Daily Papers

Autonomous agentic systems are largely static after deployment: they do not learn from user interactions, and recurring failures persist until the next human-driven update ships a fix. Self-evolving agents have emerged in response, but all confine evolution to text-mutable artifacts -- skill files, prompt configurations, memory schemas, workflow graphs -- and leave the agent harness untouched. Since routing, hook ordering, state invariants, and dispatch live in code rather than in any text artifact, an entire class of structural failure is physically unreachable from the text layer. We argue that source-level adaptation is a fundamentally more general medium: it is Turing-complete, a strict superset of every text-mutable scope, takes effect deterministically rather than through base-model compliance, and does not erode under long-context drift. We present MOSS, a system that performs self-rewriting at the source level on production agentic substrates. Each evolution is anchored to an automatically curated batch of production-failure evidence and proceeds through a deterministic multi-stage pipeline; code modification is delegated to a pluggable external coding-agent CLI while MOSS retains stage ordering and verdicts. Candidates are verified by replaying the batch against the candidate image in ephemeral trial workers, then promoted via user-consent-gated, in-place container swap with health-probe-gated rollback. On OpenClaw, MOSS lifts a four-task mean grader score from 0.25 to 0.61 in a single cycle without human intervention.

Accurate remaining useful life (RUL) prediction hinges on the quality of health indicators (HIs), yet existing methods often fail to disentangle complex degradation mechanisms in multi-sensor systems or quantify uncertainty in HI reliability. This paper introduces a novel framework for HI construction, advancing three key contributions. First, we adapt Reconstruction along Projected Pathways (RaPP) as a health indicator (HI) for RUL prediction for the first time, showing that it outperforms traditional reconstruction error metrics. Second, we show that augmenting RaPP-derived HIs with aleatoric and epistemic uncertainty quantification (UQ) via Monte Carlo dropout and probabilistic latent spaces- significantly improves RUL-prediction robustness. Third, and most critically, we propose indicator groups, a paradigm that isolates sensor subsets to model system-specific degradations, giving rise to our novel method, I-GLIDE which enables interpretable, mechanism-specific diagnostics. Evaluated on data sourced from aerospace and manufacturing systems, our approach achieves marked improvements in accuracy and generalizability compared to state-of-the-art HI methods while providing actionable insights into system failure pathways. This work bridges the gap between anomaly detection and prognostics, offering a principled framework for uncertainty-aware degradation modeling in complex systems.

Reinforcement Learning from Verifiable Rewards (RLVR) has emerged as a powerful paradigm for enhancing the complex reasoning capabilities of Large Reasoning Models. However, standard outcome-based supervision suffers from a critical limitation that penalizes trajectories that are largely correct but fail due to several missteps as heavily as completely erroneous ones. This coarse feedback signal causes the model to discard valuable largely correct rollouts, leading to a degradation in rollout diversity that prematurely narrows the exploration space. Process Reward Models have demonstrated efficacy in providing reliable step-wise verification for test-time scaling, naively integrating these signals into RLVR as dense rewards proves ineffective.Prior methods attempt to introduce off-policy guided whole-trajectory replacement that often outside the policy model's distribution, but still fail to utilize the largely correct rollouts generated by the model itself and thus do not effectively mitigate the narrowing of the exploration space. To address these issues, we propose SCOPE (Step-wise Correction for On-Policy Exploration), a novel framework that utilizes Process Reward Models to pinpoint the first erroneous step in suboptimal rollouts and applies fine-grained, step-wise off-policy rectification. By applying precise refinement on partially correct rollout, our method effectively salvages partially correct trajectories and increases diversity score by 13.5%, thereby sustaining a broad exploration space. Extensive experiments demonstrate that our approach establishes new state-of-the-art results, achieving an average accuracy of 46.6% on math reasoning and exhibiting robust generalization with 53.4% accuracy on out-of-distribution reasoning tasks.

While large language models show promise in medical applications, achieving expert-level clinical reasoning remains challenging due to the need for both accurate answers and transparent reasoning processes. To address this challenge, we introduce Fleming-R1, a model designed for verifiable medical reasoning through three complementary innovations. First, our Reasoning-Oriented Data Strategy (RODS) combines curated medical QA datasets with knowledge-graph-guided synthesis to improve coverage of underrepresented diseases, drugs, and multi-hop reasoning chains. Second, we employ Chain-of-Thought (CoT) cold start to distill high-quality reasoning trajectories from teacher models, establishing robust inference priors. Third, we implement a two-stage Reinforcement Learning from Verifiable Rewards (RLVR) framework using Group Relative Policy Optimization, which consolidates core reasoning skills while targeting persistent failure modes through adaptive hard-sample mining. Across diverse medical benchmarks, Fleming-R1 delivers substantial parameter-efficient improvements: the 7B variant surpasses much larger baselines, while the 32B model achieves near-parity with GPT-4o and consistently outperforms strong open-source alternatives. These results demonstrate that structured data design, reasoning-oriented initialization, and verifiable reinforcement learning can advance clinical reasoning beyond simple accuracy optimization. We release Fleming-R1 publicly to promote transparent, reproducible, and auditable progress in medical AI, enabling safer deployment in high-stakes clinical environments.

Safety alignment in Large Language Models is critical for healthcare; however, reliance on binary refusal boundaries often results in over-refusal of benign queries or unsafe compliance with harmful ones. While existing benchmarks measure these extremes, they fail to evaluate Safe Completion: the model's ability to maximise helpfulness on dual-use or borderline queries by providing safe, high-level guidance without crossing into actionable harm. We introduce Health-ORSC-Bench, the first large-scale benchmark designed to systematically measure Over-Refusal and Safe Completion quality in healthcare. Comprising 31,920 benign boundary prompts across seven health categories (e.g., self-harm, medical misinformation), our framework uses an automated pipeline with human validation to test models at varying levels of intent ambiguity. We evaluate 30 state-of-the-art LLMs, including GPT-5 and Claude-4, revealing a significant tension: safety-optimised models frequently refuse up to 80\% of "Hard" benign prompts, while domain-specific models often sacrifice safety for utility. Our findings demonstrate that model family and size significantly influence calibration: larger frontier models (e.g., GPT-5, Llama-4) exhibit "safety-pessimism" and higher over-refusal than smaller or MoE-based counterparts (e.g., Qwen-3-Next), highlighting that current LLMs struggle to balance refusal and compliance. Health-ORSC-Bench provides a rigorous standard for calibrating the next generation of medical AI assistants toward nuanced, safe, and helpful completions. The code and data will be released upon acceptance. red{Warning: Some contents may include toxic or undesired contents.}

Machine learning systems in fraud detection, credit scoring, and clinical risk assessment operate under delayed ground truth: outcome labels arrive days to months after the decision they evaluate. During this blind period, governance evidence degrades through mechanisms that neither drift detection methods nor governance frameworks adequately address. This paper formalizes an evidence sufficiency model with four dimensions (completeness, freshness, reliability, representativeness) and a decision-readiness gate that quantifies how label latency degrades evidence quality. The model maps three drift types to dimension-specific degradation trajectories. A complementary proxy indicator framework comprising seven measurement categories estimates sufficiency degradation without labels, with explicit coverage mapping and characterized blind spots per drift type. Evaluation on the IEEE-CIS Fraud Detection dataset (~590K transactions) with controlled drift injection shows that composite proxy monitoring detects covariate and mixed drift with 100% detection rate, while concept drift without feature change remains undetected -- consistent with the theoretical impossibility of unsupervised detection when P(X) is unchanged. Blind period simulation confirms monotone sufficiency degradation, with concept drift degrading fastest (S=0.242 at day 60 vs 0.418 for no-drift). The framework contributes a governance sufficiency monitoring instrument; its value lies in translating drift signals into auditable sufficiency assessments with characterized blind spots. Mapping sufficiency levels to governance actions requires deployment-specific calibration beyond this study's scope.

As autonomous agentic systems scale across regulated critical infrastructures, the lack of mechanistic, hardware-rooted enforcement for high-frequency policy updates presents a fundamental safety gap. We introduce Ethical Hyper-Velocity (EHV), a novel architectural framework for the formal verification of AI governance policies at runtime. Unlike retrospective auditing frameworks (ISO/IEC 42001, NIST AI RMF) which introduce 14-30 day latencies, EHV relocates the Policy Enforcement Point (PEP) into the inference pipeline via a Governance-Aware Just-In-Time (JIT) Compiler. By integrating Conflict-free Replicated Data Types (CRDTs) for policy synchronization and Epoch-based Attestation Caching within Trusted Execution Environments (TEEs), EHV achieves Sub-millisecond Formal Determinism (SMFD). We demonstrate via TLA+ formal verification that non-compliant agentic actions are computationally unreachable within the system's bounded operating state space. We prove that O(1) runtime enforcement can eliminate the traditional trade-off between deployment velocity and governance integrity, reducing Governance Latency from O(days) to O(1).

Retrieval-augmented generation (RAG) is a well-suited technique for retrieving privacy-sensitive Electronic Health Records (EHR). It can serve as a key module of the healthcare copilot, helping reduce misdiagnosis for healthcare practitioners and patients. However, the diagnostic accuracy and specificity of existing heuristic-based RAG models used in the medical domain are inadequate, particularly for diseases with similar manifestations. This paper proposes MedRAG, a RAG model enhanced by knowledge graph (KG)-elicited reasoning for the medical domain that retrieves diagnosis and treatment recommendations based on manifestations. MedRAG systematically constructs a comprehensive four-tier hierarchical diagnostic KG encompassing critical diagnostic differences of various diseases. These differences are dynamically integrated with similar EHRs retrieved from an EHR database, and reasoned within a large language model. This process enables more accurate and specific decision support, while also proactively providing follow-up questions to enhance personalized medical decision-making. MedRAG is evaluated on both a public dataset DDXPlus and a private chronic pain diagnostic dataset (CPDD) collected from Tan Tock Seng Hospital, and its performance is compared against various existing RAG methods. Experimental results show that, leveraging the information integration and relational abilities of the KG, our MedRAG provides more specific diagnostic insights and outperforms state-of-the-art models in reducing misdiagnosis rates. Our code will be available at https://github.com/SNOWTEAM2023/MedRAG

This paper presents SiliconHealth, a comprehensive blockchain-based healthcare infrastructure designed for resource-constrained regions, particularly sub-Saharan Africa. We demonstrate that obsolete Bitcoin mining Application-Specific Integrated Circuits (ASICs) can be repurposed to create a secure, low-cost, and energy-efficient medical records system. The proposed architecture employs a four-tier hierarchical network: regional hospitals using Antminer S19 Pro (90+ TH/s), urban health centers with Antminer S9 (14 TH/s), rural clinics equipped with Lucky Miner LV06 (500 GH/s, 13W), and mobile health points with portable ASIC devices. We introduce the Deterministic Hardware Fingerprinting (DHF) paradigm, which repurposes SHA-256 mining ASICs as cryptographic proof generators, achieving 100% verification rate across 23 test proofs during 300-second validation sessions. The system incorporates Reed-Solomon LSB watermarking for medical image authentication with 30-40% damage tolerance, semantic Retrieval-Augmented Generation (RAG) for intelligent medical record queries, and offline synchronization protocols for intermittent connectivity. Economic analysis demonstrates 96% cost reduction compared to GPU-based alternatives, with total deployment cost of $847 per rural clinic including 5-year solar power infrastructure. Validation experiments on Lucky Miner LV06 (BM1366 chip, 5nm) achieve 2.93 MH/W efficiency and confirm hardware universality. This work establishes a practical framework for deploying verifiable, tamper-proof electronic health records in regions where traditional healthcare IT infrastructure is economically unfeasible, potentially benefiting over 600 million people lacking access to basic health information systems.

The outbreak of COVID-19 has highlighted the intricate interplay between public health and economic stability on a global scale. This study proposes a novel reinforcement learning framework designed to optimize health and economic outcomes during pandemics. The framework leverages the SIR model, integrating both lockdown measures (via a stringency index) and vaccination strategies to simulate disease dynamics. The stringency index, indicative of the severity of lockdown measures, influences both the spread of the disease and the economic health of a country. Developing nations, which bear a disproportionate economic burden under stringent lockdowns, are the primary focus of our study. By implementing reinforcement learning, we aim to optimize governmental responses and strike a balance between the competing costs associated with public health and economic stability. This approach also enhances transparency in governmental decision-making by establishing a well-defined reward function for the reinforcement learning agent. In essence, this study introduces an innovative and ethical strategy to navigate the challenge of balancing public health and economic stability amidst infectious disease outbreaks.

