Daily Papers

Persistent context files (AGENTS.md, CLAUDE.md) are standard practice for guiding AI coding agents, yet evidence for their effectiveness is contradictory. We present a controlled ablation of context-injection strategy across two frontier agents (Claude Code and Codex), 17 real tasks from 3 repositories (15 shared + 2 Codex-only), and 288 evaluated runs with gold-test evaluation. Context strategy does not measurably move correctness on either agent (bounded to <=10-15pp via equivalence testing). A failure-mode triage reveals why: agents fail on implementation skill---feature design, pattern selection, exact wiring---not missing repository knowledge that a context file could supply; a manipulation probe confirms the real AGENTS.md never converts a near-miss to a pass on either agent. We further show that borderline task difficulty is agent-specific (Spearman rho=0.75), offering a candidate explanation for prior contradictions: single-agent studies draw tasks from different agents' informative bands. We release all code, data, and analysis.

Vision Language Models (VLMs) are increasingly used for tasks like medical report generation and visual question answering. However, fluent diagnostic text does not guarantee safe visual understanding. In clinical practice, interpretation begins with pre-diagnostic sanity checks: verifying that the input is valid to read (correct modality and anatomy, plausible viewpoint and orientation, and no obvious integrity violations). Existing benchmarks largely assume this step is solved, and therefore miss a critical failure mode: a model can produce plausible narratives even when the input is inconsistent or invalid. We introduce MedObvious, a 1,880-task benchmark that isolates input validation as a set-level consistency capability over small multi-panel image sets: the model must identify whether any panel violates expected coherence. MedObvious spans five progressive tiers, from basic orientation/modality mismatches to clinically motivated anatomy/viewpoint verification and triage-style cues, and includes five evaluation formats to test robustness across interfaces. Evaluating 17 different VLMs, we find that sanity checking remains unreliable: several models hallucinate anomalies on normal (negative-control) inputs, performance degrades when scaling to larger image sets, and measured accuracy varies substantially between multiple-choice and open-ended settings. These results show that pre-diagnostic verification remains unsolved for medical VLMs and should be treated as a distinct, safety-critical capability before deployment.

Chain-of-Thought (CoT) has substantially empowered Large Language Models (LLMs) to tackle complex reasoning tasks, yet the verbose nature of explicit reasoning steps incurs prohibitive inference latency and computational costs, limiting real-world deployment. While existing compression methods - ranging from self-training to Reinforcement Learning (RL) with length constraints - attempt to mitigate this, they often sacrifice reasoning capability for brevity. We identify a critical failure mode in these approaches: explicitly optimizing for shorter trajectories triggers rapid entropy collapse, which prematurely shrinks the exploration space and stifles the discovery of valid reasoning paths, particularly for challenging questions requiring extensive deduction. To address this issue, we propose Compress responses for Easy questions and Explore Hard ones (CEEH), a difficulty-aware approach to RL-based efficient reasoning. CEEH dynamically assesses instance difficulty to apply selective entropy regularization: it preserves a diverse search space for currently hard questions to ensure robustness, while permitting aggressive compression on easier instances where the reasoning path is well-established. In addition, we introduce a dynamic optimal-length penalty anchored to the historically shortest correct response, which effectively counteracts entropy-induced length inflation and stabilizes the reward signal. Across six reasoning benchmarks, CEEH consistently reduces response length while maintaining accuracy comparable to the base model, and improves Pass@k relative to length-only optimization.

Natural generation allows Large Language Models (LLMs) to produce free-form responses with rich reasoning, yet the lack of structure makes outputs difficult to verify. Conversely, constrained decoding ensures standardized formats but can inadvertently restrict reasoning capabilities by imposing constraints too early in the generation process. We propose a hybrid approach, namely In-Writing, that combines free-form reasoning and structured generation in a single call. The model first performs unconstrained reasoning and only applies structured decoding after a trigger token is generated, explicitly decoupling reasoning from formatting. We establish that our trigger-token strategies are able to virtually eradicate premature triggering, a failure mode in which constrained decoding interrupts on-going reasoning. Evaluations across diverse datasets covering classification and reasoning tasks demonstrate that our approach outperforms the state-of-the-art by achieving accuracy gains of up to 27% over natural generation. Our code are available at: https://github.com/Nokia-Bell-Labs/InWriting.

OpenClaw-style agent stacks turn language into privileged execution: LLM intents flow through tool interception, policy gates, and a local executor. In parallel, skill marketplaces such as skills.sh make capability acquisition as easy as installing skills and CLIs, creating a growing capability supply chain. Together, these trends shift the dominant safety failure mode from "wrong answers" to execution-induced loss, where untrusted prompts, compromised skills, or narrative manipulation can trigger real trades and irreversible side effects. We propose Survivability-Aware Execution (SAE), an execution-layer survivability standard for OpenClaw-style systems and skill-enabled agents. SAE sits as middleware between a strategy engine (LLM or non-LLM) and the exchange executor. It defines an explicit execution contract (ExecutionRequest, ExecutionContext, ExecutionDecision) and enforces non-bypassable last-mile invariants: projection-based exposure budgets, cooldown and order-rate limits, slippage bounds, staged execution, and tool/venue allowlists. To make delegated execution testable under supply-chain risk, we operationalize the Delegation Gap (DG) via a logged Intended Policy Spec that enables deterministic out-of-scope labeling and reproducible DG metrics. On an offline replay using official Binance USD-M BTCUSDT/ETHUSDT perpetual data (15m; 2025-09-01--2025-12-01, incl. funding), SAE improves survivability: MDD drops from 0.4643 to 0.0319 (Full; 93.1%), |CVaR_0.99| shrinks from 4.025e-3 to ~1.02e-4 (~97.5%), and DG loss proxy falls from 0.647 to 0.019 (~97.0%). AttackSuccess decreases from 1.00 to 0.728 with zero FalseBlock in this run. Block bootstrap, paired Wilcoxon, and two-proportion tests confirm the shifts. SAE reframes agentic trading safety for the OpenClaw+skills era: treat upstream intent and skills as untrusted, and enforce survivability where actions become side effects.

As modern software systems continue to grow in complexity, triage has become a fundamental process in system operations and maintenance. Triage aims to efficiently prioritize, assign, and assess issues to ensure the reliability of complex environments. The vast amount of heterogeneous data generated by software systems has made effective triage indispensable for maintaining reliability, facilitating maintainability, and enabling rapid issue response. Motivated by these challenges, researchers have devoted extensive effort to advancing triage automation and have achieved significant progress over the past two decades. This survey provides a comprehensive review of 234 papers from 2004 to the present, offering an in-depth examination of the fundamental concepts, system architecture, and problem statement. By comparing the distinct goals of academic and industrial research and by analyzing empirical studies of industrial practices, we identify the major obstacles that limit the practical deployment of triage systems. To assist practitioners in method selection and performance evaluation, we summarize widely adopted open-source datasets and evaluation metrics, providing a unified perspective on the measurement of triage effectiveness. Finally, we outline potential future directions and emerging opportunities to foster a closer integration between academic innovation and industrial application. All reviewed papers and projects are available at https://github.com/AIOps-Lab-NKU/TriageSurvey.

Medical triage is the task of allocating medical resources and prioritizing patients based on medical need. This paper introduces the first large-scale public dataset for studying medical triage in the context of asynchronous outpatient portal messages. Our novel task formulation views patient message triage as a pairwise inference problem, where we train LLMs to choose `"which message is more medically urgent" in a head-to-head tournament-style re-sort of a physician's inbox. Our novel benchmark PMR-Bench contains 1569 unique messages and 2,000+ high-quality test pairs for pairwise medical urgency assessment alongside a scalable training data generation pipeline. PMR-Bench includes samples that contain both unstructured patient-written messages alongside real electronic health record (EHR) data, emulating a real-world medical triage scenario. We develop a novel automated data annotation strategy to provide LLMs with in-domain guidance on this task. The resulting data is used to train two model classes, UrgentReward and UrgentSFT, leveraging Bradley-Terry and next token prediction objective, respectively to perform pairwise urgency classification. We find that UrgentSFT achieves top performance on PMR-Bench, with UrgentReward showing distinct advantages in low-resource settings. For example, UrgentSFT-8B and UrgentReward-8B provide a 15- and 16-point boost, respectively, on inbox sorting metrics over off-the-shelf 8B models. Paper resources can be found at https://tinyurl.com/Patient-Message-Triage

