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May 7

Multimodal AI predicts clinical outcomes of drug combinations from preclinical data

Predicting clinical outcomes from preclinical data is essential for identifying safe and effective drug combinations. Current models rely on structural or target-based features to identify high-efficacy, low-toxicity drug combinations. However, these approaches fail to incorporate the multimodal data necessary for accurate, clinically-relevant predictions. Here, we introduce MADRIGAL, a multimodal AI model that learns from structural, pathway, cell viability, and transcriptomic data to predict drug combination effects across 953 clinical outcomes and 21842 compounds, including combinations of approved drugs and novel compounds in development. MADRIGAL uses a transformer bottleneck module to unify preclinical drug data modalities while handling missing data during training and inference--a major challenge in multimodal learning. It outperforms single-modality methods and state-of-the-art models in predicting adverse drug interactions. MADRIGAL performs virtual screening of anticancer drug combinations and supports polypharmacy management for type II diabetes and metabolic dysfunction-associated steatohepatitis (MASH). It identifies transporter-mediated drug interactions. MADRIGAL predicts resmetirom, the first and only FDA-approved drug for MASH, among therapies with the most favorable safety profile. It supports personalized cancer therapy by integrating genomic profiles from cancer patients. Using primary acute myeloid leukemia samples and patient-derived xenograft models, it predicts the efficacy of personalized drug combinations. Integrating MADRIGAL with a large language model allows users to describe clinical outcomes in natural language, improving safety assessment by identifying potential adverse interactions and toxicity risks. MADRIGAL provides a multimodal approach for designing combination therapies with improved predictive accuracy and clinical relevance.

  • 10 authors
·
Mar 4, 2025

Domain constraints improve risk prediction when outcome data is missing

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.

  • 3 authors
·
Dec 6, 2023

Coping with Information Loss and the Use of Auxiliary Sources of Data: A Report from the NISS Ingram Olkin Forum Series on Unplanned Clinical Trial Disruptions

Clinical trials disruption has always represented a non negligible part of the ending of interventional studies. While the SARS-CoV-2 (COVID-19) pandemic has led to an impressive and unprecedented initiation of clinical research, it has also led to considerable disruption of clinical trials in other disease areas, with around 80% of non-COVID-19 trials stopped or interrupted during the pandemic. In many cases the disrupted trials will not have the planned statistical power necessary to yield interpretable results. This paper describes methods to compensate for the information loss arising from trial disruptions by incorporating additional information available from auxiliary data sources. The methods described include the use of auxiliary data on baseline and early outcome data available from the trial itself and frequentist and Bayesian approaches for the incorporation of information from external data sources. The methods are illustrated by application to the analysis of artificial data based on the Primary care pediatrics Learning Activity Nutrition (PLAN) study, a clinical trial assessing a diet and exercise intervention for overweight children, that was affected by the COVID-19 pandemic. We show how all of the methods proposed lead to an increase in precision relative to use of complete case data only.

  • 12 authors
·
Jun 22, 2022

Reflecting on Motivations: How Reasons to Publish affect Research Behaviour in Astronomy

Recent research in the field of reflexive metrics have studied the emergence and consequences of evaluation gaps in science. The concept of evaluation gaps captures potential discrepancies between what researchers value about their research, in particular research quality, and what metrics measure. As a result, scientists may experience anomie and adopt innovative ways to cope. These often value quantity over quality and may even compromise research integrity. A consequence of such gaps may therefore be research misconduct and a decrease in research quality. In the language of rational choice theory, an evaluation gap persists if motivational factors arising out of the internal component of an actors situation are incongruent with those arising out of the external components. The aim of this research is therefore to study and compare autonomous and controlled motivations to become an astronomer, to do research in astronomy and to publish scientific papers. Moreover, we study how these different motivational factors affect publication pressure, the experience of organisational justice and the observation of research misconduct. In summary, we find evidence for an evaluation gap and that controlled motivational factors arising from evaluation procedures based on publication record drives up publication pressure, which, in turn, was found to increase the likelihood of perceived frequency of misbehaviour.

  • 1 authors
·
Nov 30, 2021

Probabilistic Imputation for Time-series Classification with Missing Data

Multivariate time series data for real-world applications typically contain a significant amount of missing values. The dominant approach for classification with such missing values is to impute them heuristically with specific values (zero, mean, values of adjacent time-steps) or learnable parameters. However, these simple strategies do not take the data generative process into account, and more importantly, do not effectively capture the uncertainty in prediction due to the multiple possibilities for the missing values. In this paper, we propose a novel probabilistic framework for classification with multivariate time series data with missing values. Our model consists of two parts; a deep generative model for missing value imputation and a classifier. Extending the existing deep generative models to better capture structures of time-series data, our deep generative model part is trained to impute the missing values in multiple plausible ways, effectively modeling the uncertainty of the imputation. The classifier part takes the time series data along with the imputed missing values and classifies signals, and is trained to capture the predictive uncertainty due to the multiple possibilities of imputations. Importantly, we show that na\"ively combining the generative model and the classifier could result in trivial solutions where the generative model does not produce meaningful imputations. To resolve this, we present a novel regularization technique that can promote the model to produce useful imputation values that help classification. Through extensive experiments on real-world time series data with missing values, we demonstrate the effectiveness of our method.

  • 6 authors
·
Aug 13, 2023

Examining the Impact of Income Inequality and Gender on School Completion in Malaysia: A Machine Learning Approach Utilizing Malaysia's Public Sector Open Data

This study examines the relationship between income inequality, gender, and school completion rates in Malaysia using machine learning techniques. The dataset utilized is from the Malaysia's Public Sector Open Data Portal, covering the period 2016-2022. The analysis employs various machine learning techniques, including K-means clustering, ARIMA modeling, Random Forest regression, and Prophet for time series forecasting. These models are used to identify patterns, trends, and anomalies in the data, and to predict future school completion rates. Key findings reveal significant disparities in school completion rates across states, genders, and income levels. The analysis also identifies clusters of states with similar completion rates, suggesting potential regional factors influencing educational outcomes. Furthermore, time series forecasting models accurately predict future completion rates, highlighting the importance of ongoing monitoring and intervention strategies. The study concludes with recommendations for policymakers and educators to address the observed disparities and improve school completion rates in Malaysia. These recommendations include targeted interventions for specific states and demographic groups, investment in early childhood education, and addressing the impact of income inequality on educational opportunities. The findings of this study contribute to the understanding of the factors influencing school completion in Malaysia and provide valuable insights for policymakers and educators to develop effective strategies to improve educational outcomes.

  • 1 authors
·
Jan 30, 2025

Revisiting Multivariate Time Series Forecasting with Missing Values

Missing values are common in real-world time series, and multivariate time series forecasting with missing values (MTSF-M) has become a crucial area of research for ensuring reliable predictions. To address the challenge of missing data, current approaches have developed an imputation-then-prediction framework that uses imputation modules to fill in missing values, followed by forecasting on the imputed data. However, this framework overlooks a critical issue: there is no ground truth for the missing values, making the imputation process susceptible to errors that can degrade prediction accuracy. In this paper, we conduct a systematic empirical study and reveal that imputation without direct supervision can corrupt the underlying data distribution and actively degrade prediction accuracy. To address this, we propose a paradigm shift that moves away from imputation and directly predicts from the partially observed time series. We introduce Consistency-Regularized Information Bottleneck (CRIB), a novel framework built on the Information Bottleneck principle. CRIB combines a unified-variate attention mechanism with a consistency regularization scheme to learn robust representations that filter out noise introduced by missing values while preserving essential predictive signals. Comprehensive experiments on four real-world datasets demonstrate the effectiveness of CRIB, which predicts accurately even under high missing rates. Our code is available in https://github.com/Muyiiiii/CRIB.

