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May 7

Semixup: In- and Out-of-Manifold Regularization for Deep Semi-Supervised Knee Osteoarthritis Severity Grading from Plain Radiographs

Knee osteoarthritis (OA) is one of the highest disability factors in the world. This musculoskeletal disorder is assessed from clinical symptoms, and typically confirmed via radiographic assessment. This visual assessment done by a radiologist requires experience, and suffers from moderate to high inter-observer variability. The recent literature has shown that deep learning methods can reliably perform the OA severity assessment according to the gold standard Kellgren-Lawrence (KL) grading system. However, these methods require large amounts of labeled data, which are costly to obtain. In this study, we propose the Semixup algorithm, a semi-supervised learning (SSL) approach to leverage unlabeled data. Semixup relies on consistency regularization using in- and out-of-manifold samples, together with interpolated consistency. On an independent test set, our method significantly outperformed other state-of-the-art SSL methods in most cases. Finally, when compared to a well-tuned fully supervised baseline that yielded a balanced accuracy (BA) of 70.9pm0.8% on the test set, Semixup had comparable performance -- BA of 71pm0.8% (p=0.368) while requiring 6 times less labeled data. These results show that our proposed SSL method allows building fully automatic OA severity assessment tools with datasets that are available outside research settings.

  • 4 authors
·
Mar 4, 2020

3DReasonKnee: Advancing Grounded Reasoning in Medical Vision Language Models

Current Vision-Language Models (VLMs) struggle to ground anatomical regions in 3D medical images and reason about them in a step-by-step manner, a key requirement of real-world diagnostic assessment. This ability is essential for aligning model outputs with the diagnostic workflows clinicians use in practice, enabling trustworthy clinician-AI collaboration. Existing 3D datasets provide localization labels, but none support this "grounded reasoning" ability. To address this gap, we introduce 3DReasonKnee, the first 3D grounded reasoning dataset for medical images, which provides 494k high-quality quintuples derived from 7,970 3D knee MRI volumes. Each quintuple includes: (1) the 3D MRI volume, (2) a diagnostic question targeting a specific anatomical region (3) a 3D bounding box localizing the relevant anatomical structures, (4) clinician-generated diagnostic reasoning steps that explicitly detail the 3D reasoning process, and (5) structured severity assessments for the relevant anatomical region. The creation and validation of 3DReasonKnee, involving over 450 hours of expert clinician time for manually segmenting MRIs and generating reasoning chains, ensures its superior quality and clinical relevance. We establish ReasonKnee-Bench to evaluate localization and diagnostic accuracy, providing insight into VLM ability to perform grounding and severity assessment across anatomical regions and diagnostic inquiries. We benchmark five state-of-the-art VLMs, providing baseline performance for ReasonKnee-Bench. By providing this unique resource of expert-annotated 3D reasoning pathways, 3DReasonKnee serves as a repository of orthopedic surgeons' diagnostic expertise and offers a vital testbed for advancing multimodal medical AI systems towards 3D, clinically aligned, localized decision-making capabilities. The dataset can be found in: https://huggingface.co/datasets/rajpurkarlab/3DReasonKnee

  • 8 authors
·
Oct 23, 2025

Automated Code-centric Software Vulnerability Assessment: How Far Are We? An Empirical Study in C/C++

Background: The C and C++ languages hold significant importance in Software Engineering research because of their widespread use in practice. Numerous studies have utilized Machine Learning (ML) and Deep Learning (DL) techniques to detect software vulnerabilities (SVs) in the source code written in these languages. However, the application of these techniques in function-level SV assessment has been largely unexplored. SV assessment is increasingly crucial as it provides detailed information on the exploitability, impacts, and severity of security defects, thereby aiding in their prioritization and remediation. Aims: We conduct the first empirical study to investigate and compare the performance of ML and DL models, many of which have been used for SV detection, for function-level SV assessment in C/C++. Method: Using 9,993 vulnerable C/C++ functions, we evaluated the performance of six multi-class ML models and five multi-class DL models for the SV assessment at the function level based on the Common Vulnerability Scoring System (CVSS). We further explore multi-task learning, which can leverage common vulnerable code to predict all SV assessment outputs simultaneously in a single model, and compare the effectiveness and efficiency of this model type with those of the original multi-class models. Results: We show that ML has matching or even better performance compared to the multi-class DL models for function-level SV assessment with significantly less training time. Employing multi-task learning allows the DL models to perform significantly better, with an average of 8-22% increase in Matthews Correlation Coefficient (MCC). Conclusions: We distill the practices of using data-driven techniques for function-level SV assessment in C/C++, including the use of multi-task DL to balance efficiency and effectiveness. This can establish a strong foundation for future work in this area.