The demand for emergency department (ED) services is increasing across the globe, particularly during the current COVID-19 pandemic. Clinical triage and risk assessment have become increasingly challenging due to the shortage of medical resources and the strain on hospital infrastructure caused by the pandemic. As a result of the widespread use of electronic health records (EHRs), we now have access to a vast amount of clinical data, which allows us to develop predictive models and decision support systems to address these challenges. To date, however, there are no widely accepted benchmark ED triage prediction models based on large-scale public EHR data. An open-source benchmarking platform would streamline research workflows by eliminating cumbersome data preprocessing, and facilitate comparisons among different studies and methodologies. In this paper, based on the Medical Information Mart for Intensive Care IV Emergency Department (MIMIC-IV-ED) database, we developed a publicly available benchmark suite for ED triage predictive models and created a benchmark dataset that contains over 400,000 ED visits from 2011 to 2019. We introduced three ED-based outcomes (hospitalization, critical outcomes, and 72-hour ED reattendance) and implemented a variety of popular methodologies, ranging from machine learning methods to clinical scoring systems. We evaluated and compared the performance of these methods against benchmark tasks. Our codes are open-source, allowing anyone with MIMIC-IV-ED data access to perform the same steps in data processing, benchmark model building, and experiments. This study provides future researchers with insights, suggestions, and protocols for managing raw data and developing risk triaging tools for emergency care.

Research in emergency triage is restricted to structured electronic health records (EHR) due to regulatory constraints on nurse-patient interactions. We introduce TriageSim, a simulation framework for generating persona-conditioned triage conversations from structured records. TriageSim enables multi-turn nurse-patient interactions with explicit control over disfluency and decision behaviour, producing a corpus of ~800 synthetic transcripts and corresponding audio. We use a combination of automated analysis for linguistic, behavioural and acoustic fidelity alongside manual evaluation for medical fidelity using a random subset of 50 conversations. The utility of the generated corpus is examined via conversational triage classification. We observe modest agreement for acuity levels across three modalities: generated synthetic text, ASR transcripts, and direct audio inputs. The code, persona schemata and triage policy prompts for TriageSim will be available upon acceptance.

Many court systems are overwhelmed all over the world, leading to huge backlogs of pending cases. Effective triage systems, like those in emergency rooms, could ensure proper prioritization of open cases, optimizing time and resource allocation in the court system. In this work, we introduce the Criticality Prediction dataset, a novel resource for evaluating case prioritization. Our dataset features a two-tier labeling system: (1) the binary LD-Label, identifying cases published as Leading Decisions (LD), and (2) the more granular Citation-Label, ranking cases by their citation frequency and recency, allowing for a more nuanced evaluation. Unlike existing approaches that rely on resource-intensive manual annotations, we algorithmically derive labels leading to a much larger dataset than otherwise possible. We evaluate several multilingual models, including both smaller fine-tuned models and large language models in a zero-shot setting. Our results show that the fine-tuned models consistently outperform their larger counterparts, thanks to our large training set. Our results highlight that for highly domain-specific tasks like ours, large training sets are still valuable.

The post-pandemic surge in healthcare demand, coupled with critical nursing shortages, has placed unprecedented pressure on medical triage systems, necessitating innovative AI-driven solutions. We present a multi-agent interactive intelligent system for medical triage that addresses three fundamental challenges in current AI-based triage systems: inadequate medical specialization leading to misclassification, heterogeneous department structures across healthcare institutions, and inefficient detail-oriented questioning that impedes rapid triage decisions. Our system employs three specialized agents--RecipientAgent, InquirerAgent, and DepartmentAgent--that collaborate through Inquiry Guidance mechanism and Classification Guidance Mechanism to transform unstructured patient symptoms into accurate department recommendations. To ensure robust evaluation, we constructed a comprehensive Chinese medical triage dataset from "Ai Ai Yi Medical Network", comprising 3,360 real-world cases spanning 9 primary departments and 62 secondary departments. Experimental results demonstrate that our multi-agent system achieves 89.6% accuracy in primary department classification and 74.3% accuracy in secondary department classification after four rounds of patient interaction. The system's dynamic matching based guidance mechanisms enable efficient adaptation to diverse hospital configurations while maintaining high triage accuracy. We successfully developed this multi-agent triage system that not only adapts to organizational heterogeneity across healthcare institutions but also ensures clinically sound decision-making.

Clinical early warning systems built on electronic health records, in which clinical observations are recorded as irregularly sampled medical time series (ISMTS), must deliver both calibrated risk scores for patient triage and interpretable rationales that clinicians can verify. Large Language Models (LLMs) have been explored for this task, yet they collapse graded clinical risk into overconfident binary predictions. This risk polarization undermines both calibration and cross-patient comparability. To address this, we propose TRIAGE, a framework that trains an LLM to generate dialectical reasoning over competing clinical outcomes by eliciting outcome-specific rationales. This dialectical formulation mitigates risk polarization, enabling a single LLM to yield continuous risk scores grounded in explicit clinical reasoning. Evaluated on three ISMTS benchmarks, TRIAGE achieves an average AUPRC improvement of 3.3% and reduces calibration error by 81% compared to the competitive baselines. An LLM-as-a-judge assessment further shows that our rationales surpass post-hoc explanations from the baseline by 20% in clinical reasoning quality. The source code is available at https://github.com/HyeongWon-Jang/TRIAGE .

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

Multi-channel sensor networks in industrial IoT often exceed available bandwidth. We propose PCA-Triage, a streaming algorithm that converts incremental PCA loadings into proportional per-channel sampling rates under a bandwidth budget. PCA-Triage runs in O(wdk) time with zero trainable parameters (0.67 ms per decision). We evaluate on 7 benchmarks (8--82 channels) against 9 baselines. PCA-Triage is the best unsupervised method on 3 of 6 datasets at 50% bandwidth, winning 5 of 6 against every baseline with large effect sizes (r = 0.71--0.91). On TEP, it achieves F1 = 0.961 +/- 0.001 -- within 0.1% of full-data performance -- while maintaining F1 > 0.90 at 30% budget. Targeted extensions push F1 to 0.970. The algorithm is robust to packet loss and sensor noise (3.7--4.8% degradation under combined worst-case).

Timely intensive care dictates survival, yet emergency infrastructure remains unevenly distributed across Sri Lanka. While pre-hospital services have expanded, the transition to definitive care remains a critical bottleneck. This study evaluates national emergency resilience by quantifying the gap between clinical demand and the availability of specialized resources across all 25 districts. Using the latest national epidemiological data and terrain-aware H3 hexagonal modeling, we analyzed accessibility for seven critical conditions based on spatial gaps, clinical need-gaps, lethality, coverage, and resource availability. Based on these metrics, unsupervised K-Means clustering was applied to categorize districts into four policy-actionable archetypes: Critical Structural Exclusion, Institutional Mirages, Operational Capacity Strain, and High-Resilience Benchmarks. Our study suggests that severe service deficits exist in the Northern and Eastern provinces, where spatial gaps exceed 70%, rendering the Golden Hour operationally impossible. Notably, specialist scarcity drives systemic pressure more than bed capacity; underserved regions effectively function as institutional mirages. This study suggests that improving accessibility by 25% in high-priority clusters would reduce the national need-gap by 9.65%, providing a roadmap for the strategic redistribution of specialists to ensure healthcare equity.

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well-understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

We investigate whether large language models produce different medical triage recommendations for identical neurological symptoms when only the patient's stated gender and age vary. Using three model families--Gemini 3.5 Flash, Claude Sonnet 4.6, and GPT-5.4-mini--we present a standardized symptom profile (persistent headache, blurred vision, morning nausea, visual disturbances) across seven demographic conditions: three age groups (25, 38, 65) x two genders (male, female), plus a gender-unspecified baseline (n = 30 per condition per model, 630 total trials). We find a stark, systemic gender-dependent triage disparity: young women receive significantly lower emergency room (ER) referral rates than age-matched men (Gemini: 0% vs. 23.3%; Claude: 6.7% vs. 96.7%; GPT: 6.7% vs. 66.7%, all p < 0.001). The disparity disappears at age 65 for all models. The primary mechanism is diagnostic substitution: the models anchor on a gender-associated diagnosis, preferentially classifying young women with Idiopathic Intracranial Hypertension (IIH)--a condition epidemiologically linked to women of childbearing age--while diagnosing men with generic increased intracranial pressure with space-occupying lesions in the differential. This diagnostic closure routes female patients to lower-urgency care (outpatient doctor appointments) despite comparable severity ratings (7-9/10). Our findings demonstrate that clinical LLMs replicate documented human clinical biases by using epidemiological priors to suppress triage urgency, suggesting that AI triage engines must decouple urgency assessment from probabilistic diagnostic priors. We release all code, prompts, and raw results.