  • 7 authors
·
Sep 27, 2025

The Alzheimer's Disease Prediction Of Longitudinal Evolution (TADPOLE) Challenge: Results after 1 Year Follow-up

We present the findings of "The Alzheimer's Disease Prediction Of Longitudinal Evolution" (TADPOLE) Challenge, which compared the performance of 92 algorithms from 33 international teams at predicting the future trajectory of 219 individuals at risk of Alzheimer's disease. Challenge participants were required to make a prediction, for each month of a 5-year future time period, of three key outcomes: clinical diagnosis, Alzheimer's Disease Assessment Scale Cognitive Subdomain (ADAS-Cog13), and total volume of the ventricles. The methods used by challenge participants included multivariate linear regression, machine learning methods such as support vector machines and deep neural networks, as well as disease progression models. No single submission was best at predicting all three outcomes. For clinical diagnosis and ventricle volume prediction, the best algorithms strongly outperform simple baselines in predictive ability. However, for ADAS-Cog13 no single submitted prediction method was significantly better than random guesswork. Two ensemble methods based on taking the mean and median over all predictions, obtained top scores on almost all tasks. Better than average performance at diagnosis prediction was generally associated with the additional inclusion of features from cerebrospinal fluid (CSF) samples and diffusion tensor imaging (DTI). On the other hand, better performance at ventricle volume prediction was associated with inclusion of summary statistics, such as the slope or maxima/minima of biomarkers. TADPOLE's unique results suggest that current prediction algorithms provide sufficient accuracy to exploit biomarkers related to clinical diagnosis and ventricle volume, for cohort refinement in clinical trials for Alzheimer's disease. However, results call into question the usage of cognitive test scores for patient selection and as a primary endpoint in clinical trials.

  • 96 authors
·
Feb 9, 2020

An Analysis of Causal Effect Estimation using Outcome Invariant Data Augmentation

The technique of data augmentation (DA) is often used in machine learning for regularization purposes to better generalize under i.i.d. settings. In this work, we present a unifying framework with topics in causal inference to make a case for the use of DA beyond just the i.i.d. setting, but for generalization across interventions as well. Specifically, we argue that when the outcome generating mechanism is invariant to our choice of DA, then such augmentations can effectively be thought of as interventions on the treatment generating mechanism itself. This can potentially help to reduce bias in causal effect estimation arising from hidden confounders. In the presence of such unobserved confounding we typically make use of instrumental variables (IVs) -- sources of treatment randomization that are conditionally independent of the outcome. However, IVs may not be as readily available as DA for many applications, which is the main motivation behind this work. By appropriately regularizing IV based estimators, we introduce the concept of IV-like (IVL) regression for mitigating confounding bias and improving predictive performance across interventions even when certain IV properties are relaxed. Finally, we cast parameterized DA as an IVL regression problem and show that when used in composition can simulate a worst-case application of such DA, further improving performance on causal estimation and generalization tasks beyond what simple DA may offer. This is shown both theoretically for the population case and via simulation experiments for the finite sample case using a simple linear example. We also present real data experiments to support our case.

  • 5 authors
·
Oct 28, 2025 1

QuestBench: Can LLMs ask the right question to acquire information in reasoning tasks?

Recently, a large amount of work has focused on improving large language models' (LLMs') performance on reasoning benchmarks such as math and logic. However, past work has largely assumed that tasks are well-defined. In the real world, queries to LLMs are often underspecified, only solvable through acquiring missing information. We formalize this as a constraint satisfaction problem (CSP) with missing variable assignments. Using a special case of this formalism where only one necessary variable assignment is missing, we can rigorously evaluate an LLM's ability to identify the minimal necessary question to ask and quantify axes of difficulty levels for each problem. We present QuestBench, a set of underspecified reasoning tasks solvable by asking at most one question, which includes: (1) Logic-Q: Logical reasoning tasks with one missing proposition, (2) Planning-Q: PDDL planning problems with initial states that are partially-observed, (3) GSM-Q: Human-annotated grade school math problems with one missing variable assignment, and (4) GSME-Q: a version of GSM-Q where word problems are translated into equations by human annotators. The LLM is tasked with selecting the correct clarification question(s) from a list of options. While state-of-the-art models excel at GSM-Q and GSME-Q, their accuracy is only 40-50% on Logic-Q and Planning-Q. Analysis demonstrates that the ability to solve well-specified reasoning problems may not be sufficient for success on our benchmark: models have difficulty identifying the right question to ask, even when they can solve the fully specified version of the problem. Furthermore, in the Planning-Q domain, LLMs tend not to hedge, even when explicitly presented with the option to predict ``not sure.'' This highlights the need for deeper investigation into models' information acquisition capabilities.

  • 3 authors
·
Mar 28, 2025

Multi-resolution Networks For Flexible Irregular Time Series Modeling (Multi-FIT)

Missing values, irregularly collected samples, and multi-resolution signals commonly occur in multivariate time series data, making predictive tasks difficult. These challenges are especially prevalent in the healthcare domain, where patients' vital signs and electronic records are collected at different frequencies and have occasionally missing information due to the imperfections in equipment or patient circumstances. Researchers have handled each of these issues differently, often handling missing data through mean value imputation and then using sequence models over the multivariate signals while ignoring the different resolution of signals. We propose a unified model named Multi-resolution Flexible Irregular Time series Network (Multi-FIT). The building block for Multi-FIT is the FIT network. The FIT network creates an informative dense representation at each time step using signal information such as last observed value, time difference since the last observed time stamp and overall mean for the signal. Vertical FIT (FIT-V) is a variant of FIT which also models the relationship between different temporal signals while creating the informative dense representations for the signal. The multi-FIT model uses multiple FIT networks for sets of signals with different resolutions, further facilitating the construction of flexible representations. Our model has three main contributions: a.) it does not impute values but rather creates informative representations to provide flexibility to the model for creating task-specific representations b.) it models the relationship between different signals in the form of support signals c.) it models different resolutions in parallel before merging them for the final prediction task. The FIT, FIT-V and Multi-FIT networks improve upon the state-of-the-art models for three predictive tasks, including the forecasting of patient survival.

  • 7 authors
·
Apr 30, 2019

DDXPlus: A New Dataset For Automatic Medical Diagnosis

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

  • 5 authors
·
May 18, 2022

The Hot Mess of AI: How Does Misalignment Scale With Model Intelligence and Task Complexity?

As AI becomes more capable, we entrust it with more general and consequential tasks. The risks from failure grow more severe with increasing task scope. It is therefore important to understand how extremely capable AI models will fail: Will they fail by systematically pursuing goals we do not intend? Or will they fail by being a hot mess, and taking nonsensical actions that do not further any goal? We operationalize this question using a bias-variance decomposition of the errors made by AI models: An AI's incoherence on a task is measured over test-time randomness as the fraction of its error that stems from variance rather than bias in task outcome. Across all tasks and frontier models we measure, the longer models spend reasoning and taking actions, the more incoherent their failures become. Incoherence changes with model scale in a way that is experiment dependent. However, in several settings, larger, more capable models are more incoherent than smaller models. Consequently, scale alone seems unlikely to eliminate incoherence. Instead, as more capable AIs pursue harder tasks, requiring more sequential action and thought, our results predict failures to be accompanied by more incoherent behavior. This suggests a future where AIs sometimes cause industrial accidents (due to unpredictable misbehavior), but are less likely to exhibit consistent pursuit of a misaligned goal. This increases the relative importance of alignment research targeting reward hacking or goal misspecification.