  • 3 authors
·
Jul 24, 2024

Tri-Modal Severity Fused Diagnosis across Depression and Post-traumatic Stress Disorders

Depression and post traumatic stress disorder (PTSD) often co-occur with connected symptoms, complicating automated assessment, which is often binary and disorder specific. Clinically useful diagnosis needs severity aware cross disorder estimates and decision support explanations. Our unified tri modal affective severity framework synchronizes and fuses interview text with sentence level transformer embeddings, audio with log Mel statistics with deltas, and facial signals with action units, gaze, head and pose descriptors to output graded severities for diagnosing both depression (PHQ-8; 5 classes) and PTSD (3 classes). Standardized features are fused via a calibrated late fusion classifier, yielding per disorder probabilities and feature-level attributions. This severity aware tri-modal affective fusion approach is demoed on multi disorder concurrent depression and PTSD assessment. Stratified cross validation on DAIC derived corpora outperforms unimodal/ablation baselines. The fused model matches the strongest unimodal baseline on accuracy and weighted F1, while improving decision curve utility and robustness under noisy or missing modalities. For PTSD specifically, fusion reduces regression error and improves class concordance. Errors cluster between adjacent severities; extreme classes are identified reliably. Ablations show text contributes most to depression severity, audio and facial cues are critical for PTSD, whereas attributions align with linguistic and behavioral markers. Our approach offers reproducible evaluation and clinician in the loop support for affective clinical decision making.

  • 3 authors
·
Oct 23, 2025

Mapping LLM Security Landscapes: A Comprehensive Stakeholder Risk Assessment Proposal

The rapid integration of Large Language Models (LLMs) across diverse sectors has marked a transformative era, showcasing remarkable capabilities in text generation and problem-solving tasks. However, this technological advancement is accompanied by significant risks and vulnerabilities. Despite ongoing security enhancements, attackers persistently exploit these weaknesses, casting doubts on the overall trustworthiness of LLMs. Compounding the issue, organisations are deploying LLM-integrated systems without understanding the severity of potential consequences. Existing studies by OWASP and MITRE offer a general overview of threats and vulnerabilities but lack a method for directly and succinctly analysing the risks for security practitioners, developers, and key decision-makers who are working with this novel technology. To address this gap, we propose a risk assessment process using tools like the OWASP risk rating methodology which is used for traditional systems. We conduct scenario analysis to identify potential threat agents and map the dependent system components against vulnerability factors. Through this analysis, we assess the likelihood of a cyberattack. Subsequently, we conduct a thorough impact analysis to derive a comprehensive threat matrix. We also map threats against three key stakeholder groups: developers engaged in model fine-tuning, application developers utilizing third-party APIs, and end users. The proposed threat matrix provides a holistic evaluation of LLM-related risks, enabling stakeholders to make informed decisions for effective mitigation strategies. Our outlined process serves as an actionable and comprehensive tool for security practitioners, offering insights for resource management and enhancing the overall system security.

  • 4 authors
·
Mar 20, 2024

Automated Red-Teaming Framework for Large Language Model Security Assessment: A Comprehensive Attack Generation and Detection System

As large language models (LLMs) are increasingly deployed in high-stakes domains, ensuring their security and alignment has become a critical challenge. Existing red-teaming practices depend heavily on manual testing, which limits scalability and fails to comprehensively cover the vast space of potential adversarial behaviors. This paper introduces an automated red-teaming framework that systematically generates, executes, and evaluates adversarial prompts to uncover security vulnerabilities in LLMs. Our framework integrates meta-prompting-based attack synthesis, multi-modal vulnerability detection, and standardized evaluation protocols spanning six major threat categories -- reward hacking, deceptive alignment, data exfiltration, sandbagging, inappropriate tool use, and chain-of-thought manipulation. Experiments on the GPT-OSS-20B model reveal 47 distinct vulnerabilities, including 21 high-severity and 12 novel attack patterns, achieving a 3.9times improvement in vulnerability discovery rate over manual expert testing while maintaining 89\% detection accuracy. These results demonstrate the framework's effectiveness in enabling scalable, systematic, and reproducible AI safety evaluations. By providing actionable insights for improving alignment robustness, this work advances the state of automated LLM red-teaming and contributes to the broader goal of building secure and trustworthy AI systems.