We study the right to be forgotten (GDPR Art. 17) for large language models and frame unlearning as a reproducible systems problem. Our approach treats training as a deterministic program and logs a minimal per-microbatch record (ordered ID hash, RNG seed, learning-rate value, optimizer-step counter, and accumulation boundary). Under a pinned stack and deterministic kernels, replaying the training tail while filtering only the forget closure yields the same parameters as training on the retain set (bit-identical in the training dtype) when preconditions hold. To meet latency and availability constraints, we add complementary paths: (i) exact reverts of recent steps via micro-checkpoints or dense per-step deltas, (ii) cohort-scoped adapter deletion when the base is frozen, and (iii) a curvature-guided anti-update followed by a short retain-tune, audit-gated with escalation to exact replay. We report storage/latency budgets and a toy artifact validating mechanics; in a controlled run that satisfies the preconditions we demonstrate byte-identical equality of model and optimizer states.

In this paper, we present a framework for training large language models (LLMs) as diagnostic agents with reinforcement learning, enabling them to manage multi-turn diagnostic processes, adaptively select examinations, and commit to final diagnoses. Unlike instruction-tuned models trained on static case summaries, our method acquires diagnostic strategies through interactive exploration and outcome-based feedback. Our contributions are fourfold: (i) We present DiagGym, a diagnostics world model trained with electronic health records that emits examination outcomes conditioned on patient history and recommended examination, serving as a virtual clinical environment for realistic diagnosis training and evaluation; (ii) We train DiagAgent via end-to-end, multi-turn reinforcement learning to learn diagnostic policies that optimize both information yield and diagnostic accuracy; (iii) We introduce DiagBench, a diagnostic benchmark comprising 750 cases with physician-validated examination recommendations and 99 cases annotated with 973 physician-written rubrics on diagnosis process; (iv) we demonstrate superior performance across diverse diagnostic settings. DiagAgent significantly outperforms 10 state-of-the-art LLMs, including DeepSeek-v3 and GPT-4o, as well as two prompt-engineered agents. In single-turn settings, DiagAgent achieves 9.34% higher diagnostic accuracy and 44.03% improvement in examination recommendation hit ratio. In end-to-end settings, it delivers 15.12% increase in diagnostic accuracy and 23.09% boost in examination recommendation F1 score. In rubric-based evaluation, it surpasses the next-best model, Claude-sonnet-4, by 7.1% in weighted rubric score. These findings indicate that learning policies in interactive clinical environments confers dynamic and clinically meaningful diagnostic management abilities unattainable through passive training alone.

When applying offline reinforcement learning (RL) in healthcare scenarios, the out-of-distribution (OOD) issues pose significant risks, as inappropriate generalization beyond clinical expertise can result in potentially harmful recommendations. While existing methods like conservative Q-learning (CQL) attempt to address the OOD issue, their effectiveness is limited by only constraining action selection by suppressing uncertain actions. This action-only regularization imitates clinician actions that prioritize short-term rewards, but it fails to regulate downstream state trajectories, thereby limiting the discovery of improved long-term treatment strategies. To safely improve policy beyond clinician recommendations while ensuring that state-action trajectories remain in-distribution, we propose Offline Guarded Safe Reinforcement Learning (OGSRL), a theoretically grounded model-based offline RL framework. OGSRL introduces a novel dual constraint mechanism for improving policy with reliability and safety. First, the OOD guardian is established to specify clinically validated regions for safe policy exploration. By constraining optimization within these regions, it enables the reliable exploration of treatment strategies that outperform clinician behavior by leveraging the full patient state history, without drifting into unsupported state-action trajectories. Second, we introduce a safety cost constraint that encodes medical knowledge about physiological safety boundaries, providing domain-specific safeguards even in areas where training data might contain potentially unsafe interventions. Notably, we provide theoretical guarantees on safety and near-optimality: policies that satisfy these constraints remain in safe and reliable regions and achieve performance close to the best possible policy supported by the data.

While Large Language Models (LLMs) excel on standardized medical exams, high scores often fail to translate to high-quality responses for real-world medical queries. Current evaluations rely heavily on multiple-choice questions, failing to capture the unstructured, ambiguous, and long-tail complexities inherent in genuine user inquiries. To bridge this gap, we introduce QuarkMedBench, an ecologically valid benchmark tailored for real-world medical LLM assessment. We compiled a massive dataset spanning Clinical Care, Wellness Health, and Professional Inquiry, comprising 20,821 single-turn queries and 3,853 multi-turn sessions. To objectively evaluate open-ended answers, we propose an automated scoring framework that integrates multi-model consensus with evidence-based retrieval to dynamically generate 220,617 fine-grained scoring rubrics (~9.8 per query). During evaluation, hierarchical weighting and safety constraints structurally quantify medical accuracy, key-point coverage, and risk interception, effectively mitigating the high costs and subjectivity of human grading. Experimental results demonstrate that the generated rubrics achieve a 91.8% concordance rate with clinical expert blind audits, establishing highly dependable medical reliability. Crucially, baseline evaluations on this benchmark reveal significant performance disparities among state-of-the-art models when navigating real-world clinical nuances, highlighting the limitations of conventional exam-based metrics. Ultimately, QuarkMedBench establishes a rigorous, reproducible yardstick for measuring LLM performance on complex health issues, while its framework inherently supports dynamic knowledge updates to prevent benchmark obsolescence.

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

Medical language models (MLMs) have become pivotal in advancing medical natural language processing. However, prior models that rely on pre-training or supervised fine-tuning often exhibit low data efficiency and limited practicality in real-world clinical applications. While OpenAIs O1 highlights test-time scaling in mathematics, attempts to replicate this approach in medicine typically distill responses from GPT-series models to open-source models, focusing primarily on multiple-choice tasks. This strategy, though straightforward, neglects critical concerns like data privacy and realistic deployment in clinical settings. In this work, we present a deployable, small-scale medical language model, \mone, designed for long-chain reasoning in clinical tasks using a self-evolution paradigm. Starting with a seed dataset of around 8,000 instances spanning five domains and 16 datasets, we prompt a base policy model to perform Monte Carlo Tree Search (MCTS) to construct verifiable reasoning chains. Each reasoning step is assigned an evolution rollout value, allowing verified trajectories to train the policy model and the reward model. During inference, the policy model generates multiple responses, and the reward model selects the one with the highest reward score. Experiments on eleven evaluation datasets demonstrate that \mone outperforms prior open-source models by 2 points, with the addition of the reward model further boosting performance (sim13 points), surpassing GPT-4o-mini. Code and data are available at https://github.com/pixas/MedSSS.

Process-Level Reward Models (PRMs) are essential for guiding complex reasoning in large language models, yet existing PRM benchmarks cover only general domains such as mathematics, failing to address medical reasoning -- which is uniquely characterized by safety criticality, knowledge intensity, and diverse error patterns. Without a reliable medical PRM evaluation framework, we cannot quantify models' error detection capabilities in clinical reasoning, leaving their safety in real-world healthcare applications unverified. We propose MedPRMBench, the first process-level reward model benchmark for the medical domain. Built through a three-phase pipeline based on Clinical Reasoning Blueprints (CRBs), MedPRMBench systematically generates high-quality evaluation data from seven medical QA sources, covering 14 fine-grained error types across three categories (Simplicity, Soundness, and Sensitivity) with the first 4-level severity grading system to quantify clinical impact. The benchmark comprises 6{,}500 questions with 13{,}000 reasoning chains and 113{,}910 step-level labels, plus 6{,}879 questions for training. Our medical PRM baseline achieves an 87.1\% overall PRMScore -- substantially surpassing all baselines -- and serves as a plug-and-play verifier that improves downstream medical QA accuracy by 3.2--6.7 percentage points. Systematic evaluation spanning proprietary frontier models, open-source reasoning models, and medical-specialized models reveals critical weaknesses in current models' medical reasoning error detection capabilities, providing clear directions for future PRM improvement.

Policy compliance assessment is a fundamental task of evaluating whether an input case strictly complies with a set of human-defined rules, more generally known as policies. In practice, human experts follow a systematic, step-by-step process to identify violations with respect to specific stipulations outlined in the policy. However, such documentation of gold-standard, expert-level reasoning processes is costly to acquire. In this paper, we introduce Policy Reasoning Traces (PRT), a form of specialized generated reasoning chains that serve as a reasoning bridge to improve an LLM's policy compliance assessment capabilities. Our empirical evaluations demonstrate that the use of PRTs for both inference-time and training-time scenarios significantly enhances the performance of open-weight and commercial models, setting a new state-of-the-art for HIPAA and GDPR policies. Beyond accuracy gains, we also highlight how PRTs can improve an LLM's ability to accurately cite policy clauses, as well as influence compliance decisions through their high utilization from the raw chains of thought.

The integration of Large Language Models (LLMs) into healthcare demands a safety paradigm rooted in primum non nocere. However, current alignment techniques rely on generic definitions of harm that fail to capture context-dependent violations, such as administrative fraud and clinical discrimination. To address this, we introduce Medical Malice: a dataset of 214,219 adversarial prompts calibrated to the regulatory and ethical complexities of the Brazilian Unified Health System (SUS). Crucially, the dataset includes the reasoning behind each violation, enabling models to internalize ethical boundaries rather than merely memorizing a fixed set of refusals. Using an unaligned agent (Grok-4) within a persona-driven pipeline, we synthesized high-fidelity threats across seven taxonomies, ranging from procurement manipulation and queue-jumping to obstetric violence. We discuss the ethical design of releasing these "vulnerability signatures" to correct the information asymmetry between malicious actors and AI developers. Ultimately, this work advocates for a shift from universal to context-aware safety, providing the necessary resources to immunize healthcare AI against the nuanced, systemic threats inherent to high-stakes medical environments -- vulnerabilities that represent the paramount risk to patient safety and the successful integration of AI in healthcare systems.

Wearable devices running Human Activity Recognition(HAR) on Inertial Measurement Units~(IMUs) waste energy by performing continuous classification for each window, even during long periods of unchanged activity. We address this with a lightweight change-detection gate: a non-parametric algorithm based on dynamic template matching that runs continuously at only approximately 16kFLOPs per step, requires no offline training, and does not need prior definition of target activity classes. The gate invokes the full HAR network only when it detects an activity change, reducing the computational load by over 67% in realistic monitoring settings. The algorithm is evaluated on smart glasses, smartwatch, and smartphone data, requiring only a brief device-specific calibration phase. The gate achieves 98% sensitivity on UCA-EHAR, ensuring no genuine activity transition is missed, while 75% specificity keeps unnecessary HAR invocations low. Results on WISDM are 97% sensitivity and 76% specificity, demonstrating robustness and flexibility to various settings.

As people increasingly prioritize their health, the speed and breadth of health information dissemination on the internet have also grown. At the same time, the presence of false health information (health rumors) intermingled with genuine content poses a significant potential threat to public health. However, current research on Chinese health rumors still lacks a large-scale, public, and open-source dataset of health rumor information, as well as effective and reliable rumor detection methods. This paper addresses this gap by constructing a dataset containing 1.12 million health-related rumors (HealthRCN) through web scraping of common health-related questions and a series of data processing steps. HealthRCN is the largest known dataset of Chinese health information rumors to date. Based on this dataset, we propose retrieval-augmented large language models for Chinese health rumor detection and explainability (HRDE). This model leverages retrieved relevant information to accurately determine whether the input health information is a rumor and provides explanatory responses, effectively aiding users in verifying the authenticity of health information. In evaluation experiments, we compared multiple models and found that HRDE outperformed them all, including GPT-4-1106-Preview, in rumor detection accuracy and answer quality. HRDE achieved an average accuracy of 91.04% and an F1 score of 91.58%.

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

Reinforcement learning with verifiable rewards (RLVR) for Large Reasoning Models hinges on baseline estimation for variance reduction, but existing approaches pay a heavy price: PPO requires a policy-model scale critic, while GRPO needs multiple rollouts per prompt to keep its empirical group mean stable. We introduce Policy Optimization with Internal State Value Estimation), which obtains a baseline at negligible cost by using the policy model's internal signals already computed during the policy forward pass. A lightweight probe predicts the expected verifiable reward from the hidden states of the prompt and generated trajectory, as well as token-entropy statistics, and is trained online alongside the policy. To preserve gradient unbiasedness despite using trajectory-conditioned features, we introduce a cross-rollout construction that predicts each rollout's value from an independent rollout's internal states. Because POISE estimates prompt value using only a single rollout, it enables higher prompt diversity for a fixed compute budget during training. This reduces gradient variance for more stable learning and also eliminates the compute overhead of sampling costs for detecting zero-advantage prompts. On Qwen3-4B and DeepSeek-R1-Distill-Qwen-1.5B across math reasoning benchmarks, POISE matches DAPO while requiring less compute. Moreover, its value estimator shows similar performance to a separate LLM-scale value model and generalizes to various verifiable tasks. By leveraging the model's own internal representations, POISE enables more stable and efficient policy optimization.

