAH with a carefully designed needle set, where questions and needles have minimal lexical overlap, requiring models to infer latent associations to locate the needle within the haystack. We evaluate 12 popular LLMs that claim to support contexts of at least 128K tokens. While they perform well in short contexts (<1K), performance degrades significantly as context length increases. At 32K, for instance, 10 models drop below 50% of their strong short-length baselines. Even GPT-4o, one of the top-performing exceptions, experiences a reduction from an almost-perfect baseline of 99.3% to 69.7%. Our analysis suggests these declines stem from the increased difficulty the attention mechanism faces in longer contexts when literal matches are absent, making it harder to retrieve relevant information.

The introduction of computerized medical records in hospitals has reduced burdensome operations like manual writing and information fetching. However, the data contained in medical records are still far underutilized, primarily because extracting them from unstructured textual medical records takes time and effort. Information Extraction, a subfield of Natural Language Processing, can help clinical practitioners overcome this limitation, using automated text-mining pipelines. In this work, we created the first Italian neuropsychiatric Named Entity Recognition dataset, PsyNIT, and used it to develop a Large Language Model for this task. Moreover, we conducted several experiments with three external independent datasets to implement an effective multicenter model, with overall F1-score 84.77%, Precision 83.16%, Recall 86.44%. The lessons learned are: (i) the crucial role of a consistent annotation process and (ii) a fine-tuning strategy that combines classical methods with a "few-shot" approach. This allowed us to establish methodological guidelines that pave the way for future implementations in this field and allow Italian hospitals to tap into important research opportunities.

Tool-augmented language models, equipped with retrieval, memory, or external APIs, are reshaping AI, yet their theoretical advantages remain underexplored. In this paper, we address this question by demonstrating the benefits of in-tool learning (external retrieval) over in-weight learning (memorization) for factual recall. We show that the number of facts a model can memorize solely in its weights is fundamentally limited by its parameter count. In contrast, we prove that tool-use enables unbounded factual recall via a simple and efficient circuit construction. These results are validated in controlled experiments, where tool-using models consistently outperform memorizing ones. We further show that for pretrained large language models, teaching tool-use and general rules is more effective than finetuning facts into memory. Our work provides both a theoretical and empirical foundation, establishing why tool-augmented workflows are not just practical, but provably more scalable.

In this work, we develop an open-source surgical simulation environment that includes a realistic model obtained by MRI-scanning a physical phantom, for the purpose of training and evaluating a Learning from Demonstration (LfD) algorithm for autonomous suturing. The LfD algorithm utilizes Dynamic Movement Primitives (DMP) and Locally Weighted Regression (LWR), but focuses on the needle trajectory, rather than the instruments, to obtain better generality with respect to needle grasps. We conduct a user study to collect multiple suturing demonstrations and perform a comprehensive analysis of the ability of the LfD algorithm to generalize from a demonstration at one location in one phantom to different locations in the same phantom and to a different phantom. Our results indicate good generalization, on the order of 91.5%, when learning from more experienced subjects, indicating the need to integrate skill assessment in the future.

Clinical LLM assistants must reason over multi-visit patient trajectories, yet whether the compact history representations used to scale them---retrieval, structured timelines, LLM summaries, agentic memory---preserve the longitudinal signal clinical reasoning needs has not been measured. We introduce ClinTraceBench: 385 MIMIC-IV-derived verified dialogues with event-ID provenance, a nine-task taxonomy (T1--T9), and L0--L4 deterministic + L5 human-audit validation (98.92\% agreement). We evaluate eight history representation strategies---a no-context floor, last-visit-only, full-context, BGE-M3 dense-retrieval, two compression schemes, and two agentic-memory systems (Mem0, A-Mem)---across four backbones (DeepSeek-V3, GPT-4o-mini, Haiku~4.5, Sonnet~4.6) on 6{,}271 questions: 32 cells, 200{,}672 predictions. Four findings: (SP4) a controlled T3 injection probe isolates compression-induced relation loss---with the attribution sentence present before construction, Mem0, A-Mem and llm-summary still recover only 0--5.3\% of the injected positives; (SP1) compressed strategies pay an aggregation tax on multi-visit trends and cross-patient comparisons; (SP2) the blind-to-full gap spans +29.8~pp (GPT-4o-mini) to +62.7~pp (Haiku); (SP3) abstention scales non-monotonically with context length. On the Pareto frontier Haiku dominates Sonnet under full-context (\25.76 vs. 106.21), inverting the ``biggest backbone wins'' heuristic.

We present AutoIndex, a framework for learning representation programs: executable transformations that map raw documents into the representations exposed to a retrieval system. Rather than tuning retrievers, rerankers, or a small set of preprocessing hyperparameters, AutoIndex searches over programs that slice, enrich, normalize, reweight, or reorganize documents before indexing. At each iteration, AutoIndex performs validation-guided program search, in which agents diagnose failures of the current program and synthesize candidate updates, retaining only updates that improve retrieval quality under the resulting index. We evaluate AutoIndex on CRUMB, a benchmark of heterogeneous retrieval tasks, with BM25 held fixed across all experiments. The learned programs improve recall over a static full-document BM25 baseline on all 8 tasks, with average gains of +8.4% in Recall@100 and +8.3% in nDCG@10, and largest gains of +30.5% in Recall@100 and +43.6% in nDCG@10. These results suggest that document representation should not be treated as a fixed preprocessing choice made before retrieval begins, but as an explicit optimization target. Code to reproduce our results is available at https://github.com/auto-index/autoindex.

Patient recruitment is challenging for clinical trials. We introduce TrialGPT, an end-to-end framework for zero-shot patient-to-trial matching with large language models. TrialGPT comprises three modules: it first performs large-scale filtering to retrieve candidate trials (TrialGPT-Retrieval); then predicts criterion-level patient eligibility (TrialGPT-Matching); and finally generates trial-level scores (TrialGPT-Ranking). We evaluate TrialGPT on three cohorts of 183 synthetic patients with over 75,000 trial annotations. TrialGPT-Retrieval can recall over 90% of relevant trials using less than 6% of the initial collection. Manual evaluations on 1,015 patient-criterion pairs show that TrialGPT-Matching achieves an accuracy of 87.3% with faithful explanations, close to the expert performance. The TrialGPT-Ranking scores are highly correlated with human judgments and outperform the best-competing models by 43.8% in ranking and excluding trials. Furthermore, our user study reveals that TrialGPT can reduce the screening time by 42.6% in patient recruitment. Overall, these results have demonstrated promising opportunities for patient-to-trial matching with TrialGPT.

Retrieval over visually-rich documents, pages that interleave text with figures, tables, and charts, is essential for multimodal retrieval-augmented generation, yet most retrievers still discard the visual channel. The Multimodal Document Retrieval Challenge, Track~1 of the MIR Challenge at the first EReL@MIR workshop, co-located with The Web Conference 2025, asks participants to build a single retrieval system that handles two complementary regimes: closed-set document page retrieval within long documents from a text query (MMDocIR), and open-domain retrieval of Wikipedia-style passages from an image or image-plus-text query (M2KR). Systems are ranked by the macro-average of mean Recall@{1,3,5} over the two tasks. The challenge drew 455 entrants and 586 submissions across 22 teams. This report describes the challenge design, datasets, and evaluation protocol; reports the final standings; and analyses the three winning teams' systems. All three build on decoder-based Multimodal-LLM embedders from the Qwen2-VL family rather than on CLIP-style encoders, and differ chiefly in whether they reach the top through fine-tuned ensembles, training-free multi-route fusion with a strong vision-language re-ranker, or zero-shot late interaction. The training-free system finished within 0.1 point of the fine-tuned winner.

One essential task in information extraction from the medical corpus is drug name recognition. Compared with text sources come from other domains, the medical text is special and has unique characteristics. In addition, the medical text mining poses more challenges, e.g., more unstructured text, the fast growing of new terms addition, a wide range of name variation for the same drug. The mining is even more challenging due to the lack of labeled dataset sources and external knowledge, as well as multiple token representations for a single drug name that is more common in the real application setting. Although many approaches have been proposed to overwhelm the task, some problems remained with poor F-score performance (less than 0.75). This paper presents a new treatment in data representation techniques to overcome some of those challenges. We propose three data representation techniques based on the characteristics of word distribution and word similarities as a result of word embedding training. The first technique is evaluated with the standard NN model, i.e., MLP (Multi-Layer Perceptrons). The second technique involves two deep network classifiers, i.e., DBN (Deep Belief Networks), and SAE (Stacked Denoising Encoders). The third technique represents the sentence as a sequence that is evaluated with a recurrent NN model, i.e., LSTM (Long Short Term Memory). In extracting the drug name entities, the third technique gives the best F-score performance compared to the state of the art, with its average F-score being 0.8645.

We introduce LongSkywork, a long-context Large Language Model (LLM) capable of processing up to 200,000 tokens. We provide a training recipe for efficiently extending context length of LLMs. We identify that the critical element in enhancing long-context processing capability is to incorporate a long-context SFT stage following the standard SFT stage. A mere 200 iterations can convert the standard SFT model into a long-context model. To reduce the effort in collecting and annotating data for long-context language modeling, we develop two novel methods for creating synthetic data. These methods are applied during the continual pretraining phase as well as the Supervised Fine-Tuning (SFT) phase, greatly enhancing the training efficiency of our long-context LLMs. Our findings suggest that synthetic long-context SFT data can surpass the performance of data curated by humans to some extent. LongSkywork achieves outstanding performance on a variety of long-context benchmarks. In the Needle test, a benchmark for long-context information retrieval, our models achieved perfect accuracy across multiple context spans. Moreover, in realistic application scenarios, LongSkywork-13B demonstrates performance on par with Claude2.1, the leading long-context model, underscoring the effectiveness of our proposed methods.

Composed Image Retrieval (CIR) aims to retrieve target images based on a hybrid query comprising a reference image and a modification text. Early dual-tower Vision-Language Models (VLMs) struggle with cross-modality compositional reasoning required for this task. While adapting generative Multimodal Large Language Models (MLLMs) for retrieval offers a promising direction, we identify that this strategy overlooks a fundamental issue: compressing a generative MLLM into a single-embedding discriminative retriever triggers a paradigm conflict, which leads to Capability Degradation - the deterioration of native fine-grained reasoning after retrieval adaptation. To address this challenge, we propose ReCALL, a model-agnostic framework that follows a diagnose-generate-refine pipeline: First, we diagnose cognitive blind spots of the retriever via self-guided informative instance mining. Next, we generate corrective instructions and triplets by prompting the foundation MLLM and conduct quality control with VQA-based consistency filtering. Finally, we refine the retriever through continual training on these triplets with a grouped contrastive scheme, thereby internalizing fine-grained visual-semantic distinctions and realigning the discriminative embedding space of retriever with intrinsic compositional reasoning within the MLLM. Extensive experiments on CIRR and FashionIQ show that ReCALL consistently recalibrates degraded capabilities and achieves state-of-the-art performance. Code is available at https://github.com/RemRico/Recall.