  • 9 authors
·
Dec 21, 2025

SHAMISA: SHAped Modeling of Implicit Structural Associations for Self-supervised No-Reference Image Quality Assessment

No-Reference Image Quality Assessment (NR-IQA) aims to estimate perceptual quality without access to a reference image of pristine quality. Learning an NR-IQA model faces a fundamental bottleneck: its need for a large number of costly human perceptual labels. We propose SHAMISA, a non-contrastive self-supervised framework that learns from unlabeled distorted images by leveraging explicitly structured relational supervision. Unlike prior methods that impose rigid, binary similarity constraints, SHAMISA introduces implicit structural associations, defined as soft, controllable relations that are both distortion-aware and content-sensitive, inferred from synthetic metadata and intrinsic feature structure. A key innovation is our compositional distortion engine, which generates an uncountable family of degradations from continuous parameter spaces, grouped so that only one distortion factor varies at a time. This enables fine-grained control over representational similarity during training: images with shared distortion patterns are pulled together in the embedding space, while severity variations produce structured, predictable shifts. We integrate these insights via dual-source relation graphs that encode both known degradation profiles and emergent structural affinities to guide the learning process throughout training. A convolutional encoder is trained under this supervision and then frozen for inference, with quality prediction performed by a linear regressor on its features. Extensive experiments on synthetic, authentic, and cross-dataset NR-IQA benchmarks demonstrate that SHAMISA achieves strong overall performance with improved cross-dataset generalization and robustness, all without human quality annotations or contrastive losses.

TornadoNet: Real-Time Building Damage Detection with Ordinal Supervision

We present TornadoNet, a comprehensive benchmark for automated street-level building damage assessment evaluating how modern real-time object detection architectures and ordinal-aware supervision strategies perform under realistic post-disaster conditions. TornadoNet provides the first controlled benchmark demonstrating how architectural design and loss formulation jointly influence multi-level damage detection from street-view imagery, delivering methodological insights and deployable tools for disaster response. Using 3,333 high-resolution geotagged images and 8,890 annotated building instances from the 2021 Midwest tornado outbreak, we systematically compare CNN-based detectors from the YOLO family against transformer-based models (RT-DETR) for multi-level damage detection. Models are trained under standardized protocols using a five-level damage classification framework based on IN-CORE damage states, validated through expert cross-annotation. Baseline experiments reveal complementary architectural strengths. CNN-based YOLO models achieve highest detection accuracy and throughput, with larger variants reaching 46.05% mAP@0.5 at 66-276 FPS on A100 GPUs. Transformer-based RT-DETR models exhibit stronger ordinal consistency, achieving 88.13% Ordinal Top-1 Accuracy and MAOE of 0.65, indicating more reliable severity grading despite lower baseline mAP. To align supervision with the ordered nature of damage severity, we introduce soft ordinal classification targets and evaluate explicit ordinal-distance penalties. RT-DETR trained with calibrated ordinal supervision achieves 44.70% mAP@0.5, a 4.8 percentage-point improvement, with gains in ordinal metrics (91.15% Ordinal Top-1 Accuracy, MAOE = 0.56). These findings establish that ordinal-aware supervision improves damage severity estimation when aligned with detector architecture. Model & Data: https://github.com/crumeike/TornadoNet

  • 11 authors
·
Mar 12

CADICA: a new dataset for coronary artery disease detection by using invasive coronary angiography

Coronary artery disease (CAD) remains the leading cause of death globally and invasive coronary angiography (ICA) is considered the gold standard of anatomical imaging evaluation when CAD is suspected. However, risk evaluation based on ICA has several limitations, such as visual assessment of stenosis severity, which has significant interobserver variability. This motivates to development of a lesion classification system that can support specialists in their clinical procedures. Although deep learning classification methods are well-developed in other areas of medical imaging, ICA image classification is still at an early stage. One of the most important reasons is the lack of available and high-quality open-access datasets. In this paper, we reported a new annotated ICA images dataset, CADICA, to provide the research community with a comprehensive and rigorous dataset of coronary angiography consisting of a set of acquired patient videos and associated disease-related metadata. This dataset can be used by clinicians to train their skills in angiographic assessment of CAD severity and by computer scientists to create computer-aided diagnostic systems to help in such assessment. In addition, baseline classification methods are proposed and analyzed, validating the functionality of CADICA and giving the scientific community a starting point to improve CAD detection.