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

The digitization of medical records ushered in a new era of big data to clinical science, and with it the possibility that data could be shared, to multiply insights beyond what investigators could abstract from paper records. The need to share individual-level medical data to accelerate innovation in precision medicine continues to grow, and has never been more urgent, as scientists grapple with the COVID-19 pandemic. However, enthusiasm for the use of big data has been tempered by a fully appropriate concern for patient autonomy and privacy. That is, the ability to extract private or confidential information about an individual, in practice, renders it difficult to share data, since significant infrastructure and data governance must be established before data can be shared. Although HIPAA provided de-identification as an approved mechanism for data sharing, linkage attacks were identified as a major vulnerability. A variety of mechanisms have been established to avoid leaking private information, such as field suppression or abstraction, strictly limiting the amount of information that can be shared, or employing mathematical techniques such as differential privacy. Another approach, which we focus on here, is creating synthetic data that mimics the underlying data. For synthetic data to be a useful mechanism in support of medical innovation and a proxy for real-world evidence, one must demonstrate two properties of the synthetic dataset: (1) any analysis on the real data must be matched by analysis of the synthetic data (statistical fidelity) and (2) the synthetic data must preserve privacy, with minimal risk of re-identification (privacy guarantee). In this paper we propose a framework for quantifying the statistical fidelity and privacy preservation properties of synthetic datasets and demonstrate these metrics for synthetic data generated by Syntegra technology.

Early detection of highly pathogenic avian influenza (HPAI) and endemic poultry diseases is critical for global food security. While computer vision models excel at classifying diseases from fecal imaging, deploying these systems at scale is bottlenecked by farm data privacy concerns and institutional data silos. Furthermore, existing open-source agricultural datasets frequently suffer from severe, undocumented data contamination. In this paper, we introduce FecalFed, a privacy-preserving federated learning framework for poultry disease classification. We first curate and release poultry-fecal-fl, a rigorously deduplicated dataset of 8,770 unique images across four disease classes, revealing and eliminating a 46.89% duplication rate in popular public repositories. To simulate realistic agricultural environments, we evaluate FecalFed under highly heterogeneous, non-IID conditions (Dirichlet α=0.5). While isolated single-farm training collapses under this data heterogeneity, yielding only 64.86% accuracy, our federated approach recovers performance without centralizing sensitive data. Specifically, utilizing server-side adaptive optimization (FedAdam) with a Swin-Small architecture achieves 90.31% accuracy, closely approaching the centralized upper bound of 95.10\%. Furthermore, we demonstrate that an edge-optimized Swin-Tiny model maintains highly competitive performance at 89.74%, establishing a highly efficient, privacy-first blueprint for on-farm avian disease monitoring.

Misinformation in healthcare, from vaccine hesitancy to unproven treatments, poses risks to public health and trust in medical systems. While machine learning and natural language processing have advanced automated fact-checking, validating biomedical claims remains uniquely challenging due to complex terminology, the need for domain expertise, and the critical importance of grounding in scientific evidence. We introduce CER (Combining Evidence and Reasoning), a novel framework for biomedical fact-checking that integrates scientific evidence retrieval, reasoning via large language models, and supervised veracity prediction. By integrating the text-generation capabilities of large language models with advanced retrieval techniques for high-quality biomedical scientific evidence, CER effectively mitigates the risk of hallucinations, ensuring that generated outputs are grounded in verifiable, evidence-based sources. Evaluations on expert-annotated datasets (HealthFC, BioASQ-7b, SciFact) demonstrate state-of-the-art performance and promising cross-dataset generalization. Code and data are released for transparency and reproducibility: https: //github.com/PRAISELab-PicusLab/CER.

Clinical question answering over electronic health records (EHRs) can help clinicians and patients access relevant medical information more efficiently. However, many recent approaches rely on large cloud-based models, which are difficult to deploy in clinical environments due to privacy constraints and computational requirements. In this work, we investigate how far grounded EHR question answering can be pushed when restricted to a single notebook. We participate in all four subtasks of the ArchEHR-QA 2026 shared task and evaluate several approaches designed to run on commodity hardware. All experiments are conducted locally without external APIs or cloud infrastructure. Our results show that such systems can achieve competitive performance on the shared task leaderboards. In particular, our submissions perform above average in two subtasks, and we observe that smaller models can approach the performance of much larger systems when properly configured. These findings suggest that privacy-preserving EHR QA systems running fully locally are feasible with current models and commodity hardware. The source code is available at https://github.com/ibrahimey/ArchEHR-QA-2026.

Reinforcement learning (RL) has become a central post-training tool for improving the reasoning abilities of large language models (LLMs). In these systems, the rollout, the trajectory sampled from a prompt to termination, including intermediate reasoning steps and optional tool or environment interactions, determines the data the optimizer learns from, yet rollout design is often underreported. This survey provides an optimizer-agnostic view of rollout strategies for RL-based post-training of reasoning LLMs. We formalize rollout pipelines with unified notation and introduce Generate-Filter-Control-Replay (GFCR), a lifecycle taxonomy that decomposes rollout pipelines into four modular stages: Generate proposes candidate trajectories and topologies; Filter constructs intermediate signals via verifiers, judges, critics; Control allocates compute and makes continuation/branching/stopping decisions under budgets; and Replay retains and reuses artifacts across rollouts without weight updates, including self-evolving curricula that autonomously generate new training tasks. We complement GFCR with a criterion taxonomy of reliability, coverage, and cost sensitivity that characterizes rollout trade-offs. Using this framework, we synthesize methods spanning RL with verifiable rewards, process supervision, judge-based gating, guided and tree/segment rollouts, adaptive compute allocation, early-exit and partial rollouts, throughput optimization, and replay/recomposition for self-improvement. We ground the framework with case studies in math, code/SQL, multimodal reasoning, tool-using agents, and agentic skill benchmarks that evaluate skill induction, reuse, and cross-task transfer. Finally, we provide a diagnostic index that maps common rollout pathologies to GFCR modules and mitigation levers, alongside open challenges for building reproducible, compute-efficient, and trustworthy rollout pipelines.

Question Answering on Electronic Health Records (EHR-QA) has a significant impact on the healthcare domain, and it is being actively studied. Previous research on structured EHR-QA focuses on converting natural language queries into query language such as SQL or SPARQL (NLQ2Query), so the problem scope is limited to pre-defined data types by the specific query language. In order to expand the EHR-QA task beyond this limitation to handle multi-modal medical data and solve complex inference in the future, more primitive systemic language is needed. In this paper, we design the program-based model (NLQ2Program) for EHR-QA as the first step towards the future direction. We tackle MIMICSPARQL*, the graph-based EHR-QA dataset, via a program-based approach in a semi-supervised manner in order to overcome the absence of gold programs. Without the gold program, our proposed model shows comparable performance to the previous state-of-the-art model, which is an NLQ2Query model (0.9% gain). In addition, for a reliable EHR-QA model, we apply the uncertainty decomposition method to measure the ambiguity in the input question. We empirically confirmed data uncertainty is most indicative of the ambiguity in the input question.

A prominent challenge of offline reinforcement learning (RL) is the issue of hidden confounding: unobserved variables may influence both the actions taken by the agent and the observed outcomes. Hidden confounding can compromise the validity of any causal conclusion drawn from data and presents a major obstacle to effective offline RL. In the present paper, we tackle the problem of hidden confounding in the nonidentifiable setting. We propose a definition of uncertainty due to hidden confounding bias, termed delphic uncertainty, which uses variation over world models compatible with the observations, and differentiate it from the well-known epistemic and aleatoric uncertainties. We derive a practical method for estimating the three types of uncertainties, and construct a pessimistic offline RL algorithm to account for them. Our method does not assume identifiability of the unobserved confounders, and attempts to reduce the amount of confounding bias. We demonstrate through extensive experiments and ablations the efficacy of our approach on a sepsis management benchmark, as well as on electronic health records. Our results suggest that nonidentifiable hidden confounding bias can be mitigated to improve offline RL solutions in practice.

The rise of chronic diseases and pandemics like COVID-19 has emphasized the need for effective patient data processing while ensuring privacy through anonymization and de-identification of protected health information (PHI). Anonymized data facilitates research without compromising patient confidentiality. This paper introduces expert small AI models developed using the LLM-in-the-loop methodology to meet the demand for domain-specific de-identification NER models. These models overcome the privacy risks associated with large language models (LLMs) used via APIs by eliminating the need to transmit or store sensitive data. More importantly, they consistently outperform LLMs in de-identification tasks, offering superior performance and reliability. Our de-identification NER models, developed in eight languages (English, German, Italian, French, Romanian, Turkish, Spanish, and Arabic) achieved f1-micro score averages of 0.966, 0.975, 0.976, 0.970, 0.964, 0.974, 0.978, and 0.953 respectively. These results establish them as the most accurate healthcare anonymization solutions, surpassing existing small models and even general-purpose LLMs such as GPT-4o. While Part-1 of this series introduced the LLM-in-the-loop methodology for bio-medical document translation, this second paper showcases its success in developing cost-effective expert small NER models in de-identification tasks. Our findings lay the groundwork for future healthcare AI innovations, including biomedical entity and relation extraction, demonstrating the value of specialized models for domain-specific challenges.

Healthcare organizations are beginning to embed agentic AI into routine workflows, including clinical documentation support and early-warning monitoring. As these capabilities diffuse across departments and vendors, health systems face agent sprawl, causing duplicated agents, unclear accountability, inconsistent controls, and tool permissions that persist beyond the original use case. Existing AI governance frameworks emphasize lifecycle risk management but provide limited guidance for the day-to-day operations of agent fleets. We propose a Unified Agent Lifecycle Management (UALM) blueprint derived from a rapid, practice-oriented synthesis of governance standards, agent security literature, and healthcare compliance requirements. UALM maps recurring gaps onto five control-plane layers: (1) an identity and persona registry, (2) orchestration and cross-domain mediation, (3) PHI-bounded context and memory, (4) runtime policy enforcement with kill-switch triggers, and (5) lifecycle management and decommissioning linked to credential revocation and audit logging. A companion maturity model supports staged adoption. UALM offers healthcare CIOs, CISOs, and clinical leaders an implementable pattern for audit-ready oversight that preserves local innovation and enables safer scaling across clinical and administrative domains.

Current biomedical question answering (QA) systems often assume that medical knowledge applies uniformly, yet real-world clinical reasoning is inherently conditional: nearly every decision depends on patient-specific factors such as comorbidities and contraindications. Existing benchmarks do not evaluate such conditional reasoning, and retrieval-augmented or graph-based methods lack explicit mechanisms to ensure that retrieved knowledge is applicable to given context. To address this gap, we propose CondMedQA, the first benchmark for conditional biomedical QA, consisting of multi-hop questions whose answers vary with patient conditions. Furthermore, we propose Condition-Gated Reasoning (CGR), a novel framework that constructs condition-aware knowledge graphs and selectively activates or prunes reasoning paths based on query conditions. Our findings show that CGR more reliably selects condition-appropriate answers while matching or exceeding state-of-the-art performance on biomedical QA benchmarks, highlighting the importance of explicitly modeling conditionality for robust medical reasoning.

QDNA-ID is a trust-chain framework that links physical quantum behavior to digitally verified records. The system first executes standard quantum circuits with random shot patterns across different devices to generate entropy profiles and measurement data that reveal device-specific behavior. A Bell or CHSH test is then used to confirm that correlations originate from genuine non classical processes rather than classical simulation. The verified outcomes are converted into statistical fingerprints using entropy, divergence, and bias features to characterize each device. These features and metadata for device, session, and random seed parameters are digitally signed and time stamped to ensure integrity and traceability. Authenticated artifacts are stored in a hierarchical index for reproducible retrieval and long term auditing. A visualization and analytics interface monitors drift, policy enforcement, and device behavior logs. A machine learning engine tracks entropy drift, detects anomalies, and classifies devices based on evolving patterns. An external verification API supports independent recomputation of hashes, signatures, and CHSH evidence. QDNA-ID operates as a continuous feedback loop that maintains a persistent chain of trust for quantum computing environments.