Long-context LLM agents must access the right evidence from large environments and use it faithfully. However, the popular Needle-in-a-Haystack (NIAH) evaluation mostly measures benign span localization. The needle is near-unique, and the haystack is largely irrelevant. We introduce EverMemBench-S (EMB-S), an adversarial NIAH-style benchmark built on a 326M-token MemoryBank. While the full MemoryBank spans 326M tokens for retrieval-based (RAG) evaluation, we evaluate native long-context models only at scales that fit within each model's context window (up to 1M tokens in this work) to ensure a fair comparison. EMB-S pairs queries with collision-tested near-miss hard negatives and gold evidence sets spanning one or more documents, validated via human screening and LLM verification. We also propose a decoupled diagnostic protocol that reports evidence access (document-ID localization) separately from end-to-end QA quality under full-context prompting. This enables consistent diagnosis for both native long-context prompting and retrieval pipelines. Across a reference-corpus ladder from domain-isolated 64K contexts to a globally shared 326M-token environment, we observe a clear reality gap. Systems that saturate benign NIAH degrade sharply in evidence access under semantic interference. These results indicate that semantic discrimination, not context length alone, is the dominant bottleneck for long-context memory at scale.

Medical imaging analysis plays a critical role in the diagnosis and treatment of various medical conditions. This paper focuses on chest X-ray images and their corresponding radiological reports. It presents a new model that learns a joint X-ray image & report representation. The model is based on a novel alignment scheme between the visual data and the text, which takes into account both local and global information. Furthermore, the model integrates domain-specific information of two types -- lateral images and the consistent visual structure of chest images. Our representation is shown to benefit three types of retrieval tasks: text-image retrieval, class-based retrieval, and phrase-grounding.

Learned multivector representations power modern search systems with strong retrieval effectiveness, but their real-world use is limited by the high cost of exhaustive token-level retrieval. Therefore, most systems adopt a gather-and-refine strategy, where a lightweight gather phase selects candidates for full scoring. However, this approach requires expensive searches over large token-level indexes and often misses the documents that would rank highest under full similarity. In this paper, we reproduce several state-of-the-art multivector retrieval methods on two publicly available datasets, providing a clear picture of the current multivector retrieval field and observing the inefficiency of token-level gathering. Building on top of that, we show that replacing the token-level gather phase with a single-vector document retriever -- specifically, a learned sparse retriever (LSR) -- produces a smaller and more semantically coherent candidate set. This recasts the gather-and-refine pipeline into the well-established two-stage retrieval architecture. As retrieval latency decreases, query encoding with two neural encoders becomes the dominant computational bottleneck. To mitigate this, we integrate recent inference-free LSR methods, demonstrating that they preserve the retrieval effectiveness of the dual-encoder pipeline while substantially reducing query encoding time. Finally, we investigate multiple reranking configurations that balance efficiency, memory, and effectiveness, and we introduce two optimization techniques that prune low-quality candidates early. Empirical results show that these techniques improve retrieval efficiency by up to 1.8times with no loss in quality. Overall, our two-stage approach achieves over 24times speedup over the state-of-the-art multivector retrieval systems, while maintaining comparable or superior retrieval quality.

Recent attacks show that behavioural unlearning of large language models leaves internal traces recoverable by adversarial probes. We characterise where this retention lives and show it can be surgically removed without measurable capability cost. Our central protocol is a leave-one-out cross-sequence probe that tests whether a memorisation signature generalises across held-out sequences. The signature is real and consistent across scale: memorisation-specific gaps of +0.32, +0.19, +0.30 on Pythia-70M, GPT-2 medium, and Mistral-7B; on Pythia-70M, the random-initialisation control collapses to -0.04 at the deepest layer where the pretrained signature peaks. The probe direction is causally separable from recall -- projecting it out collapses the signature locally (+0.44 -> -0.19) while behavioural recall barely changes -- and a probe trained on naturally memorised content does not classify fine-tuning-injected secrets, marking two representationally distinct regimes. We then introduce probe-geometry alignment (PGA), a surgical erasure that aligns activations along the probe's live readout direction at each depth. PGA drives the cross-sequence probe below random chance at all four scales tested (toy depth-4: 0.17; Pythia-70M: 0.07; Mistral-7B: 0.45; GPT-2 medium: 0.06 via MD-PGA k=2) and remains robust to six adversarial probe variants. Against a re-fitting attacker who trains a fresh probe on PGA-treated activations, we extend PGA adversarially, defeating the re-fit probe at every memorisation-relevant depth while preserving five zero-shot capability benchmarks within 2.8 percentage points per task (mean Δacc = +0.2pp). The cross-sequence signature is a real, causally separable, regime-specific property of pretrained representations -- removable below chance with a single rank-one intervention per depth at no measurable capability cost.

Retrieval heads, attention heads that copy information from earlier context to the current position, have been proposed as the mechanistic substrate for long-context recall. Rotary position embeddings (RoPE) rotate queries and keys by frequencies decaying with a base hyperparameter theta, and a natural hypothesis is that this rotation either prevents retrieval heads from forming or degrades their function. We test both across four open-weight 7-8B models spanning multi-head and grouped-query attention and a 100x range of theta, using paired-seed needle-in-a-haystack tests, layer-clustered permutation, and causal head-masking. (i) Retrieval heads are causally necessary: masking the 87 detected heads in OLMo-2 collapses recall from 1.00 to 0.00, while masking matched random heads has no effect; this replicates in Qwen. (ii) Higher theta does not reduce retrieval-head count (LLaMA-3.1 at theta=500K has 47 heads vs LLaMA-2 at theta=10K with 42), refuting the prevention hypothesis. (iii) The norm-utility relation is family-specific and significant in opposite directions (Qwen d=-0.49, OLMo d=+0.50, both significant; LLaMA null); since OLMo and LLaMA-3.1 share theta=500K yet differ, the effect is not theta-driven. (iv) Building on Chiang and Yogatama (2025), a controlled patch shows that zeroing the lowest-frequency RoPE dimensions of retrieval heads degrades recall dose-dependently (1.00 to 0.18 when 32 of 128 dimensions are zeroed, vs 0.98 for random dimensions); the effect is head-specific and task-specific. The causal variable is RoPE frequency, not norm-utility. The direction holds in all five models patched (OLMo-2, Qwen2.5-7B/14B, Gemma-2, Mistral) across four lineages and two scales. We do not claim cross-model magnitude. Code and a paired-seed harness are released.

Clinical routine and retrospective cohorts commonly include multi-parametric Magnetic Resonance Imaging; however, they are mostly acquired in different anisotropic 2D views due to signal-to-noise-ratio and scan-time constraints. Thus acquired views suffer from poor out-of-plane resolution and affect downstream volumetric image analysis that typically requires isotropic 3D scans. Combining different views of multi-contrast scans into high-resolution isotropic 3D scans is challenging due to the lack of a large training cohort, which calls for a subject-specific framework. This work proposes a novel solution to this problem leveraging Implicit Neural Representations (INR). Our proposed INR jointly learns two different contrasts of complementary views in a continuous spatial function and benefits from exchanging anatomical information between them. Trained within minutes on a single commodity GPU, our model provides realistic super-resolution across different pairs of contrasts in our experiments with three datasets. Using Mutual Information (MI) as a metric, we find that our model converges to an optimum MI amongst sequences, achieving anatomically faithful reconstruction. Code is available at: https://github.com/jqmcginnis/multi_contrast_inr/

Language models (LMs) have demonstrated expert-level reasoning and recall abilities in medicine. However, computational costs and privacy concerns are mounting barriers to wide-scale implementation. We introduce a parsimonious adaptation of phi-3-mini, MedMobile, a 3.8 billion parameter LM capable of running on a mobile device, for medical applications. We demonstrate that MedMobile scores 75.7% on the MedQA (USMLE), surpassing the passing mark for physicians (~60%), and approaching the scores of models 100 times its size. We subsequently perform a careful set of ablations, and demonstrate that chain of thought, ensembling, and fine-tuning lead to the greatest performance gains, while unexpectedly retrieval augmented generation fails to demonstrate significant improvements

Linear attention mechanisms have gained prominence in causal language models due to their linear computational complexity and enhanced speed. However, the inherent decay mechanism in linear attention presents challenges when applied to multi-dimensional sequence modeling tasks, such as image processing and multi-modal learning. In these scenarios, the utilization of sequential scanning to establish a global receptive field necessitates multiple scans for multi-dimensional data, thereby leading to inefficiencies. This paper identifies the inefficiency caused by a multiplicative linear recurrence and proposes an efficient alternative additive linear recurrence to avoid the issue, as it can handle multi-dimensional data within a single scan. We further develop an efficient multi-dimensional sequential modeling framework called LightNet based on the new recurrence. Moreover, we present two new multi-dimensional linear relative positional encoding methods, MD-TPE and MD-LRPE to enhance the model's ability to discern positional information in multi-dimensional scenarios. Our empirical evaluations across various tasks, including image classification, image generation, bidirectional language modeling, and autoregressive language modeling, demonstrate the efficacy of LightNet, showcasing its potential as a versatile and efficient solution for multi-dimensional sequential modeling.

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.

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

Discharge summaries require extracting critical information from lengthy electronic health records (EHRs), a process that is labor-intensive when performed manually. Large language models (LLMs) can improve generation efficiency; however, they are prone to producing faithfulness hallucinations, statements that contradict source records, posing direct risks to patient safety. To address this, we present CuraView, a multi-agent framework for sentence-level detection and evidence-grounded explanation of faithfulness hallucinations in discharge summaries. CuraView constructs a GraphRAG-based knowledge graph from patient-level EHRs and implements a closed-loop generation-detection pipeline with sentence-level evidence retrieval and classification spanning four evidence grades from strong support to direct contradiction (E1-E4), yielding structured and interpretable evidence chains. We evaluate CuraView on a subset of 250 patients from the Discharge-Me benchmark, with 50 patients held out for testing. Our fine-tuned Qwen3-14B detection model achieves an F1 of 0.831 on the safety-critical E4 metric (90.9% recall, 76.5% precision) and an F1 of 0.823 on E3+E4, representing a 50.0% relative improvement over the base model and outperforming RAGTruth-style and QAGS-style baselines. These results demonstrate that evidence-chain-based graph retrieval verification substantially improves the factual reliability of clinical documentation, while simultaneously producing reusable annotated datasets for downstream model training and distillation.