  • 7 authors
·
Feb 1, 2024

Detecting and Evaluating Medical Hallucinations in Large Vision Language Models

Large Vision Language Models (LVLMs) are increasingly integral to healthcare applications, including medical visual question answering and imaging report generation. While these models inherit the robust capabilities of foundational Large Language Models (LLMs), they also inherit susceptibility to hallucinations-a significant concern in high-stakes medical contexts where the margin for error is minimal. However, currently, there are no dedicated methods or benchmarks for hallucination detection and evaluation in the medical field. To bridge this gap, we introduce Med-HallMark, the first benchmark specifically designed for hallucination detection and evaluation within the medical multimodal domain. This benchmark provides multi-tasking hallucination support, multifaceted hallucination data, and hierarchical hallucination categorization. Furthermore, we propose the MediHall Score, a new medical evaluative metric designed to assess LVLMs' hallucinations through a hierarchical scoring system that considers the severity and type of hallucination, thereby enabling a granular assessment of potential clinical impacts. We also present MediHallDetector, a novel Medical LVLM engineered for precise hallucination detection, which employs multitask training for hallucination detection. Through extensive experimental evaluations, we establish baselines for popular LVLMs using our benchmark. The findings indicate that MediHall Score provides a more nuanced understanding of hallucination impacts compared to traditional metrics and demonstrate the enhanced performance of MediHallDetector. We hope this work can significantly improve the reliability of LVLMs in medical applications. All resources of this work will be released soon.

  • 10 authors
·
Jun 14, 2024

A Comprehensive Evaluation of Large Language Models on Mental Illnesses

Large Language Models (LLMs) have shown promise in various domains, including healthcare, with significant potential to transform mental health applications by enabling scalable and accessible solutions. This study aims to provide a comprehensive evaluation of 33 LLMs, ranging from 2 billion to 405+ billion parameters, in performing key mental health tasks using social media data across six datasets. To our knowledge, this represents the largest-scale systematic evaluation of modern LLMs for mental health applications. Models such as GPT-4, Llama 3, Claude, Gemma, Gemini, and Phi-3 were assessed for their zero-shot (ZS) and few-shot (FS) capabilities across three tasks: binary disorder detection, disorder severity evaluation, and psychiatric knowledge assessment. Key findings revealed that models like GPT-4 and Llama 3 exhibited superior performance in binary disorder detection, achieving accuracies up to 85% on certain datasets, while FS learning notably enhanced disorder severity evaluations, reducing the Mean Absolute Error (MAE) by 1.3 points for the Phi-3-mini model. Recent models, such as Llama 3.1 405b, demonstrated exceptional psychiatric knowledge assessment accuracy at 91.2%, while prompt engineering played a crucial role in improving performance across tasks. However, the ethical constraints imposed by many LLM providers limit their ability to respond to sensitive queries, hampering comprehensive performance evaluations. This work highlights both the capabilities and limitations of LLMs in mental health contexts, offering valuable insights for future applications in psychiatry.

  • 5 authors
·
Sep 23, 2024

Predicting COVID-19 Pneumonia Severity on Chest X-ray with Deep Learning

Purpose: The need to streamline patient management for COVID-19 has become more pressing than ever. Chest X-rays provide a non-invasive (potentially bedside) tool to monitor the progression of the disease. In this study, we present a severity score prediction model for COVID-19 pneumonia for frontal chest X-ray images. Such a tool can gauge severity of COVID-19 lung infections (and pneumonia in general) that can be used for escalation or de-escalation of care as well as monitoring treatment efficacy, especially in the ICU. Methods: Images from a public COVID-19 database were scored retrospectively by three blinded experts in terms of the extent of lung involvement as well as the degree of opacity. A neural network model that was pre-trained on large (non-COVID-19) chest X-ray datasets is used to construct features for COVID-19 images which are predictive for our task. Results: This study finds that training a regression model on a subset of the outputs from an this pre-trained chest X-ray model predicts our geographic extent score (range 0-8) with 1.14 mean absolute error (MAE) and our lung opacity score (range 0-6) with 0.78 MAE. Conclusions: These results indicate that our model's ability to gauge severity of COVID-19 lung infections could be used for escalation or de-escalation of care as well as monitoring treatment efficacy, especially in the intensive care unit (ICU). A proper clinical trial is needed to evaluate efficacy. To enable this we make our code, labels, and data available online at https://github.com/mlmed/torchxrayvision/tree/master/scripts/covid-severity and https://github.com/ieee8023/covid-chestxray-dataset

