Daily Papers

We present the results of simulated injections testing the first Bayesian search-pipeline capable of investigating the angular-structure of a gravitational-wave (GW) background influencing pulsar signals. A stochastic background of GWs from the incoherent superposition of many inspiraling supermassive black hole binaries at nHz frequencies is likely to be the dominant GW signal detectable by pulsar timing arrays (PTAs). Even though one might expect a background composed of a high-redshift cosmological population of sources to be fairly isotropic, deviations from isotropy may be indicative of local GW hotspots or some form of continuous anisotropy in the angular-distribution of GW-power. A GWB induces time-of-arrival deviations in pulsar signals which are correlated between separated pulsars. In an isotropic background this cross-correlation follows a distinctive relationship, known as the Hellings and Downs curve, that depends only on the angular separation of the pulsars. If the background is anisotropic, the cross-correlation is different, but predictable, and also depends on the absolute position of the pulsars. By simulating datasets containing GWBs with various anisotropic configurations, we have explored the prospects for constraining anisotropy using near future data. We find that at moderate to high signal to noise ratio the assumption of isotropy is no longer an appropriate description of the simulated background. Furthermore, we can recover the nature of the injected anisotropy in a Bayesian parameter-estimation search, and propose a prior on the anisotropy search-space motivated by the physicality of the implied distribution of sources.

When large language model (LLM) agents are increasingly deployed to automate tasks and interact with untrusted external data, prompt injection emerges as a significant security threat. By injecting malicious instructions into the data that LLMs access, an attacker can arbitrarily override the original user task and redirect the agent toward unintended, potentially harmful actions. Existing defenses either require access to model weights (fine-tuning), incur substantial utility loss (detection-based), or demand non-trivial system redesign (system-level). Motivated by this, we propose DataFilter, a test-time model-agnostic defense that removes malicious instructions from the data before it reaches the backend LLM. DataFilter is trained with supervised fine-tuning on simulated injections and leverages both the user's instruction and the data to selectively strip adversarial content while preserving benign information. Across multiple benchmarks, DataFilter consistently reduces the prompt injection attack success rates to near zero while maintaining the LLMs' utility. DataFilter delivers strong security, high utility, and plug-and-play deployment, making it a strong practical defense to secure black-box commercial LLMs against prompt injection. Our DataFilter model is released at https://huggingface.co/JoyYizhu/DataFilter for immediate use, with the code to reproduce our results at https://github.com/yizhu-joy/DataFilter.

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

LLM agents are evolving from conversational chatbots to operational tools in real-world workspaces. In local agentic harnesses, an LLM can read and write files, call tools, and reuse workspace state across sessions. While such capabilities enhance utility, they also expose a new attack surface for attackers. Attackers can embed a prompt injection within a file or tool output. Agents may read this hidden instruction, store it, and execute it later. In this multi-step trojan attack paradigm, no individual step appears malicious on its own, but these steps can collectively turn untrusted text into persistent control content. However, existing defenses often inspect each step in isolation. As a result, they can block a clear harmful action, but fail to detect the earlier write operation that plants the backdoor. To reveal this threat, we introduce ClawTrojan, a benchmark designed to identify multi-step trojan attacks in local agentic harnesses. In an OpenClaw-style simulated workspace with GPT-5.4, ClawTrojan reaches a 95.5% attack success rate (ASR), while existing single-turn prompt-injection attacks produce near-zero ASR on the same model. To address this threat, we propose DASGuard, which scans control-like text in sensitive local files, traces its origin, and removes control content that does not originate from a trusted source. Our results show that DASGuard achieves strong dynamic defense by combining runtime attack blocking with sanitized commits to the workspace.

Indirect prompt injection attacks hijack LLM-based agents by embedding malicious instructions in third-party data that the agent retrieves during task execution. Existing defenses report near-zero attack success rate on static benchmarks, yet recent adaptive evaluations show that these results collapse once the attacker is allowed to optimize against the deployed defense. In this work, we trace this collapse to two failure modes. First, existing defense methods are confined to recognizing specific attack patterns, rather than assessing whether the intent of every embedded instruction is relevant to the user task. Second, training-based defenses, which otherwise offer the strongest safety-utility trade-off, assemble their adversarial examples from a handful of hand-crafted templates, and the resulting defender fails to generalize outside that narrow strategy distribution. To address these gaps, we propose RETA, a training-based method that grounds defense decisions on the user tasks rather than attacker-controlled data. At each tool-output step, the defender undertakes chain-of-thought reasoning verifying that its actions are consistent with the user task. Leveraging red-teaming, a simulated attacker synthesizes adversarial training data and receives a dictionary-learning diversity reward, achieving broad coverage of injection-reformulation strategies. Together, these allow the defender to be optimized via multi-objective reinforcement learning and achieve better safety-utility trade-off. Across six black-box adaptive attacks, RETA keeps every per-attack ASR below 10%, with average ASR of 2.92% and 3.75% on the two target models, while preserving most utility under attack and on clean inputs.