Long-term memory has become a crucial component of large language model (LLM) agents, with most research focusing on retrieving relevant information accurately and efficiently. However, a dependable memory system must also forget sensitive user data upon request. To evaluate this capability, we introduce MemCut, a systematic benchmark for user-requested forgetting. Its 456 hand-designed secrets in long-horizon conversations have fully annotated evidence trails to test recovery after deletion, including from messages that never state the secrets directly. We propose two recovery metrics. Native recovery measures reader success through the system's retrieval, whereas residual recovery measures the same reader's success when directly given surviving objects traced to annotated disclosures or evidence. We establish three reference deletion baselines to test how far existing retrievers and write models support forgetting across five memory designs and four LLMs. Disclosure removal reduces native recovery far more than residual recovery. LLM-guided deletion of ten additional turns from twenty retrieval candidates leaves 39-76% residual recovery. Subset sweeps (144 facts, three systems, two models) show that widening the pool at a fixed budget reduces residual recovery more than deleting all original candidates. These sweeps identify candidate coverage as a bottleneck in the reference baselines.

The training of modern large language models (LLMs) takes place in a regime where most training examples are seen only a few times by the model during the course of training. What does a model remember about such examples seen only a few times during training and how long does that memory persist in the face of continuous training with new examples? Here, we investigate these questions through simple recognition, recall, and retention experiments with LLMs. In recognition experiments, we ask if the model can distinguish the seen example from a novel example; in recall experiments, we ask if the model can correctly recall the seen example when cued by a part of it; and in retention experiments, we periodically probe the model's memory for the original examples as the model is trained continuously with new examples. We find that a single exposure is generally sufficient for a model to achieve near perfect accuracy even in very challenging recognition experiments. We estimate that the recognition performance of even small language models easily exceeds human recognition performance reported in similar experiments with humans (Shepard, 1967). Achieving near perfect recall takes more exposures, but most models can do it in just 3 exposures. The flip side of this remarkable capacity for fast learning is that precise memories are quickly overwritten: recall performance for the original examples drops steeply over the first 10 training updates with new examples, followed by a more gradual decline. Even after 100K updates, however, some of the original examples are still recalled near perfectly. A qualitatively similar retention pattern has been observed in human long-term memory retention studies before (Bahrick, 1984). Finally, recognition is much more robust to interference than recall and memory for natural language sentences is generally superior to memory for stimuli without structure.

Identifying disease phenotypes from electronic health records (EHRs) is critical for numerous secondary uses. Manually encoding physician knowledge into rules is particularly challenging for rare diseases due to inadequate EHR coding, necessitating review of clinical notes. Large language models (LLMs) offer promise in text understanding but may not efficiently handle real-world clinical documentation. We propose a zero-shot LLM-based method enriched by retrieval-augmented generation and MapReduce, which pre-identifies disease-related text snippets to be used in parallel as queries for the LLM to establish diagnosis. We show that this method as applied to pulmonary hypertension (PH), a rare disease characterized by elevated arterial pressures in the lungs, significantly outperforms physician logic rules (F_1 score of 0.62 vs. 0.75). This method has the potential to enhance rare disease cohort identification, expanding the scope of robust clinical research and care gap identification.

This paper describes the results of SemEval 2023 task 7 -- Multi-Evidence Natural Language Inference for Clinical Trial Data (NLI4CT) -- consisting of 2 tasks, a Natural Language Inference (NLI) task, and an evidence selection task on clinical trial data. The proposed challenges require multi-hop biomedical and numerical reasoning, which are of significant importance to the development of systems capable of large-scale interpretation and retrieval of medical evidence, to provide personalized evidence-based care. Task 1, the entailment task, received 643 submissions from 40 participants, and Task 2, the evidence selection task, received 364 submissions from 23 participants. The tasks are challenging, with the majority of submitted systems failing to significantly outperform the majority class baseline on the entailment task, and we observe significantly better performance on the evidence selection task than on the entailment task. Increasing the number of model parameters leads to a direct increase in performance, far more significant than the effect of biomedical pre-training. Future works could explore the limitations of large models for generalization and numerical inference, and investigate methods to augment clinical datasets to allow for more rigorous testing and to facilitate fine-tuning. We envisage that the dataset, models, and results of this task will be useful to the biomedical NLI and evidence retrieval communities. The dataset, competition leaderboard, and website are publicly available.

We present our submission to the Task 5 of SemEval-2025 that aims to aid librarians in assigning subject tags to the library records by producing a list of likely relevant tags for a given document. We frame the task as an information retrieval problem, where the document content is used to retrieve subject tags from a large subject taxonomy. We leverage two types of encoder models to build a two-stage information retrieval system -- a bi-encoder for coarse-grained candidate extraction at the first stage, and a cross-encoder for fine-grained re-ranking at the second stage. This approach proved effective, demonstrating significant improvements in recall compared to single-stage methods and showing competitive results according to qualitative evaluation.

Biomedical data is inherently multimodal, consisting of electronic health records, medical imaging, digital pathology, genome sequencing, wearable sensors, and more. The application of artificial intelligence tools to these multifaceted sensing technologies has the potential to revolutionize the prognosis, diagnosis, and management of human health and disease. However, current approaches to biomedical AI typically only train and evaluate with one or a small set of medical modalities and tasks. This limitation hampers the development of comprehensive tools that can leverage the rich interconnected information across many heterogeneous biomedical sensors. To address this challenge, we present MultiMed, a benchmark designed to evaluate and enable large-scale learning across a wide spectrum of medical modalities and tasks. MultiMed consists of 2.56 million samples across ten medical modalities such as medical reports, pathology, genomics, and protein data, and is structured into eleven challenging tasks, including disease prognosis, protein structure prediction, and medical question answering. Using MultiMed, we conduct comprehensive experiments benchmarking state-of-the-art unimodal, multimodal, and multitask models. Our analysis highlights the advantages of training large-scale medical models across many related modalities and tasks. Moreover, MultiMed enables studies of generalization across related medical concepts, robustness to real-world noisy data and distribution shifts, and novel modality combinations to improve prediction performance. MultiMed will be publicly available and regularly updated and welcomes inputs from the community.

Parametric retrieval enables LLMs to retrieve tools implicitly by assigning each API a unique virtual token and training the model to generate it via constrained beam search. Toolsense shows that this regime has two critical drawbacks: it destroys parametric tool knowledge during training, and its beam-search decoding is too slow for real-time deployment. We introduce TRACE (Tool Retrieval via Augmented Chain-of-thought and Enterprise rules), a two-stage curriculum that resolves this dissociation. Stage 1 reuses the multi-format memorization SFT from ToolSense to seed tool knowledge with LoRA. Stage 2 is our core contribution: the model is trained to emit a thinking trace before producing a JSON list of tool tokens, using two data sources -- RRB pairs from ToolSense and queries synthesized to target business rules curated by domain experts -- both augmented with reasoning traces. This training objective preserves Stage 1 MCQ and QA probing accuracy while enabling single-beam greedy decoding at production latency. Evaluated on a combined enterprise catalog of 8,300+ tools across two enterprise product lines, TRACE training for Stage 2 not only preserves but improves tool understanding: MCQ accuracy gains +3.2 pp and QA probing gains +9 pp over Stage 1. On retrieval, TRACE achieves ~86% recall on Domain A and ~60% on Domain B -- compared to embedding baseline performance of ~27% & ~52% -- both with single-beam greedy decoding, making it directly deployable at production latency.

Given the clinical notes written in electronic health records (EHRs), it is challenging to predict the diagnostic codes which is formulated as a multi-label classification task. The large set of labels, the hierarchical dependency, and the imbalanced data make this prediction task extremely hard. Most existing work built a binary prediction for each label independently, ignoring the dependencies between labels. To address this problem, we propose a two-stage framework to improve automatic ICD coding by capturing the label correlation. Specifically, we train a label set distribution estimator to rescore the probability of each label set candidate generated by a base predictor. This paper is the first attempt at learning the label set distribution as a reranking module for medical code prediction. In the experiments, our proposed framework is able to improve upon best-performing predictors on the benchmark MIMIC datasets. The source code of this project is available at https://github.com/MiuLab/ICD-Correlation.

Linear sequence modeling methods, such as linear attention, state space modeling, and linear RNNs, offer significant efficiency improvements by reducing the complexity of training and inference. However, these methods typically compress the entire input sequence into a single fixed-size memory state, which leads to suboptimal performance on recall-intensive downstream tasks. Drawing inspiration from neuroscience, particularly the brain's ability to maintain robust long-term memory while mitigating "memory interference", we introduce a novel architecture called Mixture-of-Memories (MoM). MoM utilizes multiple independent memory states, with a router network directing input tokens to specific memory states. This approach greatly enhances the overall memory capacity while minimizing memory interference. As a result, MoM performs exceptionally well on recall-intensive tasks, surpassing existing linear sequence modeling techniques. Despite incorporating multiple memory states, the computation of each memory state remains linear in complexity, allowing MoM to retain the linear-complexity advantage during training, while constant-complexity during inference. Our experimental results show that MoM significantly outperforms current linear sequence models on downstream language tasks, particularly recall-intensive tasks, and even achieves performance comparable to Transformer models. The code is released at https://github.com/OpenSparseLLMs/MoM and is also released as a part of https://github.com/OpenSparseLLMs/Linear-MoE.

LLMs hold great promise for healthcare applications, but the rapid evolution of medical knowledge and errors in training data often cause them to generate outdated or inaccurate information, limiting their applicability in high-stakes clinical practice. Model editing has emerged as a potential remedy without full retraining. While parameter-based editing often compromises locality and is thus ill-suited for the medical domain, retrieval-based editing offers a more viable alternative. However, it still faces two critical challenges: (1) representation overlap within the medical knowledge space often causes inaccurate retrieval and reduces editing accuracy; (2) existing methods are restricted to single-sample edits, while batch-editing remains largely unexplored despite its importance for real-world medical applications. To address these challenges, we first construct MedVersa, an enhanced benchmark with broader coverage of medical subjects, designed to evaluate both single and batch edits under strict locality constraints. We then propose MedREK, a retrieval-based editing framework that integrates a shared query-key module for precise matching with an attention-based prompt encoder for informative guidance. Experimental results on various medical benchmarks demonstrate that our MedREK achieves superior performance across different core metrics and provides the first validated solution for batch-editing in medical LLMs. Our code and dataset are available at https://github.com/mylittleriver/MedREK.