  • 11 authors
·
Jun 29, 2020

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

Benchmarking Small Language Models and Small Reasoning Language Models on System Log Severity Classification

System logs are crucial for monitoring and diagnosing modern computing infrastructure, but their scale and complexity require reliable and efficient automated interpretation. Since severity levels are predefined metadata in system log messages, having a model merely classify them offers limited standalone practical value, revealing little about its underlying ability to interpret system logs. We argue that severity classification is more informative when treated as a benchmark for probing runtime log comprehension rather than as an end task. Using real-world journalctl data from Linux production servers, we evaluate nine small language models (SLMs) and small reasoning language models (SRLMs) under zero-shot, few-shot, and retrieval-augmented generation (RAG) prompting. The results reveal strong stratification. Qwen3-4B achieves the highest accuracy at 95.64% with RAG, while Gemma3-1B improves from 20.25% under few-shot prompting to 85.28% with RAG. Notably, the tiny Qwen3-0.6B reaches 88.12% accuracy despite weak performance without retrieval. In contrast, several SRLMs, including Qwen3-1.7B and DeepSeek-R1-Distill-Qwen-1.5B, degrade substantially when paired with RAG. Efficiency measurements further separate models: most Gemma and Llama variants complete inference in under 1.2 seconds per log, whereas Phi-4-Mini-Reasoning exceeds 228 seconds per log while achieving <10% accuracy. These findings suggest that (1) architectural design, (2) training objectives, and (3) the ability to integrate retrieved context under strict output constraints jointly determine performance. By emphasizing small, deployable models, this benchmark aligns with real-time requirements of digital twin (DT) systems and shows that severity classification serves as a lens for evaluating model competence and real-time deployability, with implications for root cause analysis (RCA) and broader DT integration.

  • 5 authors
·
Jan 12 2

A smartphone application to detection and classification of coffee leaf miner and coffee leaf rust

Generally, the identification and classification of plant diseases and/or pests are performed by an expert . One of the problems facing coffee farmers in Brazil is crop infestation, particularly by leaf rust Hemileia vastatrix and leaf miner Leucoptera coffeella. The progression of the diseases and or pests occurs spatially and temporarily. So, it is very important to automatically identify the degree of severity. The main goal of this article consists on the development of a method and its i implementation as an App that allow the detection of the foliar damages from images of coffee leaf that are captured using a smartphone, and identify whether it is rust or leaf miner, and in turn the calculation of its severity degree. The method consists of identifying a leaf from the image and separates it from the background with the use of a segmentation algorithm. In the segmentation process, various types of backgrounds for the image using the HSV and YCbCr color spaces are tested. In the segmentation of foliar damages, the Otsu algorithm and the iterative threshold algorithm, in the YCgCr color space, have been used and compared to k-means. Next, features of the segmented foliar damages are calculated. For the classification, artificial neural network trained with extreme learning machine have been used. The results obtained shows the feasibility and effectiveness of the approach to identify and classify foliar damages, and the automatic calculation of the severity. The results obtained are very promising according to experts.

  • 4 authors
·
Mar 19, 2019

Podcast Summary Assessment: A Resource for Evaluating Summary Assessment Methods

Automatic summary assessment is useful for both machine-generated and human-produced summaries. Automatically evaluating the summary text given the document enables, for example, summary generation system development and detection of inappropriate summaries. Summary assessment can be run in a number of modes: ranking summary generation systems; ranking summaries of a particular document; and estimating the quality of a document-summary pair on an absolute scale. Existing datasets with annotation for summary assessment are usually based on news summarization datasets such as CNN/DailyMail or XSum. In this work, we describe a new dataset, the podcast summary assessment corpus, a collection of podcast summaries that were evaluated by human experts at TREC2020. Compared to existing summary assessment data, this dataset has two unique aspects: (i) long-input, speech podcast based, documents; and (ii) an opportunity to detect inappropriate reference summaries in podcast corpus. First, we examine existing assessment methods, including model-free and model-based methods, and provide benchmark results for this long-input summary assessment dataset. Second, with the aim of filtering reference summary-document pairings for training, we apply summary assessment for data selection. The experimental results on these two aspects provide interesting insights on the summary assessment and generation tasks. The podcast summary assessment data is available.