Prompt injection has emerged as a critical vulnerability in large language model (LLM) deployments, yet existing research is heavily weighted toward defenses. The attack side -- specifically, which injection strategies are most effective and why -- remains insufficiently studied.We address this gap with AttackEval, a systematic empirical study of prompt injection attack effectiveness. We construct a taxonomy of ten attack categories organized into three parent groups (Syntactic, Contextual, and Semantic/Social), populate each category with 25 carefully crafted prompts (250 total), and evaluate them against a simulated production victim system under four progressively stronger defense tiers. Experiments reveal several non-obvious findings: (1) Obfuscation (OBF) achieves the highest single-attack success rate (ASR = 0.76) against even intent-aware defenses, because it defeats both keyword matching and semantic similarity checks simultaneously; (2) Semantic/Social attacks - Emotional Manipulation (EM) and Reward Framing (RF) - maintain high ASR (0.44-0.48) against intent-aware defenses due to their natural language surface, which evades structural anomaly detection; (3) Composite attacks combining two complementary strategies dramatically boost ASR, with the OBF + EM pair reaching 97.6%; (4) Stealth correlates positively with residual ASR against semantic defenses (r = 0.71), implying that future defenses must jointly optimize for both structural and behavioral signals. Our findings identify concrete blind spots in current defenses and provide actionable guidance for designing more robust LLM safety systems.

To generate evidence regarding the safety and efficacy of artificial intelligence (AI) enabled medical devices, AI models need to be evaluated on a diverse population of patient cases, some of which may not be readily available. We propose an evaluation approach for testing medical imaging AI models that relies on in silico imaging pipelines in which stochastic digital models of human anatomy (in object space) with and without pathology are imaged using a digital replica imaging acquisition system to generate realistic synthetic image datasets. Here, we release M-SYNTH, a dataset of cohorts with four breast fibroglandular density distributions imaged at different exposure levels using Monte Carlo x-ray simulations with the publicly available Virtual Imaging Clinical Trial for Regulatory Evaluation (VICTRE) toolkit. We utilize the synthetic dataset to analyze AI model performance and find that model performance decreases with increasing breast density and increases with higher mass density, as expected. As exposure levels decrease, AI model performance drops with the highest performance achieved at exposure levels lower than the nominal recommended dose for the breast type.

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

Realistic surgical simulation plays a crucial role in training novice surgeons and in the development of autonomous agents. World models can scale such simulation environments to realistic and diverse procedures by predicting future patient states conditioned on current observations and surgical actions. However, current state-of-the-art approaches often fail to satisfy key criteria required for clinical applicability, including visual realism, physically grounded interactions, and the ability to simulate scenarios beyond the training distribution. Hence, we introduce SWoMo, a neuro-symbolic world model for cataract surgery simulation that decouples motion generation from visual realism. The symbolic component, consisting of a rule-based simulator and scene graph representations, models motion dynamics and tool-tissue interactions, while a diffusion model produces realistic visual appearance, including textures and tissue deformations. We propose an inverse pairing strategy that reconstructs real surgical videos in the simulator to obtain paired simulated and real videos, which are then used to train our video diffusion model for the reverse objective of sim-to-real translation. Our experiments show both qualitative and quantitative improvements over prior work. We demonstrate that our simulator further satisfies the key criteria, including generalisation to unseen interaction geometries, improvements in downstream phase detection, and unsupervised video style transfer. The code, data, and model weights are available at: https://ssharvienkumar.github.io/SWoMo/

With COVID-19 having emerged as the most widespread human pandemic disease in a century, the need to control its spread to avoid massive loss of life became more than necessary, and extremely fast. Several vaccines were developed and the task of policy makers was suddenly to convince the reluctant population to be vaccinated by various means. While some countries have chosen a policy of mandatory vaccination or punitive incentives, many states in the United States have adopted various incentives to try to increase vaccination coverage. A study we conducted in recent months quantified the effect of these measures on the proportion of the population vaccinated, using the synthetic control method, by simulating what would have happened without these measures. The aim now is to generalize this study to smaller scales, to improve the results of our previous study, to quantify their robustness and to provide a tool that can be used by policy makers to adapt their behavior in light of the results obtained.

Generative AI models often learn and reproduce false information present in their training corpora. This position paper argues that, analogous to biological immunization, where controlled exposure to a weakened pathogen builds immunity, AI models should be fine tuned on small, quarantined sets of explicitly labeled falsehoods as a "vaccine" against misinformation. These curated false examples are periodically injected during finetuning, strengthening the model ability to recognize and reject misleading claims while preserving accuracy on truthful inputs. An illustrative case study shows that immunized models generate substantially less misinformation than baselines. To our knowledge, this is the first training framework that treats fact checked falsehoods themselves as a supervised vaccine, rather than relying on input perturbations or generic human feedback signals, to harden models against future misinformation. We also outline ethical safeguards and governance controls to ensure the safe use of false data. Model immunization offers a proactive paradigm for aligning AI systems with factuality.

