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Nov 4

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

Comprehensive Evaluation of Machine Learning for Type 2 Diabetes Risk Prediction: Large-Scale External Validation and Fairness Analysis

Machine learning-based Type 2 diabetes risk prediction models obtain good internal validation results but lose effectiveness in real-world applications due to deficient external testing and fairness assessment. We developed a multi-dimensional framework evaluating discrimination, calibration, interpretability, and algorithmic fairness on nationally representative populations. An XGBoost model was trained on NHANES 2015-2020 (n=15,685) using eight non-laboratory predictors: age, sex, race/ethnicity, BMI, smoking status, physical activity, history of heart attack, and history of stroke. External validation was performed on BRFSS 2020-2022 (n=1,285,783) under realistic distribution shift. Internal validation showed good discrimination (AUC=0.794, 95% CI 0.788-0.800), with performance loss on external validation (AUC=0.717, relative decrease: -9.7%, p<0.001). Fairness analysis revealed severe bias: elderly adults (>=60) showed AUC=0.607 vs 0.742 for young adults (difference=0.135, p<0.001); obese individuals showed AUC=0.698 vs 0.735 for normal weight (difference=0.037, p<0.001). Gender showed comparable performance (male=0.723 vs female=0.712, p=0.142). Calibration revealed risk overestimation (Brier score=0.123). SHAP analysis identified age, BMI, and physical activity as primary risk drivers. Populations with highest diabetes risk receive the worst algorithmic performance, underscoring the need for fairness-aware, age-stratified deployment strategies before clinical use.

  • 6 authors
·
Jun 26

Structured Proper Loss Geometries for Multiclass Classification: Theory and Controlled Empirical Evaluation

Strictly proper scoring rules identify the true conditional class distribution at population level, but their curvature can alter optimization and finite-sample behavior. We study three multiclass objectives: a class-aware quadratic Bregman score (CAPM), a strongly convex generator with constrained log-cosh ridges (HPG), and an HPG objective with an annealed probability-margin penalty (APMS). CAPM is treated as a structured instance of established quadratic scoring-rule theory. We derive conditional-regret, curvature, range, and logit-gradient bounds for CAPM and HPG, and prove exact penalty-range and conditional-target displacement bounds for APMS. Controlled five-seed experiments use Digits, Wisconsin breast cancer, and synthetic confusion and long-tail problems under clean labels, symmetric and pair-flip corruption, class imbalance, calibration evaluation, input corruption, and first-order adversarial perturbations. The candidates are close to cross-entropy on clean data and show descriptive gains in some noisy-label cells, but the five-seed comparisons are interpreted descriptively rather than as significance evidence. The selected noisy-label baselines perform better on Digits with 40% symmetric label noise, and explicit prior-adjustment methods perform better in the 30:1 synthetic long-tail experiment. Ablations do not show a consistent benefit from the candidate-specific graph, ridge, or margin components. The mathematical analysis establishes the stated properties, and the experiments delimit the empirical evidence; together they do not support a claim of general superiority.

  • 1 authors
·
Jun 27

KWBench: Measuring Unprompted Problem Recognition in Knowledge Work

We introduce the first version of KWBench (Knowledge Work Bench), a benchmark for unprompted problem recognition in large language models: can an LLM identify a professional scenario before attempting to solve it. Existing frontier benchmarks have saturated, and most knowledge-work evaluations to date reduce to extraction or task completion against a specification. KWBench targets the step before that: recognizing the governing structure of the situation from raw inputs alone. The benchmark contains 223 tasks sourced from practitioners across acquisitions, contract negotiations, clinical pharmacy, organizational politics, fraud analysis, and incentive design. Each task encodes a formal game-theoretic pattern (principal-agent conflict, signaling, mechanism design failure, strategic omission, coalitional dynamics, strategic interdependence) and carries structured ground truth recording the expert reading of the situation and the anticipated failure modes. Models receive raw data and a task prompt with no indication of problem type. Scoring is a three-tier rubric gated by a mandatory conjunctive check. Mandatory criteria encode the predicted wrong paths. We evaluate 16 models. The best model passes on 27.9% of tasks. The top two models agree on only 31.7% of their passes. Among the top 8, 44 tasks are solved by exactly one model; routing across the top 8 covers 50.7% of the benchmark, nearly double the best single model. Conditional on passing, quality scores converge (approx 83% across models); unconditional scores do not. Same models articulate the relevant game-theoretic concept correctly when asked, then fail to apply it unprompted. We release KWBench to shift how frontier models are evaluated on knowledge work, scoring them on whether they recognize the right problem from the situation alone, not only on how well they execute once the problem has been framed for them.

clio-ai Clio AI
·
Apr 16 2

BS-Net: learning COVID-19 pneumonia severity on a large Chest X-Ray dataset

In this work we design an end-to-end deep learning architecture for predicting, on Chest X-rays images (CXR), a multi-regional score conveying the degree of lung compromise in COVID-19 patients. Such semi-quantitative scoring system, namely Brixia~score, is applied in serial monitoring of such patients, showing significant prognostic value, in one of the hospitals that experienced one of the highest pandemic peaks in Italy. To solve such a challenging visual task, we adopt a weakly supervised learning strategy structured to handle different tasks (segmentation, spatial alignment, and score estimation) trained with a "from-the-part-to-the-whole" procedure involving different datasets. In particular, we exploit a clinical dataset of almost 5,000 CXR annotated images collected in the same hospital. Our BS-Net demonstrates self-attentive behavior and a high degree of accuracy in all processing stages. Through inter-rater agreement tests and a gold standard comparison, we show that our solution outperforms single human annotators in rating accuracy and consistency, thus supporting the possibility of using this tool in contexts of computer-assisted monitoring. Highly resolved (super-pixel level) explainability maps are also generated, with an original technique, to visually help the understanding of the network activity on the lung areas. We also consider other scores proposed in literature and provide a comparison with a recently proposed non-specific approach. We eventually test the performance robustness of our model on an assorted public COVID-19 dataset, for which we also provide Brixia~score annotations, observing good direct generalization and fine-tuning capabilities that highlight the portability of BS-Net in other clinical settings. The CXR dataset along with the source code and the trained model are publicly released for research purposes.

  • 11 authors
·
Apr 2, 2021

PanCanBench: A Comprehensive Benchmark for Evaluating Large Language Models in Pancreatic Oncology

Large language models (LLMs) have achieved expert-level performance on standardized examinations, yet multiple-choice accuracy poorly reflects real-world clinical utility and safety. As patients and clinicians increasingly use LLMs for guidance on complex conditions such as pancreatic cancer, evaluation must extend beyond general medical knowledge. Existing frameworks, such as HealthBench, rely on simulated queries and lack disease-specific depth. Moreover, high rubric-based scores do not ensure factual correctness, underscoring the need to assess hallucinations. We developed a human-in-the-loop pipeline to create expert rubrics for de-identified patient questions from the Pancreatic Cancer Action Network (PanCAN). The resulting benchmark, PanCanBench, includes 3,130 question-specific criteria across 282 authentic patient questions. We evaluated 22 proprietary and open-source LLMs using an LLM-as-a-judge framework, measuring clinical completeness, factual accuracy, and web-search integration. Models showed substantial variation in rubric-based completeness, with scores ranging from 46.5% to 82.3%. Factual errors were common, with hallucination rates (the percentages of responses containing at least one factual error) ranging from 6.0% for Gemini-2.5 Pro and GPT-4o to 53.8% for Llama-3.1-8B. Importantly, newer reasoning-optimized models did not consistently improve factuality: although o3 achieved the highest rubric score, it produced inaccuracies more frequently than other GPT-family models. Web-search integration did not inherently guarantee better responses. The average score changed from 66.8% to 63.9% for Gemini-2.5 Pro and from 73.8% to 72.8% for GPT-5 when web search was enabled. Synthetic AI-generated rubrics inflated absolute scores by 17.9 points on average while generally maintaining similar relative ranking.

  • 16 authors
·
Mar 1

Conditional Weight of Evidence for Gradient-Boosted Credit Models: Estimation, Additivity and Its Relation to Adverse Action Reasons

Traditional weight of evidence assigns a credit characteristic a value based on its association with default across a population. Credit analysis also requires an assessment of that characteristic in the context of an individual applicant's record. We study conditional weight of evidence for this purpose. It measures the change in default log odds from observing a characteristic after the remaining credit information is known. Its sign identifies whether the characteristic adds adverse or favorable information for that applicant, and its magnitude measures the strength of that information. The same characteristic value can therefore receive different assessments for applicants with different payment histories or other credit attributes. We develop estimators using gradient-boosted trees and evaluate their accuracy in a bureau-style simulation. Regressions of the full model's predicted probabilities recover conditional evidence more accurately than separate models fitted to default outcomes, provided the full model is accurate. They also recover a deliberately constructed file-age effect whose direction varies with utilization and is often missed by marginal weight of evidence. Local class-frequency estimates improve on marginal weight of evidence but remain inaccurate for some weak effects. An application to FICO HELOC data illustrates estimation when the population evidence is unknown. Conditional weight of evidence provides an applicant-specific interpretation of the information in a credit characteristic; its population summary, a conditional information value, splits the joint information in the record across blocks when averaged over orderings. Neither is an adverse action reason, which explains the fitted score difference between the applicant and chosen passing records.

  • 2 authors
·
Oct 16

Predictive Credit: Measuring What Scientific Explanations Add to Experimental Forecasts

Research agents explain planned experiments. We measure predictive credit with paired forecasts sharing an intervention, forecaster, and outcome while varying description, matched explanation, and donor context. Five checks track commitment, delivery, predictive gain, alignment, and known-signal uptake. Across 336 prospective states in controlled learning, 12 Tox21 endpoints, and 24 OpenML tasks, v5's frozen credit decision was inconclusive. Tox21's preregistered ROC AUC interval-score harm test was unmet (D-M=-.0026, 95 percent interval [-.0174, .0104]); OpenML's joint formation, point-equivalence, and repeatability rule was unmet. Matched point-accuracy gains over description remained unconfirmed, and Tox21/OpenML seed-donor intervals spanned zero. Under requested DeepSeek V4 Pro, matched and donor cards reduced secondary Tox21 drift by 64.5 and 59.1 percent. A DeepSeek V4 Flash replay raised matched point MAE from .01823 to .02020 and missed matched-donor interval-score equivalence. OpenML full-card assignment widened nominal 80 percent intervals by 21 percent, with 49.3 percent coverage versus 51.4 percent for description and content in 66/144 cards. Direct-text Flash delivered all 144 notes without detectable matched point-accuracy gain. A researcher-authored mechanism positive control lowered point MAE by 2.60 percentage points versus description. The protocol measures predictive credit for research-agent benchmarks and scientific forecasting; natural-explanation credit remained unconfirmed at the tested donor resolutions.