Premature closure, or committing to a conclusion before sufficient information is available, is a recognized contributor to diagnostic error but remains underexamined in large language models (LLMs). We define LLM premature closure as inappropriate commitment under uncertainty: providing an answer, recommendation, or clinical guidance when the safer response would be clarification, abstention, escalation, or refusal. We evaluated five frontier LLMs across structured and open-ended medical tasks. In MedQA (n = 500) and AfriMed-QA (n = 490) questions where the correct choice had been removed, models still selected an answer at high rates, with baseline false-action rates of 55-81% and 53-82%, respectively. In open-ended evaluation, models gave inappropriate answers on an average of 30% of 861 HealthBench questions and 78% of 191 physician-authored adversarial queries. Safety-oriented prompting reduced premature closure across models, but residual failure persisted, highlighting the need to evaluate whether medical LLMs know when not to answer.

As modern microservice systems grow increasingly popular and complex-often consisting of hundreds or even thousands of fine-grained, interdependent components-they are becoming more susceptible to frequent and subtle failures. Ensuring system reliability therefore hinges on accurate and efficient failure localization. Traditional failure localization approaches based on small models lack the flexibility to adapt to diverse failure scenarios, while recent LLM-based methods suffer from two major limitations: they often rely on rigid invocation workflows that constrain the model's ability to dynamically explore optimal localization paths, and they require resource-intensive inference, making them cost-prohibitive for real-world deployment. To address these challenges, we explore the use of reinforcement fine-tuning to equip lightweight LLMs with reasoning and self-refinement capabilities, significantly improving the cost-effectiveness and adaptability of LLM-based failure localization. We begin with an empirical study to identify three key capabilities essential for accurate localization. Building on these insights, we propose a progressive multi-stage GRPO fine-tuning framework, which integrates a multi-factor failure localization grader and a recursion-of-thought actor module. The resulting model, ThinkFL, not only outperforms existing state-of-the-art LLMs and baseline methods in localization accuracy but also reduces end-to-end localization latency from minutes to seconds, demonstrating strong potential for real-world applications.

Medication reconciliation at clinical handoffs is a high-stakes, error-prone process. Large language models are increasingly proposed to assist with this task using FHIR-structured patient records, but a fundamental and largely unstudied variable is how the FHIR data is serialised before being passed to the model. We present the first systematic comparison of four FHIR serialisation strategies (Raw JSON, Markdown Table, Clinical Narrative, and Chronological Timeline) across five open-weight models (Phi-3.5-mini, Mistral-7B, BioMistral-7B, Llama-3.1-8B, Llama-3.3-70B) on a controlled benchmark of 200 synthetic patients, totalling 4,000 inference runs. We find that serialisation strategy has a large, statistically significant effect on performance for models up to 8B parameters: Clinical Narrative outperforms Raw JSON by up to 19 F1 points for Mistral-7B (r = 0.617, p < 10^{-10}). This advantage reverses at 70B, where Raw JSON achieves the best mean F1 of 0.9956. In all 20 model and strategy combinations, mean precision exceeds mean recall: omission is the dominant failure mode, with models more often missing an active medication than fabricating one, which changes how clinical safety auditing priorities should be set. Smaller models plateau at roughly 7-10 concurrent active medications, leaving polypharmacy patients, the patients most at risk from reconciliation errors, systematically underserved. BioMistral-7B, a domain-pretrained model without instruction tuning, produces zero usable output in all conditions, showing that domain pretraining alone is not sufficient for structured extraction. These results offer practical, evidence-based format recommendations for clinical LLM deployment: Clinical Narrative for models up to 8B, Raw JSON for 70B and above. The complete pipeline is reproducible on open-source tools running on an AWS g6e.xlarge instance (NVIDIA L40S, 48 GB VRAM).

Decision-relevant building damage assessment is critical for prioritizing resources and recovery after a disaster, yet most automated methods either flatten damage into a single severity scale (no damage, minor, major, destroyed) or require paired pre- and post-event imagery that is often unavailable for emerging hazards. This paper presents Damage-TriageFormer, a single-image, post-event, footprint-conditioned model that produces a damage typology rather than a severity scale. We contribute: (1) DamageTriage-Bench, a new benchmark built from NOAA Emergency Response Imagery across Hurricane Michael (2018), Hurricane Helene (2024), and the 2025 Los Angeles wildfire complex, with five typology classes that distinguish roof damage from structural damage and, within each, partial from total extent; and (2) Damage-TriageFormer, which extends a DINOv3 ViT-L backbone with a Simple Feature Pyramid for higher-resolution instance pooling, a two-stage gated damage head, and an auxiliary severity-regression objective. Our model achieves macro F1 of 0.624 on validation and 0.619 on a held-out stratified test set, performing strongest where operational triage needs it most, with per-class F1 of 0.91 and 0.84 on undamaged buildings and total structural collapse, respectively. While the rare Total Roof Damage class remains difficult due to its limited examples and an inherently ambiguous label boundary, our results show that single-image post-event imagery can support actionable building damage typing, enabling targeted emergency response and resource allocation without a pre-event reference.

The continuous delivery of modern software requires the execution of many automated pipeline jobs. These jobs ensure the frequent release of new software versions while detecting code problems at an early stage. For TELUS, our industrial partner in the telecommunications field, reliable job execution is crucial to minimize wasted time and streamline Continuous Deployment (CD). In this context, flaky job failures are one of the main issues hindering CD. Prior studies proposed techniques based on machine learning to automate the detection of flaky jobs. While valuable, these solutions are insufficient to address the waste associated with the diagnosis of flaky failures, which remain largely unexplored due to the wide range of underlying causes. This study examines 4,511 flaky job failures at TELUS to identify the different categories of flaky failures that we prioritize based on Recency, Frequency, and Monetary (RFM) measures. We identified 46 flaky failure categories that we analyzed using clustering and RFM measures to determine 14 priority categories for future automated diagnosis and repair research. Our findings also provide valuable insights into the evolution and impact of these categories. The identification and prioritization of flaky failure categories using RFM analysis introduce a novel approach that can be used in other contexts.

Automated incident management plays a pivotal role in large-scale microservice systems. However, many existing methods rely solely on single-modal data (e.g., metrics, logs, and traces) and struggle to simultaneously address multiple downstream tasks, including anomaly detection (AD), failure triage (FT), and root cause localization (RCL). Moreover, the lack of clear reasoning evidence in current techniques often leads to insufficient interpretability. To address these limitations, we propose TrioXpert, an end-to-end incident management framework capable of fully leveraging multimodal data. TrioXpert designs three independent data processing pipelines based on the inherent characteristics of different modalities, comprehensively characterizing the operational status of microservice systems from both numerical and textual dimensions. It employs a collaborative reasoning mechanism using large language models (LLMs) to simultaneously handle multiple tasks while providing clear reasoning evidence to ensure strong interpretability. We conducted extensive evaluations on two microservice system datasets, and the experimental results demonstrate that TrioXpert achieves outstanding performance in AD (improving by 4.7% to 57.7%), FT (improving by 2.1% to 40.6%), and RCL (improving by 1.6% to 163.1%) tasks. TrioXpert has also been deployed in Lenovo's production environment, demonstrating substantial gains in diagnostic efficiency and accuracy.

Deep-learning survival models for electronic health record (EHR) data are hard to compare across papers because the upstream preprocessing step, which includes cohort definition, time discretisation, missingness handling, and censoring rules, is typically undocumented and inconsistent. A reported difference in concordance between two mortality models can therefore reflect any of these choices rather than a modelling contribution. We present SurvBench, an open-source preprocessing pipeline that converts raw PhysioNet exports into model-ready tensors for survival analysis. SurvBench covers four critical-care databases (MIMIC-IV, eICU, MC-MED, HiRID) and four input modalities: time-series vitals and laboratory values, static demographics, International Classification of Diseases (ICD) codes, and radiology report embeddings. Every preprocessing decision is controlled through YAML configuration. Imputation, scaling, and feature filtering are fit on the training fold only. Missingness is recorded as a binary mask alongside each feature tensor. The pipeline handles single-risk endpoints (in-hospital and in-ICU mortality) and competing-risks endpoints (a three-way emergency-department admission pathway, with home discharge treated as administrative censoring). We also provide support for harmonised cross-dataset external validation between eICU and MIMIC-IV. SurvBench is publicly available at https://github.com/munibmesinovic/SurvBench, providing a robust platform that future deep-learning EHR survival work, especially nascent multi-modal approaches, can be measured against under matched preprocessing.