  • 5 authors
·
Jan 30

Aligning Language Models with Observational Data: Opportunities and Risks from a Causal Perspective

Large language models are being widely used across industries to generate content that contributes directly to key performance metrics, such as conversion rates. Pretrained models, however, often fall short when it comes to aligning with human preferences or optimizing for business objectives. As a result, fine-tuning with good-quality labeled data is essential to guide models to generate content that achieves better results. Controlled experiments, like A/B tests, can provide such data, but they are often expensive and come with significant engineering and logistical challenges. Meanwhile, companies have access to a vast amount of historical (observational) data that remains underutilized. In this work, we study the challenges and opportunities of fine-tuning LLMs using observational data. We show that while observational outcomes can provide valuable supervision, directly fine-tuning models on such data can lead them to learn spurious correlations. We present empirical evidence of this issue using various real-world datasets and propose DeconfoundLM, a method that explicitly removes the effect of known confounders from reward signals. Using simulation experiments, we demonstrate that DeconfoundLM improves the recovery of causal relationships and mitigates failure modes found in fine-tuning methods that ignore or naively incorporate confounding variables. Our findings highlight that while observational data presents risks, with the right causal corrections, it can be a powerful source of signal for LLM alignment. Please refer to the project page for code and related resources.

  • 1 authors
·
May 30, 2025

Skill-Targeted Adaptive Training

Language models often show little to no improvement (i.e., "saturation") when trained via vanilla supervised fine-tuning (SFT) on data similar to what they saw in their training set (e.g., MATH). We introduce a new fine-tuning strategy, STAT, to train such a student model by using the metacognition ability of a stronger large language model (LLM) as the teacher. The teacher uses the task dataset to create a list of skills needed for the task, and then labels each data point with its required skills (Didolkar et al., 2024). By monitoring the student's answers, the teacher creates a Missing-Skill-Profile for the student, tracking how often they failed to apply each skill in their responses. We use this idea to build a modified training set in one of two ways. In STAT-Sel, the teacher uses an existing set of training examples but adaptively reweights them according to the Missing-Skill-Profile. In STAT-Syn, the teacher synthesizes additional examples involving missing skills. Across extensive experiments on Llama and Qwen models, our methods yield improvements of up to 7.5% on MATH, whereas SFT provides only limited gains. Furthermore, STAT enhances performance on out-of-distribution benchmarks (e.g., AIME24/25, AMC23, etc.) by an average of 4.6%. Crucially, we find that STAT is complementary to RL via GRPO (Shao et al., 2024): after the model is improved using STAT to address skill gaps, GRPO continues to add further gains. We conclude that skill-targeted adaptive training should broadly improve current training pipelines. Our code is available at: https://github.com/princeton-pli/STAT.

PrincetonUniversity Princeton University
·
Oct 11, 2025 2

Evaluation of GPT-3.5 and GPT-4 for supporting real-world information needs in healthcare delivery

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

  • 18 authors
·
Apr 26, 2023

Model-free Approach to Evaluate a Censored Intermediate Outcome as a Surrogate for Overall Survival

Clinical trials or studies oftentimes require long-term and/or costly follow-up of participants to evaluate a novel treatment/drug/vaccine. There has been increasing interest in the past few decades in using short-term surrogate outcomes as a replacement of the primary outcome i.e., in using the surrogate outcome, which can potentially be observed sooner, to make inference about the treatment effect on the long-term primary outcome. Very few of the available statistical methods to evaluate a surrogate are applicable to settings where both the surrogate and the primary outcome are time-to-event outcomes subject to censoring. Methods that can handle this setting tend to require parametric assumptions or be limited to assessing only the restricted mean survival time. In this paper, we propose a non-parametric approach to evaluate a censored surrogate outcome, such as time to progression, when the primary outcome is also a censored time-to-event outcome, such as time to death, and the treatment effect of interest is the difference in overall survival. Specifically, we define the proportion of the treatment effect on the primary outcome that is explained (PTE) by the censored surrogate outcome in this context, and estimate this proportion by defining and deriving an optimal transformation of the surrogate information. Our approach provides the added advantage of relaxed assumptions to guarantee that the true PTE is within (0,1), along with being model-free. Finite sample performance of our estimators are illustrated via extensive simulation studies and a real data application examining progression-free survival as a surrogate for overall survival for patients with metastatic colorectal cancer.

  • 4 authors
·
Dec 18, 2024

Integrating Earth Observation Data into Causal Inference: Challenges and Opportunities

Observational studies require adjustment for confounding factors that are correlated with both the treatment and outcome. In the setting where the observed variables are tabular quantities such as average income in a neighborhood, tools have been developed for addressing such confounding. However, in many parts of the developing world, features about local communities may be scarce. In this context, satellite imagery can play an important role, serving as a proxy for the confounding variables otherwise unobserved. In this paper, we study confounder adjustment in this non-tabular setting, where patterns or objects found in satellite images contribute to the confounder bias. Using the evaluation of anti-poverty aid programs in Africa as our running example, we formalize the challenge of performing causal adjustment with such unstructured data -- what conditions are sufficient to identify causal effects, how to perform estimation, and how to quantify the ways in which certain aspects of the unstructured image object are most predictive of the treatment decision. Via simulation, we also explore the sensitivity of satellite image-based observational inference to image resolution and to misspecification of the image-associated confounder. Finally, we apply these tools in estimating the effect of anti-poverty interventions in African communities from satellite imagery.

The Ideation-Execution Gap: Execution Outcomes of LLM-Generated versus Human Research Ideas

Large Language Models (LLMs) have shown promise in accelerating the scientific research pipeline. A key capability for this process is the ability to generate novel research ideas, and prior studies have found settings in which LLM-generated research ideas were judged as more novel than human-expert ideas. However, a good idea should not simply appear to be novel, it should also result in better research after being executed. To test whether AI-generated ideas lead to better research outcomes, we conduct an execution study by recruiting 43 expert researchers to execute randomly-assigned ideas, either written by experts or generated by an LLM. Each expert spent over 100 hours implementing the idea and wrote a 4-page short paper to document the experiments. All the executed projects are then reviewed blindly by expert NLP researchers. Comparing the review scores of the same ideas before and after execution, the scores of the LLM-generated ideas decrease significantly more than expert-written ideas on all evaluation metrics (novelty, excitement, effectiveness, and overall; p < 0.05), closing the gap between LLM and human ideas observed at the ideation stage. When comparing the aggregated review scores from the execution study, we even observe that for many metrics there is a flip in rankings where human ideas score higher than LLM ideas. This ideation-execution gap highlights the limitations of current LLMs in generating truly effective research ideas and the challenge of evaluating research ideas in the absence of execution outcomes.

  • 3 authors
·
Jun 25, 2025

Environment-Adaptive Covariate Selection: Learning When to Use Spurious Correlations for Out-of-Distribution Prediction

Out-of-distribution (OOD) prediction is often approached by restricting models to causal or invariant covariates, avoiding non-causal spurious associations that may be unstable across environments. Despite its theoretical appeal, this strategy frequently underperforms empirical risk minimization (ERM) in practice. We investigate the source of this gap and show that such failures naturally arise when only a subset of the true causes of the outcome is observed. In these settings, non-causal spurious covariates can serve as informative proxies for unobserved causes and substantially improve prediction, except under distribution shifts that break these proxy relationships. Consequently, the optimal set of predictive covariates is neither universal nor necessarily exhibits invariant relationships with the outcome across all environments, but instead depends on the specific type of shift encountered. Crucially, we observe that different covariate shifts induce distinct, observable signatures in the covariate distribution itself. Moreover, these signatures can be extracted from unlabeled data in the target OOD environment and used to assess when proxy covariates remain reliable and when they fail. Building on this observation, we propose an environment-adaptive covariate selection (EACS) algorithm that maps environment-level covariate summaries to environment-specific covariate sets, while allowing the incorporation of prior causal knowledge as constraints. Across simulations and applied datasets, EACS consistently outperforms static causal, invariant, and ERM-based predictors under diverse distribution shifts.