Verification Without Sufficiency: Per-Chunk Filtering Fails on Multi-Hop RAG, and Decomposition Repairs It

Verification for retrieval-augmented generation usually scores each retrieved chunk and drops the ones that fail. We show this cannot work for multi-hop questions, and show what does. Per-chunk scoring assumes one chunk is a sufficient premise for the answer. Multi-hop questions are built so that none is, and the paragraph carrying the answer is the one the question does not name. Entailment scoring reaches 0.643, 0.523 and 0.560 AUC on HotpotQA, 2WikiMultihopQA and MuSiQue, against 0.951 on single-hop SQuAD. Seven controls rule out model capacity, premise length, hypothesis template, decision threshold, retriever, answer-matching criterion and prompt. End to end across three datasets, three generator sizes and two prompts, per-chunk gating is significantly worse than not filtering at all in every cell, and its penalty grows with generator capability. The repair is to condition verification on the decomposed sub-question rather than the original query. Using MuSiQue's gold decomposition, entailment on a later hop rises from 0.546, which is chance, to 0.840, a paired lift of +0.355 with a bootstrap interval of [0.331, 0.382]. An off-the-shelf Qwen2.5-7B decomposer, given the question and the top retrieved paragraph, reaches 0.637 and captures 31% of that ceiling; decomposing without retrieval reaches 0.533, below the original question. Iterative retrieval systems already produce such decompositions and discard them before verifying.

  • 1 authors
·
Jul 31

The Complexity Kink: A Prompt-Side Structural Complexity Index for Code-Generation Reliability

Measuring complexity from a model's own code is biased by failure: a hard prompt can produce a short, broken program that looks simple. We instead score each prompt's structure on six dimensions from the prompt alone, never from generated code or test results. We draw 5,000 Python prompts across six bands of a preliminary single-rater score, and four out-of-panel LLM judges rescore every prompt (composite ICC(2,1) = 0.872). Twenty-one models answer every prompt (105,000 generations), and an independent LLM auditor, checked against known-answer cases, reviews each unit-test verdict. Averaged over models, pass rate has a nonmonotone breakpoint at composite 14.0: 83.4% at or below, 90.1% above. That jump is not a law of difficulty: with task-type fixed effects the breakpoint stays at 14.0 but the adjusted jump shrinks from 6.8 to 0.4 points, and neither of the benchmark's two prompt sources reproduces it on its own. Nineteen models pass more often above their own breakpoint and two less often; one of those declines comes from API calls that returned nothing. In post hoc follow-up, Kimi K2.5 shows the clearest decline, at 14.25, under a prompt-source control and within the later source alone. Among failed generations with measurable output complexity, 25.0% pair a prompt composite above 8 with output complexity of at most 10, twice the share among passing ones. The pooled breakpoint moves to 11.25 on raw test outcomes. Human agreement with the index is moderate, paraphrase and cross-language rescoring preserve its ordering, and overidentification tests reject the six dimensions as instruments, so we make no causal claim. The contribution is a prompt-side way to locate where each model's pass rate changes and to test how much that depends on the prompt mix and on how success is scored.

  • 2 authors
·
Oct 19

CXR-LLaVA: Multimodal Large Language Model for Interpreting Chest X-ray Images

Purpose: Recent advancements in large language models (LLMs) have expanded their capabilities in a multimodal fashion, potentially replicating the image interpretation of human radiologists. This study aimed to develop open-source multimodal large language model for interpreting chest X-ray images (CXR-LLaVA). We also examined the effect of prompt engineering and model parameters such as temperature and nucleus sampling. Materials and Methods: For training, we collected 659,287 publicly available CXRs: 417,336 CXRs had labels for certain radiographic abnormalities (dataset 1); 241,951 CXRs provided free-text radiology reports (dataset 2). After pre-training the Resnet50 as an image encoder, the contrastive language-image pre-training was used to align CXRs and corresponding radiographic abnormalities. Then, the Large Language Model Meta AI-2 was fine-tuned using dataset 2, which were refined using GPT-4, with generating various question answering scenarios. The code can be found at https://github.com/ECOFRI/CXR_LLaVA. Results: In the test set, we observed that the model's performance fluctuated based on its parameters. On average, it achieved F1 score of 0.34 for five pathologic findings (atelectasis, cardiomegaly, consolidation, edema, and pleural effusion), which was improved to 0.46 through prompt engineering. In the independent set, the model achieved an average F1 score of 0.30 for the same pathologic findings. Notably, for the pediatric chest radiograph dataset, which was unseen during training, the model differentiated abnormal radiographs with an F1 score ranging from 0.84 to 0.85. Conclusion: CXR-LLaVA demonstrates promising potential in CXR interpretation. Both prompt engineering and model parameter adjustments can play pivotal roles in interpreting CXRs.

  • 4 authors
·
Oct 22, 2023

Auditing Multimodal LLM Raters: Central Tendency Bias in Clinical Ordinal Scoring

Multimodal large language models (LLMs) are increasingly explored as automated evaluators in clinical settings, yet their scoring behavior on ordinal clinical scales remains poorly understood. We benchmark three frontier LLM families against supervised deep learning models for scoring Clock Drawing Test (CDT) images on two public datasets using the Shulman rubric. While fully fine-tuned Vision Transformers achieve the best calibration (MAE 0.52, within-1 accuracy 91%), zero-shot LLMs remain competitive on tolerance-based agreement (GPT-5 MAE 0.67, within-1 accuracy 92%) despite higher absolute error. However, per-score analysis reveals that all three LLM families exhibit a pronounced central tendency effect (systematic endpoint compression): predictions are systematically compressed toward the middle of the scale, with over-prediction at the low end (score 0 to 1) and under-prediction at the high end (score 5 to 4). This effect disproportionately affects the clinically critical extremes where accurate scoring most impacts screening decisions for cognitive impairment. Targeted ablations show that neither few-shot exemplars spanning the full score range nor removing clinical terminology from the prompt eliminates the effect. Our findings extend the LLM-as-a-judge bias literature from NLP evaluation to clinical assessment, and highlight the need for calibration-aware evaluation and post-hoc calibration before deploying LLM-based raters in high-stakes screening workflows.

GAPS: A Clinically Grounded, Automated Benchmark for Evaluating AI Clinicians

Current benchmarks for AI clinician systems, often based on multiple-choice exams or manual rubrics, fail to capture the depth, robustness, and safety required for real-world clinical practice. To address this, we introduce the GAPS framework, a multidimensional paradigm for evaluating Grounding (cognitive depth), Adequacy (answer completeness), Perturbation (robustness), and Safety. Critically, we developed a fully automated, guideline-anchored pipeline to construct a GAPS-aligned benchmark end-to-end, overcoming the scalability and subjectivity limitations of prior work. Our pipeline assembles an evidence neighborhood, creates dual graph and tree representations, and automatically generates questions across G-levels. Rubrics are synthesized by a DeepResearch agent that mimics GRADE-consistent, PICO-driven evidence review in a ReAct loop. Scoring is performed by an ensemble of large language model (LLM) judges. Validation confirmed our automated questions are high-quality and align with clinician judgment. Evaluating state-of-the-art models on the benchmark revealed key failure modes: performance degrades sharply with increased reasoning depth (G-axis), models struggle with answer completeness (A-axis), and they are highly vulnerable to adversarial perturbations (P-axis) as well as certain safety issues (S-axis). This automated, clinically-grounded approach provides a reproducible and scalable method for rigorously evaluating AI clinician systems and guiding their development toward safer, more reliable clinical practice.

  • 41 authors
·
Oct 15, 2025

A Unified Three-Stage Machine Learning Framework for Diabetes Detection, Subtype Discrimination, and Cognitive-Metabolic Hypothesis Testing

Diabetes mellitus affects over 537 million adults worldwide and remains a major challenge in preventive healthcare. Existing machine-learning studies primarily formulate diabetes prediction as a binary classification problem, while subtype-oriented analysis and glycaemic-cognitive associations remain comparatively underexplored. We present a reproducible three-stage machine learning framework for diabetes detection, subtype-oriented clustering, and metabolic-cognitive association analysis. In Stage 1, five supervised classifiers together with a stacking ensemble are benchmarked on the NCSU Diabetes Dataset using stratified five-fold cross-validation and evaluation metrics including ROC-AUC, balanced accuracy, recall, and F1-score. SVM-RBF and Logistic Regression achieve the highest ROC-AUC (0.825 pm 0.026), while Random Forest achieves the highest accuracy (0.762 pm 0.030). SHAP explainability identifies Glucose, BMI, and Age as the dominant predictive biomarkers. In Stage 2, silhouette-validated K-Means clustering (k=2, silhouette approx 0.116) is applied to confirmed diabetic cases using Glucose, Insulin, and Age, recovering clinically plausible subtype-oriented partitions without requiring ground-truth subtype labels. In Stage 3, statistical analysis of the Ohio Longitudinal Cognitive Dataset (n=373) reveals a significant positive association between glycaemic control and cognitive function (ρ_s = 0.208, p = 5.29 times 10^{-5}), which survives Holm correction. The findings support the utility of statistically grounded and interpretable ML pipelines for reproducible diabetes analytics and subtype-aware exploratory analysis.

  • 3 authors
·
May 12

Subset Selection Based On Multiple Rankings in the Presence of Bias: Effectiveness of Fairness Constraints for Multiwinner Voting Score Functions

We consider the problem of subset selection where one is given multiple rankings of items and the goal is to select the highest ``quality'' subset. Score functions from the multiwinner voting literature have been used to aggregate rankings into quality scores for subsets. We study this setting of subset selection problems when, in addition, rankings may contain systemic or unconscious biases toward a group of items. For a general model of input rankings and biases, we show that requiring the selected subset to satisfy group fairness constraints can improve the quality of the selection with respect to unbiased rankings. Importantly, we show that for fairness constraints to be effective, different multiwinner score functions may require a drastically different number of rankings: While for some functions, fairness constraints need an exponential number of rankings to recover a close-to-optimal solution, for others, this dependency is only polynomial. This result relies on a novel notion of ``smoothness'' of submodular functions in this setting that quantifies how well a function can ``correctly'' assess the quality of items in the presence of bias. The results in this paper can be used to guide the choice of multiwinner score functions for the subset selection setting considered here; we additionally provide a tool to empirically enable this.