  • 2 authors
·
Aug 28, 2022

Predicting sepsis in multi-site, multi-national intensive care cohorts using deep learning

Despite decades of clinical research, sepsis remains a global public health crisis with high mortality, and morbidity. Currently, when sepsis is detected and the underlying pathogen is identified, organ damage may have already progressed to irreversible stages. Effective sepsis management is therefore highly time-sensitive. By systematically analysing trends in the plethora of clinical data available in the intensive care unit (ICU), an early prediction of sepsis could lead to earlier pathogen identification, resistance testing, and effective antibiotic and supportive treatment, and thereby become a life-saving measure. Here, we developed and validated a machine learning (ML) system for the prediction of sepsis in the ICU. Our analysis represents the largest multi-national, multi-centre in-ICU study for sepsis prediction using ML to date. Our dataset contains 156,309 unique ICU admissions, which represent a refined and harmonised subset of five large ICU databases originating from three countries. Using the international consensus definition Sepsis-3, we derived hourly-resolved sepsis label annotations, amounting to 26,734 (17.1%) septic stays. We compared our approach, a deep self-attention model, to several clinical baselines as well as ML baselines and performed an extensive internal and external validation within and across databases. On average, our model was able to predict sepsis with an AUROC of 0.847 pm 0.050 (internal out-of sample validation) and 0.761 pm 0.052 (external validation). For a harmonised prevalence of 17%, at 80% recall our model detects septic patients with 39% precision 3.7 hours in advance.

  • 8 authors
·
Jul 12, 2021

Enhancing Traffic Incident Management with Large Language Models: A Hybrid Machine Learning Approach for Severity Classification

This research showcases the innovative integration of Large Language Models into machine learning workflows for traffic incident management, focusing on the classification of incident severity using accident reports. By leveraging features generated by modern language models alongside conventional data extracted from incident reports, our research demonstrates improvements in the accuracy of severity classification across several machine learning algorithms. Our contributions are threefold. First, we present an extensive comparison of various machine learning models paired with multiple large language models for feature extraction, aiming to identify the optimal combinations for accurate incident severity classification. Second, we contrast traditional feature engineering pipelines with those enhanced by language models, showcasing the superiority of language-based feature engineering in processing unstructured text. Third, our study illustrates how merging baseline features from accident reports with language-based features can improve the severity classification accuracy. This comprehensive approach not only advances the field of incident management but also highlights the cross-domain application potential of our methodology, particularly in contexts requiring the prediction of event outcomes from unstructured textual data or features translated into textual representation. Specifically, our novel methodology was applied to three distinct datasets originating from the United States, the United Kingdom, and Queensland, Australia. This cross-continental application underlines the robustness of our approach, suggesting its potential for widespread adoption in improving incident management processes globally.

  • 4 authors
·
Mar 20, 2024

Enhancing clinical decision support with physiological waveforms -- a multimodal benchmark in emergency care

Background: AI-driven prediction algorithms have the potential to enhance emergency medicine by enabling rapid and accurate decision-making regarding patient status and potential deterioration. However, the integration of multimodal data, including raw waveform signals, remains underexplored in clinical decision support. Methods: We present a dataset and benchmarking protocol designed to advance multimodal decision support in emergency care. Our models utilize demographics, biometrics, vital signs, laboratory values, and electrocardiogram (ECG) waveforms as inputs to predict both discharge diagnoses and patient deterioration. Results: The diagnostic model achieves area under the receiver operating curve (AUROC) scores above 0.8 for 609 out of 1,428 conditions, covering both cardiac (e.g., myocardial infarction) and non-cardiac (e.g., renal disease, diabetes) diagnoses. The deterioration model attains AUROC scores above 0.8 for 14 out of 15 targets, accurately predicting critical events such as cardiac arrest, mechanical ventilation, ICU admission, and mortality. Conclusions: Our study highlights the positive impact of incorporating raw waveform data into decision support models, improving predictive performance. By introducing a unique, publicly available dataset and baseline models, we provide a foundation for measurable progress in AI-driven decision support for emergency care.