While large language models (LLMs) have achieved state-of-the-art performance on a wide range of medical question answering (QA) tasks, they still face challenges with hallucinations and outdated knowledge. Retrieval-augmented generation (RAG) is a promising solution and has been widely adopted. However, a RAG system can involve multiple flexible components, and there is a lack of best practices regarding the optimal RAG setting for various medical purposes. To systematically evaluate such systems, we propose the Medical Information Retrieval-Augmented Generation Evaluation (MIRAGE), a first-of-its-kind benchmark including 7,663 questions from five medical QA datasets. Using MIRAGE, we conducted large-scale experiments with over 1.8 trillion prompt tokens on 41 combinations of different corpora, retrievers, and backbone LLMs through the MedRAG toolkit introduced in this work. Overall, MedRAG improves the accuracy of six different LLMs by up to 18% over chain-of-thought prompting, elevating the performance of GPT-3.5 and Mixtral to GPT-4-level. Our results show that the combination of various medical corpora and retrievers achieves the best performance. In addition, we discovered a log-linear scaling property and the "lost-in-the-middle" effects in medical RAG. We believe our comprehensive evaluations can serve as practical guidelines for implementing RAG systems for medicine.

Over the last few years, multi-vector retrieval methods, spearheaded by ColBERT, have become an increasingly popular approach to Neural IR. By storing representations at the token level rather than at the document level, these methods have demonstrated very strong retrieval performance, especially in out-of-domain settings. However, the storage and memory requirements necessary to store the large number of associated vectors remain an important drawback, hindering practical adoption. In this paper, we introduce a simple clustering-based token pooling approach to aggressively reduce the number of vectors that need to be stored. This method can reduce the space & memory footprint of ColBERT indexes by 50% with virtually no retrieval performance degradation. This method also allows for further reductions, reducing the vector count by 66%-to-75% , with degradation remaining below 5% on a vast majority of datasets. Importantly, this approach requires no architectural change nor query-time processing, and can be used as a simple drop-in during indexation with any ColBERT-like model.

Large language models (LLMs) achieve promising results on medical question answering benchmarks, yet their use in public health is constrained by hallucinations and the rapid evolution of official guidance. Retrieval-Augmented Generation (RAG) mitigates these risks by grounding responses in an explicitly maintained corpus, but end-to-end performance depends critically on retrieval configuration and on evaluation beyond multiple-choice formats. We extend PubHealthBench, a question answering (QA) benchmark of 7,929 questions derived from UK Government public health guidance, into a retrieval-augmented setting and systematically evaluate retrieval and generation choices. We compare dense, sparse, and hybrid retrieval across multiple embedding models and corpus variants, and show that hybrid retrieval consistently improves recall and ranking quality, with chunk length and topic interacting with ranking performance. Providing retrieved context substantially increases multiple-choice accuracy across a diverse set of LLMs, enabling smaller open-weight models to match or outperform larger models used without retrieval, with gains primarily driven by retrieval quality and careful context selection. To assess realistic free-form answering, we introduce a rubric-based LLM-as-a-judge covering faithfulness, completeness, clarity, and factual consistency, and validate it against dual human annotations. Judge-human agreement is strongest for faithfulness and completeness, while factual consistency and clarity are less reliably reproduced, motivating caution when interpreting those dimensions at scale. Overall, our results highlight retrieval as a primary lever for reliable public health QA and provide practical guidance for building and evaluating RAG systems grounded in official guidance.

Linear-attention and state-space language models compress the prefix into a fixed-size recurrent state, yielding O(1) memory at the cost of a lossy exact memory: when many key--value associations compete, earlier facts are overwritten and needle recall degrades. Inspired by Complementary Learning Systems, we give linear attention a hippocampal complement. HOLA (Hippocampal Linear Attention) keeps the usual delta-rule state as a compressive memory and adds a bounded exact KV cache, forming a semiparametric test-time memory: the state models linearly compressible structure, while the cache stores associations that should not be forced through that state. The cache writes without a learned eviction module, keeping tokens with large beta * ||e||, the prediction residual actually committed to the state; a decoupled RMSNorm-gamma cache read then turns these exact KV pairs into sharp retrieval rather than soft averaging. At 340M parameters trained on 15B SlimPajama tokens, HOLA lowers Wikitext perplexity from 27.32 to 22.92 (-16.1%), below a full-attention Transformer++ (26.88), and improves LAMBADA perplexity from 30.95 to 30.26. It also achieves the best linear in-context retrieval and remains much more robust than GDN or a matched HOLA+recency cache on RULER needle-in-a-haystack recall out to 32k tokens (16x its training length).

Large Language Models (LLMs) are increasingly being explored for clinical question answering and decision support, yet safe deployment critically requires reliable handling of patient measurements in heterogeneous clinical notes. Existing evaluations of LLMs for clinical numerical reasoning provide limited operation-level coverage, restricted primarily to arithmetic computation, and rarely assess the robustness of numerical understanding across clinical note formats. We introduce ClinicNumRobBench, a benchmark of 1,624 context-question instances with ground-truth answers that evaluates four main types of clinical numeracy: value retrieval, arithmetic computation, relational comparison, and aggregation. To stress-test robustness, ClinicNumRobBench presents longitudinal MIMIC-IV vital-sign records in three semantically equivalent representations, including a real-world note-style variant derived from the Open Patients dataset, and instantiates queries using 42 question templates. Experiments on 14 LLMs show that value retrieval is generally strong, with most models exceeding 85% accuracy, while relational comparison and aggregation remain challenging, with some models scoring below 15%. Fine-tuning on medical data can reduce numeracy relative to base models by over 30%, and performance drops under note-style variation indicate LLM sensitivity to format. ClinicNumRobBench offers a rigorous testbed for clinically reliable numerical reasoning. Code and data URL are available on https://github.com/MinhVuong2000/ClinicNumRobBench.

Recent advances in large language models have led to renewed interest in natural language processing in healthcare using the free text of clinical notes. One distinguishing characteristic of clinical notes is their long time span over multiple long documents. The unique structure of clinical notes creates a new design choice: when the context length for a language model predictor is limited, which part of clinical notes should we choose as the input? Existing studies either choose the inputs with domain knowledge or simply truncate them. We propose a framework to analyze the sections with high predictive power. Using MIMIC-III, we show that: 1) predictive power distribution is different between nursing notes and discharge notes and 2) combining different types of notes could improve performance when the context length is large. Our findings suggest that a carefully selected sampling function could enable more efficient information extraction from clinical notes.

Many scientific advances come from cross-pollination, carrying an idea from one field over to a problem in another. Yet retrieving papers across fields remains underexplored, with existing benchmarks confined to a narrow range of fields. We study cross-pollination retrieval, the problem of identifying transferable ideas across research fields, and introduce CPR-Dataset, a large-scale dataset constructed by mining cross-topic citations. Its evaluation split CPR-eval has 1,300 queries in 26 fields, and its training split CPR-train has 10,573 pairs. On CPR-eval, the best of eleven existing retrievers reaches a Recall@10 of only 0.26, whereas an LLM reranker reaches 0.81. Standard contrastive fine-tuning on CPR-train raises Recall@10 to as high as 0.70. The gain carries over to domains held out from training and to analogy and reasoning-intensive retrieval. On AnaloBench, it raises nDCG@10 by up to 33% over the untrained retriever, whereas training on three existing retrieval datasets lowers it. On BRIGHT, it raises nDCG@10 by up to 70%, more than twice the gain from those datasets. CPR-Dataset is available at https://huggingface.co/CPR-Dataset, and the code at https://github.com/SeokwonJung-Jay/Cross-Pollination-Retrieval.

Medical information retrieval (MIR) is essential for retrieving relevant medical knowledge from diverse sources, including electronic health records, scientific literature, and medical databases. However, achieving effective zero-shot dense retrieval in the medical domain poses substantial challenges due to the lack of relevance-labeled data. In this paper, we introduce a novel approach called Self-Learning Hypothetical Document Embeddings (SL-HyDE) to tackle this issue. SL-HyDE leverages large language models (LLMs) as generators to generate hypothetical documents based on a given query. These generated documents encapsulate key medical context, guiding a dense retriever in identifying the most relevant documents. The self-learning framework progressively refines both pseudo-document generation and retrieval, utilizing unlabeled medical corpora without requiring any relevance-labeled data. Additionally, we present the Chinese Medical Information Retrieval Benchmark (CMIRB), a comprehensive evaluation framework grounded in real-world medical scenarios, encompassing five tasks and ten datasets. By benchmarking ten models on CMIRB, we establish a rigorous standard for evaluating medical information retrieval systems. Experimental results demonstrate that SL-HyDE significantly surpasses existing methods in retrieval accuracy while showcasing strong generalization and scalability across various LLM and retriever configurations. CMIRB data and evaluation code are publicly available at: https://github.com/CMIRB-benchmark/CMIRB.

In this work, we introduce Multiple Embedding Model for EHR (MEME), an approach that views Electronic Health Records (EHR) as multimodal data. This approach incorporates "pseudo-notes", textual representations of tabular EHR concepts such as diagnoses and medications, and allows us to effectively employ Large Language Models (LLMs) for EHR representation. This framework also adopts a multimodal approach, embedding each EHR modality separately. We demonstrate the effectiveness of MEME by applying it to several tasks within the Emergency Department across multiple hospital systems. Our findings show that MEME surpasses the performance of both single modality embedding methods and traditional machine learning approaches. However, we also observe notable limitations in generalizability across hospital institutions for all tested models.

Medical imaging is widely used in clinical practice for diagnosis and treatment. Report-writing can be error-prone for unexperienced physicians, and time- consuming and tedious for experienced physicians. To address these issues, we study the automatic generation of medical imaging reports. This task presents several challenges. First, a complete report contains multiple heterogeneous forms of information, including findings and tags. Second, abnormal regions in medical images are difficult to identify. Third, the re- ports are typically long, containing multiple sentences. To cope with these challenges, we (1) build a multi-task learning framework which jointly performs the pre- diction of tags and the generation of para- graphs, (2) propose a co-attention mechanism to localize regions containing abnormalities and generate narrations for them, (3) develop a hierarchical LSTM model to generate long paragraphs. We demonstrate the effectiveness of the proposed methods on two publicly available datasets.