De-identification of electronic health records (EHR) is a vital step towards advancing health informatics research and maximising the use of available data. It is a two-step process where step one is the identification of protected health information (PHI), and step two is replacing such PHI with surrogates. Despite the recent advances in automatic de-identification of EHR, significant obstacles remain if the abundant health data available are to be used to the full potential. Accuracy in de-identification could be considered a necessary, but not sufficient condition for the use of EHR without individual patient consent. We present here a comprehensive review of the progress to date, both the impressive successes in achieving high accuracy and the significant risks and challenges that remain. To best of our knowledge, this is the first paper to present a complete picture of end-to-end automatic de-identification. We review 18 recently published automatic de-identification systems -designed to de-identify EHR in the form of free text- to show the advancements made in improving the overall accuracy of the system, and in identifying individual PHI. We argue that despite the improvements in accuracy there remain challenges in surrogate generation and replacements of identified PHIs, and the risks posed to patient protection and privacy.

Large Language Models (LLMs) often generate code with subtle but critical bugs, especially for complex tasks. Existing automated repair methods typically rely on superficial pass/fail signals, offering limited visibility into program behavior and hindering precise error localization. In addition, without a way to learn from prior failures, repair processes often fall into repetitive and inefficient cycles. To overcome these challenges, we present TraceCoder, a collaborative multi-agent framework that emulates the observe-analyze-repair process of human experts. The framework first instruments the code with diagnostic probes to capture fine-grained runtime traces, enabling deep insight into its internal execution. It then conducts causal analysis on these traces to accurately identify the root cause of the failure. This process is further enhanced by a novel Historical Lesson Learning Mechanism (HLLM), which distills insights from prior failed repair attempts to inform subsequent correction strategies and prevent recurrence of similar mistakes. To ensure stable convergence, a Rollback Mechanism enforces that each repair iteration constitutes a strict improvement toward the correct solution. Comprehensive experiments across multiple benchmarks show that TraceCoder achieves up to a 34.43\% relative improvement in Pass@1 accuracy over existing advanced baselines. Ablation studies verify the significance of each system component, with the iterative repair process alone contributing a 65.61\% relative gain in accuracy. Furthermore, TraceCoder significantly outperforms leading iterative methods in terms of both accuracy and cost-efficiency.

Randomized controlled trials (RCTs) are the benchmark for causal inference, yet field implementation can deviate. We here present a remote audit - a design-based, preregistrable diagnostic that uses only pre-treatment satellite imagery to test whether assignment is independent of local conditions. The conditional randomization test of the remote audit evaluates whether treatment assignment is more predictable from pre-treatment satellite features than expected under the experiment's registered mechanism, providing a finite-sample valid, design-based diagnostic that requires no parametric assumptions. The procedure is finite-sample valid, honors blocks and clusters, and controls multiplicity across image models and resolutions via a max-statistic. We illustrate with two RCTs: Uganda's Youth Opportunities Program, where the audit corroborates randomization and flags selection and missing-data risks; and a school-based trial in Bangladesh, where assignment is highly predictable from pre-treatment features relative to the stated design, consistent with independent concerns about irregularities. Remote audits complement balance tests, lower early-stage costs, and enable rapid design checks when baseline surveys are expensive or infeasible.

AI powered health chatbot applications are increasingly utilized for personalized healthcare services, yet they pose significant challenges related to user data security and privacy. This study evaluates the effectiveness of automated methods, specifically BART and Gemini GenAI, in identifying security privacy related (SPR) concerns within these applications' user reviews, benchmarking their performance against manual qualitative analysis. Our results indicate that while Gemini's performance in SPR classification is comparable to manual labeling, both automated methods have limitations, including the misclassification of unrelated issues. Qualitative analysis revealed critical user concerns, such as data collection practices, data misuse, and insufficient transparency and consent mechanisms. This research enhances the understanding of the relationship between user trust, privacy, and emerging mobile AI health chatbot technologies, offering actionable insights for improving security and privacy practices in AI driven health chatbots. Although exploratory, our findings highlight the necessity for rigorous audits and transparent communication strategies, providing valuable guidance for app developers and vendors in addressing user security and privacy concerns.

Over the course of the COVID-19 pandemic, large volumes of biomedical information concerning this new disease have been published on social media. Some of this information can pose a real danger to people's health, particularly when false information is shared, for instance recommendations on how to treat diseases without professional medical advice. Therefore, automatic fact-checking resources and systems developed specifically for the medical domain are crucial. While existing fact-checking resources cover COVID-19-related information in news or quantify the amount of misinformation in tweets, there is no dataset providing fact-checked COVID-19-related Twitter posts with detailed annotations for biomedical entities, relations and relevant evidence. We contribute CoVERT, a fact-checked corpus of tweets with a focus on the domain of biomedicine and COVID-19-related (mis)information. The corpus consists of 300 tweets, each annotated with medical named entities and relations. We employ a novel crowdsourcing methodology to annotate all tweets with fact-checking labels and supporting evidence, which crowdworkers search for online. This methodology results in moderate inter-annotator agreement. Furthermore, we use the retrieved evidence extracts as part of a fact-checking pipeline, finding that the real-world evidence is more useful than the knowledge indirectly available in pretrained language models.

Open-weight bio-foundation models present a dual-use dilemma. While holding great promise for accelerating scientific research and drug development, they could also enable bad actors to develop more deadly bioweapons. To mitigate the risk posed by these models, current approaches focus on filtering biohazardous data during pre-training. However, the effectiveness of such an approach remains unclear, particularly against determined actors who might fine-tune these models for malicious use. To address this gap, we propose BioRiskEval, a framework to evaluate the robustness of procedures that are intended to reduce the dual-use capabilities of bio-foundation models. BioRiskEval assesses models' virus understanding through three lenses, including sequence modeling, mutational effects prediction, and virulence prediction. Our results show that current filtering practices may not be particularly effective: Excluded knowledge can be rapidly recovered in some cases via fine-tuning, and exhibits broader generalizability in sequence modeling. Furthermore, dual-use signals may already reside in the pretrained representations, and can be elicited via simple linear probing. These findings highlight the challenges of data filtering as a standalone procedure, underscoring the need for further research into robust safety and security strategies for open-weight bio-foundation models.

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.

Backdoor inversion, the process of finding a backdoor trigger inserted into a machine learning model, has become the pillar of many backdoor detection and defense methods. Previous works on backdoor inversion often recover the backdoor through an optimization process to flip a support set of clean images into the target class. However, it is rarely studied and understood how large this support set should be to recover a successful backdoor. In this work, we show that one can reliably recover the backdoor trigger with as few as a single image. Specifically, we propose the SmoothInv method, which first constructs a robust smoothed version of the backdoored classifier and then performs guided image synthesis towards the target class to reveal the backdoor pattern. SmoothInv requires neither an explicit modeling of the backdoor via a mask variable, nor any complex regularization schemes, which has become the standard practice in backdoor inversion methods. We perform both quantitaive and qualitative study on backdoored classifiers from previous published backdoor attacks. We demonstrate that compared to existing methods, SmoothInv is able to recover successful backdoors from single images, while maintaining high fidelity to the original backdoor. We also show how we identify the target backdoored class from the backdoored classifier. Last, we propose and analyze two countermeasures to our approach and show that SmoothInv remains robust in the face of an adaptive attacker. Our code is available at https://github.com/locuslab/smoothinv .

Seeking health-related advice on the internet has become a common practice in the digital era. Determining the trustworthiness of medical claims found online and finding appropriate evidence for this information is increasingly challenging. Fact-checking has emerged as an approach to assess the veracity of factual claims using evidence from credible knowledge sources. To help advance the automation of this task, in this paper, we introduce a novel dataset of 750 health-related claims, labeled for veracity by medical experts and backed with evidence from appropriate clinical studies. We provide an analysis of the dataset, highlighting its characteristics and challenges. The dataset can be used for Machine Learning tasks related to automated fact-checking such as evidence retrieval, veracity prediction, and explanation generation. For this purpose, we provide baseline models based on different approaches, examine their performance, and discuss the findings.

Objective: Patient notes in electronic health records (EHRs) may contain critical information for medical investigations. However, the vast majority of medical investigators can only access de-identified notes, in order to protect the confidentiality of patients. In the United States, the Health Insurance Portability and Accountability Act (HIPAA) defines 18 types of protected health information (PHI) that needs to be removed to de-identify patient notes. Manual de-identification is impractical given the size of EHR databases, the limited number of researchers with access to the non-de-identified notes, and the frequent mistakes of human annotators. A reliable automated de-identification system would consequently be of high value. Materials and Methods: We introduce the first de-identification system based on artificial neural networks (ANNs), which requires no handcrafted features or rules, unlike existing systems. We compare the performance of the system with state-of-the-art systems on two datasets: the i2b2 2014 de-identification challenge dataset, which is the largest publicly available de-identification dataset, and the MIMIC de-identification dataset, which we assembled and is twice as large as the i2b2 2014 dataset. Results: Our ANN model outperforms the state-of-the-art systems. It yields an F1-score of 97.85 on the i2b2 2014 dataset, with a recall 97.38 and a precision of 97.32, and an F1-score of 99.23 on the MIMIC de-identification dataset, with a recall 99.25 and a precision of 99.06. Conclusion: Our findings support the use of ANNs for de-identification of patient notes, as they show better performance than previously published systems while requiring no feature engineering.

It has recently been shown that deep learning models for anatomical segmentation in medical images can exhibit biases against certain sub-populations defined in terms of protected attributes like sex or ethnicity. In this context, auditing fairness of deep segmentation models becomes crucial. However, such audit process generally requires access to ground-truth segmentation masks for the target population, which may not always be available, especially when going from development to deployment. Here we propose a new method to anticipate model biases in biomedical image segmentation in the absence of ground-truth annotations. Our unsupervised bias discovery method leverages the reverse classification accuracy framework to estimate segmentation quality. Through numerical experiments in synthetic and realistic scenarios we show how our method is able to successfully anticipate fairness issues in the absence of ground-truth labels, constituting a novel and valuable tool in this field.

Differential privacy (DP) is a key technique for protecting sensitive patient data in medical deep learning (DL). As clinical models grow more data-dependent, balancing privacy with utility and fairness has become a critical challenge. This scoping review synthesizes recent developments in applying DP to medical DL, with a particular focus on DP-SGD and alternative mechanisms across centralized and federated settings. Using a structured search strategy, we identified 74 studies published up to March 2025. Our analysis spans diverse data modalities, training setups, and downstream tasks, and highlights the tradeoffs between privacy guarantees, model accuracy, and subgroup fairness. We find that while DP-especially at strong privacy budgets-can preserve performance in well-structured imaging tasks, severe degradation often occurs under strict privacy, particularly in underrepresented or complex modalities. Furthermore, privacy-induced performance gaps disproportionately affect demographic subgroups, with fairness impacts varying by data type and task. A small subset of studies explicitly addresses these tradeoffs through subgroup analysis or fairness metrics, but most omit them entirely. Beyond DP-SGD, emerging approaches leverage alternative mechanisms, generative models, and hybrid federated designs, though reporting remains inconsistent. We conclude by outlining key gaps in fairness auditing, standardization, and evaluation protocols, offering guidance for future work toward equitable and clinically robust privacy-preserving DL systems in medicine.

Reinforcement learning (RL) tasks are typically framed as Markov Decision Processes (MDPs), assuming that decisions are made at fixed time intervals. However, many applications of great importance, including healthcare, do not satisfy this assumption, yet they are commonly modelled as MDPs after an artificial reshaping of the data. In addition, most healthcare (and similar) problems are offline by nature, allowing for only retrospective studies. To address both challenges, we begin by discussing the Semi-MDP (SMDP) framework, which formally handles actions of variable timings. We next present a formal way to apply SMDP modifications to nearly any given value-based offline RL method. We use this theory to introduce three SMDP-based offline RL algorithms, namely, SDQN, SDDQN, and SBCQ. We then experimentally demonstrate that only these SMDP-based algorithms learn the optimal policy in variable-time environments, whereas their MDP counterparts do not. Finally, we apply our new algorithms to a real-world offline dataset pertaining to warfarin dosing for stroke prevention and demonstrate similar results.

Restless multi-armed bandits (RMAB) have demonstrated success in optimizing resource allocation for large beneficiary populations in public health settings. Unfortunately, RMAB models lack flexibility to adapt to evolving public health policy priorities. Concurrently, Large Language Models (LLMs) have emerged as adept automated planners across domains of robotic control and navigation. In this paper, we propose a Decision Language Model (DLM) for RMABs, enabling dynamic fine-tuning of RMAB policies in public health settings using human-language commands. We propose using LLMs as automated planners to (1) interpret human policy preference prompts, (2) propose reward functions as code for a multi-agent RMAB environment, and (3) iterate on the generated reward functions using feedback from grounded RMAB simulations. We illustrate the application of DLM in collaboration with ARMMAN, an India-based non-profit promoting preventative care for pregnant mothers, that currently relies on RMAB policies to optimally allocate health worker calls to low-resource populations. We conduct a technology demonstration in simulation using the Gemini Pro model, showing DLM can dynamically shape policy outcomes using only human prompts as input.