  • 2 authors
·
Jan 5

Glocal Information Bottleneck for Time Series Imputation

Time Series Imputation (TSI), which aims to recover missing values in temporal data, remains a fundamental challenge due to the complex and often high-rate missingness in real-world scenarios. Existing models typically optimize the point-wise reconstruction loss, focusing on recovering numerical values (local information). However, we observe that under high missing rates, these models still perform well in the training phase yet produce poor imputations and distorted latent representation distributions (global information) in the inference phase. This reveals a critical optimization dilemma: current objectives lack global guidance, leading models to overfit local noise and fail to capture global information of the data. To address this issue, we propose a new training paradigm, Glocal Information Bottleneck (Glocal-IB). Glocal-IB is model-agnostic and extends the standard IB framework by introducing a Global Alignment loss, derived from a tractable mutual information approximation. This loss aligns the latent representations of masked inputs with those of their originally observed counterparts. It helps the model retain global structure and local details while suppressing noise caused by missing values, giving rise to better generalization under high missingness. Extensive experiments on nine datasets confirm that Glocal-IB leads to consistently improved performance and aligned latent representations under missingness. Our code implementation is available in https://github.com/Muyiiiii/NeurIPS-25-Glocal-IB.

  • 5 authors
·
Oct 6, 2025 2

Efficient Variance-reduced Estimation from Generative EHR Models: The SCOPE and REACH Estimators

Generative models trained using self-supervision of tokenized electronic health record (EHR) timelines show promise for clinical outcome prediction. This is typically done using Monte Carlo simulation for future patient trajectories. However, existing approaches suffer from three key limitations: sparse estimate distributions that poorly differentiate patient risk levels, extreme computational costs, and high sampling variance. We propose two new estimators: the Sum of Conditional Outcome Probability Estimator (SCOPE) and Risk Estimation from Anticipated Conditional Hazards (REACH), that leverage next-token probability distributions discarded by standard Monte Carlo. We prove both estimators are unbiased and that REACH guarantees variance reduction over Monte Carlo sampling for any model and outcome. Empirically, on hospital mortality prediction in MIMIC-IV using the ETHOS-ARES framework, SCOPE and REACH match 100-sample Monte Carlo performance using only 10-11 samples (95% CI: [9,11]), representing a ~10x reduction in inference cost without degrading calibration. For ICU admission prediction, efficiency gains are more modest (~1.2x), which we attribute to the outcome's lower "spontaneity," a property we characterize theoretically and empirically. These methods substantially improve the feasibility of deploying generative EHR models in resource-constrained clinical settings.

  • 6 authors
·
Feb 2

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

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

LLM+Reasoning+Planning for supporting incomplete user queries in presence of APIs

Recent availability of Large Language Models (LLMs) has led to the development of numerous LLM-based approaches aimed at providing natural language interfaces for various end-user tasks. These end-user tasks in turn can typically be accomplished by orchestrating a given set of APIs. In practice, natural language task requests (user queries) are often incomplete, i.e., they may not contain all the information required by the APIs. While LLMs excel at natural language processing (NLP) tasks, they frequently hallucinate on missing information or struggle with orchestrating the APIs. The key idea behind our proposed approach is to leverage logical reasoning and classical AI planning along with an LLM for accurately answering user queries including identification and gathering of any missing information in these queries. Our approach uses an LLM and ASP (Answer Set Programming) solver to translate a user query to a representation in Planning Domain Definition Language (PDDL) via an intermediate representation in ASP. We introduce a special API "get_info_api" for gathering missing information. We model all the APIs as PDDL actions in a way that supports dataflow between the APIs. Our approach then uses a classical AI planner to generate an orchestration of API calls (including calls to get_info_api) to answer the user query. Our evaluation results show that our approach significantly outperforms a pure LLM based approach by achieving over 95\% success rate in most cases on a dataset containing complete and incomplete single goal and multi-goal queries where the multi-goal queries may or may not require dataflow among the APIs.

  • 4 authors
·
May 20, 2024

Chinese vs. World Bank Development Projects: Insights from Earth Observation and Computer Vision on Wealth Gains in Africa, 2002-2013

Debates about whether development projects improve living conditions persist, partly because observational estimates can be biased by incomplete adjustment and because reliable outcome data are scarce at the neighborhood level. We address both issues in a continent-scale, sector-specific evaluation of Chinese and World Bank projects across 9,899 neighborhoods in 36 African countries (2002 to 2013), representative of 88% of the population. First, we use a recent dataset that measures living conditions with a machine-learned wealth index derived from contemporaneous satellite imagery, yielding a consistent panel of 6.7 km square mosaics. Second, to strengthen identification, we proxy officials' map-based placement criteria using pre-treatment daytime satellite images and fuse these with rich tabular covariates to estimate funder- and sector-specific ATEs via inverse-probability weighting. Incorporating imagery systematically shrinks effects relative to tabular-only models, indicating prior work likely overstated benefits. On average, both donors raise wealth, with larger gains for China; sector extremes in our sample include Trade and Tourism for the World Bank (+6.27 IWI points), and Emergency Response for China (+14.32). Assignment-mechanism analyses show World Bank placement is generally more predictable from imagery alone, as well as from tabular covariates. This suggests that Chinese project placements are more driven by non-visible, political, or event-driven factors than World Bank placements. To probe residual concerns about selection on observables, we also estimate within-neighborhood (unit) fixed-effects models at a spatial resolution about 450 times finer than prior fixed effects analyses, leveraging the computer-vision-imputed IWI panels; these deliver smaller but directionally consistent effects.

From Words to Routes: Applying Large Language Models to Vehicle Routing

LLMs have shown impressive progress in robotics (e.g., manipulation and navigation) with natural language task descriptions. The success of LLMs in these tasks leads us to wonder: What is the ability of LLMs to solve vehicle routing problems (VRPs) with natural language task descriptions? In this work, we study this question in three steps. First, we construct a dataset with 21 types of single- or multi-vehicle routing problems. Second, we evaluate the performance of LLMs across four basic prompt paradigms of text-to-code generation, each involving different types of text input. We find that the basic prompt paradigm, which generates code directly from natural language task descriptions, performs the best for GPT-4, achieving 56% feasibility, 40% optimality, and 53% efficiency. Third, based on the observation that LLMs may not be able to provide correct solutions at the initial attempt, we propose a framework that enables LLMs to refine solutions through self-reflection, including self-debugging and self-verification. With GPT-4, our proposed framework achieves a 16% increase in feasibility, a 7% increase in optimality, and a 15% increase in efficiency. Moreover, we examine the sensitivity of GPT-4 to task descriptions, specifically focusing on how its performance changes when certain details are omitted from the task descriptions, yet the core meaning is preserved. Our findings reveal that such omissions lead to a notable decrease in performance: 4% in feasibility, 4% in optimality, and 5% in efficiency. Website: https://sites.google.com/view/words-to-routes/

  • 3 authors
·
Mar 15, 2024

Awareness in Practice: Tensions in Access to Sensitive Attribute Data for Antidiscrimination

Organizations cannot address demographic disparities that they cannot see. Recent research on machine learning and fairness has emphasized that awareness of sensitive attributes, such as race and sex, is critical to the development of interventions. However, on the ground, the existence of these data cannot be taken for granted. This paper uses the domains of employment, credit, and healthcare in the United States to surface conditions that have shaped the availability of sensitive attribute data. For each domain, we describe how and when private companies collect or infer sensitive attribute data for antidiscrimination purposes. An inconsistent story emerges: Some companies are required by law to collect sensitive attribute data, while others are prohibited from doing so. Still others, in the absence of legal mandates, have determined that collection and imputation of these data are appropriate to address disparities. This story has important implications for fairness research and its future applications. If companies that mediate access to life opportunities are unable or hesitant to collect or infer sensitive attribute data, then proposed techniques to detect and mitigate bias in machine learning models might never be implemented outside the lab. We conclude that today's legal requirements and corporate practices, while highly inconsistent across domains, offer lessons for how to approach the collection and inference of sensitive data in appropriate circumstances. We urge stakeholders, including machine learning practitioners, to actively help chart a path forward that takes both policy goals and technical needs into account.