  • 5 authors
·
Jun 16, 2023

SCORE: A Semantic Evaluation Framework for Generative Document Parsing

Multi-modal generative document parsing systems challenge traditional evaluation: unlike deterministic OCR or layout models, they often produce semantically correct yet structurally divergent outputs. Conventional metrics-CER, WER, IoU, or TEDS-misclassify such diversity as error, penalizing valid interpretations and obscuring system behavior. We introduce SCORE (Structural and COntent Robust Evaluation), an interpretation-agnostic framework that integrates (i) adjusted edit distance for robust content fidelity, (ii) token-level diagnostics to distinguish hallucinations from omissions, (iii) table evaluation with spatial tolerance and semantic alignment, and (iv) hierarchy-aware consistency checks. Together, these dimensions enable evaluation that embraces representational diversity while enforcing semantic rigor. Across 1,114 pages spanning a holistic benchmark and a field dataset, SCORE consistently revealed cross-dataset performance patterns missed by standard metrics. In 2-5% of pages with ambiguous table structures, traditional metrics penalized systems by 12-25% on average, leading to distorted rankings. SCORE corrected these cases, recovering equivalence between alternative but valid interpretations. Moreover, by normalizing generative outputs into a format-agnostic representation, SCORE reproduces traditional scores (e.g., table F1 up to 0.93) without requiring object-detection pipelines, demonstrating that generative parsing alone suffices for comprehensive evaluation. By exposing how interpretive diversity impacts evaluation outcomes and providing multi-dimensional, interpretable diagnostics, SCORE establishes foundational principles for semantically grounded, fair, and practical benchmarking of modern document parsing systems.

  • 6 authors
·
Sep 16, 2025

Review GIDE -- Restaurant Review Gastrointestinal Illness Detection and Extraction with Large Language Models

Foodborne gastrointestinal (GI) illness is a common cause of ill health in the UK. However, many cases do not interact with the healthcare system, posing significant challenges for traditional surveillance methods. The growth of publicly available online restaurant reviews and advancements in large language models (LLMs) present potential opportunities to extend disease surveillance by identifying public reports of GI illness. In this study, we introduce a novel annotation schema, developed with experts in GI illness, applied to the Yelp Open Dataset of reviews. Our annotations extend beyond binary disease detection, to include detailed extraction of information on symptoms and foods. We evaluate the performance of open-weight LLMs across these three tasks: GI illness detection, symptom extraction, and food extraction. We compare this performance to RoBERTa-based classification models fine-tuned specifically for these tasks. Our results show that using prompt-based approaches, LLMs achieve micro-F1 scores of over 90% for all three of our tasks. Using prompting alone, we achieve micro-F1 scores that exceed those of smaller fine-tuned models. We further demonstrate the robustness of LLMs in GI illness detection across three bias-focused experiments. Our results suggest that publicly available review text and LLMs offer substantial potential for public health surveillance of GI illness by enabling highly effective extraction of key information. While LLMs appear to exhibit minimal bias in processing, the inherent limitations of restaurant review data highlight the need for cautious interpretation of results.

  • 8 authors
·
Mar 12, 2025

Temporal-spatial Correlation Attention Network for Clinical Data Analysis in Intensive Care Unit

In recent years, medical information technology has made it possible for electronic health record (EHR) to store fairly complete clinical data. This has brought health care into the era of "big data". However, medical data are often sparse and strongly correlated, which means that medical problems cannot be solved effectively. With the rapid development of deep learning in recent years, it has provided opportunities for the use of big data in healthcare. In this paper, we propose a temporal-saptial correlation attention network (TSCAN) to handle some clinical characteristic prediction problems, such as predicting death, predicting length of stay, detecting physiologic decline, and classifying phenotypes. Based on the design of the attention mechanism model, our approach can effectively remove irrelevant items in clinical data and irrelevant nodes in time according to different tasks, so as to obtain more accurate prediction results. Our method can also find key clinical indicators of important outcomes that can be used to improve treatment options. Our experiments use information from the Medical Information Mart for Intensive Care (MIMIC-IV) database, which is open to the public. Finally, we have achieved significant performance benefits of 2.0\% (metric) compared to other SOTA prediction methods. We achieved a staggering 90.7\% on mortality rate, 45.1\% on length of stay. The source code can be find: https://github.com/yuyuheintju/TSCAN.

  • 6 authors
·
Jun 2, 2023

What Selects, What Reconstructs: Repairing Exemplar-Based Complex-Spectrum Separation

Exemplar methods separate a mixture by picking one learned spectrum per source and deforming it until it explains the observation, making one deformation class both reconstructor and selector. We show that the second role is empty as soon as the class can interpolate: the rule then ranks candidates on its regulariser, a choice made before the data, and the estimates sum back to the mixture whichever candidate wins. The condition is a parameter count, so the diagnosis runs before any experiment. On free per-bin deformation of complex spectra it explains the observed pathologies at once: a criterion that ranks candidates by their loudness, and half an output that is a mask on the mixture rather than an exemplar. The same theorem prescribes the repair, a selection class poorer than the reconstruction class: one complex gain and one pure delay rank the candidates, and a local combination of the best-aligned atoms, fitted jointly in closed form, rebuilds them. On MUSDB18 against the exact ceiling of the masking class, the distance between the criterion and an oracle inside its own candidate pool falls under the rigid selector from 6.2-7.7 to 0.5-2.8 dB, though only 0.9-1.2 dB of that reaches the output, and the per-frame latency of the deployed rule by a factor of 47 to 806. One lock remains, quantified: atoms are scored against the mixture, so the score carries a term for the other source that absorbs the capacity the reconstruction class gains, leaving the output 10.0 dB under the ceiling. Ranking hypotheses by the residual of a fit free enough to interpolate ranks them on the regulariser alone.

  • 1 authors
·
Sep 3

Did We Actually Fix It? An Independent Adversarial Stress-Test of Post-Point-Adjustment Evaluation Metrics for Time-Series Anomaly Detection

Point-adjustment (PA), for years the default scoring protocol in time-series anomaly detection (TSAD), was shown by Kim et al. (2022) to award near-perfect F1 to random anomaly scores. The field adopted a suite of replacement metrics (PA%K, range-based precision/recall, affiliation precision/recall, and Volume-Under-the-Surface, VUS, ROC/PR). We ask, independently and adversarially, whether these resist no-skill detectors on real benchmarks, and find the answer turns entirely on one overlooked variable: N, the number of random attempts an adversary reports the best of. Under a single honest run (N=1), not one replacement metric is gameable on any of six benchmarks (UCR, SMD, SMAP, MSL, NAB, PSM): a random detector reaches 90% of the best real detector's score on at most 11% of series for affiliation-F1, 5% for the ROC family, and 2% for the PR-based metrics and PA%K. But under best-of-N reporting, the seed-shopping endemic to ML, the metrics split sharply. affiliation-F1 and every ROC-based metric inflate steeply, affiliation crossing gameable (25% of series) by N=3 and reaching 0.98 at the full pool (N=41), the ROC family crossing by N=9-11; the PR-based metrics and PA%K stay near-flat at every N, floored near the anomaly prevalence (the lone exception is NAB at large N). A paired test finds VUS-ROC inflated on 131 series where its sibling VUS-PR is not, and never the reverse. The ROC-vs-PR split follows from the order-statistic behaviour of AUC under extreme class imbalance (a random PR-AUC is floored at prevalence); affiliation inflates by a second route, its extreme single-run leniency (already fragile at N=1). We release a pip-installable stress-test harness, and recommend reporting single-run scores or disclosing N and preferring PR-based metrics, which resist best-of-N inflation on nearly every benchmark.

  • 1 authors
·
Jul 18

AI World Cup 2026: Benchmarking Large Language Models for End-to-End Football Tournament Prediction

Large language models (LLMs) are now regularly asked to forecast real-world events, but comparisons are often difficult because models receive different information, use different tools, and are evaluated under different rules. This paper reports the completed AI World Cup benchmark, in which ten LLM-based assistants made a single pre-tournament forecast of the entire 2026 FIFA World Cup. Every submission used the same tournament snapshot, prompt, JSON schema, and scoring procedure. The forecasts covered group-stage scores, group rankings, the knockout bracket, final placings, confidence values, and short explanations. After all 104 matches had been played, GPT-5.5 Thinking finished first with 744 points, followed by GPT-5.5 with 717, Gemini with 699, and Qwen 3.7 with 687. GPT-5.5 Thinking was also the only model to select Spain, which defeated Argentina 1--0 in the final, as champion. The final ranking was driven mainly by knockout performance: total score was strongly correlated with knockout points (r=0.986), but showed little relationship with group-stage match points (r=0.055), group-standing points (r=-0.103), or their combined pre-knockout score (r=-0.054). Match-level accuracy produced a different ordering. Claude Sonnet 4.6 correctly predicted the largest number of group-stage outcomes (63.89\%) but placed sixth overall. Average self-reported confidence was also unrelated to either outcome accuracy (r=-0.060) or total score (r=-0.067). The results suggest that forecasting a complete tournament tests something different from predicting matches one at a time, while also showing how strongly a bracket-based leaderboard can depend on scoring design. The benchmark materials, raw responses, and scoring code are released to support replication and future extensions.

  • 2 authors
·
Aug 3

DistressBench: Evaluating Multi-Dimensional Crisis Support in Large Language Models

Language models have been adopted faster than evaluation practices that reliably assess their risks, and a growing share of use is affective rather than informational. Within that traffic users disclose suicide and self-harm (SSH) crises. Existing safety benchmarks score models primarily on refusal, but refusal is not the desired behavior here; the conversation requires a substantive supportive response. We introduce DistressBench, 718 English conversations with clinician-authored user turns spanning 23 SSH subcategories, each paired with a task-specific rubric of weighted atomic criteria across seven dimensions of crisis support and a clinician reference response. A model's score is the weighted average over the criteria its reply satisfies, reading directly as the fraction of required care delivered. The best of 25 frontier models satisfies 88.4% of weighted criteria and the median model 71.4%, against 98.7% for clinician references scored on the same criteria. Pooled across all 25 models, in 35.3% of conversations where a model satisfied every criterion for recognizing the crisis, it failed to route the user toward human help. The shortfall concentrates in the dimensions requiring the model to act rather than withhold. Contrasting each dimension's median model against its best separates capability limits from choices: de-escalation reaches 74.6% in the strongest model against a median of 46.0%, and safety disclaimers 84.6% against 8.3%. Multi-turn conversations score below single-turn ones (68.5% against 74.2%). We release the corpus, rubrics, judge calibration labels, and a companion annex of 20 long-horizon red-team transcripts. These results argue for evaluating crisis safety on the care a model delivers rather than on what it declines to say, and for treating de-escalation and resource routing as deployment requirements.