We present an approach to mitigating the risks of malicious image editing posed by large diffusion models. The key idea is to immunize images so as to make them resistant to manipulation by these models. This immunization relies on injection of imperceptible adversarial perturbations designed to disrupt the operation of the targeted diffusion models, forcing them to generate unrealistic images. We provide two methods for crafting such perturbations, and then demonstrate their efficacy. Finally, we discuss a policy component necessary to make our approach fully effective and practical -- one that involves the organizations developing diffusion models, rather than individual users, to implement (and support) the immunization process.

In this paper, we introduce a simulacrum of hospital called Agent Hospital that simulates the entire process of treating illness. All patients, nurses, and doctors are autonomous agents powered by large language models (LLMs). Our central goal is to enable a doctor agent to learn how to treat illness within the simulacrum. To do so, we propose a method called MedAgent-Zero. As the simulacrum can simulate disease onset and progression based on knowledge bases and LLMs, doctor agents can keep accumulating experience from both successful and unsuccessful cases. Simulation experiments show that the treatment performance of doctor agents consistently improves on various tasks. More interestingly, the knowledge the doctor agents have acquired in Agent Hospital is applicable to real-world medicare benchmarks. After treating around ten thousand patients (real-world doctors may take over two years), the evolved doctor agent achieves a state-of-the-art accuracy of 93.06% on a subset of the MedQA dataset that covers major respiratory diseases. This work paves the way for advancing the applications of LLM-powered agent techniques in medical scenarios.

Sonar image synthesis is crucial for advancing applications in underwater exploration, marine biology, and defence. Traditional methods often rely on extensive and costly data collection using sonar sensors, jeopardizing data quality and diversity. To overcome these limitations, this study proposes a new sonar image synthesis framework, Synth-SONAR leveraging diffusion models and GPT prompting. The key novelties of Synth-SONAR are threefold: First, by integrating Generative AI-based style injection techniques along with publicly available real/simulated data, thereby producing one of the largest sonar data corpus for sonar research. Second, a dual text-conditioning sonar diffusion model hierarchy synthesizes coarse and fine-grained sonar images with enhanced quality and diversity. Third, high-level (coarse) and low-level (detailed) text-based sonar generation methods leverage advanced semantic information available in visual language models (VLMs) and GPT-prompting. During inference, the method generates diverse and realistic sonar images from textual prompts, bridging the gap between textual descriptions and sonar image generation. This marks the application of GPT-prompting in sonar imagery for the first time, to the best of our knowledge. Synth-SONAR achieves state-of-the-art results in producing high-quality synthetic sonar datasets, significantly enhancing their diversity and realism.

Recent studies have revealed that self-sustaining cascading failures in distributed systems frequently lead to widespread outages, which are challenging to contain and recover from. Existing failure detection techniques struggle to expose such failures prior to deployment, as they typically require a complex combination of specific conditions to be triggered. This challenge stems from the inherent nature of cascading failures, as they typically involve a sequence of fault propagations, each activated by distinct conditions. This paper presents CSnake, a fault injection framework to expose self-sustaining cascading failures in distributed systems. CSnake uses the novel idea of causal stitching, which causally links multiple single-fault injections in different tests to simulate complex fault propagation chains. To identify these chains, CSnake designs a counterfactual causality analysis of fault propagations - fault causality analysis (FCA): FCA compares the execution trace of a fault injection run with its corresponding profile run (i.e., same test w/o the injection) and identifies any additional faults triggered, which are considered to have a causal relationship with the injected fault. To address the large search space of fault and workload combinations, CSnake employs a three-phase allocation protocol of test budget that prioritizes faults with unique and diverse causal consequences, increasing the likelihood of uncovering conditional fault propagations. Furthermore, to avoid incorrectly connecting fault propagations from workloads with incompatible conditions, CSnake performs a local compatibility check that approximately checks the compatibility of the path constraints associated with connected fault propagations with low overhead. CSnake detected 15 bugs that cause self-sustaining cascading failures in five systems, five of which have been confirmed with two fixed.

In the medical domain, the lack of large training data sets and benchmarks is often a limiting factor for training deep neural networks. In contrast to expensive manual labeling, computer simulations can generate large and fully labeled data sets with a minimum of manual effort. However, models that are trained on simulated data usually do not translate well to real scenarios. To bridge the domain gap between simulated and real laparoscopic images, we exploit recent advances in unpaired image-to-image translation. We extent an image-to-image translation method to generate a diverse multitude of realistically looking synthetic images based on images from a simple laparoscopy simulation. By incorporating means to ensure that the image content is preserved during the translation process, we ensure that the labels given for the simulated images remain valid for their realistically looking translations. This way, we are able to generate a large, fully labeled synthetic data set of laparoscopic images with realistic appearance. We show that this data set can be used to train models for the task of liver segmentation of laparoscopic images. We achieve average dice scores of up to 0.89 in some patients without manually labeling a single laparoscopic image and show that using our synthetic data to pre-train models can greatly improve their performance. The synthetic data set will be made publicly available, fully labeled with segmentation maps, depth maps, normal maps, and positions of tools and camera (http://opencas.dkfz.de/image2image).