The recent emergence of Medical Large Vision Language Models (Med-LVLMs) has enhanced medical diagnosis. However, current Med-LVLMs frequently encounter factual issues, often generating responses that do not align with established medical facts. Retrieval-Augmented Generation (RAG), which utilizes external knowledge, can improve the factual accuracy of these models but introduces two major challenges. First, limited retrieved contexts might not cover all necessary information, while excessive retrieval can introduce irrelevant and inaccurate references, interfering with the model's generation. Second, in cases where the model originally responds correctly, applying RAG can lead to an over-reliance on retrieved contexts, resulting in incorrect answers. To address these issues, we propose RULE, which consists of two components. First, we introduce a provably effective strategy for controlling factuality risk through the calibrated selection of the number of retrieved contexts. Second, based on samples where over-reliance on retrieved contexts led to errors, we curate a preference dataset to fine-tune the model, balancing its dependence on inherent knowledge and retrieved contexts for generation. We demonstrate the effectiveness of RULE on three medical VQA datasets, achieving an average improvement of 20.8% in factual accuracy. We publicly release our benchmark and code in https://github.com/richard-peng-xia/RULE.

Retrieval augmented generation (RAG) has shown great power in improving Large Language Models (LLMs). However, most existing RAG-based LLMs are dedicated to retrieving single modality information, mainly text; while for many real-world problems, such as healthcare, information relevant to queries can manifest in various modalities such as knowledge graph, text (clinical notes), and complex molecular structure. Thus, being able to retrieve relevant multi-modality domain-specific information, and reason and synthesize diverse knowledge to generate an accurate response is important. To address the gap, we present BioMol-MQA, a new question-answering (QA) dataset on polypharmacy, which is composed of two parts (i) a multimodal knowledge graph (KG) with text and molecular structure for information retrieval; and (ii) challenging questions that designed to test LLM capabilities in retrieving and reasoning over multimodal KG to answer questions. Our benchmarks indicate that existing LLMs struggle to answer these questions and do well only when given the necessary background data, signaling the necessity for strong RAG frameworks.

Recent advancements in Large Language Models have transformed ML/AI development, necessitating a reevaluation of AutoML principles for the Retrieval-Augmented Generation (RAG) systems. To address the challenges of hyper-parameter optimization and online adaptation in RAG, we propose the AutoRAG-HP framework, which formulates the hyper-parameter tuning as an online multi-armed bandit (MAB) problem and introduces a novel two-level Hierarchical MAB (Hier-MAB) method for efficient exploration of large search spaces. We conduct extensive experiments on tuning hyper-parameters, such as top-k retrieved documents, prompt compression ratio, and embedding methods, using the ALCE-ASQA and Natural Questions datasets. Our evaluation from jointly optimization all three hyper-parameters demonstrate that MAB-based online learning methods can achieve Recall@5 approx 0.8 for scenarios with prominent gradients in search space, using only sim20% of the LLM API calls required by the Grid Search approach. Additionally, the proposed Hier-MAB approach outperforms other baselines in more challenging optimization scenarios. The code will be made available at https://aka.ms/autorag.

Recent developments in representational learning for information retrieval can be organized in a conceptual framework that establishes two pairs of contrasts: sparse vs. dense representations and unsupervised vs. learned representations. Sparse learned representations can further be decomposed into expansion and term weighting components. This framework allows us to understand the relationship between recently proposed techniques such as DPR, ANCE, DeepCT, DeepImpact, and COIL, and furthermore, gaps revealed by our analysis point to "low hanging fruit" in terms of techniques that have yet to be explored. We present a novel technique dubbed "uniCOIL", a simple extension of COIL that achieves to our knowledge the current state-of-the-art in sparse retrieval on the popular MS MARCO passage ranking dataset. Our implementation using the Anserini IR toolkit is built on the Lucene search library and thus fully compatible with standard inverted indexes.

In traditional RAG framework, the basic retrieval units are normally short. The common retrievers like DPR normally work with 100-word Wikipedia paragraphs. Such a design forces the retriever to search over a large corpus to find the `needle' unit. In contrast, the readers only need to extract answers from the short retrieved units. Such an imbalanced `heavy' retriever and `light' reader design can lead to sub-optimal performance. In order to alleviate the imbalance, we propose a new framework LongRAG, consisting of a `long retriever' and a `long reader'. LongRAG processes the entire Wikipedia into 4K-token units, which is 30x longer than before. By increasing the unit size, we significantly reduce the total units from 22M to 700K. This significantly lowers the burden of retriever, which leads to a remarkable retrieval score: answer recall@1=71% on NQ (previously 52%) and answer recall@2=72% (previously 47%) on HotpotQA (full-wiki). Then we feed the top-k retrieved units (approx 30K tokens) to an existing long-context LLM to perform zero-shot answer extraction. Without requiring any training, LongRAG achieves an EM of 62.7% on NQ, which is the best known result. LongRAG also achieves 64.3% on HotpotQA (full-wiki), which is on par of the SoTA model. Our study offers insights into the future roadmap for combining RAG with long-context LLMs.

Medical imaging is frequently used in clinical practice and trials for diagnosis and treatment. Writing imaging reports is time-consuming and can be error-prone for inexperienced radiologists. Therefore, automatically generating radiology reports is highly desired to lighten the workload of radiologists and accordingly promote clinical automation, which is an essential task to apply artificial intelligence to the medical domain. In this paper, we propose to generate radiology reports with memory-driven Transformer, where a relational memory is designed to record key information of the generation process and a memory-driven conditional layer normalization is applied to incorporating the memory into the decoder of Transformer. Experimental results on two prevailing radiology report datasets, IU X-Ray and MIMIC-CXR, show that our proposed approach outperforms previous models with respect to both language generation metrics and clinical evaluations. Particularly, this is the first work reporting the generation results on MIMIC-CXR to the best of our knowledge. Further analyses also demonstrate that our approach is able to generate long reports with necessary medical terms as well as meaningful image-text attention mappings.

Medical coding translates clinical documentation into standardized codes for billing, research, and public health, but manual coding is time-consuming and error-prone. Existing automation efforts rely on small datasets that poorly represent real-world patient heterogeneity. We trained a language model on 5.8 million electronic health records from 1.8 million patients across nearly all specialties in Eastern Denmark (2006--2016) to predict ICD-10 codes from clinical notes, medications, and laboratory results. Evaluated on 270,000 held-out patients, the model achieved a micro F1 of 71.8% and a top-10 recall of 95.5%. Performance varied by specialty (F1: 53--91%), with higher scores in specialties with well-defined diagnostic criteria. Codes appearing predominantly as secondary diagnoses had markedly lower F1 scores. For three such codes (suicide-related behaviors, weight disorders, and hypertension), the model identified thousands of uncoded cases, of which 76-86% were confirmed valid upon manual review, suggesting systematic under-coding rather than model error. These findings suggest under-coding of secondary diagnoses in Eastern Denmark during this period, with potential implications for epidemiological research, public health surveillance, and understanding of multimorbidity. Similar time constraints and reimbursement structures in other healthcare systems suggest this may not be isolated to this dataset. The model can automate coding for approximately 50% of cases and provide accurate suggestions for most others, and may offer a practical solution to help capture missed secondary conditions.

Retrieval-augmented generation (RAG) augments large language models (LLM) by retrieving relevant knowledge, showing promising potential in mitigating LLM hallucinations and enhancing response quality, thereby facilitating the great adoption of LLMs in practice. However, we find that existing RAG systems are inadequate in answering multi-hop queries, which require retrieving and reasoning over multiple pieces of supporting evidence. Furthermore, to our knowledge, no existing RAG benchmarking dataset focuses on multi-hop queries. In this paper, we develop a novel dataset, MultiHop-RAG, which consists of a knowledge base, a large collection of multi-hop queries, their ground-truth answers, and the associated supporting evidence. We detail the procedure of building the dataset, utilizing an English news article dataset as the underlying RAG knowledge base. We demonstrate the benchmarking utility of MultiHop-RAG in two experiments. The first experiment compares different embedding models for retrieving evidence for multi-hop queries. In the second experiment, we examine the capabilities of various state-of-the-art LLMs, including GPT-4, PaLM, and Llama2-70B, in reasoning and answering multi-hop queries given the evidence. Both experiments reveal that existing RAG methods perform unsatisfactorily in retrieving and answering multi-hop queries. We hope MultiHop-RAG will be a valuable resource for the community in developing effective RAG systems, thereby facilitating greater adoption of LLMs in practice. The MultiHop-RAG and implemented RAG system is publicly available at https://github.com/yixuantt/MultiHop-RAG/.

A long-term conversational assistant must recall the right memory at the right moment, yet the memory that matters most is often not similar to what the user says now. Current systems recover such associations by letting an LLM reason at write or read time, at a cost of hundreds to over a thousand LLM calls per memory bank and up to several thousand context tokens per query. We argue that association is a learnable relevance: the pointwise mutual information of memories under how human lives unfold. We introduce Madeleine, which learns amortized association: offline, an LLM life simulator writes simulated lives, whose cue-trigger pairs teach a query encoder a residual association on top of frozen similarity; online, it calls no LLM and plugs into any vector memory by replacing only the query encoder. On LoCoMo-Plus under the official protocol, Madeleine (I) reaches 66.6 when plugged into HyperMem, the highest among all systems evaluated under this protocol; (II) used alone, reaches the score of HyperMem as released (52.4 vs. 52.9) with zero LLM calls and about 1/21 of its answer context; and (III) lifts T-Mem by 26.2 points, significantly outperforms the same untrained backbone inside both systems, and leaves ordinary QA intact on the 4B backbone.

Objective: To transform heterogeneous clinical data from electronic health records into clinically meaningful constructed features using data driven method that rely, in part, on temporal relations among data. Materials and Methods: The clinically meaningful representations of medical concepts and patients are the key for health analytic applications. Most of existing approaches directly construct features mapped to raw data (e.g., ICD or CPT codes), or utilize some ontology mapping such as SNOMED codes. However, none of the existing approaches leverage EHR data directly for learning such concept representation. We propose a new way to represent heterogeneous medical concepts (e.g., diagnoses, medications and procedures) based on co-occurrence patterns in longitudinal electronic health records. The intuition behind the method is to map medical concepts that are co-occuring closely in time to similar concept vectors so that their distance will be small. We also derive a simple method to construct patient vectors from the related medical concept vectors. Results: For qualitative evaluation, we study similar medical concepts across diagnosis, medication and procedure. In quantitative evaluation, our proposed representation significantly improves the predictive modeling performance for onset of heart failure (HF), where classification methods (e.g. logistic regression, neural network, support vector machine and K-nearest neighbors) achieve up to 23% improvement in area under the ROC curve (AUC) using this proposed representation. Conclusion: We proposed an effective method for patient and medical concept representation learning. The resulting representation can map relevant concepts together and also improves predictive modeling performance.