  • 4 authors
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Oct 7

Expert Evaluation of Clinical AI Tools on Real Point-of-Care Clinical Queries

Physicians now pose millions of clinical questions to AI tools each week, yet these tools are evaluated largely on hypothetical or exam-style questions, not those actually asked in practice. We report a blinded evaluation built on 620 Real-world Point-Of-Care Queries (Real-POCQi) submitted to the OpenEvidence (OE) platform by physicians spanning 30 specialties, as well as 187 questions from HealthBench. 149 practicing physicians across 36 states made head-to-head comparisons between answers from three frontier general-purpose models (Claude Opus 4.8, Gemini 3.1 Pro, and GPT-5.5) and a specialized clinical tool (OE), with graders matched to each question's specialty. When comparing answers along five dimensions relevant to clinical decision support -- accuracy, clinical utility, source quality, verifiability, & completeness -- physicians scored the specialized tool highest on all axes; in the primary analysis on Real-POCQi, win differences (margins between win and loss rates) ranged from 25 to 39 percentage points (p<0.001). Results remained consistent in sensitivity analyses stratifying by citation display, answer length, OE-user status, and Real-POCQi versus HealthBench. In parallel, LLM judges were found to systematically differ from expert judges, though both generally agreed on the best model. These findings underscore two conclusions: (i) AI tool evaluations should reflect real-world query distributions and use expert judges that mirror the specialization defining modern medicine and (ii) the consistent advantage of the specialized tool over general-purpose models does not necessarily mean that the latter cannot serve similar purposes, but that targeted engineering and customization can yield meaningful gains in performance for its users. We release Real-POCQi as a public benchmark, as well as the prespecified statistical analysis for reproducing results of this study.

  • 8 authors
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Jun 26

IDOBE: Infectious Disease Outbreak forecasting Benchmark Ecosystem

Epidemic forecasting has become an integral part of real-time infectious disease outbreak response. While collaborative ensembles composed of statistical and machine learning models have become the norm for real-time forecasting, standardized benchmark datasets for evaluating such methods are lacking. Further, there is limited understanding on performance of these methods for novel outbreaks with limited historical data. In this paper, we propose IDOBE, a curated collection of epidemiological time series focused on outbreak forecasting. IDOBE compiles from multiple data repositories spanning over a century of surveillance and across U.S. states and global locations. We perform derivative-based segmentation to generate over 10,000 outbreaks covering multiple outcomes such as cases and hospitalizations for 13 diseases. We consider a variety of information-theoretic and distributional measures to quantify the epidemiological diversity of the dataset. Finally, we perform multi-horizon short-term forecasting (1- to 4-week-ahead) through the progression of the outbreak using 11 baseline models and report on their performance. In addition to standard metrics such as NMSE and MAPE for point forecasts, we include probabilistic scoring rules such as Normalized Weighted Interval Score (NWIS) to quantify the performance. We find that MLP-based methods have the most robust performance, with statistical methods having a slight edge during the pre-peak phase. IDOBE dataset along with baselines are released publicly on https://github.com/NSSAC/IDOBE to enable standardized, reproducible benchmarking of outbreak forecasting methods.

  • 10 authors
·
Apr 28

Neural Rankers for Effective Screening Prioritisation in Medical Systematic Review Literature Search

Medical systematic reviews typically require assessing all the documents retrieved by a search. The reason is two-fold: the task aims for ``total recall''; and documents retrieved using Boolean search are an unordered set, and thus it is unclear how an assessor could examine only a subset. Screening prioritisation is the process of ranking the (unordered) set of retrieved documents, allowing assessors to begin the downstream processes of the systematic review creation earlier, leading to earlier completion of the review, or even avoiding screening documents ranked least relevant. Screening prioritisation requires highly effective ranking methods. Pre-trained language models are state-of-the-art on many IR tasks but have yet to be applied to systematic review screening prioritisation. In this paper, we apply several pre-trained language models to the systematic review document ranking task, both directly and fine-tuned. An empirical analysis compares how effective neural methods compare to traditional methods for this task. We also investigate different types of document representations for neural methods and their impact on ranking performance. Our results show that BERT-based rankers outperform the current state-of-the-art screening prioritisation methods. However, BERT rankers and existing methods can actually be complementary, and thus, further improvements may be achieved if used in conjunction.

  • 4 authors
·
Dec 18, 2022

Depression Detection and Analysis using Large Language Models on Textual and Audio-Visual Modalities

Depression has proven to be a significant public health issue, profoundly affecting the psychological well-being of individuals. If it remains undiagnosed, depression can lead to severe health issues, which can manifest physically and even lead to suicide. Generally, Diagnosing depression or any other mental disorder involves conducting semi-structured interviews alongside supplementary questionnaires, including variants of the Patient Health Questionnaire (PHQ) by Clinicians and mental health professionals. This approach places significant reliance on the experience and judgment of trained physicians, making the diagnosis susceptible to personal biases. Given that the underlying mechanisms causing depression are still being actively researched, physicians often face challenges in diagnosing and treating the condition, particularly in its early stages of clinical presentation. Recently, significant strides have been made in Artificial neural computing to solve problems involving text, image, and speech in various domains. Our analysis has aimed to leverage these state-of-the-art (SOTA) models in our experiments to achieve optimal outcomes leveraging multiple modalities. The experiments were performed on the Extended Distress Analysis Interview Corpus Wizard of Oz dataset (E-DAIC) corpus presented in the Audio/Visual Emotion Challenge (AVEC) 2019 Challenge. The proposed solutions demonstrate better results achieved by Proprietary and Open-source Large Language Models (LLMs), which achieved a Root Mean Square Error (RMSE) score of 3.98 on Textual Modality, beating the AVEC 2019 challenge baseline results and current SOTA regression analysis architectures. Additionally, the proposed solution achieved an accuracy of 71.43% in the classification task. The paper also includes a novel audio-visual multi-modal network that predicts PHQ-8 scores with an RMSE of 6.51.

  • 6 authors
·
Jul 8, 2024

Chinese Discharge Drug Recommendation in Metabolic Diseases with Large Language Models

Intelligent drug recommendation based on Electronic Health Records (EHRs) is critical for improving the quality and efficiency of clinical decision-making. By leveraging large-scale patient data, drug recommendation systems can assist physicians in selecting the most appropriate medications according to a patient's medical history, diagnoses, laboratory results, and comorbidities. Recent advances in large language models (LLMs) have shown remarkable capabilities in complex reasoning and medical text understanding, making them promising tools for drug recommendation tasks. However, the application of LLMs for Chinese clinical medication recommendation remains largely unexplored. In this work, we conduct a systematic investigation of LLM-based methodologies for Chinese discharge medication recommendation. We evaluate several representative LLM families (GLM, Llama, Qwen) under a unified methodological framework including zero-shot prompting, in-context learning, chain-of-thought prompting, and supervised fine-tuning using LoRA. We analyze model behavior across reasoning styles, error patterns, domain adaptation mechanisms, and robustness. Experimental results show that while supervised fine-tuning improves model performance, there remains substantial room for improvement, with the best model achieving the F1 score of 0.5648 and Jaccard score of 0.4477. Our findings highlight both the potential and limitations of LLMs for Chinese drug recommendation.

  • 10 authors
·
Oct 23, 2025

Predicting life satisfaction using machine learning and explainable AI

Life satisfaction is a crucial facet of human well-being. Hence, research on life satisfaction is incumbent for understanding how individuals experience their lives and influencing interventions targeted at enhancing mental health and well-being. Life satisfaction has traditionally been measured using analog, complicated, and frequently error-prone methods. These methods raise questions concerning validation and propagation. However, this study demonstrates the potential for machine learning algorithms to predict life satisfaction with a high accuracy of 93.80% and a 73.00% macro F1-score. The dataset comes from a government survey of 19000 people aged 16-64 years in Denmark. Using feature learning techniques, 27 significant questions for assessing contentment were extracted, making the study highly reproducible, simple, and easily interpretable. Furthermore, clinical and biomedical large language models (LLMs) were explored for predicting life satisfaction by converting tabular data into natural language sentences through mapping and adding meaningful counterparts, achieving an accuracy of 93.74% and macro F1-score of 73.21%. It was found that life satisfaction prediction is more closely related to the biomedical domain than the clinical domain. Ablation studies were also conducted to understand the impact of data resampling and feature selection techniques on model performance. Moreover, the correlation between primary determinants with different age brackets was analyzed, and it was found that health condition is the most important determinant across all ages. This study demonstrates how machine learning, large language models and XAI can jointly contribute to building trust and understanding in using AI to investigate human behavior, with significant ramifications for academics and professionals working to quantify and comprehend subjective well-being.

  • 5 authors
·
Oct 17, 2025

ChemArgus: Automated Scientific Diagnostics for Lab-Grade Multimodal Chemistry Reasoning: A Frontier Benchmark

Chemistry evaluation has moved past multiple-choice probes toward open-ended expert problems, yet the benchmarks that define the current frontier still score answer endpoints alone. Such scoring conflates memorized facts with stepwise derivation, treats visual and textual inputs as interchangeable, and confounds long-horizon planning with stepwise execution. These blind spots prevent any diagnosis of where the reasoning chain breaks in a model. We present ChemArgus, a competition-level chemistry benchmark drawn from chemistry competition material, textbooks, and research papers, whose scoring replaces the answer endpoint with three measurement properties. Fine-grained scoring grades every subquestion point by point with partial credit, so a score lands at the level of the step rather than the outcome. Multimodal capability is priced on every problem containing a real image, paired with a controlled text description, so visual understanding is measured against text on identical tasks. Diagnostic attribution reads paired metrics that share one scoring unit and differ only in context construction, so a gap between two scores isolates a single cause, namely integration, propagation, or local reasoning. GPT-5.6-Sol scores 23.2% on unassisted whole-problem solving against 28.8% and 30.4% under the two sequential metrics, a gap measuring the integration burden. Through rubric partial credit and these cause-isolating score gaps, ChemArgus shows not only whether a model answers chemistry correctly but where its reasoning chain fails, so that every score it reports doubles as a diagnosis, a readout of the chain rather than a verdict, aiming to guide language models step by step on their path toward chemistry expertise, one corrected step at a time, each step priced by the rubric, point by point.