In recent years, the machine learning research community has benefited tremendously from the availability of openly accessible benchmark datasets. Clinical data are usually not openly available due to their highly confidential nature. This has hampered the development of reproducible and generalisable machine learning applications in health care. Here we introduce the Health Gym - a growing collection of highly realistic synthetic medical datasets that can be freely accessed to prototype, evaluate, and compare machine learning algorithms, with a specific focus on reinforcement learning. The three synthetic datasets described in this paper present patient cohorts with acute hypotension and sepsis in the intensive care unit, and people with human immunodeficiency virus (HIV) receiving antiretroviral therapy in ambulatory care. The datasets were created using a novel generative adversarial network (GAN). The distributions of variables, and correlations between variables and trends over time in the synthetic datasets mirror those in the real datasets. Furthermore, the risk of sensitive information disclosure associated with the public distribution of the synthetic datasets is estimated to be very low.

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.

Accurate analysis and modeling of renal functions require a precise segmentation of the renal blood vessels. Micro-CT scans provide image data at higher resolutions, making more small vessels near the renal cortex visible. Although deep-learning-based methods have shown state-of-the-art performance in automatic blood vessel segmentations, they require a large amount of labeled training data. However, voxel-wise labeling in micro-CT scans is extremely time-consuming given the huge volume sizes. To mitigate the problem, we simulate synthetic renal vascular trees physiologically while generating corresponding scans of the simulated trees by training a generative model on unlabeled scans. This enables the generative model to learn the mapping implicitly without the need for explicit functions to emulate the image acquisition process. We further propose an additional segmentation branch over the generative model trained on the generated scans. We demonstrate that the model can directly segment blood vessels on real scans and validate our method on both 3D micro-CT scans of rat kidneys and a proof-of-concept experiment on 2D retinal images. Code and 3D results are available at https://github.com/miccai2023anony/RenalVesselSeg

A digital twin is a virtual replica of a real-world physical phenomena that uses mathematical modeling to characterize and simulate its defining features. By constructing digital twins for disease processes, we can perform in-silico simulations that mimic patients' health conditions and counterfactual outcomes under hypothetical interventions in a virtual setting. This eliminates the need for invasive procedures or uncertain treatment decisions. In this paper, we propose a method to identify digital twin model parameters using only noninvasive patient health data. We approach the digital twin modeling as a composite inverse problem, and observe that its structure resembles pretraining and finetuning in self-supervised learning (SSL). Leveraging this, we introduce a physics-informed SSL algorithm that initially pretrains a neural network on the pretext task of solving the physical model equations. Subsequently, the model is trained to reconstruct low-dimensional health measurements from noninvasive modalities while being constrained by the physical equations learned in pretraining. We apply our method to identify digital twins of cardiac hemodynamics using noninvasive echocardiogram videos, and demonstrate its utility in unsupervised disease detection and in-silico clinical trials.

Large language models (LLMs) now reach expert-level scores on medical licensing exams, encouraging the assumption that high scores imply safe medical judgment while patients increasingly use them for health advice. We show this assumption is fragile: when misleading context is injected into questions that LLMs originally answer correctly, they abandon the correct answer. We call the ability to maintain correct judgment under adversarial context epistemic resilience, and introduce MedMisBench to measure it. MedMisBench contains 10,932 medical question items and 48,889 misleading context-option pairs spanning medical reasoning, agentic capability, and patient-journey evaluation. Across 11 model configurations, mean accuracy falls from 71.1% on original questions to 38.0% under focused misleading context, with 51.5% attack success. The most damaging injections are formal, rule-like fabrications: authority-framed falsehoods reach 69.5% attack success and exception-poisoning claims reach 64.1%. A 14-member clinical panel from 7 countries identified serious potential harm in 38.2% of reviewed cases. MedMisBench exposes a structural blind spot in LLM evaluation in medical settings: existing benchmarks measure what models know, but not whether they preserve correct medical judgment under misleading context.