Rich Electronic Health Records (EHR), have created opportunities to improve clinical processes using machine learning methods. Prediction of the same patient events at different time horizons can have very different applications and interpretations; however, limited number of events in each potential time window hurts the effectiveness of conventional machine learning algorithms. We propose a novel time associated meta learning (TAML) method to make effective predictions at multiple future time points. We view time-associated disease prediction as classification tasks at multiple time points. Such closely-related classification tasks are an excellent candidate for model-based meta learning. To address the sparsity problem after task splitting, TAML employs a temporal information sharing strategy to augment the number of positive samples and include the prediction of related phenotypes or events in the meta-training phase. We demonstrate the effectiveness of TAML on multiple clinical datasets, where it consistently outperforms a range of strong baselines. We also develop a MetaEHR package for implementing both time-associated and time-independent few-shot prediction on EHR data.

The recent advancements in generative language models have demonstrated their ability to memorize knowledge from documents and recall knowledge to respond to user queries effectively. Building upon this capability, we propose to enable multimodal large language models (MLLMs) to memorize and recall images within their parameters. Given a user query for visual content, the MLLM is anticipated to "recall" the relevant image from its parameters as the response. Achieving this target presents notable challenges, including inbuilt visual memory and visual recall schemes within MLLMs. To address these challenges, we introduce a generative cross-modal retrieval framework, which assigns unique identifier strings to represent images and involves two training steps: learning to memorize and learning to retrieve. The first step focuses on training the MLLM to memorize the association between images and their respective identifiers. The latter step teaches the MLLM to generate the corresponding identifier of the target image, given the textual query input. By memorizing images in MLLMs, we introduce a new paradigm to cross-modal retrieval, distinct from previous discriminative approaches. The experiments demonstrate that the generative paradigm performs effectively and efficiently even with large-scale image candidate sets.

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.

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.

Identifying patient cohorts is fundamental to numerous healthcare tasks, including clinical trial recruitment and retrospective studies. Current cohort retrieval methods in healthcare organizations rely on automated queries of structured data combined with manual curation, which are time-consuming, labor-intensive, and often yield low-quality results. Recent advancements in large language models (LLMs) and information retrieval (IR) offer promising avenues to revolutionize these systems. Major challenges include managing extensive eligibility criteria and handling the longitudinal nature of unstructured Electronic Medical Records (EMRs) while ensuring that the solution remains cost-effective for real-world application. This paper introduces a new task, Automatic Cohort Retrieval (ACR), and evaluates the performance of LLMs and commercial, domain-specific neuro-symbolic approaches. We provide a benchmark task, a query dataset, an EMR dataset, and an evaluation framework. Our findings underscore the necessity for efficient, high-quality ACR systems capable of longitudinal reasoning across extensive patient databases.

Medical decision-making requires integrating diverse medical information, from imaging to clinical narratives. These medical modalities are often acquired in a many-to-many manner. However, current medical vision-language pretraining models (Med-VLPMs) fail to directly account for this many-to-many mapping in their model training and embeddings. To address this, we present Probabilistic Modality-Enhanced Diagnosis (ProbMED), a multimodal Med-VLPM that employs probabilistic contrastive learning to model distributions over embeddings rather than deterministic estimates. ProbMED aligns four distinct modalities -- chest X-rays, electrocardiograms, echocardiograms, and clinical text -- into a unified probabilistic embedding space. We use InfoNCE loss with Hellinger distance to integrate inter-modality distributions. We introduce a probabilistic synthetic sampling loss that captures modality-specific mean and variance to improve intra-modality binding. Extensive experiments across 13 medical datasets demonstrate that our model outperforms current Med-VLPMs in cross-modality retrieval, zero-shot, and few-shot classification. We also demonstrate the robust integration of multiple modalities for prognostication, showing improved intra- and inter-medical modality binding.

We introduce MRMR, the first expert-level multidisciplinary multimodal retrieval benchmark requiring intensive reasoning. MRMR contains 1,502 queries spanning 23 domains, with positive documents carefully verified by human experts. Compared to prior benchmarks, MRMR introduces three key advancements. First, it challenges retrieval systems across diverse areas of expertise, enabling fine-grained model comparison across domains. Second, queries are reasoning-intensive, with images requiring deeper interpretation such as diagnosing microscopic slides. We further introduce Contradiction Retrieval, a novel task requiring models to identify conflicting concepts. Finally, queries and documents are constructed as image-text interleaved sequences. Unlike earlier benchmarks restricted to single images or unimodal documents, MRMR offers a realistic setting with multi-image queries and mixed-modality corpus documents. We conduct an extensive evaluation of 4 categories of multimodal retrieval systems and 14 frontier models on MRMR. The text embedding model Qwen3-Embedding with LLM-generated image captions achieves the highest performance, highlighting substantial room for improving multimodal retrieval models. Although latest multimodal models such as Ops-MM-Embedding perform competitively on expert-domain queries, they fall short on reasoning-intensive tasks. We believe that MRMR paves the way for advancing multimodal retrieval in more realistic and challenging scenarios.

Retrieval-Augmented Generation (RAG) extends large language models (LLMs) beyond parametric knowledge, yet it is unclear when iterative retrieval-reasoning loops meaningfully outperform static RAG, particularly in scientific domains with multi-hop reasoning, sparse domain knowledge, and heterogeneous evidence. We provide the first controlled, mechanism-level diagnostic study of whether synchronized iterative retrieval and reasoning can surpass an idealized static upper bound (Gold Context) RAG. We benchmark eleven state-of-the-art LLMs under three regimes: (i) No Context, measuring reliance on parametric memory; (ii) Gold Context, where all oracle evidence is supplied at once; and (iii) Iterative RAG, a training-free controller that alternates retrieval, hypothesis refinement, and evidence-aware stopping. Using the chemistry-focused ChemKGMultiHopQA dataset, we isolate questions requiring genuine retrieval and analyze behavior with diagnostics spanning retrieval coverage gaps, anchor-carry drop, query quality, composition fidelity, and control calibration. Across models, Iterative RAG consistently outperforms Gold Context, with gains up to 25.6 percentage points, especially for non-reasoning fine-tuned models. Staged retrieval reduces late-hop failures, mitigates context overload, and enables dynamic correction of early hypothesis drift, but remaining failure modes include incomplete hop coverage, distractor latch trajectories, early stopping miscalibration, and high composition failure rates even with perfect retrieval. Overall, staged retrieval is often more influential than the mere presence of ideal evidence; we provide practical guidance for deploying and diagnosing RAG systems in specialized scientific settings and a foundation for more reliable, controllable iterative retrieval-reasoning frameworks.

Large language models (LLMs) trained with next-word-prediction have achieved success as clinical foundation models. Representations from these language backbones yield strong linear probe performance across biomedical tasks, suggesting that patient semantics emerge from next-token prediction at scale. However, this paradigm treats patients as a document to be summarized rather than a dynamical system to be simulated; a patient's trajectory emerges from their state evolving under interventions and time, requiring models that simulate dynamics rather than predict tokens. To address this, we introduce SMB-Structure, a world model for structured EHR that grounds a joint-embedding prediction architecture (JEPA) with next-token prediction (SFT). SFT grounds our model to reconstruct future patient states in token space, while JEPA predicts those futures in latent space from the initial patient representation alone, forcing trajectory dynamics to be encoded before the next state is observed. We validate across two large-scale cohorts: Memorial Sloan Kettering (23,319 oncology patients; 323,000+ patient-years) and INSPECT (19,402 pulmonary embolism patients). Using a linear probe evaluated at multiple points along the disease trajectory, we demonstrate that our training paradigm learns embeddings that capture disease dynamics not recoverable by autoregressive baselines, enabling SMB-Structure to achieve competitive performance on complex tasks characterized by high patient heterogeneity. Model weights are available at https://huggingface.co/standardmodelbio/SMB-v1-1.7B-Structure.

Objective: Data unavailability has been one of the biggest barriers in clinical natural language processing. This paper is aimed at providing a large-scale and publicly available patient note dataset, named PMC-Patients, with relevant articles and similar patients annotations. The ultimate goal of PMC-Patients is to facilitate the development of retrieval-based clinical decision support systems. Materials and Methods: To collect PMC-Patients, we extract patient notes from case reports in PubMed Central by recognizing certain section patterns. Patient-article relevance and patient-patient similarity are annotated by citation relationships in PubMed. In addition, we perform three tasks with PMC-Patients to demonstrate its utility in providing clinical decision support for a given patient, including (1) classifying whether another patient is similar, (2) retrieving similar patients in PMC-Patients, and (3) retrieving relevant articles in PubMed. Results: We collect and release PMC-Patients under the CC BY-NC-SA license, which becomes the largest publicly available patient note dataset so far. PMC-Patients contains 167k patient notes that are annotated with 3.1M relevant articles and 293k similar patients. Qualitative and quantitative analyses reveal the high quality and richness of our dataset. Experiments show that classifying the similarity of patient pairs is relatively easy, but it is hard to retrieve similar patients or relevant articles for a given patient from a large set of candidates. Conclusion: We present PMC-Patients, a large-scale dataset of patient notes with high quality, easy access, diverse conditions, and rich annotations. The proposed dataset can also serve as a hard benchmark for evaluating retrieval-based clinical decision support systems.

