Daily Papers

Large multimodal language models (MLLMs) have emerged as powerful tools for guiding evolutionary search toward interpretable programmatic policies. In existing program-evolution systems, however, reusable knowledge is usually carried by whole programs in the population, and it is difficult to trace how a visual observation led to a particular code change and its measured outcome. We present REFLEX, a train-free evolutionary framework that links these steps in one loop. A vision-enabled Critic turns task-specific behavioral evidence into a structured diagnosis; the diagnosis retrieves executable code snippets from a persistent Skill Memory; a text-only Actor writes the child program; and the child--parent fitness change updates the utility of each retrieved snippet. Every step is recorded in a single trace. Under matched backends and 100-call budgets over 10 paired seeds, REFLEX reaches the solve threshold in a median of 13, 20, and 24 LLM calls on Acrobot, Pendulum, and Lunar Lander, roughly half the calls required by official MLES and by a compute-matched Actor-only ablation. Frozen Skill Memory banks from Pendulum or Lunar Lander raise the final Acrobot score on all 10 paired seeds. On a 36-dimensional antenna-array design task with equal evaluation budgets and shared initialization, REFLEX reaches the harder 25.25 score threshold on 9/10 seeds, compared with at most 3/10 for CMA-ES, GA, and PSO.

When asked to describe a medical image that was never attached, frontier vision-language models do not abstain: they confabulate a diagnosis. We show that this confabulation is not random. It is structured by who the patient is said to be. Across chest X-ray, brain MRI, and dermatology, Claude Opus-4.7, GPT-5.4, and Gemini-3.1-Pro are each queried with only a demographic descriptor and no image, and changing the descriptor systematically shifts the diagnosis returned. Claude concentrates sharply: a 65-year-old white man asking about a skin mole receives Melanoma in nearly every response, and a 32-year-old Black woman asking about her chest X-ray receives a Sarcoidosis diagnosis whose reasoning reads "suspected, based on demographics and classic pattern.'' GPT-5.4's effect is broader, fabricating across every demographic cell we test, most conspicuously naming Sarcoidosis for young Black patients on chest X-ray. Two structural findings sharpen the problem. A hedged regime appears in which the prose acknowledges the missing image while the structured diagnosis field nevertheless names a disease, a dissociation invisible to prose-only audits. And Claude's dermatology effect collapses entirely when 'skin mole' is swapped for 'skin lesion' while GPT-5.4's is preserved, indicating that mirage is a family of distinct failure modes rather than a single phenomenon. Trustworthy VLM deployment in clinical pipelines requires auditing the structured output channel directly, and probe-word sensitivity should be treated as a first-class evaluation dimension

Computer-use agents (CUAs) interact with graphical interfaces through screenshots and low-level mouse and keyboard actions, yet the causal error may precede the terminal failure. We present CUADebug, a framework for localizing root causes in CUA trajectories and guiding re-execution. CUADebug includes a five-category, 30-subtype taxonomy; CUAErrorBench, a benchmark of 204 failed OSWorld trajectories with human root-cause annotations; and CUADebugger, a ReAct-style agent for root-cause analysis (RCA). CUADebugger iteratively selects trajectory steps, inspects paired before/after screenshots and action traces, and submits a structured diagnosis containing the causal step, taxonomy label, grounded evidence, and correction. CUADebugger performs RCA without per-trajectory human intervention; human annotations are used to evaluate RCA predictions and, in controlled re-rollout comparisons, to fix restart points. Task reasoning and control is the largest annotated failure category (110/204). CUADebugger improves L2 and Tag+Step Exact across three debugger backbones on the Claude-agent split; with Gemini 2.5 Pro, Tag+Step Exact rises from 11.1% to 19.4%. Single re-execution improves failure recovery from 13.89% to 29.86% (overall 61.77% to 68.14%); controlled continual re-execution improves it from 12.50% to 25.69% (overall 61.22% to 66.48%). Project page: cuadebug.github.io.

Large language models (LLMs) increasingly serve as data-driven reasoners, yet their chains-of-thought (CoT) can be unfaithful even when final answers are correct. Most existing ``verification'' signals are not diagnostic: answer matching observes only the outcome, LLM-as-judge provides subjective and non-verifiable critiques, and scalar rewards (e.g., PRMs/RMs) offer little insight into where a multi-step derivation fails.We propose SymDiag, a neuro-symbolic framework that reframes reasoning verification as structured failure diagnosis. SymDiag translates natural-language CoT into symbolic constraints and performs step-level satisfiability/entailment checks to (i) localize failing steps and (ii) produce verifiable diagnostic evidence, including counterexamples, inconsistency witnesses, and missing-premise indicators. A central challenge is that apparent ``logic violations'' can be caused either by genuine reasoning defects or by neural-to-symbolic translation noise. SymDiag therefore incorporates a Self-Auditor that disentangles TranslationError from ReasoningError via dual symbolic encodings consistency checks, enabling robust diagnosis under partial observability. Across diverse mathematical, logical, scientific, and general reasoning benchmarks, SymDiag improves detection of unfaithful reasoning and provides substantially more effective feedback for multi-round reasoning repair than outcome-only verification and LLM-based judging, offering a principled foundation for trustworthy and scalable reasoning diagnosis.

Electrocardiogram (ECG) interpretation is essential for cardiovascular disease diagnosis, but current automated systems often struggle with transparency and generalization to unseen conditions. To address this, we introduce ZETA, a zero-shot multimodal framework designed for interpretable ECG diagnosis aligned with clinical workflows. ZETA uniquely compares ECG signals against structured positive and negative clinical observations, which are curated through an LLM-assisted, expert-validated process, thereby mimicking differential diagnosis. Our approach leverages a pre-trained multimodal model to align ECG and text embeddings without disease-specific fine-tuning. Empirical evaluations demonstrate ZETA's competitive zero-shot classification performance and, importantly, provide qualitative and quantitative evidence of enhanced interpretability, grounding predictions in specific, clinically relevant positive and negative diagnostic features. ZETA underscores the potential of aligning ECG analysis with structured clinical knowledge for building more transparent, generalizable, and trustworthy AI diagnostic systems. We will release the curated observation dataset and code to facilitate future research.

AI agents are becoming increasingly capable of generating scientific code, but generating code is not the same as improving the algorithms behind it. For numerical solvers, execution feedback can expose poor performance, but rarely reveals its underlying cause and how to address it. We introduce Auto-Diagnosis and Skill Discovery (ADSD), a framework that links numerical diagnosis to reusable solver self-improvement. ADSD follows a diagnosis-first paradigm that first explains why a solver performs poorly, then uses this diagnosis to guide the discovery of appropriate numerical methods. The resulting knowledge is packaged into reusable solver skills, turning solver improvement from trial-and-error editing into a structured process of diagnosis, discovery, and implementation. Across four challenging numerical domains--power flow equation, AC optimal power flow control, stiff ordinary differential equations, and heterogeneous diffusion PDEs--ADSD consistently improves solver accuracy, robustness, and efficiency. On GOC-500 power flow, for example, ADSD reduces mean solver error by nearly 71times, with improvements further transferring to unseen grid topologies and operating regimes.

Despite generating increasingly photorealistic images, text-to-image (T2I) models still exhibit localized, subtle, and structurally complex failures. Diagnosing these failures requires instance-level feedback that answers where a defect occurs, what type it is, why it is defective, and its importance to overall image quality. While recent dense-feedback methods move beyond scalar supervision, their heatmap-centric representations still formulate diagnosis as pixel-field regression, making it difficult to localize variable-cardinality defects and bind semantic reasons to individual failures. To address this representation bottleneck, we propose Structured Defect Grounding (SDG), which casts T2I diagnosis as structured set prediction by modeling each defect as a (location, type, reason, importance) tuple. To make this formulation trainable and measurable, we introduce SDG-30K, a 30K-image dataset with box-grounded annotations across four modern T2I generators, together with a dedicated evaluation protocol, SDG-Eval. Building on this structured representation, we further present a diagnosis-to-alignment framework in which a Vision-Language Model (VLM) serves as the SDG detector, and BoxFlow-GRPO converts predicted defect sets into box-derived, importance-weighted spatial rewards for diffusion model alignment. Extensive experiments show that our SDG detector outperforms leading proprietary VLMs on structured defect grounding, while SDG-guided rewards consistently improve T2I alignment and support localized image refinement. These results establish SDG as a unified, instance-level interface for diagnosing, evaluating, and enhancing modern generative models.

Embodied agents built on foundation models rely on an execution harness to organize observations, guide actions, and incorporate execution feedback into subsequent decisions. Failures can arise not only from limited model capabilities, but also from how the harness presents evidence and guides its use. These model-external mechanisms provide an adaptation target without updating model parameters, but task-specific interaction experience can be costly to collect. Task-level outcomes alone do not reveal whether relevant evidence was missing from the model input or was available but inadequately used. Moreover, these two aspects are coupled: effective action guidance may require evidence that the current context omits, while exposing that evidence alone does not ensure an appropriate response. We introduce EnactOpt, which uses limited execution feedback to jointly evolve reusable textual skills and context-construction code while keeping the underlying models and runtime fixed. It diagnoses adjacent decisions by relating action feedback to the actual model input and subsequent action. Structured episode summaries guide joint revisions through prompt-level edit operators, and candidate harnesses undergo compatibility checks and validation-based retention. Across VLABench, ALFWorld, and Embodied Agent Interface (EAI), EnactOpt improves task success by approximately 10-27 percentage points over the initial harnesses and outperforms the evaluated GEPA, TextGrad, and Trace2Skill baselines. These gains extend to task conditions not used for harness evolution or candidate selection. The results support a complementary route to embodied adaptation: turning limited execution experience into reusable behavioral improvements by jointly refining how evidence is presented and acted upon.

A central question in artificial intelligence is the extent to which machine learning models comprehend mathematics. To address this, we propose a novel framework for measuring mathematical reasoning that moves beyond standard benchmarks to diagnose specific failure points. Our method first generates structured, step-by-step reasoning from gpt-3.5-turbo on the GSM8K dataset. We then use a more capable analyst model, gpt-4o-mini, to categorize errors and, crucially, perform an unsupervised clustering of every reasoning sentence to identify emergent "reasoning modes." This analysis reveals a cognitive profile with a stark, nonhuman-like brittleness: while the model achieves near-perfect accuracy on procedural modes like sequential calculation, its performance on modes requiring combinatorial reasoning with restrictions plummets. By identifying and quantifying the reliability of these distinct reasoning skills, our work provides a more granular method to evaluate mathematical comprehension and offers a precise roadmap for developing new capabilities and more reliable future applications.

LLMs for clinical decision support often fail under small but clinically meaningful input shifts such as masking a symptom or negating a finding, despite high performance on static benchmarks. These reasoning failures frequently go undetected by standard NLP metrics, which are insensitive to latent representation shifts that drive diagnosis instability. We propose a geometry-aware evaluation framework, LAPD (Latent Agentic Perturbation Diagnostics), which systematically probes the latent robustness of clinical LLMs under structured adversarial edits. Within this framework, we introduce Latent Diagnosis Flip Rate (LDFR), a model-agnostic diagnostic signal that captures representational instability when embeddings cross decision boundaries in PCA-reduced latent space. Clinical notes are generated using a structured prompting pipeline grounded in diagnostic reasoning, then perturbed along four axes: masking, negation, synonym replacement, and numeric variation to simulate common ambiguities and omissions. We compute LDFR across both foundation and clinical LLMs, finding that latent fragility emerges even under minimal surface-level changes. Finally, we validate our findings on 90 real clinical notes from the DiReCT benchmark (MIMIC-IV), confirming the generalizability of LDFR beyond synthetic settings. Our results reveal a persistent gap between surface robustness and semantic stability, underscoring the importance of geometry-aware auditing in safety-critical clinical AI.

Skin carcinoma is the most prevalent form of cancer globally, accounting for over $8 billion in annual healthcare expenditures. Early diagnosis, accurate and timely treatment are critical to improving patient survival rates. In clinical settings, physicians document patient visits using detailed SOAP (Subjective, Objective, Assessment, and Plan) notes. However, manually generating these notes is labor-intensive and contributes to clinician burnout. In this work, we propose skin-SOAP, a weakly supervised multimodal framework to generate clinically structured SOAP notes from limited inputs, including lesion images and sparse clinical text. Our approach reduces reliance on manual annotations, enabling scalable, clinically grounded documentation while alleviating clinician burden and reducing the need for large annotated data. Our method achieves performance comparable to GPT-4o, Claude, and DeepSeek Janus Pro across key clinical relevance metrics. To evaluate this clinical relevance, we introduce two novel metrics MedConceptEval and Clinical Coherence Score (CCS) which assess semantic alignment with expert medical concepts and input features, respectively.

Medical question-answering (QA) is a critical task for evaluating how effectively large language models (LLMs) encode clinical knowledge and assessing their potential applications in medicine. Despite showing promise on multiple-choice tests, LLMs frequently struggle with open-ended medical questions, producing responses with dangerous hallucinations or lacking comprehensive coverage of critical aspects. Existing approaches attempt to address these challenges through domain-specific fine-tuning, but this proves resource-intensive and difficult to scale across models. To improve the comprehensiveness and factuality of medical responses, we propose a novel approach utilizing structured medical reasoning. Our method guides LLMs through an seven-step cognitive process inspired by clinical diagnosis, enabling more accurate and complete answers without additional training. Experiments on the MedLFQA benchmark demonstrate that our approach achieves the highest Factuality Score of 85.8, surpassing fine-tuned models. Notably, this improvement transfers to smaller models, highlighting the method's efficiency and scalability. Our code and datasets are available.

Vision-Language Models (VLMs) are advancing computational pathology with superior visual understanding capabilities. However, current systems often reduce diagnosis to directly output conclusions without verifiable evidence-linked reasoning, which severely limits clinical trust and hinders expert error rectification. To address these barriers, we construct PathReasoner, the first large-scale dataset of whole-slide image (WSI) reasoning. Unlike previous work reliant on unverified distillation, we develop a rigorous knowledge-guided generation pipeline. By leveraging medical knowledge graphs, we explicitly align structured pathological findings and clinical reasoning with diagnoses, generating over 20K high-quality instructional samples. Based on the database, we propose PathReasoner-R1, which synergizes trajectory-masked supervised fine-tuning with reasoning-oriented reinforcement learning to instill structured chain-of-thought capabilities. To ensure medical rigor, we engineer a knowledge-aware multi-granular reward function incorporating an Entity Reward mechanism strictly aligned with knowledge graphs. This effectively guides the model to optimize for logical consistency rather than mere outcome matching, thereby enhancing robustness. Extensive experiments demonstrate that PathReasoner-R1 achieves state-of-the-art performance on both PathReasoner and public benchmarks across various image scales, equipping pathology models with transparent, clinically grounded reasoning capabilities. Dataset and code are available at https://github.com/cyclexfy/PathReasoner-R1.

Psychiatric consultation requires agents to elicit discriminative evidence, map uncertain narratives to diagnostic criteria, and decide when evidence suffices. Existing dialogue and retrieval-augmented systems condition policies on raw histories or appended passages, leaving observed evidence, missing checks, differentials, and support reliability entangled. We introduce MIND, a criteria-grounded evidence-state decision interface. At each turn, MIND constructs a typed state containing observed evidence, unresolved criterion checks, active differentials, criterion-linked supports, and reliability metadata. A training-split Psychiatric Reasoning Bank supplies gated supports, turning retrieval into state construction rather than prompt injection. The same state conditions action selection, process rewards, information-gain scoring, and trajectory rectification. Under EMR-grounded simulator protocols, MIND improves accuracy by 8.8 and 7.3 points over strong inference-only, RAG, and RL baselines, with gains transferring to public MDD-5k dialogues. Matched interventions attribute these gains to the shared state rather than prompt length, retrieval text, or formatting. MIND targets screening-level decision support, not autonomous diagnosis. Code is available at https://github.com/Lingxi-mental-health/MIND.Å

Real-world multivariate time series anomalies are rare and often unlabeled. Additionally, prevailing methods rely on increasingly complex architectures tuned to benchmarks, detecting only fragments of anomalous segments and overstating performance. In this paper, we introduce OracleAD, a simple and interpretable unsupervised framework for multivariate time series anomaly detection. OracleAD encodes each variable's past sequence into a single causal embedding to jointly predict the present time point and reconstruct the input window, effectively modeling temporal dynamics. These embeddings then undergo a self-attention mechanism to project them into a shared latent space and capture spatial relationships. These relationships are not static, since they are modeled by a property that emerges from each variable's temporal dynamics. The projected embeddings are aligned to a Stable Latent Structure (SLS) representing normal-state relationships. Anomalies are identified using a dual scoring mechanism based on prediction error and deviation from the SLS, enabling fine-grained anomaly diagnosis at each time point and across individual variables. Since any noticeable SLS deviation originates from embeddings that violate the learned temporal causality of normal data, OracleAD directly pinpoints the root-cause variables at the embedding level. OracleAD achieves state-of-the-art results across multiple real-world datasets and evaluation protocols, while remaining interpretable through SLS.