  • 3 authors
·
Apr 29, 2025

Progress Note Understanding -- Assessment and Plan Reasoning: Overview of the 2022 N2C2 Track 3 Shared Task

Daily progress notes are common types in the electronic health record (EHR) where healthcare providers document the patient's daily progress and treatment plans. The EHR is designed to document all the care provided to patients, but it also enables note bloat with extraneous information that distracts from the diagnoses and treatment plans. Applications of natural language processing (NLP) in the EHR is a growing field with the majority of methods in information extraction. Few tasks use NLP methods for downstream diagnostic decision support. We introduced the 2022 National NLP Clinical Challenge (N2C2) Track 3: Progress Note Understanding - Assessment and Plan Reasoning as one step towards a new suite of tasks. The Assessment and Plan Reasoning task focuses on the most critical components of progress notes, Assessment and Plan subsections where health problems and diagnoses are contained. The goal of the task was to develop and evaluate NLP systems that automatically predict causal relations between the overall status of the patient contained in the Assessment section and its relation to each component of the Plan section which contains the diagnoses and treatment plans. The goal of the task was to identify and prioritize diagnoses as the first steps in diagnostic decision support to find the most relevant information in long documents like daily progress notes. We present the results of 2022 n2c2 Track 3 and provide a description of the data, evaluation, participation and system performance.

  • 6 authors
·
Mar 14, 2023

Negotiative Alignment: Embracing Disagreement to Achieve Fairer Outcomes -- Insights from Urban Studies

Urban assessments often compress diverse needs into single scores, which can obscure minority perspectives. We present a community-centered study in Montreal (n=35; wheelchair users, seniors, LGBTQIA2+ residents, and immigrants). Participants rated 20 streets (accessibility, inclusivity, aesthetics, practicality) and ranked 7 images on 12 interview-elicited criteria. Disagreement patterns were systematic in our sample: wheelchair users diverged most on accessibility and practicality; LGBTQIA2+ participants emphasized inclusion and liveliness; seniors prioritized security. Group discussion reduced information gaps but not value conflicts; ratings conveyed intensity, while rankings forced trade-offs. We then formalize negotiative alignment, a transparent, budget-aware bargaining procedure, and pilot it with role-played stakeholder agents plus a neutral mediator. Relative to the best base design under the same public rubric, the negotiated package increased total utility (21.10 to 24.55), raised the worst-group utility (3.20 to 3.90), improved twentieth percentile satisfaction (0.86 to 1.00; min-max normalized within the scenario), and reduced inequality (Gini 0.036 to 0.025). Treating disagreement as signal and reporting worst-group outcomes alongside totals may help planners and AI practitioners surface trade-offs and preserve minority priorities while maintaining efficiency.

  • 3 authors
·
Mar 16, 2025

Towards a deep learning approach for classifying treatment response in glioblastomas

Glioblastomas are the most aggressive type of glioma, having a 5-year survival rate of 6.9%. Treatment typically involves surgery, followed by radiotherapy and chemotherapy, and frequent magnetic resonance imaging (MRI) scans to monitor disease progression. To assess treatment response, radiologists use the Response Assessment in Neuro-Oncology (RANO) criteria to categorize the tumor into one of four labels based on imaging and clinical features: complete response, partial response, stable disease, and progressive disease. This assessment is very complex and time-consuming. Since deep learning (DL) has been widely used to tackle classification problems, this work aimed to implement the first DL pipeline for the classification of RANO criteria based on two consecutive MRI acquisitions. The models were trained and tested on the open dataset LUMIERE. Five approaches were tested: 1) subtraction of input images, 2) different combinations of modalities, 3) different model architectures, 4) different pretraining tasks, and 5) adding clinical data. The pipeline that achieved the best performance used a Densenet264 considering only T1-weighted, T2-weighted, and Fluid Attenuated Inversion Recovery (FLAIR) images as input without any pretraining. A median Balanced Accuracy of 50.96% was achieved. Additionally, explainability methods were applied. Using Saliency Maps, the tumor region was often successfully highlighted. In contrast, Grad-CAM typically failed to highlight the tumor region, with some exceptions observed in the Complete Response and Progressive Disease classes, where it effectively identified the tumor region. These results set a benchmark for future studies on glioblastoma treatment response assessment based on the RANO criteria while emphasizing the heterogeneity of factors that might play a role when assessing the tumor's response to treatment.