  • 3 authors
·
Dec 12, 2019

MEDEC: A Benchmark for Medical Error Detection and Correction in Clinical Notes

Several studies showed that Large Language Models (LLMs) can answer medical questions correctly, even outperforming the average human score in some medical exams. However, to our knowledge, no study has been conducted to assess the ability of language models to validate existing or generated medical text for correctness and consistency. In this paper, we introduce MEDEC (https://github.com/abachaa/MEDEC), the first publicly available benchmark for medical error detection and correction in clinical notes, covering five types of errors (Diagnosis, Management, Treatment, Pharmacotherapy, and Causal Organism). MEDEC consists of 3,848 clinical texts, including 488 clinical notes from three US hospital systems that were not previously seen by any LLM. The dataset has been used for the MEDIQA-CORR shared task to evaluate seventeen participating systems [Ben Abacha et al., 2024]. In this paper, we describe the data creation methods and we evaluate recent LLMs (e.g., o1-preview, GPT-4, Claude 3.5 Sonnet, and Gemini 2.0 Flash) for the tasks of detecting and correcting medical errors requiring both medical knowledge and reasoning capabilities. We also conducted a comparative study where two medical doctors performed the same task on the MEDEC test set. The results showed that MEDEC is a sufficiently challenging benchmark to assess the ability of models to validate existing or generated notes and to correct medical errors. We also found that although recent LLMs have a good performance in error detection and correction, they are still outperformed by medical doctors in these tasks. We discuss the potential factors behind this gap, the insights from our experiments, the limitations of current evaluation metrics, and share potential pointers for future research.

  • 7 authors
·
Dec 26, 2024

Image-based Treatment Effect Heterogeneity

Randomized controlled trials (RCTs) are considered the gold standard for estimating the average treatment effect (ATE) of interventions. One use of RCTs is to study the causes of global poverty -- a subject explicitly cited in the 2019 Nobel Memorial Prize awarded to Duflo, Banerjee, and Kremer "for their experimental approach to alleviating global poverty." Because the ATE is a population summary, anti-poverty experiments often seek to unpack the effect variation around the ATE by conditioning (CATE) on tabular variables such as age and ethnicity that were measured during the RCT data collection. Although such variables are key to unpacking CATE, using only such variables may fail to capture historical, geographical, or neighborhood-specific contributors to effect variation, as tabular RCT data are often only observed near the time of the experiment. In global poverty research, when the location of the experiment units is approximately known, satellite imagery can provide a window into such factors important for understanding heterogeneity. However, there is no method that specifically enables applied researchers to analyze CATE from images. In this paper, using a deep probabilistic modeling framework, we develop such a method that estimates latent clusters of images by identifying images with similar treatment effects distributions. Our interpretable image CATE model also includes a sensitivity factor that quantifies the importance of image segments contributing to the effect cluster prediction. We compare the proposed methods against alternatives in simulation; also, we show how the model works in an actual RCT, estimating the effects of an anti-poverty intervention in northern Uganda and obtaining a posterior predictive distribution over effects for the rest of the country where no experimental data was collected. We make all models available in open-source software.

Evidence Sufficiency Under Delayed Ground Truth: Proxy Monitoring for Risk Decision Systems

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.

  • 1 authors
·
Apr 16

Diminished Diversity-of-Thought in a Standard Large Language Model

We test whether Large Language Models (LLMs) can be used to simulate human participants in social-science studies. To do this, we run replications of 14 studies from the Many Labs 2 replication project with OpenAI's text-davinci-003 model, colloquially known as GPT3.5. Based on our pre-registered analyses, we find that among the eight studies we could analyse, our GPT sample replicated 37.5% of the original results and 37.5% of the Many Labs 2 results. However, we were unable to analyse the remaining six studies due to an unexpected phenomenon we call the "correct answer" effect. Different runs of GPT3.5 answered nuanced questions probing political orientation, economic preference, judgement, and moral philosophy with zero or near-zero variation in responses: with the supposedly "correct answer." In one exploratory follow-up study, we found that a "correct answer" was robust to changing the demographic details that precede the prompt. In another, we found that most but not all "correct answers" were robust to changing the order of answer choices. One of our most striking findings occurred in our replication of the Moral Foundations Theory survey results, where we found GPT3.5 identifying as a political conservative in 99.6% of the cases, and as a liberal in 99.3% of the cases in the reverse-order condition. However, both self-reported 'GPT conservatives' and 'GPT liberals' showed right-leaning moral foundations. Our results cast doubts on the validity of using LLMs as a general replacement for human participants in the social sciences. Our results also raise concerns that a hypothetical AI-led future may be subject to a diminished diversity-of-thought.

  • 3 authors
·
Feb 13, 2023

GPT-4 passes most of the 297 written Polish Board Certification Examinations

Introduction: Recently, the effectiveness of Large Language Models (LLMs) has increased rapidly, allowing them to be used in a great number of applications. However, the risks posed by the generation of false information through LLMs significantly limit their applications in sensitive areas such as healthcare, highlighting the necessity for rigorous validations to determine their utility and reliability. To date, no study has extensively compared the performance of LLMs on Polish medical examinations across a broad spectrum of specialties on a very large dataset. Objectives: This study evaluated the performance of three Generative Pretrained Transformer (GPT) models on the Polish Board Certification Exam (Pa\'nstwowy Egzamin Specjalizacyjny, PES) dataset, which consists of 297 tests. Methods: We developed a software program to download and process PES exams and tested the performance of GPT models using OpenAI Application Programming Interface. Results: Our findings reveal that GPT-3.5 did not pass any of the analyzed exams. In contrast, the GPT-4 models demonstrated the capability to pass the majority of the exams evaluated, with the most recent model, gpt-4-0125, successfully passing 222 (75%) of them. The performance of the GPT models varied significantly, displaying excellence in exams related to certain specialties while completely failing others. Conclusions: The significant progress and impressive performance of LLM models hold great promise for the increased application of AI in the field of medicine in Poland. For instance, this advancement could lead to the development of AI-based medical assistants for healthcare professionals, enhancing the efficiency and accuracy of medical services.

  • 3 authors
·
Apr 29, 2024

One vs. Many: Comprehending Accurate Information from Multiple Erroneous and Inconsistent AI Generations

As Large Language Models (LLMs) are nondeterministic, the same input can generate different outputs, some of which may be incorrect or hallucinated. If run again, the LLM may correct itself and produce the correct answer. Unfortunately, most LLM-powered systems resort to single results which, correct or not, users accept. Having the LLM produce multiple outputs may help identify disagreements or alternatives. However, it is not obvious how the user will interpret conflicts or inconsistencies. To this end, we investigate how users perceive the AI model and comprehend the generated information when they receive multiple, potentially inconsistent, outputs. Through a preliminary study, we identified five types of output inconsistencies. Based on these categories, we conducted a study (N=252) in which participants were given one or more LLM-generated passages to an information-seeking question. We found that inconsistency within multiple LLM-generated outputs lowered the participants' perceived AI capacity, while also increasing their comprehension of the given information. Specifically, we observed that this positive effect of inconsistencies was most significant for participants who read two passages, compared to those who read three. Based on these findings, we present design implications that, instead of regarding LLM output inconsistencies as a drawback, we can reveal the potential inconsistencies to transparently indicate the limitations of these models and promote critical LLM usage.