  • 24 authors
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Oct 13

QuarkMedBench: A Real-World Scenario Driven Benchmark for Evaluating Large Language Models

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

  • 16 authors
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Mar 13

LLM Swiss Round: Aggregating Multi-Benchmark Performance via Competitive Swiss-System Dynamics

The rapid proliferation of Large Language Models (LLMs) and diverse specialized benchmarks necessitates a shift from fragmented, task-specific metrics to a holistic, competitive ranking system that effectively aggregates performance across multiple ability dimensions. Primarily using static scoring, current evaluation methods are fundamentally limited. They struggle to determine the proper mix ratio across diverse benchmarks, and critically, they fail to capture a model's dynamic competitive fitness or its vulnerability when confronted with sequential, high-stakes tasks. To address this, we introduce the novel Competitive Swiss-System Dynamics (CSD) framework. CSD simulates a multi-round, sequential contest where models are dynamically paired across a curated sequence of benchmarks based on their accumulated win-loss record. And Monte Carlo Simulation (N=100,000 iterations) is used to approximate the statistically robust Expected Win Score (E[S_m]), which eliminates the noise of random pairing and early-round luck. Furthermore, we implement a Failure Sensitivity Analysis by parameterizing the per-round elimination quantity (T_k), which allows us to profile models based on their risk appetite--distinguishing between robust generalists and aggressive specialists. We demonstrate that CSD provides a more nuanced and context-aware ranking than traditional aggregate scoring and static pairwise models, representing a vital step towards risk-informed, next-generation LLM evaluation.

ByteDance-Seed ByteDance Seed
·
Dec 24, 2025 2

The Medical Segmentation Decathlon

International challenges have become the de facto standard for comparative assessment of image analysis algorithms given a specific task. Segmentation is so far the most widely investigated medical image processing task, but the various segmentation challenges have typically been organized in isolation, such that algorithm development was driven by the need to tackle a single specific clinical problem. We hypothesized that a method capable of performing well on multiple tasks will generalize well to a previously unseen task and potentially outperform a custom-designed solution. To investigate the hypothesis, we organized the Medical Segmentation Decathlon (MSD) - a biomedical image analysis challenge, in which algorithms compete in a multitude of both tasks and modalities. The underlying data set was designed to explore the axis of difficulties typically encountered when dealing with medical images, such as small data sets, unbalanced labels, multi-site data and small objects. The MSD challenge confirmed that algorithms with a consistent good performance on a set of tasks preserved their good average performance on a different set of previously unseen tasks. Moreover, by monitoring the MSD winner for two years, we found that this algorithm continued generalizing well to a wide range of other clinical problems, further confirming our hypothesis. Three main conclusions can be drawn from this study: (1) state-of-the-art image segmentation algorithms are mature, accurate, and generalize well when retrained on unseen tasks; (2) consistent algorithmic performance across multiple tasks is a strong surrogate of algorithmic generalizability; (3) the training of accurate AI segmentation models is now commoditized to non AI experts.

  • 59 authors
·
Jun 10, 2021

GEMA-Score: Granular Explainable Multi-Agent Score for Radiology Report Evaluation

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

  • 10 authors
·
Mar 7, 2025

Multidimensional Rubric-oriented Reward Model Learning via Geometric Projection Reference Constraints

The integration of large language models (LLMs) into medical practice holds transformative potential, yet their real-world clinical utility remains limited by critical alignment challenges: (1) a disconnect between static evaluation benchmarks and dynamic clinical cognitive needs, (2) difficulties in adapting to evolving, multi-source medical standards, and (3) the inability of conventional reward models to capture nuanced, multi-dimensional medical quality criteria. To address these gaps, we propose MR-RML (Multidimensional Rubric-oriented Reward Model Learning) via GPRC (Geometric Projection Reference Constraints), a novel alignment framework that integrates medical standards into a structured "Dimensions-Scenarios-Disciplines" matrix to guide data generation and model optimization. MR-RML introduces three core innovations: (1) a "Dimensions-Scenarios-Disciplines" medical standard system that embeds domain standards into the full training pipeline; (2) an independent multi-dimensional reward model that decomposes evaluation criteria, shifting from real-time rubric-based scoring to internalized reward modeling for improved consistency and cost-efficiency; (3) geometric projection reference constraints that transform medical cognitive logic into mathematical regularization, aligning scoring gradients with clinical reasoning and enabling synthetic data-driven training. Through extensive evaluations on the authoritative medical benchmark Healthbench, our method yields substantial performance gains over the base LLM Qwen-32B (45% on the full subset and 85% on Hard subset, respectively). It achieves a SOTA among open-source LLMs with scores of 62.7 (full subset) and 44.7 (hard subset), while also outperforming the majority of closed-source models.

  • 5 authors
·
Nov 20, 2025

Case-Specific Rubrics for Clinical AI Evaluation: Methodology, Validation, and LLM-Clinician Agreement Across 823 Encounters

Objective. Clinical AI documentation systems require evaluation methodologies that are clinically valid, economically viable, and sensitive to iterative changes. Methods requiring expert review per scoring instance are too slow and expensive for safe, iterative deployment. We present a case-specific, clinician-authored rubric methodology for clinical AI evaluation and examine whether LLM-generated rubrics can approximate clinician agreement. Materials and Methods. Twenty clinicians authored 1,646 rubrics for 823 clinical cases (736 real-world, 87 synthetic) across primary care, psychiatry, oncology, and behavioral health. Each rubric was validated by confirming that an LLM-based scoring agent consistently scored clinician-preferred outputs higher than rejected ones. Seven versions of an EHR-embedded AI agent for clinicians were evaluated across all cases. Results. Clinician-authored rubrics discriminated effectively between high- and low-quality outputs (median score gap: 82.9%) with high scoring stability (median range: 0.00%). Median scores improved from 84% to 95%. In later experiments, clinician-LLM ranking agreement (tau: 0.42-0.46) matched or exceeded clinician-clinician agreement (tau: 0.38-0.43), attributable to both ceiling compression and LLM rubric improvement. Discussion. This convergence supports incorporating LLM rubrics alongside clinician-authored ones. At roughly 1,000 times lower cost, LLM rubrics enable substantially greater evaluation coverage, while continued clinical authorship grounds evaluation in expert judgment. Ceiling compression poses a methodological challenge for future inter-rater agreement studies. Conclusion. Case-specific rubrics offer a path for clinical AI evaluation that preserves expert judgment while enabling automation at three orders lower cost. Clinician-authored rubrics establish the baseline against which LLM rubrics are validated.

  • 9 authors
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Apr 26

Are Anomaly Scores Telling the Whole Story? A Benchmark for Multilevel Anomaly Detection

Anomaly detection (AD) is a machine learning task that identifies anomalies by learning patterns from normal training data. In many real-world scenarios, anomalies vary in severity, from minor anomalies with little risk to severe abnormalities requiring immediate attention. However, existing models primarily operate in a binary setting, and the anomaly scores they produce are usually based on the deviation of data points from normal data, which may not accurately reflect practical severity. In this paper, we address this gap by making three key contributions. First, we propose a novel setting, Multilevel AD (MAD), in which the anomaly score represents the severity of anomalies in real-world applications, and we highlight its diverse applications across various domains. Second, we introduce a novel benchmark, MAD-Bench, that evaluates models not only on their ability to detect anomalies, but also on how effectively their anomaly scores reflect severity. This benchmark incorporates multiple types of baselines and real-world applications involving severity. Finally, we conduct a comprehensive performance analysis on MAD-Bench. We evaluate models on their ability to assign severity-aligned scores, investigate the correspondence between their performance on binary and multilevel detection, and study their robustness. This analysis offers key insights into improving AD models for practical severity alignment. The code framework and datasets used for the benchmark will be made publicly available.

  • 7 authors
·
Nov 21, 2024

Automated Rubrics for Reliable Evaluation of Medical Dialogue Systems

Large Language Models (LLMs) are increasingly used for clinical decision support, where hallucinations and unsafe suggestions may pose direct risks to patient safety. These risks are particularly challenging as they often manifest as subtle clinical errors that evade detection by generic metrics, while expert-authored fine-grained rubrics remain costly to construct and difficult to scale. In this paper, we propose a retrieval-augmented multi-agent framework designed to automate the generation of instance-specific evaluation rubrics. Our approach grounds evaluation in authoritative medical evidence by decomposing retrieved content into atomic facts and synthesizing them with user interaction constraints to form verifiable, fine-grained evaluation criteria. Evaluated on HealthBench, our framework achieves a Clinical Intent Alignment (CIA) score of 60.12%, a statistically significant improvement over the GPT-4o baseline (55.16%). In discriminative tests, our rubrics yield a mean score delta (μ_Δ = 8.658) and an AUROC of 0.977, nearly doubling the quality separation achieved by GPT-4o baseline (4.972). Beyond evaluation, our rubrics effectively guide response refinement, improving quality by 9.2% (from 59.0% to 68.2%). This provides a scalable and transparent foundation for both evaluating and improving medical LLMs. The code is available at https://anonymous.4open.science/r/Automated-Rubric-Generation-AF3C/.

  • 4 authors
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Jan 21

Option-Aware Retrieval and Task-Specific VLM Adaptation for Medical VQA

We describe our submission to the MedReason 2026 challenge, covering multiple-choice (MCQ) and open-ended (OE) medical visual question answering (VQA) under fully offline, containerized inference. Our first finding is that MCQ retrieval must compare answer semantics rather than answer labels: labels are independently assigned per question, so copying a retrieved neighbor's label transfers no useful information, whereas scoring each current option's text against correct-answer text from similar training cases raises retrieval-only accuracy from 20.0\% to 57.5\% on a 200-case retrieval-excluded development holdout. Our second finding attributes the submitted system's accuracy: holding the task-specific MCQ Low-Rank Adaptation (LoRA) adapter fixed and varying the number \(k\) of in-prompt retrieved examples changes accuracy by at most one case --- 187/200 (93.5\%) at both \(k=0\) and the adapter's training-time \(k=1\), 188/200 (94.0\%) at the packaged runtime's default \(k=3\) --- and the submitted confidence-gated override adds no net accuracy on top of \(k=3\), selecting the VLM in 198/200 cases. With the final MCQ adapter fixed, retrieval changes accuracy by at most one case, and gating provides no net gain. On 20 OE cases, token-F1 and RaTEScore~zhao2024ratescore decrease as \(k\) grows, but paired sign tests on token-F1 differences are nonsignificant (\(p \ge 0.29\)); a single-annotator comparison found 6/20 wrong-anchor errors for the final configuration and 14/20 for an earlier configuration that jointly differed in routing, adapter, and prompting. The system reaches 94.0\% MCQ accuracy on the development holdout and 93.20\% on the organizer's official pre-evaluation, versus 29.43\% for the off-the-shelf reference baseline, while both of the organizer's open-ended scores are lower than that baseline's (ground-truth agreement 1.245 versus 1.588, visual accuracy 1.995 versus 2.696, each out of 4).