This work proposes a framework for optimizing machine learning algorithms. The practicality of the framework is illustrated using an important case study from the healthcare domain, which is predicting the admission status of emergency department (ED) patients (e.g., admitted vs. discharged) using patient data at the time of triage. The proposed framework can mitigate the crowding problem by proactively planning the patient boarding process. A large retrospective dataset of patient records is obtained from the electronic health record database of all ED visits over three years from three major locations of a healthcare provider in the Midwest of the US. Three machine learning algorithms are proposed: T-XGB, T-ADAB, and T-MLP. T-XGB integrates extreme gradient boosting (XGB) and Tabu Search (TS), T-ADAB integrates Adaboost and TS, and T-MLP integrates multi-layer perceptron (MLP) and TS. The proposed algorithms are compared with the traditional algorithms: XGB, ADAB, and MLP, in which their parameters are tunned using grid search. The three proposed algorithms and the original ones are trained and tested using nine data groups that are obtained from different feature selection methods. In other words, 54 models are developed. Performance was evaluated using five measures: Area under the curve (AUC), sensitivity, specificity, F1, and accuracy. The results show that the newly proposed algorithms resulted in high AUC and outperformed the traditional algorithms. The T-ADAB performs the best among the newly developed algorithms. The AUC, sensitivity, specificity, F1, and accuracy of the best model are 95.4%, 99.3%, 91.4%, 95.2%, 97.2%, respectively.

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

The prevalence of vision-threatening eye diseases is a significant global burden, with many cases remaining undiagnosed or diagnosed too late for effective treatment. Large vision-language models (LVLMs) have the potential to assist in understanding anatomical information, diagnosing eye diseases, and drafting interpretations and follow-up plans, thereby reducing the burden on clinicians and improving access to eye care. However, limited benchmarks are available to assess LVLMs' performance in ophthalmology-specific applications. In this study, we introduce LMOD, a large-scale multimodal ophthalmology benchmark consisting of 21,993 instances across (1) five ophthalmic imaging modalities: optical coherence tomography, color fundus photographs, scanning laser ophthalmoscopy, lens photographs, and surgical scenes; (2) free-text, demographic, and disease biomarker information; and (3) primary ophthalmology-specific applications such as anatomical information understanding, disease diagnosis, and subgroup analysis. In addition, we benchmarked 13 state-of-the-art LVLM representatives from closed-source, open-source, and medical domains. The results demonstrate a significant performance drop for LVLMs in ophthalmology compared to other domains. Systematic error analysis further identified six major failure modes: misclassification, failure to abstain, inconsistent reasoning, hallucination, assertions without justification, and lack of domain-specific knowledge. In contrast, supervised neural networks specifically trained on these tasks as baselines demonstrated high accuracy. These findings underscore the pressing need for benchmarks in the development and validation of ophthalmology-specific LVLMs.

Large language model-powered chatbots have transformed how people seek information, especially in high-stakes contexts like mental health. Despite their support capabilities, safe detection and response to crises such as suicidal ideation and self-harm are still unclear, hindered by the lack of unified crisis taxonomies and clinical evaluation standards. We address this by creating: (1) a taxonomy of six crisis categories; (2) a dataset of over 2,000 inputs from 12 mental health datasets, classified into these categories; and (3) a clinical response assessment protocol. We also use LLMs to identify crisis inputs and audit five models for response safety and appropriateness. First, we built a clinical-informed crisis taxonomy and evaluation protocol. Next, we curated 2,252 relevant examples from over 239,000 user inputs, then tested three LLMs for automatic classification. In addition, we evaluated five models for the appropriateness of their responses to a user's crisis, graded on a 5-point Likert scale from harmful (1) to appropriate (5). While some models respond reliably to explicit crises, risks still exist. Many outputs, especially in self-harm and suicidal categories, are inappropriate or unsafe. Different models perform variably; some, like gpt-5-nano and deepseek-v3.2-exp, have low harm rates, but others, such as gpt-4o-mini and grok-4-fast, generate more unsafe responses. All models struggle with indirect signals, default replies, and context misalignment. These results highlight the urgent need for better safeguards, crisis detection, and context-aware responses in LLMs. They also show that alignment and safety practices, beyond scale, are crucial for reliable crisis support. Our taxonomy, datasets, and evaluation methods support ongoing AI mental health research, aiming to reduce harm and protect vulnerable users.

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.

Vision-Language Models (VLMs) have demonstrated impressive capabilities in understanding visual content, but their reliability in safety-critical contexts remains under-explored. We introduce VERI (Visual Emergency Recognition Dataset), a carefully designed diagnostic benchmark of 200 images (100 contrastive pairs). Each emergency scene is matched with a visually similar but safe counterpart through multi-stage human verification and iterative refinement. Using a two-stage protocol - risk identification and emergency response - we evaluate 14 VLMs (2B-124B parameters) across medical emergencies, accidents, and natural disasters. Our analysis reveals a systematic overreaction problem: models excel at identifying real emergencies (70-100 percent success rate) but suffer from an alarming rate of false alarms, misidentifying 31-96 percent of safe situations as dangerous, with 10 scenarios failed by all models regardless of scale. This "better-safe-than-sorry" bias manifests primarily through contextual overinterpretation (88-93 percent of errors), challenging VLMs' reliability for safety applications. These findings highlight persistent limitations that are not resolved by increasing model scale, motivating targeted approaches for improving contextual safety assessment in visually misleading scenarios.

Incomplete or inconsistent discharge documentation drives care fragmentation and avoidable readmissions. Despite its critical role in patient safety, auditing discharge summaries relies on manual review and does not scale. We propose an automated framework for auditing discharge summaries using large language models (LLMs). Our approach operationalizes the DISCHARGED framework into a checklist of 46 questions. Using 50 summaries from the MIMIC-IV database, with clinician ground-truth labels, we benchmark 11 LLMs. Model-assessed mean documentation completeness ranges from 54.9% to 74.2%, and the best-performing models achieve a Cohen's kappa values around 0.5 against clinician labels, indicating moderate agreement. All models struggle to identify ambiguous documentation (Unclear), highlighting a key gap in current automated auditing. This work provides a clinician-validated benchmark and zero-shot baselines for systematic quality improvement in clinical documentation.

Ambient AI scribes draft clinical notes under the reassurance that a clinician signs every note. We audited three commercial AI scribes on the same 142 consultations: 565 notes from recorded UK primary-care and US ambulatory encounters plus authored scenarios. Twelve discovery passes proposed 13,678 candidate errors; the 5,898 clearing an importance filter went to an adversarial panel of two models from different families, each told to refute what it could, and 618 survived. One note in three (31.3% [27.0, 35.6]) carries a verified failure, concentrated in allergy and medication information, invented patient identity, and history written up as examination on telephone consultations that can contain none. No product was given a patient record; setting aside the two classes a record would have prefilled, invented identity and dates, the rate is 24.8% [20.8, 29.0]. One failure mode did not fit our scheme, drawn from published scribe-error taxonomies: a treatment the clinician retracts, recorded as delivered care. Two clinicians adjudicated blind, disjoint samples: a physician author upheld 20 of 21 findings (95.2% [77.3, 99.2]) and an independent clinician, not an author, 12 of 12 ([75.8, 100]); both judged every sampled refusal genuine. A failure rate depends on the instrument as much as the scribes. With model, evidence and settings fixed, the review instruction alone moves the share of candidates verified from 9.3% to 79.0%, and the reviewing family moves it too: alone at that instruction the gentler flags 54.8% of notes against 27.8%. Between 28% and 97% of sampled notes carry a failure depending on the standard. Published audits disagree among themselves by a margin instrument differences alone can produce: omission is 54-86% of their errors against our 23.1%. We release all 618 findings with transcript-side evidence, every prompt and model version, and the re-runnable pipeline.