  • 7 authors
·
May 9, 2024

Instructing Large Language Models to Identify and Ignore Irrelevant Conditions

Math word problem (MWP) solving requires generating a reasoning path based on a given problem description that often contains irrelevant conditions. Existing chain-of-thought (CoT) prompting methods elicited multi-step reasoning abilities of large language models (LLMs) to solve MWPs. However, they were seriously confused by the irrelevant conditions, resulting in low accuracy. In this paper, we propose a novel approach named I^3C that instructs LLMs to identify and ignore irrelevant conditions. It identifies a set of irrelevant condition candidates that have a weak semantic relevance with the question. Then it prompts LLMs to verify the irrelevant conditions. Lastly it instructs the LLMs with the verification on relevant and irrelevant conditions to avoid confusion and improve reasoning paths. Moreover, we propose to select (problem, reasoning paths) pairs as demonstrations to enhance I^3C with few-shot reasoning. We develop I^3C-Select that selects the most confusing problems based on the semantic relevance measurement. We conduct extensive experiments on eight MWP datasets. I^3C can be combined with any CoT prompting methods to improve the performance of solving MWPs. Notably, with GPT-3.5-Turbo and I^3C-Select, we achieve an accuracy of 96.0 and 94.1 on GSM-IC2-1K and GSM-ICM-1K, respectively, significantly outperforming the state-of-the-art few-shot prompting method Complex-CoT by +11.7 and +11.1. Our implementation is made publicly available at https://wzy6642.github.io/I3C.github.io/.

  • 3 authors
·
Mar 19, 2024

The ELEVATE-AI LLMs Framework: An Evaluation Framework for Use of Large Language Models in HEOR: an ISPOR Working Group Report

Introduction. Generative Artificial Intelligence, particularly large language models (LLMs), offers transformative potential for Health Economics and Outcomes Research (HEOR). However, evaluating the quality, transparency, and rigor of LLM-assisted research lacks standardized guidance. This article introduces the ELEVATE AI LLMs framework and checklist, designed to support researchers and reviewers in assessing LLM use in HEOR. Methods. The ELEVATE AI LLMs framework was developed through a targeted review of existing guidelines and evaluation frameworks. The framework comprises ten evaluation domains, including model characteristics, accuracy, comprehensiveness, and fairness. The accompanying checklist operationalizes the framework. To validate the framework, we applied it to two published studies, demonstrating its usability across different HEOR tasks. Results. The ELEVATE AI LLMs framework provides a comprehensive structure for evaluating LLM-assisted research, while the checklist facilitates practical application. Validation of the framework and checklist on studies of systematic literature reviews and health economic modeling highlighted their ability to identify strengths and gaps in reporting. Limitations. While the ELEVATE AI LLMs framework provides robust guidance, its broader generalizability and applicability to diverse HEOR tasks require further empirical testing. Additionally, several metrics adapted from computer science need further validation in HEOR contexts. Conclusion. The ELEVATE AI LLMs framework and checklist fill a critical gap in HEOR by offering structured guidance for evaluating LLM-assisted research. By promoting transparency, accuracy, and reproducibility, they aim to standardize and improve the integration of LLMs into HEOR, ensuring their outputs meet the field's rigorous standards.

  • 8 authors
·
Dec 23, 2024

Unbiased Recommender Learning from Missing-Not-At-Random Implicit Feedback

Recommender systems widely use implicit feedback such as click data because of its general availability. Although the presence of clicks signals the users' preference to some extent, the lack of such clicks does not necessarily indicate a negative response from the users, as it is possible that the users were not exposed to the items (positive-unlabeled problem). This leads to a difficulty in predicting the users' preferences from implicit feedback. Previous studies addressed the positive-unlabeled problem by uniformly upweighting the loss for the positive feedback data or estimating the confidence of each data having relevance information via the EM-algorithm. However, these methods failed to address the missing-not-at-random problem in which popular or frequently recommended items are more likely to be clicked than other items even if a user does not have a considerable interest in them. To overcome these limitations, we first define an ideal loss function to be optimized to realize recommendations that maximize the relevance and propose an unbiased estimator for the ideal loss. Subsequently, we analyze the variance of the proposed unbiased estimator and further propose a clipped estimator that includes the unbiased estimator as a special case. We demonstrate that the clipped estimator is expected to improve the performance of the recommender system, by considering the bias-variance trade-off. We conduct semi-synthetic and real-world experiments and demonstrate that the proposed method largely outperforms the baselines. In particular, the proposed method works better for rare items that are less frequently observed in the training data. The findings indicate that the proposed method can better achieve the objective of recommending items with the highest relevance.

  • 5 authors
·
Sep 8, 2019

SurvHTE-Bench: A Benchmark for Heterogeneous Treatment Effect Estimation in Survival Analysis

Estimating heterogeneous treatment effects (HTEs) from right-censored survival data is critical in high-stakes applications such as precision medicine and individualized policy-making. Yet, the survival analysis setting poses unique challenges for HTE estimation due to censoring, unobserved counterfactuals, and complex identification assumptions. Despite recent advances, from Causal Survival Forests to survival meta-learners and outcome imputation approaches, evaluation practices remain fragmented and inconsistent. We introduce SurvHTE-Bench, the first comprehensive benchmark for HTE estimation with censored outcomes. The benchmark spans (i) a modular suite of synthetic datasets with known ground truth, systematically varying causal assumptions and survival dynamics, (ii) semi-synthetic datasets that pair real-world covariates with simulated treatments and outcomes, and (iii) real-world datasets from a twin study (with known ground truth) and from an HIV clinical trial. Across synthetic, semi-synthetic, and real-world settings, we provide the first rigorous comparison of survival HTE methods under diverse conditions and realistic assumption violations. SurvHTE-Bench establishes a foundation for fair, reproducible, and extensible evaluation of causal survival methods. The data and code of our benchmark are available at: https://github.com/Shahriarnz14/SurvHTE-Bench .

Rethinking Retrieval-Augmented Generation for Medicine: A Large-Scale, Systematic Expert Evaluation and Practical Insights

Large language models (LLMs) are transforming the landscape of medicine, yet two fundamental challenges persist: keeping up with rapidly evolving medical knowledge and providing verifiable, evidence-grounded reasoning. Retrieval-augmented generation (RAG) has been widely adopted to address these limitations by supplementing model outputs with retrieved evidence. However, whether RAG reliably achieves these goals remains unclear. Here, we present the most comprehensive expert evaluation of RAG in medicine to date. Eighteen medical experts contributed a total of 80,502 annotations, assessing 800 model outputs generated by GPT-4o and Llama-3.1-8B across 200 real-world patient and USMLE-style queries. We systematically decomposed the RAG pipeline into three components: (i) evidence retrieval (relevance of retrieved passages), (ii) evidence selection (accuracy of evidence usage), and (iii) response generation (factuality and completeness of outputs). Contrary to expectation, standard RAG often degraded performance: only 22% of top-16 passages were relevant, evidence selection remained weak (precision 41-43%, recall 27-49%), and factuality and completeness dropped by up to 6% and 5%, respectively, compared with non-RAG variants. Retrieval and evidence selection remain key failure points for the model, contributing to the overall performance drop. We further show that simple yet effective strategies, including evidence filtering and query reformulation, substantially mitigate these issues, improving performance on MedMCQA and MedXpertQA by up to 12% and 8.2%, respectively. These findings call for re-examining RAG's role in medicine and highlight the importance of stage-aware evaluation and deliberate system design for reliable medical LLM applications.