  • 3 authors
·
Sep 13

Prediction of Alzheimer's Disease Risk Factors from Retinal Images via Deep Learning: Development and Validation of Biologically Relevant Morphological Associations in the UK Biobank

The systemic, metabolic, lifestyle factors have established associations with Alzheimer's Disease (AD) through epidemiologic and AD-specific biomarker studies. Whether colored fundus photography (CFP) contains retinal structural signatures corresponding to these AD-related risk domains remains unclear. To determine whether deep learning (DL) models can predict 12 AD-related risk factors from CFP and to characterize the retinal structures underlying these predictions, thereby assessing whether CFP reflects pathways to AD vulnerability. Using 62,876 CFPs from 44,501 unique participants from the UK Biobank, DL models were trained to predict 12 factors linked to AD incidence: 6 categorical (sex, smoking, sleeplessness, economic status, alcohol use, depression) and 6 continuous (age, age at completing education, BMI, systolic, diastolic blood pressure, HbA1c). Model performance, model saliency, and saliency-derived scores (CAM-Score) were evaluated and compared to retinal morphometry. The scores were also compared between incident-AD cases (average 8.55 years before onset) and matched controls. Performance of DL ranged from AUROC= 0.5654-0.9480 for categorical and R2=-0.0291-0.7620 for continuous factors, outperforming most of the morphometry-machine learning models. Saliency-based score consistently highlighted biologically meaningful regions, particularly the optic nerve head and retinal vasculature. It also aligned with present morphometric variations. Several saliency-based scores differed significantly between incident AD and matched controls, suggesting potential overlap between retinal correlates of risk factors and preclinical AD-associated changes. CFP encodes retinal signatures linked to AD risk factors. Although not diagnostic, DL-derived retinal representations may uncover biologically meaningful risk-related structural changes mirroring the potential AD vulnerability.

  • 4 authors
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Jun 17 1

Equal Ranking Quality, Different Decisions: Measuring and Reducing Order Dependence in LLM Scorers

In passage reranking, response ranking and multi-document question answering, LLMs can score several candidate documents or responses together in one prompt, each still receiving its own score. Such scorers are selected on ranking quality, but their scores determine a decision: what a score threshold retains, a reader answers, or which chosen/rejected pair enters preference training. Because the candidates share that prompt, reordering them changes their scores. The same query over the same candidates should still yield the same decision. However, equal ranking quality does not imply equal decisions: on passage reranking, five trained scorers within 0.010 nDCG@10 retain sets that overlap by only 0.66-0.84 when reordered. No prompt-time change we test resolves that dependence: the only one that improves ranking quality does not measurably improve decision stability. We introduce order-consistency SFT (OC-SFT), which attenuates it in the weights by penalizing disagreement between a candidate's scores across orderings. It holds ranking quality and leads every decision-stability measure among trained scorers on all three tasks. It is also more stable on 12 base models than order-averaged distillation, which trains on labels averaged across permutations. One OC-SFT permutation retains sets that overlap more than ten averaged off-the-shelf permutations. A comparison of such scorers should therefore report what a threshold retains and a reader answers, not ranking quality alone. Code is available at https://github.com/thomsonreuters/presentation-dependence.

Likelihood Is Not Authorship: Can We Reliably Measure Human Contribution in AI-Assisted Writing?

AI-text detection generally asks whether a machine wrote a text. As AI becomes an increasingly integral and accepted part of writing, the more relevant question is no longer whether AI was used, but how much of the text reflects human contribution. A prominent line of work estimates this by measuring how predictive a person's prompt is of the final text. We show that this measure can be easily manipulated. We introduce SPECIFICITY PADDING that simply asks the model to copy a few random IDs from the prompt, and that alone makes a title-only request look more human than one that supplies the article's key ideas. A context-swap audit then holds each document fixed, and only shows or hides the IDs to the evaluator. The score of the unchanged text swings by a third to half of its scale, and it rises for every document we test, on news and scientific abstracts, across varied LLMs from 3.8B to 753B parameters. The same articles can average 85\% human or 15\% human depending only on which prompt is on record, and even with no prompt at all, the output-only variant rewards the random strings themselves. An exact identity, the credit ledger, explains why. The score is a surprisal-weighted average over the text, so rare strings that the context makes copyable collect the credit, whatever they mean. A two-point bound marks a deeper limit. If the prompt could have been machine-written, every transcript-only method must, in the worst case, miss by half the contribution at stake. Likelihood-based scores alone cannot reliably establish human contribution without evidence of what the person added and how the text was produced.

  • 3 authors
·
Oct 13

Potential of Multimodal Large Language Models for Data Mining of Medical Images and Free-text Reports

Medical images and radiology reports are crucial for diagnosing medical conditions, highlighting the importance of quantitative analysis for clinical decision-making. However, the diversity and cross-source heterogeneity of these data challenge the generalizability of current data-mining methods. Multimodal large language models (MLLMs) have recently transformed many domains, significantly affecting the medical field. Notably, Gemini-Vision-series (Gemini) and GPT-4-series (GPT-4) models have epitomized a paradigm shift in Artificial General Intelligence (AGI) for computer vision, showcasing their potential in the biomedical domain. In this study, we evaluated the performance of the Gemini, GPT-4, and 4 popular large models for an exhaustive evaluation across 14 medical imaging datasets, including 5 medical imaging categories (dermatology, radiology, dentistry, ophthalmology, and endoscopy), and 3 radiology report datasets. The investigated tasks encompass disease classification, lesion segmentation, anatomical localization, disease diagnosis, report generation, and lesion detection. Our experimental results demonstrated that Gemini-series models excelled in report generation and lesion detection but faces challenges in disease classification and anatomical localization. Conversely, GPT-series models exhibited proficiency in lesion segmentation and anatomical localization but encountered difficulties in disease diagnosis and lesion detection. Additionally, both the Gemini series and GPT series contain models that have demonstrated commendable generation efficiency. While both models hold promise in reducing physician workload, alleviating pressure on limited healthcare resources, and fostering collaboration between clinical practitioners and artificial intelligence technologies, substantial enhancements and comprehensive validations remain imperative before clinical deployment.

  • 14 authors
·
Jul 8, 2024

A Zero-shot Explainable Doctor Ranking Framework with Large Language Models

Online medical service provides patients convenient access to doctors, but effectively ranking doctors based on specific medical needs remains challenging. Current ranking approaches typically lack the interpretability crucial for patient trust and informed decision-making. Additionally, the scarcity of standardized benchmarks and labeled data for supervised learning impedes progress in expertise-aware doctor ranking. To address these challenges, we propose an explainable ranking framework for doctor ranking powered by large language models in a zero-shot setting. Our framework dynamically generates disease-specific ranking criteria to guide the large language model in assessing doctor relevance with transparency and consistency. It further enhances interpretability by generating step-by-step rationales for its ranking decisions, improving the overall explainability of the information retrieval process. To support rigorous evaluation, we built and released DrRank, a novel expertise-driven dataset comprising 38 disease-treatment pairs and 4,325 doctor profiles. On this benchmark, our framework significantly outperforms the strongest baseline by +6.45 NDCG@10. Comprehensive analyses also show our framework is fair across disease types, patient gender, and geographic regions. Furthermore, verification by medical experts confirms the reliability and interpretability of our approach, reinforcing its potential for trustworthy, real-world doctor recommendation. To demonstrate its broader applicability, we validate our framework on two datasets from BEIR benchmark, where it again achieves superior performance. The code and associated data are available at: https://github.com/YangLab-BUPT/DrRank.

  • 3 authors
·
Mar 4, 2025

A Gold Standard Dataset for the Reviewer Assignment Problem

Many peer-review venues are using algorithms to assign submissions to reviewers. The crux of such automated approaches is the notion of the "similarity score" -- a numerical estimate of the expertise of a reviewer in reviewing a paper -- and many algorithms have been proposed to compute these scores. However, these algorithms have not been subjected to a principled comparison, making it difficult for stakeholders to choose the algorithm in an evidence-based manner. The key challenge in comparing existing algorithms and developing better algorithms is the lack of publicly available gold-standard data. We address this challenge by collecting a novel dataset of similarity scores that we release to the research community. Our dataset consists of 477 self-reported expertise scores provided by 58 researchers who evaluated their expertise in reviewing papers they have read previously. Using our dataset, we compare several widely used similarity algorithms and offer key insights. First, all algorithms exhibit significant error, with misranking rates between 12%-30% in easier cases and 36%-43% in harder ones. Second, most specialized algorithms are designed to work with titles and abstracts of papers, and in this regime the SPECTER2 algorithm performs best. Interestingly, classical TF-IDF matches SPECTER2 in accuracy when given access to full submission texts. In contrast, off-the-shelf LLMs lag behind specialized approaches.

  • 5 authors
·
May 29, 2025

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

Right Family, Wrong Skill: Benchmarking Risk Exposure in Agent Skill Retrieval

Agent skill libraries are becoming routable software assets: a retrieved skill can contribute instructions, scripts, resource bindings, and execution assumptions to an agent. This makes retrieval failures more specific than broad irrelevance. A system can find the right capability family yet expose the wrong same-capability representative. We study this failure as same-capability risk-exposure retrieval. Each benchmark unit pairs a helpful skill with a query-specific risky sibling that shares the capability family but differs on an execution-controlling contract, such as the required resource, precondition, procedure, or artifact. We introduce SameCapRisk-Bench, an auditable benchmark with 1,190 skill-risk units and 1,686 evaluation query cases: 694 marked-sibling units under public library pressure and 496 hard role-flip units where the same two skills swap helpful/risky roles across paired queries. The release records admission evidence, cue/leakage checks, source hashes, family relations, and fixed candidate pools. The benchmark reports helpful ranking together with harmful sibling rate (HSR@K), the top-K exposure of the marked risky sibling. On this benchmark, public SkillRouter, SkillRet, and R3-Skill retrieve helpful skills at high Recall@3 (0.848--0.888) but also expose marked risky siblings frequently (HSR@3 0.346--0.372). A fully public score-and-cluster pipeline lowers HSR@3 to 0.128--0.182, with Recall@3 of 0.713--0.776. Under a benchmark-trained reference scorer, public text-cluster and controlled resolvers reach HSR@3 0.012 and 0.007; the latter attains Recall@3 0.833. Skill retrieval should therefore report both capability matching and same-family risk exposure, with HSR serving as a targeted exposure certificate for fixed skill libraries.

  • 4 authors
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Aug 19

A Controlled Candidate-Set Benchmark for Offline Satellite-Security Plan Decomposition

Some security-development settings require local models that map an objective to an ordered, checkable plan. We present a low-rank decomposition adapter and release a case-disjoint corpus with 24 authored decompositions and 83 derived next-step examples across 24 satellite-security cases. To prevent reference-plan leakage, prompts contain one objective and eight shuffled SPARTA candidates. The evaluation candidate sets are constructed with oracle inclusion of every reference technique, so this study measures selection from a controlled set, not retrieval. On six fixed cases and five decoding seeds, mean scores vary across adapters and prompted Qwen2.5 baselines; a separate greedy check over three adapter training seeds shows non-negligible training variance. A 24-fold greedy leave-one-case-out control at the two compact sizes likewise shows tradeoffs: at 1.5B, adapter precision is 0.583 against 0.480 for two-shot prompting, while recall is 0.586 against 0.660. Case-resampling intervals for adapter precision relative to the strongest prompted baseline cross zero at 1.5B and 7B. The adapter is also substantially more format-compliant, which prevents attributing all score differences to selection. Autoregressive next-step accuracy is 0.08, 0.06, and 0.29 at 0.5B, 1.5B, and 7B. We therefore offer the formulation, leakage-controlled dataset, reproducibility package, and descriptive analysis as a proof of concept, not evidence of a reliable stand-alone decomposition system or a general adapter advantage. A separate diagnostic tests contract reuse.