Since the COVID-19 pandemic, clinicians have seen a large and sustained influx in patient portal messages, significantly contributing to clinician burnout. To the best of our knowledge, there are no large-scale public patient portal messages corpora researchers can use to build tools to optimize clinician portal workflows. Informed by our ongoing work with a regional hospital, this study introduces an LLM-powered framework for configurable and realistic patient portal message generation. Our approach leverages few-shot grounded text generation, requiring only a small number of de-identified patient portal messages to help LLMs better match the true style and tone of real data. Clinical experts in our team deem this framework as HIPAA-friendly, unlike existing privacy-preserving approaches to synthetic text generation which cannot guarantee all sensitive attributes will be protected. Through extensive quantitative and human evaluation, we show that our framework produces data of higher quality than comparable generation methods as well as all related datasets. We believe this work provides a path forward for (i) the release of large-scale synthetic patient message datasets that are stylistically similar to ground-truth samples and (ii) HIPAA-friendly data generation which requires minimal human de-identification efforts.

Misinformation in healthcare, from vaccine hesitancy to unproven treatments, poses risks to public health and trust in medical systems. While machine learning and natural language processing have advanced automated fact-checking, validating biomedical claims remains uniquely challenging due to complex terminology, the need for domain expertise, and the critical importance of grounding in scientific evidence. We introduce CER (Combining Evidence and Reasoning), a novel framework for biomedical fact-checking that integrates scientific evidence retrieval, reasoning via large language models, and supervised veracity prediction. By integrating the text-generation capabilities of large language models with advanced retrieval techniques for high-quality biomedical scientific evidence, CER effectively mitigates the risk of hallucinations, ensuring that generated outputs are grounded in verifiable, evidence-based sources. Evaluations on expert-annotated datasets (HealthFC, BioASQ-7b, SciFact) demonstrate state-of-the-art performance and promising cross-dataset generalization. Code and data are released for transparency and reproducibility: https://github.com/PRAISELab-PicusLab/CER

Digital healthcare infrastructure is crucial for global medical service delivery. Egypt faces EHR adoption barriers: only 314 hospitals had such systems as of Oct 2024. This limits data management and decision-making. This project introduces an EHR system for Egypt's Universal Health Insurance and healthcare ecosystem. It simplifies data management by centralizing medical histories with a scalable micro-services architecture and polyglot persistence for real-time access and provider communication. Clinical workflows are enhanced via patient examination and history tracking. The system uses the Llama3-OpenBioLLM-70B model to generate summaries of medical histories, provide chatbot features, and generate AI-based medical reports, enabling efficient searches during consultations. A Vision Transformer (ViT) aids in pneumonia classification. Evaluations show the AI excels in capturing details (high recall) but needs improvement in concise narratives. With optimization (retrieval-augmented generation, local data fine-tuning, interoperability protocols), this AI-driven EHR could enhance diagnostic support, decision-making, and healthcare delivery in Egypt.

The COVID-19 pandemic has posed a heavy burden to the healthcare system worldwide and caused huge social disruption and economic loss. Many deep learning models have been proposed to conduct clinical predictive tasks such as mortality prediction for COVID-19 patients in intensive care units using Electronic Health Record (EHR) data. Despite their initial success in certain clinical applications, there is currently a lack of benchmarking results to achieve a fair comparison so that we can select the optimal model for clinical use. Furthermore, there is a discrepancy between the formulation of traditional prediction tasks and real-world clinical practice in intensive care. To fill these gaps, we propose two clinical prediction tasks, Outcome-specific length-of-stay prediction and Early mortality prediction for COVID-19 patients in intensive care units. The two tasks are adapted from the naive length-of-stay and mortality prediction tasks to accommodate the clinical practice for COVID-19 patients. We propose fair, detailed, open-source data-preprocessing pipelines and evaluate 17 state-of-the-art predictive models on two tasks, including 5 machine learning models, 6 basic deep learning models and 6 deep learning predictive models specifically designed for EHR data. We provide benchmarking results using data from two real-world COVID-19 EHR datasets. One dataset is publicly available without needing any inquiry and another dataset can be accessed on request. We provide fair, reproducible benchmarking results for two tasks. We deploy all experiment results and models on an online platform. We also allow clinicians and researchers to upload their data to the platform and get quick prediction results using our trained models. We hope our efforts can further facilitate deep learning and machine learning research for COVID-19 predictive modeling.

Machine learning models in health care are often deployed in settings where it is important to protect patient privacy. In such settings, methods for differentially private (DP) learning provide a general-purpose approach to learn models with privacy guarantees. Modern methods for DP learning ensure privacy through mechanisms that censor information judged as too unique. The resulting privacy-preserving models, therefore, neglect information from the tails of a data distribution, resulting in a loss of accuracy that can disproportionately affect small groups. In this paper, we study the effects of DP learning in health care. We use state-of-the-art methods for DP learning to train privacy-preserving models in clinical prediction tasks, including x-ray classification of images and mortality prediction in time series data. We use these models to perform a comprehensive empirical investigation of the tradeoffs between privacy, utility, robustness to dataset shift, and fairness. Our results highlight lesser-known limitations of methods for DP learning in health care, models that exhibit steep tradeoffs between privacy and utility, and models whose predictions are disproportionately influenced by large demographic groups in the training data. We discuss the costs and benefits of differentially private learning in health care.

Risk decision systems in fraud detection and credit scoring operate under structural label absence: ground truth arrives weeks to months after decisions are made. During this blind period, model performance may degrade silently, eroding the governance evidence that justifies automated decisions. Existing drift detection methods either require labels (supervised detectors) or detect statistical change without distinguishing harmful degradation from benign distributional evolution (unsupervised detectors). No existing framework integrates drift detection with governance evidence assessment and operational response. This paper presents a label-free governance monitoring extension to the Governance Drift Toolkit that produces governance alerts rather than statistical alarms. The monitoring architecture applies composite multi-proxy monitoring across four proxy monitors (score distribution, feature drift, prediction entropy, confidence distribution), with governance-calibrated thresholds. Empirical evaluation on the Lending Club credit scoring dataset (1.37M loans, 11 years) demonstrates three findings. First, raw proxy metrics (Feature PSI delta up to 1.84, Score PSI delta up to 0.92) distinguish injected covariate degradation from natural temporal drift in an offline evaluation setting. Second, pure concept drift in P(Y|X) produces exactly zero delta across all proxy metrics in all windows, confirming the irreducible blind spot of label-free monitoring as a structural verification. Third, the composite score provides monotonic severity progression as more monitors trigger (0.583 to 0.833 to 1.000), enabling graduated governance response. Cross-domain comparison with IEEE-CIS fraud detection results shows the detectable/undetectable boundary is consistent across both domains. The toolkit and evaluation code are available as open-source artifacts.

Electronic Health Records (EHRs) contain rich yet complex information, and their automated analysis is critical for clinical decision-making. Despite recent advances of large language models (LLMs) in clinical workflows, their ability to analyze EHRs remains limited due to narrow task coverage and lack of EHR-oriented reasoning capabilities. This paper aims to bridge the gap, specifically, we present EHR-Ins, a large-scale, comprehensive EHR reasoning instruction dataset, comprising 300k high-quality reasoning cases and 4M non-reasoning cases across 42 distinct EHR tasks. Its core innovation is a thinking-graph-driven framework that enables to generate high-quality reasoning data at scale. Based on it, we develop EHR-R1, a series of reasoning-enhanced LLMs with up to 72B parameters tailored for EHR analysis. Through a multi-stage training paradigm, including domain adaptation, reasoning enhancement, and reinforcement learning, EHR-R1 systematically acquires domain knowledge and diverse reasoning capabilities, enabling accurate and robust EHR analysis. Lastly, we introduce EHR-Bench, a new benchmark curated from MIMIC-IV, spanning 42 tasks, to comprehensively assess reasoning and prediction across EHR scenarios. In experiments, we show that the resulting EHR-R1 consistently outperforms state-of-the-art commercial and open-source LLMs (including DeepSeek-V3 and GPT-4o), surpassing GPT-4o by over 30 points on MIMIC-Bench and achieving a 10\% higher zero-shot AUROC on EHRSHOT. Collectively, EHR-Ins, EHR-R1, and EHR-Bench have significantly advanced the development for more reliable and clinically relevant EHR analysis.

We introduce behavioral fidelity -- a third evaluation dimension for synthetic tabular data that measures whether generated data preserves the temporal, sequential, and structural behavioral patterns that distinguish real-world entity activity. Existing frameworks evaluate statistical fidelity (marginal distributions and correlations) and downstream utility (classifier AUROC on synthetic-trained models), but neither tests for the behavioral signals that operational detection and analysis systems actually rely on. We formalize a taxonomy of four behavioral fraud patterns (P1-P4) covering inter-event timing, burst structure, multi-account graph motifs, and velocity-rule trigger rates; define a degradation ratio metric calibrated to a real-data noise floor (1.0 = matches real variability, k = k-times worse); and prove that row-independent generators -- the dominant paradigm -- are structurally incapable of reproducing P3 graph motifs (Proposition 1) and produce non-positive within-entity IET autocorrelation (Proposition 2), making the positive burst fingerprint of fraud sequences unachievable regardless of architecture or training data size. We benchmark CTGAN, TVAE, GaussianCopula, and TabularARGN on IEEE-CIS Fraud Detection and the Amazon Fraud Dataset. All four fail severely: on IEEE-CIS composite degradation ratios range from 24.4x (TVAE) to 39.0x (GaussianCopula); on Amazon FDB, row-independent generators score 81.6-99.7x, while TabularARGN achieves 17.2x. We document generator-specific failure modes and their resolutions. The P1-P4 framework extends to any domain with entity-level sequential tabular data, including healthcare and network security. We release our evaluation framework as open source.

Machine learning has successfully framed many sequential decision making problems as either supervised prediction, or optimal decision-making policy identification via reinforcement learning. In data-constrained offline settings, both approaches may fail as they assume fully optimal behavior or rely on exploring alternatives that may not exist. We introduce an inherently different approach that identifies possible "dead-ends" of a state space. We focus on the condition of patients in the intensive care unit, where a "medical dead-end" indicates that a patient will expire, regardless of all potential future treatment sequences. We postulate "treatment security" as avoiding treatments with probability proportional to their chance of leading to dead-ends, present a formal proof, and frame discovery as an RL problem. We then train three independent deep neural models for automated state construction, dead-end discovery and confirmation. Our empirical results discover that dead-ends exist in real clinical data among septic patients, and further reveal gaps between secure treatments and those that were administered.

Large Reasoning Models (LRMs) have introduced a new paradigm in AI by enabling models to ``think before responding" via chain-of-thought reasoning. However, the absence of open and reproducible recipes for building reasoning-centric medical LMMs hinders community-wide research, analysis, and comparison. In this paper, we present MedVLThinker, a suite of simple yet strong baselines. Our fully open recipe consists of: (1) systematic data curation for both text-only and image-text medical data, filtered according to varying levels of reasoning difficulty, and (2) two training paradigms: Supervised Fine-Tuning (SFT) on distilled reasoning traces and Reinforcement Learning with Verifiable Rewards (RLVR) based on final answer correctness. Across extensive experiments on the Qwen2.5-VL model family (3B, 7B) and six medical QA benchmarks, we find that RLVR consistently and significantly outperforms SFT. Additionally, under the RLVR framework, a key, counter-intuitive finding is that training on our curated text-only reasoning data provides a more substantial performance boost than training on multimodal image-text data. Our best open 7B model, trained using the RLVR recipe on text-only data, establishes a new state-of-the-art on existing public VQA benchmarks, surpassing all previous open-source medical LMMs. Furthermore, scaling our model to 32B achieves performance on par with the proprietary GPT-4o. We release all curated data, models, and code to provide the community with a strong, open foundation for future research in multimodal medical reasoning.

The acute phase of the Covid-19 pandemic has made apparent the need for decision support based upon accurate epidemic modeling. This process is substantially hampered by under-reporting of cases and related data incompleteness issues. In this article we adopt the Bayesian paradigm and synthesize publicly available data via a discrete-time stochastic epidemic modeling framework. The models allow for estimating the total number of infections while accounting for the endemic phase of the pandemic. We assess the prediction of the infection rate utilizing mobility information, notably the principal components of the mobility data. We evaluate variational Bayes in this context and find that Hamiltonian Monte Carlo offers a robust inference alternative for such models. We elaborate upon vector analysis of the epidemic dynamics, thus enriching the traditional tools used for decision making. In particular, we show how certain 2-dimensional plots on the phase plane may yield intuitive information regarding the speed and the type of transmission dynamics. We investigate the potential of a two-stage analysis as a consequence of cutting feedback, for inference on certain functionals of the model parameters. Finally, we show that a point mass on critical parameters is overly restrictive and investigate informative priors as a suitable alternative.