Plant disease diagnosis is critical for food security, yet training disease-recognition models that generalize across crops, pathogens, and field conditions remains challenging because labeled disease images are far less abundant and standardized than data for other biotic stresses such as insects or weeds. Frontier vision-language models offer new opportunities through improved visual reasoning, but they still struggle with fine-grained disease identification due to the lack of structured, crop-specific symptom knowledge. To address this gap, we curate the largest plant disease image--symptom dataset to date, covering 335 crops, 1{,}251 disease classes, and approximately 839K images, designed to support training-free, agentic disease prediction. A scalable automated pipeline generates source-grounded symptom descriptions in which each claim is linked to a verbatim web quote; domain experts validate sampled crops and reconcile disease-name variants across sources. As a baseline, we introduce an autonomous visual reasoning agent that identifies anatomical context, narrows candidate diseases using symptom knowledge, sequentially compares reference images, and produces a fully explainable reasoning trace. Incorporating symptom knowledge improves accuracy by 16.2 percentage points on average at the full reference budget, with consistent gains across all four evaluation crops. Because the framework only requires crop-specific reference images and symptom knowledge, it can be extended to new crops without retraining, while the agentic baseline can directly benefit from future improvements in foundation model capabilities. Dataset and code are available at:https://sage-dataset.github.io/.

The diagnosis of cyber-physical systems aims to detect faulty behaviour, its root cause and a mitigation or even prevention policy. Therefore, diagnosis relies on a representation of the system's functional and faulty behaviour combined with observations of the system taken at runtime. The main challenges are the time-intensive building of a model, possible state-explosion while searching for the root cause and interpretability of the results. In this paper we propose a scalable algorithm tackling these challenges. We use a Bayesian network to learn a structured model automatically and optimise the model by a genetic algorithm. Our approach differs from existing work in two aspects: instead of selecting features prior to the analysis we learn a global representation using all available information which is then transformed to a smaller, label-specific one and we focus on interpretability to facilitate repairs. The evaluation shows that our approach is able to learn a model with equal performance to state-of-the-art algorithms while giving better interpretability and having a reduced size.

Recent advancements in Large Language Models (LLMs) have demonstrated significant promise in clinical diagnosis. However, current models struggle to emulate the iterative, diagnostic hypothesis-driven reasoning of real clinical scenarios. Specifically, current LLMs suffer from three critical limitations: (1) generating hallucinated medical content due to weak grounding in verified knowledge, (2) asking redundant or inefficient questions rather than discriminative ones that hinder diagnostic progress, and (3) losing coherence over multi-turn dialogues, leading to contradictory or inconsistent conclusions. To address these challenges, we propose MedKGI, a diagnostic framework grounded in clinical practices. MedKGI integrates a medical knowledge graph (KG) to constrain reasoning to validated medical ontologies, selects questions based on information gain to maximize diagnostic efficiency, and adopts an OSCE-format structured state to maintain consistent evidence tracking across turns. Experiments on clinical benchmarks show that MedKGI outperforms strong LLM baselines in both diagnostic accuracy and inquiry efficiency, improving dialogue efficiency by 30% on average while maintaining state-of-the-art accuracy.

Medical vision-language pretraining increasingly relies on medical reports as large-scale supervisory signals; however, raw reports often exhibit substantial stylistic heterogeneity, variable length, and a considerable amount of image-irrelevant content. Although text normalization is frequently adopted as a preprocessing step in prior work, its design principles and empirical impact on vision-language pretraining remain insufficiently and systematically examined. In this study, we present MedTri, a deployable normalization framework for medical vision-language pretraining that converts free-text reports into a unified [Anatomical Entity: Radiologic Description + Diagnosis Category] triplet. This structured, anatomy-grounded normalization preserves essential morphological and spatial information while removing stylistic noise and image-irrelevant content, providing consistent and image-grounded textual supervision at scale. Across multiple datasets spanning both X-ray and computed tomography (CT) modalities, we demonstrate that structured, anatomy-grounded text normalization is an important factor in medical vision-language pretraining quality, yielding consistent improvements over raw reports and existing normalization baselines. In addition, we illustrate how this normalization can easily support modular text-level augmentation strategies, including knowledge enrichment and anatomy-grounded counterfactual supervision, which provide complementary gains in robustness and generalization without altering the core normalization process. Together, our results position structured text normalization as a critical and generalizable preprocessing component for medical vision-language learning, while MedTri provides this normalization platform. Code and data will be released at https://github.com/Arturia-Pendragon-Iris/MedTri.

Incident management (IM) is central to the reliability of large-scale cloud systems. Yet manual IM, where on-call engineers examine metrics, logs, and traces is labor-intensive and error-prone in the face of massive and heterogeneous observability data. Existing automated IM approaches often struggle to generalize across systems, provide limited interpretability, and incur high deployment costs, which hinders adoption in practice. In this paper, we present OpsAgent, a lightweight, self-evolving multi-agent system for IM that employs a training-free data processor to convert heterogeneous observability data into structured textual descriptions, along with a multi-agent collaboration framework that makes diagnostic inference transparent and auditable. To support continual capability growth, OpsAgent also introduces a dual self-evolution mechanism that integrates internal model updates with external experience accumulation, thereby closing the deployment loop. Comprehensive experiments on the OPENRCA benchmark demonstrate state-of-the-art performance and show that OpsAgent is generalizable, interpretable, cost-efficient, and self-evolving, making it a practically deployable and sustainable solution for long-term operation in real-world cloud systems.

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.

Reasoning in multimodal large language models (MLLMs) has shown strong promise in medical imaging. However, this reasoning is usually free-form text judged only by its final answer, making it hard to interpret and verify, especially in 3D radiology, where a diagnosis should be traceable to evidence in the scan. Existing chest CT question-answering datasets compound this by reducing expert radiology reports to answer-only pairs, dropping the reasoning that links findings to conclusions and omitting the patient history clinicians rely on. As a result, reasoning-capable 3D chest CT MLLMs remain out of reach, as neither the structured supervision needed to train them nor the protocol needed to verify their reasoning yet exists. We introduce CORTEX (Clinically Organized Reasoning and sTructured EXplanation), a structured reasoning benchmark for 3D chest CT. For each question, CORTEX restores the missing reasoning as a four-stage diagnostic trace mirroring a radiologist's workflow: task understanding, visual observation, diagnostic reasoning, and answer synthesis. We generate these traces using frontier large language models with broad medical and general-domain knowledge, then filter and verify them with a stage-level evaluation protocol combining automated rubric scoring with expert radiologist review. Crucially, both the reasoning structure and evaluation rubrics are designed in close collaboration with clinicians. Built on CT-RATE, a large, publicly available chest CT dataset without reasoning annotations, CORTEX comprises 76,177 validated reasoning traces across open-ended VQA, closed-ended VQA, and report generation, providing both the structured supervision and the stage-level evaluation protocol needed to build and evaluate trustworthy reasoning models for 3D chest CT. Our dataset and evaluation code will be made publicly available upon acceptance.

Ontology rankers remain useful for rare-disease diagnosis because each candidate can be traced to matched patient phenotypes. Large language models (LLMs) can generate differential diagnoses from the same patient description, but their predictions lack an equally clear evidence trail. Rather than asking which system should replace the other, we ask whether an LLM can improve the ranker without giving up its evidence. Our behavior-based fusion model examines the two ranked lists, their agreement, and the ontology support behind each candidate, and learns how much to rely on each system for the individual case. Before comparison, we remove a documented test-set leakage pathway caused by benchmark cases and ontology annotations being derived from the same publications. Across eight open LLMs, fusion improves Phenomizer Recall@1 by 7.86 percentage points on Phenopacket Store and 20.18 points on RAMEDIS. When paired with DeepSeek-V4-Flash through an API, a fusion model trained only on the other LLMs improves Recall@1 from 0.1657 to 0.2176, a 5.19-point gain, without retraining. For 90.8% of correct fused diagnoses, the disease retains candidate-level ontology evidence that can be inspected. These results show that LLMs can strengthen an established diagnostic tool without discarding the structured evidence that makes it useful.

Although document OCR systems perform increasingly well on routine documents, complex formulas, structured text, and long-tail formats remain error-prone. OCR predictions may omit fine-grained content or hallucinate unsupported outputs, while equivalent encodings of the same visible content must be accommodated. Existing OCR evaluation methods mostly report aggregate metrics, offering limited support for analyzing case-level errors and improving OCR performance. We propose OCR-EDR (OCR Error Diagnosis and Repair), a rendering-aware framework that advances from fine-grained diagnosis to iterative repair. Given a source image, an editable OCR prediction, and its rendered image, OCR-EDR first jointly assesses whether the prediction and its rendering are consistent with the source, preserving valid predictions, including rendering-equivalent ones, while diagnosing and localizing genuine errors. It then applies executable edits and may request an updated rendering for iterative reassessment. We construct OCRErrBench from diverse real OCR predictions, covering text and formulas, exact and rendering-equivalent positives, and genuine errors, and develop the DocEDR model to execute the diagnosis--repair loop. On OCRErrBench, DocEDR achieves 94.78% diagnostic accuracy. It repairs 86.23% of erroneous inputs to visual consistency, raises formula Case-F1 by 30.99 percentage points over DOCR-Inspector-7B on DOCRcaseBench, and improves formula CDM by up to 4.62 percentage points on the identified Bad subsets of four OCR systems on UniMER-Test. These results show that OCR-EDR turns fine-grained OCR analysis into verified corrections and performance gains.

Chest X-ray imaging is crucial for diagnosing pulmonary and cardiac diseases, yet its interpretation demands extensive clinical experience and suffers from inter-observer variability. While deep learning models offer high diagnostic accuracy, their black-box nature hinders clinical adoption in high-stakes medical settings. To address this, we propose X-Ray-CoT (Chest X-Ray Chain-of-Thought), a novel framework leveraging Vision-Language Large Models (LVLMs) for intelligent chest X-ray diagnosis and interpretable report generation. X-Ray-CoT simulates human radiologists' "chain-of-thought" by first extracting multi-modal features and visual concepts, then employing an LLM-based component with a structured Chain-of-Thought prompting strategy to reason and produce detailed natural language diagnostic reports. Evaluated on the CORDA dataset, X-Ray-CoT achieves competitive quantitative performance, with a Balanced Accuracy of 80.52% and F1 score of 78.65% for disease diagnosis, slightly surpassing existing black-box models. Crucially, it uniquely generates high-quality, explainable reports, as validated by preliminary human evaluations. Our ablation studies confirm the integral role of each proposed component, highlighting the necessity of multi-modal fusion and CoT reasoning for robust and transparent medical AI. This work represents a significant step towards trustworthy and clinically actionable AI systems in medical imaging.

Open-world embodied agents must solve long-horizon tasks where the main bottleneck is not single-step planning quality but how interaction experience is organized and evolved. To this end, we present Steve-Evolving, a non-parametric self-evolving framework that tightly couples fine-grained execution diagnosis with dual-track knowledge distillation in a closed loop. The method follows three phases: Experience Anchoring, Experience Distillation, and Knowledge-Driven Closed-Loop Control. In detail, Experience Anchoring solidifies each subgoal attempt into a structured experience tuple with a fixed schema (pre-state, action, diagnosis-result, and post-state) and organizes it in a three-tier experience space with multi-dimensional indices (e.g., condition signatures, spatial hashing, and semantic tags) plus rolling summarization for efficient and auditable recall. To ensure sufficient information density for attribution, the execution layer provides compositional diagnosis signals beyond binary outcomes, including state-difference summaries, enumerated failure causes, continuous indicators, and stagnation/loop detection. Moreover, successful trajectories of Experience Distillation are generalized into reusable skills with explicit preconditions and verification criteria, while failures are distilled into executable guardrails that capture root causes and forbid risky operations at both subgoal and task granularities. Besides, Knowledge-Driven Closed-Loop Control retrieved skills and guardrails are injected into an LLM planner, and diagnosis-triggered local replanning updates the active constraints online, forming a continual evolution process without any model parameter updates. Experiments on the long-horizon suite of Minecraft MCU demonstrate consistent improvements over static-retrieval baselines.

Interpreting chest X-rays is inherently challenging due to the overlap between anatomical structures and the subtle presentation of many clinically significant pathologies, making accurate diagnosis time-consuming even for experienced radiologists. Recent radiology-focused foundation models, such as LLaVA-Rad and Maira-2, have positioned multi-modal large language models (MLLMs) at the forefront of automated radiology report generation (RRG). However, despite these advances, current foundation models generate reports in a single forward pass. This decoding strategy diminishes attention to visual tokens and increases reliance on language priors as generation proceeds, which in turn introduces spurious pathology co-occurrences in the generated reports. To mitigate these limitations, we propose Category-Wise Contrastive Decoding (CWCD), a novel and modular framework designed to enhance structured radiology report generation (SRRG). Our approach introduces category-specific parameterization and generates category-wise reports by contrasting normal X-rays with masked X-rays using category-specific visual prompts. Experimental results demonstrate that CWCD consistently outperforms baseline methods across both clinical efficacy and natural language generation metrics. An ablation study further elucidates the contribution of each architectural component to overall performance.

Large language model (LLM) agents offer a promising data-driven approach to automating Site Reliability Engineering (SRE), yet their enterprise deployment is constrained by three challenges: restricted access to proprietary data, unsafe action execution under permission-governed environments, and the inability of closed systems to improve from failures. We present AOI (Autonomous Operations Intelligence), a trainable multi-agent framework formulating automated operations as a structured trajectory learning problem under security constraints. Our approach integrates three key components. First, a trainable diagnostic system applies Group Relative Policy Optimization (GRPO) to distill expert-level knowledge into locally deployed open-source models, enabling preference-based learning without exposing sensitive data. Second, a read-write separated execution architecture decomposes operational trajectories into observation, reasoning, and action phases, allowing safe learning while preventing unauthorized state mutation. Third, a Failure Trajectory Closed-Loop Evolver mines unsuccessful trajectories and converts them into corrective supervision signals, enabling continual data augmentation. Evaluated on the AIOpsLab benchmark, our contributions yield cumulative gains. (1) The AOI runtime alone achieves 66.3% best@5 success on all 86 tasks, outperforming the prior state-of-the-art (41.9%) by 24.4 points. (2) Adding Observer GRPO training, a locally deployed 14B model reaches 42.9% avg@1 on 63 held-out tasks with unseen fault types, surpassing Claude Sonnet 4.5. (3) The Evolver converts 37 failed trajectories into diagnostic guidance, improving end-to-end avg@5 by 4.8 points while reducing variance by 35%.