  • 6 authors
·
Apr 25, 2025

Safety and accuracy follow different scaling laws in clinical large language models

Clinical LLMs are often scaled by increasing model size, context length, retrieval complexity, or inference-time compute, with the implicit expectation that higher accuracy implies safer behavior. This assumption is incomplete in medicine, where a few confident, high-risk, or evidence-contradicting errors can matter more than average benchmark performance. We introduce SaFE-Scale, a framework for measuring how clinical LLM safety changes across model scale, evidence quality, retrieval strategy, context exposure, and inference-time compute. To instantiate this framework, we introduce RadSaFE-200, a Radiology Safety-Focused Evaluation benchmark of 200 multiple-choice questions with clinician-defined clean evidence, conflict evidence, and option-level labels for high-risk error, unsafe answer, and evidence contradiction. We evaluated 34 locally deployed LLMs across six deployment conditions: closed-book prompting (zero-shot), clean evidence, conflict evidence, standard RAG, agentic RAG, and max-context prompting. Clean evidence produced the strongest improvement, increasing mean accuracy from 73.5% to 94.1%, while reducing high-risk error from 12.0% to 2.6%, contradiction from 12.7% to 2.3%, and dangerous overconfidence from 8.0% to 1.6%. Standard RAG and agentic RAG did not reproduce this safety profile: agentic RAG improved accuracy over standard RAG and reduced contradiction, but high-risk error and dangerous overconfidence remained elevated. Max-context prompting increased latency without closing the safety gap, and additional inference-time compute produced only limited gains. Worst-case analysis showed that clinically consequential errors concentrated in a small subset of questions. Clinical LLM safety is therefore not a passive consequence of scaling, but a deployment property shaped by evidence quality, retrieval design, context construction, and collective failure behavior.

  • 12 authors
·
May 4

Does Context Matter? ContextualJudgeBench for Evaluating LLM-based Judges in Contextual Settings

The large language model (LLM)-as-judge paradigm has been used to meet the demand for a cheap, reliable, and fast evaluation of model outputs during AI system development and post-deployment monitoring. While judge models -- LLMs finetuned to specialize in assessing and critiquing model outputs -- have been touted as general purpose evaluators, they are typically evaluated only on non-contextual scenarios, such as instruction following. The omission of contextual settings -- those where external information is used as context to generate an output -- is surprising given the increasing prevalence of retrieval-augmented generation (RAG) and summarization use cases. Contextual assessment is uniquely challenging, as evaluation often depends on practitioner priorities, leading to conditional evaluation criteria (e.g., comparing responses based on factuality and then considering completeness if they are equally factual). To address the gap, we propose ContextualJudgeBench, a judge benchmark with 2,000 challenging response pairs across eight splits inspired by real-world contextual evaluation scenarios. We build our benchmark with a multi-pronged data construction pipeline that leverages both existing human annotations and model-based perturbations. Our comprehensive study across 11 judge models and 9 general purpose models, reveals that the contextual information and its assessment criteria present a significant challenge to even state-of-the-art models. For example, OpenAI's o1, the best-performing model, barely reaches 55% consistent accuracy.

  • 5 authors
·
Mar 19, 2025

Exploring Large Language Models for Specialist-level Oncology Care

Large language models (LLMs) have shown remarkable progress in encoding clinical knowledge and responding to complex medical queries with appropriate clinical reasoning. However, their applicability in subspecialist or complex medical settings remains underexplored. In this work, we probe the performance of AMIE, a research conversational diagnostic AI system, in the subspecialist domain of breast oncology care without specific fine-tuning to this challenging domain. To perform this evaluation, we curated a set of 50 synthetic breast cancer vignettes representing a range of treatment-naive and treatment-refractory cases and mirroring the key information available to a multidisciplinary tumor board for decision-making (openly released with this work). We developed a detailed clinical rubric for evaluating management plans, including axes such as the quality of case summarization, safety of the proposed care plan, and recommendations for chemotherapy, radiotherapy, surgery and hormonal therapy. To improve performance, we enhanced AMIE with the inference-time ability to perform web search retrieval to gather relevant and up-to-date clinical knowledge and refine its responses with a multi-stage self-critique pipeline. We compare response quality of AMIE with internal medicine trainees, oncology fellows, and general oncology attendings under both automated and specialist clinician evaluations. In our evaluations, AMIE outperformed trainees and fellows demonstrating the potential of the system in this challenging and important domain. We further demonstrate through qualitative examples, how systems such as AMIE might facilitate conversational interactions to assist clinicians in their decision making. However, AMIE's performance was overall inferior to attending oncologists suggesting that further research is needed prior to consideration of prospective uses.

  • 21 authors
·
Nov 5, 2024