Asynchronous reinforcement learning improves rollout throughput for large language model agents by decoupling sample generation from policy optimization, but it also introduces a critical failure mode for PPO-style off-policy correction. In heterogeneous training systems, the total importance ratio should ideally be decomposed into two semantically distinct factors: a training--inference discrepancy term that aligns inference-side and training-side distributions at the same behavior-policy version, and a policy-staleness term that constrains the update from the historical policy to the current policy. We show that practical asynchronous pipelines with delayed updates and partial rollouts often lose the required historical training-side logits, or old logits. This missing-old-logit problem entangles discrepancy repair with staleness correction, breaks the intended semantics of decoupled correction, and makes clipping and masking thresholds interact undesirably. To address this issue, we study both exact and approximate correction routes. We propose three exact old-logit acquisition strategies: snapshot-based version tracking, a dedicated old-logit model, and synchronization via partial rollout interruption, and compare their system trade-offs. From the perspective of approximate correction, we focus on preserving the benefits of decoupled correction through a more appropriate approximate policy when exact old logits cannot be recovered at low cost, without incurring extra system overhead. Following this analysis, we adopt a revised PPO-EWMA method, which achieves significant gains in both training speed and optimization performance. Code at https://github.com/millioniron/ROLL.

The COVID-19 pandemic has underscored the need for low-cost, scalable approaches to measuring contactless vital signs, either during initial triage at a healthcare facility or virtual telemedicine visits. Remote photoplethysmography (rPPG) can accurately estimate heart rate (HR) when applied to close-up videos of healthy volunteers in well-lit laboratory settings. However, results from such highly optimized laboratory studies may not be readily translated to healthcare settings. One significant barrier to the practical application of rPPG in health care is the accurate localization of the region of interest (ROI). Clinical or telemedicine visits may involve sub-optimal lighting, movement artifacts, variable camera angle, and subject distance. This paper presents an rPPG ROI selection method based on 3D facial landmarks and patient head yaw angle. We then demonstrate the robustness of this ROI selection method when coupled to the Plane-Orthogonal-to-Skin (POS) rPPG method when applied to videos of patients presenting to an Emergency Department for respiratory complaints. Our results demonstrate the effectiveness of our proposed approach in improving the accuracy and robustness of rPPG in a challenging clinical environment.

Health misinformation spreading online poses a significant threat to public health. Researchers have explored methods for automatically generating counterspeech to health misinformation as a mitigation strategy. Existing approaches often produce uniform responses, ignoring that the health literacy level of the audience could affect the accessibility and effectiveness of counterspeech. We propose a Controlled-Literacy framework using retrieval-augmented generation (RAG) with reinforcement learning (RL) to generate tailored counterspeech adapted to different health literacy levels. In particular, we retrieve knowledge aligned with specific health literacy levels, enabling accessible and factual information to support generation. We design a reward function incorporating subjective user preferences and objective readability-based rewards to optimize counterspeech to the target health literacy level. Experiment results show that Controlled-Literacy outperforms baselines by generating more accessible and user-preferred counterspeech. This research contributes to more equitable and impactful public health communication by improving the accessibility and comprehension of counterspeech to health misinformation

Open-ended evaluation is essential for deploying large language models in real-world settings. In studying HealthBench, we observe that using the model itself as a grader and generating rubric-based reward signals substantially improves reasoning performance. Remarkably, the trained model also becomes a stronger grader. Motivated by this, we introduce Self-Rewarding Rubric-Based Reinforcement Learning for Open-Ended Reasoning, a lightweight framework that enables faster and more resource-efficient training while surpassing baselines. Remarkably, on Qwen3-32B, training with just the 4000-sample HealthBench Easy subset is sufficient to obtain a model that exceeds GPT-5 on HealthBench Hard. Incorporating a small amount of teacher-graded data further enhances performance for less capable models.

Large language models have achieved strong performance on medical reasoning benchmarks, yet their deployment in clinical settings demands rigorous verification to ensure factual accuracy. While reward models offer a scalable approach for reasoning trace verification, existing methods face two limitations: they produce only scalar reward values without explicit justification, and they rely on single-pass retrieval that precludes adaptive knowledge access as verification unfolds. We introduce method, an agentic framework that addresses these limitations by training medical reasoning verifiers to iteratively query external medical corpora during evaluation. Our approach combines tool-augmented verification with an iterative reinforcement learning paradigm that requires only trace-level supervision, alongside an adaptive curriculum mechanism that dynamically adjusts training data distribution. Across four medical reasoning benchmarks, method achieves substantial gains over existing methods, improving MedQA accuracy by 23.5% and MedXpertQA by 32.0% relative to the base generator in particular. Crucially, method demonstrates an 8times reduction in sampling budget requirement compared to prior reward model baselines. These findings establish that grounding verification in dynamically retrieved evidence offers a principled path toward more reliable medical reasoning systems.

Medical visual grounding serves as a crucial foundation for fine-grained multimodal reasoning and interpretable clinical decision support. Despite recent advances in reinforcement learning (RL) for grounding tasks, existing approaches such as Group Relative Policy Optimization~(GRPO) suffer from severe reward sparsity when directly applied to medical images, primarily due to the inherent difficulty of localizing small or ambiguous regions of interest, which is further exacerbated by the rigid and suboptimal nature of fixed IoU-based reward schemes in RL. This leads to vanishing policy gradients and stagnated optimization, particularly during early training. To address this challenge, we propose MedLoc-R1, a performance-aware reward scheduling framework that progressively tightens the reward criterion in accordance with model readiness. MedLoc-R1 introduces a sliding-window performance tracker and a multi-condition update rule that automatically adjust the reward schedule from dense, easily obtainable signals to stricter, fine-grained localization requirements, while preserving the favorable properties of GRPO without introducing auxiliary networks or additional gradient paths. Experiments on three medical visual grounding benchmarks demonstrate that MedLoc-R1 consistently improves both localization accuracy and training stability over GRPO-based baselines. Our framework offers a general, lightweight, and effective solution for RL-based grounding in high-stakes medical applications. Code \& checkpoints are available at {https://github.com/MembrAI/MedLoc-R1}.

The presence of unhealthy nodes in cloud infrastructure signals the potential failure of machines, which can significantly impact the availability and reliability of cloud services, resulting in negative customer experiences. Effectively addressing unhealthy node mitigation is therefore vital for sustaining cloud system performance. This paper introduces Deoxys, a causal inference engine tailored to recommending mitigation actions for unhealthy node in cloud systems to minimize virtual machine downtime and interruptions during unhealthy events. It employs double machine learning combined with causal forest to produce precise and reliable mitigation recommendations based solely on limited observational data collected from the historical unhealthy events. To enhance the causal inference model, Deoxys further incorporates a policy fallback mechanism based on model uncertainty and action overriding mechanisms to (i) improve the reliability of the system, and (ii) strike a good tradeoff between downtime reduction and resource utilization, thereby enhancing the overall system performance. After deploying Deoxys in a large-scale cloud infrastructure at Microsoft, our observations demonstrate that Deoxys significantly reduces average VM downtime by 53% compared to a legacy policy, while leading to 49.5% lower VM interruption rate. This substantial improvement enhances the reliability and stability of cloud platforms, resulting in a seamless customer experience.

Synthetic data generation offers a promising solution to enhance the usefulness of Electronic Healthcare Records (EHR) by generating realistic de-identified data. However, the existing literature primarily focuses on the quality of synthetic health data, neglecting the crucial aspect of fairness in downstream predictions. Consequently, models trained on synthetic EHR have faced criticism for producing biased outcomes in target tasks. These biases can arise from either spurious correlations between features or the failure of models to accurately represent sub-groups. To address these concerns, we present Bias-transforming Generative Adversarial Networks (Bt-GAN), a GAN-based synthetic data generator specifically designed for the healthcare domain. In order to tackle spurious correlations (i), we propose an information-constrained Data Generation Process that enables the generator to learn a fair deterministic transformation based on a well-defined notion of algorithmic fairness. To overcome the challenge of capturing exact sub-group representations (ii), we incentivize the generator to preserve sub-group densities through score-based weighted sampling. This approach compels the generator to learn from underrepresented regions of the data manifold. We conduct extensive experiments using the MIMIC-III database. Our results demonstrate that Bt-GAN achieves SOTA accuracy while significantly improving fairness and minimizing bias amplification. We also perform an in-depth explainability analysis to provide additional evidence supporting the validity of our study. In conclusion, our research introduces a novel and professional approach to addressing the limitations of synthetic data generation in the healthcare domain. By incorporating fairness considerations and leveraging advanced techniques such as GANs, we pave the way for more reliable and unbiased predictions in healthcare applications.

Clinicians spend large amounts of time on clinical documentation, and inefficiencies impact quality of care and increase clinician burnout. Despite the promise of electronic medical records (EMR), the transition from paper-based records has been negatively associated with clinician wellness, in part due to poor user experience, increased burden of documentation, and alert fatigue. In this study, we present Almanac Copilot, an autonomous agent capable of assisting clinicians with EMR-specific tasks such as information retrieval and order placement. On EHR-QA, a synthetic evaluation dataset of 300 common EHR queries based on real patient data, Almanac Copilot obtains a successful task completion rate of 74% (n = 221 tasks) with a mean score of 2.45 over 3 (95% CI:2.34-2.56). By automating routine tasks and streamlining the documentation process, our findings highlight the significant potential of autonomous agents to mitigate the cognitive load imposed on clinicians by current EMR systems.

Formula alpha mining, which generates predictive signals from financial data, is critical for quantitative investment. Although various algorithmic approaches-such as genetic programming, reinforcement learning, and large language models-have significantly expanded the capacity for alpha discovery, systematic evaluation remains a key challenge. Existing evaluation metrics predominantly include backtesting and correlation-based measures. Backtesting is computationally intensive, inherently sequential, and sensitive to specific strategy parameters. Correlation-based metrics, though efficient, assess only predictive ability and overlook other crucial properties such as temporal stability, robustness, diversity, and interpretability. Additionally, the closed-source nature of most existing alpha mining models hinders reproducibility and slows progress in this field. To address these issues, we propose AlphaEval, a unified, parallelizable, and backtest-free evaluation framework for automated alpha mining models. AlphaEval assesses the overall quality of generated alphas along five complementary dimensions: predictive power, stability, robustness to market perturbations, financial logic, and diversity. Extensive experiments across representative alpha mining algorithms demonstrate that AlphaEval achieves evaluation consistency comparable to comprehensive backtesting, while providing more comprehensive insights and higher efficiency. Furthermore, AlphaEval effectively identifies superior alphas compared to traditional single-metric screening approaches. All implementations and evaluation tools are open-sourced to promote reproducibility and community engagement.

Machine learning models are often trained to predict the outcome resulting from a human decision. For example, if a doctor decides to test a patient for disease, will the patient test positive? A challenge is that historical decision-making determines whether the outcome is observed: we only observe test outcomes for patients doctors historically tested. Untested patients, for whom outcomes are unobserved, may differ from tested patients along observed and unobserved dimensions. We propose a Bayesian model class which captures this setting. The purpose of the model is to accurately estimate risk for both tested and untested patients. Estimating this model is challenging due to the wide range of possibilities for untested patients. To address this, we propose two domain constraints which are plausible in health settings: a prevalence constraint, where the overall disease prevalence is known, and an expertise constraint, where the human decision-maker deviates from purely risk-based decision-making only along a constrained feature set. We show theoretically and on synthetic data that domain constraints improve parameter inference. We apply our model to a case study of cancer risk prediction, showing that the model's inferred risk predicts cancer diagnoses, its inferred testing policy captures known public health policies, and it can identify suboptimalities in test allocation. Though our case study is in healthcare, our analysis reveals a general class of domain constraints which can improve model estimation in many settings.

In this paper, we introduce agentic unlearning which removes specified information from both model parameters and persistent memory in agents with closed-loop interaction. Existing unlearning methods target parameters alone, leaving two critical gaps: (i) parameter-memory backflow, where retrieval reactivates parametric remnants or memory artifacts reintroduce sensitive content, and (ii) the absence of a unified strategy that covers both parameter and memory pathways. We present Synchronized Backflow Unlearning (SBU), a framework that unlearns jointly across parameter and memory pathways. The memory pathway performs dependency closure-based unlearning that prunes isolated entities while logically invalidating shared artifacts. The parameter pathway employs stochastic reference alignment to guide model outputs toward a high-entropy prior. These pathways are integrated via a synchronized dual-update protocol, forming a closed-loop mechanism where memory unlearning and parametric suppression reinforce each other to prevent cross-pathway recontamination. Experiments on medical QA benchmarks show that SBU reduces traces of targeted private information across both pathways with limited degradation on retained data.