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

AI-driven discovery can greatly reduce design time and enhance new therapeutics' effectiveness. Models using simulators explore broad design spaces but risk violating implicit constraints due to a lack of experimental priors. For example, in a new analysis we performed on a diverse set of models on the GuacaMol benchmark using supervised classifiers, over 60\% of molecules proposed had high probability of being mutagenic. In this work, we introduce \ourdataset, a dataset of priors for design problems extracted from literature describing compounds used in lab settings. It is constructed with LLM pipelines for discovering therapeutic entities in relevant paragraphs and summarizing information in concise fair-use facts. \ourdataset~ consists of 32.3 million pairs of natural language facts, and appropriate entity representations (i.e. SMILES or refseq IDs). To demonstrate the potential of the data, we train LLM, CLIP, and LLava architectures to reason jointly about text and design targets and evaluate on tasks from the Therapeutic Data Commons (TDC). \ourdataset~is highly effective for creating models with strong priors: in supervised prediction problems that use our data as pretraining, our best models with 15M learnable parameters outperform larger 2B TxGemma on both regression and classification TDC tasks, and perform comparably to 9B models on average. Models built with \ourdataset~can be used as constraints while optimizing for novel molecules in GuacaMol, resulting in proposals that are safer and nearly as effective. We release our dataset at https://huggingface.co/datasets/medexanon/Medex{huggingface.co/datasets/medexanon/Medex}, and will provide expanded versions as available literature grows.

Large language models (LLMs) show promise in clinical decision support yet risk acquiescing to patient pressure for inappropriate care. We introduce SycoEval-EM, a multi-agent simulation framework evaluating LLM robustness through adversarial patient persuasion in emergency medicine. Across 20 LLMs and 1,875 encounters spanning three Choosing Wisely scenarios, acquiescence rates ranged from 0-100\%. Models showed higher vulnerability to imaging requests (38.8\%) than opioid prescriptions (25.0\%), with model capability poorly predicting robustness. All persuasion tactics proved equally effective (30.0-36.0\%), indicating general susceptibility rather than tactic-specific weakness. Our findings demonstrate that static benchmarks inadequately predict safety under social pressure, necessitating multi-turn adversarial testing for clinical AI certification.

Synthetic contrast enhancement offers fast image acquisition and eliminates the need for intravenous injection of contrast agent. This is particularly beneficial for breast imaging, where long acquisition times and high cost are significantly limiting the applicability of magnetic resonance imaging (MRI) as a widespread screening modality. Recent studies have demonstrated the feasibility of synthetic contrast generation. However, current state-of-the-art (SOTA) methods lack sufficient measures for consistent temporal evolution. Neural cellular automata (NCA) offer a robust and lightweight architecture to model evolving patterns between neighboring cells or pixels. In this work we introduce TeNCA (Temporal Neural Cellular Automata), which extends and further refines NCAs to effectively model temporally sparse, non-uniformly sampled imaging data. To achieve this, we advance the training strategy by enabling adaptive loss computation and define the iterative nature of the method to resemble a physical progression in time. This conditions the model to learn a physiologically plausible evolution of contrast enhancement. We rigorously train and test TeNCA on a diverse breast MRI dataset and demonstrate its effectiveness, surpassing the performance of existing methods in generation of images that align with ground truth post-contrast sequences.

The lack of freely available standardized datasets represents an aggravating factor during the development and testing the performance of novel computational techniques in exposure assessment and dosimetry research. This hinders progress as researchers are required to generate numerical data (field, power and temperature distribution) anew using simulation software for each exposure scenario. Other than being time consuming, this approach is highly susceptible to errors that occur during the configuration of the electromagnetic model. To address this issue, in this paper, the limited available data on the incident power density and resultant maximum temperature rise on the skin surface considering various steady-state exposure scenarios at 10-90 GHz have been statistically modeled. The synthetic data have been sampled from the fitted statistical multivariate distribution with respect to predetermined dosimetric constraints. We thus present a comprehensive and open-source dataset compiled of the high-fidelity numerical data considering various exposures to a realistic source. Furthermore, different surrogate models for predicting maximum temperature rise on the skin surface were fitted based on the synthetic dataset. All surrogate models were tested on the originally available data where satisfactory predictive performance has been demonstrated. A simple technique of combining quadratic polynomial and tensor-product spline surrogates, each operating on its own cluster of data, has achieved the lowest mean absolute error of 0.058 {\deg}C. Therefore, overall experimental results indicate the validity of the proposed synthetic dataset.

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

Graphical User Interface (GUI) agents are increasingly deployed to interact with online web services, yet their exposure to open-world content renders them vulnerable to Environmental Injection Attacks (EIAs). In these attacks, an attacker can inject crafted triggers into website to manipulate the behavior of GUI agents used by other users. In this paper, we find that most existing EIA studies fall short of realism. In particular, they fail to capture the dynamic nature of real-world web content, often assuming that a trigger's on-screen position and surrounding visual context remain largely consistent between training and testing. To better reflect practice, we introduce a realistic dynamic-environment threat model in which the attacker is a regular user and the trigger is embedded within a dynamically changing environment. Under this threat model, existing approaches largely fail, suggesting that their effectiveness in exposing GUI agent vulnerabilities has been substantially overestimated. To expose the hidden vulnerabilities of existing GUI agents effectively, we propose Chameleon, an attack framework with two key novelties designed for dynamic environments. (1) To synthesize more realistic training data, we introduce LLM-Driven Environment Simulation, which automatically generates diverse, high-fidelity webpage simulations that mimic the variability of real-world dynamic environments. (2) To optimize the trigger more effectively, we introduce Attention Black Hole, which converts attention weights into explicit supervisory signals. This mechanism encourages the agent to remain insensitive to irrelevant surrounding content, thereby improving robustness in dynamic environments. We evaluate Chameleon on six realistic websites and four representative LVLM-powered GUI agents, where it significantly outperforms existing methods.