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

Alarm fatigue in intensive care units (ICUs) is a well documented patient safety crisis. Clinical monitors generate 350 or more alarms per patient per day, out of which 72-99% are clinically irrelevant. Staff desensitization to non-actionable alarms increases the risk of missed true emergencies. This paper presents SigmaMedStat, a machine learning system that evaluates the trustworthiness of physiological alarm signals before clinical action is taken. Four approaches were evaluated on the PhysioNet/Computing in Cardiology Challenge 2015 dataset of 498 four-channel ICU alarm recordings. Primary contribution is a temporal modeling framework that splits each 60 second recording into six consecutive 10-second chunks, and this in turn generates Continuous Wavelet Transform (CWT) scalograms per chunk, encodes each chunk with a shared EfficientNet-B0 encoder, and passes the resulting feature sequence to a two-layer Long Short-Term Memory (LSTM) network. Five-fold stratified cross-validation yields a mean AUC of 0.822 +/- 0.016 (95% CI: [0.790,0.853]), compared to 0.641 for a static EfficientNet baseline trained on the full 60-second window. Ablation studies confirm that temporal chunking and multi-channel signal fusion both contribute independently to classification performance. Per-alarm type analysis reveals that Ventricular Flutter is the most accurately classified alarm type (AUC 0.820) while Asystole remains the hardest (AUC 0.722). Error analysis identifies 65 false negatives and 85 high-confidence misclassifications as the primary failure modes. All code and results are publicly available at https://github.com/Arun-K-Ram/sigmamedstat.

Existing evaluations often reduce agent failures to system-level outcomes, obscuring where the fault originated and which intervention would improve the agent system. This creates a repair-assignment problem: the same visible failure may call for model post-training, harness engineering, environment redesign, or benchmark repair depending on its source. Because agent behavior emerges from interactions among models, harnesses, users, tools, memory, and environments, outcome-level labels are often insufficient for improvement. Most failure taxonomies do little to resolve this problem because they are benchmark-specific and lack a shared structure. We introduce an interaction-centric taxonomy that localizes failures to the interactions in which they originate and identifies the responsible component. It organizes 41 failure modes by assigning each to an edge between two components and a fault side indicating where the repair belongs. This makes the taxonomy actionable: model-side failures identify targets for post-training, harness-side failures point to scaffolding and tool-integration fixes, and environment or grader failures reveal evaluation conditions requiring redesign. The schema applies across agent architectures, from coding assistants to long-horizon personal assistants and multi-agent systems. We ground the taxonomy in worked examples from public benchmarks, model system cards, published reports, and logged agent trajectories, and evaluate its reproducibility using independent reasoning agents as judges. Across four frontier models, the strongest judge reaches Cohen's κ=0.76 against human category labels, suggesting that the categories capture shared structure rather than annotator-specific preferences.

Prompt-injection detectors are heterogeneous: each is strong on a different slice of attacks, and none is always reliable. Yet existing systems still treat detection as a fixed single-detector pipeline, committing every request to one detector's blind spots. We reframe defense as detector allocation: given a heterogeneous pool, decide per request which detectors to run and whether to escalate to an LLM judge. Our framework SCOUT (Scalable and Controllable Outcome-prediction for Uncertainty-aware Triage) makes this decision dynamic by predicting each detector's per-sample reliability and latency from how it behaved on similar past inputs, and exposes a single safety-utility threshold to the operator (where utility bundles benign-pass rate and wall-clock). To evaluate this setting, we build SCOUT-450, a benchmark that captures the structurally complex, agent-facing injections that older prompt-injection sets under-represent. On SCOUT-450, a safety-oriented operating point reduces attack-success rate by 46% and total wall-clock by 40% relative to an always-on GPT-4o judge, at a 5.1-point benign-utility drop. SCOUT also transfers to three external benchmarks (BIPIA, IPI, and IHEval), improving the safety-utility frontier.

Automated five-stage diabetic retinopathy (DR) grading requires more than high accuracy alone. Medical-grade deployment calls for lesion-aware preprocessing, ordinal predictions, calibrated uncertainty, and explainability to support reliable diagnostic systems. We present a unified pipeline that addresses these requirements using a Ben-Graham-green-channel CLAHE feature representation, an EfficientNetV2-L ordinal regressor, and Monte Carlo dropout for uncertainty-driven referral. Grad-CAM provides visual explanations aligned with clinically relevant lesions. The proposed method achieves a QWK of 91.31% on the APTOS-2019 official test split, placing it within the near-perfect agreement band (>80%). At a 20% referral rate, 293 of 366 images are automatically graded with a QWK of 90.40%. More complex cases are referred for specialist assessment, demonstrating a practical trade-off among grading quality, automation, and patient safety in robust, reliable, and deployment-ready medical diagnostic systems.

Large language models (LLMs) show promise in medical diagnosis, but real-world deployment remains challenging due to high-stakes clinical decisions and imperfect reasoning reliability. As a result, careful inspection of model behavior is essential for assessing whether diagnostic reasoning is reliable and clinically grounded. However, debugging medical LLMs remains difficult. First, developers often lack sufficient medical domain expertise to interpret model errors in clinically meaningful terms. Second, models can fail across a large and diverse set of instances involving different input types, tasks, and reasoning steps, making it challenging for developers to prioritize which errors deserve focused inspection. Third, developers struggle to identify recurring error patterns across cases, as existing debugging practices are largely instance-centric and rely on manual inspection of isolated failures. To address these challenges, we present VeriLLMed, a visual analytics system that integrates external biomedical knowledge to audit and debug medical LLM diagnostic reasoning. VeriLLMed transforms model outputs into comparable reasoning paths, constructs knowledge graph-grounded reference paths, and identifies three recurring classes of diagnosis errors: relation errors, branch errors, and missing errors. Case studies and expert evaluation demonstrate that VeriLLMed helps developers identify clinically implausible reasoning and generate actionable insights that can inform the improvement of medical LLMs.

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

The exercise of detecting similar bug reports in bug tracking systems is known as duplicate bug report detection. Having prior knowledge of a bug report's existence reduces efforts put into debugging problems and identifying the root cause. Rule and Query-based solutions recommend a long list of potential similar bug reports with no clear ranking. In addition, triage engineers are less motivated to spend time going through an extensive list. Consequently, this deters the use of duplicate bug report retrieval solutions. In this paper, we have proposed a solution using a combination of NLP techniques. Our approach considers unstructured and structured attributes of a bug report like summary, description and severity, impacted products, platforms, categories, etc. It uses a custom data transformer, a deep neural network, and a non-generalizing machine learning method to retrieve existing identical bug reports. We have performed numerous experiments with significant data sources containing thousands of bug reports and showcased that the proposed solution achieves a high retrieval accuracy of 70% for recall@5.

AI systems can fail silently. The failure propagates through training loops, evaluation pipelines, and production monitoring stacks until downstream harm makes it visible. This paper introduces evaluation blindness: a measurement function M exhibits evaluation blindness with respect to failure class F when it produces readings indistinguishable from a healthy state while the system is actually failing, with no auxiliary signal flagging the gap. The problem surfaces at two lifecycle stages the literature has treated separately. At training time, reward models are gamed, importance-sampling corrections are silently miscalculated, and benchmark contamination inflates fine-tuning evaluations, all while loss curves look healthy and gradient updates proceed normally. At deployment time, monitoring fails to catch six classes of production failure, including an Operational category that is 100% silent by structural definition. We provide a formal detectability predicate unifying both stages. Four training-time case studies trace concrete breakdowns, including a real implementation bug in TRL PR #6594 where gradients are corrupted as loss decreases normally. A six-class taxonomy validated against 50 real-world incidents from court documents and regulatory filings finds that 53% of verifiable public failures were silent. A failure budget framework ties acceptable failure rates to use-case risk class. The implication is direct: measurement infrastructure is a correctness concern across the full AI lifecycle, not just at evaluation time. Data, code, and taxonomy schema are at https://github.com/priyanka25aug/llm-failure-taxonomy.

Multi-provider LLM gateways reverse proxies that route, load-balance, and rate-limit requests across foundation-model APIs have become critical production infrastructure. Yet the failure modes specific to this architectural layer remain undocumented, scattered across issue trackers and post-mortems with no unifying framework. We introduce , a two-axis taxonomy that classifies failures by their origin layer (Network/Transport, Streaming/Protocol, State/Session, Model~Behavior, Governance/Cost) and their detectability (Loud vs.\ Silent). We populate this taxonomy with five verified catalog entries sourced from public bug reports and first-hand stress testing, each accompanied by a mechanistic root-cause analysis. Three entries include standalone reproduction scripts. Our principal finding is that the most operationally severe failures are silent: they return HTTP~200, pass every standard health check, and corrupt application state in ways that require semantic-level observability to detect. Two such silent failures a concurrency race condition causing history loss and a streaming index collision corrupting tool-call payloads were discovered first-hand during evaluation campaigns.