  • 27 authors
·
Nov 10, 2025

Outcome-supervised Verifiers for Planning in Mathematical Reasoning

Large language models (LLMs) often struggle with maintaining accuracy across a sequence of intermediate reasoning steps in mathematical reasoning, leading to error propagation that undermines the final result. The current methodology to mitigate this issue primarily involves using a verifier model to assess the correctness of generated solution candidates, focusing either on the overall reasoning path or on an incomplete reasoning path. By rethinking this approach, we argue that assessing potentials of incomplete reasoning paths could be more advantageous as it guides towards correct final answers, transforming the task into a planning problem. Our proposed verifier, the Outcome-supervision Value Model (OVM), employs outcome supervision for training, offering an efficient and intuitive method for planning by prioritizing steps that lead to accurate conclusions over mere per-step correctness. Furthermore, the OVM eschews the need for labor-intensive annotations on step-level correctness, enhancing its scalability. Our experiments on two multi-step mathematical reasoning datasets, GSM8K and Game of 24, demonstrate the superior performance of the OVM model. Notably, in GSM8K, our OVM-7B model achieves state-of-the-art results among LLMs up to 13B parameters; especially it does not utilize GPT-4 or code execution. These findings offer a novel perspective on the role of outcome supervision in training verifiers for multi-step reasoning tasks and provide theoretical justification for its advantage in value estimation for planning.

  • 3 authors
·
Nov 16, 2023

Determining the Difficulties of Students With Dyslexia via Virtual Reality and Artificial Intelligence: An Exploratory Analysis

Learning disorders are neurological conditions that affect the brain's ability to interconnect communication areas. Dyslexic students experience problems with reading, memorizing, and exposing concepts; however the magnitude of these can be mitigated through both therapies and the creation of compensatory mechanisms. Several efforts have been made to mitigate these issues, leading to the creation of digital resources for students with specific learning disorders attending primary and secondary education levels. Conversely, a standard approach is still missed in higher education. The VRAIlexia project has been created to tackle this issue by proposing two different tools: a mobile application integrating virtual reality (VR) to collect data quickly and easily, and an artificial intelligencebased software (AI) to analyze the collected data for customizing the supporting methodology for each student. The first one has been created and is being distributed among dyslexic students in Higher Education Institutions, for the conduction of specific psychological and psychometric tests. The second tool applies specific artificial intelligence algorithms to the data gathered via the application and other surveys. These AI techniques have allowed us to identify the most relevant difficulties faced by the students' cohort. Our different models have obtained around 90\% mean accuracy for predicting the support tools and learning strategies.

  • 6 authors
·
Jan 15, 2024

Question answering systems for health professionals at the point of care -- a systematic review

Objective: Question answering (QA) systems have the potential to improve the quality of clinical care by providing health professionals with the latest and most relevant evidence. However, QA systems have not been widely adopted. This systematic review aims to characterize current medical QA systems, assess their suitability for healthcare, and identify areas of improvement. Materials and methods: We searched PubMed, IEEE Xplore, ACM Digital Library, ACL Anthology and forward and backward citations on 7th February 2023. We included peer-reviewed journal and conference papers describing the design and evaluation of biomedical QA systems. Two reviewers screened titles, abstracts, and full-text articles. We conducted a narrative synthesis and risk of bias assessment for each study. We assessed the utility of biomedical QA systems. Results: We included 79 studies and identified themes, including question realism, answer reliability, answer utility, clinical specialism, systems, usability, and evaluation methods. Clinicians' questions used to train and evaluate QA systems were restricted to certain sources, types and complexity levels. No system communicated confidence levels in the answers or sources. Many studies suffered from high risks of bias and applicability concerns. Only 8 studies completely satisfied any criterion for clinical utility, and only 7 reported user evaluations. Most systems were built with limited input from clinicians. Discussion: While machine learning methods have led to increased accuracy, most studies imperfectly reflected real-world healthcare information needs. Key research priorities include developing more realistic healthcare QA datasets and considering the reliability of answer sources, rather than merely focusing on accuracy.

  • 9 authors
·
Jan 24, 2024

COKE: Causal Discovery with Chronological Order and Expert Knowledge in High Proportion of Missing Manufacturing Data

Understanding causal relationships between machines is crucial for fault diagnosis and optimization in manufacturing processes. Real-world datasets frequently exhibit up to 90% missing data and high dimensionality from hundreds of sensors. These datasets also include domain-specific expert knowledge and chronological order information, reflecting the recording order across different machines, which is pivotal for discerning causal relationships within the manufacturing data. However, previous methods for handling missing data in scenarios akin to real-world conditions have not been able to effectively utilize expert knowledge. Conversely, prior methods that can incorporate expert knowledge struggle with datasets that exhibit missing values. Therefore, we propose COKE to construct causal graphs in manufacturing datasets by leveraging expert knowledge and chronological order among sensors without imputing missing data. Utilizing the characteristics of the recipe, we maximize the use of samples with missing values, derive embeddings from intersections with an initial graph that incorporates expert knowledge and chronological order, and create a sensor ordering graph. The graph-generating process has been optimized by an actor-critic architecture to obtain a final graph that has a maximum reward. Experimental evaluations in diverse settings of sensor quantities and missing proportions demonstrate that our approach compared with the benchmark methods shows an average improvement of 39.9% in the F1-score. Moreover, the F1-score improvement can reach 62.6% when considering the configuration similar to real-world datasets, and 85.0% in real-world semiconductor datasets. The source code is available at https://github.com/OuTingYun/COKE.

  • 3 authors
·
Jul 16, 2024

RareBench: Can LLMs Serve as Rare Diseases Specialists?

Generalist Large Language Models (LLMs), such as GPT-4, have shown considerable promise in various domains, including medical diagnosis. Rare diseases, affecting approximately 300 million people worldwide, often have unsatisfactory clinical diagnosis rates primarily due to a lack of experienced physicians and the complexity of differentiating among many rare diseases. In this context, recent news such as "ChatGPT correctly diagnosed a 4-year-old's rare disease after 17 doctors failed" underscore LLMs' potential, yet underexplored, role in clinically diagnosing rare diseases. To bridge this research gap, we introduce RareBench, a pioneering benchmark designed to systematically evaluate the capabilities of LLMs on 4 critical dimensions within the realm of rare diseases. Meanwhile, we have compiled the largest open-source dataset on rare disease patients, establishing a benchmark for future studies in this domain. To facilitate differential diagnosis of rare diseases, we develop a dynamic few-shot prompt methodology, leveraging a comprehensive rare disease knowledge graph synthesized from multiple knowledge bases, significantly enhancing LLMs' diagnostic performance. Moreover, we present an exhaustive comparative study of GPT-4's diagnostic capabilities against those of specialist physicians. Our experimental findings underscore the promising potential of integrating LLMs into the clinical diagnostic process for rare diseases. This paves the way for exciting possibilities in future advancements in this field.

  • 6 authors
·
Feb 9, 2024

Influence-guided Data Augmentation for Neural Tensor Completion

How can we predict missing values in multi-dimensional data (or tensors) more accurately? The task of tensor completion is crucial in many applications such as personalized recommendation, image and video restoration, and link prediction in social networks. Many tensor factorization and neural network-based tensor completion algorithms have been developed to predict missing entries in partially observed tensors. However, they can produce inaccurate estimations as real-world tensors are very sparse, and these methods tend to overfit on the small amount of data. Here, we overcome these shortcomings by presenting a data augmentation technique for tensors. In this paper, we propose DAIN, a general data augmentation framework that enhances the prediction accuracy of neural tensor completion methods. Specifically, DAIN first trains a neural model and finds tensor cell importances with influence functions. After that, DAIN aggregates the cell importance to calculate the importance of each entity (i.e., an index of a dimension). Finally, DAIN augments the tensor by weighted sampling of entity importances and a value predictor. Extensive experimental results show that DAIN outperforms all data augmentation baselines in terms of enhancing imputation accuracy of neural tensor completion on four diverse real-world tensors. Ablation studies of DAIN substantiate the effectiveness of each component of DAIN. Furthermore, we show that DAIN scales near linearly to large datasets.