Acupuncture is a widely adopted medical practice that involves inserting thin needles into specific points on the body to alleviate pain and treat various health conditions. Current learning practices heavily rely on 2D atlases and practice on peers, which are notably less intuitive and pose risks, particularly in sensitive areas such as the eyes. To address these challenges, we introduce AcuVR, a Virtual Reality (VR) based system designed to add a layer of interactivity and realism. This innovation aims to reduce the risks associated with practicing acupuncture techniques while offering more effective learning strategies. Furthermore, AcuVR incorporates medical imaging and standardized anatomy models, enabling the simulation of customized acupuncture scenarios. This feature represents a significant advancement beyond the limitations of conventional resources such as atlases and textbooks, facilitating a more immersive and personalized learning experience. The evaluation study with eight acupuncture students and practitioners revealed high participant satisfaction and pointed to the effectiveness and potential of AcuVR as a valuable addition to acupuncture training.

Problem: Effective patient-centered communication is a core competency for physicians. However, both seasoned providers and medical trainees report decreased confidence in leading conversations on sensitive topics such as goals of care or end-of-life discussions. The significant administrative burden and the resources required to provide dedicated training in leading difficult conversations has been a long-standing problem in medical education. Approach: In this work, we present a novel educational tool designed to facilitate interactive, real-time simulations of difficult conversations in a video-based format through the use of multimodal generative artificial intelligence (AI). Leveraging recent advances in language modeling, computer vision, and generative audio, this tool creates realistic, interactive scenarios with avatars, or "synthetic patients." These synthetic patients interact with users throughout various stages of medical care using a custom-built video chat application, offering learners the chance to practice conversations with patients from diverse belief systems, personalities, and ethnic backgrounds. Outcomes: While the development of this platform demanded substantial upfront investment in labor, it offers a highly-realistic simulation experience with minimal financial investment. For medical trainees, this educational tool can be implemented within programs to simulate patient-provider conversations and can be incorporated into existing palliative care curriculum to provide a scalable, high-fidelity simulation environment for mastering difficult conversations. Next Steps: Future developments will explore enhancing the authenticity of these encounters by working with patients to incorporate their histories and personalities, as well as employing the use of AI-generated evaluations to offer immediate, constructive feedback to learners post-simulation.

To build effective therapeutics, biologists iteratively mutate antibody sequences to improve binding and stability. Proposed mutations can be informed by previous measurements or by learning from large antibody databases to predict only typical antibodies. Unfortunately, the space of typical antibodies is enormous to search, and experiments often fail to find suitable antibodies on a budget. We introduce Clone-informed Bayesian Optimization (CloneBO), a Bayesian optimization procedure that efficiently optimizes antibodies in the lab by teaching a generative model how our immune system optimizes antibodies. Our immune system makes antibodies by iteratively evolving specific portions of their sequences to bind their target strongly and stably, resulting in a set of related, evolving sequences known as a clonal family. We train a large language model, CloneLM, on hundreds of thousands of clonal families and use it to design sequences with mutations that are most likely to optimize an antibody within the human immune system. We propose to guide our designs to fit previous measurements with a twisted sequential Monte Carlo procedure. We show that CloneBO optimizes antibodies substantially more efficiently than previous methods in realistic in silico experiments and designs stronger and more stable binders in in vitro wet lab experiments.

Sepsis management in the ICU requires sequential treatment decisions under rapidly evolving patient physiology. Although large language models (LLMs) encode broad clinical knowledge and can reason over guidelines, they are not inherently grounded in action-conditioned patient dynamics. We introduce SepsisAgent, a world model-augmented LLM agent for sepsis treatment recommendation. SepsisAgent uses a learned Clinical World Model to simulate patient responses under candidate fluid--vasopressor interventions, and follows a propose--simulate--refine workflow before committing to a prescription. We first show that world-model access alone yields inconsistent LLM decision performance, motivating agent-specific training. We then train SepsisAgent through a three-stage curriculum: patient-dynamics supervised fine-tuning, propose--simulate--refine behavior cloning, and world-model-based agentic reinforcement learning. On MIMIC-IV sepsis trajectories, SepsisAgent outperforms all traditional RL and LLM-based baselines in off-policy value while achieving the best safety profile under guideline adherence and unsafe-action metrics. Further analysis shows that repeated interaction with the Clinical World Model enables the agent to learn regularities in patient evolution, which remain useful even when simulator access is removed.