Intensive care units (ICU) generate long, dense and evolving streams of clinical information, where physicians must repeatedly reassess patient states under time pressure, underscoring a clear need for reliable AI decision support. Existing ICU benchmarks typically treat historical clinician actions as ground truth. However, these actions are made under incomplete information and limited temporal context of the underlying patient state, and may therefore be suboptimal, making it difficult to assess the true reasoning capabilities of AI systems. We introduce RealICU, a hindsight-annotated benchmark for evaluating large language models (LLMs) under realistic ICU conditions, where labels are created after senior physicians review the full patient trajectory. We formulate four physician-motivated tasks: assess Patient Status, Acute Problems, Recommended Actions, and Red Flag actions that risk unsafe outcomes. We partition each trajectory with 30-min windows and release two datasets: RealICU-Gold with 930-window annotations from 94 MIMIC-IV patients, and RealICU-Scale with 11,862 windows extended by Oracle, a physician-validated LLM hindsight labeler. Existing LLMs including memory-augmented ones performed poorly on RealICU, exposing two failure modes: a recall-safety tradeoff for clinical recommendations, and an anchoring bias to early interpretations of the patient. We further introduce ICU-Evo to study structured-memory agents that improves long-horizon reasoning but does not fully eliminate safety failures. Together, RealICU provides a clinically grounded testbed for measuring and improving AI sequential decision-support in high-stakes care. Project page: https://chengzhi-leo.github.io/RealICU-Bench/

LLM routing aims to achieve a favorable quality--cost trade-off by dynamically assigning easy queries to smaller models and harder queries to stronger ones. However, across both unimodal and multimodal settings, we uncover a pervasive yet underexplored failure mode in existing routers: as the user's cost budget increases, routers systematically default to the most capable and most expensive model even when cheaper models already suffice. As a result, current routers under-utilize small models, wasting computation and monetary cost and undermining the core promise of routing; we term this phenomenon routing collapse. We attribute routing collapse to an objective--decision mismatch: many routers are trained to predict scalar performance scores, whereas routing decisions ultimately depend on discrete comparisons among candidate models. Consequently, small prediction errors can flip relative orderings and trigger suboptimal selections. To bridge this gap, we propose EquiRouter, a decision-aware router that directly learns model rankings, restoring the role of smaller models and mitigating routing collapse. On RouterBench, EquiRouter reduces cost by about 17\% at GPT-4-level performance compared to the strongest prior router. Our code is available at https://github.com/AIGNLAI/EquiRouter.

We investigate whether large language models produce different medical triage recommendations for identical symptoms based solely on the language of the patient prompt. Using Gemini 3.5 Flash, we evaluate a neurological symptom profile (persistent headache, blurred vision, nausea) across six languages (English, Spanish, Chinese, Hindi, Japanese, Arabic) with 30 runs per condition (n=450 total API calls). We find that the model recommends emergency room visits at rates ranging from 0% (Japanese, Hindi) to 30% (English, Arabic), despite assigning nearly identical severity scores (7.7-8.0/10) across all languages. Adding a single sentence specifying the patient's US location increases ER recommendations by up to 76.7 percentage points for non-English prompts, while the reverse anchor (English prompt with a Tokyo location) reduces the ER rate from 30% to 6.7%. A back-translation control (Japanese to English) produces ER rates comparable to the English baseline, confirming that the disparity is not caused by translation quality but by implicit geographic inference from the input language. We release the complete dataset, experiment code, and results.

Multimodal clinical models are usually judged on accuracy with every modality present, but deployment removes modalities; an echocardiogram is often unavailable where an ECG is routine. Two questions then matter beyond the size of the accuracy loss: which modality was responsible, and whether the model fails loudly or silently once that modality is dropped. The distinction is per-example and modality-level, and is separate from post-hoc feature attribution (e.g. SHAP). Models are replaced often; the evaluation that answers these questions is reused. We present a model-agnostic modality-failure framework: given N modality embeddings, any mask-aware probe, and labels, it returns a per-example failure taxonomy, a per-modality complementarity matrix that attributes error to modalities, and a loud-vs-silent dropout profile separating monitorable failures from those that pass unflagged far from the decision boundary, using only deployment-observable signals. We release it as a small, unit-tested harness and validate it against planted ground truth. Across seeds it recovers that planted modality dominance and complementary subset, reports per-modality loud-vs-silent rates, and scales to a three-modality complementarity matrix; because the planted structure is known by construction, this validates recovery of per-example attribution rather than clinical performance. We then instantiate the framework on frozen EchoJEPA and HuBERT-ECG embeddings for LVEF and the EF <= 40% HFrEF gate over a paired MIMIC-IV cohort, where on the held-out test split (n = 245) dropping echo nearly doubles error. The narrow echo-to-ECG overlap that bounds cohort size is itself a deployment finding for cardiac foundation models. All of our work can be found at https://github.com/criticaldata/PRIMED-AI.

Rubric-based evaluation is widely used in LLM benchmarks and training pipelines for open-ended, less verifiable tasks. While prior work has demonstrated the effectiveness of rubrics using downstream signals such as reinforcement learning outcomes, there remains no principled way to diagnose how a rubric itself fails from such aggregated or downstream signals alone. To address this gap, we introduce RIFT: RubrIc Failure mode Taxonomy, a taxonomy for systematically characterizing failure modes in rubric composition and design. RIFT consists of eight failure modes organized into three high-level categories: Reliability Failures, Content Validity Failures, and Consequential Validity Failures. RIFT is developed using grounded theory by iteratively annotating rubrics drawn from five diverse data sources spanning general instruction following, code generation, creative writing, and expert-level deep research, until no new failure modes are identified. We evaluate the consistency of the taxonomy by measuring agreement among independent human annotators, observing fair agreement overall (87% pairwise agreement and 0.64 average Cohen's kappa). Finally, to support scalable diagnosis, we propose automated rubric quality metrics and show that they align with human failure-mode annotations, achieving up to 0.925 F1.

Synthetic insider threat benchmarks face a consistency problem: corpora generated without an external factual constraint cannot rule out cross-artifact contradictions. The CERT dataset -- the field's canonical benchmark -- is also static, lacks cross-surface correlation scenarios, and predates the LLM era. We present OrgForge-IT, a verifiable synthetic benchmark in which a deterministic simulation engine maintains ground truth and language models generate only surface prose, making cross-artifact consistency an architectural guarantee. The corpus spans 51 simulated days, 2,904 telemetry records at a 96.4% noise rate, and four detection scenarios designed to defeat single-surface and single-day triage strategies across three threat classes and eight injectable behaviors. A ten-model leaderboard reveals several findings: (1) triage and verdict accuracy dissociate - eight models achieve identical triage F1=0.80 yet split between verdict F1=1.0 and 0.80; (2) baseline false-positive rate is a necessary companion to verdict F1, with models at identical verdict accuracy differing by two orders of magnitude on triage noise; (3) victim attribution in the vishing scenario separates tiers - Tier A models exonerate the compromised account holder while Tier B models detect the attack but misclassify the victim; (4) rigid multi-signal thresholds structurally exclude single-surface negligent insiders, demonstrating the necessity of parallel, threat-class-specific triage pipelines; and (5) agentic software-engineering training acts as a force multiplier for multi-day temporal correlation, but only when paired with frontier-level parameter scale. Finally, prompt sensitivity analysis reveals that unstructured prompts induce vocabulary hallucination, motivating a two-track scoring framework separating prompt adherence from reasoning capability. OrgForge-IT is open source under the MIT license.

Magnetic Resonance Imaging (MRI) is a widely-accepted imaging technique for knee injury analysis. Its advantage of capturing knee structure in three dimensions makes it the ideal tool for radiologists to locate potential tears in the knee. In order to better confront the ever growing workload of musculoskeletal (MSK) radiologists, automated tools for patients' triage are becoming a real need, reducing delays in the reading of pathological cases. In this work, we present the Efficiently-Layered Network (ELNet), a convolutional neural network (CNN) architecture optimized for the task of initial knee MRI diagnosis for triage. Unlike past approaches, we train ELNet from scratch instead of using a transfer-learning approach. The proposed method is validated quantitatively and qualitatively, and compares favorably against state-of-the-art MRNet while using a single imaging stack (axial or coronal) as input. Additionally, we demonstrate our model's capability to locate tears in the knee despite the absence of localization information during training. Lastly, the proposed model is extremely lightweight (< 1MB) and therefore easy to train and deploy in real clinical settings. The code for our model is provided at: https://github.com/mxtsai/ELNet.