  • 4 authors
·
Aug 23, 2021

Cost-effectiveness analysis for therapy sequence in advanced cancer: A microsimulation approach with application to metastatic prostate cancer

Purpose. Patients with advanced cancer may undergo multiple lines of treatment, switching therapies as their disease progresses. Motivated by a study of metastatic prostate cancer, we develop a microsimulation framework to study therapy sequence. Methods. We propose a discrete-time state transition model to study two lines of anti-cancer therapy. Based on digitized published progression-free survival (PFS) and overall survival (OS) curves, we infer event types (progression or death), and estimate transition probabilities using cumulative incidence functions with competing risks. Our model incorporates within-patient dependence over time, such that response to first-line therapy informs subsequent event probabilities. Parameters governing the degree of within-patient dependence can be used to calibrate the model-based results to those of a target trial. We demonstrate these methods in a study of two therapy sequences for metastatic prostate cancer, where Docetaxel (DCT) and Abiraterone Acetate (AA) are both appropriate for use in either first or second line treatment. We assess costs, Quality-Adjusted Life Years (QALYs) and Incremental Cost Effectiveness Ratio (ICER) for two treatment strategies: DCT then AA vs AA then DCT. Results. Using digitized survival curves from relevant clinical trials, we identified 8.6-13.9% of PFS times that should be categorized as deaths, allowing for estimation of cumulative incidence functions. Models assuming within-patient independence overestimated OS time, corrected with our calibration approach. Correction resulted in meaningful changes in the difference in QALYs between treatment strategies (0.07 vs 0.15) and the ICER (-\76,836/QALY vs -21,030/QALY). Conclusions. Microsimulation models can be successfully used to study cost-effectiveness of therapy sequences, taking care to account correctly for within-patient dependence.

  • 5 authors
·
Oct 10, 2022

Plan-and-Solve Prompting: Improving Zero-Shot Chain-of-Thought Reasoning by Large Language Models

Large language models (LLMs) have recently been shown to deliver impressive performance in various NLP tasks. To tackle multi-step reasoning tasks, few-shot chain-of-thought (CoT) prompting includes a few manually crafted step-by-step reasoning demonstrations which enable LLMs to explicitly generate reasoning steps and improve their reasoning task accuracy. To eliminate the manual effort, Zero-shot-CoT concatenates the target problem statement with "Let's think step by step" as an input prompt to LLMs. Despite the success of Zero-shot-CoT, it still suffers from three pitfalls: calculation errors, missing-step errors, and semantic misunderstanding errors. To address the missing-step errors, we propose Plan-and-Solve (PS) Prompting. It consists of two components: first, devising a plan to divide the entire task into smaller subtasks, and then carrying out the subtasks according to the plan. To address the calculation errors and improve the quality of generated reasoning steps, we extend PS prompting with more detailed instructions and derive PS+ prompting. We evaluate our proposed prompting strategy on ten datasets across three reasoning problems. The experimental results over GPT-3 show that our proposed zero-shot prompting consistently outperforms Zero-shot-CoT across all datasets by a large margin, is comparable to or exceeds Zero-shot-Program-of-Thought Prompting, and has comparable performance with 8-shot CoT prompting on the math reasoning problem. The code can be found at https://github.com/AGI-Edgerunners/Plan-and-Solve-Prompting.

  • 7 authors
·
May 6, 2023 1

Artificial Intelligence-derived Vascular Age from Photoplethysmography: A Novel Digital Biomarker for Cardiovascular Health

With the increasing availability of wearable devices, photoplethysmography (PPG) has emerged as a promising non-invasive tool for monitoring human hemodynamics. We propose a deep learning framework to estimate vascular age (AI-vascular age) from PPG signals, incorporating a distribution-aware loss to address biases caused by imbalanced data. The model was developed using data from the UK Biobank (UKB), with 98,672 participants in the development cohort and 113,559 participants (144,683 data pairs) for clinical evaluation. After adjusting for key confounders, individuals with a vascular age gap (AI-vascular age minus calendar age) exceeding 9 years had a significantly higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) (HR = 2.37, p < 0.005) and secondary outcomes, including diabetes (HR = 2.69, p < 0.005), hypertension (HR = 2.88, p < 0.005), coronary heart disease (HR = 2.20, p < 0.005), heart failure (HR = 2.15, p < 0.005), myocardial infarction (HR = 2.51, p < 0.005), stroke (HR = 2.55, p < 0.005), and all-cause mortality (HR = 2.51, p < 0.005). Conversely, participants with a vascular age gap below -9 years exhibited a significantly lower incidence of these outcomes. We further evaluated the longitudinal applicability of AI-vascular age using serial PPG data from the UKB, demonstrating its value in risk stratification by leveraging AI-vascular age at two distinct time points to predict future MACCE incidence. External validation was performed on a MIMIC-III-derived cohort (n = 2,343), where each one-year increase in vascular age gap was significantly associated with elevated in-hospital mortality risk (OR = 1.02, p < 0.005). In conclusion, our study establishes AI-vascular age as a novel, non-invasive digital biomarker for cardiovascular health assessment.

  • 5 authors
·
Feb 18, 2025

Understanding Disparities in Post Hoc Machine Learning Explanation

Previous work has highlighted that existing post-hoc explanation methods exhibit disparities in explanation fidelity (across 'race' and 'gender' as sensitive attributes), and while a large body of work focuses on mitigating these issues at the explanation metric level, the role of the data generating process and black box model in relation to explanation disparities remains largely unexplored. Accordingly, through both simulations as well as experiments on a real-world dataset, we specifically assess challenges to explanation disparities that originate from properties of the data: limited sample size, covariate shift, concept shift, omitted variable bias, and challenges based on model properties: inclusion of the sensitive attribute and appropriate functional form. Through controlled simulation analyses, our study demonstrates that increased covariate shift, concept shift, and omission of covariates increase explanation disparities, with the effect pronounced higher for neural network models that are better able to capture the underlying functional form in comparison to linear models. We also observe consistent findings regarding the effect of concept shift and omitted variable bias on explanation disparities in the Adult income dataset. Overall, results indicate that disparities in model explanations can also depend on data and model properties. Based on this systematic investigation, we provide recommendations for the design of explanation methods that mitigate undesirable disparities.

  • 4 authors
·
Jan 25, 2024

An Analysis of Temporal Dropout in Earth Observation Time Series for Regression Tasks

Missing instances in time series data impose a significant challenge to deep learning models, particularly in regression tasks. In the Earth Observation field, satellite failure or cloud occlusion frequently results in missing time-steps, introducing uncertainties in the predicted output and causing a decline in predictive performance. While many studies address missing time-steps through data augmentation to improve model robustness, the uncertainty arising at the input level is commonly overlooked. To address this gap, we introduce Monte Carlo Temporal Dropout (MC-TD), a method that explicitly accounts for input-level uncertainty by randomly dropping time-steps during inference using a predefined dropout ratio, thereby simulating the effect of missing data. To bypass the need for costly searches for the optimal dropout ratio, we extend this approach with Monte Carlo Concrete Temporal Dropout (MC-ConcTD), a method that learns the optimal dropout distribution directly. Both MC-TD and MC-ConcTD are applied during inference, leveraging Monte Carlo sampling for uncertainty quantification. Experiments on three EO time-series datasets demonstrate that MC-ConcTD improves predictive performance and uncertainty calibration compared to existing approaches. Additionally, we highlight the advantages of adaptive dropout tuning over manual selection, making uncertainty quantification more robust and accessible for EO applications.

  • 3 authors
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Apr 9, 2025