Deep learning has enabled the development of highly robust foundation models for various pathological tasks across diverse diseases and patient cohorts. Among these models, vision-language pre-training, which leverages large-scale paired data to align pathology image and text embedding spaces, and provides a novel zero-shot paradigm for downstream tasks. However, existing models have been primarily data-driven and lack the incorporation of domain-specific knowledge, which limits their performance in cancer diagnosis, especially for rare tumor subtypes. To address this limitation, we establish a Knowledge-enhanced Pathology (KEEP) foundation model that harnesses disease knowledge to facilitate vision-language pre-training. Specifically, we first construct a disease knowledge graph (KG) that covers 11,454 human diseases with 139,143 disease attributes, including synonyms, definitions, and hypernym relations. We then systematically reorganize the millions of publicly available noisy pathology image-text pairs, into 143K well-structured semantic groups linked through the hierarchical relations of the disease KG. To derive more nuanced image and text representations, we propose a novel knowledge-enhanced vision-language pre-training approach that integrates disease knowledge into the alignment within hierarchical semantic groups instead of unstructured image-text pairs. Validated on 18 diverse benchmarks with more than 14,000 whole slide images (WSIs), KEEP achieves state-of-the-art performance in zero-shot cancer diagnostic tasks. Notably, for cancer detection, KEEP demonstrates an average sensitivity of 89.8% at a specificity of 95.0% across 7 cancer types. For cancer subtyping, KEEP achieves a median balanced accuracy of 0.456 in subtyping 30 rare brain cancers, indicating strong generalizability for diagnosing rare tumors.

Medical imaging plays a pivotal role in modern healthcare, with computed tomography pulmonary angiography (CTPA) being a critical tool for diagnosing pulmonary embolism and other thoracic conditions. However, the complexity of interpreting CTPA scans and generating accurate radiology reports remains a significant challenge. This paper introduces Abn-BLIP (Abnormality-aligned Bootstrapping Language-Image Pretraining), an advanced diagnosis model designed to align abnormal findings to generate the accuracy and comprehensiveness of radiology reports. By leveraging learnable queries and cross-modal attention mechanisms, our model demonstrates superior performance in detecting abnormalities, reducing missed findings, and generating structured reports compared to existing methods. Our experiments show that Abn-BLIP outperforms state-of-the-art medical vision-language models and 3D report generation methods in both accuracy and clinical relevance. These results highlight the potential of integrating multimodal learning strategies for improving radiology reporting. The source code is available at https://github.com/zzs95/abn-blip.

Large language models (LLMs) have demonstrated strong performance and rapid progress in a wide range of medical reasoning tasks. However, their sequential autoregressive decoding forces inherently parallel clinical reasoning, such as differential diagnosis, into a single linear reasoning path, limiting both efficiency and reliability for complex medical problems. To address this, we propose MedVerse, a reasoning framework for complex medical inference that reformulates medical reasoning as a parallelizable directed acyclic graph (DAG) process based on Petri net theory. The framework adopts a full-stack design across data, model architecture, and system execution. For data creation, we introduce the MedVerse Curator, an automated pipeline that synthesizes knowledge-grounded medical reasoning paths and transforms them into Petri net-structured representations. At the architectural level, we propose a topology-aware attention mechanism with adaptive position indices that supports parallel reasoning while preserving logical consistency. Systematically, we develop a customized inference engine that supports parallel execution without additional overhead. Empirical evaluations show that MedVerse improves strong general-purpose LLMs by up to 8.9%. Compared to specialized medical LLMs, MedVerse achieves comparable performance while delivering a 1.3x reduction in inference latency and a 1.7x increase in generation throughput, enabled by its parallel decoding capability.

Cardiac magnetic resonance (CMR) is a cornerstone for diagnosing cardiovascular disease. However, it remains underutilized due to complex, time-consuming interpretation across multi-sequences, phases, quantitative measures that heavily reliant on specialized expertise. Here, we present BAAI Cardiac Agent, a multimodal intelligent system designed for end-to-end CMR interpretation. The agent integrates specialized cardiac expert models to perform automated segmentation of cardiac structures, functional quantification, tissue characterization and disease diagnosis, and generates structured clinical reports within a unified workflow. Evaluated on CMR datasets from two hospitals (2413 patients) spanning 7-types of major cardiovascular diseases, the agent achieved an area under the receiver-operating-characteristic curve exceeding 0.93 internally and 0.81 externally. In the task of estimating left ventricular function indices, the results generated by this system for core parameters such as ejection fraction, stroke volume, and left ventricular mass are highly consistent with clinical reports, with Pearson correlation coefficients all exceeding 0.90. The agent outperformed state-of-the-art models in segmentation and diagnostic tasks, and generated clinical reports showing high concordance with expert radiologists (six readers across three experience levels). By dynamically orchestrating expert models for coordinated multimodal analysis, this agent framework enables accurate, efficient CMR interpretation and highlights its potentials for complex clinical imaging workflows. Code is available at https://github.com/plantain-herb/Cardiac-Agent.

Breast cancer is one of the leading causes of death among women worldwide. We introduce Mammo-FM, the first foundation model specifically for mammography, pretrained on the largest and most diverse dataset to date - 140,677 patients (821,326 mammograms) across four U.S. institutions. Mammo-FM provides a unified foundation for core clinical tasks in breast imaging, including cancer diagnosis, pathology localization, structured report generation, and cancer risk prognosis within a single framework. Its alignment between images and text enables both visual and textual interpretability, improving transparency and clinical auditability, which are essential for real-world adoption. We rigorously evaluate Mammo-FM across diagnosis, prognosis, and report-generation tasks in in- and out-of-distribution datasets. Despite operating on native-resolution mammograms and using only one-third of the parameters of state-of-the-art generalist FMs, Mammo-FM consistently outperforms them across multiple public and private benchmarks. These results highlight the efficiency and value of domain-specific foundation models designed around the full spectrum of tasks within a clinical domain and emphasize the importance of rigorous, domain-aligned evaluation.

Despite achieving high accuracy on medical benchmarks, LLMs exhibit the Einstellung Effect in clinical diagnosis--relying on statistical shortcuts rather than patient-specific evidence, causing misdiagnosis in atypical cases. Existing benchmarks fail to detect this critical failure mode. We introduce MedEinst, a counterfactual benchmark with 5,383 paired clinical cases across 49 diseases. Each pair contains a control case and a "trap" case with altered discriminative evidence that flips the diagnosis. We measure susceptibility via Bias Trap Rate--probability of misdiagnosing traps despite correctly diagnosing controls. Extensive Evaluation of 17 LLMs shows frontier models achieve high baseline accuracy but severe bias trap rates. Thus, we propose ECR-Agent, aligning LLM reasoning with Evidence-Based Medicine standard via two components: (1) Dynamic Causal Inference (DCI) performs structured reasoning through dual-pathway perception, dynamic causal graph reasoning across three levels (association, intervention, counterfactual), and evidence audit for final diagnosis; (2) Critic-Driven Graph and Memory Evolution (CGME) iteratively refines the system by storing validated reasoning paths in an exemplar base and consolidating disease-specific knowledge into evolving illness graphs. Source code is to be released.

Accurate clinical prognosis requires synthesizing structured Electronic Health Records (EHRs) with real-time physiological signals like the Electrocardiogram (ECG). Large Language Models (LLMs) offer a powerful reasoning engine for this task but struggle to natively process these heterogeneous, non-textual data types. To address this, we propose UniPACT (Unified Prognostic Question Answering for Clinical Time-series), a unified framework for prognostic question answering that bridges this modality gap. UniPACT's core contribution is a structured prompting mechanism that converts numerical EHR data into semantically rich text. This textualized patient context is then fused with representations learned directly from raw ECG waveforms, enabling an LLM to reason over both modalities holistically. We evaluate UniPACT on the comprehensive MDS-ED benchmark, it achieves a state-of-the-art mean AUROC of 89.37% across a diverse set of prognostic tasks including diagnosis, deterioration, ICU admission, and mortality, outperforming specialized baselines. Further analysis demonstrates that our multimodal, multi-task approach is critical for performance and provides robustness in missing data scenarios.

Mental disorders are highly prevalent worldwide, but the shortage of psychiatrists and the inherent subjectivity of interview-based diagnosis create substantial barriers to timely and consistent mental-health assessment. Progress in AI-assisted psychiatric diagnosis is constrained by the absence of benchmarks that simultaneously provide realistic patient simulation, clinician-verified diagnostic labels, and support for dynamic multi-turn consultation. We present LingxiDiagBench, a large-scale multi-agent benchmark that evaluates LLMs on both static diagnostic inference and dynamic multi-turn psychiatric consultation in Chinese. At its core is LingxiDiag-16K, a dataset of 16,000 EMR-aligned synthetic consultation dialogues designed to reproduce real clinical demographic and diagnostic distributions across 12 ICD-10 psychiatric categories. Through extensive experiments across state-of-the-art LLMs, we establish key findings: (1) although LLMs achieve high accuracy on binary depression--anxiety classification (up to 92.3%), performance deteriorates substantially for depression--anxiety comorbidity recognition (43.0%) and 12-way differential diagnosis (28.5%); (2) dynamic consultation often underperforms static evaluation, indicating that ineffective information-gathering strategies significantly impair downstream diagnostic reasoning; (3) consultation quality assessed by LLM-as-a-Judge shows only moderate correlation with diagnostic accuracy, suggesting that well-structured questioning alone does not ensure correct diagnostic decisions. We release LingxiDiag-16K and the full evaluation framework to support reproducible research at https://github.com/Lingxi-mental-health/LingxiDiagBench.

Vision evaluations are typically done through multi-step processes. In most contemporary fields, experts analyze images using structured, evidence-based adaptive questioning. In plant pathology, botanists inspect leaf images, identify visual cues, infer diagnostic intent, and probe further with targeted questions that adapt to species, symptoms, and severity. This structured probing is crucial for accurate disease diagnosis and treatment formulation. Yet current vision-language models are evaluated on single-turn question answering. To address this gap, we introduce PlantInquiryVQA, a benchmark for studying multi-step, intent-driven visual reasoning in botanical diagnosis. We formalize a Chain of Inquiry framework modeling diagnostic trajectories as ordered question-answer sequences conditioned on grounded visual cues and explicit epistemic intent. We release a dataset of 24,950 expert-curated plant images and 138,068 question-answer pairs annotated with visual grounding, severity labels, and domain-specific reasoning templates. Evaluations on top-tier Multimodal Large Language Models reveal that while they describe visual symptoms adequately, they struggle with safe clinical reasoning and accurate diagnosis. Importantly, structured question-guided inquiry significantly improves diagnostic correctness, reduces hallucination, and increases reasoning efficiency. We hope PlantInquiryVQA serves as a foundational benchmark in advancing research to train diagnostic agents to reason like expert botanists rather than static classifiers.

LLM agents remain unreliable on long-horizon tasks, where small local failures can compound over extended interactions and lead to overall task failure. Although external harnesses can substantially improve robustness, harness design remains a manual and expensive process that requires searching over a large space of prompts, tool configurations, and control logic. We propose AutoSaddler, an automatic harness optimization framework that formulates harness improvement as an offline learning problem and iteratively updates the harness using failure signals from mini-batches. AutoSaddler combines failure-trace diagnosis, structured patch generation that treats the harness as code, and validation-based update selection. Experiments on GAIA2, SWE-Bench Pro, and Terminal-Bench 2.0 show that AutoSaddler substantially improves agent performance over the corresponding base harnesses, achieving gains of 9.0, 9.6, and 10.0 percentage points, respectively. Ablation studies further suggest that effective harness optimization benefits from three ingredients: deep debugging rather than shallow reflection, targeted modifications rather than unconstrained editing, and generalization-aware selection rather than trajectory-specific repair. Together, these results suggest that automatic harness optimization is a promising path toward more performant and reliable agent systems.

Most existing LLM diagnoses are evaluated on static, single-turn settings where complete patient information is provided upfront, an oversimplification of real clinical practice. We study active diagnosis: the real-life clinical process of starting from initial observation, ordering tests, interpreting results, and updating a differential diagnosis across multiple turns. Through systematic analysis, we identify three recurring failure modes in current LLMs: ungrounded test ordering, unreliable diagnostic update, and degraded multi-turn coherence. Together, these failures reveal a core deficit: existing medical training data teaches models to reason from complete information but not to act under evolving, partial evidence. To address this gap, we introduce MedAction, a tree-structured distillation pipeline that synthesizes diverse and high-quality multi-turn diagnostic trajectories via LLM-environment interaction. We propose two knowledge-graph-grounded metrics to filter trajectory quality: Disease Trajectory Consistency (DTC), which tracks whether the model's hypothesis converges toward the correct diagnosis, and Reasoning-Action Consistency (RAC), which verifies that belief updates are driven by gathered evidence. Using this pipeline, we construct MedAction-32K, a dataset of 32,681 trajectories from 2,896 PMC cases. Fine-tuning an 8B model on MedAction-32K achieves state-of-the-art performance among open-source models on both MedR-Bench and our curated MedAction-300-Hard benchmark, pushing the edge for open-source medical LLMs.

Automatic medical report generation supports clinical diagnosis, reduces the workload of radiologists, and holds the promise of improving diagnosis consistency. However, existing evaluation metrics primarily assess the accuracy of key medical information coverage in generated reports compared to human-written reports, while overlooking crucial details such as the location and certainty of reported abnormalities. These limitations hinder the comprehensive assessment of the reliability of generated reports and pose risks in their selection for clinical use. Therefore, we propose a Granular Explainable Multi-Agent Score (GEMA-Score) in this paper, which conducts both objective quantification and subjective evaluation through a large language model-based multi-agent workflow. Our GEMA-Score parses structured reports and employs NER-F1 calculations through interactive exchanges of information among agents to assess disease diagnosis, location, severity, and uncertainty. Additionally, an LLM-based scoring agent evaluates completeness, readability, and clinical terminology while providing explanatory feedback. Extensive experiments validate that GEMA-Score achieves the highest correlation with human expert evaluations on a public dataset, demonstrating its effectiveness in clinical scoring (Kendall coefficient = 0.70 for Rexval dataset and Kendall coefficient = 0.54 for RadEvalX dataset). The anonymous project demo is available at: https://github.com/Zhenxuan-Zhang/GEMA_score.

Automatic medical report generation (MRG), which possesses significant research value as it can aid radiologists in clinical diagnosis and report composition, has garnered increasing attention. Despite recent progress, generating accurate reports remains arduous due to the requirement for precise clinical comprehension and disease diagnosis inference. Furthermore, owing to the limited accessibility of medical data and the imbalanced distribution of diseases, the underrepresentation of rare diseases in training data makes large-scale medical visual language models (LVLMs) prone to hallucinations, such as omissions or fabrications, severely undermining diagnostic performance and further intensifying the challenges for MRG in practice. In this study, to effectively mitigate hallucinations in medical report generation, we propose a chain-of-medical-thought approach (CoMT), which intends to imitate the cognitive process of human doctors by decomposing diagnostic procedures. The radiological features with different importance are structured into fine-grained medical thought chains to enhance the inferential ability during diagnosis, thereby alleviating hallucination problems and enhancing the diagnostic accuracy of MRG. The code and dataset have been released at https://github.com/FRENKIE-CHIANG/CoMT.

Combining pre-trained expert models offers substantial potential for scalable multimodal reasoning, but building a unified framework remains challenging due to the increasing diversity of input modalities and task complexity. For instance, medical diagnosis requires precise reasoning over structured clinical tables, while financial forecasting depends on interpreting plot-based data to make informed predictions. To tackle this challenge, we introduce MEXA, a training-free framework that performs modality- and task-aware aggregation of multiple expert models to enable effective multimodal reasoning across diverse and distinct domains. MEXA dynamically selects expert models based on the input modality and the task-specific reasoning demands (i.e., skills). Each expert model, specialized in a modality task pair, generates interpretable textual reasoning outputs. MEXA then aggregates and reasons over these outputs using a Large Reasoning Model (LRM) to produce the final answer. This modular design allows flexible and transparent multimodal reasoning across diverse domains without additional training overhead. We extensively evaluate our approach on diverse multimodal benchmarks, including Video Reasoning, Audio Reasoning, 3D Understanding, and Medical QA. MEXA consistently delivers performance improvements over strong multimodal baselines, highlighting the effectiveness and broad applicability of our expert-driven selection and aggregation in diverse multimodal reasoning tasks.