Deep neural networks have brought remarkable breakthroughs in medical image analysis. However, due to their data-hungry nature, the modest dataset sizes in medical imaging projects might be hindering their full potential. Generating synthetic data provides a promising alternative, allowing to complement training datasets and conducting medical image research at a larger scale. Diffusion models recently have caught the attention of the computer vision community by producing photorealistic synthetic images. In this study, we explore using Latent Diffusion Models to generate synthetic images from high-resolution 3D brain images. We used T1w MRI images from the UK Biobank dataset (N=31,740) to train our models to learn about the probabilistic distribution of brain images, conditioned on covariables, such as age, sex, and brain structure volumes. We found that our models created realistic data, and we could use the conditioning variables to control the data generation effectively. Besides that, we created a synthetic dataset with 100,000 brain images and made it openly available to the scientific community.

Real-world data collection for robotics is costly and resource-intensive, requiring skilled operators and expensive hardware. Simulations offer a scalable alternative but often fail to achieve sim-to-real generalization due to geometric and visual gaps. To address these challenges, we propose a 3D-photorealistic real-to-sim system, namely, RE^3SIM, addressing geometric and visual sim-to-real gaps. RE^3SIM employs advanced 3D reconstruction and neural rendering techniques to faithfully recreate real-world scenarios, enabling real-time rendering of simulated cross-view cameras within a physics-based simulator. By utilizing privileged information to collect expert demonstrations efficiently in simulation, and train robot policies with imitation learning, we validate the effectiveness of the real-to-sim-to-real pipeline across various manipulation task scenarios. Notably, with only simulated data, we can achieve zero-shot sim-to-real transfer with an average success rate exceeding 58%. To push the limit of real-to-sim, we further generate a large-scale simulation dataset, demonstrating how a robust policy can be built from simulation data that generalizes across various objects. Codes and demos are available at: http://xshenhan.github.io/Re3Sim/.

Vision-Language Model (VLM) based Web Agents represent a significant step towards automating complex tasks by simulating human-like interaction with websites. However, their deployment in uncontrolled web environments introduces significant security vulnerabilities. Existing research on adversarial environmental injection attacks often relies on unrealistic assumptions, such as direct HTML manipulation, knowledge of user intent, or access to agent model parameters, limiting their practical applicability. In this paper, we propose AdInject, a novel and real-world black-box attack method that leverages the internet advertising delivery to inject malicious content into the Web Agent's environment. AdInject operates under a significantly more realistic threat model than prior work, assuming a black-box agent, static malicious content constraints, and no specific knowledge of user intent. AdInject includes strategies for designing malicious ad content aimed at misleading agents into clicking, and a VLM-based ad content optimization technique that infers potential user intents from the target website's context and integrates these intents into the ad content to make it appear more relevant or critical to the agent's task, thus enhancing attack effectiveness. Experimental evaluations demonstrate the effectiveness of AdInject, attack success rates exceeding 60% in most scenarios and approaching 100% in certain cases. This strongly demonstrates that prevalent advertising delivery constitutes a potent and real-world vector for environment injection attacks against Web Agents. This work highlights a critical vulnerability in Web Agent security arising from real-world environment manipulation channels, underscoring the urgent need for developing robust defense mechanisms against such threats. Our code is available at https://github.com/NicerWang/AdInject.

While self-supervised pretraining has reduced vision systems' reliance on synthetic data, simulation remains an indispensable tool for closed-loop optimization and rigorous out-of-distribution (OOD) evaluation. However, modern simulation platforms often present steep technical barriers, requiring extensive expertise in computer graphics and game development. In this work, we present LychSim, a highly controllable and interactive simulation framework built upon Unreal Engine 5 to bridge this gap. LychSim is built around three key designs: (1) a streamlined Python API that abstracts away underlying engine complexities; (2) a procedural data pipeline capable of generating diverse, high-fidelity environments with varying out-of-distribution (OOD) visual challenges, paired with rich 2D and 3D ground truths; and (3) a native integration of the Model Context Protocol (MCP) that transforms the simulator into a dynamic, closed-loop playground for reasoning agentic LLMs. We further annotate scene-level procedural rules and object-level pose alignments to enable semantically aligned 3D ground truths and automated scene modification. We demonstrate LychSim's capability across multiple downstream applications, including serving as a synthetic data engine, powering reinforcement learning-based adversarial examiners, and facilitating interactive, language-driven scene layout generation. To benefit the broader vision community, LychSim will be made publicly available, including full source code and various data annotations.