Pretrained Multimodal Large Language Models (MLLMs) are increasingly deployed in medical AI systems for clinical reasoning, diagnosis support, and report generation. However, their training on sensitive patient data raises critical privacy and compliance challenges under regulations such as HIPAA and GDPR, which enforce the "right to be forgotten". Unlearning, the process of tuning models to selectively remove the influence of specific training data points, offers a potential solution, yet its effectiveness in complex medical settings remains underexplored. To systematically study this, we introduce MedForget, a Hierarchy-Aware Multimodal Unlearning Testbed with explicit retain and forget splits and evaluation sets containing rephrased variants. MedForget models hospital data as a nested hierarchy (Institution -> Patient -> Study -> Section), enabling fine-grained assessment across eight organizational levels. The benchmark contains 3840 multimodal (image, question, answer) instances, each hierarchy level having a dedicated unlearning target, reflecting distinct unlearning challenges. Experiments with four SOTA unlearning methods on three tasks (generation, classification, cloze) show that existing methods struggle to achieve complete, hierarchy-aware forgetting without reducing diagnostic performance. To test whether unlearning truly deletes hierarchical pathways, we introduce a reconstruction attack that progressively adds hierarchical level context to prompts. Models unlearned at a coarse granularity show strong resistance, while fine-grained unlearning leaves models vulnerable to such reconstruction. MedForget provides a practical, HIPAA-aligned testbed for building compliant medical AI systems.

Spoken conversational systems must recover information from prior interactions (i.e., memory), yet relevant information in speech extends beyond what was said to who said it, how it was spoken, and what was audible, information that exists only in the audio signal and cannot be recovered from a transcript. Beyond what to remember, memory also demands diverse operations: retrieving a single fact, integrating evidence across turns, tracking an evolving state. Real interactions further unfold across sessions, meaning information accumulates across distinct episodes rather than a single continuous recording. Existing benchmarks fall short on all three dimensions: they focus primarily on lexical content, adopt limited and ad hoc memory operations, and treat memory as a single-session problem. We argue that principled memory evaluation requires jointly characterizing the acoustic evidence to be retained and the operations applied to it, and introduce a taxonomy along these two axes. Building on this taxonomy, we present VoxMem: 3,196 evaluation instances over 34,743 spoken sessions (177 hours) crossing four acoustic evidence types (speech semantics, speaker identity, paralinguistic cues, environmental sound) with four memory operations (information extraction, multi-session reasoning, temporal tracking, and answer refusal), grounded in multi-session histories and stratified across context budgets from 8K to 64K tokens. Evaluating 15 LALMs, no model exceeds 40% at 32K. Models retain what was said far better than who said it, how, or what was audible, a gap that widens for complex operations, grows with history length, and manifests as qualitatively distinct failure modes across evidence types. VoxMem aims to provide a foundation to measure and drive progress on the full scope of spoken conversational memory.

Large Language Models (LLMs) have demonstrated remarkable capabilities in natural language processing, and yet, their factual inaccuracies and hallucinations limits their application, particularly in critical domains like healthcare. Context retrieval methods, by introducing relevant information as input, have emerged as a crucial approach for enhancing LLM factuality and reliability. This study explores the boundaries of context retrieval methods within the healthcare domain, optimizing their components and benchmarking their performance against open and closed alternatives. Our findings reveal how open LLMs, when augmented with an optimized retrieval system, can achieve performance comparable to the biggest private solutions on established healthcare benchmarks (multiple-choice question answering). Recognizing the lack of realism of including the possible answers within the question (a setup only found in medical exams), and after assessing a strong LLM performance degradation in the absence of those options, we extend the context retrieval system in that direction. In particular, we propose OpenMedPrompt a pipeline that improves the generation of more reliable open-ended answers, moving this technology closer to practical application.

Multimodal in-context learning (ICL) remains underexplored despite significant potential for domains such as medicine. Clinicians routinely encounter diverse, specialized tasks requiring adaptation from limited examples, such as drawing insights from a few relevant prior cases or considering a constrained set of differential diagnoses. While multimodal large language models (MLLMs) have shown advances in medical visual question answering (VQA), their ability to learn multimodal tasks from context is largely unknown. We introduce SMMILE, the first expert-driven multimodal ICL benchmark for medical tasks. Eleven medical experts curated problems, each including a multimodal query and multimodal in-context examples as task demonstrations. SMMILE encompasses 111 problems (517 question-image-answer triplets) covering 6 medical specialties and 13 imaging modalities. We further introduce SMMILE++, an augmented variant with 1038 permuted problems. A comprehensive evaluation of 15 MLLMs demonstrates that most models exhibit moderate to poor multimodal ICL ability in medical tasks. In open-ended evaluations, ICL contributes only 8% average improvement over zero-shot on SMMILE and 9.4% on SMMILE++. We observe a susceptibility for irrelevant in-context examples: even a single noisy or irrelevant example can degrade performance by up to 9.5%. Moreover, example ordering exhibits a recency bias, i.e., placing the most relevant example last can lead to substantial performance improvements by up to 71%. Our findings highlight critical limitations and biases in current MLLMs when learning multimodal medical tasks from context.

Long-sequence memory tracking places two opposing demands on a recurrent state: near-lossless retention of stored bindings over long horizons, and active overwriting of stale ones. In our diagnostic suite, the strongest efficient baselines tend to solve only one side well. Continuous-time-parameterized state-space models (SSMs) such as Mamba obtain their discrete recurrence by zero-order-hold discretization of a continuous-time system; we argue that this detour is unnecessary for memory tracking and parameterize the discrete transition directly. Naju (Native Adaptive Junction Unit) factorizes the recurrent update, schematically x_n = f_nodot x_{n-1} + i_nodot(B_n u_n), into an explicit discrete pole (a learned forget gate f_n), an independent write gain i_n, and input-dependent write/read maps. Since the sigmoid pole satisfies 0<f_n<1, each frozen local coordinate is Schur-stable by construction, and the full time-varying recurrence satisfies a fading-memory/BIBO bound under uniform boundedness assumptions, with no stability regularizer. We formalize the key structural limitation of coupled designs: any non-expansive complementary single-gate recurrence ties the effective retention r and write gain w through |r|+wle 1, so near-complete retention forces weak writing; decoupling f_n from i_n removes this constraint. Empirically, Naju is the only evaluated model that remains strong on both retention and overwriting at 4x the training length. Beyond the diagnostic suite, we evaluate Naju on WikiText-103 language modeling, Long Range Arena, and multi-query associative recall. Across these settings, Naju consistently combines strong long-range memory with competitive or superior performance, outperforming the Mamba baselines in the principal comparisons while remaining competitive with the Transformer and preserving linear-time, linear-memory scaling.

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well-understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

Clinical diagnosis is critical in medical practice, typically requiring a continuous and evolving process that includes primary diagnosis, differential diagnosis, and final diagnosis. However, most existing clinical diagnostic tasks are single-step processes, which does not align with the complex multi-step diagnostic procedures found in real-world clinical settings. In this paper, we propose a multi-step diagnostic task and annotate a clinical diagnostic dataset (MSDiagnosis). This dataset includes primary diagnosis, differential diagnosis, and final diagnosis questions. Additionally, we propose a novel and effective framework. This framework combines forward inference, backward inference, reflection, and refinement, enabling the LLM to self-evaluate and adjust its diagnostic results. To assess the effectiveness of our proposed method, we design and conduct extensive experiments. The experimental results demonstrate the effectiveness of the proposed method. We also provide a comprehensive experimental analysis and suggest future research directions for this task.

Background: Recent advancements in large language models (LLMs) offer potential benefits in healthcare, particularly in processing extensive patient records. However, existing benchmarks do not fully assess LLMs' capability in handling real-world, lengthy clinical data. Methods: We present the LongHealth benchmark, comprising 20 detailed fictional patient cases across various diseases, with each case containing 5,090 to 6,754 words. The benchmark challenges LLMs with 400 multiple-choice questions in three categories: information extraction, negation, and sorting, challenging LLMs to extract and interpret information from large clinical documents. Results: We evaluated nine open-source LLMs with a minimum of 16,000 tokens and also included OpenAI's proprietary and cost-efficient GPT-3.5 Turbo for comparison. The highest accuracy was observed for Mixtral-8x7B-Instruct-v0.1, particularly in tasks focused on information retrieval from single and multiple patient documents. However, all models struggled significantly in tasks requiring the identification of missing information, highlighting a critical area for improvement in clinical data interpretation. Conclusion: While LLMs show considerable potential for processing long clinical documents, their current accuracy levels are insufficient for reliable clinical use, especially in scenarios requiring the identification of missing information. The LongHealth benchmark provides a more realistic assessment of LLMs in a healthcare setting and highlights the need for further model refinement for safe and effective clinical application. We make the benchmark and evaluation code publicly available.

A promising application of AI to healthcare is the retrieval of information from electronic health records (EHRs), e.g. to aid clinicians in finding relevant information for a consultation or to recruit suitable patients for a study. This requires search capabilities far beyond simple string matching, including the retrieval of concepts (diagnoses, symptoms, medications, etc.) related to the one in question. The suitability of AI methods for such applications is tested by predicting the relatedness of concepts with known relatedness scores. However, all existing biomedical concept relatedness datasets are notoriously small and consist of hand-picked concept pairs. We open-source a novel concept relatedness benchmark overcoming these issues: it is six times larger than existing datasets and concept pairs are chosen based on co-occurrence in EHRs, ensuring their relevance for the application of interest. We present an in-depth analysis of our new dataset and compare it to existing ones, highlighting that it is not only larger but also complements existing datasets in terms of the types of concepts included. Initial experiments with state-of-the-art embedding methods show that our dataset is a challenging new benchmark for testing concept relatedness models.

Given a question, a language model (LM) implicitly encodes a distribution over possible answers. In practice, post-training procedures for LMs often collapse this distribution onto a single dominant mode. While this is generally not a problem for benchmark-style evaluations that assume one correct answer, many real-world tasks inherently involve multiple valid answers or irreducible uncertainty. Examples include medical diagnosis, ambiguous question answering, and settings with incomplete information. In these cases, we would like LMs to generate multiple plausible hypotheses, ideally with confidence estimates for each one, and without computationally intensive repeated sampling to generate non-modal answers. This paper describes a multi-answer reinforcement learning approach for training LMs to perform distributional reasoning over multiple answers during inference. We modify the RL objective to enable models to explicitly generate multiple candidate answers in a single forward pass, internalizing aspects of inference-time search into the model's generative process. Across question-answering, medical diagnostic, and coding benchmarks, we observe improved diversity, coverage, and set-level calibration scores compared to single answer trained baselines. Models trained with our approach require fewer tokens to generate multiple answers than competing approaches. On coding tasks, they are also substantially more accurate. These results position multi-answer RL as a principled and compute-efficient alternative to inference-time scaling procedures such as best-of-k. Code and more information can be found at https://multi-answer-rl.github.io/.