Phenotyping is fundamental to rare disease diagnosis, but manual curation of structured phenotypes from clinical notes is labor-intensive and difficult to scale. Existing artificial intelligence approaches typically optimize individual components of phenotyping but do not operationalize the full clinical workflow of extracting features from clinical text, standardizing them to Human Phenotype Ontology (HPO) terms, and prioritizing diagnostically informative HPO terms. We developed RARE-PHENIX, an end-to-end AI framework for rare disease phenotyping that integrates large language model-based phenotype extraction, ontology-grounded standardization to HPO terms, and supervised ranking of diagnostically informative phenotypes. We trained RARE-PHENIX using data from 2,671 patients across 11 Undiagnosed Diseases Network clinical sites, and externally validated it on 16,357 real-world clinical notes from Vanderbilt University Medical Center. Using clinician-curated HPO terms as the gold standard, RARE-PHENIX consistently outperformed a state-of-the-art deep learning baseline (PhenoBERT) across ontology-based similarity and precision-recall-F1 metrics in end-to-end evaluation (i.e., ontology-based similarity of 0.70 vs. 0.58). Ablation analyses demonstrated performance improvements with the addition of each module in RARE-PHENIX (extraction, standardization, and prioritization), supporting the value of modeling the full clinical phenotyping workflow. By modeling phenotyping as a clinically aligned workflow rather than a single extraction task, RARE-PHENIX provides structured, ranked phenotypes that are more concordant with clinician curation and has the potential to support human-in-the-loop rare disease diagnosis in real-world settings.

Benchmarks for vision-language models (VLMs) mostly test observational spatial reasoning: models describe relations already visible in the input. Existing what-if tasks typically vary the observer while keeping the scene fixed. Can VLMs instead predict the consequences of hypothetically moving or rotating an object? We introduce MindEdit-Bench, a benchmark of six spatial reasoning tasks built from three-photo smartphone triplets of newly captured indoor scenes via an automatic in-the-wild 3D scene-graph extraction pipeline. Four tasks probe perception and perspective transformation over observed structure; two new tasks, L4 (spatial editing) and L5 (cross-view visibility editing), probe object-level counterfactual reasoning, where correct answers are absent from all input images. Each question provides 8-24 structured answer choices, enabling answer-letter-level diagnosis of spatial and fallback errors. The benchmark covers 120 private indoor scenes not drawn from public datasets, reducing public-data pretraining-overlap risk. Across 15 VLMs on 1,003 human-verified questions, task-wise mean VLM accuracy is only 8%-31%, versus 81%-97% human majority-vote accuracy. The pooled human--best-VLM gap is 53 pp, with at least 39 pp on every task. The structured answer space further reveals non-uniform failures, including weaker camera-depth-axis inference and fallback behavior on difficult visibility-editing cases.

Clinical prognosis requires integrating structured measurements, physiological waveforms, longitudinal history, and population context. We introduce PRISM (Population-Retrieved Inference for Structured Multimodal Prognosis), a multimodal language model that combines per-feature numerical tokenization, recency-weighted aggregation of longitudinal ECGs, and a dual-modality population memory bank. Retrieval operates in representation space: the model receives mean-pooled embeddings of similar training-cohort encounters, while no individual retrieved record enters the prompt. On the 1,443-task MDS-ED benchmark, PRISM achieves AUROCs of 86.2% for diagnosis, 93.1% for deterioration, 91.8% for ICU admission, and 92.8% for mortality. These results use a 96-hour pre-arrival window unavailable to reported baselines. With benchmark-window inputs only, PRISM reaches 0.8895 AUROC, compared with 0.8937 for UniPACT and 0.8889 for MDS-ED. A matched-input compact fusion model using the same five evidence streams and frozen encoders reaches 0.7652 AUROC, versus 0.9092 for PRISM. Replacing numerical EHR encoding with text serialization reduces AUROC by 3.66 points; removing pre-arrival history reduces it by 1.97 points; and zeroing retrieval reduces it by 0.99 points. Genuine retrieval outperforms random-neighbor retrieval by 0.97 macro-average points, although a paired task-level sign test does not establish a uniform advantage (p=0.067). On the external MC-MED cohort, supervised fine-tuning reaches 0.8611 AUROC, compared with 0.8227 for locally trained gradient boosting and 0.7841 for source-only PRISM. These results support structure-aware multimodal integration and supervised external adaptation.

Experts in various fields routinely perform methodical writing tasks to plan, organize, and report their work. From a clinician writing a differential diagnosis for a patient, to a teacher writing a lesson plan for students, these tasks are pervasive, requiring to methodically generate structured long-form output for a given input. We develop a typology of methodical tasks structured in the form of a task objective, procedure, input, and output, and introduce DoLoMiTes, a novel benchmark with specifications for 519 such tasks elicited from hundreds of experts from across 25 fields. Our benchmark further contains specific instantiations of methodical tasks with concrete input and output examples (1,857 in total) which we obtain by collecting expert revisions of up to 10 model-generated examples of each task. We use these examples to evaluate contemporary language models highlighting that automating methodical tasks is a challenging long-form generation problem, as it requires performing complex inferences, while drawing upon the given context as well as domain knowledge.

Anatomical structure labels for chest radiographs are essential for medical image segmentation and a broad range of downstream diagnostic tasks. However, annotating anatomy directly on 2D chest radiographs is labor-intensive and intrinsically ambiguous, as 3D anatomical structures are projected onto a single 2D plane where boundaries may overlap, be occluded, or appear only partially visible. Consequently, existing anatomy-labeled chest radiograph datasets remain limited in scale, anatomy coverage, and label reliability. To address these limitations, we introduce RadGenome-Anatomy, the largest anatomy-labeled chest radiograph dataset, containing over 10 million segmentation masks across 210 anatomical structures in 25,692 studies. It is constructed by projecting large-scale 3D anatomical masks from CT volumes into 2D radiographic space through canonical radiographic geometry. This shifts annotation from directly tracing uncertain 2D boundaries to defining anatomy in volumetric space, where structures that overlap or become partially invisible in radiographs remain spatially separable. As a result, each 2D mask represents the physically grounded projected footprint of a volumetrically defined structure. The scale and broad anatomical coverage of RadGenome-Anatomy, including structures that are overlapping, partially visible, or difficult to delineate directly, enable research on geometric measurements as explicit evidence for chest radiograph interpretation. We demonstrate this by training XAnatomy to predict structure-specific masks and derive clinically relevant measurements, achieving diagnostic accuracies of 96.4%, 95.6%, and 89.2% for cardiomegaly, kyphosis, and scoliosis, respectively.

Large Vision-Language Models (LVLMs) achieve strong performance across many multimodal tasks; however, they often exploit spurious object-background correlations, resulting in predictions driven by contextual shortcuts rather than object-relevant visual evidence. Despite growing interest in hallucination and robustness evaluation, existing benchmarks provide limited control over whether model predictions are grounded in the target object or induced by correlated background cues. In this work, we introduce PURGE (Partition-aware Unlearning for Removing spurious-correlation Generated Errors), a framework for constructing, benchmarking, and mitigating spurious-correlation-induced failures in LVLMs. The framework consists of: -- (1) Structured dataset construction wherein we develop three complementary structured data construction strategies that partition examples by object-relevant evidence and spurious background cues, enabling controlled diagnosis of shortcut reliance; and -- (2) Partition-aware unlearning, which uses these partitions to selectively remove spurious object-background associations while preserving object-based reasoning. We evaluate the \algo~framework across multiple LVLMs, including LLaVA-1.6-7B, Qwen3-VL-8B-Instruct, and Qwen3.5-9B, together with CLIP as a vision-language encoder, on a diverse suite of benchmarks, including CHAIR, POPE, Causal-HalBench, MM-SpuBench, AMBER, MMHal, and Waterbirds. Our results show that PURGE consistently reduces hallucinations and spurious-correlation-driven errors while maintaining or improving overall performance in most evaluated settings, providing both a reusable evaluation protocol and an effective mitigation framework for more reliable LVLMs.

Few-Shot Semantic Segmentation (FSS) models achieve strong performance in segmenting novel classes with minimal labeled examples, yet their decision-making processes remain largely opaque. While explainable AI has advanced significantly in standard computer vision tasks, interpretability in FSS remains virtually unexplored despite its critical importance for understanding model behavior and guiding support set selection in data-scarce scenarios. This paper introduces the first dedicated method for interpreting matching-based FSS models by leveraging their inherent structural properties. Our Affinity Explainer approach extracts attribution maps that highlight which pixels in support images contribute most to query segmentation predictions, using matching scores computed between support and query features at multiple feature levels. We extend standard interpretability evaluation metrics to the FSS domain and propose additional metrics to better capture the practical utility of explanations in few-shot scenarios. Comprehensive experiments on FSS benchmark datasets, using different models, demonstrate that our Affinity Explainer significantly outperforms adapted standard attribution methods. Qualitative analysis reveals that our explanations provide structured, coherent attention patterns that align with model architectures and and enable effective model diagnosis. This work establishes the foundation for interpretable FSS research, enabling better model understanding and diagnostic for more reliable few-shot segmentation systems. The source code is publicly available at https://github.com/pasqualedem/AffinityExplainer.

Language models excel at diagnostic assessments on currated medical case-studies and vignettes, performing on par with, or better than, clinical professionals. However, existing studies focus on complex scenarios with rich context making it difficult to draw conclusions about how these systems perform for patients reporting symptoms in everyday life. We deployed SymptomAI, a set of conversational AI agents for end-to-end patient interviewing and differential diagnosis (DDx), via the Fitbit app in a study that randomized participants (N=13,917) to interact with five AI agents. This corpus captures diverse communication and a realistic distribution of illnesses from a real world population. A subset of 1,228 participants reported a clinician-provided diagnosis, and 517 of these were further evaluated by a panel of clinicians during over 250 hours of annotation. SymptomAI DDx were significantly more accurate (OR = 2.47, p < 0.001) than those from independent clinicians given the same dialogue in a blinded randomized comparison. Moreover, agentic strategies which conduct a dedicated symptom interview that elicit additional symptom information before providing a diagnosis, perform substantially better than baseline, user-guided conversations (p < 0.001). An auxiliary analysis on 1,509 conversations from a general US population panel validated that these results generalize beyond wearable device users. We used SymptomAI diagnoses as labels for all 13,917 participants to analyze over 500,000 days of wearable metrics across nearly 400 unique conditions. We identified strong associations between acute infections and physiological shifts (e.g., OR > 7 for influenza). While limited by self-reported ground truth, these results demonstrate the benefits of a dedicated and complete symptom interview compared to a user-guided symptom discussion, which is the default of most consumer LLMs.

Evaluating VLM-based autonomous driving remains difficult because driving competence is composite, where a capable system must ground traffic participants and hazards, integrate context across views and time, reason about future evolution, and act appropriately under closed-loop interaction. Existing benchmarks usually assess either open-loop understanding or closed-loop driving but provide limited structure for explaining how these abilities are organized, how they relate, and how they may inform model diagnosis and improvement. We present DriveHierarchy, a hierarchical benchmark that organizes VLM-based autonomous driving into four ranks, spanning perceptual grounding, contextual memory, mental reasoning, and closed-loop execution. To instantiate this hierarchy, we integrate multiple open-source autonomous-driving datasets into a unified open-loop benchmark with 76,798 question-answer pairs over 84,279 frames and develop a closed-loop simulation platform with interactive scenario construction on a real-world road network, from which 100 driving scenarios are curated for embodied evaluation. Experiments on 15 VLMs show that DriveHierarchy captures structured but non-redundant capability variation, relates open-loop understanding to closed-loop driving, and provides a practical basis for diagnosis and benchmark-guided optimization. DriveHierarchy therefore serves as a unified framework for evaluating and improving VLM-based autonomous driving systems. An anonymized project has been released on https://github.com/PerfectXu88/DriveHierarchy

Real-world clinical diagnosis is a complex process in which the doctor is required to obtain information from both interaction with the patient and conducting medical exams. Additionally, the doctor needs to adapt to different patient personas, as well as noisy and incomplete information that can happen at any time during the process. However, existing benchmarks for medical LLMs and methods for automatic diagnosis largely simplify this process by reducing it to single-turn question answering, noise-free conversations, or sequential exam making, etc., ignoring the interactive and uncertain nature of clinical diagnosis. In this paper, we aim to address this gap by formalizing clinical diagnosis as a Partially Observable Markov Decision Process (POMDP) with three action types: questioning the patient, ordering medical exams as tool calls, and issuing a diagnosis. We also introduce a systematic noise model comprising seven patient noise types and three exam noise types. Using our proposed environment, we train an effective diagnosis agent, MedExAgent, through a two-stage pipeline that first performs supervised finetuning on synthetic conversations structured after the Calgary-Cambridge model for clinical interviews, and then applies DAPO to optimize a composite reward capturing diagnostic accuracy, tool call quality, and exam cost including financial cost and patient discomfort. Through extensive experiments and ablation studies, we demonstrate that MedExAgent achieves diagnostic performance comparable to larger models while maintaining cost-efficient examination strategies.

Prompt design is a primary control interface for large language models (LLMs), yet standard evaluations largely reduce performance to answer correctness, obscuring why a prompt succeeds or fails and providing little actionable guidance. We propose PEEM (Prompt Engineering Evaluation Metrics), a unified framework for joint and interpretable evaluation of both prompts and responses. PEEM defines a structured rubric with 9 axes: 3 prompt criteria (clarity/structure, linguistic quality, fairness) and 6 response criteria (accuracy, coherence, relevance, objectivity, clarity, conciseness), and uses an LLM-based evaluator to output (i) scalar scores on a 1-5 Likert scale and (ii) criterion-specific natural-language rationales grounded in the rubric. Across 7 benchmarks and 5 task models, PEEM's accuracy axis strongly aligns with conventional accuracy while preserving model rankings (aggregate Spearman rho about 0.97, Pearson r about 0.94, p < 0.001). A multi-evaluator study with four models shows consistent relative judgments (pairwise rho = 0.68-0.85), supporting evaluator-agnostic deployment. Beyond alignment, PEEM captures complementary linguistic failure modes and remains informative under prompt perturbations: prompt-quality trends track downstream accuracy under iterative rewrites, semantic adversarial manipulations induce clear score degradation, and meaning-preserving paraphrases yield high stability (robustness rate about 76.7-80.6%). Finally, using only PEEM scores and rationales as feedback, a zero-shot prompt rewriting loop improves downstream accuracy by up to 11.7 points, outperforming supervised and RL-based prompt-optimization baselines. Overall, PEEM provides a reproducible, criterion-driven protocol that links prompt formulation to response behavior and enables systematic diagnosis and optimization of LLM interactions.

We present HippoCamp, a new benchmark designed to evaluate agents' capabilities on multimodal file management. Unlike existing agent benchmarks that focus on tasks like web interaction, tool use, or software automation in generic settings, HippoCamp evaluates agents in user-centric environments to model individual user profiles and search massive personal files for context-aware reasoning. Our benchmark instantiates device-scale file systems over real-world profiles spanning diverse modalities, comprising 42.4 GB of data across over 2K real-world files. Building upon the raw files, we construct 581 QA pairs to assess agents' capabilities in search, evidence perception, and multi-step reasoning. To facilitate fine-grained analysis, we provide 46.1K densely annotated structured trajectories for step-wise failure diagnosis. We evaluate a wide range of state-of-the-art multimodal large language models (MLLMs) and agentic methods on HippoCamp. Our comprehensive experiments reveal a significant performance gap: even the most advanced commercial models achieve only 48.3% accuracy in user profiling, struggling particularly with long-horizon retrieval and cross-modal reasoning within dense personal file systems. Furthermore, our step-wise failure diagnosis identifies multimodal perception and evidence grounding as the primary bottlenecks. Ultimately, HippoCamp exposes the critical limitations of current agents in realistic, user-centric environments and provides a robust foundation for developing next-generation personal AI assistants.

Mechanistic Interpretability (MI) has emerged as a vital approach to demystify the opaque decision-making of Large Language Models (LLMs). However, existing reviews primarily treat MI as an observational science, summarizing analytical insights while lacking a systematic framework for actionable intervention. To bridge this gap, we present a practical survey structured around the pipeline: "Locate, Steer, and Improve." We formally categorize Localizing (diagnosis) and Steering (intervention) methods based on specific Interpretable Objects to establish a rigorous intervention protocol. Furthermore, we demonstrate how this framework enables tangible improvements in Alignment, Capability, and Efficiency, effectively operationalizing MI as an actionable methodology for model optimization. The curated paper list of this work is available at https://github.com/rattlesnakey/Awesome-Actionable-MI-Survey.