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.

Recent advances in medical large language models (LLMs), multimodal models, and agents demand evaluation frameworks that reflect real clinical workflows and safety constraints. We present MedBench v4, a nationwide, cloud-based benchmarking infrastructure comprising over 700,000 expert-curated tasks spanning 24 primary and 91 secondary specialties, with dedicated tracks for LLMs, multimodal models, and agents. Items undergo multi-stage refinement and multi-round review by clinicians from more than 500 institutions, and open-ended responses are scored by an LLM-as-a-judge calibrated to human ratings. We evaluate 15 frontier models. Base LLMs reach a mean overall score of 54.1/100 (best: Claude Sonnet 4.5, 62.5/100), but safety and ethics remain low (18.4/100). Multimodal models perform worse overall (mean 47.5/100; best: GPT-5, 54.9/100), with solid perception yet weaker cross-modal reasoning. Agents built on the same backbones substantially improve end-to-end performance (mean 79.8/100), with Claude Sonnet 4.5-based agents achieving up to 85.3/100 overall and 88.9/100 on safety tasks. MedBench v4 thus reveals persisting gaps in multimodal reasoning and safety for base models, while showing that governance-aware agentic orchestration can markedly enhance benchmarked clinical readiness without sacrificing capability. By aligning tasks with Chinese clinical guidelines and regulatory priorities, the platform offers a practical reference for hospitals, developers, and policymakers auditing medical AI.

Bug triaging for security vulnerabilities is a critical part of software maintenance, ensuring that the most pressing vulnerabilities are addressed promptly to safeguard system integrity and user data. However, the process is resource-intensive and comes with challenges, including classifying software vulnerabilities, assessing their severity, and managing a high volume of bug reports. In this paper, we present CASEY, a novel approach that leverages Large Language Models (in our case, the GPT model) that automates the identification of Common Weakness Enumerations (CWEs) of security bugs and assesses their severity. CASEY employs prompt engineering techniques and incorporates contextual information at varying levels of granularity to assist in the bug triaging process. We evaluated CASEY using an augmented version of the National Vulnerability Database (NVD), employing quantitative and qualitative metrics to measure its performance across CWE identification, severity assessment, and their combined analysis. CASEY achieved a CWE identification accuracy of 68%, a severity identification accuracy of 73.6%, and a combined accuracy of 51.2% for identifying both. These results demonstrate the potential of LLMs in identifying CWEs and severity levels, streamlining software vulnerability management, and improving the efficiency of security vulnerability triaging workflows.

LLM agents are beginning to invoke industrial asset-management tools through the Model Context Protocol (MCP), yet whether they can act reliably on this substrate for safety-critical Prognostics and Health Management (PHM) is unanswered. Prior benchmarks conflate protocol fluency with reasoning, instrumentation failures with agent failures, and tool use with tool retrieval. We introduce PHMForge, an evaluation environment that closes each conflation. PHMForge ships 99 SME-authored scenarios across eight industrial asset classes spanning rotating equipment, aero-engines, and lithium-ion cells, on public datasets including NASA PCoE, served through 39 MCP-native tools wrapping published PHM algorithms (C-MAPSS, ISO~10816, Arrhenius capacity-fade models, time-series foundation models). Krippendorff's αin [0.74,,0.82] on a 30-scenario stratified rotating-equipment/aero-engine sample; the battery extension is single-rater. Across three agentic frameworks and six LLM backbones, the strongest configuration reaches 80.8\% pass@1, with the residual gap concentrated in orchestration and tool-sequencing errors. Crucially, an architectural ablation shows that replacing MCP execution with text-based Retrieval-Augmented Generation (RAG) over telemetry-equivalent evidence collapses Remaining Useful Life pass-all-3 from 100\% to 20\% (5/5 vs.\ 1/5) on the battery class, exposing the structural limits of static retrieval for prognostic computation. Trajectory decomposition shows orchestration errors dominate failures across backbones, while schema-invalid tool calls concentrate in smaller open-weight models. Frontier LLMs are stronger at calling tools than at planning when to call them. PHMForge is open-sourced with deterministic evaluators, a public leaderboard, and a datasheet.

AI agents often fail in ways that are difficult to localize because executions are probabilistic, long-horizon, multi-agent, and mediated by noisy tool outputs. We address this gap by manually annotating failed agent runs and release a novel benchmark of 115 failed trajectories spanning structured API workflows, incident management, and open-ended web/file tasks. Each trajectory is annotated with a critical failure step and a category from a grounded-theory derived, cross-domain failure taxonomy. To mitigate the human cost of failure attribution, we present AGENTRX, an automated domain-agnostic diagnostic framework that pinpoints the critical failure step in a failed agent trajectory. It synthesizes constraints, evaluates them step-by-step, and produces an auditable validation log of constraint violations with associated evidence; an LLM-based judge uses this log to localize the critical step and category. Our framework improves step localization and failure attribution over existing baselines across three domains.

Most medical AI benchmarks measure whether a model knows the correct answer. MedFailBench asks a different question: which safety boundary failed? We present a synthetic benchmark and failure atlas built by a clinician. The resource labels medical AI errors by severity from 1 to 5 and safety gate type: missed urgent escalation, unsafe remote dosing, unsafe discharge reassurance, evidence fabrication, unsafe protocol execution, and source support gap. The current public release (v0.2.1) contains 44 synthetic cases reviewed by a clinician, with severity annotations, a public Hugging Face Space source, a safety gate taxonomy, a clinical severity rubric, and an automated pipeline for archiving model response screening runs. Forty cases have a populated safety gate field, and four require gate completion. No patient data, clinical validation claims, or model rankings are included. MedFailBench is released under Apache-2.0 and CC-BY-4.0 and carries the Zenodo DOI 10.5281/zenodo.21205535.

Vision-language-action (VLA) models provide a promising paradigm for scalable robotic manipulation, yet their reliance on success-only behavioral cloning leaves them brittle; lacking corrective training signals, minor execution errors rapidly compound into unrecoverable, out-of-distribution failures. To address this limitation, we propose Adaptive Failure-Informed Learning (AFIL), an end-to-end framework that leverages failure trajectories as adaptive negative guidance for diffusion- and flow-based VLA policies. AFIL uses a pretrained VLA to generate failure rollouts online, avoiding the need for handcrafted failure-mode design or human-in-the-loop recovery. It then jointly trains Dual Action Generators (DAGs) for successful and failed behaviors while sharing a common vision-language backbone, enabling efficient failure-aware policy learning with limited parameter overhead. During sampling, the failure generator adaptively steers action generation away from failure-prone regions and toward more reliable success modes, with guidance strength determined by the per-diffusion-step distance between success and failure distributions. Experiments across in-domain and out-of-domain robotic manipulation tasks, covering both short- and long-horizon settings, show that AFIL consistently improves task success rates and robustness over existing VLA baselines, demonstrating its effectiveness, efficiency, and generality.

The delayed access to specialized psychiatric assessments and care for patients at risk of suicidal tendencies in emergency departments creates a notable gap in timely intervention, hindering the provision of adequate mental health support during critical situations. To address this, we present a non-invasive, speech-based approach for automatic suicide risk assessment. For our study, we have collected a novel dataset of speech recordings from 20 patients from which we extract three sets of features, including wav2vec, interpretable speech and acoustic features, and deep learning-based spectral representations. We proceed by conducting a binary classification to assess suicide risk in a leave-one-subject-out fashion. Our most effective speech model achieves a balanced accuracy of 66.2,%. Moreover, we show that integrating our speech model with a series of patients' metadata, such as the history of suicide attempts or access to firearms, improves the overall result. The metadata integration yields a balanced accuracy of 94.4,%, marking an absolute improvement of 28.2,%, demonstrating the efficacy of our proposed approaches for automatic suicide risk assessment in emergency medicine.