While Retrieval-Augmented Generation (RAG) has been swiftly adopted in scientific and clinical QA systems, a comprehensive evaluation benchmark in the medical domain is lacking. To address this gap, we introduce the Medical Retrieval-Augmented Generation (MRAG) benchmark, covering various tasks in English and Chinese languages, and building a corpus with Wikipedia and Pubmed. Additionally, we develop the MRAG-Toolkit, facilitating systematic exploration of different RAG components. Our experiments reveal that: (a) RAG enhances LLM reliability across MRAG tasks. (b) the performance of RAG systems is influenced by retrieval approaches, model sizes, and prompting strategies. (c) While RAG improves usefulness and reasoning quality, LLM responses may become slightly less readable for long-form questions. We will release the MRAG-Bench's dataset and toolkit with CCBY-4.0 license upon acceptance, to facilitate applications from both academia and industry.

Large language models (LLMs) have the potential to transform medicine, but real-world clinical scenarios contain extraneous information that can hinder performance. The rise of assistive technologies like ambient dictation, which automatically generates draft notes from live patient encounters, has the potential to introduce additional noise making it crucial to assess the ability of LLM's to filter relevant data. To investigate this, we developed MedDistractQA, a benchmark using USMLE-style questions embedded with simulated real-world distractions. Our findings show that distracting statements (polysemous words with clinical meanings used in a non-clinical context or references to unrelated health conditions) can reduce LLM accuracy by up to 17.9%. Commonly proposed solutions to improve model performance such as retrieval-augmented generation (RAG) and medical fine-tuning did not change this effect and in some cases introduced their own confounders and further degraded performance. Our findings suggest that LLMs natively lack the logical mechanisms necessary to distinguish relevant from irrelevant clinical information, posing challenges for real-world applications. MedDistractQA and our results highlights the need for robust mitigation strategies to enhance LLM resilience to extraneous information.

Long-term conversational memory requires retrieving evidence scattered across multiple sessions, yet single-pass retrieval fails on temporal and multi-hop questions. Existing iterative methods refine queries via generated content or document-level signals, but none explicitly diagnoses the evidence gap, namely what is missing from the accumulated retrieval set, leaving query refinement untargeted. We present EviMem, combining IRIS (Iterative Retrieval via Insufficiency Signals), a closed-loop framework that detects evidence gaps through sufficiency evaluation, diagnoses what is missing, and drives targeted query refinement, with LaceMem (Layered Architecture for Conversational Evidence Memory), a coarse-to-fine memory hierarchy supporting fine-grained gap diagnosis. On LoCoMo, EviMem improves Judge Accuracy over MIRIX on temporal (73.3% to 81.6%) and multi-hop (65.9% to 85.2%) questions at 4.5x lower latency. Code: https://github.com/AIGeeksGroup/EviMem.

The needle-in-a-haystack (NIAH) test, which examines the ability to retrieve a piece of information (the "needle") from long distractor texts (the "haystack"), has been widely adopted to evaluate long-context language models (LMs). However, this simple retrieval-based test is indicative of only a superficial form of long-context understanding. To provide a more comprehensive evaluation of long-context LMs, we create a new synthetic benchmark RULER with flexible configurations for customized sequence length and task complexity. RULER expands upon the vanilla NIAH test to encompass variations with diverse types and quantities of needles. Moreover, RULER introduces new task categories multi-hop tracing and aggregation to test behaviors beyond searching from context. We evaluate ten long-context LMs with 13 representative tasks in RULER. Despite achieving nearly perfect accuracy in the vanilla NIAH test, all models exhibit large performance drops as the context length increases. While these models all claim context sizes of 32K tokens or greater, only four models (GPT-4, Command-R, Yi-34B, and Mixtral) can maintain satisfactory performance at the length of 32K. Our analysis of Yi-34B, which supports context length of 200K, reveals large room for improvement as we increase input length and task complexity. We open source RULER to spur comprehensive evaluation of long-context LMs.

The Needle-in-a-Haystack (NIAH) benchmark is widely used to evaluate Large Language Models' (LLMs) ability to understand long contexts (LC). It evaluates the capability to identify query-relevant context within extensive query-irrelevant passages. Although this method serves as a widely accepted standard for evaluating long-context understanding, our findings suggest it may overestimate the true LC capability of LLMs. We demonstrate that even state-of-the-art models such as GPT-4o struggle to intactly incorporate given contexts made up of solely query-relevant ten sentences. In response, we introduce a novel benchmark, NeedleChain, where the context consists entirely of query-relevant information, requiring the LLM to fully grasp the input to answer correctly. Our benchmark allows for flexible context length and reasoning order, offering a more comprehensive analysis of LLM performance. Additionally, we propose an extremely simple yet compelling strategy to improve LC understanding capability of LLM: ROPE Contraction. Our experiments with various advanced LLMs reveal a notable disparity between their ability to process large contexts and their capacity to fully understand them. Source code and datasets are available at https://github.com/hyeonseokk/NeedleChain

Medical systematic reviews can be very costly and resource intensive. We explore how Large Language Models (LLMs) can support and be trained to perform literature screening when provided with a detailed set of selection criteria. Specifically, we instruction tune LLaMA and Guanaco models to perform abstract screening for medical systematic reviews. Our best model, Bio-SIEVE, outperforms both ChatGPT and trained traditional approaches, and generalises better across medical domains. However, there remains the challenge of adapting the model to safety-first scenarios. We also explore the impact of multi-task training with Bio-SIEVE-Multi, including tasks such as PICO extraction and exclusion reasoning, but find that it is unable to match single-task Bio-SIEVE's performance. We see Bio-SIEVE as an important step towards specialising LLMs for the biomedical systematic review process and explore its future developmental opportunities. We release our models, code and a list of DOIs to reconstruct our dataset for reproducibility.

Recent advances in large language models have demonstrated remarkable effectiveness in information retrieval (IR) tasks. While many neural IR systems encode queries and documents into single-vector representations, multi-vector models elevate the retrieval quality by producing multi-vector representations and facilitating similarity searches at the granularity of individual tokens. However, these models significantly amplify memory and storage requirements for retrieval indices by an order of magnitude. This escalation in index size renders the scalability of multi-vector IR models progressively challenging due to their substantial memory demands. We introduce Embedding from Storage Pipelined Network (ESPN) where we offload the entire re-ranking embedding tables to SSDs and reduce the memory requirements by 5-16x. We design a software prefetcher with hit rates exceeding 90%, improving SSD based retrieval up to 6.4x, and demonstrate that we can maintain near memory levels of query latency even for large query batch sizes.

We describe our submission to the MedReason 2026 challenge, covering multiple-choice (MCQ) and open-ended (OE) medical visual question answering (VQA) under fully offline, containerized inference. Our first finding is that MCQ retrieval must compare answer semantics rather than answer labels: labels are independently assigned per question, so copying a retrieved neighbor's label transfers no useful information, whereas scoring each current option's text against correct-answer text from similar training cases raises retrieval-only accuracy from 20.0\% to 57.5\% on a 200-case retrieval-excluded development holdout. Our second finding attributes the submitted system's accuracy: holding the task-specific MCQ Low-Rank Adaptation (LoRA) adapter fixed and varying the number \(k\) of in-prompt retrieved examples changes accuracy by at most one case --- 187/200 (93.5\%) at both \(k=0\) and the adapter's training-time \(k=1\), 188/200 (94.0\%) at the packaged runtime's default \(k=3\) --- and the submitted confidence-gated override adds no net accuracy on top of \(k=3\), selecting the VLM in 198/200 cases. With the final MCQ adapter fixed, retrieval changes accuracy by at most one case, and gating provides no net gain. On 20 OE cases, token-F1 and RaTEScore~zhao2024ratescore decrease as \(k\) grows, but paired sign tests on token-F1 differences are nonsignificant (\(p \ge 0.29\)); a single-annotator comparison found 6/20 wrong-anchor errors for the final configuration and 14/20 for an earlier configuration that jointly differed in routing, adapter, and prompting. The system reaches 94.0\% MCQ accuracy on the development holdout and 93.20\% on the organizer's official pre-evaluation, versus 29.43\% for the off-the-shelf reference baseline, while both of the organizer's open-ended scores are lower than that baseline's (ground-truth agreement 1.245 versus 1.588, visual accuracy 1.995 versus 2.696, each out of 4).

Dense retrieval models usually adopt vectors from the last hidden layer of the document encoder to represent a document, which is in contrast to the fact that representations in different layers of a pre-trained language model usually contain different kinds of linguistic knowledge, and behave differently during fine-tuning. Therefore, we propose to investigate utilizing representations from multiple encoder layers to make up the representation of a document, which we denote Multi-layer Representations (MLR). We first investigate how representations in different layers affect MLR's performance under the multi-vector retrieval setting, and then propose to leverage pooling strategies to reduce multi-vector models to single-vector ones to improve retrieval efficiency. Experiments demonstrate the effectiveness of MLR over dual encoder, ME-BERT and ColBERT in the single-vector retrieval setting, as well as demonstrate that it works well with other advanced training techniques such as retrieval-oriented pre-training and hard negative mining.

State-of-the-art retrieval models typically address a straightforward search scenario, where retrieval tasks are fixed (e.g., finding a passage to answer a specific question) and only a single modality is supported for both queries and retrieved results. This paper introduces techniques for advancing information retrieval with multimodal large language models (MLLMs), enabling a broader search scenario, termed universal multimodal retrieval, where multiple modalities and diverse retrieval tasks are accommodated. To this end, we first study fine-tuning an MLLM as a bi-encoder retriever on 10 datasets with 16 retrieval tasks. Our empirical results show that the fine-tuned MLLM retriever is capable of understanding challenging queries, composed of both text and image, but underperforms a smaller CLIP retriever in cross-modal retrieval tasks due to modality bias from MLLMs. To address the issue, we propose modality-aware hard negative mining to mitigate the modality bias exhibited by MLLM retrievers. Second, we propose to continually fine-tune the universal multimodal retriever to enhance its text retrieval capability while maintaining multimodal retrieval capability. As a result, our model, MM-Embed, achieves state-of-the-art performance on the multimodal retrieval benchmark M-BEIR, which spans multiple domains and tasks, while also surpassing the state-of-the-art text retrieval model, NV-Embed-v1, on MTEB retrieval benchmark. Finally, we explore to prompt the off-the-shelf MLLMs as the zero-shot rerankers to refine the ranking of the candidates from the multimodal retriever. We find that through prompt-and-reranking, MLLMs can further improve multimodal retrieval when the user queries (e.g., text-image composed queries) are more complex and challenging to understand. These findings also pave the way to advance universal multimodal retrieval in the future.