Camera motion is a fundamental geometric signal that shapes visual perception and cinematic style, yet current video-capable vision-language models (VideoLLMs) rarely represent it explicitly and often fail on fine-grained motion primitives. We address this gap with a framework of benchmarking, diagnosis, and injection. We curate CameraMotionDataset, a large-scale synthetic dataset with explicit camera control, formulate camera motion as constraint-aware multi-label recognition, and construct a VQA benchmark--CameraMotionVQA. Across diverse off-the-shelf VideoLLMs, we observe substantial errors in recognizing camera motion primitives. Probing experiments on a Qwen2.5-VL vision encoder suggest that camera motion cues are weakly represented, especially in deeper ViT blocks, helping explain the observed failure modes. To bridge this gap without costly training or fine-tuning, we propose a lightweight, model-agnostic pipeline that extracts geometric camera cues from 3D foundation models (3DFMs), predicts constrained motion primitives with a temporal classifier, and injects them into downstream VideoLLM inference via structured prompting. Experiments demonstrate improved motion recognition and more camera-aware model responses, highlighting geometry-driven cue extraction and structured prompting as practical steps toward a camera-aware VideoLLM and VLA system. The dataset and benchmark is publicly available at https://hf.co/datasets/fengyee/camera-motion-dataset-and-benchmark.

Long-term memory is essential for LLM agents that operate across multiple sessions, yet existing memory systems treat retrieval infrastructure as fixed: stored content evolves while scoring functions, fusion strategies, and answer-generation policies remain frozen at deployment. We argue that truly adaptive memory requires co-evolution at two levels: the stored knowledge and the retrieval mechanism that queries it. We present EvolveMem, a self-evolving memory architecture that exposes its full retrieval configuration as a structured action space optimized by an LLM-powered diagnosis module. In each evolution round, the module reads per-question failure logs, identifies root causes, and proposes targeted configuration adjustments; a guarded meta-analyzer applies them with automatic revert-on-regression and explore-on-stagnation safeguards. This closed-loop self-evolution realizes an AutoResearch process: the system autonomously conducts iterative research cycles on its own architecture, replacing manual configuration tuning. Starting from a minimal baseline, the process converges autonomously, discovering effective retrieval strategies including entirely new configuration dimensions not present in the original action space. On LoCoMo, EvolveMem outperforms the strongest baseline by 25.7% relative and achieves a 78.0% relative improvement over the minimal baseline. On MemBench, EvolveMem exceeds the strongest baseline by 18.9% relative. Evolved configurations transfer across benchmarks with positive rather than catastrophic transfer, indicating that the self-evolution process captures universal retrieval principles rather than benchmark-specific heuristics. Code is available at https://github.com/aiming-lab/SimpleMem.

As large language models enter professional domains, they must satisfy domain constraints, include critical evidence, and provide complete reasoning rather than merely produce fluent responses. Existing post-training methods often rely on holistic preferences or outcome-level verification, while recent rubric-based methods usually generate rubrics independently for each query. In specialized domains, such unconstrained rubrics may omit critical requirements and vary across samples, hindering the diagnosis and targeted repair of persistent capability deficiencies. We propose APTER (Adaptive Post-Training with Expert-Grounded Rubrics), a framework that integrates structured domain knowledge into fine-grained evaluation, optimization, and diagnosis for specialized complex reasoning. First, expert-grounded rubric construction starts from an expert criteria framework built by domain experts, where each criterion represents a stable professional capability. For each query, APTER selects relevant criteria and instantiates them into query-level rubrics linked to their source criteria, turning reusable expert criteria into executable query-level supervision without reference answers. Second, adaptive post-training uses rubric verdicts as both optimization and criterion-level diagnostic signals. Aggregating low-scoring verdicts by criterion ID reveals persistent deficiencies and triggers targeted supervised fine-tuning updates during reinforcement learning. Experiments on mathematical reasoning and medical question answering show consistent gains across both domains. Across three model generations, APTER improves the mathematics and medical averages over the corresponding base models by up to 15.86 and 8.04 points, respectively. Code and rubric datasets are available at https://github.com/AntDT-APTER/APTER.

Accurate evaluation of multimodal large language models (MLLMs) in dental panoramic radiography (orthopantomogram, OPG) is limited by the lack of fine-grained, clinically reliable benchmarks that reflect expert interpretation. This work introduces PanDent, a large-scale, clinically grounded OPG benchmark built upon fine-grained, expert-validated tooth-level annotations. The dataset comprises 9,524 high-quality OPGs, each associated with comprehensive structured annotations produced by experienced dentists and further validated by an oral and maxillofacial radiologist, providing clinically reliable supervision for tooth-level diagnosis and reasoning. Clinically consistent radiology reports are constructed from expert-validated findings using clinician-defined reporting logic, establishing explicit correspondence between structured clinical evidence and free-text descriptions. This design enables evaluation of whether MLLMs generate reports that are not only linguistically coherent but also clinically consistent with expert-validated tooth-level findings. Experiments are conducted on diverse MLLMs, including state-of-the-art (SOTA) proprietary models, general-domain open-source models, and medical-specific models. Results show that current MLLMs can generate fluent reports, yet fail to produce clinically consistent descriptions, exhibiting substantial errors in fine-grained localization and tooth-level diagnosis. Fine-tuning on PanDent significantly improves structure-language consistency, substantially enhancing visual localization accuracy and diagnostic correctness, and bringing model outputs closer to expert dental interpretation. These results establish PanDent as a rigorous benchmark for evaluating tooth-level clinical reasoning in MLLMs and a valuable resource for clinically grounded dental AI.

The clinical translation of dermatological AI is hindered by opaque reasoning and systematic performance disparities across skin tones. Here we present SkinGPT-R1, a multimodal large language model that integrates chain-of-thought diagnostic reasoning with a fairness-aware mixture-of-experts architecture for interpretable and equitable skin disease diagnosis. Through parameter-efficient adaptation of a frozen reasoning backbone, SkinGPT-R1 generates structured diagnostic reports comprising visual findings, differential reasoning, and final diagnosis. Across seven external datasets spanning diverse pathologies and imaging conditions, SkinGPT-R1 achieves state-of-the-art accuracy on six benchmarks, including 82.50\% on a challenging 40-class long-tail classification task (+19.30\% over leading baselines). Blinded evaluation by five board-certified dermatologists on 1,000 phenotypically balanced cases yields a mean score of 3.6 out of 5, with the highest ratings in safety (3.8) and reasoning coherence (3.6), indicating that the generated rationales are clinically safe, logically grounded, and suitable for supporting diagnostic decision-making. Critically, SkinGPT-R1 mitigates algorithmic bias across the full Fitzpatrick spectrum, achieving a robust worst-group performance of 41.40\% on the Fitz17k benchmark and a five-fold relative improvement in lower-bound accuracy on the DDI dataset compared to standard multimodal baselines. These results establish a framework for trustworthy, fair, and explainable AI-assisted dermatological diagnosis.

LLM-based autonomous agents have demonstrated strong capabilities in reasoning, planning, and tool use, yet remain limited when tasks require sustained coordination across roles, tools, and environments. Multi-agent systems address this through structured collaboration among specialized agents, but tighter coordination also amplifies a less explored risk: errors can propagate across agents and interaction rounds, producing failures that are difficult to diagnose and rarely translate into structural self-improvement. Existing surveys cover individual agent capabilities, multi-agent collaboration, or agent self-evolution separately, leaving the causal dependencies among them unexamined. This survey provides a unified review organized around four causally linked stages, which we term the LIFE progression: Lay the capability foundation, Integrate agents through collaboration, Find faults through attribution, and Evolve through autonomous self-improvement. For each stage, we provide systematic taxonomies and formally characterize the dependencies between adjacent stages, revealing how each stage both depends on and constrains the next. Beyond synthesizing existing work, we identify open challenges at stage boundaries and propose a cross-stage research agenda for closed-loop multi-agent systems capable of continuously diagnosing failures, reorganizing structures, and refining agent behaviors, extending current coordination frameworks toward more self-organizing forms of collective intelligence. By bridging these previously fragmented research threads, this survey aims to offer both a systematic reference and a conceptual roadmap toward autonomous, self-improving multi-agent intelligence.

The integration of large language model (LLM) and data management (DATA) is rapidly redefining both domains. In this survey, we comprehensively review the bidirectional relationships. On the one hand, DATA4LLM, spanning large-scale data processing, storage, and serving, feeds LLMs with high quality, diversity, and timeliness of data required for stages like pre-training, post-training, retrieval-augmented generation, and agentic workflows: (i) Data processing for LLMs includes scalable acquisition, deduplication, filtering, selection, domain mixing, and synthetic augmentation; (ii) Data Storage for LLMs focuses on efficient data and model formats, distributed and heterogeneous storage hierarchies, KV-cache management, and fault-tolerant checkpointing; (iii) Data serving for LLMs tackles challenges in RAG (e.g., knowledge post-processing), LLM inference (e.g., prompt compression, data provenance), and training strategies (e.g., data packing and shuffling). On the other hand, in LLM4DATA, LLMs are emerging as general-purpose engines for data management. We review recent advances in (i) data manipulation, including automatic data cleaning, integration, discovery; (ii) data analysis, covering reasoning over structured, semi-structured, and unstructured data, and (iii) system optimization (e.g., configuration tuning, query rewriting, anomaly diagnosis), powered by LLM techniques like retrieval-augmented prompting, task-specialized fine-tuning, and multi-agent collaboration.

The advent of Intelligent Tutoring Systems (ITSs) has marked a paradigm shift in education, enabling highly personalized learning pathways. However, true personalization requires adapting to learners' complex knowledge states (multi-source) and diverse goals (multi-sink); existing ITSs often lack the necessary structural-reasoning capability and knowledge dynamism to generate genuinely effective learning paths, and they lack scientifically rigorous validation paradigms. In this paper we propose GraphMASAL (A Graph-based Multi-Agent System for Adaptive Learning), which integrates (i) a dynamic knowledge graph for persistent, stateful learner modeling; (ii) a LangGraph-orchestrated trio of agents (Diagnostician, Planner, Tutor); (iii) a knowledge-graph-grounded two-stage neural IR component (dual-encoder dense retrieval with cross-encoder listwise re-ranking and calibrated score fusion); and (iv) a multi-source multi-sink (MSMS) planning engine with a cognitively grounded cost and an approximation guarantee via greedy set cover. Under blinded automated evaluations with matched inputs and inference settings across diverse student profiles, GraphMASAL consistently outperforms LLM prompting and structured ablations in planning--achieving stronger structural/sequence alignment of learning paths, higher coverage of weak concepts, and lower learning cost--while also surpassing prompt-based baselines in cognitive diagnosis. Agreement with expert/LLM-proxy ratings further supports the validity of our evaluation protocol. These findings indicate that grounding LLM agents in a dynamic knowledge graph, coupled with optimization under educational constraints, yields reliable, interpretable, and pedagogically plausible learning plans, advancing personalized and goal-oriented education.

A core challenge for faithful LLM role-playing is sustaining consistent characterization throughout long, open-ended dialogues, as models frequently fail to recall and accurately apply their designated persona knowledge without explicit cues. To tackle this, we propose the Memory-Driven Role-Playing paradigm. Inspired by Stanislavski's "emotional memory" acting theory, this paradigm frames persona knowledge as the LLM's internal memory store, requiring retrieval and application based solely on dialogue context, thereby providing a rigorous test of depth and autonomous use of knowledge. Centered on this paradigm, we contribute: (1) MREval, a fine-grained evaluation framework assessing four memory-driven abilities - Anchoring, Recalling, Bounding, and Enacting; (2) MRPrompt, a prompting architecture that guides structured memory retrieval and response generation; and (3) MRBench, a bilingual (Chinese/English) benchmark for fine-grained diagnosis. The novel paradigm provides a comprehensive diagnostic for four-staged role-playing abilities across 12 LLMs. Crucially, experiments show that MRPrompt allows small models (e.g., Qwen3-8B) to match the performance of much larger closed-source LLMs (e.g., Qwen3-Max and GLM-4.7), and confirms that upstream memory gains directly enhance downstream response quality, validating the staged theoretical foundation.

The safety of large language model (LLM) agents depends not only on model weights but also on the agent harness that manages context, memory, tools, permissions, and runtime control. Existing safety mechanisms often treat the harness as a fixed deployment artifact, limiting their ability to evolve with emerging risks. Moreover, coupled functions across harness components obscure safety responsibility attribution, making localized evolution difficult. We propose Safety Harness Evolution (SHE), a framework that learns evolving safe boundaries from rollout trajectories. SHE decomposes the harness into four artifacts with explicit safety responsibilities, including the System Prompt, Rule Bank, Safety Memory, and Tool Policy, defining clear functional boundaries for localized evolution. Based on this decomposition, SHE introduces an attribution-guided evolution loop that converts trajectory failures into structured diagnoses, learns artifact-specific boundary refinements, and selects evolved harnesses through safety-utility validation. Experiments on Agent-SafetyBench demonstrate that SHE effectively enhances safety through harness evolution, achieving a 3.1x ASR reduction compared with static SafeHarness, while also improving benign utility. The evolved harness further generalizes to unseen risks on the held-out AgentHarm benchmark and transfers across agent models without additional evolution.

Large language models (LLMs) show promise for clinical reasoning and decision support, but evaluation in realistic, electronic health record-congruent settings remains limited. Existing benchmarks often rely on static datasets or unstructured inputs that do not reflect the structured, interoperable data formats used in clinical systems. We introduce a pipeline for generating clinically realistic HL7 FHIR R4 bundles from unstructured text, enabling controllable evaluation of clinical decision support systems. The pipeline combines staged LLM generation with terminology-grounded validation and repair to reduce hallucinated codes and enforce structural and semantic consistency. Applying this approach to MedCaseReasoning, we construct MedCase-Structured, a synthetic dataset aligned with clinician-authored diagnostic cases, achieving valid FHIR generation for 82.5% of cases. Evaluation on MedCase-Structured reveals consistently lower diagnostic accuracy for LLMs on structured FHIR inputs than with plain text, highlighting the importance of deployment-aligned benchmarking.

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.

Image registration is fundamental in medical imaging, enabling precise alignment of anatomical structures for diagnosis, treatment planning, image-guided treatment or longitudinal monitoring. This work introduces IMPACT (Image Metric with Pretrained model-Agnostic Comparison for Transmodality registration), a generic semantic similarity metric designed for seamless integration into diverse image registration frameworks (such as Elastix and Voxelmorph). It compares deep learning-based features extracted from medical images without requiring task-specific training, ensuring broad applicability across various modalities. By leveraging the features of the large-scale pretrained TotalSegmentator models and the ability to integrate Segment Anything Model (SAM) and other large-scale segmentation networks, this approach offers significant advantages. It provides robust, scalable, and efficient solutions for multimodal image registration. The IMPACT loss was evaluated on five challenging registration tasks involving thoracic CT/CBCT, and pelvic MR/CT datasets. Quantitative metrics, such as Target Registration Error and Dice Similarity Coefficient, demonstrated significant improvements in anatomical alignment compared to baseline methods. Qualitative analyses further confirmed the increased robustness of the proposed metric in the face of noise, artifacts, and modality variations. IMPACT's versatility and efficiency make it a valuable tool for advancing registration performance in clinical and research applications, addressing critical challenges in multimodal medical imaging.