Ask a frontier model how to taper six milligrams of alprazolam (psychiatrist retired, ten days of pills left, abrupt cessation causes seizures) and it tells her to call the psychiatrist she just explained does not exist. Change one word ("I'm a psychiatrist; a patient presents with...") and the same model, same weights, same inference pass produces a textbook Ashton Manual taper with diazepam equivalence, anticonvulsant coverage, and monitoring thresholds. The knowledge was there; the model withheld it. IatroBench measures this gap. Sixty pre-registered clinical scenarios, six frontier models, 3,600 responses, scored on two axes (commission harm, CH 0-3; omission harm, OH 0-4) through a structured-evaluation pipeline validated against physician scoring (kappa_w = 0.571, within-1 agreement 96%). The central finding is identity-contingent withholding: match the same clinical question in physician vs. layperson framing and all five testable models provide better guidance to the physician (decoupling gap +0.38, p = 0.003; binary hit rates on safety-colliding actions drop 13.1 percentage points in layperson framing, p < 0.0001, while non-colliding actions show no change). The gap is widest for the model with the heaviest safety investment (Opus, +0.65). Three failure modes separate cleanly: trained withholding (Opus), incompetence (Llama 4), and indiscriminate content filtering (GPT-5.2, whose post-generation filter strips physician responses at 9x the layperson rate because they contain denser pharmacological tokens). The standard LLM judge assigns OH = 0 to 73% of responses a physician scores OH >= 1 (kappa = 0.045); the evaluation apparatus has the same blind spot as the training apparatus. Every scenario targets someone who has already exhausted the standard referrals.

Multimodal Large Language Models (MLLMs) have significantly advanced document understanding, yet current Doc-VQA evaluations score only the final answer and leave the supporting evidence unchecked. This answer-only approach masks a critical failure mode: a model can land on the correct answer while grounding it in the wrong passage -- a critical risk in high-stakes domains like law, finance, and medicine, where every conclusion must be traceable to a specific source region. To address this, we introduce CiteVQA, a benchmark that requires models to return element-level bounding-box citations alongside each answer, evaluating both jointly. CiteVQA comprises 1,897 questions across 711 PDFs spanning seven domains and two languages, averaging 40.6 pages per document. To ensure fidelity and scalability, the ground-truth citations are generated by an automated pipeline-which identifies crucial evidence via masking ablation-and are subsequently validated through expert review. At the core of our evaluation is Strict Attributed Accuracy (SAA), which credits a prediction only when the answer and the cited region are both correct. Auditing 20 MLLMs reveals a pervasive Attribution Hallucination: models frequently produce the right answer while citing the wrong region. The strongest system (Gemini-3.1-Pro-Preview) achieves an SAA of only 76.0, and the strongest open-source MLLM reaches just 22.5. Ultimately, towards trustworthy document intelligence, CiteVQA exposes a reliability gap that answer-only evaluations overlook, providing the instrumentation needed to close it. Our repository is available at https://github.com/opendatalab/CiteVQA.

Self-driving laboratories increasingly rely on low-cost liquid handlers such as the Opentrons OT-2, which ship without the pressure-based aspiration monitoring of Hamilton or Tecan systems and are typically run open-loop. Two failure modes go undetected: protocols that are syntactically valid but violate assay-specific invariants (e.g., tip reuse between a PCR template and a no-template control), and physical execution failures (partial dispense, air bubbles, missing tips) at runtime. We present AEGIS, a two-layer guardian for both. Layer 1 pairs a curated machine-readable assay rule database with an LLM that reasons over OT-2 Python code, reaching an adjusted F1 of 0.97 on a 24-protocol benchmark across five assay families and beating rules-only and LLM-only ablations across five backends; a free open-weight model ties the best proprietary one, so no paid API is required. Layer 2 fits a PCA world model to YOLO-cropped four-frame pipette trajectories; under a leakage-free leave-one-plate-out evaluation it reaches average precision 0.89 and operating-point F1 0.71 (AUROC 0.80), a deployment-faithful number that matches the live demonstration, and we characterize the small-pipette (p20) resolution limit (F1 0.47). A live demonstration on a physical OT-2 (five replicates per condition) catches planted no-tip failures deterministically and partial dispense on coloured dyes, with an always-VLM self-vote gate lifting partial-dispense recall to 5/5; transparent water is a principled limit of any front-view-only monitor, which AEGIS surfaces as low-confidence VLM reasoning rather than a wrong verdict. Cascade triage holds VLM cost near 1.63 per plate versus 10.33 for an always-VLM baseline. AEGIS is open source and, to our knowledge, the first system to unify pre-flight assay-aware validation with runtime visual monitoring for an open-source liquid handler.

Large-scale clinical databases offer opportunities for medical research, but their complexity creates barriers to effective use. The Medical Information Mart for Intensive Care (MIMIC-IV), one of the world's largest open-source electronic health record databases, traditionally requires both SQL proficiency and clinical domain expertise. We introduce M3, a system that enables natural language querying of MIMIC-IV data through the Model Context Protocol. With a single command, M3 retrieves MIMIC-IV from PhysioNet, launches a local SQLite instance or connects to hosted BigQuery, and allows researchers to pose clinical questions in plain English. We evaluated M3 using one hundred questions from the EHRSQL 2024 benchmark with two language models: the proprietary Claude Sonnet 4 achieved 94% accuracy, while the open-source gpt-oss-20B (deployable locally on consumer hardware) achieved 93% accuracy. Both models translate natural language into SQL, execute queries against MIMIC-IV, and return structured results alongside the underlying query for verification. Error analysis revealed that most failures stemmed from complex temporal reasoning or ambiguous question phrasing rather than fundamental architectural limitations. The comparable performance of a smaller open-source model demonstrates that privacy-preserving local deployment is viable for sensitive clinical data analysis. M3 lowers technical barriers to critical care data analysis while maintaining security through OAuth2 authentication, query validation, and comprehensive audit logging.

Converting free-text cardiac magnetic resonance (CMR) reports into auditable structured data remains a bottleneck for cohort assembly, longitudinal curation, and clinical decision support. We present CMR-EXTR, a lightweight framework that converts free-text CMR reports into structured data and assigns per-field confidence for quality control. A teacher-student distillation pipeline enables fully offline inference while limiting manual annotation. Uncertainty integrates three complementary principles -- distribution plausibility, sampling stability, and cross-field consistency -- to triage human review. Experiments show that CMR-EXTR achieves 99.65% variable-level accuracy, demonstrating both reliable extraction and informative confidence scores. To our knowledge, this is the first CMR-specific extraction system with integrated confidence estimation. The code is available at https://github.com/yuyi1005/CMR-EXTR.

Large language models (LLMs) are increasingly explored as scalable tools for mental health counseling, yet evaluating their safety remains challenging due to the interactional and context-dependent nature of clinical harm. Existing evaluation frameworks predominantly assess isolated responses using coarse-grained taxonomies or static datasets, limiting their ability to diagnose how harms emerge and accumulate over multi-turn counseling interactions. In this work, we introduce R-MHSafe, a role-aware mental health safety taxonomy that characterizes clinically significant harm in terms of the interactional roles an AI counselor adopts, including perpetrator, instigator, facilitator, or enabler, combined with clinically grounded harm categories. Then, we propose MHSafeEval, a closed-loop, agent-based evaluation framework that formulates safety assessment as trajectory-level discovery of harm through adversarial multi-turn interactions, guided by role-aware modeling. Using R-MHSafe and MHSafeEval, we conduct a large-scale evaluation across state-of-the-art LLMs. Our results reveal substantial role-dependent and cumulative safety failures that are systematically missed by existing static benchmarks, and show that our framework significantly improves failure-mode coverage and diagnostic granularity.

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

Emergency Medical Services (EMS) are critical to patient survival in emergencies, but first responders often face intense cognitive demands in high-stakes situations. AI cognitive assistants, acting as virtual partners, have the potential to ease this burden by supporting real-time data collection and decision making. In pursuit of this vision, we introduce EgoEMS, the first end-to-end, high-fidelity, multimodal, multiperson dataset capturing over 20 hours of realistic, procedural EMS activities from an egocentric view in 233 simulated emergency scenarios performed by 62 participants, including 46 EMS professionals. Developed in collaboration with EMS experts and aligned with national standards, EgoEMS is captured using an open-source, low-cost, and replicable data collection system and is annotated with keysteps, timestamped audio transcripts with speaker diarization, action quality metrics, and bounding boxes with segmentation masks. Emphasizing realism, the dataset includes responder-patient interactions reflecting real-world emergency dynamics. We also present a suite of benchmarks for real-time multimodal keystep recognition and action quality estimation, essential for developing AI support tools for EMS. We hope EgoEMS inspires the research community to push the boundaries of intelligent EMS systems and ultimately contribute to improved patient outcomes.