  • 3 authors
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Jul 28

AES Systems Are Both Overstable And Oversensitive: Explaining Why And Proposing Defenses

Deep-learning based Automatic Essay Scoring (AES) systems are being actively used by states and language testing agencies alike to evaluate millions of candidates for life-changing decisions ranging from college applications to visa approvals. However, little research has been put to understand and interpret the black-box nature of deep-learning based scoring algorithms. Previous studies indicate that scoring models can be easily fooled. In this paper, we explore the reason behind their surprising adversarial brittleness. We utilize recent advances in interpretability to find the extent to which features such as coherence, content, vocabulary, and relevance are important for automated scoring mechanisms. We use this to investigate the oversensitivity i.e., large change in output score with a little change in input essay content) and overstability i.e., little change in output scores with large changes in input essay content) of AES. Our results indicate that autoscoring models, despite getting trained as "end-to-end" models with rich contextual embeddings such as BERT, behave like bag-of-words models. A few words determine the essay score without the requirement of any context making the model largely overstable. This is in stark contrast to recent probing studies on pre-trained representation learning models, which show that rich linguistic features such as parts-of-speech and morphology are encoded by them. Further, we also find that the models have learnt dataset biases, making them oversensitive. To deal with these issues, we propose detection-based protection models that can detect oversensitivity and overstability causing samples with high accuracies. We find that our proposed models are able to detect unusual attribution patterns and flag adversarial samples successfully.

  • 6 authors
·
Sep 23, 2021

CARE to Compare: A real-world dataset for anomaly detection in wind turbine data

Anomaly detection plays a crucial role in the field of predictive maintenance for wind turbines, yet the comparison of different algorithms poses a difficult task because domain specific public datasets are scarce. Many comparisons of different approaches either use benchmarks composed of data from many different domains, inaccessible data or one of the few publicly available datasets which lack detailed information about the faults. Moreover, many publications highlight a couple of case studies where fault detection was successful. With this paper we publish a high quality dataset that contains data from 36 wind turbines across 3 different wind farms as well as the most detailed fault information of any public wind turbine dataset as far as we know. The new dataset contains 89 years worth of real-world operating data of wind turbines, distributed across 44 labeled time frames for anomalies that led up to faults, as well as 51 time series representing normal behavior. Additionally, the quality of training data is ensured by turbine-status-based labels for each data point. Furthermore, we propose a new scoring method, called CARE (Coverage, Accuracy, Reliability and Earliness), which takes advantage of the information depth that is present in the dataset to identify a good all-around anomaly detection model. This score considers the anomaly detection performance, the ability to recognize normal behavior properly and the capability to raise as few false alarms as possible while simultaneously detecting anomalies early.

  • 3 authors
·
Apr 16, 2024

Conditional Accuracy Profiles: Diagnosing LLM Judges across Deployment Conditions

LLM-as-judge is now a standard tool for scalable evaluation, but judge performance is still often summarized by a single accuracy number. This aggregate view hides the deployment conditions under which a judge succeeds or fails. We introduce Conditional Accuracy Profiling (CAP), a post-hoc diagnostic framework that decomposes pairwise LLM-judge accuracy into eight conditions organized into content sensitivity, robustness, and rationale quality. CAP is benchmark-agnostic: it can be applied directly when a benchmark provides the required annotations, approximately through task-subset proxies, or through controlled augmentation when perturbation pairs can be generated. We instantiate CAP on seven LLM judges across six pairwise judging benchmarks, including judgerEva-Standard, a controlled testbed we created to support all eight conditions. CAP exposes profile differences hidden by aggregate accuracy: on judgerEva's judge-independent Hard-Constructed subset, the two judges most sensitive to omitted qualifications rank in the bottom three of seven by overall accuracy, so omission sensitivity is not predicted by aggregate accuracy. Across benchmarks, Position Robustness shows the strongest rank stability (mean Spearman barρ{=}0.87) but is itself fragile under JudgeBench-Pro adversarial stress, showing the largest mean accuracy drop among the shared conditions, though the dominant degradation channel varies by judge. Condition-level profiles provide a more actionable basis than aggregate accuracy for selecting LLM judges.

  • 6 authors
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Oct 5

Towards Accurate Differential Diagnosis with Large Language Models

An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.

  • 28 authors
·
Nov 30, 2023 1

Quantifying the Reasoning Abilities of LLMs on Real-world Clinical Cases

Recent advancements in reasoning-enhanced large language models (LLMs), such as DeepSeek-R1 and OpenAI-o3, have demonstrated significant progress. However, their application in professional medical contexts remains underexplored, particularly in evaluating the quality of their reasoning processes alongside final outputs. Here, we introduce MedR-Bench, a benchmarking dataset of 1,453 structured patient cases, annotated with reasoning references derived from clinical case reports. Spanning 13 body systems and 10 specialties, it includes both common and rare diseases. To comprehensively evaluate LLM performance, we propose a framework encompassing three critical examination recommendation, diagnostic decision-making, and treatment planning, simulating the entire patient care journey. To assess reasoning quality, we present the Reasoning Evaluator, a novel automated system that objectively scores free-text reasoning responses based on efficiency, actuality, and completeness using dynamic cross-referencing and evidence checks. Using this benchmark, we evaluate five state-of-the-art reasoning LLMs, including DeepSeek-R1, OpenAI-o3-mini, and Gemini-2.0-Flash Thinking, etc. Our results show that current LLMs achieve over 85% accuracy in relatively simple diagnostic tasks when provided with sufficient examination results. However, performance declines in more complex tasks, such as examination recommendation and treatment planning. While reasoning outputs are generally reliable, with factuality scores exceeding 90%, critical reasoning steps are frequently missed. These findings underscore both the progress and limitations of clinical LLMs. Notably, open-source models like DeepSeek-R1 are narrowing the gap with proprietary systems, highlighting their potential to drive accessible and equitable advancements in healthcare.

  • 10 authors
·
Mar 6, 2025

Boosting EfficientNets Ensemble Performance via Pseudo-Labels and Synthetic Images by pix2pixHD for Infection and Ischaemia Classification in Diabetic Foot Ulcers

Diabetic foot ulcers are a common manifestation of lesions on the diabetic foot, a syndrome acquired as a long-term complication of diabetes mellitus. Accompanying neuropathy and vascular damage promote acquisition of pressure injuries and tissue death due to ischaemia. Affected areas are prone to infections, hindering the healing progress. The research at hand investigates an approach on classification of infection and ischaemia, conducted as part of the Diabetic Foot Ulcer Challenge (DFUC) 2021. Different models of the EfficientNet family are utilized in ensembles. An extension strategy for the training data is applied, involving pseudo-labeling for unlabeled images, and extensive generation of synthetic images via pix2pixHD to cope with severe class imbalances. The resulting extended training dataset features 8.68 times the size of the baseline and shows a real to synthetic image ratio of 1:3. Performances of models and ensembles trained on the baseline and extended training dataset are compared. Synthetic images featured a broad qualitative variety. Results show that models trained on the extended training dataset as well as their ensemble benefit from the large extension. F1-Scores for rare classes receive outstanding boosts, while those for common classes are either not harmed or boosted moderately. A critical discussion concretizes benefits and identifies limitations, suggesting improvements. The work concludes that classification performance of individual models as well as that of ensembles can be boosted utilizing synthetic images. Especially performance for rare classes benefits notably.

  • 3 authors
·
Nov 30, 2021

Learning Human Health and Diseases from 24-hour Wrist Movement

Much of human health and function unfolds beyond the clinic, through the movements of everyday life. Wrist-worn accelerometers capture these movements continuously, yet their rich signals are often reduced to a small set of predefined behavioural summary measures. Here, we present Sensori, a self-supervised foundation model that learns general-purpose health representations directly from 24 hours of raw tri-axial wrist movement. We developed and evaluated the model across four population-based cohorts from the United Kingdom, China and the United States, comprising 122,640 participants contributing 683,617 person-days of free-living recordings. Sensori condensed each day of movement into a representation that captured diverse movement behaviours, demographic characteristics, health axes and physical function. Evaluation in independent cohorts showed that these representations generalised across populations and measurement settings without retraining. When added to common clinical covariates, Sensori significantly improved prevalent disease classification for 52 of 102 eligible conditions (median delta AUROC, 0.060; range, 0.012-0.242) and incident disease risk prediction for 26 of 87 eligible conditions (median delta Uno's C-index, 0.064; range, 0.025-0.172), with the largest gains for neurological and psychiatric disorders. These findings establish 24-hour wrist movement as a rich and scalable source of health information, with the potential to support passive health monitoring and disease prediction at population scale.

  • 24 authors
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Aug 29

Enhancing Health Information Retrieval with RAG by Prioritizing Topical Relevance and Factual Accuracy

The exponential surge in online health information, coupled with its increasing use by non-experts, highlights the pressing need for advanced Health Information Retrieval models that consider not only topical relevance but also the factual accuracy of the retrieved information, given the potential risks associated with health misinformation. To this aim, this paper introduces a solution driven by Retrieval-Augmented Generation (RAG), which leverages the capabilities of generative Large Language Models (LLMs) to enhance the retrieval of health-related documents grounded in scientific evidence. In particular, we propose a three-stage model: in the first stage, the user's query is employed to retrieve topically relevant passages with associated references from a knowledge base constituted by scientific literature. In the second stage, these passages, alongside the initial query, are processed by LLMs to generate a contextually relevant rich text (GenText). In the last stage, the documents to be retrieved are evaluated and ranked both from the point of view of topical relevance and factual accuracy by means of their comparison with GenText, either through stance detection or semantic similarity. In addition to calculating factual accuracy, GenText can offer a layer of explainability for it, aiding users in understanding the reasoning behind the retrieval. Experimental evaluation of our model on benchmark datasets and against baseline models demonstrates its effectiveness in enhancing the retrieval of both topically relevant and factually accurate health information, thus presenting a significant step forward in the health misinformation mitigation problem.