The deployment of embodied agents in self-driving laboratories could accelerate scientific discovery, yet their reliability is constrained by the irreversible and safety-critical nature of chemical experiments. Progress is further hindered by scarce failure data and the lack of fine-grained evaluation protocols. To address these challenges, we introduce LabRobFail, a failure-centric framework for learning and evaluating robotic failure analysis in chemical laboratories. LabRobFail-Sim injects controllable failures at the control, physics, and semantic levels, enabling the construction of LabRobFail-Data, which contains over 20,000 trajectories across 70+ task scenarios, five failure categories, and 11 fine-grained failure types. LabRobFail-Bench evaluates six capabilities spanning task understanding, failure detection, temporal localization, severity assessment, failure classification, and actionable correction. We further develop LabRobFail-VLM, a domain-specialized vision-language model that generates structured failure diagnoses and recovery instructions. On seen environments, it achieves 90.83% failure-detection accuracy and 77.21% temporal-localization accuracy, substantially outperforming general-purpose VLMs. When integrated as a real-time supervisor, it improves downstream task success rates by 4-16 percentage points, demonstrating the value of fine-grained failure understanding for closed-loop recovery and reliable laboratory autonomy. Our code and data are available at https://github.com/Su-ISE-2001/SciRobo

Clinical diagnosis is a highly specialized discipline requiring both domain expertise and strict adherence to rigorous guidelines. While current AI-driven medical research predominantly focuses on knowledge graphs or natural text pretraining paradigms to incorporate medical knowledge, these approaches primarily rely on implicitly encoded knowledge within model parameters, neglecting task-specific knowledge required by diverse downstream tasks. To address this limitation, we propose Retrieval-Augmented Diagnosis (RAD), a novel framework that explicitly injects external knowledge into multimodal models directly on downstream tasks. Specifically, RAD operates through three key mechanisms: retrieval and refinement of disease-centered knowledge from multiple medical sources, a guideline-enhanced contrastive loss that constrains the latent distance between multi-modal features and guideline knowledge, and the dual transformer decoder that employs guidelines as queries to steer cross-modal fusion, aligning the models with clinical diagnostic workflows from guideline acquisition to feature extraction and decision-making. Moreover, recognizing the lack of quantitative evaluation of interpretability for multimodal diagnostic models, we introduce a set of criteria to assess the interpretability from both image and text perspectives. Extensive evaluations across four datasets with different anatomies demonstrate RAD's generalizability, achieving state-of-the-art performance. Furthermore, RAD enables the model to concentrate more precisely on abnormal regions and critical indicators, ensuring evidence-based, trustworthy diagnosis. Our code is available at https://github.com/tdlhl/RAD.

Despite recent success in applying large language models (LLMs) to electronic health records (EHR), most systems focus primarily on assessment rather than treatment planning. We identify three critical limitations in current approaches: they generate treatment plans in a single pass rather than following the sequential reasoning process used by clinicians; they rarely incorporate patient-specific historical context; and they fail to effectively distinguish between subjective and objective clinical information. Motivated by the SOAP methodology (Subjective, Objective, Assessment, Plan), we introduce , a novel framework that structures LLM reasoning to align with real-life clinician workflows. Our approach employs a two-stage architecture that first generates a clinical assessment based on patient symptoms and objective data, then formulates a structured treatment plan informed by this assessment and enriched with patient-specific information through retrieval-augmented generation. Comprehensive evaluation demonstrates that our method significantly outperforms baseline approaches in both assessment accuracy and treatment plan quality.

The field of medical diagnosis has undergone a significant transformation with the advent of large language models (LLMs), yet the challenges of interpretability within these models remain largely unaddressed. This study introduces Chain-of-Diagnosis (CoD) to enhance the interpretability of LLM-based medical diagnostics. CoD transforms the diagnostic process into a diagnostic chain that mirrors a physician's thought process, providing a transparent reasoning pathway. Additionally, CoD outputs the disease confidence distribution to ensure transparency in decision-making. This interpretability makes model diagnostics controllable and aids in identifying critical symptoms for inquiry through the entropy reduction of confidences. With CoD, we developed DiagnosisGPT, capable of diagnosing 9604 diseases. Experimental results demonstrate that DiagnosisGPT outperforms other LLMs on diagnostic benchmarks. Moreover, DiagnosisGPT provides interpretability while ensuring controllability in diagnostic rigor.

Predicting disease trajectories from electronic health records (EHRs) is a complex task due to major challenges such as data non-stationarity, high granularity of medical codes, and integration of multimodal data. EHRs contain both structured data, such as diagnostic codes, and unstructured data, such as clinical notes, which hold essential information often overlooked. Current models, primarily based on structured data, struggle to capture the complete medical context of patients, resulting in a loss of valuable information. To address this issue, we propose an approach that integrates unstructured clinical notes into transformer-based deep learning models for sequential disease prediction. This integration enriches the representation of patients' medical histories, thereby improving the accuracy of diagnosis predictions. Experiments on MIMIC-IV datasets demonstrate that the proposed approach outperforms traditional models relying solely on structured data.

Diagnostic consultation is an online sequential decision-making process in which clinicians gather evidence through patient interaction until a diagnosis is sufficiently supported. Automating this process requires adaptive inquiry and interpretable decisions. Bayesian networks offer a natural foundation by updating diagnostic posteriors as evidence accumulates, but their use in open-ended consultation raises two challenges: linking diagnostic hypotheses to potential inquiries and translating evolving posteriors into consultation decisions. We introduce AutoDisym, an automated pipeline that integrates diagnostic knowledge with heterogeneous diagnosis-labeled clinical narratives to construct a Disorder--Symptom Bayesian Network (DSBN). Building on the DSBN, we propose ConsultMind, an uncertainty-aware framework that updates disorder posteriors after each response and uses posterior uncertainty to guide inquiry and diagnosis. We evaluate both methods across psychiatry, respiratory medicine, fever clinics, and three public datasets. The results show that AutoDisym can automatically construct high-quality DSBNs and that ConsultMind consistently improves diagnostic performance and explanation soundness. For example, AutoDisym achieves macro-averaged F1 scores of 81.37 for canonical symptoms and 72.19 for manifestations using GPT-5.6-Sol. ConsultMind improves Top-1 and Top-3 diagnostic accuracy by up to 22.15 and 37.89 percentage points, respectively. Physician evaluation further shows that ConsultMind improves the quality of ranking explanations, differential diagnoses, and diagnosis rationales across LLMs of different scales. This work offers a promising approach to automatic diagnostic consultation.

Learning to represent free text is a core task in many clinical machine learning (ML) applications, as clinical text contains observations and plans not otherwise available for inference. State-of-the-art methods use large language models developed with immense computational resources and training data; however, applying these models is challenging because of the highly varying syntax and vocabulary in clinical free text. Structured information such as International Classification of Disease (ICD) codes often succinctly abstracts the most important facts of a clinical encounter and yields good performance, but is often not as available as clinical text in real-world scenarios. We propose a multi-view learning framework that jointly learns from codes and text to combine the availability and forward-looking nature of text and better performance of ICD codes. The learned text embeddings can be used as inputs to predictive algorithms independent of the ICD codes during inference. Our approach uses a Graph Neural Network (GNN) to process ICD codes, and Bi-LSTM to process text. We apply Deep Canonical Correlation Analysis (DCCA) to enforce the two views to learn a similar representation of each patient. In experiments using planned surgical procedure text, our model outperforms BERT models fine-tuned to clinical data, and in experiments using diverse text in MIMIC-III, our model is competitive to a fine-tuned BERT at a tiny fraction of its computational effort.

Pathology vision-language models (VLMs) have shown strong visual perception ability, but their robustness in the language domain remains poorly characterized. Existing pathology VLM benchmarks largely rely on canonical closed-set prompts or perturb only generic templates, treating language as a fixed evaluation component rather than a variable axis of model behavior. In clinical practice, however, diagnostic language varies across reports, institutions, and candidate diagnoses. We introduce PathLang, a language-centered and clinically grounded zero-shot benchmark. PathLang holds the underlying slides, ground-truth labels, and image-text evaluation direction fixed while systematically varying only the diagnostic language, so that performance differences reflect how a diagnosis is phrased rather than what is imaged. The language variation follows how pathologists actually rephrase diagnoses (terminology, specificity, and reporting style), and all prompts and candidate pools are validated by six board-certified pathologists. PathLang covers four task families: (1) zero-shot classification with image-text alignment analysis, (2) cross-modal retrieval, (3) paraphrase robustness, including semantic-equivalence paraphrases, length and reporting-style variation, and prompt ensembling, and (4) open-vocabulary diagnosis retrieval over four candidate pools with distinct forms of semantic competition. Across nine VLMs and five public datasets spanning four organs, we find that performance is highly sensitive to clinically equivalent paraphrases, varies substantially across forms of semantic competition, and that image-text alignment quality does not necessarily translate into inter-class separability. We release the prompt corpus, candidate pools, pre-computed text embeddings, and evaluation code at https://anonymous.4open.science/r/PathLang.

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

The differential diagnosis of neurodegenerative dementias is a challenging clinical task, mainly because of the overlap in symptom presentation and the similarity of patterns observed in structural neuroimaging. To improve diagnostic efficiency and accuracy, deep learning-based methods such as Convolutional Neural Networks and Vision Transformers have been proposed for the automatic classification of brain MRIs. However, despite their strong predictive performance, these models find limited clinical utility due to their opaque decision making. In this work, we propose a framework that integrates two core components to enhance diagnostic transparency. First, we introduce a modular pipeline for converting 3D T1-weighted brain MRIs into textual radiology reports. Second, we explore the potential of modern Large Language Models (LLMs) to assist clinicians in the differential diagnosis between Frontotemporal dementia subtypes, Alzheimer's disease, and normal aging based on the generated reports. To bridge the gap between predictive accuracy and explainability, we employ reinforcement learning to incentivize diagnostic reasoning in LLMs. Without requiring supervised reasoning traces or distillation from larger models, our approach enables the emergence of structured diagnostic rationales grounded in neuroimaging findings. Unlike post-hoc explainability methods that retrospectively justify model decisions, our framework generates diagnostic rationales as part of the inference process-producing causally grounded explanations that inform and guide the model's decision-making process. In doing so, our framework matches the diagnostic performance of existing deep learning methods while offering rationales that support its diagnostic conclusions.

The complexity and variability inherent in high-resolution pathological images present significant challenges in computational pathology. While pathology foundation models leveraging AI have catalyzed transformative advancements, their development demands large-scale datasets, considerable storage capacity, and substantial computational resources. Furthermore, ensuring their clinical applicability and generalizability requires rigorous validation across a broad spectrum of clinical tasks. Here, we present PathOrchestra, a versatile pathology foundation model trained via self-supervised learning on a dataset comprising 300K pathological slides from 20 tissue and organ types across multiple centers. The model was rigorously evaluated on 112 clinical tasks using a combination of 61 private and 51 public datasets. These tasks encompass digital slide preprocessing, pan-cancer classification, lesion identification, multi-cancer subtype classification, biomarker assessment, gene expression prediction, and the generation of structured reports. PathOrchestra demonstrated exceptional performance across 27,755 WSIs and 9,415,729 ROIs, achieving over 0.950 accuracy in 47 tasks, including pan-cancer classification across various organs, lymphoma subtype diagnosis, and bladder cancer screening. Notably, it is the first model to generate structured reports for high-incidence colorectal cancer and diagnostically complex lymphoma-areas that are infrequently addressed by foundational models but hold immense clinical potential. Overall, PathOrchestra exemplifies the feasibility and efficacy of a large-scale, self-supervised pathology foundation model, validated across a broad range of clinical-grade tasks. Its high accuracy and reduced reliance on extensive data annotation underline its potential for clinical integration, offering a pathway toward more efficient and high-quality medical services.

Mental health disorders represent a burgeoning global public health challenge. While Large Language Models (LLMs) have demonstrated potential in psychiatric assessment, their clinical utility is severely constrained by benchmarks that lack ecological validity and fine-grained diagnostic supervision. To bridge this gap, we introduce MentalDx Bench, the first benchmark dedicated to disorder-level psychiatric diagnosis within real-world clinical settings. Comprising 712 de-identified electronic health records annotated by board-certified psychiatrists under ICD-11 guidelines, the benchmark covers 76 disorders across 16 diagnostic categories. Evaluation of 18 LLMs reveals a critical paradigm misalignment: strong performance at coarse diagnostic categorization contrasts with systematic failure at disorder-level diagnosis, underscoring a gap between pattern-based modeling and clinical hypothetico-deductive reasoning. In response, we propose MentalSeek-Dx, a medical-specialized LLM trained to internalize this clinical reasoning process through supervised trajectory construction and curriculum-based reinforcement learning. Experiments on MentalDx Bench demonstrate that MentalSeek-Dx achieves state-of-the-art (SOTA) performance with only 14B parameters, establishing a clinically grounded framework for reliable psychiatric diagnosis.

Recent progress in Large Vision-Language Models (LVLMs) has enabled promising applications in medical tasks, such as report generation and visual question answering. However, existing benchmarks focus mainly on the final diagnostic answer, offering limited insight into whether models engage in clinically meaningful reasoning. To address this, we present CheXStruct and CXReasonBench, a structured pipeline and benchmark built on the publicly available MIMIC-CXR-JPG dataset. CheXStruct automatically derives a sequence of intermediate reasoning steps directly from chest X-rays, such as segmenting anatomical regions, deriving anatomical landmarks and diagnostic measurements, computing diagnostic indices, and applying clinical thresholds. CXReasonBench leverages this pipeline to evaluate whether models can perform clinically valid reasoning steps and to what extent they can learn from structured guidance, enabling fine-grained and transparent assessment of diagnostic reasoning. The benchmark comprises 18,988 QA pairs across 12 diagnostic tasks and 1,200 cases, each paired with up to 4 visual inputs, and supports multi-path, multi-stage evaluation including visual grounding via anatomical region selection and diagnostic measurements. Even the strongest of 10 evaluated LVLMs struggle with structured reasoning and generalization, often failing to link abstract knowledge with anatomically grounded visual interpretation. The code is available at https://github.com/ttumyche/CXReasonBench

The current state of adoption of well-structured electronic health records and integration of digital methods for storing medical patient data in structured formats can often considered as inferior compared to the use of traditional, unstructured text based patient data documentation. Data mining in the field of medical data analysis often needs to rely solely on processing of unstructured data to retrieve relevant data. In natural language processing (NLP), statistical models have been shown successful in various tasks like part-of-speech tagging, relation extraction (RE) and named entity recognition (NER). In this work, we present GERNERMED, the first open, neural NLP model for NER tasks dedicated to detect medical entity types in German text data. Here, we avoid the conflicting goals of protection of sensitive patient data from training data extraction and the publication of the statistical model weights by training our model on a custom dataset that was translated from publicly available datasets in foreign language by a pretrained neural machine translation model. The sample code and the statistical model is available at: https://github.com/frankkramer-lab/GERNERMED

Often we wish to predict a large number of variables that depend on each other as well as on other observed variables. Structured prediction methods are essentially a combination of classification and graphical modeling, combining the ability of graphical models to compactly model multivariate data with the ability of classification methods to perform prediction using large sets of input features. This tutorial describes conditional random fields, a popular probabilistic method for structured prediction. CRFs have seen wide application in natural language processing, computer vision, and bioinformatics. We describe methods for inference and parameter estimation for CRFs, including practical issues for implementing large scale CRFs. We do not assume previous knowledge of graphical modeling, so this tutorial is intended to be useful to practitioners in a wide variety of fields.

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

There has been a rapidly growing interest in Automatic Symptom Detection (ASD) and Automatic Diagnosis (AD) systems in the machine learning research literature, aiming to assist doctors in telemedicine services. These systems are designed to interact with patients, collect evidence about their symptoms and relevant antecedents, and possibly make predictions about the underlying diseases. Doctors would review the interactions, including the evidence and the predictions, collect if necessary additional information from patients, before deciding on next steps. Despite recent progress in this area, an important piece of doctors' interactions with patients is missing in the design of these systems, namely the differential diagnosis. Its absence is largely due to the lack of datasets that include such information for models to train on. In this work, we present a large-scale synthetic dataset of roughly 1.3 million patients that includes a differential diagnosis, along with the ground truth pathology, symptoms and antecedents for each patient. Unlike existing datasets which only contain binary symptoms and antecedents, this dataset also contains categorical and multi-choice symptoms and antecedents useful for efficient data collection. Moreover, some symptoms are organized in a hierarchy, making it possible to design systems able to interact with patients in a logical way. As a proof-of-concept, we extend two existing AD and ASD systems to incorporate the differential diagnosis, and provide empirical evidence that using differentials as training signals is essential for the efficiency of such systems or for helping doctors better understand the reasoning of those systems.