Health Indicators (HIs) are essential for predicting system failures in predictive maintenance. While methods like RaPP (Reconstruction along Projected Pathways) improve traditional HI approaches by leveraging autoencoder latent spaces, their performance can be hindered by both aleatoric and epistemic uncertainties. In this paper, we propose a novel framework that integrates uncertainty quantification into autoencoder-based latent spaces, enhancing RaPP-generated HIs. We demonstrate that separating aleatoric uncertainty from epistemic uncertainty and cross combining HI information is the driver of accuracy improvements in Remaining Useful Life (RUL) prediction. Our method employs both standard and variational autoencoders to construct these HIs, which are then used to train a machine learning model for RUL prediction. Benchmarked on the NASA C-MAPSS turbofan dataset, our approach outperforms traditional HI-based methods and end-to-end RUL prediction models and is competitive with RUL estimation methods. These results underscore the importance of uncertainty quantification in health assessment and showcase its significant impact on predictive performance when incorporated into the HI construction process.

Recent work on reinforcement learning with verifiable rewards (RLVR) has shown that large language models (LLMs) can be substantially improved using outcome-level verification signals, such as unit tests for code or exact-match checks for mathematics. In parallel, process supervision has long been explored as a way to shape the intermediate reasoning behaviour of LLMs, but existing approaches rely on neural judges to score chain-of-thought steps, leaving them vulnerable to opacity, bias, and reward hacking. To address this gap, we introduce Verifiable Process Reward Models (VPRMs), a reinforcement-learning framework in which intermediate reasoning steps are checked by deterministic, rule-based verifiers. We apply VPRMs to risk-of-bias assessment for medical evidence synthesis, a domain where guideline-defined criteria and rule-based decision paths enable programmatic verification of reasoning traces. Across multiple datasets, we find that VPRMs generate reasoning that adheres closely to domain rules and achieve substantially higher coherence between step-level decisions and final labels. Results show that VPRMs achieve up to 20% higher F1 than state-of-the-art models and 6.5% higher than verifiable outcome rewards, with substantial gains in evidence grounding and logical coherence.

Current evaluations of LLM safety predominantly rely on severity-based taxonomies to assess the harmfulness of malicious queries. We argue that this formulation requires re-examination as it assumes uniform risk across all malicious queries, neglecting Execution Likelihood--the conditional probability of a threat being realized given the model's response. In this work, we introduce Expected Harm, a metric that weights the severity of a jailbreak by its execution likelihood, modeled as a function of execution cost. Through empirical analysis of state-of-the-art models, we reveal a systematic Inverse Risk Calibration: models disproportionately exhibit stronger refusal behaviors for low-likelihood (high-cost) threats while remaining vulnerable to high-likelihood (low-cost) queries. We demonstrate that this miscalibration creates a structural vulnerability: by exploiting this property, we increase the attack success rate of existing jailbreaks by up to 2times. Finally, we trace the root cause of this failure using linear probing, which reveals that while models encode severity in their latent space to drive refusal decisions, they possess no distinguishable internal representation of execution cost, making them "blind" to this critical dimension of risk.

Reinforcement learning with verifiable rewards (RLVR) has emerged as a promising paradigm for enhancing the reasoning capabilities of large language models (LLMs). In this context, models explore reasoning trajectories and exploit rollouts with correct answers as positive signals for policy optimization. However, these rollouts might involve flawed patterns such as answer-guessing and jump-in-reasoning. Such flawed-positive rollouts are rewarded identically to fully correct ones, causing policy models to internalize these unreliable reasoning patterns. In this work, we first conduct a systematic study of flawed-positive rollouts in RL and find that they enable rapid capability gains during the early optimization stage, while constraining reasoning capability later by reinforcing unreliable patterns. Building on these insights, we propose Flawed-Aware Policy Optimization (FAPO), which presents a parameter-free reward penalty for flawed-positive rollouts, enabling the policy to leverage them as useful shortcuts in the warm-up stage, securing stable early gains, while gradually shifting optimization toward reliable reasoning in the later refinement stage. To accurately and comprehensively detect flawed-positive rollouts, we introduce a generative reward model (GenRM) with a process-level reward that precisely localizes reasoning errors. Experiments show that FAPO is effective in broad domains, improving outcome correctness, process reliability, and training stability without increasing the token budget.

We present FairHealth, an open-source Python library that provides a unified, modular framework for trustworthy machine learning in healthcare applications, with particular focus on low-resource and low-income country (LMIC) settings such as Bangladesh. FairHealth addresses four critical gaps in existing healthcare AI toolkits: (1) the absence of integrated fairness auditing for biosignals and clinical tabular data; (2) the lack of privacy-preserving federated learning tools compatible with standard ML workflows; (3) missing explainability tools tailored for low-bandwidth clinical decision support; and (4) no existing toolkit covering Global South healthcare datasets. Built from five peer-reviewed research contributions, FairHealth provides six modules covering federated learning with homomorphic encryption (fairhealth.federated), intersectional fairness metrics (fairhealth.fairness), hybrid fuzzy-SHAP explainability (fairhealth.explain), multilingual dengue triage (fairhealth.lowresource), equitable disaster aid allocation (fairhealth.equity), and public dataset loaders (fairhealth.datasets). All datasets used are publicly available without institutional data use agreements. FairHealth is installable via pip install fairhealth(PyPI: pypi.org/project/fairhealth/) and available at https://github.com/Farjana-Yesmin/fairhealth.

Recent machine learning papers often report 1-2 percentage point improvements from a single run on a benchmark. These gains are highly sensitive to random seeds, data ordering, and implementation details, yet are rarely accompanied by uncertainty estimates or significance tests. It is therefore unclear when a reported +1-2% reflects a real algorithmic advance versus noise. We revisit this problem under realistic compute budgets, where only a few runs are affordable. We propose a simple, PC-friendly evaluation protocol based on paired multi-seed runs, bias-corrected and accelerated (BCa) bootstrap confidence intervals, and a sign-flip permutation test on per-seed deltas. The protocol is intentionally conservative and is meant as a guardrail against over-claiming. We instantiate it on CIFAR-10, CIFAR-10N, and AG News using synthetic no-improvement, small-gain, and medium-gain scenarios. Single runs and unpaired t-tests often suggest significant gains for 0.6-2.0 point improvements, especially on text. With only three seeds, our paired protocol never declares significance in these settings. We argue that such conservative evaluation is a safer default for small gains under tight budgets.

Large Language Models (LLMs) and AI chatbots are increasingly used for emotional and mental health support due to their low cost, immediacy, and accessibility. However, when safety guardrails are triggered, conversations may be abruptly terminated, introducing a distinct form of emotional disruption that can exacerbate distress and elevate risk among already vulnerable users. As this phenomenon gains attention, this viewpoint introduces Abrupt Refusal Secondary Harm (ARSH) as a conceptual framework to describe the psychological impacts of sudden conversational discontinuation caused by AI safety protocols. Drawing on counseling psychology and communication science as conceptual heuristics, we argue that abrupt refusals can rupture perceived relational continuity, evoke feelings of rejection or shame, and discourage future help seeking. To mitigate these risks, we propose a design hypothesis, the Compassionate Completion Standard (CCS), a refusal protocol grounded in Human Centered Design (HCD) that maintains safety constraints while preserving relational coherence. CCS emphasizes empathetic acknowledgment, transparent boundary articulation, graded conversational transition, and guided redirection, replacing abrupt disengagement with psychologically attuned closure. By integrating awareness of ARSH into AI safety design, developers and policymakers can reduce preventable iatrogenic harm and advance a more psychologically informed approach to AI governance. Rather than presenting incremental empirical findings, this viewpoint contributes a timely conceptual framework, articulates a testable design hypothesis, and outlines a coordinated research agenda for improving psychological safety in human AI interaction.

The proliferation of online misinformation has posed significant threats to public interest. While numerous online users actively participate in the combat against misinformation, many of such responses can be characterized by the lack of politeness and supporting facts. As a solution, text generation approaches are proposed to automatically produce counter-misinformation responses. Nevertheless, existing methods are often trained end-to-end without leveraging external knowledge, resulting in subpar text quality and excessively repetitive responses. In this paper, we propose retrieval augmented response generation for online misinformation (RARG), which collects supporting evidence from scientific sources and generates counter-misinformation responses based on the evidences. In particular, our RARG consists of two stages: (1) evidence collection, where we design a retrieval pipeline to retrieve and rerank evidence documents using a database comprising over 1M academic articles; (2) response generation, in which we align large language models (LLMs) to generate evidence-based responses via reinforcement learning from human feedback (RLHF). We propose a reward function to maximize the utilization of the retrieved evidence while maintaining the quality of the generated text, which yields polite and factual responses that clearly refutes misinformation. To demonstrate the effectiveness of our method, we study the case of COVID-19 and perform extensive experiments with both in- and cross-domain datasets, where RARG consistently outperforms baselines by generating high-quality counter-misinformation responses.

Electronic Health Records (EHRs) are integral for storing comprehensive patient medical records, combining structured data (e.g., medications) with detailed clinical notes (e.g., physician notes). These elements are essential for straightforward data retrieval and provide deep, contextual insights into patient care. However, they often suffer from discrepancies due to unintuitive EHR system designs and human errors, posing serious risks to patient safety. To address this, we developed EHRCon, a new dataset and task specifically designed to ensure data consistency between structured tables and unstructured notes in EHRs. EHRCon was crafted in collaboration with healthcare professionals using the MIMIC-III EHR dataset, and includes manual annotations of 3,943 entities across 105 clinical notes checked against database entries for consistency. EHRCon has two versions, one using the original MIMIC-III schema, and another using the OMOP CDM schema, in order to increase its applicability and generalizability. Furthermore, leveraging the capabilities of large language models, we introduce CheckEHR, a novel framework for verifying the consistency between clinical notes and database tables. CheckEHR utilizes an eight-stage process and shows promising results in both few-shot and zero-shot settings. The code is available at https://github.com/dustn1259/EHRCon.

Patient notes contain a wealth of information of potentially great interest to medical investigators. However, to protect patients' privacy, Protected Health Information (PHI) must be removed from the patient notes before they can be legally released, a process known as patient note de-identification. The main objective for a de-identification system is to have the highest possible recall. Recently, the first neural-network-based de-identification system has been proposed, yielding state-of-the-art results. Unlike other systems, it does not rely on human-engineered features, which allows it to be quickly deployed, but does not leverage knowledge from human experts or from electronic health records (EHRs). In this work, we explore a method to incorporate human-engineered features as well as features derived from EHRs to a neural-network-based de-identification system. Our results show that the addition of features, especially the EHR-derived features, further improves the state-of-the-art in patient note de-identification, including for some of the most sensitive PHI types such as patient names. Since in a real-life setting patient notes typically come with EHRs, we recommend developers of de-identification systems to leverage the information EHRs contain.

Understanding the prevalence of misinformation in health topics online can inform public health policies and interventions. However, measuring such misinformation at scale remains a challenge, particularly for high-stakes but understudied topics like opioid-use disorder (OUD)--a leading cause of death in the U.S. We present the first large-scale study of OUD-related myths on YouTube, a widely-used platform for health information. With clinical experts, we validate 8 pervasive myths and release an expert-labeled video dataset. To scale labeling, we introduce MythTriage, an efficient triage pipeline that uses a lightweight model for routine cases and defers harder ones to a high-performing, but costlier, large language model (LLM). MythTriage achieves up to 0.86 macro F1-score while estimated to reduce annotation time and financial cost by over 76% compared to experts and full LLM labeling. We analyze 2.9K search results and 343K recommendations, uncovering how myths persist on YouTube and offering actionable insights for public health and platform moderation.