  • 2 authors
·
Feb 7, 2025

Beyond English benchmarks: clinical llm evaluation in Brazilian Portuguese

Large Language Models are transforming the support for clinical decision and their application in real scenarios. Yet, most benchmarks are conducted in English, and cross-lingual evaluation is needed to tackle the language gaps in global access. We introduce ClinicalBr, the first bilingual benchmark for clinical decision built from real Brazilian case reports. The corpus contains 2,892 cases drawn from 28 SciELO medical journals, spanning 18 specialties, and is structured as parallel Portuguese-English pairs. Each case supports four evaluation tasks: diagnosis retrieval, differential diagnosis, exam recommendation, and treatment planning. We evaluate four models: MedGemma-27B, Sabiá-4, DeepSeek-R1, and o3-mini, across both languages. The central finding is that the Portuguese-English performance gap is task-dependent, not general. In diagnosis retrieval, English yields a consistent advantage across all models, with +7.5-12.1 accuracy points. This advantage disappears in differential diagnosis, exam recommendation, and treatment planning, where confidence intervals cross zero for most models and Portuguese completeness scores are marginally higher. Brazilian-endemic conditions proved easier than the full corpus, not harder, indicating that tropical presentations are adequately represented in current pre-training. Exam recommendation was the hardest task across all models and both languages, with F1 scores below 0.10, well below the differential diagnosis ceiling of 0.20-0.27.

  • 4 authors
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Jun 4

A medical coding language model trained on clinical narratives from a population-wide cohort of 1.8 million patients

Medical coding translates clinical documentation into standardized codes for billing, research, and public health, but manual coding is time-consuming and error-prone. Existing automation efforts rely on small datasets that poorly represent real-world patient heterogeneity. We trained a language model on 5.8 million electronic health records from 1.8 million patients across nearly all specialties in Eastern Denmark (2006--2016) to predict ICD-10 codes from clinical notes, medications, and laboratory results. Evaluated on 270,000 held-out patients, the model achieved a micro F1 of 71.8% and a top-10 recall of 95.5%. Performance varied by specialty (F1: 53--91%), with higher scores in specialties with well-defined diagnostic criteria. Codes appearing predominantly as secondary diagnoses had markedly lower F1 scores. For three such codes (suicide-related behaviors, weight disorders, and hypertension), the model identified thousands of uncoded cases, of which 76-86% were confirmed valid upon manual review, suggesting systematic under-coding rather than model error. These findings suggest under-coding of secondary diagnoses in Eastern Denmark during this period, with potential implications for epidemiological research, public health surveillance, and understanding of multimorbidity. Similar time constraints and reimbursement structures in other healthcare systems suggest this may not be isolated to this dataset. The model can automate coding for approximately 50% of cases and provide accurate suggestions for most others, and may offer a practical solution to help capture missed secondary conditions.

  • 6 authors
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Mar 2

The Winner's Curse in LLM Self-Improvement Loops: Selection Noise, Lock-in, and Acceptance Rules

Self-improving LLM systems propose changes to themselves and keep those that score better on a small evaluation set. We treat this keep-if-better step as selection under measurement noise, model the correlated errors of the candidates in a single decision, and study empirically what happens when the evaluation set is reused. In runs where Qwen models rewrite their own instructions and every candidate is also scored on 600 held-out items, most proposals after the first are harmful, and the model gives the size of the winner's curse of a generation's best candidate. With a prior from a separate pilot, it matches the average overstatement of first-generation commits in native loops, though not setting by setting. In a pre-registered study, the final selection-set score of greedy loops exceeded held-out accuracy by 13 to 20 points with 16 selection items and by 1 to 5 points with 256. Held-out gains grew with the selection set on TREC but not on GSM8K, and the tested acceptance rules did not beat greedy acceptance over whole runs. Gains measured on the selection set also exceeded held-out gains when a current model refined a competent instruction, and in the validation scores of GEPA and MIPROv2. Scoring the starting and the current instruction on 64 items never used for selection removes the average bias of a loop's reported gain, but single estimates remain off by about 6 points. Self-improvement studies should report held-out gains with their uncertainty.

  • 2 authors
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Oct 6

KG-Rank: Enhancing Large Language Models for Medical QA with Knowledge Graphs and Ranking Techniques

Large language models (LLMs) have demonstrated impressive generative capabilities with the potential to innovate in medicine. However, the application of LLMs in real clinical settings remains challenging due to the lack of factual consistency in the generated content. In this work, we develop an augmented LLM framework, KG-Rank, which leverages a medical knowledge graph (KG) along with ranking and re-ranking techniques, to improve the factuality of long-form question answering (QA) in the medical domain. Specifically, when receiving a question, KG-Rank automatically identifies medical entities within the question and retrieves the related triples from the medical KG to gather factual information. Subsequently, KG-Rank innovatively applies multiple ranking techniques to refine the ordering of these triples, providing more relevant and precise information for LLM inference. To the best of our knowledge, KG-Rank is the first application of KG combined with ranking models in medical QA specifically for generating long answers. Evaluation on four selected medical QA datasets demonstrates that KG-Rank achieves an improvement of over 18% in ROUGE-L score. Additionally, we extend KG-Rank to open domains, including law, business, music, and history, where it realizes a 14% improvement in ROUGE-L score, indicating the effectiveness and great potential of KG-Rank.

  • 11 authors
·
Mar 9, 2024

Healthcare NER Models Using Language Model Pretraining

In this paper, we present our approach to extracting structured information from unstructured Electronic Health Records (EHR) [2] which can be used to, for example, study adverse drug reactions in patients due to chemicals in their products. Our solution uses a combination of Natural Language Processing (NLP) techniques and a web-based annotation tool to optimize the performance of a custom Named Entity Recognition (NER) [1] model trained on a limited amount of EHR training data. This work was presented at the first Health Search and Data Mining Workshop (HSDM 2020) [26]. We showcase a combination of tools and techniques leveraging the recent advancements in NLP aimed at targeting domain shifts by applying transfer learning and language model pre-training techniques [3]. We present a comparison of our technique to the current popular approaches and show the effective increase in performance of the NER model and the reduction in time to annotate data.A key observation of the results presented is that the F1 score of model (0.734) trained with our approach with just 50% of available training data outperforms the F1 score of the blank spaCy model without language model component (0.704) trained with 100% of the available training data. We also demonstrate an annotation tool to minimize domain expert time and the manual effort required to generate such a training dataset. Further, we plan to release the annotated dataset as well as the pre-trained model to the community to further research in medical health records.

  • 6 authors
·
Jan 28, 2020

PyMETA: Evaluating Student Code Diagnosis on and Beyond the First Execution Error

Large language models can diagnose a student program from its code, problem statement, and reference solution. Evaluating this ability requires a clear definition of what counts as the correct diagnosis. We introduce PyMETA, a Python error dataset with 48,646 student submissions to 155 problems. Every submission has a single label for the first execution error identified by an Online Judge, or No Error when the program passes all tests. A targeted subset of 97 submissions also has expert labels collected through iterative repair and re-execution. The taxonomy has three levels; its most detailed level contains 14 labels, including No Error, Logic Error, named Python exceptions, and an Other Errors category. We evaluate two finetuned models and two groups of prompted LLMs: four earlier models and four recent models. When evaluated against the first execution error, the recent prompted models reach 87.5--93.8% macro F1, above the strongest finetuned baseline at 80.6%. This is the opposite of the comparison obtained with the earlier prompted models. On the 97-item expert subset, however, exact-set match is only 43.3--48.5%, although sample F1 is about 79--81%. Output format also matters. On the same 45 audited submissions whose expert label sets do not contain Logic Error, none of the four recent models returns that label under single-error prompting, but 46.7--57.8% of their multi-error outputs include it, usually after an explicit-error label. The results show that model rankings and claims about label bias depend on the meaning of the gold label, the number of labels a model may return, and the scoring rule.

  • 6 authors
·
Sep 14

Question-Answering Model for Schizophrenia Symptoms and Their Impact on Daily Life using Mental Health Forums Data

In recent years, there is strong emphasis on mining medical data using machine learning techniques. A common problem is to obtain a noiseless set of textual documents, with a relevant content for the research question, and developing a Question Answering (QA) model for a specific medical field. The purpose of this paper is to present a new methodology for building a medical dataset and obtain a QA model for analysis of symptoms and impact on daily life for a specific disease domain. The ``Mental Health'' forum was used, a forum dedicated to people suffering from schizophrenia and different mental disorders. Relevant posts of active users, who regularly participate, were extrapolated providing a new method of obtaining low-bias content and without privacy issues. Furthermore, it is shown how to pre-process the dataset to convert it into a QA dataset. The Bidirectional Encoder Representations from Transformers (BERT), DistilBERT, RoBERTa, and BioBERT models were fine-tuned and evaluated via F1-Score, Exact Match, Precision and Recall. Accurate empirical experiments demonstrated the effectiveness of the proposed method for obtaining an accurate dataset for QA model implementation. By fine-tuning the BioBERT QA model, we achieved an F1 score of 0.885, showing a considerable improvement and outperforming the state-of-the-art model for mental disorders domain.

  • 2 authors
·
Sep 30, 2023

Rubric Dropout: A Simple Way to Mitigate Reward Hacking in Rubric-as-Reward RL

Reinforcement learning against rubrics, lists of criteria graded by an LLM judge, has become a standard way to post-train language models on tasks with no deterministic answer. The rubric, however, is a fixed proxy for quality, never a complete description of it, and a policy trained against it long enough will learn to exploit the difference. We measure this directly. Training Qwen3-8B with Group Relative Policy Optimization (GRPO) on medical and science rubrics and grading out-of-distribution (OOD) benchmarks with both the training judge and a stronger gold judge, we find that the two scores diverge during training. The training judge's score keeps climbing while the gold judge's score peaks and then falls, by 3 points on HealthBench-Hard and by 22 points on ResearchQA. A judge with a fixed bias would shift the gold curve by a constant, not send it down while the training score rises, so the divergence is reward hacking, not judge noise. We propose Rubric Dropout, a one-line fix borrowed from neuron dropout. At every step, we randomly drop a subset of the rubric's criteria before computing the reward, so the policy never optimizes the same rubric twice. The dropped subset is shared across each rollout group, so GRPO's group-relative advantages stay comparable, and evaluation always uses the full rubric. Comparing no dropout against dropout at 30% and 50% on both benchmark pairs, dropout raises the OOD gold score at every matched checkpoint (+1 to +2 points on HealthBench-Hard, +6 to +7 points on ResearchQA), lowers the two hacking measures we track, and costs nothing in domain. Sweeping the dropout fraction shows a broad 30-50% sweet spot, while the natural alternative, reweighting criteria by how useful they are to training, performs worse than no intervention at all in our setting.

  • 9 authors
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Aug 11