Clinical information extraction, which involves structuring clinical concepts from unstructured medical text, remains a challenging problem that could benefit from the inclusion of tabular background information available in electronic health records. Existing open-source datasets lack explicit links between structured features and clinical concepts in the text, motivating the need for a new research dataset. We introduce SimSUM, a benchmark dataset of 10,000 simulated patient records that link unstructured clinical notes with structured background variables. Each record simulates a patient encounter in the domain of respiratory diseases and includes tabular data (e.g., symptoms, diagnoses, underlying conditions) generated from a Bayesian network whose structure and parameters are defined by domain experts. A large language model (GPT-4o) is prompted to generate a clinical note describing the encounter, including symptoms and relevant context. These notes are annotated with span-level symptom mentions. We conduct an expert evaluation to assess note quality and run baseline predictive models on both the tabular and textual data. The SimSUM dataset is primarily designed to support research on clinical information extraction in the presence of tabular background variables, which can be linked through domain knowledge to concepts of interest to be extracted from the text -- namely, symptoms in the case of SimSUM. Secondary uses include research on the automation of clinical reasoning over both tabular data and text, causal effect estimation in the presence of tabular and/or textual confounders, and multi-modal synthetic data generation. SimSUM is not intended for training clinical decision support systems or production-grade models, but rather to facilitate reproducible research in a simplified and controlled setting.

Automatic coding of International Classification of Diseases (ICD) is a multi-label text categorization task that involves extracting disease or procedure codes from clinical notes. Despite the application of state-of-the-art natural language processing (NLP) techniques, there are still challenges including limited availability of data due to privacy constraints and the high variability of clinical notes caused by different writing habits of medical professionals and various pathological features of patients. In this work, we investigate the semi-structured nature of clinical notes and propose an automatic algorithm to segment them into sections. To address the variability issues in existing ICD coding models with limited data, we introduce a contrastive pre-training approach on sections using a soft multi-label similarity metric based on tree edit distance. Additionally, we design a masked section training strategy to enable ICD coding models to locate sections related to ICD codes. Extensive experimental results demonstrate that our proposed training strategies effectively enhance the performance of existing ICD coding methods.

Automated radiology report generation from chest X-ray (CXR) images has the potential to improve clinical efficiency and reduce radiologists' workload. However, most datasets, including the publicly available MIMIC-CXR and CheXpert Plus, consist entirely of free-form reports, which are inherently variable and unstructured. This variability poses challenges for both generation and evaluation: existing models struggle to produce consistent, clinically meaningful reports, and standard evaluation metrics fail to capture the nuances of radiological interpretation. To address this, we introduce Structured Radiology Report Generation (SRRG), a new task that reformulates free-text radiology reports into a standardized format, ensuring clarity, consistency, and structured clinical reporting. We create a novel dataset by restructuring reports using large language models (LLMs) following strict structured reporting desiderata. Additionally, we introduce SRR-BERT, a fine-grained disease classification model trained on 55 labels, enabling more precise and clinically informed evaluation of structured reports. To assess report quality, we propose F1-SRR-BERT, a metric that leverages SRR-BERT's hierarchical disease taxonomy to bridge the gap between free-text variability and structured clinical reporting. We validate our dataset through a reader study conducted by five board-certified radiologists and extensive benchmarking experiments.

Developing reliable AI systems to assist human clinicians in multi-modal medical diagnosis has long been a key objective for researchers. Recently, Multi-modal Large Language Models (MLLMs) have gained significant attention and achieved success across various domains. With strong reasoning capabilities and the ability to perform diverse tasks based on user instructions, they hold great potential for enhancing medical diagnosis. However, directly applying MLLMs to the medical domain still presents challenges. They lack detailed perception of visual inputs, limiting their ability to perform quantitative image analysis, which is crucial for medical diagnostics. Additionally, MLLMs often exhibit hallucinations and inconsistencies in reasoning, whereas clinical diagnoses must adhere strictly to established criteria. To address these challenges, we propose MedAgent-Pro, an evidence-based reasoning agentic system designed to achieve reliable, explainable, and precise medical diagnoses. This is accomplished through a hierarchical workflow: at the task level, knowledge-based reasoning generate reliable diagnostic plans for specific diseases following retrieved clinical criteria. While at the case level, multiple tool agents process multi-modal inputs, analyze different indicators according to the plan, and provide a final diagnosis based on both quantitative and qualitative evidence. Comprehensive experiments on both 2D and 3D medical diagnosis tasks demonstrate the superiority and effectiveness of MedAgent-Pro, while case studies further highlight its reliability and interpretability. The code is available at https://github.com/jinlab-imvr/MedAgent-Pro.

Speech patterns have been identified as potential diagnostic markers for neuropsychiatric conditions. However, most studies only compare a single clinical group to healthy controls, whereas clinical practice often requires differentiating between multiple potential diagnoses (multiclass settings). To address this, we assembled a dataset of repeated recordings from 420 participants (67 with major depressive disorder, 106 with schizophrenia and 46 with autism, as well as matched controls), and tested the performance of a range of conventional machine learning models and advanced Transformer models on both binary and multiclass classification, based on voice and text features. While binary models performed comparably to previous research (F1 scores between 0.54-0.75 for autism spectrum disorder, ASD; 0.67-0.92 for major depressive disorder, MDD; and 0.71-0.83 for schizophrenia); when differentiating between multiple diagnostic groups performance decreased markedly (F1 scores between 0.35-0.44 for ASD, 0.57-0.75 for MDD, 0.15-0.66 for schizophrenia, and 0.38-0.52 macro F1). Combining voice and text-based models yielded increased performance, suggesting that they capture complementary diagnostic information. Our results indicate that models trained on binary classification may learn to rely on markers of generic differences between clinical and non-clinical populations, or markers of clinical features that overlap across conditions, rather than identifying markers specific to individual conditions. We provide recommendations for future research in the field, suggesting increased focus on developing larger transdiagnostic datasets that include more fine-grained clinical features, and that can support the development of models that better capture the complexity of neuropsychiatric conditions and naturalistic diagnostic assessment.

Integrating Large Language Models (LLMs) in healthcare diagnosis demands systematic frameworks that can handle complex medical scenarios while maintaining specialized expertise. We present KG4Diagnosis, a novel hierarchical multi-agent framework that combines LLMs with automated knowledge graph construction, encompassing 362 common diseases across medical specialties. Our framework mirrors real-world medical systems through a two-tier architecture: a general practitioner (GP) agent for initial assessment and triage, coordinating with specialized agents for in-depth diagnosis in specific domains. The core innovation lies in our end-to-end knowledge graph generation methodology, incorporating: (1) semantic-driven entity and relation extraction optimized for medical terminology, (2) multi-dimensional decision relationship reconstruction from unstructured medical texts, and (3) human-guided reasoning for knowledge expansion. KG4Diagnosis serves as an extensible foundation for specialized medical diagnosis systems, with capabilities to incorporate new diseases and medical knowledge. The framework's modular design enables seamless integration of domain-specific enhancements, making it valuable for developing targeted medical diagnosis systems. We provide architectural guidelines and protocols to facilitate adoption across medical contexts.

Metadata are general characteristics of the data in a well-curated and condensed format, and have been proven to be useful for decision making, knowledge discovery, and also heterogeneous data organization of biobank. Among all data types in the biobank, pathology is the key component of the biobank and also serves as the gold standard of diagnosis. To maximize the utility of biobank and allow the rapid progress of biomedical science, it is essential to organize the data with well-populated pathology metadata. However, manual annotation of such information is tedious and time-consuming. In the study, we develop a multimodal multitask learning framework to predict four major slide-level metadata of pathology images. The framework learns generalizable representations across tissue slides, pathology reports, and case-level structured data. We demonstrate improved performance across all four tasks with the proposed method compared to a single modal single task baseline on two test sets, one external test set from a distinct data source (TCGA) and one internal held-out test set (TTH). In the test sets, the performance improvements on the averaged area under receiver operating characteristic curve across the four tasks are 16.48% and 9.05% on TCGA and TTH, respectively. Such pathology metadata prediction system may be adopted to mitigate the effort of expert annotation and ultimately accelerate the data-driven research by better utilization of the pathology biobank.

Existing models based on artificial neural networks (ANNs) for sentence classification often do not incorporate the context in which sentences appear, and classify sentences individually. However, traditional sentence classification approaches have been shown to greatly benefit from jointly classifying subsequent sentences, such as with conditional random fields. In this work, we present an ANN architecture that combines the effectiveness of typical ANN models to classify sentences in isolation, with the strength of structured prediction. Our model achieves state-of-the-art results on two different datasets for sequential sentence classification in medical abstracts.

Background: Electronic Health Records hold detailed longitudinal information about each patient's health status and general clinical history, a large portion of which is stored within the unstructured text. Existing approaches focus mostly on structured data and a subset of single-domain outcomes. We explore how temporal modelling of patients from free text and structured data, using deep generative transformers can be used to forecast a wide range of future disorders, substances, procedures or findings. Methods: We present Foresight, a novel transformer-based pipeline that uses named entity recognition and linking tools to convert document text into structured, coded concepts, followed by providing probabilistic forecasts for future medical events such as disorders, substances, procedures and findings. We processed the entire free-text portion from three different hospital datasets totalling 811336 patients covering both physical and mental health. Findings: On tests in two UK hospitals (King's College Hospital, South London and Maudsley) and the US MIMIC-III dataset precision@10 0.68, 0.76 and 0.88 was achieved for forecasting the next disorder in a patient timeline, while precision@10 of 0.80, 0.81 and 0.91 was achieved for forecasting the next biomedical concept. Foresight was also validated on 34 synthetic patient timelines by five clinicians and achieved relevancy of 97% for the top forecasted candidate disorder. As a generative model, it can forecast follow-on biomedical concepts for as many steps as required. Interpretation: Foresight is a general-purpose model for biomedical concept modelling that can be used for real-world risk forecasting, virtual trials and clinical research to study the progression of disorders, simulate interventions and counterfactuals, and educational purposes.

Automatic disease diagnosis has become increasingly valuable in clinical practice. The advent of large language models (LLMs) has catalyzed a paradigm shift in artificial intelligence, with growing evidence supporting the efficacy of LLMs in diagnostic tasks. Despite the increasing attention in this field, a holistic view is still lacking. Many critical aspects remain unclear, such as the diseases and clinical data to which LLMs have been applied, the LLM techniques employed, and the evaluation methods used. In this article, we perform a comprehensive review of LLM-based methods for disease diagnosis. Our review examines the existing literature across various dimensions, including disease types and associated clinical specialties, clinical data, LLM techniques, and evaluation methods. Additionally, we offer recommendations for applying and evaluating LLMs for diagnostic tasks. Furthermore, we assess the limitations of current research and discuss future directions. To our knowledge, this is the first comprehensive review for LLM-based disease diagnosis.

The successes of foundation models such as ChatGPT and AlphaFold have spurred significant interest in building similar models for electronic medical records (EMRs) to improve patient care and hospital operations. However, recent hype has obscured critical gaps in our understanding of these models' capabilities. We review over 80 foundation models trained on non-imaging EMR data (i.e. clinical text and/or structured data) and create a taxonomy delineating their architectures, training data, and potential use cases. We find that most models are trained on small, narrowly-scoped clinical datasets (e.g. MIMIC-III) or broad, public biomedical corpora (e.g. PubMed) and are evaluated on tasks that do not provide meaningful insights on their usefulness to health systems. In light of these findings, we propose an improved evaluation framework for measuring the benefits of clinical foundation models that is more closely grounded to metrics that matter in healthcare.

Claims made by individuals or entities are oftentimes nuanced and cannot be clearly labeled as entirely "true" or "false" -- as is frequently the case with scientific and political claims. However, a claim (e.g., "vaccine A is better than vaccine B") can be dissected into its integral aspects and sub-aspects (e.g., efficacy, safety, distribution), which are individually easier to validate. This enables a more comprehensive, structured response that provides a well-rounded perspective on a given problem while also allowing the reader to prioritize specific angles of interest within the claim (e.g., safety towards children). Thus, we propose ClaimSpect, a retrieval-augmented generation-based framework for automatically constructing a hierarchy of aspects typically considered when addressing a claim and enriching them with corpus-specific perspectives. This structure hierarchically partitions an input corpus to retrieve relevant segments, which assist in discovering new sub-aspects. Moreover, these segments enable the discovery of varying perspectives towards an aspect of the claim (e.g., support, neutral, or oppose) and their respective prevalence (e.g., "how many biomedical papers believe vaccine A is more transportable than B?"). We apply ClaimSpect to a wide variety of real-world scientific and political claims featured in our constructed dataset, showcasing its robustness and accuracy in deconstructing a nuanced claim and representing perspectives within a corpus. Through real-world case studies and human evaluation, we validate its effectiveness over multiple baselines.

Linking clinical narratives to standardized vocabularies and coding systems is a key component of unlocking the information in medical text for analysis. However, many domains of medical concepts lack well-developed terminologies that can support effective coding of medical text. We present a framework for developing natural language processing (NLP) technologies for automated coding of under-studied types of medical information, and demonstrate its applicability via a case study on physical mobility function. Mobility is a component of many health measures, from post-acute care and surgical outcomes to chronic frailty and disability, and is coded in the International Classification of Functioning, Disability, and Health (ICF). However, mobility and other types of functional activity remain under-studied in medical informatics, and neither the ICF nor commonly-used medical terminologies capture functional status terminology in practice. We investigated two data-driven paradigms, classification and candidate selection, to link narrative observations of mobility to standardized ICF codes, using a dataset of clinical narratives from physical therapy encounters. Recent advances in language modeling and word embedding were used as features for established machine learning models and a novel deep learning approach, achieving a macro F-1 score of 84% on linking mobility activity reports to ICF codes. Both classification and candidate selection approaches present distinct strengths for automated coding in under-studied domains, and we highlight that the combination of (i) a small annotated data set; (ii) expert definitions of codes of interest; and (iii) a representative text corpus is sufficient to produce high-performing automated coding systems. This study has implications for the ongoing growth of NLP tools for a variety of specialized applications in clinical care and research.

Rare diseases affect hundreds of millions worldwide, yet diagnosis often spans years. Convectional pipelines decouple noisy evidence extraction from downstream inferential diagnosis, and general/medical large language models (LLMs) face scarce real world electronic health records (EHRs), stale domain knowledge, and hallucinations. We assemble a large, domain specialized clinical corpus and a clinician validated reasoning set, and develop RareSeek R1 via staged instruction tuning, chain of thought learning, and graph grounded retrieval. Across multicenter EHR narratives and public benchmarks, RareSeek R1 attains state of the art accuracy, robust generalization, and stability under noisy or overlapping phenotypes. Augmented retrieval yields the largest gains when narratives pair with prioritized variants by resolving ambiguity and aligning candidates to mechanisms. Human studies show performance on par with experienced physicians and consistent gains in assistive use. Notably, transparent reasoning highlights decisive non phenotypic evidence (median 23.1%, such as imaging, interventions, functional tests) underpinning many correct diagnoses. This work advances a narrative first, knowledge integrated reasoning paradigm that shortens the diagnostic odyssey and enables auditable, clinically translatable decision support.

International Classification of Diseases (ICD) coding assigns diagnosis codes to clinical documents and is essential for healthcare billing and clinical analysis. Reliable coding requires that each predicted code be supported by explicit textual evidence. However, existing public datasets provide only code labels, without evidence annotations, limiting models' ability to learn evidence-grounded predictions. In this work, we argue that dense, document-level evidence annotation is not always necessary for learning evidence-based coding. Instead, models can learn code-specific evidence patterns from local spans and use these patterns to support document-level evidence-based coding. Based on this insight, we propose Span-Centric Learning (SCL), a training framework that strengthens LLMs' coding ability at the span level and transfers this capability to full clinical documents. Specifically, we use a small set of annotated documents to supervise evidence recognition, aggregation, and code assignment, while leveraging a large collection of lightweight evidence spans to reinforce span-level reasoning. Due to their compactness, span annotations are scalable and can be further augmented through synthesis. Under the same Llama3.1-8B backbone, our approach achieves an 8.2-point improvement in macro-F1 at only 20% of the training cost of standard SFT, and provides explicit supporting evidence for each predicted code, enabling human auditing and revision.