Continuum robots are advancing bronchoscopy procedures by accessing complex lung airways and enabling targeted interventions. However, their development is limited by the lack of realistic training and test environments: Real data is difficult to collect due to ethical constraints and patient safety concerns, and developing autonomy algorithms requires realistic imaging and physical feedback. We present ROOM (Realistic Optical Observation in Medicine), a comprehensive simulation framework designed for generating photorealistic bronchoscopy training data. By leveraging patient CT scans, our pipeline renders multi-modal sensor data including RGB images with realistic noise and light specularities, metric depth maps, surface normals, optical flow and point clouds at medically relevant scales. We validate the data generated by ROOM in two canonical tasks for medical robotics -- multi-view pose estimation and monocular depth estimation, demonstrating diverse challenges that state-of-the-art methods must overcome to transfer to these medical settings. Furthermore, we show that the data produced by ROOM can be used to fine-tune existing depth estimation models to overcome these challenges, also enabling other downstream applications such as navigation. We expect that ROOM will enable large-scale data generation across diverse patient anatomies and procedural scenarios that are challenging to capture in clinical settings. Code and data: https://github.com/iamsalvatore/room.

Surgical simulation plays a pivotal role in training novice surgeons, accelerating their learning curve and reducing intra-operative errors. However, conventional simulation tools fall short in providing the necessary photorealism and the variability of human anatomy. In response, current methods are shifting towards generative model-based simulators. Yet, these approaches primarily focus on using increasingly complex conditioning for precise synthesis while neglecting the fine-grained human control aspect. To address this gap, we introduce SG2VID, the first diffusion-based video model that leverages Scene Graphs for both precise video synthesis and fine-grained human control. We demonstrate SG2VID's capabilities across three public datasets featuring cataract and cholecystectomy surgery. While SG2VID outperforms previous methods both qualitatively and quantitatively, it also enables precise synthesis, providing accurate control over tool and anatomy's size and movement, entrance of new tools, as well as the overall scene layout. We qualitatively motivate how SG2VID can be used for generative augmentation and present an experiment demonstrating its ability to improve a downstream phase detection task when the training set is extended with our synthetic videos. Finally, to showcase SG2VID's ability to retain human control, we interact with the Scene Graphs to generate new video samples depicting major yet rare intra-operative irregularities.

With the continuous advancement of image generation technology, advanced models such as GPT-Image-1 and Qwen-Image have achieved remarkable text-to-image consistency and world knowledge However, these models still fall short in photorealistic image generation. Even on simple T2I tasks, they tend to produce " fake" images with distinct AI artifacts, often characterized by "overly smooth skin" and "oily facial sheens". To recapture the original goal of "indistinguishable-from-reality" generation, we propose RealGen, a photorealistic text-to-image framework. RealGen integrates an LLM component for prompt optimization and a diffusion model for realistic image generation. Inspired by adversarial generation, RealGen introduces a "Detector Reward" mechanism, which quantifies artifacts and assesses realism using both semantic-level and feature-level synthetic image detectors. We leverage this reward signal with the GRPO algorithm to optimize the entire generation pipeline, significantly enhancing image realism and detail. Furthermore, we propose RealBench, an automated evaluation benchmark employing Detector-Scoring and Arena-Scoring. It enables human-free photorealism assessment, yielding results that are more accurate and aligned with real user experience. Experiments demonstrate that RealGen significantly outperforms general models like GPT-Image-1 and Qwen-Image, as well as specialized photorealistic models like FLUX-Krea, in terms of realism, detail, and aesthetics. The code is available at https://github.com/yejy53/RealGen.

Agent skills provide a lightweight mechanism for extending general-purpose agents, but their open format exposes them to skill-poisoning attacks. A practically dangerous injection must stay invisible: if executing the payload derails the user's legitimate task, the resulting failure signal invites inspection of the skill. We therefore evaluate attacks by Attack Success Rate, which requires the injected payload to execute and the user's task to still pass its verifier in the same trial. Prior skill-poisoning attacks face a reliability-stealth trade-off under this lens: YAML-header injections are reliably loaded but easily inspected, whereas stealthier body injections that place explicit malicious commands in the skill prose are less reliable because out-of-context commands invite the agent's own suspicion. We introduce POISE, a position-aware attack that compresses the trigger into a single, benign-looking body instruction, placing it at a feasible position and using a context-aware generator to blend it with nearby setup or prerequisite steps. On Skill-Inject with codex+gpt-5.2, POISE achieves an 89.3% ASR, 28.0 points above a random-placement body baseline and 2.6 points above a YAML-only baseline, while retaining the stealth advantage of body placement. That stealth is the decisive margin: because legitimate skill bodies naturally require privileged tool operations, LLM scanners are hyper-sensitive, falsely flagging 74.6% of clean skills on average across four judges and both benchmarks. Blending into these false alarms, POISE causes only 5.6% of poisoned variants to gain a new high-risk alert over their clean baselines, rendering current static defenses ineffective.