Reliable clinical decision support requires medical AI agents capable of safe, multi-step reasoning over structured electronic health records (EHRs). While large language models (LLMs) show promise in healthcare, existing benchmarks inadequately assess performance on action-based tasks involving threshold evaluation, temporal aggregation, and conditional logic. We introduce ART, an Action-based Reasoning clinical Task benchmark for medical AI agents, which mines real-world EHR data to create challenging tasks targeting known reasoning weaknesses. Through analysis of existing benchmarks, we identify three dominant error categories: retrieval failures, aggregation errors, and conditional logic misjudgments. Our four-stage pipeline -- scenario identification, task generation, quality audit, and evaluation -- produces diverse, clinically validated tasks grounded in real patient data. Evaluating GPT-4o-mini and Claude 3.5 Sonnet on 600 tasks shows near-perfect retrieval after prompt refinement, but substantial gaps in aggregation (28--64%) and threshold reasoning (32--38%). By exposing failure modes in action-oriented EHR reasoning, ART advances toward more reliable clinical agents, an essential step for AI systems that reduce cognitive load and administrative burden, supporting workforce capacity in high-demand care settings

Large language models (LLMs) hold immense promise to serve complex health information needs but also have the potential to introduce harm and exacerbate health disparities. Reliably evaluating equity-related model failures is a critical step toward developing systems that promote health equity. In this work, we present resources and methodologies for surfacing biases with potential to precipitate equity-related harms in long-form, LLM-generated answers to medical questions and then conduct an empirical case study with Med-PaLM 2, resulting in the largest human evaluation study in this area to date. Our contributions include a multifactorial framework for human assessment of LLM-generated answers for biases, and EquityMedQA, a collection of seven newly-released datasets comprising both manually-curated and LLM-generated questions enriched for adversarial queries. Both our human assessment framework and dataset design process are grounded in an iterative participatory approach and review of possible biases in Med-PaLM 2 answers to adversarial queries. Through our empirical study, we find that the use of a collection of datasets curated through a variety of methodologies, coupled with a thorough evaluation protocol that leverages multiple assessment rubric designs and diverse rater groups, surfaces biases that may be missed via narrower evaluation approaches. Our experience underscores the importance of using diverse assessment methodologies and involving raters of varying backgrounds and expertise. We emphasize that while our framework can identify specific forms of bias, it is not sufficient to holistically assess whether the deployment of an AI system promotes equitable health outcomes. We hope the broader community leverages and builds on these tools and methods towards realizing a shared goal of LLMs that promote accessible and equitable healthcare for all.

Foundation Models that are capable of processing and generating multi-modal data have transformed AI's role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety. We define medical hallucination as any instance in which a model generates misleading medical content. This paper examines the unique characteristics, causes, and implications of medical hallucinations, with a particular focus on how these errors manifest themselves in real-world clinical scenarios. Our contributions include (1) a taxonomy for understanding and addressing medical hallucinations, (2) benchmarking models using medical hallucination dataset and physician-annotated LLM responses to real medical cases, providing direct insight into the clinical impact of hallucinations, and (3) a multi-national clinician survey on their experiences with medical hallucinations. Our results reveal that inference techniques such as Chain-of-Thought (CoT) and Search Augmented Generation can effectively reduce hallucination rates. However, despite these improvements, non-trivial levels of hallucination persist. These findings underscore the ethical and practical imperative for robust detection and mitigation strategies, establishing a foundation for regulatory policies that prioritize patient safety and maintain clinical integrity as AI becomes more integrated into healthcare. The feedback from clinicians highlights the urgent need for not only technical advances but also for clearer ethical and regulatory guidelines to ensure patient safety. A repository organizing the paper resources, summaries, and additional information is available at https://github.com/mitmedialab/medical hallucination.

Hepato-pancreato-biliary (HPB) disorders represent a global public health challenge due to their high morbidity and mortality. Although large language models (LLMs) have shown promising performance in general medical question-answering tasks, the current evaluation benchmarks are mostly derived from standardized examinations or manually designed questions, lacking HPB coverage and clinical cases. To address these issues, we systematically eatablish an HPB disease evaluation benchmark comprising 3,535 closed-ended multiple-choice questions and 337 open-ended real diagnosis cases, which encompasses all the 33 main categories and 465 subcategories of HPB diseases defined in the International Statistical Classification of Diseases, 10th Revision (ICD-10). The multiple-choice questions are curated from public datasets and synthesized data, and the clinical cases are collected from prestigious medical journals, case-sharing platforms, and collaborating hospitals. By evalauting commercial and open-source general and medical LLMs on our established benchmark, namely ClinBench-HBP, we find that while commercial LLMs perform competently on medical exam questions, they exhibit substantial performance degradation on HPB diagnosis tasks, especially on complex, inpatient clinical cases. Those medical LLMs also show limited generalizability to HPB diseases. Our results reveal the critical limitations of current LLMs in the domain of HPB diseases, underscoring the imperative need for future medical LLMs to handle real, complex clinical diagnostics rather than simple medical exam questions. The benchmark will be released at https://clinbench-hpb.github.io.

In this paper, we compare and evaluate different testing protocols used for automatic COVID-19 diagnosis from X-Ray images in the recent literature. We show that similar results can be obtained using X-Ray images that do not contain most of the lungs. We are able to remove the lungs from the images by turning to black the center of the X-Ray scan and training our classifiers only on the outer part of the images. Hence, we deduce that several testing protocols for the recognition are not fair and that the neural networks are learning patterns in the dataset that are not correlated to the presence of COVID-19. Finally, we show that creating a fair testing protocol is a challenging task, and we provide a method to measure how fair a specific testing protocol is. In the future research we suggest to check the fairness of a testing protocol using our tools and we encourage researchers to look for better techniques than the ones that we propose.

While large language models hold promise for complex medical applications, their development is hindered by the scarcity of high-quality reasoning data. To address this issue, existing approaches typically distill chain-of-thought reasoning traces from large proprietary models via supervised fine-tuning, then conduct reinforcement learning (RL). These methods exhibit limited improvement on underrepresented domains like rare diseases while incurring substantial costs from generating complex reasoning chains. To efficiently enhance medical reasoning, we propose MedSSR, a Medical Knowledge-enhanced data Synthesis and Semi-supervised Reinforcement learning framework. Our framework first employs rare disease knowledge to synthesize distribution-controllable reasoning questions. We then utilize the policy model itself to generate high-quality pseudo-labels. This enables a two-stage, intrinsic-to-extrinsic training paradigm: self-supervised RL on the pseudo-labeled synthetic data, followed by supervised RL on the human-annotated real data. MedSSR scales model training efficiently without relying on costly trace distillation. Extensive experiments on Qwen and Llama demonstrate that our method outperforms existing methods across ten medical benchmarks, achieving up to +5.93% gain on rare-disease tasks. Our code is available at https://github.com/tdlhl/MedSSR.

Large Language Models have demonstrated profound utility in the medical domain. However, their application to autonomous Electronic Health Records~(EHRs) navigation remains constrained by a reliance on curated inputs and simplified retrieval tasks. To bridge the gap between idealized experimental settings and realistic clinical environments, we present AgentEHR. This benchmark challenges agents to execute complex decision-making tasks, such as diagnosis and treatment planning, requiring long-range interactive reasoning directly within raw and high-noise databases. In tackling these tasks, we identify that existing summarization methods inevitably suffer from critical information loss and fractured reasoning continuity. To address this, we propose RetroSum, a novel framework that unifies a retrospective summarization mechanism with an evolving experience strategy. By dynamically re-evaluating interaction history, the retrospective mechanism prevents long-context information loss and ensures unbroken logical coherence. Additionally, the evolving strategy bridges the domain gap by retrieving accumulated experience from a memory bank. Extensive empirical evaluations demonstrate that RetroSum achieves performance gains of up to 29.16% over competitive baselines, while significantly decreasing total interaction errors by up to 92.3%.

The scholarly publishing ecosystem faces a dual crisis of unmanageable submission volumes and unregulated AI, creating an urgent need for new governance models to safeguard scientific integrity. The traditional human-only peer review regime lacks a scalable, objective benchmark, making editorial processes opaque and difficult to audit. Here we investigate a deterministic simulation framework that provides the first stable, evidence-based standard for evaluating AI-generated peer review reports. Analyzing 352 peer-review simulation reports, we identify consistent system state indicators that demonstrate its reliability. First, the system is able to simulate calibrated editorial judgment, with 'Revise' decisions consistently forming the majority outcome (>50%) across all disciplines, while 'Reject' rates dynamically adapt to field-specific norms, rising to 45% in Health Sciences. Second, it maintains unwavering procedural integrity, enforcing a stable 29% evidence-anchoring compliance rate that remains invariant across diverse review tasks and scientific domains. These findings demonstrate a system that is predictably rule-bound, mitigating the stochasticity of generative AI. For the scientific community, this provides a transparent tool to ensure fairness; for publishing strategists, it offers a scalable instrument for auditing workflows, managing integrity risks, and implementing evidence-based governance. The framework repositions AI as an essential component of institutional accountability, providing the critical infrastructure to maintain trust in scholarly communication.

Modern deployments require LLMs to enforce safety policies at scale, yet many controls rely on inference-time interventions that add recurring compute cost and serving complexity. Activation steering is widely used, but it requires runtime hooks and scales cost with the number of generations; conditional variants improve selectivity by gating when steering is applied but still retain an inference-time control path. We ask whether selective refusal can be moved entirely offline: can a mechanistic understanding of category-specific refusal be distilled into a circuit-restricted weight update that deploys as a standard checkpoint? We propose C-Δθ: Circuit Restricted Weight Arithmetic, which (i) localizes refusal-causal computation as a sparse circuit using EAP-IG and (ii) computes a constrained weight update ΔθC supported only on that circuit (typically <5% of parameters). Applying ΔθC yields a drop-in edited checkpoint with no inference-time hooks, shifting cost from per-request intervention to a one-time offline update. We evaluate category-targeted selectivity and capability retention on refusal and utility benchmarks.

Large language models have shown promise in clinical decision making, but current approaches struggle to localize and correct errors at specific steps of the reasoning process. This limitation is critical in medicine, where identifying and addressing reasoning errors is essential for accurate diagnosis and effective patient care. We introduce Med-PRM, a process reward modeling framework that leverages retrieval-augmented generation to verify each reasoning step against established medical knowledge bases. By verifying intermediate reasoning steps with evidence retrieved from clinical guidelines and literature, our model can precisely assess the reasoning quality in a fine-grained manner. Evaluations on five medical QA benchmarks and two open-ended diagnostic tasks demonstrate that Med-PRM achieves state-of-the-art performance, with improving the performance of base models by up to 13.50% using Med-PRM. Moreover, we demonstrate the generality of Med-PRM by integrating it in a plug-and-play fashion with strong policy models such as Meerkat, achieving over 80\% accuracy on MedQA for the first time using small-scale models of 8 billion parameters. Our code and data are available at: https://med-prm.github.io/

Evaluating retrieval-augmented generation (RAG) pipelines requires corpora where ground truth is knowable, temporally structured, and cross-artifact properties that real-world datasets rarely provide cleanly. Existing resources such as the Enron corpus carry legal ambiguity, demographic skew, and no structured ground truth. Purely LLM-generated synthetic data solves the legal problem but introduces a subtler one: the generating model cannot be prevented from hallucinating facts that contradict themselves across documents.We present OrgForge, an open-source multi-agent simulation framework that enforces a strict physics-cognition boundary: a deterministic Python engine maintains a SimEvent ground truth bus; large language models generate only surface prose, constrained by validated proposals. An actor-local clock enforces causal timestamp correctness across all artifact types, eliminating the class of timeline inconsistencies that arise when timestamps are sampled independently per document. We formalize three graph-dynamic subsystems stress propagation via betweenness centrality, temporal edge-weight decay, and Dijkstra escalation routing that govern organizational behavior independently of any LLM. Running a configurable N-day simulation, OrgForge produces interleaved Slack threads, JIRA tickets, Confluence pages, Git pull requests, and emails, all traceable to a shared, immutable event log. We additionally describe a causal chain tracking subsystem that accumulates cross-artifact evidence graphs per incident, a hybrid reciprocal-rank-fusion recurrence detector for identifying repeated failure classes, and an inbound/outbound email engine that routes vendor alerts, customer complaints, and HR correspondence through gated causal chains with probabilistic drop simulation. OrgForge is available under the MIT license.

Automating radiology report generation can significantly alleviate radiologists' workloads. Previous research has primarily focused on realizing highly concise observations while neglecting the precise attributes that determine the severity of diseases (e.g., small pleural effusion). Since incorrect attributes will lead to imprecise radiology reports, strengthening the generation process with precise attribute modeling becomes necessary. Additionally, the temporal information contained in the historical records, which is crucial in evaluating a patient's current condition (e.g., heart size is unchanged), has also been largely disregarded. To address these issues, we propose RECAP, which generates precise and accurate radiology reports via dynamic disease progression reasoning. Specifically, RECAP first predicts the observations and progressions (i.e., spatiotemporal information) given two consecutive radiographs. It then combines the historical records, spatiotemporal information, and radiographs for report generation, where a disease progression graph and dynamic progression reasoning mechanism are devised to accurately select the attributes of each observation and progression. Extensive experiments on two publicly available datasets demonstrate the effectiveness of our model.