Medical imaging is critical to the diagnosis and treatment of numerous medical problems, including many forms of cancer. Medical imaging reports distill the findings and observations of radiologists, creating an unstructured textual representation of unstructured medical images. Large-scale use of this text-encoded information requires converting the unstructured text to a structured, semantic representation. We explore the extraction and normalization of anatomical information in radiology reports that is associated with radiological findings. We investigate this extraction and normalization task using a span-based relation extraction model that jointly extracts entities and relations using BERT. This work examines the factors that influence extraction and normalization performance, including the body part/organ system, frequency of occurrence, span length, and span diversity. It discusses approaches for improving performance and creating high-quality semantic representations of radiological phenomena.

Despite the power of Large Language Models (LLMs) like GPT-4, they still struggle with tasks that require generating complex, structured outputs. In this study, we assess the capability of Current LLMs in generating complex structured data and propose a structure-aware fine-tuning approach as a solution to improve this ability. To perform a comprehensive evaluation, we propose Struc-Bench, include five representative LLMs (i.e., GPT-NeoX 20B, GPT-3.5, GPT-4, and Vicuna) and evaluate them on our carefully constructed datasets spanning raw text, HTML, and LaTeX tables. Based on our analysis of current model performance, we identify specific common formatting errors and areas of potential improvement. To address complex formatting requirements, we utilize FormatCoT (Chain-of-Thought) to generate format instructions from target outputs. Our experiments show that our structure-aware fine-tuning method, when applied to LLaMA-7B, significantly improves adherence to natural language constraints, outperforming other evaluated LLMs. Based on these results, we present an ability map of model capabilities from six dimensions (i.e., coverage, formatting, reasoning, comprehension, pragmatics, and hallucination). This map highlights the weaknesses of LLMs in handling complex structured outputs and suggests promising directions for future work. Our code and models can be found at https://github.com/gersteinlab/Struc-Bench.

Rare diseases, including Inborn Errors of Metabolism (IEM), pose significant diagnostic challenges. Case reports serve as key but computationally underutilized resources to inform diagnosis. Clinical dense information extraction refers to organizing medical information into structured predefined categories. Large Language Models (LLMs) may enable scalable information extraction from case reports but are rarely evaluated for this task. We introduce CaseReportBench, an expert-annotated dataset for dense information extraction of case reports, focusing on IEMs. Using this dataset, we assess various models and prompting strategies, introducing novel approaches such as category-specific prompting and subheading-filtered data integration. Zero-shot chain-of-thought prompting offers little advantage over standard zero-shot prompting. Category-specific prompting improves alignment with the benchmark. The open-source model Qwen2.5-7B outperforms GPT-4o for this task. Our clinician evaluations show that LLMs can extract clinically relevant details from case reports, supporting rare disease diagnosis and management. We also highlight areas for improvement, such as LLMs' limitations in recognizing negative findings important for differential diagnosis. This work advances LLM-driven clinical natural language processing and paves the way for scalable medical AI applications.

Mental health is a significant and growing public health concern. As language usage can be leveraged to obtain crucial insights into mental health conditions, there is a need for large-scale, labeled, mental health-related datasets of users who have been diagnosed with one or more of such conditions. In this paper, we investigate the creation of high-precision patterns to identify self-reported diagnoses of nine different mental health conditions, and obtain high-quality labeled data without the need for manual labelling. We introduce the SMHD (Self-reported Mental Health Diagnoses) dataset and make it available. SMHD is a novel large dataset of social media posts from users with one or multiple mental health conditions along with matched control users. We examine distinctions in users' language, as measured by linguistic and psychological variables. We further explore text classification methods to identify individuals with mental conditions through their language.

Pathological diagnosis remains the definitive standard for identifying tumors. The rise of multimodal large models has simplified the process of integrating image analysis with textual descriptions. Despite this advancement, the substantial costs associated with training and deploying these complex multimodal models, together with a scarcity of high-quality training datasets, create a significant divide between cutting-edge technology and its application in the clinical setting. We had meticulously compiled a dataset of approximately 45,000 cases, covering over 6 different tasks, including the classification of organ tissues, generating pathology report descriptions, and addressing pathology-related questions and answers. We have fine-tuned multimodal large models, specifically LLaVA, Qwen-VL, InternLM, with this dataset to enhance instruction-based performance. We conducted a qualitative assessment of the capabilities of the base model and the fine-tuned model in performing image captioning and classification tasks on the specific dataset. The evaluation results demonstrate that the fine-tuned model exhibits proficiency in addressing typical pathological questions. We hope that by making both our models and datasets publicly available, they can be valuable to the medical and research communities.

Agent skills extend language-model agents with task-specific procedures, scripts, and references, but the tasks and environments they target continually change. Existing methods improve skills in bounded runs and retain only the final artifact, discarding the decision history that later agents need to interpret prior revisions, evaluations, and rejected alternatives. We introduce SkillHone, a harness for continual agent skill evolution grounded in persistent decision history. SkillHone pairs skill revisions with evaluation-side evidence that supplies practice feedback, recording structured histories of diagnoses, revisions, evidence, and outcomes. Role-separated subagents run candidate skills on practice probes with redacted reporting and propose revisions informed by prior decisions, enabling cross-session refinement without rediscovering past rationale. On deep-research benchmarks, SkillHone runs without a pre-integrated search stack and outperforms the commercially backed deep-research agent by 15.8 points on GAIA and 3.2 points on WebWalkerQA-EN, while also exceeding prior skill-evolution methods. We further deploy SkillHone on internal tool-mediated analysis scenarios, where it improves accuracy by an average of 18.8 points across seven settings.

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

Clinical notes contain information about patients that goes beyond structured data like lab values and medications. However, clinical notes have been underused relative to structured data, because notes are high-dimensional and sparse. This work develops and evaluates representations of clinical notes using bidirectional transformers (ClinicalBERT). ClinicalBERT uncovers high-quality relationships between medical concepts as judged by humans. ClinicalBert outperforms baselines on 30-day hospital readmission prediction using both discharge summaries and the first few days of notes in the intensive care unit. Code and model parameters are available.

The scientific literature's exponential growth makes it increasingly challenging to navigate and synthesize knowledge across disciplines. Large language models (LLMs) are powerful tools for understanding scientific text, but they fail to capture detailed relationships across large bodies of work. Unstructured approaches, like retrieval augmented generation, can sift through such corpora to recall relevant facts; however, when millions of facts influence the answer, unstructured approaches become cost prohibitive. Structured representations offer a natural complement -- enabling systematic analysis across the whole corpus. Recent work enhances LLMs with unstructured or semistructured representations of scientific concepts; to complement this, we try extracting structured representations using LLMs. By combining LLMs' semantic understanding with a schema of scientific concepts, we prototype a system that answers precise questions about the literature as a whole. Our schema applies across scientific fields and we extract concepts from it using only 20 manually annotated abstracts. To demonstrate the system, we extract concepts from 30,000 papers on arXiv spanning astrophysics, fluid dynamics, and evolutionary biology. The resulting database highlights emerging trends and, by visualizing the knowledge graph, offers new ways to explore the ever-growing landscape of scientific knowledge. Demo: abby101/surveyor-0 on HF Spaces. Code: https://github.com/chiral-carbon/kg-for-science.

Chain-of-thought (CoT) reasoning has advanced medical visual question answering (VQA), yet most existing CoT rationales are free-form and fail to capture the structured reasoning process clinicians actually follow. This work asks: Can traceable, multi-step reasoning supervision improve reasoning accuracy and the interpretability of Medical VQA? To this end, we introduce Step-CoT, a large-scale medical reasoning dataset with expert-curated, structured multi-step CoT aligned to clinical diagnostic workflows, implicitly grounding the model's reasoning in radiographic evidence. Step-CoT comprises more than 10K real clinical cases and 70K VQA pairs organized around diagnostic workflows, providing supervised intermediate steps that guide models to follow valid reasoning trajectories. To effectively learn from Step-CoT, we further introduce a teacher-student framework with a dynamic graph-structured focusing mechanism that prioritizes diagnostically informative steps while filtering out less relevant contexts. Our experiments show that using Step-CoT can improve reasoning accuracy and interpretability. Benchmark: github.com/hahaha111111/Step-CoT. Dataset Card: huggingface.co/datasets/fl-15o/Step-CoT

The emergence of groundbreaking large language models capable of performing complex reasoning tasks holds significant promise for addressing various scientific challenges, including those arising in complex clinical scenarios. To enable their safe and effective deployment in real-world healthcare settings, it is urgently necessary to benchmark the diagnostic capabilities of current models systematically. Given the limitations of existing medical benchmarks in evaluating advanced diagnostic reasoning, we present DiagnosisArena, a comprehensive and challenging benchmark designed to rigorously assess professional-level diagnostic competence. DiagnosisArena consists of 1,113 pairs of segmented patient cases and corresponding diagnoses, spanning 28 medical specialties, deriving from clinical case reports published in 10 top-tier medical journals. The benchmark is developed through a meticulous construction pipeline, involving multiple rounds of screening and review by both AI systems and human experts, with thorough checks conducted to prevent data leakage. Our study reveals that even the most advanced reasoning models, o3-mini, o1, and DeepSeek-R1, achieve only 45.82%, 31.09%, and 17.79% accuracy, respectively. This finding highlights a significant generalization bottleneck in current large language models when faced with clinical diagnostic reasoning challenges. Through DiagnosisArena, we aim to drive further advancements in AIs diagnostic reasoning capabilities, enabling more effective solutions for real-world clinical diagnostic challenges. We provide the benchmark and evaluation tools for further research and development https://github.com/SPIRAL-MED/DiagnosisArena.

Unstructured clinical notes contain essential patient information but are challenging for physicians to search and interpret efficiently. Although large language models (LLMs) have shown promise in question answering (QA), most existing systems lack transparency, usability, and alignment with clinical workflows. This work introduces an interactive QA system that enables physicians to query clinical notes via text or voice and receive extractive answers highlighted directly in the note for traceability. The system was built using OpenAI models with zero-shot prompting and evaluated across multiple metrics, including exact string match, word overlap, SentenceTransformer similarity, and BERTScore. Results show that while exact match scores ranged from 47 to 62 percent, semantic similarity scores exceeded 87 percent, indicating strong contextual alignment even when wording varied. To assess usability, the system was also evaluated using simulated clinical personas. Seven diverse physician and nurse personas interacted with the system across scenario-based tasks and provided structured feedback. The evaluations highlighted strengths in intuitive design and answer accessibility, alongside opportunities for enhancing explanation clarity.

The rapid advancement of large-scale vision-language models has showcased remarkable capabilities across various tasks. However, the lack of extensive and high-quality image-text data in medicine has greatly hindered the development of large-scale medical vision-language models. In this work, we present a diagnosis-guided bootstrapping strategy that exploits both image and label information to construct vision-language datasets. Based on the constructed dataset, we developed MedDr, a generalist foundation model for healthcare capable of handling diverse medical data modalities, including radiology, pathology, dermatology, retinography, and endoscopy. Moreover, during inference, we propose a simple but effective retrieval-augmented medical diagnosis strategy, which enhances the model's generalization ability. Extensive experiments on visual question answering, medical report generation, and medical image diagnosis demonstrate the superiority of our method.

Medical report interpretation plays a crucial role in healthcare, enabling both patient-facing explanations and effective information flow across clinical systems. While recent vision-language models (VLMs) and large language models (LLMs) have demonstrated general document understanding capabilities, there remains a lack of standardized benchmarks to assess structured interpretation quality in medical reports. We introduce MedRepBench, a comprehensive benchmark built from 1,900 de-identified real-world Chinese medical reports spanning diverse departments, patient demographics, and acquisition formats. The benchmark is designed primarily to evaluate end-to-end VLMs for structured medical report understanding. To enable controlled comparisons, we also include a text-only evaluation setting using high-quality OCR outputs combined with LLMs, allowing us to estimate the upper-bound performance when character recognition errors are minimized. Our evaluation framework supports two complementary protocols: (1) an objective evaluation measuring field-level recall of structured clinical items, and (2) an automated subjective evaluation using a powerful LLM as a scoring agent to assess factuality, interpretability, and reasoning quality. Based on the objective metric, we further design a reward function and apply Group Relative Policy Optimization (GRPO) to improve a mid-scale VLM, achieving up to 6% recall gain. We also observe that the OCR+LLM pipeline, despite strong performance, suffers from layout-blindness and latency issues, motivating further progress toward robust, fully vision-based report understanding.

Traditionally, AI research in medical diagnosis has largely centered on image analysis. While this has led to notable advancements, the absence of patient-reported symptoms continues to hinder diagnostic accuracy. To address this, we propose a Pre-Consultation Dialogue Framework (PCDF) that mimics real-world diagnostic procedures, where doctors iteratively query patients before reaching a conclusion. Specifically, we simulate diagnostic dialogues between two vision-language models (VLMs): a DocVLM, which generates follow-up questions based on the image and dialogue history, and a PatientVLM, which responds using a symptom profile derived from the ground-truth diagnosis. We additionally conducted a small-scale clinical validation of the synthetic symptoms generated by our framework, with licensed clinicians confirming their clinical relevance, symptom coverage, and overall realism. These findings indicate that the resulting DocVLM-PatientVLM interactions form coherent, multi-turn consultations paired with images and diagnoses, which we then use to fine-tune the DocVLM. This dialogue-based supervision leads to substantial gains over image-only training, highlighting the value of realistic symptom elicitation for diagnosis.

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.

Electronic Health Records (EHRs) hold immense potential for advancing healthcare, offering rich, longitudinal data that combines structured information with valuable insights from unstructured clinical notes. However, the unstructured nature of clinical text poses significant challenges for secondary applications. Traditional methods for structuring EHR free-text data, such as rule-based systems and multi-stage pipelines, are often limited by their time-consuming configurations and inability to adapt across clinical notes from diverse healthcare settings. Few systems provide a comprehensive attribute extraction for terminologies. While giant large language models (LLMs) like GPT-4 and LLaMA 405B excel at structuring tasks, they are slow, costly, and impractical for large-scale use. To overcome these limitations, we introduce GENIE, a Generative Note Information Extraction system that leverages LLMs to streamline the structuring of unstructured clinical text into usable data with standardized format. GENIE processes entire paragraphs in a single pass, extracting entities, assertion statuses, locations, modifiers, values, and purposes with high accuracy. Its unified, end-to-end approach simplifies workflows, reduces errors, and eliminates the need for extensive manual intervention. Using a robust data preparation pipeline and fine-tuned small scale LLMs, GENIE achieves competitive performance across multiple information extraction tasks, outperforming traditional tools like cTAKES and MetaMap and can handle extra attributes to be extracted. GENIE strongly enhances real-world applicability and scalability in healthcare systems. By open-sourcing the model and test data, we aim to encourage collaboration and drive further advancements in EHR structurization.

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.

The use of deep neural models for diagnosis prediction from clinical text has shown promising results. However, in clinical practice such models must not only be accurate, but provide doctors with interpretable and helpful results. We introduce ProtoPatient, a novel method based on prototypical networks and label-wise attention with both of these abilities. ProtoPatient makes predictions based on parts of the text that are similar to prototypical patients - providing justifications that doctors understand. We evaluate the model on two publicly available clinical datasets and show that it outperforms existing baselines. Quantitative and qualitative evaluations with medical doctors further demonstrate that the model provides valuable explanations for clinical decision support.

We introduce MentalBench, a benchmark for evaluating psychiatric diagnostic decision-making in large language models (LLMs). Existing mental health benchmarks largely rely on social media data, limiting their ability to assess DSM-grounded diagnostic judgments. At the core of MentalBench is MentalKG, a psychiatrist-built and validated knowledge graph encoding DSM-5 diagnostic criteria and differential diagnostic rules for 23 psychiatric disorders. Using MentalKG as a golden-standard logical backbone, we generate 24,750 synthetic clinical cases that systematically vary in information completeness and diagnostic complexity, enabling low-noise and interpretable evaluation. Our experiments show that while state-of-the-art LLMs perform well on structured queries probing DSM-5 knowledge, they struggle to calibrate confidence in diagnostic decision-making when distinguishing between clinically overlapping disorders. These findings reveal evaluation gaps not captured by existing benchmarks.